The Quackometer

Tonight, on BBC2, we were treated to Professor Regan’s Medicine Cabinet, where we were walked through the vast amount of quackery that we can find in a high street pharmacists.

Homeopathy was given a thorough kicking and straightforwardly shown to be utter nonsense. I did love the Ainsworth’s Pharmacist trying to defend his batshit robotic dilution apparatus, the The Pinkus Potentizer, that produced dilutions of 100 to the power of 100,000 – a truly barking level of dilution that would leave one molecule in a hundred squillion visible universes.

Happily, we were also shown some of his minions in the background preparing remedies in the more traditional manner of banging the vials against a leather Bible whilst looking slightly possessed. And then we were told by the Ainsworth chap, Mr. Tony Pinkus, Homeopathic Pharmacist,  that modern science had not yet caught up with the wonders of homeopathy. Yes, I am sure.

My position has always been that homeopathy’s biggest threat is for people to find out what it is. It is not herbalism, it is modern day witchcraft wearing the white coat of a scientist. This programme will have done wonders for the demise of this shabby trade.

You can watch the programme on the fabulous BBC iPlayer. Unless you live outside of the UK, in such a place as America, and have rejected the rule of our sovereign Queen and  have chosen not to pay the BBC licence fee. I suggest you get straight on an aircraft to Heathrow now, or use some techie proxy server thingy to get round the BBC rules.

Enjoy.

Labels: homeopathy

 

The stillborn homeopathy campaign, Homeopathy Worked for Me, that attempted to collect 250,000 signatures but managed just a few percent of that, has now resorted to producing a laughably daft critique of Ernst & Singh’s Trick or Treatment.

William Alderson, a homeopath, has produced a 142 page response to the book that attempts to show that the book has “has no validity as a scientific examination of alternative medicine”. Entitled, Halloween Science, the critique is a collection of misunderstandings, quibbles, strawmen and just plain daftness.

The approach that Alderson is taking here is to produce so many half baked critiques that to debunk the whole work would take 500 pages or more. Even if I was to show that the first few pages contained nothing but nonsense, the charge could be made that the rest of the book must contain some well targeted criticism. The whole book is destined to become an exemplar of the Dunning-Kruger effect.

Nonetheless, given that I have a life, I have no choice but to pick out a few examples and display their total inadequacy to you. The rest I shall leave as an exercise to the reader. No doubt, as with any work, there may well be weaknesses in Trick or Treatment and Alderson may well stumble over a few of them. Whether this undermines the main argument of the book though is a different matter. In that regard, Alderson fails to plant any fatal punches.

For the easily bored, or for those with delicate foreheads (for you will be sure to be banging yours on the desk if you attempt to read the full tome), Alderson gracefully produces a précis of his magnum opus.

So, a quick example: early on in Trick or Treatment, Ernst and Singh show how early versions of clinical trials established effective treatments for sailors’ scurvy. By trialling different proposed remedies and comparing outcomes, the British Navy was able to eradicate the curse of scurvy by allowing sailors access to lemons and oranges, a good source of vitamin C.

Alderson contends that in doing so the authors are “confusing two types of intervention”.

In fact, we need to be clear that the condition which lemons, oranges or vitamin C are actually curing is the absence of vitamin C in the diet. In other words the treatment in this case is actually the ending of a harmful intervention (deprivation of vitamin C), and this harmful intervention is the one and only cause of the illness. In this respect dietary deficiency diseases and poisonings are totally different from infections or chronic diseases, where there are multiple causes. The point can be illustrated by reference to another of Ernst and Singh’s examples: loss of blood as a result of bloodletting simply requires one to stop depriving the patient of blood, whereas a haemorrhage requires an active intervention to be initiated to solve the problem. Nobody would call the former action a ‘cure’, yet that is precisely what Ernst and Singh are doing in the case of scurvy.

You might want to read that again, because, yes Alderson is really saying what you thought he did.

Before I highlight his error here, it is worth noting Alderson’s misplaced obsession with theory in medical treatments. He claims that Ernst and Singh ignore theory when they say that “by experimenting and observing, [we] can determine whether or not a particular therapy is effective.” Alderson contends that “Ernst and Singh [believe] the scientific method is about “experimenting and observing”, not about experimenting, observing and theory.” The observant might notice the Alderson is attacking an argument that the authors do not make. Ernst and Singh do not attempt to define science as being about “experimenting and observing” but that we can determine what facts are true about the world by such processes. We can understand if an intervention has an effect on a disease without having a theoretical understanding of the diseases nature. That may well come later.

Alderson obsesses about theory because, like a lot of homeopaths, he delights that homeopathy provides a theory of disease – imbalances in vital forces (or something) and a theory of cure – ‘like cures like’. Like all homeopaths, he does not understand that you cannot have a theory until you have a set of observations that need explaining by a theory. No such observations exist for homeopathy. In two hundred years, homeopaths have failed to produce a similar demonstration of efficacy as this primitive trial with lemons.

So, back to our scurvy problem. What Alderson is missing is that when citrus fruits were proposed as a cure for scurvy, that this was not based on any theory of disease. Indeed, it was completely unknown what caused the terrible disease amongst sailors. It could have been an infection or diet; some though the disease was caused by sailor’s laziness and so made sick sailors work harder. Physicians at the time had no knowledge of vitamins and the book makes this clear. The sailors’ trials tried different suggested remedies including cider, sulphuric acid, vinegar, sea water, garlic paste and, of course, oranges and lemons on twelve afflicted patients. The two given fruit recovered very quickly, the cider drinkers somewhat and the rest made no progress. As trials go, it is pretty primitive, but understandably compelling.

Even with this result, it would take a long time to establish that that the reason lemons worked was because of a dietary deficiency. Alderson is quite wrong to suggest that somehow the trial only worked because of the nature of the cause. In fact, the nature of the trial makes no assumptions about the cause of the illness; it merely seeks to determine what intervention has an effect on the illness. The trial has about as much need of theory as a ruler does of General Relativity. Alderson fails to state why this so called failure or ‘confusion’ had any bearing on this or any other trial.

The rest of Halloween Science is riddled with the same error and similar misunderstandings. What is unforgivable is that that Ernst and Singh go to some six pages explaining very carefully the same point I have made above. William Alderson does not, or chooses not to, understand.

Of course, the whole Alderson book is a mere fig-leaf. Its clumsy rhetoric and lengthy nitpicking is a disguise of the embarrassment that homeopaths have over the fact that they cannot produce any reliable evidence for the efficacy of their treatments and the validity of their hypotheses (not theories). This pamphlet may well please the homeopaths who continue to avoid acknowledging the genuine and urgent criticisms of their shabby trade (such as their refusal to condemn the practices of their colleagues who dish out sugar pills in Africa in order to 'prevent’ malaria or treat HIV infection). More competent readers will not be impressed.

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UPDATE

It is probably worth mentioning the section in Halloween Science that discusses the attempts by the Society Homeopaths to sue my internet service provider when I dared to criticise them.

William Alderson, a member of that society continues to misrepresent what happened in the most shocking way.

Ernst and Singh said in their book,

Worse still, when the Society of Homeopaths, based in Britain, was criticized for not taking a firm stand against inappropriate use of homeopathy, it decided to suppress criticism rather than to address the central issue. Andy Lewis, who runs a sceptical and satirical website (www.quackometer.net), had written about the Society and the issue of homeopathic malaria treatments, which resulted in the Society asking the company that hosts his website to remove the offending page. In our opinion, the Society needs to improve in three ways. First, it ought to police its practitioners more thoroughly. Second, it ought to act publicly and promptly when serious complaints are made. Third, it should listen to its critics rather than silence them.

You can read my criticism here. It is harsh – but the issue was very important.

At its most basic level, the Society fail to uphold their own code of conduct, never censor anyone for clear breaches and allow their members to offer dangerously misleading advice to the public. (Example here)Those charges demand a serious response. The Society have never done so.

Alderson responds to this rather serious charge by just quoting the Society asserting what good eggs they are. He then repeats the lie that the Society could not take action against any members as no information had been given to them. This is simple untrue as you can read here. To say that the society had nothing to “police” is an utter distortion. The Society is riddled with members who either support or who actively engage in immoral and dangerous uses of homeopathy on Africans with malaria or AIDS.

Alderson then claims that the Society was justified in calling in their lawyers because my remarks were not criticism but defamatory. I wrote to Paula Ross asking for an explanation. None was ever forthcoming. They simply wanted to silence me.

And the Society and their members made no meaningful attempt to stamp out dangerous practices. Indeed, they went on to host a conference on treating AIDS with sugar pills and have been financially supporting members experimenting on Africans with AIDS. Let me now defame them: despicable scum.

Labels: edzard ernst, homeopathy, Simon Singh

 

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* I have since found out that two of the homeopathic treatments reviewed were atypical homeopathic remedies and were undiluted. These were the two that have shown preliminary and tentative positive results. Do these treatments then really work? Well, at least they have some plausibility – but as the reviewers state, the positive results from these small studies need to be independently replicated. What is the betting that they will not but homeopaths will take this as all the evidence they need?

** Here is the Cochrane review...

http://www3.interscience.wiley.com/homepages/106568753/CD004845.pdf

PPS It has also just been pointed out to me that the paper on the topical cream dos not even mention the word homeopathy in it.

http://jco.ascopubs.org/cgi/content/full/22/8/1447

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Follow Up.

This is how the completely batshit site What Doctor's Don't Tell You said about the review:

Homeopathy relieves side effects of cancer therapies

15 April 2009

Homeopathy isn’t quite the quack medicine its critics claim.  It can help relieve some of the side effects of cancer therapy, the prestigious Cochrane Collaboration has discovered.

Calendula ointment eases skin irritations after radiotherapy, and Traumeel, a combination of 14 homeopathic medicines, helps relieve mouth sores caused by chemotherapy.

The Cochrane researchers found eight studies, involving 664 participants, which produced valid results.

Don't say I didn't warn you.

Labels: cochrane, homeopathy

 

Today has seen lots of extraordinary news in the world of quackery. I am rushing around too much to digest it all fully, but I thought some of it deserved a brief mention.

We hear today that Steve Jobs of Apple is to step down as top dog at apple while he battles with health problems. The Guardian reports that it took some time earlier to persuade him to undergo surgery for his cancer as he was trying a 'homeopathic diet' - whatever that is. I sincerely wish Mr Jobs a full and speedy recovery. We cannot live without your gadget-tastic influence in our lives. Please, stay off the woo.

Next, the Times Higher reports that Salford is to close its Quack BSc course. We are told that "The University of Salford is to stop offering undergraduate degrees in acupuncture and complementary medicine because they are no longer considered "a sound academic fit".

That is rather good news and it is pleasing that it is for good reasons. Recently, the University of Central Lancashire said it was stopping its Homeopathy BSc this year due to lack of interest. It is currently reviewing these courses. We can only hope it comes to the same conclusions that these courses are academic bullshit that damage their academic reputation.

Hopefully, the other Wooniversities, such as Westminster and the University of Wales will be taking note. Will they be left holding the quack baby?

Gimpy has exploded the myth that Jeremy Sherr is some sort of Colonel Kurtz figure - a rogue homeopath gone bad and ended up with a heart of darkness in the depths of Africa, attempting to see if sugar pills can cure AIDS in deluded and dangerous experiments. With some marvelous research, we are shown how Sherr and his wife have been backed academically and financially by a string of prominent homeopaths. No one in the homeopathic community is standing up to the deluded and unethical practices going on in East Africa. The Society of Homeopaths wash their hands of him, despite Sherr being a Fellow of their society.

Gimpy concludes,

Jeremy Sherr is merely the prick that has burst the homeopathic boil and exposed the festering pus of ignorance and incompetence that defines the alternative sector. This movement is rotten from the heart of its establishment to the practitioners operating on the margins. Sherr, a respected teacher, is representative of homeopathy, not an individual acting on his own initiative. It is time these people were called to account and stripped of their influence.

The Horror. The Horror.

Labels: homeopathy, Society of Homeopaths

 

It looks as if homeopaths will be making a noise about their victorious successes in Cuba against the scourge of leptospirosis. Last month, a conference was held in Havana, entitled "Nosodes 2008: International Meeting on Homeopropylaxis, Homeopathic Immunization and Nosodes against Epidemics". Homeopaths turned up to hear stories of the successes of magic water against dangerous diseases.

What is a nosode? A Nosode is "a homeopathic remedy prepared from a pathological specimen. The specimen is taken from a diseased animal or person and may consist of saliva, pus, urine, blood, or diseased tissue." This may sound a little like conventional vaccines - but there are important differences. When you wish to immunise someone against a dangerous disease, the key trick is to use something that is far less dangerous that what you are protecting against. Real vaccines protect against microorganisms by introducing the body to killed, attenuated or partial versions of the same microorganism. Nosodes do not introduce the body to anything. The dangerous "saliva, pus, urine, blood" is made safe by diluting to such extreme levels so that all that is left is water. Yes, homeopathic nosode immunisation is the same as any other homeopathic remedy - nothing. Of course, homeopaths claim that shaking the water introduces important quantum, vibrational dooda into the water - and this is what protects you.

However, even amongst homeopaths, the practice of homeoprophylaxis through nosodes is highly controversial. There are a number of reasons why.

• Firstly, you see, homeopathy in its 'classical' form is about 'like cures like'. The important word being 'like'. Homeoprophylaxis does not use 'like' but 'same'. This is heretical for many fundamentalist homeopaths. It is often called 'Isopathy', rather than homeopathy. In his later life, Hahnemann, the founder of homeopathy, denounced this heretical and deviant form of medicine. "To desire to cure thus, by a pathogenic power rigorously equal (per idem) is contrary to common sense and even to all experiences".
• Secondly, homeopathy is supposed to be 'individualised'. That is, a remedy is selected from a vast selection based on a wide range of 'symptoms'. These may not just be the symptoms of your disease, but on your state of mind, whether you were stuck in traffic that morning, your dreams about cheese last night - the list goes on. For many homeopaths, the idea that you can give the same remedy to millions of people without 'individualising' goes against the principles of homeopathy.
• Thirdly, homeopathic immunisation, or homeoprophylaxis, relies on giving the remedy before you have the symptoms that you are supposed to match against. Again, a major no-no for many homeopaths.

However, one can be pretty certain though: differences in homeopathy only really matter when discussing failures to cure. If there is a whiff of success in the air, these minor ecumenical disagreements will be dropped faster than an motion to promote the MMR vaccine at a homeopaths' conference. These differences persist over the decades in homeopathy as there is no acceptable standard of evidence to either accept or reject any belief. Homeopaths believe what they want to believe forever, no matter how absurd, dangerous and deluded.

So, what was going in Cuba? A presentation was given at the conference that suggested that an outbreak of leptospirosis had been prevented in Cuba by mass homeopathic immunisation. Leptospirosis "Weil's disease" is an endemic disease in many countries caused by bacteria in water, transmitted often by rats. In many developing countries it can account for many deaths per year. In the UK, it only manages to kill the odd canoeist once in a blue moon.

Cuba has has a problem with the disease. When the Autumn hurricanes hit, rats can be swept out of the sewers and into the paths of humans. Many more people come into contact with infected water. The prevalence of the disease is not constant though and depends on many factors. Up until the end of the eighties, the disease was under control. One factor was that the Soviet Union was supporting Cuba and supplying a vaccine that appeared to be effective. With the collapse of communism in Europe, such assistance quickly dried up and reports of leptospirosis leapt from 0.16 deaths per 100,000 in 1987 to 1.03 deaths per 100,000 in 1993.

Since then, the government of Cuba has taken action. Due to the enormous embargoes placed on them by the US, the Cuban economy has become remarkably self-sufficient in many areas and has achieved sometimes extraordinary things on minute budgets. It has a literacy rate of 99.8% (one of the highest in the world) and a life expectancy from birth of 75 for men and 79 for women (c.f. USA 75 and 80 respectively.) This is despite spending only $229 dollars per head on health compared with $6,096 in the US.

One thing that has been achieved against leptospirosis is the development of a new local vaccine. It appears that a mass vaccination programme has been underway for several years now with the locally developed vaccine Vax-Spiral ®. Also, the government has been recognising the importance of prevention:

Public health authorities are prioritizing rodent control and surveillance to prevent the disease known as leptospirosis. It’s recommended to see a doctor immediately if persistent fever appears and MINSAP is offering prophylactic medicines and including a vaccine to control leptospirosis, which is being administered in areas where there’s risk of contracting this disease.

Deaths from the disease need not happen if the public is educated about the symptoms and effective treatments are put in place. The Cuban government appears to be pretty good at ensuring there are a 'pool of community doctors on every corner' .

What did the homeopaths in Cuba do and what do they think they achieved? Details are hard to come by as there is no published 'scientific' paper yet. Reports from the conference suggest that 2.5 million people were given two doses of a homeopathic nosode (Nosolet) alongside "two Bach Flower Essences to address the typical mental and emotional effects of the disease. " This cost, apparently, $200,000. Now, seeing as the homeopathy is simply water, costing nothing, surely the bulk of the cost must have come from the imperialist dogs at Nelson's Homeopathic Pharmacy in London who make the Bach Flower Essences. Bach remedies are like homeopathic remedies except that they use brandy rather than water. The little vials you can buy in Boots are just tiny bottles of dilute Brandy - the most expensive brandy in the world. If Ernesto 'Che' Guevara were alive today, he would be turning in his grave at the thought of such decadent western nonsense being use to subvert the revolution from imperial corruption.

So, is there evidence that the homeopathic experiment worked? Of course not. Accounts from the conference suggest that there were merely 10 infections per month and no deaths. Can this be attributed to homeopathy or the other health measure in effect? We will not know until a paper is published. But here is my prediction: it will basically say, we dished out the magic water and brandy, we saw a small amount of infection, we concluded it woz the homeopathy wot did it. No control groups. No baseline. Just assertion.

Will we see UK homeopaths crowing about this? Maybe. But they may have also learnt a lesson from last year when a conference by the Society of Homeopaths flaunted nonsense about the treatment of HIV. They were crucified in the press.

I actually look forward to them trying to shout about this. It will simply highlight their inability to recognise the boundaries of what they know they can safely achieve. And this is the major criticism I have of homeopathy. If they stuck to being truly complementary and having nice chats about aches and pains I would have little to say. But they continue to persist in fantastical delusions that they are a true alternative to science and medicine. And in that role, they are a menace.

Labels: cuba, homeopathy, leptospirosis

 

Merry Christmas!

Last Christmas, we looked at the quackery surrounding myrrh. This year, it is time for me to have little whine about mistletoe. Christmas would not be the same without a little cheeky kiss under this herb - usually with someone you really ought not to. But, its role at Christmas undoubtedly stretches back in time to more paganistic practices.

According to Pliny the Elder, it was central to Druid rituals:

After due preparations have been made for a sacrifice and a feast under the tree, they hail it as the universal healer and bring to the spot two white bulls, whose horns have never been bound before. A priest clad in a white robe climbs the tree and with a golden sickle cuts the mistletoe, which is caught in a white cloth. Then they sacrifice the victims, praying that the gods will make their gifts propitious to those to whom they have given it.

They believe that a potion prepared from the mistletoe will make barren animals to bring forth, and that the plant is a remedy against all poisons.

Nowadays, the web is full of claims about how injecting cancer patients with mistletoe extract can have remarkable effects. In many European countries it is not really seen as part of alternative medicine but as part of the oncologists repertoire. In 2002, mistletoe extract was the most frequently prescribed therapy in German outpatient cancer clinics. You may find that it goes by the trade name Iscador when you look for it online.

But the evidence for its effectiveness is rather weak. This year, the Cochrane review published the result of a thorough investigation into the evidence. They noted the high usage in Europe saying, "Proponents claim that mistletoe extracts stimulate the immune system, improve survival, enhance quality of life and reduce adverse effects of chemo- and radiotherapy in cancer patients. "

However, after reviewing the evidence, they concluded,

The review found that there was not enough evidence to reach clear conclusions about the effects on any of these outcomes and it is therefore not clear to what extent the application of mistletoe extracts translates into improved symptom control, enhanced tumour response or prolonged survival. Adverse effects of mistletoe extracts were reported, but appeared to be dose-dependent and primarily confined to reactions at injection site and mild, transient flu-like symptoms.

Not very good news if you were thinking that mistletoe could be the answer.

So, how did the popularity of mistletoe come about? The answer is quite strange. The idea that injecting mistletoe to cure cancer is homeopathic in origin. For those of you who know something about homeopathy, this may come as a surprise. After all, homeopathy is all about infinite dilutions and magic sugar pills. Well, homeopaths would say, not really. Homeopathy is first and foremost about 'like-cures-like'. If a substance has some sort of resemblance to an illness or can induce the symptoms of an illness in healthy people, then it can be used to cure that illness (their idea, not mine). As ideas, dilution and succussion are reduced to being merely a common delivery mechanism of homeopathy. Again, a rather strange idea where the delivery mechanism does not actually deliver any medicine. However, you may remember, that modern homeopaths invent new delivery mechanisms all the time that do not deliver anything, such as mp3 files. Some can transmit homeopathy through emails, or just write the name of a remedy down on a prescription pad. Anyway, sugar pills are just a common delivery mechanism as found in Boots or Holland and Barrett.

That ultimately eccentric and bizarre homeopath, Rudolf Steiner, came up with the mistletoe thing. As it is Christmas, I must point out that it is unreported if he had a red nose, although he did have some funny grooves above it.

Rudolf noted that mistletoe grew like a cancer on other plants; its yearly rhythms so at odds with the rest of nature. He said,

Mistletoe provides, beyond question, a means which — when given in potencies — should enable us to dispense with the surgical removal of tumours. The point is only to find out how to treat the mistletoe fruit in combining it with other forces of the mistletoe plant, in order to arrive at a remedy.

Steiner was a mystic. His rather strange thoughts have developed into the fields of anthroposophical medicine and biodynamic farming. His ideas made Pliny's druids look perfectly rational. For example, if you wish to enrich your compost you can stuff oak bark into the skull of a dead cat and then bury it in peat for a while, or if you have an infestation of field mice, then catch a few, ceremoniously burn the little buggers, and then sprinkle the ashes around, but do this only when Venus is in Scorpio. (I am serious.) Biodynamic farming has evolved a little since into the slightly less batty form of farming known as 'organic'. There are some practitioners who still see this as a sell out and stick to the cat-skull-burning-mice-wicker-man original formulas. Buy your biodynamic wines in Waitrose.

So, why is mistletoe therapy still going? Especially in the UK? The Cochrane Review did note:

In the absence of good quality, independent trials, decisions about whether mistletoe extracts are likely to be beneficial for a particular problem should rely on expert judgement and practical considerations

So, where do you go for your "expert judgement?"

The answer, of course, is your local NHS Homeopathic Hospital.

Dr Elizabeth Thompson MRCP MFHom, in an article entitled, When orthodox medicine has nothing more to offer ..., notes that the Glasgow Homeopathic Hospital (paid by your taxes) is seeing an increasing number of cancer patients and notes that they have "experience in using Mistletoe which is given by injection and has been shown to stimulate the group of white cells whose numbers can be depleted." Another NHS Hospital, the Royal London Homeopathic Hospital is said to spend "5 million pounds on treatments such as Indian head massage, hypnotherapy and mistletoe, each year."

Of course, if you do not want to use public facilities, you can spend your own money privately. Harley Street is the place to go, where you can find doctors like Dr Sosie Kassab MB BS FFHom MRCGP, who is also Director of Complementary Cancer Services at Royal London Homoeopathic Hospital, offering mistletoe treatment through the private London Oncology Clinic.

Whether or not patients receive any benefit from these public and private services looks rather doubtful. Of course, doctors should be free, within ethical guidelines, to explore new treatments and develop new therapies. Patients obviously need to be fully informed though of what is going on. My concern is that anyone who has bought into the whole homeopathy thing may not be objectively evaluating the rationality and evidence-base for such treatments. But, this may not be too big an issue for too much longer. 2009 will see one of the NHS Homeopathic hospitals closing for good, and the others are struggling to stay open. They claim patient choice is being eroded by these decisions and the 'campaigns' against homeopathy. Patient choice though is about more than having available whatever bizarre treatment available anyone can dream up.

And, as it is Christmas, it would be rather Scrooge-like to end on such a down note. Myrrh might be rubbish, mistletoe doubtful, but a review in the BMJ by Edzard Ernst, just a few days ago, concluded that the evidence for treatments containing frankincense (B serrata) extracts is "encouraging, but not compelling".

Results of all trials indicated that B serrata extracts were clinically effective. Three studies were of good methodological quality. No serious safety issues were noted.

Not too bad then. Maybe we will look at that next year.

Have a peaceful Christmas, good luck under the mistletoe, and may Santa spare you the mad Aunt giving you a selection of Neal's Yard Remedies toiletries.

Labels: homeopathy, mistletoe, NHS

 

Today Prince Charles visited the Nelson's Homeopathic Pharmacy manufacturing laboratories in London. He was supposed to be turning up with his wife, Camilla, but unfortunately she has not been taking her magic sugar pills and was too ill to inspect the identical tubs of white sugar pills.

It looks like Charles and his spin off commercial enterprises, "Duchy Originals" is getting into bed with the magic pill manufacturers to produce his own range of "herbal products." Charles, destined to become King, is also becoming the nation's healer.

We scoff and scorn third world leaders who in feats of pure derangement and power proclaim their bizarre healing powers. In Gambia, President Yahya Jammeh announced he had discovered a cure for AIDS. Gambian Health Minister, Tamsim Mbowe, a trained doctor and obvious sycophant, supports his president's belief that he can cure AIDS in three days with his secret medicinal herb concoctions.

Ex South African president Thabo Mbeki wallowed in his own murderous AIDS denialism and allowed his health minister, Manto Tshabalala-Msimang, to promote her own cure of garlic and beetroot whilst actively preventing a roll out of antiretrovirals to the vast HIV+ population. The University of Cape Town estimates that 340,000 deaths could have been prevented if the government had not been enthralled by quack alternatives.

In both cases, delusional health beliefs were allowed to reach murderous proportions because no one dared question authority, without fear of reprisals. In Gambia a UN representative pointed out that there was absolutely no evidence that Jammeh's cures worked. She was given 48 hours to leave Gambia.

We are shocked at such 'backward' antiscience and quackery. But we have own chief witch doctor a heart beat from being head of state. Charles' views on alternative medicine are well known. When Professor Edzard Ernst criticised his views, Sir Michael Peat, Prince Charles's private secretary, made an official complaint about him which resulted in his employers at Exeter University spending a year running disciplinary hearings and investigations.

As Ernst remarked, "I have repeatedly been told he cannot tolerate advice which is not 100% in line with his opinion ... I think his advisors are all sycophants".

Charles talks of 'Integrated Medicine'. It is a euphemism. There is no way you can integrate nonsense with reality - and that is what homeopathy is. The real agenda of Charles is to promote alternative medicine and force it upon the NHS at all costs. His main vehicle for this is his Foundation for Integrated Health and his involvement with ensuring new bodies are set up to give official sanction to quacks, such as the newly emerging Ofquack.

At his tour of Nelson's today, he praised them for their efforts in "leading the way to integrate natural and conventional ‎healthcare". Again, it is difficult to see what Nelsons are doing to integrate with conventional healthcare. It is difficult to talk about a homeopathic pill manufacturer without calling it a fraud. The picture above shows Charles inspecting a number of vats containing wing of bat or hyena saliva. No matter what is in those vats, after it has gone through the magic rituals of homeopathic preparation, the pills leaving the factory are to all purposes identical and contain no meaningful active ingredient. They then ship them off to pharmacies like Boots where they are sold in packages and given nice names like Teetha - a remedy for teething babies which contains no medicine.

I have sometimes wondered if all they do is scoop out pills from one giant pot into little pots and just label them differently. The effect would be exactly the same. Nelson's manufacturing process is indistinguishable from a fraudulent activity in its output. And here we see Charles endorsing it.

I have recently asked each of the Universities offering a BSc in homeopathy in the UK, to see if they can do a simple test to tell one homeopathic pill from another. I have written twice now to ten homeopathic academics and none have seen fit to reply to me yet. The only academic studying alternative medicine in the UK who is willing to put such beliefs to objective test is Edzard Ernst and his team at Exeter. And for doing so, it causes nothing but contempt from the homeopathic community and their royal patron.

Charles is set to be King. His constitution role is being stretched to intolerable levels by his insistence to move into commercial exploitation of quack products. We may think we live in a sophisticated and developed nation, but Charles may play a useful role of reminding us we are still easily enthralled by authority and magic. We risk a health despotism in the UK no better than a failing African state run by a self aggrandising mad man.

Labels: homeopathy, Prince Charles

 

It is now one year since I issued a simple challenge to the homeopathic community to provide a simple and clear demonstration that what they say is true. If homeopaths could provide basic evidence that their beliefs are demonstrable, then much of the criticism of the trade would disappear.

But not one homeopath has been willing to give it a try. I bent over backwards to make it easy, cheap and accessible. Despite much bluster and hot air, on this site, and homeopathic discussion boards, no homeopath had the balls to come forward.


The test I proposed was simple: homeopaths claim that their pills have specific effects. In particular, each type of pill can induce specific and repeatable symptoms in healthy volunteers. (See the Society of Homeopaths explanation.) This is called a 'proving' in homeopathy and it is how homeopaths determine what each sort of pill is good for curing - 'like cures like.' For example, if a pill makes you feel tired when you are healthy it can be used to cure lethargy. Homeopaths routinely do provings on new substances, record the symptoms in groups of volunteers, and then add the new pills to their medical store cupboard. My test was simply this: given six different homeopathic pills, could a homeopath identify correctly which pill was which if all they know were what the six remedies were, but not which pill was which? The homeopath could choose whatever remedy they liked - to make them as distinct from each other as possible - and to take them in any 'strength' (remember homeopaths believe that the more dilute a substance, the more 'potent' it is). Just tell six pills apart. Simple.

I extended my challenge in a number of ways. I was quite happy for groups of homeopaths to do the 're-proving'. Some complained that this was too much of a burden for one homeopath. I was also quite happy for anyone to do anything to determine which pill was which. They could perform a re-proving, they could use any analytical technique (physical or chemical), they could dowse the pills or subject them to anything else they could think of. But not one homeopath wanted to end the controversy and prove homeopathy was real.


The reluctance of anyone to do this is fascinating in itself. But maybe I am making a big ask of homeopaths. Maybe it is a lot for just one or two homeopaths to do. And maybe it will take up more resources than I anticipate. Maybe it is more the sort of experiment that can only be realistically be done in a University. I don't believe any of this, but I want to give homeopaths the benefit of the doubt, and so I am now asking Universities to take up the challenge.

There are a small number of UK universities that offer a BSc degree in Homeopathy. These courses have been heavily criticised for being unscientific and not worthy of a science degree. At least one of the Universities is struggling with its course and is holding an internal review to see if it should continue to offer the course. I am asking these Universities to take up the challenge and encourage their students to do this test.

This ought to be easy. In any science degree, students spend many hours in laboratories, doing experiments, repeating the classic results that underpin their subject and learning about experimental technique and communicating their results. Why do BSc homeopathic courses not do simple tests like this as part of the learning programme? Why do students not take part in fundamental empirical tests of their subjects, like all other science degrees? If the universities want to deflect criticism of their courses, then surely demonstrating that their courses contain basic laboratory training in the fundamental scientific aspects of the subject would remove all criticism?


This test would undoubtedly be a great way for students to think about the scientific method and the nature of evidence. More than that, if the test was successful then it would be one of the biggest breakthroughs in homeopathy in 200 years. If such a test could be replicated across the Universities then I am sure criticism of homeopath would turn to amazement and excitement.


So, what I am proposing is the following:

1. I am writing to course heads and lecturers in five universities (details below) to invite them to take part in this test.


2. If they accept the test, I will post them six bottles of remedies. I propose to use standard High Street 30C remedies available from Boots, Holland and Barrett etc. However, the University may propose any remedies in any potency they like and I will source them from online homeopathic pharmacies.


3. The names of the remedies will be published on this site. The remedies will be dispatched in identical homeopathically ready bottles obtained from homeopathic supply companies. I will pay for the pills.
   
4. Each of the six bottles will only be identifable by a code letter (A-F).


5. I will post online an MD5 hash message digest of the code that relates each letter to each remedy with a salt to minimise attack. (Technical, but it means I cannot deny the results if they work out positive.)


6. When the university has completed whatever test it likes, I will post the code so that all can check this matches the hash and that I have not cheated.

I am quite willing to entertain all sensible proposals to modify this protocol as long as the statistical power of the test is not weakened and that the test remains blinded. I am happy for participants to try to make the test as easy as possible for them to pass in any way without compromising blinding.


And of course, the challenge is still open to any other individual or organisation that believes can prove homeopathy is not just plain sugar pills.


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

In the morning, I am sending the offer to the following Universities and staff members:

Labels: $100 challenge, homeopathy

 

There is a claim by many sceptical writers that we live in a new age of endarkenment. Our public lives, whether in politics, universities, businesses and health, face an onslaught of irrational thought. However I have uncovered some remarkable evidence to suggest that interest in homeopathy is declining rather aggressively. I am not sure I believe it, and I want to encourage comments and interpretations to see if this might be real.

All this came about because Google have unveiled the latest part of their rather splendid toolset that allows researchers to look at search trends and see how this might be used to monitor and predict all sorts of behaviour. As a showcase for their techniques, they have developed flutrends that shows how people are searching about flu across the United States. They believe this correlates very closely with incidence of the disease and thus can be used as a near real time monitor of the severity of outbreaks. Standard reporting techniques mean that reporting lags two weeks behind and so this technique may be a much more timely and accurate measurement. Fascinating stuff. And very useful if you want to deploy resources effectively.

So, I decided to play around myself and naturally wanted to see if people were looking for stuff about homeopathy on the web. The graph below shows the relative incidence of the search term in the United Kingdom over the past few years. (The lower part of the graph shows results for news items.)

 

 

This is remarkable. Interest in homeopathy is only about 40% now of what it was at the beginning of 2004. if this is true it shows a devastating collapse in interest that surely must be reflected in the businesses of homeopaths.

(as a side note the letters above the graph refer to the following events:

B) The Lancet meta analysis published

C) The letter to PCTs asking them to reconsider funding NHS homeopathy

D) Degrees in homeopathy criticised as being unscientific)

Can we trust this curve?  Is this just an artifact of Google? Are people getting more sophisticated in how they use Google rather than relying on blunt and simple searches? Let is compare with France. Is a similar trend seen? Lets see the curve for homeopathie searches in France.

Much flatter. In France, homeopathy has a very different cultural dynamic. There are no lay homeopaths. Medical doctors prescribe pills or people self-'medicate' in large numbers from their local pharmacie. The largest homeopathy company in the world, Boiron, is French with a turnover of half a billion euros. There is no significant sceptical community as far as I can tell.

Does this result correlate with any other evidence we have about interest in homeopathy? We know GPs are prescribing fewer homeopathic prescriptions. Is this because interest is waning or do fewer prescriptions mean fewer web searches as patients find out what the hell their doctor has given them. The Society of Homeopaths has occasionally published memberhip figures. The last graph was in 2005 and shows a peak membership in 2004 and that it was then in decline. They have not published similar figures since. Are they embarrassed? Their membership income has increased but they say this is due to their better efforts at moving members up the grade scheme with higher fees due. I have reason to believe, albeit anecdotally, that few lay homeopaths are able to make a full time living and most do it as part of a portfolio, part time or as a paid hobby. Will members be renewing through the coming recession? We also know that NHS funding for homeopathy is decreasing as PCTs refuse to fund referrals and hospitals. There are definitely threats to homeopathy, but this severe?

If the trend continues, there will be no Google searches for homeopathy sometime around 2011-2012. Does homeopathy have two to three years left? Even if the trend is true, surely it must bottom out as we are left with a rump of True Believers.  I am quite sure that homeopathy's greatest threat is that people will find out what it is - magical witchcraft. Is the Internet allowing people to see through the homeopathic propaganda? All very tantalising.

So, how reliable is the Google trends programme? They say is a 'beta' and so not to write PhD theses on it. An hour of fun has produced the following trends that suggest it is at least getting something right...

Can you tell there was no Glastonbury festival during 2006?

Led Zeppelin has been very steady (bar their reunion show last year).

Barbeques show predictable trends. I will leave it as an exercise for the reader to correlate barbeque searches with daily temperatures/hours of sunshine. (You can download data into a spreadsheet.)

Searching for Majorca and the Maldives shows the results you might expect with an upsurge of interest for both over Christmas as people open their Radio Times and think about their holidays. Majorca shows a highly seasonal trend whereas the Maldives reflects its more all year appeal. (My guess is I do not need to spell out what the spike for the Maldives at the end of 2004 was all about).

Barack Obama and Sarah Palin have thoroughly predictable profiles.

Interest in sex appears to be pretty steady (with some surprising uplift at Christmas again)

And so back to topic. What about other quackery? We can compare searches for homeopathy (blue), osteopathy (red) and chiropractic. (orange)

The decline of homeopathy is much more marked than the spinal techniques. Maybe something is real here.

The Google tool has a number of other excellent facilities. We can find out where the most homeopathic searches are coming from. The result is...

India. It shows the highest infliction of homeopathy where the nationalist governments actively encourage 'Traditional' medicines as part of the Hinduisation of politics - even though homeopathy is German. I have written about the World Health Organisation's disgraceful role in this hoax on the vulnerable.

So, what do we make of this? The trend is not easy to explain away and yet appears to remarkable to be true. Will we see homeopathic companies going out of business soon? Will membership of the pretend regulatory bodies drop precipitously? Is this the end of the last few decade's resurgence in this quackery?

I welcome your thoughts.

Labels: Google, homeopathy

 

It looks like we have a new comic sceptic genius in our midst. Welcome to the UK, Tim Minchin.




Tour dates available here: http://www.timminchin.com/

Labels: homeopathy

 

The Adverting Standards Authority has today found that a homeopath advertised their asthma clinic for kids by making untruthful, unsubstantiated and irresponsible claims. Archway House Natural Health Centre holds an Asthma and Eczema clinic for children, run by Julia Wilson, a member of the Society of Homeopaths.

Inasmuch, this is not news. The ASA make judgments like this every week. Their weekly published list today contains all sorts of findings against chiropractors and related quacks. But what makes this interesting is that this advert, in the form of a leaflet, has already been subject to a complaint directly to the Society of Homeopaths, who claim to regulate their members. Over a year ago, I was concerned that the Society's Code of Ethics was being widely ignored by their member and there was no evidence that they took any steps to uphold their code which is designed to protect the public. If so, this was pretty serious. People would be visiting homeopaths under the impression that their membership of the Society of Homeopaths ensured that certain standards would be maintained and that they would not be misled or endangered as a result of the consultation.

I picked on one homeopath from their register pretty much at random. Not only was Julia Wilson making claims to treat asthma (which would be in breach of the code) but also she has spent time in Kenya in a clinic that dishes out sugar pills to prevent malaria and to treat HIV. One would have thought that a responsible organisation would want to rein in such dangerous excesses. This homeopath appeared to be in breach of several points in their code including treating named diseases and advertising in a way that claimed superiority to real treatments.

You can read about the Society of Homeopath's response here. Julia Wilson defended herself by claiming that her adverts (see here) did not claim superiority of homeopathy over conventional treatment, that she made no stated or implied claim that homeopathy can treat asthma, and that no cure was implied. She also said that she could not be held responsible for the Kenyan clinic's claims on their website and that she did not claim to cure HIV or malria when working there. I would suggest you read the leaflet yourself and see if this defence merits any credibility. The Society of Homeopaths wrote to me to tell me that they were satisfied that no breach of their code had taken place and that "no action will be taken."

Well, the Society of Homeopaths did take action. Their solicitor wrote to my web hosts demanding that I take down web pages that commented on this and other aspects of their lack of concern for the dangerous practices of their members. When I wrote to the Society's CEO Paula Ross asking for an explanation, I got a threatening letter back from their solicitor. Naturally, bloggers on the web went crazy, reposting my articles and condemning the behavior of the society, calling them 'Cowards and Bullies".

The ASA read this leaflet and decided that on four counts it was in breach of the CAP rules on advertising for being unsubstantiated, untruthful and irresponsible. They decided the leaflet did imply a cure for asthma because it denigrated conventional treatment - "puffers can provide temporary relief, they're not offering your child a cure. Homeopathy is different...". They asked Archway House for evidence that their treatments 'helps alleviate the flaring skin and tightening lungs of your child's allergic reactions". They could not answer this to any degree of satisfaction. Most strikingly, the ASA found the leaflet was irresponsible because it was likely to dissuade parents from seeking medical advice. A testimonial read "I was frightened by how much my daughter relied on her inhalers". Damningly, Archway house could not provide any evidence that the testimonials on the leaflet were real.

I have emailed the Society of Homeopaths to ask why their conclusions were so different from the ASA. I have also asked if they will relook at the complaint and take action against their member as it is a requirement of their code that member's adverts do not breach Advertising Standards rules. Importantly, I have asked if the public can have confidence in their code of ethics and complaints process. (Update: response, so far, below)

Does this matter? Asthma is not a trivial disease. Asthma UK report that,

A person is admitted to hospital every 8 minutes in England because of their asthma. That's on average 185 people per day and one in six people require further emergency care again within two weeks, yet 75% of admissions for asthma are avoidable and could save the NHS in England an estimated £43.7 million a year.

It is estimated that there are 1,500 deaths and 74,000 emergency hospital admissions for asthma each year in UK. A child whose parents go a homeopathic route rather than following the management plan of their doctor is being put at risk. The Society of Homeopaths do not appear to care about this. But people in the UK quite rightly have choices. When homeopaths take their sugar pills to Africa and tell them that they are better and cheaper than medicine at preventing malaria and managing HIV, then the delusion of homeopathy becomes truly murderous. If you want to believe the homeopaths that they act responsibly over this, then you should see the latest newsletters from the Abha Light Foundation in Kenya where Julia Wilson worked. They are handing out homeopathic remedies to 1,500 families and telling them that they are malaria prophylactics. 34,000 people die in Kenya each year from malaria. Over a third of children die before their first birthday from Malaria. Telling families that magic water pills can protect them will reduce the likelihood that they will seek proven safe alternatives, such as mosquito nets for babies. The Society of Homeopaths have never spoken out against this terrible western delusion inflicted on Africa.

In the year 2000, the House of Lords looked into the question of regulation of Alternative Medicine and made a large number of recommendations about how various treatments should be controlled. Eight years on and the government strategy is in tatters. The homeopaths have actively campaigned to be exluded from greater regulation and decided that they can regulate themselves. This is clearly not true. The deluded cannot regulate the deluded if the public want to be protected. The government has set up the Complementary and Natural Healthcare Council (better know as Ofquack). This has failed for a number of reasons. Firstly, few alternative medicine groups have wanted to join. As Ofquack will have council members that are not part of the alternative medicine communities that they will regulate, none of the practitioners want to be judged by anyone who does not share their delusions. And secondly, as Ofquack has failed to get up and running and will be entirely voluntary, there has been no compulsion for quacks to subject themselves to any meaningful scrutiny.

Prince Charles has been deeply involved in trying to set up Ofquack. The Prince's Foundation for Integrated Health put one of their own people into a group that would try to unite the homeopathic profession and create a single register that could be effectively managed. The squabbling between homeopaths ensured this failed. Ofquack appears to have abandoned any pretense that it can now regulate vast swathes of the alternative medicine industry. The Society of Homeopaths have now stated that they intend to create their own 'single register' - a move that has angered the rest of the UK homeopaths and is doomed to failure too.

So, in the UK, when a member of the public seeks the services of an alternative medicine practitioner, they are likely to see someone with letters after their name and a web site that says that they are members of professional bodies with a strict code of conduct. This is a thoroughly misleading picture. Homeopaths and other practitioners may well sign up to a code of conduct, but in the knowledge that it will never be enforced.

In the Guardian recently, the same comment was made in an article entitled "A Question of Ethics". The article noted that one of the most senior member of the Society of Homeopaths was a strong advocate for providing homeopathic 'immunisations' - the belief that magic water can protect people from dangerous diseases. The arctile concluded, "It seems that codes of ethics are good for window dressing while pragmatism is better for profit. ". The Society responded with a press release,

The Society would like to advise Guardian readers that any suspected breach of The Society's Code of Ethics & Practice should be formally reported to its Professional Conduct Department where it will be fully investigated.

Investigated maybe. Enforced? Doubtful. The codes are an illusion and we are being taken for fools.

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

Update

I have had a reply from Jayne Thomas, Chair of the Board of Directors at the Society of Homeopaths:

As we have not yet seen the findings of the ASA adjudication to which you refer, The Society of Homeopaths is unable to comment on the specifics of this case.

However, we would like to reassure you that due process was followed in the handling of this case.

By their own admission, The Committee of Advertising Practice (CAP), have been delayed in finding an expert to assess the evidence base for homeopathy, which was submitted to them earlier this year.

The Society of Homeopaths is therefore awaiting the outcome of this assessment to inform future guidelines to our members concerning the advertising of homeopathy

So, we will have to wait for a more detailed response. I must admit that I surprised that SoH have not seen the adjudication yet. The ASA release a preliminary report to all parties several weeks before publication to allow the advertiser to respond and make corrections. Did Archway House really not consult SoH both originally and on the preliminary finding? The advertiser would also have been aware of the final outcome about a week before publication too. How do the SoH know that the ASA could not find an 'expert' to help them? In what way have SoH been involved here?

Labels: ASA, homeopathy, Natural Healthcare Council, ofquack, Society of Homeopaths

 

Anyone who has ever entered into a debate with a homeopathy about the nature of their trade will have sooner or later bumped into this objection to their arguments. At one level, it is a simple deflection away from whatever point you were trying to make and an attempt to turn the conversation to your apparent lack of credentials and authority to question the subject. Without doubt, the homeopath will have paid for their three or four years of correspondence courses, or may even have obtained a BSc from a minor UK University. They have letters after their name and certificates on their walls. You do not. So shut up.

Instead of a coherent and credible voice we are steadily turning into a veritable dawn chorus of approaches, systems, methods and madness that sit uncomfortably under the umbrella we call ‘homeopathy’. It is a cacophony of noisy speculations, so singly indefinable that it is almost impossible to raise a critical objection to anyone, and if so, the questioner risks being taunted and accused of obstructing other people’s views by being critical, right-wing, right-brained and probably paid by Swiss drug companies to boot. We should be careful. Ironically, the veneer of that all embracing, ‘lovey-dovey, kisses and cuddles’, Californian approach, that so marks the alternative scene, actually masks a hidden and tyrannical agenda.

Labels: homeopathy

 

Dr* T on his Thinking is Dangerous blog reports that Helios appear to have stopped selling their Malaria nosodes for the homeopathic prevention of Malaria. This is good news. A quick check also reveals that Ainsworths also appear to have stopped selling it too.

Labels: homeopathy, Society of Homeopaths

 

Homeopathy on the NHS has nearly vanished. We see prescriptions have halved in the past two years and one of the last five hospitals has been confirmed to close. This is as it should be. The last vestigial remnants of nineteenth century quackery in the state health care system are being dropped from the tax payers burden. There is nothing unsurprising here. It is the natural result of an increasing awareness of the need to adopt evidence based practices. As much as quackbusters would like to think that it is their influence that has achieved this, I would guess what we are seeing is the result of more general and broader historical changes.

But the homeopaths, in their fabulously constructed fantasy world, see an army of quackbusters crossing the Vistula and are conspiring in their bunkers to strike back with what depleted reserves they have. We can expect to see increasing and bizarre attempts by homeopaths to bolster their position and smear their enemies.

The Faculty of Homeopaths, who represent medically trained homeopaths, has been hard at work. It has issued a press release reporting supposedly dramatic benefits for NHS homeopathy. 'Angry' Melanie Oxley, ex Society of Homeopaths, appears to be issuing press releases for the Faculty.

In one press release, she tries to discount reports that doctors are not prescribing homeopathic pills any more. She says there are three reasons:

Although balanced by increased patient numbers, the proportion of prescriptions actually written by a GP is not representative of the whole; other health professionals such as nurses and pharmacists have prescribing rights.

Of course, the Faculty do not appear to have any evidence that there is a massive shift to nurse based prescribing of homeopathy within the NHS. That would be fascinating in its own right.

The cost of buying a homeopathic medicine over the counter is often less than for a NHS prescription (prescription £7.10, homeopathic medicine typically less than £5.00). Increasingly, prescribers are recommending their patient buys the
remedy over the counter, saving the patient money.

This may well be true, but many people on long term illness, the young and the old, do not pay prescription charges anyway. Again, there is no evidence to support the assertion that doctors (or nurses) are asking patients to cough for their own sugar pills.

Only a tiny proportion of the 3,500 plus homeopathic medicines available are listed in the computer software for GPs, and so most homeopathic prescriptions are handwritten. It is not clear whether these are entered into the data.

Mmmm. The computer says, 'No'. Yes, there are thousands of remedies, but most prescriptions are undoubtedly for the common dozen you can find anywhere. Is the NHS really prescribing hyena saliva and Vacuum Cleaner Dust remedies? I doubt it.

The latest piece of rubbish to emerge from the Faculty is about a paper that has just been published from research at the Bristol Homeopathic Hospital in the Faculties comic, Homeopathy. This follows the appalling 'Spence' paper from Bristol that claimed to show that 70% of their patients reported health improvements. There were no control groups in this study. There was no evidence that homeopathy was the cause of the health improvements. It was rubbish and Bristol have not learnt the simple lesson.

This time we learn that "Nearly 60% of patients who had received a series of homeopathy appointments reported an improvement in health that affected their daily lives." Again, nothing to compare this figure to. No way of knowing what the health improvements would have been without homeopathy. We just find out the startling truth that some ill people get better. But this is unsurprising as the paper was about a pilot study to test methods in quality assurance in homeopathic hospitals. It is a way of conducting homeopathic customer satisfaction surveys and tells us nothing about the effectiveness of the magic sugar pills.

But being good PR people at the Faculty, the truth will not get in the way of a good story. The Daily Mail has already reported on this nonsense, The alternative Holby City that treats 30,000 patients a year.

The Mail says,

But with budgets in crisis, critics claim spending on complementary medicine is frivolous - and last week it was revealed that GPs' homeopathic prescriptions have fallen by 40 per cent in two years.

Yet according to the journal Homeopathy, among those receiving these remedies, 60 per cent say their health improved after treatment. We spoke to a range of patients at the hospital who have turned to homeopathy.

In other shock medical news, children who have visited hospital tend to grow taller over the following year. And so, the Mail trots out the anecdotes. In one hilarious one, a patient recounts the failure of homeopathy,

Dr Saul Berkovitz, who leads the clinic, put me on homeopathic remedies at first - causticum, which is supposed to help stiffness, and cimicifuga, which alleviates aches. Neither helped.

But never mind. Some chinese herbal medicine was the thing that 'worked for her' in the end. We also find out how Gertrude does not get colds anymore and how Joshua's childhood eczema cleared up. Also, in a remarkable testimony, Nike Jonah's headaches have been helped by real medicine, but now she has taken some homeopathy and is waiting to see if it works. And 95 year old Jane swears by arnica for her bruises. You could not make this stuff up.

The Faculty of Homeopaths are taking entirely the wrong track here. They are swimming against the current of science and reason. As the (relatively) sane wing of the homeopathy movement, the Faculty really ought to be having a frank discussion about the practicalities and ethics of using an entirely placebo based therapy in modern healthcare. That is what all the science and evidence says homeopathy is and that is the only discussion that could feasibly save homeopathy on the NHS. Can they muster the insight and courage to have that conversation?

Labels: homeopathy, NHS

 

Reported today in Pulse,

Campaigners look to have lost their fight to save a leading homeopathic hospital, in a landmark case that accelerates the treatment’s deepening crisis over NHS funding.
West Kent PCT decided there was ‘not enough evidence of clinical effectiveness’ to justify funding routine homeopathic consultations and treatments at the Tunbridge Wells Homeopathic Hospital, a decision which may force its closure.

Amazingly, most patients and GP's did not want to see funding for homeopathy,

Campaigners against the cuts in West Kent applied for a judicial review last year . Although it was later dropped it forced the PCT to launch its own independent review. But this found 66% of patients and 80% of GPs did not support funding homeopathic services at the hospital, justifying the PCT decision to stop referrals for homeopathy.

It won't be long before the rest follow.

Dr Tim Robinson, a GP who provides a local homeopathic service in Dorset, said this was a ‘test case’ which would send ripples around the country. ‘The worry is that other PCTs may follow West Kent’s lead. The monies that are being spent on homeopathy compared with the NHS budget are small and are falling.’

Let's be clear. The Quackometer does not want to see homeopathy banned. It just thinks that spending public money on witchcraft cannot be justified in a modern social healthcare system. GPs may well still prescribe homeopathic remedies if they like and I do not have too much of a problem with this, but there ought to be a franker debate about the ethics involved in lying to patients about the pills. At the end of the day, people can still pop into Boots the Chemist if they so wish and pick up some sugar pills. Or even, if they are feeling brave, consult a lay homeopath. But the NHS does not have to pretend anymore that homeopathy works. A good decision.

Labels: homeopathy, NHS

 

Bafflegab - the multiloquence characterized by consummate interfusion of circumlocution or periphrasis, inscrutability, and other familiar manifestations of abstruse expatiation - is word that ought to be familiar to Lionel Milgrom.

Milgrom is a champion apologist for homeopathic 'science'. As a former director of the Society of Homeopaths, he delights the homeopathic community with his musings on quantum theory, entanglement and its hypothesised role in 'patient-practitioner interactions'. Since quantum theory is highly specialised and requires advanced mathematical understanding to appreciate, one can be pretty sure there is not a member of the Society of Homeopaths who has the slightest clue what he is on about, or the knowledge to judge if he is speaking sense. But that does not matter. They wallow in his his quantum words like a medieval peasant listening to a Latin sermon. Or if I was being particularly cruel, like a dog, head cocked, listening to its owner describe her day at work. It is comforting, beguiling, but meaningless. But more on quantum homeopathy later.

Milgrom is now accusing critics of homeopathy as being the 'New Fundamentalists'. Somehow, the likes of Edzard Ernst, Richard Dawkins, David Colquhoun and Ben Goldacre and stuck in some naive philosophical view of science that cannot comprehend the 'new paradigm' of homeopathy. I want to show how his arguments are a distraction and just plain wrong; rhetorical devices designed to deflect from the substantive criticisms being made. They are at essence a classic ad hominem attack using the old devices of straw men and misrepresentation. For homeopaths, his arguments are just impenetrable but comforting words that allow them to ignore the serious concerns being expressed about the activities and beliefs of homeopaths.

Milgrom's accusations that critics of homeopathy are the 'New Fundamentalists' have appeared in a number of places. Most prominently, a series of seminars were held recently by Jayney Goddard. The accusations made it (shamefully) onto the pages of the Times Higher Education Supplement. The presentation that Milgrom gave is available from the vitamin pill industry lobby group, the Alliance for Natural Health. But importantly, Milgrom has set forth his ideas in a paper published in the Journal of Alternative and Complementary Medicine, entitled Homeopathy and the New Fundamentalism: A Critique of the Critics.

So what are the accusations that Milgrom makes against Homeopathy's critics and why are we 'fundamentalist' in our outlook? His arguments can be summarised as:

1. We are 'economical with the truth' and we 'propagate porkies'. Straight up, we are liars.
2. Modern medicine is 'deadly' and we are ignoring this fact.
3. We lie when we say there is no good evidence for homeopathy. We cling to 'discredited' meta-analyses, such as Shang at al.
4. We ignore 'developments' in material science that shows water has a memory.
5. We are philosophically naive in our demands of 'proof' for homeopathy and that we are challenged by 'Popperian and Kuhnian' views of science. Hence, we are 'unscientific'.

In Milgrom's own words,

New Fundamentalism’s hallmarks include the denial of evidence for the efficacy of any therapeutic modality that cannot be consistently “proven” using double-blind, randomized controlled trials. It excludes explanations of homeopathy’s efficacy; ignores, excoriates, or considers current research data supporting those explanations incomprehensible, particularly from outside biomedicine: it is also not averse to using experimental bias, hearsay, and innuendo in order to discredit homeopathy. Thus, New Fundamentalism is itself unscientific.

Let's examine these charges.

Liars?

It is not clear what untruths Milgrom is accusing the critics of uttering. He uses the example of Nick Cohen's article in the Observer where he said that "To its fans, homeopathy is the ultimate cure-all. In fact, its effects can be positively deadly". Milgrom does not make clear what is a lie here. Cohen's article argues that if homeopaths pretend they can cure AIDS and other dangerous diseases with magic water then there beliefs are undoubtedly deadly. As with all homeopaths, Milgrom is ignoring the charge and instead labeling those that point out the obvious as just liars. Homeopaths like to pretend that this criticism is a lie. It is easier than policing their own trade.

It is an odd accusation to make since we are now accustomed to high profile homeopaths being 'economical with the truth'. We have seen Neal's Yard Remedies misrepresent themselves after being caught out selling illegal homeopathic products and the Society of Homeopaths have never been straightforward over their role in pushing sugar pills for malaria.

Modern medicine is 'deadly'

This is a common homeopathic trick: to point out how many people are harmed by medical treatments, often using highly suspect figures. The argument is meaningless because homeopaths never put any of their charges in context - that medicine is often about taking risks and that the benefits need to be weighed against the risks.

The emptiness of this argument was recently demonstrated by Harriet Hall in a article called 'Death by Medicine' where she takes this common homeopathic whine and substitutes 'medicine' for 'food'. It is worth quoting her at length:

Overweight is known to cause hypertension, heart disease and early death, as well as a huge number of other health problems. It is a major factor contributing to diabetes. Attempting to control weight (treating the symptoms instead of the cause) has led to a proliferation of dangerous diets and drugs such as the recent Fen/Phen scandal and the ephedra catastrophe. Unnecessary surgical procedures (again, treating the symptoms instead of the cause) mutilate the gastrointestinal tract of these unfortunate victims of food. Concerns about food lead to anorexia nervosa and bulimia. More money is spent on food than on any other class of products; just think how much more good that money could have done if it were spent instead on valuable research into things like homeopathy, acupuncture, and therapeutic touch! Frequent automobile trips to grocery stores and restaurants cause accidents, depletion of fossil fuels, and contamination of the atmosphere. Thousands suffer from indigestion, constipation, and diarrhea. Certain foods are deadly for those with allergies. Wheat is poison for those with celiac disease. Phenylalanine in foods causes mental retardation in children with undiagnosed PKU. Food may not contain all the vitamins and minerals and trace nutrients required for good health; people who depend on diet and refuse to take supplements can be seriously harmed. If you add up all the years of life lost due to overeating, obesity, allergic reactions, contaminants and toxic chemicals in food, deficiency syndromes, botulism, food-transmitted diseases like hepatitis, salmonella and E. coli, etc. etc. you will quickly come to the conclusion that food is the leading cause of death and injury in the United States. In fact, it is the ONLY cause: no illness has ever developed without previous food ingestion.

Of course, the ultimate parody of this form of thinking was achieved at DHMO.org, the campaign body that has shown that water is a deadly chemical that needs to be banned NOW! Yes, water, food and medicine all carry risks: intrinsic, political, technical and commercial. By only examining risks without balancing benefits, you can condemn any activity in life. And in all cases, delusional alternatives are never the answer.

We lie when we say there is no good evidence for homeopathy.

Over the past two decades there has been a steady increase in the number of trials of homeopathy. In turn, various authors have looked at the accumulation of evidence and performed 'meta-analyses' where all the evidence is drawn together to try to come to an overall conclusion. The early meta-analyses tended to show a small but positive effect for homeopathy but acknowledged the poor quality of evidence available. Later and better analyses have shown smaller effects until the latest and most definitive, Shang et al, was able to conclude that homeopathy is just a placebo therapy.

Homeopaths have a number of strategies to cope with this hammer blow:

1. Only cite the earlier, cruder and more positive studies.
2. Attack the Shang study as discredited and unscientific.
3. Make up ad hoc meta-analyses and hope no-one notices what you are doing.

The third trick is interesting and common. You will find homeopaths saying things like, "81% (insert high number here) of clinical trials into homeopathy show a positive effect. Critics ignore these trials.' Homeopaths are performing their own on-the-hoof metaanalysis - assessing lots of disperate data to come to an overall conclusion.

Now, this is not true that these positive trials are ignored. Science is not a democracy where the majority result wins. What researchers like Shang do is look at all the trials and then weight them by quality. Poor quality trials are either discounted or given low weight. When this is done it is seen that high quality trials show little or no effect. This is truly taking into account all the evidence, including the evidence of quality. What homeopaths are doing is pre-selecting trials on their result (positive) and then drawing conclusions from only those trials regardless of the quality of those trials - cherry picking. It is at best poor meta-analytical technique; at worst, entirely dishonest.

Milgrom chooses to use technique 2 - discredit Shang et al. Now, as with all scientific papers, Shang has flaws. It is publicly published so that other researchers can pick over those flaws and hence give the original researchers and others chances to address the flaws or do more work. If after this criticism, sufficient corrections can be made without the whole work collapsing then we can be sure that the work is solid. Homeopaths pick out the original flaws in the Shang paper, but then completely ignore how those flaws have been dealt with. They then call the paper 'discredited'. AP Gaylard discusses this in an article - Shang’s secret - the hydra of homoeomythology. In short, the weaknesses of the Shang paper do not invalidate or distract from its conclusion - homeopathy is an inert therapy.

We ignore 'developments' in material science that shows water has a memory.

Milgrom believes that critics are unduly dismissive of research in material science that shows water has a 'memory' and hence there are plausible mechanism for homeopathy. Milgrom highlights several papers that claim such a thing. However, as of yet, there are no repeatable experiments that have been done that can show a consistent difference between two ultramolecular homeopathic remedies. Rao et al, published in Homeopathy (July 2007), is the study that come closest and is often brought up by homeopaths such as Milgrom.

This paper is excoriatingly bad. In the next issue of the journal, a response was published that tore it apart. The major concerns are:

1. Despite being used as good evidence for the memory of water, all experiments were done on ethanol.
2. There were no controls to ensure that different samples came from the same stock bottle of ethanol. Hence, different contamination levels could account fo differences seen.
3. There were no data to show that the differences were consistent.
4. Graphs presented in the paper were clearly not what they said they were.

They concluded,

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 so that it can be substantiated 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.

That Milgrom and others have completely ignored this devastating critique speaks for itself. It is noteworthy that it is critics of homeopathy who published this analysis in Homeopathy. Rather than critics ignoring the work in material science, they have fully engaged with it and show how it is lacking. It is the homeopaths who then fail to engage and ignore these arguments. Homeopaths have not published critical appraisals of Rao - instead it used as a tool of propoganda.

The 'memory of water' is a holy grail for homeopaths that will be forever out of their grasp. Water does cluster in memory-like ways, but only over picoseconds. Not a good shelf-life. And, has been pointed out numerous times, even if water did have a memory, it is only one of the difficulties amongst many that make homeopathy so implausible.

Milgrom also likes his own work on the 'quantum theory of homeopathy' to show that critics are 'stuck in an old paradigm of science'. Now it is true that Milgrom's work has almost entirely been ignored by other quantum physicists and that is because it is utter meaningless bafflegab. If Milgrom had wanted to be taken seriously then he would have published in a physics journal. Instead he chooses to play to the gallery and publish in Homeopathy again. It is a thoroughly confused paper that cannot decide whether his ideas are real or just a metaphor. It is just a metaphor then it fails on two levels: firstly, it is not clear what it is a metaphor for; secondly, metaphors are supposed to enable insight into difficult ideas by comparing them with familiar ideas. Does he believe that quantum mechanics is a familiar idea for homeopaths? Pure bafflegab.

It is true that such musing are largely ignored by physicist because they are obvious nonsense. At least one has taken time out to show us why.

We are philosophically naive in our demands of 'proof' for homeopathy

Here Milgrom descends into more bafflegab, this time of a philosophical nature. His intention is to show that critics of homeopaths are simplistic in their views of science (people like Richard Dawkins no less) and that our demands for 'proof' are naive.

I will not fully deconstruct Milgrom's views on paradigms and the philosophy of science: the work is done much better by AP Gaylard here.) What I will say is that Milgrom is essentially setting up a straw-man.

To illustrate this, we can see how he treats the recent challenge by Ernst and Singh to homeopaths to show some good evidence for homeopathy. Milgrom uses his sophistry to suggest that Ernst, Singh and indeed Randi will never pay out their prize money because they know full well that science can never provide 'proof' of anything. What Milgrom fails to tell his audience is that Ernst and Singh do not use the word 'proof' in their challenge. Has Milgrom even read their challenge? It does not look like it. What they ask for is evidence. And they state exactly what sort of evidence they require. I do the same in my own simple challenge. I do not ask for proof. What I am looking for is strong evidence that would be clear and unambiguous to anyone. No sophisticated philosophy required. Ernst and Singh are not naive in their views of science - what they ask for is simple - good evidence, that we can all debate and assess.

Milgrom says that there is evidence, but that it is rejected because people like Ernst are somehow stuck in an 'old paradigm' of science and that such evidence does not fit in with their 'currently held theory'. This is nonsense.

Image that your partner rushes into the room and says there is a tiger in the garden. Do you believe them? Probably not - despite them being normally truthful. If your partner had said nothing, the chances of there being a tiger in the garden are near zero. What does this new information add to the probability of their being a large carnivorous cat there? The chances are still near zero as it is far more likely that your partner is mistaken, playing a joke or had one too many margaritas. If however, you partner rushed in with pictures on the digital camera and half the street were running down the road screaming, you may wish to re-assess you beliefs about garden-feline interactions. There is a mathematical formulation for assessing the importance of new evidence like this - Bayesean analysis of prior probabilities. It can be summed up as 'extraordinary claims require extraordinary evidence'.

Such is the same for homeopathy. Weak evidence will not change the 'scientific paradigm' when the new theory is so highly implausible. There is nothing 'unscientific' about this and nothing 'subjective' in the rejection of such evidence that does exist for homeopathy.

Will the real fundamentalists please stand up

So, has Milgrom convinced anyone apart from the cock-headed homeopaths that critics are the 'new fundamentalists'? No. What Milgrom is doing is best summed up by Steven Poole in his book, Unspeak. Poole tells us that 'words are weapons'. The idea is to stop thought and make dissent impossible - to shut down debate before it happens. Anti-abortionists are 'pro-life'. How can you be against them? Are you 'against life'? Friends of the Earth - how can you criticize them? Are you an enemy of the Earth? Bush has been a master of using upspeak. The War on Terror - are you with us or not? His administration describes the beating to death of Iraqi prisoners as ' the repeated administration of legitimate force'. Bafflegab. Milgrom is using upspeak to allow homeopaths to ignore the serious criticisms being made of them by allowing them to dismiss their critics as just simple minded fundamentalists who are not open to new ideas.

Milgrom has failed to prove his point, not least because he fails to consider what a fundamentalist is. Usually, fundamentalism is used in a religious context and means,

a deep and totalistic commitment to a belief in the infallibility and inerrancy of holy scriptures, absolute religious authority, and strict adherence to a set of basic principles (fundamentals), away from doctrinal compromises with modern social and political life.

And of course, you only have to look to homeopathy for similar views. Another prominent homeopath George Vithoulkas confronts a similar question to Milgrom in the journal Homeopathy again, and comes to a thoroughly fundamentalist conclusion.

Vithoulkas asks "British media attacks on homeopathy: Are they justified?". His response is to blame 'progressive' homeopaths from straying from the teachings of Hahnemmann in his 'bible' the Organon. He condemns new homeopaths for having new 'dangerous ideas' on vaccination and provings.

He attacks the heretical homeopaths and blames them for the critical onslaught. He says,

With all these irrational and arbitrary ‘‘new ideas’’ the ‘‘modern teachers’’ are defaming homeopathy and demolishing the corner stones that constitute its scientific edifice. So it is not without reason that scientists reacted badly, that the media launched a war against homeopathy and the opponents of homeopathy are at this moment celebrating.

His call is for homeopaths to fall back to the 'rational' teachings of Hahnemann. He concludes,

There are today enough sane homeopaths who can turn the [homeopathic] craziness, disorder and confusion into order and sanity, but they must speak out. This journal should be part of such a proactive movement defending the essence and substance of the theories and principles bequeathed to us by Samuel Hahnemann.

The parallels with religious fundamentalists are obvious. Substitute Jesus or Mohammad for Hahnemann and you see a call to a strict interpretation of the scriptures and a rejection of progressive thought. The reasons for Homeopathic fundamentalism and religious fundamentalism may be similar: the feeling of being under attack from a powerful degenerate hegemony and a strong belief in holding the keys to the truth of the universe.

So, Lionel Milgrom. Who are the new fundamentalists? Those that seek evidence and insight? Or those that want to hide in their beliefs and sacred texts and are too afraid to allow them to be subject to criticism and enquiry?

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

An analysis of another presentation made at Jayney Goddard's fun day by Dr Alex Tournier has now been taken to bits by gimpy.

Labels: BPSDB, homeopathy, Lionel Milgrom

 

Labels: edzard ernst, homeopathy

 

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

 

How should homeopaths be regulated? I am not sure I have made up my mind yet about what I would like to see and I am not convinced there is a perfect solution. However, I hope some debate has been kicked off by all the goings on last year, here and on various other blogs and forums. One thing I am pretty sure of is that homeopaths have pretty much ruled themselves out of the discussion. Adults only from now on.

And the reason for this is that they have had their chance - and a good shot at trying to regulate themselves. Indeed, this was the stated aim of the Society of Homeopaths last year. Two of their annual goals were:

To facilitate the smooth handover of Society regulatory processes to a new regulatory and registration body

and,

To uphold and review The Society’s professional standards especially in relation to the development of a new regulatory and registration body (NRRB)

They failed miserably at both.

The farce of creating a single homeopaths' single register is being documented at gimpy's blog. Squabbling about money made sure the register did not get off the ground. I believe this reflected deeper rivalry between the various homeopaths' groups based on philosophical differences and also just plain old human power struggles.

The Society also demonstrated that their code of ethics could not protect the public from the worst delusional beliefs of their members. Their utter two-faced failure to tackle the problems posed by members offering anti-malaria advice led to the Society being prepared to directly misrepresent their own actions to the papers. They were also last year promoting homeopathic intervention in HIV people in Africa. It is difficult to think of more exploitative, deluded and dangerous actions.

So, to start off - what are we trying to protect against? Ben Goldacre has been quite clear about the dangers of alternative medicine - bullshit. And that bullshit manifests itself in a couple of dangerous ways with homeopaths. Firstly, they may delay a customers access to effective treatment - in the case of serious illness this can be fatal. Secondly, they may present themselves as serious alternatives to real medicine. We have found this most shocking when homeopathic missionaries tell vulnerable African people with HIV that they can treat them. Homeopaths use the denigration of medicine as a standard marketing tool. Homeopaths stand out in the alternative medicine crowd in their anger and hostility towards real doctors and medical practices. It is how they define themselves and what makes them most dangerous to the public. They most definitely are not a 'complementary medicine'.

It is not that I want people to stop visiting homeopaths and other therapists. People often do get benefit from the self-indulgent friendly chat that a GP is just not in a position to offer. Homeopaths ought to be in a prime position to offer this as I have said before. However, in visiting a practitioner, we need to consider how the public may be protected against two main problems we find in quackery: being exploited financially, and being given inappropriate and dangerous medical advice.

One potential solution is coming from Prince Charles and his Foundation for Integrated Health. FIH is looking into setting up a Natural Healthcare Council that will offer regulatory functions to the broad church of complementary and alternative therapies. The Times reports that this new voluntary register should be established this year and,

will be able to strike off errant or incompetent practitioners. It will also set minimum standards for practitioners to ensure that therapists are properly qualified.

Their hope is that,

all practitioners will be forced to join or lose business as the public will use the register as a guarantee of quality. The council will register only practitioners who are safe, have completed a recognised course, are insured and have signed up to codes of conduct.

Funnily enough, the homeopaths appear to be deeply hostile to this move. "The homeopathy profession has been unanimous in rejecting federalisation as an option for regulation" reports the Alliance of Registered Homeopaths. But, as I have said, I am not really interested in what they think - their only motives in discussing regulation appear to be self-interest and survival.

So, will the chief tree-talker's ideas be a good move? Should Prince Charles' organisation be allowed to succeed?

I have some serious reservations.

Firstly, by what standards will the Natural Healthcare Council set for competence and training? Professor David Colquhoun has documented the training dilemma of alternative medicine by noting that most alternative therapies are based on nonsense ideas that have no scientific and objective merit. "It cannot be expected that a universities will provide a course that preaches the mumbo jumbo of meridians, energy lines and so on... Can any serious university be expected to teach such nonsense as though the words [of alternative medicine] meant something? ". Since, homeopaths cannot even agree amongst themselves what homeopathy is and what are its essential elements (not surprising, as it is not based on reality) then the Council risks either alienating large swathes of practitioners or being completely arbitrary in its criteria. Either will not protect the public. Setting education standards for homeopaths is like trying to accommodate Hogwarts into the National Curriculum.

Secondly, by what standards will practitioners be judged in handling complaints and when upholding professional standards? Should we uphold a homeopath to standards of homeopathy, aromatherapy, reiki or - heaven forbid - evidence and science? This is important. In deciding whether a homeopath has crossed a line of ethics in offering malaria prophylactics, who will judge them? If homeopaths are involved, the the public will not be protected as they have dangerous and delusional ideas about their magic sugar pills. However, if they are to be judged by the standards of best evidence, then no homeopath will join the organisation as they know that they cannot practice within their strongly held beliefs. In either case, the Council will fail to protect the public. You might think that homeopaths would be willing to disengage from their wilder healing fantasies in order to gain the credibility of the name of Prince Charles, but all my experience says that homeopaths are fiercely proud, angry and determined not to be constrained by any external forces (probably orchestrated by 'allopaths').

And if the Council do uphold the strongest standards and do this in a transparent and accountable way, will the UK suddenly be free from rogue practitioners? Well, no. My recent example of the the ASA upholding a complaint against Osteomylogist, Robert Delgado, showed that even statutorily registering complementary therapists has big loopholes. This non-statutory and voluntary registered body, the Natural Healthcare Council, will have even less power over practitioners.

But what it will achieve is that Prince Charles' name will give credibility to all sorts of unproven therapies and wacky non-medically qualified people to go out there and pretend to be healers. And at the same time, offer no guarantee of protection to the public.

I don't think this is the answer and I think it will even lead to a greater threat to the public.

Labels: Ben Goldacre, homeopathy, Natural Healthcare Council, regulation, Society of Homeopaths

 

Homeopaths claim that their pills can induce predictable and distinct sets of symptoms in healthy people. That is how they prove their powerful medicine. This is basic stuff for homeopaths and my simple test asks them to prove it because I do not believe it for a minute. If this claim is not true then everything else they say falls apart. So, far no-one has the courage to come forward.

But I want to extend my offer. I have given homeopaths almost complete freedom in how they do this test. The only real basics I ask for is that the test is verifiably blinded and they do the test publicly, that is, say what they are doing in advance. I do not need to be involved.

Homeopaths are claiming that us sceptics are behind the times and there is now research from material scientists that show that homeopathic preparations are different from normal diluted solutions. I do no believe this too. I think the experiments so far can be explained by bad experimental design: either contamination or instrumentation problems. No chemist can reliably show how homeopathic water is different from ordinary water.

So, the extended challenge: exactly the same as before; any six remedies; some third party swaps the labels around; tell us which remedy is which when the labels are not on the bottle. You can use any experimental equipment you like, any conditions you like - you just have to be blinded. Simple.

As this is analytical chemistry, I think I would one further condition over the original challenge. The remedies must be 12C, or more potent. The claims of homeopaths are that post-Avogadro dilutions are recognisable.

Let's see it.

Any homeopathic friendly chemists want to do this? Your chance to punch this smart alec sceptic on the nose.

Labels: $100 challenge, homeopathy

 

There can be few comment-enabled web pages left in the world that do not testify to the fact that Dana Ullman has published his latest book: The Homeopathic Revolution: Famous People and Cultural Heroes Who Chose Homeopathy. His claim for the book is that,

It is a project that may actually change the face (and the heart) of medicine and may make homeopathy a household word.

Dramatic stuff.

I have written about the book before, a few months before publication. This was because Ullman was making claims that I found incredible. Wherever you find a promotion for the book, you will find the claim that Charles Darwin was saved by homeopathy and this allowed him to publish the Origin. Ullman goes further and says that Darwin was an advocate of homeopathy. This was going to be easily verifiable, as all of Darwin's letters and writings are available online at the Cambridge Darwin Correspondence Project.

So, I did check, and I wrote about my findings at some length. And what I found was that Darwin did nothing but ridicule homeopathy and made it very clear that he thought it was nonsense. Darwin did, at times, take homeopathic remedies. But only when convalescing at a spa near Malvern where the resident doctor made all his patients take the pills. But Darwin did this 'without an atom of faith'. It was quite clear that it would be difficult to reconcile Ullman's statements with Darwin's own stated beliefs, and it looked like we were seeing nothing but the usual homeopathic propganda.

As you might expect, Dana Ullman took exception to my analysis and claimed I had missed many references, that I was superficial and undertook inadequate scholarship, that I was partial in my quotations, and my analysis contained misinformation. He emailed me to say "my research on Darwin [has] surpassed yours by a significant degree" and,

I sincerely hope that you are a good enough man (or duck) to admit that you MAY have been a bit too rash in your previous comments. People will TRUST you more if you admit that you were wrong about something. I realize that this tends to be rare amongst quackbusters, but perhaps you are different.

Now, to be fair, I was not reading from Ullman's book - it had not been published yet - only wondering how he came to such conclusions for his promotional material. So, out of courtesy, I got hold of a copy, read it, and now am in a position to give a fuller review and see if Ullman's own evidence stands up to scrutiny.

Charles Darwin

So, let's start off with Dana Ullman's coverage of Charles Darwin.

The first mention of Darwin is in the Introduction. Ullman obviously thinks Darwin is central to his thesis. He starts off by saying that Darwin had great admiration for his homeopathic doctor and his treatments, "though these facts are scandalously missing from the history of medicine and science". Later, in the chapter on Physicians and Scientists, Ullman devotes ten pages to Darwin and homeopathy. Now, given Ullman's denunciations of my analysis of Darwin, I was expecting a lot of significant material that I had missed. But, it is just not there. However, there is a lot of insignificant material, a lot of jumping to conclusions and unsubstantiated speculations. This appears to be the greater scholarship that Ullman alludes to.

So, Ullman readily admits that Darwin was openly scathing about homeopathy and that he never attributed any of his health improvements to homeopathy. The evidence for this is overwhelming. Nonetheless, Ullman claims that Darwin's healthier moments during his long illness could be attributed to homeopathy. Ullman provides no evidence for this assertion. Darwin did suffer a long standing illness. The illness was sometimes totally debilitating, and regularly he experienced periods of remission. One time he got better was when Darwin was recuperating at Dr Gully's hydrotherapy spa. Now because Dr Gully gave Darwin homeopathy remedies, Ullman then contends that the homeopathy caused Darwin's health improvements.

This is nothing other than the same systematic logical mistake that all homeopaths make - post hoc ergo propter hoc - "after this, therefore because of this". Just because one event follows another does not mean that one event caused another. The entire foundation of homeopathy is built on this logical fallacy, and Ullman makes no allowance for it. The nature of Darwin's illness is unknown; many have speculated as to what it was, from an illness picked up in South America to purely psychosomatic illness. Therefore, to make any assessment of how Darwin's illness should have progressed is to overstretch our knowledge of that illness. The fact that Darwin felt better after spending time at a relaxing spa should not surprise us. Ullman, however, finds it difficult to conceive of any explanation beyond a homeopathic cure.

One part of Ullman's analysis I thought was particularly misleading. He says,

After just a month of treatment, Charles had to admit that Gully's treatments were not quackery after all.

I emailed Dana to ask for a reference for this and to state how he came to this conclusion. He did have a reference, but it was quite clear that Darwin was talking specifically about the hydrotherapy treatments and made absolutely no mention of homeopathy. Darwin's opinions of the sugar pills appears to have been steadfast.

Ullman goes on to explore an area I did not; that is Darwin's research on the response of the insectivorous plant Drosera (sundew) to dilute ammonia salt solutions. Darwin was shocked at the response of the plant's tentacles to ever increasingly dilute solutions. Ullman pounces on this as proof of Darwin wanting to research homeopathic solutions. There are three things wrong with this: one, Darwin never says anything about his research being homeopathic in nature; two, homeopaths tell us that dilute solutions are not homeopathic - succussion is necessary (apparently); and thirdly, the solutions are still light by homeopathic standards - homeopaths dilute beyond the point that the original chemical will be present. Ullman makes a similar error on his own websites and elsewhere in his book when he calls homeopathy the science of nanopharmacology. Now diluting to the nano level (a billionth) is still well within the realms of standard analytical physical chemistry. Measuring dosages at the nano-mole level is now standard laboratory practice. Homeopathic dilutions make nano doses look positively gargantuan. I have no idea why Ullman wants to insists on such terminology when it is so obviously misleading.

Darwin was shocked at the results of his dilution experiments, not because he thought that it confirmed homeopathy, but because he did not expect such dilute substances to have such a dramatic effect. This was new science and he was instinctively cautious. Darwin wanted to replicate his own work and confirm his findings. He doubted his own experience, experiments and capabilities and made doubly sure he was not deceiving himself. This is something that homeopaths could learn from.

And on to Ullman's worst crime in this chapter. Ullman insists that Darwin was a supporter of homeopathy despite all the evidence to the contrary and he does this by asserting that he was afraid of what this peers would think if he said such a thing. Ullman does not present any evidence to back this up. I find this a terrible besmirchment of Darwin's character. One thing that you cannot say about Darwin was that he was unduley cowered in the fear of what the establishment might think of him. He did not launch his theory of evolution into a compliant and accepting orthodoxy. Darwin had to win over his scientific peers, the establishments of church and state, and society as a whole, through sheer strength of argument alone. Darwin was well aware of the implications of his work and how that might threaten the established view of a natural world created by a benevolent god. It took courage and much deliberation to take on this worldview and it is inconceivable that Darwin would quibble over a trifle such as homeopathy even if he did believe in it. No, Darwin knew homeopathy was nonsense. All the evidence points to that. Any other conclusion is just perverse.

Adolf Hitler

For me, in his treatments of Darwin, Ullman looses all credibility in his analysis. It would be enough to stop here in this review, but his analyses of Adolf Hitler is in some ways even more perverse.

Now, Ullman's book is about famous people and cultural heroes. Obviously, Ullman does not see Hitler as a cultural hero and he makes this clear. But in doing so, he then feels it necessary to show that Hitler was not an advocate for homeopathy and never benefited from it. But again, this is in the face of contradictory evidence that Ullman himself presents.

In the chapter Politicians and Peacemakers, Ullman describes how Hitler took nux vomica and belladonna, two staples of every homeopath's pharmacy, every day for nine years up to his suicide. Unlike Darwin, Hitler was convinced that these pills were saving his life. Now, to get around the rather nasty conclusion that this supremely evil man was a supporter of homeopathy, Ullman tells us that it was unlikely that Hitler's pills had undergone the proper dilution and succussion process, and were therefore not properly homeopathic. This contrasts rather starkly with Ullman's insistence that Darwin's simple dilutions were part of some homeopathic experimentation.

But the rather nasty conclusion is, and at risk of invoking Godwin's Law, that the Nazi state was rather enraptured with homeopathy. It would be surprising if it was not. German nationalism latched onto all sorts of mystical and distinctly Germanic notions during these terrible decades. The fact that homeopathy was of German origin no doubt had some bearing on its adoption by the various Nazi doctors in attendance to Hitler. Ullman insists that the pattern of prescribing remedies to Hitler did not match standard homeopathic practice, but one must also take into account that Hitler's doctors would also have done anything the Führer desired. These were not standard prescribing times.

It is difficult to come away with any other impression that Ullman is twisting his own presented evidence to reach whatever conclusion he chooses. If there is any credibility left, it is dashed when you note that one of the sources that Ullman references for his information on Adolf Hitler is the discredited historian David Irving.

'No Smoke Without Fire'

After looking at these examples, it is difficult to take any of the biographical details and conclusions seriously. But in a very important regard, this is utterly immaterial because it does not matter one jot what Darwin or Hitler thought about their experiences with homeopathy. Their opinions do not prove or disprove whether homeopathy is nothing but nonsense.

In order to judge Ullman's book, we ought to see if Ullman succeeds in the task he sets himself. The subtiltle of the book is Why Famous People and Cultural Heroes Choose Homeopathy? Does Ullman answer this question? In short, no.

Ullman assumes the answer from the start, and it is the answer of the commited homeopath - that homeopathy is a powerful healing force. And so in doing so, he fails to address the obvious problems with taking a string of historially based anecdotes. In looking at peoples accounts of homeopathy, you have to take into account the various ways in which people might acquire mistaken beliefs. Ullman does not do this and so we have no way of weighing the importance of this mass of ancdotes.

Even homeopaths do not deny that people are subject to a placebo response when taking medicines. This can be personally interpreted as a positive healing response to an otherwise inert pill. Also, many illnesses, being cyclical in nature, allow natural disease remissions to be attributed to the cure. This is almost undoubteldy what was going on in Darwin's case. When he was at his worst, he went to see Dr Gully. Any subsequent improvement would be attributed to whatever Dr Gully was doing - Darwin thought it was the hydrotherapy; Ullman the homeopathy. There are other ways of being fooled, of course. There is no need to go into them here. The point is that Ullman should have considered them in detail in his book if he wants us to take his mass of anecdotes as serious evidence. The fame and celebrity of Ullman's cultural heroes make no difference to the importance of these subjects' beliefs. If one person can hold a mistaken belief about a healing experience then so can thousands of others. Mere numbers make no difference. It does not enhance the quality of the evidence in anyway. A common delusion can produce millions of the deluded.

This point is noted by the writer of Ullman's foreward, Dr Peter Fisher, Clinical Director of the Royal London Homeopathic Hospital, when he says,

Of course, the fact that the extraordinary range of talented, intelligent, and independent-minded people depicted in this book benefited from homeopathy does not represent a scientific argument.

I would agree fully, but maybe just caveat that these people believed they benefited. But rather bizarrely, Fisher then immediately says,

"but, it is a strong 'no smoke without fire' argument".

This sounds so out of place for a man who considers himself to be a man of science. It is the talk of gossiping schoolgirls in an unsupervised playground. Of course there can be smoke without fire. It is entirely possible for large numbers of people to hold entirely mistaken beliefs, even intelligent celebrities and politicians. And so, this book has the significance of the nauseating and suffocating mobile wedding disco smoke machine, designed to hide the balding uncoolness of the past-it DJ. The book is a 400 page fig-leaf and Ullman is using his celebrity gossip and bizarre interpretations to obscure the embarrassing lack of convincing evidence that would show us homeopathy is nothing but a discredited philosophy, practiced by scientifically illiterate narcissists, using inert sugar pills.

As such, this book is not going to 'change the face and heart of medicine'. It is of interest only to those who want their prejudices confirmed and their delusions massaged. To really understand why so many people can so easily be sucked into the irrationality of alternative medicine is going to take another book. There may be a few of those along soon.

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

See also Orac's review of excerpts from the Homeopathic Revolution.

Labels: celebrity quackery, dana ullman, homeopathy

 

In his Guardian article, Ben Goldacre wrote about how homeopaths respond to criticism:

Labels: Ben Goldacre, homeopathy, Society of Homeopaths

 

One thing always puzzled me about Tony Blair (well in fact, many things) was when he rather suddenly came out in defence of homeopathy. Out of the blue, he told the detractors of this weird superstition to back off:

Labels: ARH, homeopathy, Society of Homeopaths

 

Homeopaths are feeling under threat at the moment and are scrambling around wondering what to do about it. I think there are a number of things they could do: most importantly, they should better manage their own business by showing that they respect the boundaries of what they can reasonably assume is good practice, e.g. stop the dangerous nonsense of believing that can do anything about dangerous conditions such as malaria and AIDS; they can be much more complementary and less alternative.

But there is something else that they can do too: start showing a desire to develop a base of data that can be relied upon, and respected, to support their methods. The focus to-date has been on clinical trials. Doubters say that trials show no evidence of efficacy. Supporters point to many positive trials. But it has been well documented that the many positive trials are most often poorly designed and reported, and are at best ambiguous in their results. There is not a compelling evidence base for homeopathy. If there was, there would be no argument.

So, let's take a step back. What sort of evidence would be required to convince me that there might be something in it? Fundamentally, my problem with homeopathy is its total implausibility - it contradicts what we know about the behaviour of matter. How can a plain sugar pill have any significant therapeutic effect on health? So, why not test the basic plausibility of homeopathy - can homeopathy pills do more than sugar pills in predictable way? There are a number of discussions about this going on in bloggerland and I would like to pick up on these and set a challenge...

Here is a rough outline of the sort of test I would like to see done...

1. A trained homeopath selects six homeopathic remedies of any type and strength.


2. The remedies are posted to an independent third party who removes the labels and replaces them with a code letter, A, B, C...F, and posts them back.


3. The homeopath takes each remedy in turn and notes the 'totality of symptoms'.


4. The homeopath writes down which remedy corresponds to which code letter.


5. The third party 'breaks the code' and we note how many are right.

1. Tell the world in advance that you are going to do this. Post your intention on a blog or web site, tell the world what you are going to do, be open to suggestions about how to simplify and make it a fair test. The more detail you publish, the more trust you will have. Remember, sceptics have a problem with trust of homeopaths.


2. State in advance what you think would be a successful result and any caveats you may have. Think of ways in which the trial may go wrong in advance, and make efforts to minimise those risks. None of us want excuses afterwards if it does not go well.


3. Find a genuine independent third party - someone with no stake in the outcome. Publish who they are and ensure they are happy to field questions from people after the trial. (People will want to know that protocol was followed).


4. Publish your results on the web before the code is broken to reveal how well you have done.

Labels: $100 challenge, homeopathy

 

Dr. Manish Bhatia of Hpathy.com has issued a new email newsletter entitled The Fight Back for Homeopathy. Apparently, there are a lot of anti-homeopathy bloggers and newspaper articles around at the moment. Get away? The impact of this, says Dr B, is devastating with homeopathy bleeding to death. Dr B is marshaling the troops for a come-back.

Labels: homeopathy

 

This, morning David Colquhoun was on the Radio 4 Today programme (listen again, 20 minutes in) making the charge that today's Society of Homeopaths Symposium on AIDS was deeply irresponsible.

Labels: homeopathy, Society of Homeopaths

 

Healing fools. The seemingly miraculous ability of our bodies to naturally fight and recover from illness, and our inquisitive brains that are eager to seek out causative patterns in all things, means that we all too readily attribute our healing moments to whatever magic beans we were rubbing at the time. Some are so impressed by their own healing stories that they start to make businesses selecting the appropriate beans for others' healing. And the rest of us listen to the tales of the healing fools, as a sincerely told story appears to hold such power over us. Without care, we all risk becoming healing fools.

Healing stories, or anecdotes, are the rocket fuel of alternative medicine. No matter how carefully the evidence against a treatment has been collected , or the shear implausibility of a mechanism has been explained, somehow the heartfelt and sincere story of a fellow suffering human trumps all reason. As humans, our evolved brains resonate with the stories of those we trust. But, if we care about our health, there are good reasons why we should distrust such healing testimony. Humans are fallible in many ways, and our willingness to see patterns where none exist, our readiness to please those that do us favours, and our desire to believe that what we wish to be true, leads to the stories of quackery taking a deep hold.

And when our illnesses are life threatening, we need good stories and effective actions to guide us back to health.

Let us look at two stories. The first is from Jeanette Winterson's defence of homeopathic AIDS clinics that appeared in the Guardian a couple of weeks ago,

Edwin Cameron, a justice of South Africa's supreme court of appeal who is HIV positive, has done much to counter the disastrous Aids denialists there. He visited Maun and agreed in writing that "there are patent health benefits". He also admitted that, although initially sceptical of homeopathy, he had had a persistent mouth and gum disease, untreatable by antibiotics, but which was cleared by homeopathic intervention.

As Winterson might say, 'dramatic stuff'.

More drama in the second story:

It was very dramatic. By the end of October 1997, I suddenly became very sick with a lung infection... I had lost an enormous amount of weight, my immune system had stopped functioning and the virus was raging throughout my body.

I knew that I had to contemplate this treatment... which was fantastically expensive... way out of the reach of most Africans with Aids or HIV.

Within 10 days of starting anti-retroviral medication, I knew that a physiological miracle was happening within me. I knew that the virus had come to a standstill. I felt my health, my energy, my appetite and my joy for life returning.

Now, I can tell you that one of these anecdotes is probably a misrepresention - the other is probably a very fair representation of reality. Which story do we trust? How can we tell these superficially equal plausible accounts apart?



The temptation is to look at the authority of the story teller. The first anecdote is told by 'top intellectual' Jeanette Winterson about the experience of a Supreme Court Justice; the second, by some anonymous African. But as even Winterson would tell us, we cannot and should not privilege the author in finding meaning. But where I might start to differ from Winterson is that we can privileged science. We can attribute authority to the process of collecting data, compiling evidence and testing against theory. The authority of science comes from its constant quest to falsify: ten thousand voices looking to criticise, to find holes and to knock down. When an explanation is left standing, then it can gain the authority required for us to place trust. And when wanting to heal desperately ill people, we need good authoritative evidence and theory, and to not be fooled by our 'authoritative' stories.

And fortunately for millions of people, there is authoritative evidence for how HIV infection can be managed so that they can lead normal lives without undue risk of death. This is not the place to go into that evidence - you can look into it yourself. The Cochrane HIV/AIDS Group compiles a list of of all the evidence for various therapies and treatments, both biomedical and behavioural/social. How very holistic. It goes without saying that homeopathy plays no role in the evidence base of how HIV/AIDS may be managed. Antiretrovirals have proven very effective and have saved countless lives.

It would look as if the teller of our second anecdote was much closer to the truth. But with all good stories, there is a twist and the unexpected. I was not entirely truthful about the second story coming from an 'anonymous African'. The speaker of those words was indeed also the Honourable Mr Justice Edwin Cameron of the South African Supreme Court of Appeal.

Justice Cameron is a startling character and one of the foremost Human Rights activists in the world. He was instrumental in ensuring South Africa had the first Constitution in the world to protect the rights of gay and lesbian people. He was appointed by Nelson Mandela to join special commission into illegal arms trading. Importantly, he has made huge progress in ensuring that South Africans have access to antiretroviral drugs and has been confronting the denialist stance of senior politicians in the region, eventually resulting in President Thabo Mbeke conceding and giving the go-ahead to distribute essential drugs to those that need them.

So, can both anecdotes be true? Can someone who has campaigned so vigorously for medical intervention for Africans with HIV really be a supporter of homeopathic quackery? Well, maybe a letter that Cameron sent to the Guardian (so far unpublished) will answer that,

Jeanette Winterson in her defence of homeopathy ('In defence of homeopathy', Guardian Tuesday 13 November 2007) ascribes words to me I never used. On a visit in June this year, I was impressed with the work of the Maun homeopaths, which is strictly supplemental to the Botswana government's provision of anti-retroviral treatments for AIDS. But I did not say there were patent benefits to homeopathy - nor could I have. I merely noted that patients reported experiencing such benefits.

A key point I have made in my challenge to the South African government's response to AIDS - including President Mbeki's lamentable dalliance with AIDS denialism - is that medical facts are best determined by science. I am not a doctor or a scientist. Winterson is therefore on the wrong tack to invoke - and quote incorrectly - my personal impressions in this field.

Edwin Cameron, Supreme Court of Appeal of South Africa

Dramatic stuff.

Now one thing I would disagree on is that Maun homeopaths can be 'strictly supplemental'. That is something they find very hard to be, as the whole philosophy of homeopathy is defined in opposition to real medicine and what they call 'allopathy'. Homeopathy is an alternative medicine and not a complementary medicine. As such, it risks people putting their trust in the wrong places. It is worth repeating the words of Yusef Azad, Director of Policy and Campaigns for the National AIDS Trust,

The tragedy is that there are still far too many governments not funding the treatment properly, and too many people with HIV who have not been informed of its benefits. Quack cures abound of course, all unproven, all cruelly deceiving, all a massive distraction from what we know genuinely works.

Also, the words of the Treatment Action Campaign, echo Cameron's trust of science,

We recommend that you DO NOT put your trust in one of the numerous people and organisations offering cures and treatments for HIV/AIDS. Many people with HIV are taken advantage of by unscrupulous charlatans or well-intentioned but uninformed people. Learn the science and trust the science. HIV is a manageable chronic disease if you follow sound medical advice. It is deadly if you do not.

So, Jeanette Winterson has been telling us stories again. In the words of Lord Melvin Bragg when interviewing her on the South Bank Show,

You say 'I'm telling stories - trust me' - why should we?

Labels: homeopathy, Jeanette Winterson

 

On the eve of the Society of Homeopaths' symposium in London on homeopathy and AIDS, the SoH issue a press release. It is a statement about how they are warm and cuddly and complementary and working oh so hard to dominate create a single register of homeopaths. They are definitely not promoting quack cures for AIDS.

It is well documented now about how so many of their press releases are simply misleading. (The current press release is thoroughly taken apart by Gimpy).

What caught my eye was the link at the end to the National AIDS Trust. Did this organisation support them, endorse their views and think homeopathy has a role in AIDS management? I had to find out. So, I emailed their policy advisor, Alana Lewis.

Yusef Azad, their Director of Policy and Campaigns, emailed me back to say that, of course, they do not support the seminar and would be in contact with SoH. He rang them. And now, the reference has been removed from the online press release. Their excuse was that it was a reference for their AIDS figures. Typical quack referencing: incomplete, inappropriate and confusing.

Tomorrow is World AIDS day. Yusef has this to say:

"There is no current cure for HIV. But there is effective treatment in the form of antiretroviral therapy which is saving millions of people and enabling them to live healthy active lives. The tragedy is that there are still far too many governments not funding the treatment properly, and too many people with HIV who have not been informed of its benefits. Quack cures abound of course, all unproven, all cruelly deceiving, all a massive distraction from what we know genuinely works."

I really cannot add anymore.

Labels: homeopathy, Society of Homeopaths

 

Readers of Prospect Magazine have voted Jeanette Winterson as one of Britain's 'top intellectuals', falling well below Richard Dawkins and Germaine Greer, and somewhat below Matt Ridley, recently resigned chairman of the troubled Northern Rock bank.

There have been a number of articles in the press recently criticising homeopathic remedies as worthless at best, and potentially lethal at worst, if they are being taken instead of tried-and-tested conventional medicines for conditions such as malaria or HIV.

Of particular concern is a claim by the British homeopath Peter Chapel [sic] and his Dutch colleague, Harry Van Der Zee, that Chapel [sic] has developed a remedy, PC1, that can be used to treat the HIV virus.

it is hard to talk about what it is that homeopathy actually does,

where is the [...] sense in saying that because [homeopaths] don't understand something, even though [homeopaths] can discern its effects, [homeopaths] have to ignore it, scorn it, or suppress it?

The patients in Botswana have no knowledge about homeopathy, and are very rarely interested in learning more. All they need to know is that the homeopaths have helped a neighbour or a relative and, personal recommendation being the way of life in Africa, they come full of confidence that they’ll be healed.

For the people visiting the clinic, we are “doctors”. A bit weird for doctors - no white coats, no nurses, the clinic is sometimes a bit of shade and a couple of plastic chairs, and the pills are small and few - but they seem to trust us more than the doctors in the hospital, who never seem to have time to listen.

Labels: celebrity quackery, homeopathy, Jeanette Winterson, Society of Homeopaths

 

Radio 4's You and Yours programme has been running a series on Chronic Fatigue Syndrome/ME. Today saw the last in the series and concentrated on 'alternative treatments' for patients who do not get 'satisfaction' from their GP.

ME is a quack's dream. It does not have a specific set of diagnostic criteria - it is what left when all other possibilities have been ruled out - follows a cyclical pattern of symptoms, and tends to get better on its own. Kerching. As such, the Radio 4 programme explored the full zoology of quack therapies for ME, including reflexology, nutritional therapy, mickel therapy and, of course, homeopathy.

The first homeopath to be interviewed was Dr Susie Rockwell, who is an NHS GP, but also runs her own private homeopathy clinic. She points out on her website the rather confusing contradiction,

I advise on management and treatment according to NICE guidance. This guidance does not support the use of complementary therapies in CFS/ME as there is currently insufficient evidence for their use. However a wide range of complementary therapies have been tried in CFS/ME and I can advise about which may be useful and how to access them.

Since completing and reporting on this study, I have reflected on and researched the relevance and appropriateness of the design of this study for investigating homeopathic treatment. (...) At the time of designing this trial, I believed the triple/double-blind placebo randomized controlled trial fit these criteria.

In retrospect, however, it is clear that the presence of a placebo arm in a study of homeopathic treatment can compromise the practice of homeopathy. In a further paper, colleagues and I conclude that “It is not reasonable to assume that the specific effects of homeopathic medicine and the non-specific effects of consultations are independent of each other—specific effects of the medicine (as manifested by patients’ reactions) may influence the nature of subsequent consultations and the non-specific effects of the consultation may enhance or diminish the effects of the medicine.” and that “For clinical trials of homeopathy to be accurate representations of practice, we need modified designs that take into account the complexity of the homeopathic intervention.”.

It is probably the case that the results of the CFS/ME homeopathic treatment trial were influenced by the existence of a placebo arm in the study. (...) They are also a possible explanation why only small effects are seen in placebo-controlled trials of homeopathy.

Whilst placebo-controlled trials of specific homeopathic remedies are valid, it is time to halt the misguided task of conducting placebo-controlled RCTs to test efficacy of individualized treatments; to redirect our energies to analyses of whole-systems health care and to design more relevant and meaningful pragmatic studies of comparative effectiveness, where untested treatments are compared to those where there is evidence of effectiveness.”

Labels: homeopathy

 

Labels: homeopathy, Society of Homeopaths

 

I doubt we will ever see an X-Factor moment where a homeopath is forced to brutally confront the totality of their own delusions as they are exposed to a direct and uncompromising truth assault by a quackbusting Simon Cowell. Their emotional commitment to their healing fantasies is far stronger than their intellectual commitment to reason, truth and evidence. But I would have hoped that a homeopath's disregard for truth was limited to the truths of science, however, events in the last week or two have made me wonder.

Last week, Ben Goldacre wrote an article in the Guardian newspaper (Threats – the homeopathic panacea) about how the Society of Homeopaths had attempted to silence this site over its criticism of the Society's ability to protect the public from harmful advice from its members. This was highlighted by the BBC Newsnight/Sense about Science investigations into homeopaths giving advice about malaria prevention. As you might recall, at no point did the society try to contact me to explain their grievances - they used legal chill on my website hosts to silence me. The Society saw fit to respond the Guardian article and sent the editor a letter. To the best of my knowledge it has not been published. However, it is published on the Society web site and is the first insight into their thinking.

However, before exploring that, a number of things jumped out. In their letter of 22nd October 2007, they said (with my emphasis),

We contacted the programme makers directly to ask for their evidence that any Society members had given dangerous or misleading advice to members of the public. They were unable to provide a single example. The Society’s professional conduct procedures cannot be invoked without a specific complaint, an alleged offender or any evidence. In these circumstances, The Society was unable to investigate a specific case.

Elsewhere on their web site, they state that,

The Society of Homeopaths takes any alleged breach of its Code of Ethics & Practice very seriously and we must follow a due process when dealing with any allegation.

And,

The research conducted by Sense About Science failed to identify the homeopaths interviewed. Not all homeopaths are registered members of The Society. Nevertheless, any alleged breach by a registered member, of The Society’s Code of Ethics & Practice, will be investigated by our Professional Conduct Department.

Now, what I do not understand is how these statements can be made in light of the fact that I have an email from Paula Ross, Chief Executive of the Society of Homeopaths, addressed to the programme investigators (dated 22 August 2006), that starts,

"I am in receipt of your summary transcripts."

The transcripts contain two conversations between an undercover investigator and a named homeopath who just so happens to be a Fellow of the Society of Homeopaths. I will not name him, but I am happy to do so if the Society dispute this.


In the transcripts, the investigator asks if the named homeopath is able to offer a homeopathic alternative to her doctor-prescribed anti-malarials. The homeopath confirms that he is able to, and offers a consultation on that basis. In a subsequent transcripted conversation, when asked by the investigator why the Health Protection Agency web site says that you should not take homeopathy for malaria, the named homeopath laughs and replies “Of course they did. Right, if you are influenced by that go with whatever will make you comfortable.”


The investigator, still acting as a client, asks why the Faculty of Homeopaths says pretty much the same thing. The homeopath replies, “the faculty are all medics so they must more or less toe the medical line.” The homeopath constantly portrays this as an either/or choice for the client: either they stick with their side-effect inducing ‘orthodox’ treatments or go with homeopathy. The homeopath tells the investigator to do some research on the Society of Homeopath’s web site and on the What Doctors Don’t Tell You web site. When asked to confirm again that there is a homeopathic alternative, he replies, “The answer to that is yes, but not approved by orthodoxy. Plain and simply.”

(You can see a summary of all the transcripts here.)

So, what the hell is going on here? It is possible that the Chair of the Society of Homeopaths, Andy Kirk, who wrote letter to the Guardian, may not have been aware that the Chief Executive, Paula Ross, was in possession of the transcript evidence and had been given the name of the Fellow of the Society who gave the advice. Presumably, their complaints officer, Patricia Moroney, was also not in possession of the evidence. This would be fairly shambolic - a word I used in the first sentence of my 'banned' article.

It may also be possible that Paula Ross came to the conclusion on her own that the transcripts did not contain sufficient evidence of wrongdoing. However, the Society is quite clear that "we must follow a due process when dealing with any allegation". Was due process not undertaken? Again, they are quite clear: "the Society was unable to investigate a specific case." It is worth pointing out that Paula Ross is not a trained homeopath, nor is she trained scientifically. She is an English graduate who has a Post-Graduate Diploma in Management.

There are, of course, far worse interpretations of this situation. Unfortunately, it looks like we may never know why these contradictory statements have been made by the Society. Did an investigation take place? If not, why not? If it did, why no apparent action? And why make statements that suggest that it was the failure of the BBC/SaS team to hand over evidence and names that prevented the Society from taking action? They quite clearly did hand over the evidence required. I have written to the Society and Ms Ross twice now over the past week to help me clarify the issues and they have seen fit not to reply.

One reason they might not have replied is contained in their letter to the Guardian. Rather than highlight what they thought was defamatory in my blog post, they say,

Dr Lewis, in his article, stated as fact highly offensive comments about The Society and it is for that reason that The Society decided it had no option but to take action.

Due to the unpleasantness and surprisingly vitriolic nature of the postings on the Quackometer website and others, The Society has taken a conscious decision not to respond to these bloggers.

So first, offensive is not the same as defamatory. And, as Richard Dawkins put it so well, "offense is what people take when they can't take argument". Offense is so often the refuge of the unquestionably right. What I find offensive is the fact that a Fellow of the Society of Homeopaths is quite prepared to let a gap year student or young tourist travel deep into Africa with nothing but a magic fairy pill to protect themselves against a common and often fatal disease. And more deeply offensive is that his so-called regulatory body sees no reason to take any action at all and is even prepared to state untruths about the matter in a national newspaper and on their website. And unpleasant? I hear dying of cerebral malaria is unpleasant.

Vitriolic? Vitriol suggests I was abusive. That I was not. What I was, was shocked and angry at what I was discovering and I was forthright in my opinions. I was not the only angry person. It is always worth re-quoting Dr Peter Fisher - the Queen's Homeopath - on the affair, "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."

The vitriol undoubtedly came from a stream of emails from around the world to the Society following their attempt to silence me. I do not condone this abuse - reasoned argument is much stronger and it has given the Society a fig-leaf to hide behind. But their quoting of this vitriol is typical of homeopathic thinking - it has confused the nature of cause and effect. The vitriol was the result of their actions, not the prompt for them to take action.


And so, as Nick Cohen discussed in yesterday's Observer, we live in a society that sees organisations like the Society of Homeopaths as "a funny little alternative institute we too casually dismiss as quaint". But homeopathy is founded on a cavalier attitude to reason and truth and that makes the practice dangerous. Their propaganda tells us that homeopathy is safe, natural and effective. This is not true - and truth matters most when dealing with life and death issues. I do not favour heavy handed legislation to stamp out these practices - I still believe homeopathy could just about evolve into something genuinely useful. But maybe the zeitgeist is changing. Holding dangerous beliefs, that show such a lack of care for consequences, should be as seen as socially unacceptable and as selfish and as irrational as running a gas guzzling 4x4 for city school runs, or as dangerous and irresponsible as drink driving.

Labels: Ben Goldacre, homeopathy, Society of Homeopaths

 

This is an old post, but I wanted to bump it up given the current homeopathic shenanigans

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originally posted: Monday, July 17, 2006

In looking at countless quack web sites and having discussions with various quacks on message boards, the inevitable question that I ask myself is "What sort of quack am I dealing with - deluded or fraudulent?" The fraudulent quack knows they are promoting cures and remedies that do not work (above the placebo) but make money out of it anyway. The deluded quack believes they are promoting something genuinely wonderful, but misunderstood by 'science'.

The more I delve into quackery, the more I believe that we are mostly dealing with the deluded. Frauds can be dealt with by legislation and prosecution. The deluded appear to be a tougher nut to crack - minds have to be changed. However, the belief systems around alternative medicine appear to be impervious to criticism and rational enquiry. The defensive walls are high.

This situation appears to be very similar to arguments surrounding religious beliefs. Religion is largely immune to rational enquiry with people who hold such beliefs as they have many defenses against such enquiry.

Richard Dawkins coined the term 'meme' to represent a 'replicator of cultural information that one mind transmits (verbally or by demonstration) to another mind'. The God meme is usually at the foundation of religious beliefs. If you are unfamiliar with the concept of the meme then best start here. The point I want to make is that memes rarely appear on their own, but usually cluster together to form cooperating meme-plexes that help each other to survive. A God meme on its own may not last in a culture for long. Gods are notorious in their reluctance to offer direct evidence of their existence and so a God meme may soon be subject to attack from a sceptical mind. However, if you couple a God meme with a 'faith is good' meme and a 'doubt is bad' meme then together, these memes may form a more stable meme-plex. Any sceptic can be brushed aside as a 'doubter' and any self-doubt can be parried with a renewed sense of the need for faith.

I would suggest that Alternative Medicine advocates must surely also carry around similar meme-plexes of symbiotic ideas that prevent logic, reason, intelligence, science and experimental evidence from demolishing the core ideas of the practice.

However, a customer of alternative medicine need not carry around huge meme-plexes in order to take their medicine. A person need only believe a few things about homeopathy in order to try it - gentler than 'western' medicine, ancient principles, no side-effects, and so on.

However, the meme theory would predict that the stronger the advocate of homeopathy, the more memes need to be believed to fend off scepticism and evidence. This contrasts with a scientist; the closer you are to the science, the more facts and theory you will know - there is no need to hold beliefs that prevent rational enquiry about the science - their defense is the strength of the evidence. The homeopathists on the other hand needs more and more defensive walls around a small core of unchanging beliefs. So here is my hypothesis of the memetics of quackery and pseudoscience:

The greater advocate a person is for quackery, the more that defensive memes need to be held that can stall rational enquiry, whilst the core memes regarding the theory of the quack subject remain fairly constant with the degree of advocacy.

So we need to test this now. Maybe I can even build tests into the quackometer to spot pseudoscience and quackery!

Looking at the homeopathist example a bit further. The BBC's Newsnight programme this week carried a report into how high street homeopathists are giving dangerous advice regarding the prevention of malaria. Of ten surveyed, all offered a homeopathic sugar pill to act as prophylactic and gave no other advice about bite prevention and the need to see your GP. This is appallingly dangerous as malaria kills. Melanie Oxley of the Society of Homeopaths appeared on the programme to answer these allegations. Her response was breath-taking in her inability to grasp the nature of what the accusations were and was a classic example of complete internal denial. Is Ms Oxley stuffed full of quack memes to prevent critical analysis?

The Society of Homeopaths has a list of press releases, the most recent one about the above BBC report. These press releases appear to contain lots of 'official' responses to complaints or criticism and so, according to my hypothesis above, be rich with memes for preventing rational enquiry into homeopathy.

Let's dig out some of those memes...

1. In the response to the BBC report, the society is adamant still that homeopathy can act as an alternative to malarial prophylactics. (An utter outrage.) The society states the truth at one point:

At present, there is no large scale research evidence to support the use of homeopathy in preventing malaria.

but then goes to on to offer a list of memes to get out of this...

Consequently, there is substantial anecdotal evidence from around the world to suggest that homeopathy may offer a gentle, yet effective, complementary or alternative approach.
...
Clearly, this needs more research. Nevertheless, absence of evidence is not the same as evidence of inefficacy”.

So, we see several memes to ward of the uncomfortable nature of the truth - anecdotal evidence says is works and the (brilliant) "absence of evidence is not the same as evidence of inefficacy". We would love to point out to them that anecdotal evidence is not sufficient to prove efficacy and of course, that absence of evidence is not evidence of efficacy.

2. The next press release is about Professor Michael Baum's report that homeopathy is an implausible treatment for which over a dozen systematic reviews have failed to produce convincing evidence of effectiveness. The press release quotes a number of flawed studies to suggest that Prof. Baum is wrong, but also comes up with the exceptional defensive meme that

Access to [homeopathy] should be a matter of choice for individuals and The
Society of Homeopaths firmly supports the Government’s agenda of patient choice.

In other words, freedom of choice is more important than evidence of efficacy.

3. The next defensive press release concerns an article in the Guardian, by our friend Ben Goldacre, regarding recent meta-analysis of trials showing homeopathy as being just placebo. The Society naturally brush this off and use another well crafted meme to dismiss this criticism:

It has been established beyond doubt and accepted by many researchers, that the placebo-controlled randomised trial (RCT) is not a fitting research tool with which to test homeopathy.

So, the cornerstone of modern evidence-based medicine cannot be used to test homeopathy - a very useful quack meme. Homeopaths complain that the 'individualised treatments' involved in 'real' homeopathy cannot be subject to placebo controlled trials. An obvious canard. Even more bizarrely, the claim here is that what is important is not what is in the pills, but the very experience of the consultation and dispensing of the pills. I would appreciate their sincerity in this belief, but I do not see the Society condemning Boots for offering off-the-shelf homeopathic pills.

I am sure there are more in there, but this blog entry has gone on long enough.

What does this mean for our fight against quackery? If it is true that most participants in quackery (both practitioners and customers) are more likely to be deluded and protected by defensive memes, rather than outright frauds, then legislation and prosecution may not do so much good. Rather we need ways to prevent these sort of memes and canards from being implanted in the first place. Better science education and science reporting in the press would go a very long way here.

Labels: homeopathy, Society of Homeopaths

 

Homeopathy is fun. Pretending you can cure minor self-limiting ailments with magic water and sugar pills obviously brings countless hours of pleasure to lots of people and I, for one, would not want to take their ball away. Hey! You can even make some money out of it too, as lots of people like to join in and pay money to play patient and be part of the fantasy. But like all fantasy games, there really ought to be some pre-arranged agreement on limits; someone to shout a code word, or hold up a red card, when it looks like things might be going a bit too far, and where someone might get hurt. All participants can then step back, have a laugh, a cup of tea, and re-start tomorrow with some more bumps and bruises.

I have written many times on this blog that there appears to be nobody in the homeopathic community who really wants to take on this role of referee. Without someone to blow the whistle, people may actually get so deep into the homeopathic game that they really start believing they can cure serious illnesses, like malaria and AIDS. And, as part of the role playing is to pretend that real doctors are nasty, conspiratorial and in it for the Big Pharma money, some of the patients may also start crossing the safety boundaries.

There are a number of homeopathic members' clubs out there that have ethics codes and complaints committees, but after the BBC Newsnight/Sense about Science malaria sting which resulted in little visible change, one has to wonder how effective these procedures are? As Simon Singh, the science writer and broadcaster, said at the time,

I was shocked that there was such willingness to give advice and sell products that would leave people exposed to a highly dangerous disease… Beforehand I suspected that one or two homeopaths might offer pills to protect against malaria, but it turned out that ten out of ten were guilty of such irresponsible practice. This makes me think that there is something fundamentally wrong with the way homeopaths are regulated.

Now, Peter Chappell, you may remember, claims to be able to do wonders for just about everything, including AIDS and cancer, with not only his own magic homeopathy concoctions, but downloadable homeopathic MP3 files. Peter sports the designation FSHom (Fellow of the Society of Homeopaths) in a number of places, so, I rattle off a quick letter to them to see what they make of his practices. The Society of Homeopaths complaints officer, Patricia Moroney, replies that Peter is 'no longer a member of the Society of Homeopaths and therefore is not bound by our Code of Ethics and Practice. He is not entitled to FSHom."

My mistake.

In my defence, Peter Chappell carries the FSHom designation all over the web. Surely the Society of Homeopaths will be furious that he is still promoting himself as FSHom, whilst outrageously breaking their own code of practice, and try to do something about it? So furious in fact, that there could be no way that they would still be promoting his book on the society web site, under "Recommended Reading", and describing him as FSHom and 'a Registered Member and Fellow of the Society"? And so furious that there is no way that they would be holding an AIDS symposium on the 1st of December (World AIDS day) which will specifically give a platform to Peter Chappell's ridiculous healing ideas?


The second complaint I made was regarding Julia Wilson RSHom who holds a homeopathic asthma clinic and says that she has worked in a Kenyan homeopathic AIDS, TB and malaria clinic. In my opinion, her advertising literature advocated specific homeopathic cures for asthma that are superior to real medicine. The Society of Homeopaths found that no breach of their code had been made.

Let me repeat what I believe to be one of the difficult sections of the leaflet.

Conventional medicine is at a loss when it comes to understanding the origin of allergies. ... The best that medical research can do is try to keep the symptoms under control. Although creams and puffers can provide temporary relief, they are not offering your child a cure.

Homeopathy is different, it seeks to address the triggers for asthma and eczema. It is a safe, drug free approach that helps alleviate the flaring of skin and tightening of lungs...

Leaving aside the self-contradictory nature of these claims about suppressing symptoms, it appears to me that Julia is saying that homeopathic approaches can do things that medicine cannot and that it offers a better approach. Julia, in her defence, says that 'absolutely no cure is implied'. Please re-read the above to make your own mind up. Specifically, she says to the SoH complaints officer that 'my leaflet makes no claims, stated or implied, that homeopathy can treat asthma...Absolutely no cure is implied' and SoH accepts this. "No further action will be taken". What do you think?

The response to my complaint also pointed out that the leaflet made clear that 'it does not claim superiority over conventional treatment, it is at pains to make it clear that homeopathy can be integrated with conventional treatment'. The only section that goes anywhere near such a statement is 'Homeopathic treatments are safe for children – and they work alongside conventional medicines such as creams and puffers.' Is that 'going to great pains' and advocating 'integration'? I think not. Is this why she talks of a 'drug free approach'?

As for her involvement in the Kenyan homeopathy clinic that claims to be a centre for treating AIDS and malaria, "[I] did not, at any point, claim to cure malaria, HIV/AIDS or TB. ... Not only would such a claim contravene section 72 of the Code of Ethics & Practice, it would of course, be counter to the very way in which homeopaths practice'. It is well worth visiting the Abha Light Foundation's web site and attempt to understand if that is what Abha believe too.

I wish I could point you to a relevent page on the SoH website that publicised the outcomes of the above investigations, but their ethics and complaints procedures appear to be private and closed. It is worth comparing and contrasting this with the GMC and their conduct enquiries in doctors' standards. Full details of their current investigations and decisions can be found on their site. I would argue that the GMC was better protecting patients' interests by being open and public.

In closing, when dealing with homeopaths, it does look like we have to be very careful about words. Their world view is so far from reality that we can never be sure we are talking about the same thing. Many homeopaths do not recognise illnesses like AIDS, malaria and TB and their pathogenic origins . They see these illnesses as being symptoms of underlying imbalances in mystical energies, miasms, or fairy dust, or something. These 'life-force problems' are what homeopaths claim to be treating - not the disease. When they talk about 'treating' and 'curing' they are talking about the 'underlying reason' and the 'whole person'. Such pseudo-scientific subtlety will be lost on most people. And so, what look like contradictory thought process to us, make perfect sense in their Humpty Dumpty world. In a world where words mean whatever you want them to mean, it is difficult to see how any complaint against you could ever be upheld.

Labels: homeopathy, Society of Homeopaths, SoH

 

Some of you around here may have noticed that homeopaths are feeling a little threatened at the moment. Some have responded to the perceived threats with rather impolite and aggressive behaviour. Others are setting up new campaigns.

A new web site has appeared in the last few days called Homeopathy: Medicine of the 21st Century. (I won't link to it, they do not need the Google points, but you can find it here: www.hmc21.org). Now, leaving aside the obvious mistake that they have put a 21 in their name rather than an 18, their rational for setting up the site is as follows:

H:MC21 was set up in September 2007 to inform the public about homeopathy and its relation to orthodox medicine. It will do this through research, publication and campaigning. Our first project is to counter the wave of negative publicity by collecting signatures to the following declaration.

When you go to the declaration, you are presented with the following form to describe your homeopathic experience:

For me, nothing sums up homeopathic thinking more than this. It is the blind refusal to accept anything other than that homeopathy can be a positive experience. There is no acknowledgment that homeopathy needs to have boundaries and can pose dangers, if not practiced within its limited scope. Those of us who criticise homeopathy fully acknowledge that people can have positive experiences with it: the placebo can work wonders on some minor, self-limiting conditions, and a nice hour long chat with a 'caring' person is a wonderful thing. That is not our complaint.

Our complaint is that homeopaths appear to lack any insight into what they are doing. There is almost no critical self-appraisal of their own work. There is widespread denigration of 'allopathic' real medicine and you set yourselves up as an alternative panacea without the slightest shred of reliable evidence for this, and very good reasons to think that homeopathic theory is utter nonsense. In that climate, harm will be done. People may shun effective treatments and homeopaths may attempt to manage dangerous conditions on their own. The BBC/Sense about Science report into homeopathic advice on malaria prevention was a scandal that should have galvanised the homeopathic community into action. The silence was deafening. And it gets worse, with conferences being held on the management of AIDS with homeopathy which give platforms to people who really ought to be subjected to heavy criticism because people will unnecessarily suffer and even die.

The worldwide criticism of homeopathy will not stop because homeopaths cover their ears, or worse, reach for their lawyers. It will stop when someone within the homeopathic community has the courage and leadership to tackle these issues head on. I believe that there is possibly a useful role for a homeopathic community to offer a genuine and responsible complementary therapy in the 21st Century.

But, where is that responsible and courageous leadership going to come from? Can anyone see where?

Labels: homeopathy, SoH

 

After several decades of increasing popularity, the homeopathic community is finding itself under growing pressure. There is an increasing level of criticism of the practice coming from many quarters, including Richard Dawkins recent Channel 4 programme, lots of bloggers and academics too.

Importantly, homeopathy is not being seen as as benign as its adherents' propaganda suggests and that there are real dangers in the belief in magic water and sugar pills. It's not all bad news for homeopaths, there is unexpected support in some quarters. So, why is there so much pressure on them at the moment and where will this leave the homeopaths in the UK? More importantly, what should homeopaths being doing if they want to survive in any meaningful and respected way?

To make an attempt at answering this question, we need to understand a little history of homeopathy in the UK. The man considered responsible for introducing homeopathy into Britain was a Dr F H F Quin. He first starting touting his remedies in the 1830's, and being of aristocratic origin, his patients were the upper classes and nobility of British Society. He was keen to keep homeopathy within the medical profession and with the high paying aristocracy.

Another strand of homeopaths emerged in the wake of the ever increasing regulation and scientific nature of the medical profession. Lay homeopaths started emerging in the later half of the 19th century. These practitioners were not medical qualified and were from the start associated with more radical approaches to homeopathy. Despite offering their services to the lower echelons of society, radical lay homeopathy found it difficult to gain a foothold and homeopathy never really achieved mass popularity like it did in other countries.

The twentieth century saw the reversal of this picture with medical homeopaths in decline and lay homeopaths in ascendancy. The vestigial remnants of institutional medical homeopathy are now mainly centred within a few remaining homeopathic hospitals, and interestingly, they still have their aristocratic ties. Dr Peter Fisher of the London Homeopathic Hospital is proud to be called the Queen's physician. Homeopaths see this as a big stamp of approval for their quackery, although the HRH support says more about our royals than about the efficacy of homeopathy. When did we last see a Prince of the Realm educated in a science subject at university? We are much more likely to see them being trained in history, agriculture and how to kill foreigners.

But of course, the shocking thing is that homeopathy and these hospitals are funded by the NHS. It is a bit like finding a room in the cellars of a modern city hospital that still had working tanks for breeding leeches. This ghost of Victorian patriarchal medical quackery lurking within a modern public health service is of course an absurdity, and this is increasingly being pointed out both by senior academics and medics and the hospital managers who want to spend their limited budgets as wisely as possible. Medical homeopaths recognise the threat and are trying to campaign to save their funding. Even with their attempts to court members of parliament, it would look likely that those tasked with spending NHS money will make medical homeopathy an interesting modern historical anomaly. NHS Homeopathic hospitals are doomed by the simple asymmetry of their position. Stopping funding and closing hospitals is a fairly easy decision to make. Arguing for increased homeopathic provisioning and opening new hospitals looks almost impossible in today's climate. Would you want to argue for massive increased funding of contentious, unproven quackery in front of parliament? No, medical homeopathy will dwindle and die and be left with just a few GPs dabbling on the side.

That leaves the question of the future of lay homeopathy. Although somewhat antagonistic towards each other, lay homeopaths depend on their dwindling medically trained colleagues for a certain amount of credibility. However, lays have their own set of problems and these are mostly self-inflicted. Lays prefer to be called Professional Homeopaths as this gives them the appearance of, err, professionalism. However, their central problem is that they lack any sort of professional ethos whatsoever. Medical homeopaths are registered mainly with the Faculty of Homeopathy. However, they are ultimately accountable to their medical colleagues and can suffer severe penalty if they transcend their medical codes. Lay homeopaths are under no such sanction. This would explain the different attitudes of Dr Peter Fisher and his lay colleagues to the treatment of malaria with homeopathic pills. Fisher condemns the practice in the strongest terms whilst the Society of Homeopaths take absolutely no action to take their members to task over the widespread practice.

One could predict that without the constraints of either legislation, professional sanction or a commitment to rational enquiry that lay homeopaths will go off the deep end with ever increasing absurdity in their delusions. And that is just what we see. Not content with trying to treat a few headaches and grazed knees, their healing fantasies spread across the medical spectrum. Homeopaths take great pride in their work in 'helping' Africans with malaria or HIV. They proudly set themselves up as real alternatives to the medical profession and will tell their patients that. They splinter into factions with some saying that the only true homeopathy is that set out by Hahnemann whilst others take on more radical and 'progressive' approaches. Ever more 'inventive' remedies are produced from weird substances like hyena saliva, bewick swan and stone circles. Some are totally unconstrained and start believing they can make homeopathic mp3 files. Despite the various organisations that represent lay homeopaths expressly forbidding practices like these, no action ever appears to be taken. Homeopathic solidarity appears to be more important than constraining their members' out of control actions.

Of course, there is debate about these issues between homeopaths. One remedy at a time? Or multiple remedies? But having rejected the normal standards of scientific evidence and methodology that would normally settle such medical disputes, there are no ways of reaching consensus and so the community settles into its little-enders and big-enders groupings. Science has to be rejected as when it is used it consistently shows all homeopathic flavours to be equally as deluded. There is equivalence in all homeopathic delusions. And without a rational approach and mindset, homeopaths are free to drift off into deep and dangerous nonsense, best exemplified by the recent scandals of their advocacy of treatment of malaria and AIDS. This is not fringe behaviour. The Society of Homeopaths, the biggest register of lay homeopaths in the UK, is holding a symposium in London in December on the treatment of AIDS with homeopathy.

Criticism of homeopaths is widely seen as a conspiracy of vested interests and pharmaceutical company evil that is 'frightened of alternatives to their money making obsessions'. This is, of course, nonsense. Critics are just deeply concerned about the behaviour and consequences of the purveyors of unfettered nonsense setting themselves out to have healing responsibilities. This handy ready-made excuse of 'Big Pharma' prevents homeopaths having to think critically about what their detractors are saying. Few engage with the outside world and try to tackle their genuine concerns in a meaningful way.

There is, however, widespread recognition that they do need to get their house in order. There does need to be the appearance of a professional set of people able to look after their own affairs. Looking at other alternative medical practices, and seeing external regulatory pressures being put on them, homeopaths fear the consequences of either UK or European pressure to sort themselves out or restrict their activities. There has been a recent attempt to create a body that will oversee a single register of homeopaths as the first step towards a unitary self-regulatory body. However, the newly created body, CORH, recently collapsed with unpaid debts after some of the member bodies refused to pay dues and after widespread squabbling about what exactly homeopathy was. A new body is feebly trying to raise out of the CORH ashes, but the question of funding such a register is still undecided.

Regulation and legislation under the Blair Woo government has been lax and sometimes favourable. By giving fake pill manufacturers like Nelson's the ability to sell sugar pills as treatments for named conditions like hayfever and teething pains, homeopathy certainly gained some credibility and some profits for companies like Boots. This is unlikely to be maintained or strengthened under less 'new age' governments and after the torrent of criticism directed at the MRHA on the issue.

Attitudes of both the public and regulatory bodies tends to be fairly neutral towards homeopathy. It is seen incorrectly as a form of herbal medicine by some, or a benign nonsense by others and so not worth wasting effort on. Homeopathy rather slips under the radar and is not seen as something that can cause harm. What direct harm is done appears to be exported to developing nations with huge health care problems. Pretending you can cure AIDS with magic water will, of course, kill people. But it is tolerated in the UK by a society that likes the anti-establishment nature of it and the supposed self-empowerment. Jeanette Winterson writes in the Times about her first publisher, Philipa Brewster's attempts to export murderous delusion to Botswana without a hint of the controversy that such an action deserves.

Whether renewed UK or EU regulatory bodies wake up and take notice of homeopaths in the same way that they are curbing the excesses of vitamin pill sellers remains to be seen. What would be far preferable would be to see homeopaths take control of their own profession and reform it in meaningful ways. I must say that I see this as most unlikely as I cannot identify any leadership that could unite the majority of practitioners and take them towards a new vision. The depths of delusion, the resistance to criticism and the distrust of the wider medical community make my hopes rather futile.

But what sort of reform would be required? Well, there are perhaps a couple of levels of reform that could be made:

The first step would be to embrace the data. Just as the medical profession have spent the last five decades relinquishing their personal authority to the democratic pool of scientific evidence, so too homeopaths need to recognise that what they do is indistinguishable from providing placebos. That is what the data says, consistently. If homeopaths were to practice within the boundaries of that knowledge then almost all criticism would vanish overnight. Of course, homeopaths would have to start to understand placebos and let go of their more mystical notions of self-healing. Placebos have limits. Many complaints, and especially serious conditions, are not placebo responsive and so there would be no more dangerous nonsense about treating cancer, malaria or AIDS. Homeopathy could happily survive in a limited form if this was taken on board. At best, homeopaths could offer a lay complementary therapy alongside real medicine. At worse, it would be no different from any cranky new age crystal healer or aromatherapist. Maybe it would be just a bit of tolerated nuttiness.

The second and bigger step would be to fully recognise that the benefit that homeopaths give to their clients is all in the consultation. They are counsellors. Recognising this would mean abandoning the mumbo-jumbo of 'like-cures-like' and their crazy dilution/succussion rubbish. The homeopathic community represents a huge pool of people who are good at listening to people with health problems in a way that the GP cannot. Developing these skills, retraining and finding a way to integrate and exploit this pool would undoubtedly provide real complementary medical service within the UK, and almost certainly deserving of NHS funding.

They might not call themselves homeopaths anymore, but our society would benefit from a more rounded, effective, rational, caring, and, dare I say, holistic approach to health care.

And then pigs might fly.

Labels: homeopathy, Society of Homeopaths, SoH

 

The Internet is a wonderful thing. It allows you check stuff, like the claims of quacks, in a way that was not possible just a few years ago. This blog entry would have taken many months of library work and correspondence without the web and some of its amazing content, and now I can do it between mowing the lawn and popping down the pub for a pint.

Dana Ullman (8 Canards), an American homeopath, is just about to publish a book. Titled, The Homeopathic Revolution: Famous People and Cultural Heroes Who Chose Homeopathy he describes it as,

the most important work of my life. It is a project that may actually change the face (and the heart) of medicine and may make homeopathy a household word. This is a bold statement...and yet, I sense deeply that it is true. The feedback that I have received to date has further confirmed this.

The book is given a forward by the Queen's Physician and Clinical Director of the London Homeopathic Hospital, Dr Peter Fisher.

Now, it is a usual quack's trick, when you have little scientific evidence to back up your claims, to fall back on celebrity endorsements. This book is a big list of celebrities, politicians and other prominent figures who have allegedly been duped into using homeopathy. His number one claim is,

Charles Darwin could not have written Origin of Species without the homeopathic treatment that he received from Dr. Gully (based on Darwin's own letters!).

This is a very important claim as obviously Darwin is a hugely important icon within the wider sceptic community. Darwin's achievements are a huge intellectual monument to the power of rationality over superstition, religion and unreason. To claim that Darwin is on the side of homeopaths ought to be a big blow to us doubters. Ullman's claims are spreading quickly amongst the homeopathic community to tell of the revelation that the Great Scientist is actually on their side.

But is this true? Well an hour on a sunny Saturday afternoon reveals a lot about Dana Ullman's research methods for his 'most important work'. You see, just about everything that Darwin ever wrote is available online. Not just his books, but his letters, and letters sent to him. The words to and from scientists, doctors, his family and wife are all there - we can peer into his personal thoughts. The University of Cambridge gives us the Darwin Correspondence Project. We can check out Dana's claims.

So, a bit of background. Darwin was a sickly man for most of his life. He suffered from stomach cramps, vomiting and other symptoms that made it difficult for him to work. Some have suggested that his symptoms were brought on by the stress of work and the difficulty of facing the controversial nature of what he was doing. It has been suggested too that he was suffering from a disease he picked up when on his Beagle voyages in South America. Whatever the cause, his doctors could not do anything for him.

Eventually, he sought the services of a Dr James Gully of Malvern who offered a treatment based on bathing and douching in cold water. In a letter to Richard Owen, coiner of the term dinosaur and founder of the Natural History Museum in London, Darwin wrote,

I have resolved to go this early summer & spend two months at Malvern & see whether there is any truth in Gully & the water cure: regular Doctors cannot