Amber Teething Beads: A Few Points to Consider

By Darcy Cowan 21/02/2011 143


Being a new parent and a sceptic I have been on guard regarding dubious advice and practices. Parents, especially new parents like myself, are a vulnerable group. We tend to be full of anxiety that we are doing the ’right thing’ by our children. Where-ever you find a vulnerable group like this you also tend to find those who prey on such fears. I have actually been pleasantly surprised, despite my vigilance I have not yet been subjected to any dubious advice (that I’ve noticed). But early last week I was confronted by a practice from a fellow new parent that I found a little disturbing. I’m taking about using necklaces of amber beads to reduce the pain of teething for babies.

Teething can be an especially stressful time for parents and children, the child may be experiencing pain as the new teeth break through the gums. This means an irritable child and frazzled parents. Anything that promises to relieve or prevent this harrowing time is gratefully embraced.

On to the amber beads. This practice disturbs me for several reasons. First is safety, the necklace if left on the baby for long periods may pose a strangling hazard of it becomes caught on something. Most advertise that they are made to break easily to prevent this and that the beads are individually knotted onto the necklace to prevent scattering on breakage. However this still seems to leave a broken string of beads in reach of a baby, as as most people know – anything a baby can get it’s hands on goes straight into the mouth. So choking is also a concern[1&17].

Now, I’m not one to be a worry wart over every little potential hazard, used correctly under parental supervision I suspect that the likelihood of a tragedy of this kind is low. But not zero[15&16]. This coupled with the low possibility that the necklace actually does anything is what worries me. The second disturbing thing is that parents are accepting this via word of mouth and apparently not consulting their doctors before subjecting their child to an intervention of unknown safety and efficacy.

I have three main points I want to cover with regard to these amber beads that parents should consider before trying these beads (in addition to the physical safety above). The first relates to basic plausibility.

Before we get to that though it depends on which mechanism of action for the beads you subscribe to. There are several explanations regarding how the beads are supposed to work floating around the intertubes, many are of the tinfoil hat brigade variety, these will be ignored (but look here and here for a bit of a chuckle). Only one explanation I have found makes biological sense so that’s the one I’ll be focusing on.

That explanation is Succinic acid, baltic amber is known to contain between 3-8% succinic acid. According to proponents this is released from the beads and into your baby. The succinic acid then allegedly has an analgesic effect and so reduces the pain of teething. Here is where my first point regarding plausibility comes in:

Amber is tough, really tough. This is a material that has persisted for thousands and in some cases millions of years unchanged. Suffering through heating and cooling of innumerable climatic changes through the years. Yet this same tough unchanging material with happily give up it’s chemical components upon the gentle heating it receives on being placed next to your baby’s skin? Colour me unconvinced[1&2]. Related to this point amber has a hardness on the Mohs scale of between 1 and 3 [3], baltic amber which is usually touted as the therapeutic variety (because of the high succinic acid content) is at the high end of this scale 2 — 2.5. To put this in perspective, Tin has a hardness of about 1.5 and Gold is 2.5-3 [4]. But forget about this point, I don’t need it. Lets say for argument sake that clinically relevant amounts of succinic acid are released by the amber and absorbed by your baby’s skin.

My second point then, relates directly to the claims made for succinic acid. Succinic acid is made in the body (and in plants) as part of the citric acid cycle (aka krebs cylce)[5]. It is also use in the food and beverage industry as a food acid (additive #363 to be precise)[6]. Interestingly in this capacity there are recommendations from some quarters to avoid the substance[7]. Even so, apart from it’s early use as a topical treatment for rheumatic pain[8] there is no evidence that I could find (searching Pubmed at least, where I would expect a decent study to be referenced) that it is effective as either an anti-inflammatory or general analgesic. Let me be clear on that, I don’t mean low quality evidence, I don’t mean small poorly designed trials with equivocal effects, I mean nothing. Zip. Nada. In fact if anyone knows of any let me know because I find this complete lack quite surprising, I’m open to the idea that I was looking in the wrong place or was using incorrect search terms. So, unless there is late breaking news, it fails on that count as well. Meh, what do we care about evidence of efficacy anyway? Throw this point out too. Lets move on to my final argument, uh, I mean point to consider.

Lets say that a. the beads do indeed release succinic acid into your baby and b. this succinic acid has an analgesic effect once it enters your baby’s body. Doesn’t the very fact that an unknown amount of a drug[9] is being put into your baby’s body bother you? What is that I hear? It’s natural? Oh, well, that’s ok then. No wait, no it’s not. I don’t care what the origin of a compound is, the question is what are it’s effects on the body and do the benefits out weigh the risks. Ok, lets replace succinic acid with some other naturally occurring substance, salicylic acid. This is a compound with known anti-inflammatory properties[10]. Would you be happy with a product that introduced unknown levels of this compound into your baby? What if I said that overdoses with this compound could lead to a 1% chance of death?[11] It’s natural, it’s also the precursor to acetylsalicylic acid, otherwise known as Aspirin[12].

Now, lest I be accused of unnecessary fear mongering and drawing false comparisons I would like to admit that at present there is no evidence to suggest that succinic acid is hazardous, nor even that it is potentially hazardous[5]. This does not detract from my main point however, the point isn’t whether this particular compound is safe or not but that the reasoning[13] around it’s use is faulty and cannot be used as a substitute for evidence.

Based on the complete lack of plausibility on any level of efficacy any potential for harm, however small, must tip the balance of this equation away from the use of this product. Don’t trust me though, talk to your doctor, I suspect though that given the complete lack of reliable information on this topic they will be left to rely on their own philosophy of harm vs benefit. In the final analysis, there are not always clear answers[14], but developing good critical thinking skills will at least provide you with a small light in the darkness.

Footnotes:

1. http://www.3news.co.nz/Teething-necklaces-dangerous—sceptics/tabid/423/articleID/160820/Default.aspx

2. I found this paper that analysed the volatile out gassing of amber, succinic acid was not mentioned as an identified component. http://www.springerlink.com/content/865ku15055np3x78/

3. http://www.emporia.edu/earthsci/amber/physic.htm

4. http://en.wikipedia.org/wiki/Mohs_scale_of_mineral_hardness

5. http://www.accessdata.fda.gov/scripts/fcn/fcnDetailNavigation.cfm?rpt=scogsListing&id=339

6. http://en.wikipedia.org/wiki/List_of_food_additives,_Codex_Alimentarius

7. http://www.foodreactions.org/allergy/additives/300.html

8. http://en.wikipedia.org/wiki/Succinic_acid#History

9. If it has biologic activity that can be used in a therapeutic fashion, it’s a drug, no quibbling on that point please.

10. http://en.wikipedia.org/wiki/Salicylic_acid#Medicinal_and_cosmetic_uses

11. http://en.wikipedia.org/wiki/Salicylic_acid#Safety

12. http://en.wikipedia.org/wiki/Aspirin

13. ie “It’s got to be good, it’s natural.”. Don’t make me barf.

14. Who am I kidding, there are almost never clear answers. Who wants certainty anyway?

15. http://safekidspiercecounty.health.officelive.com/Documents/Choking%20and%20Suffocation%20Fact%20Sheet.pdf This is an american document but I don’t think necklaces become safer just because we’re in NZ.

16. http://www.nzchildren.co.nz/infant_mortality.php NZ infant mortality statistics.

17. http://www.bpac.org.nz/magazine/2010/april/docs/bpj_27_oral_pages_30-41.pdf See page 33.

Filed under: Alternative medicine, Medicine, Questionable Techniques, Sciblogs, Science, skepticism Tagged: Alternative medicine, altmed, Amber, Aspirin, babies, baby, Baltic amber, complementary and alternative medicine, crunchy, Earth Science, health, mothers, Necklace, parents, skeptic, skepticism, Succinic acid, trendy


143 Responses to “Amber Teething Beads: A Few Points to Consider”

  • From the first chuckle-worthy site you link to: <Amber is a bio-transmitter comparable to aromatherapy and homeopathy
    LOL, in fact if there weren’t students queueing (sp?) up to get in my door while I eat my lunch it would be ROFLMAO. And if the static charge they claim is set up on the child’s skin is anything like what you get from wearing wool & walking on nylon carpets, well! cue startled yelps every time the poor kid grounds on something.

  • And things would keep getting stuck to the kid, oh wait, that happens anyway. nvrmnd
    Ah, you’ve made that happy discovery. Never mind, most of it will come off in the wash. Well, maybe after several washes :)

  • The necklace speaks for itself and it works wonders for my children. Do us a favour, be brave and conduct your research via means other than through wikipedia.
    Reputable sellers do state that it should not be worn when unsupervised, as anything worn around the neck can be dangerous.
    The benefits of Baltic Amber can hardly be a placebo effect when an infants teething trouble subsides within a few hours of wearing the necklace.
    Infact I’ll bet that when your own infant is keeping you up at night, and with red cheeks, drooling and pain from swollen gums.. and despite you ODing the poor child on your medicated paincare relief, that you might just dare to give Baltic Amber a go.

  • Believer says: “Reputable sellers do state that it should not be worn when unsupervised, as anything worn around the neck can be dangerous.”

    I wonder if the fact that the baby is now being supervised while it is being “calmed” by the amber beads are related??? Nothing like close parental “supervision” to calm a kid. Comfort is a powerful weapon.

  • Thanks Ross,

    Time to make a comment on the other points Believer made. First the placebo is not a single entity that is easily whipped out to explain or refute particular situations. You’ll notice I did not refer to it in the article, neither did I make any attempt to explain why people may think they work in the absence of hard evidence.

    Asserting that it could not be placebo is to misunderstand the catch-all nature of the term and to over-estimate our ability to accurately infer causal connections.
    Part of it can be subjective experience, for an individual if they report feeling better after an intervention but by objective measurements have not improved – are they better? Applying this to babies who have no verbal skills – if the parent says/thinks they are better – are they?

    Further, given that with informal experiments like this we are all single case studies we can not accurately gauge how the situation might have been different without the intervention. Would the baby calmed down on their own? Who knows, perhaps in the past they did not but the particular circumstances around this instance would have made things turn out differently. This is where large studies come in, each of these contingencies would hopefully cancel out and allow us to see the signal above the noise.

    Regression to the mean could account for some of the perceived benefit. If as you say I were to be faced with a screaming baby – obviously suffering from extreme symptoms of teething – and in desperation try the beads and my baby appears to get better (after several hours perhaps, as you state) is this because the beads help or because the pain he experience had peaked when I decided to use the beads and once again returned to baseline levels?

    As you can see the experience of one person can be unreliable and this is why carefully controlled studies are required to sift accurate knowledge from bias and wishful thinking.

    Finally your last sentence strikes me as petty and needlessly judgmental, similar to the sentiments I see along the lines of “When you are rotting in hell you’ll wish you had believed.”

    No judgment is intended in either my analysis in the post above nor my comments here, only an understanding that humans are flawed and we all need help in accurately interpreting the vagaries of our existence sometimes. I occasionally delude myself into thinking I provide that help in some cases.

  • One day I got a new car. I got into the new car and the light “telling” me that a door was open stayed on. Check the four doors. All OK. Must be the boot. Got out, walked around and closed the boot, got back in and the light was off. Infuriatingly, that boot kept coming open as everytime I got into the car the light came on. Around the back, open and close the boot, get back in and the light was out. Good job Ross. Even more infuriatingly, this went on for about a week. By this stage I had even booked the car in to get it fixed.

    At the end of a week, I was nonchalantly playing with the keys and of course, the light came on. I knew I wasn’t going anywhere and sat there listening to the radio. After about 30 seconds, the light went out. Wha…..??????

    I suddenly had this dawning realisation and sat there laughing my head off and calling myself a deluded idiot. The light, when I had a closer look at it was a “temporary” light to invite me to put my seat belt on. For the whole week I had not (haha) clicked.

    Skinners pigeons came to the fore of my mind. I had been triggered by the light. I had concluded I knew what to do. I did it. The light went out. I had succeeded in fixing it.

    The time it took to get out of the car, go around the back, open and close the boot and get back in the car was just enough for the light to go out by itself!

    Stunning example as Darcy says: ” to over-estimate our ability to accurately infer causal connections.”

  • Oh, that’s an awesome example.
    I bet I do that sort of thing all the time. In my job I do a fair bit of troubleshooting, all too often though I can’t tell if I’ve fixed the issue by what I’ve done or if it was resolved due to something else.

    Thanks for sharing, that’s just great.

  • Feynman’s quote – or at least a variant of it according to Wiki:

    Science is a way of trying not to fool yourself. The first principle is that you must not fool yourself, and you are the easiest person to fool.

  • exactly what i needed to read. mums have recommended this necklace to me and i was very sceptical about…it was the words
    atural remedy that made me want to research further into this…but after reading this article, im not interested, so thanks for doing the research

  • Lusi, you are welcome.
    When I researched them myself all I found were credulous sites. The number of hits I get on this post tells me there’s a need for this type of analysis.

  • Not sure how relevant this is but I remember watching an episode of Target and they just happened to be doing a product test on amber bead neacklaces. I had to laugh as I know so many people who swear by them. Turns out that for the beads to release any of their healing properties they have to be heated over 200 degrees. Now, Im no genius but I have a feeling that a baby cant get there temp that high! Yet you wont see this on the packages huh?

  • No sorry, but I had seen an episode when they did a product review on baby monitors but forgot what one was best, so i emailed and asked what episode it was. They were realy good and got in touch with me in a few days with a link to the full episode. Heres their email if you would like to get a direct link from them target@clear.net.nz I would deff reccomend this show because it put me off buying one!!

  • Last time I saw the amber teething beads surface in the media I tried (unsuccessfully of course) to argue with some of the believers. Didn’t help that I didn’t know enough of the science behind it that they were quoting at me. But I was highly amused that my suggestions for some simple double blind tests were met with “no responsible parent would let anyone do TESTS on their BABY”, despite the fact that using these amber necklaces with no testing is vastly worse!

  • Well obviously you should have just tried it and seen that it works :-)

    Yeah, essentially they are performing an un-blinded experiment on their own baby, without the benefit of actually producing reliable knowledge.

    It’s unfortunate how few people understand that anecdote is the start of the process, not the end. Sigh.

  • Most items I’ve read about the healing properties of amber tend to associate any positive effect with the static charge that is produced by the amber in response to friction. If this is the case, you could get the same effect by knitting your child a woolen hat or giving them a baloon. I have many friends who do this,but I sometimes get annoyed when people claim something occurring naturally makes it superior to something which was synthesized. Tetrodotoxins are purely natural but you wouldn’t want to touch them. Has anyone heard the add on the radio for the mens product “herbal ignite” where they claim that it’s good for you because it’s all natural and contains no chemicals, so what the heck is in it then, hopes and dreams?

  • Thanks so much for your blog, I too am very sceptical of these types of “natural” remedies and horrified at how quickly many people seem to adopt them for their babies.
    Was at a mothers group run by a midwife yesterday and witness to an alarming conversation about teething remedies which was interesting as it related to both teething beads and Pamol.
    Due to the recent media story about Pamol being ineffective for fever the advice being given to this group of Mum’s was to not use it at all as it is a nasty medical intervention. Something I’d be willing to accept on my doctors advice or when MOH changes their guidelines on use of paracetamol. In any case everyone was very happy to take this on board as Pamol is not “natural”. Then the advice moved on to teething beads, a “natural” remedy. we were told they should be left on 24 hours a day until they are 7 years old (at night in bed with noone watching, um sounds very safe???????!!!), and that they work so well for a nice price of $95. Again everyone seemed very happy to swallow this information with no supporting data or reference to any studies, and were not in the least concerned despite having just had a discussion about how dangerous it must be to use Pamol (despite the fact you know the dose and how it works??).
    My point is it is pretty alarming that a health professional gives this advice out willy nilly, and people take it as gospel and treat their babies with no further info. Various other “natural” teething remedies were also discussed. Sorry I am not about to sling all manner of things down my baby’s throat with no evidence of efficacy or safety and products from an industry that is not properly regulated!! And as you point out also no control over dose.
    “Natural” does NOT mean safe I totally agree with Matthew. Anything substance that has an effect in the body is a DRUG, no matter whether from a plant, a rock or synthesised in a lab, at least the lab stuff is tested and manufactured under quality and safety regulation. In fact many drugs were originally of plant origin.
    I’d be happy to use remedies that were advised by an expert trained in a reputable manner, and with proper studies backing them.

  • Excellent point there Isabel (of course I would say that – you agree with me)

    Just a point about Pamol (warning NOT medical advice!), my understanding is that is is pecifically in regard to use as an anti-pyretic for Influenza infection not fever in general. The concern is that fever is part of the body’s response to infection and helps reduce the over-all infection. In this case reducing the fever using paracetemol may actually worsen the infection and contribute to increased mortality.

    To apply this to general fever and teething seems to be taking it out of context, and it worries me that a midwife (apparently) is not sufficiently knowledgeable or nuanced to apply this correctly.

    I agree that using this as ammunition to say that “drugs” are bad, natural is good is to massively over-simplify to the point of missing the point all-together. But this is what people are like, we prefer simple narrative structure to complicated reality.

  • Darcy said, “It’s unfortunate how few people understand that anecdote is the start of the process, not the end. Sigh.”

    Darcy, I’d suggest few people understand that anecdote is the start of the process AND the end.

    Anecdote motivates a clinical trial of product A… Randomised clinical trials show it works in 50 percent of subjects tested… two people go to the doctor with the appropriate complaint… the doctor prescribes product A to both… one ends up 100 percent convinced that it works and starts a Pro-Product A blog… the other is 100 percent convinced that Product A is useless and starts an Anti-Product A blog…

    Both bloggers opinions are based on anecdote; their experience of a clinically proven product…

    Darcy, which blogger is correct? The one who observed the anecdote where it worked, or the one who observed anecdote where it didn’t work?

  • Excellent answer… hence, medical science begins and ends with anecdote… clinical trials prove nothing at an individual levels… every doctor hands over a prescription with the words, if you’re no better in a week come back and we’ll try something else (or words to that effect)… what a marvelous business model…

    • Excellent bait and switch Ron, I bow to the master.

      The doctor however is not basing the opinion on anecdote but on the data. Choosing medications on the basis of the probability of benefit. You can not equate that to the patient being uninformed. Sorry.

  • Anecdote motivates a clinical trial

    To extend/correct this a little, the starting point of research itself is not anecdote, but hypothesis. (You first have to work it into something that can be tested first, etc.)

    A point to note in Ron’s example is that if his bloggers chose to base their conclusions only on their personal experience alone they would be ignoring evidence (the trials in his case), i.e. they would not be not putting their personal experience in the context of the wider framework of what has been previously learnt about the thing. In that case neither would be right.

    On that note, science bloggers usually argue about the evidence for a product, or not as the case may be, rather than just for or against the product in and of itself. Darcy’s post is an example.

  • Darcy said, “You can not equate that to the patient being uninformed. Sorry.”

    Darcy, I totally agree… but for the individual patients, whilst the efficacy might say it works in 50% of cases, the effectiveness data the doctor and patient work with relates solely to a single patient… that’s anecdote, don’t you agree??

  • To my reading you are confusing anecdote for some a term describing the likelihood that the treatment will work on any one patient. That’s not ‘anecdote’; try ‘likelihood’ or ‘(prior) probability’, etc.

    Anecdote is what you get from using personal accounts of an outcome (or outcomes), but the doctor advises the patient before any outcome and the doctor’s advice will be informed by trials, etc.

  • Darcy, the 50 percent is probability… the 100 percent/zero percent for the two individuals is not probability, it is reality… probability is always theoretical…

  • Sure, you could record the observations as either/or. (You’d likely do better if you considered different levels of infection/illness and levels of treatment success, the presence/absence of factors that are known or suspected to influence outcomes, etc., but for convenience let’s skip these.)

    But however you word it, what happened to the patients are after offering the treatment. That can’t be part of the doctor’s advice or patient’s opinion before the treatment is offered – unless you’re suggesting time travel took place.

    Regards “is not probability, it is reality… probability is always theoretical”: here you seem to be trying to dismiss things by labelling them “theoretical”.

    Probabilities can be just how things are or behave too (i.e., reality), and, more relevant here, can be used describe or summarise an outcome.

    A reality of studying complex systems is that they are usually best described in probabilities. It’s one of the points that others have suggested is an aspect of modern science that isn’t widely appreciated. Peter Gluckman wrote about this some time ago. (It makes me wonder if it’s worth bringing this up again as the subject of a blog article some time.)

  • My experience with amber beads is as a grandparent. I was asked what I thought… I looked at the efficacy science and couldn’t find any randomised controlled trials to support it’s use… I looked at the risks and found the occasional comment, such as yours above, talking about the theoretical risk if choking/strangulation etc… but I couldn’t find any case evidence to show that was the case… I contacted various injury/mortality/risk analysts I know, including NZ injury unit at Dunedin, and Canada’s safekids unit… none was aware of any actual evidence, just hypothetical judgements… I asked a coroner I know… nothing there either… My advice was… don’t know that it will help… can’t find evidence that it will harm… outcome… followed lead of 3-4 friends and used it 24/7 for about 18 months with no teething problems. Number 2 has now inherited the necklace… did the necklace work? Who knows…?

  • I know that the probability of a coin landing on its head is 50/50… but what is the probability when a coin has already landed on its head…? The reality is not 50/50… the reality is 100 percent.

  • Ron, you keep switching between patient outcomes (reality if you like) and the doctor/patient interaction (probability) so no wonder you are confusing us.

    It seems to me you are attempting to equate the practice of medicine to the reliance on anecdote and through this equivalence smuggle unproven modalities in the back door. This argument does not negate the fact that medicine is based on data (mostly) and the beads are based on anecdote that is prone to bias.

    I’m not really interested in convincing people not to use them. That’s their choice. I’m just pointing out that there is no reason to think that they work.

  • Darcy, it is a three legged stool, not two… the science (hopefully) the recommended treatment (doctor/patient interaction) and the reality (did the treatment work.) If a doctor prescribes a treatment and the patient gets better, then the patient usually ascribes the getting better with the medicine’s effect… you and I know that the effect could have been the medicine, could have been a placebo effect, or the patient may have got better without any treatment at all… If the patient does not get better, then it is reasonable to assume the medicine did not work for that particular patient, even though it has been proven to work in x% of cases…

    There is a reason to think that they work… there are in fact at least two… one, the tradition of use… if it’s been used by so many over a long period of time then it is reasonable to assume they work (whether they actually do or not) and if parents friends have tried them and it SEEMED to work, then it is logical to at least give them a go… in the absence of any downside, what have they to lose??? Maybe a few dollars, but they spend money on paracetamol and the like anyways, so it it gets them peace of mind so be it…

    I don’t know if they work or not… I do know my grandson had teething probs with sleepless nights… they put the necklace on him and he and mum/dad had good night sleeps… everyone was happy… coincidence? maybe…

  • By the way, my original point related to hypothetical risks being used a a reason for not using them.

  • Ron, the patient’s outcome is not the criteria used to determine whether the next person should get the treatment. It’s simply their outcome.

    I’m not really swayed by tradition and anecdote. I’m given to understand blood-letting had a pretty long tradition.
    I have no stake in proving amber beads don’t work but I don’t see why the onus is on me to do so rather than on advocates to show they do.

  • Darcy, in your ordinary life I’m sure you are swayed by tradition and anecdote… what we eat, live in, drive, dress in is all driven by tradition/fashion and anecdote/recommendation/discouragement by someone who had a good experience/bad experience.

    Your article on amber beads implied they were dangerous so shouldn’t be used… you even gave two references, neither of which provided any evidence to support your argument… my response was there is no evidence they are dangerous, but there is speculation…

  • Darcy said, “the patient’s outcome is not the criteria used to determine whether the next person should get the treatment. It’s simply their outcome.”
    Actually, pharmacovigalence is all about this… there are a plethora of so-called ‘scientifically proven beneficial’ drugs that the accumulative data on hundreds/thousands of individual ‘anecdotal’ outcomes has proven to kill thousands resulting in the withdrawal of the so-called treatment.

  • Ron, we are talking (I thought, am I wrong?) about medical interventions, not what to have for lunch.

    Those references support my argument, what they don’t do is prove it.

    Do you think that collecting data on patient outcomes is the same as mothers swapping anecdotes?

    I’m done.

  • Ron,

    ” there are a plethora of so-called ’scientifically proven beneficial’ drugs that the accumulative data on hundreds/thousands of individual ‘anecdotal’ outcomes has proven to kill thousands resulting in the withdrawal of the so-called treatment.”

    Could you provide the names of these drugs and any references you have about them? This is an area I am interested in looking into further.

  • Darcy, good list, though very sanitised…

    Rofecoxib (Vioxx) 2004 Withdrawn because of risk of myocardial infarction…/// Why don’t they mention the thousands of premature deaths???

  • Darcy, Do [I] think that collecting data on patient outcomes is the same as mothers swapping anecdotes?

    Clearly note…Dr Graham, from FDA, got pilloried coz he dared to collect anecdote and analyse them…

  • Started using it yesterday, and noticed a distinct change of behavior. For me this proves it does something at least.
    But feel quite bad using my little one a Guinea Pig.

    -He normally cries when he wakes up in the night, didn’t do this just light there doing nothing
    -At breakfast he seemed a bit stoned

  • meindert,

    I glad you feel that you gain some benefit. I would be very cautious about leaving them on overnight when you can’t supervise.

    My child seems stoned in the morning sometimes too, even after a long night of uninterrupted sleep. I’m not sure what conclusions can be garnered from this observation. Single anecdotes are not an especially reliable source of evidence.

    If you wish to continue using this product then I hope you keep the risks in mind.

    off topic, I have removed the link on your name as it contained personal info (address & phone number).

  • “If you wish to continue using this product then I hope you keep the risks in mind.”

    Why do skeptics use anecdote to support their arguments when it comes to trying to discredit so-called alternative? It’s an interesting paradox observed on many occasions.

    meindert, the risks Darcy alludes to is strangulation… there is no evidence that Amber beads have caused such problems… the risk is purely hypothetical… not evidence based.

    The risks associated with using paracetamol are legendary, real and well documented… If the Amber beads appear to be working my advice would be to stick with what’s working… Havingsaid that, I appreciate that an anecdote doesn’t prove anything… unless its an adverse effect associated with a so-called alternative… :-))

  • Darcy, you’re welcome. My point was that skeptics often exhibit double standards… On the one hand, “Evidence that Amber bead work can’t be trusted because it’s anecdotal” on the other “there is anecdotal evidence [actually it’s only theoretical] that Amber beads COULD be dangerous so don’t use them… they are unsafe…”

    Darcy, it cuts both ways… anecdotal evidence is anecdote whether it supports one’s argument or not… that’s my point, double standards.

  • Ron, my point isn’t that my anecdote trumps other anecdote (especially as you correctly point out I’m not even advancing an anecdote) but that in the absence of reliable evidence of benefit that even “theoretical” risks should be seriously considered.

  • “…in the absence of reliable evidence of benefit that even “theoretical” risks should be seriously considered.”

    Darcy, if we regulated life based on all possible theoretical risks then we’d be totally screwed… Your argument cuts both ways… “in the absence of reliable evidence of harm even “theoretical” benefits should be seriously considered.”

    As paradoxical as it might seem, From a risk management perspective the occasional harm to individuals actually heightens awareness of risks and overall reduces harm to the populace… It’s called the paradox of ultrasafe systems and is well studied. Make life too safe and you actually increase the risk of harm…

    meindert, don’t allow hypothetical risks to dictate life… If the Amber beads have [apparently] worked, then good for you… there is no evidence of harm documented due to strangulation… there is plenty of harm documented due to frustrated and sleep deprived parents doing things to their grissly sleep depriving children that they and society regrets…

  • Ron, I’m aware of the issues around safety you bring up. Humans are comfortable with a certain level of risk, if a situation is made safer then we will tend to act in ways that bring the risk level back to a perceived equilibrium.
    eg. make cars safer -> people drive more recklessly.
    or give people vitamin supplements -> they eat and behave less healthily.

    I’m not convinced that applies in this situation. Are you suggesting that my advice to be aware of any risks will make meindert or other parents undertake more risky actions? Did I tell meindert to stop using the beads and thus forcing more risky behaviours?

    I do consider the lack of good evidence to be a reason for people to be wary of this product.

  • Ron,

    Note how in

    “If the Amber beads appear to be working my advice would be to stick with what’s working…”

    in the first part your have “appear to be”, as in for example the placebo effect, but in the second part you’ve moved to a definitive “what’s working” with nothing in between.

  • Darcy, as someone who argues based on scientific evidence where is your evidence to support the following hypotheses???

    eg. make cars safer -> people drive more recklessly.
    or give people vitamin supplements -> they eat and behave less healthily.

    The evidence I’ve seen is that people who typically consume supplements actually eat a better diet, not the other way around. If your argument that people drove more recklessly in safer cars was true then there would be more accidents in safer cars… where is your evidence to support that?

    Darcy, you, “consider the lack of good evidence to be a reason for people to be wary of this product.” but then use a purely hypothetical risk to put people off…

    How do you define, “good evidence.” If I take an Aspirin for a headache and it goes away, for me, is that not good evidence that it worked… I have a problem… I try a solution that I expect to work… the problem goes away… is that placebo effect or chance or did it work… hey, who cares? I no longer have the headache, so my problem is solved. Would you suggest that I should not use Aspirin because there is little “good evidence” that it works and it’s routine use kills 50,000 people around the world every year as a result of gastrointestinal and cerebral bleeds?

  • Grant, when I see a peer reviewed tweet site then I’ll give some credence to your critique… If something appears to be working then in most cases it is working…

    In meindert’s case the problem has gone away… what caused that to happen…??? In my daughter’s case, her friend was told about amber beads, she tried them and the child slept well and grisling reduced somewhat… her friend told another friend and the same result occurred… she told my daughter and the same result occurred… all three mothers have conjoint degrees, so the are not dumb… all three (plus most of their friends) use them… even on #2 & #3 children… For them it is working… so they have stuck to a winning formula…

  • Ron,

    If something appears to be working then in most cases it is working…

    So you think assumption is sufficient? Way to go. Not.

    That’s entirely backwards. Until you have evidence you can’t make definitive statements that something “is” working.

    The reason I pointed it out is it’s bit rich of you to accuse others of poor reasoning or poor logic, when you own is wanting. Likewise, it’s rich of you “demand” that others back statements with evidence, when you skip over this yourself.

    You should hold yourself to the same standards you ask of others.

    In meindert’s case the problem has gone away…

    So? Plenty of things resolve themselves. Likewise you’re not exactly controlling for all the others things that might have solved her problem, are you? (Yet you are the person who keeps demanding controlled trials. You can’t have this both ways.)

    For them it is working… so they have stuck to a winning formula…

    Terrible logic – you’ve set yourself up to confirm the antecedent rather than test it. Not something we ought to be reading from someone who touts himself as a ‘risk analyst’, IMO. You have no idea if the ‘treatment’ is ‘working’ or not.

  • Grant, what some scientists don’t understand is that life does not revolve around, nor is it dependent on science… science is one little sideshow that has little impact on day to day decisions…

    One does not go through a robust decision-making process when buying a chocolate bar at the supermarket counter… that does not mean that there is not a place in society for decision theory… Likewise, something cheap that appears to work and does no known harm does not require endless academic studies to justify its existence or use.

    My beef with Darcy is highlighting his double standard… he argues from a science/skeptics point of view but uses the exact same form of evidence he’s arguing against to try and make his point…

    Bottom line… there is evidence that Amber beads work… there is no known evidence that they have caused any significant harm… including strangulation he was inferring…

  • Grant said, “Terrible logic – you’ve set yourself up to confirm the antecedent rather than test it. Not something we ought to be reading from someone who touts himself as a ‘risk analyst’, IMO. You have no idea if the ‘treatment’ is ‘working’ or not.”

    Grant, I don’t live in a sterile world… you don’t have to stick your head in the dunny to know that it stinks… you don’t need any scientific experiment to confirm that it stinks… it just does…

    I have no idea whether strawberries are good for me, but I love eating them… One doesn’t need to know if something ‘works’ or not… life does not revolve around sterile science… I had a problem, I tried something without causing harm, the problem went away (for what ever reason), I have no problem… My friend has the same problem, they try the sme solution, the problem goes away (for whatever reason) Problem solved… THAT, my friend, is how most of life works… word of mouth, trial and error, personal experience…

    A scientific study is done to prove the efficacy of a cancer treatment. It proves that it is 50 percent effective.

    Patient A is treated and is cured. Patient B is treated and dies. The scientist is happy because it confirms his study. Patient A and family are happy because he is 100 percent alive… Patient B is 100 percent DEAD.

    The scientists study showed the treatment worked… Patient B’s family would beg to differ… Who is right???? Certainly Patient B’s family… The scientist’s work never ever relates to an individual… only the crowd…

    You don’t have to have a PhD to understand how life works…

    You don’t need to be a risk analyst to understand or apply risk…

  • Darcy, you say, “crappy evidence + reason to consider harm = not worth it”

    The problem with your argument here is that “reason to consider harm” does not relate to evidence of harm… your ‘evidence’ is purely theoretical… The crap evidence you talk about is many parents getting good nights sleeps after using Amber beads… for them the timing is not crappy evidence…

  • Darcy, I agree… my beef was that you are a skeptic… you laud evidence-based whatever… you dick anyone who claims anything that is not scientifically proven works… and yet here you are, using hypothetical harm to try and convince someone not to do something… You are not walking the talk…

  • I’m not familiar with your idiom “dick anyone”, but I don’t feel you’ve proved you’re argument that my stance is a double standard.
    Nevermind, like all interactions with you it seems we aren’t even talking the same language, let alone likely to influence each others thinking. As such, my contrubutions here are ended for now.

  • Ron,

    Grant, what some scientists don’t understand is that life does not revolve around, nor is it dependent on science… science is one little sideshow that has little impact on day to day decisions…

    Dressing it up as ‘us’ v. ‘them’ is a distraction and misleading. That anecdotes don’t ‘prove’ something works, etc., applies to everyone.

    there is evidence that Amber beads work…

    An empty assertion. You can’t use the anecdotes as evidence – you’ve said as much elsewhere.

    Relying on this sort of thing can just as easily have people believing in silly things. I gave one example ages ago. (Different setting, but the same thinking applies.)

    Who is right???? Certainly Patient B’s family…

    Actually, in a very real sense, both – which you should be able to see from your argument (try not to take sides).

    The way you’re presented this flips between two different views (population/individual) then tries to say only one can be right and that the other ‘must’ wrong – they can both be right. Trying to make this into ‘us’ v. ‘them’ doesn’t fit and only serves to be inflammatory.

    I could go on, but it seems to me that you want a situation where you want others should be rigidly ‘correct’ while you excuse yourself to use ‘alternative reasoning’.

    Reading you reminds me of reading creationists’ logical contortions where they try self-justify something they want to be true by setting up atheists v. religious missing that the reasoning atheists are using can be applied by anyone. It’s the same here. Good critical thinking can be done by anyone, with a little practice it’s not ‘special to scientists’ and it’s the reason I and others wish it were taught at school, etc.

    With that said, I’m going to let this go too.

  • That anecdotes don’t ‘prove’ something works, etc., applies to everyone…. Absolutely… never said it did…

    “You can’t use the anecdotes as evidence – you’ve said as much elsewhere.”

    You can and I haven’t… of course anecdote is evidence… it’s just not very strong evidence…

    “Actually, in a very real sense, both …”

    Agree… never said otherwise… just that at an individual level the scientist has nothing to contribute… their evidence only ever applies to averages… the masses… never the individual…

    “The way you’re presented this flips between two different views (population/individual) then tries to say only one can be right and that the other ‘must’ wrong – they can both be right. Trying to make this into ‘us’ v. ‘them’ doesn’t fit and only serves to be inflammatory.”

    Rubbish… I argue that the scientist can only ever be right at the population level… they only work in statistics… you can’t be a little bit pregnant… you are or you’re not… you can’t be 50%. A cancer patient either dies or lives… can’t be 50 percent…

    Understanding the difference between the individual and the populace is something many scientists obviously don’t understand.

    “Reading you reminds me of reading creationists’ logical contortions where they try self-justify something they want to be true by setting up atheists v. religious…”

    This is an argument skeptics drag up when they need a crutch… I’ve never argued such an argument and you trying to distort the discussion gives me great satisfaction… The bottom line is that clinical trials only ever produce results for the populace never the individual… averages never apply yo the individual…

    Looking forward to the rest of the evening being quiet.

  • “1. http://injuryprevention.bmj.com/content/4/2/89.full
    I didn’t say the behaviour lead to more accidents did I? That assumes that the perceived risk is lower than the actual risk.”

    You said, “Humans are comfortable with a certain level of risk, if a situation is made safer then we will tend to act in ways that bring the risk level back to a perceived equilibrium.
    eg. make cars safer -> people drive more recklessly.
    or give people vitamin supplements -> they eat and behave less healthily.”

    What else were you inferring/implying other than the reckless behaviour lead to more accidents? Or did you mean wreckless??? :-))

    The risk theory you linked to is predicated on theory… regarding the switch from left to right hand driving in Sweden, i suspect there were many factors that kicked in… including complacency…

    You say Good evidence consists of basic plausibility, coupled with positive trials. We have this for aspirin… Actually we don’t… more and more evidence is coming in every day that Aspirin is not the panacea claimed… it is actually very risky… it kills tens of thousands of people every year. There is a significant raging debate going on in the medical literature as we speak… including for statins which have no evidence of benefit for healthy people… this recent contribution to the statin debate is spot on… “if you believe that statins prevented early death given that the difference in death rates was not significant, the number need to treat to prevent 1 death in 1 year was 1429. The numbers needed to harm for some fairly significant adverse effects were an order of magnitude less. So, assuming statins do prevent death in primary prevention, for each death prevented in 1 year, statins might cause approximately 2-3 cases of acute renal failure, 9 cases of liver dysfunction, and 14 cases of myopathy. One could potentially harm quite a few people for each death prevented. This makes it even less obvious that the benefits of statins in primary prevention outweigh their harms.”

    Are you going to warn people off statins like you have for Amber beads when the growing known list of risks out weigh the reducing list of benefits..? Surely a skeptic would follow the evidence, not supposition, theory and hope.

    • ok, final comment.
      1. Could you then please provide references for your statement “From a risk management perspective the occasional harm to individuals actually heightens awareness of risks and overall reduces harm to the populace… It’s called the paradox of ultrasafe systems and is well studied. Make life too safe and you actually increase the risk of harm…”

      obviously we are talking about different things. Further I said “Perceived risk”, that does not mean that the more reckless driving is not compensated for by the improved safety features. It may or may not be.

      2. When did I say Aspirin was a panacea? Ye olde bait and switch plus strawman again Ron?
      We have evidence it works for some indications (eg this review http://www.bmj.com/content/344/bmj.e241.short?rss=1) the fact that the overall picture of risk vs befit is complicated does not negate this. I have not investigated statins…so I have no opinion at this point. Nor am I likely to investigate them. You are now way, way off topic.

  • “Could you then please provide references for your statement “From a risk management perspective the occasional harm to individuals actually heightens awareness of risks and overall reduces harm to the populace… It’s called the paradox of ultrasafe systems and is well studied. Make life too safe and you actually increase the risk of harm…””

    Sure… here one… http://www.ida.liu.se/~eriho/SSCR/images/Amalberti%20_(2001).pdf

    2… you didn’t say it was a panacea… I did… you did say the evidence “Good evidence consists of basic plausibility, coupled with positive trials. We have this for aspirin.”

    Good evidence of what? It kills tens of thousands of people each year?

    The reference you gave is a news clip about a study published elsewhere titled, “Risks of aspirin outweigh benefits in people without cardiovascular disease.” The link is not evidence… it is a news clip… how ironic for a skeptic to not reference the actual study. Nevertheless, the news clip accurately summarises the study and supports my argument…

    We THOUGHT we knew… but when people go and look at the evidence they discover that what was referred to as “Prophylactic aspirin reduces the risk of non-fatal myocardial infarction in people without cardiovascular disease but does not reduce cardiovascular or cancer mortality, and any benefit is offset by the raised risk of bleeding events, shows a large meta-analysis looking at aspirin in primary prevention.

    The authors argue that guidelines currently recommending use of aspirin in primary prevention should be reviewed in the light of their findings. They say that routine use of aspirin for primary prevention is not warranted and that treatment decisions need to be considered on a case by case basis (Archives of Internal Medicine doi:10.1001/archinternmed.2011.628).”

    You said “”Good evidence consists of basic plausibility, coupled with positive trials. We have this for aspirin.””

    Your reference debunks that… it wasn’t good evidence… the good evidence (meta-analysis) has debunked what you have described as ‘positive trials.’ They were positive trials… but they were not good trials and science is in the process of largely debunking them… cheers

  • Ron,

    Rather than draw this to a close, as you implied you were doing, you drag up a whole lot more?! Seeing as you’ve restarted this, let me add two clarifications.

    (1.) This is an argument skeptics drag up when they need a crutch…

    Ha. That wasn’t presented as a ‘crutch’ but as a comparison, or analogy, to the scientists v. non-scientists approach you took for you (not for me). Disagree if you like (I’ll stand by what I wrote), but dismissing it out-of-hand is a cop-out.

    I didn’t offer it as a slight to religion, or whatever, either – just noting the style of argument you’re using.

    (2.) Some of what you have written is difficult to make sense of, as you mix (sometimes conflicting) lines of reasoning, even within the same paragraph or sentence. My own reading of what you have written is that you are trying to convince yourself that anecdotes can be determine if something is working or ‘be evidence for’ something working or not. (i.e. consistent with you writing “of course anecdote is evidence…”)

    You mentioned surveys earlier. I wonder if you are confusing the individual answers within in retrospective surveys and anecdotes.

    I also wonder if you are mixing definitions of ‘evidence’, confusing scientific evidence (which is perhaps better read as ‘evidence for’ or ‘evidence against’, as the case may be) and some wider or looser definition of your own choosing, e.g. one that has any observation or statement being ‘evidence’. In the latter use some observations or statements may have no value at all in resolving an issue; these would not be considered evidence for scientific purposes.

    Later I may take the opportunity to write something explaining the issues with anecdotes. (For my readers, not for you in particular. No promises that I’ll do this – I have other posts in draft I want to publish and to be honest going back over basics doesn’t always appeal to me.)

    In the meantime (and here for you in particular!), and using the scientific sense of ‘evidence’, a key point is that anecdotes, e.g. accounts that ‘it worked for me’, cannot distinguish between different possible causes. As a consequence you can’t use anecdotes (by themselves) to say that ‘something works’.

    Just as one example, you earlier wrote:

    “… I no longer have the headache, so my problem is solved.”

    Sure, but as that’s not evidence that the aspirin resolved the headache. Something else might have resolved the headache. You have no means from an anecdotal account (on it’s own) to sort out what of the different possible things that might have resolved the headache actually did resolve the headache. Thus you can’t on the basis of that anecdote alone claim aspirins resolve headaches (for you or anyone else).

    Similarly, you can’t claim amber beads work based on anecdotes alone.

    (You can’t argue ‘by degree’ either as “not very strong evidence”.)

    I don’t intend to take this further here, as I feel it’s already been covered more that enough.

  • Grant said, “ust as one example, you earlier wrote:

    “… I no longer have the headache, so my problem is solved.”

    Sure, but as that’s not evidence that the aspirin resolved the headache. Something else might have resolved the headache. You have no means from an anecdotal account (on it’s own) to sort out what of the different possible things that might have resolved the headache actually did resolve the headache. Thus you can’t on the basis of that anecdote alone claim aspirins resolve headaches (for you or anyone else).

    Similarly, you can’t claim amber beads work based on anecdotes alone.”

    Grant, life’s experiences are not predicated on scientific ordainment… the way life works is that we progress through a journey of trial and error… if things we try appear to work we retain them… if they don’t we may or may not continue using them depending on cost/enjoyment/comfort/whatever.

    Have you ever wondered why science has become less significant in society… mainly, IMHO, because it has become focussed on the dollar and not on helping humanity… For individuals, “… I no longer have the headache, so my problem is solved.” The skeptic scientist required a study involving thousands of people before they will accept the fact.

    Grant, next time you reach for an Aspirin for pain relief, ask yourself, have any scientific studies been undertaken to prove that a 500mg dose of Aspirin actually works? Well they have, and meta-analysis shows it doesn’t… Even at 600mg 4 people need to be treated for one to have a 50 percent reduction in pain…

  • As I wrote “I don’t intend to take this further here, as I feel it’s already been covered more that enough.”

    Perhaps you could respect that?

    I see that you appear have backed down (to my reading) and not referred to evidence this time. Now it’s “cost/enjoyment/comfort/whatever”. Regards the aspirin jibe, I can’t help noticing that in citing trials you acknowledge that trial data are needed to call if aspirin works or not.

  • It’s simple Grant… don’t reply… as for the aspirin… “trial data are needed to call if aspirin works or not.”

    You keep missing the point… for the individual, the ultimate trial is trial and error, whether one is prescribed a substance by a medical doctor or recommended something by a friend… if a doctor prescribes something and it [appears] to work, for the individual that is identical to a friend recommending something and trying that with [apparent] effectiveness… exactly the same for the individual… both are anecdotes….

  • >both are anecdotes

    Err, not quite, Ron. A substance that gets prescribed by a medical practitioner has been through a very detailed set of tests to both confirm it works and doesn’t cause adverse side-effects. The same thing cannot often be said for a substance recommended by a friend. Your friend, well-meaning though they may be, hasn’t had much experience with the principle of first, do no harm. They are unlikely to have the breadth of experience with the medication that a prescription drug’s makers will have to have had. The drug maker has had to prove very clearly that the effectiveness is real and not apparent. And the risk is that during the time the friend’s recommendation is being taken,if it doesn’t work, the delay will allow the individual’s underlying medical problem to get worse.

  • Possum, you clearly don’t understand how things get registered as medicines or used. Clinical trials mostly o not detect most adverse effects and they are certainly mostly not safe…

    Do you really believe that “The drug maker has had to prove very clearly that the effectiveness is real and not apparent.”

    That couldn’t be further from the truth…

    You have missed what I was saying… Clinical trials do not reveal how a drug will affect an individual… how many times have you heard a doctor say, try this and if you’re no better in a week come back and we’ll try something different…

    A 2010 meta-analysis in the Archives of Internal Medicine, for example, found a small reduction in all-cause mortality in the statin group: 7 per 10,000 person-years of observation (number needed to treat to prevent 1 death in 1 year, 1429) but the small risk reduction was not statistically significant, although it was close.

    The bottom line is that if you assume the reduction was real, 1429 people need to be treated to prevent 1 death in 1 year, so by that measure 1428 of 1429 people may not benefit.

    A large study on the adverse effects of statins in the British Medical Journal calculated the harm caused for several adverse effects of statins in a medium-risk population.

    Women: one case of acute renal failure for every 593 treated; 1 cataract per 40 treated; 1 liver dysfunction per 154 treated ; 1 myopathy per 313 treated.
    Men: acute renal failure, 447; cataract 66; liver dysfunction, 155; myopathy, 106.That’s a lot of harm… commonly prescribed drugs are not harmless, or safe at all.

  • Ron, I think it is you who either does not understand/ who has a very distorted view of how clinical trials.
    Clinical trials do attempt to pick up any problems or side effects with medications and forthe most part they do. Medications with significant side effects tend to wash out in trials and do not proceed to being manufactured for use. Of course what is considered a significant side effect depends on the seriousness of the condition being treated. For example protease inhibitors have some unpleasant side effects however, their ability to extend life expectancy and quality outweighs these effects.

    You are correct in that some side effects only become obvious after the release of a medication for sale (often because some effects only occur in a tiny proportion of the population or only after long term use. This is why most drugs are monitored for several years after they become commercially available.

    With the statins the questions that need to be asked are:
    Do the benefits outweigh these risks?
    Now that these risks have been identified , can monitoring for them pick them up before they become a problem?

    You seem to have a very black and white approach to things, which probably doesn’t mesh very well with understanding science which often involves various shades of grey.

  • Ron,

    “It’s simple Grant… don’t reply…”

    If you’re going to be rude (arrogant) then it wouldn’t be surprising if I chose not to reply. (I have plenty of things I want to do and assisting you is low priority.)

    You keep missing the point… for the individual, the ultimate trial is trial and error

    I am not missing the point you are trying to relate, in fact I suspected you might respond saying pretty much exactly this.

    Before I briefly tackle this, against my better judgement, it would help matters if you would give consideration to the possibility that you are in error. You’ve been down this road on sciblogs before. You seem to tie yourself up in knots over some things through not considering that you might be in error and that others are trying to patiently point your error out to you.

    (Either that or you’re just trolling – I’ll leave that possibility open.)

    I am familiar with the difference between individual and population effects – it would be very difficult to do biology (any branch of it) without being familiar with these.

    I suggest you read right through what I’ve written below before drawing conclusions. You will need to link the ‘obvious’ connecting points yourself.

    if a doctor prescribes something and it [appears] to work, for the individual that is identical to a friend recommending something and trying that with [apparent] effectiveness… exactly the same for the individual… both are anecdotes….

    You have mixed ‘anecdote’ and ‘recommendation’ to confused effect.

    Both are recommendations, one is a recommendation based on trial evidence (from a doctor), the other a recommendation based on anecdote.

    An anecdote is a claim something works based on an individual’s experience. The doctor by contrast is drawing on research results, not just his (her) experience.

    (I am using ‘anecdote’ in the sense that a scientist would. I mention this as I earlier noted that I suspected you might be using ‘evidence’ in a non-science sense.)

    The semantics matters here, as your wording conveys an incorrect idea.

    In the case of the doctor, the prescription is (hopefully!) primarily on the basis of what has been established to work in the population using a controlled trial. The treatment may not work for some individuals, but the rate of this is known (as are the expected clinical outcomes); these can be advised in advance.

    In the case of casual recommendation on the basis of an individual’s anecdotal experience at best the recommendation is based on the proposed treatment working for one person. At worse it is an unfounded recommendation, e.g. a placebo effort or misattribution where something else effected the ‘cure’. No-one can advise the likelihood the treatment might work as there is no basis to be able to do this.

    To illustrate this consider the case of recommending a treatment on the basis of anecdotal experience, setting aside the placebo effect and misattribution for a moment – i.e. assume for the sake of argument that the treatment had genuinely effected a cure, even though in this setting you couldn’t determine which of these were the case.

    The person recommending the treatment could be a rare case of it the treatment working with it not working for the majority of people.

    I realise you want to (somehow) discard population considerations and only consider individual responses to treatment, but you can’t really do that when comparing tested remedies and recommendation based on anecdotal experience as the former already has knowledge of it’s population properties by it’s nature.

    Medicines (of any kind) are ‘balance of risk’ things. One of the risks is that the treatment might not work. One difference with tested medicines is that this risk has been measured – it’s one of the outcomes of clinical trials. You can’t ignore this ‘population’ element when comparing tested treatments with those that have not been, as it is inherently a part of assessed treatments. Your argument rests on ripping out part of what tested treatments are, creating a false comparison.

    Furthermore, your argument overlooks that the likelihood of different treatments working provides a basis for choosing one over another, which naturally is important for patients.

    (I realise you have pointed (speciously) to cases where additional findings after the drug was released changed the balance of risk. That ignores what is typical true of released drugs and ‘overlooks’ that anecdotal recommendations have no measure of likelihood of the treatment working – it is better than there be some measure than none.)

    You also confuse—again—that anecdotal accounts (e.g. ‘it worked for me’) on their own cannot determine if something works. You keep saying this correctly, but then go on to use it incorrectly.

    I’ll be honest and say I feel I have expended far more time than I feel this needs.

  • Ron said, ““It’s simple Grant… don’t reply…”

    Grant said, “If you’re going to be rude (arrogant) then it wouldn’t be surprising if I chose not to reply.”

    RATFL… Grant, you clearly need a new dictionary… :-)

    We live in a democracy… there is no compulsion to reply… I won’t be offended if you don’t. I’d just have to look for entertainment elsewhere. Trials are about statistics… statistics derived from a collection of semi-controlled anecdotes…statistics can never be attained from a trial of one… only experience. Statistics have zero impact on an individual… only experience…

  • Grant says, “(I realise you have pointed (speciously) to cases where additional findings after the drug was released changed the balance of risk.”

    Grant, if you do have expertise in clinical trials you’d realise that many trials are set up and run to make sure positive results are achieved. Many trials, such as a recent influenza vaccine one, are stopped/abandoned and never get published when it is realised they are not going o provide the results wanted. This creates a bias in publication as the ‘positive’ results get published and the ‘negative’ ones don’t… this flows through to meta-analysis when the ‘positive’ results are deemed the gold standard by default.

    Celebrex trials showed increased risk of serious harm, but the data presented to the FDA and others for licensing massaged the data to make the benefits outweigh the harms… and you claim that these findings of harm came AFTER licensing…

    Next… at least 50 percent of drug use is off-license… in other words, they have never been approved for the conditions they are used for… do you dispute that?????

    As I said, statistics NEVER apply to an individual… only experience does…

  • Ron,

    You state that at least 50% of drug use is off license. Could you please provide your source for this statistic?
    You are correct that some studies with less than positive results have been concealed by some drug companies (and typically it is medical scientists who catch them out at it) however, this does not mean that the vast majority of trials are inadequate.

  • Michael… that’s the easiest request to fulfill in a long time…

    Try this for starters…
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC27251/pdf/79.pdf

    Survey of unlicensed and off label drug use in paediatric
    wards in European countries

    2262 drug prescriptions were administered to 624 children in the five hospitals. Almost half of all drug prescriptions (1036; 46%) were either unlicensed or off label. Of these 1036, 872 were off label and 164 were unlicensed. Over half of the patients (421; 67%) received an unlicensed or off label drug prescription.

    More recently,

    Of the 141 children, 108 received 629 prescriptions. Of the 108 children with a prescription, 82 (76%) had at least one off-label or unlicensed drug prescribed; 79% in the NICU, 63% in the general ward and 91% in the surgical ward (P = 0*014). Of the 108 children with a prescription, 26 (24%) received prescriptions for licensed drugs, 71 (66%) received prescriptions off-label and 36 (33%) for unlicensed drugs. Of all 629 prescriptions, 321 (51%) were for licensed drugs, 226 (36%) for off-label and 82 (13%) for unlicensed drugs. International studies showed similar extents of off-label and unlicensed-drug prescribing.

    CONCLUSION:

    This study indicates that the use of off-label and unlicensed drugs is widespread in all the different paediatric wards surveyed and was as extensive as those reported for other countries.

    http://www.ncbi.nlm.nih.gov/pubmed/19650250

    or

    Moreover, among the nine studies reporting the contribution of an off-label/unlicensed drug use to the occurrence of adverse events, the percentage of unlicensed and/or off-label prescriptions involved in an adverse drug reaction ranged between 23 and 60%. To ensure that children are not exposed to unnecessary risks, controlled clinical trials are required.

    http://www.ncbi.nlm.nih.gov/pubmed/16907660

    or

    The off-label and unlicensed classification methods varied, making results difficult to compare. In general, off-label/unlicensed prescription rates ranged from 11%-80%, and higher rates were found in younger versus older patients and in the hospital versus community settings. On the paediatric hospital wards, off-label/unlicensed prescriptions ranged from 16%-62% and most often concerned acetaminophen, cisapride, chloral hydrate, and salbutamol. In the neonatal wards, rates ranged from 55%-80% and often involved caffeine. In the community setting, rates ranged from 11%-37% and the most commonly implicated drugs were salbutamol and amoxicillin. Conclusion:A lack of harmonization between the evidence, the information available to doctors, and its use in clinical practice exists and this is part of the reason off-label therapies are so common.

    http://www.ncbi.nlm.nih.gov/pubmed/15912383

    or

    Some 17 694 prescriptions of 235 different drugs were prescribed during this period. Thirty-seven (16%) drugs and 4445 (25%) medications prescribed were licensed for use in pregnancy; 57 (24%) drugs and 3363 (19%) of the total prescriptions were off-label but considered safe by the manufacturers (e.g. erythromycin, prochlorperazine and clotrimazole); 138 (58%) drugs and 9722 (55%) prescriptions were cautioned or contraindicated by the manufacturer in pregnancy (e.g. cefalexin, magnesium sulphate and nifedipine). After further investigation into the safety of the off-label medications from the FDA safety profile and with the opinion of a multidisciplinary team, we were able to draw up a list of high-risk off-label medicines. This consisted of 38 drugs (16% of total) and 1735 (10%) of the total prescriptions (e.g. lisinopril, diazepam and morphine).

    CONCLUSIONS:

    A significant number of prescriptions being used in an off-label manner at LWH are high risk.

    http://www.ncbi.nlm.nih.gov/pubmed/20636674

    or

    There is no FDA-approved indication for a drug to treat psychosis or agitation in persons with dementia. However, unlabeled (or “off-label”) use of pharmacotherapy, especially antipsychotics, is common practice.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2553721/?tool=pubmed

    or

    A total of 1341 prescriptions for 192 hospitalized patients were analysed. Twenty three per cent of the prescriptions were off-label. Among all patients, 70% received at least one off-label medicine.

    http://www.ncbi.nlm.nih.gov/pubmed/17160629

    Michael… average this out… 50 percent is not a bad average figure… if we added drugs approved for or young children that have never been tested in those age groups the figure would be much higher.

  • Grant, Darcy, Michael, Possum, whoever.

    A simple question. Is it possible to have an unblinded, uncontrolled clinical study of one and draw any conclusions?

  • Ron,

    As I asked my question first regarding your comment about over 50% of drug use being off license, it would only seem fair that you answer my question before I respondto yours.

  • We live in a democracy… there is no compulsion to reply…

    Sigh. Resorting to trolling and twisting words now. I note you have ignored my reply.

    Trials are about statistics […]

    So? (Reads as just trolling to me.)

    Grant, if you do have expertise in clinical trials you’d realise that many trials are set up and run to make sure positive results are achieved. Many trials, such as a recent influenza vaccine one, are stopped/abandoned and never get published when it is realised they are not going o provide the results wanted. This creates a bias in publication as the ‘positive’ results get published and the ‘negative’ ones don’t… this flows through to meta-analysis when the ‘positive’ results are deemed the gold standard by default.

    Ignoring your silly opening jibe (more trolling…) as you say, but try twist, it is the publications that can be biased. There’s no need to load non-publication with conspiracy theory nonsense – your loss, really, as the point can be made without that.

    It is a pity if negative results aren’t published as often as positive ones. I haven’t stats for this (do you?) but as it costs money and time to publish papers, one obvious (and non-conspirational) issue is that they’d have to put staff and money away from other work for little gain – it wouldn’t be entirely in their interests to do spend time & money writing them.

    You’re playing word games with the meta-analysis too; it’s easy to point to a lack of positive trials and note that.

    I have no particular interest in defending other companies, but it’s silly to resort to extraordinary reasoning when more obvious reasons exist.

    Celebrex trials showed increased risk of serious harm, but the data presented to the FDA and others for licensing massaged the data to make the benefits outweigh the harms…and you claim that these findings of harm came AFTER licensing…

    Please quote me writing anything (of any kind) about the “Celebrex trials” – I haven’t.

    Next… at least 50 percent of drug use is off-license… in other words, they have never been approved for the conditions they are used for… do you dispute that?????

    Argumentative; I never raised this topic either.

    As I said, statistics NEVER apply to an individual… only experience does…

    So? Argumentative & travelling in a circle.

    Strictly speaking your statement isn’t quite right; see my previous comment. You can apply a likelihood of an outcome to individuals – it’s done all the time. The example I previously gave was statistics applied to individuals to chose which of several treatments is most likely to work for them (all other things being equal).

    (As an aside I’m astonished to read this from a (self-styled) risk analyst. This is exactly what risk analysis delivers – a likelihood of outcomes.)

    In the end it seems you just seem to want to ‘find’ a means of dismissing trials entirely. It’s silly and talking about other things won’t put right your earlier errors.

  • Michael… have answered it… for some reason the moderator has parked it and not released it…

    Cheers

    Ron

  • “for some reason the moderator has parked it and not released it…”

    If a comment includes several links the spam filters running on most blogs will withhold the comment for manual approval; if so links, it’s not the moderator’s doing (and so no need to accuse of them of anything).

    The number of links to trip the spam filter will differ on different blogs. Some may also trip on the size of a comment, or use of poor language, etc.

  • Grant, why are you so obnoxious? My reply was tagged that it was awaiting moderation… therefore it had been parked by the moderator… if your explanation is correct, (and I have no knowledge about moderating blogs so I accept is as being correct, then the moderator in this case was software… so my statement was totally correct… the moderator had parked my reply….

  • Ron,

    I was just politely trying to clarify for (or remind) you.

    if your explanation is correct, (and I have no knowledge about moderating blogs so I accept is as being correct[)], then the moderator in this case was software… so my statement was totally correct

    No, the moderator is a person as explained below the comment box – “all comments are moderated by the blog author”. Similarly I referred to ‘them’, not ‘it’, in my explanation.

    (For what’s worth, you have previously accused me of withholding comments (!) so I thought you knew that people moderate the comments.)

    Either way replace ‘moderator’ with ‘spam software’ in your wording.

    The message tells you that the spam software has trapped and withheld the comment awaiting the person (moderator) manually approving it.

  • Grant, I find your comments obnoxious… If I was informed that the comment was awaiting moderation, then as someone who is totally ignorant of the protocol of how blogs are run then I can rightly assume that the moderator was with holding the release of my post. It would appear from your diatribe that the moderator is a combination of ‘him’ and ‘it/them/whatever.’ Please don’t try and patronise me… It appears that the note, “Note: all comments are moderated by the blog author” is false… or at least only partially correct… what you seem to be saying is that this skeptics blog should have: Note: all comments are moderated by the blog author and some fancy software that has rules which may park your comment until the human moderator releases it…”

    The difference between your blog and Darcy’s is that you stand guard over every post and censor many… you even attempt to chastise contributors; nay, even debate contributors by cherry picking any un-released posts and arguing your case without the readers being able to see the full argument… Darcy at least is open to criticicm or critical debate… I respect him greatly for that… so it was a complete surprise and disappointment that he [appeared] to censor the comment with requested references… Anyways, I still respect the way Darcy manages his blog…

  • Ron,

    so it was a complete surprise and disappointment that he [appeared] to censor the comment with requested references…

    I tried to politely explain to you that is unlikely to be him; why the need to be rude, be defensive about it or accuse me of things?

    There is more to moderation, and hence why you may still be confused, but seeing as you are determined to be rude and misrepresent me I guess you can figure it out in yourself.

    “is that you stand guard over every post and censor many”, etc.

    Every now and then you lower yourself to trotting out variations of this. You know it is not correct as you have had this explained to you many times but allow me to, yet again, repeat myself:

    Your comments (and no-one else’s) are under moderation because of your persistent rudeness both to me and others. In particular you persist in being rude and ill-treating others after many requests not to. Your approach makes others feel uncomfortable and reluctant to comment. It has been explained to you that your comments are moderated because of how you treat others and that it has nothing to do with differing views, nor has it anything to do with ‘censorship’.

    I have lost count of how many times this has been explained to you.

  • Grant, regardless of your pointless explanations, to someone who is ignorant as to how blogs are administered, and based on what is provided on the Skepticon website regarding moderation, your explanations fall on deaf ears… simply because they are irrelevant…

    Grant, maybe it is your personality, but I find your so-called ‘explanations’ obnoxious and condescending… to me it is as though you expect me to accept what you say simply because you have said it… you seem not to be able to be challenged… and then refuse to engage in facts…

    I asked it it was possible to have a scientific trial of one… everyone headed for the hills and hasn’t answered the question…

    Where am I heading on that? Well, parents are always trialling and erroring things in bringing up kids… often by the time they get to considering amber beads they’ve tried all sorts of mainstream solutions… they want teething gels to work… but often they don’t… so they try this and that hoping they’ll all work… so the placebo effect has every opportunity to work… then they try Amber beads and for many the problem goes away… there is clearly a temporal relationship and the problems gone so they associate the amber bead use with the solution… who could possibly argue with that.

    On the other hand, and this is where I entered this thread… a skeptic warns a parent off because of hypothetical risks… how crazy is that? Or should I say, how paradoxical is that; a skeptic arguing a case based on folk-lore, not evidence…

  • I can’t speak for others but besides having to deal with the rudeness I’m not interested in going back over stuff that for the most part has already been covered.

  • Grant, we live in a democracy… no one is compelling you to respond to anything… but I do smile when I see self-proclaimed skeptics run from a discussion on fact and evidence, rather than nebulous arguments about, “I have said this and that, therefore it is correct… how dare you challenge my man-hood…”

    Again, you are backing away from a simple question… can a clinical trial involve one person…

    My experience as an observer, reader of medical literature, and life experience is that every prescription constitutes a clinical trial… at least when it’s first issued.

    Have a read of this… our top scientist trying high dose vitamin C when scientifically “proven” treatments failed him… I note he’s now reverted to failed ‘accepted’ treatment whilst rejecting failed ‘unaccepted’ treatment…

    Now, discipline yourself… you don’t have to reply… but I suspect you won’t be able to refrain…

  • Ron, you are being a teensy bit disingenuous. You have already experienced and I have explained the difficulties with the blog comments and email notifications.

    As such I only actually noticed your comment pending moderation when I was going about trashing genuine spam. 7 links will be withheld almost anywhere, to a spam filter it’s like waving a red flag.

    I do agree with Grant that your manners can at times be seriously lacking. I don’t ban you because you’re not worth it.

  • Darcy, thanks for clarifying that and confirming that the note at the bottom of the page is partly false and incomplete… “Note: all comments are moderated by the blog author.”

    So let’s come back to your article… your first reference is a puzzle… apart from a skeptic portraying a media story as reason to be concerned, it contains an equally puzzling piece of information:

    “The Ministry of Consumer Affairs says there is a risk children could be strangled or hang themselves.

    It recommends:

    Amber necklaces should be removed from a baby when the baby is unattended, even if this is likely to be for a very short period of time.
    Babies should not be left wearing necklaces while sleeping – whether that is during the day or overnight.”

    If the Ministry of Consumer Affairs was genuinely concerned about the safety of these products then it has a legal duty of care to recall or ban them… it’s done neither… doesn’t that say something????

    Your ref 17 (actually 2nd ref) provides no evidence but references the MCA the url given doesn’t exist now, but is probably this one.
    http://www.consumeraffairs.govt.nz/for-consumers/goods/product-safety/keeping-kids-safe/amber-teething-necklace

    The MCA acknowledges that “Amber teething necklaces: the basics

    Amber has been worn for centuries as a natural remedy for pain relief and to promote fast healing and boost the immune system. Wearing amber in the form of a necklace is a traditional European remedy for teething babies.

    Babies should be supervised when wearing amber necklaces as there is a risk of strangulation and choking.”

    It even gives advice on wearing them, and refers to strangling/hanging as a risk whilst providing no evidence.

    Now here’s the skeptics paradox… if these things have been used/worn for centuries with no evidence of harm… why are skeptics using supposition to try and discredit them?

    The article says, “used correctly under parental supervision I suspect that the likelihood of a tragedy of this kind is low. But not zero[15&16].”

    Refs 15 & 16 provide no evidence whatsoever that amber bead necklaces are harmful… it is simply guilty by innuendo.

    I note that Spain and France have started to ban some of the necklaces on the suspicion that they might cause harm… where does that stop? Your ref 15 highlighted that most strangulation/choking deaths are due to clothing, bedding, and food… Amber beads appear to be on the radar of skeptics who use fairy evidence when real evidence is conspicuous by its absence.

    Ciao4niao

  • Ron, the other reason that amber beads might be on the radar of skeptics is that the claimed mode of action is questionable. Supposedly the genuine beads contain succinic acid, which may have analgesic properties. However, I haven’t seen any evidence that therapeutic quantities are a) present & b) readily absorbed through the skin. Given the claims made for the action of these beads, the onus is on those making those claims to back them up with evidence, not anecdotes. Similarly there is no actual evidence that they ‘promote fast healing’ or ‘boost the immune system’ (& in fact ‘boosting’ a normally functioning immune system is not a particular good idea); just because something has a long history of use doesn’t mean it actually works.

  • Ron, assuming for a moment that people do experience these beads to work for their babies, there could be a number of explanations for this that are are less questionable, as Alison politely put it, than the ones put forward by the manufacturers:

    (this from http://www.baabaabeads.co.nz/about.html)

    “Benefits
    In contact with your baby’s skin, the amber warms and the beads release healing oils to help calm and sooth babies and toddlers through the discomfort of teething.

    Amber teething necklaces are becoming the number one choice as a non-invasive remedy for the side effects associated with teething, such as ear ache, fevers, upset tummies and lack of appetite. They are also understood to have additional positive effects such as boosting the immune system and helping with mild eczema.”

    Leaving aside that there are all kinds of completely dubious and unsubstantiated claims being made, perhaps in the case of teething pain these beads just happen to be the right size, shape and texture to chew on to be soothing. Or perhaps the parent feels that they are doing something beneficial and become less anxious and more calm and reassuring, which could communicate itself to the baby.

    Let’s get this totally clear. Are you supporting the beneficial claims for amber beads in their entirety, as per the extract from the website shown above?? Perhaps you can point us towards a peer-reviewed study on “the release of healing oils” from amber beads?

    As for safety – this is what the website above has to say:
    “Safety
    For safety, each bead has been individually knotted and the necklace will break under stress.”

    Hmmmm. Not reassuring IMHO. I wonder if the Consumers Institute has looked into these things.

  • Alison & Carol

    First, let me state that I fully agree that false claims should be prosecuted… whether that be pharmaceutical medicines, natural health products, motor cars or Amber beads… I have and alway do support enforcement of the Fair Trading Act… and Consumer Guarantee Act for that matter. I have been involved in developing appropriate legislation for Natural Health Products in New Zealand for 14 years and since day one have advocated the prosecution of false claims made by marketing companies.

    With regard to Amber beads, this is an interesting product in that the market has actually been consumer driven… now that it has become mainstream that is possibly changing with new entrants to the market trying to create market share. In other industries I’m involved in it is usually the Johnny Come Lately’s that make the most inaccurate/false claims as they have no understanding of the product’s history or even the product itself. My experience is that they are the ones in it purely for profit… people in the market early for these sorts of products have been mostly just trying to help people.

    With Amber Beads, my observation is that wealthier educated people have driven the consumer buy-in… it is interesting that SUDI deaths (Sudden unexpected Death of an Infant which includes suffocation, strangling and choking) is approximately 1/5th that of SUDI in poor people. There are several factors working there… young mums are associated with much higher SUDI (poor mums tend to be younger that rich mums) and prems have higher SUDI (prems are higher in poor people…)

    As for Amber beads, as I’ve said, Skeptics claim to be evidence-based people… yet they argue that there is no evidence that Amber Beads work, and yet use fantasy evidence claiming that they are/could be dangerous…

    Let’s all it the Skeptic’s Paradox…

  • I don’t really see much of a paradox. The marketing of amber beads has nothing to do with what sceptics think, and launching an ad hominem attack on sceptics is irrelevant.

  • Carol, to address your post directly.

    (this from http://www.baabaabeads.co.nz/about.html)

    This is my opinion without having asked the owners of the website for information to back up its claims… so I’m not saying what is correct or not… (I suspect more not than correct) but if I was the regulator, this would be my response under existing law as I understand it.

    Claim: “Amber products have been around a very long time, and are known to reduce inflammation, fight irritations, infections as it dramatically improves the body’s immunity. ”

    The first part is obviously correct… I would be asking them for evidence to support the therapeutic claims.

    If they had used the words “has been used to” rather than “are known to” I’d be more relaxed. Even if they had said, “are thought to” I’d be more relaxed.

    Claim: “…is made from 100% Baltic amber…” I’d be asking for a certificate of analysis to prove this to be the case. 100 pecent is unequivocal… my guess is that most necklaces sold as ‘Amber’ are in fact some other resin, even synthetic… my studies of relics suggest that if all of the fragments of Jesus Cross that have been sold as souvenirs were piled up they’d equate to a whole forest!

    Claim: “In contact with your baby’s skin, the amber warms and the beads release healing oils…” Again, I’d be asking for the evidence that these beads release oils [for years]…

    That said, the knotting and breaking under stress statements are interesting… I’m not aware of necklaces breaking easily… the knotting makes sense even for maintaining a nice looking necklace.

    Have you studied the evidence or history of use behind Amber beads? One of the more credible sites I’ve come across is this one…
    http://www.ambergallery.lt/en/disp.php?itm=en_museums_3

  • Skeptic’s Paradox:

    Having raised concern about a skeptic using folklore as evidence to caution someone against using amber bead necklaces, and using the Ministry of Consumer Affairs as their ‘evidence’ I put an Official Information Act request into the Ministr of Consumer Affairs asking for copies of their evidence…

    Have just received a near hundred page response of mostly repeated emails… their evidence can be summed up thus:

    Good Afternoon Everyone

    We have thought long and hard on this issue and have had to balance off the potential risks with amber bead
    necklaces and the fact that it would appear that these items have been used for many years (perhaps hundreds)
    without any reported incidents. Contact with our counterparts in other jurisdictions has indicated that these things
    have not be involved in cases of injury or worse.

    So with that being !he case we feel that at this point in time, the best approach is to raise awareness of the potential
    ‘risks and to provide some simple’guidance on the safe use of these amber bead necklaces.

    It would be useful if you could raise awareness of the issue within your organisations and with any organisations you
    network with.

    It [c]an be a tricky judgement call with regard to product safety and what actions to take to mitigate risk.

    Any feedback would be useful – the website material can easily be changed if needs be.

    Hope all is well with you all.

    So there you have it… 200 years with no evidence of harm or accidents anywhere in the world and the skeptics still make claims putting people off… mean while anyone making a claim about any benefits they’ve experienced and they are labelled as woo-ist…

    That’s the Skeptic’s Paradox… They use woo when it suits their argument and reject it when it doesn’t… It’s also known as double standards.

    A question I have for you Darcy… when is something safe enough?

    hildfict grandsona,

  • Darcy, I was simply pointing out the double standards… this has nothing to do with whether something works or not, it has everything to do with skeptics who laud science and evidence using inuendo, folklore and sheer myth to support their ideology when it suits.

    All I’m asking is if you are going to set the bar as scientific evidence, or even evidence of any kind, then that fine… just use it for all arguments… if it’s good for the goose, it’s good for the gander…

    This whole blog begs the question, … when is something safe enough? Can you answer that?

  • So, Darcy, I gather by your silence that you agree that claiming or implying something as fact when the evidence shows otherwise is just plain wrong…

  • Request for information

    OK, here’s your chance to engage in a hunt for real evidence. I’m undertaking three projects at the moment. One for a client in NZ, and two others in the UK and EU countries assessing actual risks due to the use of natural and traditional health products. I’m looking for evidence of deaths over the past 10 years. Wherever possible I verify sources through fist principles, so any evidence is welcome in the first instance.

    What I’m after is evidence of deaths caused by natural health products in NZ, UK, or Europe (or anywhere else for that matter)

    Thanks

    Ron

  • Thanks Alison

    I’d been looking through that. Most are the result of stupidity, death wasn’t caused by the product. eg, Cameron Ayres

    Age: 6 months
    Fulham, west London, England
    Died
    May 1999
    Cameron was born with a rare but treatable disorder, but his parents distrusted conventional medicine. A nurse/homeopath begged them to take him to a doctor, but they refused. He died.

    I just noticed a typo in my last post… I don’t resort to fist principles… I meant first principles… ie, track back to find the original source and try and asses credibility and causality

    What I’m looking for is evidence re the product itself killing people… not the practitioner or parents incompetence, stupidity, or ideology. That said, often one has to look at the full evidence before reaching such a conclusion…

    keep it coming…

    R

  • 2. United States Dispensatory 1926.
    Amber. Succinum. Ambre, Succin, Fr. Bernstein, G.
    Amber is a fossil resin, occurring generally in small detached masses in alluvial deposits, in different parts of the world. According to Goefert, there are about fifty species of extinct coniferous trees of which amber represents the resinous exudation. It is found chiefly in East (Prussia, either on the seashore, where it is thrown up by the Baltic, or underneath the surface. Large deposits occur in some lakes on the eastern coast of Courland, and an extensive bed of yellow amber was discovered im 1854, on sinking a well in the coal mines near Prague. The largest mass of amber yet found weighed thirteen pounds. Amber also occurs in considerable quantities near Catania, in Sicily. It is usually associated with lignite, and sometimes encloses insects and parts of plant tissues.

    In the United States, it was found at Cape Sable, Maryland, by Troost. In this locality it is associated with lignite and iron pyrites. It has also been discovered in the green-sand formation of Martha’s Vineyard, at Harrison-ville, N. J., and elsewhere. The amber consumed in this country is brought from the ports of the Baltic. A deposit of it is said to have been discovered near Rockwood, in Australia.

    It is a brittle solid, generally in small irregular masses, permanent in the air, having a homogeneous texture and vitreous fracture, and susceptible of a fine polish. It becomes negatively electric by friction. Its color is generally brownish-yellow, either light or deep, but is occasionally reddish-brown or bluish from staining with ferric phosphate. It has no taste, and is inodorous when cold, but exhales a peculiar, aromatic odor when heated. It is usually translucent, though occasionally transparent or opaque.

    Its sp. gr. is about 1.07. Water and alcohol scarcely act on it. When heated in the open air, it softens, melts at 286.7° C., swells, and at last inflames, leaving, after combustion, a small amount of ash. Subjected to distillation it yields first a yellow acid liquor, which is a solution of impure Succinic Acid, then a thin yellowish oil together with a yellow, waxy substance which is deposited in the neck of the retort. This waxy substance yields the chrysen of Laurent and the idrialin of Dumas, both of which are hydrocarbons. (Pelletier and Walter, J. P. C., , 60.) As the distillation proceeds, a considerable quantity of combustible gas is given off, which must be allowed to escape. By continuing the heat, the oil gradually deepens in color, until towards the end of the distillation, it becomes black and of the consistence of pitch.

    Tschirch (Harze und Harztbehälter) finds the main constituents to be a Succinoabietic ester of borneol, which is extracted by prolonged treatment with alcohol, and amounts to 30 per cent, of the amber, and the succinic ester of succino-resinol, which is insoluble in alcohol and makes up 70 per cent, of the amber. This latter compound contains a small amount of sulphur (about 0.47 per cent.).

    Amber was held in high estimation by the ancients as a medicine, but at present is never so used. The credulous sometimes employ an amber necklace to keep away infantile ills. The oil of amber is an empyreumatic product which is prepared by destructive distillation of amber. The heat requisite for the complete decomposition of amber cannot be supported by a glass retort; and, in order that all the oil which it is capable of yielding may be collected, the distillation should be performed in a tubulated iron or earthenware retort, which may be placed immediately upon the fire; sand is added to prevent the amber from swelling too much. The oil may be separated from the acid liquor by means of the separating funnel. As first procured, it is a thick, very dark-colored liquid, of a peculiar, strong, empyreumatie odor. In this state it is occasionally employed as a liniment, but for internal use it should be rectified.

    By successive distillations oil of amber becomes thinner and more limpid, till at length, it is obtained colorless. Under the name of Oleum Succini Rectification the U. S. P. of 1870 recognized the oil of amber purified by redistillation with water. For practical purposes, however, the oil is sufficiently pure when once redistilled. As first distilled it has an amber color, sp. gr. 0.903 at 15.6° C., and a boiling point from 170.5°-186.1° C. (Ebert.) When quite pure it is said to be colorless, as fluid as alcohol, of the sp. gr. 0.758 at 23.8° C., and to boil at 85.5° C. It has a strong, peculiar, unpleasant odor, and a hot acrid taste. It imparts these properties in some degree to water, without being perceptibly dissolved. It is soluble in five parts of 90 per cent, alcohol and in all proportions in absolute alcohol, ether, chloroform, carbon disulphide, and the fixed oils. (Ebert.) It appears to be a hydrocarbon of the terpene class. It was officially described as ” a colorless or pale yellow, thin liquid, becoming darker and thicker by age and exposure to air, having an empyreumatic, balsamic odor, a warm, acrid taste, and a neutral or faintly acid reaction. Sp. gr. about 0.920. It is readily soluble in alcohol.

    When mixed with fuming nitric acid, it acquires a red color, and, after some time, is almost wholly converted into a brown, resinous mass of a peculiar musk-like odor.” U. S., 1870.

    Rectified oil of amber was employed in amenorrhea, hysteria, and whooping cough. The dose is from five to fifteen minims (0.3-0.9 cc.), diffused in some aromatic water by means of sugar and gum arabic. Externally applied the oil is rubefacient.

  • Alison, your example really is fascinating…

    I’ve been working trough the cases… most of the deaths have no relationship to the use of anything… they are caused by ignoring advice. A number of cancer and aids cases may well have been terminal.

    This case highlights the importance of applying what all skeptics should apply, first principles.

    Mahendra Gundawar & 6 others

    Chandrapur, India

    Three dead, seven blinded
    December 14, 2007
    Gundawar was a homeopath who sold a new tonic, recently introduced on the market, that was supposed to reduce fatigue. He himself died, along with several of his patients. Several others were blinded, and other cases occured elsewhere in India. Read more & more

    I still haven’t reached the source of the Nile, but I’m getting there…

    Have a read of this… it seems to me that this was a case of methanol poisoning… maybe x2 sources… What do you think?

    Will dig to see if I can get closer to the source.

    As per the information, on December 12, Pravin Khedkar and his two friends — Prashant Lakhe and Dinkar Bedarkar — allegedly consumed ‘Sati-F’ with alcohol. After consuming lethal mixture, the trio fell unconscious and was rushed to a hospital in Dhantoli. Khedkar died in the course of treatment, while Lakhe and Bedarkar lost their eyesight. Khedkar is said to be died of cardiac arrest, respiratory and nervous system failure.

    During investigations, the police learnt that Dr Deo had prescribed the homoeopath tonic to him. Subsequently, police raided Deo’s clinic and arrested him on the charges of negligence. The police also sent the samples of those tonic to forensic laboratory for medical analysis.

    ‘Sati-F’ tonic was made by an Indore-based pharmaceutical company and contains methyl alcohol as a major component. It is generally prescribed for neurasthenia, fatigue, sleeplessness and as an appetiser in convalescence.

    In past, there have been cases of alcoholics consuming tonics containing medicinal alcohol for a kick. In this case the combination of liquor and the tonic probably proved dangerous, as per the doctors.

    http://articles.timesofindia.indiatimes.com/2008-01-10/nagpur/27761668_1_tonic-pravin-khedkar-cardiac-arrest

  • Ron,

    I meant first principles… ie, track back to find the original source and try and asses credibility and causality

    To draw from first principles is to draw from irreducible elements, as someone might do in physics or mathematics (or in pure philosophy). In short, that expression does not say what you seem to think it says.

    What I’m looking for is evidence re the product itself killing people… not the practitioner or parents incompetence, stupidity, or ideology.

    Delays in sound treatment, incompetence, malpractice, etc., are factors in patient outcomes.

    At the very least you would have to note prominently that you left these factors out and that these omitted elements will be factors in the overall outcomes from using these the products.

    Are you similarly excluding illness? Increased illness often means a shift to conventional treatment (e.g. at a hospital). By omitting consideration of illness, an analysis would ‘overlook’ all cases where a delay in proper treatment led to the patient becoming less well.

    The reason I mention this is that I see too frequently ‘studies’ that ‘examine’ natural remedies looking only at deaths and not at cases, which can lead to quite distorted conclusions regards safety. (You have not stated the aim of this study, but I presume it is safety.)

    This could, for example, be from use of a worthless ‘natural remedy’ allowing an illness to progress, or from a ‘natural remedy’ harming the patient, with the patient being moved to conventional care before the harm had progressed to fatal harm. (Not to mention that recovery in these cases would be in the hands of conventional treatment. Note these are an increased burden on the medical system -they’re not cost-free.)

    Consider for example the Indian case you cite; two patients recovered after treatment in hospital, but clearly all three suffered from the same poisoning – if you ‘overlook’ illness you undercount badly and score only one-third of the actual poor outcome.

    I believe I am correct in saying that in your past you have acted as a representative for the natural remedy industry in New Zealand. I would hope has been disclosed to your clients and will be disclosed in this analysis.

    In the interests of caution, I would point out that it would be incorrect to cite a lack of evidence presented here as evidence of a lack of evidence.

    it seems to me that this was a case of methanol poisoning […] What do you think?

    Never minding what I or others think, the article is telling you that methanol was part of the solvent used in the homeopathic remedy, and attributed the deaths to the homeopathic remedy.

    Finally, isn’t this wildly off-topic?

  • Such striving for first principles in medicine is not new; it’s been around since Hippocratic times… you know the guy who said doctors should first do no harm?

    Why you you suppose that first principles only apply to physics or maths????? In my first lecture in 1970, my lecturer said, in medical science you can’t trust too much… if you want to mack sure the article is accurate, go look at the references…. that’s why they’re there. She said and if the reference refers t nother reference then check that out and keep going until you get to the original source. She said the medicine was famous for it chinese whispers when it came to dogma de jour… That lecture shaped my thinking ever since… call me a skeptic if you like.

    I asked for evidence… Alison gave me at best anecdote… one click on one reference revealed that the problem was almost certainly methanol poisoning… not homeopathy…

    Anyways, I’ve emailed the author of th article to see if I can get any more info…

    Coming back to the first principle of medicine… so-called… It says, “first do no harm…’ not, ‘first do good.’

    If no significant harm is done, then what the problem… if some harm is done, then that is when you look at benefits…

    And it is very much on topic…. Darcy warned someone off a product based on folklore… no doubt this blog would be covered in skeptic’s drool if a woo0ist had advised someone to use a product basd on folklore…

    It’s called the skeptics paradox… double standards, or worse…

    I’m looking for evidence of harm… if I find it then I’ll look for evidence of benefit to look at the risk/benefit ratio…

  • one click on one reference revealed that the problem was almost certainly methanol poisoning… not homeopathy
    Isn’t this being a little disingenuous? The patient took a ‘homeopathic’ remedy – which happened to contain methanol at dangerously high levels. The remedy & the homeopath who prepared it are hardly exempt from blame. It’s an example of how using homeopathy actually did harm.

  • Hi Ron,
    let us natural medicine people just understand that the whole body of Homeopathy lies trampled in the dust because of a dose of methanol (Sob)

    An amber bead or a piece of smoothed out amber will need a minimum of 86% ethanol to put the bead into solution and in fact to be sure I would personally use 90%

    I hardly feel that sucking on a bead is going to do the child any harm and if it does could someone produce the bodies as proof?

  • Ron,

    “drawing from first principles” ≠ “tracking back to the original source”

    These are two different concepts.

    Yes, tracking back to the source can be good practice, but as I’ve tried to explain “drawing from first principles” is a different thing.

    A suggestion: when I or others point out an error like this, rather than hastily reply defensively you’d be wiser to go and check to make sure you understand why you were called out. I don’t usually recommend wikipedia for a source, but you could try there, e.g.: http://en.wikipedia.org/wiki/First_principle

    On that note, I note you have not acknowledged the errors I pointed to in examining this data in the way you seem to be doing. You seem to be avoiding the main points of my comment. The approach you seem to be taking will not assess the safety of natural remedies. (If anything you appear to be approaching this to confirm your own beliefs, rather than test them – that’s not sound analysis.)

    one click on one reference revealed that the problem was almost certainly methanol poisoning… not homeopathy…

    See my previous comment. It seems you are trying rather hard to “wave away” what you don’t want to see. This looks dangerously like ‘massaging’ the data to suit a particular conclusion or favoured viewpoint.

    I have no idea where this “work” is to be used. Perhaps it’s some rag that gets little attention, in which case “what the hey”. It sounds like pretty poor work from where I’m standing, though. (I’m being very polite in writing that.)

    And it is very much on topic….

    Why the excuses? This call for evidence for your “analysis” has nothing whatsoever to do with Darcy’s post – you’re using another person’s forum as a platform for your own interests.

    It’s called the skeptics paradox… double standards, or worse…

    This is silly. Repeating accusations doesn’t make them right.

    If no significant harm is done, then what the problem… if some harm is done, then that is when you look at benefits…

    and

    I’m looking for evidence of harm… if I find it then I’ll look for evidence of benefit to look at the risk/benefit ratio…

    Bizarre. It’s upside down. Look for benefits first; if there are none, you have a non-remedy. Furthermore the benefit/risk ratio will have be zero or negative. In the case of homeopathy there cannot be any benefits, essentially by definition, so for all practical purposes you can stop from the onset.

    I can’t help but think you are approaching this upside down to including natural remedies that have no effect as ‘remedies’.

  • Grant, I love the way you repeat over and over statements such as, “A suggestion: when I or others point out an error like this, rather than hastily reply defensively you’d be wiser to go and check to make sure you understand why you were called out.”

    I’m not an idiot… and you are not the font of all knowledge… and neither is wikipedia…

    In philosophy, a first principle is a basic, foundational proposition or assumption that cannot be deduced from any other proposition or assumption. That’s why it applies to tracking a statement or proposition back to its source… to find out if it has a foundation.

    A first principle is one that cannot be deduced from any other…. so if someone makes a statement as fact, using first principle, one tracks the statement back to its source to see if it is valid; to see if it has an evidential basis…

    Go read your own reference before you start accusing people of ignoring your obvious wisdom! The meaning of words change over time… I was brought up in an era when gay meant happy… you’re probably too young to have lived through that less than enlightened era, so please have some compassion for those of us who are so obviously ignorant of the nuances of language.

    RL said, I’m looking for evidence of harm… if I find it then I’ll look for evidence of benefit to look at the risk/benefit ratio…

    GJ said, Bizarre. It’s upside down. Look for benefits first; if there are none, you have a non-remedy.

    mmmm… me thinks you simply do not understand that first principle of medicine… first do no harm… in case you are not aware, things are (usually) only banned when there is evidence of harm… you obviously are unaware of the process of testing new drugs… phase I studies test for harm… phase II effect… Phase III effectiveness….

    Before you get all pious and start accusing people you should make sure you actually understand what you are talking about… especially when you claim to be a skeptic!

  • Your persistent ‘thing’ of playing word games in response to having errors pointed out is bizarre and, to be frank, always results in you being quite rude to others, and the insinuations are childish.

    The two are different concepts. An original source is not a first principle – the two are different things.

    Seeing you’re back to tit-for-tat, as you have so often resorted to, I’ll leave you with your views on that. I can’t be bothered with your rudeness and the games you want to play.

    More to the point, you appear to me to be avoiding the main points I were making, that the data analysis you suggest will not measure safety in the way you imply.

    me thinks you simply do not understand that first principle of medicine… first do no harm… in case you are not aware

    Ignoring these childish insinuations you seem so fond of, data analysis is not ‘doing medicine’ as you have shifted to here.

    This does show, however, and “yet again” that there is no having a conversation with you. In the end you invariably resort to word games and trolling. The issues I pointed to about your “analysis” are sincere. If you don’t want to tackle my points sincerely that reflects on you.

  • Alison, you say, “The patient took a ‘homeopathic’ remedy – which happened to contain methanol at dangerously high levels. ”

    But how can you make such a definitive statement from the evidence? You can’t… don’t forget they may also have been binge drinking… methanol… which may have been methanol…

    Your link links to this

    http://whatstheharm.net/herbalremedies.html

    Skim down to Norman Ferrie

    Age: 64
    Invergowrie, Perthshire, Scotland

    Died (liver failure)
    July 3, 2004
    Norman suffered from arthritis, and decided to take an herbal remedy (glucosamine) to ease his pain. Only 2 months after starting, he died of a severe allergic reaction.

    Firstly, glucosamine is not a herb… factual error… secondly, the coroner/sheriff ruled that there was no evidence that glucosamine caused his death… if skeptic accepts anecdote as evidence of harm, then what is your take in this?

    http://iansvoice.org/default.aspx

    Can I ask you a question… in terms of scientific evidence, which of these two sites is more scientific?

    http://whatstheharm.net/homeopathy.html
    http://iansvoice.org/default.aspx

  • Alison, a skeptic wouldn’t jump to such a conclusion as, “which happened to contain methanol at dangerously high levels…. It’s an example of how using homeopathy actually did harm.” without the evidence… do you know the results of the test? Do you know what the alcohol was?”

    Now, using you logic, Vaccines are dangerous and kill people… but I suspect you’d deny that? Take a look and read…

    http://iansvoice.org/default.aspx

  • Well, my son was a miserable little monster when his bottom two teeth cut. Three werks of fussiness, crying, and being soaked in drool were some of the worst of my life. I purchased a baltic amber teething necklace on the advice of about 50 moms (no exaggeration) and the only reason I knew his two top teeth had come in two months later was because he bit me. Since one cannot be susceptible to the placebo effect if one doesn’t know he’s being treated for something, I’m going to go with the amber being effective.

    • This, alas, fall into the category of anecdote – it’s a testimonial, not good evidence. I’ve seen testimonials regarding all sort of things that can’t possibly work, they are the lowest form of evidence.

      Now please note what I say carefully, I have never said that the beads don’t or can’t work. What I have said is that plausibility is against them and that there is no good evidence to show that they do work.

      With regard to the placebo effect (which I don’t say is occurring here) people may be interested to read my follow-up post, here.

  • It scares me someone can casually say what harm can it do for a baby to chew on a bead. What harm indeed the bead may become inhaled into the lung causing irreparable damage and lifelong illnesses if not death. The bead may become lodged in the windpipe making it practically impossible for a first aider to dislodge or parent or who ever. People need to wake up the evidence is not there the amount of heatr it would take to heat amber is? Is the child’s body even warm enough? Surely as parents we would see the risk but then surely as parents we would know not to leave our infant in a car for hours on a hot day. I have also now heard young African children wear beads so that must make them safe …………

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