LAUSR

When one penetrates the cloud of COVID-19, this year has seen more than its fair share of charlatans and pharmaceutical jailbirds. NHS England started us off by firing a new salvo at homeopathy, for which the United Kingdom (UK) taxpayer ceased paying in 2017 [1]. This time, NHS England expressed its incredulity that the Professional Standards Authority (the regulator of regulators in the UK) had recently renewed its accreditation of the Society of Homeopaths (SoH), especially when homeopaths were ‘propagating misinformation about vaccines’ [2]. This misinformation included unfounded therapeutic claims for ‘CEASE’ therapy, for which the concomitant use of homeopathic remedies helps ‘clearance’ of antigens and toxins, thus curing autism and replacing vaccination for infectious diseases [3, 4]. In fact, when read closely, the web pages showing the SoH position statement declare ‘CEASE’ therapists acceptable, although they do not actually and directly support the therapeutic claims. NHS England has now emphasised that, in particular, homeopaths should not abet the decline in uptake of pre-school vaccinations. Meanwhile, the SoH is running workshops centred on the ‘three vital steps towards becoming a homeopath—belief, confidence and risk-taking’ [5]! The abuse of ‘anabolic’ steroids is getting much less press than that for opioids. Evidence that athletic performance is enhanced by steroids is meagre (beyond mere increase in muscle mass) [6], while there is robust evidence for endocrinological, hepatic, and psychological toxicities of these drugs [7]. A dubious record was broken this year by one Jacob Sporon-Fiedler, a Danish owner of an Indian generic drug manufacturer. He had been managing to ship approximately four tonnes of anabolic steroids each month (sic) into the illicit European market. In the UK alone, his revenues were about £65 million per year [8]. Importantly, this record-breaking case illustrates an international disparity in drug regulation and a legal loophole. Anabolic steroids are Schedule 3 controlled substances in the USA (i.e. possession without medical prescription is a felony). However, in England and Wales, while also being Class C drugs, possession of anabolic steroids is not necessarily an offence, unlike supplying them.1 The loophole, therefore, is that a Londoner receiving a retail shipment from, say, India, might not commit any offence because the supplier is outside the UK jurisdiction. However, as a matter of logistical efficiency, to fulfil his large markets, Mr Sporon-Fiedler had to resort to shipping wholesale quantities into European countries, and these were then broken down into smaller shipments for local, retail distribution. In the UK, that does count as supplying within the jurisdiction, about which Mr SporonFiedler now has plenty of time to reflect, while serving his 5 years and 4 months sentence imposed at the Old Bailey (in all likelihood, he is likely to serve about half of it before being released on licence). A very questionable effort was started in February by the French Government to incriminate a large pharmaceutical company for failure to warn about a drug adverse event (AE). The AE in question is that sodium valproate has a low incidence of cleft palette after exposure in utero [10]. Rarer, and more controversial, are associations with mental retardation and spina bifida [9]. One wonders about the motivation for the charge. The information on the AE has been well known for decades [10], the hazards are in product labelling, the drug is one of the most effective anti-seizure medications ever discovered, and alternative therapies commonly have similar (if not worse) teratogenic effects [11]. Furthermore, the hazards to the foetus of untreated maternal