Liverpool NHS PCT Offering Quack Mysticism as Cancer Cure
Rudolf Steiner's mystical beliefs in mistletoe alive and well in an NHS Hospital.
Liverpool NHS Primary Care Trust funds a Department of Homeopathy, one the last four remaining publicly funded homeopathic hospitals in the UK. It publicises that the clinic in the Old Swan Health Centre can offer homeopathic treatments for everything from arthritis to depression and bowel disorders. There is no good evidence that this is an effective use of public money. Indeed, as was reported in the Guardian yesterday, it looks like the few doctors who support the use of this 19th Century quackery in a modern healthcare system have to depend on misleading representations of the research data in order to justify the expenditure.
Once you appear to believe in one set of nonsense, then you are likely to get involved in all sorts of daft treatments. The Liverpool homeopathy department does not make an exception. On its web page, it tells us that it also offers,
a complementary cancer care service using Iscador which is a mistletoe based anti-cancer treatment. Iscador has been in use as a treatment for cancer since the 1920’s. It is in widespread use in Germany and Switzerland where it is one of the most widely used anti cancer therapies.
Iscador is not a homeopathic treatment, but an approach advocated by one of the greatest mystics and quacks of the 20th Century, Rudolf Steiner.
Steiner was a homeopath who took the ideas of Hahnemann and developed a whole new mystical approach to medicine – anthroposophical medicine. Its pretty bonkers stuff with astral bodies, angels and spirits being at the heart of not only his medicine, but also his beliefs in agriculture. His biodynamic methods involved making fertiliser out of cat skulls and deer bladders. Astrology was central to his thinking. He proposed mistletoe as a cancer treatment as it grows on trees like a cancer. And given his homeopathic beliefs of ‘like cures like’ that was enough evidence for him to get cracking. That is it.
Steiner’s preparation techniques for many of his potions were quite strange. If your farm gets infested with mice, Steiner tells us to “catch a fairly young mouse and skin it . . . at a time when Venus is in the sign of Scorpio”, then to burn the skin and scatter the ash over our fields. “Henceforth, your mice will avoid the field.” For fertilizer you can use a cow horn with crushed quartz and burying it in the field you wish to help. Similarly, mistletoe preparations for cancer treatment needs a mixture of mistletoe sap collected both in the Summer and the Winter. Steiner is quite simply an advocate of voodoo and Liverpool NHS PCT appears to happy to adopt it.
Because Steiner’s beliefs have become very popular in mystical circles, most notably through the schools that follow his equally batty educational philosophy, mistletoe has been used as a popular treatment of cancer with many advocates.
But is there any evidence that it actually works? As usual, when we have a crank cure we will find lot of small studies or deeply flawed studies that make up an evidence base. The studies have been reviewed and there is very little convincing evidence that this treatment does anything for the patient. This is odd given that Liverpool NHS PCT tell us that Iscador can induce cell death in cancer cells, allows immune cell populations affected by cancer to regenerate and protects the DNA of healthy cells. Patients are supposed to “feel better and stronger, sleep better and have less pain”.
In 2006, Edzard Ernst, Professor of Complementary Medicine gave a very straightforward message in the BMJ,
Mistletoe has been tested extensively as a treatment for cancer, but the most reliable randomised controlled trials fail to show benefit, and some reports show considerable potential for harm. The costs of regular mistletoe injections are high. I therefore recommend mistletoe as a Christmas decoration and for kissing under but not as an anticancer drug. At the risk of upsetting many proponents of alternative medicine, I also contend that intuition is no substitute for evidence.
The current Cochrane review of the evidence (2010) shows that despite there being many studies of mistletoe therapy, the trials tend to be of poor quality with lack of randomisation, and poor reporting quality.
The evidence from RCTs to support the view that the application of mistletoe extracts has impact on survival or leads to an improved ability to fight cancer or to withstand anticancer treatments is weak. Nevertheless, there is some evidence that mistletoe extracts may offer benefits on measures of QOL during chemotherapy for breast cancer, but these results need replication.
A review by Ostermann, Raak and Büssing (2009), despite coming to a fairly positive but qualified conslusion about mistletoe, found evidence of significant publication bias by looking at funnel plots. Funnel plots are graphs of the treatment effects found in studies plotted against study size. If researchers are fairly publishing their results it should have a symmetrical shape. If it is skewed, it suggests researchers are withholding less favourable results from publication and, hence, reviews of all studies may conclude that there is a stronger effect than there really is. This is what Osterman saw in the studies of mistletoe.
There are other problems too. Patients who receive mistletoe therapy may suffer from distinct (but apparently fairly mild side effects) such as skin reactions at the injection site. This has the effect that patients enrolled into trials can easily find out if they had the real treatment or a placebo. Knowing whether you received a placebo or not makes it more likely for you to misreport your experiences – that is why trials must be blinded. Hence, we would expect even blinded trials to overstate their benefits.
Given that this is a therapy that was invented from a mystical ramblings of a irrational mind and that its use based on an evidence base riddled with poor quality studies, it would be safe to conclude that mistletoe therapy is of little or no value.
We regularly hear how cancer patients in the NHS are denied therapies because they do not prove to be cost effective under the NICE guidelines. It is quite right that all treatments are subject to scrutiny to ensure public money is being spent in the best manner. Somehow, so called complementary therapies slip under this hurdle and patients are being injected in Liverpool with a drug that is almost certainly worthless. It is not cheap either. The brand of mistletoe injection used by Liverpool PCT is made by Weleda, the company founded by Steiner in the 1920s to flog his preparations. It is still in private hands and based in Switzerland (like all the best Pharma companies) and produces homeopathic, biodynamic and anthroposophical products based on the crackpot mysticism of Steiner. It operates in 53 countries and has over 2,000 employees. Its revenues are hundreds of millions (about $300 million in 2005) and the majority of its pharmaceutical revenue came from mistletoe treatments. I can see no obvious reason why its claims should be treated with less rigour than its Swiss neighbours when it comes to flogging drugs to the NHS.
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From the homeopathy page at weleda.co.uk:
"Homeopathy does not treat diseases but, rather, individuals with specific symptom pictures."
Then two paragraphs down:
"The theory and philosophy of Homeopathy is far more complex than has been detailed here – however such knowledge is not essential in order to use Homeopathic medicines for every-day ailments. For more complex ailments please seek the advice of a Doctor who specialises in Homeopathy"
And further down:
"For minor, self-limiting conditions, self-help or counter-prescribing is applicable – as with conventional medicines."
Black is white, up is down, round is square.
You say 'Given that this is a therapy that was invented from a mystical view of the world and that is riddled with poor studies, it would be safe to conclude that mistletoe therapy is of little or no value.' But I wonder if we can dismiss it's effectiveness if no decent studies have been performed? We surely can't know either way without evidence.
From an idiot,
Megan- we have no decent studies performed on the existence of pink unicorns and leprechauns, does this mean we should assume that they exist too?
It is up to those who make claims to back them up- where these treatments are potentially hazardous and for such critical illnesses such as cancer- where delaying conventional treatment for made up rubbish such as this has killed many people already, this evidence is critical before it is allowed to be supplied.
Megan said: "I wonder if we can dismiss it's effectiveness if no decent studies have been performed?"
I have a cure for cancer: Instead of eating your lamb chop, suck the marrow out of the transected bone.
Hey, don't dismiss it – no decent studies have been performed yet.
I understand that it is the job of people making quacky claims to back them up. What I am saying is that their appears to be no evidence either way. While in practical, logical and financial terms it is preferable not to give a treatment because it has no evidence base, from a scientific point of view the possibility that it works cannot be dismissed. It is an unanswered question. If you don't understand this, you are missing a fundamental point of scientific enquiry.
Megan – not all claims are equal. On what basis do we believe that Steiner's claims might actually be true? Since he came to his beliefs in mistletoe through nothing but mystical intuition it would indeed appear to be miraculous if they were true.
To put it another way: there is no evidence to suggest there is not a tiger in my kitchen right now. That does not mean that it is likely that there is a tiger in my kitcehn.
kind of OT, sorry, but spotted this just now – http://www.mumsnet.com/Talk/allergies/910397-nhs-direct-advice
someone reports ringing NHS Direct for advice on dealing with after effects of allergic reaction in young child and being asked if they had ever thought of homeopathy…
obviously difficult to verify but worrying if true
To gain some understanding of the confusion felt by CAM supporters/ practitioners at their attempt to better the plight of patients’ illness with CAM alongside usual medical care (evidence based or not) and develop insight into the vehemence of anti -CAM sentiment you might find this link of assistance, but then again you might not? http://www.alice-miller.com/video.php suggest you click on the ‘roots of violence are NOT unknown’ offering or check out the home page? http://www.alice-miller.com . It can sometimes appears a great big stick is being used to attempt to beat submission from disobedient CAM supporters, for them to refrain from detracting/ questioning the fashionable dogma espoused by the current swathe of vociferous authoritarian ‘fashionistas’? (The History of medicine is littered with discarded fashions) Looks like a parallel to contemporary political manoeuvres and even the ‘QOF stick’ in General Practice? Might even shine a light on pan-specialty ‘functional illnesses’- which are a huge drain on ‘NHS tax paid’ resources?
Rejecting hypotheses based on incredulity is unscientific, unethical and endangers the public interest. Megan is quite right. History of science abounds with examples of such institutionalised prejudice impeding progress.
With cancer treatment we should remember the Hippocratic oath: DO NO HARM, and give first preference to ideas that create and sustain health, rather than poison the organism. The War on Cancer waged through chemotherapy and surgery is lost – time for open-minds at least from you sceptics.
If you all find it hard to believe Steiner’s elementary idea that lunar cycles affect nature (and therefore growth), you could try my Biodynamics 101 course which starts with 6-hour fieldwork trial where you chain yourselves to the seaward end of a breakwater at low-tide
but hey don’t – you guys are too much fun..
Rejecting hypotheses based on mere incredulity may well be unscientific, but accepting hypotheses on credulity is far worse.
If you actually read my article you will note that I reject the mistletoe hypothesis on both a) its absurd origins and b) the lack of any credible and convincing evidence that it might be true.
Merely believing it is true because it is possible is also a way in which scientific progress can be hindered.
@bemused, a belief is not a hypothesis.
Well it’s incredulous to me that no reputable academic institution has not completed the requisite trials if there is even a suggestion of a result in the case of cancer. Despite all the millions of pounds going into conventional research, the public are still faced with the same choice of radiotherapy, chemotherapy and surgery. I would suggest that there are very few people who have any idea of what is actually being researched and what advances are being made in this field. Every few years there is a media report about some new advance with the caution that many years of research are required before a treatment can be expected. Years pass with no word of any failure or success. There is much talk about the lack of evidence in homeopathy yet it would be a simple matter to prove its effectiveness. A double-blind randomised trial using homeopathically prepared allergen such as pollen to show that the homeopathic preparation at least (if not the method traditional method of prescription) does have a therapeutic effect. The question is who would carry out the research? If the research is carried out by proponents or practitioners of homeopathy it is disregarded as being biased or discredited by those with vested interests as of “poor quality”.
[...] list of complaints to Bristol. However, it does have a very peculiar speciality in that it offers mistletoe treatment for cancer. This is a hocus-pocus treatment based on the mystical musings of Rudolf Steiner who believed [...]