A Healthy Dose of Skepticism

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Web Name: A Healthy Dose of Skepticism

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"educational and emotional" - Mr DispenserPagesHomeWhat is homeopathy? Is it the same as herbal medicines?Am I Being Paid by Big Pharma? Homeopathic Harms Sunday, 3 May 2015 A Shiny New Blog and Web AddressHello all,

Just to let you know that I've moved over to another blog at another address. The new one is miles prettier. I've moved all of my old posts over and will be posting new ones over there only, so make sure that you change your bookmarks and all of that kind of malarkey.

I'm going to look into trying to sort out automatic redirection, but in the meantime, make sure you head on over to:

www.healthydoseofskepticism.com
HxxxPosted bySparkleWildfireEmail ThisBlogThis!Share to TwitterShare to FacebookShare to Pinterest Tuesday, 28 April 2015 The beauty of disagreementIf this skepticism lark has taught meanything, its that disagreeing is a beautiful thing. Disagreeing withsomeone is a hard thing to do, in any context. Yet as humans, healthcare professionals, and as skeptics, its one of our keenest tools.Its only by being able to step into disagreement that we canunderstand our topic, our audience, and hopefully steer hearts andminds away from those willing to mislead.
I recently attended a panel aboutdaring to disagree, which mainly focused on religious debates overTwitter and the like. I'm guilty of wiling away hours of my lifearguing with homeopaths over twitter, and I'm often asked why, as I'mnever going to change their minds. The short, and most noble answeris that someone undecided might spectate, and I might be able to makesome impact into how they think about the subject. The moreself-serving version is that its good practice to hone my skills inidentifying fallacies and flaws, finding workarounds and ways ofwording things, and to understand an argument in advance of the nexttime. In these types of arguments, the people who you are speaking toare removed from yourself, perhaps not anonymous as such but theytend to be used to arguing. Their position is usually on thedefensive in the first place because their chosen subject has usuallybeen the butt of skeptical inquiry for years.
But what of those closer to home?Sticking out heads up above the parapet in other situations is one ofthe hardest things in life to do. Most of us instinctively seedisagreement as a threat and a personal attack, and we reactaccordingly. Even now, despite all I've learnt about constructingarguments and debates, with all of this practice, I certainly stillget physical reactions when someone disagrees with me. My heart willpound, my mouth with become dry, and I'll want to curl up in fearbecause my body and brain immediately leap to the conclusion that noone likes me, that I'm so insignificant that I must automatically bewrong. I'm thankful to skepticism in that I'm able to take a deepbreath and overcome those initial few moments, then can try toreassess my position. Am I actually right, but there are some goodpoints to take away from the other stance? Or actually, is myreasoning flawed? In which case, why? Where could I have found moreinformation, what is the other person bringing to it? Whichever wayit goes, I, and the other person, end up learning more. Ultimately,we're not here to be right or wrong- we're hear to learn more, andthat's the important bit.
Problems arise though because often ourinstincts take hold. I can't describe the number of times its allgone tits up. I can spend ages agonising over whether or not todisagree. Once I've decided to do so, I write and rewrite my argumentso that it is as objective as possible, structured clearly, evidencebased etc., only to have the response be Eurgh why are you beingso mean?! I thought we were friends! or similar. I've triedall sorts of ways to word things, and I haven't quite come up with ananswer on how best to avoid this response. Its not just Facebook etc.where this is a problem- we all hear in the news about irrevocablebreakdowns in the doctor-patient relationship (Ashya King, as anexample). We've all encountered the patient at the pharmacy counterwho believes a random person waiting in the queue over our own expertadvice. No one learns anything from these sort of exchanges, andthat's a real missed opportunity.
So the question is, how do we go aboutpromoting disagreement as a positive thing that we all need in ourlives? How do we turn the tables on the thousands of years ofevolution that make us shut down arguments as soon as they begin?Well I think the answer has to initially come from example. I believethe skeptical movement is extremely well placed to start this tidalchange in thought, but we all have to practise the heck out of itevery single day if we're ever going to get anywhere. We have tostart being known synonymously as folk who are really, really good atdisagreeing respectfully, and that has to start from within. Itsclear that the skeptical community in the UK and beyond occasionallyfalls short in this regard, and that's a real shame as it appears tobe driving good people away.
We need to recognise that we mightagree with someone on one thing, but not the other. We can't see aperson as synonymous with one of their opinions, and put people ingood or bad boxes based on that. We shouldn't be labelling people asanti-this, or anti-that, and then refusing to engage further. Weshould be experts at digging deeper than that, looking behind theheadlines to search for shared humanity underneath. We need to leadthe way in disagreeing without bullying, and we should never, everlet up on that. We put ourselves in a position that could so easilybe mashed up together with bullying by the general population when we dareto disagree, and we need to be relentlessly exemplary in ourbehaviour to prove that we aren't. We need to be the type of peoplewho, even if faced with a mutant hybrid of Nigel Farage and PiersMorgan, would manage to keep their cool and be polite.
But then again, feel free to disagree ;)

HxxxPosted bySparkleWildfireEmail ThisBlogThis!Share to TwitterShare to FacebookShare to PinterestLabels:critical thinking,debating,skepticism Friday, 20 March 2015 Allergy Relievers: Red Light NonsenseIts just about coming into allergy season again, so today I am turning my attention to a product Ive seen for sale in a few pharmacies Ive locumed at of late: The Allergy Reliever Device. These things are sold under some pharmacy chains own names, or under brand names like Kinetik.
Its yet another medical device. These things seem to be hitting the pharmacy shelves more and more often these days, giving them a level of respectability which personally I dont think they deserve. At least this device makes it clear that it is a device though, unlike things like Prevalin which pretend to be real medicine.
According to Kinetik, it uses red light therapy to suppress the cells that release histamine, thereby relieving the symptoms of hayfever and allergic rhinitis.
So, essentially shoving some Christmas tree lights up your nose then. Well I must admit thats a new one on me. Its pretty hard to sniff out (geddit?) the theory behind this one too. The manufacturers of these things dont give any explanation as to why red light would suppress mast cells, and several Google searches later Im none the wiser. I have managed to dig outone published paper in rats, where the authors seem to be suggesting that red light changes the redox state of cells, which might cause some changes within the cell. Even these others say that theyre not quite sure whats happening though, and that further investigation is required.
Armed with a few unsuccessful Google Searches, I delved into the medical literature. I tried every which way I could think of to search for evidence that this thing works, but ended up drawing a total blank. I think this may well be the least successful search for evidence Ive done so far, and thats saying something. Even the manufacturers cant be bothered with listing any sources instead they go wild with the clipart, giving us a Generic Smiley White Coated Person and Happy Photostock Chef alongside some very random recipes and general lifestyle advice.
And it looks like this thing really isn't very pleasant or practical to use. You're supposed to shove the probes up your schnozz as far as you comfortably can, then keep them there for three minutes. Not the most dignified of poses. And you're supposed to do this three or four times a day. That's a lot of inconvenience. Seems like prime Use Once Then Put In A Dark Cupboard territory for me, especially since taking a one a day antihistamine tablet is no hassle at all.
In short, I wouldnt waste your money. Theres no basis to these things, and it saddens me that they are not only being sold in pharmacies, but are being sold under pharmacy brand names. The more we associated our profession with such nonsense, the less trustworthy we become to other healthcare professionals and patients alike.
HxxxPosted bySparkleWildfireEmail ThisBlogThis!Share to TwitterShare to FacebookShare to PinterestLabels:allergies,alternative medicine,clinical evidence,complementary medicine,hayfever,OTC meds,OTC sales,pharmacy,quackery,skepticism Friday, 13 March 2015 "I do my own research"Something that I see a lot inon-linedebates about alternative medicine is phrases like I did myown research or people should be allowed to do their own research and make their own decisions
However, I dont think that the vast majority of people are able to do their own research. Now, thats probably a pretty unpopular opinion. Its patronising, paternalistic, and it flies in the face of patient choice. Who am I to question the intelligence and abilities of other people? Why do I thinkI'mso clever compared to anyone else out there? Allow me to explain myself.
I'vebeen a pharmacist for a very long time now. From uni, through pre-reg, to my own revision at work,I'vebeen taught critical appraisal skills. Yet to this day, its something that Iactually find really hard work. Its a skill that requires continual honing, and every time I use it I feel like I am fighting with my brain.
Even in the last two weeks,I'vebeen revisiting my critical appraisal skills to make sure they areup to date.I'vedone some in-house work, threeon-linecourses, and a one to one trainingsession. Yet I still find myself sat here at my desk for several hours, if not days, looking over the same study with a furrowed brow, desperately trying to make the numbers and statistics tell me their story.
Theres hazard ratios, odds ratios, confidence intervals, numbers needed to treat, event rates, absolute risks and other confuddling terms to deal with. I naturally struggle with numbers at the best of times; like most people, I much prefer narratives. That means that I have to constantly argue with myself to keep looking at the results page, rather than just flicking to the discussion. Becasue if I did that, I'd be relying on what the authors, with all of their possible biases and agendas, say their numbers say. Then, when I eventually manage to squeeze the swimming mass of figures into some sort of order in my head, I find out that these numbersaren'tthe full story, and I need to dig even deeper into other analyses of the samefigures to find out whats really going on.*
A quick and very simplistic visualisation of all the layers of interpretation that might lead to information found on your common or garden health information website. That's a whole lot of bias.I am truly terrible at MS paint, but you get the idea.What a typical EMBASE search looks like. This is for a new drug with few synonyms so its a fairly straightforward one. Others can have forty odd lines of searches.

Its not a pleasant task by any stretch of the imagination. It really does feel like a mental marathon. I often question whether I am even up to the task- I can end up feeling stupid, and confused. But in order to really figure out whether or not a drug works I need to strip away all the levels of other peoples interpretation and start from scratch, with the cold, hard, impersonal numbers. That way I can build my own narrative, uninfluenced by what the studys authors or sponsors want me to think, by what newspapers want me to believe, by what campaigners want me to know. The only way to know the truth is to start right at the bottom, in a dark dank pit of statistics, then to slowly start building yourself a ladder until you emerge, blinking, into the pleasant knowledge thatyou'veworked out what on earth is going on.
This sort of raw data is not only extremely hard to deal with once its in front of you, but its also pretty difficult to come by. Finding it in the first place includes searching multiple medical databases- and these thingsaren'tjust a quickfree textsearch like you would do on Google.Constructing a search can in itself take an hour or so, and then you have to trawl through the results to decide which are relevant to what you are specifically looking for. For me, most of the time, a question is structured like this:
What is the evidence that [drug/ group of drugs] works for [disease] in [patient group]?So, in my poorly drawn Venn diagram below, I need to find those holy grail papers that reside in the pink area:

Some of these papers might bepay-walled, so itll take me a week or so to get my hands on them.Some of them might initially look promising, but once you start to dig down into the figures you see that there might actually be problems with how they were undertaken or reported, or they might turn out to not quite fit in some way- perhaps the dose they used in the trial is different to the licensed dose in the UK, or the people enrolled into the trial dont quite fit the population you want to know about, or perhaps the trial justdidn'trecruit enoughpeople so any results from it are invalidated.
I'vebeen doing this job for years, and I really do still struggle with all of this stuff. Thats not becauseI'mpoor at my job, or becauseI'mstupid, or because I havent put the effort intounderstand it. Its because, when it comes down to it, this stuff is really bloody hard. Its time-consuming, boring, and unintuitive.
People might well feel likethey'vedone their own research. They might spend several hours diggingabout on the internet and feel empowered by any decisions that they make. But what they dont realise is that whatthey'vebeen researchingisn'tjust the information- itstheinformation with many, many layers of interpretation (and therefore bias) added. For a choice to be truly informed, you need to go right back to the start, to those terrifying tables of numbers and statistics. Thats simply not realistic for the majority of people.
Far better, then, to learn how to decide on whose interpretation youre going to rely on. Will it be those that take the media reports at face value, or who have an agenda or a product to sell you? Or will you go with those that have years of training in how to pull apart complicated data and disseminate it in understandable ways?
Hxxx




*I thought Id give you a quick real life example here, but I thought it best to asterisk it becauseI'veprobably bored you enough already.I'mcurrently looking at a drugcallededoxaban and its use in reducing the risk of stroke in patients with atrial fibrillation. Its the newest in a series of novel oral anticoagulant drug- theyre supposedly like warfarin, but less faffy. So I find and look at themain trial, and spend days unpicking the stats. It looks like both strengths used in the trial are no worse than warfarin, and the higher dose might even be a little better. Great, right?
Well, thats not quite the end of the story. Because it turns out- and thisisn'treported in the trialat all, but instead is contained in theFDAs briefing document- that in people with fully working kidneys, edoxaban is actually worse than plain old warfarin. In people whose kidneysaren'tquite at full capacity though, it might work better than warfarin. So the overall trialresults are kind of skewed, and if wedidn'tdig deeper, we might have been giving a wholegroup of people a more expensive drug with worse outcomes than warfarin.
Posted bySparkleWildfireEmail ThisBlogThis!Share to TwitterShare to FacebookShare to PinterestLabels:alternative medicine,cancer,clinical evidence,conventional medicine,critical thinking,dangerous advice,pharmacy,quackery,skepticism Older PostsHomeSubscribe to:Posts (Atom)About MeHello, @SparkleWildfire here.
This blog is one way in which I fight the good fight against pseudoscience and quackery. It's my way of loudly promoting skeptical principles in healthcare.I'm a passionate advocate of Evidence-Based Medicine and am also hopefully a half-decent pharmacist. Say HelloIf you'd like to get in touch, drop me an e-mail at:
healthydoseofskepticism@gmail.com
I'd love to hear from you, but please note that I'll happily respond to reason, politeness, and evidence, but I wont respond to non-evidence based pseudo-scientific nonsense, spam, or rudeness.
A note on commentsJust to let you know, I've hidden comments at the moment.
This is purely because I simply don't have the time to moderate them, so I've a huge backlog and I can never keep on top of publishing them or responding. I feel like I've been doing a half-arsed job of it lately so I thought the best way was to switch them off for now and hope that a few extra hours will be added onto each day in future.
HxxxBlog Archive 2015(6) May(1)A Shiny New Blog and Web Address April(1) March(3) February(1) 2014(20) December(3) November(1) October(5) September(1) August(2) July(1) March(2) February(2) January(3) 2013(84) December(1) November(3) October(6) September(1) August(6) July(9) June(7) May(10) April(12) March(14) February(8) January(7) 2012(16) December(6) November(1) October(4) September(5)What I've been wittering aboutabout me(41)adolescence(1)advert annoyances(1)alcohol(2)allergies(1)alternative medicine(21)Amazon(2)atheism(11)ayurvedic medicine(1)Bach flower remedies(1)books(2)brain cancer(2)Burzynski(3)cancer(9)charity(6)child-free by choice(3)christmas(1)circumcision(1)clinical evidence(30)complaints(9)complementary medicine(20)constipation(1)conventional medicine(30)coughs and colds(4)critical thinking(21)dangerous advice(14)death(6)debating(1)diabetes(1)diagnosis(1)divorce(2)drugs in pregnancy(2)e-cigarettes(2)family(4)feminism(3)film(4)ghosts(1)halotherapy(2)harm(13)hayfever(5)herbal medicines(12)history(1)homeopathy(25)humanism(2)immigration(1)in vitro(1)in vivo studies(1)love(5)malaria(1)mental health(12)music(2)NHS(11)obesity(1)Open data campaign(2)OTC meds(25)OTC sales(15)pain(2)pharmacy(56)politics(3)prescriptions(2)professionalism(7)psoriasis(5)quackery(33)religion(4)safety(3)science(12)skepticism(58)skin conditions(5)teratology(2)toxicity(4)traditional chinese medicine(1)vaccines(1)weight loss(3)WH Smith(2)Find What You're Looking For:FollowersSubscribe ToPosts Atom PostsAll Comments Atom All CommentsThe disclaimer bitAll views expressed are my own and are in no way representative of my employer's views or the pharmacy profession as a whole (although occasionally, they probably *should* be!)

I would love to hear from you if you have a differing opinion to mine. However, I'lll respond to evidence, not to woolly statements or personal abuse.


Wahey, I got shortlisted for an award!
The Pod Delusion
Hear my dulcet tones on this episode of The Pod DelusionProud member of....
Backlight
Get your nose into a book H-Jo's bookshelf: skeptic-stuff Trick or Treatment?: Alternative Medicine on Trial by Simon Singh Accessible, putting evidence into context. Live the historical stuff. tagged: skeptic-stuff The Young Atheist's Handbook: Lessons for Living a Good Life Without God by Alom Shaha Not even sure where to start, but this book made me think a lot about a few different aspects of my life in a new light. It-and its author- also appears to have turned me into some sort of schoolgirl-esque groupie gibbering wreck who i... tagged: skeptic-stuff
The showing off how popular I am bit:

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