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Discussing homeopathy on Rip Off Britain
it's been so long since my last post, for which I apologise. I have had a fairly severe case of Writer's Block. But I figure helping out on a national TV programme is worth a few words, right?
if you go down to i-player today (or within the next 20-odd days), you won't find a teddy bears picnic, but you will find yesterday's episode of Rip-off Britain, featuring one of the smartest, bravest community pharmacists I know. And the subject is our old nemesis, homeopathy.
A few months ago, I got an e-mail asking if I would be willing to help provide some background information to the show. I jumped at the chance, though I was also a little wary, in case it became a hatchet job for the whole profession.
but I decided the risk was worth it, and so had a conversation with a very nice chap one evening, in which I essentially ranted on for a long time whilst made notes. I gave him the background on how pharmacists are regulated, and the difference in roles between the RPS and GPhc. I told him about how I thought homeopathy breached our professional standards if not sold correctly.I told him about how, if I'm in a pub talking about homeopathy, I'll often collect together various pint glasses in order to better demonstrate the dilution process, and how people are then usually amazed and outraged when they realise that homeopathic medicines contain no active ingredient. Most importantly of all, I told him my theory that most pharmacists who sell homeopathy badly do so because of a lack of knowledge, rather than a willful way of exhorting money from poorly customers.
Then came the dreaded question: would I be willing to appear on camera to say all of this? Yes. Yes I would. I would absolutely adore to, in part because it is the scariest thing I could ever think to do and I haven't been so good at challenging myself of late. But my workplace would no doubt see it differently, as they have done before. But luckily, I knew exactly who to ask to do it in my place though, and she's done me and the profession proud.
in the programme, the undercover journalist actually received the best advice from Holland and Barrett. Let's just let that sink in for a bit, shall we? Holland and Barrett gave better advice that several registered pharmacies. Yes, it's a small sample, and the chap in this particular Holland and Barrett is likely an outlier, but if ever something should make our profession hang our heads in shame, it is that.
There is a mistake in the programme too. They referred to the Faculty of Homeopathy as regulating homeopaths, but that's nonsense. Homeopaths don't have to be a member of the Faculty, and it seems that they do very little in the way of regulation anyway. Homeopaths can do what they please, with no one to slap their wrists when they harm people, unlike real healthcare professionals.
The researchers contacted Nelson's, who said that they were disappointed that pharmacists weren't giving the right advice. They offered to provide more training, but I certainly do not think that's the sort of thing the profession needs. We need to be better able to distinguish between homeopathy and herbal medicines, and we need to make sure that we are honest with our patients. We need to know that "a lot of people buy it" is NOT the same thing as "it works", and we need to find better ways of connecting community pharmacists with good quality evidence.
Thank you, Cathryn. You've done us proud.
Tagged: pharmacy, homeopathy
A lot of the posts on this blog are looking at homeopathy and its harms. I've been working on the basis that most people that read this blog have a knowledge of what it is and how it differs from, say, herbal medicines. However, on speaking to a lot of people, it would seem that it is worth reiterating what it actually is, as this really helps to put into context the sort of harms that might be caused by it.
The ingredients of a homeopathic medicine are beyond a 12 C or 24 X dilution are as follows:
That's it. That's all it is. Homeopathic medicines are so highly diluted that by the time the pills are made, there is essentially no probability of it having any molecules of the "active" ingredient in it at all.
So, although homeopathic medicines are made from all sorts of things- plant materials, heavy metals, conventional medicines, dolphin sonar, body part, tumours, ducks, exhaust fumes, the light reflected from Saturn etc, none of these ingredients are actually present in the final formulation- the pill or tincture that you take. It probably hasn't even been within a mile of the remedy listed on the pack.
If you didn't know this already, you're now probably thinking 'Eh? What are they playing at? How on earth is that supposed to work?!" Well this website is probably the best one to tell you that: How Does Homeopathy Work?
Herbal medicines are different. They are made from plants or plant extracts, and they haven't been subjected to the dilution process- in other words, there are high enough levels of pharmacologically active component in them to mean that they could-at least theoretically- work
Lake Superior as a homeopathic solution
A good way to illustrate what I mean about homeopathy is to use Lake Superior as an example.
At its longest, Lake Superior is 360 miles, and it is 160 miles at its widest point. Let's say we filled Lake Superior with a 30C Nat Mur (salt) solution.
Lake Superior holds 12,000 square km of water.
In this volume of a 30C solution, there would be 40080 molecules of sodium chloride (salt).
40080 molecules = 0.000,000,000,000,000,003,89 grams of salt.
1 grain of salt weighs approx 0.064799 grams
If Lake Superior were a 30C Nat Mur solution, it would a teeny, tiny fraction of one grain of salt. That's how dilute a homeopathic solution is. It makes no sense whatsoever for it to possibly work, and indeed all good quality evidence suggests that it doesn't.
Tagged: homeopathy, critical thinking, skepticism
In memory of Rachel
I didn't know Rachel at all. But I was told her story last night, and all of today I have been thinking about her. I don't know how old she was, what her life was like, the colour of her hair, whether she spelt her name with just an 'e' or if there was an 'a' in there too.
It sounded like Rachel was a nice person. It sounded like she was enthusiastic (I think she met the teller of her story whilst volunteering for something).
Rachel was diagnosed with bipolar disorder. She was encouraged to try homeopathic treatment for it, and to stop her conventional medicines.
Several days after stopping her medicines, Rachel took her own life.
Many of you might remember that I blogged about a homeopath's response to my good friend's request for help for her own bipolar disorder. At the time, I theorised that, had my friend followed this homeopath's advice, she would have destabilised and it would have killed her.
I'm so, so sad that this happened to Rachel. I often get questioned about why I do what I do, why I rant on about homeopathy and alternative medicine so much. If other people want to use it, I'm told, then just leave them be. But how can I sit back and not do anything, when there are other people out there just like Rachel? If I can make any difference at all, even a tiny one, then I will do. If I can make even just a couple of people raise their eyebrows and wonder why homeopathy is still used in this day and age in place of effective treatments, then I'll keep doing what I'm doing.
Sorry, Rachel. I'm really sorry that this happened to you. I didn't know you, but I'm sorry that you went through all of that, and I'm sorry that your friends and family and the world lost you.
Tagged: homeopathy, alternative medicine, dangerous advice, harm, skepticism
Evidence-Based Ambridge
Ahh. Sunday mornings. They can mean only one thing: bacon.
Okay, two things: bacon and tea
Whoops, no let's make that three things: bacon, tea, and The Archers omnibus.
So welcome to the first instalment of an occasional series (probably so occasional that this is the only one), in which I critically examine the treatment choices of the fictional residents of Ambridge.
In today's omnibus, Hell-on's child falls over. There is much hysterical panic, and much bewailing the fact that she wasn't watching him properly. Apparently its hard to look after a child and gaze lovingly off into the distance in the direction of Rob Titchener's house. Who knew.
But never fear, Hell-on's mother, Pat (who doesn't appear to have noticed that her husband has been kidnapped and replaced by an interloper), is on hand to reassure her that she has done her best with the arnica.
Arguably, I'd say arnica is one of the most accepted forms of woo in the UK. Arnica cream is a standard item in many pharmacies, and I would say that many people know that it is supposed to be useful for bruises. I wonder just how many first aid boxes have a tube of arnica languishing in them, but I reckon it is quite a few.
Its also a poster boy for the sort of confusion that reigns between the public perception of homeopathy and herbal medicine. herbal arnica cream often sits side by side homeopathic versions with no explanation of the difference.
Even Nelson's seem rather confused about which modality to use, with both herbal and homeopathic arnica sitting in their "Arnicare" range of products. I can't quite get my head around this to be honest. Imagine going into an off-license and seeing two bottles of Smirnoff, one of which contains vodka and one of which contains water, though the only difference on the label is that one says Smirnoff Vodka 30C. Hmm.
Does the distinction matter? Yes, I think it does. I think its pure, outright deception to sell a homeopathic product to someone expecting a herbal medicine. One has arnica in, one doesn't.
Anyway, all of this is by the by. Obviously there is no evidence that homeopathic arnica works for bruising. It's homeopathy. It has nothing in it.
And as for herbal arnica? there's also no evidence that it works, although there is a little bit of prior plausibility, in that some of the chemicals in the arnica plant have an anti-inflammatory and anti-platelet action. There is, however, no information on how clinically significant these actions are, and whether rubbing a bit of cream into an area would get these potentially useful chemicals to the right place in any meaningful amounts.
Let's not forget that bruises are self-limiting. They go away of their own accord (and probably at the same pace), regardless of whether or not you rub some gunk into them. herbal arnica isn't risk free: the cream can cause contact itchiness, dry skin, and rash. Orally, arnica can be pretty nasty stuff, even causing coma and death in extreme cases.
So, my evidence-based advice to Helen would be: kiss it better, and leave it be. Henry is a small child, and falling over is pretty common in that age group. Don't apply an ineffective treatment which could rarely lead to side effects, and save your money.
Tagged: clinical evidence, critical thinking, homeopathy, herbal medicine, skepticism, quackery, pharmacy
The Society of Homeopaths and what they pass off as evidence
So today has seen some great news for rationality, science, and above all patients. The ASA has announced this ruling, leading to the Society of Homepaths taking down a rather large chunk of their website- the bit about what homeopathy can be used for.
However, using their search function, you can still find some of the nonsense they are promoting. I stumbled across this article, for example, entitled "Homeopathy Offers Alternative Relief for hay fever sufferers". I'd be very surprised if this article doesn't get taken down soon also, to be honest. It really should, given part of the ASA's ruling relates to their claims over the efficacy of homeopathy for hay fever.
That use of the word alternative (as opposed to complementary) is interesting. That in itself suggests that the Society of Homeopaths are advocating patients not using conventional medicines in favour of their homeopathic products.
One thing that I have learnt about homeopaths is that, despite the fact that they often claim that randomised controlled trials (and indeed science in general) can't explain their wondrous treatment because of its individualised nature and quantum nanoparticles blah blah all the other words that they're clinging onto, they like to cite trials. A lot.
Homeopaths will often spout names of trials and provide links to PubMed abstracts with abandon, even when the trials say little about the clinical use of homeopathy in humans. In vitro or animal trials are favourites, and on the odd occasion where I have been sent a human trial, the result usually show that homeopathy is no better than placebo, and in some cases actually worse than placebo. At best, I'm guessing this is just ignorance- maybe they have misread the results of the trial? At worst (and more realistically), its a pretty obvious and petty method of obfuscation, and a pretty rubbish one at that. Presumably they think I will be so vowed by the fact that a trial exists that I wont bother to check the actual results of what the trial is saying.
This hayfever page overs a great example of this:
"A number of research trials have shown that homeopathic treatment can produce a significant improvement in hay fever symptoms,(4-7) but what does this involve?"
Let's have a look at the "number of research trials", shall we?
Reilly DT, Taylor MA, McSharry C, Aitchison T. Is homeopathy a placebo response? Controlled trial of homeopathic potency, with pollen in hayfever as a model. Lancet,1986;2: 881-6.
This is a trial from 1986. Really, that's the best they can do, in 2013? The abstract of this trial appears impressive: "The homoeopathically treated patients showed a significant reduction in patient and doctor assessed symptom scores", but neglects to mention the most important part of a study like this: blinding. How can we assess the placebo effect in a study that isn't blinded? especially when the results rely on only reported outcomes. We can tick this one off the list as being a pretty rubbish effort at a trial. Must try harder.
Kleijnen J, Knipschild P, ter Riet G. Clinical trials of Homeopathy. Br Med J, 1991; 302:316-22.
Ahh, the early nineties. We're getting thoroughly modern and hip now, eh? This is a meta-analysis. hay fever isn't mentioned in the abstract at all, and the conclusion of the paper is that studies performed in homeopathy are rubbish, and better ones need to be done. Hardly a conclusive statement that homeopathy works for hay fever. We can tick this one off the list too.
We're now left with two trials to back up that statement above. To me, two trials is not "a number" of trials, even at this point. Even if these two trials were massive, robust, good quality randomised controlled trials, I still wouldn't be entirely convinced: I'd want to see the result replicated in as many different trials as possible. Anyway, we shalll soldier on, in the hopes of being dazzled by the brilliance of these two references.
Launsø L, Kimby CK, Henningsen I, Fønnebø V. An exploratory retrospective study of people suffering from hypersensitivity illness who attend medical or classical homeopathic treatment. Homeopathy, 2006; 95: 73-80.
Oh dear. A retrospective study. So not a controlled trial at all then? The results? "The two groups of patients were similar in respect of their health at the start of the treatment, 57% of the patients who consulted a CH experienced an improvement of their state of health compared to 24% of the GP patients." well, that's all very well and good, but there is no blinding here whatsoever, and only 88 patients completed the study. means nothing at all, except for- as even the authors put it- as an exploratory study, maybe to try to find ways of how to conduct as more robust actual trial in the future.
That's it, down to the final trial. I'm expecting great things.
Kim LS, Riedlinger JE, Baldwin CM, Hilli L, Khalsa SV, Messer SA, Waters RF. Treatment of Seasonal Allergic Rhinitis Using Homeopathic Preparation of Common Allergens in the Southwest Region of the US: A Randomized, Controlled Clinical Trial. Ann Pharmacother, 2005; 39(4): 617-24.
HURRAH!!! It's double-blind! We've gotten there! We've gotten some good, robust evidence tha- oh hang on, its only got 40 participants in it. It's just a wee ickle study that's far too small to draw any conclusions from.
So there you have it. This page is still up there on their website, using crappy references that don't back up their claims. The Society of Homeopaths- and quacks in general- need to realise that, no matter how hard they try, just trying to shoehorn poor excuses for studies in wherever they like isn't good enough.
Here's how it should go: you look at the evidence, you evaluate the evidence, and you make your claim on the basis of that evidence. Not: "I shall claim this, then try desperately to find something that vaguely looks like it backs me up, and I'll just hope for the best that no-one else bothers reading it. It seems the Society of Homeopaths are going in for the latter, and good on the ASA for pulling them up on it.
"We told the Society of Homeopaths not to discourage essential treatment for conditions for which medical supervision should be sought, including offering specific advice on or treatment for such conditions. We also told them not to make health claims for homeopathy unless they held sufficiently robust evidence of efficacy." -ASA ruling
Tagged: alternative medicine, complementary medicine, homeopathy, hayfever, information resources, research, critical appraisal, critical thinking, skepticism
Making Clinical Trials Sexy
If you're buying a new TV, how do you go about it? My guess is that you probably have a look around the shops or internet, find a model you like, then get online to find some reviews of it and decide whether or not to buy based on what you've read. You may well scroll down to the reviews if you're buying something on Amazon, before you click the "Buy" button. If you book a holiday, you're probably straight on Trip Advisor to see what other people- humans just like yourself- have got to say about the hotel.
It is perfectly reasonable behaviour. We understand and respond to the personal experiences of other people- its part of our nature, stitched into our being. Each review is a little story, and humans love stories, especially when they are about other humans.
Its therefore a hugely unfortunate problem that, when it comes to healthcare, stories just aren't good enough. When peoples' lives are hanging in the balance, reviews and testimonials just aren't up to scratch. Here's why:
I have guttate psoriasis. Imagine I go on holiday (alas this is merely a pipedream this year, thanks to what feels like millions of large unexpected bills that seem to keep turning up in my life) and lo and behold, when I return, my psoriasis has cleared up. I conclude that it is definitely the sunshine that has cured it, and proceed to proclaim that I have found the ultimate 100% effective cure for psoriasis.
Is it reasonable that I have come to that conclusion, based only on my own experience? No, not at all. Why have I focused on the sunshine aspect alone? Maybe a week spent relaxing is what has actually cured it. Maybe its because I've changed my diet on holiday and have been eating lots of lovely fresh fruit and vegetables and fish? Maybe it is because there is a magic ingredient in Sangria which miraculously beats rogue skin cells into submission. What if chlorine in swimming pool water is my skin superhero? Maybe-just maybe- its because guttate psoriasis can be self-limiting, and it has just faded away of its own accord. With just my experience to go on, there is no way I will ever be able to know what it is that has made my condition improve.
What I would need to do to be able to decide is to scale things up. Get as many people as possible with guttate psoriasis, and divide them into at least two groups- one exposed to sunlight, one not. I'd have to try to control the peoples' behaviour as best as I could for the other factors like diet, chlorine exposure, sangria intake, stress etc. Whilst I could never completely control for everything, if the group exposed to sunshine experience a significantly better improvement in their psoriasis, then I could say with more certainty that it is the sunshine that did it rather than anything else.
This is the beauty and elegance of a clinical trial. They are simply the best, slickest, most reliable way we have of teasing out whether a treatment actually does make a difference. They're like an anthology of stories, carefully selected and analysed by researchers in a bid to start finding an answer to a treatment question. Whilst they're not 100% perfect, they're certainly the best sort of information we have at the moment on which to base any decisions about which treatment to choose for which disease, and for which patient.
This is, however, very easy to forget when you actually have to read one. I do not have a mathematically inclined brain, and when faced with tables full of numbers, p values, confidence intervals, hazard ratios, relative and absolute risks etc, my grey matter is usually to be found quivering and wimpering in the corner of my skull. I have to really try hard to focus on the stats and results when reading a clinical trial- its a constant fight to wrench my thoughts back onto the page, when they keep merrily skipping away to think about kittens or bunnies or *that* picture of a minipig wearing red wellies. And I say this as a geeky pharmacist who has undertaken a decent amount of training in how to read a clinical trial. What hope then, does an individual patient or regular joe have of understanding trial data?
A quick glance at pretty much any website selling an 'alternative medicine' and you'll notice there is usually a "Testimonials" page on there. Many other types of healthcare sites also use testimonials to prove their treatment works. They're easy to read, often full of personality, and can really seem to speak to you as a reader. They may seem convincing, but as you've (hopefully) seen from my example above, they simply can't be used to decide if a product works or not. A glossy celebrity story endorsing a product in a magazine is infinitely more sexy than ten pages full of stats and graphs in a medical journal.
Testimonials and reviews are, at first glance, more attractive and more seductive than the more dowdy clinical trial. So what can we do to help the clinical trial apply a bit of lippy, spray some perfume on itself, and don its heels to get out on the town and make people weak at the knees? My short answer is I don't know. Campaigns like International Clinical Trials Day help of course, but at the moment it feels like we're swimming against the tide somewhat. My ultimate dream would be a primetime TV series, fronted by a hunky Brian Cox type. If he can make physics sexy enough to be at the forefront of our entertainment, surely there is some way that we can do the same for one of the best inventions in healthcare? I'd like to get to a place were it's second nature for everyone, whether they be a patients, pharmacist, healthcare professional or general geek, instinctively bypasses testimonials to look for clinical trial evidence instead.
Do you have any ideas? Have you had any really good experiences of explaining clinical trials to patients? Are there any techniques we can use to simplify the stats and make trials more accessible to all? My friend Nancy had a great idea of including a Plain English summary as part of an abstract for every trial. Is there anything else we could do? Let me know, however outlandish your idea, either by commenting, tweeting me (@SparkleWildfire), or dropping me an e-mail at my new shiny sparkly e-mail address healthydoseofskepticism@gmail.com
Tagged: clinical evidence, pharmacy, skepticism, research, reference sources, alternative medicine, Amazon, complementary medicine, herbal medicine, homeopathy, psoriasis
The Not-So-Wise Owls
You might have noticed that Holland and Barrett, the high street's most proliferative purveyor of pointless supplements, homeopathic, and herbal medicines are in the midst of a rather odd marketing campaign, called #AskOurOwls.
*Gratuitous Fluffy Animal Pic* Meet Willow. Willow is a fully grown, 10 year old south African Owl who lives in Kielder Forest. Willow does not purport to be an expert in complementary and alternative medicines, but he does have very soft feathers. Willow would like to make it known that he does not condone the actions of Holland and Barrett owls
#AskOurOwls means you can ask any question about a Holland and Barrett product, and if their staff can't answer your question, you get 20% off in store. This is accompanied by a kawaii cute animated advert featuring bunnies, hedgehog, and other adorable woodland creatures. Because natural remedies are always totally cute, safe and innocuous, right? And presumably because everyone who works there is in actual fact a shape-shifting owl cavorting as a human. Its like David Icke stuff, but with more feathers.
In the words of the ad agency who designed it:
"The campaign aims to demonstrate Holland & Barrett's USP of considerable staff expertise, endorsing the fact that every Holland & Barrett store within the UK has had an officially qualified associate to give advice on all own label supplements, vitamins, healthy foods and weight management products"
Now, I've lost count of the number of enquiries I've dealt with because of Holland and Barrett. These enquiries are usually along the lines of "My patient has bought <insert Holland and Barrett product> and wants to know if they're safe to use with their other medicines." In some of these cases, patients have presented with over £40 worth of herbal medicines etc, and have then been told that no, they can't take it, either because it will interact with their medicines, or because it isn't suitable to be taken by someone with their medical problems.
I have no idea what the Holland and Barrett in-house staff training consists of, but I'm not sure what part of it would allow someone to buy multiple, expensive remedies beforethey know if they are safe for them to use. Its not only a dangerous strategy, but its really very poor customer service, and doesn't do much to 'demonstrate considerable staff expertise'.
Anecdotally, I have heard that in some areas, Holland and Barrett employees have been known to send patients to a nearby pharmacy to ask if they are able to take a product. Whilst this at least demonstrates an awareness of their knowledge limitations, its also pretty inconvenient for the customer to have to traipse in and out of different shops, and i should imagine pretty irritating for the pharmacist, who is having to do H&B's work for them. And believe me, these sorts of enquiries aren't always easy to do, and can be very time consuming.
So that's not all that encouraging for their #AskOurOwls scheme, is it? And it is a really quite bizarre strategy. If I ask a question about whether a product is safe for me to take, and they can't answer it, I can't really see how offering me a discount on something that I don't know is safe or not would help.
Of course the skeptical community understandably used this opportunity to Ask Some Owls some reasonable questions about where the evidence is for many of the products they sell, why they sell homeopathy when there is literally nothing in it, why they promote detox products when there is no scientific evidence for detox, why they sell high dose vitamins when there is some evidence that they may increase cancer risk etc. And no answers flowed in at all. I ask three questions, and got no response, then sent a Tweet about how I had gotten no response. This did attract a -very curt and actually pretty damn rude- reply from Holland and Barrett demanding to know if it was a question or not.
Funnily enough, after being bombarded with questions about their selling of quackery, the terms and conditions now read that the offer does not apply to questions asked via Facebook or Twitter. I have no idea at all whether these terms were the same at the start of the campaign (do let me know if you know), but it would seem very strange indeed if they have launched a campaign centred around a hashtag but which is not for use on social media. It would sort of suggest that they was actually being rather misleading, or just very careless in the original advertising campaign. Or, of course, that they hadn't quite thought through the consequences of encouraging people to ask questions about remedies that have no basis in science or evidence. Presumably they think that us mean skeptic-types will be so overwhelmed by their wondrous array of snake oil remedies that we will turn to mush and be unable to think of a question in store.
Let's see what that ad agency says again, shall we?
"The brand strategy extends to social media, where customers can engage with Holland& Barrett staff via Twitter to answer relevant health questions. By using the hashtag, #askourowls, customers are directed back to the brand."
Suspicious, non? And lets just think about this strategy for a moment. They are encouraging people to ask them health questions in less than 140 characters. Given that people are complex, and may have multiple health issues and be on many different medicines, this seems a somewhat cavalier strategy.
Then again, Holland and Barrett are home to some other really quite bizarre offers as well. What on earth is going on with that buy one, get the other for 1p thing? Save everyone the bother of having to faff about with change and just do a plain old BOGOF, for goodness sake. Or, even better, how about not encouraging pointless polypharmacy with multi-buy offers in an area where they are clinically inappropriate and potentially even dangerous?
So, next time you're passing a Holland and Barrett store, take a moment or two to drop in, and ask them for the evidence. If they can't provide you with any, then enjoy your 20% off- you should be able to find something to buy there- they do sell Bombay mix after all, which is approximately 50% more baked than their #AskOurOwls campaign ever was. Do let me know how you got on, if you do get a chance to ask a question.
You can read some more about how the #AskOurOwls campaign went wrong for H&B but right for skeptics here, and the sort of non-answer Slipp Digby got here.
UPDATE: interestingly, a mere few hours after I published this post, I got an @reply from Holland and Barrett on Twitter, promising me that someone was looking into my enquiry about acai and i would hear from a nutritionist soon. At the same time, they were merrily sending out requests for follows so that they could DM answers to many other people who had asked similar questions. However, I've never heard anything since, or been asked to follow them to get a DM response-this is now 3 days after they told me someone would contact me.
Putting aside all the other problems with this campaign, this is just utterly terrible customer service. My job involves me dealing with often very complex enquiries, and it would maybe take me three days maximum to do a complex enquiry involving a full research strategy, medical literature searches, critical appraisal of multiple papers, and to compose an answer. I would, of course, acknowledge the enquiry immediately and let the enquirer know of any delays- its common courtesy.
I can't help but notice that on their Twitter feed they do appear to be answering other questions about their products using their Timeline. So why are they using DMs to answer any which question the efficacy of their products?
I've decided to give them another chance, however, and have just asked them another, very specific question, which would take a pharmacist maybe 30mins-1 hour to answer fully:
We'll see how long that takes to get a response, shall we?
(Update: I never did hear back at all)
Tagged: alternative medicine, herbal medicine, homeopathy, holland and barrett, pharmacy, safety, drug interactions, skepticism
Happy Birthday, Dr Hahnemann
I baked you a cake to celebrate!
Tagged: homeopathy
Some thoughts on quality and quantity
The sad news about Iain Banks has gotten me thinking today.
I'll be honest here and say I've never read any of his books (so many books in the world, so little time!). I know nothing at all about him. Yet when I read his statement at work this afternoon, I had tears in my eyes. His words were so dignified, so stoical, and so noble that they really touched my heart. The ability to have humour at such a time is something I admire hugely.
I'm sure his words are the tip of the iceberg. I really can't even begin to understand what a lengthy, horrific process it must be to come to terms with such news. But what struck me most of all was his plans to spend his remaining time with his family, friends and loved ones. Isn't that, when it comes down to it, what we would all want? And yet it seems to me that cases such as his appear to be in the minority of those that are reported in the media.
Many moons ago, at university, I went to a lecture by Sir Michael Rawlins. He discussed the thorny issue of how NICE assess drugs, and he touched upon quality of life measures. I remember being utterly shocked when he said that the majority of terminal patients choose longevity over quality of life. That's always stuck with me, as it seems so starkly counter-intuitive to me that I genuinely can't get my head around it. I also know that's very easy for me to say, and that I have absolutely no idea what it must be like to have to face such decisions. A few years ago I did my Diploma in Therapeutics, and we had to try out some of the quality of life rating scales that are used at NICE. Believe me, this really gets you thinking about how difficult these sorts of choices are. I also remember a really brilliant workshop with Claud Regnard, a palliative care consultant and author of some highly-esteemed books in the field. I remember being bowled over by how positive and creative such a potentially depressing subject could be.
We're a nation (and potentially a planet) that are very medicalised. We hunt for a cure for everything, and a miracle pill to make us cleverer, slimmer, healthier. When given the choice between taking a tablet and changing our lifestyles, I think it's safe to say that most of us would rather opt for the former. This is fuelled by any number of things, but I think the media has a lot to do with it: there's always a story about how some new drug is going to cure Alzheimer's, or obesity, or heart disease, and there's story after story of families desperately searching for a cure or treatment that can cure their love ones.
And here's what I've been thinking about: when all the options have been explored, and there is no cure, practitioners of conventional medicine (by which I mean medicine which is proven to work) will usually tell you so.
At this point, the quest for something else, perfectly understandably, kicks in. Of course you would grasp at any straws, any vestige of hope. And so, right at the time where people should be spending their days doing what they love with the people they love, as Iain Banks is doing, some of them turn to alternatives.
It could be weird diets, it could be homeopathy, it could be a certain well-known quack's clinic in Texas, it doesn't matter. What all of these things do is sell hope when all else has failed. They're a very seductive prospect, and it may well seem perfectly logical that you'd spend every penny in trying them, and you'd leave no stone unturned trying to find the perfect treatment for you, or your loved one.
Just at the time when you should be kicking back and enjoying your time as much as you can, you end up on a plane across the world, which is stressful enough for anyone at the best of times. Or you might end up on a strict diet regime, having to deprive yourself of the foods you love just when you should be enjoying them more than ever. You might end up a slave to a complex regime of megadose vitamins, enemas, pills and injections when you should be being made as comfortable as possible with palliative care.
These people who sell false hope rob patients not only of their money, but of their precious time as well. And that, in my opinion, is the most evil and unforgivable of sins.
I hope that, eventually, we get to a place where a quality life and death become the most important thing to anyone with a terminal illness.
This is yet another blogpost where I feel the need to write "hope this all makes sense" at the end. I probably should just plan posts better, but I've always found I'm usually better at just writing as I think at times. My humble apologies also for any typos... I'm absolutely rubbish at touch screen typing
Tagged: alternative medicine, complementary medicine, Burzynski, cancer, death, conventional medicine, potential harm, herbal medicine, homeopathy
Homeopathic Harms Vol 5: Interactions
In February 2013, my friend @EBMScientist and I delivered a Newcastle Skeptics in the Pub talk entitled Homeopathy: Where's The Harm? As a follow up to this, we've decided to write a series of blog posts expanding on a number of points we covered in the talk.
In the next instalment of our series on the harms of homeopathy, I want to talk about interactions. I've covered this a bit in the past, but let's have a look at this area in a bit more detail.
We all hopefully know by now that homeopathic medicines pretty much have no trace of active ingredient in them by now. Do we need to worry about drug interactions with homeopathic remedies?
Can homeopathic medicines interact with conventional medicines?
The obvious answer is no. Magic Sugar Water Pills are highly unlikely to affect any conventional medicines. There's a lack of actual evidence to prove this, but I think it's pretty safe to rely on a theoretical basis here. So that's great, right, blog post over and see you later. If only it were that simple.
Can homeopathic practitioners interact with conventional medicines?
Unfortunately, yes. very much so. It's pretty well known that homeopathic practitioners step over (and in some cases stomp over, then jump up and down repeatedly on) the boundaries between conventional and homeopathic medicines, just by the advice they give. One example would be vaccines- many homeopathic practitioners are against vaccines and therefore advise their patients to avoid them- Just look at the emails sent by pharmacist (and embarrassment to the profession) Tony Pinkus to an undercover BBC reporter. Little offhand remarks about the toxicity of conventional medicines, or big pharma conspiracies, or how conventional medicines might not work, all add up to the effect of harming the patient's relationship with their actual doctor. And how about the spectacular example of inappropriate advice in my previous post?
Can conventional medicines interact with homeopathic medicines?
I'd like to say no here, because of course homeopathic medicines are inert and don't actually contain any medicine. It is the case, however, that homeopathic practitioners unfortunately think otherwise, which can lead to a huge amount of harm as patients discontinue their conventional medicine in favour of homeopathy.
I have in front of me a book called "Homeopathic Pharmacy", by Stephen Kayne. This is a book aimed at healthcare professionals, and indeed is a recommended resource for medicines information pharmacists in the UK. (EDIT: This book no longer appears as a recommended source.) And yet, even this source, which we could consider to be one of the more balanced tomes (despite the ominous mention of Dana Ullman in the acknowledgements), contains a wealth of dangerous nonsense. This book tells me that, for example, "potent topical steroids are thought to negate the use of homeopathy in the treatment of eczema and psoriasis" Now I know more than some that skin conditions such as this can be horrifically uncomfortable, not to mention their effects on your self-esteem. Stopping treatment that works in favour of a placebo is not, in my opinion, acceptable in any shape or form, especially given how vulnerable and desperate people can be because of skin conditions- don't forget that in some cases, dermatological conditions are terminal, as they can drive sufferers to suicide.
There can, apparently, be interactions between oral steroids and homeopathy too. "the patient's symptoms tend to be masked, however, making an accurate choice of remedy much more difficult", we are told on page 205 of Homeopathic Pharmacy. Well, you could call it a masking of symptoms, or you could- as I prefer, refer to it as "working". So what is the average homeopath to do then, when presented with a patient who is taking steroids but seeking their help? It would seem that the obvious (but sadly not the ethical) solution would be to ask them to discontinue their steroids so that that the symptoms are "unmasked". This will obviously lead to an increase in symptoms for the patient, and lead to unnecessary suffering, but it can also precipitate acute adrenocortical insufficiency, which can in the worst case scenario be fatal. Patients should "ideally" discontinue their steroids for 6 weeks prior to initiating a homeopathic remedy- this is more than enough time to result in loss of control in their condition.
It's not just drugs themselves that can be a problem, but the excipients (inactive ingredients used in the formulation of a medicine) too. Strong flavours used in syrups, for example. This could potentially discourage patients to take- or to give their child- antibiotic syrups, with the potential to worsen or prolong a patient's condition.
Can foodstuffs interact with homeopathic medicines?
Yes, apparently so, though again there is no hard study evidence for this- why would there be, when there's no good hard study evidence that homeopathy works in the first place? Coffee, tea, cocoa, chocolate, and spicy foods are all to be avoided. Aside from being unnecessarily restrictive, and potentially causing a patient anxiety, this idea fills me with horror. Imagine a life without tea, chocolate, or spicy foods. I rely on all of these three things to get me through my daily life, and would inevitably become depressed if I had to avoid any of them.
Can homeopathy interact with homeopathy?
I know, right? What a bizarre question, given that homeopathic remedies are sugar with specially shaken water sprinkled on. Can sugar interact with sugar? Well it seems that someone has decided that they can, based on a grand total of no evidence. Aromatic preparations, such as camphor, menthol, and peppermint, are supposed to inactivate other homeopathic medicines. Remember, though, that homeopathic camphor, menthol or peppermint is highly unlikely to actually contain any molecules of camphor, menthol or peppermint, and we're left in a bit of a ridiculous situation based on nothing at all.
It would seem that homeopaths utilize certain foods or remedies as "antidotes". Apparently, if a remedy isn't working, and they want to try something else, they might ask a patient to drink a cup of coffee, or take a remedy like camphor to "wash out" the previous remedy so that they can start again. I'll refer you again to "Homopathic Pharmacy"- with a reminder that this is one of the more reasonable texts:
"It is certainly not dangerous in life-threatening terms, but used injudiciously will interfere with the vibrational pattern of the vital force."
Vital force, vibrational energy, sugar as an antidote to sugar, and none of it- not a scrap- based on science, evidence, or even basic logic.
See you again soon for the next episode :)
Tagged: homeopathy, homeopathic harms, reference sources, drug interactions, alternative medicine, complementary medicine, clinical evidence, critical thinking, dangerous advice, potential harm, science, skepticism, harm, pharmacy
@EBMScientist
Homeopathic Harms Vol 2. Where's the Evidence?
Here's the next in our series of blog posts following on from our SITP talk about the harms of homeopathy. This is a guest post written by the marvellous @EBMScientist of Evidence-Based Skepticism fame. Now, I'm going to be a bit bossy here and insist that, if you haven't already bookmarked her blog, you do so right this minute. Future blog posts in this series will just be posted on our respective blogs, but we'll be sure to post links to all of them so you don't miss any instalments. so, without further ado, I shall hand you over to @EBMScientist:
We often harp on about the evidence for homeopathy working or otherwise, and I'm not going to touch on that here, because it's been covered beautifully by many more eloquent writers than me. What you don't often see though, is comment on the evidence for homeopathy doing harm. In the last post in this series the lovely @SparkleWildfire touched on medicalisation, an indirect harm that's very real but tough to quantify; but what about direct harms? I'm glad you asked…
In conventional medicine, randomised controlled trials are the best kind of study we can do of a drug to see if it works and if it it's safe. What maybe doesn't mentioned quite so often is that there's an even *better* form of evidence – the systematic review. These are produced when someone sits down to do the very tough but remarkably important job of finding every single scrap of evidence they can on a given topic, and pooling it all together to try and get closer to the definitive answer. The result is a document that represents the best evidence possible for how well a drug (or anything else, for that matter) works, and how safe it is.
One of the biggest and most respected sources of these systematic reviews is theCochrane Collaboration, who cover all areas of medicine. Happily, they also have a few reviews related to homeopathy, and that seems as good a place to start as any. The most recently published is:
Homeopathic Oscillococcinum® for preventing and treating influenza and influenza-like illness
The authors searched multiple databases of medical literature, covering a time period dating back to the mid-60s and all the way up until August 2012. That's a lot of literature. Out of all the results they found six randomised, placebo-controlled trials of Oscillococcinum that were similar enough to be directly compared. Since we're not really interested in efficacy in this review, I'll skip straight to the safety part: out of these six trials, including a total 1,523 people, there was one reported adverse event. One. It happened to be a headache. Let's stop and think about that for a moment.
A good quality randomised controlled trial collects every single adverse event that happens to every single patient. And the use of the term "adverse event" is very deliberate, because it includes absolutely everything unexpected and unwelcome that happens (and here's the key part) whether or not it's likely to be related to taking the drug. That might sound counter-intuitive, but the reason is simple – we want to pick up every possible side effect of drugs, and sometimes side effects are…weird. So it might sound odd to include as an adverse event that someone got hit by a bus, but what if the drug they were taking made them dizzy, or confused, or clumsy? It's not unreasonable to suggest that any one of those things could end up in getting you involved in a traffic accident. So every single little thing is recorded, and once the trials is over you do some sums to work out the key question – are these things *more likely to happen in the people who took the drug*? If 20 people broke a leg but they were equally spread out among the trial groups then nothing further needs to be said; if 19 of them were on the drug being studied then there might be something to worry about. The flip side of that of course is that if 19 were in the placebo group, you might want to wonder if the drug is (perhaps unintentionally) promoting better balance and co-ordination, for example (or if everyone in the placebo group was a keen but inept snowboarder).
Is that one single adverse event out of over 1,500 people taking Oscillococcinum starting to look fishy yet? What about if I drop in the snippet that some of the people involved (327, to be precise) took the remedy every day for four weeks, to see if it stopped them from getting flu in the first place? How many times in four weeks would an average, healthy person experience something that you could call an adverse event – a headache, a tummy upset, indigestion, a strained ankle, a touch of insomnia? I've had three of those things in the last 24 hours, and I wouldn't say I'm a particularly remarkable individual.
So hopefully you can see from this that there's simply a huge, yawning hole in the evidence about safety in homeopathy. There are ways and means to address this (though they're far from perfect), and I'll address one of those in my next post in this series.
Tagged: clinical evidence, complementary medicine, conventional medicine, potential harm, harm, homeopathy, homeopathic harms, quackery, science, skepticism
Homeopathic Harms Vol 1: Medicalisation
In February 2013, my friend Nancy and I delivered a Newcastle Skeptics in the Pub talk entitled Homeopathy: Where's The Harm? As a follow up to this, we've decided to write a series of blog posts about a number of points we covered in the talk. Here is the first:
Doctor's appointments: often you feel like you're in and out before you know it, and they can't get you out the door quick enough. They have a target number of minutes to spend with each patient, and sometimes you can feel like they don't have as much time as you'd like to discuss all the things you want to with them.
There is, then, one aspect of homeopathic practice which can be superior to that of conventional medicine: the consultation. A homeopath might spend an hour or more assessing each individual, not just asking about particular symptoms but about their personality as well, how they think and feel about the world. I've never been to see a homeopath, but I'd imagine this is really valuable to a patient, particularly those with minor mental health complaints. I know myself that when I've been to see a good GP who I feel has really listened to me, I leave feeling a bit better already.
I suspect that the consultation itself may be part of what provides benefit to patients, rather than the sugar pills that are given out at the end of it. I'm not aware of any evidence that compared individualised homeopathic treatment to the OTC stuff though, which would be the only way to tease out and quantify any benefit from the consultation.
So what's the problem here? If a consultation with someone who appears to listen to you and care makes you feel better, where's the harm in that? The sort of subtle, indirect harms that we'll be discussing in this series of posts are often theoretical and would be very, very difficult to assess via hard, clinical evidence, so you'll have to bear with me while I discuss them with you and see if they make sense at the end of it. Consider the following story:
Imagine I'm quite an anxious person (in actual fact I am, so it doesn't take that much imagining to those who know me). Imagine I'm particularly anxious at the moment because I maybe have a public speaking event (something like Skeptics In The Pub, say!) to deliver in a few week's time. I might be finding it hard to sleep, I find I'm worrying about it quite often, and getting some physical symptoms- my heart is beating quite fast at times, say, and my stomach hurts at times, but it's nothing too serious.
I go to visit a homeopath (admittedly, this would be an unlikely thing to do if I was actually talking about myself) who takes time to discuss with me my problems. I get on well with them, and feel like they are really listening to me. During the discussion, I find that vocalising my anxieties helps me to rationalise them and my fears are allayed somewhat. Just the act of talking about it makes me feel better- in other words, the homeopath is delivering a talking therapy service to me. By the end of the consultation, I'm already feeling more in control of my anxieties, yet I'm still given some tablets to take home, and I dutifully follow the instructions I'm given.
As I've discussed elsewhere, there is a stigma about mental health issues. This also, unfortunately, extends to talking therapies too. Its quite likely that some people would be happier to declare "I'm seeing a homeopath" than "I'm seeing a counsellor" in front of their friends or acquaintances. The handing over of the sugar pills at the end of the consultation will no doubt suggest the talking bit is more "justified", and they can convince themselves that they're not mad, or the sort of weak person who would have to resort to a talking therapy. And thus, the stigma is reinforced. Talking therapies shouldn't be something to be ashamed of. You don't need some inert sugar pills to justify and hide the fact that, now and then, you just need to be able to talk to someone about your problems or feelings.
There are wider issues with this kind of thing too. The visit to the homeopath has made me feel better. I've been to see someone, left with some pills in my hand, and I've improved, reinforcing the fact that I feel better when given something to take. Let's say that in the next few months, I feel a bit rubbish because I've had a bit of a cold and I'm left with a cough that's been there for a couple of weeks. I go to see my Dr, who tells me that my chest is clear, and the cough should clear up of its own accord. However, I've expected to get something out of the visit- I don't want to leave the surgery with no pills in my hand, as I know that last time I left a consultation about my health I was given pills at the end of it and I felt better. It's left to the Dr to explain to me that I don't need antibiotics, and this can be a notoriously difficult thing to do. Some Drs might relent and give me a prescription for an antibiotic, contributing to the catastrophic situation we're in now with antibiotic resistance. If the Dr doesn't give me a prescription, I'm left with a bad taste in my mouth and a bit of mistrust in the conventional health care system. 'Next time I'm feeling ill', I think, 'I'll go back to that homeopath. They take me seriously because they gave me pills'.
And so the cycle goes on....
Tagged: homeopathic harms, homeopathy, alternative medicine, complementary medicine, mental health, quackery, skepticism
The General Pharmaceutical Council: Let's hope they do the right thing
Many years ago, just after I qualified, I was working in a new 100 hour pharmacy in a very well known supermarket chain.
To be honest, the working conditions were pretty terrible in that store. I had brilliant staff, but not enough of them. At the time, the policy of the supermarket for 100 hour pharmacies was to have no support staff there for the first hour and a half of the day, and the last two hours of the day. I argued tooth an nail against this, as we all know that pharmacists should ideally not self-check a prescription, no matter how quiet the pharmacy was between those times. The attitude of the company was that I was in the minority, and that I was complaining unnecessarily.
At this time I was the only permanent pharmacist working there: the rest of the time we were running on locums. The company policy was to ideally use their locum booking system, but this was notoriously unreliable. I found myself setting my alarm for 6 am every morning, getting up and getting ready to wait for a phone call to tell me I would have to go in because the locum hadn't turned up, even on my days off. I found myself doing 16 hour shifts, occasionally one after the other, and with 3.5 hours of that spent on my own.
Even without the horrendous attitudes from other managers in-store (the daily battles, the snide comments about how much I was getting paid, the total lack of understanding about pharmacy law, and the outright sexism), these conditions were brewing for a dispensing error.
The day it happened, I was working a 14 hour shift the day after working after a 16 hour shift. I was having to check a prescription whilst also being on the phone, because of the lack of staff. I checked that the drug, strength, directions etc were correct, but I didn't spot that the wrong name was on the label.
The patient rang up to check that the cream was the right one for them. We apologised profusely, offered to redispense, offered to go through our complaints procedure etc. the patient was happy with the reassurance that it was the right cream and refused the other measures, stating that she was quite happy that the situation was rectified.
Next thing I know, I'm being investigated by the then-regulator, the Royal Pharmaceutical Society of Great Britain. You can't even imagine what this did to me. I was an absolute mess, convinced that I was going to lose the career I had worked so hard for. I co-operated entirely with the investigation, just as I had with the patient. I informed the inspector of the working conditions and my fears that it would lead to something more serious. None of this was taken into account in the final report, which gave me a warning, and the fright of my life.
All this for a minor dispensing error, which caused no harm to anyone.
You'd think, then, that the current regulator, the General Pharmaceutical Council, would come down hard on any pharmacist who actually endangered patients willingly. You'd think they would take decisive action, particularly where a pharmacist has had similar previous warnings which they have chosen to ignore. You'd think this would especially be the case where the pharmacist in question had been caught out by a BBC journalist posing as a concerned mother wondering about whether her child should be protected against whooping cough, a disease which can - and does- kill people.
See where I'm going with this? I'm hearing reports that the GPhC are suggesting that the Ainsworth's pharmacy case is nothing to do with them, and that as homeopathy is regulated by the MHRA it isnt their area. If that's the case, why is Mr Pinkus and the premises even registered with them?
I'm really hoping that this isn't the case, and that the GPhC are actually going to take decisive action. After all, what sort of a message does it give out to the public if they aren't being protected from harm? What sort of a message does it give out to the pharmacists that do their bet every day, trying their hardest to be as accurate as possible in working conditions that are ill-designed for such a purpose?
Come on GPhC, be fair to the majority of your pharmacists who work according to your standards and actually do put patients first, and who do ensure that their recommendations are evidence-based and made with the best interests of the patient at heart. .
Tagged: pharmacy, homeopathy, complaints, dangerous advice, NHS, regulation
Big Pharma & Big Homeo: Titans will clash, and ducks will die.
There has been much talk of homeopathy in the media in the past few days. I want to pick up on one point that is being brought up by homeopathy believers everywhere at the moment in response to any criticism.
"But Big Pharma has many problems! Just read Bad Pharma by Ben Goldacre!"
There are a few reasons why this is an utterly terrible argument.
The Logical Fallacy
This is not a two option scenario, so this is a false dilemma. homeopathic supporters are attempting to suggest that because Big Pharma has its problems, homeopathy is a better alternative. But here's the problem: These are not the only options in the world. Big Pharma does have massive, endemic problems, but that bears no resemblance to whether or not homeopathy works. Even if there were no evidence that any conventional medicine works ever, there still wouldn't be any evidence that homeopathy works either.
There's definitely an element of a "You too!" fallacy here as well. Big Pharma has its problems, but this is no reason to expect anything less than impeccable ethics from any other sector.
The Misleading Rustic Image
Homeopathic manufacturers would very much like us to have a fluffy, warm, reassuring image in our heads of some nice, compassionate people making a tincture from plants, shaking it in a special way, and making a nice, safe medicine from it. In actual fact, the image is rather more grubby, with diseased body parts, conventional medicines, and limbs being used in the manufacture. Oscillococciinum, supposedly the most popular homeopathic remedy for flu, involves killling a muscovy duck and using its heart and liver to produce a mother tincture. I wonder if folks who are against animal testing and the likes in the pharmaceutical industry are aware of this fact? For the purposes of this blog post, lets call our duck Dave
A Muscovy Duck Named Dave
Homeopathy is not usually made by ethical practitioners in their kitchens. And frankly, if it were, i'd be pretty concerned about hygeine etc and would be wanting inspectors to go round to check it. Its mainly made by large companies who are ultimately concerned with profits. In fact, until very recently, New Era homeopathic products (ooh, sounds all new age-y and nice and hopeful, doesn't it?) were made by Merck (Sounds-and indeed is- a pretty damn large corporate pharmaceutical company).
We also know from the FDA that homeopathic manufacturers can be less than meticulous to say the least in their standards. Broken glass? That's not a problem, just leave it there on the production line, no one will mind. More info on this story can be found at The Quackometer
The Massive Mark Up Margins
Pharmaceutical companies spend a HUGE amount on research and development of new drugs. First they have to employ people to find a new chemical entity, whether that be in the rainforest or in the lab. Then they have to find out if it works, which involves a huge amount of lab work. If that seems postive, they then have to do trials, which is hugely expensive. At any of these stages, there is a huge likelihood of failure and it is a very, very small minority of new chemical entities that actually get through to a stage where they can be marketed. At that point, price margins can be pretty damn high, which is in part to cover all of those R&D costs. Yes, there are also huge profits that are made in the pharmaceutical industry, and there are all the associated problems covered in Bad Pharma. This is certainly not an ideal scenario, but at least at the end of the day we are left with some drugs that work.
Big Homeo, on the other hand, puts little-if any- funds into research and development. If it did, we would have a load more trials than we do now. The work in drug discovery has been done for them, by Hahnemann et al who have written Materia Medica and the likes. So not many outgoings there then.
What about the costs of the ingredients? Well sugar is cheap, as is water. And even if your mother tincture comes from a valuable substance, you can make a hell of a lot of homeopathic medicine from it. Here is the recipe for Boiron's Oscillococcinum (according to Wikipedia)
Active ingredient: Anas Barbariae Hepatis et Cordis Extractum (extract ofMuscovy Duck liver and heart) 200CK HPUS 1×10−400 g[9]
Inactive ingredient: 0.85 g sucrose, 0.15 g lactose (100% sugar.[10])
So to make 1 gram of oscillococcinum, you only need 1×10−400g of extract of poor Dave's heart and liver. This is a ridiculously tiny amount, and as you will hopefully now know, there will be VERY VERY VERY little chance of any of Dave's molecules remaining in the resulting solution.
I have no idea how much the heart and liver of Wor Duckie Dave would weigh. I also have no idea how much an extract made from him would cost. I'm guessing, however, that the number of packs of homeopathic pills I could make from his unfortunate organs would mean it is very, very lucrative, and I would be laughing all the way to the bank with my profits were I a company with few scruples about selling nonsense to vulnerable people.
The Pointlessness Of It All
Poor Dave. Dave has been killed to make a medicine. However, none of Dave's molecules actually make it into that medicine in the end, because it has been diluted to such extremes. There's no memory of Dave in the water or sugar left in the medicine, only in the minds of his little duckie friends and his family who miss him dearly. There are huge outcries about bear bile being collected for use in chinese traditional medicines- why is no one speaking out for Dave?
At the end of the day, evidence suggests that after all the sacrificing, succussing, potentization, and all the other fancy words they use for magic rituals, what we are left with is an inert sugar pill.We could have saved ourselves all the bother, and saved Dave's life, if we just made an inert sugar pill in the first place and didn't bother with all the pretending.
Won't anyone think of the ducks?
Tagged: alternative medicine, clinical evidence, complementary medicine, conventional medicine, Big Pharma, homeopathy, quackery, skepticism
A Christmas Dinner Conversation
Hope you all had a lovely festive period, whatever religion (or lack of) you may follow.
I spent christmas day with my parents and remaining grandparents, and thought I'd regale you with the tale of part of our christmas dinner conversation.
Having been asked what I was doing in life at the moment, one of the things that was mentioned was the Newcastle Skeptics in the Pub talk that my good friend and Helper Dog Nancy and I are doing in February. This prompted Mum to state that she thought that homeopathy might work, after all plants had been used for many years in medicine. Now, I have written before about the case of the magic crystals, and do remember mum trying homeopathic remedies on me as a child (out of desperation due to my awful car sickness. Out of interest, I also remember them not working) when I was a bit older, so this stopped me short. I do have a suspicion that the majority of users of homeopathy have little knowledge of how it is made, and therefore no idea how unreasonable it is to expect it to work. And here was living proof that this was, indeed the case. Dad was aware of the like-cures-like principle, but they had no idea at all of the serial dilutions used in homeopathy.
Cue a demonstration (involving wine), and an explanation that beyond 12C there is virtually no likelihood of any molecules of the "active" ingredient appearing, and the general consensus was that they were amazed at this turn of events, and couldn't understand how on earth it could work and how anyone could possibly be taken in by such nonsense.
And so it seems to me that a general lack of good information about what homeopathy is, and what the principles of it are, may well be responsible for the majority of people who may believe it still works.
What do you think? I wonder if there is any way to measure this? If you have any ideas, do give me a shout.
Tagged: about me, homeopathy, christmas, family, questioning


My problem: I opened b.sldprt and saved it as bb.sldprt with code (swModel.SaveAs2 sSVAE_DOCUMENT, 0, True, False). But the sheet-B in file ab.slddrw is still linked to b.sldprt not bb.sldprt I just saved.
I am just wondering maybe part b.sldprt opening with not linked to drawing file. When we manually use open part file and save as method we pick the view and right click mouse then click open icon, see the picture below. how to use VBA code to imitate this process? maybe it is the clue to solve this issue.


text:
« Ethiopia's Emerging Art Scene Pits Creativity Against Profits
Ethiopian Mother Angry Over Murdered Son »
Face2Face Africa Honors Bethlehem Tilahun Alemu, Alek Wek, Femi Kuti
Published by Tadias Magazine July 27th, 2014	in Featured and News. Closed
At the 2014 Face2Face Africa Awards ceremony in New York on Saturday, July 26th. (Photograph: Tadias)
Tadias Magazine
By Tadias Staff
Published: Sunday, July 27th, 2014
New York (TADIAS) – On Saturday evening at New York University's Skirball Center for the Performing Arts a diverse and stylish crowd of African professionals filled the hall to celebrate and honor six trailblazers from the African continent in business, fashion, entertainment, social innovation and democratic governance.
Among those recognized by the pan-African media company Face2Face Africa include Bethlehem Tilahun Alemu of Ethiopia who received the "Entrepreneur Award" for her pioneering work as Founder and CEO of the international footwear brand SoleRebels. The "Humanitarian Honor" was awarded to U.S.-based Ghanaian social entrepreneur Dr. Oheneba Boachie-Adjei, Founder of FOCUS (Foundation of Orthopedics and Complex Spine) which provides orthopedic care to patients in Ghana and several other African countries.
The Global Ambassador Honor was given to South Sudanese British model and designer Alek Wek who saluted all the honorees and pointed out that "Africa needs more women in business and entrepreneurship like SoleRebel's Bethlehem Tilahun" and added that above all education is the key for all. She reminded the audience to " study hard, stay focused and celebrate others."
The Trailblazer award went to Masai Ujiri – the Nigerian-born President and General Manager of Basketball Operations at the Tronto Raptors organization. The Entertainment Honor was also given to Nigerian Afrobeat pioneer Femi Kuti, who spoke about the need to "focus globally not just Africa."
The Lifetime Achievement Honor was conferred on Sudanese-British mobile communications entrepreneur and billionaire Dr Mohamed "Mo" Ibrahim – who was not present, but sent a video message accepting the accolade.
Below are photos and video from the event:
Video: The Face2Face Africa Awards Gold Carpet Presentation
Oprah Magazine Names Bethlehem Tilahun Alemu to Annual Power List

redpajama_set_name: RedPajamaCommonCrawl


A gentle breeze lapped against the hay bales. Farmer Wyatt leaned against his porch, soaking in another day of rural paradise. Pigs snuffled, chickens chirped. Then one of the 99 other farmers caved his skull in with a hoe.
Stardew Valley modder "Ilyaki" has brought battle royale to the nominally peaceful farming-sim. Time to sharpen your pitchforks.
It works exactly like you'd expect. Up to 100 farmers start off in random places across the valley, then eschew foraging for berries in favour of swords, slingshots, bombs and healing items – "and sometimes horses or even hats". The map constricts around an increasingly small play area, and the last farmer standing wins.
Fortnite fans will be pleased to see the inclusion of tactical building, as shown off in this video of some "high-level play".
You can download the mod here, though fair warning – I couldn't get it to work. Or rather, I couldn't get the separate server browser mod to work, and noticed a few others complaining about the same issue.
As such, I can't comment on how easy it is to find a game, or how many farmers you'll be facing off against if you do. Or indeed whether this is actually any fun: Stardew Valley's combat is best described as 'functional'. It's fine for fending of slimes and such when you're digging your way towards a broader goal in the actual game, but it's a clunky means to a more abstractly satisfying end. You don't need me to tell you this is mostly a novelty.
Still, there's a lot to be said for incongruous agricultural assassination.
Tagged with Battle Royale, Chucklefish, mods, Stardew Valley.


Wiring Boxes - part II.
The five wiring boxes are now complete, or they would be if we hadn't managed to loose two of the 400W power supplies (the big greenish grey boxes). Each box has external connection ports for cat5 (carrying DMX) and a caravan plug so that power can be connected using a regular extension cord.
In these pictures you can see the new smaller controllers we have from Ray Wu, a very popular Chinese supplier through Alibaba.com (with the blue labels). So far these are wonderful. 24 Outputs (the much larger green ones in the left picture are only 16!), 24 Volts, and channels are set with dials so you always know exactly what is set and you can change things very easily while the unit is on the network - simply power down and start again.
You can also see that the boxes look nice and tidy until the tail connectors are attached to the controllers. We will have some more cable management installed before the boxes go up so it will all be nice and tidy!
With a new collection of controllers and lights arriving we need some new boxes to mount everything in at Christmas, so Tuppetsdad has been busy playing with his dovetail jig.
We now have 5 big boxes to put everything in at Christmas - nice and tidy, reasonably waterproof (the boxes will be under the eaves so waterproof is not a big issue) and made to fit the house. The boxes are now getting a coat of paint to match the house before they are mounted in preparation for Christmas - just 7 weeks to go!


text:
Danilovo is an air base in Mari El Republic, Russia located 11 km east of Yoshkar-Ola. It was a small interceptor aircraft airfield, now used by a Helicopter Squadron of the Missile forces.

The base is currently home to the 108th independent Helicopter Squadron of the 14th Kievsko-Zhitomirskaya order of Kutuzov Missile Division of the 27th Guards Vitebskaya Red Banner Missile Army.

The base was home to the 681st Fighter Aviation Regiment PVO between 1952 and 1994.

References

Soviet Air Force bases
Soviet Air Defence Force bases
Airports in Mari El
Strategic Rocket Forces

redpajama_set_name: RedPajamaWikipedia


text:
Q: Multi session in spring security 3.1 We develop a web application that need different authentication, in my case this is agent and member. This is the detail:

*

*Agent profile page is at http://my.local/spring-security-hello-world/agent/profile

*Member profile page is at http://my.local/spring-security-hello-world/member/profile

*Both of pages are filtered by springSecurityFilterChain

But i have some issues here. First I login at agent profile page, and successfully logged in. But then I open the member page, and I got HTTP Status 403 - Access is denied. The situation i want to achieve is both agent and member is able to logged in.
Here is my web.xml
<?xml version="1.0" encoding="UTF-8"?><web-app xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"
xmlns="http://java.sun.com/xml/ns/javaee" xmlns:web="http://java.sun.com/xml/ns/javaee/web-app_2_5.xsd"
xsi:schemaLocation="http://java.sun.com/xml/ns/javaee http://java.sun.com/xml/ns/javaee/web-app_2_5.xsd"
id="WebApp_ID" version="2.5">
<display-name>spring-security-hello-world</display-name>
<welcome-file-list>
    <welcome-file>index.html</welcome-file>
    <welcome-file>index.htm</welcome-file>
    <welcome-file>index.jsp</welcome-file>
    <welcome-file>default.html</welcome-file>
    <welcome-file>default.htm</welcome-file>
    <welcome-file>default.jsp</welcome-file>
</welcome-file-list>

<servlet>
    <servlet-name>mvc-dispatcher</servlet-name>
    <servlet-class>org.springframework.web.servlet.DispatcherServlet</servlet-class>
    <load-on-startup>1</load-on-startup>
</servlet>

<servlet-mapping>
    <servlet-name>mvc-dispatcher</servlet-name>
    <url-pattern>/</url-pattern>
</servlet-mapping>

<listener>
    <listener-class>org.springframework.web.context.ContextLoaderListener</listener-class>
</listener>

<context-param>
    <param-name>contextConfigLocation</param-name>
    <param-value>
        /WEB-INF/mvc-dispatcher-servlet.xml,
        /WEB-INF/spring-security.xml
    </param-value>
</context-param>

<filter>
    <filter-name>springSecurityFilterChain</filter-name>
    <filter-class>org.springframework.web.filter.DelegatingFilterProxy</filter-class>
</filter>

<filter-mapping>
    <filter-name>springSecurityFilterChain</filter-name>
    <url-pattern>/*</url-pattern>
</filter-mapping>

And this is my spring-security.xml
<beans:beans xmlns="http://www.springframework.org/schema/security"
xmlns:beans="http://www.springframework.org/schema/beans" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"
xsi:schemaLocation="http://www.springframework.org/schema/beans
http://www.springframework.org/schema/beans/spring-beans.xsd
http://www.springframework.org/schema/security
http://www.springframework.org/schema/security/spring-security.xsd">

<!-- <http pattern="/agent/login" security="none" /> -->

<http pattern="/member/**">
    <intercept-url pattern="/**" access="ROLE_MEMBER" />
    <form-login login-page="/member_login" default-target-url="/member/profile"
        authentication-failure-url="/member_loginfailed" />
    <logout logout-success-url="/member_logout" />
</http>

<http auto-config="true">
    <intercept-url pattern="/agent/**" access="ROLE_AGENT" />
    <form-login login-page="/agent_login" default-target-url="/agent/profile"
        authentication-failure-url="/agent_loginfailed" />
    <logout logout-success-url="/agent_logout" />
</http>

<authentication-manager>
    <authentication-provider>
        <user-service>
            <user name="agent" password="123456" authorities="ROLE_AGENT" />
        </user-service>
    </authentication-provider>

    <authentication-provider>
        <user-service>
            <user name="member" password="123456" authorities="ROLE_MEMBER" />
        </user-service>
    </authentication-provider>
</authentication-manager>

Notes:
In my case one user must only have one role (either agent or member only)

A: If you do it in the same browser then your Agent with ROLE_AGENT is used to access page which is restricted to ROLE_MEMBER. You can add ROLE_MEMBER to your access="ROLE_AGENT, ROLE_MEMBER" to check it.

redpajama_set_name: RedPajamaStackExchange


text:
Film Points of Interest set jetting
Lindsay Blake
@iamnotastalker
Go On Location: Los Angeles Locations from The Fast and the Furious Movies
Templin Highway from "Furious 7" | Photo by Lindsay Blake
The Fast and the Furious tells the story of undercover police officer Brian O'Conner (played by Paul Walker) taking on Dominic Toretto (Vin Diesel) and his crew of hijackers. The 2001 action film was followed by six sequels and has become Universal's biggest franchise of all time.
The Fast and the Furious movies boast a strong connection to Los Angeles, where the fast furious set took to the real streets of L.A., though not all of the franchise's installments were shot here. Fans can discover many iconic locations from the films throughout Los Angeles, from Downtown to Malibu. Read on for 20 Fast and Furious locations in L.A. County, including the site of the unforgettable "One Last Ride."
Note: Spoilers ahead for those who haven't seen the movies!
enlarge photo [+]
At the beginning of The Fast and the Furious, Brian O'Conner (Paul Walker) tests out his racing skills while driving his iconic neon green Mitsubishi Eclipse in the parking lot of Dodger Stadium during the first Fast and Furious race. Brian returns there with the rest of the "familia" in Furious 7. In one of the movie's most picturesque scenes, the gang stands against a guardrail overlooking the Downtown L.A. skyline and discusses how to take down Jakande (Djimon Hounsou) on their own turf. That guardrail can be found in the southern portion of the stadium's parking lot.
1000 Vin Scully Ave. Los Angeles, CA 90012
Add to My LA
Toretto's Market & Cafe - Bob's Market
The clapboard corner market owned by Dominic Toretto (Vin Diesel) in The Fast and the Furious, where "no one likes the tuna," is actually Bob's Market in Echo Park. The small bodega was constructed by George F. Colterison in 1913 and was designated Los Angeles Historic-Cultural Monument #215 in June 1979. Both the interior and the exterior of Bob's were used in the filming of The Fast and the Furious, though the interior was dressed heavily for the shoot and is largely unrecognizable from its onscreen appearance. Unlike the movie, Bob's does not serve food or offer counter seating in real life. The market has been featured several times on screen, in such features as L.A. Confidential, The Salton Sea, and Nightcrawler, as well as in episodes of The Mentalist and Mob City.
580 E Kensington Rd Los Angeles, CA 90026
Street Rally - Alameda Square
In the franchise's first installment, Brian challenges Dominic to a race at a street rally that's held in the parking lot of Downtown L.A.'s Alameda Square, located on the edge of the Arts District. A large parking structure is currently being built in that lot, but the warehouses that are visible in the background of the scene remain unchanged. The street race itself takes place a good distance away from the parking lot, on Prairie Avenue, between 118th and 120th Streets, in Hawthorne. Brian loses the race – and his Eclipse – to Dom in front of 11862 South Prairie Ave., but he comes out of it smiling because, "Dude, I almost had you."
777 Alameda St Los Angeles, CA 90021
Toretto House - Echo Park
Toretto's House,the Echo Park home of Dominic and his sister, Mia (Jordana Brewster) appears in several of the Fast and Furious movies. Both the interior and the exterior of the two-story structure were utilized in the films, most notably in the first installment. For the shoot, director Rob Cohen had the owner paint the 1906 dwelling white so that the gang's bright cars would stand out against it. In real life, the house is a four-unit, multi-family dwelling. The residence's detached garage, where Dom keeps his 1970 Dodge Charger R/T, was demolished at some point after the filming of The Fast and the Furious and had to be rebuilt for Fast & Furious (2009). Though the Toretto's house meets its untimely demise in Furious 7 when it's blown up by Deckard Shaw (Jason Statham), in real life it is still standing and looks much the same as it did onscreen.
722 East Kensington Road Los Angeles, CA 90026
Dominic's Auto Shop - Huron Substation
Dom's auto repair, the auto shop where Brian and the gang repair Dom's ten-second car in The Fast and the Furious, is a former 1906 substation that once provided electricity to the Yellow Car transit line. After the city sold the property in the late 1950s, the space went through subsequent stints as a signal manufacturing plant, a welding shop and a furniture workshop. Listed as Los Angeles Historic-Cultural Monument #404, the Huron Substation is now used as a special event, wedding and filming space. The 32-by-46-foot interior, with its 45-foot ceilings, exposed brickwork and arched windows was transformed into Dom's auto shop for The Fast and the Furious 2001 shoot.
2640 Huron St. Los Angeles, CA 90065
Neptune's Net
After smoking a Ferrari in a street race, Dom and Brian head to Neptune's Net Fast and Furious restaurant, which is really a landmark Malibu restaurant that was originally established in 1958. On the patio of the seaside eatery, Brian tells Dom that he wants in on Dom's illegal activities. Neptune's Net serves fresh seafood, which patrons choose from the restaurant's many tanks and the chefs then steam on the premises. The eatery is popular with both movie crews (it's appeared in Point Break, People Like Us and The Hills) and celebrities (Michelle Pfeiffer, Bono, Gene Hackman and Cher have all been spotted there).
42505 Pacific Coast Hwy Malibu, CA 90265
LAPD/FBI Headquarters - Beverly Hills
One of the most unique and memorable locations in The Fast and the Furious unfortunately no longer exists. The circular-shaped, Mid-Century Modern home that served as the LAPD/FBI undercover headquarters in the movie was demolished shortly after filming took place. Though Sgt. Tanner (Ted Levine) states in the film that Eddie Fisher had the residence built for Elizabeth Taylor in the 1950s, in actuality the house was constructed in 1963 by architect David Fowler and bears no Taylor-Fisher connection. Today, a 49,300-square-foot home (currently, the second largest residence in L.A.) stands on the site.
1261 Angelo Drive Beverly Hills, CA 90210
In The Fast and the Furious, Mia declares that she doesn't typically date her brother's friends. But after serving Brian countless tunas on white (no crust!), she finally agrees to go out with him. The two share a romantic first date at Cha Cha Cha restaurant, one of Silver Lake's most historic eateries. The family-owned and -operated site, which serves contemporary Caribbean fare, was originally established in 1986. At the colorfully decorated restaurant, Mia tells Brian how Dominic's team came together.
Oro Valley High School - Juan Rodriguez Cabrillo High School
Before being sent to Japan to live with his father as punishment for illegal street racing in The Fast and the Furious: Tokyo Drift, Sean Boswell (Lucas Black) attends Oro Valley High School in Arizona. In reality, filming took place at Juan Rodriguez Cabrillo High School. The race that gets Sean busted was not filmed anywhere near the school, though. That scene was shot about 80 miles outside of Los Angeles at a housing community in Victorville that was under development at the time. Cabrillo High School also regularly masked as William McKinley High School during the first season of the television series Glee.
2001 Santa Fe Ave Long Beach, CA 90810
Parking Garage Races - Hawthorne Plaza
Though largely set in Japan, The Fast and the Furious: Tokyo Drift was shot almost entirely in Los Angeles. Twinkie (Bow Wow) introduces Sean to Tokyo's drift racing scene at what is actually the parking garage at Hawthorne Plaza Shopping Center in Hawthorne. The garage features several circular ramps that were perfect for shooting the drift sequences. Hawthorne Plaza originally opened in 1977, but was shuttered in 1999 and subsequently gutted. It has sat abandoned ever since, though plans are currently in the works to turn it into a high-end outlet mall. The property has been used countless times on screen, including films such as Minority Report, Evolution, Gone Girl and The Green Hornet, as well as in the television series Teen Wolf.
12000 Hawthorne Blvd Hawthorne, CA 90250
Han's Garage - Downtown L.A.
After ruining Han's (Sung Kang) Nissan Silvia S15 during his first drift race in The Fast and the Furious: Tokyo Drift, Sean is forced to work off the debt. He winds up spending quite a bit of time fixing cars in Han's large garage, which is located in an industrial part of Tokyo. In real life, the garage is a warehouse on Santa Fe Avenue in Downtown L.A. The area used as the front of the garage is the Mesquit Street side of the building. The interior and the exterior of the property were used extensively in the filming, though the exterior was dressed heavily with Japanese signage for the shoot. Unfortunately, the area surrounding the garage is currently undergoing massive construction and the garage is set to be torn down in the next year.
590 S. Santa Fe Ave. Los Angeles, CA 90013
"Tokyo Drift" Donuts - Wilshire Blvd. & Hope St.
Towards the middle of The Fast and the Furious: Tokyo Drift, Han shows Sean the real reason why he drifts – to meet girls – by doing donuts around two attractive women in a Nissan Skyline at a Downtown Tokyo intersection. Unbelievably and despite all aesthetic evidence to the contrary, that sequence was shot in Downtown L.A. The strip of Wilshire Boulevard between Grand Avenue and Flower Street was completely transformed using neon displays, twinkle lights and Japanese signage for the shoot. SPOILER ALERT: It's the same spot where Han is killed near the end of the movie. In that scene, he crashes his car in the southwest portion of the intersection, with the camera looking southwest down Hope Street.
700 Wilshire Blvd Los Angeles, CA 90017
FBI Building - Ambassador College
In Fast & Furious (2009), Brian reports to work each day at a large Mid-Century Modern FBI building. In reality, that building is the Hall of Administration at the former Ambassador College in Pasadena. The school was founded in 1947 by evangelical radio personality Herbert W. Armstrong. After closing in 1997, portions of the campus were purchased by Maranatha High School and Harvest Rock Church. In 2010, the remaining sections of the campus were bought by an Orange County developer who has converted the site into a large mixed-use complex, the Ambassador Mansion & Gardens. Several buildings have been torn down during the transformation and many more are set for demolition in the near future, including the Hall of Administration, which was designed by Peter J. Holdstock in 1967. The Ambassador College site has been used regularly for filming over the years, in movies like A Single Man, Inherent Vice, Glory Daze and That Thing You Do!, in episodes of The Incredible Hulk, Bones, Leverage and King of the Nerds, as well as in a popular Microsoft Surface commercial.
300 W Green St Pasadena, CA 91105
Letty's Funeral - Sunnyside Cemetery
Letty's (Michelle Rodriguez) funeral in Fast & Furious is held at Sunnyside Cemetery in Long Beach. Founded in 1907, the cemetery features a striking backdrop, thanks to the oil that was discovered in the area in 1921. Several oil derricks now surround the property and make for an arresting site. Dominic watches Letty's funeral from a distance, near one of those oil derricks. With its unique aesthetic and picturesque greenery, Sunnyside has long been popular with filmmakers. Other productions shot there include 8MM, Click, Phantasm II, Joan of Arcadia and The Bridge.
1095 E Willow St Long Beach, CA 90806
David Park's Apartment - Stratford Hotel
Seeking revenge for Letty's death in Fast & Furious, Dom heads to the apartment of David Park (Ron Yuan) to gather some intel. When David proves tight-lipped, Dom hangs him by his feet out of a fourth floor window. Though Dom does wind up dropping him, Brian swoops in to save him. In real life, David's building is known as the Stratford Hotel and houses 93 apartment units. The rear side of the four-story structure was also featured in one of the opening scenes of Fast & Furious as the spot where Brian captures a suspect after a long foot chase through Downtown L.A.
2629 W. 8th St. Los Angeles, CA 90057
Street Rally - Starkman Building
In Fast & Furious, Dom and Brian have a terse meet-up at a street rally held at one of L.A.'s most-filmed locales, the Starkman Building. Located in the Arts District of Downtown L.A., the picturesque brick structure (aka the Pan Pacific Warehouse) was built in 1908 as a factory for the Nate Starkman & Son company. The building's other onscreen stints include masking as Paddy's Pub on It's Always Sunny in Philadelphia and Nicholas Cage's apartment in National Treasure.
544 Mateo St. Los Angeles, CA 90013
AT&T Switching Center
Though the parking garage where Dom and Deckard Shaw (Jason Statham) go head to head at the end of Furious 7 is located in Atlanta, as are many of the movie's final race locations, the tower that provides the signal for Ramsey (Nathalie Emmanuel) to run the hack on the God's Eye program is located at the top of the AT&T Switching Center in Downtown L.A. Jakande (Djimon Hounsou) blows up the tower in the movie, but in real life it still stands atop the 448-foot building.
420 South Grand Ave. Los Angeles, CA 90014
Leo Carrillo State Park
In one of the most memorable scenes from Furious 7, the gang bids a heartfelt farewell to Brian at the eastern edge of Leo Carrillo State Park Park, one of the Fast and Furious 7 filming locations . Dom stands up to leave and tells everyone "It's never goodbye," while Brian plays with Mia and their young son. Brian is finally home "where he belongs… where he's always belonged."
35000 W Pacific Coast Hwy Malibu, CA 90265
"One Last Ride" - Templin Highway
After Dom leaves the beach without saying goodbye, Brian surprises him at what is supposed to be the intersection of Decker Road and Mulholland Highway in Malibu. Filming actually took place about sixty miles north, at the intersection of Templin Highway and Ridge Route Road in Castaic. In the unforgettable scene, the men's cars are stopped on Templin Highway, facing north. After driving off, the two share a final ride along the short picturesque stretch of Templin Highway located immediately north and south of Ridge Route Road, while the melancholic, uplifting strains of Wiz Khalifa's See You Again play in the background. That same road also masked as the Dominican Republic freeway where Dom and Letty steal gas from fuel tankers in the opening scene of Fast & Furious.
Intersection at Ridge Route Road Castaic, CA 91384
"One Last Ride" Road Split - Templin Highway
Furious 7 filmmakers employed some major CGI to create the road split where Brian parts ways with Dom for the last time. In reality, this split does not exist. Instead, Brian's car (Paul Walker's personal Toyota Supra was used in the scene) pulled off onto a roadside turnout on the eastern side of Templin Highway, approximately 2,000 feet south of the intersection with Ridge Route Road. Digital imaging was later heavily employed to that was make the turnout look like a fork in the highway.
View in Experience Builder
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35000 W Pacific Coast Hwy
90265 Malibu , CA
Los Angeles Dodgers / Dodger Stadium
1000 Vin Scully Ave.
90012 Los Angeles , CA
Hawthorne Plaza
90250 Hawthorne , CA
Bob's Market
580 E Kensington Rd
1261 Angelo Drive
90210 Beverly Hills , CA
590 Santa Fe Studios
590 S. Santa Fe Ave.
722 East Kensington Road
Alameda Square
777 Alameda St
Famima Wilshire
700 Wilshire Blvd
Huron Substation
2640 Huron St.
Juan Rodriguez Cabrillo High School
2001 Santa Fe Ave
90810 Long Beach , CA
Ambassador Mansion & Gardens
300 W Green St
91105 Pasadena , CA
Starkman Building
544 Mateo St.
Stratford Hotel
2629 W. 8th St.
1095 E Willow St
420 South Grand Ave.
Templin Highway
Intersection at Ridge Route Road
91384 Castaic , CA
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© 2019 LOS ANGELES TOURISM & CONVENTION BOARD.


Very light spotting to page edges; minor bump to spine head. Binding tight and square; inside pages clean. JACKET: Light scrattling and edgewear. Nineteenth Printing. Size: 12mo (7 to 7.5 inches). ISBN: 0804813736. ISBN/EAN: 9780804813730.


* Remove Sven Velt from Uploaders. He is apparently not active anymore.
* airstrike.desktop: Add keywords. Change category key to ActionGame.
* Update menu file. Add longtitle and icon entry.
* Remove Replaces field from airstrike-common. It is no longer necessary.
* Use a different short description for airstrike-common.
* Install man page with manpages file.
* Simplify debian/rules by using dh sequencer.
* Drop dirs file. Not needed.
* Add DEP3 headers to all patches. Rename .diff extensions to .patch.
* Rename fix-link-flags.diff to Add-lm-to-fix-FTBFS-with-binutils-gold.patch.


text:
Q: BDD: How does Baby steps work? I'm trying to learn about BDD and I've read about baby steps. How do they work? I'm trying to figure it out.
For example, using the following feature:
Feature: Months and days to days
In order to see months and days as days
As a date conversion fan
I need a webpage where users can enter days and
     months and convert them to days.

Scenario: Convert 12 months and 0 days to days
Given "12" months And "0" days
When I click on convert button
Then I should get: 360

Should I create a code to make the conversion right in the steps methods and then refactor the code and put them in classes or should I start with classes?
It's looks simple but I'm confused. I want to learn about the baby steps and I don't want to break it...
Thank you.

A: As far as i can see, baby steps mean that you have to perform only small changes step by step. It is similar to TDD : write new test, write code, make sure that it does not works, make it work fine, write new test... etc
Lets look like onto your example:

Convert 12 months and 0 days to days Given "12" months And "0" days
  When I click on convert button Then I should get: 360

I assume, that first thing you gotta do is create class name like a "Convertor". The first step done. The next small step is to create method
int convertToDays(int monthCount,int daysCount)

And go by this steps. You firstly describe behavior of your code, coding goes after it.
The next steps will be something like those:

*

*Fill the method to work correctly with int values

*Make it work with string input values.

*Add validation of data typed in

*Make user notification if input is not valid

*Do some refactoring

I hope it will help you. Thanks.

A: Your question is quite difficult to understand, but by baby steps the author probably means beginning with a very basic scenario and working up to a more complex one. For the story you describe, the most basic example could be entering 0 months and 0 days, and verifying that the result is 0 days. From there you could go from inputting only days or only months, and eventually to an example containing both months and days.

A: You haven't said anything about what platform you are working on, or whether you have any code yet. Ruby? Rails? Java? C#? Python?
Baby steps means moving in very small steps, unsurprisingly, and re-running your tests each time. The "Baby steps" was originally conceived to apply to the inner red-green-refactor loop, at the unit test level. BDD has come along and added an external loop as well, at the acceptance test level. The BDD style is to develop "outside-in".
There is another phrase often used in combination, which goes something like "Let the compiler guide your steps".
Assuming you have no code, and you are using say Cucumber and RSpec - the description will not change much on other platforms - when you run your story in cucumber it will tell you you have unimplemented steps, and even give you basic suggestions as to how to implement your Given When and Then.
So, Baby Steps. Take one of those, let's say "Given", and use the suggested implementation. You create some step-code in Ruby, which pattern matches the line, and then calls what.. nothing for now. In this code it might simply convert the parameters to integers (later on you might build constructors, but for now just do the simplest thing that could possibly work).
When you run cucumber again, it complains about the two missing steps, but the message about the step you have filled in has changed.
Now fill in the next step. When you run cucumber again, only the last step is failing. But you have to add some more content to your second step. etc
Check out this tutorial, it gives you some idea.
http://www.slideshare.net/josephwilk/outsidein-development-with-cucumber-and-rspec