Homeopathy: US mandates ‘No evidence’ labels

arnica-pills

Bottle claiming to contain one trillion trillion trillion trillion trillionth of this flower.

The US Federal Trade Commission (FTC) has just issued an enforcement policy statement requiring marketers of homeopathic products to ‘effectively communicate the lack of scientific evidence’ on product labels.

The move is being heralded as the first time that homeopathic products will legally require a label stating that they don’t work.

Numerous submissions to the FTC report cited the Australian 2015 comprehensive assessment of evidence by the NHMRC, which concluded there is no reliable evidence that homeopathy is effective for any health conditions.

Although the evidence overwhelmingly supports the new FTC policy, much of their report deals with legal issues, possibly pre-empting industry arguments that regulating advertising claims might be inconsistent with the US First Amendment around free speech.

The FTC policy does not constitute a new law, but it clarifies the minimum standards for homeopathic health claims, which until now have largely been left to self-regulation. Homeopathic products will now “be held to the same truth-in-advertising standards as other products claiming health benefits.”

But not all is rosy… Continue reading

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With Obamacare gone, how will Trumpcare affect US health?

trumpcare

The world is a less certain place than it was this time yesterday, and the health industry has not escaped waking up with that feeling of ‘what just happened?’

US President elect Donald Trump vowed through his campaign to ‘immediately repeal’ Obamacare, but it seems no one has any idea what Trumpcare will look like. The Affordable Care Act will be afforded no longer, and health analysts are scrambling to find much more than election sound bites to predict what might replace it.

To consult the modern oracles, one need never travel further than the stockmarket. As investors fled US-dollar exposed shares yesterday, health insurance stocks were caught in the maelstrom.

Repealing Obamacare entirely would leave 20 million without health insurance, and although few believe the Republicans will go so far, Trump is predictably unpredictable. That’s enough to spook health insurers and owners of private hospitals. Continue reading

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Mothers, don’t plan on early delivery unless it’s medically necessary.

1. pregnancy

Important new findings today suggest that planning to have your child born before 39 weeks’ gestation may be associated with worse brain developmental outcomes, once your child reaches school age.

 

SOMETIMES there is no choice in having to pre-book an early birth. If your pregnancy is high-risk or complicated by a particular medical condition, then planning an early delivery, by C-section or going to the hospital for induction, may be the safest option.

However, increasingly the delivery of babies is pre-planned without necessarily a pressing medical need. In fact, in Australia, planned births now account for around half of all deliveries at 37 and 38 weeks’ gestation. Today’s news it that your child may be more likely to have unforeseen complications down the track.

What is this new study?

A study published today in Paediatrics linked the birth records of 153,730 children born in NSW in 2002-7 with the child’s performance some years later, as graded by their teacher in the triennial Australian Early Development Census (AEDC).

Continue reading

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GP Sceptics pod3: Pain

gp_sceptics_small    pain

itunes-logo    soundcloud

Sceptical medicos Justin Coleman and Liz Sturgiss take on a world of pain.

What doesn’t work for back pain? (Hint: most things)

Are opioids taking over the world?

We look at various cognitive biases when doctors make decisions. Liz tries to persuade Justin that we all want to be normal. Then she spoils her argument by pulling out a toy plane.

Refs:

Efficacy of paracetamol for acute low-back pain: a double-blind, randomised controlled trial Lancet, 2014

Paracetamol for low back pain Cochrane Review, 2016

Innovative pain therapy with a fixed combination of prolonged-release oxycodone/naloxone: a large observational study under conditions of daily practice. Current Medical Research and Opinion, 2010.

Cognitive biases (Wikipedia list)

Targin promo, as described in the podcast:

targin-promo-of-nothing

Continue reading

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GP Sceptics podcast 2: Diabetes

gp_sceptics_smallSugar Cubes by howzey

 

 

 

 

itunes-logo         soundcloud

Liz Sturgiss and I decide to tackle diabetes – do we even know what we are diagnosing, or is it a ‘category error’? Does metformin have anti-aging properties? If so, why isn’t Justin taking it?

Justin’s Factoid focuses on wacky newspaper headlines about medical research, then Liz makes him squirm with her nasty ethical dilemma.

Refs:

Is T2DM a category error? Lancet 2013

The epidemic of pre-diabetes: the medicine and the politics. BMJ 2014;349:g4485

Choosing Wisely Australia recommendations

Testing times! Choosing Wisely when it comes to monitoring type 2 diabetes. MJA 2015

 

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Starts at 60 interview

startsat60

This week I was interviewed by ‘Starts at 60’ to discuss the role a GP might play for older people, with particular reference to how the Choosing Wisely Australia program can improve consultations.

Starts at 60 only took off a year ago, but is already incredibly popular – 20,000 people have watched this video in the first 48 hours. The other possibility is that it’s me who’s popular. Okay, nope.

Click on the photo above to watch the video. Warning: it takes half an hour, so bring some tea and toast.

 

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GP Sceptics podcast 1: Big Soda

gp-sceptics-logosoda

itunes-logo   soundcloud

In the first of the GP Sceptics podcast series, Dr Justin Coleman and Dr Liz Sturgiss team up to dissect, analyse and sometimes trash medical research that is relevant to GPs.

This first podcast looks at the influence of Big Soda on health research. The good, the bad and the fizzy.

Refs:

Relationship between Research Outcomes and Risk of Bias, Study Sponsorship, and Author Financial Conflicts of Interest in Reviews of the Effects of Artificially Sweetened Beverages on Weight Outcomes: A Systematic Review of Reviews. PLOS One, Sept 2016

Relationship between Funding Source and Conclusion among Nutrition-Related Scientific Articles PLOS Medicine 2007

Big Soda sponsored 96 health groups — a big conflict of interest, study says. Washington Post, Oct 2016

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Coffee – safe even if your heart is a bit dicky

 

heart-coffee

Heart smart latte

Coffee drinkers with heart issues can breathe a sigh of relief. A new study shows coffee is safe for people at risk of arrhythmias, even if they have heart failure and are wearing a pacemaker.

 

It seems intuitive that caffeine intake should be limited or prohibited in patients with heart disease. No-one wants to die with a latte in their hand. On the other hand, for a coffee drinker, the idea of facing a lifetime of coffee-free mornings might seem more unpalatable than risking sudden death.

The beautiful news from this well-designed study from Brazil (where they know their coffee) is that this risk is non-existent after all. The heart keeps ticking along just fine, even as the morning fog clears.

The background

Evidence prior to this study had not shown that coffee was risky, but nor was there proof it was safe. Continue reading

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Do GPs ever regret referrals?

Je ne regrette rien

Je ne regrette rien

An Australian study (featured today in Medical Observer) has found prostate cancer patients are more likely to regret surgery than radiotherapy. This had me wondering; if my patient regrets surgery, should I then regret having referred them to a surgeon?

We would like to think our referrals are always based solely on the best outcomes, but can we really claim, as Edith Piaf did, Je ne regrette rien?

Or are we in fact sometimes swayed by factors other than outcomes – things like tradition, familiarity, friendships, or yesterday’s guidelines? It’s hard to identify any one referral as adamantly wrong, particularly if we self-reflect through rose-coloured lenses. But surely not every decision can be all La vie en rose.

If a GP refers to a surgeon in the private sector, the patient usually ends up getting surgery. Something about hammers seeing everything as nails?

So, radiologists advise further radiology and pathology begets pathology. Sure, some private urologists routinely consider re-referral for radiotherapy, but many don’t. This, despite a recent high-quality study showing both produce similar prostate cancer outcomes*. Continue reading

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Pharma targeting nurses for ‘education’

 

nurse-jackie

Who’s been talking to Nurse Jackie?

Pharmaceutical companies are increasingly targeting nurses when it comes to industry-sponsored events.

Although nurse-only events are still uncommon (5% of all events), nearly twice as many pharma-sponsored events in Australia now have nurses present than have GPs.

 

Research by the University of Sydney, published in JAMA Internal Medicine today, examined four years of industry-sponsored events to 2015. A total of 116,485 events were reported by pharmaceutical companies who were members of Medicines Australia.

Nurses were present at 40% of all events, GPs at 21%, while specialist physicians came in top, at 69%.

Of events aimed at a single profession, 5% included only nurses, 9% only GPs, and 18% only specialists.

Nurse-only events were decidedly cheaper for the sponsors:  The per-person cost was only 39% of the amount spent at doctor-only events. Events where nurses were present were significantly less likely to include a served dinner, or to be held overseas.

So, why is money being spent on nurses, at two in five events? Continue reading

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