Boobs and Woo

I’m quite ashamed to admit that I’ve been duped by complimentary and alternative medicine (CAM). A long while ago I mentioned to my general practitioner (GP) that I suffered from breast tenderness, or mild mastalgia, just prior and during my period (i.e. cyclical mastalgia). She suggested I try Evening Primrose Oil as that should help.

I thought fair enough and sauntered off to Boots to buy a jar. As it turns out, I’ve never actually got round to trying it. Then recently, with all of the hullabaloo around homeopathy, I decided to look up Evening Primrose Oil (EPO) on PubMed to find this:

Evidence-based management of Mastalgia: a meta-analysis of randomised trials

Which states:

“EPO did not offer any advantage over placebo in pain relief”

Now this pissed me off lots and lots. I had believed that my medically trained GP would suggest something that was evidence-based and had not done so because either a) she was unaware of the current evidence and/or was one of these CAM-peddling NHS doctors or b) she was trying to placebo my ass. Both of which are troubling.

Firstly, if it was because she was unaware/a CAM peddler then this undermines my trust in the medical opinion of NHS doctors (and none of this “but she was only a GP”). Not everyone is going to check their medical advice online or if they do they are more likely to come across pseudoscience and quackery than know where to look for a systematic review. We can’t check everything all the time and so generally we rely on the expertise of those we assume will have more knowledge than us.

Obviously this was a very minor aliment for me and so I didn’t check. Most people on finding out that they have a serious illness do and should investigate it as much as possible.

But secondly, if she was trying to palm me off with a placebo then I’m fucking livid. There is over-prescribing in certain areas of general practice because people go expecting an intervention for their health problem. I, however, didn’t want an intervention and mentioned the jublies pain as an aside.

If she knew that EPO only acted as a placebo not telling me has left me feeling stupid and lied to. If I had had all the information at the time I would have made a different decision on the basis that the tit ache isn’t that bad, just a mild annoyance, and chocolate is my preferred placebo.

This of course links nicely to homeopathy; if it is simply a placebo then doesn’t the positive outcome justify the means? The placebo effect is real and therefore if homeopathy works solely as a placebo can’t it still ‘help’?

The significance is displayed in my outrage at finding out that EPO has no evidence-base for treating bap pain. I felt stupid and disempowered. I had been made an unwilling victim of marketing over substance. And this is what is wrong about homeopathy; its marketing and spin masquerading as authoritative medical knowledge. It dupes individuals into thinking they are taking control of their own health when in fact they are not being given access to the full facts.

If you want to know what my GP should have done, here’s a handy guideline flow-chart from NHS Lothian (*cough* her Health Board).

For people with ouchy knockers there’s some helpful guidance here and here.

15 Responses to “Boobs and Woo”

  • Neuroskeptic Says:

    Maybe you should talk to Crispian Jago (bottom of the page…)

  • James Says:

    You don’t say how long ago this happened, but you may be being a wee bit unfair on your GP. EPO actually had a Product License (the brand name was Efamast) and was available on NHS prescription for many years. Not a kid-on product license like the homoeoquackery has, but a full clinical trials blah blah Product License which you can only get if your product has good evidence of efficacy. What is most fascinating is that Efamast (and Efamol – the similar product used for eczema) had their PLs withdrawn as the evidence base turned against them.
    I can’t think of any other licensed medicine where this has happened.
    So, to get back to the GP, at the time they would probably have seen EPO as a real medicine, not quackery. (Mind you, I don’t know why she sent you to Boots and didn’t just write a script…)

  • James Says:

    Sorry – it was Epogam, not Efamol that was licensed for eczema. My memory is playing tricks on me.

  • Carmenego Says:

    I’ve offerred *several times* to help with your cyclical mastalgia. Since when were my teeth not good enough for you?!

    On a serious note though, I was fuming when my GP recommended acupuncture to help treat my migraines. She assured me that it was scientifically proven to work, despite me saying that I’d read that it wasn’t. Then to really put the icing on the cherry, she spelt it wrong in my notebook. I tend to only go to the GP after I google my symptoms and check for possible ailments myself first before I get an “informed” opinion on something. Luckily I’ve been ok so far!


  • Victohenry Says:

    Barbara Ehrenreich was on the Guardian Books Podcast with an excellent bit on boobs and woo – specifically the oft-repeated theory that “positive thinking” helps boost the immune system to fight breast cancer (thereby putting the onus on sufferers to get themselves well by smiling a lot and not complaining). To paraphrase, “I have a PhD in cellular immunology. Cancer is not fought by the immune system, the immune system fights foreign infections. Attitude does nothing to improve the survival rate of breast cancer”. (middle-ish of the podcast)

  • Naomi Mc Says:

    That’s a very good point Victohenry *cough* …

  • Victohenry Says:

    Hah! Should have known you’d beat me to it, by a long shot…

  • Kerry Says:

    BUT… a significant number of women do find EPO helps mastalgia. It may not be statistically significant in meta analyses but what if you are one of those women?

    Black cohosh helps some menopausal womens symptomatology too. I don’t think its wrong of me to say “some women have found this helpful”.

    Any wise GP comes to learn that people are individuals first, and classical meta analysis provers second.

  • Barbara Says:

    Since you purchased it already what’s the harm in trying it first, and then letting your body be the judge? My guess is that there is ample evidence on either side of the fence, but actually listening to your body only requires you.

  • Michelle Says:

    Actually, the field of “oils” is still emerging, and opinions in the field are really split. I worked in the patent department of drug discovery company (U.S.) and I read a lot of submissions about them, and I worked with the smartest scientist I’ve ever known and he whole-heartedly believed in them. I think fish oil results were more convincing than the evening primrose, but ugh.

  • Katy Newton Says:

    I am sceptical about all forms of woo, but I also became pretty desperate about my PMT and did give EPO a whirl, reasoning that even if it only worked as a placebo that was better than bursting into tears every five seconds and wincing every time I put a bra on. It did seem to help. I reckon either it only helps a relatively small amount of women for reasons that aren’t yet fully understood, or it’s a placebo that suits me. Either way, I’m somewhat happier and more pain-free when I take it. I will add that whilst I have mentioned it to friends who also suffer from PMT, I’ve always been careful to point out that it isn’t backed up by empirical testing and that I may well just be benefiting from the placebo effect.

  • Katy Newton Says:

    … I personally wouldn’t feel misled if my doctor told me that some women have found that EPO helps.

  • Libby Says:

    For the other ladies with very ouchy knockers reading this, I’ve found vitamin E to be helpful –

  • Nicola Says:

    You will complain, though, right?

  • SSS Says:

    I know this is an old post but I have to say at least your GP didn’t try to give you antidepressants. Here in the states more than half of women who go to their doctor about premenstrual complaints are given a script for antidepressants. Insulting, isn’t it?

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