Monthly Archives: June 2010

Saint Cosmas and Saint Damian (c. 200 CE)

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Cosmas and Damian were twin brothers who lived in Syria during the 200s CE. Under the influence of their devout mother, they embraced the Christian religion that was still outlawed by the Roman authorities. They were both physicians and, unlike colleagues, are said to have provided free treatment. Their growing fame brought them to the attention of the Roman consul, who ordered them to make a sacrifice to the gods. When they refused, they were executed.

Over 48 miracles were credited to the twins, including, amongst others, the development of remedies against plague, scabs, scurvy, kidney stones and bed-wetting. Their most famous miracle involved the alleged replacement of a diseased leg of a white patient with the leg of a recently deceased black man. This legend became increasingly popular from 1200 onwards, and contemporaries would have been in no doubt that it was a miraculous procedure. While amputation was a known, if extreme, procedure, there is no way that a limb from a corpse could have been successfully transplanted to an ailing donor, who then went on to live.

Cosmas and Damian are regarded as saints by the Roman Catholic, Eastern Orthodox and Coptic Christian churches. Roman Catholics consider them the patron saints of medicine and their skulls are venerated as holy relics in a shrine at a church in Madrid. Their saints’ day is 26 September.

Via the Science Museum's unrivaled "Brought to Life" web exhibition.

Click on image to see larger version; Image caption: "A verger's dream: Saints Cosmas and Damian performing a miraculous cure by transplantation of a leg." Oil painting attributed to the Master of Los Balbases, Oil 15th/16th century. Image credit: Wellcome Library, London via Brought to Life.

What Do You Expect From Your Pharmacy?

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What evidence standard should exist for health products sold in pharmacies? That’s today’s bleg, and I’m seeking your input.

In most countries, pharmacy is a registered, self-regulated health profession, with a responsibility to optimize the use of drugs. Pharmacist education consists of several years of university-level education and practical training in real-world health care settings. Pharmacists with advanced degrees and post-graduate residencies are common. Not all pharmacists work in community (retail) pharmacies, but that’s where many pharmacists end up, and it’s the public face of the profession.

In most countries, pharmacies are private businesses, either owned by a pharmacist or by a corporation. They are granted a privileged and exclusive right in the provision of health care: certain health products (both prescription and non-prescription) are only available in pharmacies, because pharmacist consultation and availability has been deemed necessary to maximize the safe use of these products. While it’s a setting for health care (and often the first point of contact into the system), retail pharmacy is a business. Pharmacies count on the retail sale of products for revenue and traffic. And in general, pharmacies have the legal right to stock and sell whatever products they want. Tobacco is one exception, where it is no longer sold in most Canadian pharmacies, but remains prevalent in American pharmacies. And as I discussed in a prior post, when we look internationally there can be considerable differences between which drugs are prescription, and these that can be sold over-the counter.

How Much Evidence?

The evidence standard for products sold in pharmacies is facing increasing scrutiny. Concerns have been raised in several countries that pharmacies may be taking advantage of their privileged status as provers of prescription drugs, and are selling products that aren’t supported by good scientific evidence. Some recent examples:

  • Australian Skeptics awarded pharmacists their Bent Spoon Award in 2006 for selling “quackery and snake oil.” They recently published an open letter to pharmacists criticizing the sale of ear candles, noting, “Pharmacies need to make a profit, but this should not be done through quack products and bad advice. To regain the status a pharmacy should have – a place to get sound advice and effective medicine, supported by scientific and clinical evidence – we implore our pharmacists to stick to worthy products sold by knowledgeable staff.”
  • In New Zealand, some are asking, What are homeopathic remedies doing in New Zealand Pharmacies?
  • In Canada, pharmacists have been advised not to sell natural health products that are not approved for sale by Health Canada. While this sounds promising, it does not establish a rigorous evidence standard, as Health Canada approves and regulates products such as homeopathy.
  • In the United States, the FDA warned consumers in 2009 to stop using Zicam intranasal products, commonly sold in pharmacies, because of serious adverse effects.
  • In the United Kingdom, as part of the Evidence Check into homeopathy, the Professional Standards Director for Boots, a British pharmacy chain, made the following admission: “There is certainly a consumer demand for these products. I have no evidence to suggest they are efficacious. It is about consumer choice for us and a large number of our customers believe they are efficacious.”

Establishing a Standard?

Is it possible to define a minimum evidence standard for products sold in pharmacies? Here are some possible thresholds:

  • Copper bracelets, magnets, homeopathy, and similar implausible products without any persuasive evidence of effect
  • Products with biological plausibility, but without any clinical data (positive or negative) in humans
  • Plausible products, (e.g., some herbal remedies), supported by anecdotal evidence, case reports, or very weak RCT data
  • Products with evidence of benefit and possible harms (e.g.,  some vitamins)
  • Products that may not be helpful, but are generally regarded as safe (e.g., cough and cold products)
  • Products backed with robust evidence, approaching the standard used for prescription drugs (e.g., antibiotics, analgesics)

Other Considerations

In the United Kingdom, the Evidence Check into homeopathy made the following recommendation:

Although the availability of homeopathic products in pharmacies could be interpreted by patients as an endorsement of efficacy, in our view it would be pointless to seek to remove homeopathic products from sale in pharmacies. Many pharmacies sell ranges of non-evidence-based products and homeopathic products are easily available over the internet in any case. We consider that the way to deal with the sale of homeopathic products is to remove any medical claim and any implied endorsement of efficacy by the MHRA—other than where its evidential standards used to assess conventional medicines have been met—and for the labelling to make it explicit that there is no scientific evidence that homeopathic products work beyond the placebo effect.

Is the sale of homeopathy, or any other product acceptable in a pharmacy, if there is full disclosure about the level of evidence supporting efficacy claims?

In Canada, the United States, and some other countries, pharmacies can be part of large retailers like Walmart. Should there be a different threshold in these types of pharmacy settings?

Where do you see the line being drawn between the right of a retailer to sell a product, and the responsibility of a health professional to sell credible products?

Focusing the Question

Let’s keep the discussion focused on products intended or marketed for therapeutic or health use. That is, set aside the sale of chips, tobacco, cosmetics, televisions, donuts, or propane. We’re discussing products intended for therapeutic use, that may be legally sold.

Assume for this exercise that pharmacies that restrict the sale of certain products don’t interfere with market access through other retailers, like vitamin shops.

Pharmacy practice varies by country and even by state. Describe the current standard you observe in pharmacies, and what you think the standard should be.

Let’s leave aside discussion about prescription drug access. Focus only on products available for self-selection (over-the-counter).

Conclusion

Pharmacies play an important role in the health care system by providing access to pharmacists and therapeutic products to support health. If our intent is to support self-selection of science-based products supported by good evidence, what evidence standard should be applied in pharmacies? I look forward to your comments.


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Art Students League of Denver Summer Art Market

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Live Music
Take a break in the Art Students League garden located on the north side of the school and enjoy some music. Check out the schedule for a line-up of the performances.

Free Adult Art Classes
Free art classes for adults are located inside the Art Students League of Denver building.
Classes are limited to the first 20 attendees on a first come, first served basis.
No experience is necessary–just bring your interest in art! See the class schedule.

Free Kids Art Projects
Stop by the Kids Art Tent located in the parking lot on the south side of the school for a fun activity for your child. A list of activities can be found HERE.

Interested in taking classes at the Art Students League, but haven’t yet?
Join the Art Students League during Summer Art Market and get your FIRST CLASS FREE!
To join, visit the Art Students League booth–right in front of the school entrance–or the main office inside the building. Offer valid for new and returning members. Free class must be redeemed by December 31, 2010. Good for one day of an ongoing class or $25 toward the cost of a workshop.

We need your help. Volunteer your time to help make Summer Art Market a success.
Choose from many VOLUNTEER JOBS
at various times, from pre-event set up and traffic directors to greeters and artist “hosts.”
To volunteer, email samvolunteers@asld.org or call Joy at 303-730-6012.

Secret Museum Closing Party and Morbid Anatomy Library/Observatory Open Studios, This Weekend!

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This weekend, The Morbid Anatomy Library and Observatory--which are next door neighbors, by the way!--will host open hours as part of Atlantic Avenue Artwalk. So, if you're in the hood from 12-6 PM and would like to poke about the library with a glass of wine, or peek into The Secret Museum with the photographer on hand to guide you through the exhibits, then please, come on by!

Following the open studios, Observatory will be hosting a free closing party for The Secret Museum, which will run from 6 PM until the wine runs out (which we are approximating at 10:00 PM); there will also be snacks and the DJ stylings of Mister Friese Undine.

All events will take place at the old box factory at 543 Union Street, Brooklyn at Nevins; enter via Nevins Street alley and Proteus Gowanus Gallery. Click here to view map.

This promises to be good times; very much hope to see you there!

You can find out more about Atlantic Avenue Artwalk by clicking here. You can find out more about the Secret Museum Exhibition by clicking here and more about the closing party by clicking here. You can find out more about the Morbid Anatomy Library by clicking here and about Observatory by clicking here.

Image: Installation view of Observatory's Secret Museum Exhibition.

Monet’s Water-Lily Painting For Sale

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(Reuters) – Auction house Christie’s is offering a Monet water-lily painting worth an estimated 30 to 40 million pounds ($44-59 million) this month in what it expects to be the biggest sale it has ever mounted in London.

With the international art market booming again after a slump when financial markets crashed, the Christie’s sale also includes a Blue Period portrait by Pablo Picasso, offered by the Andrew Lloyd Webber Foundation founded by the composer, and carrying a price tag about the same as the 1906 Monet.

The Monet, which is to be unveiled on Thursday, and the Picasso, plus 61 other works on offer, are expected to take the tally on June 23 to 164-231 million pounds.

This would be in excess of the London record of 147 million pounds set at rival Sotheby’s in February.

That amount was boosted by a world auction record for a work of art when an Alberto Giacometti statue went under the hammer for $104.3 million.

Three months later, Christie’s topped that high with a Picasso which fetched $106.5 million in New York.

“We are witnessing a great willingness from clients to consign works of art of the highest quality,” said Giovanna Bertazzoni, head of impressionist and modern art at Christie’s.

The top European auction total stands at 183 million pounds for the impressionist and modern art section of the private Yves Saint Laurent collection.

With records tumbling, it comes as little surprise that owners of the finest art are willing to offer it up for sale.

Ongoing uncertainty over the state of the broader global economy has failed to dampen the mood in sales rooms, with only a handful of super-wealthy individuals or museums needed to drive values higher.

A relatively short-lived slump in the art market was driven as much by sellers drying up as by buyers no longer wanting to pay out large sums for paintings and sculptures.

The company described demand for the rarest works of art as “fierce,” coming from Russia, China and the Middle East as well as the more traditional markets of Europe and North America.

“Nympheas,” the work by Monet to be offered, was shown at the famous 1909 exhibition in Paris where the artist’s studies of the effects of light in his garden in Giverny won critical acclaim.

Also to be sold at the impressionist and modern art evening sale are important works by Gustav Klimt and Vincent van Gogh.

Original article found here

Various Works by Dorian Iten

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Dorian Iten is an Austrian born painter and illustrator currently residing in Florence, Italy.  Dorian earned a degree from Kantonsschule Zug in 2005 and soon entered The Angel Academy of Art, in 2006.  A highly trained classical drawer Dorian has studied under Canadian Classical Realist, Micheal John Angel and Classical Painter Jered Woznicki.  He is currently looking for a professional painter, to work with as an assistant after his 2009 graduation.

You can learn more about Dorian and view additional artwork through his personal site at
http://www.dorian-iten.com

Phase I clinical trial of ICT-107

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Immune response correlation with progression-free survival in glioblastoma following dendritic cell immunotherapy (ICT-107) by Surasak Phuphanich and 9 co-authors, including Manish Singh, Keith Black and John Wu, J Clin Oncol 28:7s, 2010 (suppl; abstr 2097). To be presented at the 2010 ASCO Annual Meeting, June 06, 2010.

Related news releases:

ImmunoCellular Therapeutics Ltd. (IMUC) to Present Cancer Vaccine Candidate, International Business Times, June 02, 2010. Excerpt:

Data from the company’s recent clinical trial of ICT-107, the company’s dendritic cell-based cancer vaccine candidate, will be presented at the 46th Annual Meeting of the American Society of Clinical Oncology (ASCO) June 4-8 in Chicago.

See also: Immunocellular brain cancer vaccine shows promise, Reuters, June 02, 2010. Excerpt:

"We are targeting specific antigens that are on cancer stem cells ... the only population of cells that can really propagate a tumor," said Dr. John Yu, director of surgical neuro-oncology at Cedars-Sinai Medical Center in Los Angeles and ImmunoCellular's chief scientific officer.

Another related news release: Immunocellular Therapeutics Enters into Research Agreement with University of Pennsylvania to Support Phase II Clinical Trial of ICT-107, Business Wire, April 21, 2010.

David Tredinnick in quacks for questions

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David Tredinnick, Conservative MP for Bosworth, fulfils a traditional role, required of those who are outliers to the left of the ability curve, in the Westminster Village.  The idiot.  This has enabled him to have a long undistinguished career, previously he was best known for his role in the ‘cash for questions‘ affair, taking a cheque for £1,000 to ask a question in parliament, now his concerns are quacks and their questions.

In an ePolitix article, to promote his adjournment debate on integrated healthcare, Mr Tredinnick presents all the ability and skills that have kept him out of the 3rd reserves for the Conservative front bench.  An ungracious observation about Evan Harris, the former Liberal Democrat MP for Oxford and Abingdon, one of the previous parliaments most rational and respected members is followed by much crowing about the poor performance from one his challengers in Bosworth, the science writer Dr Michael Brooks.  Mr Tredinnick’s reasoning then goes the way of his charm with the following paragraph:

Surveys show that support for a healthcare model that allows doctors to refer to other therapists such as herbalists, acupuncturists, homeopaths and aromatherapists is increasing. The new coalition government seeking to both give more say to doctors and more choice to patients should embrace integrated health care as its model.

This is presumably referring to the infamous Northern Ireland Trial.  This was carried out by a marketing company, hired by a lobby group fronted by Boo Armstrong, who used to write articles for an AIDS denialist magazine and was latterly Chief Executive of the Prince’s Foundation for Integrated Health (FIH), until it fell victim to fraud.

Tredinnick would like the new government to consider this report.  He would also like them to consider regulating alternative therapists through the Health Professionals Council (HPC), rather than the Complementary and Natural Healthcare Council (CNHC).  This is interesting as the CNHC, an offshoot of the disgraced FIH, has been struggling to recruit enough members to survive, and has already been rejected by herbalists and the Society of Homeopaths (SoH), who have previously collaborated with Tredinnick. Is this a move by these alternative elements and their political proxy reflecting a power grab in the alternative healthcare sector?

And what of Boo Armstrong, now that the FIH are disgraced she must be looking for a new job, is she in league with the legions of the dumb?  Is it coincidence that Tredinnick has cited her report?  Time will tell.  However, such an alliance would be a reflection of the fall of alternative medicine in recent years.  The collapse of the chiropractors, thanks to an ill advised libel claim, as well as the damning Select Committee report on homeopathy has put tremendous pressure on this sector.  Once Boo Armstrong and alternative medicine had the ear of Peter Hain, a former government minister of some considerable standing, now they have the ear of David Tredinnick, a minister only in his imagination.

Health Benefits of Pets – Mayo Clinic Video

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May 10, 2010 — Health Benefits of Pets.

People will do a lot for their pets - see below:
- Somebody found a solution: Smokers are motivated to quit to protect their pets from secondhand smoke http://is.gd/iZ58
- "Do it for Fido: smokers may quit smoking because of their pet" http://is.gd/iZtQ

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