Friday, 22 July 2011

PLAYING WITH WORDS - HEALTH CANADA'S REPLY TO OUR LATEST APPEAL TO RECONSIDER THEIR STAND ON E-CIGARETTES


Here is Health Canada’s reply to our latest appeal to them to reconsider their stand on electronic cigarettes. 

Health Products and Food Branch 
Inspectorate
Graham Spry Building, 3rd Floor
250 Lanark Avenue
Address Locator #2003C
Ottawa, Ontario
K1A 0K9

July 11, 2011


Thank you for your correspondence dated April 30, 2011 and your request that Health Canada reconsiders its controversial stand on banning the import and marketing of electronic nicotine delivery devices commonly known as e-cigarettes.  We apologize for the delay in our response. 
 
The recent U.S. FDA announcement about its intent to regulate electronic cigarettes as tobacco products when not associated with therapeutic claims will not change the regulation of electronic cigarette products in Canada.  Analysis of the US decision indicate that it is based on very different wording found in the United States Tobacco Act compared to the Canadian Tobacco Act.

Electronic cigarettes will continue to fall within the scope of the Food and Drugs Act because they deliver nicotine, a drug, to a consumer.  All other nicotine containing products, other than naturally sourced nicotine in cigarettes, cigars, etc, have been assessed under the Food and Drug Regulations.  Currently since all approved nicotine products are now non-prescription drugs they fall under the Natural Health Products Regulations.   However, nicotine intended for an electronic cigarette is not exempted from prescription status.  Accordingly, market authorization must be granted by Health Canada prior to the importation and sale of these products in Canada.  In this regard, Health Canada’s approach is in line with the recommendations of the World Health Organisation. 

Yours Truly,
Diana Dowthwaite
Director General 

It is quite clear that according to Health Canada the health of an individual is at the mercy of ‘’different wording’’ and ‘’different acts’’ and that all that matters is that a substance contained in a product occurs naturally as opposed to being extracted from the plant and added to a delivery device.   Little does it matter to Health Canada that that is precisely the process the pharmaceutical industry uses to manufacture different nicotine delivery devices such as inhalers, patches, gums and lozenges and it matters even less to them that the tobacco industry has been (rightly or wrongly) under attack for years for free-basing nicotine to give it a more potent ‘’hit’’ and that there is nothing ‘’natural’’ about that process.  Irrelevant to them that thousands if not millions of smokers throughout the world who wanted to quit have successfully managed to do so with a device that has so far not only proven to be many times more effective than pharmaceutical overpriced nicotine replacement therapy but that has also no documented case of harm since its approximately 7-year existence. 

Dear fellow citizens, the next time your father, aunt, uncle, or grandmother complain that smoking conventional cigarettes worsens their emphysema symptoms yet they find it impossible to renew their supply of nicotine for their e-cigarette because Health Canada does not approve of harm reduction, please set them straight immediately and stress to them that ‘’emphysema’’ is now called COPD and that wording is of utmost importance when one wants to improve their health.    


Wednesday, 20 July 2011

CAN THE STATE STEAL OUR KIDS WITHOUT DUE PROCESS?

A 9-year old child was removed from her father without due process and medicated with anti-psychotic drugs within 70 hours.  The child is autistic, does not require medication and according to the father the only reason she was removed from him was because she wandered off to the neighbor’s backyard and after he searched for her for 20 minutes, he called the police for help.  According to BC Child Protection Services, the father is too overwhelmed to properly look after his daughter. 


Since Child Protection Services refuse to comment, this of course is only the father’s side of the story.  However, whatever the other side of the story is, nothing can justify that the child gets separated from her father with only a picture of him to appease her worries and medicated without the father’s consent and all this without prior legal process.  The father has no idea how long it will take before the judicial system hears his case and returns his daughter to him.  Meanwhile the child’s mental and physical health is compromised. 

This should be of great concern to all of us.  If we allow the state to get away with such actions, there is no telling how many families will one day live the same tragedy as the Hoares.  
Find out how you can help here :  http://www.facebook.com/groups/152278868178942

 

Monday, 4 July 2011

SPONTANEOUS COMBUSTION


Guest commentary by Andrew Phillips - Libertarian Party of Canada - Ontario Libertarian Party, on an article that appeared in the New York Daily News titled Unlicensed vendors flood area beaches, turning city shores into open-air marketplaces
 

Well the economic law of unforeseen circumstances is certainly at work here!

Nobody ever thought of this happening as the social engineers creating laws are so far removed from the real world. This is the free market at work it's chaotic, unorganized, and worst of all for the social engineers, it works. If the market place (the customers) weren't there the suppliers (the vendors) wouldn't be there as well. Whoever showed up first is not all that important as a market was there to be created and the two principals the customers and the vendors found each other. As there are a lot of vendors they are in direct competition with each other. Thus prices are kept down through competition. In all cases the free market is controlled by the consumer and the purchases they decide to make based on their own needs and / or wants. You're not paying for a government service you have no use for, the salary of the people who supply the service you have no use for, and inflated prices and shoddy service that are the end result of any monopoly.

Here if a vendor screws somebody they would lose their market share. What is also funny is Bloomberg the mayor brought in the smoking bans on public beaches but budget cuts have gutted the people who were supposed to do the enforcing. You have to wonder if any of those vendors might be laid-off enforcement officers who are using the free market to better their own situation. Recently a newspaper article here pointed out the underground economy in Canada has been estimated at 36 billion dollars a year. I'd like to know what the real amount actually is if they'll even admit to that amount in the first place. Markets like this were a permanent fixture in the old Soviet Union as the central planners were completely unable to control the supply of 24 million market items.

I enjoy the irony in this line towards the end of the article, "A guy who doesn't pay rent, he takes business away from the restaurant who pays rent. There should be some more enforcement." What took the business away from those establishments in the first place was enforcement of a ban that they didn't want. That violated their property rights and in many cases forced them out of business or facing the law of diminishing returns. Unwanted social engineering was, and remains, the real problem. In all cases the social engineers are cocooned from the economic fallout of bad decisions by mostly working for the government. However bring in enough bad laws and even they will feel the effects of diminishing returns from the rise of the
underground unfettered free market.

After all, water in the real world always finds its own level.

Thursday, 23 June 2011

INSOLITE : CHASSE AUX SORCIÈRES À L'ANCIENNE LORETTE

La ville de l’Ancienne Lorette imite désormais quelques municipalités du Canada anglais et interdit de fumer dans les parcs et les espaces verts selon la source interne des nouvelles de Québécor, le QMI.

L’article en question (lien ici-bas) nous rapporte que l’Organisation Mondiale de la Santé (OMS) préconise que les espaces sans fumée protègent les non-fumeurs des effets néfastes de la fumée, elles n’affectent pas l’économie, et elles incitent les fumeurs d’arrêter de fumer. En plus, elle avance que le tabagisme passif provoque plus de 600 000 décès prématurés par année dans le monde, et dans près du tiers des cas ce sont des enfants qui en sont victimes.

Pour faire passer les interdictions de fumer dans les parcs de l’Ancienne Lorette, on a eu recours à beaucoup de rhétorique. La rhétorique est un discours qui fait davantage appel aux émotions et aux sentiments et il est, hélas, facile d'obtenir ce qu'on veut de la part d'un peuple qui est dominé par ses émotions. Est-ce que le discours qu'on nous sert dans cet article approche un si peu soit-il la réalité ? Examinons ce qui en est :

Primo, des études effectuées par des professionnels en toxicologie qui déclarent aucun conflit d’intérêts, ont estimé que dépendamment de la substance en question, il faudrait entre 1250 et 1,000,000 de cigarettes fumées simultanément dans une pièce enfermée de 100m cubes et sans aucune ventilation, pour dépasser les seuils d’exposition acceptables pour l’être humain avant que cela devienne un risque pour la santé (voir le tableau à la page 5 de ce lien http://www.forces.org/evidence/download/ntp915c.pdf ) . Peut-on seulement imaginer à combien de cigarettes simultanément allumées on peut exposer un individu dans un parc sans aucun souci pour sa santé ?

Secundo, malgré ce qu’ils essaient de nous faire avaler, l’économie de l’industrie de l’accueil fut affectée à des niveaux plus ou moins différents suite aux interdictions de fumer et ce partout où des telles interdictions ont eu lieu. L’état du Nevada, dont l’industrie de l’accueil a essuyé des pertes substantielles, a d’ailleurs allégé sa loi anti-tabac pour permettre désormais de fumer aux endroits où on sert de la nourriture.  http://www.rgj.com/article/20110617/NEWS07/110617027/1002D’autres pays comme le Venezuela, la Croatie et la Bulgarie ont totalement abolit leurs lois respectives. La Hollande permet maintenant de fumer dans les petits bars et bistros qui n’engagent pas du personnel et plusieurs comtés américains ont d’une façon ou d’une autre allégé leur loi pour la rendre plus favorable à l’économie.


Tercio, contrairement aux dires de l’OMS, le taux de tabagisme est demeuré inchangé et a même augmenté à plusieurs endroits où des interdictions draconiennes telles qu’on les connaît au Québec furent implémentées. Le Québec ne fait pas exception. Tandis-ce que le taux de tabagisme dans l’année de l’interdiction en 2006 était de 20%, il était de 21% en 2009, et de 20% au courant de la première partie de 2010 http://www.hc-sc.gc.ca/hc-ps/tobac-tabac/research-recherche/stat/_ctums-esutc_prevalence/prevalence-fra.php


Pour ce qu’il est des enfants dont le tiers sont supposément emportés par la fumée secondaire, rien de plus absurde. Certes qu’il y a des enfants chez qui les crises d’asthme sont exacerbées par la fumée du tabac, mais généralement, tout comme on protège les enfants allergiques au lactose et aux arachides. la majorité des parents ont assez de jugement pour ne pas soumettre leurs enfants intolérants à la fumée du tabac à des endroits où la fumée est intense.  D'ailleurs, peut-on vraiment  trouver de la fumée intense dans les grands espaces verts du Québec ?  Pour le reste, lorsqu’on considère que cela prend un minimum de 20 ans pour un gros fumeur de peut-être contracter une maladie reliée au tabac et en mourir, combien d’années cela prend-il pour compromettre la santé d’un non-fumeur (adulte ou enfant) qui sent de la fumée des milliers de fois plus diluée lors d’une occasionnelle ou même régulière visite au parc ?


Les journalistes qui ont rapporté les dires de l’OMS, auraient eu intérêt de sauver leur crédibilité en faisant un peu de recherche avant de rapporter des telles aberrations sous la rubrique ‘’Santé’’. La section ‘’Insolite’’ aurait été plus appropriée. Tant qu’à nous, nous l’aurions volontiers classé sous la rubrique ‘’Chasse aux sorcières’’.

On ne fume plus dans les parcs à L’Ancienne-Lorette

Friday, 17 June 2011

MORE PROPAGANDA FROM THE WEALTHIEST NON-PROFIT SOCIETY, THE ACS

A report by none other than the American Cancer Society has found (as to be expected from any tunnel vision anti-smoking organization) that raising taxes and smoking bans could save $2 billion in health costs.


Never mind that smoking rates are either stagnating or increasing ever since smoking bans were enacted in various countries including the US, and this during hard economical times which only further proves that disposable income and prices have no real impact on smoking prevalence .  Health Advocates Hope Substantial Cigarette Tax Counteracts Increasing US Smoking Rate

Never mind that high tobacco taxes cause an ever increasing contraband problem which further subtracts governments from revenue.  Canada with $2 billion losses per year is the perfect example, however the U.S.A. has its very own contraband problems U.S. Attorney for the Southern District of New York Charges Elleven Members of Contraband Cigarette Trafficking Organization

The American Cancer Society is wasting tax payers' money and donations to make up reports that don’t even remotely ressemble reality.  Shouldn’t Americans be demanding that their precious tax dollars and donations be going towards better uses such as serious research into the causes of cancer?

Smoking Bans, Taxes Could Save Nearly $2 Billion in Health Costs

Saturday, 4 June 2011

THE WAR ON DRUGS IS A FAILURE - The Global Commission on Drug Policy

An international commission, the Global Commission on Drug Policy, issued a report that unequivocally states that the global “war on drugs” has failed with devastating consequences for individuals and societies around the world.  It recommends that nations end the criminalization, marginalization and stigmatization of people who use drugs but who do not harm others. Arresting and jailing millions of recreational drug users, farmers, couriers and petty sellers, has filled prisons and destroyed lives without making a dent in consumption and criminal activities linked to illicit drugs.  The commissioners therefore recommend that:

- Governments should experiment with the legalization of marijuana which can serve as a model to eventually legalize other drugs. 
 
- Offer health and treatment services as well as harm reduction programs such as clean needles.  


- Respect the human rights of drug users.  Abolish abusive methods of treating drugs users such as forced detention, forced labor and physical and psychological abuse.  


-  Deploy educational efforts grounded in credible information and prevention programs for the youth.  


- Focus repressive actions on violent criminal organizations, but do so in ways that undermine their power and reach while prioritizing the reduction of violence and intimidation. 


- Replace drug policies and strategies driven by ideology and political convenience with fiscally responsible policies and strategies grounded in science, health, security and human rights.

Kudos to the commissioners for their clarity in this issue!  Fears and taboos may cause some of us to disagree with the carrot approach these commissioners are recommending.  But when we think about it rationally and logically, is illegality really what deters most people from using drugs?   Admittedly, not too many people give illegality as the reason for not being attracted to recreational drugs.  To people who are attracted to them, their illegality is the last thing they worry about when they want to use them or abuse them and when they can get them as easily as making one phone call.  Eliminating many criminal cartels by making recreational drugs legal while implementing harm reduction programs, will most certainly benefit everyone including those who will have continued using them even if they had remained illegal.   Moreover, making them legal will perhaps have the added benefit of deterring defiant of authority young and less young people from using them because they will no longer have the ‘’forbidden fruit’’ appeal.

Download a copy of the report here:   http://www.globalcommissionondrugs.org/Report


Tuesday, 31 May 2011

LE CHAMPIX NE SERA PLUS REMBOURSÉ EN FRANCE !

Nous apprenons par Canoë.ca que les instances de santé françaises ont  ‘’mis leurs culottes’’ et ont annoncé qu’ils ne rembourseront plus le médicament pour le sevrage du tabagisme, le Champix.  Nous aurons préféré de lire qu’ils interdisaient sa vente totalement en raison de tous ses effets secondaires y compris le suicide, mais c’est quand même un pas dans la bonne direction qui, nous espérons, découragera les fumeurs d’y avoir recours.  Rappelons à nos lecteurs que le Dr. Michael Siegel, anti-tabagiste notoire, a déjà demandé à ce que ce médicament soit retiré du marché.   

Le mécontentement des anti-tabagistes  ne nous surprend aucunement étant donné que plusieurs entre eux entretiennent des relations incestueuses avec l’industrie pharmaceutique.  Il y en a même une anti-tabagiste britannique qui a déjà exprimé qu’il importait peu que ce médicament soit dangereux car 50% des fumeurs vont mourir des méfaits de leur tabagisme de toutes façons !  (“We are talking about a fairly unhealthy section of the population anyway . . . one in two will die because of smoking.)

Bravo à la France !  Il reste à espérer que le Canada suive.  

Célébrons la journée internationale sans tabac en motivant ceux qui désirent d’arrêter, de le faire sans médication.  Des millions l’ont fait à travers le monde avant que l’industrie pharmaceutique les prenne en otage en leur inculquant la notion qu’ils sont trop dépendants pour y arriver sans la pharmacothérapie.  


Friday, 27 May 2011

ONTARIO LUNG ASSOCIATION - CHARITY ORGANIZATION OR BIG PHARMA FRONT GROUP?


Pharma inhaler ressembling a tampon
Nicotine replacement therapy has been ever increasingly marketed aggressively since the early 90’s. Over the years, the pharmaceutical industry has been attempting to make it ever more attractive to consumers by sugar coating it and enhancing its flavor with fruit and mint essences – while at the same time they mudsling the tobacco industry for marketing attractive and kiddy friendly smokeless tobacco products.  Many nicotine replacement products such as lozenges, patches and even inhalers - poorly mimicking the act of smoking with devices ressembling tampons - are continuously peddled to the public directly by the pharmaceutical industry, pharmacists and anti-tobacco advocates. They have even succeeded to convince governments in various countries (including the province of Quebec) and private insurance companies to reimburse the cost of using nicotine replacement therapy which costs pennies to manufacture but is indecently marked up when it reaches the consumer. Pr. Robert Molimard had this to say on the cost of nicotine: ’ Nicotine presently costs, if you buy it at Fluka -- that is an international chemical product company -- 440 euros per liter. An average cigarette will deliver to you about 0,8 mg of nicotine -- since there are 1 million of 1mg in one liter – it would mean 1 200 000 cigarettes. In other words with one euro -- and you can calculate it yourself -- you would buy 143 packs of cigarettes. http://cagecanada.homestead.com/CorporateShenanigans.html

One can rightfully think that it’s all worth it if it really helps people stop smoking for good . Unfortunately this can’t be further from the truth. Reputable studies have shown that nicotine replacement therapy has very poor (as little as 1,6%) long term success rates. Such poor succes rates would not have only never been acceptable for any other type of medication but public or private insurance plans would have categorically refused covering its costs.

Yet nicotine replacement therapy gets a free, no questions asked, pass. Why? Part of the reason may reside in the fact that when it comes to the tobacco issue, Big Pharma tends to do its  lobbying and bidding through the sponsoring of associations that politicians, insurance companies and much of the public blindly trust, or at least pretend to. Who would dare question the authoritarian opinion and advice of long established charity organizations such as the cancer, the lung and heart associations?  It would be political and professional suicide and would be considered as a callous attitude if either politicians or other authoritarian entities dared to challenge their contentions.  Nicotine replacement therapy therefore remains a) heavily prescribed b) continuously reimbursed either through private or public medical insurance plans in various countries including the province of Quebec c) highly lucrative repetitive business for Big Pharma d) an un-attackable myth

The latest campaign to boost nicotine replacement therapy and the dangerous drug Champix (Chantix in the USA) and Zyban which carry a black box warning in the U.S.A., comes to us from the Ontario Lung Association.


In a recent press release that the Canadian press picked up (linked below), they are launching the ''Abolish Word Habit Program''  which is campaigning  for stopping to call smoking a habit and start calling it by what it is i.e. an addiction.

They explain how quitting smoking is harder than quitting heroin and cocaine and how nicotine is delivered to the brain in the addictive format.

Then they switch into their offensive mode of peddling nicotine replacement therapy and medication and especially their main agenda for this particular campaign:  getting public healthcare and private insurance plans to cover nicotine replacement therapy and Champix/Zyban :

‘’Seventy-nine per cent of smokers surveyed said they would be more likely to try at least one smoking cessation medication if they were free of charge.


(…) most smokers can't quit cold turkey and politicians need to step up.’’


He advocates counselling, nicotine replacement therapies and medications that people can afford through a drug plan.’’

How shameful for the Ontario Lung Association to lobby  for the squandering of public funds and especially that our public healthcare system is on the verge of becoming totally unsustainable!

Oh, just in case anyone still thinks that their motives are noble, reading the very last sentence of their press release should convince even the most skeptical of our readers:

‘’The association's 'abolish the word habit' program is being sponsored by the drug company Pfizer Canada Inc.’’

We will leave the last word on nicotine addiction to Pr. Robert Molimard’s expertise and wisdom.  Excerpt from: BELIEFS, MANIPULATION AND LIES IN THE TOBACCO ISSUE - Robert Molimard

The big fraud in the tobacco issue was none other than the publication of the 1988 Surgeon General Report entitled “Nicotine Addiction’’. This fraud is incomprehensible unless one sees the link with the launch of the nicotine gum. The major premise of the Report seems to be a syllogism that states: “Tobacco products cause a powerful addiction’’ The minor premise is: “Tobacco contains a neurotropic poison - nicotine’’. Hence follows the conclusion: “Therefore nicotine is responsible for the addictiveness of tobacco’’. But there is no evidence that allows us to draw such a conclusion. A host of other assumptions are possible, and there are even major arguments to oppose it, such as the fact that no cases of nicotine dependence have ever been documented when this substance was used in isolation, as was already established long before the “Medication Enterprises” began marketing nicotine as a form of medication.

(…)having arbitrarily decided that nicotine alone explains tobacco dependence and having it engrained in the minds of doctors, the authorities and the public, any research on the other possible factors of this dependency is now excluded in advance and a vast new market is made available for commercial exploitation by the pharmaceutical industry.

Kick the habit of calling smoking a habit, it's an addiction: lung association

Monday, 23 May 2011

ARE DOUGHNUTS IN HOSPITALS OUR MOST PRESSING ISSUE?

We are informed that doughnuts will disappear from Tim Hortons shops at Halifax-area hospitals this fall. Oh great, another feel-good policy that encroaches on people’s individual freedoms instead of tackling real problems.



Timbits should be the least of our worries when admitted into a hospital especially that we are free not to indulge in them as opposed to ingesting an overdose of medication inadvertently served to us by an overworked nurse - accident over which we have absolutely no control. A comprehensive 2004 study in the CMA Journal found that preventable medical errors contribute to between 9,000 and 24,000 deaths in Canada a year as reported by the CBC at the time.


Admittedly, our medical authorities and administrators have more pressing issues to address than micromanaging what we eat through bans unless of course our medical condition dictates otherwise. It’s not as if the patient who insists on having a doughnut after (or instead of) a hospital meal will not get a relative to bring one or a dozen when visiting. The question begs to be asked that if they are going to dictate to Tim Horton’s to leave off the menu the main food item they are known for, why are they allowing them a franchise on the hospital premises in the first place? How long before they also ban them from selling coffee?

Tim Hortons: Should doughnuts be banned from hospitals?

Saturday, 14 May 2011

L'EFFET NOCEBO


Canoe.ca nous informe qu’une étude de l’université McGill a découvert que 1 sur 5 médecins et psychiatres prescrivent des placebos à leurs patients.  ‘’ Bien que plusieurs médecins disent prescrire des placebos pour «faire plaisir» à leurs patients qui souhaitent sortir du cabinet médical avec une ordonnance en main, 60% des psychiatres interrogés dans le cadre de la recherche déclarent croire à l’effet thérapeutique des placebos. L’«effet placebo» ferait en sorte qu’une personne qui pense recevoir un traitement actif se sentirait mieux par un mécanisme psychologique d’autosuggestion. Seulement 2% des psychiatres ne croient pas à l’effet placebo.’’

Si 98% des psychiatres et plusieurs médecins croient à l’effet placebo,  il va de soi qu’ils croient également à son contraire - l’effet nocebo.  Il ne peut y en être autrement.  L’effet nocebo est ce qui se produit chaque fois qu'un médecin ou autre professionnel de la santé cause plus de tort que de bien lorsqu’il fait appel à l’état émotionnel de son patient.  Dire à un patient qu’une procédure médicale sera extrêmement douloureuse, par exemple, peut faire en sorte que le patient sentira plus de douleur que si on lui avait rien dit.  Selon la Framingham Heart Study, une étude américaine continue concernant les maladies cardio-vasculaires, les femmes qui se croyaient susceptibles à des maladies cardiaques étaient quatre fois plus susceptibles de mourir de telles maladies que celles qui, tout en ayant des facteurs de risque semblables, ne le croyaient pas.  La littérature nous indique aussi que l’effet nocebo peut être contagieux.  On nous donne comme exemple le cas d’un professeur  qui signala une odeur d'essence à l’école qui lui a vraisemblablement causé des maux de tête, des nausées et des étourdissements.  L’école a été évacuée. La semaine qui suivit, près d'une centaine d'étudiants et personnels se sont présentés aux urgences avec des symptômes similaires.  Aucune explication médicale ne pouvait justifier ces symptômes malgré les divers examens médicaux qui ont été effectués.  Cependant, un questionnaire a fait ressortir que la plupart des patients connaissaient ou avaient vu une personne malade avant de développer les mêmes malaises qu’eux.

Sachant qu’un si grand nombre de professionnels de la santé croient à l’effet placebo et nécessairement à son contraire, l’effet nocebo qui en latin signifie ‘’je nuirai’’, comment est-ce qu’ils peuvent rester aussi passifs devant les diverses ‘’campagnes de peur’’ que la santé publique administre à la population au quotidien et même y participer ?  N’est-il pas de leur devoir de se révolter devant ces campagnes de santé dites préventives qui suscitent des grandes peurs aux plus vulnérables au point de les rendre malades autant psychologiquement que physiologiquement ?  (Voir notre article DE LA GASTRO À LA PSYCHOSE EN PASSANT PAR LA VARICELLE )

N’est-il pas du devoir de chacun de nos médecins et spécialistes d’exiger auprès de la santé publique et les médias de mettre un bémol aux messages de santé dits préventifs qui, au lieu d’aider la population, causent sans doute  l’effet contraire allant jusqu’à possiblement créer le phénomène d’hystérie de masse ?  


Plusieurs médecins prescrivent des placebos