Wednesday, January 01, 2014

The rise of humbug medicine

This last weekend's column in the Kingston Whig-Standard.

Calgary: In March this year seven-year-old Ryan Lovett died as result of cardiac arrest. His mother, after years of homeschooling her son, decided to ‘treat’ his strep infection not with antibiotics but with homeopathic concoctions and other herbal remedies.
The poor kid was bedridden for about 10 days and eventually died an entirely preventable death at the hands of his fanatic mother who had decided that her beliefs in homeopathy and ‘alternatives’ to modern medical treatments were more valid than scientific evidence. She has since been charged with criminal negligence and one can only hope that she will face the full force of the law for her omission to take her son to an actual doctor for appropriate medical care.
Tragic cases such as this are more commonplace than the more sane parents in our midst might think. Every other week such cases are reported from some place or another just in our hemisphere. No doubt there are many others who don’t even make it into the news.
It’s understandable that some people would grow weary about the integrity of pharmaceutical industry-sponsored clinical research and the medications that get subsequently approved on its evidence. Quite a few high-profile cases have made the news headlines over the years. Anyone remember Vioxx? Food and Drug Administration specialists in the USA estimated that this drug led to about anywhere between 80,000 and 140,000 heart attacks, of which a large percentage resulted in the death of the patient. There has been a lot of forth and back about the data and some suggestion has recently been made that particular patient groups could actually still benefit from this drug. Still, the baseline is that a lot of people died because the drug continued to be marketed when it was known that there were significant health risks attached to taking it.
What’s the difference between cases like the Vioxx scandal and homeopathic concoctions, herbal remedies, and whatnot? Simply put: putting your lives in the hands of purveyors of alternative, complementary etc. etc. ‘medicine’ is a bit like saying that given that modern medicine has its flaws, I’m switching to witchcraft. There is zero evidence that homeopathy works, or most of the herbal remedies that are also on the market. In fact, just this week a major study was released in the Annals of Internal Medicine, demonstrating that the vitamin concoctions that are sold to us in pharmacies and health food stores are completely useless. They are one of the reasons for why urine in our part of the world has been described as the most expensive fluid there is. We really simply release those vitamins and homeopathic concoctions right back into nature. Zero positive health effect for us.
In mainstream medicine at least we have a shot at rectifying mistakes. We have methods that eventually permit us to determine whether a particular drug works, and what its short-, medium- and long-term effects are. In hocus-pocus ‘medicine’ there isn’t even evidence – flawed or otherwise – when a concoction is given by a ‘practitioner’ to a patient. I am not suggesting that all those herbal remedies are necessarily useless. The reality is though, until they have been tested in methodologically sound clinical research nobody knows. Once they have been tested in a clinical trial and have been shown to work they cease to be alternative remedies. We call them medicine and you can get the prescribed by your doctor and some of them by some nurses.
Meanwhile in Ontario the association of naturopaths is lobbying the provincial government to regulate them as if they were a body made of professionals. They even lobby for the right to prescribe medication. For an organisation that’s representing a body of ‘practitioners’ who are overwhelmingly deeply skeptical of mainstream science and who consider the gold standard of clinical research, namely randomised controlled clinical trials, not very useful, that’s a bit rich. If you go to any of their ‘homemade’ colleges (they call themselves accredited but their accreditation is really by a body made up of colleges like themselves) you will come across a hell of a lot of unscientific nonsense. The principal idea here is a naive trust in nature’s ability to heal our disease-afflicted bodies. We are supposed to trust in our body's ability to heal itself.
Funny enough, they charge for advice based on that insight. Turns out, many more men than women follow this advice regardless of the existence of naturopaths and wait for their bodies to heal themselves. Their health outcomes are significantly poorer as a result of this. Men are much less likely than women to see doctors when they should seek medical care, hoping that their body will heal itself. That’s one of the reasons for why men die in the average about five years earlier than women.
In a rational world the naturopaths lobbying our provincial government would go nowhere. However, it looks as if they will become a self-governing health care profession some time in 2014, courtesy of our Regulated Health Professions Act. They will even have their own regulatory college, much like doctors have. This is completely bizarre. Doctors in Ontario are obliged to provide patients (as part of the informed consent process) with high levels of information about the evidence supporting the course of action they are proposing. The nature of naturopathic ‘medicine’ is such that there is no evidence worth the name that ‘practitioners’ can rely on during their consultation. Meanwhile they promise to manage conditions such as diabetes, cardiovascular diseases and so on and so forth.
What’s next, Ontario? A self-regulating College of Astrology? Welcome to Ontario 2014. Happy New Year!
Udo Schuklenk holds the Ontario Research Chair in Bioethics and Public Policy at Queen’s University, he tweets @schuklenk

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