Vagina Dentata

I’m quite ashamed to admit that I’ve been duped by complimentary and alternative medicine (CAM). A long while ago I mentioned to my general practitioner (GP) that I suffered from breast tenderness, or mild mastalgia, just prior and during my period (i.e. cyclical mastalgia). She suggested I try Evening Primrose Oil as that should help.

I thought fair enough and sauntered off to Boots to buy a jar. As it turns out, I’ve never actually got round to trying it. Then recently, with all of the hullabaloo around homeopathy, I decided to look up Evening Primrose Oil (EPO) on PubMed to find this:

Evidence-based management of Mastalgia: a meta-analysis of randomised trials

Which states:

“EPO did not offer any advantage over placebo in pain relief”

Now this pissed me off lots and lots. I had believed that my medically trained GP would suggest something that was evidence-based and had not done so because either a) she was unaware of the current evidence and/or was one of these CAM-peddling NHS doctors or b) she was trying to placebo my ass. Both of which are troubling.

Firstly, if it was because she was unaware/a CAM peddler then this undermines my trust in the medical opinion of NHS doctors (and none of this “but she was only a GP”). Not everyone is going to check their medical advice online or if they do they are more likely to come across pseudoscience and quackery than know where to look for a systematic review. We can’t check everything all the time and so generally we rely on the expertise of those we assume will have more knowledge than us.

Obviously this was a very minor aliment for me and so I didn’t check. Most people on finding out that they have a serious illness do and should investigate it as much as possible.

But secondly, if she was trying to palm me off with a placebo then I’m fucking livid. There is over-prescribing in certain areas of general practice because people go expecting an intervention for their health problem. I, however, didn’t want an intervention and mentioned the jublies pain as an aside.

If she knew that EPO only acted as a placebo not telling me has left me feeling stupid and lied to. If I had had all the information at the time I would have made a different decision on the basis that the tit ache isn’t that bad, just a mild annoyance, and chocolate is my preferred placebo.

This of course links nicely to homeopathy; if it is simply a placebo then doesn’t the positive outcome justify the means? The placebo effect is real and therefore if homeopathy works solely as a placebo can’t it still ‘help’?

The significance is displayed in my outrage at finding out that EPO has no evidence-base for treating bap pain. I felt stupid and disempowered. I had been made an unwilling victim of marketing over substance. And this is what is wrong about homeopathy; its marketing and spin masquerading as authoritative medical knowledge. It dupes individuals into thinking they are taking control of their own health when in fact they are not being given access to the full facts.

If you want to know what my GP should have done, here’s a handy guideline flow-chart from NHS Lothian (*cough* her Health Board).

For people with ouchy knockers there’s some helpful guidance here and here.

I guest blogged at Bright Green over the weekend, whoop here it is:

On Saturday at 10.23am hundreds of people across the country opened a small vial of pills and swallow them all. There was a group of 42 of these people in Edinburgh (video), but no emergency services were called and no deaths or complications were reported. This was because it was a mass overdose of homeopathic remedies.

The ‘Swallowers’, as they are delicately calling themselves, are conducting this stunt as part of the 10:23 campaign (hence the timing) which seeks to raise awareness about the case against homeopathy and those who supply it.

As one of the organisers of the London event, Carmen D’Cruz put it:

“The public have the right to know what we put into our bodies. “Freedom of choice” is not possible without the ability to make an informed decision. A large part of this campaign is to raise public awareness of what homeopathy actually is. Once people understand both sides of an argument, they are better able to make a real choice.”

Homeopathy was invented by Samuel Hahnemann, a German physician, in the late 18th century. It is based on the principle that “like cures like”, but significantly, that a substance taken in small amounts will cure the same symptoms it would cause if taken in large amounts. And when I say small amounts …

Homeopathic remedies are usually diluted to a factor of 30c, that is:

1:1000000000000000000000000000000000000000000000000000000000000.

Or to give you some idea of what that represents; imagine a sphere of water with a diameter from the Earth to the Sun (a distance that takes light, yes light, about 8 minutes to travel), then imagine one single molecule of that sphere is an active ingredient of the substance that is supposed to cure you. Remember, it isn’t a drop; it’s a single molecule. THAT is what 30c looks like.

Homeopaths claim that this works because water “has a memory” which preserves the active ingredient through the dilutions due to a special shaking. After each dilution the mixture is vigorously agitated in a machine that delivers a calibrated amount of shaking (That last sentence was a direct quote from the Society of Homeopaths website, just in case anyone thinks I’m trying to make them sound stupid. I mean actively trying to make them sound stupid).

Many scientists say that the only possible impact of such remedies is as a placebo.

Therefore, there was no need to perform mouth-to-mouth on any Swallowers. But what are the implications? Raise awareness yes, but should these remedies be provided on the NHS? Should commercial businesses be able to sell them?

This is the second aim of the 10:23 campaign, targeting outlets such as Boots. As D’Cruz explains: “It’s a bit unethical for Boots to sell these pills in their medicine section whilst admitting they don’t work. They’re a trusted company. Why are they lying to their customers (or at least being ambiguous with the truth)?”

Many who wouldn’t go so far as to defend the “science” of homeopathy will at least espouse the positive effects of placebo. And indeed the effects of placebo are amazing and well documented. But should we market a product that we know is a placebo with a mythology of how it works? I would argue that this kind of marketing has a corrosive effect on the public’s understanding of science and medicine. Rather than empowering the patient, it dupes them in the time-honoured tradition of the snake-oils salesmen.

But this stunt has got some people’s backs up. “My inbox is full to the brim with people from all over telling me how much they enjoyed taking part,” says D’Cruz, “with only two people contacting me who were against what we were trying to do.”

“One of them was actually really lovely, and seemed glad that I’d replied in a sensible way (I suggested a couple of books she might find interesting to see things from my point of view if I wasn’t being articulate enough: Trick or Treatment and Bad Science). The other said I was an attention seeker and that I should be arrested. I’m pretty sure that was my mum. She’s got a really good sense of humour.”

To those who have taken homeopathic remedies and believe that they cured them, it is scientifically more likely that you experienced the placebo effect (you got better because you thought you were going to get better) or regression to the mean (you were going to get better anyway, like with a cold).

Now let’s not talk down the placebo effect, it is a truly amazing phenomenon. People have even got better with placebo surgery. It doesn’t mean that you were previously faking it; believing an intervention will make you better can really can make you better (listen to Dr Ben Goldacre’s two part radio programme on the placebo effect).

We can and should harness the power of the placebo effect without misleading people. And we should be just as uneasy with the aggressive marketing of the billion dollar homeopathy industry as we are of the (albeit bigger) billion pharmaceutical industry.

Links:
More on the overdose in Edinburgh
Follow 10:23 tweets: #1023

And a historical look at Apple vs Feminine Hygiene (boak) marketing. Hmmmm.

Via Society for Menstrual Cycle Research.