[Discussion] Medical Quackery

This is a follow up to the thread "Medical quackery in the US upsets me very, very much". The aim of this current thread is to take up the discussion on medical quackery (widening the scope since the US isn't the only country concerned), discuss news item pertaining to it and the potential responses to address it.
The definition of medical quackery is not up for debate and includes, among others, homeopathy, vaccine skepticism, naturopathy, crystal healing, psychic healing.

Speaking of medical quackery, we're making decent headway here in France. There have been leaks from the HAS (Haute Autorité de Santé, High Authority for Health, the agency which regulates this), and the report we're waiting on goes against reimbursing homeopathy. We're not quite there yet, but we're getting there.

Homeopathy: France should not reimburse, report says (The Connexion)

The HAS made the conclusion after completing a study on 1,200 homeopathic medicines. It said that these medicines “provide insufficient medical service”, and recommended that they no longer be reimbursed at all by the State.

They are currently reimbursed up to 30%. The HAS has sent its findings to a number of leading homeopathic medicine manufacturers, to inform them officially of its position, it said.

A decision from the HAS on the reimbursement position of homeopathic drugs has been long awaited by the medical profession. Health minister Agnès Buzyn asked the HAS to consider the issue in the face of growing criticism of homeopathy in recent months and years.

A definitive decision is expected in June.

I think the State should continue to reimburse homeopathic treatments as a gesture of inclusion and to satisfy all shareholders. In fact, it should increase the potency of these homeopathic reimbursements by diluting them to 0.00001% of the current value. That should be incredibly valuable.

LarryC wrote:

I think the State should continue to reimburse homeopathic treatments as a gesture of inclusion and to satisfy all shareholders. In fact, it should increase the potency of these homeopathic reimbursements by diluting them to 0.00001% of the current value. That should be incredibly valuable.

The bank accounts will retain a memory of the funding the used to contain before dilution, which is just as effective.

LarryC wrote:

I think the State should continue to reimburse homeopathic treatments as a gesture of inclusion and to satisfy all shareholders. In fact, it should increase the potency of these homeopathic reimbursements by diluting them to 0.00001% of the current value. That should be incredibly valuable.

This might be my favorite post of the last three years.

Agreed. Just perfect. Masterful.

Eleima wrote:

Speaking of medical quackery, we're making decent headway here in France. There have been leaks from the HAS (Haute Autorité de Santé, High Authority for Health, the agency which regulates this), and the report we're waiting on goes against reimbursing homeopathy. We're not quite there yet, but we're getting there.

Homeopathy: France should not reimburse, report says (The Connexion)

The HAS made the conclusion after completing a study on 1,200 homeopathic medicines. It said that these medicines “provide insufficient medical service”, and recommended that they no longer be reimbursed at all by the State.

They are currently reimbursed up to 30%. The HAS has sent its findings to a number of leading homeopathic medicine manufacturers, to inform them officially of its position, it said.

A decision from the HAS on the reimbursement position of homeopathic drugs has been long awaited by the medical profession. Health minister Agnès Buzyn asked the HAS to consider the issue in the face of growing criticism of homeopathy in recent months and years.

A definitive decision is expected in June.

Thanks for bringing it back to Quackery. Homeopathy should be one of the easiest forms of fraud to squash, yet we have insurance paying for the sugar pills and governments like Canada supporting sending quacks to countries like Honduras for 'aid'.

The fact that it's so hard to crush is one of the signals that ours is the darkest timeline.

I'd love to know how many people who might buy homeopathic junk actually know what it is. I'd bet that a majority of them think it's just "natural" or "herbal" or something of that sort, not that it's literally nothing.

Or at least that it's *supposed* to be nothing but who knows what's in unregulated pseudomedicine?

qaraq wrote:

I'd love to know how many people who might buy homeopathic junk actually know what it is. I'd bet that a majority of them think it's just "natural" or "herbal" or something of that sort, not that it's literally nothing.

Or at least that it's *supposed* to be nothing but who knows what's in unregulated pseudomedicine?

Probably a lot. When my wife was looking for cough medicine for our kid she ended up getting some accidentally. It was labelled as natural and the fact that it was homeopathic wasn't noticeable unless you got into reading all the very small print on the back of the box.

Stengah wrote:
qaraq wrote:

I'd love to know how many people who might buy homeopathic junk actually know what it is. I'd bet that a majority of them think it's just "natural" or "herbal" or something of that sort, not that it's literally nothing.

Or at least that it's *supposed* to be nothing but who knows what's in unregulated pseudomedicine?

Probably a lot. When my wife was looking for cough medicine for our kid she ended up getting some accidentally. It was labelled as natural and the fact that it was homeopathic wasn't noticeable unless you got into reading all the very small print on the back of the box.

When I was young and dumb I had assumed that homeopathy was herbal remedies. In reality it’s magic water, but magic doesn’t exist so... It’s expensive water.

I remember having the same ignorance of homeopathic stuff. They market it as 'natural this and that' and when that's your only exposure, that's what you think. It shouldnt be up to consumers to know what it is. Go up the chain.

Walgreens and Bartells and CVS shouldnt be selling them. They know what it is.
The distribution companies they use... probably can't really be expected to care about what's in the boxes they move about.
The country shouldnt allow companies to make them or import them. It's fraud in pill form and they know it
The companies that make them shouldnt be making them. They know its nothing. They're nakedly greedy.

Our consumer protection in the US is garbage.

I have mixed feelings about all of this stuff. I view this as similar to religion. It seems crazy to non-believers but for believers, there is no way to discuss it rationally. I would say at least half of my patients do homeopathy or something similar (probably more because I’m sure many don’t tell me). The vast majority do conventional therapy too. Actually I prefer homeopathy because there is nothing actively harmful in it but for other supplements there is always a risk of harmful interactions with the treatment we are giving.

Occasionally people believe in it so much or distrust conentional medicine so much that they eschew standard therapy but that’s pretty rare. When someone tells me they are taking a wonder supplement I ask our dietician to cross reference the MD Anderson database to make sure there are no know harmful interactions. If it’s homeopathy I usually just tell them that’s fine. I don’t want to interfere with the placebo effect after all.

Homeopathic crap isnt externally regulated, so you still get unexpected substances in them sometimes, like when some technician forgets how many times they've done the hokey-pokey with their solution and they end up with actual belladonna in a 'treatment' for infants

I'm not calling you out Docjoe, you shouldn't have to deal with this, I'm frustrated with the FDA's failures. Homeopaths and supplement makers aren't just selling magic water and sugar and sawdust pills. They have no idea what they're selling because they're unscientific or actively fraudulent.

CVS once sold a "homeopathic" laxative that was just alcohol. 20% alcohol is on par with many cocktails.

Quintin_Stone wrote:

CVS once sold a "homeopathic" laxative that was just alcohol. 20% alcohol is on par with many cocktails.

Baileys is 17% ABV, and you don't wanna know what the bathroom looks like after a bottle of that, so that seems legit.

polypusher wrote:

Homeopathic crap isnt externally regulated, so you still get unexpected substances in them sometimes, like when some technician forgets how many times they've done the hokey-pokey with their solution and they end up with actual belladonna in a 'treatment' for infants

I'm not calling you out Docjoe, you shouldn't have to deal with this, I'm frustrated with the FDA's failures. Homeopaths and supplement makers aren't just selling magic water and sugar and sawdust pills. They have no idea what they're selling because they're unscientific or actively fraudulent.

No I totally agree there could literally be anything in the supplements and in an ideal world it would be great to know that the hoo haa you are taking actually contains the hoo haa on the label. I guess I’ve just become exhausted over time with this particular battle and I’ve just given up fighting it. There is so much distrust of the medical profession already, I’m tired of being accused of being part of the conspiracy. I’ve rationalized that people are adults and if they want to use coffee enemas or ozone saunas or apricot pits to treat their pancreatic cancer because they saw it on the internet, that’s their choice.

I used to try to explain why testimonials on the internet are not the same as carefully conducted clinical trials but you know, pharma is evil and we’re just trying to keep people sick yadda yadda.

Just don’t have the energy so I focus on those who are interested in modern medicine and do what I can to help people suffer as little as possible at the end whichever path they chose. I know that sucks but it’s my survival mechanism.

I respect your approach, Docjoe, that's very much what I look for in a doctor. Advise me of my options, and support me in whatever option I choose, even if it's not one you approve of and it's one that makes you think less of me.

Except that's not what happens. More and more, we have case reports coming in of people choosing homeopathy instead of evidence-based medicine. Then you have people coming in with stage 3 or 4 cancers.

Regardless, I don't see why my taxes should fund homeopathy. That's what's going on here in France. We're not aiming to outlaw it, not even close. We're asking public healthcare funds be used for worthier causes. Like drugs that have actually proved their efficacy. Or extra personnel in hospitals.

Sorry, but as a MD specialized in public health, I don't just look at the harmless placebo effect. I look at the damage being done by companies charging 450€ per kilo of sugar water.

We just had a doctor in the Philippines who was selling untested and unregulated herbal remedies for cancer. Once a few docs in her area got stage 4 breast cancer patients from her who used to be stage 1, we got together and asked the medical association and the Department of Health to shut her down. Which they did. A lot of people were incensed over it and accused us of jealously destroying a competitor.

I don't doubt that many of those people will continue to spend their money on nonsense, but at least it won't be nonsense that we're responsible for.

Public... healthcare... funds?

Eleima wrote:

Except that's not what happens. More and more, we have case reports coming in of people choosing homeopathy instead of evidence-based medicine. Then you have people coming in with stage 3 or 4 cancers.

Regardless, I don't see why my taxes should fund homeopathy. That's what's going on here in France. We're not aiming to outlaw it, not even close. We're asking public healthcare funds be used for worthier causes. Like drugs that have actually proved their efficacy. Or extra personnel in hospitals.

Sorry, but as a MD specialized in public health, I don't just look at the harmless placebo effect. I look at the damage being done by companies charging 450€ per kilo of sugar water.

I've been a cancer doc for 20 years and at least in my experience, it is pretty rare that people pursue quackery alone, especially for curable cancers. It happens but not very often. Now sometimes people will pursue conventional therapy begrudgingly as long as they can do their quackery concurrently. I saw a young breast cancer patient today who has curable but very serious (stage III) disease. She has a naturopath who has her on a bunch of garbage supplements. Likelihood of her beating this cancer with chemotherapy, surgery and endocrine therapy is pretty good. Likelihood of beating this cancer with quackery alone in my opinion is zero.

She saw another oncologist who told her she would not treat her unless she stopped the supplements. Patient refused standard therapy. Came to see me and I said I'm Ok with supplements as long as we agree that she will give me a list of what she is taking and I get veto power if there is evidence of interactions with her chemo. She agreed to stop 3 of them and is now halfway through treatment without missing a dose and cancer by exam is gone.

I wish the garbage that the naturopath is giving her were not part of the equation. But it's important to her and she's willing to meet me half way. If I badmouth her naturopath or tell her show me the science, she will flee and probably die of her cancer. Doing "natural" remedies is frankly part of her value system and she is showing tremendous trust by allowing me to treat her with things that she probably never imagined she would agree to. In the end, I hope she beats her cancer and feels respected in the process.

Now would I be OK with taxpayer money paying for her garbage supplements? Oh hell no.

This is why the scientific method doesn't rely on empirical evidence. Your experience, whether it's 2 or 20 years, is just a sample. My job is to think large scale. And if even one patient dies because of forgoing treatment to a preventable disease, then it's time to reassess. Especially if it's just a three year old with an ear infection.
We're getting more and more case reports of patients coming in with stage 1, deciding to try "alternative medicines" and coming back with stage 3 and 4. That's not opinion, that's fact.

And please don't go with the argument from authority with the "in my 20 years of experience as a cancer doc". I'm betting you've heard of JAMA Oncology, and they're not too keen on the idea either:
Complementary Medicine, Refusal of Conventional Cancer Therapy, and Survival Among Patients With Curable Cancers

Question What patient characteristics are associated with use of complementary medicine for cancer and what is the association of complementary medicine with treatment adherence and survival?
Findings In this cohort study of 1 901 815 patients, use of complementary medicine varied by several factors and was associated with refusal of conventional cancer treatment, and with a 2-fold greater risk of death compared with patients who had no complementary medicine use.
Meaning Patients who received complementary medicine were more likely to refuse other conventional cancer treatment, and had a higher risk of death than no complementary medicine; however, this survival difference could be mediated by adherence to all recommended conventional cancer therapies.

That's nearly two million patients. Isn't that evidence enough? We're already getting the placebo effect with actual drugs, why throw in magic sugar pills?

News from the homefront. Boiron, the pharmaceutical company producing homeopathy in France, has now escalated to blackmail, threatening to fire employees if homeopathy is no longer reimbursed. FYI, they spend 155 million a year in PR campaigns (which they aren't calling ads because they're technically not supposed to advertise). I'd also like to remind people that they're even trying to "cure" malaria with homeopathy. It's infuriating. Let's all take a page from the book of Sawbones: cure alls cure nothing.

clover wrote:

Public... healthcare... funds?

She lives and practices medicine in France. Ironically if you live in the US (me does) the idea of public healthcare funds truly is foreign.

RawkGWJ wrote:
clover wrote:

Public... healthcare... funds?

She lives and practices medicine in France. Ironically if you live in the US (me does) the idea of public healthcare funds truly is foreign.

that, as they say, is the joke.jpg

Eleima, we’re on the same side here. I hate quackery just as much as you do. I’ve actually personally taken care of people as they die of cancer due to horrible choices including a 21 year old who died unnecessarily of a stage 1 lymphoma because of a quack chiropractor. My wife’s cousin died of cancer last year after running to some nutty clinic where they treated her with ozone saunas and coffee enemas. She came to me asking for conventional therapy in her last weeks of life and we found a targetable driver mutation one week after she died. Those people should be in jail. So it is more personal to me than a public health statistic.

And it’s fine to be dismissive of my experience, I never portrayed it as more than anecdote. And I understand the scientific method, I’ve been a principal investigator on over 100 clinical trials.

My point is that I don’t condone or encourage quackery but I think that people who are prone to it are more likely to adhere to conventional therapy if they don’t feel attacked by what is at the end of the day their belief system. If our cousin would have come to me I would have agreed to concurrent ozone saunas and conventional therapy. But the doctor she saw belittled her for considering quackery so she felt she had to choose one or the other.

When someone comes in and tells me their uncle told them Essiac Tea is a cure for leukemia, of course I dissuade them of that idea. But when they come in suspicious of conventional medicine already having followed with a naturopath or native shaman, my approach is going to be a little different.

I’d love to see this garbage outlawed and would be enraged if homeopathy was given the same credence as treatments that are scientifically proven. I hope you are able to get that changed in France.

I just arrived in Chicago for the annual American Society of Clinical Oncology research conference riding from the airport in my Uber. Along with a dozen billboards advertising pharma stuff, we passed a billboard for a stem cell clinic for arthritis and it said covered by Medicare and most insurance.

Medicare can’t actually be paying for that garbage, can they? That would be right up there with homeopathy except that crap is more expensive, invasive and truly dangerous.

DocJoe, you seem to be under the impression that I'm making this personal. Let me dissuade you of that.
The facts are these. (insert Pushing Daisies theme song here) In many Western countries, "alternative" medicines are given as much if not more credence than allopathic treatment. It's dangerous to let that belief persist. There is no room for belief in science.

You seem to be missing my point entirely.

I do understand how science works. What I'm trying to explain to you is that human beings who are sick and scared don't take well to me explaining to them that they should avoid empiricism when determining what treatments to pursue for their illness.

I practice in a community with many Somali, Hmong and Russian patients. They come with all kinds of cultural beliefs that have nothing to do with whether there is randomized data demonstrating efficacy. I can either do my best to try to stamp out those beliefs since there is no room for them in science or I can try to find a way to get them to allow me to provide the proven care that will help them. If I am rigid and dogmatic about the former, I will definitely be less successful in achieving the latter.

Sometimes people are just trying to take control of an out of control situation. Will going on a ketogenic diet get rid of your metastatic lung cancer? Of course not. But in Western medicine, our prescriptions are things we are doing to people and we give them very few tools that they can use themselves. When people ask me what they can eat to help their cancer, the truth is that I don't know of a diet that makes advanced cancer better. So when someone really feels it is important to take some extra turmeric or curcumin, I understand where that's coming from. I like to tell people that I prefer their supplements come from real food but I'm also not going to try to destroy that belief in the name of science if that's what they need to get through chemotherapy and surgery.

So am I being less scientifically pure by allowing my patients to partake in unproven remedies? For sure. But where I used to try to beat them up over it in the name of science, I've now come to accept that in the end, I'm only here to guide them with what knowledge I have. At the end of the day, they are in charge of their health, even if I don't agree with every decision they make.

So again, I agree that there is no room for belief in science. But to be a doctor who takes care of actual people? You better bring more to the table than just being a scientist.

Docjoe wrote:

So again, I agree that there is no room for belief in science. But to be a doctor who takes care of actual people? You better bring more to the table than just being a scientist.

Amen! I'm a huge advocate of evidence-driven medicine and I'm routinely infuriated by the claims and consequences of most CAM treatments, but a hard-nosed, black-and-white approach to patients runs into the same problems encountered by economists who try to predict consumer behaviors and are often wildly wrong: people simply aren't rational about a lot of life decisions, and that's particularly true when it comes to healthcare for themselves and their family members.

If I argue until I'm blue in the face with an anti-vax mother about the actual scientific evidence regarding vaccines, I'm likely to watch a kid walk out without any vaccinations at all. But if I acknowledge her concerns and even praise the fact that she's so involved in her child's healthcare, I'm likely able to negotiate an "adjusted schedule" for vaccinations that results in her child being protected. There's absolutely no evidence that spacing out vaccines is less harmful, but it makes the difference between a kid getting the care they need and not being protected at all.

I don't have data for the number of people who have made CAM a part of their lifestyle and have subsequently turned away from conventional, evidence-based medicine due to a bad encounter with a physician, but I suspect that a concerning number of folks have not received care that they might have consented to receive with a gentler approach. Eleima really struck a chord with me when she said "And if even one patient dies because of forgoing treatment to a preventable disease, then it's time to reassess." I think that sword swings in both directions. We absolutely need to be advocates for evidence-based practice, should campaign against using healthcare money to fund treatments that simply don't work, and should be the source of current best-practice information for our patients. But if our approach is so hard-line that patients are either being denied care or are felt driven away, then we need to reassess our methods to see if it's achieving the goal of bringing the most help to the most people.

Internally, I may be rolling my eyes and banging my head on the desk, but externally I'm listening to what the patient says (including the stuff that has no evidence), and trying to work that into a treatment plan that is acceptable to the patient. I'll never pretend that the CAM stuff is more effective than evidence suggests, and I'll always bring evidence to the table, but I will accept CAM as part of a patient's treatment regimen as long as it lets me do what needs to be done.

There's a reason that we refer to the "Art and Science of Medicine". We all have a scientific understanding of medicine, but the art is bringing it to the complex, often irrational, angry, fearful, wonderful, annoying, perplexing, humbling, mistrustful, trusting, and sometimes weird people who come to us for help.

You guys are putting words into my mouth and it's unbecoming of you. Glad you think I'm advocating for a rigid and dogmatic position.
And let's not put the responsibility of antivaxxers on migrant cultures, it's just a tad little racist.
Research shows that that kind of patient is overwhelmingly female, well off and white (article in Vaccine, or here). And since we're all talking about personal experience, the people first in line to catch up on immunizations are immigrants.