The Quackometer

Let’s run with an idea and see where it goes.

The 10:23 campaign has now had loads of publicity and Boots have failed to address any of the central concerns: mainly, that homeopathy is a daft pseudoscience. Moreover, the pharmacy profession and the drugs regulator have remained silent.

In all likelihood, Boots will not withdraw their sugar pills and pharmacists will continue to take your money in exchange for pseudo-medicine. An immediate capitulation was never on the cards – the world does not work like that. But the Boots brand has been damaged as thousands of people have become aware of just what they are prepared to sell you in order to make money.

And let us also take on board the homeopaths argument that banning homeopathy would ‘restrict customer choice’. (Even though 10:23 did not seek to ‘ban’ homeopathy, only remove it from the pharmacy counter and, perhaps, into the health food shop next to the crystals.)

The campaign was really about making sure people understood what homeopathy is: it is not a herbal medicine, as herbs are often not used and any content gets diluted to the point where there is often nothing left. You are buying sugar pills that have had ritual magic performed on them.

As I have said, the villains here are the medicine regulators who allow deceptive labelling of these products. The MHRA say that they test the labels to make sure the public understand what they are buying. This is not true, as their recent submission to the House of Commons revealed. Nothing in their testing asked if customers understood they were buying pills that stated they contained an ingredient but that actually contained nothing, and that there was no reason to believe the pills did anything other than act as a placebo.

The legal blogger Jack of Kent has done a superb job of deconstructing the language on the labels.

Other industries have to battle with the problem with how to convey important information to the consumer that may affect buying considerations based on health: notably the food industry. In the last few years we have seen ‘traffic lights’ highlighting, for example the amount of salt in a ready meal.

Why shouldn't the packaging of items in the pharmacy not be subject to the same clear labelling requirements?

As Edzard Ernst, Professor of Complementary medicine, has said,

My plea is simply for honesty. Let people buy what they want, but tell them the truth about what they are buying. These treatments are biologically implausible and the clinical tests have shown they don't do anything at all in human beings. The argument that this information is not relevant or important for customers is quite simply ridiculous. If [pharmacists] are unable to stick to their ethical code, then they should change their code and be clear that it is alright to put profits before patients.

If we were expecting pharmacists to be honest, what would a typical homeopathic product label looks like? I suggest the following:

This quickly gets the key facts across that distinguish the product from others that might have survived some testing. After reading this, most people ought to be able to make an informed decision, and if you are the sort of person who uses crystals for deodorant then you still have your ‘right’ to buy this stuff. Everybody is happy.

Could we ever see such labelling? Somehow I doubt it, for a number of reasons.The government appears to be incapable of taking a position on pseudoscience. Indeed it has recently said that "The government does not find it helpful to define pseudoscience."

I am sure the businesses behind the pharmacies would resist such a move fiercely as it might be difficult to see how any reasonable person would purchase a product labelled as such. The pharmacists would undoubtedly resist it as it would expose them as having being flogging worthless shit for years. Plus, their ranks appear to be filled with supporters of pseudomedicines. The recently departed president of the Royal Pharmaceutical Society of Great Britain, the regulatory body of pharmacists, is now doing this. (Please empty your mouth of liquids before clicking link as otherwise your screen will get wet.)

Plus, and this is a big one, I would imagine that the majority of products for sale in a pharmacy such as Boots, homeopathic, complementary or regular, would be more likely to have red circles than green ones.

The fact that we could, in principle, have such a scheme and the distance we appear from being able to adopt something like this tells us how little our modern pharmacies have progressed from the quack’s apothecary of old.

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Update

Thanks to Richard's suggestion in the comments that the homeopathy in Boots simply be moved to a section labelled 'Placebos'.

Of course we get into a dilemma then when the professionals tell you they are giving you a placebo as is so well observed in the (hugely underrated) Smack the Pony sketch...

Labels: 10:23 campaign, boots the chemist, homeopathy

 

 

Thanks to Stephen Law at the Centre of Inquiry for posting this video of myself and Simon Singh, just after our talks at Conway Hall.

The day started with a mass overdose of homeopathic pills (see report in the Telegraph; it’s also on the front page of the BBC web site) , followed by talks on the evidence for alternative medicines and his legal battles (from Simon), the reasons why homeopathy might survive and other forms of quackery die (from me) and the problems diet quacks pose for people’s understanding of good eating and the inadequacy of the law (from from Professor John Garrow, Founder of Healthwatch).

For the record, despite my continuous consumption of Lachesis, Belladonna and Sulphur for about 24 hours, I am in good health and about to have my dinner. My arms work work and all appears well.

Labels: 10:23 campaign, homeopathy

 

Right now, if the homeopaths are correct, I should have paralysed arms, be in severe pain, have convulsions, delirium, skin itching all over and be unable to stand. That is because I have taken a massive overdose of the homeopathic remedies, Belladonna 30C, Sulphur 30C and Lachesis 5MM. I wrote this post last night and set it to appear at 10:23 today, the moment I will also be taking a whole packet of Boots homeopathic sleeping pills.

I expect to be quite alright because despite the labelling of these products, homeopathic pills are just sugar pills – there is nothing in them. They are inert and completely ineffective.

I am taking this overdose because Boots the Chemists sell these products as if they were real medicines. They make money by misleading the public that these pills can relieve them of various symptoms, from hay fever to infant teething pain. They do not, of course, and Boots know there is no evidence, but they sell them nonetheless. Hundreds of like minded people will be doing the same in cities throughout the UK as part of the 10:23 homeopathy campaign.

The Society of Homeopaths is condemning this protest as “an ill advised publicity stunt”. Why it should be ‘ill advised’ is not clear. They go on to say in their press release that they “would not therefore expect any reaction to the proposed ‘overdose’ by this group.”

Well we are all in agreement that nothing will happen then. And that is precisely the message that we want the public to take away – homeopathic remedies cannot have any effects because they contain no active substance – they are diluted to the point that no material remains. Homeopathy is a pseudo-medicine based on magical and pre-scientific belief systems that should have no place in a modern High Street pharmacy.

But, as usual, the Society of Homeopaths are not being straightforward with the public. For on another of their pages they repeat the homeopathic belief that their sugar pills can produce symptoms in healthy people. This is known as a homeopathic ‘proving’.

Volunteers or ‘provers’ take the new substance until they experience symptoms. All symptoms that result from taking the substance are recorded in detail.

Now of course this does not really happen. What homeopathic ‘provers’ experience are just random symptoms – there is no evidence that homeopathic pills can induce any consistent symptoms in people because they are just sugar pills. Such is the imagination.

If the Society of Homeopath believes this though, it is a mystery why they decline to warn the protesters about this.

The medical doctors who use homeopathy have come out strongly against this protest too. They say “The BHA regards the 10:23 stunt as grossly irresponsible”. Personally, I think that doctors misleading patients by telling them that a 19th Century pseudoscientific cultish quack medicine can help them is deeply irresponsible. I am amazed they are not struck off.

But to satisfy the homeopaths, in addition to downing by whole box of homeopathic sleeping pills, I have started taking the sulphur, belladonna and lachesis, 2 tabs of each at 2 hourly intervals. I started at 9pm last night and will continue until the tubs run out.

The lachesis is supposed to be particularly nasty. It is made from a snake venom (Bushmaster) and is supposed to induce horrific symptoms. Previous provers have reported paralysis of the arms and lots of pain. But because my pills do not actually contain any snake venom, I feel pretty confident I will be OK.

I am supposed to be giving a talk with Simon Singh and John Garrow in an hour, “Trick or Treatment: The Event.” If I am not there, you know why.

If you want to check I am alive, follow my twitter stream: http://www.twitter.com/lecanardnoir

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If you want to find out more about why I am doing this, read here.  And if you want to know why it is called the 10:23 campaign, you could do worse than read this.

Labels: 10:23 campaign, homeopathy

 

This Saturday, hundreds of people, in many cities,  will be demonstrating outside Boots the Chemists about their selling of homeopathic remedies. Each volunteer will be taking a homeopathic ‘overdose’ of a Boots homeopathy product to demonstrate that there is nothing in the tablets but sugar.

Out of all the volunteer ‘overdosers’ and their supporters in the 10:23 campaign, there may well be many reasons for taking part. The homeopaths think this is a conspiracy by Big Pharma and that the demonstration proves nothing. They are entirely missing the point. But the main point, and the one I would emphasise, is that this mass overdose is designed to embarrass the pharmacists who sell these pills to the public in the full knowledge that they are useless.

The pharmacy profession has been granted statutory privileges to dispense medicines to the public. They do so under a code of practice that insists they do act with ‘honesty and integrity’, that they do not ‘exploit the vulnerability or lack of knowledge of others’, and that they “provide accurate and impartial information to ensure that [they] you do not mislead others or make claims that cannot be justified”

When pharmacists on the high street accept cash for homeopathic pseudo-medicines that promise to relieve their customers of hay fever symptoms, help insomnia, or sooth a baby’s teething pain, they appear to be ignoring their professional standards in the pursuit of profits.

The pharmacists have evolved from the ancient protected trade of apothecaries. Since the middle ages, the state has afforded certain privileges to apothecaries to formulate and dispense medicines. Historically, these privileges have been seen as a restraint on trade by outsiders wishing to cash in on people’s desires for medicine, and as a necessary state by their supporters against rogues, quacks and charlatans.

Indeed, Samuel Hahnemann, the founder of homeopathy had a very unhappy relationship with apothecaries. He felt he was being persecuted by them for allowing people to dispense their own cures. But deeper than that, his philosophy of homeopathy made it impossible for a person to simply walk into a high street store, select a remedy they required and ask an apothecary to make it up for them. Homeopathy had to be ‘individualised’ to the patient, and this was something only a skilled homeopath could do – and not some mere dispenser of medicines.

Indeed, in an exam paper that Hahnemann set for a doctor who wanted to practice Homeopathy, the tenth question, in leading terms, made this quite clear,

10. Why can the homoeopathic medicines never be dispensed by the apothecary without injury to the public?

Any true homeopathic practitioner should object strongly to the idea of a mere dispensing chemist handing out homeopathic cures.

But his objections also recognised the direct conflict between both the financial needs of the apothecary and the nature of their beliefs and training.

In a letter to a friend, Hahnemann wrote,

I do not wish to go to the town of Altenburg itself, to be in the way of you, dearest friend, and of your colleagues. I only wish to be able to settle in some country town or market village, where the post may facilitate my connexion with distant parts, and where I may not be annoyed by the pretensions of any apothecary, because, as you know, the pure practice of this art can only employ such minute weapons, such small doses of medicine, that no apothecary could supply them profitably, and owing to the mode in which he has learnt and has always carried on his business, he could not help viewing the whole affair as something ludicrous, and consequently turning the public and the patients into ridicule.

For these and other reasons it would be impossible to derive any assistance from an apothecary in the practice of homoeopathy.

As is often the case, Samuel Hahnemann is spectacularly wrong in the most interesting ways.

Firstly, Hahnemann appears to believe that you can only sell a medicinal product in proportion to the amount of substance you are vending. Indeed, as the amount of substance is proportionate to its effects, then this would be a common sense view. However, the absurdity of homeopathy is that it subverts the obvious. Hahnemann postulated that the more dilute a substance, the greater the effects. (A claim never substantiated, of course).

However, Boots the Chemist, and other modern day apothecaries understand that what it is in the pill is irrelevant. What the pharmacists in Boots are selling is not the substance of the pills (as there is quite simply nothing in homeopathic remedies bar the sugar), but a promise based on both the trusted brand of Boots and the professional standing of pharmacists.

And with that trust in the Boots brand and the authority of the pharmacist nearby behind the counter, you can charge quite a lot for worthless sugar pills. Boots homeopathic Teething Pain Relief powders contain less than 1 part in a trillion of active ingredient (and there is not even any evidence that the active ingredient does anything). They sell for nearly £5. This pseudo-medicine will do nothing for a distressed baby apart from make the parent think they are doing something and make Boots shareholders a little richer.

The professional code of ethics of a pharmacists would suggest that they are required to provide the customer with all the “necessary and relevant information”. It is surely necessary to inform someone that they are buying a worthless product that cannot work as described and there is no reason to suppose it does. Pharmacists must fall into two camps here: those that believe that homeopathic preparations do work as described, in which case they are simply incompetent, and those that shut up for fear of their jobs and for an easy life.

As David Colquhoun noted some time ago, the real villains here are the regulators of the pharmacy trade, the Royal Pharmaceutical Society of Great Britain. They issue advice to their members about how to interpret their code of ethics when selling homeopathic quackery (under the ironic heading ‘Pharmacists - the scientists in the high street’), and what advice to give to the public. Nowhere does it suggest that you ought to tell the customer that they are buying magic pseudo-medicine.

To add to the rogues’ gallery we must also add the Medicines and Healthcare Products Regulatory Agency (the MHRA) who grant licenses to homeopathic sellers to make claims for their products that cannot be justified by any form of evidence or rationale. They preside over a regime that has allowed the pseudo-apothecaries, such as Neal’s Yard Remedies to sell homeopathic pills for the prevention of malaria. Their light touch on the issue appears to almost offer a wink to the sellers that they can get away with anything.

The 10:23 campaign will almost certainly not stop Boots selling this quackery. There is too much money in it. Perhaps the biggest effect of the demonstration will be to raise some awareness of what your local ‘scientist on the high street’ is prepared to sell you. This should make you angry that your trust is being abused. If you cannot trust them to tell the simple truth about such obvious nonsense as homeopathy, why should you trust them on more important matters, such as the side effects of real medicines?

I shall leave my last words to repeat those Samuel Hahnemann, who showed some unusual insight when he said that,

he [the pharmacist] could not help viewing the whole affair [homeopathy] as something ludicrous, and consequently turning the public and the patients into ridicule.

And that is the pharmacists’ shame: using their trusted position to make fools of the public.

Labels: 10:23 campaign, homeopathy, MHRA

 

In the last few days, a new campaign has been launched with the aim of showing that homeopathy is an ‘absurd pseudoscience’ and that Boots the Chemists should not be selling these sugar pills to the public as if they were genuine medical products. The ‘10:23’ campaign, as it is known, has a very flashy web site (http://www.1023.org.uk) and states that it has been set up and organised by a group calling themselves the Merseyside Skeptics Society, a branch of the Skeptics on the Pub movement.

It goes without saying that homeopaths will be doubting that such a sophisticated and hard hitting campaign could be set up by a bunch of feckless, workshy scousers who sit around all day drinking in Liverpool pubs and discussing their nerdish obsession with ghosts and UFOs. Surely, Big Pharma is behind this?

Indeed, it does appear unlikely that such a move could be set up by dole-cheating scallies and alcoholic cynics. So, who is really behind all of this? The clues are in the name of the campaign.

What do the numbers 10 and 23 mean for this organisation? To understand the significance of these numbers, you need to know not just where to look, but how to look. The Sceptics themselves show that they hold the numbers to be significant by holding a mass homeopathic overdose by 300 sceptics at exactly 10:23 in the morning in a few days time.

The numbers 10 and 23 were deeply significant to the founder of homeopathy. Samuel Hahnemann was born on the 10th of April in 1755. He became a doctor on the 10th of August in 1779 and his groundbreaking book, The Organon, was first published in 1810. Hahnemann studied medicine in Vienna (German, Wien W = 23rd letter of the alphabet) for 10 months. He died in July 1843, signified by the number 23 (7 + 1 + 8 + 4 + 3). The name of the campaign would look to be a reference to the death of homeopathy – a stated campaign aim.

The numbers also have deep occult meaning. In tarot, the number 10 is highly significant, being the end of the pip sequence and indicating that ‘the cycle has ended and a new one is beginning.’ In astrology, the number ten is associated with ‘intelligence and integrity’, an obvious conceit on the part of Merseyside sceptics. It is also associated with great rises and falls, and also is the number of the Sun. Although Boots appears to be the target right now, perhaps the homeopathic pharmacy Helios (the sun personified) is their real target. Whatever the target, the number ten has been chosen to signify the end of one era and the heralding of a new beginning.

The number 23 is an even more powerful occult number and is also very important for scientists. Charles Darwin's Origin of Species was published in 1859 (1+8+5+9 = 23). The Hiroshima bomb was dropped at 8.15am (8+15= 23). It has more terribly auspicious associations: Julius Caesar was stabbed 23 times. The terrorist attacks on New York happened on 9/11 2001 (9+11+2+0+0+1=23).

The number 1023 would also appear to contain a little joke from the sceptics who believe that homeopathy is nothing but magical thinking as, according to Jules Bass and Arthur Rankin, 1023 was the year that all fairy tales happened. It is also worth noting that Oliver Wendell Holmes was the early arch nemesis of homeopathy and first completely debunked the practice in a lecture given in 1842 entitled Homeopathy and its Kindred Delusions. His initials, OH, add up to 23 (O=15, H=8) and his middle initial is the 23rd letter of the alphabet.

Given the significance of this number, could the 10:23 campaign have bigger aims? Although targeting homeopathy right now, it is worth looking at the other targets of these sceptic groups. One of the most significant set-backs to the so-called sceptic movement was when chiropractors won a historic suit against the American Medical Association and stopped AMA campaigning against chiropractic and calling it quackery.

That court decision was now exactly 23 years ago.

It would appear to be an extraordinary coincidence that 23 years later the chiropractors are back in court. On the 23rd of next month in the 10th year of the millennium, Simon Singh will be in court to appeal in his case against the British Chiropractic Association.

This hearing will be highly unusual in that the presiding judges will include the Lord Chief Justice of England and Wales and also the Master of the Rolls. These are two of the most powerful judges in Britain. Why would they be presiding over a relatively minor appeal court that is only hearing an appeal about a preliminary decision on meaning and not even the full case?

We need to look a little deeper and go back to Liverpool, the home of the campaign. Indeed, we find the number 23 has deep ties with Merseyside. Liverpool art school student William Ernest Drummond set up the mysterious group known as the Justified Ancients of Mu Mu (23 letters), sometimes known as the KLF or K-Foundation. He once wrote the line “23 years is a mighty long time”. They famously presented an award for the ‘worst artist’ to Rachel Whiteread on 23rd of November 1993 and burnt a million pounds on the 23rd of August 1994. More worryingly, Drummond was involved in the Liverpool production of the Illuminatus!, a musical story of conspiracy theories about the hidden rulers of the world. It opened on the 23rd of November 1976 (1+9+7+6=23) and the show consisted of five acts (2+3=5), each 23 minutes in length, with 23 actors on stage.

Robert Anton Wilson once claimed in a 1988 interview that "23 is a part of the cosmic code. It's connected with so many synchronicities and weird coincidences.” Given that the number 23 is so significant, could the Secret Rulers of the World be somehow behind the 10:23 campaign? Could they be using their minions, the CEOs of the pharmaceutical companies, and their minions, the skeptics in the pub drones, to direct this attack against alternative medicine?

One clue comes from the Merseyside Sceptics statement that they want to have 300 people in the campaign taking homeopathic overdoses. Surely, it will be very hard to get exactly 300 people to do this? This is quite likely to be a code for the real intelligence behind what is going on: The Committee of 300.

The Committee of 300 is a secret society formed in Britain in the 18th Century, and is also known as the ‘Hidden Hand’. An MI5 officer once wrote a book exposing their antics and they are thought to be in charge of the banking system, judiciary (hence the Singh case) and the media (which explains why sceptics find it so easy to publish their denouncements of alternative medicine). The Committee is thought to be even higher up in the Illuminati than the Bilderberg Group.

One surprise is that the campaign was not launched on the 23rd of October (10/23). Indeed, this date is known to many scientists as International Mole Day (http://www.moleday.org/) and is celebrated annually on this date from 6:02 a.m. to 6:02 p.m. It is a strange celebration that seeks to enrol children in a strictly materialistic view of the world. In rituals that mirror the ceremonies of the satanic, Illuminati group, the Bohemian Club, who worship a giant owl, they do not have a flag to salute, but instead ask new members to bow their heads towards the ground (where the moles are) and repeat the scientistic pledge of allegiance: “I pledge allegiance to the mole, to the International Union of Pure and Applied Chemistry, and to the atomic mass for which it stands, one number, most divisible, with atoms and molecules for all.” A chant which would be anathema to all homeopaths.

It is difficult to ignore the significance of the chosen numbers. The Knights Templar had 23 Grand Masters. William Shakespeare was born on the 23rd of the month and died on the 23rd. Adam and Eve were supposed to have 23 daughters. Princess Leia was held in detention block AA23 on the Death Star (AA = 1 + 1 which equals 10 in binary arithmetic, look it up on Wookieepedia). John Nash, Nobel Prize winning mathematician was obsessed with the number 23. He wrote exactly 23 papers. It is one of only two numbers that need nine cubes to represent it . (The other being 239.)

(Incidentally, 23 was the date of death of a Wilhelm Hahnemann. Hahnemann was noted for playing exactly 23 games for the Austrian football team, 23 games for the German national team and scoring exactly 23 goals for his club to become the league's top scorer. He once achieved a remarkable double (2) hat-trick (3) whilst playing for Germany. Of the 46 (23+23) caps he won, his teams won 23 of these matches. )

Portentous stuff. So soon, in many cities we are going to see many demonstrations against Boots selling homeopathy. My advice to homeopaths on the their day of reckoning would have to come from Matthew Chapter 10, verse 23: “But when they persecute you in this city, flee ye into another”. One day though, you are going to run out of cities.

The homeopaths may well think this is just a nerdish group showing off a bit. My analysis would suggest there are much darker forces at work here.

Remember: 10:23. There’s nothing in it.

Labels: 10:23 campaign, apophenia, fun, homeopathy

 

Further documents have been published after the House of Commons held its enquiry into the evidence base for government policy on homeopathy. There are some real treats in there, but I am most concerned about new evidence from the Medicines and Healthcare Products Regulatory Agency (the MHRA) on how they test the public’s understanding of the labeling of homeopathic products.

The new document was submitted to the enquiry after Professor Kent Woods (pictured) was challenged over how the regulator allows homeopathic products to make claims on their labels when it is known that these claims are false. The concern is that a customer could walk into Boots the Chemist and see two products for, say, hayfever and be unaware that the homeopathic product has no active ingredient, is just a sugar pill and will not help the relief of any symptoms. Clearly, this is a very unsatisfactory situation, where the medicines regulator is charged with ensuring medicines are safe and do what they claim but appears to wave homeopathic products through without regard to these principles. The public are being badly misled by the people charged with protecting them.

In the enquiry, Evan Harris MP asked a very pertinent question of Professor Woods,

Do you think that people reading that will think that it works for symptomatic relief of those minor conditions, or do you think that label that you have read out - and please feel free to read it out again - would make the average person think, which is the truth, as far as you are concerned, that there is no evidence of efficacy backing it up. Which of those two do you think is most likely, for the average person?

At is issue is the question of how far the MHRA go to ensure that the public are not being misled by the labeling they authorize on homeopathic products.

Professor Woods response was,

Well, fortunately, by law all packaging and patient information leaflets are subjected to user testing to ensure that they are comprehensible to the man in the street, and indeed that seems to be a very straightforward statement of the reality. This is a homeopathic medicinal product used within the homeopathic tradition for the symptomatic relief of sprains, muscular aches and bruising or swelling after contusions. That is what it says and the user testing is part of the approval of that leaflet, has the labeling been tested on the average man in the street.

This did not satisfy the MP, Dr Harris,

Sadly my question was not "What does it say? Has it been tested?" My question is, and maybe it is the result of this testing and you need to tell me, does the average person think that that label suggests that it is going to be useful for the symptomatic relief of those indications?

This is an important question. Does the MHRA care if the public are misled by homeopathic labeling or not? What do people make of the labels?

The new documents posted on the House of Commons web site shed light on this question.

It is worth reporoducing the test questions that are used to establish what people make of the labeling on a homeopathic product:

Three rounds of user testings were carried out with ten participants in each testing. Twelve questions relating to the key safety messages were asked and were designed to assess whether the respondent was able to find the information, understand it and use the information. The questions asked were as follows:

1. Can you tell me the name of this medicine?

2. What does the label say that this medicine is for?

3. If you take too much of this product (overdose) what does the label tell you to do?

4. Is there any advice on the label for women who are pregnant or breast feeding?

5. What does the label say is the active ingredient in this medicine?

6. If you have missed a dose of this medicine, what does the label tell you to do?

7. Once you have opened your medicine, how does the leaflet tell you that you should store it?

8. This medicine contains Arnica Montana 30C. What are the other ingredients in this medicine?

9. How many pillules are there in the Clikpak container?

10. This medicine contains lactose and sucrose which are types of sugar. If you have an intolerance to some sugars, what does the pack tell you to do before taking this product?

11. How many pillules does the pack say that you should take in a dose and how many times a day should you take them?

12. The pillules in this medicine are contained in a plastic Clikpak to help protect them. What instructions does the label give you as to how to dispense the pillules from the Clikpak?

These questions fail to address the central concern that labeling homeopathic products for the relief of specific symptoms is going to mislead patients into thinking that there is reason to believe this is true and that there is evidence to back up the stated claims. In my opinion, the MHRA is complicit in supporting a fraud on the public.

Question 2 is quite insidious in my view. It tests to see if the subject understands the medicine is targeted at specific conditions, when there is no evidence to suggest that the medicine can help. What would the answer to the question mean? Question 5 implies there is an active ingredient in the pill. If the test subject answered ‘Arnica’ would the MHRA conclude that the patient has been deceived by the packaging or has just read the label and concluded that it is telling the truth?

Question 8 explicitly states that the pill contains “Arnica Montana 30C”. Only someone with a good understanding of the nonsensical production methods of homeopathy would appreciate that this means that the pill does not contain any Arnica (it has all been diluted away). What would the average customer on the street conclude? In the original hearing, Professor Woods states that the labeling is designed for people who believe in homeopathy,

To begin with the fact that this is a homeopathic remedy, we are making provision for a group of people who believe in homeopathic remedies and, therefore, the first thing to establish is that this particular remedy is recognised by homeopathic practitioners as a homeopathic remedy. That is the essence of what we are trying to prove.

This is simple nonsense, as the products are likely to end up on the shelves of Boots where people may simply misread ‘homeopathic’ as ‘natural’ rather than ‘batshit magic pseudo-medicine’, the wording that ought to be on the label.

The MHRA appear to completely miss the point over homeopathy. As I have written before, they fail twice over. Firstly, they endorse misleading labels on homeopathic products and fail in their primary mission to “ensure that medicines and medical devices work.” Secondly, they appear to be blind to the blatant abuses that do go on in the creation of homeopathic medicines where claims are made explicitly and implicitly without even seeking MHRA approval.

The mistake that all regulatory efforts from this government has made is to attempt to regulate alternative medicines as if they were medicines. They are not: they are pseudo-medicines and need a different style of thinking. Trading Standards should take a more leading role in prosecuting misleading claims as they would with any other consumer product. The MHRA need to stop feeling they need to treat homeopathy as if it were medicine and give special dispensations in the claims that they can make. As with any other medicine, homeopathy should only be allowed to make claims if they can back them up with sound evidence.

I understand that there are some efforts within the MHRA to look into the issues I have raised with them. It has been several months since I last heard from the investigating officer involved. My first enquiry took 17 months for a response. In the meantime, I hope the the upcoming publication of the House of Commons Evidence Check report into homeopathy will be severely critical of them for presiding over a regulatory regime that endorses the homeopathic trade in misleading the public.

Labels: 10:23 campaign, homeopathy, MHRA, regulation

 

We have a conflicted relationship with the things that give us pleasure. We fear overindulgence may be harming us, and we desperately seek evidence that suggests our habits are beneficial, so that we can continue to enjoy them without guilt. This year appears to have been a good year for coffee in this contradictory quest.

Over the past twelve months, the People’s Medical Journal, the Daily Mail, has given us the following stories about coffee:

15/12/2009	Drinking three cups of tea or coffee a day cuts risk of age-related diabetes by 23%
12/12/2009	Men should wake up and drink the coffee
09/12/2009	A hangover? Don't reach for a coffee (it just stops you realising you're still drunk)
08/12/2009	Coffee 'helps prevent the most dangerous forms of prostate cancer'
19/19/2008	Need to lose weight? Then try a green coffee
06/08/2009	Giving up alcohol and caffeine 'as good as IVF' for women wanting to have a baby
07/07/2009	Forget the health fascists, coffee IS good for you!
27/06/2009	How a cup of coffee keeps your breath smelling sweet
04/05/2009	Are you wrecking your brain? Chilling pictures reveal shocking effects of alcohol, cigarettes and even caffeine on the mind
06/04/2009	Fitness news: Caffeine helps you exercise
06/03/2009	Britain's biggest coffee chains promise to cut salt and fat in snacks and drinks
18/02/2009	Three coffees a day can slash stroke risk in women
26/01/2009	Coffee may raise child cancer risk: New evidence that caffeine could damage babies' DNA
15/01/2009	Start drinking coffee and cut your risk of Alzheimer's disease
14/01/2009	Go easy on the coffee, you could start seeing things

 

So, on balance, it looks as if his year coffee will have been doing us good as long as we are not trying for a baby, wanting to avoid wrecking our brain, reducing damage our baby’s DNA or not wanting to hallucinate wildly.

My nearest big town, Oxford, boasts a little coffee shop that dates back to 1650. It was one of the first places to brew coffee in the UK and is still going strong. Before long, Oxford saw coffee houses as centres of public scientific discussion and debate, with Robert Boyle taking part in the Oxford Chemical Club, which met in a coffee house, and would later become the Royal Society. (We now hold our Skeptics in the Pub, a little further up the High Street.)

It would look like concerns from coffee drinking did not first come from the problems of direct consumption but from the threat caused by radical thought and discussion taking place in the newly emerging coffee houses. The Vice-Chancellor of Oxford soon had to ban the perusal of pamphlets in the coffee houses that were critical of the University and the State. King Charles II tried to shut down the Oxford coffee shops for fear of fermenting rebellion – but the outcry was so huge, the order was soon rescinded.

By the beginning of the nineteenth century, coffee was a ubiquitous drink. And health fears were sure to follow.

Enter Samuel Hahnemann, founder of the doctrines of homeopathy. Before Hahnemann had fully formed his ideas about shaken and diluted water as a panacea, he had quite different and conflicting views about what caused illness and what could cure it.

In 1803, he published an essay entitled, On the Effects of Coffee. This essay gives fascinating insights into the beliefs of the inventor of homeopathy and how they must have changed. He starts out by explaining that

In order to enjoy a healthy and long life, man requires foods which contain nutritious, but no irritating, medicinal parts.

Hahnemann sees a clear distinction between medicine and food. However, he worries that many foods are more medicinal in their nature than nutritious,

Medicinal things are substances that do not nourish, but alter the healthy condition of the body.

Coffee is a purely medicinal substance.

We are told that the only foods that are are free from all medicinal properties are spring water and milk. All foods appear to have some degree of medicinal quality and so should be eaten with caution. If we want to flavour our food “the only substances that have been found to be harmless and suitable for the human body are kitchen salt, sugar and vinegar.”

All other accessaries, which we term spices, and all spirituous and fermented liquors, bear a greater or less resemblance to medicines in their nature. The nearer they resemble medicines, the more frequently and the more copiously they are taken into our bodies, the more objectionable are they, the more prejudicial to health and long life.

Hahnemann, in choosing his diet, is then left with a bit of a quandary, as he believes that medicines should only be used on the sick,

Used by themselves, and when no disease is present, they are absolutely hurtful tilings for health and normal life. Their frequent use as articles of diet deranges the harmonious concordance of our organs, undermines health and shortens life. A wholesome medicine for a healthy individual is a contradiction of terms.

Interestingly, Hahnemann tells us,

All medicines have, in strong doses, a noxious action on the sensations of the healthy individual.

At this point in time, it would appear that Hahnemann believed that a medicine’s effect is positively associated with its dose. His later homeopathic ideas would, illogically, reverse this point – a matter that has subjected homeopathy to continuous derision since its inception.

Hahnemann’s dislike of coffee appears to stem from what he believes is its unnatural bitter taste,

No one ever smoked tobacco for the first time in his life without disgust; no healthy person ever drank unsugared black coffee for the first time in his life with gusto—a hint given by nature to shun the first occasion for transgressing the laws of health, and not to trample so frivolously under our feet the warning instinct implanted in us for the preservation of our life.

However, Hahnemann did understand the benefits of coffee. Indeed, it is almost as if he knew me personally, and my general demeanour in the morning,

In the first moments or quarters of an hour after awaking, particularly when this takes place earlier than usual, every one who is not living completely in a state of rude nature, has a disagreeable feeling of not thoroughly awakened consciousness, of confusion, of laziness, and want of pliancy in the limbs ; it is difficult to move quickly, reflection is a labour.

But, see, coffee removes this natural disagreeable sensation, this discomfort of the mind and body, almost instantaneously; we suddenly become completely alive.

He also recognised the benefits of a post-prandial coffee. If you have overindulged during a meal, a coffee can put things right.

Coffee puts a sudden stop to this lassitude of mind and body, and removes the disagreeable sensation in the abdomen after a meal. The more refined gourmands drink it immediately after dinner—and they obtain this unnatural effect in a high degree. They become gay, and feel as light as though they had taken little or nothing into their stomach.

And, as an aphrodisiac,

Even the sexual desire, which in our age has been exalted into the chief of all pleasures, is excited by the primary action of coffee more than by any other artificial means. As quick as lightning there arise voluptuous images in the mind from very moderate exciting cause, and the excitation of the genitals to complete ecstacy become the work of a few seconds; the ejaculation of the semen is almost irrestrainable.

I wonder where Samuel Hahnemann got his coffee from? Maybe Mr Gold Blend turned out to be a bit of a disappointment after all.

Anyway.

So what is the problem, you might think? Well all of this Muslim roasted bean infusion imbibing is rather unnatural. And if you obtained some benefits from the coffee, then the payback was going to be worse than the gains,

When the first transient effect of coffee has departed after a few hours, there follows gradually the opposite state, the secondary action. The more striking the former was, so much the more observable and disagreeable is the latter.

The comedown from your caffeinated high caused all sorts of problems. Peter Morrell lists all the Hahnemannian problems associated with coffee drinking,

constipation, impotence, dental caries, abscesses in children, pulmonary mucus, blue rings around the eyes, leucorrhea, ulcers, general megrim, nervous affections, chronic diseases, insomnia, stammering of speech, lack of appetite for food, ophthalmias, rattling in the chest, etc.

Indeed, Morrell suggests that “Hahnemann was tempted in 1803 to ascribe to Coffee a grand theory of chronic disease remarkably similar to that which he later, in 1827, ascribed to the Itch animal of Scabies”

In developing his theories of illness and homeopathy, Hahnemann came to realise that it was a mistake to ascribe all these bad effects to coffee. In his essay, Chronic Diseases, he says,

That the drinking of warm coffee and Chinese tea...has further augmented the tendency of this period to a multitude of chronic diseases and thus aided psora, I least of all can doubt, as I have made prominent, perhaps too prominent, the part which coffee takes with respect to the bodily and mental sufferings of humanity, in my little work on the 'Effects of Coffee'. This perhaps undue prominence given was owing to the fact that I had not then as yet discovered the chief source of chronic disease in Psora.

The strange sounding psora became the new Cause of All Illness for his homeopathic theories. And no doubt, the comments section of an early 19th Century online edition of the Daily Mail would have been full of curses to ‘scientists’ not being able to make their mind up about anything.

Morrell, the historian of homeopathy, criticises Hahnemann for using selective evidence to come up with his coffee theories and jumping too quickly to extrapolated conclusions about his observations.

Being convinced in his mind of the certainty of the theory apparently impelled him to then find 'evidence' for it, no matter how ridiculous. That was my main point. Further, one might say, he showed a peculiar and recurrent tendency to create 'grand theories' upon what is arguably scant evidence.

It was a tendency and a mistake that Hahnemann was destined to repeat when he observed that the bark of Peruvian tree could cure malaria – from which he developed his new ‘grand theory’ of homeopathy,  like-cures-like. His life was then a continual search for any evidence, no matter how slight, to back up his over-reaching scheme. This being a grand tradition that homeopaths continue to this day.

And, I guess, this is what we see in these contradictory Daily Mail stories too. We feel guilty about the obvious pleasures of a coffee and intuitively believe that this must be doing us harm, but we also easily latch onto any evidence that suggests that we are right to continue with our habit. The newspaper columnists provide us with over interpreted views of small studies that have been extrapolated into possible dramatic interventions we can make in our lives to ensure we are free from disease. The stories miss all the subtleties, uncertainties and nuances that make definite recommendations impossible and so the reader is left with a confused impression of contradictory ideas about an every day, and almost certainly relatively harmless, little pleasure.

And it is, of course, the scientists who are blamed for this fog of nutritional confusion.

Labels: daily mail, homeopathy, nutritionist

 

In a recent submission to the House of Commons Evidence Committee on Homeopathy, the Society of Homeopaths proudly assert that,

The Society has long been committed to the highest standards for homeopathy, having run a voluntary regulatory system for the last 30 years and a course recognition process for the last 15 years. Further, it was the first homeopathy organisation to institute a Code of Ethics & Practice. Members must meet the stringent standards of competence for clinical and administrative practice set by the Society. Consequently our members are trained to very high academic and professional standards.

The government appears to be convinced that the public can be protected by ensuring that the practitioners of pseudomedical treatments have had proper, accredited training. Setting up the Complementary and Natural Healthcare Council (Ofquack) is predicated on that only people who have met standards of training can be registered.

I would suggest that the exact opposite is true. That training in irrational beliefs is likely to create a more dangerous practitioner.

To highlight my concerns, I want to discuss some course notes that arrived in my post. They were sent to me by a homeopath (let me call her P) who, after a great deal of reflection, had become quite concerned about what and how she had been taught.

The notes consist of a course outline, handouts and hand-written notes and describe a series of lectures on treating cancer with homeopathy. All the courses were given by the same lecturer, let’s call him homeopath H, at a college that was one of the first accredited by the Society.

First of all, it is quite a shock to see that a homeopathy college is giving lectures on treating cancer with homeopathy. Let us remember that homeopathy is just a chat and sugar pills. One would have thought that the best a homeopath can do is be supportive of their customer when going through difficult treatments – basic tea and sympathy. We would expect the homeopath to comply with the Society’s Code of Ethics and ensure that they have a “sound, open, co-operative and professional relationship” with their customer’s GP and act within “the bounds of their legal and ethical responsibilities and competencies”.

However, my previous investigations of homeopathy in the UK would suggest the exact opposite is true; that the Code of Ethics is a mere unenforced fig leaf and that homeopaths are trained to have a huge antipathy towards real medical practitioners. Furthermore, what homeopaths say to the outside world is quite different from what they say to each other.

These course notes are a horrifying example of this. Breathtaking in their stupidity, arrogance and cruelty.

At the centre of the lectures is a detailed case history and video of the treatment of a patient with cancer. Patient J appears to be refusing to speak to his GP anymore and H starts off by advising the patient to eat organic brown rice and drink spring water “to detox as quickly as possible”. Right from the word go, the homeopath puts their customer on a very restrictive diet for nonsensical reasons.

It gets much worse.

The lectures describe the homeopath’s responses to the progression of J’s illness and why different sugar pills are selected. And it is worth remembering this as you read the notes. No matter what justifications are given for each pill selection, J will have been given just plain sugar pills: the only difference being what might have been written on the labels.

A word of warning is given to the students on the course:

It is illegal to treat cancer. Treat patients who happen to have cancer

So, the lecturer understands that as homeopaths, advertising and offering to treat cancer would be breaking the law. Never mind. Use some weasel words in a shallow attempt to circumvent such inconveniences. Now, before I go on, I would say that I fully understand and could support genuine complementary therapies helping people with cancer cope with the emotional trauma of their disease and treatments. This is not what we see here though. We see nothing complementing a patient’s treatment and nothing about just happening to treat people who may have cancer. These notes describe a direct attempt to rid J of their cancer, no matter what word trickery H tries to pull.

Indeed, the antipathy to real treatments is clear in the notes. It is even suggested that it might be the chemotherapy (Rx) that kills patients:

It is the Rx that kills them. When people choose only to be treated homeopathically – have to have strength of character to see it through - pressure from allopaths and family.

It is not clear who has to have the ‘strength of character’. No doubt the patient must have their beliefs reinforced that homeopathy will save them, but also that the homeopaths must not buckle and allow the patient to return to real treatment.

Doctors are described as ‘allopaths’, the derogatory term used by the creator of homeopathy for those that did not adhere to his methods. From its inception, homeopath was never intended to be a complementary medicine to anything. It was designed as a complete system of medicine in its own right – suitable for everything and everyone. (The Society of Homeopaths still describes its methods as such on its home page.) Worse, Samuel Hahnemann saw the cause of many diseases as being due to treatments from ‘allopaths’. These beliefs obviously continue into current courses.

The students are told that,

Cancer in unvaccinated people tends to be in older people.

Another, near universal dogma amongst homeopaths are that vaccinations are ineffective and are actually the cause of many illness. Most see a conspiracy amongst ‘allopaths’ to keep us ill and in need of their drugs. The implication in these notes is that unvaccinated people are healthier and do not get cancer until later in life. These cancers, we are told, are slower growing and due to ‘psora’ (mythical homeopathic causes of illness), not vaccines, and these types of cancer ‘don’t kill them’.

If homeopathy is so good, then homeopaths are going to need good excuses for why their treatments fail. Homeopathy has had two hundred years to come up with good excuses. Again, allopathic drugs can destroy a patients ‘vitality’. H tells his students,

Not everyone has the vitality to deal with tumours – some people reabsorb – some people form calcification around it.

For those patients who kill themselves, “most people who commit suicide have been on antidepressants.”

The lecture notes are full of details about what homeopathic remedy can be used with what cancer symptoms. You can see similar sorts of nonsense on popular homeopathy web sites, such as hpathy. Along with these remedies, there are lots of unevidenced and irrational assertions about the nature of cancer, such as,

Breasts are the seat of mothering and there is usually a mothering issue in breast cancer.

When pain continues it is usually because we are denying something. When we deal with issue, pain goes away.

These ‘emotional’ issues are important for homeopaths as they see this as being ‘holistic’. We must not think that in describing these emotional states homeopaths are attempting to treat specifically these states – no, treating these emotions is indistinguishable from treating the disease. The direct implication is if that a sugar pill remedy can counter ‘mother issues’, the breast cancer will go away.

The remedy selection also contains advice for how to treat patients who have refused to go it alone with homeopathy and are also being treated in a hospital. There are remedies to ‘strengthen the kidneys’ after chemotherapy and bizarrely,

Potentised MRI can be used after scans.

Quite what this means is at first a little difficult to fathom. However, homeopathy is not just about diluted herbs. This is an example of an one of the more bizarre remedies where an ‘intangible’ essence is captured, usually by holding some vial in the vicinity of what you wish to make a remedy from, and then carrying out your magic dilution. You can find remedies made from ‘mobile phone’, the ‘light from venus’ and ‘antimatter’. Here, the MRI scan has been capture to counteract the bad effects (whatever they are) from an MRI scan.

It gets much worse.

At some point during the treatment of J, it became clear that he had TB and that this was being treated by a dreaded ‘allopath’ with their poisonous cocktail of drugs.

The lecture notes describe the drug regime that J was on. H makes it clear that TB is a notifiable disease.

Now has TB – TB notifiable disease.

So have to have Rx by law – or can be sectioned.

TB is notifiable because it is contagious and dangerous, killing about half of untreated infected people. Very effective treatments now exist, but it takes a long time on a cocktail of drugs which can have side effects.

In the notes, H appears to conspire with the patient to only take rifampicin, which can colour urine red, and another drug which may show up in a urine test, to convince the doctors that the treatment regime was being adhered to. In place of the real therapy, J is given more homeopathy and vitamin pills. (H, the lecturer, also runs an online vitamin store.)

P’s notes simply say, “This was illegal – [H]’s conscience dictated what he did.”

You may be shocked by this and quite rightly. Taking only part of the drug regime can lead to very bad complications, such as drug resistance. Such actions stand a high chance of killing someone with TB. But, even within the world of homeopathy, such actions are explicitly forbidden by the code of ethics. We can only ask, just what does this code mean when a homeopaths ‘conscience’ so easily overrides it?

J did not get better, as you might have guessed. The case study documents the terrible pain, fear and inevitable deterioration experienced by someone essentially untreated for cancer. Eventually, J declines further homeopathic help and dies some time later.

Now, all I have here is one student’s notes from a lecture series that happened over a decade ago. The college that this took place in has since changed hands. The lecturer is now running another accredited college and has since been made a Fellow of his registration body for services to homeopathy.

But this is not the only evidence to suggest that serious disconnects are manifest between the stated code of ethics of homeopaths and the actual practice of homeopaths in their training. Blogger ‘land tim forgot’ has documented his concerns about the Allen College of Homeopathy and their approach to cancer. Again, shocking stuff. Edzard Ernst has been reported in the BMJ talking about how the Society of Homeopaths appear to break their own code of ethics on their web site by posting “speculative," "misleading," and "deceptive" statements.

Can we really trust homeopaths to police themselves? The answer is a resounding ‘no’. They have failed to stop the extremes in their trade that threaten lives. They refused to condemn the homeopaths caught out handing out sugar pills to prevent malaria. When the WHO issued a statement saying homeopathy should not be used for the treatment of HIV/Aids, they resorted to misleading bluster. And it appears to be not just a fringe that have dangerous views. Fundamentalist approaches to homeopathy are taught as mainstream. In discussions with P, she tells me homeopathy in the UK has become dominated with a dogmatic approach to issues and that those that might question lecturers are bullied into silence.

Homeopathy in the UK has become a pseudomedical cult where the novitiates are quickly taught not to question, where conspiracy theories about Big Pharma are used to ensure external criticism is ignored and where irresponsible practices are taught as heroic actions.

All homeopaths need is blind and ignorant faith. One line in the cancer notes chillingly stood out,

If you do not understand what is going on – trust and wait. Homeopathy is the ability to trust and wait.

And in the meantime, their patients are being denied life saving treatments. Their fears about medicine are being turned into a distrust of doctors. Their autonomy is being replaced with false hope. Their chances for a longer life are being replaced by conspiratorial fantasy. This is not complementary medicine. It is the despair of our capacity for irrationality and delusion.

Labels: homeopathy, regulation, Society of Homeopaths

 

Luc Montagnier is an interesting and strange character. Last year he was a shared winner of the Nobel Prize for Medicine. A remarkable achievement. However, his latest research can only really be described as quite bizarre and some of his statements, are desperately and deadly worrying. So much so, that I think Montagnier ought to be the first recipient of both a Nobel and IgNobel prize. Let me explain.

In the past few weeks we have seen the announcements for the winners of the 2009 Nobel Prizes for Science. They are the highest accolade achievable by a scientist and are given to honour outstanding contributions to their field. Last year, French scientist Luc Montagnier shared the award for medicine for his part in the discovery of the HIV virus – something that has undoubtedly resulted in many lives being saved.

A few days before, we also saw announcements for the winners of the 2009 IgNobel Prizes. Lesser known, these prizes honour research that ‘cannot or should not be replicated’. The idea of the prizes is to ‘make people laugh and then make people think’. Previous winners have included decidedly odd but sensible papers on the side effects of sword swallowing and the the word "the" -- and of the many ways it causes problems for anyone who tries to put things into alphabetical order, to the completely batty papers, such as for the ‘discovery’ that “not only does water have memory, but that the information can be transmitted over telephone lines and the Internet”, from homeopathic researcher Jacques Benveniste.

In January of this year, Montagnier published quite a remarkable paper entitled, “Electromagnetic Signals Are Produced by Aqueous Nanostructures Derived from Bacterial DNA Sequences” in the Journal of Interdisciplinary Sciences: Computational Life Sciences. The headline makes a bold claim: that diluted DNA from pathogenic bacterial and viral species is able to emit specific radio waves. Furthermore, there are claims that these radio waves might be associated with 'nanostructures’ in the solution that might be able to recreate the pathogen. These radio waves do not appear to be emitted by ‘probiotic “good” bacteria’. After diluting solutions to the point to where no DNA could remain, it is claimed these ‘nanostructures’ somehow emit radio waves and recreate the pathogens. Luc Montagnier makes startling claims that,

In patients infected with HIV, EMS can be detected mostly in patients treated by antiretroviral therapy and having a very low viral load in their plasma. Such nanostructures persisting in the plasma may contribute to the viral reservoir which escapes the antiviral treatment, assuming that they carry genetic information of the virus.

The claims in the paper are simply unbelievable: that by serially diluting and agitating solutions of infectious agents, ‘nano’ structures can be set up in water that can emit specific radio frequencies and that even after filtration that should remove all traces of biological molecules, the pathogens can be cultured and detected, somehow by recreation.

At least, I think that is what is being claimed. The paper, it is fair to comment, lacks any rigour. It is a sequence of ad hoc assertions, hypotheses and post hoc rationalisations. Important experimental steps are described dismissively in a sentence and little attempt is made to describe the detail of the work.

There are many problems with the paper, not least that it is pretty much self-published in a journal without rigorous peer-review (it took two days from ‘receipt’ of the paper to publishing) and the journal was set up and edited by Montagnier himself.

I am not sure where to begin. But let me start with one massive problem that should have resulted in the paper ending up in the compost bin of science. It appears to fly in the face of one the greatest traditions of post-enlightenment thinking in that it seeks to reintroduce an anthropocentric view of the universe. The great early strides in scientific thought removed human beings from their special place in the universe. Primitive views placed us at the centre of creation with all things placed around us for our care. We were special. Gradually, we learned that the Earth was not the centre of the universe, and neither even was the Sun. We learned that we were not separate from creation, but part of a continuum of biological existence that joined all living things together. Our minds did not make us different from the rocks as we could see that biological processes differed merely in complexity and scale from the more mundane chemical and physical processes around us.

So, Montagnier is proposing that these electromagnetic signals are only given off by pathogenic organisms. This assertion cries out the question – pathogenic to whom? Are we to believe that these DNA signals are only given off by infectious agents to humans? That would be a most staggering claim. What about infectious agents for other species? Do they not get handy radio signals too? And what if a particular human has specific immunity to a virus? Does the DNA sequence somehow know that it much switch off its broadcasts?

Bonkers.

This is to leave aside how DNA could actually transmit radio waves. The generation of such a signal would require an oscillating current at the right frequency. How this could be achieved by a sequence of DNA is unanswered – probably because it is physically absurd.

The experimental apparatus itself looks decidedly amateurish with a the central detection mechanism appearing to be a coil of wire plugged into the soundcard of a PC via a device claimed to be invented by another infamous Frenchman, J Benveniste (previous IgNobel winner). Few details are given about this device.

It would appear, at first glance, to be a device designed to pick up background radio emissions. Indeed, the signals appears to be strong around the frequencies emitted by mains equipment and the paper does indeed mention that these signals disappear when attempts are removed to reduce background noise (such as by switching off other equipment). However, rather than conclude that the device is merely picking up noise, the paper asserts that the background noise is required to induce ‘resonance phenomena’. Your chin should be beginning to itch here. It does indeed look as if the experimental result are the result of digging around in the noise and finding signals at the limit of detection – a classical hallmark of pathological science where an unblinded researcher keeps probing noise until they convince themselves they are seeing signals. (see N-rays for a parallel, ‘discovered’ by yet another Frenchman, the physicist René-Prosper Blondlot.)

The paper takes even stranger twists when we look at the background to the paper. The Telegraph reported that Montagnier was in a legal battle with inventor Bruno Robert over the rights to the device that can detect the fantastical radio waves. Both Montagnier and Robert submitted patent applications for the same device:

The Telegraph makes no mention that the device is clearly crackpot. It is worth reading the patent examiner’s scathing assessment of the application, who concludes,

The invention is based on phenomena which contradict the fundamental principle of physics and of chemistry, i.e. the existence of biological or effect without an active molecule and no explanation or theoretical basis makes it impossible at the current time to explain the results obtained.

The story takes another breathtaking turn when it is realised that the device pictured above is identical to the one used by Jacques Benveniste to ‘digitise’ homeopathic signals and send them by email. IgNobel prize winning stuff. This research was replicated using the same device at the request of the United States Defense Advanced Research Projects Agency and no signal was detected.

It would appear that neither Montagnier or Robert were the inventor, but instead, the late, great, discredited Benveniste – homeopathic apologist and experimenter into nonsense. So, the French appear to fighting over the legacy of their greatest pseudo-scientist. Montagnier is clearly dabbling in the black arts of homeopathy and the homeopaths are crowing about it. My old friend Dana Ullman, whose academic thoroughness I took apart when he declared homeopathy had saved Charles Darwin, is jumping for joy over Montagnier’s research. He is not the most self critical thinker around. Harriet Hall demolishes his claims.

So, no doubt Montagnier deserves an IgNobel prize. His research makes us laugh. His apparatus has already earned the prize when the prize is clearly for research that ‘should not be repeated’. The IgNobel committee need to ram the message home.

But the award should be also for research that then makes is think. And what I see makes me think that Montagnier could lead to seriously bad consequences.

Not content with merely trying to perpetuate the discarded nonsense of previous homeopathic quacks, he appears to picks up the ideology of the homeopathic mindset. Montagnier appears in the AIDS denialist film House of Numbers saying that HIV can be ‘cleared naturally’ by nutritional means. All it requires is to have a ‘good immune system’. I see no evidence to support such claims. Now, many scientists were misrepresented in this disingenuous film, but it looks hard to see how Montagnier was. These views are not without terrible potential consequences. Such views lead to the deaths of hundreds of thousands of people who are dependent on governments to provide a decent level of care for people with HIV.

Montagnier’s status as a Nobel Prize winner lends a level of credence to these views that they do not deserve. His authority will be used by those who wish to exploit the vulnerable with quack cures. This is life and death stuff. Nobel prizes are the greatest scientific honour, but they also create false authorities and science, unique in human endeavours, does not need authorities. It runs on evidence, reason and critical thinking. And that is dangerously missing from Montagnier’s work.

Nobel Prize winners often feel a sense that they are freed to dream thoughts that others cannot. That is, on balance, a good thing. Science can make huge strides when people are able to think the unthinkable. But all Nobel unthinkable thoughts need not be true. In fact, very few will be. We need to be on our guard against those that exploit the false authority of the Nobel Laureate and examine all scientific claims with equal dispassion.

Labels: dana ullman, homeopathy, Luc Montagnier

 

As I write this, two married Australian homeopaths are spending their first nights in gaol as they begin prison sentences for six and four years respectively for the manslaughter of their baby daughter, Gloria.

This is a tragic, not least for the convicted parents. A nine month old baby died unnecessarily in the most horrific way because of her parent’s belief in the superiority and power of homeopathic sugar pills. Gloria suffered from severe eczema where the sores became severely infected. She constantly cried in pain and her skin became broken and oozing with fluid. She became malnourished and died.

This case has very important implications for those who are seeking better ways to regulate the so-called ‘complementary and alternative medicine’ (CAM) sector here in the UK. Understanding the nature of this tragedy will highlight the shortcomings of the approaches being taken by the government.

The parents of baby Gloria Thomas have been branded “cruel”, “arrogant” and “irresponsible”. The couple wept in the dock and it is easy to understand why. It is not just the loss of their daughter, or their impending incarceration, but almost undoubtedly their complete failure to understand what has happened to them.

This gulf may be difficult to grasp by those who do not understand the nature of homeopathy and see it just as a natural and safe complementary medicine. It is nothing of the sort. Whilst its pills are completely safe (they are just sugar pills), the homeopathic belief system is quite dangerous. Homeopathy does not define itself as complementary. It is not designed to assist treatments by real medicine. Homeopathy defines itself as ‘a compete system of medicine’ in its own right and, importantly, it defines itself in conflicting opposition to what homeopaths call ‘allopathy’ – or mainstream medicine. Homeopathy is strictly alternative.

The founder of homeopathy, Samuel Hahnemann, was keen to discover the universal laws of health and to create general and complete principles of healing. Homeopathy is the result. Indeed, Hahnemann saw chronic disease as actually being caused by other forms of non-homeopathic treatment and that deviations from the strict homeopathic doctrines as being disastrous for health. The Society of Homeopaths describe homeopathy on the front page of their site as a “complete system of medicine”. It describes how homeopathy can treat “all a patients symptoms”. This is a system that is not presented as a complement to other therapies, but a full system in its own right.

These belief systems persist for many interesting reasons. In two hundred years, the homeopathic principles have not been underpinned with an evidence base of any reliable sort. Worse, the principles have been shown to be in direct contradiction with well established principles of physics and chemistry. Homeopathy is magical in its nature, not scientific. The beliefs persist not because of their veracity but because they are taught within a cult-like atmosphere. The homeopath, Michael Bridger writes that,

The unwritten rule is not to be critical or try to define. No one has to publicly burn the books; you simply deify the inane and render critical thought unfashionable. Politically, this is a sophisticated form of authoritarianism; medically and clinically, it is the seeds of psychosis.

Recently, another homeopath has commented on Gimpy’s blog about the cult like nature of homeopathy. She describes it as a ‘pyramid scheme’, and like all successful pyramid schemes you need to ‘sell the dream.’ In her words, “We alone care about health – everyone else (Big Pharma, allopaths, EU, WHO, in conscious conspiracy, only wish to destroy health.” and, importantly for the case of Gloria, “You can be a part of saving the world’s health – but you have to be brave enough to tackle any case”.

I have recently received in the post some lecture notes from a UK homeopathy school accredited by the Society of Homeopaths. The notes describe a case of someone with a notifiable disease who was treated homeopathically without alerting the authorities, on the basis that the homeopath’s conscience dictated that he should not. To legally notify an allopath would be to alert the enemy, no doubt. When treating cancer homeopathically, the students are told to ‘trust and wait’. I will be writing more about this soon. Being trained to avoid medicine and trust only in homeopathy is mainstream thought in homeopathy, not exceptional.

The other cult-like aspect of homeopathy is its insistence in believing in a spiritual force that is being manipulated by the pills. According to Hahnemann, it is the ‘Vital Force’ that needs help with the pills. This is a vitalistic belief system with no place in modern science. As such, homeopathy is a spiritual belief which requires adherents to accept this quasi-religious world view.

In this light we can see that the parents of Gloria were doing what they were trained to do by the cult of homeopathy. If they had been trained well and had bought into the whole Hahnamanian philosophy then to take their seriously ill baby to an ‘allopath’ would have put it in danger. The only method to treat Gloria was with sugar pills. Homeopaths are taught that symptoms inevitably get worse when treated homeopathically. An ‘aggrevation’ is the remedy working the illness out of the body. No doubt as Gloria deteriorated, their training would have told them that this was a ‘good thing’ and that they should ‘trust and wait’. Her death must have been quite unexpected.

The parents of Gloria Thomas are not an exception. They are not an extreme. They have been good homeopaths and have merely been unlucky and had the misfortune to have the courage to stick with their beliefs. We can see on homeopathic discussion boards that tensions exist about resorting to real medicine when things look bad and that the choice of sticking with homeopathy is a question of “staying strong”. I have written before about the prominent UK homeopath Grace Da Silva-Hill MSc LCPH MARH MAAMET RGN who says about the fatal childhood illness of bacterial meningitis that “It requires a great deal of trust between patient and homeopath, for a serious acute to be treated solely with homeopathy.” Grace also is a supporter of homeopathic treatments for malaria in West Africa.

The implication in all of this is that even with very serious illnesses the homeopath has to stay true and believe in their cult and not betray their beliefs by accessing the outside world and their allopathic ways. Their education is full of denouncements of mainstream medical practice. It is a fundamental part of the creed that vaccinations are harmful and that chemotherapy is a killer. Medical drugs are a collection of side effects and not effective in their own right. Conspiracy theories abound about how ‘Big Pharma’ is out to destroy homeopathy. Harald Walach, Research Professor in Psychology at the University of Northampton has written that homeopaths should “Be proud, not afraid, fight back and don’t duck.” in light of the conspiracy theory that ‘Big Pharma’ is attacking them for homeopathic ‘successes’. Robert Davidson, a founder of one of the London homeopathy schools, describes how Pharmaceutical companies are trying to eliminate things like vitamins “to ensure sickness, so that everyone has to take drugs with no other choices available”. He says they are “evil, so totally evil”. Cults need their evil opponents to survive.

How many Gloria Thomas’s are there out there? It is difficult to know. We hope Gloria is at the extreme end of cases. But how many cancer patients needlessly delay treatment? How many chronic illnesses remain untreated due to such beliefs? Part of the problem is that homeopaths themselves do not collate the sort of records that would help us answer these types of questions. Sites such as What’s the Harm gathers news stories but these must be the tip of the iceberg. In Africa, where missionary homeopaths use homeopathic pills prophylactically to prevent malaria or even treat HIV we can have little idea how much harm is being done. The homeopathic belief is absolute. The current regulatory bodies such as the Society of Homeopaths refuse to discipline their members or even criticise them for taking part in such activities. Understanding homeopathy as a cult makes it easy to see why.

So how can we protect other Glorias? The homeopaths themselves will do nothing. There will be no response to this tragedy from the Society of Homeopaths, the medical Faculty of Homeopaths or even Prince Charles’ Foundation for Integrated Health. When criticism of homeopathy strikes, these organisation most often engage in bluster and obfuscation – or simply ignore the problem.

But, the government recognises that harm can be done by alternative medicine and that some sort of framework needs to be in place to protect the vulnerable. There could be no more vulnerable victim than Gloria, and indeed future infants like her deserve protection. And it is not just homeopaths we need worry about. Chiropractors display similar cult-like attitudes, and indeed much of alternative medicine appears to use similar anti-medical rhetoric to define itself and lock its members into cultish denial. You need only look at at sites such as What Doctors Don’t Tell You to understand the mentality of people attracted to such beliefs.

Unfortunately, UK government, like many other governments, appears to believe that regulating such practices is best done in a way similar to medical practitioners: registration and accreditation of training.

The folly of this is to believe that in doing this you are regulating health care professionals. You are not. You are trying to protect the public from health-threatening cultish beliefs. This is not medicine – it is pseudo-medicine with deluded practitioners. We do not protect people from Scientologists by formally recognising their leaders and giving their ‘Bishops’ seats in the House of Lords. And neither should we protect people from homeopaths by giving them protected title and a stamp of official approval from the Health Professions Council.

The government has pumped lots of money into a new organisation called the Complementary and Natural Healthcare Council (Ofquack) that claims its primary goal is to “protect the public by means of regulating practitioners on a voluntary register for complementary and natural healthcare practitioners”. It does this by ensuring their members have “undertaken a programme of education and training which meets, as a minimum, the National Occupational Standards for that profession/discipline”. It appears to think that by ensuring that an alternative therapist has been through training then people are protected. Gloria’s legacy should be to show us that this is not the case. Training is the problem, not the solution.

The National Occupational Standards scheme has tried to draw up standards for homeopathic education. These standards are to ensure that practitioners have the right “knowledge and understanding”. But as Professor David Colquhoun says, “no attention whatsoever is paid to the little problem of whether the “knowledge and understanding” are pure gobbledygook or not.” The problem is caused by the fact that these standards were set up in consultation with the Society of Homeopaths; the very people whose members’ beliefs the next baby Gloria needs protecting from. I once complained to the Society of Homeopaths about a homeopath who set up an eczema and asthma clinic. Despite obvious breaches of their own code of ethics, and that the Advertising Standards Authority concluded that this homeopath made “untruthful, unsubstantiated and irresponsible claims”, the Society decided there was no case to answer. The Society of Homeopaths believed that their time was better spent attempting to sue me.

In France, it is illegal to practice Homeopathy without a medical license. There is no such thing as lay homeopathy there and the Society of Homeopaths would be an illegal organisation. How much this protects people though is debatable. France has an enormous over-the-counter homeopathy trade through pharmacies, with Boiron, a homeopathic sugar pill manufacturer, making hundreds of millions of Euros from their big vat of sugar pills. The French self-medicate with homeopathy and their doctors are free to dish them out, although the state is fortunately reducing the amount it reimburses people for sugar pills. At least if a doctor prescribes a sugar pill when a placebo treatment is not required, then the regulatory bodies could well step in.

In the UK, we appear to be moving in the direction of legitimising various forms of quackery through various forms of state approval and recognition through statutory regulation. It is a disastrous move. There are currently reviews taking place for the regulation of acupuncture and herbal medicine. The same problems exist there with degree courses in Chinese medicine teaching students how to weasel word around regulation when making claims to treat cancer. Regulation of this style will put people at risk. The chiropractors have already achieved protected title and statutory regulation. This may not last much longer though as the regulator buckles under the weight of hundreds of complaints about chiropractors bogusly claiming to treat children’s illnesses in the light of the Simon Singh affair.

I believe a significant part of the answer is already with us. We do not need new regulation and statutory recognition of pseudo-medical cults. We need prosecution.

We already have the laws that say you cannot make false claims when selling goods and services. The Trading Standards laws are explicit in saying you cannot make false medicinal claims. What is not happening is enforcement of these laws as Trading Standards do not appear to have the training to go after these sorts of breaches. I would think it would be far more cost effective to provide this training rather than set up useless regulatory regimes for registering quacks.

The other change that would greatly help is for the Medicines and Healthcare products Regulatory Agency(MHRA) to drop its ridiculous stance on believing you only have to ensure homeopathic medicines are safe. No one disputes sugar pills are intrinsically safe – there is nothing in them. The MHRA though allow homeopaths to submit pseudoscientific ‘traditional’ evidence for a pill’s effectiveness so that they can make claims on packets. The MHRA legitimises dangerous quackery with homeopathy and it undermines its authority in doing so.

In summary, protecting future children like baby Gloria will require authorities to abandon the belief that they need to regulate homeopaths like medical practitioners and instead treat them according to the more accurate picture of them being a pseudo-medical and mystical cult with dangerous and irrational beliefs.

Labels: CNHC, Complementary and Natural Healthcare Council, homeopathy, ofquack, Society of Homeopaths, SoH, the law

 

 

This video is starting to do the rounds about how wonderful homeopaths are helping people in Ghana in malarial areas. I hope as many people as possible watch this to better understand this irresponsible and murderous delusion.

I have no doubt that the homeopath here is sincere. Adjoa Margaret Stack obviously believes she is doing good in Ghana with her Senya/Tamale Homeopathy Project but she appears to lacks any insight into what dreadful harm she is almost certainly doing.

Ms Stack highlights the problem well. She says “Homeopathy was born treating malaria.”. Indeed. The founder of homeopathy noticed that a quinine appeared to produce malaria like symptoms when he experimented on himself. From this he made the huge and stupidly overreaching conclusion that this was the reason why quinine was effective against the fever. From this, his philosophy of ‘like cures like’ was born and has remained despite no-one ever demonstrating that homoeopathically prepared treatments can either prevent or cure malaria.

It is worth noting in this video that, despite the appeasing cries of homeopaths, there is no mention of this homeopathic treatment being ‘complementary’ to real medicine. It is designed to be a treatment in its own right. One of the core homeopathic beliefs is that real medicine is a false belief and is actually responsible for much chronic disease. Despite what homeopaths might say in public, their treatments are strictly alternatives to what they call ‘allopathic’ medicine.

Malaria is at the heart of the origin myths of homeopathy. It is a fundamental part of the credo of the homeopathic religion and this is why Homeopathic organisations have reacted so badly to the recent WHO condemnation of such treatments. Homeopaths cannot abandon this crusade to treat and prevent malaria even though it is totally ineffective.

No one within the homeopathic trade will try to prevent people like Adjoa Margaret Stack from continuing in her fantasy. It will be up to governments like the Ghanaian government to do something and clear and unambiguous statements from the WHO have to help. The WHO need to be even more proactive than they have been before a critical mass of African homeopaths have been trained to exploit their fellow citizens.

Homeopaths will not consider that they could be wrong. They have not earned the right to practice their beliefs on people whose life and death may depend on them being right. All the homeopaths have is the fairy tales of their founder and an unquestioning zeal in their beliefs. This is missionary medicine – but without any hope of success.

As Dara O'Briain says in this next clip “Earned knowledge is better than fairy tales”. The pressure must not be let up on these people.

Labels: homeopathy, WHO, World Health organisation

 

The Medicines and Healthcare products Regulatory Agency (MHRA) have been heavily criticised in recent years for abandoning their core mission by allowing homeopathic sugar pills to contain statements about what symptoms and illnesses they can be used for without having to provide evidence that this is true.

The MHRA mission and values:

Mission
The MHRA’s mission is to enhance and safeguard the health of the public by ensuring that medicines and medical devices work, and are acceptably safe.

Values
In pursuing our mission we will strive to act with:

• integrity;
• openness;
• courtesy;
• responsiveness;
• timeliness;
• professionalism;
• impartiality; and
• consistency.

The MHRA allow sellers to submit evidence from homeopathic ‘provings’ as evidence. A proving is where a homeopath takes a new type of homeopathic pill to see what symptoms it generates. Homeopaths believe ‘like cures like’, so an onion, which makes your eyes stream, can cure hayfever – allegedly. However, homeopathic pills have been so diluted that no ingredients actually remain. What homeopaths ‘prove’ is plain sugar pills – any symptoms they note are either coincidental or imaginary. This is the first failure of the MHRA to allow such nonsense methods to act as a guide to efficacy.

In order for a homeopathic pharmacy to make claims, they must submit the evidence from their provings. So, far few submissions have been made. And yet, homeopathic pharmacists continue to sell many sugar pills, with indications, with no license and apparently with impunity. Is the MHRA even failing to uphold its own rules?

I tested this out.

Over a year ago I was invited to speak at London’s Skeptics in the Pub. I chose to speak about the dilemmas of regulating quackery. As part of my preparation, I visited London’s Nelson’s Homeopathic Pharmacy just off Oxford Street. I went in and said I needed something for an upset stomach and that I had diarrhoea. “Do you have anything like Imodium?” I was told that the stuff they has would not just ‘suppress my symptoms’ but get to the bottom of my problem – so to speak.

I was handed a little green container of white sugar pills labelled ‘Traveller’s Diarrhoea’. The full label read:

TRAVELLER'S DIARRHOEA

RELIEVES SYMPTOMS OF DIARRHOEA & VOMITING DUE TO

CONSUMPTION OF UNWASHED FRUITS, VEGETABLES, BAD MEAT

OR FISH. DOSAGE. TAKE 2 TABLETS EVERY HOUR UNTIL BETTER

ARSENICUM 30/PODOPHYLUM 30/PYROGEN 6/CARBO VEG 30/NUX

VOMICA 30

EXP 12/12 KEEP OUT OF CHILDRENS REACH

NELSON'S HOMEOPATHIC PHARMACY

73 DUKE STREET, LONDON W1K 5BY 020 7629 3118 P

The number 30 is significant because it means the ingredients have been diluted to 1 part in 10 to the power of 60. (that is 30 sequential dilutions of 1 part in 100). In other words – the pills I got were just plain sugar pills with no active ingredients.

Now, remember – like cures like. So being actually healthy at the time, if I had taken one of these pills I would have ‘proved’ the pill and developed the symptoms. Not wanting to do a crude experiment of n=1, during my talk at Skeptics in the Pub I handed them out to the crowd so that dozens of brave and selfless sceptics had the chance to develop a rather uncomfortable journey home.

We downed our pills, and thankfully, due to science, we all remained rather intact and the pub landlord did not have to clear up a rather horrible mess.

On the 28th of March 2008, I submitted an enquiry to the MHRA suggesting that this might be an illegal product as it had no marketing authorisation. On the 14th of April 2008 I was told that the case had been passed onto the MHRA's Enforcement and Intelligence Group.

Now you may have noticed that the MHRA’s listed values include

• responsiveness;
• timeliness;
• professionalism;

25th August 2009

I have been informed by our Enforcement Unit that an investigation has taken place in response to your complaint below. The outcome of the investigation is that following advice from the Enforcement Unit, Nelson's have removed the product you mentioned from their display shelves.

Regards,

Yes, timeliness in this case means 17 months.

It may also come as a bit of a shock to find this product still for sale on Nelson’s website. It may have been ‘removed from the shelves’ but is still advertised on the web. You can also see other similar products that are intended to cure constipation, accident & injury, allergic reactions, bites & stings, hangover & indigestion, heat exhaustion, jet lag, and sun exposure. All the same sugar pill.

In fact, the Nelson’s web site is riddled with products that make specific claims and that do not appear to have any marketing authorisation.

Some examples:

• Migraine Headaches (Helps with migraine symptoms.) http://www.nelsonshomeopathy.com/shop-online/Migraine-Headaches_prod1628.aspx
• Morning Sickness Relief (To help relieve symptoms of morning sickness....) http://www.nelsonshomeopathy.com/shop-online/Morning-Sickness-Relief_prod1629.aspx
• PMT (To help relieve symptoms of premenstrual tension.) http://www.nelsonshomeopathy.com/shop-online/P.M.T._prod1634.aspx
• Sore Throat (To help relieve symptoms of sore throat) http://www.nelsonshomeopathy.com/shop-online/Sore-Throat_prod1639.aspx
• The Nelsons Quit Smoking Kit http://www.nelsonshomeopathy.com/shop-online/The-Nelsons-Quit-Smoking-Kit_prod1664.aspx

So, what’s the harm? On the face of it, all the consumer will be getting is some sugar pill placebos and so there can be no more harm than any other homeopathic remedy. But the harm comes when the purchaser may well be relying on specific effects.

We saw recently how Neal’s Yard Remedies were selling sugar pills to customers and telling them that these could prevent malaria. The BBC undertook an investigation and interviewed their ‘Medicines’ Director, who stormed out of the meeting after being asked if this was ethical and legal.

After the BBC forwarded on their evidence, the MHRA investigated and slapped their wrists. That was it. Despite the appallingly irresponsible nature of Neal’s Yard behaviour the MHRA saw fit not to prosecute. I for one, was quite shocked.

The MHRA appear to be quite tolerant of homeopathic pharmacies sales processes. Why should this be? Could the MHRA think it not worth the effort to better police this sector? Are they under other influences to tread softly here?

I do not know. But the problem is deeper and more entrenched than even these problems suggest. Homeopaths are a group explicitly opposed to real medicine. They define their product in terms of direct opposition to medicine. From its first invention, homeopathy made grand claims to universality and having found the true philosophy of curing illness. All other approaches were heresy and to be opposed. This is what makes the vipers nest of homeopathy so insidious as a source of anti-scientific thinking about disease which leads to more widespread problems such the stubbornly unreasonable anti-vaccine movement.

We can see this foundation of anti-vaccine thinking in many homeopathic products. A large fraction of the Ainsworths medicine cabinet consists of homeopathic versions of vaccines. These are often in the form of what homeopaths call nosodes where some diseases tissue or some other ‘infectious’ agent is taken and serially diluted and shaken and probably banged against a leather bible many times to create the homeopathic witchcraft pill. Look at the remedy lists of Ainsworths and you will see a product for each Influenza strain going back 20 years. You will find homeopathic replacements for Measles vaccine, Parotitis vaccine (mumps) and Rubella. You find homeopathic sugar pills for all forms of Hepatitis, strains of TB, and Typhoid, as well as the usual comedy remedies such as shipwreck, trout and Ayres rock.

These products are making implicit claims to be alternatives to real vaccines. All of them are the same useless sugar pill pulled from the same large tub at Ainsworths, some hocus pocus spouted over them, bottled, labelled and shipped.

Why the MHRA do not prosecute for straightforward fraudulent trading I just do not know.

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

Update

18th September 2009

Simon Perry from the excellent Adventures in Nonsense blog wrote to the MHRA to see what their response to this criticism would be. I have also written, but not received a reply.

Dear Mr Perry,

Thank you for your recent enquiry to the MHRA and please accept our apologies for the wait you have experienced. We have liaised with our enforcement team and the investigator involved and we can confirm that our response to this blog post is as follows:

"This referral was allocated to an investigator and concluded by way of a compliance visit when the product was removed from the shelves. The matter of the product being available via the company internet site has been referred to our enforcement group to take the appropriate action."

Please contact us again if you need further assistance with this, or any other queries.

Kind Regards,

Ben, on behalf of the

Central Enquiry Point

Information Centre

Medicines and Healthcare products Regulatory Agency

At the time of writting, Nelsons are still selling the product online.

Labels: homeopathy, MHRA

 

Put conventional logic to one side and join me on a trip to the Caribbean where we will meet holistic therapists, dodgy diagnostic tests, fantastical cancer treatments, heavy metal rock gods, porn stars and also some really bad and shocking things too.

Louise Mclean (not pictured) is a rather prominent UK homeopath and writer. Based in London, and a member of the Homeopathic Medical Association, she is probably most famous for her Zeus Homeopathic News Service. This fortnightly newsletter (subscription £1)  is a round up of web links for news about homeopathy. It also includes links to articles condemning real medicine, conspiracy theories, anti-vaccination sites and ‘Health Freedom’ advocates, and so reveals much about the homeopathic mindset. Naturally, there is little criticism of claims in the newsletter. Pretty much any ‘alternative’ health belief is accepted.

Her web site is now advertising “The Miracle of Ozone Therapy” which appears to be some sort of cancer therapy based at the Sante Caribe Wellness Center, Nevis and St Kitts in the Caribbean. Louise Mclean tells us that “Ozone is electrified oxygen which can turn around any disease process.” The treatments are targeting people with “degenerative diseases or cancer.” Louise looks like she is acting as an agent for this facility as she says,

Email Louise Mclean at santecaribe@XXXX or louise4writer@XXXX for details on how to contact Sante Caribe Ozone Center. I can also give contact details to prospective patients who want to find out exactly what can be treated. Telephone (UK): 0208 728 XXXX or 0208 998 XXXX. Practitioners can contact me to find out about referral commission.

The Sante Caribe Center appears to be run by Director of Operations, Dr. Richard Santee, N.D., C.N.M., Dr. Alan Schwartz, M.D. and Dr. Charles Morris, N.D. But let’s leave these characters to one side for the moment – we can have a good look at them later – and also let’s not worry too much about the Cancer Act of 1939 that makes it a criminal offence to “take any part in the publication of any advertisement containing an offer to treat any person for cancer”. Instead, let us begin by looking at the techniques on offer at the Sante Caribe Center.

We are told that:

At Sante Caribe, we treat the PERSON, not the DISEASE.

We take pride in offering only:
• non-toxic,
• holistic, and
• highly effective programs for most chronic and degenerative conditions

Some of the diseases we treat:
• Cancer
• Cardio-Vascular Disease
• Diabetes
• ALS, CFS, MS
• Kidney Disease
• Liver Disease

Bold claims.

To treat these diseases simply requires a non refundable deposit of $12,000 with the full amount of $19,000 to cover the health programme and meals (airfares and bar drinks not included.)

It is not clear from their brochure what sort of facility Sante Caribe ‘Ozone Center’ appears to be.  It looks like a hotel  that the ‘center’ is borrowing. Indeed, the brochure claims that

Sante Caribe is a full service wellness center as well as a top Caribbean resort destination. In addition to the wellness center services, we offer many outdoor activities for the entire family and casino gambling for adults.

Most of our modalities can be administered to you
in the privacy of your own suite.
• Our ozone generators are portable, so we bring the treatments to you.
• You will have time to go down to the beach and get plenty of sunshine
while enjoying our many beach activities.
• Meals can be served in your room or in the main dining room.
• Lectures on treatments and modalities used at our center will be
conducted several times per week in the conference room.

It would appear that the Sante Caribe ‘Ozone Center’ is actually the Royal St. Kitts Hotel & Casino, a  business formerly known as “Jack Tar Village”. Apparently, this resort has won the “Most Creative Business Award” at the St. Kitts Tourism Authority's 2008-09 Tourism Awards.

So, it sounds like a nice place. The brochure says “There are full restaurant, bar and casino facilities on the property. We have many water activities such as snorkeling [sic], SCUBA, surfing, sail boarding, kayaking and sport fishing available.” Everything the terminally ill patient may need.

Before treatment can begin at Sante Caribe, a number of special diagnostic techniques are on offer. Let’s look at these:

Live Blood Analysis

We have seen this technique before at a similar ‘alternative cancer clinic’ Las Mariposas in Spain. This technique is described as an ‘unrivaled [sic] tool in diagnostic technology’ and is able to give ‘clues to the overall condition of the patient’ and help ‘educate and motivate the patient’. Stephen Barrett describes Live Blood Analysis as “Another Gimmick to Sell You Something”. This technique appears to be nothing more than looking a blood cells down a microscope and then proclaiming that (usually)  you need lots of expensive vitamin pills.

An article in the Guardian described Live Blood Analysis as where

…patients are potentially cheated three times over. First, you are diagnosed with a "condition" you don't have; then a lengthy and expensive treatment ensues; and finally the bogus test is repeated and you are declared "improved" or "back to normal".

Seeing one's own blood cells on a video screen is, admittedly, a powerful experience. It gives patients the impression of hi-tech, cutting edge science combined with holistic care. And impressed patients are ready to part with a lot of money. American websites explain how a practitioner can make $100,000 (£57,000) annually by purchasing the equipment necessary for performing LBA. The bulk of this money is made not through charging for the test itself but by selling expensive nutritional supplements to the patient with the promise that these will correct whatever abnormality has been diagnosed.

Not satisfied that the blood test is enough, Sante Caribe will next deliver:

Hair Mineral Analysis

We have discussed this technique too on the Quackometer, as it is a tool favoured by disciples of Patrick Holford. Once again, the technique looks very scientific and gives you lots of computer readings, but it is just not possible to make dietary or clinical recommendations based on such a broad sweeping tool. As Barrett says,

Hair analysis is worthless for assessing the body's nutritional status or serving as a basis for dietary or supplement recommendations. Should you encounter a practitioner who claims otherwise, run for the nearest exit!

The few clinical trials of this technique have not been favourable with labs not being able to agree with each other:

The reported levels of most minerals varied considerably between identical samples sent to the same laboratory and from laboratory to laboratory. The laboratories also disagreed about what was "normal" or "usual" for many of the minerals. Most reports contained computerized interpretations that were voluminous, bizarre, and potentially frightening to patients.

Six laboratories recommended food supplements, but the types and amounts varied widely from report to report and from laboratory to laboratory. Literature from most of the laboratories suggested that their reports were useful in managing a wide variety of diseases and supposed nutrient imbalances. However, commercial use of hair analysis in this manner is unscientific, economically wasteful, and probably illegal.

Need to stoop a little lower? Then try:

Stool Analysis

Yes, taking their lead from Gillian McKeith, they will earn their $19,000 by poking around in your poo. Actually, I am wrong. They say, “Stool samples are sent to our partner laboratory”. I am sure they do not want to ruin the smell of the sweet Caribbean air by doing it themselves. Whatever results comeback from the poo lab we can be pretty sure that it may well lead to further vitamin pill sales.

And on to the treatments.A wide range is available.

 Immuno Therapy and Liver Detoxification

Things that ‘boost the immune system’ and ‘detox’ are simple quackery.  Meaningless mumbo jumbo usually involving the sale of ‘immune boosting’ and ‘detoxing’ vitamin pills.

Enzymatic Therapy

This a technique that Sante Caribe claims to “digest and destroy cancer and to aid in the reduction of fibrin round the tumor mass. Enzymes can also boost the immune system and enhance the circulatory system.” A company that developed “Enzymatic Therapy products” was closed by the Amercian FDA “follow[ing] a six-year FDA investigation prompted by reports to the agency of serious injuries and a death following use of so-called "nutritional supplements" manufactured by the  firm.”

Massage Therapy

Now, this is the only treatment that I may not get too upset about. Who would not want a good rub down. For $19,000 though you would hope it was ‘top notch’.

Cesium / High PH Therapy

Now we start getting into serious quackery, Cesium Therapists claim that cesium chloride supplements can kill cancer cells. Apparently “proponents claim the intracellular pH of tumor cells is usually very low, or acidic, compared to normal cells, and that cesium chloride supplements raise the pH level of tumor cells to a normal level, which may slow the cancer's growth.”

According to Cancer.org “evidence does not support the claim that the intracellular pH of a cancer cell is any different than that of a normal cell or that malignant cells are more susceptible to toxic effects of high pH. Thus, the underlying principle behind high pH therapy remains unproven

Side effects of this treatment can be severe, including “ nausea, diarrhea, disturbed heart rhythm, loss of consciousness, or even death.” Not want you want on your Caribbean casino break.

And on to a quack favourite,

Chelation

This treatment “involves the safe removal of toxic elements like Mercury, Lead, Arsenic, Antimony and Uranium from the body”.

Whilst chelation is a mainstream therapy for heavy metal poisoning there is no evidence that it can help people with cancer.

And so, to the main course,

Ozone Therapy

The Sante Caribe claim is that:

Almost all chronic and degenerative illness is caused by one factor:
oxygen deficiency at the cellular level.

By flooding the body with reactive oxygen in the form of ozone, we can safely and
quickly stop the process of fermentation, also known as cancer.

Cancer can not exist in a high oxygen environment. People suffering from a chronic
or degenerative illness are without question deficient in oxygen.

Our well trained staff administers Ozone in many safe and effective methods
including Direct Injection, I.V. Diffusion, Rectal and Vaginal Insufflation, Inhalation,
Ozone sauna, Ozonated water, etc.

At the heart of this stupidity is a confusion of the form of oxygen that we breathe 0₂ and ozone 0₃.

0₂ is what we breathe and absorb in our lungs for transport to our cells. 0₃ is a highly oxidising form of oxygen that has very harmful effects on our respiratory systems. As such, if you squirt ozone on cancer cells on a dish they will die – but then so will all cells. Cancer therapies work, in the main, by exploiting poisons that kill cancer cells faster than non-cancer cells. This is pretty hard in practice as cancer cells are very, very similar to normal cells. The mere fact that a poison kills cancer cells in a test tube does not mean that it can form a therapy. Vodka kills cancer cells in a test tube – yet we do not see vodka therapy yet. Ozone has been proclaimed as a miraculous cure for over a hundred years. There is yet to be any meaningful evidence that it can help cancer patients. The available good evidence so far suggests that harms will outweigh any potential benefits. To me, it looks just like one more exploitative quack therapy.

 

So, the diagnostic techniques and  therapies at Sante Caribe do not look as if they hold much promise. But maybe, just maybe, the doctors at the centre have made some major breakthoughs and are doing wondrous things.

So who are these doctors and have that made these miraculous discoveries?

Let’s start with,

Dr. Charles Morris, N.D.

Morris claims that he has “received a Doctor of Medicine In Alternative Medicines - M.D.(A.M.) from The Indian Board of Alternative Medicines.” Just how much study did Morris require to receive this honour? Well according to their site, this course takes one year (by correspondence) and $750. You can take the final exam in your own home and then post off your results for ‘evaluation’.  I am inclined to suspect that academic standards here might not be what you would expect for an innovative cancer specialist.

Dr. Alan Schwartz, M.D.

Dr Schwartz would appear to be a real doctor who claims to be the Owner and Medical Director of the Holistic Resource Center in Agoura Hills, California. According to Casewatch, Dr Schwartz had his medical license revoked for “charges of incompetence, gross and repeated negligence, unprofessional conduct, and violating a previous probationary order”. The case makes disturbing reading. Nearly ten years ago, the Medical Board of California had placed him on 10 year’s probation and required him to have a chaperone present during medical examinations after he had ‘inappropriate sexual contact with a 15 year old male patient’. In his defence he said that “the penis was most accurately measured while erect.” Unfortunately, the measurement continued “until he ejaculated”.

Director of Operations, Dr. Richard Santee, N.D., C.N.M.

This is the most intriguing character here and investigating him is made much easier when you realise that Richard Santee may not be his real name. Santee appears to go by various names including, Dick Santee, Christian Logue, Christopher Black or Ricardo Santini.

Christian Logue is lead singer with the 1980’s speed metal band Savage Grace (pictured). Under various names, he appears to also run the porn production company Bordellonoir. Since my gentle readers may not be familiar with his oeuvre I will not link to his sites as it may cause consternation whilst you surf this site during your coffee break at work.

A few years ago, Logue appears to have been arrested for practising medicine without a license. He was held on

10 felony counts, including fraud, identity theft, grand theft and assault weapons charges. He is accused of performing blood tests, diagnosing patients and offering cures for cancer and diabetes, officials said. His fees ranged from $350 for an office visit to $1,000 for health aids that he claimed would cure disease.

When the authorities raided his flat they seized

medical supplies and equipment, along with a cache of military-style weapons, thousands of rounds of high-powered rifle ammunition and hand grenades.

Typical doctor’s bag contents.

Santee/Logue is apparently now free and about to tour with a reformed Savage Grace. And all whilst fulfilling his commitments in the Caribbean Cancer Center now doubt.

 

Where can we go from here. The quackometer is founded on the principle that the best form of criticism against quacks is often just plain laughter. There are a few cases where this may well not be justified.

Telling people with terminal illnesses that you have special cures when you do not is a pretty unfunny thing to do. It is hard to imagine the state of mind of someone who is willing to fork out thousands of dollars in the hope that Santee and co. have a special cure for you after your real doctors have told you that your choices are  few. What such centres do is provide totally unrealistic hope whilst depriving the patient of thousand of dollars that may help their families after they have gone. It is about as low as you can get.

It is hard to believe that Louise Mclean is really attracting her commissions for this outfit. I hope I am right. What I think this story really highlights is that homeopaths struggle to tell right from wrong.

Labels: homeopathy, louise mclean, zeus

 

The last time I said that, the Society tried to sue me and my web hosts for defamation. So let’s say it again. They are a shambles and a bad joke. Worse, their irresponsible behaviour puts lives at risk.

Today the World Health Organisation condemned the use of homeopathy for dangerous diseases such as malaria, AIDS and childhood diarrhea. It has taken a very long time for them to do this and has been a result of a campaign by the Voice of Young Science to draw attention to the murderous practices of Western homeopaths in Africa who dish out useless sugar pills in an attempt to prevent and cure these fatal diseases.

The Society of Homeopaths have been at the root of the problem here. Many of the homeopaths involved in this dangerously misguided enterprise are members of the Society and they have done nothing to stop their members from exporting their healing fantasies to some of the most vulnerable people in the world. Indeed, the Society hold conferences highlighting the use of sugar pills for such illnesses. They refuse to uphold their own code of conduct when these excesses are pointed out and they legally threaten people like me who shine a light into their shenaningans.

So, how do the Society respond to the WHO issuing this warning? Their press release is a text book example of disingenuousness, cherry picking and diversion.

They say,

[B]oth the BBC and WHO have failed to acknowledge the evidence base for the use of homeopathy in the treatment of childhood diarrhoea in which, using randomised, double-blinded trials, the results were significant versus placebo(1).

They then cite two studies and a meta-analysis. It is worth quoting them in full…

Treatment of acute childhood diarrhoea in Nicaragua
This trial involved 81 children aged from 6 months to 5 years in a randomised, double-blind trial of intravenous fluids plus placebo versus intravenous fluids plus homeopathic remedy individualised to the patient. The treatment group had a statistically significant decrease in duration of diarrhoea.
Jacobs J. Treatment of acute childhood diarrhoea with homeopathic medicine: a randomized clinical trial in Nicaragua. Pediatrics 1994; 93: 719-725.

Treatment of acute childhood diarrhoea, repeated in Nepal
In a replication of a trial carried out in Nicaragua in 1994, 116 Nepalese children aged 6 months to 5 years suffering from diarrhoea were given an individualised homoeopathic medicine or placebo. Treatment by homoeopathy showed a significant improvement in the condition in comparison to placebo.
Jacobs J., Jimenez M., Malthouse S., Chapman E., Crothers D., Masuk M., Jonas W.B., Acute Childhood Diarrhoea- A Replication., Journal of Alternative and Complementary Medicine, 6, 2000, 131-139.

A meta-analysis of childhood diarrhoea trials
This meta-analysis of 242 children showed a highly significant result in the duration of childhood diarrhoea (P=0.008). It should be noted that the World Health Organisation consider childhood diarrhoea to be the number one public health problem today because of the millions of children who die every year from dehydration from diarrhoea.
J. Jacobs, WB Jonas, M Jimenez-Perez, D Crothers, Homeopathy for Childhood Diarrhea: Combined Results and Meta-analysis from Three Randomized, Controlled Clinical Trials

Let’s be a little bit more comprehensive. The Society have cherry picked their studies and failed to acknowledge the sticking points.

Here are all the trials published on childhood diarrhoea and homeopathy, including the ones the Society failed to mention.

1. Jacobs J, Jimenez LM, Gloyd SS, et al. Treatment of acute childhood diarrhea with homeopathic medicine: a randomized clinical trial in Nicaragua. Pediatrics. 1994;93:719–725.
2. Jacobs J, Jimenez LM, Malthouse S, et al. Homeopathic treatment of acute childhood diarrhea: results from a clinical trial in Nepal. J Altern Complement Med. 2000;6:131–139.
3. Jacobs J, Jimenez LM, Gloyd SS, et al. Homeopathic treatment of acute childhood diarrhea: a randomized clinical trial in Nicaragua. Br Homeopath J. 1993;82:83–86.
4. Jacobs J, Guthrie BL, Montes GA et al. Homeopathic combination remedy in the treatment of acute childhood diarrhea in honduras. J Altern Complement Med. 2006;12:723-32.

The obvious thing is that they have all been done by the same author. So, an alarm bell should ring that these studies have not been independently replicated.

The first of these studies was perhaps the most important, being published in a real journal, and not a CAM comic, and showing a 'significant' effect. The next issue of the journal contained a rather damning critique,

http://pediatrics.aappublications.org/cgi/content/abstract/96/5/961

Analysis of Homeopathic Treatment of Childhood Diarrhea by Sampspon and London.

They concluded,

"In summary: 1) The study used an unreliable and unproved diagnostic and therapeutic scheme; 2)There was no control for product adulteration; 3)Treatment selection was arbitrary; 4) The data were placed into odd groupings without explanation, and contained errors and unexplained inconsistencies; 5) The results were not clinically significant and were probably not statistically significant; 6) There was no public health significance; 7) Selection of references was incomplete and biased to support the claims of the article, and references were quoted inaccurately; and 8) Editorializations were inappropriate."

When Jacobs did her own metaanalysis of the first three trials she acknowledged the lack of statistical power in these studies and recommended larger trials. She did the fourth larger trial (which was also of better quality) and surprise surprise,

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

The result of this careful study was that the homeopathic treatment was no better than a placebo. But the homeopath authors do not conclude that homeopath did not work, they speculate the tablets had not been stored properly or that the wrong combination of sugar pills was made. At no point do they propose as a possibility that homeopathy can have absolutely no effect on a third-world child with the squits. And joking aside, diarrhea kills hundreds of thousands of children around the world, so intellectual honesty in studies like this, is not an optional add-on.

The Society of Homeopaths have failed to note these severe shortcomings. I can only conclude that the Society of Homeopaths are intellectually dishonest and only interested in misrepresenting science for the sake of their shabby trade.

The Society cannot be trusted to give meaningful health advice and to rein in the dangerous practices of their members. In giving out this misleading press release, the Society once again endanger children’s lives.

Labels: homeopathy, Society of Homeopaths, SoH

 

This is an open letter to all homeopaths in the UK.

It has been a bit of a surprise to me to learn that the Society of Homeopaths is wanting to lobby the Health Professions Council to include homeopathy within its regulation remit. As such, you will receive protected title (only registered homeopaths will be able to call themselves that) and be held against a code of standards and ethics.

Why do you want to do this? I can guess some of the reasons.

Homeopathy has always battled to be recognised – both as a science and as a healing profession. Deep within the homeopathic mindset is a belief that you hold a valuable principle of healing, if not the fundamental theory of healing. Over two centuries you have battled to gain acceptance and validation against what you see as a hostile (even conspiratorial) medical profession. You call the medical profession allopaths and define yourselves in opposition to your own picture of them.

Undoubtedly, you see that statutory regulation will put yourself at least on a par with doctors. You will no longer legally be invisible in the healing professions. But there are other more economic reasons too. Being statutorily registered will make it easier to gain referrals from the huge source of cash that is the NHS. It will also make it easier to get payments from private health insurers. You won’t have to pay VAT, although I doubt many of you make enough to have to worry about that. Universities have recently said that they will not teach BSc courses to train homeopathic practitioners unless they achieve statutory regulation.

So, the prize appears to be huge. Recognition, financial gain and the secured future of your profession through accredited education. The Society of Homeopaths can free itself of the tedious burden of having to pretend to regulate you and instead become something like the BCA and concentrate more on trying to sue its critics.

But what of the cost? Such rewards will come at a price – and I am amazed that the Society of Homeopaths believes you will wish to pay that price.

First, before we look at what this might all mean for homeopathy, I would suggest that the path to Statutory regulation will not be easy. I am sure you are aware that there are many people who think such a step would be absurd, myself included. Homeopathy has failed in two hundred years to make any progression in showing that it is nothing other than a inert treatment based on pre-scientific and magical thinking. The basic science to show that your principles are true is not there. My own simple challenge to homeopaths to demonstrate their fundamental propositions has not been taken up in 85 weeks. More damningly, in the two hundred years since homeopathy was invented, our scientific understanding of medicine, chemistry and physics has moved on enormously and it clearly shows that homeopathy is not just implausible but is utterly contradicted by everything we know about the world. Homeopathy lies outside of reason and science. It is a pseudo-medicine and is just a placebo therapy. It is just not tenable to hold any other position.

To gain statutory regulation, you will have to demonstrate that it is indeed possible to have meaningful standards in education and training for a pseudoscientific subject. That is not impossible – the current government has on the whole failed to see the problem with regulating absurd treatments. It is funding Ofquack, the Prince Charles backed Complementary and Natural Healthcare Council, as a voluntary regulator for a rag bag of quack practitioners. The government does not appear to see that upholding such people to high degrees of training and competence is problematic when such people believe in absurdities. I would suggest though that the HPC may well be tougher judges than Prince Charles.

So, onto the costs. In order to appreciate what such regulation might mean for homeopaths it is worth looking at what it has done for other statutorily regulated alternative medicines. Chiropractic would be a good example.

The regulation of chiropractic was not without its controversy. The Society of Homeopaths claim that 65% of its members support the route to such regulation. The Society of Homeopaths only represents 65% of homeopaths, so we can only be sure that 42% of homeopaths support such a route. Even then, this survey was taken in 2006 and a lot has changed since then. I would be very surprised if this support has grown. Are the majority of you in favour of this move? Chiropractors were also split when the Chiropractic Act was brought in. Many saw it as an attempt to control their practice and restrict what they could do. Chiropractic philosophy appears to embrace a libertarian stance and many resented passing control of their work to people who may not share their beliefs and views. Some were worried that the move had conspiratorial overtones of the medical community trying to suppress an alternative to them. There were quite a few who refused to be registered and had to cease calling themselves chiropractors and instead called themselves simply spinal manipulators or even the grand sounding osteomyologists.

Over a decade later, the political infighting still continues. Many resent that the McTimoney Chiropractors were let into the exclusive regulated club. McTimoney is seen as a chiropractic heresy where bones are not cracked so violently and training takes place through part-time courses. It is not seen as being real chiropractic and the practitioners as being undertrained – through cheaper courses. It represents a threat to the chiropractors who will have invested well over £40,000 in fees for their training at one of the other two ‘real’ chiropractic colleges.

The General Chiropractic Council, the regulatory body, appears to be popularly despised by the ordinary chiropractor. It is seen as heavy handed in its regulation, costly and not in tune with chiropractors’ needs (to be left alone). It has no duty to promote chiropractic but only to protect the public and enforce its code of conduct. It is also increasingly dominated by lay representatives – chiropractors are getting a smaller voice in its running. Much of this resentment has been well documented on the chiropractic blog chiropracticlive.com.

When the British Chiropractic Association decided to sue Simon Singh for criticising the lack of evidence base for the treatments it was promoting, I doubt they understood the difficulty they would be putting their members in because of the very fact that they were statutory regulated. The ensuing debate has exposed the non existent foundations of much of chiropractic care and this has led to an unprecedented number of complaints being made to the GCC about chiropractors misleading the public on their websites for the effectiveness of the treatments they offered. There are now perhaps 20-30% of the entire chiropractic profession undergoing statutory complaints procedures which could result in the loss of their registration and their ability to practice.

The mistake the government and chiropractors made in accepting statutory regulation was allowing it to go ahead before chiropractors could demonstrate that they were not simply a vestigial remnant of Victorian back cracking quackery. Now, chiropractors find themselves being held to the highest forms of professionalism and practice without an evidence base for pretty much anything they do. It is now possible that chiropractic in the UK will not survive the current onslaught of professional complaints and trading standards investigations being pursued against them. What will come out the other side is pretty much anyone's guess, but I am pretty sure it is not a situation that the majority of chiropractors would have wished for in their quest for recognition.

And this is what I find extraordinary about the attempt by homeopaths to join the HPC. At present, the nightmare that is happening to chiropractors cannot happen to homeopaths. Despite what you say, you have had the freedom of living without any form of genuine regulation. The Society of Homeopaths has never ruled against a homeopath for the way they practice when when faced with clear breaches of the code of ethics. Homeopaths have been free to indulge in whatever delusions they fancy without fear of sanction. You have claimed to treat malaria and AIDS and have done so without a single voice of censure from within the lay homeopathic trade. You have no idea what it is like to be regulated and to be subject to a real code of ethics and practice. I suggest you pop along to your nearest chiropractor to find out what it is like.

And I must say that chiropractors have it fairly easy. Their treatments (at least for lower back pain) have an air of plausibility and some evidence for effectiveness. Homeopaths lack these luxuries of plausibility and reliable evidence for anything. What makes your situation worse is that your belief set is acutely in conflict with those who will become your statutory medical colleagues. You regularly undermine public healthcare messages about childhood inoculation and believe your sugar pills are an alternative. You show no sense of boundaries for what you can reasonably hope to achieve and make claims to be a superior treatment for everything from asthma and swine flu to autism and cancer. Do you really believe you could continue with your alternative beliefs in a statutory world? And they are alternative. Whilst you denounce the side effects of real medicine as being avoidable by homeopathy you pitch yourself against the medical world. And I doubt that a regulated profession could last long with such rhetoric.

Homeopaths. You have never had it so good. And you do not realise it. You are pretty much free from any constraint on what you say and do. You may moan about the continuous criticism you get from people like me – but that is the worst you have to suffer at the moment – criticism. If by some fluke you do manage to achieve full regulation, expect your cosy world to come crashing down very fast. Your quest for regulatory recognition will be hubris. It took over fifteen years for the chiropractors to realise they had been practising on borrowed time. Your regulatory nemesis will come much quicker.

Labels: British Chiropractic Association, chiropractors, CNHC, Complementary and Natural Healthcare Council, homeopathy, regulation, Society of Homeopaths, SoH, the law

 

Cut free from the tethers of evidence and reason, homeopathy, as a system of thought, is free to soar into lofty heights of wild fantasy. Unrestrained by the weight of reality and the heavy ethical demands of accountability, practices and principles are able to float into almost any area that the imagination will allow. There are no maps to guide this flight of the bizarre and no compass to return the traveller to a safe base.

Despite two hundred years of existence, you will still find vigorous debates on homeopathic discussion boards about what exactly homeopathy is. There are homeopaths who will only ever give one pill. There are homeopaths that do not mind mixing pills. Some only accept remedies based on the original forms of testing, known as the ‘proving’. Others allow themselves to dream what a remedy might do. Homeopaths squabble about what is right, but can never resolve their difference because they have long ago abandoned objective means of settling disputes. An uneasy truce exists between the various schools of thought with only occasional cold war like peripheral fights breaking out, mainly in the form of a diatribe by one side denouncing heresies and calling for all homeopaths to unite under the scriptures of Hahnemann, the founder, and the One True Authority.

A few common principles bind the various factions together – the idea of similarity, that like cures like; the need to match the totality of symptoms to a remedy; and the idea of minimum dose – use the smallest amount of remedy possible. This last point means that homeopaths most often give no dose. The medicine has been so diluted away that not a single molecule remains. The beauty of homeopathy, and probably the reason that it is has done so well, is that it is a pure placebo therapy. There are no risks of side effects and the patent is quite free to allow nature to take its course and the complaint to get better on its own.

When the actual physical acts of homeopathy are completely inert and when practiced by people with no regard for critical self appraisal, the scientific method and the objective collection of data, one can expect a certain amount of arbitrary evolution of ideas and the generation of whimsical variants. The only criteria that restrain such ideas are the need to keep the treatment inert, the philosophical acceptability to the vitalist mindset of the homeopath and, most importantly, its profitability in practice.

Thus, in the UK, we have seen the former founder of the Society of Homeopath, Peter Chappell, invent the homeopathic delivery of remedies by MP3 file. Since homeopaths invent cod explanations for their work along the lines that it is an ‘energy medicine’ or a ‘vibrational medicine’ then the thinking goes that because MP3 files can encode sound vibrations, then they can also encode ‘healing vibrations’. And so, we find Chappell running a little business where people can download MP3 files and play sounds of waves crashing as they worry that they might have swine flu.

It is in India though that we must look to see some true inventiveness. The country has more homeopaths than any other and the government appears to be quite happy to support all manner of quackery in the name of political expediency.

And so, I stumbled across the works of the followers of Dr. B. Sahni who runs the Research Institute Of Sahni Drug Transmission & Homoeopathy (risdth.org). Without a hint of irony, the home page proclaims “Welcome to Medicine Free World“. The Sahni protocol is rather wonderful: a homeopathic remedy is chosen in the classical way, by matching symptoms to a remedy. The chosen pill is then dissolved in a vial and a single hair is then plucked from the customer’s head and placed in the vial with a little bit sticking out. The hair is then able to transmit the remedy back to the owner.

Naturally, there are great benefits in this method. Once the homeopath has the hair, then no further visits are required. A letter or telephone call can update the choice of remedy (“Yes, don’t worry. I am dipping your hair in the new remedy now. Can you feel that? Good.”) If a patient’s illness gets worse (as homeopaths come to expect – they call this an aggravation and this shows the remedy is working) then the hair can be removed from the vial until the aggravation passes. All marvellous stuff.

Naturally, the most wealthy homeopaths in India are not those that stick to treating customers, but those that manage somehow to take money off other homeopaths. The Sahni institute is able to train other homeopaths in the invaluable hair dipping technique for the sum of US$500 (a rather large amount in India where the annual average per capita income is under $1000).

Claims for the technique are of course high with case histories of customers with renal failure and diabetes. Online customers are invited to come forward for the treatment of cancer and multiple sclerosis, fill in a form, send in up to $300 if you are from the USA or Europe, and, of course, send in a sample of your hair.

Nice work if you can get it.

Of course, we will not see any homeopaths here in the UK condemning such practices. They will look on. Wonder if it is strictly Hahnemannian. But ultimately let a fellow homeopath do whatever they like. It does not matter how much such delusional thinking might end up hurting vulnerable people. This is an evidence free environment. A criticism void. What matters is that the Sahni Institute is finding another means to denounce ‘allopathy’.

It would be tempting to ignore and dismiss this variant of homeopathy as utterly bizarre. But it reminds us that all of homeopathy is just as equally implausible and nonsensical. What you might find in Boots the Chemist is just as daft. The NHS Royal London Homeopathic Hospital is dealing in similarly batty ideas. We become numb to the idiocy of our own local brands of quackery and heightened to exotic forms. We must remember that all forms of homeopathy are essentially forms of sympathetic magic – the idea that an object once in contact with something either good or bad can inherit those properties. The sugar pill, once associated with a healing object can retain healing properties. The hair on your head retains a connection with you and can transmit the goodness of the remedy to you. The pin stuck into a doll wrapped in the torn corner of your skirt can inflict pain in you. Its all voodoo. Let’s not kid ourselves that our NHS is beyond such superstitious thinking.

The justification for supporting homeopathy in India comes in some part from references to the old colonial power that still provides homeopathic hospitals under its National Health Service and is supported by the Royal Family. The NHS, by allowing this vestigial remnant of pre-enlightenment shamanism to remain, and keep certain aspects of the middle class and worried well happy, is responsible to helping to allow the Indian government to deprive some of the poorest people of even basic medical care.

Labels: homeopathy

 

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

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

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 membership 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 are 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: budwig, 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 scepti