Thursday, 27 September 2012

The Magazine Of Doom

Today, I and several others have sent strongly worded emails to W.H. Smith's.

The reason? A magazine they are stocking which is frankly disgraceful. Encased in a glossy, brightly coloured cover, this is clearly such a blood-pressure-raising piece of crap it's ridiculous.

However, to the untrained eye, it's another helpful glossy magazine, packed with useful hints and tips for how to stay healthy. Look at that nice, smiling, benign healthy looking lady. And it is a sad fact of life that patients and the public really do respond to these sorts of publications more than they do to advice from their healthcare practitioners. I can't tell you how many patients have stormed into my pharmacy with a piece of paper cut from a newspaper, demanding to know why they have been given this horrifically dangerous drug. Goodness only knows how many would turn up at their doctors. I would often spend a lot of time with these patients and explain to them what i could about the limitations of these sources, but to be honest I often felt that i had neither the resources or time to be able to do so properly. Some would change their mind, some would be marching off to their GP, usually demanding  more expensive newer drugs whose safety record we know even less about.

To be honest, even the title of this publication upsets me: What Doctors Don't Tell You. As if they are willingly sat in their surgeries or their hospital wards, giggling evilly about all of the suckers that they are going to see who are in pain, or depressed, or generally feel sick and vulnerable, rubbing their hands together, and all the while they are thinking "I could CURE you within a second, but I'm not going to, I'm going to sit here and watch you SUFFER! MWAHAHAHAHAAAA!". Actually, doctors (and any other healthcare professional) are usually people whose primary aim is to help people. They're usually overworked and under-resourced, and I suspect that many (like me, when I worked in community pharmacy) constantly feel guilty that they aren't able to help as much as they would like, because of their lack of time and resources. Yes, there is the odd Shipman character here and there, but I suspect very few people actually go into front line health care purely for money, or for the kicks of withholding various cures and treatments from their patients. Doctors, pharmacists, nurses, and other healthcare professionals may not get everything right every time, they may not be as up to date with evidence as they would like, and they may not make exactly the right decision for every single patient. But my word, I bet they really, really would like to.

The fact of the matter is: What The Doctors Don't Tell You about are usually overly hopeful health claims based on little evidence, and peddled by people who DO have the intention to make money. What they don't usually tell you about is unicorn tears and magic water and rooms made of salt and badges with unicorns drawn on (listen to Skeptics with a K podcast episode 45) because they very probably DON'T WORK, and your doctor wants more than anything to make you better. No doctor is going to advise that you try to avoid a hysterectomy with diet (Front Page of What The Doctors Don't Tell You)  if you are in a lot of pain now and a hysterectomy would improve your quality of life for you quickly, as an example. A nutritional therapist, though, as an example, may advise you to delay surgery and try diet instead, causing you to suffer for longer than is necessary.

I know this has turned into a bit of a rant. It's hardly evidence based, but it is based on genuine emotion from someone who, despite all my cynicism and negativity, just wants to do whats best for patients. I know that most of my health care professional colleagues feel the same, and this sort of sugar coated nonsense is actually rather offensive. I used to lie awake at night worrying about the patients i had seen through the day. I had many episodes of private tears for the ones that i couldn't help, and my whole week would be lifted when I had made someone's life a little bit easier. I wonder how many purveyors of woo could say the same.

Anyway, the general gist of this post is: email W.H. Smith and tell them to get this nonsense off their shelves, 

Wednesday, 26 September 2012

Am I the World's Worst Skeptical Pharmacist?

Yesterday, I had a cold.

We all joke about Man-Flu, and how rubbish men can be when they have a cold. But even the worst of Man-Flu sufferers is nothing compared to me. I am the Queen of Minor Illness related whinging.Instead of merely having a simple cold that makes me feel slightly rubbish, I have some sort of TB-Ebola crossover which makes me the illest person alive at that particular time.

I'm feeling a bit better today, but I'm left with a cough. Not a particularly bad cough, but a cough nonetheless. So this morning, I found myself buying Buttercup syrup.

Now, I know fine well that there is no good evidence for any cough preparations. I know that squill, the main active ingredient, has insufficient evidence to rate its efficacy. I know that capsicum is just going to give me a little bit of a warming sensation and that's it. I know that, for a couple of seconds after a swig, my throat may be thinly coated with a viscous substance which will feel nice, but will soon be washed away by all the other goo encased in my body. And yet, I still spent some of my hard earned money on it.

So, I suppose the question is: why? Surely, with knowledge that there is no evidence, and all of my new found skepticism, I should be steering away from products that I know won't work? Am I really just a poor excuse for a skeptic, and a poor excuse for a pharmacist? After I'd finished hanging my head in shame, I thought about this a bit.

And my primary answer is probably: Hope. I know it wont work, but I hope that it will because I may have a date-type thing on Saturday and I don't particularly think hacking up a lung is a great way of selling myself (and no, I probably can't fall back on my charming personality as I doubt that is much better than lung-hancking). The secondary answer would be that it tastes nice, and it has teensy tiny amount of alcohol in which makes me feel slightly smug about alcohol intake at work.

I find myself wondering (ugh, this sounds like a SATC storyline now) how many people who turn to woo and quackery as a treatment option think similarly. I wonder how many blindly accept that, say, homeopathy is going to work for them, and how many go along with it in the vain hope that something good may happen. I also wonder how many peddlars of woo think like this themselves, and how many think "haha, suckers!" when practising fake magic on people.

Anyway, back to whinging profusely and coughing up parts of various organs.

Monday, 24 September 2012

Halotherapy: a pinch of nonsense?

My first subject on this blog is a result of an enquiry we encountered a while ago at work. I had never in my life heard of halotherapy, or "salt cave therapy" as its also known.

What does halotherapy involve? well, at first glance it appears to be mainly sitting on an Ikea chair in a room for an hour. Actually, on second glance, it appears to be the same. For the privilege of doing this, you pay £35 a hour.

I'm over simplifying, of course. According to The Salt Cave's website:

"The healing microclimate of a natural salt mine is recreated  inside a therapeutic salt room using the Breeze Tronic Pro medical device pharmaceutical grade salt is finely milled and accurately mixed with a regulated current of air, which is then evenly dispersed throughout the salt room.Breeze Tronic Pro is programmed to synchronise particle size, concentration, room temperature and humidity and to maintain the optimum, therapeutic environment for each client."

The website then helpfully goes on to tell us about all the other conditions that halotherapy can be used for: asthma, COPD, acne, ADHD, and various other ailments. It's packed with testimonials using words like 'miracle' and recommendations, but sadly lacking in anything like useful clinical information. We are told that: The clinical state of 85% of the patients with mild and moderate bronchial asthma, 75 % with severe bronchial asthma, 98%- with chronic bronchitis, bronchiectasis and cystic fibrosis improved after Salt Therapy. The patients were examined 6 and 12 months after the first Salt Therapy course.
But of course there is no reference cited to have a good look at where they've gotten their figures from.

So let's think about this. I'm not that hot anymore on inhalation formulations (university was a long, long time ago folks), but i do remember than inhalation therapy was quite a complex area. Could sitting in a room with some salt on the walls really have all these health benefits? I can see the point of a steam room type situation (especially as I sit here typing with a cold, thinking how lovely a steam room would be), but a dry room?

I'm going to have a bit of a look into it, and get back to you. (That's how we medicines information pharmacists roll). In the meantime... Those Ikea chairs... I just can't take it seriously. I could always be wrong, of course.

Helper Dog Blogs

Just a quick little post to recommend another shiny new blog to the skeptical circuit, written by one of my greatest friends and aforementioned Helper Dog:

Favourite it now. Or, if you haven't yet favourited this one, do it after you've favourited mine, pretty please

H xxx

What skepticism means to me

Hi all,

Welcome to my new humble little blog about skepticism. It's going to be mainly based on healthcare because, as a pharmacist, that's what I come across the most in daily life, but there may well be the odd few other bits and pieces that creep in also.

So about me:
My friends call me Simple Dog, because I'm generally useless at life, in particular electrical items and computers confuse me. I'm easily distracted by pretty coloured things, sparkly things, cake and other baked goods, and have a tendency to make high pitched noises when I get excitable about something.

I started off my professional life as a hospital pharmacy pre-reg. I then worked in community pharmacy for a good few years, in a supermarket pharmacy then an independent chain. I now work in medicines information, but still do regular locums around about.

During my time in community, I used to regularly sell things that i had no idea about, or that i knew had very little if any benefit. I used to tell patients this, but on many occasions they would go ahead and buy it anyway. I'll even admit here to ordering homeopathic products to fill the shelves of a pharmacy I managed. At the time, I vaguely knew it was a load of old tosh, but didnt have the time or the inclination to bother doing anything about it.

This job in Medicines Information has opened my eyes a hell of a lot. I started having a poke about on various different skeptical blogs. The Miracle Mineral Solution Saga and the Burzynski Hoohah piqued my interest further.  And when my good friend and Helper Dog Nancy suggested we go to something called Skeptics In The Pub, I was hooked. The nerdy part of my loves learning new stuff, and I'm a proper beer drinker, so combine the two and I'm a happy girl. I find myself thinking about a whole load of things that I would never have bothered devoting any time to before, and I think I'm much better off for it. I've also met some wonderful new people.

Something I've noticed from all this skeptical activity is that I'm now able to do my job much better. I used to think I was rubbish at critical appraisal, which is a very dry subject that always really bored me. However, put it into the context of woo and quackery and I've found its much easier to grasp. I'm hoping to use this knowledge to try and promote skeptical ideas and critical thinking to pharmacists. At the moment I have a few vague ideas floating around my head.

Skeptics get a bad rap in a lot of cases. It seems that believers (in whatever area it may be) are ready and eager to just dismiss them out of hand. But I believe (There's that word again) that a healthy dose of skepticism can only do good. Either it strengthens a cause if the belief is proved right, or it can be used to change beliefs to something more evidence-based and worthwhile.

This is my little contribution.

H xxx