The National Post has published several articles and letters lately that have been harshly critical of naturopathic doctors and alternative medicine. The latest one to catch my eye was the letter on this page by Dr. Susan Piccinin, a medical doctor from Ancaster, Ontario. (Scroll down about two-thirds of the page for the item headlined "Why wasn't the naturopath charged?")
The first thing that caught my eye is Dr. Piccinin's error in saying that salicylic acid comes from birch bark. It doesn't: it comes from willow bark. But there is other far more important misinformation in her letter.
I will grant that Dr. Piccinin is correct in saying that pharmaceuticals generally have a botanical source, but she is wrong in saying that the main distinction between pharmaceuticals and natural products is in the testing. Pharmaceuticals are distinct because they've been deliberately altered in some way that makes them different from their natural source. That's the only way that manufacturers can be sure of obtaining patents for them. You can't patent a natural substance that's been used for centuries for the purpose you want to patent it for. So pharmaceuticals are generally substances foreign to the human body, which explains why they so frequently have side effects.
She claims that "modern pharmaceuticals are safe and effective when taken properly." However, this 2003 study called "Death by Medicine" co-authored by three MDs and two PhDs estimated that in the U.S., approximately 186,000 people have serious adverse drug reactions annually when taking medications exactly as prescribed. Of these, as many as 100,000 per year die. These numbers are distinct from those who die due to drug errors (i.e. mistakenly receiving the wrong drug, or the wrong dose).The number of iatrogenic (doctor-induced) deaths is probably proportionate for Canada and is likely higher now, since people are taking ever more prescription drugs.
You simply can't combine the entire population into a single composite and say that the drug is on balance beneficial.
As for effectiveness, prescription drugs are not required to be effective for all patients in order to gain approval. They probably never are. Efficacy is considered demonstrated in drug trials if the drug is simply "more effective than placebo." This can mean a drug is ineffective for a huge percentage of patients -- perhaps even a majority.
Dr. Irving Kirsch of Harvard Medical School caused a furor when he published studies showing that prescription antidepressants currently on the market are not significantly more effective than placebo. This finding was featured on an episode of 60 Minuteswhich aired in February 2012, and can still be viewed online.
Health Canada says that it assesses drugs by considering both the benefits and the risks. All drugs have risks: that's why they come with a monograph describing their side-effects and telling you when to rush to a doctor's office after taking them. A drug receives approval when, in the opinion of a Health Canada bureaucrat, the benefits outweigh the risks. But this decision is entirely subjective, for two reasons.
First, every individual patient has a different hierarchy of values. Suppose, for instance, that drug X, a proposed new beta blocker, demonstrates a record of fixing heart arrhythmias in 60 per cent of patients, while reducing sex drive in 35 per cent. A widowed 80-year-old grandmother might be perfectly willing to accept that risk, while a 25-year-old newly married man wouldn't be. Neither of them is wrong. You simply can't combine the entire population into a single composite and say that the drug is on balance beneficial.
Second, there will always be some unfortunate percentage of patients who fall into both the cohort of patients (40 per cent) whose arrhythmias are not rectified by drug X and the cohort whose libido is reduced (35 per cent). In this example, somewhere around 14 per cent of patients (40 times 35 per cent) could be expected to be harmed by this medication without obtaining any benefit whatsoever.
Therefore, the blanket statement that pharmaceuticals are safe and effective when taken properly is simply false.
Finally, Dr. Piccinin's image of naturopaths telling patients to go boil some tree bark on their front lawns is utterly ludicrous. The world has many excellent nutraceutical manufacturers who purify the active ingredients in their natural products, standardize the potency, and encapsulate them in known doses for consumers. Naturopaths recommend pills and capsules, just like allopathic doctors do. Witch hunters will have to look elsewhere for their boiling cauldrons.
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