Medicines rules are insulting to consumers

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Posted 19 June 2014

This article, written by Leon Louw,  the executive director of the Free Market Foundation, was published online on Business Day BDLive. Some commentators have stated that this is “simply an ill-informed rant“, “sheer nonsense and ill-informed“.

Leon Louw writes: “Antagonists, such as CAMcheck, should be as free to denounce Cams as Cams folk are free to denounce both CAMcheck and aspects of mainstream medicine.”

We were going to write a succinct response, only to find that Prof David Gorski, writing as Orac, could respond far better than we could.
Quote: “However, it’s depressing in that it tells me that the bovine excrement reasons people use to defend CAM, including free market fundamentalist “health freedom” religion, are the same the world over.

Jacques Rousseau also weighed in.
Quote: “Far from reducing customer choice, the regulations enhance those choices. For how can you call something a choice if you don’t know what you’re choosing?

Both these articles make Leon Louw look like a mampara!

Medicines rules are insulting to consumers

by Leon Louw, 18 June 2014, 05:20

Business Day BDLive

THE new complementary and alternative medicines (Cams) regulations are draconian, misleading and insulting. In the name of science, they might promote rather than curb scams and pseudoscience. Instead of protecting consumers, they erode access to products and information. They subject supposedly unscientific Cams to supposedly scientific allopathic standards. Notwithstanding the regulations and the pretentious explanatory memorandum, the difference between the two is smaller than protagonists of science assume.

The far-reaching regulations were gazetted with the Department of Health’s characteristic disregard for the public and Parliament. Instead of legislation being passed by MPs under the separation of powers, it was concocted behind closed doors. It effectively bans many popular Cams and subjects others to prohibitive controls, which the Health Products Association says are “unworkable”. Cams, including your favourite supplements, must now pass mainstream tests. What might render the measure unconstitutional (as not being a law of general application) is that traditional healers (sangomas, etc) are treated differently.

That Cams are “unscientific” simply means they have not yet passed tests applied to most, but not all, mainstream treatments. A leading authority, the US’s National Institutes of Health, explains that “the list of what is considered to be Cam changes continually, as those therapies that are proven to be safe and effective become adopted into conventional health”. Every mainstream treatment starts as someone’s alternative idea, including “natural”, “holistic” and “traditional” healers. Unless treatments are shown to be dangerous, they should be allowed without false or misleading claims. Antagonists, such as CAMcheck, should be as free to denounce Cams as Cams folk are free to denounce both CAMcheck and aspects of mainstream medicine.

Pretentious regulators want us to believe, and may themselves believe, that science proves things. It does not. Especially not health science. There is no such thing as “scientific proof”. The father of the scientific method, Karl Popper, explained that science establishes degrees of probability, never absolutes except disproof. Scientific evidence ranges from overwhelming, such as the efficacy of anaesthetics, to virtually zero, such as the nature of consciousness, something as fundamental to medicine as life and death.

Mainstream registration of Cams could cost billions. Where the cost of approval exceeds profits, perfectly safe mainstream medicines are abandoned as “orphan drugs”. That will be the fate of many beloved Cams unless the law is rectified or continues to be unenforced. The regulations have such absurdities as requiring unregistered Cams to say: “This medicine is not intended to diagnose, treat, cure or prevent any disease.” That Cams must be called “medicine” and not be “intended” to be medicine is like a warning that “this newspaper is not intended to be read”. Of course treatment is intended, and consumers are entitled to know. The purpose of elaborate, constitutionalised and parliamentary processes is to prevent such nonsense.

There is a flawed notion that mainstream medicine establishes safety and efficacy conclusively. Science is about uncertainty, as revealed by the new US Food and Drug Administration (FDA) warning for statins. Statins are among the commonest medicines, once thought to be so safe that healthy people were encouraged to take them. Having assured us they are safe, the FDA now warns of statins causing liver, cognitive, memory, concentration, blood sugar, diabetic and muscle damage. A local statin insert has been extended to include skeletal, neurological, hypersensitivity, skin, reproductive, eye and other “abnormalities”.

Consumer rights are violated by laws that ban nonfraudulent products and good-faith claims. “Unproven” remedies might work because of chemical reactions or belief, which are perfectly scientific. From tobacco to Cams, consumers are entitled to honest competition and marketing among suppliers. These regulations create false, misleading impressions about consumer protection and science.

Louw is executive director of the Free Market Foundation.

An astoundingly dumb bit of CAM apologia from thousands of miles away
by Orac on June 19, 2014

Respectful Insolence

One of the benefits of blogging is that it’s broadened my horizons. Although the vast majority of what I write about happens in my very own country, the United States, nonetheless I frequently learn about things happening in many other countries, some that I wouldn’t necessarily pay a lot of attention to. But when something happens in a country, not matter how far away, that interests me, sometimes it’ll interest me enough to write about it. This is particularly true when it’s a story about how other countries deal with the pseudoscientific bunch of quackery that comprise most of the treatments that are commonly referred to as “complementary and alternative medicine” (CAM) or “integrative medicine.”

I’m referring to South Africa.

Yesterday, my Google Alerts for CAM popped up a rant by a man named Leon Louw against a new policy regarding CAM in South Africa that he views as unduly restrictive. That, of course, means that it’s almost certainly a good policy. Also, Louw’s little opinion piece uses a lot of fallacious arguments for CAM that are useful to examine. Of course, I had no idea who Leon Louw is; so I had to Google his name, which lead me to learn that he’s a South African intellectual, author, speaker and policy advisor and one of the co-founders of the Free Market Foundation. When coupled with his little rant, the name of this foundation tells me a lot about it. His reasoning ability is also rather lacking:

THE new complementary and alternative medicines (Cams) regulations are draconian, misleading and insulting. In the name of science, they might promote rather than curb scams and pseudoscience. Instead of protecting consumers, they erode access to products and information. They subject supposedly unscientific Cams to supposedly scientific allopathic standards. Notwithstanding the regulations and the pretentious explanatory memorandum, the difference between the two is smaller than protagonists of science assume.

Right off the bat, Louw is demonstrating a whole lot of special pleading, objecting to holding CAM treatments to the very same standards for efficacy and safety as “allopathic” treatments. After invoking that logical fallacy, he then argues that the “difference between” CAM and “allopathic medicine” is smaller than protagonists of science assume. Well, one might reasonably wonder, if the difference between the two is so small, as Louw argues, then why shouldn’t they be subject to the same scientific standards? Obviously, they shouldn’t. That doesn’t stop him from burying himself deeper into a pile of stupid:

That Cams are “unscientific” simply means they have not yet passed tests applied to most, but not all, mainstream treatments. A leading authority, the US’s National Institutes of Health, explains that “the list of what is considered to be Cam changes continually, as those therapies that are proven to be safe and effective become adopted into conventional health”. Every mainstream treatment starts as someone’s alternative idea, including “natural”, “holistic” and “traditional” healers. Unless treatments are shown to be dangerous, they should be allowed without false or misleading claims. Antagonists, such as CAMcheck, should be as free to denounce Cams as Cams folk are free to denounce both CAMcheck and aspects of mainstream medicine.

No, many CAMs are “unscientific” because not only haven’t they passed tests applied to mainstream treatments but because many of them are based on prescientific vitalism, mystical concepts, and ideas that, for them to be true, would violate multiple laws of physics and chemistry, such as homeopathy or reiki. Some CAMs claim the existence of nonexistent anatomic structures or abnormalities, such as the meridians of acupuncture, the craniosacral rhythms of craniosacral therapy, the “subluxations” of chiropractic, or the links between locations on the tongue or on the hands and the feet and internal organs postulated in traditional Chinese medicine or reflexology, respectively. Moreover, such modalities have been tested and failed to be shown to be more efficacious than the placebo control. Louw is wrong on nearly every level.

However, I can see what he is about. He’s obviously a hard core free market type, as his argument sounds very much like the arguments libertarians make against government regulation of medicine. Of course, there’s a hole you can drive a truck through in Louw’s argument. It’s inconsistent. He says that it should be OK to allow treatments that haven’t been shown to be dangerous, as long as the practitioners of these treatments don’t make misleading claims. But who’s going to regulate whether claims are misleading or false? The not-so-subtle implication of Louw’s argument is that it shouldn’t be the government. Rather, he thinks the free market should do it, with CAMCheck, a group I hadn’t heard of, “denouncing” CAM just as CAM promoters denounce CAMCheck. Hmmm. Come to think of it, there’s a false scientific equivalence there (between CAMCheck and CAM practitioners), as well as nonsensical radical free market ideology about medicine. Here in the States, we tried that kind of approach for the first 100+ years of our nation’s existence. It didn’t work so well, which is why the Pure Food and Drug Act was passed in 1906 and the FDA formed. When it was found not to be strict enough, the act was replaced by the Federal Food, Drug, and Cosmetic Act in 1938.

Next up, a massive straw man:

Pretentious regulators want us to believe, and may themselves believe, that science proves things. It does not. Especially not health science. There is no such thing as “scientific proof”. The father of the scientific method, Karl Popper, explained that science establishes degrees of probability, never absolutes except disproof. Scientific evidence ranges from overwhelming, such as the efficacy of anaesthetics, to virtually zero, such as the nature of consciousness, something as fundamental to medicine as life and death.

Of course regulators say nothing of the sort, usually. Scientists know that nothing in medicine can be “proven” conclusively. But they do know that there’s a huge difference in the “degree of probability” that a medicine that has a reasonable mechanism of action and has passed randomized clinical trials is safe and effective and the “degree of probability” that a CAM remedy with no prior plausibility and no evidence that it is better than placebo actually is safe and effective. And, of course, that bit about the end is nothing more than an appeal to the unknown and an attempt, as Dara Ó Briain puts it, to insert into the gaps of our understanding “whatever fairy tale appeals to you.”

Of course, according to this story, manufacturers of CAM products are outright disobeying the law, ignoring a February 15 deadline to put disclaimers on its products and continuing to sell products that are now illegal. Progress is being made, though. No doubt Louw approves such passive resistance to the jackbooted thugs of the South Africa version of the FDA.

Of course, having used straw men, special pleading, a misunderstanding of how science works, and a whole lot of appeal to free market mythology, there’s only one thing left for Louw to resort to. What could that be? I bet you can guess, but if not here it is:

There is a flawed notion that mainstream medicine establishes safety and efficacy conclusively. Science is about uncertainty, as revealed by the new US Food and Drug Administration (FDA) warning for statins. Statins are among the commonest medicines, once thought to be so safe that healthy people were encouraged to take them. Having assured us they are safe, the FDA now warns of statins causing liver, cognitive, memory, concentration, blood sugar, diabetic and muscle damage. A local statin insert has been extended to include skeletal, neurological, hypersensitivity, skin, reproductive, eye and other “abnormalities”.

Yup, it’s the typical tu quoque argument; i.e., “you do it too!” He’s claiming that because there are problems with science-based medicine and how drugs are approved for use, because the process is imperfect and sometimes there are issues, because real medicines have side effects and complications that can sometimes severe, then quackery must work. Or, at least, it must be treated as the equal of real medicine. Well, whenever I hear such an argument, I’m reminded of Ben Goldacre’s famous retort (no pharma shill, he!) in which he says, “Just because there are problems in the airline industry does not mean that flying carpets work.” Similarly, just because there are problems with “conventional” medicine and sometimes drugs are approved and later found to have unexpected adverse reactions does not mean that the “flying carpet” that is CAM works. It certainly doesn’t imply that CAm should be treated as an equal, which is the main argument that Luow is making, when boiled down to its essence.

Reading this article was simultaneously depressing and uplifting. It was uplifting to see a country like South Africa cracking down on pseudoscience and fraudulent claims this way. Would that my own country would do the same! However, it’s depressing in that it tells me that the bovine excrement reasons people use to defend CAM, including free market fundamentalist “health freedom” religion, are the same the world over.

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