Archive for January, 2010

Money is better disaster aid than homeopathy

January 21, 2010

In which Dr Aust suggests that while sending money for disaster relief may not feel like enough, it it better than sending nothing. Even magic nothing.

Earlier this week Dr Aust wrote out a cheque to the Disasters Emergency Committee.

At times of disasters with tragic costs in human lives, people are naturally moved to think about what they can do to help. Money seems a feeble response, in a way – but here in rich countries, money is what we have to contribute. It is also something that is needed urgently, and will continue to be for many years to come.

Beyond that, though – and perhaps other slightly more “political” measures like campaigning for cancelling of Haiti’s debt – there is little concrete you can do.

And anyway, it would be rather arrogant to think you could do anything on the ground. Or even that you know what needs doing. Though certain things are fairly obvious, like medical supplies for overstretched hospitals, or – possibly most urgent of all – getting enough clean water to people to try and head off deadly outbreaks of water-borne infectious diseases.

It would certainly be arrogant, though, to think one knows exactly and precisely what kind of medical treatments are required to deliver the necessary care. How could one know from here?

Some people do seem to think they do know quite precisely, though. You can find a few of them here, or here. Some of these folk seem to think that homeopathic first aid (sic) would be just the thing for the people of Haiti.

It strikes Dr Aust that this is a touch self-centred.

If the homeopaths want to help, they should do what everyone else does and donate their pounds, or dollars, or whatever, through some non-profit NGO (non-governmental organisation) with an existing local presence – like Oxfam, or Unicef, or Save the Children. That would be my first thought, and indeed it seems to be what real aid workers tell you to do too.

To be fair, there are some people on the homeopathy blogs and forums saying this. But there are also some commenters who seem as interested, or more interested, in promoting homeopathy. Or telling you the established NGOs are (to paraphrase)  “just going to spend all your donation on administration and jobs for fat cat managers”

[PS - even if some aid organisations do spend more money on "administrative costs" than others, I think you'll find it's just a bit more complicated than that]

Instead, some of these folk want to send homeopathic first aid kits. Or “trained homeopaths”.

To me this smacks of arrogance, and insularity.

It seems to me that it would be a bit like me thinking that I knew exactly - and better than the people at the sharp end – the precise medical interventions, and indeed brand of supplies, that were needed to deal with a diarrhoeal disease outbreak, or some other epidemic, in an unprecedented disaster setting halfway around the world.

It would also be a bit like me telling Oxfam, or the Red Cross, or Médecins Sans Frontières, that I was not going to donate money, but instead was going to buy £££ worth of the remedy of my personal choice – say branded Generic Evul Pharma Dioralyte – and send it to their depot.

Now, I’m sure they could use the Dioralyte, which is a perfectly good product for treating water, and more particularly salt, loss in diarrhoea. Even if it does taste a bit bleagh. (I speak from experience)

On the other hand, perhaps they would prefer something else, like a cheaper unbranded version. Or, in an emergency setting, they might prefer a bunch of water boilers (for sterilizing water) plus a crate of 10 kg tubs of NaCl (sodium chloride, aka salt) and glucose, or sucrose. For the reason why this is useful stuff, see the end of the post.

Or alternatively, perhaps what they would really need is a generator to run the water-boilers. Or bottled gas. Or  well-digging equipment to find a source of water.

Perhaps they need all of the above.

The point, of course, is that I DON’T KNOW just what what would be most useful for the people in the disaster zone, or the local workers on the ground. The local aid workers on the ground, on the other hand, do know.

And what we can do, hopefully, is give their organisations the resources to buy what they say they need and to get it to them.

It isn’t really enough. But it is,  hopefully, something real.


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Edit: There is a brilliant blog post from the British Red Cross blog, pointed out by Zeno (see first comment below), that makes the point about why donating money – not items – really is the best way to help. Highly recommended.

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Appendix:  Salt, sugar and water

When you have diarrhoea you lose water, and salts. The best way to treat you is to replace these, orally if at all possible (and intravenously if that is not enough). For oral rehydration the World Health Organisation defines Oral Rehydration Solutions, and most manufactured (packet) formulae follow these.  The basic points are that they contain salts, and also sugars. This is because you need to replace the lost salts, and salt and sugar are absorbed together in the small intestine via linked transport (“co-transport” is the technical term) of sodium ions and glucose into your intestinal epithelial cells. [Sucrose, table sugar, can be used since it is rapidly broken down into glucose and fructose].

Since severe diarrhoeal disease means that you lose not just water, but also sodium, potassium and chloride ions, the rehydration formulae contain not only NaCl (sodium chloride) but also potassium chloride (KCl). Some versions contain bicarbonate too, since diarrhoea also leads to the loss of bicarbonate ions.   More fascinating stuff about diarrhoea and oral rehydration therapy at Wikipedia.

In emergency settings, simpler “homemade” versions are also used. Perhaps the most famous is:

- one level teaspoon of salt
- eight level teaspoons of sugar

- dissolved in one litre of clean drinking water, or water that has been boiled for 10 minutes and then cooled.

This simple recipe has saved innumerable lives – some estimate as many as fifty million in the last three decades. It is particularly important for children under five who are at increased risk from diarrhoeal disease – the second leading infectious killer of under-fives worldwide.   As Ben Goldacre says, behold the power of ideas, and the scientific principles on which these ideas are based.

More Twisted Führer Mash-Up Fun: Today Homeopathy, Tomorrow…

January 11, 2010

In which Dr Aust hails the work of the polymath Dr DeeTee

Dr Aust often wishes he could do several things at once. Sadly, experience has shown that he can only manage this by doing everything in an incompetently amateur-ish fashion.

Some other folk, however, manage to do several things with amazing competence, despite one wondering where they find the time and energy. Many of the medical bloggers I have got to know, largely virtually, seem to fall into this category (some examples can be found in the blog sidebar on the main page).

“DeeTee” (or just “dt”) is the “nom de blog” of a hospital consultant in infectious diseases in the UK. After many years as a regular on the Bad Science Forums, and sterling work defending vaccination in the thankless and invariably nutter-rich surroundings of the Guardian’s Comment is Free discussion threads (like this one), he is now to be found blogging from time to time over at The Lay Scientist.

However, he has also found the time, perhaps amid the Christmas and New Year lull in the swine flu cases (?) to devise a new Führer-Mash-Up. This was originally linked from the previous Mash-Up thread about Chiropractic, but clearly deserves a post of its own.

In this one the Führer is in a distressed state because he cannot get his homeopathic sugar pills.

Enjoy!

(To which the appropriate response is “Zu Befehl!” Heel-clicking optional)

Beware: strong language. Make sure you have captions turned on (arrow in bottom right corner of the video)

Notes:

1. If you think the homeopathic remedy “Berlin Wall 30cthat the Führer refers to in the video is a joke, then you are insufficiently familiar with the loonier fringes of homopathy – or, in other words, with homeopathy. The remedy does exist: you can buy it from Helios homeopathic pharmacy here, while for more about it, and a fascinating insight into the way homeopaths think (!), try here or here. Please, though, do not visit these latter pages if under the influence of any mind-altering substances, as a Psychic Embolism might ensue. Or you might die laughing.

2. The Bristol study is the notorious survey-masquerading-as-a-clinical-study also sometimes referred to as “the Spence et al. study.” The full reference is:

David S. Spence, Elizabeth A. Thompson, S.J. Barron. “Homeopathic Treatment for Chronic Disease: A 6-Year, University-Hospital Outpatient Observational Study” Journal of Alternative and Complementary Medicine. October 2005, 11(5): 793-798. doi:10.1089/acm.2005.11.793.

The “study” is distinguished (if that is the word) by having no control group, and by being about as utterly useless as a purported piece of science as is possible. David Colquhoun gives it a quick fisking here.

Notwithstanding its utter feebleness, the Spence et al study is routinely cited by homeopaths as “compelling evidence that homeopathy is a valuable intervention”, or some variant thereof. I seem to remember that when Dr Peter Fisher, the Queen’s homeopathic doctor, debated Ben Goldacre some years ago (video here), he showed at least one slide summarizing the results of the Spence et al. paper. One should also note the journal in which the study appeared, that legendarily credulous house organ of Unreality the  Journal of  Alternative and Complementary Medicine .

3. The question of Hitler’s possible medical conditions has its own fascinating Wikipedia entry, which includes some history of the discussion over whether Der Führer might have had syphilis. One of the arguments against his having the disease (and particularly its tertiary manifestations) is that a reasonably effective treatment for syphilis was available at the time; the arsenical drug Salvarsan (arsphenamine), discovered in Germany in 1908 by Sahachiro Hata and Paul Ehrlich.

4. The reference to “Quantum entanglement” will be instantly recognisable as indicating the Führer’s was aware of the seminal work of noted Quantum Homeopathic Unreality guru, Dr Lionel Milgrom. Some viewers may object that the Führer could not possibly be aware of Milgrom’s work, which has largely been published in last decade. However, in the Quantum Unreality Many-Unreal-Worlds Hypothesis, all states of time co-exist simultaneously in one of the infinite number of possible realities. So there. And if you don’t believe me, it’s in Michael Crichton’s novel Timeline, so it must be true.

5. The Fuhrer makes reference in the video to the German pharmaceutical companies Merck and Bayer. Both companies were around in the Nazi era, though Bayer was then subsumed into the notorious chemical conglomerate IG Farben. The German pharmaceutical and chemical industry, and particularly IG Farben, was intimately involved with the Nazi regime, as you can read in the company’s Wikipedia entry. This involvement is something that Herr Dr Med Matthias Rath makes much use of in his regular schtick that one might paraphrase as “Mass murderers of Big Pharma, then and now”. Less bonkers readers might feel that drawing comparisons between IG Farben’s use of slave labour and manufacture of Zyklon B, and the current manufacture and use of antiretroviral drugs to treat HIV, is the purest insane nonsense.

6. There is actually a fascinating history of homeopathy, and alternative medicine generally, connected with the Third Reich. I may add something about this later as I have time. Alternatively, you can find bits about it in many places around the Internet. Homeopathy was well-established in Germany in the 1930s, as were various other alternative therapies.  Among the senior Nazis there was a fair bit of enthusiasm for anything that could be identified as being a “folk” (völkisch) practice. The senior Nazi most renowned for his enthusiasm for homeopathy was Hitler’s deputy Rudolf Hess, later the prisoner of Spandau.

And since we’re doing homeopathy on video…

And finally, since we are celebrating homeopathy in cinematic form, I couldn’t resist finishing by adding yet another bit of Youtube magic, in this case the marvellous Mitchell and Webb “Homeopathic A&E” sketch. Even if you’ve seen it (and I’m sure most of you have) it is still funny on repeat viewing.


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