Promoting the benefits of chiropractic care and highlighting incompetent chiropractic politicians.

Sceptic outrage at products been sold in Boots

We live in a free country and people should be able to protest about what ever they want. I can think of many more important things to protest “about”, but what ever flies their kite. Shit! there I go again falling into Andy’s trap: quacktrick #39; “what aboutery”.

To be honest, like most people, I could care less about what is in a homeopathic remedy or whether it works or not I dont use the stuff. Surely there are  things that Boots sell that actually harm and cause death which are more worthy of protest   What aboutery??

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Let me put “protest” into context. When I was a child my mother took me on the Ban the Bomb marches. I was at Grosvenor Square when the police attacked the anti Viet Nam March, I saw her thump a suit in a bowler hat who was urging the police on. My mother made the first public protest in the house of commons after Bloody Sunday. She helped those brave young girls who were sacked from Dublins Dunnes stores in the late 80s for refusing to sell South African fruit. In 1988 while her body was riddled with cancer, she made her last protest, chaining herself to the gates of the Irish parliament for twelve hours  in protest at the divorce ban, she helped bring attention to the plight of many people.

Phylis McGhee devoted her life to fighting social injustice and my family were so proud when Christy Moore dedicated his song Yellow Triangle to her memory. Most people dont speak out and they look the other way when autocratic bullies use lawyers to silence dissent. So hats off to people who speak out for what they believe in, no matter how ridiculous their cause. 

 

 

 

 

 

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#1 Benji on 2.05.2010 at 9:13 AM

www.dcscience.net

#2 Paul on 2.05.2010 at 10:06 AM

Pity it wasn't a 'mass nocebocide attempt' - the world would feel lighter without them...

#3 fed up on 2.05.2010 at 11:17 AM

What I would actually like to see is evidence that people had used homeopathic anti malaria but then caught malaria. I would like to see evidence that children had become seriously ill because their parents only gave them a sugar pill. The skeptics call for evidence that something works and hide behind scare tactics that they have no evidence for, just a theory.

#4 rjs on 2.05.2010 at 1:07 PM

Will this do you for evidence?

whatstheharm.net/.../homeopathy.html

#5 Benji on 2.05.2010 at 1:23 PM

Here's one for you fed up.

www.smh.com.au/.../parents-guilty-

#6 Nico M on 2.05.2010 at 3:12 PM

Those examples are ridiculous as evidence. I don't use homeopathy and have no interest in it, but you can't come on here and claim that case studies are not valid as evidence then present websites and a tabloid story as evidence that homeopathy is dangerous. Just 2 more hypocrite scepdicks.

#7 rjs on 2.05.2010 at 4:18 PM

Nico. fed-up asked for evidence that people had used homeopathic anti malaria treatment and then caught malaria. In this situation the case studies are evidence that such an event has occurred, yes? One of the links on the website I linked to further links to an article in the BMJ documenting such a case. If these are not evidence that such an event has occurred then please explain how they are not.

#8 Paul on 2.05.2010 at 5:00 PM

rjs - they are case studies - the very studies that Anti Cammers describe as non evidence.

I have a case study that involves an asthmatic recovering full lung function and beyond as theri chiropractic care progressed - are you willing now to accept that chiropractic works for asthmatics?

#9 Richard Lanigan on 2.05.2010 at 6:20 PM

To be fair thats a list of people who did not use conventional medicine and died. My dad is 84 has cancer and gave up on chemo, he wants to die with dignity when his time comes. To have chemo was his choice to give it up was his I told him I did not know what he should do. Would he qualify for that list. They doctors spent the winter trying to get him to have the swine flu vaccine and he has worked out for himself its a sales pitch.

I have traveled all over the world without vaccines or anti maleria. I supose if I used homeopathy I would put it down to that, or chiropractic or whatever, I always drink Coke with my meals in the developing world, I believe that protects me from Hep A. perhaps its the sugar. The fact I avoid medicine if possible may help.

I get gout diclofenic is the only thing that touches it. Orthodox medicine is not as effective as many believe and sceptics are assuming all these people would have lived if they had taken the orthodox route, I am not so sure. Every unvaccinated child that dies is because the parents did not vaccinate if the child is vaccinated and dies it is coincidence and they would have died anyway?

Ones immunesystem is what protects us from bacteria and virus. Some people rely on anti biotics for everthing others like me and my dad just do our best to be healthy. "Guiness is good for you" Vitamin B6.

#10 rjs on 2.05.2010 at 6:54 PM

Paul, again, please explain to me how they are not "evidence that people had used homeopathic anti malaria but then caught malaria". They are exactly that. I make no more claims about the efficacy or otherwise of homeopathy, but the case studies *are* the evidence that was requested.

#11 Paul on 2.05.2010 at 7:39 PM

rjs - wise up - the point is that you are offering a case study when anti cammers like yourself disgard them when they are proof of cam efficay. Have a nice weekend idiot.

#12 Jeremy on 2.05.2010 at 8:48 PM

Rjs - your non-sensical argument is a joke.

#13 rjs on 2.05.2010 at 8:49 PM

Wise enough already thanks. The case studies are evidence that people have taken homeopathic malaria tablets and caught malaria. That in itself is not evidence that homeopathic malaria tablets don't work, merely that there are cases where they don't work. Have a nice weekend too.

#14 rjs on 2.05.2010 at 8:54 PM

Sorry Jeremy, what's nonsensical? I haven't made any arguments.

#15 Jeremy on 2.05.2010 at 9:17 PM

Rjs, your semantics make me laugh. Nonetheless....

So by your logic, some of the case studies in the article below are cases where Chiropractic works for colic?

www.naturalnews.com/.../026069_colic_ch

#16 Jeremy on 2.05.2010 at 9:24 PM

So by your logic, some of the case studies in the article below are cases where Chiropractic works for colic?

Sorry, by cases I meant evidence.

#17 rjs on 2.05.2010 at 10:41 PM

Hi Jeremy, didn't realise semantics were so funny. But each to their own I suppose.

Case studies can only be used as evidence in certain limited ways, but they rarely tell the whole picture:

1) They can tell you when a treatment hasn't worked in a case or cases. e.g. In the homeopathic malarial treatment cases linked to above, the studies demonstrate that, in *only those cases*, the treatment did not work, not that homeopathic malarial treatment does not, in general, work. Same goes for Chiropractic and colic.

2) They can help to identify rare side effects of known and widely used treatments.

3) But, in cases where the symptoms can also disappear without treatment (e.g. colic) a single or small number of case studies that find treatment and symptom relief coincide *cannot* provide evidence of efficacy. Though a large number might be a useful indication of where to direct research.

#18 Nico M on 2.05.2010 at 11:43 PM

Yawn.

#19 rjs on 2.06.2010 at 11:48 AM

Sorry to bore you (or were you just tired, it was late), it just seems there was some confusion as to the evidence that case studies provide.

#20 Paul on 2.06.2010 at 12:55 PM

There was no confusion. We see anti cammers change the rules to suit themselves all the time.

#21 rjs on 2.06.2010 at 1:06 PM

Oh so you agree that the links provided evidence that there exist cases where a homeopathic malarial treatment didn't work?

#22 Jeremy on 2.06.2010 at 1:40 PM

@Nico M

Agreed, I just couldn't be bothered constructing a reply.

#23 Jeremy on 2.06.2010 at 1:42 PM

By the way the evidence presented is weak and pretty much non existent. Not really worthy of even mentioning.

Tsk, tsk, you skeptics should know better than presenting with anecdotal evidence.

#24 rjs on 2.06.2010 at 2:19 PM

The links provided cite published papers that report people who have taken homeopathic anti-malarial treatment yet succumbed to malaria.

Indeed they are anecdotes that demonstrate that for those people homeopathic anti-malarial tablets didn't work for whatever reason.

As far as I can see they are the evidence that was asked for.

If you were asking me for evidence that homeopathic malaria treatment was ineffective then I would agree that they are insufficient evidence.

Do you agree or disagree with anything I've said? Or is what I've said still not clear?

#25 Paul on 2.06.2010 at 3:39 PM

@ Jeremy

@Nico M

Agreed, I just couldn't be bothered constructing a reply.

+1

#26 Nico M on 2.06.2010 at 4:37 PM

Long story short, yes they are insufficient. Thanks.

#27 rjs on 2.06.2010 at 4:52 PM

Good, we got there in the end, you agree that they were sufficient evidence for fed up's question, just insufficient to demonstrate anything meaningful about the efficacy or otherwise of homeopathic malaria treatments.

#28 Jeremy on 2.06.2010 at 5:08 PM

So in a nutshell, rjs provided insufficient and weakass evidence.

#29 rjs on 2.06.2010 at 5:26 PM

...for the efficacy or otherwise of homeopathic malarial treatment.

There, finished the sentence for you. :)

#30 Jeremy on 2.06.2010 at 6:03 PM

or...

So in a nutshell, rjs provided insufficient and weakass evidence, whilst continuing to be a smartass with semantics fullstop.

#31 rjs on 2.06.2010 at 6:18 PM

But semantics are extremely important, otherwise you'd have people believe that I'm implying that the results of a small number of case studies support the efficacy of, oooh I don't know, Chiropractic? :)

#32 GoodOldBoy on 2.06.2010 at 6:36 PM

@ rjs

'......semantics are extremely important'

As recently pointed out by Mr Justice Eady?

#33 Nico M on 2.06.2010 at 9:12 PM

"yes they are insufficient" Are you some kind of moron?

#34 Jeremy on 2.06.2010 at 11:00 PM

@rjs

Sure, whatever you say.

#35 Benji on 2.07.2010 at 9:50 AM

so, what kind of evidence would you like to see? And can we maybe tone down the insults? I don't think i have once been rude to any of you. Thanks.

#36 fed up on 2.07.2010 at 3:12 PM

I would need to see evidence that would be acceptible to the scientific community, not 1 or 2 cases published in a paper.

ie how many people have been diagnosed with malaria after travelling to a certain country. Of the total number how many-

A- took prescribed anti-malaria drugs.

B- How many took homeopathic remedies.

C- how many took no precautions.

This I beleive would be a skeptics argument and level of evidence that unfortunately your websites don't provide.

#37 rjs on 2.07.2010 at 6:56 PM

And there's why semantics are so important. What you've just asked for (evidence of the efficacy of homeopathic malaria treatments ) is entirely different from what you asked for at the beginning (that people had caught malaria having taken a homeopathic malaria treatment).

To some, that might sound like goalposts being moved.

#38 fed up on 2.08.2010 at 11:13 AM

What I asked for was evidence, and as usual you change the level of evidence required to suit yourself.

#39 Benji on 2.08.2010 at 1:15 PM

Fed up,

You asked for evidence yes. You were given evidence. You didn't like the quality given so we will present some more.

You can't expect RCT level data for this for obvious reasons. Also, you cannot use case studies to show something does or doesn't work, as you cannot derive causality from them.

Your statement of "changing the level of evidence required..." shows a lack of understanding of the usefulness and applications of different experimental procedures.

#40 Richard Lanigan on 2.08.2010 at 3:20 PM

Evidence is just another tool that can be manipulated by various groups. You can use it to make a point or reject someone else’s point. He who pays the piper also has an unhealthy influence on the end product. Last week in the Guardian there were a number of articles demonstrating how the peer review process has been corrupted in relation to climate change.

Of course anecdotal evidence of people rejecting the biomedical model and trying homeopathy and dying could suggest homeopathy was dangerous, on the other hand one could speculate on the presumably much greater numbers of people who did not die because for example they took homeopathy instead of Vioxx for these very same reasons.

The thing that annoys clinicians like myself about the way many sceptics interpret “scientific evidence” regarding CAM is; if there are no RCTs, it becomes not a “jot of evidence”. They completely ignores the experience of the clinician and how Sackett framed the "evidence based "concept and base their views entirely on scientists who support their particular viewpoint seemingly unable to be objective about the evidence of the subject being discussed. Then when the Sceptics wish to make a case of the dangers of CAM any old story or wives tale will do for the evidence they present.

#41 fed up on 2.08.2010 at 4:19 PM

Exactly my point Richard.

I wasn't asking for rct standard, just numbers. Figures for people who have contracted malaria and if possible what percentage took homeopathy, what percentage took conventional( because we all know you can still catch malaria even while taking conventional drugs) and those that took no precautions. Surely as a Skeptic you would want to know if these cases on these website where just one offs or if there was a pattern. I have spoken to 3 people who are convinced they didn't catch malaria because of the homeopathic remedies they took. I could write case studies on them and my evidence would be stronger than yours.

So all I want is some supporting evidence that there is a greater risk of catching malaria while taking a homeopathic remedy compared to taking conventional anti malaria drugs. Numbers, comparisons. If you can't provide these then you are altering the level of evidence when it suits you and using scare tactics that are based solely on somebodies (a skeptic or science writers) viewpoint.

#42 rjs on 2.08.2010 at 7:54 PM

Fed-up, Richard,

I don't know if you're wilfully trying to misunderstand me (and Benji) or not. So I will try again,

1) Originally, Fed-up asked for evidence that people had taken homeopathy and had succumbed to homeopathy.

2) Links were provided that such cases existed.

3) At no point did I or anyone else claim that the cases linked to proved that homeopathy was ineffective (they don't prove it).

4) Fed-up *then* asks for evidence concerning the efficacy of homeopatic malaria treatment, conventional treatment and the risks of catching malaria.

Is this not a fair summary?

Now, 4 is actually the really interesting and useful question, and if I can find the stats I will, you could try to if you like.

#43 Richard Lanigan on 2.08.2010 at 11:35 PM

Hi Rjs

I dont dispute what you are saying, however the inference is that homepathy is a threat to public health and I am pretty sure that is not the case.

#44 fed up on 2.09.2010 at 1:14 PM

Taking Anti-Malaria Tablets

"It should be noted that no prophylactic regimen is 100% effective and advice on malaria prophylaxis changes frequently. There are currently five prophylactic regimens used (A,B,C,D & E), due to the differing resistance that exists by the malaria parasites to the various drugs used"

I still require what you call evidence. Not a, possibly incorrect translation of a, slovenian story. Would you class that as evidence?

"Because there are very few English news outlets in Slovenia, and web services to translate from Slovene are currently rather poor, these news stories were translated from Slovene by Jan Kalin & Tim Farley, using machine assistance. We apologize in advance for inevitable errors in translation. Links to the original stories are provided."

And the second one 10 years ago.

"40 year old woman took two holidays a year in tropical countries. After experiencing digestive disorders with conventional prophylactic drugs she decided to seek medical advice from a homoeopath for her forthcoming holiday in Togo."

From malaria advice website.

"For most people, symptoms begin 10 days to 4 weeks after infection, although a person may feel ill as early as 8 days or up to 1 year later. Two kinds of malaria, P. vivax and P. ovale, can relapse; some parasites can rest in the liver for several months up to 4 years after a person is bitten by an infected mosquito . When these parasites come out of hibernation and begin invading red blood cells, the person will become sick.

Any traveller who becomes ill with a fever or flu-like illness while travelling and up to one year after returning home should immediately seek professional medical care. You should tell your GP that you have been travelling in a malaria-risk area."

So this lady had probably travelled abroad to a malaria affected area once maybe twice in the 12 months before she fell ill. She had returned from her last trip not feeling well ,digestive disorders, after taking conventional anti malari meds. "Nausea, vomiting, and diarrhoea may also occur."

Is it not beyond the realms of possibility that she may have been infected before this trip?

Again do you still think this is evidence?

#45 Benji on 2.09.2010 at 1:27 PM

Hi Fed Up,

Malaria aside for the time being (incedently I agree the above evidence is shakey), I assume you believe hpathy to be effective.

However it has been shown time and time again to be no more than a placebo. The more controlled the study, the less effective it is.

It is therefore likely that it provides no protection against maleria (or anything for that matter). Do you disagree with this?

In that case, do you think it is ethical to charge people for a treatment that is shown not to be effective.

And before I'm accused of changing the direction of the arguement (I acknowledge I have) , I am just trying to get a feel for Fed Up's attitude toward hpathy. I get the impression you are a CAM apologist (for want of a better term), and not purely one for chiro (which as I have stated already, think is a better supported CAM treatment for certain conditions).

In which case the modern medicine is evil/, EBM is rubbish argument is not one I wish to pursue as it goes no where.

Regards.

#46 Andy Lewis on 2.09.2010 at 1:51 PM

I would like to remind Richard and his chums about an article he wrote a little while ago about why RCTs are not the be all and end all of evidence...

chiropracticlive.com/.../evidence-based-

With non-subjective measurables (death/catching malaria) observational evidence can be quite robust.

Have you forgotten this Richard? Or just being disingenuous?

#47 fed up on 2.09.2010 at 3:02 PM

Benji

I have travelled a couple of times to areas that have malaria. Once I took conventional anti malarias the other I took nothing. My (teenage)kids took conventional anti malaria meds on the first trip. I have used homeopathy in the past on my children. My son had 2 stays in hospital with bad croup attacks. Both times he was given certain meds and he recovered enough after several hours for us to take him home. On his third attack, as I was breaking every speed limit to reach A&E my wife gave him a homeopathic remedy given to us by a GP, whom my mother knew, and before we reached the hospital his symptoms cleared. We still took him in but they just sent us straight home. He continued to see the homeopath for a couple of years and never had another attack.

Beleive it or not I'm a sceptic and an aethist but I don't subscibe to science can prove everything and if it can't be proved with RCT it can't work.

#48 Benji on 2.09.2010 at 3:20 PM

Hi Fed Up.

Thanks for your response.

I wasn't saying if I can't be shown to work in RCT it can't work.

What an RCT does is establish causality, and it is the best method to do so.

With hpathy there is no plausible way it can work (as there is nothing in it). For it do so would require rewriting all the laws of physics. The fact that it is shown to work no better than placebo when looking at thousands of patients is enough to convince me it doesn't work. When good evidence comes in to show the contrary I put my hands up and change my view point.

As has already been discussed in this post, anecdotal data is not good enough for evidence. There are plenty of examples of this throughout history (i.e. someone's observations, when tested, were shown to be incorrect).

#49 fed up on 2.09.2010 at 3:48 PM

Thats exactly why I made my post. For some anything positive(if it's not what they beleive) needs a level of evidence so high only rct costing hundreds of thousands will do. But they happily wheel out anectodal evidence for anything negative and say heres the proof, look it's on this website.

#50 fed up on 2.09.2010 at 4:20 PM

Benji.

Your link at the top of the post about a child with eczma.

I think this is probably the biggest factor. Maybe more sugar pills would have helped, or just some food.

"The pathologist who did the autopsy, Ella Sugo, said she had sought advice from experts outside Australia because she had never seen a child so malnourished and her condition was at a level more commonly observed in third world countries."

#51 Benji on 2.09.2010 at 5:28 PM

Fed Up,

Yes, maybe more sugar pills would have helped.

What almost certainly would have is proper medical advice and treatment from the onset.

#52 fed up on 2.09.2010 at 5:52 PM

Hi Benji

I think that case is child neglect, pure and simple. If the parents are unable to even feed their child properly what hope has it got of receiving any treatment?

#53 Benji on 2.09.2010 at 7:29 PM

I agree to a point.

However, they took the child for a treatment that has been shown to work. It was the infection that killed the child. AN infection that would have been avoided with proper treatment.

The fact they chose to ignore the seriousness of the disease and persevere with an ineffective treatment is indeed neglect.

#54 rjs on 2.09.2010 at 9:40 PM

Fed-up wrote: "Thats exactly why I made my post. For some anything positive(if it's not what they beleive) needs a level of evidence so high only rct costing hundreds of thousands will do. But they happily wheel out anectodal evidence for anything negative and say heres the proof, look it's on this website."

I have never seen a single post by a genuine skeptic who has cited positive results from a case study or studies as evidence for the efficacy of conventional medicine. So you're going to have to justify that with evidence.

#55 Nico M on 2.09.2010 at 9:49 PM

Yawn

#56 fed up on 2.09.2010 at 9:57 PM

rjs????

thats my point sceptics want rcts for positive evidence but then use scare tactics based on evidence from case studies. you did just that.

#57 rjs on 2.09.2010 at 10:16 PM

fed-up, from you response I take it you can't point me to a single post where a skeptic has used the positive results from case study/studies as evidence for conventional medicine? (And I have *never* done that, point me to the post by number if you think I have.)

#58 fed up on 2.10.2010 at 8:37 AM

I don't think you understand what I'm trying to get over. I didn't say they use case studies for positive results. I said sceptics WANT rct level evidence before they accept a positive outcome but then THEY use case studies to show negative outcomes. But if you want positive outcomes in conventional medicine based almost entirely on case studies and individuals experience look no further than nearly every surgical procedure.

#59 fed up on 2.10.2010 at 8:39 AM

So to try to get you to understand here is you posting case studies as evidence for NEGATIVE outcomes.

"#4 rjs on 2.05.2010 at 1:07 PM

Will this do you for evidence?

whatstheharm.net/.../homeopathy.html "

#60 Benji on 2.10.2010 at 9:28 AM

HI Fed up.

I understand what you are saying. And yes skeptics do ask for RCT data to show something works - because this form of trial, if done correctly eliminates as much bias as possible.

You are quite correct with your point re surgical techniques. However it would be unethical and and highly unneccessary to perform an RCT trial for say, blood transfusion in a patient who has lost a lot of blood. That would involve one group recieving no treatment, and one the transfusion. This form of surgical proceedure has a clear, plausable mechanism by which is works- i.e. replacing blood that has been lost though trauma.

A homeopathic medicine has time and time again been shown to be no more than a placebo in well controlled RCT.

There is also no explanation in the realms of physics or human physiology that would allow a treatment that has been diluted down so that it contains no trace of the active molecule (with the theory being the more dilute it is, the stronger it is!) can work.

The knowledge of all the negative systematic reviews and RCTs indicating that it is no better than placebo, is backed up by case studies. The case studies DO NOT show that it does not work, merely indicates cases were it hasn't. The RCTs provide the reason they haven't.

Positive case studies can be used to inform an RCT to test a treatment thoroughly, to elimate bias, and see if the intervention is actually having the effect it has.

Therein lies the difference.

#61 Fedup on 2.10.2010 at 11:37 AM

Thanks benji. I understand all of that, but there has been a blind trial on some knee surgery that showed the surgery was no better than placebo. I merely made my post because the YouTube clip of the 2 ronnies is using scare tactics based on very flimsy anecdotal evidence. When I asked for evidence I was pointed to weak case studies. It has to go both ways. If not just stick to the argument that rct show homeopathy doesn't work more than placebo and not then say my theory is it's dangerous because people may avoid conventional care. As there is no evidence that this has happened

#62 Benji on 2.10.2010 at 11:58 AM

Hi Fed up.

I don't think I commute what I mean to say through text very well.

But it has been a nice change to have a polite discussion. All to rare these days as both sides more often than not get shouty etc.

Regards.

#63 David Colquhoun on 2.10.2010 at 9:49 PM

This is one case where evidence isn't needed. It is really very simple.

Since the pills contain nothing whatsoever, they obviously can't protect you against malaria or anything else. To pretend otherwise is culpable homicide.

#64 fed up on 2.11.2010 at 9:42 AM

So this doesn't apply?

"A true scientist needs scientific evidence to believe in a certain theory or claim."

Just make up the rules as you go along.

#65 GoodOldBoy on 2.11.2010 at 10:28 AM

That would’ve ruled out Einstein and many of the other theoretical physicists then!

Sometimes evidence (eventually) follows theory, sometimes it’s the other way round, and sometimes they develop hand in hand.

I must say I find statements such as ‘This is one case where evidence isn't needed. It is really very simple.’ a little too certain for my liking (although I sympathize with the author’s position).

Space and time were once considered to be absolutes….…they too were ‘really very simple’!

#66 fed up on 2.11.2010 at 10:47 AM

Thought you might like this David and Benji.

cat.inist.fr

And this one is interesting reading.

cat.inist.fr

and this

www.ajtmh.org/.../430

#67 Richard Lanigan on 2.11.2010 at 12:29 PM

Hi David,

Every year travel agents airlines make a fortune on pilgrimages to Lourdes. There are reports of unexplained spontanous remission for all sorts of ailments there . Catholics believe its Mary the mother of Jesus who is doing the healing , I would say its placebo. Does it matter? No. People make choices how they live and die according to their education and experiences.

Should cynics like myself wage war on business who make profit from these activities? Where does genuine sceptic ism end and cynicism take over? I have always been cynical about religion and many medical doctors have always been cynical about CAM. Such is life.

#68 Benji on 2.11.2010 at 12:57 PM

Many doctors are rightly cynical about various CAM treatments - becasue they are time and time again shown not to work.

#69 fed up on 2.11.2010 at 1:30 PM

And what about all the drugs and procedures that don't work?

“It hasn’t hurt my body, but apparently it hasn’t done any good either,” said MacLeod, who wonders why he’s been shelling out $100 a month in co-payments for a brand-name drug that doesn’t work.

“If lowering your cholesterol doesn’t reduce your risk, then what’s the point?” another Vytorin user wrote on an msnbc.com message board about the issue. “Maybe I’m dense, but I just don’t understand.”

Those questions are on the minds of millions of consumers in the wake of a string of startling findings about some of the nation’s best-selling — and most heavily promoted — drugs. In less than a year, patients have learned that a popular diabetes drug, Avandia, may raise the risk of heart attack, and that antidepressants, the most widely prescribed drugs in America, may work no better than placebo.

They’ve watched as the federal Food and Drug Administration expanded use of a top cancer drug, Avastin, to treat breast cancer, on basis of a trial that showed that while the drug slowed the disease, it didn’t impact overall survival.

And now they’ve seen the results on Vytorin and Zetia, which account for more than 15 percent of the cholesterol-lowering drug market in the U.S. — and more than $5 billion in annual sales.

It’s a confusing situation for consumers who assume that widely used drugs are both safe and effective, said Fran Visco, president of the National Breast Cancer Coalition and a 20-year survivor of the disease.

“You want drugs that save lives, that have a significant impact on the quality of life,” said Visco, whose agency helps patients make treatment decisions. “The drugs do not show these things.”

Time for docs to pause and say ‘Whoa’

And it’s not just patients who’ve been stumped. The chain of surprises began in late 2006, said Dr. Harlan M. Krumholz, a professor of medicine at Yale University. That’s when an apparent increase in patient deaths abruptly halted development of torcetrapib, a promising cholesterol drug that boosted “good” HDL cholesterol, a new approach in the fight against heart disease.

When that was followed by Avandia, which raised questions about the assumed benefits of lowering blood sugar, and later by Vytorin and Zetia, which challenged the benefits of lowering LDL cholesterol — it rocked the medical world, Krumholz said.

“It was a time to pause and say ‘Whoa,’’’ he said. “It has caused us to take a step back and say ‘How much do we really know?’”

The situation has renewed debate about the ways drugs are tested and approved in the U.S. and whether they’re being released to market too soon.

It also has raised doubts about the FDA’s practice of accepting “surrogate endpoints” for drug approval. Instead of relying on ultimate outcomes — a reduction in heart attacks or strokes, for instance, or a decrease in deaths — many studies measure a drug’s effectiveness by using interim markers, such as decreasing blood pressure levels or lowering LDL cholesterol.

The FDA long has allowed use of such markers because waiting for the results of large-scale outcome trials would cost too much and take too long, possibly delaying life-saving advances for millions of people, said Dr. Robert Temple, director of the agency’s office of medical policy.

But the practice has been called into question by the surprises of recent research, said Dr. Nortin M. Hadler, a professor of medicine at the University of North Carolina.

“In our zeal to do modern medicine ... we’ve managed to lose our way,” he said. “We’ve forgotten to ask: ‘Does this matter to the patient?’”

#70 fed up on 2.11.2010 at 1:53 PM

Funny how Mr Goldacre starts with actually some serious problems then spends most of the time attacking homeopathy. He doesn't seem to want to start an argument with surgeons who perform knee, angina or pace maker operations.

www.youtube.com/.../watch

#71 Richard Lanigan on 2.12.2010 at 1:19 PM

Benji, lack of evidence, is not the same as "time and time again shown not to work" Yesterday a junior doctor spent 3 hours observing me, I saw about 15 clients most of whom had been to their doctor. I know she was blown away by what she saw. One 75 year old woman had been told by her doctor to stay away despite the fact she was in agony with pain running down her leg. Two visits and she is a different woman. 365 visits and I might enter her in the Olympics.

#72 Benji on 2.12.2010 at 3:59 PM

Hi Richard.

I'm aware of that, my wording is perhaps not clear.

In essence, what I mean is homeopathy has been shown not to work any better than placebo in well controlled trials.

There is a large pool of evidence for hpathy. Unfortunately it is negative. The better controlled the trial, the less favourable the result.

#73 Richard Lanigan on 2.12.2010 at 6:28 PM

As a child of the 60s, I was smoking weed and hash when I was about 15 but rarely had the money to buy it. This wealthy guy started hanging out with us and was happy to fund our dope if I made the purchase and rolled the joints for him. Gerry was not able to inhale a cigarette so it seemed wasteful to put any dope in a joint for him. I used to put aromatic tobacco in the joint and he got as high as a kite and a bad case of the munchies involving a box of Sugar Puffs.

Our brains can do amazing things without any chemical stimulus. A blush is a thought that is transforms into vasodilatation of the blood vessels in upper layer of skin no one can explain how that happens. The mistake homepaths make is trying to explain homeopathy to people who dont believe in it.

#74 Benji on 2.13.2010 at 12:36 PM

Richard,

Richard,

Yes the placebo effect is well documented.

"The mistake homepaths make is trying to explain homeopathy to people who dont believe in it".

I believe very much in the placebo effect. I also have no problem with people choosing to use homeopathy, providing its an informed choice.

I.e they know there is no active ingredient in the sugar pill because its been diluted out of the solution.

That homeopaths believe that the more dilute something is, the more powerful its effect.

Like cures like (i.e. caffiene as a remedy for insomnia).

I do take issue with homeopaths offering inert treatments for malaria, cancer and AIDS, as no matter how powerful the placebo effect, they will not help these serious conditions.

Cue big pharma, drugs and modern medicine is bad post...

#75 Paul on 2.13.2010 at 1:30 PM

Benji

I think you missed the point.

There is believed to be an effect opposite of the placebo, where an improvement in health previously proven attributable to an actual treatment is not actually observed due to patient expectation that the treatment is inert. It is to this that Richard refers.

I often wonder how little of the most cutting edge science anti cammers and CAM deniers really know including quantum physics, atom influences, zero point / field and intent, Masura Emoto’s work etc. Not much I expect.

Perhaps a place to start and with an open mind.

#76 Richard Lanigan on 2.14.2010 at 11:36 AM

I would not suggest to know anything about quantum physics, how or if homeopathy works or whether it is a a placebo or vitalism.

I don’t believe in God and I think people waste their money going to Lourdes hoping for a cure. If there are people out there offering “Cures” for AIDS or cancer using homeopathy, I would say its outrageous. Those are my beliefs nevertheless there are far more people on the planet who believe in a God who am I to say there are all wrong.

If there are homeopaths or CAM practitioners out there who offer help to people with terminal diseases and those people want to try it and its compatible with their belief system, I would say go for it.

If RCTs are the gold standard for efficacy of a pharmaceutical intervention, a bell shape curve may suggest significance, however one would assume there were people at the beginning of the curve and the end who did not respond ideally to the treatment . Therfore according to sceptic beliefs , these people should do nothing more as medicine has failed and they will only be ripped off by going down the CAM road.

People who are dying want hope more than anything , its for courts to decide if the creation of that hope was unreasonable or fraudulent. The point is not “the active ingredient” the point is does the ingredient (which could be the colour of the pill) induce an positive effect in the physiology of the recipient.

#77 Richard Lanigan on 2.15.2010 at 9:17 PM

For some reason comment 69 by Fed up needed my aproval and is now up.