"What Doctors Don't Tell You" about homeopathy?

We in the US certainly have our share of pure quackery; there’s no denying it. After all, we have to take “credit” for inflicting the likes of Joe Mercola, the ever-libeling conspiracy crank and hilariously off=base scientist wannabe Mike Adams, Gary Null, Robert O. Young, and many others on the world. Unfortunately, we sometimes export our quacks elsewhere. Such was the case with expat Lynn McTaggart, who with her husband Bryan Hubbard moved to London to inflict their woo on our friends the Brits.

I first heard of her when I encountered her mystical magical belief that our thoughts can heal the world (and even has a website saying as much complete with advertisements urging readers to “learn about their psychic abilities,” although it’s been “down for maintenance” a long time), basically a variant of that incredible New Age nonsense known as The Secret. I later heard about her through her most visible and apparently successful project, What Doctors Don’t Tell You (WDDTY). As Guy Chapman describes and Josephine Jones catalogues, it is a publication that touts every form of quackery and medical pseudoscience known to human beings. Not surprisingly, McTaggart is antivaccine to the core. Also not surprisingly, she loves to threaten her critics with spurious libel suits.

The reason I mention WDDTY and its creator is because a reader of my not-so-super-secret other blog sent me an article from that fabled repository of nonsense claiming to make The Doctors’ case for homeopathy. The reader asked us to treat the claims seriously and fairly, and I tried. I really, really did. However, the article represents (to use one of my favorite metaphors) a steaming, stinking load of fetid dingos’ kidneys from a scientific and medical standpoint, so much so that I couldn’t restrain myself from unleashing at least some not-so-Respectful Insolence at it. Also, since the source is a British publication, even if one owned by an American expat, letting a character as quintessentially British as Orac have at it seems appropriate, particularly given that it is Orac as channeled through an American with the temerity to take the ‘nym of a character from an obscure 35-year-old British SF series.

What appears to have “inspired” this article, whose author is not identified as far as I can tell, is the pressure being put on the UK government to ban homeopathic remedies within the National Health Service, something that certainly sounds like a good idea to me. After all, it’s not for nothing that I like to refer to homeopathy as The One Quackery To Rule Them All given that it is arguably the form of alternative medicine based on the silliest and most easily demonstrably ridiculous concepts. The first is the “Law of Similars,” which postulates that to treat a symptom you must use something that causes that symptom in healthy people. The second is even more ridiculous, namely the “Law of Infinitesimals,” which states that diluting a homeopathic remedy makes it stronger. Specifically, homeopathy claims that serially diluting a remedy with vigorous shaking between each step (succussation) to the point where it is incredibly unlikely that a single molecule of that remedy remains will produce ever more potent remedies. That doesn’t even get into the methodology of “provings,” which is how homeopaths claim to be able to figure out which remedies should be used for what symptoms and have produced things as outright dumb as homeopathic plutonium and homeopathic antimatter.

So what does WDDTY have to say about homeopathy? Let’s take a look:

Ever since the birth of the National Health Service in 1948, homeopathy has been an integral part of the medical care offered by GPs and hospital doctors. Costing a tiny fraction of the NHS’s overall drug bill—£4 million out of £113 billion last year—homeopathic remedies have offered any NHS doctor who cared to do extra training a clinical alternative to the monoculture of pharmaceutical drugs. Some 400 doctors who took the training now offer homeopathy in addition to standard medical care.

But this option is now under threat, largely as a result of a decade-long propaganda campaign mounted by a small band of British ‘sceptics’ who have lobbied the UK government to ‘blacklist’ homeopathic remedies.

Gee, you say that as though it were a bad thing. I know that if I were a Brit I wouldn’t want my tax dollars going to support such incredibly silly pseudoscience. Eight years ago, I visited London and, while I was there, made it a point to have my picture taken in front of the Royal London Homeopathic Hospital as a joke. Unfortunately, the Royal London Homeopathic Hospital was no joke. Almost a year ago, I visited London again to give a scientific talk and extend that to a vacation. Although the Royal London Homeopathic Hospital is no more, magically renamed to the Royal London Hospital for Integrated Medicine but offering the same nonsense, homeopathy in the NHS is still not a joke. Let’s just put it this way. Homeopathy is such utter pseudoscience that £4 million is far too much to be paying for it, even if it is a tiny fraction of the entire NHS budget. In fact, spending even £1 on homeopathy is £1 too much.

At this point, though, I do have to admit to some envy of my British skeptic friends. Over the years, I’ve lost track of how many times I’ve seen British quacks complaining about how a “small band of British ‘sceptics’” causes them them so much problem and, apparently, has an outsized influence on the British government, to the point of endangering what little funding there is left for homeopathy. It’s a narrative that I’d love to believe as true. You never hear this in the US, where quacks aren’t complaining about a “small band of American ‘skeptics’” eliminating homeopathy in the US. The best we’ve come up with is the FDA re-examining how it regulates homeopathy. On the other hand, maybe I shouldn’t feel so bad. After all, we have our biggest cranks, like Mike Adams, complaining that a small band of skeptics utterly controls Wikipedia, all led by an American, Susan Gerbic.

Not surprisingly, WDDTY paints the whole kerfuffle as two things: The aforementioned campaign by British skeptics to “suppress” homeopathy and, of course, a “turf war” on the part of MPs who are physicians to “suppress” homeopathy. Again, the complaint is made as though suppressing homeopathy were a bad thing. I certainly don’t consider eliminating such obvious quackery to be undesirable—quite the opposite, in fact.

Now here’s the funny thing. WDDTY openly admits that many homeopathic remedies don’t contain a single molecule of the starting remedy, quoting Professor Colin Blakemore, head of Britain’s Medical Research Council, who sounds just like me in saying, ““If we were to accept the principles of homeopathy, we would have to overturn the whole of physics and chemistry.” As I like to put it, it is simply incredibly implausible that so many well-supported principles of physics and chemistry are not just wrong, but spectacularly wrong, but that’s what would have to be true for homeopathy to work. Apparently WDDTY is so very, very offended that there are scientists telling it like it is about homeopathy and that some of them are actually a bit intemperate in their characterization, which is funny, given how often WDDTY paints conventional medicine as being hopelessly in the thrall of big pharma in equally intemperate terms. Particularly unhappy is a GP named Noel Thomas:

This kind of invective means it’s a dialogue of the deaf, says Noel Thomas, a GP in South Wales. “Opponents make much of the ‘consistent failure to demonstrate effect beyond placebo’ when trials of homeopathy are studied; this is untrue. It is depressing to see the interests of patients being threatened by a small posse of poorly informed and discourteous critics, who mix a little science with denigration and abuse,” he says.

“Only a very few critics confine themselves to what they regard as scientific principles—people who believe that science knows everything about everything, and nothing remains to be explained—scientific ‘fundamentalists’, perhaps.”

Ah, yes. You knew that was coming: The charge of “scientific fundamentalism.” As long as I’ve been in the skeptic biz blogging about pseudoscience like homeopathy, I’ve come to recognize that whenever an advocate of quackery like homeopathy starts whining about “scientific fundamentalism” or “scientism,” it’s because he doesn’t have any science to back up his own position. Indeed, the use of the word “fundamentalism” is very much a case of projection, and inevitably what follows is predictable:

Dr Thomas has put his finger on the nub of the issue. The war is not about evidence, but scientific ideology. Because homeopathic medicines often contain not a single molecule of an active ingredient, opponents mock them as an affront to rationality—and indeed, a threat to the whole of science. Hence the hostility from lobbying organizations such as the self-styled Sense About Science and The Good Thinking Society (a name eerily close to Orwell’s dystopian “Ministry of Truth”), whose attacks echo those of the medieval Vatican against Galileo: it cannot be true, so it’s not.

No, we don’t mock homeopathic “medicines” a threat to the whole of science (although, to be fair, we do mock them as an affront to rationality, because they are). WDDTY also invokes what I like to call the “Galileo gambit,” something I first wrote about over 11 years ago. As I like to say whenever I hear a quack invoking Galileo, for every Galileo, Ignaz Semmelweis, Nicolaus Copernicus, Charles Darwin, Louis Pasteur, etc., whose scientific ideas were either ignored, rejected, or vigorously attacked by the scientific community of his time and then later accepted, there are always untold numbers of others whose ideas were either ignored or rejected initially and then were never accepted—and never will be accepted because they were wrong. The reason the ideas of Galileo, Semmelweis, Copernicus, Darwin, Pasteur, et al, were ultimately accepted as correct by the scientific community is because they turned out to be correct! Their observations and ideas stood up to repeated observation and scientific experimentation by many scientists in many places over many years. The weight of data supporting their ideas was so overwhelming that eventually even the biggest skeptics could no longer stand. That's the way science works.

None of this stops quacks from invoking Galileo’s name a way of characterizing scientists who criticize their pseudoscience as doing so based on the equivalent of religious beliefs. Of course, the critics of homeopathy have science on their side. What does WDDTY have? Why, anecdotes, of course! Several of them, in fact. There’s a patient who had a peritonsillar abscess, supposedly resolved with homeopathic belladonna. Of course, homeopathic belladonna preparations tend to be less “strong”—i.e., less dilute to the point of having actual remedy in them—with potentially enough left to have anticholinergic effects, such as decreasing the saliva production that the patient was having trouble swallowing. One also notes that abscesses can spontaneously drain, commonly after manipulation. What’s more plausible, that homeopathic belladonna cured a peritonsillar abscess within minutes or that it drained spontaneously? Then, of course, there were a whole lot of anecdotes about patients with chronic pain treated with homeopathy who did much better. Never mind the usual confounding effects like placebo effects, regression to the mean, and the like.

Particularly amusing is WDDTY’s attempt to argue that nonhuman uses of homeopathy rule out “placebo effects” as the cause. How does he know it helped? Proponents of alternative medicine will claim that quackery like acupuncture “works” in animals because it couldn’t possibly be due to placebo effects, but they are only sort of correct. The reason is that the only way we can know what animals are feeling is through the observations of humans, who interpret those observations as the animal either being in pain or getting better. Thus, placebo-like effects can occur in animals, but in reality they are a result of a change in perception of the animal’s condition by the owners, who expect results and, after treatment, look for results. If they believe acupuncture will work, often they report results. It’s difficult enough to quantify pain reliably in humans; in animals, it’s even harder. Add to that the tendency of most conditions to regress to the mean or to slowly improve, and, if the acupuncture or chiropractic adjustment is performed as improvement is beginning or around the time when the symptoms are at their worst (which is often the time when treatment will be sought), then it can appear that the treatment “worked.” There appears to be a phenomenon in veterinary medicine known as caregiver placebo effects, which appears to be a real phenomenon. Indeed, frequently, there is little or no correlation between owner-reported observations of animal pain and objective measures.

Then there are attempts to make turn the plural of anecdotes into valid data when it’s not:

In 2006, Tom Robinson, a Dorset GP who offers both conventional medicine and homeopathy, published a 12-month audit of his homeopathic treatments.2 His records showed that he used them for roughly one in 10 patients, the top conditions treated being ear, nose and throat problems, mental health issues, skin disorders and “miscellaneous, such as ‘tired all the time’, bruising, motion sickness, leg cramp, chilblains—all situations,” he says, “where conventional medicine has nothing to offer.

“An analysis of the responses to the homeopathic medicines revealed that 78 per cent of my patients noted an improvement following treatment, even when prescribed in a standard 10-minute GP consultation.”

The paper cited was published in Homeopathy and completely useless, a case series with no control group that boiled down to basically a patient satisfaction survey.

Not surprisingly, WDDTY also invokes flaws in conventional medicine:

A year ago, Lancet Editor-in-Chief Richard Horton reported on a closed-door Wellcome Trust conference in which medical science was pilloried for “questionable research practices”, “many a statistical fairy tale”
and “a research culture that occasionally veers close
to misconduct”.

As a result, says Horton, “much of the scientific literature, perhaps half, may simply be untrue”.5

Of course, the fact that pharmaceutical medicine has a poor evidence base doesn’t necessarily make a stronger case for homeopathy.

Imagine my relief that WDDTY admitted that problems with conventional medicine don’t mean that homeopathy works. It’s disingenuous as hell, of course. If WDDTY didn’t mean to imply that problems with conventional medicine mean that homeopathy works, why were these problems mentioned? As Ben Goldacre says:

Yet that is exactly what WDDTY is arguing, while denying that that’s what it is arguing.

Then there’s the “let’s count the randomized controlled trials” gambit:

Much of the data have come from places like Brazil and India, where homeopathy is welcomed as a valuable part of their national healthcare systems. In India, homeopathy is taught in universities and medical schools, sending thousands of qualified doctors every year out into hospitals and the community, and carrying out clinical trials on a range of chronic conditions, including cancer.

By the end of 2014, homeopathy had been tested in 104 RCTs for 61 different medical conditions: 41 per cent were positive; 5 per cent were negative; and 54 per cent were inconclusive.6

One notes that the source of this number is the Faculty of Homeopathy, who published its results on a webpage without peer review. I noticed that at least a few of these studies are ones I’ve blogged about before, describing their poor methodological quality and why they don’t show what homeopaths think they show. Personally, I’ll stick with Sense About Science’s interpretation that “over 150 clinical trials have failed to show that homeopathy works. Some small-scale studies have yielded positive results, but this is due to poor methodologies or random effects.”

Hilariously, near the end, WDDTY tries to argue that homeopathy is “more than just water,” resurrecting some of the silliest pseudoscientific claims about how homeopathy might “work.” One such claim is that there is “electromagnetic communication between in cells” that is affected by homeopathy. This claim is based on work by Jacques Benveniste’s thoroughly debunked experiments from the 1980s and from more recent work of Nobel laureate Professor Luc Montagnier, whose work I deconstructed in detail five years ago. The other “mechanism” by which homeopathy “works” is, according to WDDTY, the ever-popular nanoparticles. Nope. Sorry. That explanation doesn’t fly.

Homeopathy is pseudoscience. In fact, it’s such obvious pseudoscience and it’s so easy to explain why it is pseudoscience that I frequently use it as an example when teaching basic skeptical principles—as do many skeptics. There is no scientific basis for homeopathy, which is rooted in prescientific vitalism and whose precepts were dreamt up before basic chemical principles like Avogadro’s number had been worked out. Even as early as 1842, Oliver Wendell Holmes could explain why homeopathy was a delusion, penning the immortal Homeopathy and Its Kindred Delusions. Unfortunately, 174 years later and 173 years after the death of homeopathy’s creator Samuel Hahnemann, there exist publications like WDDTY that actively promote the quackery that is homeopathy. Of course, cupping is thousands of years old and still practiced by elite athletes despite its being equally quackery. Truly, the battle against irrationality in human beings is akin to the task faced by Sisyphus.

Yet we must continue to push that boulder up that hill.


More like this

First I must confess to being part of the conspiracy of sceptics who did manage to persuade various retailers to stop stocking WDDTY...

McTaggart is very fond of crying "free speech" (odd as we don't have the same legal concept here as in Merkinania), but then applies the banhammer on the WDDTY Farceberk pages whenever anyone suggests anything critical of them or their stance. F'rinstance I'm banned for having the temerity to point out the lack of medical qualifications or credibility of their editorial board. I'm pretty sure Guy is banned, as are a couple of other occasional UK-ian posters on here (many of us with connections to Bad Science).

WDDTY is really a pernicious rag with no content that stands up to critical scrutiny (check out What Doctors Don't Tell You Don't Tell You).

McTaggart is also fond of the "Big Pharma Shill" line, while taking money hand over fist from supplements companies, folk selling dodgy "tests" and all the usual wooerama in the form of advertising money, which is obviously different to any other form of money...

Perhaps, the homeopathic practitioners would volunteer for a study on greenstick femoral fractures.
The controls will be the populace, both with femoral fractures and conventionally treated vs the practitioner, who shall receive homeopathic analgesics PRN, as much as is desired.
Circulatory overload, of course, shall also be treated via homeopathic medications, administering as much medication as is necessary until circulatory overload has been remedied.
Then, transport to A&E can be initiated.

In an effort to be of assistance, I can provide hammers in the weight of one stone and two stone. Homeopathic heroin (UK only) or morphine (US or UK) to be provided by the homeopathic practitioner, who shall also be the patient.

Additional equipment, heavy lorry, two dozen pallbearers.
Water *is* heavy.


McTaggart is also quick to ban the least scent of potential doubt and questioning from her personal blog. This promptly led several of us to play the screenshot game. Even the politest of inquiries was vanished from history.

And now a request: may we reblog this 'with full attribution of course) to WWDDTYDTY?

By Anarchic Teapot (not verified) on 17 Aug 2016 #permalink

I got banned from McTaggart's FaceBook pages too. And I read The Field with the aim of writing a debunking review but its so devoid of any actual substance that I couldn't be bothered. I still cover any copies of her atrocious rag that I come across. Sad to say that there were copies in the shop on MacDill AFB in Tampa.

McTaggart is, I suspect, beyond help. She simultaneously attacks science while taking on its clothes to add a veneer of respectability to her nonsense.

On homeopathy, is there a point at which the supposed miracle powers of the "preparation" lose their power or do they become even more effective once they have been through the sewage system and the effluent diluted in reservoirs and lakes? If the power is retained then we can all get the effect for free (although blue green algae might nullify it somewhat).

By Fragmeister (not verified) on 17 Aug 2016 #permalink

On homeopathy, is there a point at which the supposed miracle powers of the “preparation” lose their power or do they become even more effective once they have been through the sewage system and the effluent diluted in reservoirs and lakes?

As succussion is essential for the remedies to work, it is obvious that flushing will completely eliminate their activity.

By Chris Preston (not verified) on 17 Aug 2016 #permalink

the medieval Vatican against Galileo

Medieval... High Renaissance... it's all the same, innit?

By Herr Doktor Bimler (not verified) on 17 Aug 2016 #permalink

"...the top conditions treated being ear, nose and throat problems, mental health issues, skin disorders and “miscellaneous, such as ‘tired all the time’, bruising, motion sickness, leg cramp, chilblains—all situations,” he says, “where conventional medicine has nothing to offer."

But aren't you guys always telling us that Allopathic Physicians just douse everyone coming through the door with drugs?

Now I'm confused. :(

By Dangerous Bacon (not verified) on 17 Aug 2016 #permalink

“…the top conditions treated being ear, nose and throat problems, mental health issues, skin disorders and “miscellaneous, such as ‘tired all the time’, bruising, motion sickness, leg cramp, chilblains—all situations,” he says, ...

...that are most susceptible to a placebo effect.

Of course, the reason why conventional medicine "has nothing to offer" for these is because it requires treatments to work better than placebo. If you want to give placebos, though, they will work for these things.

By Marry Me, Mindy (not verified) on 17 Aug 2016 #permalink

The only mildly plausible explanation for homeopathy is that is structures the water in an orderly fashion, but this would only work for certain mineral ions. A homeopathic preparation of morphine would just be dilute laudanum with little structuring.

It just seems like a scam invented by some old powdered-wig type.

By FuzzyKitten (not verified) on 17 Aug 2016 #permalink

Article: ...dreamt up before basic chemical principles like Avogadro’s number had been worked out.

I don't want the reader to be left with the impression that Avogadro's number is anything more than an arbitrary constant. The passage above almost implies that it is as important as the natural logorithm or pi, nothing could be further from the truth.

There is nothing fundamentally important about this number. Avogadro's Number is just an arbitrary convention.

By Russ Darrow (not verified) on 17 Aug 2016 #permalink

But there is something fundamentally very important in the concept behind the number; i.e., the knowledge of how many molecules/particles are in any given mass of a pure substance. Avogadro's number might be arbitrary, but the science behind that number (that there are a certain number of particles/molecules per given mass of matter) tells us that 30C homeopathic dilutions don't have a single molecule of starting substance left.

"I don’t want the reader to be left with the impression that Avogadro’s number is anything more than an arbitrary constant."

Odd, I see a formula for Avogadro's constant, from the ratio of the molar mass of the electron to the rest mass of the electron.
That doesn't sound very arbitrary.

By Wzrd1 (not verified) on 17 Aug 2016 #permalink

In reply to by Russ Darrow (not verified)

My toes curl in horror just thinking of "treating" chilblains with homeopathy. Thank goodness my conventional medicine doctor sensibly prescribed thicker socks instead of magic water.

My toes curl in horror just thinking of “treating” chilblains with homeopathy.

Eesh. I'll stick with Raynaud's.

@12: It is not a fundamental constant per se, but it does give a good idea of the scaling between numbers of particles and aggregate features like grams. It's not far off to say there are about that many particles in an amount of material that humans conventionally deal with - say a gram or so.

By Steve Vejcik (not verified) on 17 Aug 2016 #permalink

Avogadro’s Number is just an arbitrary convention.

Funny, I had a similar conversation about the arbitrariness of mathematics with colleagues a few days ago.
They, too, were mixing up the name we give to a thing with the thing itself.

Defining one kilogram as the weight of one liter of pure water is just an arbitrary convention, too. You can use different units (pounds, stones...) , or go for a different "arbitrary" value and give it a name of your choosing.

But if you accidentally drop on your feet 5 kilograms worth of heavy material, using whichever unit you like won't change the fact that your feet are on the receiving end of 5 kg of crushing matter.

By Helianthus (not verified) on 17 Aug 2016 #permalink

And yet, holy water still burns vampires... The 'holy' these days being fairly diluted.

With respect to pressures on the National Health to cover crackpot remedies, I am sad to report that Massachusetts is moving in the wrong direction on this issue.

So called "medical marijuana" has been muscled into place via referendum, a neat little end run around evidence based procedures to ensure safety and effectiveness. The mental health practitioners I know are howling with despair, as patients show up too stoned for any sort of therapy, while the "weed cures cancer" nutters are free to walk among us.

The Lege is no better, having over ridden the veto of a bill requiring health insurance to cover crackpot treatments for "Chronic Lyme" with no provisos for proving first that any such condition really exists.

The big fight today on this front is the corresponding bill to force coverage of acupuncture as if it were a legitimate therapy.

By Robert L Bell (not verified) on 17 Aug 2016 #permalink

So called “medical marijuana” has been muscled into place via referendum, a neat little end run around evidence based procedures to ensure safety and effectiveness.

Annnd, that would be what we call 'no studies to show' --It is hard to show efficacy while the herb remains schedule I where no researcher has access to any but the govmnt supplied dirt weed out of Mississippi.

I preferre passiflower incarnata for much good that cannabis can be a stand-in for; Though, Tigger please.

That list of problems that genuine medical practitioners supposedly have no treatment for includes some that I have or have had. Medication has helped me greatly. Somehow I don't think that having somebody credulous enough to believe in it can help me by sticking pins in my ass (There are some properly educated people who might want to do that to me anyway, but that's to treat a different sort of issue.).

Any case, the combination of the British Nasty Health Service, as an acquaintance calls it, with homeopathy always brings this to mind:

By Old Rockin' Dave (not verified) on 17 Aug 2016 #permalink

I started What "What Doctors Don't Tell You" Don't Tell you (wwddtydty.com) - it proved too much of a challenge keeping up with the firehose of crap and it's not had much activity this year. McTaggart launched a number of deranged paranoid personal attacks on friends and me, but they were done so ineptly as to cause no harm.

By Guy Chapman (not verified) on 17 Aug 2016 #permalink

Ah, perhaps a real, accurate version of "What Doctors Don't Tell You".
Such as, "Your specialist ordered the appropriate treatment, now it has to go before the insurance company board. Shan't take much longer than the next global glaciation".
"I'm not mentioning it, but that medication that's your primary specialist ordered treatment, which took since the last mass extinction for the insurance board to approve may well have to be replaced with a similar, but mandatory boarded medication, which will likely be approved as the sun becomes a red giant".
Or, the every popular:
"You know that medication that is keeping you alive and preventing disability and disfigurement isn't covered by insurance and won't be until the sun goes white dwarf. However, this medication is and will only cause projectile vomiting, soiled undergarments and between three and six hospitalizations per year".

All, quite close to actual patient level experiences this year.
People can't quite grasp why I have such a homicidal view toward insurance company boards and executives...

By Wzrd1 (not verified) on 18 Aug 2016 #permalink

In reply to by Guy Chapman (not verified)

Your specialist ordered the appropriate treatment, now it has to go before the insurance company board.

I'm delighted to report it doesn't work that way in the UK. Vive la NHS and down with Big Insurance! waves flag, goes on rampage, etc.

By Anarchic Teapot (not verified) on 18 Aug 2016 #permalink

In reply to by Wzrd1 (not verified)

There's definitely room for an anonymous, confessional site for medical students, called "What doctors really won't tell you or their parents".

By Rebecca Fisher (not verified) on 18 Aug 2016 #permalink

@Wzrd1 #25

The popular (for a rather low value of popularity) around here for the asthmatic kids is the roulette wheel of which brand of controller medication and rescue inhaler the insurance company will kinda cover some of the cost for this year. It isn't the same brand as last year, and who cares if that last year's actually works for you!

Whoever decided that changing the propellant means you get a whole new full set of years of patent protection for the same medication should have to breath through one of those really thin straws for the rest of their life. And even in the face of no generic alternatives they penalize you for using the name brand.

What kills me is the apparent idea that it is much cheaper to just let all the kids end up in the ER or urgent care and on prednisone for a few weeks to prevent an immediate return ER visit than pay for the inhalers,. Because they act like preventing asthma attacks or DIY rescue treatments has to be the most expensive treatment possible given they don't seem to want to pay for the medications that will keep you out of the ER.


Inhaler, my butt. The civilized world, where medicine is advanced, uses nebulizers for home use.
Oh wait, in the US, those are durable medical equipment and hence, optional.
Third world care for first world prices and rationing aplenty.

By Wzrd1 (not verified) on 18 Aug 2016 #permalink

In reply to by KayMarie (not verified)

I thought when used with a spacer inhalers were as effective. They are more portable, at least what I've seen around here.

Although some people don't like carrying around the spacer. Word from the youth sports is the more asthma away coaches will craft a spacer out of one of the many empty water bottles they have around as it at least seems they work better with the spacer, especially with the newer propellants.

The portable inhalers have *always* worked better with the spacer tube (aerochamber). That's been known for well over 30 years, few insurers want to pay the loose change for one.
But, a full size nebulizer can deliver the same performance (why not? That's what's used in the ED) and one can tailor the dosage rate and amount. A little less portability for superior treatment.
But, one has to carry sterile water and medication with the unit. At a minimum, far superior for home treatment.

By Wzrd1 (not verified) on 18 Aug 2016 #permalink

In reply to by KayMarie (not verified)

I still think a good test for Homeopathy would be curing toe fungus. Not too many ethical concerns and there are other treatments to compare it to.

Wzrd1: I have both a nebulizer and rescue inhalers. My insurer paid for both; I am fortunate to have good employer-provided insurance. I think that given the choice, though, I'd rather rescue inhalers be given. That little difference in portability is significant, because it means they can keep one in their pocket or purse while traipsing around a carnival or hiking in the backcountry or even just shopping. And for people with severe asthma, that little difference in portability can be lifesaving.

Now, for the controller meds, a neb makes sense. But for the rescue meds, it should be as portable as humanly possible, IMHO.

By Calli Arcale (not verified) on 18 Aug 2016 #permalink

Got to agree: a less than perfectly effective rescue inhaler in your pocket is a lot better than a fabulous nebuliser that's back at your house somewhere :-)

By Guy Chapman (not verified) on 18 Aug 2016 #permalink

In reply to by Calli Arcale (not verified)

Wzrd1: I also have both a nebulizer and rescue inhalers in addition to two other inhalers used daily. My Medicare Advantage coverage paid for all but a small copay.

OTOH, I have a friend who has ended up in the ER 4 times in the last 6 months, where they give her nebulizer treatments, but they sent her home with an Albuterol inhaler. Medical coverage in this country is confusing.

I can not respect the argument, that political muscle is an acceptable excuse for over riding the evidence based FDA approval mechanisms in those cases where I personally enjoy using the substances in question on for recreational purposes.

I simply can not.

By Robert L Bell (not verified) on 18 Aug 2016 #permalink

@Robert L Bell #36, so you're against opioid analgesics? Some use them for enjoyment (called abuse), so there is incessant pressure to outlaw them, despite major strong arming by those of the public that rely upon them to avoid writhing on the floor in agony.
Meanwhile, some receive respite from pain from using marijuana and there is some evidence to support their claims of pain relief, but research has been forbidden in this nation, all over political pressure against "reefer madness", nonsense that goes back to the Randolph Hearst days.

By Wzrd1 (not verified) on 19 Aug 2016 #permalink

In reply to by Robert L Bell (not verified)

My wife has run into "we're no longer stocking the test strips for your glucose meter so you'll have to get a different model" a couple times.

The little supermarket where I shopped this morning didn't have the usual rags griping about Hillary health, but in between competing books for Hindu art therapy (Zen) and Islamic art therapy(mandalas) was an issue of WDDTY telling how to completely eliminate pain. I understand death has that effect, but I prefer to forgo the treatment.

By squirrelelite (not verified) on 19 Aug 2016 #permalink

Published 2009-01-16 (Rev. 2014-02-05) -- The World Health Organization estimates that 65 - 80 percent of the population use holistic naturopathic medicine as a primary form of health care.
Author: Dorothy M. Neddermeyer, PhD.
She goes on to quote:
"If everyone knew they could prevent any disease with plant extracts, medicinal herbs, natural vitamins, minerals, and supplements, as well as having peace of mind, the pharmaceutical and medical industry would collapse overnight."

I have been involved in the medical world since 1955 - in both allopathic as well as other medical sciences which do not rely on long confusing Latinised names to show patients just how smart their doctors are. How good is a system that is so expensive that only the privileged few can afford it - and then - only at the whim of their Insurance company who is surely far more qualified to decide what should or should not be prescribed.
It would be a courtesy - as well as s show of humility, tolerance and understanding if the shrill voices of the 'naysayers', most of whom have little knowledge of which they speak - and often do nothing more than parrot what someone else has said - would stop for a moment and listen to just how ridiculous they sound.
What happened to "Primum Non Nocere?" Just look at the list of dangerous possibilities and side-effects that accompany most drugs. Just look at the fact that avoidable medical error accounts for nearly 300,000 deaths a year in the US alone. Just look at the abysmal outcomes with sleep disorders - despite the billions of dollars being wasted on night-time intervention, where the problem is largely of daytime origin. And then - take a long and hard look at one of the facile comments made earlier on about 'placebo" treatment. If what I do for a patient relieves them of their symptoms and they feel better - who has the right to tell me I'm wrong? Just remember what Voltaire wrote - way way back in 1770 - "The Art of Medicine lies in amusing the patient while nature cures the disease". What we perpetrate, condone and, worse still, perpetuate, is that odd combination of Idiopathic and Iatrogenic science which - when translated means nothing other than "I don't have a clue what's wrong or how to fix it" and "Gee - I'm so sorry - It was the treatment I prescribed that caused the problems you now have.". If you do not have respect for others - how can you possibly have respect for yourselves. It might be a great idea if those hysterical, tambourine banging, RCT-DB-Meta-data, Cochrane Collaboration fundamentalists took a long and hard look at the very large percentage of the world that uses Chinese, Ayurvedic, Kanpo, Aboriginal and other time-honored and successful remedies, and realised that the hotbed of cancers, heart disease, hypertension, diabetes, and the host of other chronic and crippling (physical as well as financial) diseases reside right slap-dab in the heart of the Western Disease Management Business that is so blindly followed. Universities teach Dysfunctional Medicine. It is all about what is wrong, how to diagnose it and how to try to fix it. Functional Medicine looks at the causes and prevention. I know what my choice is. Oh - and by the way - I have the deepest respect and regard for those amazing doctors, nurses and other health professionals who so passionately and professionally address, heal and repair the horrendous effects of accidents, injury and other physical defects. They are truly heroes in my eyes.

By ROGER PRICE (not verified) on 19 Aug 2016 #permalink

Ah, the good old "nature cures everything", save for a greenstick femoral fracture. That needs accupuncture and hypnotherapy.
Or something.

I do ponder though, whyinhell Voltaire is so germane to modern medicine? Are we now to also regress back to the humours of the body, evil winds and miasma theory of disease - despite seeing the microorganisms that cause infectious disease with a microscope and the ability to culture most of them?
What precious little weed will treat my wife's insulin dependent diabetes, which was never treatable until insulin was discovered, purified and used to treat the disease?
Well, before, a shovel was used to bury the one who died of complications of diabetes.
I'd just as soon not bury my wife, thank you, all woo peddlers. Indeed, offer such to her, be at risk of finding one of my fighting knives that I keep readily available at all times being used as an acupuncture treatment for your disease.*

*Excuse my foul mood. I saw my ortho today, thankfully, no separation of the shoulder, just the ligaments are stretched by the old sprain. The poking, prodding and manipulation would've been bad enough, but I also received an injection into the afflicted area and I'm feeling a lot sore and that means, adrenaline gets released and I get extremely irritable. Irritable enough to hit someone over the head with a Buick. ;)
OK, maybe not irritable enough to violate the laws of physics.
But, for once, something hurts more than my back does!
Doctor and I are agreed, a course of treatment with a physical terrorist should do the trick for the shoulder.
Note the lack of noxious nostrums to treat the problem.

That should tide me over until my home GCU can swing back, grow me a new body and transplant me into it. ;)

By Wzrd1 (not verified) on 19 Aug 2016 #permalink

In reply to by ROGER PRICE (not verified)

@Roger Price: Your comment might make some sense if it weren't for the fact that the US is extremely unusual in having a system where large numbers of people can't afford healthcare, and if the fields of genetic medicine, immunology, preventive medicine and epidemiology did not exist.

At least, unlike most quackery shills, you at least acknowledge the existence of trauma medicine. Your straw man is still made of straw.

By Guy Chapman (not verified) on 19 Aug 2016 #permalink

In reply to by ROGER PRICE (not verified)

Dr. Dorothy, Hypnotherapist, is an internationally recognized authority on bridging Science, Spirit, and Human Potential with over 30+ years experience.

By Woo Fighter (not verified) on 19 Aug 2016 #permalink

On the legalisation of marijuana, I used to be somewhere on the spectrum between "sympathetic" and "indifferent". But the last few years we keep hearing of stronger forms of the stuff (or marijuana derived products) which can be, or are, significantly dangerous :

Will it be possible to distinguish between the milder and dangerous forms in a legal framework?

By Peter Dugdale (not verified) on 19 Aug 2016 #permalink

@Peter Dugdale, obviously yes. The law can distinguish between street heroin and morphine. Designer drugs can be outlawed in the same way, with the term "synthetic compounds related to" or similar terms.
Just as we still have whipping cream nitrous oxide used to still whip cream, but medical nitrous still remains regulated.

Indeed, if marijuana were legalized for medical usage, it doesn't uncouple it from regulation at all, any more than my wife's morphine sulfate is unregulated, despite a demand by abusers of the drug.
But, the question becomes, if we regulated marijuana like we regulate alcohol and tobacco products, how much demand would there by for the illicit, heaven knows what's in it "spice" crap? Users find a product when their desired drug isn't available. When it is available, they go for their usual source.
The funny thing is, neither my wife or I could use marijuana, we're both extremely allergic to it. A mere whiff of the smoke and we're having difficulty breathing.

But then, a *lot* of money is being made in support and prosecution of our war on drugs, with a fair amount being distributed just prosecuting marijuana possession. It's unlikely that that source of income would be given up easily by agencies so addicted to such easy money and forfeiture laws.

The US has far more people in prison per capita than even dictatorships, a hell of a lot over drug possession and far too many due to possession of reefer madness nonsense, while chronic pain patients cannot lawfully benefit from a potential relief from pain or even have analgesic qualities legally evaluated.
To the point where one cannabinoid is illegal to even study for treatment of glaucoma in the US, but in the rest of the world study was allowed. Zero THC, no other intoxicant, promising effects against glaucoma, but the US prohibited even that specific compound from being studied in the US.
That isn't sensible law!
Hell, it's illegal to grow hemp of any sort, even hemp with a THC content that one would have to smoke an entire field of it to acquire the same THC content of a "joint"! So, the US imports processed hemp from Canada, to hell with "Grown in the USA" for that plant product.

Apparently, the US has entirely failed to learn a lesson that should have been learned between 1920 and 1933, prohibition only strengthens organized crime.

By Wzrd1 (not verified) on 19 Aug 2016 #permalink

In reply to by Peter Dugdale (not verified)

The World Health Organization estimates that 65 – 80 percent of the population use holistic naturopathic medicine as a primary form of health care.

I am saddened but not enormously shocked to learn that the majority of humankind cannot afford access to medicine that works.

By Herr Doktor Bimler (not verified) on 20 Aug 2016 #permalink

I sincerely doubt that they use "holistic naturopathic medicine" (i.e. Western anti-science quackery) as a *primary* health care route. This is probabbly the usual bait-and-switch: adding everybody who ever bought a vitamin pill and everybody who lives in a country with poor health infrastructure, and counting them all as devotees of the cult of BecauseNatural.

By Guy Chapman (not verified) on 20 Aug 2016 #permalink

In reply to by Herr Doktor Bimler (not verified)

Chinese, Ayurvedic, Kanpo, Aboriginal and other time-honored and successful remedies

Tell us more of these successful Aboriginal remedies, and of the health and life expectancies they have successfully delivered to Aboriginal populations.

By Herr Doktor Bimler (not verified) on 20 Aug 2016 #permalink

@Herr Doktor Bimler (#47)
If you get an answer to that, try asking the dingleberry why he felt he had to pad his list of "time-honored and successful remedies" by mentioning Chinese medicine twice. "Kanpo" is just the Japanese word for "traditional Chinese medicine," after all.

I have been involved in the medical world since 1955 – in both allopathic as well as other medical sciences which do not rely on long confusing Latinised names to show patients just how smart their doctors are.

Wait – the only non-"allopathic" medical "science" is the one that uses comically alchemical Latin names.

The *real* irony here is that allopathy - the practice of bloodletting purging and so on in order to rebalance the humours - is extinct other than in the offices of naturopaths and like quacks.

Oh I know they *mostly* don't do bloodletting any more, but the talk of vital forces and the reliance on ancient wisdom as opposed to empirically validated fact, is precisely what characterised allopathic medicine. It lived for nearly two and a half thousand years, and only died out in the 19th Century. And of course the science that got rid of allopathy is the same science the quacks reject because it does not suit their beliefs.

Funny old world.

By Guy Chapman (not verified) on 20 Aug 2016 #permalink

In reply to by Narad (not verified)

Nicely done, Narad. I'm afraid however that this one suffers from an extremely insensitive irony meter.

"If what I do for a patient relieves them of their symptoms and they feel better – who has the right to tell me I’m wrong?"

I suspect it would be the county attorney or state attorney general, if you're practicing medicine without a license.

"I have the deepest respect and regard for those amazing doctors, nurses and other health professionals who so passionately and professionally address, heal and repair the horrendous effects of accidents, injury and other physical defects."

As do I. I also have great respect and sympathy for those who address, and attempt to heal and repair the damage caused by woo-promoters and quacks who steer patients away from effective care, and and cause grievous harm and preventable deaths.

By Dangerous Bacon (not verified) on 20 Aug 2016 #permalink

"I have been involved in the medical world since 1955.."

How old is Dorothy? Does she have a picture in her playroom?

Ellie, I think it's Roger Price who is claiming to have been involved for 55 years, not the hypnotist.

Check out the hypnotist's website if you want to see some nonsense. She does "past live regression" in addition to smoking cessation.

By Woo Fighter (not verified) on 20 Aug 2016 #permalink

Sorry, make that "involved since 1955", not 55 years.

By Woo Fighter (not verified) on 20 Aug 2016 #permalink

"She does “past live regression” in addition to smoking cessation."

That almost makes some kind of sense. You need only be regressed to a past life that occurred before smoking was invented. But don't go too far back or you'll turn into a fish.

@rs #55, so *that* explains my advanced skills of a sturgeon, hanging about the bottom for a disconcerting amount of time. I regressed back to being a fish!
Or something. ;)

Yeah, I'm the joker that actually does hang out at the bottom of the pool long enough to worry people.
Not bad, as I'm a smoker.

By Wzrd1 (not verified) on 20 Aug 2016 #permalink

In reply to by rs (not verified)

@ Woo Fighter Thanks. I misread it. I wouldn't have even asked, except I found her picture and she didn't look as though she had been in "practice" for 60+ years. I don't know about Roger Price.

The World Health Organization estimates that 65 – 80 percent of the population use holistic naturopathic [sic] medicine as a primary form of health care.

I am saddened but not enormously shocked to learn that the majority of humankind cannot afford simply don't have access to medicine that works.

FTFY. Oh, and the percentage range qualified by "the population" is predictably an utter crock (see Table 69.1). The attempted deception of "a primary form of health care," I take it, is obvious. The same could be said of bandages.

Chinese, Ayurvedic, Kanpo, Aboriginal and other time-honored and successful remedies

The Ayurveda grift is passe. All the hipsters will be moving on to Unani Healing Practices soon.

By Herr Doktor Bimler (not verified) on 20 Aug 2016 #permalink


OK, that's a bit British.

By Guy Chapman (not verified) on 20 Aug 2016 #permalink

In reply to by Herr Doktor Bimler (not verified)

This website, after reading through most of it's articles, would appear to be objective to the uninformed... HOwever, this site supports modern day medical quackery, yes, medical science is the new quackery and attacks natural, holistic medicine, that actually works. This site is rubbish and should be taken with a quacks grain of rock salt.

My, how positively Orwellian!
Evidence based medicine is quackery, but evidence free "medicine" is real medicine.

Sorry, but I'll stick with evidence based medicine, based upon science and experimentation, not woo and BS claims.
As a case in point, how would "natural, holistic medicine" treat hyperthyroidism? Modern medicine treats it with drugs that block the production of thyroid hormone.
What's "natural, holistic medicine" treat hyperthyroidism with, other than a shovel for a premature grave?

By Wzrd1 (not verified) on 21 Aug 2016 #permalink

In reply to by peter (not verified)

@Peter: How long did it take you to read most of the articles, and how did you manage, during that no doubt protracted exercise, to escape learning anything?

By Guy Chapman (not verified) on 21 Aug 2016 #permalink

In reply to by peter (not verified)

"after reading through most of it’s articles"

Since this is Orac we're talking about I am convinced you're a liar.

@rs #63, that came out not as a response to Peter.
I'll stand by my assessment of Orwellian doublethink on his part, where evidence based medicine is quackery and "natural, holistic medicine" is considered genuine medicine, despite its fact free existence.
So, I'd not call him a liar, I'd call him willfully delusional. A delusion is bad enough when it's involuntarily experienced, when it's willfully experienced in place of reality, it's simply very, very sad.

By Wzrd1 (not verified) on 21 Aug 2016 #permalink

In reply to by rs (not verified)

would appear to be objective to the uninformed

Those uninformed of the meaning of "insolence", which hardly aims to be objective. :)

@Jay #66, while Orac prefers insolence, I prefer insolent hyperbole to ludicrous proportions.
Following, of course, "the next logical step" (read, 100 large steps onward toward massive fail land), in a humorously over the top exaggeration.

Hence, on some sites, where the far right brain trust blames Obama for things he wasn't even born for, let along been in office for, I refer to it as "The Time Machine Gambit", elaborating on full the delights of the Obama Time Machine and Obama's superpowers. Alas, he lacks a sonic screwdriver and never carries the day. ;)
Although, his time machine isn't a TARDIS, it's a TURDIS (after a specific brand of London portapot unit). ;)
In that specific scenario hyperbole, there are also weeping angels, alas, weeping over lousy puns and beyond absurd comparisons to starkly outline the epic failures in comprehending causality on the part of the one drawing my ire. :)
Alas, in those stories, reality and the storyline share one common true reality. I lack a TARDIS or TURDIS, however, I have a RETARDIS, which slows time agonizingly. :P:p:P:p

By Wzrd1 (not verified) on 21 Aug 2016 #permalink

In reply to by Jay (not verified)

"This website, after reading through most of it’s articles, would appear to be objective to the uninformed…"

Well, the uninformed deserves praise if it has actually read as many as 1/100 of the articles appearing on this site over the years.

Sadly it is still uninformed. :(

By Dangerous Bacon (not verified) on 21 Aug 2016 #permalink

@DB #68, would that dinner were presented on the countertop and with robotics.
IN our world, you're worthless, we concede.

By Wzrd1 (not verified) on 21 Aug 2016 #permalink

In reply to by Dangerous Bacon (not verified)


I am a fan of that approach, nothing better to make them realise the ridiculousness of their argument.

Myself, my metier is to adopt a pose of cheerful bonhomie* and counter all arguments using the principles of Suzette Haden Elgin's "The Gentle Art of Verbal Self-defence".

This can drive trolls wild and I've had some great results, meaning that minds were changed and people deleted comments.

Anybody interested, apparently the basics may be found here: http://elfwreck.homecircle.org/stuph/VSD_Basics.pdf

*Two French words in one sentence, what a coup :)

Of course, two words in French does not necessarily serve one's cause well in an "always" sense.
After all, there's...
C'est merde. ;)

By Wzrd1 (not verified) on 21 Aug 2016 #permalink

In reply to by Jay (not verified)

Jay...and a third in the ultimate sentence.

By shay simmons (not verified) on 21 Aug 2016 #permalink

Oh, for the record, that's the essence of my fluency in French. :/

@ Shay - Indeed ;)

@Wzrd1 - Fair enough, you are an ocean away after all.