Natural is not the same as safe

Herbal remedies linked to drug side effects

http://www.telegraph.co.uk/health/healthnews/9636982/Herbal-remedies-linked-to-drug-side-effects.html

Interactions between prescription drugs and herbal or dietary supplements can cause complications including heart problems, chest and abdominal pain and headache, according to a review of existing evidence.

Remedies and supplements including ingredients like St John’s wort, magnesium, calcium, iron and ginkgo caused the greatest issues, researchers reported in the International Journal of Clinical Practice.

Experts from the China Medical School in Taiwan studied data from 54 review articles and 31 independent studies involving 213 herbal and dietary supplements and 509 prescribed drugs.

A total of 882 linked effects were observed, with warfarin, insulin, aspirin digoxin and ticlopidine among the drugs which were most affected.

Flaxseed, echinacea and yohimbe, a stimulant and aphrodisiac found in Africa, were the herbal ingredients which were found to cause the greatest number of drug interactions.

It seems these days that one of the most common logical pitfalls I come across is the naturalistic fallacy. It’s everywhere you go, from those natural herbal supplements, natural milk, pretty much everything is marketed as natural at the moment, it’s the big buzz word, probably surpassing organic.

For those that aren’t aware of the naturalistic fallacy it is the flaw in logic that describes that because something is natural it must be beneficial, or at least not harmful. It doesn’t take much to dispel this particular fallacy. I like to point out that arsenic, cyanide, snake venom and crude oil are natural, and I sure wouldn’t want to ingest those.

So let’s talk about this recent literature review, it highlights what the medical profession and Skeptics have been trying to put across for years. News Flash! Herbs are drugs! That’s right folks, they are not inert, and they actually have physiological effects on your body. Unfortunately they are not normally the effects that are claimed on the bottle.

The biggest problem is that patients rarely report to their doctors what supplements they are taking because they don’t consider them to be drugs, it doesn’t even occur to most people. The fact is that most of our potent pharmaceuticals were found in nature, the difference between a pharma drug and a “natural” remedy is that pharmaceuticals are refined and defined. This means you take a pure form of the drug and you know how much you are taking. The same cannot be said for herbal remedies.

Why is this an issue? It’s because of the aforementioned non inertness of herbal remedies. While a lot of herbal remedies don’t really have a big effect by themselves (with the exception of some quite toxic remedies) they can react with real drugs that you are taking at the time. St Johns Wart is just one example, and probably the most well-known, this study also identified flaxseed and Echinacea. These are all commonly taken supplements that could be harming unknowing patients who are taking prescription meds. Heart problems are serious and potentially life threatening, whilst headaches, chest and abdominal pain are nothing to be sniffed at.

The moral to this story is that tell you doctor EVERYTHING, honestly you just don’t know how useful and even potentially lifesaving this could turn out to be.

The Shonky

The Shonky for
Woo water goes to… Nature’s Way Kids Smart Natural Medicines

http://www.choice.com.au/reviews-and-tests/awards/shonky-awards/shonkys/the-2012-shonky-awards.aspx

http://www.choice.com.au/reviews-and-tests/awards/shonky-awards/shonkys/the-2012-shonky-awards/page/natures-way-kid-smart-range.aspx

Shonky loves homeopathy. The idea of selling water for upwards of $1000 per litre and claiming it’s medicine represents the very essence of shonkiness. But convincing anxious or desperate parents they can use it to treat their children’s ailments takes it to a whole new level. Introducing the Nature’s Way Kids Smart Natural Medicine range, with variants for colds and flu, hay fever and runny nose, pain and fever, and for calming kids down. Already feather-whipped by the TGA for making unsubstantiated claims about the uses and effectiveness of the products, the company has done nothing to temper its assertions the products might actually do something.”

Every year the Australian consumer watchdog group; Choice, releases its “Shonky Awards”. For the non-Australians among us shonky means dodgy, suspect, misleading or fraudulent. Each year the Shonky Awards highlight the most inefficient, poor value for money and sometimes outright dangerous products or services making their rounds in Australia.

Well the results are in… amongst the usual suspects of ineffective cleaning products, inefficient washing machines and disproportionate service fees is Nature’s Way. As you may have already guessed from the name Nature’s Way is a brand of alternative “natural” medicine products. They earned their Shonky this year for their range of Kids Smart homeopathic remedies. That’s right folks, a range of homeopathy targeted at children!

While homeopathy can be considered a sham at the best of times, targeting worried parents with sick children must surely be considered a new low. Dr Ken Harvey sums up his thoughts on the matter;

Symptoms like ‘restlessness, anxiety, irritability and agitation’ the ‘Calm’ claims to treat can be the symptoms of potentially serious childhood infectious diseases for which a homeopathic remedy is entirely inappropriate, and such misguided treatment might make a parent postpone seeking more appropriate medical advice to the child’s detriment.

In a welcome development the claims of this company have been referred to the Australian Competition and Consumer Commission (ACCC) and the New South Wales Fair Trading commission has written to the ACCC and offered their assistance.

Acupuncture and poor science… again.

A study published in the Journal of Clinical Oncology this week has concluded that acupuncture can decrease cancer related fatigue in breast cancer patients. However concluding something and finding something are two separate beasts.

In this study, 227 breast cancer patients were treated with acupuncture alongside the usual care they receive, 75 patients did not receive acupuncture but continued to receive their normal care. In order to asses fatigue levels, anxiety, depression and quality of life, established 20 point scales determined by questionnaires were performed and the results show that on average the acupuncture patients improved on all assessments compared to the non-acupuncture group.

That sounds promising doesn’t it? Surely the only thing you might conclude from this study is that acupuncture can reduce fatigue in breast cancer patients? Well not exactly no; what we can conclude from these results is that acupuncture might reduce fatigue in breast cancer patients and here’s why.

Clinical science is a funny old thing, this is mostly because human beings are a fairly odd sort with complicated psychology and what some may call intelligence. This means that studying the effects of health care interventions is a lot different from studying say physics. The laws of physics are immutable and constant, if you were to drop a ball with the exact same weight and dimensions from the same height with the same force and the exact same environmental conditions, the ball would take exactly the same amount of time to hit the ground, every time. Humans though, not so much.

How do you feel right now? It seems like an easy question but I’m willing to bet that you had to think quite hard about it, chances are if I asked you tomorrow you might not give me the same response, even though little will have changed. This is because human emotions and perception is affected by the experiences and expectations you gain from your existence. This is what makes clinical trials quite tricky, if you are told that you are getting a treatment, you might expect to get better, then when you are asked if you feel better you think that you do, because it’s what you expect. This is called the placebo effect.

So let’s get back to why the conclusion from this study is not congruent with the results they obtained. The author described this study as a “Pragmatic Study”, what this means is that is a real world study. Usually a pragmatic study is used to make an observation and then form a hypothesis. In order to reach a conclusion you must do a controlled trial that accounts for all the variables that are reasonable to control. Concluding that an effect exists from a pragmatic study is just plain poor science.

In the study there were two groups, one that did not receive acupuncture and a group that did. As stated earlier the group that received acupuncture improved on all measured levels of wellbeing by a small amount, which might suggest that acupuncture is useful as a treatment, however that is all you can surmise from those results, it might be useful. This is because the study did not control for the other variables that might account for these results.

Let’s talk about blinding, this is a tool used by scientists to remove variables such as the placebo effect. Blinding means that the patients do not know whether they are receiving the treatment or not. This is important because if the patient doesn’t receive a treatment but still reports an improvement the effect can’t be due to the treatment, but more likely because they expected to improve. If the effect from the treatment group isn’t stronger than the placebo group, it is safe to assume that the treatment is no more effective than no treatment at all.

What this trial needed then was a third group, this group would have received a placebo type of treatment, this involves using fake needles that retract rather like a stage knife, or the acupuncture is done in none-acupuncture points (although this makes the assumption acupuncture must be done on certain points on the body and isn’t just the process of inserting the needles) my preference would be the fake needles because these don’t actually pierce the skin. Importantly the subjects would not know whether they were receiving “real” acupuncture or the placebo acupuncture.

If the results of this trial had then shown that the real acupuncture group had a bigger effect than both the non-treatment and placebo acupuncture group, that would have been more interesting and the conclusion that acupuncture is effective rather than might be effective is much more valid.

At the least this trial should have included a group that received another form of alternative treatment such as massage or aroma therapy. While this still doesn’t allow us to make firm conclusions about the effectiveness of acupuncture it would at least indicate whether the effect was specific to acupuncture or not.

The fact is that a non-blinded, non-placebo controlled study is almost worthless to our understanding of whether something works or not. For the author of this study to make such a definitive conclusion shows a poor lack of knowledge about the scientific method and at worst an agenda to promote acupuncture. That this article was published in a reputable journal is all the more disappointing.

doi:10.1200/JCO.2012.41.6222

Bones in Bulgaria may be of John the Baptist: study

http://phys.org/news/2012-06-bones-bulgaria-john-baptist.html

It seems that every few months some one claims to have found body parts, shrouds or other artefacts of biblical figures. The problem is: with modern scientific techniques, people who read about such finds are over generous with their certainty and credulity than is due. The fact is that these finds can scarcely be considered more authentic or certain now than they were 50 or even 100 years ago.

I’ll give you an example, for some time now archaeologists and other bone experts have had the ability to fairly well describe the ethnic origin of bone remains. Now with DNA analysis technology being faster and cheaper we are able to very accurately define the ethnic origin of bone. This is a great thing, especially when we discover a species of hominid. What does it tell us about these kinds of finds though? It tells us exactly what it would tell us about any other archeological find. Where the person was from. Unless John the Baptist is the only middle-eastern man known to have existed at the time this means very little.

The dating of the bone is faced with a similar problem, just because the bone can be dated to when a person was alleged to be alive does not make it a compelling case for the bone belonging to that person, as there were a lot of other males from the middle-east alive at that time also.

What is more slightly more compelling is the box that was found near the sarcophagus. The box had inscriptions that referenced John the Baptist as well as the date of his birth which is celebrated by Christians. This piece of evidence is also not without it’s problems though. Firstly the box was found near the sarcophagus, the body parts weren’t inside of it. Also the inscription itself is somewhat suspicious to me, the exact birthdate of people from those times was seldom known and was often arbitrarily assigned at a later date, so for the box to bear that date rings alarm bells for me. Finally the inscription itself has not been dated. It’s not too long ago that a certain documentary claimed to have found the body of Jesus only for real scientists to discover the inscription was a fake.

This brings me nicely to my final point. Always be suspicious of anything when the results are presented first by the media, especially in a high-profile documentary. Peer review of evidence by other experts in your field is the best validation you can get. So many claims fall by the way side after rigorous scrutiny from well-trained and experienced contemporaries. I highly expect this case to be no different.