Monday, 3 April 2017

homeopathic hoo-har

Stat News bills itself as reporting from the frontiers of health and medicine and you may be sure that it does not often emulate the early BBC in putting on the then regulation dinner-jacket to say "There is no news tonight" and cuing a string quartet instead. That's partly, of course, because health and medicine has become so enormous in our lives that there is bound to be something happening somewhere in that field. Yes, even if you adopt the regular news policy that good news is not news; the public only wants the grief. And if you're living in the pocket of the medicine industry an adverse straw in the wind about homeopathy is surely good for copy.
The major supplier of homeopathic remedies in North America is Hylands Homeopathic originally from Los Angeles. STAT are pretty gleeful to report that Hyland's Homeopathic Teething Tablets are now associated in people's minds with rather adverse publicity: I gave my child HHTTs and s/he had a fit, turned blue, started twitching or died . . . that sort of thing. Lots of such anecdotes are enumerated in the article because that's what the public, like night-crawlers, feeds off. The Food and Drug Administration is being urged to Act because a number of adverse reactions have been reported. The FDA, very properly, is being circumspect because they are aware of the logical error of post hoc ergo propter hoc: just because two things happen one after the other doesn't necessarily indicate that the first causes the second.

But advocacy groups like Public Citizen Health Research Group are being shrill in their demands for Action. Public Citizen was founded in the 1971 by Ralph Nader,  They dumped him when he ran for President in 2000, eroding, perhaps fatally, Al Gore's vote and ensuring the election of George W. Bush. PC [a rather apposite acronym for the non-profit, non-partisan organisation] makes its living from standing up to Megacorp and encouraging more regulation and legislation to protect citizens from the rapacity, short-cuts and pure chicanery which they believe is endemic in capitalist medicine.

Hyland's are sufficiently beleaguered as to post an open letter on their Home Page announcing that they are ceasing production of their Teething Tablets and Gel. They are not admitting liability and still assuring parents ["Moms and Dads" is their phrase] that any tablets remaining in bathroom cabinets are completely safe.  The FDA went into Hyland's production facilities a few years ago and found 'inconsistent levels' of belladonna in and along the production line. We've some experience with medical belladonna back in the day which turned The Boy's eyes into dark limpid pools. I'm interested to see the current FDA take on that drug “the body’s response to belladonna in children under two years of age is unpredictable and puts them at unnecessary risk." I wish thet'd communicated this to our GP in 1976. I'm reading between the lines but I suspect that the inconsistency is a difference between parts per trillion and parts per quadrillion. At The Institute we are current trying to measure lithium in ground water and cannot get instruments sufficiently sensitive for parts per billion, let alone more dilute. Actually parts per quadrillion is not even close to the levels of dilution found in homeopathic remedies: Belladonna 30 means that the 'active principle' has been serially 10x diluted thirty times. Avogadro's number suggests that, as that level of dilution, it is unlikely that even a single molecule of atropine remains. [Atropine is the active chemical in Belledonna, it's an antagonist of the muscarinic acetylcholine receptors in the parasympathetic nervous system . . .  but I won't go into any of that detail here and now]

IF the product HHTT is taken by thousands and thousands of kids over several decades, and it has been, THEN the laws of coincidence dictate that some adverse events will occur at the same time. Kids do the darnedest thangs, turning blue and having fits among them, and it is all too easy to blame the last pills. That is a Bad Thing because, if you are wrong in your assessment, you are giving a free pass to the real culprit.

It is also a bad thing to force a probably innocent remedy off the market because teething is still going to happen and parents are going to be driven to distraction to do something; even if that something is pouring a stiff gin in the gaping maw to get everyone in the family some sleep. We've seen this before where a rather effective morning sickness remedy was withdrawn from the market because Dr William 'Thalidomide' McBride went on the war-path against Debendox and was later found to have falsified his adverse data. For decades, doctors prescribed penicillin for children and others as a get-this-distraught-parent-out-of-here placebo. Back in the day, penicillin was treated as GRAS = generally recognised as safe or mostly harmless. That parent is sorry now that the child has grown up and has caught a case of the clap. Because of open-handed distribution of antibiotics back in the day, gonorrhoea is no longer treatable with penicillin nor even with gentimycin.

It seems possible that there was a cock-up in the production line at Hyland's where insufficiently dilute belladonna extract got too far down through the process. But that's not sufficient reason to withdraw the product; it just requires a fix in best practice at the production plant.

I'm very sorry "Moms and Dads" if your child gets sick, I've had my own children in medical emergency rooms, so I feel your pain and anxiety . . . but that's no reason to put reason and evidence aside in trying to find a cure or, in the worst case scenario, ensuring that this will never happen again to another family. We have seen the effect of high publicity about very rare adverse events putting the kibosh on a medical intervention that appears to be effective against a potentially fatal disease. See my take on HPV vaccination, cervical cancer and Gardasil last October.

Bottom line: let's not knock homeopathy into touch until we have another similarly psycho-active option available. Psycho-active in the sense of placebo-effective. We know, science knows, that the placebo effect is real and can be real powerful. The gold standard for proving the efficacy of a drug is whether it is better than placebo: unless it is, it just won't get licensed. But there is no legitimate vehicle for a concerned GP to offer to a patient who is clamouring for something . . . anything . . . from the doctor to make me better. Sometimes, everyone need to step back a pace and let the immune system do what it does so well, without being tricked about with external interventions. Homeopathic remedies would do nicely there thank you and would work. But the medical licencing industry requires homeopathy to be better than placebo, not be placebo. Damn foolish if you ask me.

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