Saturday, October 19, 2013

There's medicine and then there's other stuff


Today's piece from the Kingston Whig-Standard on 'alternative medicine'.

It’s one of those things: you better not criticize homeopathy or else there will be a deluge of complaints from homeopathy ‘practitioners’ as well as satisfied ‘patients’ questioning your motives, your connections to that oh-so-evil pharmaceutical industry, and whatnot else.
Well, let me start this off then by saying that I am not an industry shill, that — to the best of my knowledge — I own no shares in pharmaceutical companies and that I am not paid by any pharmaceutical company to say what I am about to say.
How do we establish whether a particular chemical substance works as medicine? We test it elaborately in clinical trials. Typically we test the substance first in animal experiments. That has its own set of ethical issue that I won’t go into today. Then we move from animal experiments to toxicity tests in a small number of people. All we want to find out here is whether a particular candidate drug is safe. Once we have established that it’s sufficiently safe to test it on a much larger number of people we begin in all earnest clinical trials. Here we compare our candidate drug either against an already existing drug — to see whether it fares better or worse — or against a placebo if we have no gold standard of care. These trials, while not perfect, give us pretty good indications of whether something ‘works’ for particular conditions. Based on the evidence accumulated in these clinical trials drugs get eventually approved (or rejected, as the case may be) by Health Canada, the FDA in the United States and their equivalents elsewhere. It is a system that isn’t perfect, but as far as the scientific method goes, it’s the best that we can do.
Then there is other stuff out there in the business of health care. Plenty of ‘complementary’, ‘alternative’, ‘natural’, you name it concoctions. We know of many of them that they either definitely do not work at all or that they can in fact be bad for your health. There is ever more evidence accumulating that those much praised anti-oxidants in many ‘natural’ products, for instance, might actually be detrimental to our health. What all these concoctions have in common is that they have not been rigorously tested. Had they been tested they would already have lost their cloaking device of ‘natural’, ‘complementary’ and ‘alternative’. Simply put: any such concoction can in principle be tested for safety and efficacy. Once they have been tested we can know whether they work or not. Once we know they become standard medicines or they are discarded. After all, most of them have chemical substances at their heart that do something, but until we test what they do, they’re just that, untested concoctions that may or may not do what their buyers hope they will do.
Strangely these concoctions can be bought as ‘remedies’ of some sort or another in many alternative health food stores, and sadly even pharmacies. They are actually really expensive, too. I went to such a store a few months ago, and I couldn’t believe how much these little plastic bottles with their miracle powders and natural pills of sorts cost. It all seemed like a rich people’s hobby to me. In any case, this begs the question of why Health Canada approves the sale of such concoctions.
According to an editorial published in the British Columbia Medical Journal, Health Canada has approved the sale of various homeopathic concoctions as flu remedies. They are supposed to prevent flu and its related symptoms. Well, to cut a long story short, these homeopathic concoctions are nothing other than super-highly diluted infectious agents that are orally administered. They are so highly diluted that often you can’t find anything other than water in these homeopathic remedies. The danger here is that people choose to ‘protect’ themselves against the flu by using such untested concoctions. None of them have been shown to actually protect against the flu. Health Canada is seemingly OK with this status quo. It notes on its websites that these concoctions can be used safely as long as the directions from the manufacturer are followed. Funny enough, they can be used safely, because they don’t actually do anything. You could also drink water from the tap safely that’s properly treated. Do you recall the mass ‘suicide’ attempt by homeopathy critics a year or so ago? They publicly, all over the world, ‘overdosed’ on homeopathic sleeping remedies. Ignoring the warning labels they downed full bottles of homeopathic sleeping pills, and, surprise, surprise, they didn’t even get tired.
Health Canada now requires such remedies to show warning labels stipulating that they are not meant to replace properly tested vaccines. That’s all nice and well, but it begs the question why health remedies that have not been shown to have any demonstrable health effects should be on the shelves of health food stores, pharmacies and other outlets at all? The British Columbia Medical Association got it right when it insisted that Health Canada should only permit the sale of such concoctions after they have been shown to be both safe and effective. That is not the case today. There is a reason why the English National Health Service closed down its last homeopathic non-treatment facility, aka hospital. It just doesn’t work.
There is another danger in our regulatory agency’s approach to these kinds of remedies. By virtue of its stamp of approval people skeptical of mainstream vaccines might think of them as possible alternatives, despite the agency’s disclaimer. After all, Health Canada has approved these concoctions for sale. The fewer people get vaccinated, the weaker we are as a group. Herd immunity prevents outbreaks of infectious illnesses, but it requires that most of us participate. We know that in communities with high levels of resistance to mainstream vaccines infectious disease outbreaks occur. Alternative untested flu concoctions will likely contribute to such occurrences if Health Canada does not stop their sale as health products.
Udo Schuklenk teaches bioethics at Queen’s University, he tweets @schuklenk.

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