Its been a hard week for us pharmacists. To be honest, I'm sort of at a loss as to where to start, but the most obvious place is in London, at a pharmacy called Ainsworths, where a man called Tony Pinkus works.
Ainsworths is a real life, registered pharmacy, and Mr Pinkus is a real life, registered pharmacist. The main problem with this story, however, is that Mr Pinkus is not selling real life medicines to his real-life patients, and in doing so he is putting peoples' lives at risk.
In an expose by BBC News, Mr Pinkus has been caught recommending by email that homeopathic whooping cough "vaccines" are used instead of getting a proper, real-life vaccine. In the email exchange, Mr Pinkus is careful to express his recommendations as personal choice, and this will presumably form his defence. However in my eyes this is absolutely no defence at all. For years, the pharmacy profession has been slowly but surely promoting ourselves as the trusted healthcare professionals that we are, therefore we have a responsibility to be aware of the position of high esteem we may be held in by the public. We have a duty to know that any 'personal recommendations' we make will constitute medical advice in the eyes of many patients.
Mr Pinkus also states that the patients' GP "will undoubtedly throw a lot of fear in your direction". Now, I remember having it very firmly drummed into me that we need to be careful in our role as a pharmacist not to break the trust a patient has in their GP. Obviously, this doesn't mean that we should cover up any mistakes or errors from them, but it does mean some quite careful wording as enquiries arise. Mr Pinkus is clearly and flagrantly attempting to reduce the trust this patient would have had in their GP's advice and showing a shocking lack of respect to the GP in question, despite knowing absolutely nothing about their practice. I wonder if he has ever considered the longer term implications of such wording. "oh, the GP has told me I should be worried about this lump in my breast, but of course they'll just throw a lot of fear in my direction", for example.
Mr Pinkus has also been investigated by pharmacy's governing body before. In 2006 he was caught selling homeopathic travel vaccines. In 2009 he was investigated by the PRSGB for selling homeopathic swine flu vaccines. In 2011 he was investigated for marketing homeopathic travel vaccines again and malaria prophylaxis. In each case the regulator has let the public down by not taking decisive action over a pharmacist who is regularly and routinely endangering lives, all in the name of "free choice". I don't think i actually need to point out the serious indirect harms that could happen if a patient were to use a sugar pills to prevent malaria, or yellow fever etc.
Free patient choice is not a defence when patient's lives are at risk.
I've been asking for a response to the case from the GPhC on twitter for a few days now and have heard nothing. I'm also wondering why the story hasn't appeared in some of the major pharmacy news publications (Chemist and Druggist, I'm looking at you).
This story has really angered me, and i can pinpoint exactly why. I've written before about the constant fear I and many other pharmacists feel whilst at work- the fear that one little throwaway mistake could have huge implications for a patient's life. And there's an added, secondary fear that, if something goes wrong, a regulator could step in and your whole livelihood and career could be at stake. This is a fear that all good pharmacists carry to some degree, and it can weigh heavily on your life. And yet here strides Tony Pinkus, who waves away any notion of patient safety, and flagrantly (I know it's the second time I've used this word, but it seems to fit the situation rather well) ignores the standards of the regulatory body without, apparently, a care in the world.
Well, I'm taking to heart the GPhC standards for conduct, ethics and performance, one of which is:
"Be prepared to challenge the judgement of your colleagues and other profesionals if you have reason to believe that their decisions could affect the safety or care of others"
So this, Mr Pinkus (and any other homeopathic pharmacists who would recommend a homeopathic vaccine) is me challenging your decision, because I believe it most definitely could affect the safety and care of others.
UPDATE: Chemist and Druggist have now covered the story (registration required). The comments section is interesting, with a couple of folk showing a staggering lack of knowledge about homeopathic products.
The Pharmaceutical Journal have also covered the story (registration required). This includes some interesting tidbits, like the fact the MHRA have been investigating 20, yes TWENTY unlicensed medicines being sold on the Ainsworth's website. And the post script is particularly interesting:
'Some of you have noticed that the pertussin products highlighted in the
BBC investigation are still on sale. We've clarified this with the MHRA -
a spokeswoman confirmed that the MHRA asction (sic) was against products
labelled as vaccines.
"Substances and products labelled with the names of serious diseases
such as pertussis are part of a wider, ongoing investigation," she said.
So it's watch this space for the outcome of that branch of the
investigation."'
This wider, ongoing inestigation sounds very interesting indeed.
Friday, 18 January 2013
Monday, 14 January 2013
Malik's Mesothelioma Magic
I'm still pretty new to this skepticism thing, but I'm starting to become immune to the bog-standard nonsense claims that I see homeopaths constantly making. There are still the odd ones, however, that knock me for six and leave me feeling rather staggered at the sheer dangerous nature of the claims.
It'll come as no surprise to some of you that the culprit of the most recent of these claims is "Dr" Nancy Malik, who yesterday posted the following on twitter:
That's right, people, apparently mesothelioma is curable with "alternative and natural treatments". And so, with bated breath and already-slightly-higher blood pressure, I followed the link provided by I'm Not Really A Dr Malik. What I was faced with was, to say the least, rather misleading and made my blood boil. Take this paragraph for instance:
"If mesothelioma patients have the desire to maintain quality of life, often they will choose alternative and natural treatments for the disease. The survival rates for those having success with natural treatments greatly enhance quality of life during treatment due to the fact that they forego poisoning their systems using toxic chemicals that hamper the body's immune system."
In other words: if you choose conventional medicine, you're an idiot who is essentially killing themselves by choosing poison. So what would they recommend instead, this website which has no references at all to back up their claims, and who appear to be desperately trying to sell me various nonsense books?
There is one thing I can say in defense of this website is at least it appears to be peddling herbal medicines rather than homeopathy. I wonder if "Dr" Malik has realised this, as she seems to have been furiously retweeting and promoting things from this website.
They recommend Nigella sativa, celandine, mistletoe, and cat's claw. Oh really? let's check that, shall we, by having a lookie at the evidence for these products in mesothelioma, brb....
...
Nigella sativa: no evidence.
...
Celandine: insufficient evidence to rate effectiveness for cancer.
No evidence in mesothelioma
...
Mistletoe: insufficient evidence to rate effectiveness for cancer. No evidence in mesothelioma
...
Cat's claw: no evidence.
Well, that was quick then. For transparency, I checked the evidence using the Natural Medicines Comprehensive Database, a gold standard resource for information on herbal medicines.
This website does of course close with the obligatory "It's all a big conspiracy and big pharma and the medical profession just want everyone to die horribly" statement, so any teensy tiny miniscule scrap of plausability has gone out the window even without the total lack of evidence to back up their claims.
Do these people really not realise the danger they put people in by encouraging them not to use conventional medicine (which we have evidence to say it works at least some of the time) and to use alternative medicines (which there is zero evidence to say if it works or not) So where is the conspiracy here, folks? Is it really from the people who know about physiology and pharmacology, and who are primarily motivated to help people? Or does it come from the "alternative" camp, who seem hell bent on selling various books and expensive remedies and are happily peddling misinformation like there is no tomorrow?
H xxx
It'll come as no surprise to some of you that the culprit of the most recent of these claims is "Dr" Nancy Malik, who yesterday posted the following on twitter:
That's right, people, apparently mesothelioma is curable with "alternative and natural treatments". And so, with bated breath and already-slightly-higher blood pressure, I followed the link provided by I'm Not Really A Dr Malik. What I was faced with was, to say the least, rather misleading and made my blood boil. Take this paragraph for instance:
"If mesothelioma patients have the desire to maintain quality of life, often they will choose alternative and natural treatments for the disease. The survival rates for those having success with natural treatments greatly enhance quality of life during treatment due to the fact that they forego poisoning their systems using toxic chemicals that hamper the body's immune system."
In other words: if you choose conventional medicine, you're an idiot who is essentially killing themselves by choosing poison. So what would they recommend instead, this website which has no references at all to back up their claims, and who appear to be desperately trying to sell me various nonsense books?
There is one thing I can say in defense of this website is at least it appears to be peddling herbal medicines rather than homeopathy. I wonder if "Dr" Malik has realised this, as she seems to have been furiously retweeting and promoting things from this website.
They recommend Nigella sativa, celandine, mistletoe, and cat's claw. Oh really? let's check that, shall we, by having a lookie at the evidence for these products in mesothelioma, brb....
...
Nigella sativa: no evidence.
...
Celandine: insufficient evidence to rate effectiveness for cancer.
No evidence in mesothelioma
...
Mistletoe: insufficient evidence to rate effectiveness for cancer. No evidence in mesothelioma
...
Cat's claw: no evidence.
Well, that was quick then. For transparency, I checked the evidence using the Natural Medicines Comprehensive Database, a gold standard resource for information on herbal medicines.
This website does of course close with the obligatory "It's all a big conspiracy and big pharma and the medical profession just want everyone to die horribly" statement, so any teensy tiny miniscule scrap of plausability has gone out the window even without the total lack of evidence to back up their claims.
Do these people really not realise the danger they put people in by encouraging them not to use conventional medicine (which we have evidence to say it works at least some of the time) and to use alternative medicines (which there is zero evidence to say if it works or not) So where is the conspiracy here, folks? Is it really from the people who know about physiology and pharmacology, and who are primarily motivated to help people? Or does it come from the "alternative" camp, who seem hell bent on selling various books and expensive remedies and are happily peddling misinformation like there is no tomorrow?
H xxx
The Commenting Conundrum
My commuting-podcast of choice this morning was The Pod Delusion. I was really interested to hear their piece on the effects comments have on someone's opinion of science information.
You can listen to the piece here: http://poddelusion.co.uk/blog/2013/01/11/episode-169-11th-january-2013/
It featured an interview with Dominique Broussard, who had been involved in some research which ultimately showed that people's opinions of a science article (nanotechnology was the basis for the research) could be swayed by the comments left on the page. Essentially, the research found that abusive comments could actually lead to more polarised opinions in the reader, so if someone had vaguely held views against nanotechnology, and the comments on the piece were derogatory to the science in the paper, they would end up with more strongly held views against nanotechnology.
This got me thinking about a bit of research that me and my colleague Nancy (of Evidence Based Skepticism fame) did a while ago. We looked at information available if you searched for antineoplastons on google, and whether the quality and types of concepts used on websites differed depending on the motivations of the writer. I'm not going to cover the whole Burzynski saga here, because its been done much better elsewhere, but I just wanted to focus on one really interesting finding.
We split the concepts found in original articles from those found in comments left on each article, and one thing became very glaringly obvious: Hardly any sites that had "pro-Burzynski" sentiments had the facility for commenting, whereas those that were questioning the value of his treatments tended to have comments available, in which rather heated debates would strike up (in some cases, becoming rather abusive at times, mainly on the part of the pro-Burzynski supporters).
When I set up this blog, I decided to have open comments. I'm happy to invite debate and feel confident enough in my arguments because they are backed up in evidence as much as possible, and if they're not, I will have said so in the post. I don't want to be accused of not publishing comments from people who disagree with my views. But it strikes me that, based on this new evidence, this may not be the best tactic. Should we, as skeptics, rethink how we invite commenting on our blogs and websites, and take on the tactics of, for example, Burzynski supporter websites and just close down commenting? To me, this feels like the wrong thing to do, and it seems to counteract a lot of principles that i think we as skeptics share. But we also need to reassess our stance given evidence to the contrary.
Do we need to consider the risk that someone who may have vaguely held views reads something we write, then sees the sort of comments we are becoming used to from anonymous shills or those who disagree with the evidence, which makes them disagree with us more?
I guess it's ironic to now invite comment, but I would love to know what other people think on this subject.
H xxx
You can listen to the piece here: http://poddelusion.co.uk/blog/2013/01/11/episode-169-11th-january-2013/
It featured an interview with Dominique Broussard, who had been involved in some research which ultimately showed that people's opinions of a science article (nanotechnology was the basis for the research) could be swayed by the comments left on the page. Essentially, the research found that abusive comments could actually lead to more polarised opinions in the reader, so if someone had vaguely held views against nanotechnology, and the comments on the piece were derogatory to the science in the paper, they would end up with more strongly held views against nanotechnology.
This got me thinking about a bit of research that me and my colleague Nancy (of Evidence Based Skepticism fame) did a while ago. We looked at information available if you searched for antineoplastons on google, and whether the quality and types of concepts used on websites differed depending on the motivations of the writer. I'm not going to cover the whole Burzynski saga here, because its been done much better elsewhere, but I just wanted to focus on one really interesting finding.
We split the concepts found in original articles from those found in comments left on each article, and one thing became very glaringly obvious: Hardly any sites that had "pro-Burzynski" sentiments had the facility for commenting, whereas those that were questioning the value of his treatments tended to have comments available, in which rather heated debates would strike up (in some cases, becoming rather abusive at times, mainly on the part of the pro-Burzynski supporters).
When I set up this blog, I decided to have open comments. I'm happy to invite debate and feel confident enough in my arguments because they are backed up in evidence as much as possible, and if they're not, I will have said so in the post. I don't want to be accused of not publishing comments from people who disagree with my views. But it strikes me that, based on this new evidence, this may not be the best tactic. Should we, as skeptics, rethink how we invite commenting on our blogs and websites, and take on the tactics of, for example, Burzynski supporter websites and just close down commenting? To me, this feels like the wrong thing to do, and it seems to counteract a lot of principles that i think we as skeptics share. But we also need to reassess our stance given evidence to the contrary.
Do we need to consider the risk that someone who may have vaguely held views reads something we write, then sees the sort of comments we are becoming used to from anonymous shills or those who disagree with the evidence, which makes them disagree with us more?
I guess it's ironic to now invite comment, but I would love to know what other people think on this subject.
H xxx
Friday, 4 January 2013
The paracetamol paradox
I'll often bang on about how "natural" does not necessarily mean safe, and you'll often hear me muttering about how new drugs can be a cause for concern because of lack of safety data. Today, however, I want to talk about some problems with one of our oldest, most reliable friends in the drug world: paracetamol (acetaminophen to our US friends).
Paracetamol appears to have first been used clinically as far back as 1887. It's very widely used in the UK and is very easily accessbile: packs of 16 tablets are classed as GSL medicines, meaning they can be sold pretty much anywhere. Its accepted as a social norm: adults take paracetamol for headaches, and they give their children Calpol (a branded liquid paracetamol) at the first sign of illness.
And herein lies my first point: its almost so widely available that I think people are starting to forget that it works. I've come across patients and friends who instantly dismiss paracetamol for their pain because "its not strong enough" or "it won't work, this headache's too bad". I'm starting to think that its dismissed offhand without trying it because its so well accepted its almost forgotten in the general public's mind that it is still a medicine, and one that works well. People are too quick to dismiss plain old paracetamol in favour of a shiny new combination product which costs more but works less well, or they're taken in by the promise of a "stronger" painkiller like co-codamol (with little evidence of benefit over paracetamol alone, but a whole lot more problems). Paracetamol has hardly any significant side effects, and it does actually work well for mild to moderate (and even some types of severe) pain, but many people won't even give it a chance. I'm interested to know what you guys think of this and whether or not you would agree that this is the case- do let me know by leaving a comment or tweeting me @SparkleWildfire. Do you think this yourself, or have friends that do? If you're a pharmacist or another healthcare professional, have you noticed a similar attitude? Or is it just me?
More scary, though, is my second point: Because people seem to be sort-of-forgetting its a medicine, they are forgetting that it can be dangerous. Horrifically so, in actual fact. Whilst it has few side effects with normal, recommended use, it's horribly toxic in overdose.
Overdose? Lets have a think about that word. It immediately brings to mind suicide attempts, right? So that wouldn't apply to most people, right? Very much wrong. In the last few weeks and months (it being the cold season and all), I've noticed a few of my friends on social media rather jokingly saying things like how they've taken a few extra doses of paracetamol, or they're taking lots of Lemsips because they like the taste, or they're combining a branded cold and flu product with paracetamol tablets, and I've felt the need to intervene and ask them to be careful about the amounts that they are taking. Would they consider themselves to be taking "overdoses"? I fear not. I also don't think they're taking me seriously, to be honest, and I think they think "what's a few extra doses going to do, it's just paracetamol after all". What they don't realise is that this sort of therapeutic excess or staggered overdose scenario can be just as-if not more-serious than a classsic, acute self-harm attempt-type of overdose. And the sort of toxicity that happens is not pleasant, and ultimately, in the worst case scenario could mean a slow, painful death, or a liver transplant. The antidote to paracetamol poisoning (although its not always able to be used, particularly in these sorts of cases) isn't a walk in the park either. It's a lengthy course of an IV drug (in the UK, anyway) which could mean at least a few days hospital stay.
Unfortunately, its easy to accidentally take too much paracetamol. There's so many branded products that require a fair amount of package-reading before you work out that they contain paracetamol. I think its also easy for people to feel blase about the way they're using it, because if its available everywhere and its "just paracetamol" its safe to take more than is directed. Maybe people think taking extra paracetamol "proves" that their pain is more severe than other people's pain, who knows. I think many of us would agree that we've heard anecdotal reports of parents putting Calpol in babies' bottles, or leaving the bottle with a child to self-administer overnight, or giving their child Calpol "to make them sleep" (it would have no direct effects to promote sleep).It's just so pervasive that it's almost become like vitamins or a foodstuff in some peoples' mind, or so it would seem.
Just because a drug is as old as the hills, and its safe in everyday use, and it works, doesn't mean that its innocuous and we can throw caution to the wind when we're using it and have as much as we like, whenever we like.
Why am I on about this? Well, part of my day job involves advising on management of poisoning cases, and as a result I see a lot of these types of cases. And it can be really sad and frustrating and sometimes scary to hear of how commonly this sort of thing happens, and the variety of reasons for it.
So my point is: if you're taking paracetamol, please take no more than 4 grams per 24 hour period, and please check for other sources of paracetamol in cold remedies or other branded products first.
H xxx
Paracetamol appears to have first been used clinically as far back as 1887. It's very widely used in the UK and is very easily accessbile: packs of 16 tablets are classed as GSL medicines, meaning they can be sold pretty much anywhere. Its accepted as a social norm: adults take paracetamol for headaches, and they give their children Calpol (a branded liquid paracetamol) at the first sign of illness.
And herein lies my first point: its almost so widely available that I think people are starting to forget that it works. I've come across patients and friends who instantly dismiss paracetamol for their pain because "its not strong enough" or "it won't work, this headache's too bad". I'm starting to think that its dismissed offhand without trying it because its so well accepted its almost forgotten in the general public's mind that it is still a medicine, and one that works well. People are too quick to dismiss plain old paracetamol in favour of a shiny new combination product which costs more but works less well, or they're taken in by the promise of a "stronger" painkiller like co-codamol (with little evidence of benefit over paracetamol alone, but a whole lot more problems). Paracetamol has hardly any significant side effects, and it does actually work well for mild to moderate (and even some types of severe) pain, but many people won't even give it a chance. I'm interested to know what you guys think of this and whether or not you would agree that this is the case- do let me know by leaving a comment or tweeting me @SparkleWildfire. Do you think this yourself, or have friends that do? If you're a pharmacist or another healthcare professional, have you noticed a similar attitude? Or is it just me?
More scary, though, is my second point: Because people seem to be sort-of-forgetting its a medicine, they are forgetting that it can be dangerous. Horrifically so, in actual fact. Whilst it has few side effects with normal, recommended use, it's horribly toxic in overdose.
Overdose? Lets have a think about that word. It immediately brings to mind suicide attempts, right? So that wouldn't apply to most people, right? Very much wrong. In the last few weeks and months (it being the cold season and all), I've noticed a few of my friends on social media rather jokingly saying things like how they've taken a few extra doses of paracetamol, or they're taking lots of Lemsips because they like the taste, or they're combining a branded cold and flu product with paracetamol tablets, and I've felt the need to intervene and ask them to be careful about the amounts that they are taking. Would they consider themselves to be taking "overdoses"? I fear not. I also don't think they're taking me seriously, to be honest, and I think they think "what's a few extra doses going to do, it's just paracetamol after all". What they don't realise is that this sort of therapeutic excess or staggered overdose scenario can be just as-if not more-serious than a classsic, acute self-harm attempt-type of overdose. And the sort of toxicity that happens is not pleasant, and ultimately, in the worst case scenario could mean a slow, painful death, or a liver transplant. The antidote to paracetamol poisoning (although its not always able to be used, particularly in these sorts of cases) isn't a walk in the park either. It's a lengthy course of an IV drug (in the UK, anyway) which could mean at least a few days hospital stay.
Unfortunately, its easy to accidentally take too much paracetamol. There's so many branded products that require a fair amount of package-reading before you work out that they contain paracetamol. I think its also easy for people to feel blase about the way they're using it, because if its available everywhere and its "just paracetamol" its safe to take more than is directed. Maybe people think taking extra paracetamol "proves" that their pain is more severe than other people's pain, who knows. I think many of us would agree that we've heard anecdotal reports of parents putting Calpol in babies' bottles, or leaving the bottle with a child to self-administer overnight, or giving their child Calpol "to make them sleep" (it would have no direct effects to promote sleep).It's just so pervasive that it's almost become like vitamins or a foodstuff in some peoples' mind, or so it would seem.
Just because a drug is as old as the hills, and its safe in everyday use, and it works, doesn't mean that its innocuous and we can throw caution to the wind when we're using it and have as much as we like, whenever we like.
Why am I on about this? Well, part of my day job involves advising on management of poisoning cases, and as a result I see a lot of these types of cases. And it can be really sad and frustrating and sometimes scary to hear of how commonly this sort of thing happens, and the variety of reasons for it.
So my point is: if you're taking paracetamol, please take no more than 4 grams per 24 hour period, and please check for other sources of paracetamol in cold remedies or other branded products first.
H xxx
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