Aude Sapere

Jason Gencher, U3 Bachelor of Music

Homeopathy bottlesOn Tuesday, November 27th, 2012 students and the general public gathered for the second and final time at McGill University to hear a debate between Drs. Joe Schwarcz and André Saine. This debate would serve as the last chance for the two to present their views on the topic of homeopathy. While the motion was curtly stated as “Homeopathy: Mere Placebo, or Great Medicine,” the arguments seemed to downplay these adjectival modifiers. Having attended the first round, there were stark contrasts, and slight refinements to both gentlemen’s arguments that I noticed.

The general atmosphere of this second debate I perceived to be more academic. This was likely because the event was held during the school year, in a larger lecture hall, and advertised to the students of one the McGill World of Chemistry courses. Yet, when the moderator, Dr. Mark Ware probed the audience for their sympathies to either side of the motion, I noticed that those who endorsed Dr. Saine’s side of the argument were present in significant number. Still, I hold that compared to the first debate, billed as an event of the 2012 Alternative Medicine week in Montreal, the ‘academic spirit’ this time round was present to a greater extent.

André Saine, who is the “Dean and main instructor for the postgraduate program of the Canadian Academy of Homeopathy since 1986,” began his 30-minute opening argument with a belabored general account for the validity of homeopathy. Often, he would begin by quoting some past article by Schwarcz which would dismiss the point he would then make. While he briefly covered the history of homeopathy, raising Hahnemann, it’s founder, to cultish or prophetic level of fame, he spent most of his time presenting cherry-picked articles from the vast archives of scientific journals. Perhaps the most accurate way of representing Saine’s opening remarks would be as follows:

“Joe Schwarcz says that it is impossible that X can occur. Well this is a paper that suggests the contrary.”

Dr. Saine was not able to finish his opening arguments in 30 minutes.

Joe Schwarcz then began his opening 30 minutes. He delineated what seemed to me to be the scientific consensus with regard to homeopathy, arguing based on many of the points that he made at the last debate. He spoke of the nonsense of dilutions, of the unlikelihood of water having a memory, of the countless studies that exposed homeopathy as being synonymous with the placebo effect. He cautioned to the effect of cherry picking data, as Saine had done, stating that everything, including science, is on a bell curve, and that just because someone is able to point to a study that proves one thing, it is the analysis of where the robustness of the results are found. In this case, it is demonstrably of the persuasion that homeopathy, or the phenomena associated with it, are not yet accounted for.

I should admit, that I was struck off guard at one point made by Saine in his opening presentation. One of the articles he presented discussed nanoparticles, and their continued presence in solution upon dilution. This seemed convincing to me, considering his assertion that water can retain an active chemical upon dilution. It appears, upon further research on my part that this reality, likely provides more trouble to Saine’s argument than he might suspect. The paper which he sites, mentions nanoparticles; what he did not care to add, was that these particles were present in concentrations at the level of nano, so about 10-9. Yet, to be consistent with 20C and 30C homeopathic remedies, these nano-solutions would have been completely impossible. A 20C solution is something that is diluted to about 10-40, well beyond Avogadro’s limit. Further, the effect was only possible with certain particles or molecules, and that there was no evidence to suggest that this might be done with organic molecules. Saine is left with the same trouble of accounting for the homeopathic dilution ‘phenomenon’ while clearly also demonstrating his lack of basic scientific knowledge.

The rebuttals were somewhat hard to listen to. Saine, feeling personally attacked by Schwarcz, spent half of his 10 minutes personally addressing Schwarcz while he sat in the audience, seemingly neglecting the rest of the crowd of people. He returned to his unfinished opening arguments, but was yet unable to finish them. Schwarcz returned to the podium for his 10 minutes, but did not have much to add, already having clearly stated his points, but using the time nonetheless, to talk about Randi’s one million dollar challenge, and commenting on the poor methodology of many of the often cited studies that appear to confirm homeopathic principles.

The final round of the night was set to be a cross examination between both Schwarcz and Saine. The most striking question Saine asked Schwarcz was perhaps the most typical. He asked if, given a hypothetical situation where a loved one has lost consciousness due to a bacterial infection, and no medication was working, if he would give homeopathy a try. To which Schwarcz responded, “Desperate people will do desperate things.” Schwarcz, inquiring as to why Saine would not take Randi up on his challenge was answered that he did not have the resources to take up such an offer, but if Schwarcz was willing to lend his equipment, would be glad to split the money with him. At one point, both debaters deferred to a special guest in the audience, Dr. Amir Raz, who specializes on the placebo effect commented that his coming to this debate was like listening to “Science Fiction versus Reality.” Of course, he got cat-called and hissed at by those dearest and meek supporters of homeopathy, while the scientifically literate of us in the audience bit our tongues.

While I mentioned that I found that their arguments downplayed the adjectives in the motion, I think Joe Schwarcz stated this the most concisely. While homeopathy is likely the placebo effect in action, he said, there is nothing mere about it. We know that the placebo effect is responsible for a great deal of recovery in patients, and that it’s intricacies and nuances can be a great boon. Even knowing that you are taking a placebo seems to still promote recovery. But we must not fool ourselves into thinking that we can only recover through the action of the placebo effect. In cases like cancer, where if all patients were to defer from chemotherapy, or surgery, and solely rely on the placebo (or homeopathy), the death rate would be close to 100%. Medicine, while not able to lower this rate to 0, can at least boast to being more effective than this. In effect, homeopaths are reticent to comment on this because they are fixed to their beliefs. Like creationism, they hold homeopathy as a position of faith, and shun any information that suggests otherwise. Thus, I was not surprised in the least, when Saine made his final comment, in a fanatic ‘just you wait’ tone, adamantly stating that homeopathy is the future of medicine. I think the jury is still out on that one, but to André Saine, I might be just the person he wants, a doubting Tom.

Spreading the word, but not the virus

Don’t kiss me! Ever heard a girl say that to you? Well, I had to say that to a rather cute guy last weekend.

Medical school is coming to an end. As a matter of fact, I have five more weeks to go and I’m done. And boy do I have a bad case of the Senioritis Syndrome. According to Wikipedia, one of my favorite sources of information to the (rightful) dismay of my professional superiors, senioritis is a colloquial term used to describe the decreased motivation towards studies displayed by students who are nearing the end of their schooling careers. In other words, can you get me out of here already?

Therefore when a nice cute guy asks fed up girl out on a date, she gladly accepts. On we went to see Spiderman The  Musical.  To be honest, comics aren’t really my thing, and Spiderman had opened to rather unflattering critiques, but the public seemed to really love the action. Plus I’m always open to try something different, so why not?

Unlike in high school when you pay $5 to go to the movies to not watch the movie, we have now grown to be mature adults who can appreciate culture.  Unfortunately I side more with the critics than the crowd on this one. The music was pretty negligible, the dancing was subpar for Broadway standards, although I must admit that watching Spiderman and the Goblin flying all over the audience was quite thrilling and brought out the child in me.  However, it seemed like it wasn’t the only thing it brought out in me as I started feeling some itching on my lower lip all of the sudden. Did a bug bite me? Am I getting a pimple?

I slipped into the bathroom during intermission to find out what was going on. What I saw in the mirror was horrifying: Two or three tiny vesicles on an erythematous base right on the border of my lip. A cold sore! Otherwise known as a fever blister, or herpes labialis in the medical field. I remember I used to get them when I was a little girl, and it’s coming back to haunt me now?! Seriously?

Herpes labialis

Herpes labialis is caused by herpes simplex virus type 1 (HSV-1), and typically causes blisters or sores on or around the mouth area. On the other hand, herpes simplex virus type 2 (HSV-2) usually causes genital herpes, although it is possible for HSV-1 to affect the genitalia and HSV-2 to affect the oral region as well.

Herpes simplex virus is fairly common in the population, especially HSV-1.  As a matter of fact, most physicians won’t even bother testing for it. According to the College of Family Physicians of Canada, about 80% of people have been exposed to HSV-1 by adolescence, although some may never display any symptoms.  During an outbreak, the virus actively sheds from the blisters and the skin, and that’s when it is highly contagious. Once infected, the virus stays dormant in the nerve, usually retreating back to the trigeminal ganglion, and future outbreaks might be brought on by weather changes, stress, illness, or other unknown causes. Although annoying, it is a harmless condition in most healthy people, and the sores usually go away on its own in one to two weeks without intervention. There are treatment options that might speed up the healing process, though probably not by as much as one would like.

Docosanol 10% cream, or Abreva, is the only FDA-approved treatment for oral-facial herpes simplex infection. It is most effective if applied right at the prodromal phase, meaning at the first tingle or burning sensation before the blisters appear, and it needs to be applied five times a day. Docosanol works by inhibiting fusion between the human cell plasma membrane and the herpes simplex virus envelope, thereby preventing viral entry into cells and subsequent viral replication. Since the compound doesn’t act directly on the virus, it is less likely than antiviral drugs to produce resistance.

Other studies have shown that application of zinc oxide and glycine cream every two hours while awake shorten the duration of symptoms from 6.5 days to 5 days. Studies on antiviral creams such as acyclovir or penciclovir have mixed results, and the same goes for oral antiviral treatments.

The only significant improvement was seen in one old and very small study with 7 subjects published in the Lancet in 1989 showing that the anesthetic lidocaine and prilocaine creams (25 mg of each per 1 g) reduced the mean duration of subjective symptoms from 5.1 days to 2.1 days and the duration of eruption from 7.3 to 2.6 days.

Bottom line is, treatment is most effective if you start early; as soon as you feel something brewing underneath and even before the first sign of a blister, and it might accelerate the healing process by a bit.

As for my date, when he leaned in at the end of the night, I couldn’t help but shout: “Don’t kiss me! I think I have a cold sore.” Even though the vast majority of the population has been exposed to HSV-1, I still thought it was better to issue a warning. Well, no romantic Spiderman kiss for me! But I guess if he still calls me after that, I’ll know that he likes me for more than just my lips.

“Comfortably Numb”

From time to time, we get a patient that we almost hate. Either due to noncompliance, disruptive behavior, or maybe a personal choice with which we strongly disagree. And we all hate to admit that. JR is that  patient. For those of you who read my previous blog entry, JR is the bed-ridden gentleman with the foul-smelling ulcerated and purulent legs. Basically, they look like they are rotting, and if he doesn’t start taking care of himself, or at least allow someone to do so, they might just rot away.

At first, my attending physician did not want me to enter JR’s room, because he could be aggressive and even threatening. He has been in the hospital for months, and has become quite the infamous villain among doctors, nurses, and social workers. Even his roommate complained about him and asked to be transferred to another room. (more…)

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