This year has not been a good year for homeopathy. There have been many blows to the industry in the form of more research finding it ineffective, position statements from organisations of health practitioners discouraging its use, and successful complaints to regulatory authorities. And this trend shows no signs of abating.
In March, the Australian National Health and Medical Research Council (NHMRC) published their Statement on Homeopathy, following a rigorous review of the evidence encompassing over 50 systematic reviews. The conclusion was clear:
there are no health conditions for which there is reliable evidence that homeopathy is effective.
Statement on Homeopathy – National Health and Medical Research Council (Australia)
Most organisations of medical professionals have codes of ethics that make it clear prescribing or selling treatments which are not supported by evidence is unethical. Putting two and two together, these ethical standards and the clear findings of the NHMRC have prompted the Royal Australian College of General Practitioners (RACGP) to publish a position statement on homeopathy:
The RACGP supports the use of evidence-based medicine, in which current research information is used as the basis for clinical decision-making.
In light of strong evidence to confirm that homeopathy has no effect beyond that of placebo as a treatment for various clinical conditions, the position of the RACGP is:
- Medical practitioners should not practice homeopathy, refer patients to homeopathic practitioners, or recommend homeopathic products to their patients.
- Pharmacists should not sell, recommend, or support the use of homeopathic products.
- Homeopathic alternatives should not be used in place of conventional immunisation.
- Private health insurers should not supply rebates for or otherwise support homeopathic services or products
Position statement: homeopathy – Royal Australian College of General Practitioners
Following this, in an interview with Radio New Zealand the chair of the New Zealand Medical Association (NZMA), Dr Stephen Child, made the NZMA’s position clear:
Susie Ferguson: So Australian doctors being told not to be prescribing this, and they should come off the shelves as well so people couldn’t even buy them over the counter. Would you support that happening here?
Dr Stephen Child: Well yes, it’s an ineffective treatment. It’s basically giving a glass of water or a sugar pill to patients, and I think you would consider that unethical if I gave you a sugar pill and charged you eighty dollars for that.
Homeopathy has never been supported by evidence, but the recent findings from the NHMRC have strengthened the scientific consensus and allowed many organisations to take a stronger stance against it.
When there is also a clear ethical mandate not to promote or provide healthcare that is not supported by evidence, all it takes to put two and two together is a little courage.
Now, Kingsley Village Pharmacy in Australia is paving the way, stating that their “Homeopathic products [are] going in the bin”:
The owner of Kingsley Village Pharmacy, pharmacist Grant McGill, has explained why he made this decision:
I’ve never promoted or recommended these products but I’ve accepted them passively and I felt a bit hypocritical having them on the shelves.
I operate a bit differently to corporate chains and believe a pharmacy should be professional rather than a place selling a lot of cosmetics.
If someone comes in with sleep problems, I will look at what is known to help and address things like sleep hygiene issues, rather than recommending flower essences.
Pharmacist bins ‘crap’ homeopathic products – The West Australian
When the Twitter account for the pharmacy was asked if they thought their customers would notice or care about the change, they said:
A tweet from Grant McGill echoed the same sentiment as the reason for this change:
When I had an complaint upheld against an Auckland Pharmacy for a misleading display stand for the homeopathic product No-Jet-Lag, that pharmacy promised to remove the product from sale and I hoped that New Zealand pharmacists would follow their example.
But it isn’t feasible for me to complain about each and every homeopathic product sold in a New Zealand pharmacy (although that hasn’t stopped me complaining about some). New Zealand pharmacists need to follow Kingsley Village Pharmacy’s example and remove the products not because complaints have been upheld, but because there’s no evidence they work so it’s clearly the ethical thing to do.
The Pharmacy Council of New Zealand is the body legally responsible under the Health Practitioners Competence Assurance Act for setting standards of ethical conduct to be observed by pharmacists on this side of the Tasman. To this end, they have published a Safe Effective Pharmacy Practice Code of Ethics. Section 6.9 of this code is very clear when it comes to pharmacists’ ethical responsibilities surrounding evidence-based healthcare:
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
Safe Effective Pharmacy Practice Code of Ethics – Pharmacy Council of New Zealand
Despite this, as mentioned in the Radio New Zealand interview with Dr Stephen Child from the NZMA, “In New Zealand, many pharmacies stock a range of homeopathic treatments”. When New Zealand pharmacists have been challenged on this point, their defences have ranged from bizarre misunderstandings of the evidence (e.g. “Auckland pharmacist Martin Harris says there is good evidence for homeopathy in the field of quantum physics”) to arguments that patient choice overrides their ethical responsibility:
But homeopathy is part of a holistic approach to healthcare, according to Auckland pharmacist Caleb Townsend, whose Lincoln Mall Pharmacy has qualified homeopaths onsite.
There is not one system that suits all people, Mr Townsend says in an email.
“Homeopathy is seen at this pharmacy as complementary to conventional medicine, in much the same way as acupuncture, vitamins and herbs are.”
Many patients believe homeopathy has been of benefit and they should be given the freedom to choose it if they want, he says.
“We have not yet become a society where cultural beliefs are legislated out of existence.”
Pharmacists Support Patient Choice with Homeopathy – Pharmacy Today
Dr Child provided a response to this line of argument in his interview:
Well, again as I say they argue that it’s mainly free trade basically, or a free market, so if people are willing to pay the money, and they think it works, then what are they doing that’s wrong?
And my problem with that argument though is to say that if they are telling the patient that it works then they are misleading in their advertising and even the Consumer Guarantee Act that it’s not allowed to mislead the consumer.
Second of all there’s an imbalance of a relationship when you come in to see a health practitioner and you’re the patient.
And thirdly when you’re suffering and you’re unwell you’re possibly not in a position to make an informed, balanced decision as a consumer. So I’m not even sure the free market argument would suggest that it would be legitimate practice.
Dr Stephen Child, Doctors Told to Stop Prescribing Homeopathic Products – Radio NZ
The Society for Science Based Healthcare has also been in touch with Green Cross Health, an umbrella organisation that owns brands such as Unichem and Life Pharmacy and represents over 300 New Zealand pharmacies, to ask if they have a commitment to uphold section 6.9 of the Pharmacy Council’s code of ethics. Despite following up multiple times, the closest thing to a direct answer Green Cross Health has given to this question is:
While we support best practice we are also supportive of consumer choice.
Green Cross Health
The remaining defence of this practice is that pharmacists do more than provide healthcare, they also have to run a business. Following his Radio NZ interview, Dr Child alluded to this in an article from Pharmacy Today following his Radio NZ interview:
“Medically, it’s unethical to provide a treatment that’s not proven,” Dr Child says.
However, he has stopped short of telling pharmacies not to sell homeopathic products.
“It’s not really appropriate, I believe, for the medical profession to tell pharmacies how to run their business and how to act.”
Pharmacies have a difficult balance between providing healthcare and running a business, Dr Child says.
“It must be very difficult because they are a business as well.”
Homeopathy discredited again on both sides of the Tasman – Pharmacy Today
There is a range of behaviours among New Zealand pharmacies when it comes to promotion of homeopathy. Some few pharmacists refuse to sell the products at all, whereas many stock them but might not actively promote or recommend them. On the extreme end of this ethical scale, there are pharmacies like Lincoln Mall Pharmacy in Auckland, which promotes “homeopathic consultations” from homeopaths within the pharmacy, and Simillimum Pharmacy in Wellington, which describes itself as a “homeopathic pharmacy”.
The fact that there are some pharmacists who operate without relying on profits from selling homeopathic products indicates that it is entirely possible. Those pharmacists who passively sell them likely don’t rely on the profits made from those products as the difference between financial success and failure, so I’d hope they wouldn’t use higher profits as a justification for breaching their ethical obligations.
If any pharmacy has got to the level where their business would fail financially were it not for homeopathic products and services that they sell, then their business practices would blatantly violate their ethical responsibilities. I should think the risk of financial failure in a case like this should certainly not be an acceptable excuse for such unethical conduct.
Kingsley Village Pharmacy in Australia has set a great example for all pharmacists, having the courage to take a stand on ethics and stop selling homeopathic products. New Zealand pharmacists who currently have them on their shelves should follow in these footsteps.
To borrow Grant McGill’s words, pharmacists need to stand up for patient outcomes.
After my earlier post on this topic, I talked to a few people about why they thought these stretching reflections happened. There were a few different ideas, and when I talked to my brother about it he pointed out something in one of the images on my last post that was inconsistent with my explanation.
My hypothesis would have predicted that reflections would stretch down, but not up. However, looking more carefully at this image, the reflection of the Sun is clearly both stretching down and stretching up to the horizon. So it can’t be explained just by the surface appearing to be rougher as it gets closer to the observer.
However, in that discussion we came up with a new hypothesis. As I said in my last post, if we imagine a rough surface as being made up of a lot of small flat mirrors at random angles, some of them will be at the correct angle to reflect light toward you so you’ll see a reflection in those places. The new hypothesis was that the angle required for this would be less extreme above and below the reflection than to the side of it.
In order to test this, I needed 3 things:
- A light source
- A flat reflective surface
- A wedge
- A flat surface to rest it all on
Luckily, these things were all readily at hand. For a light source, I used a nearby lamp. My phone’s screen made a good flat reflective surface. I used the alarm remote for my car as the wedge, and rested everything on the floor. I’m sure you could find similar objects to reproduce this experiment for yourself.
First, I lined up the lamp, my phone, and myself so that I could see the lamp’s reflection in the centre of my phone’s screen when it was sitting flat on the floor. Then, using my makeshift wedge I tiled the screen of my phone away from me, then moved the tilted reflective surface towards me until the lamps’ reflection was in the middle of the screen.
I then repeated this for the other directions – away from me, to the left, and to the right. Because my phone isn’t square, I also rotated it so it was landscape when I moved it towards me and away from me, but portrait when moving it left and right. That made it easier to judge when the reflection was in the centre of its screen.
What I found was that I had to move the phone a lot further toward me or away from me than I had to move it left or right in order to see the reflection again. I think this explains, at least in part, why reflections on rough surfaces appear to be stretched towards you.
We can get a rough approximation of the outline of a reflection on a rough surface by assuming it has a maximum roughness, i.e. the maximum angle at which one of those little mirrors that make up its rough surface could be tilted. Then, the approximate outline of the reflection would be along the curve where a mirror at that maximum angle, facing in the right direction, would reflect light toward you.
On a perfectly flat surface, this maximum angle is 0. So the shape of the reflection is exactly as you’d expect, undistorted.
However, as the maximum roughness of the surface increases, the outline moves out from the undistorted reflection. And the reflection doesn’t just get larger, it gets stretched towards you. It’s because the angle required to reflect it at you is less within that outline that reflections on rough surfaces appear to be stretched.
If you’re interested, you can also take a look at the source on GitHub.
The simulation works by sending out rays from the observer to hit different parts of a horizontal reflective surface. When a ray hits the surface, the simulation calculates the angle that would be required at that point to cause the simulation’s light source (displayed as a red dot) to be reflected there. Places where there would be a reflection are shaded according to the required angle, with brighter yellow areas being flatter, and areas where there would be no reflection are black. The simulation also draws a reflected red dot to show where the reflection would be on a very flat surface.
There are a few numbers you can configure to see how the shape of the shadow changes under various scenarios:
- Light source distance
- The distance “into the screen” that the light source (the red dot) is from you.
- Light source height
- How much higher than you the light source is. You’ll want to make sure it’s higher than the reflector.
- Reflector height
- How much lower (using negative numbers) the reflective surface is than you. The simulation doesn’t look above horizontal for reflections, so this won’t work with positive numbers.
- Maximum angle
- The maximum amount of roughness the reflective surface can have. Higher numbers are rougher, lower numbers are flatter.
- Step size
- How far apart the rays are, in degrees. The default setting is 0.1 degrees. Larger step sizes will make the simulation run faster, but it will be less precise.
The simulation shows how reflections can be stretched vertically in this way, depending on the roughness of the reflecting surface and the relative positions of the observer and the light source. If you make the light source very far away and near the horizon, you’ll see that the reflection can stretch all the way up to the horizon just like the Sun’s reflection in that picture.
However, there’s still a decent amount of horizontal spreading so I don’t think this entirely explains the stretched reflections. Yesterday, I saw this beautiful photo on Twitter, taken by Ian Griffin of a sunset in Otago:
In this photo, there is pretty much no horizontal stretching. This can be seen in the black lines in the reflection caused by trees blocking the Sun’s light – if the reflection were stretching sideways then these would be blurred and wouldn’t have such a uniform thickness.
There could be a few things helping in this case. Because this particular example is taken with water being the reflective surface, and the observer was standing at the shore, the waves are mostly perpendicular to the line of sight. That would help minimise horizontal scattering.
It can’t be just that, though, because the same stretching is seen on rough surfaces where the roughness has no direction, such as wet roads:
I think the rest of this could possibly be explained by surfaces that reflect the light straight towards you from under the light source appearing larger, because they’re angled towards you. Surfaces to either side of the reflection could also reflect the light towards you, but perspective would cause them to be foreshortened and therefore contribute less to the overall picture.
What do you think?
On a rough reflective surface like the ocean or a dark wet road, reflections from bright lights like city lights, car brake lights, or the Moon appear stretched vertically. Why is this?
When a surface is perfectly flat, like a regular mirror, the image we see in the reflection isn’t distorted at all. Even if we put a mirror flat on the ground, we wouldn’t see a vertically stretched reflection like this.
Neither the road nor the ocean are perfectly flat though. Their surfaces are rough, and this rough surface scatters light when it’s reflected. If we imagine that each piece of the surface was a little flat mirror, with each piece facing in a random direction, some of these would be at the right angle to reflect light from a source (like the Sun) directly into our eyes, and most would not. We’d only see a reflection in those pieces that are at the correct angle to reflect the light into our eyes.
The further these little mirrors are from the area where we’d see the reflection in a flat mirror, the more extreme an angle they will need in order to still reflect the light at us. If every one of these little surfaces was really really tiny, what we’d expect to see is a blurry reflection. The smaller the pieces get, the less blurry the reflection would get.
We can actually see this in effect when we compare pictures of the Sun reflected off the ocean. When you’re quite near the ocean, all the different reflecting surfaces are relatively large so the reflection is quite blurry and broken (especially if there are lots of waves):
In comparison, if we look at a reflection of the Sun on the ocean that was taken from space, all the waves and ripples that distort the reflection are far too tiny to see, and as a result the reflection is quite clear and crisp:
Another difference that’s quite apparent between these photos is the vertical stretching that I’ve been wondering about. From up close, it’s very stretched. From a distance? Not so much. This gives me a thought, one that actually hadn’t occurred to me until I got to this point in writing this post and saw those images one after another:
What if it’s important that there’s a significant relative distance between the closest and furthest parts of the surface that are reflecting the light source?
From a long way away, these distances appear quite small. For example, if I’m 1 km away from a surface, then a 1 m distance between two points on that surface is really quite small. If I’m only a metre away myself though, then that’s a very significant distance.
As we just saw, reflections on non-flat surfaces are more blurry when they’re closer to you, so what if this vertical stretching is actually just the reflection getting more blurry towards the bottom, because that part of the road or ocean is closer? As it’s more blurry, this would let the edge of the reflection creep out further, and could look like stretching.
If I’m right, then I should be able to see the same type of stretching if I look at a reflection on a vertical surface, except the stretching would be horizontal in that case. I should also be able to replicate the same stretching effect if I can get a reflecting surface that is smooth on top and gets rougher towards the bottom, and look at a reflection of a light in it like I would a normal mirror (i.e. with the reflecting surface vertical and the light source behind me).
Let me know what you think of this idea in the comments, and if you have any ideas of your own for why we see these stretched reflections. Any ideas about how I could try to disprove my idea would be welcome too! In the meantime, I’ll try to do these experiments, and see if I can find an expert to talk to about this question.
I’ve written more on this topic in another article: Natural Curiosity: Stretching Reflections 2
On the second Wednesday of every month, there’s a great Twitter chat on science communication in New Zealand: #SciCommNZ
Unfortunately I’m always busy on Wednesday evenings while this is going on, but I’ve tried to participate as much as I can by joining in late and reading through each discussion. The questions that have been asked have made me think about the things I write about on this blog, and some of the things I’d like to write about:
After having these thoughts churn around in my head for a few weeks, I’ve come up with something I’d like to try.
There are a lot of “everyday science” questions that I see asked and answered fairly often. Common examples include “why is the sky blue?” (which is not quite as simple as you might think) and “how do rainbows work?”. I really like these questions, but I feel sometimes like they’ve all been done many times already.
Of course, they haven’t all been done many times already. But I do feel like I see the same “everyday science” questions over and over again. I think they’re great and really interesting the first time you encounter them, so I want more.
As a remedy to this, and as an attempt to do something different and (hopefully) interesting with my science communication, I’m going to start asking some of my own everyday science questions. This might be a bit grandiose, but I’m calling this little project of mine Natural Curiousity
The format may change as I get into it, but the way I see this happening is to take every question in two parts:
First, I’ll write a post framing the question and some of my own thoughts (as a non-scientist) on what the potential answers might be, and what some problems with those potential answers might be. I want to try to do this without any Googling, but I might try a few homemade experiments. My hope would be that posts like these could get some interesting discussion going, but I guess we’ll see.
After that, I’d like to talk with someone who is an expert in a relevant topic and get their thoughts on the question, both on the potential answers brought up in the first post and on what they think the answer probably is and why. This isn’t something I’ve done before, so I hope I’ll be able to find some experts who’ll be happy to find some time to talk to me about this.
If you have any everyday science questions that you’ve been wondering about, let me know in the comments. I’ll update this post with links to posts using this format as I publish them.
In 2007, the Ministry of Health undertook a review of the “complementary medicines industry” in New Zealand, and found that a significant majority of companies weren’t complying with consumer protection legislation.
The review was never made public, but when I saw it mentioned in a recent article in North & South magazine I asked the ministry for a copy. It has been released to me under the Official Information Act.
Since it was written in 2007, both the industry and the regulations have undergone changes, so the review’s findings won’t be accurate now. However, I think it’s worthwhile looking at it to get a general understanding of the relationship between this industry and its regulators.
The June edition of North & South has published an article that Peter Griffin and I co-wrote about the implications of a recent Press Council ruling. Excluding letters to the editor, this was the first time something I’ve written has appeared in mainstream print media. Filled with vain excitement, I purchased a magazine for the first time.
When I saw the cover of this issue, promoting a story by Donna Chisholm entitled “Truth (and Lies) About Supplements”, I realised that it was a much better reason for me to buy this magazine than just to see my own name in print. I wasn’t disappointed either, the story is a great summary of the issues surrounding supplementation, and it’s written from a New Zealand perspective. I’d recommend that everyone interested in this topic pick up a copy of North & South to read it.
This is something I’m interested in so I already follow the news on this topic. A lot of what was discussed in the article I’d already seen, but there was also some very interesting stuff in there that I’d never heard anything about before. One of those things was a review of New Zealand natural health websites that the Ministry of Health undertook in 2007, apparently finding that nearly 80% of them were not complying with the Medicines Act:
[Natural Products NZ executive director Alison] Quesnel’s confidence in the veracity of claims made in New Zealand may also be misplaced. A Health Ministry review of 263 industry websites in 2007 found nearly 80 per cent making illegal therapeutic claims. A later “compliance awareness programme” discovered that more than half the ads on websites for natural products made therapeutic claims, with a third of the websites making “high-level” claims.
Chisholm, Donna (2015). The Truth (and Lies) About Vitamins. North & South, June, p41
When trying to find this review online, the closest I could find was a Regulatory Impact Statement that the Ministry of Health published in 2010, about “The Development of a Natural Health Products Bill”. This document doesn’t contain the review, it only references some of its results.
After Donna Chisholm told me that she found the information from her article in this document but didn’t have a copy of the review, I contacted the Ministry of Health to ask if it was available anywhere online, and if it wasn’t if they could send me a copy. They interpreted my email as an Official Information Act request, and within a couple of weeks the report appeared in my inbox.
EDIT 2015/05/31 3:44 pm: As Thomas Lumley has pointed out in the comments, they were entirely correct to interpret it in this way. I just hadn’t thought of it as an OIA request at the time.
Usually I use the great website FYI to make OIA requests. It’s a great service which I’ve mentioned before, that allows OIA requests to be made in a way that makes both the request and the response public. It was relaunched this year with sponsorship from the New Zealand Herald. This time, however, I didn’t realise at first that my email would be interpreted in this way, so the request and response aren’t hosted on FYI.
However, I have uploaded the report and made it available here: Overview of the New Zealand Complementary Medicines Industry. I found it quite interesting reading, and a bit disappointing that it was never released publicly until now, when it’s 8 years old. Please keep that in mind when reading it.
The report gathered information on businesses operating in this industry to produce estimates about the industry as a whole. The report includes information like the proportion of companies of various sizes (e.g. < 10 employees). Once again, remember this report is 8 years old at the time I’m writing this, so the state of the industry has certainly changed since then.
The section which I found most interesting by far is, of course, Non-Compliance. Here’s the blurb for that section (the emphasis is mine):
Of the companies where it was possible to obtain specific details about their products, an assessment was made of the level of non-compliance with the current Medicines Act (1981) and the Dietary Supplements Regulations (1985). Non-compliance was defined only on the basis of the presence of therapeutic claims associated with the product and no attempt was made to determine any other aspect of non-compliance e.g. the presence of scheduled medicines. Dietary supplement-type products (intended for oral use) carrying therapeutic claims and other products (including foods, cosmetics and complementary medicines) carrying therapeutic claims (i.e. unlicensed medicines) all came under the umbrella of “non-compliant”.
Medsafe. (2007, August 29). Overview of the New Zealand Complementary Medicines Industry.
Any product that is promoted with therapeutic claims as defined in the Medicines Act (this definition was updated in July 2014) is considered a medicine for regulatory purposes. I’m not a lawyer, and I’ve never been involved in the approval process for a medicine, but my understanding is that means it needs to go through a process that requires rigorous evidence to support its safety and efficacy, then before it can be sold it must be approved by the Minister of Health.
This is why products that haven’t gone through this process but still have therapeutic claims made about them are “unlicensed medicines”. Because the claims make them medicines for regulatory purposes, but they have not been approved. They might do what they’re claimed to do or they might not, but what they have in common is skirting the regulations that require them to back up claims of safety and efficacy.
It also means that the same product could be treated as an unlicensed medicine in one context but be perfectly acceptable in another. For example, if I advertise bananas as a cure for cancer, then that’s an unlicensed medicine. If I advertise bananas as a tasty fruit, that’s perfectly acceptable.
The review reported the number of compliant vs. non-compliant products found, as well as companies with and without non-compliant products:
|Number of Non-compliant Products|
|Total no. products found||12,261|
|Number of Companies with Non-compliant Products|
|No. of companies (%)|
|Total no. companies||263|
To get some rough idea of the completeness of this review, the Ministry of Health’s natural health products bill regulatory impact statement I mentioned earlier, which I believe was written in 2010 and is an interesting document to read, estimates that there are around 6,600 products and 450 companies in total. However, they also noted that the estimate of 6,600 products might be a significant underestimate and that the real number might have been as high as 20,000.
The regulatory impact statement describes this as “A systematic review of websites undertaken in March 2007″, and gives some examples of non-compliant claims:
Examples of low level claims included claims for providing relief from the symptoms of arthritis or psoriasis, relieving the symptoms of seasonal allergies such as hay-fever, relief of pre-menstrual tension, or temporary relief of the pain of gout, headaches or migraine. Higher level claims included claims for preventing, treating or curing serious diseases, such as cancer.
Ministry of Health. (2010). Regulatory Impact Statement. The Development of a Natural Health Products Bill.
The review broke down the level of non-compliance into low and high severity, and reported the average for different companies:
The severity of non-compliance was also assessed. The severity of non-compliance was based upon the type of therapeutic claims being made by the company for their products and was divided into either high (claims of efficacy about a product for serious diseases and conditions including cancer, depression, diabetes etc.) or low (therapeutic claims likely to be appropriate for a low risk medicine). An “average severity” of the therapeutic claims made be [sic] each company was grouped into low or high.
Medsafe. (2007, August 29). Overview of the New Zealand Complementary Medicines Industry.
|Severity of Non-Compliance per Company|
|Average severity of non-compliance||No. of companies (% of total)|
|High for >80% of products in catalogue||26 (10%)|
The type of product was also reported for non-compliant products:
The non-compliant products (i.e. those carrying therapeutic claims) were further subdivided into cosmetic, food, dietary supplements and complementary medicines to provide some information about the types of products that were non-compliant. Cosmetics included products which were intended to have a primarily cosmetic purpose eg. moisturisers with anti-aging claims and food included products consumed in a normal diet such as fruit drinks carrying therapeutic claims. Dietary supplements included vitamins and minerals and products generally meeting the definition of a dietary supplement according to the Dietary Supplements Regulations 19851 apart from the claims made. Complementary medicines included products that did not fall into any of the above categories, including creams and balms with no primary cosmetic purpose and herbs with a traditional history of use as a medicine.
1 Dietary supplement means any amino acids, edible substances, foodstuffs, herbs, minerals, synthetic nutrients, and vitamins sold singly or in mixtures in controlled dosage forms as cachets, capsules, liquids, lozenges, pastilles, powders, or tablets, which are intended to supplement the intake of those substances normally derived from food.
Medsafe. (2007, August 29). Overview of the New Zealand Complementary Medicines Industry.
Unsurprisingly, as this was a review of the “complementary medicines industry” and “complementary medicines” was the catch-all category, most non-compliant products were in that category. I’m not sure why the total number of non-compliant products is lower than the 6253 non-compliant products reported earlier in the review.
|Areas of Non-Compliance|
|Number (% of total)|
|Dietary supplements||1357 (27%)|
|Complementary medicines||3170 (63%)|
|Total number of non-compliant products identified||5029|
This was all 8 years ago, so what’s happened since? I don’t have any comparable data on how the state of the industry compares to these results today, but the Regulatory Impact Statement document I’ve mentioned a few times offers some insight here. Here’s what was done following this review:
In a subsequent compliance awareness programme, the websites reviewed contained advertisements for over 12,000 products with just over half of these advertisements including therapeutic claims. Out of 355 websites reviewed as part of this programme, 107 were found to be making high-level claims.
Ministry of Health. (2010). Regulatory Impact Statement. The Development of a Natural Health Products Bill.
That’s roughly 30% making high-level claims, which is higher (although possibly not significantly) than the 26% found in the review. Overall non-compliance is “just over half”, compared with 78% from the earlier review. So it’s not entirely clear what impact this “compliance awareness programme” had, but if I had to guess based on what information I have it seems it may have resulted in some low level claims being removed but had no effect on high-level claims.
I asked for this in my OIA request as well, but no written report was prepared so I was just sent the raw data. Unfortunately, this came in the format of a spreadsheet saved as a PDF. It’s text searchable, but given the format and inconsistencies with how results are reported within the file it’s not easy to tell what it says about the industry overall. Also, presumably as it was only ever intended to be an internal document, it contains some strange stuff. For example, it reports Deer Velvet NZ as having 3 out of 1 non-compliant complementary medicines and notes that Crombie and Price “Have homeopathic lollipoops for kids”, whatever that might mean.
You can look at the data yourself here: Compliance of complementary medicines manufacturers 2 October 2007
EDIT 2015/05/31 5:48 pm: Thanks again to Thomas Lumley, who pointed out on Twitter that the open source software Tabula is able to pull the data out of that PDF and turn it into a CSV. I’ve made a CSV version created with Tabula available as well. Here’s a link to it on Google Drive, note that Drive doesn’t display large CSVs very well but you can download it or, if you’re signed in with a Google Account, open it as a Google Spreadsheet: Compliance of complementary medicines manufacturers 2 October 2007
The Regulatory Impact Statement document also has a section on “Compliance and enforcement difficulties” which I found very interesting (emphasis mine):
It has long been recognised that the regulation of natural health products is inadequate and working on achieving new legislation has been underway for close to 20 years. Because new legislation has been anticipated, only limited amendments have been made to update existing legislation, and enforcement activities have largely been limited to dealing with the most serious breaches, such as promoting a product as a cure for cancer when that product is not an approved medicine, or supplying a product that purports to be a dietary supplement but contains undeclared ingredients that are prescription medicines.
Enforcement actions usually arise following investigation of a complaint or concerns about product arriving at the New Zealand border. Enforcement is complicated because the interface between the Medicines Act and Dietary Supplements Regulations is not clearly stated. As a consequence it is usually unclear whether non-compliance should be dealt with under food or medicines legislation. The outcome is generally destruction of product or removal from the market, rather than prosecution. The penalty for non-compliance is extremely low ($500) in comparison with similar legislation and does not act as an effective deterrent.
Enforcement of the Dietary Supplements Regulations has long been problematic due to the large number of breaches relating to the prohibition of therapeutic claims. Past attempts to raise awareness and enforcement of the legislation relating to natural health products met with resistance from both suppliers (who fear they will lose sales) and consumers (who fear they will lose access to products they consider are important to their health and well-being).
There is no provision in the Regulations for a register of dietary supplement products or suppliers. Hence it is difficult to trace suppliers and take appropriate action to protect the public from harm when safety issues arise.
Ministry of Health. (2010). Regulatory Impact Statement. The Development of a Natural Health Products Bill.
This was written 5 years ago. In that time, new legislation has continued to be anticipated: the Natural Health and Supplementary Products Bill was introduced in September 2011 and passed its second reading in March 2013, but hasn’t progressed since then. Throughout this period, enforcement of consumer protection legislation to prohibit misleading therapeutic claims has remained very low. Even in cases where I’ve submitted complaints, months have often passed before any action was taken by Medsafe.
This makes it sound like the sooner this bill passes, the better. But if the Natural Health and Supplementary Products Bill passes in its current state, it will allow “traditional evidence” to be used to support health claims. It defines this essentially as evidence of use:
traditional evidence means evidence of traditional use of a substance based on knowledge, beliefs, or practices passed down from generation to generation
On the other hand, the bill also requires that summaries of the evidence used to support health claims be provided on a public website in section 13(2A):
Before completing the product notification, the product notifier must make available on an Internet site, in respect of each health benefit claim made for the product, a summary of the evidence that the product notifier relies on to support the claim.
I think that part of the bill is fantastic, but I don’t think it will be directly useful to consumers. Surely only a very small minority of consumers will bother to go online to check what evidence is used to support health claims. In cases where claims are supported only by evidence of traditional use, I think a large number of consumers could be misled, and that seems to me like a pretty big loophole in a piece of legislation intended to protect consumers from misleading health claims about “natural health and supplementary products”.
I hope that the bill will pass soon, so that the “natural health” industry will not continue to be effectively unregulated as it has been for years, but I also hope that before this happens the bill will be fixed so that the only evidence permitted to support health claims is evidence that actually supports those health claims.
In February this year, an article was published in the Wairarapa Times-Age (both in print and online) headlined Use of natural remedies is on the rise. The article discussed some specific cases of so-called “natural remedies” being used to treat serious diseases, such as intravenous vitamin C for leukaemia and homeopathy to treat various forms of cancer.
Except for a brief mention at the bottom of the article encouraging people with cancer to talk to their doctor before using any “alternative therapies”, there was no mention of the fact that none of the treatments discussed are supported by any reliable evidence. Instead, the article uncritically included various quotes such as this, from homeopath Claire Bleakley:
Featherston-based homeopath Claire Bleakley said she has treated cancer patients using similar natural remedies [to intravenous vitamin C] – significantly extending life expectancy.
She mentioned two of her patients in particular: A man with tumours who lived for seven years after being given two to live, and a woman with ovarian cancer who lived 15 years past her initial prognosis.
“There have been some exceptional results,” Mrs Bleakley said.
“We are indoctrinated to think chemotherapy is the only cure for cancer, but alternative [remedies] have been proven to be more life giving.”
Medical anecdotes such as these unfortunately tend to be very convincing despite the fact that they can also be completely misleading. The reasons why people might get better are varied and complex. Without running a controlled test, there’s no way to know whether or not a particular treatment contributed to an improvement in health. That’s exactly why we need to undertake rigorous clinical trials before we can say with confidence what the effects of any particular treatment are. It’s also why the Medicines Act prohibits the use of health testimonials like this in advertisements, although that restriction of course doesn’t extend to news articles in publications like the Times-Age.
I thought, and still do think, that the lack of balance in this article has the capacity to do serious harm. I wrote to the editor of the Wairarapa Times-Age to make my case, and to give some suggestions for how they might attempt to mitigate the damage this article could do, in a formal complaint:
To whom it may concern,
I am writing to you to make a formal complaint regarding the article “Use of natural remedies is on the rise” published in the Wairarapa Times-Age this morning:
This article uncritically promotes the use of so-called “natural remedies” such as vitamin C or homeopathy for the treatment of cancer. They are promoted by the inclusion of quotes such as “There have been some exceptional results”, regarding the treatment of cancer with homeopathic products.
None of the relevant controversy regarding these treatments is discussed in the article. Although there is a brief note at the end that “those living with cancer [are encouraged] to consult their doctor or specialist before embarking on any alternative therapies”, this does not sufficiently address the important and relevant fact that these treatments are entirely unsupported by scientific evidence, as well as the utter implausibility of treatments like homeopathy.
The failure to discuss the lack of scientific evidence supporting these treatments, as well as the complete lack of plausibility underlying homeopathy, violates the Press Council’s principle of “Fairness, Accuracy and Balance”. The description of this principle on the Press Council’s website states that:
“Publications should be bound at all times by accuracy, fairness and balance, and should not deliberately mislead or misinform readers by commission or omission. In articles of controversy or disagreement, a fair voice must be given to the opposition view.
Exceptions may apply for long-running issues where every side of an issue or argument cannot reasonably be repeated on every occasion and in reportage of proceedings where balance is to be judged on a number of stories, rather than a single report.”
This is not a long-running issue in which readers can readily be expected to be familiar with the lack of evidence supporting the treatments discussed in the article, so the exception should not apply. There is significant controversy surrounding the issues discussed in this article, but a fair voice has not been given to the opposition view.
Particularly as this article could lead to people living with serious diseases such as cancer to rely on ineffective treatments such as homeopathy, its lack of balance has the potential to cause real and serious harm. Therefore it is important that the Wairarapa Times-Age take appropriate action to prevent this harm by amending the article, publishing a prominent correction, or publishing a followup article linked to from today’s article, that discusses the lack of evidence and plausibility underlying the treatments discussed in today’s article.
If the Wairarapa Times-Age has trouble finding any experts to talk to about this topic, either the Society for Science Based Healthcare (http://sbh.org.nz/contact) or the Science Media Centre (http://www.sciencemediacentre.co.nz/contact-us/) will be able to help.
Society for Science Based Healthcare
Despite sending a follow-up email a few days later, I still hadn’t heard back from the editor over the next 10 working days, which is the deadline set in the Press Council’s complaints process as the time to wait before escalating a complaint to them if you don’t hear back from the editor. After I forwarded my complaint to the Press Council, the editor contacted me to apologise that he’d overlooked my complaint messages, which was apparently due to his having to deal with another complaint about the same article from Peter Griffin, manager of the Science Media Centre (Peter is also the editor and manager of Sciblogs, where my blog is syndicated, and we’d discussed our complaints via email prior to submitting them).
When I forwarded my complaint to the Press Council, I fleshed it out a bit more. I won’t quote the whole thing here as a lot of it would just be repeating myself, although I’d be happy to share my full complaint if anyone would like to see it, but here is one part I added that I think is important and worth sharing:
As far as I’ve been able to tell, the Wairarapa Times-Age has not published a large number of articles regarding this, so it cannot be argued that the counterpoints have already been published in earlier articles.
When it comes to whether or not readers can be expected to be familiar with the important facts not mentioned in this article, I would like to bring the Press Council’s attention to a 2009 study (I am not aware of any more recent data collected on this) published in the New Zealand Medical Journal entitled “Beliefs about homeopathy among patients presenting at GP surgeries”. This study can be accessed for free on Page 94 of this PDF:
This study found that only 8 out of 124 respondents disagreed to some extent that “There is good scientific evidence that homeopathy works”, and only 24 respondents reported that they believed homeopathic products were either “very dilute” or that there was “nothing there”. In contrast, 82 respondents agreed to some extent that “There is good scientific evidence that homeopathy works”, and 80 believed that homeopathic products are either “Very concentrated”, “Moderately concentrated”, or “Moderately dilute”.
Contrary to these common beliefs, most homeopathic products are diluted to the point that it is astronomically unlikely that there is even a single molecule of the original ingredient present in the product, and there effectiveness is thoroughly unsupported by scientific evidence. For example, a rigorous review undertaken by the Australian Government’s National Health and Medical Research Council (NHMRC) in 2013 investigated the evidence regarding homeopathy for 68 clinical conditions and concluded that “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”
For this reason, and especially because the article discussed the use of ineffective therapies in the treatment of terminal illness, it is very important that stories such as this be balanced. As I stated in my original complaint to the editor, I believe the article in its current form has the capacity to do serious harm and that the Wairarapa Times-Age has a responsibility to mitigate this harm. An appropriate response would be amending the article, publishing a prominent correction, or publishing a followup article linked to from the article from the 10th of February that discusses the lack of evidence and plausibility underlying the treatments discussed in today’s article.
(The NHMRC link I provide there is from their 2013 conclusion. Within 2 weeks of submitting this complaint, however, they released their final statement on homeopathy, which states “there are no health conditions for which there is reliable evidence that homeopathy is effective”. This statement was not reported in the Wairarapa Times-Age)
Once the complaint was escalated to the Press Council, the editor of the Times-Age was given an opportunity to respond, then I had a final opportunity to write a short response to that. His primary argument was that the topic of “alternative medicine” was a long-running issue in a wider context, and that the exemption to the principle of balance should apply because other media have reported on the opposing side of the issue.
I strongly disagree with this argument. Although it’s true that media like the Wairarapa Times-Age do not exist in a vacuum, I don’t think this should mean that they don’t have a responsibility to provide balanced articles for their readers. The way I interpret the Press Council code, the exception can be useful when an article is part of a series of articles on the same issue, and when taken in the context of other articles in the series the overall view still maintains an appropriate balance. In the interest of balanced reporting, I believe exceptions to the principle of balance should be applied very sparingly.
Unfortunately, the Press Council disagreed with me. They have ruled not to uphold the complaint, and you can view their entire decision on their website here:
Case Number: 2426 MARK HANNA AGAINST WAIRARAPA TIMES-AGE
Here’s a link to their similar ruling regarding the complaint from the Science Media Centre:
Case Number: 2425 SCIENCE MEDIA CENTRE AGAINST WAIRARAPA TIMES-AGE
Here is a summary of their decision:
The Press Council agrees with the editor that the debate over alternative remedies is sufficiently well known not to require balancing comment in every story about them. The subject falls within the exception to the principle of balance for issues of enduring public discussion.
The complainant in this case raised the important question of whether the exception can be invoked for an article in a newspaper that may not itself have covered both sides of the debate. The Council considered this point closely and came to the view that the exception has not been applied as narowly as the complainant contends and should not be. A newspaper, even if it is the sole newspaper of its locality, does not exist in a vacuum. Its readers, meeting an uncritical story on the supposed popularity of homeopathy and natural remedies, are likely to be aware the efficacy of these treatments is strongly contested by medical science.
I think this is a very worrying precedent to set. Newspapers such as the Wairarapa Times-Age can now feel justified in publishing unbalanced articles on topics such as homeopathy without feeling bound to uphold the Press Council’s principle of balance. The public have a reasonable expectation, given that the Press Council exists to uphold standards in reporting and its first principle is that articles should be accurate, fair, and balanced. While it’s a good idea to take everything you read with a grain of salt, you should be able to feel justified in expecting media reports on controversial topics to provide a balanced view. I worry that people might read articles such as this with that assumption in mind, and falsely conclude that the views omitted from the article are not merited.
I’m also rather frustrated that the Press Council concluded that anyone reading articles such as this is “likely to be aware the efficacy of these treatments is strongly contested by medical science” even though I provided data from a survey that found only 6% of respondents disagreed that “there is good scientific evidence that homeopathy works”. I understand that the survey I cited was conducted 6 years ago, but as I said in my complaint I’m unaware of anything more recent.
Although I don’t think it is, I really hope that the Press Council’s conclusion that most people are aware that homeopathy is not supported by evidence is correct. Following last year’s story about Green MP Steffan Browning backing homeopathy for ebola and March’s story about the Australian National Health and Medical Research Council concluding that homeopathy does not improve people’s health, I think there is some basis to believe that more people are familiar with the lack of evidence surrounding homeopathy than 6 years ago, but I don’t expect there would be that large a difference.
One positive thing to take away from this, at least, is that the journalist who wrote the article said in a Facebook comment that she understood the article was unbalanced and that she should have done better. I hope she’ll take this as a learning experience and, when she or other Wairarapa Times-Age reporters write on matters of “natural health” in the future, that they get in touch with the Science Media Centre to provide that much-needed balance. If we can’t rely on the Press Council to hold journalists to a high standard of balanced reporting, then we’ll have to rely on journalists’ and editors’ own standards.
EDIT 2015/04/14 10:05 am: Peter Griffin, who also complained to the Press Council about this article, has published his thoughts on the ruling as well: When balance goes out the window
EDIT 2015/04/04 1:13 pm: The Wairarapa Times-Age has published a short article on this ruling: Times-Age supported by Press Council
EDIT 2015/04/14 2:21 pm: Grant Jacobs has also published a post with his thoughts on this ruling: Press Council rules on knowing readers minds?
EDIT 2015/04/15 2:51 pm: Andrew Bonallack, the editor of the Wairarapa Times-Age, has published his thoughts on the Press Council decision in an opinion piece for the Times-Age: Your right to choose sacrosanct
I’m very happy to have had an article published on the website of the New Zealand Science Teacher, the official publication of the New Zealand Association of Science Educators.
My article is about applied kinesiology, I’ve embedded the introduction below and you can read the whole thing on the NZST website: Finding Power and balance: proving and disproving claims
When reading a story about someone who has been scammed, it’s very easy to think ‘that could never happen to me’. From the outside, warning signs always appear obvious and the conclusion often seems untenable. It’s easy to assume that people who fall for scams or are otherwise misled must be unintelligent or gullible. The reality is less comfortable. We can all be fooled, even the best of us.
One historical example of someone very intelligent falling for what now seems to be clearly false, involves author and doctor Sir Arthur Conan Doyle, creator of Sherlock Holmes. Despite obviously understanding the principles of scepticism, Doyle became convinced in the early 20th century that fairies were real, based on a series of photographs of the “Cottingley Fairies”, which were revealed decades later to have been faked using paper cut-outs. Intelligence is no failsafe against being fooled.
More recently, many people, including Shaquille O’Neil and Bill Clinton, have been fooled by a plastic wristband: the makers of which claim it can improve a person’s strength and balance.
The ‘theory’ behind the tests used to promote these wristbands is also employed by various alternative health practitioners in attempts to evaluate treatment effects and to diagnose illnesses, allergies, and intolerances, despite the fact that there is no scientific proof behind it.
It’s known as ‘applied kinesiology’ and, if you don’t know any better, it can be very convincing.