The Quackometer

Professor Jayney Goddard is the president of the Complementary Medical Association (CMA), "the world's largest professional membership body for complementary medicine" and has been elected a Fellow of the Royal Society of Medicine. She studied homeopathy at Imperial College for five years and has won numerous awards. According to various sites, she is "considered to be among the world’s leading experts in complementary and integrated medicine."

Impressive stuff. No wonder she was invited onto today's The Wright Stuff to debate with Simon Singh on the subject "Homeopathy: A Waste of Money". Indeed, Jayney Goddard is a regular guest on the show and boasts an impressive appearance list in other shows, including being resident 'Expert' on Discovery TV. But Jayney appeared to state a number of surprising factual errors and have some over optimistic interpretations of the research literature (and I will come onto these). How could such a eminent expert make such mistakes? I thought a little background research might be in order.

So, President of the CMA, "the world's largest professional membership body for complementary medicine". What is the CMA? Well, the CMA web site does not appear to be what I expected. It offers some articles, sells a few books and food supplements and offers marketing services for members. Looking at Company House records, the CMA is registered address is Chase Bureau Services, a supplier of 'off the shelf companies' and other company secretarial services. So, no 'head office' for the CMA then. The web site for the CMA is registered to a private individual with an address given in a residential block of flats in Wandsworth. I'm disappointed. The CMA is not sounding so grand as I first thought. However, the CMA does usefully offer viewers of the Wright Stuff options to buy products that Jayney mentions on air. It looks to me like Jayney Goddard is president of a shop.

So, what about being Professor Jayney Goddard? We are told that Jayney was "recently awarded a Professorship from Mahendra Sanskrit University in Kathmandu, Kingdom of Nepal". The university was set up to promote the Sanskrit language in Nepal. However, when I tried to contact the University to find out more about Jayney's Professorship, I found their website is permanently down. Unfortunately, it would appear that in 2002, a hoard of women Nepalese Maoist rebels reduced the University 'to cinder' and destroyed all the ancient Sanskrit texts, University buildings, furniture, and all university records. The rebels had previously planted a 'crude but powerful bomb' there too. It is not clear if Jayney Goddard makes frequent visits to fulfil her Professorial duties.

And what of these claims to have studied homeopathy at Imperial College? The University is one of Britain's most prestigious degree level teaching and research institutions. It does not offer a degree in homeopathy. Elsewhere we are told that her qualifications are "diploma in hypnotherapy and is a Licentiate of the London College of Classical Homeopathy". No qualifications from IC then? This is a puzzling one.

And finally, Jayney says she has been elected a Fellow of the Royal Society of Medicine. What does it take to become a Fellow of the Royal Society of Medicine? The answer looks to be about £356 for a London resident. You can join online. I filled in the form and elected myself to become a Regional Fellow for £287. Bargain! Le Canard Noir, Fellow of the Royal Society of Medicine. Magnificent! My mum will be so proud. It looks like Jayney could become a Fellow as her 'presidency' of the CMA is obviously a 'senior management' role in healthcare.

There is so much more on Jayney's CV that we could explore. But enough for now.

So, what of these errors she made on the Wright Stuff? Simon Singh was arguing that the totality of scientific evidence for homeopathy showed that it was ineffective and a placebo based therapy - unsurprising given that it is just plain sugar pills. Jayney tells us though that 'outcome trials' are the way to measure homeopathy. These trials almost always give you positive results for homeopathy - they are just not very good as they do not compare homeopathy against any control group. It is impossible to know if the effect was caused by homeopathy or it was just people getting better on their own. Simon argues this, so Jayney went into animal experiments and this is where she lost the plot.

There is just some research printed recently, I think it was actually in Immunology which is one of the worlds leading scientific journals and it showed that mice exposed to something causes Chagas disease (guffaws) ... these mice were treated homeopathically, prior to being infected. It was a properly run double blind placebo controlled trial - the gold standard that Simon is actually talking about - and what actually happened was the untreated mice died, the mice that were treated did not get the disease.

Wow. But is it true? Well, no.

The research was done, but not published in Immunology. It was published in the in-house comic of the Faculty of Homeopaths, Homeopathy - a rag with as much scientific integrity as the Beano. The paper, "Effects of homeopathy in mice experimentally infected with Trypanosoma cruzi ", did not say that the untreated mice died or that the treated mice did not get the disease. It reported that more mice died in the control group but that this was not statistically significant. But the main criticism would be that the statistical certainty of effects were low (only p<0.05) and that multiple measurements were being made in five groups that would undoubtedly result in many false positives. If Professor Jayney Goddard thinks this is the best evidence for homeopathy, then we can be pretty sure it does not work. What is certain, is that this TV show was not the right forum for discussing p-values.

But Jayney went on to discuss homeopathy for childhood diarrhoea. She talks of trials 'all over the world, in developing countries' where children with diarrhoea have been treated with homeopathic medicines and also placebos and Jayney claims that the children who have been treated homeopathically had shorter periods of diarrhoea. Jayney tugs the heartstrings and tells us that the poor children of Burma, after the recent cyclone, could benefit enormously from such treatment. Undoubtedly, it is the sceptic scientists like Singh who get in the way of saving the children. Again. Is this true? Again, no. Diarrhoea and homeopathy is really just one researcher's passion - Jacobs. She has been involved in a number of trials in places such as Nepal and Nicaragua. Individually, these trials did not show a strong significant effect for homeopathy. But when Jacobs did her own meta analysis on three trials, she claims to be able to show a statistically significant effect. Jacobs suggests that "larger sample sizes be used in future homeopathic research to ensure adequate statistical power".

As meta analyses go, doing your own analysis on just three papers that you have been involved with is not really showing multiple independent confirmation of your result and is unlikely to be sufficiently self-critical of the work and take adequate precautions usually found in competent meta-analyses. Tellingly, Jacobs did go on to do another larger trial in Honduras in 2006. The conclusion was,

The homeopathic combination therapy tested in this study did not significantly reduce the duration or severity of acute diarrhea in Honduran children.

Showing his own biases, the paper did not discuss the possibility that homeopathy could not work, but rather that the homeopathic pills had been stored incorrectly and so on.

In discussing the Chagas and diarrhoea trials, Jayney Goddard misled her TV audience. It would have taken half an hour for Singh to untangle that lot, even if he had the relevant papers to hand. Given the the show host was acting like a moron pretending him and his friends did not need protection in malarial areas, Simon Singh did not have a chance of getting clear science across.

The most telling moment came when one of the other guests asked,

Simon, you've got trials that prove your case, Jayney, you've got trials that prove your case, which makes it very difficult for us to know where the truth lies.

Well, if Simon's colleague, a real professor of complementary medicine from Exeter University, Edzard Ernst, had come on, then perhaps there could have been a rational and fruitful discussion about the role of homeopathy in the NHS. But instead of Professor Ernst, we had to have a Professor from a long-since burnt down Nepalese Sanskrit University who runs a web site selling homeopathic books and pills. That, in my opinion, creates the obvious confusion shown on this show.

Labels: BPSDB, homeopathy, Jayney Goddard

 

In a recent post, I described how Neal's Yard Remedies had withdrawn their Malaria homeopathy pills. Their press release said,

as this is obviously a contentious issue which is causing customer concern, we have decided to withdraw the product, Malaria Officinalis 30c from sale with immediate effect.

I described this as bullshit, just like the rest of their press release. The much more likely cause was that they were being investigated by Trading Standards and the MHRA - the medicines regulator in the UK - after a BBC investigation had 'stung' one of their branches.





Well today, the MHRA have issued their own press release, which I will reprint here...

The Medicines and Healthcare products Regulatory Agency (MHRA) has clamped own on a homeopathic remedy intended to be viewed as a treatment or preventive for malaria sold by the cosmetic chain, Neal’s Yard Remedies. The MHRA has received confirmation from the company that the remedy, Malaria Officinalis 30c, will be removed from sale immediately.

All homeopathic remedies are classed as medicines and require prior authorisation by the MHRA before being placed on the market. The MHRA was concerned that no record of an authorisation had been given for Malaria Officinalis 30c and therefore concluded that it was an offence to sell, supply or to advertise this product which had not been authorised.

David Carter, Head of the Borderline Team at the MHRA said, “This product was clearly intended to be viewed as a treatment or preventive for malaria, which is a serious and potentially life-threatening disease. We regard the promotion of an unauthorised, self-medicating product for such a serious condition to be potentially harmful to public health and misleading. We are pleased that Neal’s Yard Remedies have complied with our request and removed this product from the market.”

So, Neal's Yard ethical bullshit has been exposed.



Now, I emailed their MD, Jonathan Hook, to ask if he supported the claims made by his unmedically qualified Medicines Director, Susan Curtis. In her book Homoeopathic Alternatives To Immunisation she describes how similar remedies could prevent malaria. Some of them are still for sale. No reply so far.



The book is still for sale on Neal's Yard's website. It continues to make alarming claims...

An invaluable guide for all trevellers[sic]. This book contains practical
information on preventing and treating major infectious diseases, including hepatitis, flu, measles and whooping cough.

Only the claim for malaria has now been dropped.

It looks like Neal's Yard has done the absolute minimum to avoid prosecution. This is shameful and is contemptuous of its customers. When is Neal's Yard going to come clean and do the right thing?

And let us not forget, Neal's Yard were only acting as resellers for Ainsworths. Are the MHRA going to anything about that company too?

***********************************************************************

The BBC have now picked up on this story. "Firm 'misled' over malaria drug". Of course, it wasn;t a 'drug' they were selling, but a plain sugar pill.

Labels: homeopathy, Neal's Yard Remedies

 

Edzard Ernst has accused practitioners of alternative medicine of lying to their patients. In last week's New Scientist he gave an interview where he described his childhood experiences with homeopathy, and his subsequent medical and homeopathic training, and his work in the only German homeopathic hospital. His conversion to doubt has been slow and guided by the evidence. He now believes that homeopathy is nothing more than a placebo therapy. That is what the science says. According to Ernst, the continued popularity of homeopathy is essentially due to homeopaths lying to their patients about the state of research into the subject. If they told the truth, their businesses may collapse.

Now, Dr Brian Kaplan, a medically qualified homeopath, has taken exception to Ernst remarks and thrown down the gauntlet - pistols at dawn. Kaplan says,

I have met hundreds if not thousands of homeopaths in my career. Some have indeed believed in some strange things, some have been very naive indeed in my opinion, but I have never met a homeopath whom I thought was lying to his/her patients. They may have said things to patients that Ernst thinks is untrue but that is very different from lying which is the deliberately not telling the truth.

Now, for once, I would pretty much like to agree with Kaplan. I think few homeopaths are out-and-out liars. Lying is not the word for what homeopaths do. The actual word that is most commonly appropriate is 'bullshitters'.

To explore this issue, I would like to draw on the work of renowned moral philosopher and Professor Emeritus of Philosophy at Princeton University, Harry G. Frankfurt. In 2005, Frankfurt published an essay entitled On Bullshit. This groundbreaking work explores the philosophical meanings of bullshit, why there is so much around and how it differs from other sorts of untruths.

Frankfurt argues that bullshitting is not the same thing as lying, but both are an abuse of the truth. In his words,

It is impossible for someone to lie unless he thinks he knows the truth. Producing bullshit requires no such conviction. A person who lies is thereby responding to the truth, and he is to that extent respectful of it. When an honest man speaks, he says only what he believes to be true; and for the liar, it is correspondingly indispensable that he considers his statements to be false. For the bullshitter, however, all these bets are off: he is neither on the side of the true nor on the side of the false. His eye is not on the facts at all, as the eyes of the honest man and of the liar are, except insofar as they may be pertinent to his interest in getting away with what he says. He does not care whether the things he says describe reality correctly. He just picks them out, or makes them up, to suit his purpose.

Homeopaths are renowned bullshitters. They do not care about the truth. They are extremely reluctant to say anything definitive that can be proven wrong. They do not test their ideas themselves in any meaningful way. They will say anything to make themselves look plausible in the face of sincere criticism. Instead of addressing the concerns raised by Ernst, they bullshit about conspiracy theories about how pharmaceutical companies are funding people like him to discredit them. There is not a shred of evidence for this - but that does not matter - they just bullshit away.

We saw Neal's Yard Remedies this week after they were caught dishing out useless sugar pills to prevent malaria bullshitting for England. Their PR department will undoubtedly be winning PR bullshit awards over that attempt to get-out of-gaol-free.

We have seen The Society of Homeopaths trying to bullshit their way out of similar accusations, issuing press releases that really did not appear to care if what they were saying was the truth. They claim to be consulting with the Department of Health over self-regulation. A freedom of information act request suggest otherwise.

We see their 'intellectuals' publishing papers on quantum mechanical explanations for homeopathy. It is utter bullshit of the highest order, but that does not matter, because the homeopaths lap it up.

When homeopaths, like Kaplan, only partially review the evidence for homeopathy, cherry picking the positive studies and ignoring the overwhelmingly disappointing, they are bullshitting. By continuously saying that meta-analyses are 'discredited' when they are not is just pure bullshit.

Bullshit may not cover all homeopaths abuses of the truth though. Some have seen Frankfurt's analysis of truth abuses as incomplete and in need of further revision and extension. It was therefore necessary for former Oxford Wilde Reader in Mental Philosophy and current Professor of Philosophy at the University of Miami to publish an essay entitled mindfucking.

McGinn's 2008 analysis notes that not everyone who engages in speaking without regard to the truth is a bullshitter. They may well be just telling stories, or singing a song, and is not making any claims to be either telling the truth or a lie. Defining a bullshitter cannot be done by just noticing a disregard for truth.

In examining the true nature of bullshit, we discover that in order to be a bullshitter you must intentionally represent yourself as competent and sincere and be trying to place this false belief in the listeners head that you are telling the truth. As such, a bullshitter is not completely indifferent to truth and falsehood as Frankfurt has suggested. We can see how homeopaths publishing papers on quantum mechanics gives the impression that they know what they are talking about in this area. There is the intention to come across as an authority. The fact that these papers are not published in quantum physics journals should set off loud alarm bells. There is no one in an alternative medicine journal capable of telling the authors that the paper is bullshit and so rejecting it.

But deeper into this new analysis of truth abuse comes the concept of mindfucking. Both liars and bullshitters are concerned with beliefs - that of what their listeners think. There are always two untruths for the liar and the bullshitter - the (possible) untruth of what is being said and the untruth of the belief in the listeners head that what is being said is sincere. The mindfucker, on the other hand, does not just care about their listeners beliefs and what the listener thinks of them, but about manipulating their emotions too. The intention is to disturb and abuse. The mindfucker seeks to raise emotions of alarm, confusion, insecurity, fear and hatred. At the very least, mindfucking is using emotion to manipulate thought.

And this is where we can see that homeopaths are most definitely mindfuckers. It is just not good enough to lie to you patients about the power of the pills. It is also not good enough to bullshit about evidence. Homeopaths find it necessary to fuck with people's minds. They tell them that the real enemy is their doctor. They scare them in one-sided stories about the harm that drugs and immunisations do. They tell them their medication will do them more harm than good. They talk incessantly about side-effects of drugs as if the actual effects of the drugs and the illness itself were secondary issues.

Is Kaplan guilty of a mindfuck in his criticism of Ernst? Instead of addressing Ernst's evidence of the ineffectiveness of the majority of complementary medicine, Kaplan accuses Ernst of ignoring the supposed lack of evidence behind conventional medicine. It is a mindfuck because it plays to the usual emotion of distrust in Big Pharma, it deflects from the issue and seeks to cause alarm about Ernst's motives. But of course, Ernst is Britain's only Professor of Complementary Medicine and it is a complete red herring to accuse him of ignoring a subject that he never intended to study. There are thousands of researchers in Britain studying and improving the evidence base of medicine and yet Kaplan wants to attack Ernst over it. The irony is of course is that Ernst is improving the evidence base of CAM - people like Kaplan do not like the answers coming out of his department. Let's fuck with people's minds instead.

So, I am not sure if Ernst is going to take up Kaplan's offer of a duel. My bets would be on the canny German. They still train people to duel there, you know. Kaplan has not made a case that a duel is necessary. Rather, it is up to Kaplan to state that homeopaths do not misrepresent the truth about the evidence base for homeopathy. If he is sincere about the truth, why is he not as concerned about his own profession as Ernst appears to be? Where is the condemnation of homeopaths running high street shops with dangerous beliefs about immunisations? Where is the concern that homeopaths do not practice within the knowledge of a sound evidence base?

I think Ernst was actually being rather kind in calling homeopaths liars. He should have called them all bullshitters and mindfuckers.

Labels: edzard ernst, homeopathy

 

Neal's Yard Remedies has announced that it is withdrawing is Malaria Officinalis 30C homeopathic remedy from sale. This is the absolute minimum it could have done given that its Exeter Branch was recently caught out by the BBC South West programme Inside Out selling this remedy as protection against malaria. (I wrote about this staggering event recently.)

What reason do Neal's Yard give? Let's look at their press release in detail.

The BBC’s Inside Out programme - Homoeopathy and Malaria

We love the BBC, but we all know from time to time they can be guilty of naughty editing, especially when it comes to showing people apparently storming ‘out’. Our Medicines Director Susan Curtis was interviewed for the Inside Out programme last week, and unfortunately a lot of what she was trying to say was not shown. The most important point, and something we are very passionate about, it that as our health is so important, we advise that people seek professional advice on all matters of health.

So, we note that Neal's Yard remind us of how recently the BBC were discovered to be less than honest in their film report showing the Queen 'storming out' of the BBC filming of a documentary. So, Neal's Yard want to compare the 'misrepresented' Susan Curtis to the Queen. All I can suggest is that you watch the footage of the non medically qualified Medicine's Director 'hurriedly leaving' the interview. Make sure you pay attention during the bit where Susan Curtis rips of her microphone and says 'I have actually had enough" and then quickly leaves as the interviewer asks if what the company was doing was "criminal, unethical and dangerous". A full transcript can be found on 'thinking is dangerous'.

The statement claims that Neal's Yard ensures people "seek professional advice on all matters of health". We shall examine that a little more closely later.

Next in the press release,

We know there have been no clinical trials for the use of homoeopathy in the prevention of malaria but homoeopathy does have a good track record in preventing and treating other epidemic diseases. Susan said that there is no absolute guarantee that you will not get malaria with any treatment and that the most important factor is to take measures to prevent being bitten by mosquitoes.

Neal's Yard acknowledges that there is no good evidence that homoeopathy can prevent malaria. So, why does it sell it then? Malaria kills. By offering a prevention where there is no scientific evidence or reason to suppose that it will prevent malaria, you are simply putting lives at risk. Susan then claims that there is a "good track record in preventing and treating other epidemic diseases." This is bullshit of the highest order. There is no good evidence that homeopathy can prevent or cure any disease - it's just sugar pills. Homeopaths like to tell each other stories and myths about cholera epidemics in the 19th Century. Not good enough. Can you imagine a drug company offering evidence for a new drug based on 200 year old fairy stories? By saying that "no absolute guarantee that you will not get malaria with any treatment " it ignores the fact that there is good evidence that convential anti-malarials, properly prescribed, can do a great deal to protect you, whilst homeopathic sugar pills do absolutely nothing. Weasel words.

And on,

We do not advertise or sell the remedy as a prevention for Malaria. It is supplied on request by practitioners working in Neals Yard Remedies stores, and in fact, the practitioners have been trained to always explain that the remedy should not be considered as a guarantee of prevention of malaria. The name of the remedy is based on its latin name and not on its claim to cure or prevent an ailment.

Now this is one of the most beautiful bits of bullshit I have yet come across. I purchased a tub of Neals Yard Malaria pills. A picture of the product is shown above. So, I am supposed to believe that when the word 'MALARIA' appears on the label it is actually a very technical latin name which a mere lay person like me could not understand and in fact has nothing to do with the deadly disease spelt using the same letters in the same order. Let us remind ourselves what MALARIA CO 30C actually is. It is a homeopathically prepared 'nosode' dilution of the malaria parasite designed with the like-cures-principle in mind. The product is specifically designed to prevent or cure malaria, but is so dilute that all you end up with is the plain sugar pill and so cannot possibly do anything. There is 1 part 'remedy' to 1,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000 parts water. (100 to the power of 30)

Well, did Neal's Yard sell this as a prevention or cure for malaria? The page from their web site has now gone. But, by the amazing powers of the interweb I can remind you what the page looked like here (also here). The product was being sold alongside Medicines Director Susan Curtis' book Homoeopathic Alternatives To Immunisation in which she describes how such a remedy could prevent malaria. And did my purchase come with a warning? Nothing. Not a word about the fact that I should be seeing my GP and taking anti-bite measures? Silence.

The press release ends,

However, as this is obviously a contentious issue which is causing customer concern, we have decided to withdraw the product, Malaria Officinalis 30c from sale with immediate effect.

I have a feeling that the real reason might be to do with the fact that the BBC passed on their information to Trading Standards and the MHRA, the body who make sure all medicines are licensed and marketed appropriately. Selling a homeopathic remedy with claims, implied or otherwise, without a license is a criminal offense. Even if you do have a license, you are only allowed to make claims for conditions that do not normally require a doctor's attention, like 'feeling a bit under the weather'.

The product sold to me by Neal's Yard was manufactured by Ainsworth's, the homeopathic pill company. Their web site still contains the same product. I am sure there is some anxiety there that they do not want the MHRA telling them that they cannot sell this stuff. Let's hope the MHRA are not aware of this.

But back to the main issue. This press release is almost a complete string of bullshit statements designed to obscure the fact the Neal's Yard were selling dangerous products. The company likes to portray its ethical nature, and wants to fill the gap on the high street now that The Body Shop have been acquired by a big multinational. Is this press release a one-off? Sadly not.

Their previous press release was an attempt to discredit the Cochrane review of vitamin supplements that showed that there was little evidence that certain vitamin supplements did you much good and that they even could be shortening your life. The Vitamin Companies and Health Food Industry came out in a massive PR battle to rubbish this study - without even reading it. Ben Goldacre covered this in this Saturday's Guardian where he showed that the Health Food Manufacturers Association had roped in various clueless celebrities to condemn the work. It was obvious that none of the celebrities had either read the work or understood it. The vitamin pill salesman Patrick Holford started saying that it was a 'conspiracy' by vested interests to destroy the vitamin industry whilst neglecting to mention that the Cochrane collaboration is independent and forbids its members from taking corporate funding for its studies and that Holford himself had taken around half a million pounds from the vitamin industry over the past year or so.

The deliberate obfuscation of this serious report is shameful. All have been at it, from Holland and Barrett to the 'mad-as-a-box-of-frogs' website What Doctors Don't Tell You. All of their criticisms were shallow and idiotic. Rather than issue a press release that said they would be "studying the conclusions of this important study and seeing how it affected their business", as you might expect ethical and responsible businesses to do, there was nothing but a universal knee jerk reaction of the type you might expect of the asbestos or tobacco industries.

Neal's Yard Remedies were no different. Their press release did not even give specific criticisms of the Cochrane review but of a previous piece of work by the authors. The Cochrane review was in part a response to these previous criticism and was ten times longer than the study criticised by Neal's Yard. The press release concluded,

there is considerable documented evidence both for vitamin deficiencies in the general diet (particularly for specific at-risk groups), and for the health benefits of vitamin supplementation when taken at recommended doses. Those individuals who wish to take vitamin supplements to maintain good health should therefore continue to do so, and should not be discouraged by the shoddy scientific study by Bjelakovic et al.

That is a shameful statement to make. The only thing that is shoddy is Neal's Yard criticism of a gold standard review that it looks like it has not even read.

Neal's Yard is portraying itself as wearing the mantle of ethical business. It is marketing bullshit. It likes to be seen as green, organic and 'carbon neutral'. What can be ethical about selling overpriced cosmetics to the self-indulgent? What is ethical about selling useless sugar pills for lethal diseases? The business has a new Managing Director, Jonathan Hook. He says "Our ultimate aim is to be entirely organic". Ex mobile phone salesman Mr Hook was shoehorned in by owner Peter Kindersley as Hook's father was an organic farmer, and Kindersley likes that kinda stuff. The company is pleased with itself that it is now 'carbon neutral'. But these claims of being organic and ethical do not take into account the context of their business. Would an atomic bomb be ethical because it has a lower carbon footprint than 100,000 tonnes of TNT?

On the subject of the wild claims Neal's Yard make about their health products, Jonathan Hook shows a hint of doubt. He said in the Times,

“All our products have a therapeutic intent as well as being beautiful,” he says. “You can say: ‘This is really gentle, it will do good.' You can't say: 'It will cure eczema.'”

Therapeutic intent. That's nice. But it is also bullshit. What Neal's Yard sells is shiny blue bottles for the gullible. Any more claims to be ethical and I might start getting angry.

Labels: homeopathy, Neal's Yard Remedies

 

Unbelievably, nearly two years after BBC Newsnight exposed ten homeopaths offering dangerous advice to travellers about malaria protection, the BBC have found high street chain Neal's Yard Remedies offering sugar pills as protection against malaria.

The BBC, in a press release, said,

The presenter of [BBC] Inside Out South West Janine Jansen was sold homeopathic remedies by the manager of Neal's Yard in Exeter and was advised that she could use them to help deal with malaria.

This is quite an extraordinary happening. The BBC first exposed the dangers of unregulated homeopaths offering lethal malaria advice on their Newsnight programme. The Society of Homeopaths, the largest members club in the UK, refused to discipline or even condemn any of its members caught out. Furthermore, it refused to offer proper guidance to homeopaths on this subject. What it did do was legally threaten me when I pointed out their lack of action, it issued guidance to its members to keep their mouths shut when answering queries about this, and issued thoroughly misleading press statements saying why it took no action.

Nonetheless, an enormous amount of bad publicity was generated and it cannot have gone unnoticed at Neal's Yard Remedies.

Neal's Yard is a very well known brand in the UK with operations now in Japan and the US. Founded in the trendy and touristy Covent Garden area of London, it is well known for its bath and shower products. It also thinks it is in the medical and healthcare market. Its web site shows it offering all sort of herbal and homeopathic remedies as well as in-store therapies. For example, it says it can offer Hopi Ear Candling and tells the fib that that it is "a traditional healing technique of the Native American Hopi Indians".

Neal's Yard Remedies is offering a Malaria 30C Homoeopathic Remedy on its web site. This is again breathtaking. In the past, people like Professor David Colquhoun have exposed the 'wicked scam' of such products, often sold overseas. We now see such products on the high street in the UK. A local newspaper has picked up on the story and interviewed Nicola Gillespie of Neal's Yard in Exeter who said, "Homeopathy can be used for that (treatment of malaria)", but then confusingly added, "We are not going to say they can prevent people from getting malaria".

Let's be quite clear. There is not a shred of evidence to suggest that homeopathic sugar pills can prevent or cure malaria. The suggestion is utterly implausible and is no different from witchcraft. Dr Ron Behrens, the Director of the Hospital for Tropical Diseases Travel Clinic in London, said

making claims that homeopathic remedies can prevent or treat malaria was potentially highly dangerous and it puts people's lives at risk.

Dr Peter Fisher, the Director of the Royal London Homeopathic Hospital and the Queen's Homeopath, has previously said about such advice,

I'm very angry about it because people are going to get malaria - there is absolutely no reason to think that homeopathy works to prevent malaria and you won't find that in any textbook or journal of homeopathy so people will get malaria, people may even die of malaria if they follow this advice.

Unfortunately, whilst Dr Fisher is absolutely right that people will get malaria if they follow such advice, he is wrong that you cannot find it in homeopathic textbooks. I founnd a book in my local bookshop this afternoon carrying this crazy nonsense. Rob Hinkley at SemiSkimmed has written about this in detail in response to this story.

We can perhaps understand Neal's Yard's position here when you appreciate that their 'Director of Medicine', Susan Curtis, has herself written a book entitled, Homoeopathic Alternatives To Immunisation, which is promoted as,

An invaluable guide for all travellers. This book contains practical information on preventing and treating major infectious diseases, including hepatitis, flu, malaria, measles and whooping cough.

Staggering. All these diseases are killers, especially in poorer countries, and if you were a traveller, you would want prompt and good medical care. Susan is a Member of the Society of Homeopaths. Their code of conduct expressly forbids them from stating or implying that they can cure named diseases. However, we know that the SoH will never discipline any of its members or fellows for doing so. We cannot look to homeopath's 'professional' bodies to stamp out this insanity.

According to Healthwatch, Susan Curtis has no medical training. She was interviewed by the BBC but walked out after 15 minutes in a bit of a huff. The interviewer had to yell after her to ask if what she was doing was criminal. On the programme, Professor Edzard Ernst, Britian's only holder of a chair in CAM, said,

It's awful. I would not hesitate to call this criminal. I don't know whether this is legally criminal but, in my view, this is so amoral and unethical that I would not hesitate to call it criminal.

This statement stands in stark contrast as to how Neal's Yard likes to portray itself as 'the ethical brand'. It won the Sunday Times 'Best Ethical Brand' last year. Will it put itself forward this year?

Curtis is well aware that there is no scientific evidence to suggest that magic sugar pills have any role in preventing or treating malaria. She is able to justify the sale herself by suggesting there is 'evidence by extension'. What this means is that homeopaths 'know' homeopathy works. They do not need real and direct evidence. They can just 'extend' their delusions in any direction they wish. Criminal? Definitely, irresponsible beyond belief.

One area of law breaking that does need to be fully explored is to see if Neal's Yard Remedies are in breach of the MHRA rules on medicines. Homeopaths have recently been given special dispensation to tell lies on the labels of their products, but as long as it is only for minor illnesses and after they have submitted a 'dosier of delusions' to the MHRA. The BBC have passed on their evidence to the MHRA to see if an offense has been committed. There are two possibilities - Neal's Yard are selling such products without a license; the MHRA have given a license (which I doubt). Both would be a disgrace.

In the meantime, what will Neal's Yard do? On their web site they say their values are to "take great care to be responsible in everything we do." The only responsible thing to do right now would be to fire their Medicines Director, Susan Curtis, withdraw their homeopathy products, conduct a thorough review and get back to the business of selling perfumed bathroom products.

Something tells me this will not happen.


*********************************************************************

A full transcript of the programme is now available at Thinking Is Dangerous.

See the follow up post to this at "Neal's Yard Ethical Bullshit Remedy."

And how the MHRA has clobbered them.


*********************************************************************

Labels: homeopathy, Neal's Yard Remedies, Society of Homeopaths

 

Some years ago, a well meaning but utterly deluded friend gave me a book entitled Natural Remedies For Your Cat by Christopher Day. It is a slightly disturbing tome that appears to recommend homeopathic remedies for pretty much everything - from fleas to gunshot wounds.

Rational cat lovers might find this book pretty disturbing. In many ways, it is a classic homeopathy text. It sees homeopathy as verging on the panacea, has a brief disclaimer telling owners to seek veterinary help and has a chapter on feline vaccination.

A cat's immune system is a very finely poised and delicately balanced yet powerful entity in the daily battle for life and health. (...) Deaths, severe illness and chronic mild illness have all been recorded as following closely on vaccination. (...) There is an alternative to conventional vaccination but it has not been efficacy-tested on laboratory animals. No proof of efficacy therefore exists. However, many breeders, show people, cat lovers and catteries now feel strongly that the alternative is as effective as, and, safer than, conventional vaccination.

Christopher Day is not some soft-headed amateur pet healer. Day is a fully qualified vet and paid up member of the Royal College of Veterinary Surgeons. Recently, his name has been popping up a few times. A friend in the pub said she was going to see him about a troubled horse that was clearly in a lot of pain. As tactfully as possible, I suggested that he had slightly unorthodox ideas and another vet might be more appropriate. I was told that "he was a qualified vet" and that "holistic approaches appeal to me because they ultimately have the patients best interest at heart". Apparently, they do not fob you off and they take their time. Fortunately, Christopher Day turned out to be far more expensive than 'mainstream' vets.

I have also been pointed towards him by a few homeopaths with the idea that a vet practicing homeopathy is somehow proof that it works. Animals do not know about the placebo effect, apparently. We shall explore this canard a little more shortly.

There is something important going on here. Day runs the 'Alternative Veterinary Medicine Centre' in Oxfordshire. He describes himself as a 'holistic vet' and offers the following treatments,

Homeopathy : Herbs : Acupuncture : Moxibustion : Aromatherapy (Essential Oils) : Tissue Salts : Bach Flowers : LASER : Magnet Therapy : Chiropractic Manipulation : Nutrition : Crystals : Ultra-Sound : Physiotherapy : Positive Health : Holistic Medicine : First-Aid : Preventive Medicine

His site says that he specialises in alternative medicine but does not shun conventional medicine "per se". Apparently, "it is our pleasure not to have to resort to it very often".


It is difficult to imagine a medical doctor who used homeopathy using such language. Indeed, Peter Fisher, the director of the London Homeopathic Hospital, can be quite circumspect and modest when talking about the capabilities of homeopathy. It is not possible to imagine a doctor writing books like this, offering clinics like this and eschewing conventional treatment without getting into trouble with regulations. In the human medical world, such total embracing of the alternative worldview is almost exclusively the reserve of your non-medically qualified private practitioner.


Bizarrely, if a lay homeopath were to set up a practice to treat animals without a veterinary qualification, they would be breaking the law. Homeopaths may practice freely on humans, but not on cats, budgerigars and whippets. Chris Day himself tells us on his web site that,

The Veterinary Surgeons Act 1966 was put in place to regulate the treatment of animals. Under its provisions, it is basically only veterinary surgeons who may legally diagnose, prescribe, advise on the basis of a diagnosis and perform surgery on animals.

There are exceptions to this. Various massage like 'manipulative therapies' are allowed but should be overseen by a vet. The RCVS web site says,

All other forms of complementary therapy in the treatment of animals, including homoeopathy, must be administered by veterinary surgeons. It is illegal, in terms of the Veterinary Surgeons Act 1966, for lay practitioners however qualified in the human field, to treat animals. At the same time it is incumbent on veterinary surgeons offering any complementary therapy to ensure that they are adequately trained in its application.

What does it mean for a homeopathic vet to be "adequately trained in its application"? Since homeopathy is a pseudoscience and without scientific justification, rational or adequate evidence base, how can you be "adequately trained" in it? The idiocy of this position does not go unnoticed within the veterinary field and has been beautifully spoofed by the The British Veterinary Voodoo Society.

The problems of allowing "adequately trained" homeopaths to have free reign on animals is that homeopathic thinking is diametrically opposed to accepted standards of care. Homeopathy is not a complementary therapy that works alongside real medicine. It is, and always has been, strictly alternative. Homeopathy is a 'complete system of medicine' that is in opposition to the principles of science-based thinking about health. One of the characteristics of homeopaths is to denigrate real medicine. It is how they differentiate themselves and how they appeal to people who feel they have been let down by conventional care.

The latest handbook for homeopathic vets, the Textbook of Veterinary Homeopathy (Saxton, J. & Gregory, P. Beaconsfield Publishers, Beaconsfield, Bucks UK. 2005) has this to say about mixing homeopathy with conventional treatments...

There is little doubt that most orthodox drugs impede the action of homeopathic remedies. This is not surprising when one considers that the action of most of these medicines is in direct contradiction to that of homeopathy; anything which suppresses a reaction of the body will act counter to homeopathy, and considering the subtle energetic nature of homeopathic medicine it is only logical that such powerful drugs as corticosteroids or NSAIDs will antidote its effects.

and,

Perhaps the most important issue here is to be aware that any orthodox Medication may interfere with the action of a homeopathic remedy and to take account of this in prescribing these medicines. Ideally, all orthodox medication should be stopped prior to commencing treatment with homeopathy.

This book was written by two vets, John Saxton and Peter Gregory, who are members of the Royal College of Veterinary Surgeons and Fellows of the Faculty of Homeopaths.

So, at least, homeopathy is a big no go for the amateur vet. The Animal Society of Homeopaths would be an illegal organisation. But, veterinary homeopathy is a strange beast. For a start, homeopathy relies on the concepts of 'like cures like'. A substance that causes symptoms in the well can cure the ill. And yet, homeopathic 'provings' are done on humans. Do these translate to animals? All animals? We know different substances can affect different species in wildly different ways. How does my cat's response to Sepia differ to mine? I think that maybe I am taking the principle too seriously. Homeopathy also prides itself on the time spent in consultation with their customers in order to come up with a 'holistic symptom picture' and an 'individualised' remedy. It is this consultation that gives a talking-therapy-like benefit to customers, not the pill iteself. Does Christopher Day spend an hour in a field talking to a herd of cows about foot and mouth and their feelings about the disease, the stresses in their lives, and their hopes for the future, before dropping a vial of plain water in their communal trough? Maybe not.

As far as I can see, Christopher Day is a genuine character who believes that homeopathy is a useful way of treating sick animals. It is my opinion that this is a deeply misguided belief as homeopathy is nothing but a pre-scientific magical belief system based on totally implausible premises and with an evidence-base that is far too weak to suggest that anything real is going on. In such circumstances, one would expect that a regulatory authority would have something to say about this, in order to protect the welfare of animals, prevent owners from wasting money and to protect the professional image of veterinary surgeons.

So, who is regulating animal homeopathy? Day is a member of three organisations. He is a member of the RCVS - he has to be in order to practice. He is a Fellow of the Faculty of Homeopaths, the club reserved for medically trained homeopaths (both doctors and vets) and so can carry the designation VetFFHom. Indeed, he is listed as the Veterinary Dean of the Faculty of Homeopaths. Day is also a member BAHVS, the British Association of Homeopathic veterinary Surgeons. Indeed, Day was for 25 years the Secretary of the BAHVS. Out of all these organisations, who is making sure homeopathy is being practiced responsibly and in the best interest of the welfare of animals?

The Faculty of Homeopaths, although quite outspoken about the excesses of non medically qualified human treating homeopaths, appears to welcome vets into their fold without question. The Royal College of Veterinary Surgeons appears to wash its hands and not want to interfere. We cannot expect BAHVS to take a meaningful role as their officers, like Day, hold the very beliefs that ought to be questioned. I see little evidence that suggests that anyone wants to tackle the inconvenient problem that homeopathy is a useless placebo therapy.

Of course, we hear that customer choice is what justifies the use of voodoo and homeopathy on animals. It would be wrong to restrict choice, when paying customers, like my friend in the pub, believe it helps their pets and farm animals. The big difference between animals and humans though is who is making the choice. The animals have no say and are silent in the matter. Choice can be such a weasel word and we should be suspicious when politicians use it. We usually do not want a choice of schools. We want our local school to be of a high standard so that we can send our kids their with confidence. We do not want a choice of hospitals. We would rather the closest and most convenient one for ourselves and our families was up to scratch. Choices like these is used to hide inequalities and injustices by people who will usually gain financially, socially or politically.

Giving people a choice between quackery and proper care for their animals hides a huge injustice. It adds no choice to owners since there are false options involved which actually detract from the animal owner's empowerment. The owner may well feel better for providing 'holistic' care to their animal. They may well feel superior and 'caring more' than leaving their animal to a standard vet, who may not be able to do too much. But, this is at the expense of the animal who may find it hard to tell us that the magic homeopathy water was ineffective. The owner, full of fresh expectations of improvement in their animal, interprets any sign to justify the expense of their 'alternative approach'. The usual thinking biases kick in such as post hoc reasoning after regression to the mean, wishful thinking and selection biases. Meanwhile, an animal may still be suffering.

Can it be justified to use a placebo on an animal? The debate about humans being given placebos is interesting. It is a valid discussion because placebos are a function of the recipients beliefs and a placebo may well do some limited good. In animals, such complex social and ritualised beliefs can only be marginal. The function of an animal placebo is to palliate the owner's anxieties and fears, not the animal's. This strikes me as unequivocally morally wrong.

Labels: animals, homeopathy, regulation, veterinary homeopathy

 

Watching the antics of quacks is funny and I hope some of that humour comes across on this blog. Sometimes, however, humour just appears to be so misplaced. Las Mariposas Clinic, in Torremolinos, Malaga, Spain, is a clinic that offers homeopathic and nutritional cures for cancer. They promise,

“Unique methods that induce the natural remission of cancer and other illnesses”

Nothing about this is likely to be funny. The clinic was brought to my attention by an email. Simon wrote,

A friend of mine recently passed-away from cancer. Unfortunately she had decided to turn away from conventional medicine and seek some alternative interventions.

She was a regular visitor to spain and heard from other expats about the "las Mariposas clinic in malaga. Like all other alternative"specialists" they took advantage of her desperation to live and said they could treat her. The hospital bills costs thousands and I am convinced they added to her suffering and pain.

So, a little investigation appeared to be entirely justified. The clinic has several English language web sites and appears to be well targeted at either the ex-pat community (half a million Brits in Spain). A directory web site tells us,

Their fee for cancer therapy and counseling is 10,000 Euros, which provides all homeopathic medicine that could be needed, consultation and treatment, HLB - high blood resolution analysis to allow them to tailor their approach to your specific endogenic (immune) status and hormonal needs, EAP (Electro-Acupuncture) treatment, and Dr. Budwig's protocol (They claim to be the only ones in the world to be trained and authorized by Dr. Johanna Budwig). This is a once in a life time payment. However, additional herbs, vitamins and minerals that are needed are not included in the consultation fee. Depending on the type of cancer and how advanced it is, it could cost an additional $200 to $300 the first month. The recommended stay is a minimum of two weeks.

So, what do you get for your 10,000 Euros?

Well, first of all, you are offered "very accurate diagnosis". Mariposas offers a number of techniques as they claim,

"One size fits all” is the approach that many take in treating death dealing cancer, almost everyone gets the same prescription. Not so at our clinic! Las Mariposas clinic takes into account that each human body is unique with its own set of DNA and its own particular level of endogenic defenses. No two people are alike when it comes to personality and the same is often true of our state of health and in how our body reacts to different therapies.

To gain this unique diagnosis, the clinic says it uses a number of techniques. The first is,

HLB (High-Resolution Blood) analysis. What is HLB? Well, most laboratories will magnify a blood sample up to 1,200 times and then work with these results. However by using a HLB microscope we are able to magnify a fresh and a dry blood sample up to 18,000 times its normal size.

Wow. If they have achieved optical magnifications of 18,000 times then they have made the most significant breakthrough in optical microscopy ever. Diffraction in microscopes optical systems limit resolutions to approximately 1,500 times. Secondly, they apply a microscopy technique called 'Dark Field Analysis' which removes background light from the image. How all this improved diagnosis is not made clear. The 'Enderlin' technique has at least one paper written on it that concludes,

Dark field micoroscopy does not seem to reliably detect the presence of cancer. Clinical use of the method can therefore not be recommended until future studies are conducted.

This all sounds like a lot of pseudoscience designed to impress prospective customers. Just to confirm this, they also say that they apply "Energetic Frequency Testing" which involves homeopathy and 'holistic kinesiology' to improve diagnosis. I can't help feeling they are making it up as they go along.

So, when you have your improved diagnosis, what do Mariposas do with you? It's a right ragbag of ideas...

• drinking water to ensure the urine is transparent
• consuming 'celtic sea salt'
• daily infrared saunas to remove 'toxins' - the root of all disease
• EFT to 'erase and neutralize past emotional upsets and trauma'
• homeopathic cancer treatment - homeopathic snake venom - a 'natural' chemotherapy.
• homeopathic antibiotics, anti viral and anti fungal medicines
• a diet of flaxseed oil and cottage cheese

A masterful portfolio of quackery, if ever I have seen one. There is too much going on in this clinic to tackle it all in one blog post.

Who is behind this clinic? There are no names on the web sites - something that ought to set off alarm bells. If this clinic was operating in Britain, it would undoubtedly be breaking the law. Being in Spain, and offering an English language service, nicely sidesteps this troublesome issue. Malaga is a short £40 flight away. What is also most noticeable is that the way in which homeopathy is described would flout the conduct codes of most homeopathic registrars in the UK. Now I know, they do not enforce their code of conducts, but neither do organisations like the Society of Homeopaths speak out and warn people about the dangers of such clinics. Their complicit silence is damning.

I asked Simon, the original correspondant, what he knew. He said,

The director of the clinic is a Dr Raymond Hilu. My friend consulted with this guy over a few months and he regularly told her that he had never lost a patient.

Hilu is difficult to track down. A number of other names crop up. The cottage cheese diet ideas appear to originate from a Dr. Johanna Budwig of Germany who appears to offer her own cancer curing protocol and be associated with the clinic.

How do people fall for this? I guess it is difficult to know how you would respond if you had a life threatening illness and that your doctors were struggling to manage it and may even be telling you that your choices are limited. To see a glimmer of hope in people who tell you that there are more 'natural and better' ways of dealing with serious illness, must be compelling. Hope is so important. If all that stands in your way of saving your own life is 10,000 Euros then it must appear to be very cheap.

And the Mariposas clinic does offer a money back guarantee. How could you go wrong? I asked Simon what he thought about this guarantee,

I don't think either my friend, or the family, requested any money back. For several reasons I suppose: my friend died, the family just wanted to move on, the family didn't know their legal rights regarding getting money back etc...

As I indicated in my original email, until directly observing the experience of my friend I didn't realise how unscrupulous and dangerous these people are. The clinic has been operating for a number of years...they simply must know their treatments don't work.

It is also likely that if conventional treatment is also been followed, then any remission, temporary or not, will be seen as proof that the clinic is doing what it says it can do. And as the web site contains no terms and conditions to this offer, it would have to be taken with a pinch of salt. Who would actually decide if an improvement had been made? The persons GP? The Mariposa Clinic. I am sure we can guess.

I shall leave the last words to Simon,

I have always regarded alternative medicine as, by and large, quackery. However, I did not think they did that much damage. This view has now changed.

Andy, I have learned a lot from this experience. That people's desperation leads them to try anything and that alternative therapists abuse this despair for financial gain. The most important lesson is that I now firmly believe that doctors, nurses and consultants could do a much better job when they are counselling patients who are diagnosed as terminal. Granted doctors, nurses and consultants cannot offer hope as the alternative therapists can, but they could communicate how such treatments have no scientific support and are ineffective. Most importantly they should communicate that alternative treatments more often than not place an unnecessary monetary burden on patients and their family...

Yes, and this would be much easier if homeopaths and their ilk did not routinely undermine the authority and respect due to the medical profession. Their shrill shrieks that homeopaths do no harm is just not tenable.

Labels: homeopathy, mariposas

 

Figure1. The Quackometer Quackery Quadrants

Let's call this the Quackometer Quackery Quadrants - of course. How would we divide the scales to use on each axis? For ‘evidence’, this is not too hard. There are accepted measures of the degree of evidence available for a treatment. A heirarchy of medical evidence can be constructed as follows:

1. Systematic Reviews of well controlled Randomized Controlled Trials (meta-analysis) or single RCT with narrow CI (confidence interval)
2. Systematic review cohort studies or lesser quality RCTs
3. Case controlled studies (non randomized)
4. Case series (no control group)
5. Expert opinion (GOBSAT - Good Old Boys Sat Around Table)

Can we construct a similar hierarchy of plausibility? That is possible too. We could, for example, take a mathematical approach and assign the axis a Bayesean prior probability scale. This might be the most desirable approach, but largely impractical in that it is difficult to assign meaningful probabilities to hypotheses, such as the homeopathic one, that 'like-cures-like'. How likely is it that homeopathy will overthrow all that we know about biology? It is vanishingly small, but difficult to be quantitative about it. We can, put a more qualitative scale and grade a treatment according to how well it conforms to well tested knowledge or how much it relies on speculative knowledge or even magical thinking.

1. Proposed mechanism of action based on similar well understood treatments.
2. Consistent with well established biochemistry
3. Consistent with accepted biology and chemistry
4. New biological mechanisms required
5. New chemistry and physics required
6. Inconsistent with accepted physics/chemistry/biology.
7. Requires magical mode of operation/inconsistent with natural laws

You may well come up with your own scale. For the sake of my argument, constructing a definitive and absolute scale is not important. A qualitative approach like the above will do.

So now we have a set of four quadrants that we can use to broadly classify medical interventions according to their plausibility and evidence base. The top right quadrant contains treatments that are well understood in terms of their modes of action and have a good evidence base to support them. The lower left hand quadrant contains interventions that are not based on known science, or rely on pseudoscientific explanations, or even at the extreme magical and supernatural thinking. This is truly the quadrant of quackery.

We would like to think that our medical interventions are all nicely housed in the top right hand quadrant, but this is not the case. For example, the Cochrane methodology, in solely looking at the clinical evidence base will allow us to draw a line of ‘evidence based medicine’ that runs horizontally across the quadrants as shown in Figure 2.

Figure 2. The Realm of Evidence Based Medicine

Everything above the line can be considered as evidence based and, therefore, worthy of public funding and likely to form effective treatments.

However, the problem with this approach can be illustrated with the quackery quadrants. Such a demarcation could possibly allow treatments that have an evidence base, but that are based on highly implausible mechanisms. Can this situation arise? Of course it can.

When medical evidence is evaluated, it is usually of a statistical nature. An arbitrary cut of point is decided where the confidence limits for acceptance becomes defendable. If we get better statistical results than this cut off then we can say we have a significant result. Usually, this cut-off is set at a 95% confidence limit. You may see this written in papers as the p=0.05 threshold. Any test with a p value of less than 0.05 is determined to be of ‘significance’. Unfortunately, the p values in themselves are not enough to tell us if a particular experiment is giving us reliable information about a medical intervention. The p value merely tells us that if the test was fair and unbiased, then what is the probability that the result was merely due to chance and not due to the effects of the intervention? For a p value of 0.05 this means that 1 in 20 fair tests will give the wrong answer.

It is worse than that though as it can be very difficult to construct fair tests. Experiments and reviews can have flawed methodology, incomplete controls and blinding, unpublished results, and, in the worse cases, even be subject to fraud and dishonesty. As such, the proportion of experiments and reviws that give the wrong answer will be much worse than 1 in 20. The upshot of this is that for a highly implausible, but popular alternative medical treatment, then many trials will generate a significant fraction of results that show positive results. If we were to plot the distribution of the various elements of homeopathic evidence on our quackery quadrants, we might end up with something like figure 3.

Figure 3. Where Homeopathic Treatments lie in the Quackery Quadrants

With homeopathy, as we are repeatedly told by the homeopaths, there is an evidence base for supporting the efficacy of their treatments for at least some conditions. This is indeed true, but it is insufficient to convince sceptics that homeopathy is anything other than a placebo. We can see that these positive results, such as the small positive effect in the Oscillococcinum result in the Cochrane review, try to force us to accept that we have a genuine effect from a highly implausible treatment. In other words, we are being forced to accept a miracle. The top left quadrant is indeed the quadrant of miracles in that we are being asked to accept something that appears to be against natural laws.

Now science is not well known for its casual acceptance of miracles, and we should definitely not be accepting the evidence of homeopathic trials as evidence of a medical miracle. The philosopher David Hume (1711-1776) was one of the first to describe the conditions by which we should accept the occurrence of a miracle and that is that the probability that the evidence for the miracle is good evidence should be greater than the probability that the evidence is flawed in some way, such as by mistaken testimony, chance or deceit.

In Hume's words,

When anyone tells me that he saw a dead man restored to life, I immediately consider with myself whether it be more probable, that this person should either deceive or be deceived, or that the fact, which he relates, should really have happened. I weigh the one miracle against the other, and according to the superiority, which I discover, I pronounce my decision, and always reject the greater miracle. If the falsehood of his testimony would be more miraculous than the event which he relates; then, and not till then, can he pretend to command my belief or opinion.

With clinical trials, we have a pretty good idea of what the confidence a trial gives us – typically a 95% confidence level. How confident are we that our basic science of matter is correct? Would you take a 1 in 20 bet that the properties of matter were not to do with atoms? I would suggest that our confidence in basic physics is a lot better than 95% and that homeopathy is in direct contradiction with this knowledge. We have around two hundred years of good research into the properties of matter, collected by thousands of researchers. One little homeopathy study is very unlikely to threaten that body of knowledge. It is much more likely that the positive results of homeopathy are due to statistical chance, poor experimental methodology and even fraud, than showing contradictory evidence for the refutation of fundamental physics.

On our quackery quadrants then, we can draw a line that can tell us when we should accept the result of the evidence before us for any particular treatment. That line will run from the top left to the bottom right. What we are doing here is simply graphically illustrating the mantra of sceptics that extraordinary claims require extraordinary evidence. The corollary to this is that mundane, highly plausible and, dare I say, ‘common sense’ claims require a lower standard of evidence.

Figure 4. The Realm of Scientific Medicine. The evidence base for homeopathy is now excluded from scientific medicine, although may well sit within 'evidence based medicine'

Figure 4 then gives us a quite different view of how to accept the health claims of medicine from the standard one adopted by Cochrane and such bodies as NICE. We are describing scientific medicine as opposed to purely evidence based medicine. Scientific medicine takes into account the scientific context of the evidence and says that we should interpret that evidence in light of what we know about the world. It forbids us from casually accepting light evidence for treatments that are not plausible from what we know about physics, chemistry and biology. We can now only accept the evidence of a treatments efficacy when that evidence is greater then prior probability of that treatment being ineffective. This approach has a number of important implications.

Firstly, and most importantly, to all intents and purposes, clinical trials of highly implausible treatments, such as homeopathy, can never be used as evidence of their efficacy. No matter how good the statistical result of a trial, or how much data is analysed in a meta-analysis, the probability will always be greater that we are just analysing flawed data rather than there being a real effect. Homeopaths complain that sceptics never accept that trial data is proof of the effectiveness of homeopathy. This approach shows that homeopaths are quite right in their fears, although sceptics ought to be careful to point out that it is not because there is no evidence, but rather than the available evidence falls far short of any meaningful threshold of acceptance. Without a degree of plausibility, homeopaths are asking scientists to believe in the daily occurrence of miracles, and that will not do.

This answers my question as to whether Cochrane should be calling for more clinical research. What good would it do if more research was done in Oscillococcinum? More positive results for homeopathy might allow treatments to slip by simplistic ‘evidence based’ criteria for determining effectiveness, but will never satisfy broader scientific scepticism of homeopathy. There is a possible split that exists at the moment where many clinicians working in the NHS provide homeopathy to their patients whilst many academics and scientists are shouting what a nonsense this is. The hospitals are accepting a degree of evidence that is far too weak for real confidence to be expressed in the efficacy of homeopathy. Rather than use a simplistic evidence based approach to deciding which treatments to use in the NHS, a scientific approach needs to be adopted where the prior plausibility of a treatment is first evaluated so that it is possible to decide the degree of evidence required to support that treatment. Not all proposed treatments are the same and can be judged by the same criteria.

By conducting more research, we allow more anomalous evidence to creep in and that can only add to the difficulty of making health care decisions in our hospitals and governments. Rather than clarifying the position, clinical research into highly implausible treatments runs a very high risk of obscuring the truth. It is not that I do not accept that one day a highly implausible treatment will be shown to be effective, but rather there is a far higher chance of producing a nonsense result that just obfuscates the discussion. I will discuss how implausible research should be conducted shortly.

This brings me onto the second point. Homeopaths often accuse sceptics of double standards where low standards of evidence appear to exist for many routine hospital procedures whereas strong evidence is demanded for homeopathy. We can now see that this is not hypocrisy, but an inevitable consequence of scientific thinking. It is perfectly rational to accept treatments as effective if they have very high plausibility but little in the way of good objective evidence. Taking a trivial example, we all know that putting pressure on a wound stops bleeding. But I bet no randomised controlled trials exist to support such a procedure. Would anyone want to doubt that? For many surgical procedures, little in the way of high quality trial data may exist, the evidence may be at worst of the GOBSAT variety. But, many procedures may be inherently less susceptible to biases and subjective measurement errors. Death is a hard measurement point and is not easy to fudge. If a surgical procedure appears to prevent a quick death then we may well be quite right to accept largely anecdotal and case-based evidence. In fact, to insist on randomised controlled trials might well be highly unethical given the high degree of plausibility of the procedure.

This is, of course, in stark contrast to homeopaths claims that their pills can prevent or cure malaria. There is absolutely no good reason to think that this might be true. The plausibility of such a treatment is as near to zero as makes no difference. And yet many homeopaths insist that this is a bedrock of their practice (Hahnemann’s first homeopathic experiments were on malaria). Furthermore, some homeopaths insist on doing their own trials, often in Africa. Such experiments must be totally unethical, because their results, even if positive, could never be sufficient to demonstrate the efficacy of their treatment. Trials such as these put patients at risk with no prospect of any enlightenment to come from that risk.

So, my third point is what sort of research should homeopaths be doing, if any? Well, the only ethical and constructive research that could be done is research that could move homeopathy along the plausibility axis. This would be fundamental research that sought to uncover potential models of how the treatment might work. Before embarking on using real patients as test subject, confidence must be established that a treatment may be effective. That is not just good science but good ethical behaviour.

Figure 5. Direction of Investigations into implausible treatments

Homeopathy has a long path to go along here. Some homeopath supporters recognise this fact and see the importance of both demonstrating their fundamental tenets are true and also trying to show how homeopathy might be integrated into science. (My homeopathy challenge is a simple test to ask homeopaths to demonstrate that their beliefs about the preparation of homeopathic remedies are not just wishful thinking. So far, no one has agreed to the test.) There are some researchers who are looking into so-called ‘memory of water’ effect, that might add a smidgen of plausibility into their claims. So far, the experimental evidence for water memory is woefully inadequate, even if it was in itself a plausible hypothesis.

The utter degree of implausibility is so staggering that I believe it would be difficult to justify public expenditure on fundamental homeopathic research. The only reason it is given any credibility is because so many people have staked their livelihoods in believing it. If Hahnemann had not been born two hundred years ago, but turned up at an NHS hospital today asking them to buy his pills, he would be unceremoniously thrown out for being an utter crank. And that is how we ought to treat homeopaths today.

The news this week has been filled with reports of the relative ineffectiveness of many antidepressant medications. The real shocker is how important data has not been made available to properly establish their effectiveness. Taking this science based medicine approach allows us to clearly differentiate between the different demands of whether more research is warranted into various sorts of antidepressants. Homeopaths may try to seek some equivalence between their failed and partially successful trials and the disappointing evidence for the effectiveness of some antidepressants. Both may look like placebos. But with the conventional pharmaceuticals, plausibility may still be much higher. We may not understand detailed mechanisms for how these drugs affect mood, but at least chemical intervention has some plausibility. My current glass of wine proves that. And, these drugs do show some effect for more depressed people. Understanding why this is and how these effects might be improved would look to be imperative. Homeopathy can make no such claim on limited research money.

And so to summarise, the Cochrane Review should limit its calls for further research to situations where plausible hypotheses exist, as without this, clinical data can never be persuasive. And for sceptics, attacking homeopathy cannot be done by solely by attacking the clinical evidence base. That evidence may well be poor and fragmented but there will always be a constant trickle of positive results such as the Oscillococcinum review, no matter how minor, that allow homeopaths to claim they are part of the evidence based medicine movement and that sceptics are being hypocrites. Homeopathy is wrong because the the evidence that does exist is far too limited for us to accept its efficacy given the extreme implausibility of its action.

****************************************************************************

If you want to explore more of the ideas raised here, a new blog has recently started. ScienceBasedMedicine.org is being written by prominent sceptic bloggers such as Steven Novella, Wallace Sampson, Harriet Hall and David H. Gorski.

Labels: evidence based medicine, homeopathy, pseudoscience

 

The Homeopathy Research Institute (HRI) has been set up by homeopaths Alex Tournier (who apparently works for Cancer Research UK) and Clare Relton (who is based at the University of Sheffield). The Alliance of Registered Homeopaths in one of their rare press statements have made much of it. They say,

The aim of the Homeopathy Research Institute is to promote and facilitate high-quality scientific research in the field of homeopathy. The HRI will be the first central resource dedicated solely to research about homeopathy as it is practised today. A key task of the Institute will be to communicate about the science relating to homeopathy to the medical and scientific communities, the media, the general public, and to homeopaths themselves. The Institute will form a bridge between the scientific and homeopathic communities backed up by a strong PR and communications team.

The HRI itself says that its aims are to:

To perform and promote innovative research of the highest scientific standard in the field of homeopathy .

To enable and encourage communication between the scientific community, the medical profession, professional homeopaths, the media and the public at large.

This could be good news. A team of dedicated professionals who are prepared to tackle the problems of the paucity of evidence for homeopathy. Can this be true? Let's look at their first newsletter.


The first article in their newsletter says that 'It's not 'just' water'. Clearly a response to the criticisms made by sceptics like myself. So, do they demolish the obvious criticisms? Do patients get anything other than plain old water? It's not pretty...


The thrust of their argument is that 'It is hard to realise just how complex a substance water really is.' They start off by saying,

Water is everywhere; it covers 2/3 of the earth’s surface and makes up 60-70% of the human body. In our daily life, we only know water as either a liquid, ice or vapour. However upon closer inspection, scientists have catalogued 15 different types of ice, which can be admired in the intricate designs of snow flakes and the amazing pictures of water crystals taken by Dr Imoto. This complexity is due to the precise structure of the water molecule, making water one of the most complex substances known to science.

Now the fifteen types of ice have nothing to do with homeopathy. They are crystalline phases produced under enormously different conditions. They say these have been photographed by 'Dr Imoto' and so betray their first failure to stick to 'high quality'. Dr Emoto has photographed various standard ice crystals, but claims that human thought can make the pictures pretty or ugly depending on what thoughts you 'direct' at the water. This is odd given that Alex Tournier says he has a PhD in physics. Does he really believe this? Thought directed crystal growth?

Next they say,

In the field of toxicology there is a known and documented phenomenon known as ‘hormesis’. A substance showing hormesis has the property that it has the opposite effect in small doses, than in large doses. This supports the use of tautopathy, where homeopathic doses of a toxin are given to accelerate the detoxification of that same toxin.

Now, hormesis has nothing to do with water memory. Hormesis requires small doses. Homeopathy most commonly uses no doses. Central to the hormesis idea is that the same substance has beneficial effects at small doses and bad effects at large doses. Water memory requires a different agent - water structures - to play some sort of role if they existed. It has nothing to do with the doses of the substance, since there is no dose in homeopathy. Why hormesis is included to support water memory is just not clear.

Next, epitaxy:

in the field of material sciences, there is a phenomenon known as ‘epitaxis’. This phenomenon is used in the industrial manufacture of semiconductors for microprocessors. Epitaxy refers to the transfer of structural information from one substance to another, which can happen at the interface between the two substances. This transfer of structural information can remain after the original substance has disappeared from the system. This is very similar to the theory of homeopathic dilutions, the only difference being that epitaxy is known to happen in crystalline materials but not in liquids such as water.

They refute their own argument here in that epitaxy is a solid-state surface process. It cannot take place in a liquid medium. Epitaxy has nothing to do with homeopathy. I have discussed the paper quoted in support of hormesis and epitaxy at great length. Mastrangelo has to start by redefining science in order for his arguments to even start to appear to be credible.

Now, the biggest boo-boo so far,

More recently, experiments using the light emission spectrum (Raman and Ultra-Violet-Visible spectroscopy) of homeopathic water vs normal water have shown that homeopathically prepared water has a different molecular structure than normal water. Although these are preliminary results they do indicate that homeopathic remedies are not ‘just water’, something has remained of the originally diluted substance.

It is quite remarkable that for Dr Tournier, who has a PhD in physics, to think that the 'molecular structure' of water has changed. This is pseudoscience at its worst. At best, it is a bad summary of the Rao paper. But reading the Rao paper is like reading a parody of itself. It starts of by discussing the structure of water and then present its experimental evidence on ethanol.

Yes, ethanol.

As you might guess, the paper has been torn to shreds. A subsequent issue of Homeopathy published a damning critique that was not properly addressed by the authors. I fail to see how a respectful journal would not have withdrawn the paper. The letter in Homeopathy ends

It is clear that the data presented are wholly inadequate to support the authors’ assertion that UV spectroscopy can differentiate between the two remedies, and between different potencies of the remedies. If the authors wish to test their assertion it will be necessary to repeat the work from the beginning, ensuring that all samples used in the study are sourced from the same bottle of stock solvent, that all duplicate preparations for precision assessment are separately prepared de novo from the mother tinctures, and that sufficient data are generated to allow robust and valid statistical analysis of the results.

The conclusion to this review ends,

Finally, I want to return to the work of the late Dr Benveniste (1935-2004). Benveniste’s original publication in 1988 in Nature7 – science’s most prestigious journal – created outrage in the scientific community all over the world.

Why would they bring up this discredited work? The review states that "It is reassuring that his results have since then been reproduced and confirmed, showing that indeed highly (homeopathically) diluted substances retain a biological activity akin to that of the substance in its crude form". We are given two references to papers by someone by the name of Belon.

To remind us, Benveniste and the team failed to reproduce his work when a team of Nature investigators were present. Most authors retracted their names from the paper. Unfortunately, Benveniste died. Belon, one of the original authors, republished the work elsewhere. By the way, Belon is a director at Boiron, the half a billion dollar French homeopathic pharmaceutical company.

I am afraid I have to conclude that this newsletter has not been produced with the 'high quality' aims of the Homeopathy Research Institute. That is a shame. There was an opportunity for these people to assimilate and communicate the various problems with the state of research into homeopathy to their largely scientifically illiterate audience. What this newsletter looks like is little more than propaganda. I would contend that we are being offered little more than the highest pseudoscientific standards.

Labels: BPSDB, homeopathy, Homeopathy Research Institute

 

It looks like the campaign to clean up homeopathy is having effects! A new supplier of homeopathic remedies appears to have entered the market with the promise that "we won't lie to you".

They say,

"For some reason, many homeopaths feel they have to tell their patients lies and fairy stories, and try to baffle them with pseudo-science. Here at FairDeal Homeopathy, we treat you like adults, and only tell you the truth."

For example, on their FAQ, they ask the question: "What side effects can I expect?". They respond,

None. That's one of the great things about homeopathy - there are no side effects (unless you're allergic to sugar, or water) as there are neither actual medical effects, nor active ingredients in the remedies!

They point out the power of the the placebo effect and that it is very effective for certain conditions, but echoing the smoking patches that "require willpower" to give up, homeopathy "requires belief" to be effective in any way.

Refreshing stuff from FairDeal Homeopathy. I suggest we all buy our "Remedies" from them straight away!

We at the Quackometer welcome this innovation in the world of self-empowered healing.

Talking of miraculous innovations, not quackery related, but another great little website that you may wish to peruse: bovine descenders. We have all done it. Accidentally, lead a cow upstairs only, to find that it is impossible for a cow to walk down stairs. You prayers are now answered with these specialists and "world-wide leader in the getting-cows-down-stairs field".


Marvelous. The white hot pace of technology amazes me.

Labels: fun, homeopathy