clinical governance

A comparison between medical and homeopathic information sources

Recently, I’ve been delving back into the world of homeopathy, and all of the nonsense that it entails.

Part of my research and preparation has been consulting homeopathic texts- materia medica and repertories that are still in use by modern homeopaths.

One thing that I have been repeatedly struck by is the stark differences in the quality of these information sources compared to those used in modern medicine. Let’s take a look at some of those differences.

Up To Date?

Part of my day job’s role is resource management. This means that I need to make sure that all of the resources that we use and have access to are present and up to date. Whenever I use a book as part of my work, I document which edition I have used. If I use a website, I make sure to include when it was last updated. When we get a new book in the office, I find the old copy and cover it in stickers saying “Out of date- do not use”.

I don’t do these things because I am weird, or because I enjoy it. I do it to ensure that I give the most accurate, up to date information so that the patient gets the best care. What we know about medicines is constantly evolving- new medicines, new safety information, and new evidence is emerging daily. What might have been correct to the best of our knowledge last year may now have been subsumed by more recent experiments, and so the information sources I use change accordingly. So, for example, I can reach for a copy of the British National Formulary from 2005, and find information that recommends sibutramine as a weight loss aid in certain patients. However, if I look at the current version, I won’t see it in there, as it has since been withdrawn for safety reasons. If I were to have used the 2005 copy to advise a patient, I might have given them the wrong advice, in the context of what we know today.

How up to date is the information used by homeopaths? According to The Homeopathic Pharmacy (Kayne, S. 2nd Edition, published in 2006 by Elsevier Churchill Livingstone, page 192- I did warn you about the documentation): ‘The most well known are Boericke’s Materia Medica with repertory and Kent’s Repertory of the Homeopathic Materia Medica’. Sadly, the author of this book doesn’t see fit to bother telling us when these were published. Neither does the online version of it, although there is a bit of a hint in that the “Preface to the ninth edition” on there is signed off by William Boericke in 1927.

Nineteen Twenty Seven. Medicine and healthcare is a pretty fast-paced industry, with new innovations and information coming out at an overwhelming rate. So much has happened in medicine since 1927 that there is no way that anyone should accept health care advice based on something written from that time. I know I certainly wouldn’t be too happy if my GP gave me health advice from a dusty tome, or if I went to the dentist’s to find them using equipment from the 1920’s.

Maybe Kent’s Repertory will be more up to date? A Quick look at the website gives us no clues. This time, the preface contains no date at all. The closest thing that we have to a publishing date is the fact that the website is copyright 1998, and appears to have been formatted by a default-font loving child in the early nineties.

Political Correctness

Over the years, medical terminology has changed and evolved along with society and scientific discoveries, and rightly so. In some cases, words that used to be considered as perfectly legitimate scientific terminology (such as ‘Mongol’, or ‘Mongoloid Idiocy’, used to describe a person with Down syndrome) are now considered downright offensive. Even whole swathes of what is now considered normal society (such as gay people) were once declared as illnesses- and of course we know better by now, or at least we should do, and if you don’t- grow the hell up, will you. We generally don’t refer to people as “hysterical”, or “insane” anymore, as we know a lot more about such conditions, so are able to categorise people more helpfully and professionally.

As a result, we healthcare professionals are very aware of how crucial the use of clear, concise, professional communication is, including the information in our resources. No self-respecting modern medical text would ever dream of using out-dated, offensive terms, and if it did, there would be an outcry.

Let’s have a look at the sort of thing that Boericke’s Repertory wants to help us to treat. There are things like “Brain-Fag”, “Cretinism”, “Masturbatic dementia”, “Fears of syphilis”, “hysteria”, “insanity”, “weak memory from sexual abuse”, “Haughty”, “Stupid”, and many others. These were just taken from the “Mind” section, but there are many other examples in the other sections too. These terms are just too outdated and are wholly inappropriate to be used in today’s society.

Having looked through various other Materia Medica entries too, I’ve found statements that are sexist, bigoted, and occasionally racist. Nice eh? You don’t find that sort of thing in an up-to-date copy of Martindale: The Complete Drug Reference.

Clarity

Good, modern medical resources are all about clarity. They need to be- after all if someone gives the wrong medical advice because they have interpreted something incorrectly, patients could be at risk.

Jargon is sometimes necessary, but nowadays medical jargon tends to use standardized, accepted terminology which keeps the risks of misinterpretation to a minimum.

Homeopathic repertories and material medica, on the other hand, are full of vague, odd terms which are massively open to interpretation. What, pray tell, is a “voluptuous, tingling female genitalia” when it is at home? (and I wonder whether Ann Summers offers free delivery on such a thing?). What does “expectoration, taste, herbaceous” mean clinically? How is one supposed to diagnose “Taedium vitae”? When would you class a person as “Obscene, amative”, and when would they be considered as merely “gay, frolicsome, hilarious”?

In Conclusion

Our health is arguably the most important asset that we have. Why would we entrust it to sources which are terribly out of date, inaccurate, and in some cases, offensive?

Homeopaths like to paint themselves as a caring, human alternative to the more business-like, clinical world of real health-care professionals. But when this alternative categorises people as being “stupid”, or “cretinous”, and is happy to use criminally out of date resources which can risk peoples’ health, I wonder just how caring and ethical it really can be.  

I've said this before, and I'll say it again: why would you continue to use an abacus when calculators exist, and are proven to have a better record at getting the right answer?

 

e-cigarettes: accidents waiting to happen

We all know smoking is bad for us, and we all know that giving it up is a good idea. E-cigarettes have been around for a good few years now, and they seem to be the answer to a lot of our prayers to some people: That lovely nicotine hit, without having to traipse outside, and without any of the nasty tar or other chemicals that makes smoking bad for you.

There's currently a bit of a kerfuffle going on about them as the EU look into tighter regulation of them. A quick search on Twitter reveals lots of folk stating that they save thousands of lives, are much safer than other pharmacological smoking cessation methods, and are totally safe, therefore shouldn't be banned by the EU. Others have covered the fact that e-cigarettes are unregulated, that they may actually contain chemicals and ingredients which can be carcinogenic, that they might have adverse safety effects so I'm not going to cover all of those potential issues here. .But there is one aspect of their use which I think is easily forgotten about, but has the potential to be very worrying.

It seems that e-cigarettes come in a variety of forms- none of which are regulated. Some are disposable, some have refillable cartridges, and some require refilling with a liquid. There are even some sites which encourage mixing your own nicotine liquid: a complicated process requiring mixing a nicotine concentrate with a flavouring and a diluent using a dropper.

Now, as a fairly young pharmacist (or so I keep telling myself), it has been a long time since I compounded any medicines myself, but I do remember doing so in university and I have a pretty good idea of how to work out and produce mixtures. I'm a keen baker, so used to following recipes which can be complex at times. And yet a quick glance at some of the mixing guides for nicotine liquids makes me worried. They look complicated enough for a pharmacist like me to follow, never mind anyone else. Milligrams, drops, milliliters, colours, parts etc are all terms used on the same instruction sheet, and the medicines safety part of me is crumpled and crying in a corner, wailing "HIGH RISK COMPOUNDING PROCEDURE!" loudly to anyone who will listen. And yet, because these things aren't considered a medicine, anyone can sell this stuff, and anyone can buy it. There are risks at every step of producing these mixes: not understanding the instructions, not accurately measuring amounts, mixing up the different liquids, storage of the liquids, spillages etc etc. Some sites even suggest using a syringe- complete with needle- to inject the nicotine solution into devices. A little bit of me is dying inside. 

Even the ready made liquids are problematic enough. They come in little eye-dropper type bottles, and are often pleasantly flavoured. In short, they're probably rather attractive to children. 

In my day job, which partly involves advising on poisoning cases, I have come across quite a few cases where nicotine liquid intended for use in e-cigarettes has been accidentally ingested. A lot of people don't know that nicotine itself can be horribly toxic, particularly for children. It only takes a small amount orally to get some pretty nasty, potentially fatal effects. And yet, freely available to buy without any regulation at all, a variety of attractively flavoured and packaged -and really highly concentrated- nicotine liquids are sitting ready to be bought by eager punters. You can even buy multi-packs of large bottles of highly, highly concentrated nicotine liquid. They don't even have child-resistant tops on them- and why should they, as they're not even considered a medicine? The websites selling these things aren't particularly clear about the dangers of them- again, why should they be, when they're trying to sell them as a safe alternative to smoking?

I've had a quick look around the medical literature and as of yet there is very little information published on this aspect of e-cigarette usage. And that's part of the problem: the technology has been widely adopted without a thorough understanding of all the different aspects of its safety. Even if they were tightly regulated and highly safe, this aspect of accidents with refills will still remain, and in my opinion it is only a matter of time until there are some very serious accidents of this nature. 

So, whilst e-cigarettes might be a useful ally in giving up smoking for some people, we really need to put some thought into the safety issues surrounding them, and not just the obvious ones which might affect the person using them.

All of this is without even considering the fact that using them can sometimes make you look a bit daft, especially the ones that light up at the end like a pretend-y cigarette. Others, frankly, look like "discreet" vibrating devices for ladies. You'd be better off with those yummy candy cigarettes from the eighties, if you ask me- they look more like an actual cigarette than most of the e-cigs and they're a whole lot cheaper too. 

Hxxx 
 


Minor Update (2nd May 2015): Some time has passed since I wrote this, and I think my fears have started to be borne out in the evidence. Poisons Centres around the world are starting to report evidence of toxicity. Deaths in both humans and animals are being reported. Its a real shame that it came to this, but hopefully with proper regulation the safety of e-cigarettes can be improved.