Like mice in a maze: the world of potions, healers and pseudoscience
Homeopathy, herbal remedies.. Do these actually work?
I’ve recently bumped into the issue of whether there is any proof of the effectiveness of so-called ‘alternative medicine’, namely homeopathy and other forms of alternative therapy that modern medicine does not renown even today. The conversation about this subject heated up quickly in a TV show some time ago, where a doctor, also trained as a homeotherapist, debated over the matter with a docent of health sociology, who is known for his upfront, steeply negative attitude for homeopathy and other alternative treatments. I couldn’t stop laughing at the homeopathic doctor who persistently tried to convince both the show host and the sociologist that homeopathy actually works – her reasoning was so much in conflict with scientific facts and reasoning that I honestly started to doubt whether she actually has academic degree in medicine at all. Her arguments
also made me question her sanity, to be honest. It’s one thing to admit that today’s science cannot answer all questions and quite the other to claim that some forms of therapy cannot be explained or examined by using scientific methods.
The idea of using toxins to cure ailments and illnesses isn’t unheard of, but the homeopathic principle of potensing, which means diluting a toxin with water until there is no toxin left at all, and using the resulting water for treatment purposes is rather controversial. Homeopaths claim that the residual water has a ‘memory’ of the toxin even after thousands of times of diluting. I’d really like to know how this ‘memory’ has been found and where’s the proof of it. The homeopath doctor on the TV show also had an answer to the question of how there is no scientific evidence supporting the effectiveness of homeopathic remedies: according to her, the effect cannot be measured using the traditional scientific maneuvers! And again I was laughing out loud from the bottom of my heart. All in all, the talk show quickly started to resemble a comedy.
The sad thing is that there are a lot of people believing all kinds of imaginary ‘information’ and explanations partly because they come from a person with a medical or nursing background and partly because these people are just gullible. It’s amazing how people with a medical or nursing degree dear to proudly use their degree in marketing their private business, no matter if it’s homeopathy or other alternative treatment. They must be either doing it without realizing that by doing so they give the impression that these alternative therapies are accepted in actual medical and nursing care, or they are taking advantage of this idea purposefully which is sickening.
One problem with alternative treatments is that they may end up causing you actual harm rather than any good. 
For example, even today there are a lot of people unaware that certain herbal remedies, such as the hypericum perforatum (picture on the left) may have unexpected interactions with commonly used prescription medication such as anticoagulants. In addition, some of the remedies such as echinacea purpurea (below picture), may cause severe allergic reactions and even lead to an anaphylactic shock.
Still wondering why I’m so strongly against homeopathy and other alternative forms of therapy? Well, one of the reasons must be obvious after reading the above text – I’m definitely a science believer, maybe even a bit fanatic. I’m perfectly aware of the fact that a lot of stuff in our world, in the universe and all the wonders we’ve already discovered are still lacking a big bunch of logic, and scientific explanations. We think we know a lot about how the planet we live on has formed or ’born’, if you will, but the how and the why are still pretty much just based on the present existing evidence gathered by scientists in the fields of astronomy, geology and biology, just to name a few obvious ones.
Science is always uncertain and any new evidence must constantly be subjected to criticism, doubt and uncertainty since there may be coming a moment when some kind of a new ground-breaking evidence about the state of things messes our current conceptions up big time. Our lives may be hanging on the thread of the current paradigm of science, and at any moment a revolutionary change in science or in the state of the universe might swipe away everything we know , us included. We just have to live with the possibility of that this sort of change may be occurring at some point and in the mean time keep on concentrating in what seems to be the state of things, founding our lives and existence on that basis. The wait for the end of the world may be a long and boring one so we might as well enjoy our time left in here, right?
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Can anyone become a health care professional?
News about employment office counselors guiding people with mental health issues, alcohol or drug abuse history to start studying for practical nurse degree once again reached headlines in Finnish newspapers and online newsrooms last November. According to the Finnish National Authority for Welfare and Health (Valvira), the national agency operating under the Ministry of Social Affairs and Health that acts as a supervising authority for health care services and professionals, there have been multiple cases where a person with alcohol or drug abuse history has been guided to apply for practical nurse education. Representatives of Valvira stated that the agency is concerned that guiding people with an alcohol or drug problem to apply for nursing education may be used as a treatment or rehabilitation method. The reports also mention that Valvira has already had to warn employment officers not to guide unsuitable people to apply for nursing education. One news site interviewed Valvira’s director Tarja Holi, who stated (informally translated): “These people (employment office clients with mental illness, alcohol or drug abuse background) are unable to practice the (nursing) profession. They cannot be guided to get the (practical nurse) degree only because they are not accepted to study elsewhere.”
In Finland, a student position in the practical nurse education is generally considered easy to access, and the growth of unemployment numbers in recent years has lead to increasing number of unsuitable people applying for nursing education. It seems that employment officers are in fact under the impression that practical nursing is a profession that anyone can learn and practice for living, and the employment officers seem to apply this idea to other nursing degrees as well. It’s as if these people are thinking: ‘How hard can it be to work in three shifts, change diapers for elderly, perhaps demented people and treat their pressure ulcers?’ As a result, it’s not unusual that an unemployed +50-year-old man is urged to apply for practical nurse education by employment officers even if he has previously worked in an industrial occupation for all his life. After all, there are plenty of working years still left for him before retirement since at the moment, people around their 50’s are expected to retire around the age of 63 to 65 years in Finland. If the man declines the suggestion, he may end up losing his unemployment benefit for three to six months as a punishment. The withholding of unemployment benefits is in fact a standard protocol for just about anyone declining to take a job or student position offered via the employment office. But hey, nursing is an easy and suitable option for anyone, right?
An intoxicated nurse equals nothing but patient safety hazard
The number of health care professionals with a severe alcohol or substance abuse problem has grown dramatically in Finland. When in 2005 the Valvira supervisory committee dealt with more than twenty cases, the prognosis for 2014 was 260 cases. During last year (2015), a total of 36 practical nurses and 17 registered nurses lost their license. Common reasons for losing a license include errors in prescribing medicine, in addition to severe alcohol or drug abuse. Nurses have also lost their license after getting caught stealing drugs, and medication thefts are a typical first sign of a drug problem among nurses. The thefts are usually detected by fellow nurses and nurse managers, who have become more sensitive in noticing the problem over the years.
The greatest problem with an alcohol or drug addictions is that it will start to affect work at some point. A nurse with an alcohol or drug problem often starts making a lot of mistakes at work and as the number, frequency, nature and extent of errors increases, the co-workers will end up spending more and more time in damage control. Typically, an addicted nurse also begins to seem unfocused, decreasingly alert and unable to notice changes in their patients’ condition that require action. There have already been cases in Finland where a medication error, done by a nurse with an addiction, has in fact led to the death of a patient in a very short period of time.By the time a nurse with an addiction or mental health issues is detected and the case is put under investigation the underlying problem may have lasted for several years already. It’s either the co-workers or managers at work who blow the whistle, but patients are also known to have made complaints about problems and 
incidents during their care, and these reports have in some cases lead to an investigation revealing the nurse’s predicament.
Some bystander experiences
During the very first few years of my career as a dental health professional I stumbled upon a couple of cases at two separate private dental clinics where a dental assistant obviously had an alcohol problem. Luckily I never witnessed them drinking at work or anything but it’s quite obvious that something’s going on when a colleague repeatedly calls you late in the evening asking to cover their morning shift (background noises revealing that they’re calling from a bar) or calls in sick suspiciously often. Both of these ladies in their late 40’s or early 50’s would show up at work looking very tired and pretty obviously having a hung-over and I bet their blood-shot eyes weren’t caused by an eye infection. In the first case one day I got an urgent call from work to come cover for the dental assistant who then got fired in the middle of her shift and in the second case the party animal quit before she would have been fired, I think. One day she just didn’t show up at work in the morning, the managers mentioned nothing about it and shortly after that new assistant was hired. I was too young and unsure what was going on to talk to anyone about my notions and suspicions at work but I got the impression that there had already been problems with both women for quite some time before I was hired.
Silence fixes nothing
There is clearly a strong need to develop supervision and whistle-blowing policies to detect and catch nurses and nursing students with mental health issues and addictions. You can always try to confront the person with the problem to seek help but what if it doesn’t work? Whistle-blowing on a colleague or a co-worker shouldn’t be considered as interfering into other people’s business let alone some kind of a deception but an attempt to help them in solving the problem. After all, whistle-blowing on someone with a mental health problem or an addiction is intended to act as means of ensuring and promoting the patient safety and quality of nursing.
In the nursing profession, taking care of patients means taking care of yourself, your colleagues and co-workers as well. This way everybody wins.
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Cochrane confusion
Cochrane promotes itself as ‘an international, non-profit, independent organization, established to ensure that up-to-date, accurate information about the effects of healthcare interventions is readily available worldwide’. Cochrane reviews are considered to be the most reliable source of scientific evidence there is worldwide. I used to think this is true but now my head is full of doubt, and after reading this post yours might be, too.
Last spring, a Cochrane review by Riley et al. (2015) ended up drawing a lot of confusion among laypersons, and especially oral health professionals and members of scientific communities. Based on the results of the review, the authors stated that ‘There was insufficient evidence, from single studies (mostly with small sample sizes), to determine a difference in caries between the following groups, and thus the uncertainty associated with the effect estimates resulted in them being compatible with both a reduction and an increase in caries associated with xylitol’.
In Finland, researchers and experts in the field of dentistry were very 
surprised by the results of the review and quite soon a statement by docents Eva Söderling and Kaisu Pienihäkkinen from University of Turku (Finland) was released in both the journal and website of the Finnish Dental Journal (text only available in Finnish, I’m afraid). In their statement, Söderling and Pienihäkkinen, both renowned researchers with decades of experience in xylitol research, criticize a number of things about the review. Due to the lack of an English version of the statement, I’m explaining the main points of the response below to save you from crappy online translators leaving you with nothing but just more questions.
First of all, Söderling and Pienihäkkinen question the fact that only ten studies were regarded as eligible for the review when there are more than five hundred published studies on the effects of xylitol. According to the docents, the review authors had also ignored the fact that the effects of xylitol depend highly on the dosage and frequency of the xylitol intake per day. The duo reminds that xylitol is not an antimicrobial compound and that it appears to have plaque-reducing and caries preventing effects only when the minimum daily intake is five grams. They point out that in half out of the ten selected studies included in the review, the given dosage of xylitol was less than five grams. Söderling and Pienihäkkinen state that the Costa Rica study that is included in the review, is very hard to access and that the study does not even reveal the dosage of xylitol that was given to the test subjects. According to the docents, the Lycksele study included in the review was conducted on small children and the dosage of xylitol was tiny. The inclusion of a probiotics study by Teemu Taipale also raises questions, for in his study, xylitol was used for a few hundred milligrams merely as a bulk agent in probiotic tablets given to study subjects.
As for the rest of the five studies, one of them was conducted on children with excellent state of oral health and thus the results of the xylitol intake were impossible to prove even in theory. All in all, the five studies were not even comparable to one another as the form of xylitol varied from pastilles and syrup to somekinds of ‘wipes’, and the age of the study subjects varied from children of different age to adults. In addition, the other one of the two xylitol pastille studies included in the review was regarded as having a ‘high overall risk of bias’. Söderling and Pienihäkkinen remind that there are dozens of studies on xylitol chewing gums that have been accepted as the basis of recommendations of EFSA and the International Association of Paediatric Dentistry. The docents do admit that there is still need for new, carefully designed studies examining the effects of xylitol with high enough intake, and this is about the only thing that both the review authors and the docents seem to agree on. In the final words of their response, Söderling and Pienihäkkinen state that they cannot but wonder about the intentions of the authors. After all, they conclude, news headlines are based on a half a page summary and few people pay closer attention to the matter at hand and assess the report itself.
Interested in learning more about these mysterious xylitol studies? Here’s one list of xylitol studies mainly conducted by Finnish researchers but you might as well type ‘xylitol’ in Google Scholar or any other scientific database search engine (while writing this post I tested Google Scholar and got 69,500 hits). As an oral health professional and an academic I can only note that all that glitters is not gold – and that applies to Cochrane reviews as well.
Still believe that Cochrane reviews automatically equal truth and nothing but the truth?
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Patient education – worth the effort or a waste of time?
Patient education plays a big role in my work as a dental hygienist. I can honestly say that not a day goes by that I don’t give some kinds of instructions and advice related to oral health. Based on my clinical experience, I’ve noticed that people can be categorized in two groups based on their needs concerning oral health education and counseling. The first group of people are those with lack of information and/or skills, which prevents them from making reasoned decisions. The second group of people are those with disinformation or misconceptions regarding oral health. The common nominator to both
groups is the lack of proper information. One might think ‘That’s easy to fix: just tell them what they need to know’, but the thing is, we need more than just oral health-related information in order to ensure that the given information and advice lead to positive changes. Cutting right to the chase is a bad idea, and by reading further you will find out why.
Information, knowledge and motivation as change agents
As humans we are complex beings, partly because of the high level of intelligence that separates us from other living things. Our behavior is the result of multiple factors such as information, knowledge and motivation, and this applies to health behavior, to
o. Today, thanks to internet, anyone can search for information about a specific health issue, although many scientific journal articles are still accessible only to subscribers. On the other hand, internet and especially social media, such as discussion forums and blogs, have made it possible for anyone to write and claim anything. There are also people who pose as experts on a specific field of knowledge with no actual recognized degree. Well, they are experts in one thing, namely spreading phony information and skewed conceptions while driving their own agenda, which is usually money-making. But the con artists’ claims are geniously disguised as ‘truths’, often supported by made-up testimonials — and so the illusion begins to build in the heads of people prone to influences.
One of the things that separates professionals from the non-professionals is the ability to tell whether a text is based on factual information, that is, scientific evidence. At work I often meet people who mention or ask me about an oral health-related claim they’ve heard or read somewhere. I get to correct certain misunderstandings almost daily, like that one should avoid brushing areas where the gums are bleeding. This kind of misconception is actually quite understandable since people are used to linking any kind of bleeding to a cut or a laceration — I think few people would dare to brush an area like that since if you have a cut, you are supposed to leave it alone and let it heal by itself. Pretty logical. But
if these people knew that bleeding gums are a symptom of an oral disease known as gingivitis, and that it is caused by the presence and accumulation of bacterial plaque on tooth surfaces due to incorrect and/or irregular tooth brushing, they might understand that the problem can easily be avoided by following good oral hygiene practices. (more…)
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Can we trust scientific articles?
The case of John ‘Johannes’ Bohannon a.k.a. Ocorrafoo Cobange
An article about the truth behind a groundbreaking chocolate diet study caught my eye in a Finnish newspaper Helsingin Sanomat (article available in Finnish only) earlier this summer (2015), stating that PhD Johannes Bohannon, the man behind the study, was actually a science reporter named John Bohannon, a man with no doctoral degree. The study was actually performed, but with only fifteen subjects and by analyzing so many factors that a false positive result, weight loss in this case, could be found. And so Bohannon basically claimed in his study report that eating chocolate made people lose weight – a scientific sensation which was spread all over the newsrooms around the world. Scientific world and media went ‘whoa’, and there seemed to be no room for criticism. Fail. Big time. 
In his article, John Bohannon also mentions another hoax he pulled a couple of years ago. Bohannon came up with an idea to test whether the quality control of scientific journals was as strict as the journals claimed. He decided to name himself as Ocorrafoo Cobange, a biologist from the Wassee Institute of Medicine (which doesn’t exist), made up a research on a wonder drug and sent 304 versions of a research paper, filled with amateurish flaws, to open access scientific journals. Within ten months, over half of the journals accepted the offered paper for publication, despite the fact that the publishers promised to follow strict peer review practices.
I must say I was utterly shocked after reading Bohannon’s story. And I know I’m not the only one thinking ‘How the heck is this even possible?’
My academic career is yet in its very beginning, having the Bachelor’s and Master’s degree in Nursing Science and only two published articles (as the main author) in peer-reviewed journals and three rejections so far. Despite the small number of publications I already know that a peer review process can be aggravating in its strictness, mainly because of the request from the reviewers to correct or clarify even the smallest details in a single sentence. It’s easy to become blind to one’s own text at some point so it’s good that an outsider gets to read it with a critical eye. As far as preparing and correcting a manuscript goes, I really feel that a microscope might come in handy. Honestly.
As an author it may seem irritating to do corrections to your precious paper over and over again, but all the time and effort is paid for a good purpose: quality assurance. In order to achieve and attain a reputation as a highly rated high-quality academic journal, the articles to be published must meet strict criteria in terms of quality and the journal must review all manuscripts rigorously. Naturally, this means that some manuscripts are rejected straight away, others perhaps after submitting one or several corrected versions. And yes, I’ve already been there, too. It stings, I admit, but at least I’ve mostly been given great suggestions and feedback in how to enhance the article in order to get it published in some other journal, perhaps. I can’t imagine anything worse than a reviewer who says ‘no’ to your manuscript when it’s obvious that (s)he hasn’t bothered to even read it carefully enough to give proper feedback and explain why the manuscript should be rejected. I’ve experienced that once (the other reviewer’s feedback was quite the opposite) and to me that is simply a sign of disrespect, after all, a submitted manuscript is usually the result of several weeks, even months of hard work by the author(s).
Bohannon points out that despite of the originally good intention, the business behind the open access journals seems somewhat shady these days. It is typical to an open access journal to charge the authors for publishing an article, but some of the open access journals are willing to print just about anything to get paid. The fact that publishers behind these journals, such as Wolters Kluwer, Sage and Elsevier, are world renowned, is even more shocking. On the other hand, Bohannon mentions that some of the open access journals, regarded weak in quality assurance, were meticulous in reviewing his article. Interesting, isn’t it? And hey, at least the famous journal PLOS ONE (Public Library of Science) rejected Bohannon’s article in just two weeks after submission. Ha!
Summa summarum, after read
ing about Bohannon’s experiments I can’t help but to quote the Danish philosopher Søren Kierkegaard:
There are two ways to be fooled. One is to believe what isn’t true; the other is to refuse to believe what is true.
Edit: here’s one version of the chocolate study by Bohannon et al. 2015, published in Global Journal of Medical Research (K: Interdisciplinary) vol. 15, Iss. 1.
Enjoy!
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From thoughts to words
This could have ended up as a book project lasting for years but technology won, as it so often does these days. Sometimes it seems that after seeing, doing and experiencing enough things in some field in life, the need to share your thoughts and reflect grows to an extent where occasional conversations over coffee simply aren’t enough anymore. The moment of finding a new channel to share one’s thoughts arrives. No more waiting for an opportunity to open conversation, even the time of day doesn’t matter anymore.
Luckily, it’s 2015 and I’m a child of the Y generation. So blog is the answer.
You probably already guessed what I’m going to be writing about: health. I’m interested in both health and health care services, topics that have already been discussed a lot in a world with millions and millions of bloggers and vloggers. Despite this, I’ll address these topics from both the patients’ and professionals’ point of view. My life has been pretty health care-related for the past fifteen years as a health care student and a professional. I have four degrees from three health care education levels: a vocational degree, two Bachelor degrees and a Master’s degree. And it seems that I won’t stop until I get the PhD as I’m already preparing a study proposal with my supervising professor.
The idea of starting a blog stems from all the personal experiences I’ve had as a student, professional, tutoring students in clinical practice and from my experiences as a health care educator. Influenced by my academic background, evidence based knowledge, practice and research are topics I consider very important and I will bring up these perspectives actively in my posts.
I’m constantly coming up with new topics to address and I’m also curious to find out what my readers think. So welcome to my blog, enjoy the ride, feel free to comment and remember to share this with others!
The world of health and science 