Pharmacists to say that homeopathy does not work?

By Grant Jacobs 25/04/2010 60


Previously I have written that in my opinion homeopathy has no place in pharmacies. In a recent comment on his blog, Stephen Curry pointed to a BBC News article reporting that the governing body of pharmacists in Northern Ireland has

proposed that patients be told that homeopathic products do not work, other than having a placebo effect

A copy of the draft proposed to form the consultation guidelines for pharmacists in Northern Ireland is available on-line (PDF file, 5 pages including title page).

The opening paragraph notes that given an obligation to provide patients with scientific accurate advice,

the only advice a pharmacist could reasonably give about such products is that they are placebos

It is an excellent document, brief and clear; well worth reading.

Following the lead from the early UK House of Commons Science and Technology Committee report, they (timidly?) do not seek removal of the remedies from the stores. Personally, I feel offering a product you know not to be effective is a lack of care and duty to consumers.

If they are to advise people that they don’t work, why should they offer them for sale?

Placing these remedies alongside those that are effective, and in a place that dispenses prescription medication, gives the impression that sound science backs them, when in practice what sound science backs is that they are only as effective as a placebo.

But it is good to hear that they are considering obliging their members to tell their customers that.

They point out that current licensing is for safety and quality, not if the product has a beneficial effect. I suspect many consumers think that the licensing also conveys that the product is ’good’, i.e. beneficial to them.

I know very little about licensing of medical products, but it does makes you wonder if countries need to only issue licenses when there is evidence demonstrating some minimal level of beneficial effect, or to have different levels of licensing levels with a lower level reflecting a lack of evidential support for beneficial effect and carrying with it an obligation for the product to have on it a disclaimer that (say) ’this product has no evidence demonstrating it gives benefit to patients.’

In one sense the latter is already true, but in a way that I don’t think the public are aware of. There are medicines and then there are remedies, which in various ways are able to avoid the medicines legislation.

In New Zealand edition 6.7 of the MedSafe rulings of when an application for approval is required for a new or changed medicine (.doc file; view as HTML) says that:

4. Homeopathic Remedies

A homeopathic remedy which is prepared under the principle of homeopathy in which the active ingredient to be administered is in a concentration not more than 20 parts per million, and the remedy is labelled only with the name of the active ingredient, trade name (if any) and a statement that it is a homeopathic remedy does not normally require Ministerial consent before distribution. The product label or associated advertising material must not contain therapeutic claims or indications for use.

A homeopathic remedy which is labelled or advertised with claims as to its therapeutic purpose is a medicine and subject to the full control of the Medicines legislation.

Sterile homeopathic preparations intended for injection or for administration to the eyes are regarded as medicines and therefore subject to the full control of the Medicines legislation

[My emphasis added.]

This allows homeopathic remedies without having to meet the medicines legislation, provided they don’t make therapeutic claims.

(Philosophical aside: can something be offered in good faith as a remedy if it has no claim to therapeutic benefit?)

One thing I need to learn is if New Zealand pharmacists are obligated, under law that is, to point out that the homeopathic remedies are ineffective when the customer presents them to the counter to purchase them, and if New Zealand pharmacists are obligated to scrutinise the patient, checking that the purchase is appropriate. (Given that customers are aware they are placebos, how are they ever appropriate to purchase as a remedy?)

Unfortunately I haven’t the time to explore this in any realistic way, but the Pharmacy Council of New Zealand Code of Ethics does include this:

1.3 Medicines and therapies not prescribed by another provider *

Where the patient is seeking to purchase, from the pharmacist or from other personnel for whom he or she has responsibility, any medicine, complementary therapy, herbal remedy or other healthcare product not prescribed by another healthcare provider, the pharmacist must ensure that the patient is provided with credible, understandable information about its safe and effective use, expected outcomes of therapy within the limitations of available information, what to do if side effects occur, storage and disposal requirements, and any significant risk of therapy or insufficiency of evidence about efficacy of the therapy, to allow the patient to make an informed choice.

[My emphasis added.]

A simplistic reading of this would be that pharmacists in NZ are obligated by their Code of Ethics to inform customers that homeopathic remedies are only effective to the level of a placebo and that no therapeutic outcome should be expected of them beyond any placebo effect.

Share your thoughts in the comments below.


Other posts on homeopathy on Code for life:

Time for disclaimers on remedies?, ’alternative’ or not

Homeopathic remedies in NZ pharmacies

Popularity does not mean effectiveness or sensibility

Homeopathy check-up: Not in the health system, disclaimers on labels

Undiluted humour: If Homeopathy Beats Science

Alliances of pharmacists & GPs; opportunities to pressure for removal of useless ’remedies’?

Advertising campaigns: homeopathy or a sceptical series?


60 Responses to “Pharmacists to say that homeopathy does not work?”

  • Soooo…. for consistency, are you going to lobby for similar conditions to be placed on the prescription of SSRIs?

  • Are SSRIs sold over-the-counter, i.e. without prescription? I wouldn’t have thought so. I’m writing about what is on the shelves, not prescription medicines. Things that consumers pick up for themselves.

    More generally, I wrote earlier that the should be played evenly determined by the evidence, not what I views as marketing labels & strategies. See the first link under “Other posts” (note the title).

    I’m not familiar with SSRIs beyond the general gist of them, but my understanding is that they do work for some people, just not for everyone, and that they are a case of a treatment that is given along with monitoring progress. On both counts, they’re a different matter compared to a remedy that is known to always be ineffective beyond placebo, as homeopathy is, and which people are using on their own initiative alone.

    (FWIW, I’m aware of research to try determine at an early stage if these types of psychotherapeutic treatments are ineffective, so that the patient might move onto another treatment.)

  • Homeopathy is mere placebo, eh? Well…. try this quote, from the article, “Beware Scientism’s Onward March”, by Lionel Milgrom found at THIS link:

    http://www.anhcampaign.org/news/anh-feature-beware-scientism%E2%80%99s-onward-march

    “Baum and Ernst then describe homeopathy as “….among the worst examples of faith-based medicine that gathers shrill support of celebrities and other powerful lobbies in place of a genuine and humble wish to explore the limits of our knowledge using the scientific method ….”. [8] Apart from astounding hypocrisy (the pharmaceutical industry constitutes one of the most powerful lobbying organisations on the planet), Baum and Ernst repeatedly cite the 2005 Lancet meta-analysis by Shang et al [10] as the ‘genuine and humble wish to explore the limits of our knowledge…’, etc. They put this analysis forward as conclusive ‘proof’ that homeopathy is no more than placebo. Nothing could be further from the truth. In fact, this paper was severely criticised on methodological grounds by several independent authors, [11-14] and contains significant scientific flaws. [15, 16] Not only does it lack any literature citations (a fundamental academic gaff that makes one wonder why the paper was passed fit for publication in the first place), the Shang et al meta-analysis violates even the Lancet’s own strict guidelines on methodological and publication transparency. [17]”
    (quoted from “Beware Scientism’s Onward March” by L. Milgrom).

    In fact, the “placebo” explanation merely acknowledges the Homeopathic curative effect but then deftly attempts to divert credit for it by claiming it only part of another unknown thing – the “placebo” effect. The placebo effect is quite real but its mechanism, as with Homeopathy, remains unknown.

    I understand your negative opinion of Homeopathy but, before banning any of its remedies for any reason, is it not proper to let genuine scientific research, rather than the near hysteria of several media pundits, book writers and the “amazing” Randi, start dictating public policy? Even if you disagree totally about the efficacy of Homeopathy.

  • Given some of Lionel Milgrom’s statements (quantum homeopathy etc) I would be inclined to take what he has to say with a grain of salt.
    In fact, if you read Grant’s posts here you’ll see that he cites the available literature in support of his statements. There is no credible scientific evidence that homeopathy is anything more than a rather elaborate (& expensive) placebo.

  • I agree with James, genuine scientific research should dictate public policy. So as repeated genuine scientific research has shown that homeopathy does not work, therefore public policy should require that it be taken off the shelves of pharmacies. Instead of homeopaths making silly statements elsewhere, such as “homeopathy is waiting for science to catch up with it” perhaps they should acknowledge that 200 years of trying to demonstrate scientifically that it works has shown no useful results beyond the placebo effect.
    Theoretically homeopathy flies in the face of what we know about chemistry and physics, and the “mechanisms” suggested for how it might work “water has a memory” or vague comments about electromagnetic fields are vague and unsubstantiated.
    And in practical terms, if homeopathy is so great why are there not homeopathic cures for septicemia and AIDS? Why are homeopathic “cures” only used to treat ailments that typically will clear by themselves? Would a homeopath sell “homeopathic vitamin C” to someone with scurvy?
    In anticipation that someone might suggest that there is research that supports homeopathy such as a recent paper in the International Journal of Oncology 2009, 395 – 403 a look at them always shows flaws in their methodology or their results.
    Finally, people such as Milgrom who are homeopaths have a vested interest in making sure homeopathy survives. Many of those who oppose homeopathy have no financial interest in challenging it (I doubt very many work for “Big Pharma” as conspiracy theorist might suggest). I see homeopathy more as an affront to the scientific method and a danger to the unwary.

  • [Content deleted: No spam please! … ]
    [Addendum: While you may been trying to make a sensible point, as it was written it looked like spam and I have to apply this consistently 😉 ]

  • James,

    In fact, the “placebo” explanation merely acknowledges the Homeopathic curative effect but

    You realise don’t you that in writing this you’ve admitted homeopathy has no effect beyond placebo?

    deftly attempts to divert credit for it

    Trying to make turn this placebo effect in a “real” effect by conspiracy theory not evidence is hardly going to impress anyone with a little sense! :-)

    It also suggests a lack of understanding what the placebo effect is.

    another unknown thing – the “placebo” effect

    The placebo effect is well-understood in the sense of knowing what it is and that it occurs.

    Pointing to a lack of detailed mechanism (in the sense of molecular mechanisms) and trying to use this to excuse the lack of mechanism for homeopathy is a red herring, which sensibly enough I’m not buying into 😉

    The point was about evidence for effectiveness, not what particular mechanism is proposed (or not) for the claimed effect to occur; you’re shifting from one thing to another.

    Furthermore, it’s not that homeopathy “lacks a mechanism”, but that the several different mechanisms offered fly in the face of well-established physics and chemistry.

    Infinite dilutions don’t exist because atoms are finite. This is part of the original sales pitch for homeopathy, but has been known to be incorrect for a very long time.

    The “water has a memory” notion is an attempt to try get around that “little” hiccup, as are attempts to cite “quantum” nonsense, which seemingly half the “woo” merchants on the planet think is a way to pull the wool over consumers eyes.

  • Thanks for responding.

    I have placed a “>” before your comments with my responses are in the lines below it.

    >In fact, the “placebo” explanation merely acknowledges the Homeopathic curative effect but
    >You realise don’t you that in writing this you’ve admitted homeopathy has no effect beyond placebo?

    I realize nothing of the sort. The existence of the Homeopathic curative effect may or may not be placebo, or it may have elements of both. I happen to think that the curative effect is directly attributable to the Homeopathic remedy. High dilutions and all.

    >Trying to make turn this placebo effect in a “real” effect by conspiracy theory not evidence is hardly >going to impress anyone with a little sense! :-)

    I’m not trying to impress anyone. I’m trying to suggest that an equally valid alternative viewpoint is quite reasonable, given the paucity or equivocal nature, so far, of the scientific evidence.

    >It also suggests a lack of understanding what the placebo effect is.
    >The placebo effect is well-understood in the sense of knowing what it is and that it occurs.

    My comment acknowledges this.

    >Pointing to a lack of detailed mechanism (in the sense of molecular mechanisms) and trying to use >this to excuse the lack of mechanism for homeopathy is a red herring, which sensibly enough I’m >not buying into 😉

    I have not asked you to buy into anything and your opinion is a perfectly reasonable one, an alternative to my opinion. That’s all we have at this stage, opinions. That’s my point.
    I attach significance to the attempt to dismiss Homeopathy which has an unknown mechanism, by reference to another phenomenon, also of unknown mechanism. The presumptive a priori assertion that Homeopathy could have no mechanism has not been established and remains merely an assumption which is, of course, another opinion.

    >The point was about evidence for effectiveness, not what particular mechanism is proposed (or not) >for the claimed effect to occur; you’re shifting from one thing to another.
    Change of context. The point was regarding the ascription of Homeopathy as placebo. Mechanism discussion therefore becomes operative.

    >Furthermore, it’s not that homeopathy “lacks a mechanism”, but that the several different >mechanisms offered fly in the face of well-established physics and chemistry.

    Agree fully! That why I retain a degree of scepticism, despite my optimistic view of the possibility that homeopathy does work above placebo and does have a scientifically explainable mechanism.

    >Infinite dilutions don’t exist because atoms are finite. This is part of the original sales pitch for >homeopathy, but has been known to be incorrect for a very long time.

    Disagree fully! Modern research involving an anomaly recorded by M. Ennis (Inflammation Research, vol 53, p181) indicates the possibility of a high dilution causing biological effects by molecules which are no longer there. The experiment has been confirmed and repeated. The explanation remains unknown. Please no TV documentary references, they did not repeat her experiment despite claims to the contrary.

    >The “water has a memory” notion is an attempt to try get around that “little” hiccup, as are attempts >to cite “quantum” nonsense, which seemingly half the “woo” merchants on the planet think is a way >to pull the wool over consumers eyes.

    Disagree fully! If it were not for Ennis and the other experimenters, I might agree but an entire field of high dilution research is ongoing regarding the anomaly. In addition, we are talking about genuine scientific researchers as well as MD and other health professional practitioners of Homeopathy. I see no reason to impugn their good reputation and honest efforts by reference to “woo” merchants.

    I see you have ignored all of the research mentioned in Milgrom’s article “Beware the Onward March of Scientism”. Including his criticism of a famous meta-analysis used to claim that Homeopathy is no better than placebo. By the way, I do not agree with Quantum Mechanical explanations of Homeopathy, they are rather far fetched. But the Ennis effect is genuine and she has recently called for coordination of labs to explain the thing once and for all. Last but not least, the Homeopaths have not had 200 years to prove their system – with modern scientific instrumentation, they have had barely 30 or 40 years. Again I say, it is time to allow the real scientists to do real work and either confirm what could be a major medical breakthrough or else dismiss it. No “woo” needed.

  • James,

    I have downloaded Milgrom’s article and the Ennis article and will have a read through them. Thanks for the references. I find your arguments quite interesting but it will take a while to get my head around the various points you make and read the references you list.
    One of the first things I noticed is that the criticisms of the meta analysis are all published in complementary medicine journals and not mainstream science journals. Also I think Milgrom’s arguments about scientism are a bit unclear. Perhaps if he stated what other sources of knowledge other than scientific he believes will also provide access to “the truth” his argument would be a bit clearer.
    You suggest that it “is time to allow the real scientists to do real work” but isn’t this what Milgrom calls “scientism”? My impression was that in arguing that science is not the only “justifiable access to truth” that Milgrom believes that there are other ways to prove homeopathy works?
    Regarding Milgrom, he is a homeopath charging between 50 and 100 pounds for his homeopathic services so he does have a financial interest in promoting homeopathy.
    And homeopaths have had just as much time (200 years) as scientists to develop the theories related to their subject.

  • If this policy of evidence-based medicine was mandated for all non-prescription medicines then there would indeed be a long list… let’s start with pharmaceutical cough and cold remedies… I’m sure pfizer et el would be championing that… not! (1)

    JAMA published such evidence of lack of efficacy nearly two decades ago… I suspect no customers will be informed of this fact by ‘ethical’ pharmacists.

    Is this a double standard or simply pharma-politics at work?

    (1) http://pediatrics.aappublications.org/cgi/content/full/108/3/e52
    (2) http://jama.ama-assn.org/cgi/content/abstract/269/17/2258?ijkey=b03de2339b55b0cde06a9e641e68424736cf5a76&keytype2=tf_ipsecsha

  • Ron, quite right, evidence based medicine should apply to all medications. The two references you include focus on a lack of evidence for using some cough and cold medications in children. However, they do appear to be effective in treating adults and adolescents.
    No doubt pharmaceutical companies do make some financially driven decisions that they need to be called on. And slowly they are being called on them, and sometimes being substantially fined for it. It would be nice to see the same things happening to those who make big money with bottles of water.

    In fact, even if one assumed that homeopathy did work, it seems to me that their “cures” should be a lot cheaper than $10 a teaspoon when all they are water?

  • Michael E, in a market economy, people pay what they want to based on perceived benefits… eg, what are the benefits of bottled water? A major one is convenience… What about pharmaceutical medicines where the cost to the consumer/government is huge compared to the costs of production… you need to be consistent… pharmaceutical companies are the most profitable in society because they rort the system.

    As for cough mixtures for adults… they don’t work for them either… (1)

    Antihistamines and/or decongestants do not help and may harm when used for symptoms of otitis media with effusion (‘glue ear’). (2)

    No statistical or clinical benefit was found for any of the interventions or outcomes studied. However, treated study subjects experienced 11% more side effects than untreated subjects (number needed to treat to harm = 9).
    Authors’ conclusions? Because the pooled data demonstrate no benefit and some harm from the use of antihistamines or decongestants alone or in combination in the management of OME, we recommend against their use.”

    Will pharmacists be advising customers that many products they sell not only don’t work, but actually cause harm? I don’t think so… at least not for pharmaceutical products.

    (1) http://www.bmj.com/cgi/content/full/324/7333/329
    (2) http://www2.cochrane.org/reviews/en/ab003423.html

  • Ron, the reference you used in your first post actually states that some cough mixtures work for adults and adolescents. So which reference is correct the first one you used or these new ones?
    And yes in a market economy people pay for the perceived benefits, however, when the perceived benefits are based on unfounded claims then don’t you see a problem with this. You contend that some pharmaceuticals are ineffective but I don’t see you using a market economy approach to justify that they should be available in pharmacies. Your argument lacks consistency if you use a market economy approach to support the sale of ineffective homeopathic remedies while wanting ineffective pharmaceutical products to be removed.

  • Ron, please note the following statement from the first of the references in your last message.

    “Because of the small number of trials in each category, the results have to be interpreted cautiously.”

    Hardly a conclusive statement.

    Your second reference challenges the use of antihistines and other drugs for the treatment of glue ear. This does not automatically mean that such drugs are not effective in the treatment of other conditions.

  • Michael E, you ask, ‘when the perceived benefits are based on unfounded claims then don’t you see a problem with this.”? I do… we have a fair trading act which makes false claims illegal… people should be prosecuted for making false claims.

    The second refs had the evidence… many common remedies do not work… when a cochrane review says there’s no evidence to support a claim then isn’t it fraudulent to market products making such claims?

    Coming back to the righteous path being taken by a group of pharma minded pharmacists, shouldn’t pharmacists be consistent and tell consumers that there is no evidence to show these products work? And that there is evidence to show they cause harm???

  • Ron I agree, if there is no evidence that certain products do not work, then a pharmacist should be consistent and tell customers. However, I disagree with the conclusions you draw from the references you listed regarding cough and cold remedies. Even in the small number of references you provided you have cherry picked the reference that seems to support your argument that cough and cold remedies may not work (even though the authors state it is a small sample and care needs to be
    taken in drawing conclusions from it) and ignored the one that you provided which actually states that
    “Certain single over-the-counter medications and combinations have been shown to reduce cold symptoms in adolescents and adults.”
    If you are trying to determine the effectiveness of any pharmaceutical you need to consider ALL of the work published, not just pick out the ones that support your argument.
    Not quite sure what/who you are referring to as “the righteous path being taken by a group of pharma minded pharmacists”. Would you care to clarify?

  • Ron, I don’t think Michael meant the bottled water you can buy on supermarket shelves (although I do feel that it’s daft they’re promoted so heavily when most of us have access to perfectly good drinking water at a fraction of the cost). He was referring to homeopathic remedies, which in the bottled form are just that, water in bottles. But very expensive water.

  • Grant, or was it Michael E (:-)) the last two references are quite recent… the first reference makes reference to another one based on two studies using Pseudoephedrine, one undertaken in 1960 by Wellcome Laboratories which I suspect would be treated in a similar fashion of a study undertaken by a homeopathic company.

    Regardless of where the water came from, I have just read a study saying tea was better for one than water…! So should we be promoting tea more?

    Grant & Michael E, is it wrong to use pseudonyms on boards like this so that you can get a discussion going?

    Ron

    [I would suggest you leave moderation issues with me and refrain from making allegations of other commenters.]

  • Ron, I’m confused about the pseudonym comment. Could you please clarify what you mean?
    Again, I would make the point that if one is considering the effectiveness of any treatment, one must look at all the studies that have been carried out and not select only those which support your argument.
    The study saying that tea is better for one than water sounds interesting. Could you include a reference?

  • Michael,

    Regards Ron’s reference to pseudonyms, Ron is alleging that I’m playing sock puppets (pretending to be two people in conversation, once as me and once as you). On one hand it’s a pretty silly allegation to make; on the other hand It’s a pretty low sort of allegation to make, too.

  • How rude, I’m so much better looking – just kidding :-) but obviously a bit more naieve as I didn’t pick up on the insinuation.

    Actually it doesn’t say much for Ron’s observational skills. I think our writing styles are quite distinct.

  • I didn’t pick up on the bottled water confusion, so I guess that evens things up…:-)

    An individual’s writing styles can vary wildly… I’ll accept I jumped to a wrong conclusion… humblest apologies.

  • Michael,

    How rude, I’m so much better looking

    Hahaha :-)

    I’m sure you are better looking than me.

    a bit more naieve as I didn’t pick up on the insinuation

    I wouldn’t expect to.

    I think our writing styles are quite distinct.

    Hmm… maybe I should practice writing skills by trying to copy your style… Just kidding, just kidding :-)

  • yes, tea contains quite a few anti-oxidant compounds, so I can understand why it might be considered to be better for you.
    Personally, I’m not much of a hot drink drinker and am quite sensitive to caffeine so tend to avoid tea (and definitely coffee), although have occasionally enjoyed a cup of green tea which I think is lower in caffeine content but still has many antioxidants. Even weak black tea tends to act as an effective diuretic with me – images of me trotting off to the loo every half hour :-) after drinking black tea.

    Actually, I wonder if I made tea at a homeopathic dilution whether it would still act as a diuretic 😉

  • Michael,

    Just for fun (I wouldn’t entirely trust this without further checking, but like I say, for fun):

    http://coffeetea.about.com/library/blcaffeine.htm

    I also recall that the laxatives I had on a long overseas trip in my medicine kit were basically caffeine pills.

    Personally, I suspect the anti-oxidant thing is oversold too often, just FWIW.

    Actually, I wonder if I made tea at a homeopathic dilution whether it would still act as a diuretic 😉

    You’d want to re-phrase that to ask if water or a sugar pill would act as a diuretic 😉

  • A diuretic is a substance which makes your body increase its production of waste fluids, with the result that you need to urinate more often than usual. Water is one of the most potent diuretics around…

  • Grant, good point, I have a biochemist colleague who despairs at the oversell of “anti-oxidants” because oxidation has been coupled in the mind of the public to the aging process. However, there are processes in the body where oxidation is an important process, and not something we should be trying to prevent.
    Actually Ron, although increased water intake will indeed increase urination, diuretics are usually defined as compounds that stimulate the body to excrete water, so while drinking a litre of water will certainly increase urination, as little as 50 to 100 mg of caffeine can act as a diuretic, so by sheer volume/mass water is much less effective.

  • Yes, I’ve often wondered about the oversell of antioxidants (& of foods supposedly rich in them as ‘superfoods’. The consequences of antioxidants getting involved in aerobic respiration would be fairly terminal.

  • drmike, I know a biochemist who swears by anti-oxidant use… I don’t think job title or anecdote should be used to define what is acceptable science…

    One can talk semantics… simply, a diuretic is a substance that acts to increase urine production. A diuretic (noun) is used in the medical industry to describe any drug that elevates the rate of urination and thus provides a means of forced diuresis… but increased (excess) water intake itself does that too… if a person drinks an excess of water, the sodium in the body fluids, including the blood becomes more dilute and the release of ADH is inhibited. The lack of ADH causes the distal and collecting tubules to become more impermeable to water, and less water is reabsorbed from them back into the blood. Consequently, the kidneys excrete more watery urine until the water concentration of the body fluids returns to normal when it self adjusts. If one drinks too much water without adequate salt intake then the blood becomes hypotonic… that’s not good.

  • re the water as a diuretic thing,

    It’s moot really as we’re talking about homeopathic remedies and the amount of water (or sugar) involved wouldn’t have any practical effect. How much do most homeopathic remedies ask you to drink in a dose? 10ml? 5ml?

    I don’t think job title or anecdote should be used to define what is acceptable science…

    Don’t forget that cuts both ways: you’re the one who brought this up, citing an anecdote from a media interview by a Dr. 😉

  • The purpose of mentioning my bichemist colleague was simply to point out that someone who understands biochemistry quite well considers that anti-oxidants are over hyped. I haven’t had time to examine the data myself and if you can provide referenced evidence that anti-oxidants are beneficial I would be interested – it is a fascinating area.
    Regarding the term diuretic, I think it is useful to use terms precisely, as it leads to better communication. I think drinking adequate water is important for health and allows the body to flush waste products more effectively, but I think it is inaccurate to refer to water as a diuretic.
    The article by Dr Ruxton is quite interesting as she states that tea having fluoride in it is beneficial when many people seem quite wary of fluoride in water (not that I think there is any harm in it).
    It is also interesting that her work is sponsored by the Tea Council. Personally I don’t think this invalidates the work, but this sort of industry related funding is what seems to cause so many problems with researchers involved in research sponsored by the pharmaceutical industry or in climate research.
    Thanks Ron, it is quite an interesting article on so many levels.
    It makes sense that tea, overall, is not dehydrating if one is consuming 3 to 4 cups a day. My sensitivity to caffeine is partially due to the fact I generally avoid caffeinated beverages.

  • drmike, I know someone who understands biochemistry extremely well who considers that anti-oxidants are very important to maintaining good health… many things get over-hyped… especially if there is money to be made.

    Is there a difference between natural fluoride and fluorosilicate waste products from industry…???

  • Possibly I phrased the view of my biochemist colleague poorly. Her opinion is that excessive anti-oxidant use could be harmful, which doesn’t necessarily conflict with your acquaintances view that they are important. It’s probably just a matter of how much is good and how much is too much.

    And, no, I don’t think there is any difference between fluoride ions from “natural” sources and fluoride ions derived from fluorosilicate by-products from industry. A fluoride ion is a fluoride ion, with properties independent of it’s source.

  • Ron,

    Whether anti-oxidants are important part of normal biochemistry is besides the point; what is relevant is if they are meaningful as “treatment” or supplements. For example, vitamins are obviously important for maintaining good health, but there is good argument that they’re not meaningful as general supplements.

  • drmike, I never asked if there was any difference between fluoride ions from “natural” sources and fluoride ions derived from fluorosilicate by-products from industry.

    I asked “Is there a difference between natural fluoride and fluorosilicate waste products from industry…???”

    Your comment is fascinating… please read http://www.oag-bvg.gc.ca/internet/English/pet_221B_e_31256.html and especially note table 39…

  • Ron,

    Fluoride is the ionic form. Ionic fluorine is called fluoride.

    If you mean some particular compound containing fluorine (confusingly casually called fluorides*, plural), it be clearer if you named it explicitly. Put another way, what is it that you mean by “natural fluoride”? Fluoride is found in a number of compounds in the environment and the different compounds have different properties.

    *Excuse the terrible alliteration.

  • Ron, thanks for the clarification, my initial interpretation of your question was “was there a difference between fluoride ions derived from “natural” sources and those derived from hexafluorosilicates to which my answer was no.
    Thanks to your additional information I now see that your concern is that hexafluorosilicates are still present in water when consumed. From what I have read (http://ntp.niehs.nih.gov/ntp/htdocs/Chem_Background/ExSumPDF/Fluorosilicates.pdf) hexafluorosilicates completely and rapidly hydrolyse in water to produce fluoride ions, hydrogen and hydrated silica. I need to read more to see what happens to the silica and I’m curious about what happens to the hydrogen as well.

  • The other thing that should be considered here is dose. The data in the table you referred to, Ron, are in mg/kg body weight. The levels of Fl- in drinking water are several orders of magnitude lower (less than 1 part per million).

  • drmike, your paper says, “In water, the compound readily dissociates to sodium ions and hexafluorosilicate ions. At the pH of drinking water (6.5-8.5) and at the concentration usually used for fluoridation (1 mg fluoride/L), essentially 100% of sodium hexafluorosilicate dissociates to fluoride ions and hydrated silica (Crosby, 1969; Urbansky and Schock, 2000).”

    Urbansky and Schock’s paper is not a primary source; I haven’t been able to track down Crosby’s paper to determine whether it is a primary source and what its evidence is, or whether, as often happens in science, other scientists statements are repeated as statements of fact.

  • Ron, do you have access to the primary source for the table you cited?
    I would find it very interesting as is seems such a counterintuitive result.

  • There is a review article on the fate of fluorosilicates by Urbansky in Chemical Reviews, 2002, 102, 2837- 2854. It’s quite complex but should list all relevant sources of primary data up to 2002. Chemical reviews is a highly reputed journal with thoroughly researched articles.
    The author does sum up his review of the literature by stating that “all the rate data suggest that
    equilibrium should have been achieved by the time the water reaches the consumer’s tap if not by the
    time it leaves the waterworks plant.” although complete understanding of fluoride speciation mechanisms hasn’t been completed sorted out.

  • drmike, imagine the outrage is a defender of homeopathic medicine undertook a research review and concluded that it was efficacious… that’s urbansky’s job… defend the use of fluoride… It’s an interesting parallel… given that fluoride at best reduces fillings by about 1-2 per mouth,… hardly a public health masterpiece… I can’t access the 2002 paper.

  • Grant, these are interesting reads. Of course, when it comes to individual patients, double-blind, placebo controlled, randomised clinical trials are irrelevant… what is relevant is whether it works or not.

    My [then] 88 year old mother-in-law had perstistant rhinitis… she went to her medical doctor many times… he prescribed her all of the ‘proper’ medicines in due course, none of which made a difference… some cleared it up for a bit but it came back when ‘treatment’ was stopped. In the end, and perhaps out of frustration, perhaps out of experience, he wrote the name of a product on a piece of paper and told her she could get it from the local pharmacist. She duly thought this was another prescription and went to the chemist… he sold her the product, she used it and guess what… for Nan, it worked. She was delighted. No runny nose and more to the point, no runny nose when she stopped the treatment. Hallelujah!!! What was it? I saw the bottle in her cupboard and noted that it was a homeopath… I never plucked up the courage to tell her that her doctor and pharmacists were quacks… I just rejoiced with her that she no longer had a chronic runny nose that was starting to bother her. Anecdote? Sure… but as far as my MIL is concerned the doctor treated her with a medicine and it worked.

  • Of course, when it comes to individual patients, double-blind, placebo controlled, randomised clinical trials are irrelevant… what is relevant is whether it works or not.

    Without formal clinical trials you wouldn’t know if a treatment is able to work.

    One case cannot (easily) point to which of the different possible resolutions ended the illness. (The treatment, or a placebo effect, or new environmental conditions, or … etc.)

    I hope I am reading you right: the example you give isn’t of a treatment working, but of someone *thinking* it worked.

  • Grant, It’s A shame your latest comment isn’t tagged to the response it was responding to.

    You certainly deserve a ‘Defender of the Faith’ defender award. No doubt if my MIL had taken a prescription medicine and got better you would have declared it being proof of the effectiveness of the drug.

    Is it coincidence that a number of pharma drugs failed to work, but a homeopathic did? Maybe… but what are the statistical odds… especially given my MIL had no idea it was anything but another prescription drug…

  • It’s A shame your latest comment isn’t tagged to the response it was responding to.

    It’s self-evident. You got it after all 😉

    You certainly deserve a ‘Defender of the Faith’ defender award.

    Pasting labels on someone is a bit cheap, eh? If you are interested in a tit-for-tat arguments, something I’m not the slightest bit interested in, I would suggest you try another forum. There are other places that delight in that sort of thing.

    No doubt if my MIL had taken a prescription medicine and got better you would have declared it being proof of the effectiveness of the drug.

    Please don’t say “what I would say” 😉 (It’s a straw-man argument.) Read my comment again: it doesn’t refer to the kind of treatment, etc., just ‘One case’.

    especially given my MIL had no idea it was anything but another prescription drug…

    How do you think the placebo effect works? 😉

    Is it coincidence that a number of pharma drugs failed to work, but a homeopathic did?

    Notice how you’ve placed your answer in the question. (Note final verb, ‘did’.) Your wording presumes the answer to your question before it’s answered! 😉

    I’ve already answered your question here (see my previous reply).

    Let me add one point for your consideration (i.e. in your own time) before I leave this discussion. Assuming that because one event occurred before the other means that the former event caused the latter event is the post hoc ergo propter hoc fallacy. Wikipedia has a starter on this: http://en.wikipedia.org/wiki/Post_hoc_ergo_propter_hoc There will be presentations related to health issues around if you look for them.

  • LOL!… If anything was going to have a placebo effect then surely it would have been the first one… Nan likes her GP and given she’s 92 and still driving doesn’t want to upset him… if the placebo effect was going to work it would have kicked in well before it did… Nan had no reason to want this one to work any more than she did any of the others… as I said, as far as she is concerned, this one worked.!

  • Ron,

    You can have your self-justifications. As I wrote earlier, I am leaving this “conversation”: you’re repeating the same fallacies, there is no conversation to be had.

  • I was just explaining that 1) clinical trials never decide whether something works in an individual case… what does that is whether what is prescribed/taken leads to an improved outcome.

    Fact: The patient had tried a number of ‘proven’ medicines that didn’t work.
    Fact: Given another one without knowing that it was a homeopathic, this one worked.
    Fact: As far as the patient is concerned, this one worked… the others didn’t.
    Fact: The fct that the patient never knew this was a homeopathic and that she wanted ALL of them to work there is no rational reason to claim that it was a placebo effect… even if it was… good on placebo!!!

  • Ron,

    I have no interest this. You are doing a very familiar pattern for you slightly shifting your position around in circular fashion to keep your self-justification going. (“Fact 2″ isn’t a fact, it’s an assumption, proclaiming it as a fact is to reason using a fallacy, one I explained to you earlier. Obviously you either aren’t aware of that or aren’t taking in anything I’ve said. Either way this illustrates why there is little point in me trying to be patient and helping you.)

    Have your self-justification.

  • Grant, I thought you’d left the discussion… welcome back. Fact 2 is a fact as far as my MIL is concerned… it doesn’t matter what I think… but it is a fact that in her opinion it worked… it doesn’t matter what you or I think… and that’s a fact… I wasn’t aware I’d asked for help… I wasn’t even aware that I needed help… I’m not fter self-justification… was just pointing out that scientific studies don’t ptove anything at an individual level…

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