In May this year, One News ran a story on a US skincare company releasing what it was calling “drinkable sunscreen”. Around the world, various sceptical websites also picked up the story, such as Doubtful News and Neurological Blog. The message was roughly that a “drinkable sunscreen” is a cool idea that isn’t entirely implausible, but that this company’s “Harmonized Water” product seemed to be entirely ineffective pseudoscience.
I tweeted about the story from One News, noting that the article seemed like little more than free advertising of what really seemed like quite a dangerous product. Thomas Lumley, a professor of Biostatistics at Auckland University who runs the great blog Stats Chat, picked up this story and wrote about it there: Revolutionary new advertising success
He also pointed out to me on Twitter that this company, Osmosis Skincare, has a New Zealand distributor, and that they have a website. Here’s that website’s Harmonized Water product listing page. If you look at it now, you’ll luckily see that although it does list a large number of “Harmonized Water” products that almost certainly don’t do what is claimed about them, it does not include any products that claim to be able to be used as “drinkable sunscreen”. The reason for this is that the Advertising Standards Authority has upheld a complaint I lodged against their online advertisements for these products.
As part of submitting this complaint, I took screenshots of the advertisements. I’ve embedded these below so you can see the claims as they were originally made:
My full complaint is available for you to read, as well as Osmosis Skincare’s response and the ASA’s decision, on the ASA’s website. I encourage you to read it in full, but I’ve put some of the highlights in this article.
The gist of my complaint was, as usual, that I don’t believe the advertiser has any evidence to support the claims they were making about the product. I also argued that the advertisements “abuse scientific terminology in a way that seems intended to exploit consumers’ lack of knowledge”.
In my complaints I generally also argue that making misleading or unsubstantiated therapeutic claims is socially irresponsible, and when the ASA upholds my complaints they tend to agree. In this case though, I felt the advertiser went a step further:
The New Zealand Cancer Society website writes, on the dangers of unprotected sun exposure:
New Zealand has the highest rate of melanoma in the world, and other skin cancers are also very common. You can help reduce your risk of skin cancer by using sunscreen the right way.
By misleading consumers into believing they are protected when in fact they very likely are not, this advertisement is likely to increase their risk of contacting [sic] melanoma due to unprotected exposure to UV radiation from the Sun. This misrepresentation is highly irresponsible.
Soon after submitting my complaint, I saw that the British Association of Dermatologists had published a response to these products. It’s worth reading in full, but here’s a highlight:
We want to make it immediately clear at this stage, the formulation is 100% water and, as far as our experts are concerned, it is complete nonsense to suggest that drinking water will give you a Sun Protection Factor (SPF) of 30.
They also contacted Osmosis Skincare to ask what the “scientific basis” for their claims was. The full message and its response are available at the link. Osmosis Skincare confirmed that the product is 100% water and didn’t provide them with any evidence to support their claims.
In Osmosis Skincare’s response to my ASA complaint, they said they’d made some changes like calling the products “UV Neutralizer” instead of “UV Protection”. How they thought this made it acceptable is entirely beyond me.
They also said the following:
This is a new type of technology being used in this way and Head office can reference the internal research they did showing the product to be effective, but their independent clinical trial isn’t until the 28th of June, whereby they will put 30 people outside for one hour in San Diego, CA at noon supervised by a plastic surgeon. So perhaps we have some extra time to submit these results? We are told our UK distributor will also be conducting their own study. We have been selling this in New Zealand for the past couple of years without any issue.
I can’t say I was surprised to read that the “independent clinical trial” they were planning on would have a tiny sample size of 30 and be without a control group, let alone adequate randomisation and blinding.
DermNet NZ has a page on sunscreen testing and classification that says sunscreens in New Zealand are now tested in vitro. That makes perfect sense to me, partly because in vivo testing for something like sunscreen seems like it would likely be unethical (which is mentioned on DermNet’s page) and partly because the difference between sunscreen and no sunscreen – blocking UV radiation when placed on the skin surface – would presumably be much easier to test and measure than more complex medical outcomes.
I would also imagine that the placebo effect will not have a strong influence here, but that’s only a guess and I have no evidence to support that. However, a study like this would still need a control group to be able to tell how much of a difference the product made, and in such a design it would still be more rigorous to randomise participants and blind both them and the researchers to eliminate potential sources of bias.
It will be interesting to see if this trial is published, and what its methodology and findings are. Especially since they’ve publicly reported beforehand that an independent trial was due to be done.
The Advertising Standards Complaints Board seemed to agree with my complaint on all its main points. To quote the summary of their decision (which they note is not the decision itself, but the whole decision is available on their website):
The Complaints Board acknowledged the changes made by the Advertiser, however, it said that the amended advertisement was still misleading, abused the trust and exploited the knowledge of the consumer by stating that the product offered sun protection using scientific terminology without adequate substantiation. It said this was exacerbated within New Zealand as sun exposure can have significant negative effects in comparison with other countries.
Accordingly the Complaints Board said the advertisement was in breach of the Therapeutic Products Advertising Code and did not observe a high standard of social responsibility effecting a breach of the Therapeutic Products Advertising Code.
In their full decision, the complaints board noted that although Osmosis Skincare alluded to evidence, they didn’t actually provide any. They also raised the valid point that their US-based clinical trial’s “application in a New Zealand context considering the strength of the sun was questionable”. They also said that:
the advertisement was likely to abuse the trust and exploit the knowledge of the consumer by stating the product offered sun protection “30 x more than normal” and used scientific terminology like “isolates the precise frequencies” without adequate substantiation.
I have to applaud the complaints board here for taking a stand against this sort of language, which abuses scientific jargon in a way that makes the advertisement sound more authoritative than it should. As they would have been able to uphold the complaint on the sole basis that the claims are unsubstantiated, I’m glad they also decided to take on this language as well.
To their credit, Osmosis Skincare has quickly removed the advertisements for these products entirely from their New Zealand website, even before the ASA’s decision was released. However, as you’ll have seen if you clicked on the link to Osmosis Skincare’s “Harmonized Water” product listing page at the top of this article, they still sell a number of these products that also seem to make unsubstantiated therapeutic claims.
All of my complaints about misleading healthcare claims, including this one, are now submitted under the Society for Science Based Healthcare. If you’re interested in these complaints, have a look at their website. You can also keep up to date with their complaints on Twitter @SBHNZ.
Every month there’s a meetup at Juice Bar in Parnell, Auckland, of the Auckland Skeptics in the Pub group. This month, I was asked to be the speaker. The topic of my talk was the regulation surrounding medical advertisements in New Zealand, and what can be done by members of the public to counteract some of the misinformation out there.
I’ve shared the slides for my talk, and you can see them embedded below. Please have a look at the speaker’s notes too, as I have some relevant quotes and links in there:
Pharmacies are an integral part of the healthcare industry. They provide a valuable decoupling between the doctor you see for an examination and potentially a prescription, and the institution that stands to profit from the medicine you pay for. Without this separation, there’s the potential for a conflict of interest where the physician examining you would profit more from giving you a prescription than they would from telling you that you’re fine and sending you on your way.
I’m not trying to imply that bias has been entirely removed from the healthcare industry, but having independent pharmacies fill prescriptions from doctors does help. You unfortunately don’t generally see this sort of separation of interests in the alternative healthcare industry, where practitioners who claim to know the secret true cause of your “dis-ease” or “lack of wellness” (blocked chi, misaligned chakras, vertebral subluxation complexes etc.) also just so happen to also offer the solution; for a price, of course.
This association between pharmacies and doctors leads pharmacies to be respected and trusted institutions. After all, we expect the person behind the counter – the pharmacist – to not only be able to dispense the correct amount of the correct drug we’ve been prescribed, but also to have a sufficient understanding of how it works so they can advise us on such things as precautions we should take. “Do I need to take this with food?”, “Will this make me drowsy?”, and so on. However, pharmacies also need to be profitable to work as a business, which is why you’ll also be able to find all sorts of non-prescription products for sale such as cosmetics and non-prescription medication. Because of their involvement with the healthcare industry and respected status, it’s important that these other products sold in pharmacies also be reliable, and they should not be stocked without good reason. Essentially, pharmacies should be held to a relatively high ethical standard.
In New Zealand, there is a crown entity known as the Pharmacy Council that is established by the Health Practitioners Competence Assurance Act 2003. The Pharmacy Council is responsible for duties such as registering pharmacists and setting standards of conduct, although in cases where pharmacists require disciplining that is carried out by another crown entity also established by the Health Practitioners Competence Assurance Act: the Health Practitioners Disciplinary Tribunal. In order to ensure that pharmacists are held to an appropriate ethical standard, the Pharmacy Council has developed a Safe Effective Pharmacy Code of Ethics, published in 2011, which is publicly available on their website.
In my opinion, this Code of Ethics is an admirable document, and I’m encouraged by the idea that New Zealand pharmacists might be held to such an appropriate ethical standard. For example, it defines its principles to be the following:
AS A PHARMACIST YOU MUST:
- Make the health and well-being of the patient your first priority.
- Promote patient self-determination, respect patients’ rights, autonomy and freedom of choice.
- Use your professional judgment in the interests of the patients and the public and promote family, whānau and community health.
- Show respect for others and exercise your duties with professionalism.
- Actively seek and apply contemporary pharmacy knowledge and skills to ensure a high standard of professional competence.
- Act in a manner that promotes public trust and confidence in pharmacists and enhances the reputation of the profession.
- Practise in a manner that does not compromise your professional independence, judgement or integrity, or that of other pharmacists.
The Code of Ethics goes on to expand on each of its principles in seven sections. I encourage you to read through the document, as it’s interesting to come to a better understanding of the ethical standards to which New Zealand pharmacists should be held. For example, part 2.4 regards the patient’s right to informed consent:
YOU MUST… Explain the options available to patients and the public, to help them make informed decisions. Make sure the information you give them is impartial, relevant, up-to-date and independent of personal commercial considerations.
The section of this Code of Ethics which I found most interesting, as well as most encouraging, is section 6.9 (emphasis mine):
YOU MUST… Only purchase, supply or promote any medicine, complementary therapy, herbal remedy or other healthcare product where there is no reason to doubt its quality or safety and when there is credible evidence of efficacy.
Although it is written here in this code, most people who use a pharmacy in their day to day lives aren’t aware of it. Instead, it is more like an unspoken assumption: if it’s sold in a pharmacy, then surely it’s legitimate, reliable, and effective. And of course, this should be the case – if there is no credible evidence of efficacy then an ethical institution should neither promote nor supply it. The Pharmacy Council has also published Advertising Guidelines, and its General Principle 7 reiterates this point (emphasis mine):
Any medicine, complementary therapy, herbal remedy or other healthcare product associated with the maintenance of health must have credible evidence of efficacy and safety (Code of Ethics 2011: 6.9). Health claims for complementary therapies or herbal remedies must be able to be substantiated and must not breach the Medicines Act with regard to therapeutic purpose.
Unfortunately, it appears many New Zealand pharmacists do not abide by these rules. I was unfortunate enough recently to discover an instore display in an Auckland pharmacy for a product called “NO-JET-LAG”. While I was in the pharmacy, I took a photograph of this display with my phone:
As you can see, this display makes some strong and explicit claims regarding the effect of the product:
It Really Works
Homeopathic Jet Lag Prevention
The five homeopathic remedies listed below are the active ingredients in No-Jet-Lag.
Arnica Montana 30C (Leopard’s Bane), Bellis Perennis 30C (Daisy), Chamomilla 30C (Wild Chamomile), Ipecacuanha 30C (Ipecac), Lycopodium 30C (Clubmoss)
If you’ve read my post on homeopathic dilutions, you may recall that “30C” means the ingredient has been diluted by 1/100 30 times. That is a mind bogglingly large dilution. If you were to end up with just one single molecule of the original ingredient at the end of that, you’d have to start with 1060 molecules of it.
That’s a hard number to visualise though, and it’s hard to think of things in numbers of molecules, so let’s compare it to something more familiar. The Earth is made up of roughly 1050 atoms, so the amount of ingredient we’d have to start with would be roughly 10,000,000,000 (yes, that’s ten billion) times bigger than the planet. Even the Sun only has around 1057 atoms in it: still 1,000 times fewer than the number we’d need. Needless to say, after the dilution is done there is absolutely no amount of any of these ingredients remaining in any “NO-JET-LAG” pills.
Knowing this, it seems rather implausible that they’d be effective for anything at all, let alone specifically preventing jet lag, but all the same it’s best to look at the evidence. The manufacturer’s website has a Scientific Test page. Now, given that I have spent some time writing up a complaint to the Advertising Standards Authority because I don’t think this evidence even comes close to being enough to substantiate the claims made about these products, I don’t particularly want to write out the same arguments all over again. So I am going to make this complaint public. While the first section specifically regards the instore display I saw in Parnell Pharmacy on the 2nd of July, the other sections are about the evidence regarding “NO-JET-LAG” and the ethical implications of my complaint, and these sections apply to all of the many New Zealand pharmacies that promote and supply this product.
This complaint should be read with the following in mind: Assuming I am correct regarding the evidence for this product, I think the appropriate response of pharmacies stocking it would be to immediately remove it from their stock, and to apologise to the customers they have failed to protect. The Code of Ethics for an industry is the absolute minimum acceptable level of ethical behaviour, and it appears for all the world that many New Zealand pharmacies haven’t even been doing that.
(Note that the original complaint was in plain text but I’ve edited it to add appropriate formatting here)
An instore advertisement for “NO-JET-LAG” in Parnell Pharmacy contains misleading therapeutic claims, in violation of the Therapeutic Products Advertising Code Principle 2. Because these claims are misleading, the advertisement also fails to observe the high standard of social responsibility required of it by the Therapeutic Products Advertising Code Principle 3.
The advertisement contained the following text (also see image attached):
It Really Works
Homeopathic Jet Lag Prevention
Natural | Effective | No Side Effects or Drug Interactions
The Perfect Travel Companion
The product packaging, also visible from the front in the attached image, displayed this text:
The Perfect Travel Companion
Long Haul, for flights longer than 7 hours
Homeopathic Jet Lag Prevention
The strong and absolute therapeutic claims “Homeopathic Jet Lag Prevention”, “Effective”, and “It Really Works” require robust substantiation. Although it may not fall within the ASA’s jurisdiction, it is important to consider the advertisement within therapeutic context implied by its placement on the front desk of a pharmacy and by the prominently displayed name of the product “NO-JET-LAG”.
As far as I can tell, the only substantiation offered by the manufacturer is a small (n=19) pilot study that does not appear to have been published in a peer-reviewed scientific journal. This pilot study can be found on the manufacturer’s website: http://www.jetlag.co.nz/jet-lag6.html
Although it is not stated in the study, the POMS scale on which subjects rated their level of “fatigue-inertia” (the only measured end point reported to have statistically significant differences between control and experimental groups) is measured on a scale from 0-28. In this context, the mean difference between control and experimental groups of 3.84 is less impressive than in the context of a smaller scale that seems a sensible conclusion from reading the study, given that the y-axis of the bar chart only goes from 0-12. The non-significant measure of “vigor-activity” is similarly displayed on a chart with a y-axis from 0-22, whereas the actual scale is from 0-32.
Also, the POMS scale includes 6 measurements, yet there is no mention in the study of having corrected their statistical analysis for multiple measurements. Assuming that no adjustment for this was made, as none is mentioned in the study, this means that although one of the 6 measurements purportedly reached statistical significance it is fairly likely to have been a false positive. From random chance alone, the chance that 1 out of 6 measurements would reach this level of statistical significance is approximately 1/4 (26.5%). A relatively conservative method of correction, the Šidák correction, would alter the required p-value for statistical significance in this case to 0.0085. However, the measurement’s p-value of 0.026 doesn’t even come close to crossing below this threshold and would therefore not normally be considered statistically significant.
The study also brings the effectiveness of its participant blinding measures into question with the following statements:
When asked if they knew whether they had taken the remedy or the placebo, they said that at the time of arrival in Germany the whole party all felt very tired but most were already fairly sure which treatment they had taken.
On the outward journey, of the 19 taking part 13 (68%) correctly guessed whether they had taken the placebo or No-Jet-Lag. Of the others, three did not know and three incorrectly assigned themselves to the wrong group.
On the return journey, two were incorrect, three did not know and 14 (74%) correctly guessed.
Also, one of the study’s authors was the Director of Research at Miers Laboratories, the manufacturer of this product. It is not clear how much influence the manufacturer had over the study design or operation, or to what extent it may have been funded by them.
So, as far as I’ve been able to find, the only evidence that could be used to support the very strong claims made on this advertisement is a small unpublished non-independent pilot study with questionable blinding that does not appear to have reached the threshold for statistical significance. In short, the claims do not appear to have been adequately substantiated, and should therefore be considered to violate the Therapeutic Products Advertising Code Principle 2.
Although it falls outside of the ASA’s jurisdiction, I feel it would be appropriate to briefly discuss the Pharmacy Council’s Safe Effective Pharmacy Practice Code of Ethics 2011. Section 6.9 of this industry code of ethics states that:
YOU MUST… Only purchase, supply or promote any medicine, complementary therapy, herbal remedy or other healthcare product where there is no reason to doubt its quality or safety and when there is credible evidence of efficacy.
I sincerely hope that the manufacturer of this product has high quality rigorous scientific evidence that substantiates the claims made about this product hidden away somewhere and that, despite the fact that the only evidence they publicise on their website is the tiny low quality pilot study I discussed above, they have shared this evidence with every single one of the many New Zealand pharmacies who stock their product. If not, and things really are as they seem, then this would be an appallingly widespread violation of perhaps the most important part of the Pharmacy Council’s Code of Ethics.
The Accident Compensation Corporation (ACC) is part of the healthcare system in New Zealand. To quote themselves on their purpose, they provide “comprehensive, no-fault personal injury cover for all New Zealand residents and visitors to New Zealand”. To put it simply, if you hurt yourself in an accident in New Zealand, ACC will likely pay for all treatment you require to recover from that injury.
They are not strictly part of the government, but they are a Crown organisation set up via the Accident Compensation Act 2001, and they are controlled directly by the government through an ACC minister. At the time of writing, the current ACC minister is Judith Collins. The ACC is funded publicly through various avenues, including levies on people’s earnings.
Please can you tell me, for each of the last 10 years, how much the
ACC has paid out for each of the following services:
On the 20th of May 2014, the ACC responded to Gold’s OIA request with this information:
The following table shows the total amount (in dollars, excl GST) ACC has paid under Regulations for Osteopathic, Acupuncture and Chiropractic services for the last 10 years.
Financial Year $ cost Osteopathy Acupuncture Chiropractic Total 2003/04 6,210,642 4,424,458 8,056,875 18,691,975 2004/05 6,767,849 5,452,119 8,007,011 20,226,979 2005/06 7,237,766 5,954,239 7,947,342 21,139,347 2006/07 8,038,676 7,616,042 8,734,453 24,389,171 2007/08 10,082,351 12,392,494 12,007,580 34,482,415 2008/09 10,945,880 15,761,415 13,173,902 39,881,197 2009/10 10,470,269 15,605,042 11,804,095 37,879,406 2010/11 9,802,401 16,225,902 10,832,912 36,861,215 2011/12 10,029,446 16,958,808 11,654,292 38,642,546 2012/13 10,964,806 19,961,329 12,312,832 43,238,967
Naturopath is not an ACC funded service; therefore your request for this information is declined under section 18(e) of the Act, as the document alleged to contain the information requested does not exist or cannot be found.
Here’s that information on a chart, excluding the totals. As you can see, spending on acupuncture in particular has increased dramatically over the last decade:
This OIA request was a follow-up to an earlier request from Mark Honeychurch regarding essentially the same information. The response to Gold’s request included a new column for 2012/13, as well as the “Total” column although that isn’t strictly new information. Also, the information from Gold’s request seems to have been a catalyst for an article published on the 24th of May 2014 on stuff.co.nz: Big Bill for Alternative Health.
This article did a little more digging, asking questions of doctors, acupuncturists, and the ACC. I highly recommend you read it. The most interesting part to me was this:
In 2009, then-ACC Minister Nick Smith questioned the ballooning ACC bill for complementary treatments and said their effectiveness would be reviewed.
Since then, the cost has risen another $5m but ACC said no review ever took place.
ACC Minister Judith Collins did not answer questions about the review.
It is not mentioned in this article, but I have known for some time that the ACC has a document published on their website entitled Acupuncture Treatment Profiles. The document describes itself as:
a valuable guide in the application of protocols that are included within a Traditional Chinese Medical (TCM) diagnosis, providing important information that assists an acupuncturist’s treatment strategy.
This appears to be an official ACC document, to be used by ACC-registered acupuncturists to determine appropriate methods of diagnosis and treatment that are approved for ACC funding. However, having a look through it one can’t help but notice egregiously wrong and pseudoscientific statements such as the following:
- Acupuncture… Relieves pain by treating stagnation of Qi and Blood in the affected areas and channels
- Qi is the vital force of life which… Is the material substrate of the Universe
- Brain… Is considered to be the same in substance as marrow
- the Kidney produces marrow
I shudder at the thought that the ACC levies I pay are partly used to fund this. It seems to me that it’s high time the ACC carried out a review of the evidence behind these therapies that it funds, so problems like this can be rooted out and dealt with. Publicly funded healthcare should be based on science, after all.
In last month’s issue of my local community newsletter, Onehunga Community News, an article was published about water fluoridation. For those of you who are non-locals, Onehunga is a suburb of Auckland, and in general drinking water in Auckland is fluoridated.
The article mentioned some of the recent national news about fluoridation, which I won’t get into here, and used it to bring up the fact that much of Onehunga’s water is not fluoridated. It gave links to the Ministry of Health for pro-fluoridation information and Fluoride Action Network New Zealand (FANNZ) for anti-fluoridation information, and it called for readers to send in their thoughts.
I decided to send in a message in response to the article. The May edition of this newsletter has just been released, and as part of it several responses, including a small part of mine, have been published:
I was happy to see that most of the responses were sensible, although there was still one talking about such rubbish as “chemicals” being synonymous with “poisons”. As only a small section of my message was published, I’ve decided to publish the entire message here. Here is the full message I sent in to Onehunga Community News:
To whom it may concern,
I was rather disappointed to see the article “To fluoridate or not to fluoridate…” mention the anti-fluoride group “Fluoride Action Network New Zealand” as though it were a reputable source of information on fluoride. This group relies largely on scare-tactics and misinformation, driven by ideology rather than evidence. In comparison, the Ministry of Health is driven by the available to evidence to find the best conclusion, which it believes is that fluoridating the public water supply is an effective, safe, and cost-effective way of improving dental health.
The Ministry of Health website has a page listing a number of websites that provide accurate information on water fluoridation. The FANNZ site is not on this list. That is not simply because FANNZ disagrees with the Ministry of Health on this issue, it is because FANNZ is not a reliable or trustworthy science-based source of unbiased information on this issue.
When I first discovered that Onehunga is not fluoridated I admit I was very disappointed. I had thought that all public water supplies in Auckland were fluoridated, and was sad to hear that I lived in one of the few areas in which this is not the case. I would be ecstatic to see the public water supply in Onehunga go through a process of fluoridation.
It is worth noting that the process of fluoridation is not necessarily as simple as adding fluoride to the water – it is ensuring that the levels fall within a particular range. As some locations have high natural levels of fluoride, this process can involve the lowering of fluoride levels in order to ensure it is maintained at a concentration that is safe and effective.
According to data from the New Zealand Institute of Chemistry (the data are from 1995, but I’m not aware of any more recent data. I have no particular reason to expect a large change since that date though) the level of fluoride in Onehunga drinking water is around 0.15-0.16 mg/L. In comparison, the fluoride level in Ardmore drinking water was increased from 0.04 mg/L to 0.86 mg/L. Onehunga water did have substantially higher natural levels of fluoride than that of the other Auckland areas sampled, but the final level after treatment was also significantly lower than those areas in which the water was fluoridated.
Water fluoridation to prevent dental caries is akin to the fortification of bread with folic acid to prevent neural tube defects in children, or iodine in table salt to prevent iodine deficiency. These are all safe and effective science-based preventive methods that improve public health.
I understand the journalistic urge to provide balance on all issues, but it is important not to establish a false balance such as this. This is a topic on which it is important to listen to the experts.
The editor responded to defend their approach to pursue balance by saying that they shouldn’t only provide government resources. I didn’t find it convincing, but I do understand somewhat the urge for journalists to provide both sides of every story. There is some merit in that but, as I said in my message quoted above, it is possible to take it too far.
It feels relevant to note that, since I sent this message, 3 separate ASA complaints have been upheld against FANNZ on the basis that they failed to adequately distinguish opinion from fact. I wouldn’t be surprised to see a couple more in the future either.
When it comes to the fluoride debate there is a lot of misinformation out there, so you have to be extra careful that you’re getting yours from a reliable source. FANNZ is not a reliable source of information. The Ministry of Health is, and if you want a non-governmental source then you might want to check out Making Sense of Fluoride.
For the sake of full disclosure, I’m Facebook friends with some of the people in charge of Making Sense of Fluoride, and gave some advice on the ASA complaints submitted against FANNZ when they were being written.
In the Herald today, a letter to the editor from a Mr Barry Davis was published regarding an article about a recent scientific report on the evidence regarding homeopathy published by the Australian National Health and Medical Research Council: Effectiveness of Homeopathy for Clinical Conditions: Evaluation of the Evidence
The report evaluated the evidence regarding homeopathic treatment of several conditions, and drew the following conclusion:
The available evidence is not compelling and fails to demonstrate that homeopathy is an effective treatment for any of the reported clinical conditions in humans.
This letter to the editor, given the title “Homeopathic treatment”, mostly took the form of an anecdote. As far as I am aware letters to the editor are not published online, so here it is in its entirety:
I strongly disagree with your Saturday article on homeopathy. After having open-heart surgery for a faulty valve, I had a series of transient ischaemic attacks (mini strokes).
This resulted in seven visits to hospitals, totalling 42 days, numerous tests and scans, and two outpatient visits. The doctors told me they had no idea what was causing the strokes.
If the cause is not found, and treated, it could lead to a full stroke.
A relative, who has a PhD in chemistry and a diploma in homeopathy, took an interest in the problem. She recommended a homeopathic treatment, and in the last year, whenever I have felt an attack coming on, I have taken two of her pills and sat down, and the attack has stopped.
The only time in the last year that I have had an attack is when I twice failed to carry the pills.
Five years ago, I had a problem with recurring sore throats and congestion – this was also cured by homeopathic treatment.
I do not criticise the doctors or the hospitals – they tried and could not find the solution – but I firmly believe the medical profession and alternative medical practitioners should work in parallel, and each recognise the other.
Citing anecdotes seems to be a common way to defend modalities such as homeopathy, which are not supported by rigorous evidence. Unfortunately, personal stories can often be much more convincing than they should be. I am sending a letter of my own to the editor of the Herald in response to this one.
As I can’t be sure if it will be published, or if sections will be removed (although I’ve tried to keep it brief), I will publish it fully here as a rebuttal to the strategy of attempting to defend homeopathy against this report by citing personal experience.
There was once a time when medicine was based on personal anecdotes such as that of your correspondent Barry Davis. This philosophy gave rise to such false ideas as the four humours and ineffective and harmful treatments like bloodletting, for which there was no shortage of anecdotes.
It is only with the advent of medical science, particularly the randomised clinical trial, that we have become able to truly test medical interventions. Isolated cases such as Mr Davis’ still have a place in medical science, but they are considered the lowest form of evidence and best used in deciding where to allocate resources for testing treatments. There is good reason why our own Medicines Act prohibits their use in medical advertisements.
In order to provide safe and effective healthcare, doctors need to be able to accurately predict the outcomes of a treatment. Relying on poor evidence, like anecdotes, is likely to lead to inaccurate predictions and lower quality healthcare.
It is only by assessing high quality evidence, like in the recent report from the Australian National Health and Medical Research Council that looked at the best evidence regarding homeopathy, that we are able to reliably provide high quality healthcare.
If you really care about the truth then evidence trumps personal experience, not the other way around. If you really care about whether or not homeopathy is effective, then you need to follow the evidence where it leads, even if it does not line up with personal experience. Currently, as the aforementioned report concludes, that means:
“The available evidence is not compelling and fails to demonstrate that homeopathy is an effective treatment for any of the reported clinical conditions in humans.”
Update 2014/04/24 8:38 a.m.
My letter to the editor was published in the Herald this morning. It looks like it was kept pretty much intact, the only difference I noticed is that the very end was edited to appear as though the conclusion I quoted from the report was in my own words.
As I mentioned in an earlier post, after looking up at the night sky through binoculars for the first time over my summer holiday, I decided to buy a telescope this year. On the 27th of January, I went to see a show at the local observatory, Stardome, and ended up talking to one of the staff about the telescopes they had on sale. I came home the excited new owner of a “Celestron Powerseeker 114EQ”.
It’s a “Newtonian” telescope, also known as a “reflector”. It uses a mirror to gather light, as opposed to a “refractor” that uses a lens. The light comes in the front of my telescope and hits a concave mirror 114 mm in diamater at the other end of the tube, where it is bounced back up to a flat mirror near the opening that reflects the light out the side into the eyepiece. I have 3 eyepieces that give 45x, 90x, and 100x magnification.
My first target was Jupiter, which I’d got a brief glimpse of from one of Stardome’s much more expensive telescopes after the show I saw. When viewing it from home, I was thrilled to be able to make out its 4 Galilean moons, and tried taking a photo. It turns out, as you might be able to guess, that holding an iPhone 4 camera up against the eyepiece of a telescope in the dark, then holding it steady and pressing the “take a photo” button without bumping the phone, is actually pretty hard. I got very lucky though, and the first photograph I took clearly showed an overexposed Jupiter and its 4 largest moons:
Some time later, I was also lucky enough to take a recognisable photo of Saturn using the same technique:
That picture was taken with the highest magnification eyepiece, which has a lens only about 6 mm in diameter. It was really difficult to hold my phone steady for this, even with the trick I’d learned of using the iPhone headphones’ volume buttons as a remote for the camera app. After this, I decided I should look to see if I could buy an adapter to fit my iPhone directly onto my telescope, but while searching for one I found an article about how to make your own adapter. I didn’t follow the steps in that article, but I did decide to give it a shot. I found a piece of plastic, an old cover for part of a swimming pool pump, that fit perfectly over my telescope’s eyepiece, and put it together with a bunch of foamboard and glue to get the final product. Here are a few pictures of the process:
Using this new adapter and some astrophotography image processing software called Registax that lets me combine multiple images or frames of a video to form a single clean image, I’ve been easily able to take some clear images of Jupiter, the Moon, and Saturn:
Registax also allows for a bit of processing to remove noise and sharpen the image. I’m not sure what I think of this yet, as I’m pretty much flailing blindly and to be honest it feels a bit like cheating, but here’s what came out the other end when I applied some of its filters to that Saturn image:
I also took some photos of Mars, but they’re all horribly overexposed and not really worth looking at. I’ve been having trouble seeing anything aside from just a circle of light when it comes to Mars. It’s tough using an iPhone 4 as a camera. It’s not possible to manually change settings like focus or exposure, and in order to take photos and videos of Jupiter that weren’t overexposed I had to lock the camera’s settings on the brightest part of the Moon (done not by tapping to focus like usual but by holding my finger on the spot for a second or so). Luckily Jupiter and the Moon are quite close in the sky at the moment so that wasn’t too much effort, but moving the telescope back and forth between the Moon and Mars was quite annoying. I’m sure there’s a better way that I’m yet to find. It possibly involves buying a decent camera.
One other thing I was finally able to do last night is resolve the Alpha Centauri system (the outermost of the 2 “pointers” that show the way to the Southern Cross) as a binary star system. I wasn’t able to photograph it though, the stars still appear very close together and my phone overexposed them to look like a single star. I guess that’s a challenge for another night.
I’m also quite looking forward to the upcoming total lunar eclipse on the 15th of April. Although I’ve read that the Moon is meant to turn a dark red during the totality of the eclipse, I’m not really sure what to expect when it comes to viewing or photographing it, which I find pretty exciting.