Why don’t we vaccinate against chickenpox?

A friend asked me the other day, “why don’t we vaccinate against chickenpox?”. It’s a fair question. Currently in the UK we vaccinate every child against measles, mumps, rubella, diphtheria, pertussis, meningitis, pneomococcal disease, and others. Chickenpox is usually a mild illness (I had it three times, shut up, that’s totally normal), but just like those other infections it can sometimes be very serious. A tiny proportion of people with chickenpox develop encephalitis or meningitis, and recently a young boy very sadly died.

So, why don’t we vaccinate? The answer isn’t straightforward, and to understand it properly you need to know a bit about chickenpox and shingles.

Chickenpox is caused by a virus called varicella zoster. The initial infection causes chickenpox, which involves the itchy spots, blisters and general poorly-ness that we all know. Generally the acute infection clears within a few days and the spots and blisters clear up within a week or two. But what about the virus? Sadly, it doesn’t leave the body when the rash does.

Instead, virus particles lie dormant in nerve ganglia, which are nerve roots found in or near to the spinal column. The virus sleeps happily there, doing absolutely no harm for many years, and kept in check by the immunity that we develop after fighting off the initial infection. Most people then go on to meet other people with chickenpox. Maybe your kids get it, or people you meet at work, or socially. However it happens, every time you encounter the virus your immune system gets a little refresher course in how to deal with it effectively, and those viruses sleeping in your nerve ganglia are effectively kept snoozing for a while longer.

But (oh, that but) eventually the viruses wake up. They multiply, as viruses do, and spread up the infected nerve until they reach the surface and cause symptoms. This new illness is called shingles (or sometimes herpes zoster); it mainly affects adults, and it ranges from mild irritation to debilitatingly painful. Every nerve ganglion serves a distinct area of our bodies, so the area served by the infected nerve develops a painful, itchy, blistery rash. That rash can cause chickenpox in people who have never been exposed, because it’s full of newly-hatched virus particles. Commonly the rash appears on the torso, but it can also affect the face, causing embarrassment as well as pain and discomfort. It an even affect the eyes, causing ophthalmic shingles. Usually people also feel generally unwell, so alongside the rash there’s headache, fever, and generalised yuck. When we bear in mind that shingles often occurs in people who are already run down – perhaps due to old age, stress, other infections such as HIV, or chemotherapy – we realise that this is potentially a pretty serious condition.

Usually that’s that; the rash clears up and everything’s fine. But sometimes even when the bout of shingles has resolved people can be left with a condition called post-herpetic neuralgia, which simply means pain caused by herpes zoster. NHS Choices sums this up well – it’s a painful, burning, itchy, throbbing or stabbing sensation. It can last for months and it can be absolutely debilitating for an unlucky few. Other complications are similar to those of chickenpox – pneumonia, encephalitis, and meningitis. When you consider that the people most likely to get shingles are already likely to be vulnerable, that’s pretty concerning.

So that’s all very interesting, but how does it relate to chickenpox vaccines? As alluded to right at the start of this post, regular exposure to people with chickenpox acts as a kind of refresher course to the immune system. It reminds our immune mechanisms that varicella zoster virus exists, and gives us the tools to fight it off quickly if it pops up – either in the environment or in our own nerve ganglia. If we started to vaccinate against chickenpox – as many parts of the world do, incidentally – entire generations of adults would lose this immunity boost, because our children, grandchildren and peers simply would not be catching chickenpox.

We would drastically reduce childhood chickenpox, but the price would be up to 50 years of more frequent cases of shingles. This rise has been clearly seen in the USA, where the introduction of routine chickenpox vaccination has led to roughly a two-thirds increase in the rate of shingles among veterans.

Is that a price worth paying? That’s not a simple question to answer. The last time they looked at the question in 2010, the UK’s Joint Committee on Vaccination and Immunisation thought that it wasn’t. The fact is that these decisions are never easy, and they have to be made to benefit the population as a whole, and not individuals. Is the decision not to vaccinate against chickenpox in the UK the right one? That’s not really answerable. But is it the best possible interpretation of the evidence we currently have? I think it probably is.

Homeopathic harms vol. 8: Opportunity costs

The excellent Nightingale Collaboration published some figures lately on how much the NHS in England spends on prescribing homeopathy. The figures are publicly available (and linked via the Nightingale Collaboration post), and represent every prescription for homeopathy dispensed by a community pharmacist – anything provided in a homeopathic hospital (or ordinary hospital, though I’d hope that doesn’t happen too often) wouldn’t show up.

You should go and take a look at that post because it’s interesting to see how prescribing has changed over the last 15 years or so.  It did make me wonder though, what is the opportunity cost of all this homeopathy? That is, what opportunities have we lost because we spent that money on homeopathic treatments? These opportunity costs represent one more indirect harm of the continued use of homeopathy.

I accessed a few resources to see what the score is.  Those resources are all publicly available, so you can (and should) double check my workings. I used:

• A copy of the 2014-15 National Tariff Payment System, which lists how much the NHS expects to pay for a multitude of different things
• NHS Careers, which has a few useful things including the 2014-15 NHS pay scales, and expected salaries for several jobs.

In the 2013 calendar year, the NHS paid £137,000 for homeopathic remedies dispensed in community pharmacies.  By my calculations, that’s enough to pay for:

• Wages for six newly qualified nurses, dieticians or radiographers or
• Wages for five specialist nurses or
• Twenty-six hip replacements (without complications) or
• Twenty-four knee replacements (without complications) or
• Delivery of ninety-one babies or
• One hundred and ninety-six cataract operations or
• Four hundred and fifty-nine MRI scans

(All numbers are rounded down, since it’s pretty hard to employ 0.4 of a person or replace three-quarters of a hip. Staff are assumed to be at the bottom of their pay band, which is probably a bit optimistic.)

Those numbers might not seem like much, but once again it comes down to cost/benefit analysis.  The best that we can hope that those homeopathic prescriptions achieved was some kind of comforting placebo effect for the patient.  Six nurses, even spread out around the country, could achieve an awful lot more than that.

Informed consent and alternative medicine

A guiding principle in modern medicine is that of informed consent.  This means that not only do you have the right to make decisions about your healthcare, you have the right to have all the necessary information to make a good decision.  The Oxford Dictionaries define informed consent as:

permission granted in full knowledge of the possible consequences, typically that which is given by a patient to a doctor for treatment with knowledge of the possible risks and benefits

That last part is key: knowledge of the possible risks and benefits is absolutely essential to making a good decision.  A good doctor will always make sure to take the time to explain these to you, and if you feel you need information please always feel free to ask for it.  My big concern though, is that this doesn’t always happen with alternative medicine.  In fact, I think it rarely happens.  There are two big parts to this and the first one relates to my favourite word: evidence.

Informed consent has to be informed

In order for consent to be truly informed, you need to know a few things:

• Exactly what is in the treatment, and how was it made?
• How likely is it to work?
• How likely is it to cause harm of any kind?

If any on of these elements is missing, informed consent is simply not possible.  Most of this information is also, in my experience, absolutely missing from consultations regarding alternative medicine.  Assertions will be made (“this is a very effective treatment”, “this has been used for years”, “my whole family uses it”, “it’s totally safe”), but evidence is not offered.

To make an example of a pet topic, if the above questions were answered honestly and frankly for a homeopathic remedy, the answers would be:

• There is no active ingredient in this treatment.  It was made by diluting the original substance beyond the point where any active ingredient could possibly remain. It consists purely of solvent or vehicle (usually water, alcohol, sugar or similar).
• It cannot work beyond placebo effect, according to all of the good quality evidence and the principle of prior plausibility.  All of the evidence suggesting it does work is poor quality, with systematic bias.
• It is unlikely to cause direct harm unless poorly made.  It may cause indirect harm if you fail to seek treatment for an ailment that requires it.

How many homeopaths will tell you those things?  Very few. How many homeopaths will directly contradict the first two points at least?  Anecdotally, most of the ones I have encountered specifically deny these facts. I am not aware of any people who have had these facts properly explained to them by a homeopath.  If you are aware of this happening, please do let me know (evidencebasedskeptic at gmail dot com). How, then, can consent to homeopathic treatment ever be truly informed? It can’t.

One important thing to note is that if you fully understand and accept those three facts, and still want to try homeopathy, then fair play to you.  That is your choice, and it’s an informed one.  Which leads me neatly to the second big component of this post – what about people who can’t consent?

Consent and children

Adults have choices. They are generally capable of understanding the information about the chances a treatment will help them, weighing that against the chances it will hurt them, and making a choice. When this is not the case, mechanisms in place to provide vulnerable people with help to make those decisions. But what about children?  Where a family seems normal, happy and healthy, it is assumed that a child’s parents will make the best possible decisions about that child’s health.

Sadly, when alternative medicine enters the scene, this doesn’t always happen; otherwise wonderful parents can make some really awful choices, all the while believing that they are acting in the best interests of their children.

Recent high profile examples of this include:

• A woman who took her son into hiding, rather than allow radiotherapy his doctors felt was essential.
• An Amish family who went into hiding rather than allow their daughter to receive chemotherapy for her leukaemia
• A seven year old Canadian boy who died of a treatable infection because his mother chose to treat it with alternative medicine
• A nine month old Australian girl who died under broadly similar circumstances

Let me repeat for clarity: these are good parents. They are loving and caring, and want the best possible health for their children. They take advice from people they trust. But they are often not giving informed consent, and neither are their kids.

Happily these cases are very much the exception, but they are still tragic.  The only good way to prevent them that I can see is education; good quality education for all people, so they can tell the difference between good evidence and bad evidence, and make good decisions for themselves and their families. Until they have the skills to ask the right questions and appraise the answers, people will continue to use alternative medicines for themselves and their children without informed consent. That’s not only unethical and immoral on the part of the people providing “treatment”, it’s highly dangerous too.

Green tea and beta blockers

The BBC published an article a few days ago titled “Green tea ‘can impede nadolol blood pressure medicine’” It represents some pretty sloppy health reporting. Let me expand, bit by bit.

Green tea can weaken the effects of a commonly prescribed blood pressure pill, experts warn.

We’re off to a bad start. Right from the first sentence of the article, we have a glaring error.

The drug in question is called nadolol, which is a beta blocker from the same family as atenolol and propranolol. The chances are you’re familiar with one of those drugs, but not with nadolol, and there’s a very good reason for that – nadolol is not commonly prescribed as claimed by the BBC. In fact, it’s barely prescribed at all. The evidence for that is publicly available; the Health and Social Care Information Centre (HSCIC) is a UK body which regularly publishes statistics on drugs prescribed in England. The latest set was published on the 4th of April 2013, and details everything prescribed in 2012 – an awful lot of drugs. You can get a copy for yourself here.

The HSCIC data tell us that in 2012 there were 32,355,600 prescriptions dispensed for beta blockers. Those figures include 11.5 million prescriptions for atenolol, 14 million for bisoprolol and over 3.5 million for propranolol. How many prescriptions for nadolol? Seventeen thousand. That means that nadolol accounted for 0.05% of all the beta blocker prescription items dispensed in England in 2012. I don’t think that 0.05% of anything can ever be described as “common”.
One important thing to note about the prescribing data is that it doesn’t tell you how much of each drug a prescription represents – some might have been for a four weeks supply, some might have been for 12 weeks. However to change the figures above, each nadolol prescription would need to have been for several years supply, which isn’t something that happens.

The next problem with the BBC article is this:

The study in the journal Clinical Pharmacology & Therapeutics found nadolol’s lowering effect on blood pressure was blunted in the 10 volunteers who agreed to drink green tea.

Ten volunteers. Ten. Volunteers. Neither of these words is good in terms of clinical research. If I were evaluating a drug and saw a trial with ten people in it, I would only take the evidence into account if there was no larger, randomised trial available. In fact, if a trial in ten volunteers was the only available data I still might not read it; my recommendation would be along the lines of “we do not know enough about this drug to use it safely; we need more evidence”. The burden of proof for a safety issue is clearly lower, so that’s not the best analogy, but the fact remains that the sample size is not sufficient for the level of fuss that’s been caused here. It’s also worth noting that these were *healthy* volunteers. How do we know that the same thing would happen to a person who was unwell and required a beta blocker?

Follow-up tests in the laboratory revealed that green tea blocked a drug transporter present in the lining of the human gut that helps move nadolol into the cells.

Well. Kind of. Follow-up tests were done in a laboratory, but not in human guts. The tests were done on cells, in a petri dish, on a cell line called HEK293, which were originally derived from Human Embryonic Kidney. Although they are kidney cells they’re probably not very useful for telling you what would happen in a living, adult kidney. It maybe doesn’t matter too much what the cells are as long as the drug transporter involved is the right one, but I’d expect more clarity from the BBC.

So the end result is that some scientists found that drinking green tea makes a drug that is very rarely prescribed work a bit less well, probably, in healthy volunteers. Let’s be clear: that’s a perfectly adequate conclusion for a scientific study – it’s tiny nuggets like this that are the building blocks of good medicine. The problem here is the quality of the reporting on the issue. Very little additional time, effort or words would have been needed to make the article much more representative of the real impact of the findings.

If you’re a regular green tea drinker who takes nadolol, the chances are that your dose has been adjusted to suit you already, through a process of your doctor checking your blood pressure and tweaking the dose. If you’re an occasional green tea drinker, you probably have nothing to worry about, but you can minimise any risk by leaving several hours between taking your pills and drinking any tea. It’s very important to realise that if there is any risk (and we can’t be sure by any means from a study of ten healthy people), it’s likely to be minimal. If you’ve any worries at all, have a chat with a local pharmacist or your doctor.

And the next time you see a story like this, don’t immediately take it at face value.

Edit: it’s worth mentioning that this study tells us nothing about other beta blockers. They might be affected in the same way, they might not – we won’t know until someone takes the time to do the experiments. If you’re concerned about a drug other than nadolol, and your habits haven’t changed lately, it’s unlikely you have anything to worry about. If you have any worries at all, your pharmacist or doctor will be happy to discuss them with you.

Why you can’t believe weight loss testimonials

I wrote yonks ago about why you can’t always beleve the hype about fitness fads, and encouraging people to think critically before buying in to anything. At this time of year a lot of people are making themselves promises about the way they look, so when I stumbled across a short blog post this evening, I thought it was worth sharing.

The post illustrates exactly how easy it is to fool the eye (and the wishfully-thinking brain) with just a little work on posture, flexing the right muscles, using good lighting and a touch of post-production work. Just take a look at the panel below – all of the images in it were taken within the space of an hour. With a few changes of outfit and a quick shave, the author was able to take a series of photos that any fitness “guru” would be proud to use as a before/during/after montage (click on the image to view a bigger version, click here to read the blog post in full).

So what’s my point? When it comes to fitness, don’t believe your eyes. Don’t part with your hard-earned cash on the basis of a flashy web page and a few beguiling words. The best way to assess these things is to find someone who knows what they’re talking about, and talk to them about it – social media is a great way to do this, as it gives you access to thousands of experts almost instantly. I’d be happy to help you start – just leave a comment or send me a tweet.

So you think you do Tabata?

I just found this post, fully-formed, in my drafts folder. I wrote it in April, which shows just how badly I’ve neglected this blog. Sorry about that, but to tide you over, have a little post on fitness. This post is shamelessly stolen from myself, from a totally different blog.  I’m re-posting it here because I think it makes points about critical thinking and evidence that fit with this blog’s ethos pretty well, and also carry on the theme of questioning what you’re told about health and fitness that I started a few weeks ago.  Without any further hesitation, here’s what to bear in mind when you hear the word “Tabata”…

I have a bugbear. I’m going to use it to hopefully produce a blog post that’s useful and informative, but first I’m going to get something off my chest.

If you work out regularly, or even if you don’t, the chances are you’ve heard of the Tabata protocol.  Named after Izumi Tabata, the chap who first published an academic journal on the subject, the protocol is very simple:

1. 20 seconds of work, immediately followed by 10 seconds of rest
2. performed 8 times without any pauses or interruptions, for a total of 4 minutes
3. with the working phases performed at 170% of VO2max

If you deviate from this on any point, you’re not doing Tabata, you’re doing interval training.  You may even be doing High Intensity Interval Training (HIIT), but it’s still not Tabata.  Does it matter? Well, yes.  Just because you’re doing intervals on a 20:10 split doesn’t mean you’re working to the same intensity as the Tabata protocol, and that means you can’t necessarily expect to get the results of the Tabata protocol.  As an example, depending how hard you’re working it’s a little bit like the difference between doing a class like Body Pump, and training with Olympic weightlifting; both might make you sore the next day, and help you get stronger, but it’s evident that in the long-term, and arguably the short- and medium-term too, the results are very different.

That’s my pet peeve (more-or-less) off my chest, so on to the useful part.  Points one and two on the list above seem straightforward, but what’s VO2max?

Simply put, it’s the maximum volume of oxygen that your body is capable of using. It’s usually expressed in litres per minute (L/min), or in millilitres per kilogram of bodyweight per minute (mL/kg/min). Men generally have a higher VO2max than women, and it tends to increase as you get fitter (and also decrease as you get older).

The next obvious question is, if VO2max is the maximum volume of oxygen your body can use, how can you reach more than 100% of it? That’s because your body has two energy systems.  Let me expand

• The aerobic energy system uses oxygen to produce energy. It uses glucose, which goes through a series of chemical reactions to produce energy molecules like ATP, with CO2 and water as the waste products, and a few other things that are important to your body (but not to this blog post).
• The anaerobic system can produce energy in the absence of oxygen, by using up molecules like ATP, and by breaking down glucose and glycogen in the absence of oxygen.  This produces by-products like lactic acid.  Once you’re at rest, your body will use some of the oxygen it’s consuming to metabolise these by-products and return your muscles to peak condition.  This is sometimes referred to as the “oxygen debt”, because you’re paying back oxygen for energy you’ve already used.

What this means for you is that you can work at a rate that is higher than your VO2max; your aerobic system will consume as much oxygen as it can, and your anaerobic systems will also kick in, but you’ll have an oxygen debt to pay off once you’re finished.  Back in the 1990s Tabata decided to test what effect using both of these systems at once would have on fitness, so he took the now-familiar 20:10 protocol (which was already being used by the Japanese speed skating team in training) and compared it to steady-state cardio.

A summary of the results is available for anyone to read if they want to, but the gist of it is this:

1. The study was quite small, with a total of 23 men who were already physically active – no women were tested. Only 7 men completed the interval training experiment.  All athletes trained 5 times per week in total.
2. Athletes performing cardiovascular exercise at steady state (70% of VO2max) for an hour significantly improved their VO2 max.
3. Athletes performing intervals of 20 seconds of work at 170% VO2max interspersed with 10 seconds rest (with one 30 minute session per week at steady-state 70% VO2max) increased their VO2 max by a similar amount to the other group, but also increased their anaerobic capacity by 28%. In reality this group performed 7-8 sets of high-intensity work in each session; the session was terminated if their pedalling speed dropped below 85RPM.  If they were able to do 9 sets, the difficulty was increased the next time. This means that the workout was always varying, and it’s likely both that no two men ever did the same workout, and that no man ever did an identical workout more than a few times.

One really important point to take away from all of this is that working at 170% of your VO2 max is hard.  Really hard.  Joe Bloggs can’t do it, at least not without falling over or being sick (or both). It takes a trained athlete, someone who pushes their limits most days to achieve this kind of intensity. And since this is the only protocol that was tested, this is the only protocol that we can make claims about.  Even them the claims aren’t particularly strong if you look at this trial in isolation – the results for seven men who were already quite fit aren’t likely to generalise very well to a larger population of diverse individuals. Crucially, if you work at less than 100% VO2max (which most people will), you certainly shouldn’t expect anaerobic benefits of this magnitude, if any.

So what was my point again?  A large part of this is my belief that language should be used accurately – call a spade a spade.  The Tabata protocol is a very specific thing, which has been found to produce very specific results.  Calling your workout Tabata when it’s not is at best pointless, and at worst misleading (or, if you’re a fitpro selling your services, false advertising).

There’s no doubt that doing almost any form of HIIT is beneficial  (and I don’t mean to discourage it), so please don’t stop doing it, but – to keep me sane – please do stop calling it Tabata?  Cheers 😉

Homeopathic Harms Vol 7.1: Professional Ethics

Here’s a teaser for the latest in our Homeopathic Harms series – head on over to A Healthy Dose of Skepticism to read the full post…

As you’ll know by now, I’m a pharmacist. And as such, I have to be registered with the General Pharmaceutical Council (GPhC) to practice in the UK. I’m therefore governed by the GPhC, and in particular their code of conduct, ethics and performance, which has seven main points:

1. Make patients your first concern
2. Use your professional judgement in the interests of patients and the public
3. Show respect for others
4. Encourage patients and the public to participate in decisions about their care
5. Develop your professional knowledge and competence
6. Be honest and trustworthy
7. Take responsibility for your working practices.

If I-or any of my colleagues- were to act against this code of ethics, we could be held to account by our regulator and reprimanded accordingly. Other healthcare professionals- Doctors, nurses etc- all have similar codes of conduct produced by their regulatory bodies. They all have one thing in common- that the patient is central to everything you do, and if a member steps outside this code of conduct, there is a clear and organized route through which complaints or concerns can be raised. This is as it should be: healthcare professionals have the lives of patients in their hands, and need to be held to account if anything goes wrong. As I’ve written before in this series, homeopaths don’t have to register with a regulatory body and anyone can set themselves up as a homeopath with no training whatsoever. Whilst some ‘professional’ bodies exist in the UK, they have no regulatory powers so are unable to reprimand anyone if they receive a complaint.

Why vaccines *won’t* overwhelm your immune system

A very quick post today, but a topical one given the situation in Wales (and the UK in general) with regards to measles.  The latest press release from the Welsh NHS has said that there are now 765 known cases, and that over 70 of these people have been hospitalised.  That’s one in ten of the people affected who have ended up in hospital.

There has been (entirely reasonable) supposition in the press that the people affected are largely children who were not vaccinated with the MMR due to the completely false suggestion that the vaccine may cause autism or bowel disorders.  It is felt in some circles that the vaccine may somehow overwhelm a child’s immune system, and lead to illness.

Numerous studies have disproven ths link, and the original paper that suggested it has been withdrawn by the publisher.  The paper itself has been called not only wrong, but downright fraudulent.  Sadly this hasn’t been enough to undo the damage done by the original paper, and by the subsequent media storm that erupted around it.  Measles is not a trivial infection, and as the Welsh NHS press release rightly says, “it is just a matter of time before a child is left with serious and permanent complications such as eye disorders, deafness or brain damage, or dies.”

So in light of all that, I stumbled across this quote this morning in an article published at Medscape.  It’s a rather eloquent way of highlighting the scale of immune assault that we all face every single day, and how unlikely it is that any vaccine could pose a risk on these grounds:

In general, however, if you take a step back and look at this question, the notion that the number of immunologic components in vaccines could in some way weaken, overwhelm, or perturb the immune system is fanciful. When we are in the womb, we are in a sterile environment. When we leave the womb and enter the birth canal and the world very quickly, we are colonized with trillions of bacteria, to which we make an immune response. The total number of immunologic components in today’s vaccines is approximately 165. When you think about the number of antigens that you encounter (remembering that a single bacterium has 2000-6000 immunologic components) and that you are making grams of immunoglobulin every day, that the dust you inhale isn’t sterile, and the food and water that you eat and drink aren’t sterile…The notion that vaccines would somehow weaken or overwhelm the immune system is certainly not supported by what we know about immunology and microbiology.

To put it another way, one single bacterium has 12-36 times as many immunologic components as the average vaccine.  The average person has trillions of bacteria on and in their bodies (in fact in terms of cell numbers we’re more bacteria than we are human), so the addition of a few extra antigens in a vaccine is really a vanishingly tiny drop in a huge ocean.

While I’m not trying suggest that vaccines are risk-free (because that can’t be said of any medicine), the risk of being vaccinated is certainly much lower than the risk of complications from catching something like measles.

Postscript: Medscape have a second article about a recent study that found no link between childhood vaccination and autism; it’s worth a look if you have a login.

EDIT: thanks to Nico in the comments for pointing out a factual error.  I originally asserted that by weight a human being is more bacteria than human.  That is of course wrong (we’re 1-3% bacteria by weight).  We do however contain 10 times as many bacterial cells as our own cells.  Which is either quite wonderful or rather creepy, depending on how you look at it.

Homeopathic Harms Vol 6: Self-awareness & self-criticism

One of the most important mechanisms that people have for regulating their own behaviour is feedback from other people.  This happens from the day we’re born – babies learn that some behaviours earn a smile so they repeat them; toddlers learn that other behaviours get attention, so they repeat them.  As adults we do exactly the same thing – we learn behaviours that make us successful friends, partners or parents based on how people react to us.

This carries over into professional life too, and in some professions is even put into words as codes of conduct, or ethics.  We learn what is and is not acceptable by seeing how people respond to our actions.

Well, that’s a lovely little snippet about human behaviour, but what does it have to do with harm caused by homeopathy?  Sadly, lots.  Homeopaths style themselves as health professionals, meaning people trust and respect them.  In other health professions – let’s take conventional doctors as an example – if an individual gives poor advice or commits an act that’s seen as misconduct, there are mechanisms in place to deal with that.  They can be sanctioned or struck off, re-educated, suspended, and any number of other things.  Crucially, their peers support this process; if a doctor suspects misconduct by another they can act on it, formally or informally.  The same is true in other health professions – nurses, pharmacists, you name it.

So surely homeopaths do the same?  Well…no.

The Society of Homeopaths exists, and has a code of conduct and ethics.  However there’s no requirement whatsoever for a homeopath to be a member of the society, and I couldn’t find anything on their website about disciplinary processes or how to complain about a member. When asked to publicly condemn behaviour that is clearly unacceptable in individuals trusted to give health advice, the society has consistently failed to do so.

But the society doesn’t represent every homeopath, and in any case these are independent people – surely individuals have spoken out about poor behaviour among their peers?  I’d like to say yes, but again, the answer’s no.

When Anthony Pinkus was found by BBC reporters to be promoting homeopathic vaccines (after previously being investigated by the General Pharmaceutical Council for similar behaviour), his fellow pharmacists were outraged at what they saw as acts that put patients at risk and brought their profession into disrepute.  His fellow homeopaths?  Not a peep.

When various homeopaths were found to be promoting homeopathy for the treatment of rape, domestic violence and homosexuality, the general public were rightly angered at the outrageously offensive claims.  Their fellow homeopaths gave barely a whimper.

When Penelope Dingle died after suffering months of excruciating pain because her homeopath told her it was all in her head, the coroner’s report was damning.  The homeopathic community was oddly silent.

When homeopaths peddle their remedies to incredibly vulnerable people in Africa for the treatment and prevention of HIV and AIDS, their peers say nothing about it.  However Peter Chappell, a founder member of the Society of Homeopaths is all in favour, and in fact produces his own range of remedies, as well as others for  malaria, dengue fever, and goodness knows what else.

When Nelsons in London were found to have such poor manufacturing standards that there was broken glass present on their production line, and one in six vials of remedy actually had no homeopathic ingredient added, the Food and Drug Administration (the American drug regulator) pulled no punches in their report.  The UK homeopathic community, of which Nelsons is a part, said nothing.

There are doubtless many, many more examples just like these, but I think I’ve hammered the point home well enough.  And I am sure that some homeopaths who read this will be rather offended, because maybe they did oppose these things; but that’s not enough.  If homeopaths want to be seen as trustworthy providers of complementary therapies they need to change this pattern, they need to be vocal.  Where poor behaviour is evident, they need to shout first and loudest about it, like the pharmacists did with Anthony Pinkus. They need to scream from the rooftops that unethical advice, endangerment of people’s safety is against everything that they stand for, and that an individual who does those things doesn’t represent their community.  Even leaving aside the problems regarding lack of efficacy, how else can anyone ever trust that they can visit a homeopath and receive honest, ethical advice?

Homeopathic Harms vol 5: interactions

I might be a little quiet for the next wee while due to some unforeseen circumstances,  but to tide you over here’s the next installment in the Homeopathic Harms series by @SparkleWildfire – interactions.

In the next installment of our series on the harms of homeopathy, I want to talk about interactions. I’ve covered this a bit in the past, but let’s have a look at this area in a bit more detail.

We all hopefully know by now that homeopathic medicines pretty much have no trace of active ingredient in them by now. Do we need to worry about drug interactions with homeopathic remedies?

Can homeopathic medicines interact with conventional medicines?
The obvious answer is no. Magic Sugar Water Pills are highly unlikely to affect any conventional medicines. There’s a lack of actual evidence to prove this, but I think it’s pretty safe to rely on a theoretical basis here. So that’s great, right, blog post over and see you later. If only it were that simple.

Read the rest over at A Healthy Dose of Skepticism.