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Like conspiracy theories, junk science is also wide spread. Let’s put an end to it.

Veterinary Acupuncture: Name That Logical Fallacy

I have wanted to post a commentary ever since I’ve been seeing ads in the Ann Arbor Observer advertising acupuncture for pets by non-veterinarians. Recently, AnnArbor.com has hosted a couple pieces on acupuncture for pets including one from Lorrie Shaw and Dr. Taryn Clark and Dr. Jessica Franklin, two local veterinarians. The piece by Dr. Clark and Dr. Franklin will do nicely for deconstruction and a game of name that logical fallacy.

Acupuncture has been practiced for a long time — estimates range from 3,500-5,000 years, with written records dating to the second century B.C., though its origins are unclear.

The obvious reason for such a statement is to make the implication that since it’s been around for so long, it must therefore also be effective (logical fallacy: appeal to antiquity). However, longevity doesn’t argue for efficacy, otherwise everyone would likely agree that astrology can determine a person’s destiny based the position of celestial bodies; astrology has been practiced for many more years than acupuncture.

Despite ancient sources showing acupuncture being applied to animals, it has only started to catch on in modern veterinary medicine in the last few decades.

Obviously, proponents of complementary and alternative medicine (CAM) want their ideas to be viewed as being widely used and accepted. Even though the popularity of an idea does not reliably indicate how whether or not the idea is true (logical fallacy: Argumentum ad populum), it is natural to think there is at least some truth to it if a lot of people believe in it. Despite the historical claim that veterinary acupuncture has been around for a long time, more than likely, it’s not what you think.

Whether the explanation for its effect comes from contemporary medicine (it stimulates nerves and releases endorphins) or traditional Chinese (it restores the flow of Qi through the area), the purpose of acupuncture is to relieve pain and stimulate the healing process.

Here’s an instance of ‘you can’t have it both ways’ (logical fallacy: inconsistency fallacy). Acupuncture is based on pre-scientific concepts of a vitalistic entity (Qi) and of meridians and acupuncture points unknown to anatomists. More scientific explanations have been offered as to how it might work, including a counterirritant effect or the gate control theory of pain. There is evidence that acupuncture can stimulate endogenous endorphin production, but there is evidence that placebo pills can do that as well. Acupuncture has been studied for decades but the results are inconsistent. If a treatment is truly effective, studies tend to produce more convincing results as time passes and the weight of evidence accumulates. In fact, taken as a whole, the published (and scientifically rigorous) evidence leads to the conclusion that acupuncture is no more effective than placebo.

Benefits include: Drug-free; Surgery-free; Immediate results

Applications for acupuncture include: Treatment of arthritis, degenerative joint disease, or hip dysplasia; General pain management; Post-surgery pain; Cancer chemotherapy/radiation support; Immune support; Treatment of nerve dysfunction

There is good evidence that the therapeutic ritual of acupuncture has some symptomatic benefit for such indications, at least in humans. This is almost certainly a non-specific treatment effect (aka “placebo”). It does not seem to matter where needles are inserted or if they are inserted at all, and acupuncture therapy does not appear to measurably affect the course of any actual disease. (The Skeptic’s Dictionary has a clear and concise review). The term ‘support’ used above does not even having any useful meaning. Immune support… it sounds like the immune system is sagging against gravity due to age and needs a lift.

Acupuncture can be administered at any time and is frequently tried after other types of treatments, such as non-steroidal anti-inflammatory drugs (NSAIDs), have failed to produce the desired results or have undesirable side effects. In cases of degenerative nerve disease, it actually works better than drugs because it stimulates nerve function.

Acupuncture has been studies extensively in humans and it seems that the ritual of acupuncture is what provides the perception of pain reduction. In animals, there is no reliable, high-quality research evidence for the benefits of acupuncture. The studies that have been done have found both positive and negative results, but the poor quality and lack of replication make the existing evidence insufficient to recommend acupuncture therapy. And what does ‘stimulate nerve function’ mean? I can poke someone in the arm with a pencil and that person should be happy since I just stimulated their nerve function.

Electroacupuncture, a variation on traditional acupuncture, also involves needles being inserted at specific locations. The difference is that an electric pulse is applied, through two needles at a time, in sessions typically lasting 20 minutes.

Electroacupuncture has been referred to as a bait-and-switch, because it is arguably not acupuncture at all. Obviously, the ancient Chinese lacked electricity, so the theories and guidelines developed for acupuncture in humans are not really relevant to the effects of electricity on the body.

An informative study was published in the Journal of the American Veterinary Medical Association (JAVMA) on June 1, 2010, about intervertebral disk disease (IVDD) — a common though difficult and painful disease we see in dogs — and the use of electroacupuncture to treat it. The study showed a significantly higher success rate for dogs who underwent electroacupuncture than for dogs that received decompressive surgery.

Electroacupuncture alone saw success in 15 of 19

Decompressive surgery saw success in 4 of 10

Surgery followed by acupuncture saw success in 8 of 11

Here’s a closer look at this study. To sum it up, there were major methodological problems (no blinding, no subjective way to characterize and compare the quality of treatments, small study size). Although it is possible that electrical stimulation can have some effect on various parts of a dog, much better designed studies would be necessary to legitimately claim the same conclusions as this paper did.

A case study from Ann Arbor Animal Hospital

We have seen a lot of wonderful old pets who are generally healthy but in pain, like Maggie, a 15-year-old cat.
Maggie, my beloved 15 year old feline has had a relatively healthy life. But when she started having problems, even though I suspected they were part of the aging process, I became alarmed. Last winter, I noticed Maggie was limping, which was followed by her inability to groom herself in the meticulous way she always had. Then as time went on, I noticed she had stopped playing and going up and down the stairs was becoming difficult for her. Then, it seemed that I could not even pick her up without her flinching from pain and crying when I put pressure on her lower spine.

Presenting these problems to Maggie’s veterinarian, Dr. Jess Franklin, Maggie was eventually given a diagnosis of arthritis. I knew Dr. Franklin was also an animal acupuncturist, so I asked her if she thought acupuncture would help and could she do it for her. She said the Ann Arbor Animal Hospital has had good outcomes with other animals and she would certainly try to help Maggie.

After weeks of acupuncture sessions combined with Dasuquin (a Glucosamine for cats), my Maggie is back to her near meticulous grooming and she no longer cries when I pick her up. She is moving a bit slower and she still has a slight limp, but Maggie is back to being the queen of the household and she won’t let anyone forget it!

Maggie is a great example of how well acupuncture and natural products can be integrated into the care of our animals. Maggie also takes Amlodipine for high blood pressure; Standard Process Renal Support, a whole food supplement; and uses Hill’s Prescription K/D for ongoing kidney disease.

Case studies are among the lowest forms of evidence and rank just above anecdotal evidence. I would venture to say that the above example is anecdotal evidence. Basically, it does not prove acupuncture was the treatment that worked for Maggie and it should be pointed out that acupuncture was not the sole treatment used. In fact, Dasuquin is marketed as a treatment for joint pain like arthritis in both dogs and cats.

Around 85% of our acupuncture patients are older dogs with musculoskeletal ailments. Some signs that your dog is experiencing pain that acupuncture may be able to assuage:

Abnormal sitting or lying posture; Restlessness; Whining, groaning or other vocalizing; Limping, unable to get up or lie down; Difficulty getting into car or down stairs; Lack of grooming; Won’t wag tail; Licking or biting area; Lack of appetite; Trembling

Obviously, if something appears off with your pet, see the vet, but the evidence that acupuncture works in humans, let alone, animals, is questionable at best. Personally, I’ve been looking for a vet that’s a little closer since I moved a few months ago to Ann Arbor. Ann Arbor Animal Hospital has been crossed off  my list permanently.

The results of a real “vaxed versus unvaxed” study

From the indefatigable Orac:

Vaccination
For the anti-vaccinationists out there: The results of a real "vaxed versus unvaxed" study

In many ways, the anti-vaccine movement is highly mutable. However, this mutability is firmly based around keeping one thing utterly constant, and that one thing is vaccines. No matter what the evidence, no matter what the science, no matter how much observational, scientific, and epidemiological evidence is arrayed against them, to the relentlessly self-confident members of the anti-vaccine movement, it’s always about the vaccines. Always. Vaccines are always the root many human health problems, be they asthma, autoimmune diseases, autism, and chronic diseases of all types. Everything else is negotiable. For instance, back when Andrew Wakefield ignited a scare about the MMR vaccine by publishing a fraudulent case series linking the MMR to a new syndrome consisting of regressive autism and enterocolitis, it was the measles vaccine that caused this syndrome. Here in the U.S., it was the mercury in the thimerosal preservative that used to be used in many childhood vaccines until 2001 that was the cause of all evil. However, as scientists did more and more studies, testing vaccines to see if they were associated with an increased risk of autism and found zero, nada, zip association with either vaccines or the thimerosal preservative in vaccines, the anti-vaccine movement was nothing if not mutable. Before long, Jenny McCarthy was declaring that it was the “toxins” in vaccines that were causing autism, and Generation Rescue was asserting that children were getting “too many too soon.” Of course, as far as the anti-vaccine movement was concerned, the beauty of these ideas was (and is) that they are much harder to falsify scientifically because they are so much more vague.

Of late, the anti-vaccine movement has hit upon a new strategy. Specifically, they are demanding what they like to call a “vaxed versus unvaxed” study. Basically, their claim is that unvaccinated children are so much healthier than vaccinated children, and they think that such a study would prove it. Of course, they only hit on this message after making some rather embarrassing missteps. In particular, they didn’t seem to realize that a randomized, double blind study of vaccination according to the currently recommended schedule versus unvaccinated children was totally unethical. So, they figured out another angle. They acknowledge that a randomized trial of unvaccinated versus vaccinated children would not be feasible (although they appear not to be able to admit just how unethical it would be), and blithely suggest instead an epidemiological study of the vaccinated versus the unvaccinated without realizing just how horrendously difficult it would be to overcome the confounders that would plague such a study or that ethical considerations still require sound scientific justification for such a study. That’s why it’s so cute to see anti-vaccine loons trying to justify such a study.

All of which is why it’s pretty amusing that just such a study was recently reported in Germany. Can you guess what it found? Let’s just say that, to those of us who accept the science showing that vaccines do not cause autism, autoimmune diseases, asthma, and the like, the results were utterly unsurprising:

In their study, the authors compare the occurrence of infections and allergies in vaccinated and unvaccinated children and adolescents. These include bronchitis, eczema, colds, and gastrointestinal infections.The evaluation showed that unvaccinated children and adolescents differ from their vaccinated peers merely in terms of the frequency of vaccine preventable diseases. These include pertussis, mumps, or measles. As expected, the risk of contracting these diseases is substantially lower in vaccinated children and adolescents.

Surprise, surprise! Unvaccinated kids differ from vaccinated kids only in having a much higher risk of vaccine-preventable disease! Who’da thunk it? But, as is my wont, I need to see the actual study, rather than a news report. So, as they say, let’s go to the tape. Unfortunately, the authors feel obligated to lay out exactly why they did their study:

The benefits, efficacy, and safety of protective vaccinations are widely scientifically proven. Furthermore, modern vaccines are well tolerated (4, 5). In spite of all this, some parents and doctors have reservations against vaccinations. The fear is that vaccinations overburden, stress, or weaken a child’s immune system and may therefore cause harm. As a result they think that vaccinated children are more prone to falling ill than non-vaccinated children. In addition, vaccinations are deemed to be responsible for the occurrence or increased incidence of other diseases, including chronic diseases (6, 7).

In other words, Generation Rescue, Dr. Jay Gordon, Jenny McCarthy, and others. They spread this misinformation.

Basically, what the German investigators did was to examine data collected aas part of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), which was conducted from May 2003 to May 2006 by the Robert Koch Institute. The data collected were primarily from a standardized, computer-assisted personal interview of the parents, but diagnoses reported and vaccination status were verified through medical records. Results were compared between vaccinated and unvaccinated children, defined thusly:

Children and adolescents were defined as unvaccinated if at the time of the KiGGS survey no documentation existed for any vaccination against diphtheria, pertussis, tetanus, Haemophilus influenzae type b, hepatitis B, poliomyelitis, measles, mumps, or rubella. By contrast, children who had by then received at least one vaccination according to their vaccination card were categorized as vaccinated. Immigrant families were excluded from the analyses in order to avoid misclassification because of the often missing or incomplete vaccination documents.

On the basis of the KIGGS data, investigators concluded that approximately 0.7% of nonimmigrant children and adolescents in Germany are completely unvaccinated. This is in line with estimates I have seen for the percentage of children in the U.S. who are completely unvaccinated, although this population is more difficult to ascertain in the U.S., at least on a national level. In any case, there was a vaccination card available for 13,453 children aged 1 through 17. Out of this group, for 94 children no evidence of vaccination could be found. Consistent with results in the U.S., the unvaccinated children tended to be from families of higher socioeconomic status. Less relevant, unvaccinated children tended to live in older German states than in the new German states.

Otherwise, the children in both groups were very similar, except in one way. This graph in Figure 1 tells the tale.

Figure1.jpg

Basically, unvaccinated children had a much higher prevalence of vaccine-preventable infectious disease. The results were significant for pertussis, measles, and mumps, as described in the text:

The proportion of children and adolescents who had had pertussis, measles, mumps, and/or rubella was much higher in unvaccinated children than in those who had been vaccinated against the respective disease to a sufficient extent. For pertussis, the lifetime prevalence in unvaccinated subjects was 15.8% (95% CI 8.5 to 27.6, n = 11), in those with sufficient vaccination cover only 2.3% (95% CI 2.0 to 2.8), n = 184). For measles, the lifetime prevalence was 15.0 (95% CI 7.7 to 27.4, n = 10) in unvaccinated subjects and 5.2% (95% CI 4.7 to 5.8, n = 431) in sufficiently vaccinated ones. For mumps, the lifetime prevalence in unvaccinated subjects was 9.6% (95% CI 4.2 to 20.2, n = 7) and in vaccinated ones, 3.1% (95% CI 2.6 to 3.7, n = 305). For rubella, the lifetime prevalence was 17.0% (95% CI 9.4 to 29.0, n = 11) for unvaccinated subjects and 6.8% (95% CI 6.0 to 7.6, n = 642) for vaccinated ones. Differentiated stratified analyses confirmed the described higher proportions of subjects with the respective disease among unvaccinated subjects for boys and girls and for different age groups (data not shown).

It was at this point that the authors included an interesting control. One might imagine that if, for some reason, there were differences in infectious disease prevalence in general between the two groups, there might be differences in vaccine preventable diseases as well. What the investigators found was that there was no difference in the number of infections between vaccinated and unvaccinated children in any of the age groups studied:

Figure2.jpg

In other words, as expected, the only difference in prevalence observed was in diseases for which vaccines make a difference, and those diseases were much less prevalent among vaccinated children than among unvaccinated children.

Finally, the investigators examined the hypothesis that vaccines increase the risk of allergies and immune system dysfunction by looking at atopic disorders. The authors examined the prevalence of three conditions, bronchial asthma, atopic eczema, and allergic rhinoconjunctivitis. Just like the case for diseases not currently vaccinated against, there was no difference in prevalence found between vaccinated and unvaccinated children, strongly suggesting that vaccines do not cause atopic disorders. This evidence is, of course, consistent with previous studies that have similarly failed to find evidence that vaccines increase the risk of asthma and other atopic disorders. Overall, this study is a near slam dunk against the idea that vaccines are in any way associated with atopic diseases, including this part:

In addition to atopic disorders, we further compared diseases–such as obstructive bronchitis, pneumonia and otitis media, heart disease, anemia, epilepsy, and attention deficit hyperactivity disorder (ADHD)–in unvaccinated and vaccinated subjects. No relevant differences in the lifetime prevalences were found, neither for different age groups nor between girls and boys. Schneeweiß et al. conducted a comprehensive literature review of vaccine safety, the central part of which was the evaluation of vaccine critical arguments on the basis of the current state of scientific knowledge. None of the hypotheses were found to be valid (5).

Let me repeat this again. None of the hypotheses were found to be valid.

It is true that, as large as it is, this study is relatively small given the low percentage of completely unvaccinated children. This made subgroup analysis impossible for some measures and limited the power of the analysis due to low numbers of unvaccinated children in several of the categories. After all, there were only 94 unvaccinated children, which makes it impossible to compare autism and ASD prevalence with the vaccinated cohort, because the expected prevalence of autism is only approximately 1 in 100 anyway. That means that on average roughly one autistic child would be expected in such a cohort. To look at differences in autism prevalence between the groups, many times more than 13,000 subjects would be needed, which would be a hugely expensive study, particularly if medical records and vaccination cards were reviewed for every child. This study also bolsters what I said before by showing how difficult it would be to do such a “vaxed versus unvaxed” study with sufficient subjects to provide adequate statistical power to detect even fairly large differences in prevalence. For diseases and conditions sufficiently prevalent to allow the detection of differences in the sample size the investigators had, though, there was no evidence of differences in conditions commonly blamed on vaccines between vaccinated and unvaccinated children. Certainly, this study provides no support for doing a larger study. For it to do that, there would have to be a hint of a whiff of an association between vaccinated status and the atopic diseases examined or the risk of infectious diseases not prevented by vaccines. There wasn’t. If I were on an IRB, and someone proposed doing a larger study, this German study would be an argument that there is inadequate scientific justification to do a larger study, particularly in light of other studies like thisthis, and this, which suggest that early vaccination might actually be protective against atopic diseases.

The wandering band of anti-vaccine propagandists over at, for example, Age of Autism say again and again that they want a “vaxed versus unvaxed” study. Indeed, after the recent Supreme Court decision in Bruesewitz v. Wyeth upholding the primacy of the Vaccine Court in disbursing compensation to children injured by vaccines, AoA seems to have lost what’s left of its mind, posting multiple times about it as though it were some grave injustice and their rights had been completely stripped away. Add to that the picture of Barbara Loe Fisher comparing the anti-vaccine movement to Winston Churchill facing down Hitler, and the picture remains truly nauseating.

Be that as it may, I’d like to finish by offering our “friends” in the anti-vaccine movement a bit of advice. You keep saying you want the government to fund a “vaxed versus unvaxed” study. You keep repeating it until you’re blue in the face. Based on this German study, you might want to be a bit more careful. In other words, be careful what you wish for. You just might get it. And, based on this study and the vast preponderance of evidence, if that study you so fervently wish for is well-designed and conducted properly, you probably won’t like the results.

But why worry? If a “vaxed versus unvaxed” study is negative, the anti-vaccine movements will just ignore it. It’s what they do.

REFERENCE:

Schmitz, R; Poethko-Müller, C; Reiter, S; Schlaud, M (2011). Vaccination Status and Health in Children and Adolescents: Findings of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) Dtsch Arztebl Int, 108 (7), 99-104

Indian High Court Rules Astrology is a Science

Bombay high Court
The Bombay High Court is the High Court of India

EDIT: An Indian Astrologer website has linked to this post to attempt to justify themselves  through us. I have edited the post to to more accurately reflect that Astrology is not scientifically provable and in fact is not real. Also anyone that would charge fees for such a service I would consider to be committing fraud.

The Bombay High Court has ruled that Astrology is a science and that real scientists have to accept them as their colleagues.

The case was brought to the Court by Janhit Manch, a campaign group which sought a ruling against practitioners of “tantric” black magic and “fake” astrologers. They argued that what they do should be phohibited, citing India’s Drugs and Magical Remedies Act of 1954, which bans false claims in advertisements.

Janhit Manch is:

A leading judicial activist NGO of the country, founded by Bhagvanji Raiyani in 2002, has filed about 55 Public Interest Litigations in the Bombay High Court and the Supreme Court.

…doing [our] bit to salvage the deteriorating conditions of the country, work as watchdog agencies and catalysts between authorities and public.

The decision is based on an affidavit by Dr R Ramakrishna, a government deputy drug controller, who said: “The Act does not cover astrology and related sciences. Astrology is a trusted science and is being practised for over 4000 years.”

The entire basis of the ruling is that Astrology is a science and therefore not magical and does not fall under the Act’s jurisdiction. Which suggests that science does not have to be proven to work while magic does. This is just another step that India is taking backwards away from reason and intelligence.

Central Drugs Standard Control Organization Building
Central Drugs Standard Control Organization Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India

You can see a slide show of India’s Central Drugs Standard Control Organization here.

Update: DrJoe is an awesome contributor and has found the court case! The ruling has not been uploaded yet but you can find the case here: Reg. #PIL/3/2010

Update 2: The judgment has been uploaded. PIL14809030211

Homeopathic Quackery and Pharmacists

A few years ago when I began following skeptic blogs and podcasts, I learned about the existence of homeopathic remedies. Of note, two of the main doctrines of homeopathy include the law of similars and the law of infinitesimals. The law of similars is also known as ‘like cures like.’ Briefly, an individual’s symptoms may be relieved by administering homeopathic drugs which are known to cause in higher doses those same symptoms in healthy people. For example, homeopathic preparation of ipecac is indicated to relieve vomiting. Historically, healthy individuals would be given gradually increasing doses (non-homeopathic) of a substance to illicit any symptoms. Known as ‘provings,’ the symptoms were carefully documented and form the basis of the law of similars. (Sucks to be the guys who ‘proved’ mercury and lead.) The law of infinitesimal (also known as the doctrine of minimum dose) requires that homeopathic remedies be highly diluted prior to administration. Starting with the original powder or liquid, a homeopathic practitioner may dilute one part with 99 parts of solvent (either ethanol or water) to give a 1C (centidecimal) dilution. A 1 to 9 dilution is a 1X (decimal) dilution. Higher dilutions are achieved by taking one part of the prepared dilution and again diluting it with solvent. Therefore a homeopathic remedy labeled as 3X means that it underwent three 10-fold dilutions (equivalent to one part per 10^3). A 200C or 200CK indicates that it underwent 200 successive 100-fold dilutions (equivalent to one part per 10^400). Part of the dilution process involves vigorous shaking or banging of the bottle on a surface meant to transfer energy to the solution, a process called succussion. Interestingly, homeopathic remedies are suppose to become more potent the higher the dilution.

WARNING: Scientific jargon abound, but bear with me, as it will be over shortly.
Say you start with one liter of a 1 molar solution of sugar (6.022*10^23 molecules in a mole; molar means how many moles per liter). After a 1C dilution, you’d have a 0.01 molar solution (6.022*10^21 molecules per liter). At a 11C dilution, you’d have a 1*10^-22 molar solution (60 molecules per liter). At a 12C dilution, you’d have a 10^-24 molar solution (0.6 molecules per liter). [sound of tires screeching] Hang on; you can’t have a 0.6 molecule! There’s nothing left to dilute! There’s only solvent being diluted with even more solvent (ever try 190 proof alcohol?). Yet, homeopathic remedies are frequently found as 12C, 30C and even 200C preparations. These incredibly dilute solutions are often added dropwise to sugar pills for subsequent sale and administration to patients.

As a scientist, I deal with extremely dilute solutions every day. For example, a bacterium has a single molecule of DNA per cell. The volume of a bacterium like Escherichia coli is approximately 1×10^-15 liters (1 femtoliter) so a single DNA molecule is at a nanomolar concentration ( [1 molecule / 6.022*10^23 molecules per mole] / 1*10^-15 liters = 1.66*10^-9 molar or 1.66 nanomolar). Clearly, 1 molecule in a cell can be very important biologically but if you go below 1 molecule, there’s nothing. For the sake of argument, let’s say a single molecule makes it all the way through to the final dilution of a 30C preparation. A 100 mL volume has approximately 1000 drops. If one drop was added to each sugar pill, there would be only a 1 in 1000 chance that any of the sugar pills would have a single molecule of the original active ingredient. Further divide the pills for sale into bottles containing 50 pills; you now have only 1 in 20 bottles for sale having a single molecule of active ingredient. Sugar pills sprinkled with water or ethanol for sale must have an awesome profit margin (CVS figured this out, see picture below). Homeopaths  admittedly recognize the scientific conundrum and sidestep the issue entirely by proposing all sorts of nifty mechanisms involving water memory, nanoparticles, clathrates, or even silicates dissolved from the bottles used in the succussion process. Imagine silicate able to cure just about anything. You know what else has silicate (aka silicon dioxide)? Taco Bell’s seasoned ground beef. Mmmmm, homeopathic chalupas. j/k

Can you spot the CVS generic brand of Oscillococcinum? -Photo take 2/5/2011

In the 20th century, homeopathic  medicine waned in popularity steadily until the advent of the holistic health movement of the 1970’s and the “New Age” Movement of the 1980’s. Today, homeopathic remedies are being sold in the U.S. under the guise of ‘dietary supplements.’ Concerning to me is the sale of over-the-counter (OTC) homeopathic remedies by pharmacists, especially those employed at major chains like Walgreens, CVS and Wal-Mart. Homeopathic remedies are often sold alongside with conventional medicines  (click on picture to enlarge). Without the knowledge of what homeopathy is, it’s likely that consumers assume homeopathic remedies sold at a pharmacy are no different than herbal or conventional medicines. Just three years ago, I thought the same way. Now I know better and you know who should know better too? Pharmacists.

It’s a fair assumption that pharmacists are highly educated professionals well versed in the scientific method and should appreciate the discoveries made from its application. Yet, for a pharmacist to stock, recommend and sell OTC products that have not been proven to be safe or effective through application of the scientific method is just mind bottling. “You know, when things are so crazy it gets your thoughts all trapped, like in a bottle?” (Blade of Glory, 2007) As professionals, pharmacists pride themselves as being honest, having integrity, and wanting to offer patients the best level of care. However, the sale of homeopathic remedies violates the inherent high ethics and morals of pharmacists because homeopathy is quackery, plain and simple.

Quackery (aka health fraud) is defined by the FDA as, “the deceptive promotion, advertisement, distribution or sale of articles, intended for human or animal use, which are represented as effective to diagnose, prevent, cure, treat or mitigate disease, or provide a beneficial effect on health, but which have not been scientifically proven safe and effective for such purposes.” Homeopathic remedies have very low regulatory standards besides labeling of packages with the mandatory disclaimer, “This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease.” So in practice, a homeopathic product cannot be marketed with a specific claim, rather they are allowed non-specific/structural claims like, ‘boosts the immune system’ or ”shortens duration of flu-like symptoms.’ Of further concern is that dietary supplements like homeopathic remedies are explicitly exempt from being required to provide the FDA with documentation of their product’s safety and efficacy. It’s entirely up to the manufacturer to ensure their products are safe while at the same time they can manufacture as many sugar pills as they want and charge a premium for them. The FDA can do nothing unless consumers start complaining. Imagine if ‘Big Pharma’ was allowed to play by those rules. But I digress. Homeopathy clearly fits within the definition of health fraud, but still pharmacists are more than happy to sell these products.

11 Reasons Why Pharmacists Should Not Sell Homeopathic Remedies

  1. After 200 years, no conclusive scientific evidence exists for the effectiveness of homeopathic treatments (reviewed here, here, here, here, and here). A product that has been diluted so much that not a single molecule of the original active ingredient is present would require a highly implausible mechanism and break the laws of physics and chemistry as we know them.
  2. Homeopathic remedies are legally exempt from providing documentation to the FDA showing their products are safe. It’s solely up to the manufacturer to ensure safety. What could go wrong? Oh, right…You could lose your sense of smell, permanently. Or poison children.
  3. When pharmacists misuse their professional reputation to recommend products that are not known to be effective, patients may feel that they can forgo legitimate therapy.
  4. For added confusion, homeopathic ingredients are listed in Latin. For example, a popular product sold as a remedy of flu-like symptoms is Oscillococcinum. The ingredients are lists as Anas Barbariae Hepatis et Cordis Extractum – 200 CK. Think about it. Pharmacists are selling products that they themselves have no clue as to what’s in the box. By the way, the Latin translation is roughly, ‘extract of heart and liver from a duck.’ Yum!
  5. The American Pharmacists Association (APhA) endorses homeopathic products through several means. Firstly, the APhA accepts money from homeopathic manufacturers for booth rentals at APhA conventions and advertisements in their journals. Secondly, the APhA publish book chapters and articles written by homeopaths, guaranteeing a favorable bias of the material taught. Therefore, the professionalism of the APhA has been compromised. Pharmacists must refuse to sell homeopathic products because doing so legitimizes the non-professional stance taken by the APhA and other organizations, and further degrades the status of  the pharmacy.
  6. Selling homeopathic products dishonors the professional relationship with the patient and yields a dishonest profit. This practice reduces pharmacists to the level of hucksters and predators who prey on their unsuspecting patients.
  7. Selling homeopathic products is, at best, legally questionable. Any product stocked by a pharmacy is subject to an ‘implied warranty’. This is to ensure that products sold are fit for a particular purpose. Recently, pharmacists in the UK were the subject of four year investigation for selling homeopathic anti-malaria remedies to travelers headed to Africa. The cases were unfortunately dropped but let that be a warning to pharmacists who think that they are doing nothing wrong.
  8. Selling homeopathic products violates the ‘oath of a pharmacist,’ in which US graduates vow to ‘. . . apply my knowledge, experience, and skills to the best of my ability to assure optimal outcomes for my patients.’ Selling unproved products clearly and unequivocally violates this vow as optimal outcomes cannot be achieved with expensive placebos.
  9. Pseudo-medical practitioners wish to displace legitimate medicine. By only selling products proved safe and effective, pharmacists hold the line against the encroachment of quackery on conventional medicine. Conversely, selling homeopathic products hastens the erosion of conventional medicine and lowers that pharmacist to quackery. Those pharmacists are essentially no better than some scientifically illiterate health food store clerks. Selling homeopathic products thus lowers esteem for the pharmacist, the pharmacy and the profession at large.
  10. Homeopathic products appeal to the greed and profit motive. Health food stores are making huge profits off the sale these worthless products and pharmacies want a slice of the pie. “If the guy down the street is making money, why can’t I?” The argument that profit justifies the sale of homeopathic medicines is the identical justification used by illicit drug dealers, pimps, and illegal arms dealers. Profitable quackery is still quackery.
  11. Selling homeopathic products betrays a lack of intellectual honesty and rigor in thinking. To know the scientific method, but to ignore its power and utility is perhaps even worse than to be scientifically illiterate. Selling quack products lowers respect for the pharmacy in the eyes of physicians and others who adhere to the principles of legitimate medicine.

Survey of pharmacists regarding OTC homeopathic remedies

As part of my own ongoing investigation on homeopathic remedies, I conducted a survey of pharmacists located within Ann Arbor and Ypsilanti.  The survey was conducted February, 2011. A total of 7 pharmacists were surveyed from as many pharmacies, including Walgreens, CVS, Rite-Aid, Kroger, and K-Mart.

  • When did you receive your Pharm.D. degree?
    • Pharm.D.: Est. 2014, 2010, 2007, 2005, 2001; B.S.: 2006, 2001
  • Where did you receive your degree?
    • China (1), India (1), Nevada (1) , University of Michigan (4)
  • What is your definition of ‘evidence-based medicine’?
    • Provided some definition referring to evidence gained from clinical studies (5), Had never heard of ‘evidence-based medicine’ (2)
  • Rank the following in order of importance when selling an over-the-counter product: Safety, Evidence of efficacy, Patient preference
    • Safety::                                #1 (6), #2 (1), #3 (0)
    • Evidence of Efficacy*:: #1 (1), #2 (4), #3 (1)
    • Patient preference*::    #1 (0), #2 (1), #3 (5)
      *One pharmacist said many other factors should be considered
  • What is your definition of a homeopathic remedy?
    • “diluted ingredients” (2),”not chemicals” (1), “herbal/natural remedies” (3), “non-traditional” (1), and “medicine that works with the body” (1)
  • Have you ever sold a homeopathic remedy?
    • Yes (7), No (0)
  • Have you used a homeopathic remedy?
    • Yes (3), No (4)
  • In your opinion, should homeopathic remedies be sold by pharmacists?
    • Yes (5), No (1), Depends of the evidence (1)
  • Does the FDA mandate that homeopathic remedies be tested for safety and efficacy?
    • Yes (1), No (5), I don’t know (1)

If the store sold either Oscillococcinum or Zicam lozenges, two popular homeopathic remedies, the following questions were asked with the boxes in hand:

  • Can you tell me the ingredients of Oscillococcinum (Anas Barbariae Hepatis et Cordis Extractum – 200 CK)?
    • I don’t know (4), Diluted liver (1)
  • On a box of Oscilloccinum, what does 200CK mean?
    • Correct answer (0), I don’t know (4), Dosage (1)
  • On a box of Zicam, what does 2X mean?
    • Correct answer (0), I don’t know (5), 2 times dosage (1), 2 parts per million (1)

Results and Conclusions

The survey was hampered by the severe weather this past week. As more pharmacists are surveyed, this blog post will be updated. A few conclusions can be drawn from my limited survey. When selling an OTC product, safety is by far the #1 concern, regardless of the evidence of efficacy. This assertion is supported by a 2007 survey of pharmacists in Ireland. Pharmacists overwhelmingly approve of the sale of homeopathic remedies. Yet, none of the pharmacists could  fully translate the Latin ingredients or assess the dosage labeled on the homeopathic products presented to them. The majority were aware that the FDA does not regulate the safety of efficacy of these products. Most pharmacists surveyed were trained locally at the University of Michigan, College of Pharmacy.  Interestingly, the only pharmacist, educated outside of the US and had never heard of ‘evidence-based medicine’, asserted that homeopathic remedies were “not chemicals” and should not be sold by pharmacists. Based on a discussion with a Pharm.D. candidate, only recently has the U. of M. curriculum begun teaching about alternative medicines including homeopathy; all the others were never educated in school about homeopathic remedies. The quality of the Pharm.D. curriculum at U. of  M. will likely be a follow-up blog post.

Conflicts of Interest: The author is a skeptic and smolders when presented with stupidity, ignorance and greed. He has not been paid or plied with alcohol to write this post.
Acknowledgments: Professor Pray has been a big help in providing inspiration and references for this post.

Est. 2014, 2010, 2007, 2005, 2001; B.S.: 2001, 2006;

Statistics – Destroyer of Superstitious Pretension

From 3 Quarks Daily:

In Philip Ball’s Critical Mass: How One Thing Leads to Another, he articulates something rather profound: statistics destroys superstition. The idea, once expressed, is simple but does not stem its profundity. Incidents in small numbers sometimes become ‘miraculous’ only because they appear unique, within a context that fuels such thinking. Ball’s own example is Uri Geller: in the 1970’s, the self-proclaimed psychic stated he would stop the watches of several viewers. He, perhaps, twisted his face and furrowed his brow and all over America watches stopped. America, no doubt, turned into an exclamation mark of incredulity. What takes the incident out of the sphere of the miraculous, however, is the consideration of statistics: With so many millions of people watching, what was the likelihood of at least some people’s watches stopping anyway? What about all those watches that did not stop?

Our psychological make-up seeks a chain in disparate events. Our mind is a bridge-builder across chasms of unrelated incidents; a credulity stone-hopper, crouching at each juncture awaiting the next link in a chain of causality. To paraphrase David Hume, we tend to see armies in the clouds, faces in trees, ghosts in shadows, and god in pizza-slices.

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Walking in an Underwater Land: Episode 6 of the Drunken Skeptics

Peter Sinclair
The Green Man himself

Well episode 6 is finally here for you!

Sorry it took so long, we had a bit of a meltdown at the MISkeptics command center / living room. We lost two computers due to a brown out.

But never mind that, there’s a podcast to talk about! In this episode we have a recording of a presentation that was given at one of our Get Togethers. Our speaker that month was Peter Sinclair of Climate Crocks. His blog and Youtube channel are simply amazing! He gave a wonderful presentation that we saved just for you.

We also give a small review of our previous episodes and as always we have our Whiskey and Shenanigans.

After you’ve heard the podcast, head over to Climate Crocks and get better informed.

I’ll put up the show notes this weekend. It’ll be a hoot 🙂

* – If you get a glitchy download, you have to delete and re-download. Sorry for any inconvenience.

Pentagon uses False Study to Deny Healthcare to Vets with Head Trauma

Via NPR and ProPublica

During the past few decades, scientists have become increasingly persuaded that people who suffer brain injuries benefit from what is called cognitive rehabilitation therapy — a lengthy, painstaking process in which patients relearn basic life tasks such as counting, cooking or remembering directions to get home.

Many neurologists, several major insurance companies and even some medical facilities run by the Pentagon agree that the therapy can help people whose functioning has been diminished by blows to the head.

But despite pressure from Congress and the recommendations of military and civilian experts, the Pentagon’s health plan for troops and many veterans refuses to cover the treatment — a decision that could affect the tens of thousands of service members who have suffered brain damage while fighting in Iraq and Afghanistan.

Tricare, an insurance-style program covering nearly 4 million active-duty military and retirees, says the scientific evidence does not justify providing comprehensive cognitive rehabilitation. Tricare officials say an assessment of the available research that they commissioned last year shows that the therapy is not well proven.

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Adam’s Song: Episode 5 of the Drunken Skeptics Podcast

Bug Girl
Bug Girl (not to scale)

The next episode of The Drunken Skeptics is here!

In this episode, we talk with Bug Girl about fighting mosquitoes with DDT, and also bed bugs.
The great and powerful Oz
The great and powerful Oz

We also talk with David Gorski about the distinction between Science-Based Medicine and Evidence-Based Medicine. (39:24)

And as always, we also have our Whiskey & Shenanigans where we bring attention to the good things that happened (the Whiskey) and call out the bad things (the Shenanigans).

You can find our show notes here.

Production Notes: We’ve received some feedback on episodes that were downloaded that had technical issues (repeating segments, abrupt endings, etc.).  If this happens to your download, try re-downloading.  That seems to fix the issue.

The December MISkeptics Get Together

Our next Get Together will be on Saturday, December 11 at 4:00 PM. Our special guest will be Peter Sinclair of Climate Denial Crock of the Week. He will be speaking and giving a video presentation.

Be sure to check out his YouTube channel as well!

We will be in the back room of Ginger Restaurant, located at:

8465 N. Lilley Rd

Canton, MI 48187
Tel: 734-414-1818

Come and join us for lively discussion, drinks, dinner and debate! This is a good event for Skeptics of Michigan to come together and discuss local, national, worldwide items affecting skeptics. All are welcome to listen and participate.

Please be sure to RSVP so I know how many are coming. We seem to be outgrowing the venue rather quickly.

We also set up a Meetup group to help organize the events. Please register and RSVP!

I hope to see you all there!

Good Morning America Touts Homeopathy as Flu Cure

This morning on Good Morning America, they brought a guest on to talk about flu prevention and cures for children. The guest was Dr Lawrence Rosen of the Whole Child Center in Oradell, New Jersey. Generally not a big deal right? They have stuff like this on all the time right? Unfortunately this is a big deal.

What makes this a big deal was that this doctor was recommending herbal and homeopathic remedies.

Dr. Rosen specifically states that: “Oscillococcinum has been found to be a good homeopathic treatment for children and adults with flu-like symptoms.”

Oscillococcinum, which besides being a word that makes me happy for copy-and-paste, is a homeopathic remedy made from the heart and liver of a duck. “The preparation is derived from duck liver and heart, diluted to 200C—a ratio of one part duck offal to 100200 parts water. This is such a high dilution that the final product likely contains not a single molecule of the original liver. Homeopaths claim that the molecules leave an “imprint” in the dilution that causes a healing effect on the body, although available evidence does not support efficacy beyond placebo.” [Wikipedia]

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