Regulating health claims

2011-01-25

in Economics, Law, Politics, Rants, Science

Arguably, the existence of truth in advertising laws has a perverse effect when they are not rigorously enforced.

For example, all kinds of highly dubious claims get made about herbal supplements. Not only do manufacturers not need to provide high-quality evidence to back them up, but they can print things that are contradicted by high quality studies that have been done.

In Trick or Treament? The Undeniable Facts about Alternative Medicine, Simon Singh lists some of these:

  • The evidence that chamomile or lavender helps with insomnia is poor.
  • There is poor evidence that either asian or siberian ginseng helps with impotence, cancer, diabetes, performance enhancement, or herpes. There is also poor evidence that it serves as a ‘cure all’.
  • The evidence that aloe vera helps with herpes, psoriasis, wound healing, or skin injuries is poor.
  • There is poor evidence that evening primrose helps with eczema, menopausal problems, PMS, asthma, or psoriases, or that it is a ‘cure all’.

Singh also lists some side effects of herbal medicines that are often not described on the packages. For instance, hops can interfere with oral contraceptives, and many herbal supplements can interfere with anticoagulant and antidiabetes drugs. St John’s Wort can inhibit the normal operation of over half of prescription drugs, including anti-HIV and anti-cancer drugs, as well as oral contraceptives.

I have personally seen really absurd claims made on products in health food stores, often featuring real scientific terms used in meaningless ways.

What I worry is that people have an inflated expectation about how closely health claims are scrutinized. That could give people a false sense that the claims made on herbal supplement bottles, by dieting companies, and so on deserve to be taken seriously, when they could well be pure hogwash.

I was surprised and disappointed recently to listen to a conversation in which the participants asserted that (a) most or all of the claims made by doctors and pharmaceutical companies are false and made in bad faith and (b) that the claims made by companies selling ‘alternative’ treatments were credible. While the system for reviewing the former may be lacking, there seems to be no system at all for reviewing the latter. As a consequence, there is a lot of dangerous nonsense out there.

Perhaps there should be some sort of mandatory warning included in advertising that contains unverified medical claims. Something along the lines of: “The health claims made in this advertisement have not been evaluated for accuracy”.

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{ 8 comments… read them below or add one }

oleh January 27, 2011 at 8:43 am

It would be helpful if there was one credible institution to evaluate the credibility of health claims or at least to conduct a reporting of reliable studies. This is in contrast with the clinical studies that medications must review before obtaining approval.

With increasing use of and associated expenditure on herbal remedies, I wonder if the the Food and Drug Administration in the US would or could undertake this.

crf January 27, 2011 at 3:00 pm

oleh, the US department of health has at least partially done this (on orders from CAM advocates in congress). It’s called NCCAM (and it’s a bit of a fiasco — wasting money chasing after angels CAM backers earnestly believe in).

Milan January 27, 2011 at 5:04 pm

The Cochrane Collaboration is an excellent resource for information on evidence based medicine.

Milan January 27, 2011 at 6:01 pm

This is probably one major thing that drives people toward alternative medicine:

Doctors need more training in empathy, report finds

Doctors are routinely missing or ignoring moments that beg for empathy and need more training in responding to human emotions, an article in Canada’s leading medical journal says.

Researchers from the University of Toronto and Duke University in Durham, North Carolina say studies suggests doctors fail up to 90 per cent of the time to respond to emotional cues from their patients.

“Empathy is the ability to understand another’s experience, to communicate and confirm that understanding with the other person and to then act in a helpful manner,” the authors write in the Canadian Medical Association Journal.

But, in real practice, doctors “infrequently articulate” empathetic responses, they say.

The team points to a recent study, published in the Archives of Internal Medicine, where researchers analyzed 20 transcripts from recordings of 137 consultations between doctors at a U.S. Veterans Affairs hospital and patients with lung cancer. In all, 384 moments or “empathetic opportunities” when patients expressed fears, worries or concerns were identified.

. January 30, 2011 at 3:27 am

Long and Short of Calcium and Vitamin D
By JANE E. BRODY
Published: January 24, 2011

The new daily recommendations for calcium and vitamin D, issued in November by the Institute of Medicine, have left many people wondering whether they are getting enough, or perhaps too much, in their diets and supplements.

The institute’s expert committee, which included bone specialists, concluded that most people don’t need supplements of these critical nutrients and warned of serious health risks from the high doses some now take — including kidney stones and heart disease linked to calcium supplements, and the very falls and fractures that vitamin D is meant to protect against.

For bone health, vitamin D and calcium go hand in hand, because the vitamin must be present for calcium to be absorbed from the digestive tract. But who, if anyone, needs supplements — and how much? Can you get enough from foods naturally rich in these nutrients or fortified with them?

These are important questions, given the steady increase in life expectancy and the already epidemic levels of osteoporosis and fractures among older Americans, men and women alike. (Women are especially vulnerable, because estrogen loss at menopause can cause a precipitous decline in bone density.)

The answers depend on three things, not to mention which experts you happen to ask: the foods and drinks you regularly consume, your personal and family history of broken bones, and habits that influence bone health.

. January 30, 2011 at 3:30 am

For daily calcium intake, the institute now recommends 1,000 milligrams for children 4 to 8, women and men 19 to 50, and men 51 to 70; 1,300 milligrams for children 9 to 18; and 1,200 milligrams for women 51 and older and men 71 and older. The upper limit of safety, the institute said, is 2,000 milligrams a day for men and women over 51.

Thus, if you are a postmenopausal woman who typically consumes only one or two servings a day of dairy, you may be hard put to get 1,200 milligrams of calcium from the rest of your diet unless you take a supplement. Dr. Ethel Siris, director of the osteoporosis clinic at Columbia University Medical Center in New York, said such women could benefit from a supplement of calcium carbonate (600 milligrams a day) or calcium citrate (500 milligrams a day).

. March 8, 2011 at 5:33 pm

Ronald Doering, who served as head of the Canadian Food Inspection Agency from 1998 to 2002, says he’s not referring to outright lies in labelling, because a liar deliberately sets out to deny or disguise the truth, while a person exaggerating a product’s virtues “isn’t concerned about the facts except insofar as they may be pertinent to his interest in getting away with what he says.”

Doering, tapped by Agriculture Minister Gerry Ritz just a few months ago to chair a new ministerial advisory board of the agency, addresses label claims in the current issue of an online trade magazine aimed at the food industry.

“Bullshit on food labels is everywhere,” he writes.

He cites several examples of what he thinks are exaggerated claims. One involves the “shameless proliferation of implied claims” about the power of antioxidants in food products that contain trace amounts of green tea, blueberry, acai or just “blueberry flavour.” Green tea is the only prepackaged food in Canada allowed to make claims about antioxidants, so including a small amount of it as an ingredient in a product implies the product contains antioxidant properties.

“The companies don’t care about the facts (the science on the real value of antioxidants is not that clear anyway), they just want to get away with creating an erroneous impression,” Doering writes.

Other “tolerated bullshitting claims” common today include implying that sea salt is healthier than ordinary salt, writes Doering. The same goes, he says, for claims that leave the false impression that brown eggs are different nutritionally from white eggs, or labelling products as being free of genetically modified organisms, creating the impression the products are, therefore, safer.

“In practice, unless there is a pushy competitor complaint, (CFIA) does not usually take aggressive enforcement against mere bullshit claims,” Doering writes.

Still, the language he uses in his article suggests these claims are legally dicey. Doering points out that a key provision of the Food and Drugs Act not only prohibits false claims on pre-packaged food labelling, it also makes it illegal to use statements that are “likely to create an erroneous impression.”

The government’s interpretation of this section of the law “does not expressly refer to bullshit, but it comes close when it explains why it is a criminal offence to make such factual statements: they ‘infer a false uniqueness and give an unfair advantage to that food,’ ” Doering writes.

. March 22, 2011 at 8:12 am

Some companies try to make their ingredients appear more natural or organic than they are. One common tactic is to use hydrosols or “flower waters” in a formula. Hydrosols are made when water is steeped or steamed with a natural ingredient and that liquid is added to the product.

Sounds nice, but with no minimum amount of the natural ingredient that formulators are required to use, it may be a very weak tea. Throw a slice of lemon in a swimming pool and suddenly you’ve got natural “citrus water.” And when formulators use this water in their products — in place of the water they were already going to add — it gives the appearance of a lot of organic or natural content, often near the top of the ingredient list. In reality, it may be mostly water.

“Fragrance” or “parfum” is another loophole — a catch-all phrase that might be hiding hundreds of ingredients that you don’t want to buy, notably phthalates, used to make scents linger. Fragrance is considered a trade secret: companies don’t have to tell you exactly what makes your shampoo smell like honey and pear (and there may very well be no honey or pear doing the heavy lifting).

Still others indicate that some ingredients are “naturally-derived” when they are, for all intents and purposes, synthetic. A chemical like PEG-7 glyceryl cocoate may have some origin in natural ingredients — in this case, coconut oil — but it is so heavily processed, that its link to the natural world is tenuous at best.

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