There is no shortage of villains in the world. Psychopaths – domestic and national – whalers, toxic waste dumpers, global eavesdroppers, billionaire tax avoiders and their army of accountants – all well worth campaigning against with the aim of getting them banged up or forced to cough up.
There is also an infinite supply of people who are mildly irritating who misplace apostrophes, wear Croc shoes, do crochet, litter their sentences with “you know” and text using their middle finger.
However most of us can tell the difference. In fact mixing the two categories up is a pretty reliable indicator of a serious level of battiness . Picketing shops that sell Crocs or campaigning to forbid the sale of mobiles to clumsy texters puts you firmly in the mild-to-fairly-irritating and definitely-a-bit -potty class.
Step forward the Nightingale Collaboration, earnest and self-styled defender of rationalism, whose seriously potty members have got these categories mixed up. They have picked on something that might, to some, be mildly irritating – homeopathy – and pumped up their dislike into a cause, complete with demonstrations, calls for bans and a vindictive campaign – CAMpain? – directed against homeopaths’ livelihood.
Personally I am agnostic about homeopathy, I fully appreciate the apparent absurdity of the mechanism but I know plenty of perfectly rational people who swear it has helped them. Maybe it has a strong placebo element but so do anti-depressant SSRIs. The data on effectiveness may be mixed – both sides can cite sheaves of negative and positive studies. But unlike regular drugs, these trials are not all run by those selling the remedies nor do they have vast marketing budgets to accentuate the positive and conceal the negative.
Irritating and should be banned
I bring all this up because this week Nightingale was supposed to be protesting outside the Advertising Standards Authority (because they haven’t been diligent in chasing homeopaths for making unsupported claims on web sites) and lobbying Parliament (because “something has to be done”). I don’t know if any of this actually happened – I couldn’t find any news coverage –but I’m writing about them because they are irritating and batty and should be banned (ironic joke).
Homeopathy and the other CAM activities that grinds the Nightingale’s gears don’t exist is a vacuum. They are part of the health and healing options open to all of us. In other words you can’t make a judgement about them without considering what may be involved in taking drugs to deal with your ailments. In other words, as drug regulators are fond of saying: it is a matter of balancing risk and benefit.
I don’t plan to rehash all the evidence for pharma’s sometimes fraudulent practices and unreliability – Ben Goldacre’s latest book has done that very comprehensively – but it does seem useful and revealing to highlight the stories about the risks involved in taking drugs that were reported in a single issue of the BMJ – June 22 – the same week that the Nightingale felt that the best way to protect patients was to lay into homoeopathy.
Significant rise in brain haemorrhage
No worries for them about a drug widely prescribed on the NHS for the treatment of acute stroke and recommended by NICE called Alteplase. An investigation has just found that only two of a dozen randomised trials of Alteplase showed benefit while five had had to be stopped early because of: ‘lack of benefit, higher mortality and significant rise in brain haemorrhage’.
How could such a mismatch between evidence and recommendations have occurred? The investigation also found that the clinical guidelines for Alterplase – what doctors rely on to guide them in the use of a drug – had been written by experts who nearly all had links with companies making or marketing the drug. This is a long-running problem and possibly a little more dangerous than homoeopathy.
Another issue that is all too familiar is the dubious drugging of young children. A German study had just found that the use of antipsychotic drugs – powerful tranquilisers with a nasty range of side-effects – on children aged ten and over had gone up in the last four years by 41per cent “for no medical reason.” There is good reason for thinking the situation is very similar in the UK. What do these drugs do to a developing brain? We’ve no idea. Is this worrying and probably not in the children’s best interests? I think so.
A central charge against homoeopathy is that there is no evidence it works. OK but what about the missing evidence about the effectiveness or otherwise of Tamifu. For at least three years researchers have been asking to see the full evidence that this flu drug, on which the NHS has spent 500 million pounds, cuts infection risk or shortens time you are sick.
Not being told the entire truth
The BMJ reported that the journal’s editor had told a Commons committee that only half of the Tamiflu trials had ever been published and that a positive trial was twice as likely to be published as an unsuccessful one.
These are all long running examples of why it is perfectly rational to suspect you may not be told the entire truth about both the safety and the effectiveness of standard treatments. But now there is a new one. This issue of the BMJ also followed up on an alarming story the journal had broken a couple of weeks about a new class of diabetes drug that was being linked with a raised risk of pancreatic inflammation and cancer, which the companies involved had been slow to investigate. See my story here.
Known as incretins, the drugs come in two types GLP1 and DPP-4 that both boost insulin production. The companies and their critics, which now includes the American Diabetic Association, are settling in for a long battle. The journal makes a strong case for believing the warning signs had been there since the drugs were first licenced and there had been little enthusiasm for investigating them.
Nightingale usually advances these arguments for why homeopaths must be hounded: that any reported benefit is due to the placebo effect; that treatment claims therefore lack evidence and are fraudulent; that homoeopathy distracts patients from getting a real treatment that works.
But all of these can be applied with equal force to one or more of the drug examples covered in the BMJ. Ultimately what Nightingale is attacking is the intelligence and judgement of people who are trying to find an effective way to heal themselves. If homeopathy, which even its most virulent critics cannot claim is remotely likely to be harmful, works for you, then someone needs to combine serious arrogance with real battiness to believe they have the right to stand in the way.