The Quackometer

In my last post I discussed how Hopi Ear Candles has nothing to do with the American Hopi tribe and was a technique that had only been scalding ear drums since the Eighties. Quackery likes to sell itself on its ancient roots and traditional heritage. But, by the looks of it, most quackery techniques have much more modern roots. Someone emailed me to ask if I could expand on this, so here goes:


Reiki
Reiki is a technique that claims to be able to channel healing energy from the 'cosmos' through an 'attuned' practitioner, and into the customer. Its language is that of mystical cosmic energies and draws on its Eastern origins. In fact, Reiki was invented in 1922 by Usui-Sensei and has been criticised as being little more than a pyramid scam where 'attuned masters' get paid to 'attune' new recruits.

Reflexology
The belief that feet are connected to the rest of the body through some sort of life force and that massaging the right part of the foot can affect diseased organs goes all the way back to the 1930s and was largely invented by an American, Eunice Ingham. It is not recorded if she had a foot fetish.

QiGong
The belief that cosmic qi can be drawn through the body through regulated breathing exercises and movements to produce healing has its origins in the 1950's. Mao's China saw the revolutionary Chinese medical establishment, concerned with the Westernization of medical practice in China, create a popular spiritual healing technique. It did not take off though as a mass movement until the 1980's. Expect to see it as an Olympic sport this year.

Applied Kinesiology
AK is a practice of diagnosing illness by testing muscle strength when presented with various chemical or nutrient challenges. The mere presence of an allergen in a nearby bottle can weaken muscles, apparently. This bogus technique was utterly made up by a chiropractor in 1964.

Bach Flower Remedies
The belief that doing weird things with flowers and brandy in order to capture their 'energetic signature' comes from the 1930's. It was made up by a homeopath from Oxfordshire. As Nigella Lawson's late husband so wisely said, flower remedies "make perfect sense on a sort of flowers-are-harbingers-of-good level which wouldn’t have grasped the public imagination quite so forcefully, I imagine, if (Dr Bach had) used 38 types of spider to produce the Bach Spider Remedies."

Aromatherapy
Whilst scented oils have been in widespread use in many cultures for many centuries, aromatherapy was invented by a Frenchman in the 1920's. The french chemist burnt his arm in a laboratory and plunged his arm into the nearest vat of liquid which happened to be laveder oil. From the single unusual event, the generalised technique of Aromathérapie was born, although plunging arms into vats is no longer necessary. Sniffing will do.

Homeopathy
This technique is the oldest so far with its roots in early 19th Century Germany. Despite its Teutonic origins, homeopathy likes to define itself in opposition to 'Western' medicine. Samuel Hahnemann was experimenting with Cinchona bark as a cure for malaria. When he ingested it, he noticed he got quite ill. Some have suggested he was allergic to chemicals in the bark. Again from a simple false attribution, a whole multi-million dollar industry of delusion was born.

Osteopathy and Chiropractic
These 'Bone Doctors' are inventions of the late 19th Century. Andrew Taylor Still invented osteopathy in the 1870's and said he could "shake a child and stop scarlet fever, croup, diphtheria, and cure whooping cough in three days by a wring of its neck". Had he been watching the Victorian Simpsons? Chiropractic was based around the invented idea of 'subluxions' - blockages in the bones that caused all illness. Despite millions of X-rays inflicted on customers by chiropractors, no subluxions have ever been seen. Bone doctors are one of the few fully regulated quacks in the UK. Some chiropractors did not like this step and set up on their own over the past decade or so, and changing their name to evade the law of having to be registered. I will not mention them because they are attention seeking half-wits who would love the publicity.

Acupuncture.
This is quite an interesting one and getting clear information is quite difficult. Advocates claim that acupuncture has roots in China going back many thousands of years. However, early forms look like they were more like bloodletting, using blades instead of needles. The main development of the techniques appears to have taken place over a few hundred years up to the Seventeenth Century before going into rapid decline. Acupuncture was once again revived during the Cultural Revolution by Chairman Mao in the 1950's as part of his (possibly cynical) plan to create a distinct 'Traditional Chinese Medicine' that could be quickly delivered to the vast population. The 'barefoot doctors' were given crash courses in acupuncture and herbal remedies and sent out into the countryside of China. A few decades later, every high street in the UK has a branch of Mao's new medicine. That is a long way to go barefooted.

Of course, many alternative medicine practices may indeed have very old roots. Finding reliable information on this is quite hard as many histories are written by advocates and do not provide a dispassionate view. Ayurveda may well be a truly ancient practice. Herbalism, in its many forms, undoubtedly has roots in pre-history, although evidence that there is a consistent and continuous belief in the philosophies and the nature of remedies looks unlikely. As I have discussed before, herbal remedies look as if they may well have stronger cultural meanings than medicinal meanings and the attributed effects of herbs appear to change across times and geography.

What we see is that the vast majority of quackery is a recent invention that only pretends to have ancient roots. Just like the ear candles we saw last week, alternative medicine has thoroughly modern origins and so we are truly living in the Age of Quackery right now.

 

Quacks like to tell us that their healing arts are thousands of years old and based on ancient principles that have withstood the test of time. Like most things in their advertising spiel, it is a canard and does not bear any resemblance to the truth. Reiki, Reflexology, Osteopathy and Chiropractic are around a hundred years old. Homeopathy is about 200 years old and even acupuncture as we know it may only be 300 years old. Real ancient healing beliefs, such as a belief in the humours and treatments such as trepaning are strangely absent from the quacks repertoire.

Hopi Ear Candling, or thermo-auricular therapy (TAT) as it is known, is a rather strange technique that involves sticking a burning candle in your ear. The mundane reason for doing this is that it can allegedly draw out the nasty wax from your ears. Quacks never like to restrict their techniques to the obvious, so the candle apparently acts on the 'energetic level' and can also detoxify you and treat all sorts of ailments unconnected with your ear.

The main manufacturer of ear candles is a German company called Biosun. Their web site tells us about the Hopi tribe of native Americans and their ancient wisdom. Pictures on their web site show tribe members and ancient murals showing the Hopi sharing candles. The problem is that all this is just made up nonsense. All of it.

Firstly, the Hopi tribe appear to be quite upset that western quacks are appropriating their name. Biosun tell us,

The Hopi, the oldest Pueblo people with great medicinal knowledge and a high degree of spirituality, brought this knowledge to Europe with the professional involvement of BIOSUN.Since 1985 we have been researching the use of Earcandles and re-establishing their popularity.

However, the Hopi have been telling people that ear candling has nothing to do with them. On one ear candling site, we learn,

The Hopi Cultural Preservation Office is not aware of Hopi people ever practicing "Ear Candeling." Biosun and Revital Ltd. are misrepresenting the name "Hopi" with their products. This therapy should not be called "Hopi Ear Candeling." The history of Ear Candeling should not refer to being used by the Hopi Tribe. Use of this false information with reference to Hopi should be stopped.We appreciate your efforts to stop this false representation the United Kingdom, and we will inquire as to whether Martin Gashweseoma gave permission for the use of his image for the promotion of ear candles. Thank you for your interest in resolving this situation. If you have any questions or need additional information, please contact Lee Wayne Lomayestewa at the Hopi Cultural Preservation Office.

Thank you again for your consideration.

Respectfully,

Leigh J. Kuwanwisiwma,
Director Hopi Cultural Preservation Office

What of the picture that shows the Hopi using candles (pictured above)?

Biosun say the picture is a "Coloured wall mural in the Hopi Tower, Grand Canyon".

What they fail to mention was that the Hopi Tower was built in 1930 as a gift shop for the Grand canyon, by the American architect Mary Coulter. You can see the mural in context on this page with the complete gift shop mural here. The picture has nothing to do with candles. The items being passed are feathers. One might as well say that the strange object below the Hopi warriors is a set of iPod portable speakers.

So, ear candling looks like it is little more than twenty years old and is just abusing an American tribe to make believe that the stupid practice of sticking a candle in your ear is ancient and justified. But then again, anyone who does go through with this nonsense probably has very little between their ears that could be damaged by such stupidity.

Labels: ear candles, hopi ear candling, quacks

 

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

 

Here are the stated aims of the Society of Homeopaths for 2007 and set out at the start of the year...

Labels: Society of Homeopaths

 

If you are worried about the activities of an alternative medicine practitioner, there is not an easy way to find the right authority who might look into it. The Advertising Standards Authority are very effective at investigating complex matters, but can only really rap knuckles and leave traders to carry on pretty much unharmed. Often, the only damage is an ASA ruling placed well down in the Google result list. The ASA can only also look into a narrow range of promotional material; they cannot touch web sites, for instance. Trading Standards have deeper powers and can criminally prosecute, but are not too well geared up to look into false medical claims. They are regional in their authority and have a shed load of complicated legislation to work within. The MHRA are probably quite rightly mostly concerned with the evils of Big Pharma. And the regulatory authorities that provide standards of behaviour and codes of ethics to alternative medicine practitioners are a hollow sham: can you find one example where a self-regulatory body has disciplined one of its members and documented the result?

But, the world of quackery is about to be shaken and I am being nice to them by giving them the 'heads up'. The infighting about how best to regulate homeopaths may well become moot as legislation being brought in will allow direct consumer redress against many practices that mislead.


The complexity of trading standards legislation is being largely swept away and replaced with generalised laws to clamp down on unfair sales and marketing practices. The act is a incorporation of an EU directive into English law and so will be applicable throughout the EU area.


The regulations will cover a whole raft of,

Misleading practices, like false or deceptive messages, or leaving out important information.

Now, a lot of alternative medicine is full of that. Have a look at David Colquhoun's blog about Boots and their new wonder drug, CoQ10. Within the act, there will be specific restrictions on certain practices. The ones I am going to be interested in are:

Falsely claiming accreditation
1. Faking credentials
Claiming to be a signatory to a code of conduct when the trader is not.
2. You’re not who you say you are.
Displaying a trust mark, quality mark or equivalent without having obtained the necessary authorisation.
3. Your endorsement is not real
Claiming that a code of conduct has an endorsement from a public or other body which it does not have.
4. Not being true to the terms of the endorsement
Claiming that a trader (including his commercial practices) or a product has been approved, endorsed or authorised by a public or private body when he/it has not or making such a claim without complying with the terms of the approval, endorsement or authorisation.

Specifically, if a alt med trader claims to be governed by a code of conduct and their behaviour does not comply, then they will be guilty. To me it looks like it is immaterial as to whether the governing body actually adjudictates on the traders compliance. That should be interesting, given the widespread practice of alternative medicine governing bodies not enforcing their codes of practice. It does look like it will be illegal for the providers of codes of practice to do so if it misleads the consumer.


Specifically, it will be an offense if,

• the trader has undertaken to be bound by a code of conduct (or code of practice), and indicates that he is bound by it,
  AND
  • the trader fails to comply with a firm and verifiable commitment in that code,

Next:

10. Scare tactics

Making a materially inaccurate claim concerning the nature and extent of the risk to the personal security of the consumer or his family if the consumer does not purchase the product.
That is a stock trick of the trade. What would Clarins make of this? Should homeopaths be telling their patients about the evils of medical science anymore? What about anti-vax advice from homeopaths?

20. Pyramid schemes
Establishing, operating or promoting a pyramid promotional scheme where a consumer gives consideration for the opportunity to receive compensation that is derived primarily from the introduction of other consumers into the scheme rather than from the sale or consumption of products.

There goes Reiki, where practitioners typically only make money by 'tuning' new recruits.


But most interestingly,

11. Over promise, under deliver
Falsely claiming that a product is able to cure illnesses, dysfunction or malformations.

Now, what is going to be interesting is to what extent words like 'cure' are interpreted. The good news is there is going to be a 'man on the Clapham omnibus' principle here. What are the 'reasonable expectations of the average consumer' when they engage with a trader. It does not matter is a weaselly homeopath uses words like 'treat' - if it is reasonable that the customer expects to get better after the specific treatment then the homeopath could well find themselves on the wrong end of a guilty verdict.


The courts are going to demand that traders are going to be able to substantiate their claims. And we have a good idea of what they will make of anecdotal and testimonial based evidence.

It also looks like that there will be no need to establish there is an intention to deceive. The trader will be expected to undergo sufficient due diligence about their claims. It will not be sufficient just to wander around with your head in La La Land to escape the law.

Traders will also not be able to give false or misleading information is "the typical consumer takes, or is likely to take, a different decision as a result." Such information concerns things like:

(a ) the existence or nature of the product
(b) the main characteristics of the product
(n) specification of the product

Will homeopaths be able to get away with saying things like 'contains small amounts of natural remedies'? Probably not. I am sure the list is endless.

Also, the use of titles and credentials is likely to come under scrutiny. It will be an offense to mislead about the 'nature, attributes and rights of the trader or his agent' which include:

(c) qualifications
(d) status
(e) approval
(f) affiliations or connections
(g) ownership of industrial, commercial or intellectual property rights, and
(h) awards and distinctions.

Wow. That could be fun.

The new regulations will come in to force in a few months. As always with new legislation, we will need to see how the act is interpreted and how effectively it is enforced. But it does look like it might be much simpler to complain about certain practices and seek action.

So, if you are running a web site where you imply you are a doctor and you are not, and you claim to part of a regulated profession and you are not, and you offer healing practices that mislead, then you probably need to rethink your business. And you had better be nice to me.

Labels: regulation, the law

 

On the eve of the Cheltenham Festival, the race organisers are battling to repair the storm damage after ferocious winds have been bashing the West of England. Cheltenham is one of the biggest events in the racing calendar and for one of the most famous jockeys, Tony McCoy, a little storm damage has been the least of his problems.

McCoy fractured two vertebrae in a fall two months ago and things were not looking good. But last week, the British Horseracing Authority gave him the green light to race at the festival.

A miracle?

Well maybe. The newspapers have been full of reports that McCoy has been undergoing a healing technique called kriotherapy where the customer is placed in a chamber at -130 C for a few minutes. It has been fantastic news for the owners of the Kriotherapy Clinic as the story has hardly been off the racing pages for weeks now.

Sky News tells us,

It has previously been used by international rugby players, footballers and jockeys and its reputation is growing. Kriotherapy, popular in Japan and Poland, works by stimulating the hormone system and enhancing blood circulation, leaving the patient feeling extremely alert. In addition to helping recovering athletes it has been used to help people suffering from depression.

McCoy has been enjoying this freezing treatment twice a day for a while now. We are also told that,

Kriotherapy expert Dr Anthony Soyer believes that the treatment effectively shocks the body into getting better.

Dr Anthony Soyer is also an expert in a "holistic and an integrated approach to Cancer treatment" and works at a clinic that specialises in,

treatments in Acupuncture, Chinese Herbal Medicine, Electro-Acupuncture Diagnosis, Homotoxicology (Complex Homeopathy), Integrated Medicine and Shiatsu - specialising in the treatment of low-grade bacterial, fungal, parasitical and viral infections.

Marvelous.

Well, good luck to you Tony. I hope my money is safe with kriotherapy. Hot Tip on Cold Cure?

Labels: kriotherapy

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I shall leave the last words to Simon,

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

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

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

Labels: homeopathy, mariposas

 

A bit of a ding dong has started up over at HolfordWatch after they questioned some of the activities of a charity called Life’s 4 Living. There is now a huge red banner on their homepage that proclaims the following:

There has recently been a vicious, sustained and unprovoked attack on this charity.
Over the next few days life's 4 living will refute each and every allegation in this spurious attack.

I have a nasty feeling that Life's 4 Living do not know what they are getting into. What did Holfordwatch do that was so wrong?

On the face of it, Life's 4 Living look like a rather marvelous idea. As the Barefoot Doctor says on their homepage,

We agree that life's worth living...

This is especially so if you are the mother of as child suffering from a condition which is beyond current medical help or results in a seriously debilitating lifestyle. For the parents of these children, dealing with all aspects of everyday life poses a major challenge.

If life's worth living, its worth living for everyone, especially families
facing such a challenge.

Laudable sentiments.

However, it was not these simple aims of the charity that attracted HolfordWatch's attention. Two issues were commented on. The first was their worry that the Barefoot Doctor, Stephen Russell, had admitted to having sex with his patients in the past. Was the charity aware of this and what was its attitude to such ethical matters? Particularly pressing was the charities aim of taking Russell off to China on a 'healing expedition' with children and young adults.

The second concern was to do with bizarre associations with various forms of mystical healing practices. Holfordwatch documented their connections with a health spa/alternative medicine outfit called Energy Bank that had in the past made strong claims to cure AIDS by waving arms around, giving up sex and 'energy channelling' - all for about 30,000 pounds. People involved in these enterprises appear to be involved in all sort of deep quackery where the rejection of conventional medicine is routine. Deaths have been reported. The charity at the moment is offering strange energy cures for MS. All this is enough to warrant critical appraisal of the charity and what they are doing with young people.

The reaction of the charity looks hyperbolic. We are lead to believe there will be much more from them. What is most alarming is that the author of the response, sixties rocker Lynton Guest, resorts to attacking HolfordWatch and Ben Goldacre rather than address the concerns. We expect such behaviour from quack circles. Guest cannot get over the fact that HolfordWatch wish to remain anonymous and sees this as reason not to have to respond - just get angry and shouty.

For my part, the charity look as if they are enamoured with the idea that there is an alternative to 'Western Medicine' and that where it has 'given up' on the children with incurable conditions, then Chinese Medicine can come to the rescue. They say,

Western medicine approaches disease from a mechanical point of view, separating the body into a series of parts that are treated individually. This makes it difficult to approach systemic diseases such as MS, which affect many different parts of the body at the same time. The Chinese model of health is based on a view of the human being as an integrated system and treats the whole person rather than the physical body alone. By boosting the body’s natural systems for resisting and healing disease Health Rejuvenation avoids the negative side effects of medicines and promotes long-term health as well as tackling the specific disease.

Now, I do not doubt that having supportive charities is great for parents of very ill children. But to tell them untruths about quack treatments and give them false hope is just wrong. As an example of how far divorced from reality this charity is, there is a section on their site that uses children's testimonies to tout some highly dubious treatments. (I will not link to the childrens' pages).

One testimony is about an autistic girl who is given Lightwave Stimulation using as device called a Lumatron. I will let them explain,

The light is set to flicker, different people and different coloured lights need different rates of flicker. The theory behind LWS is that the brain needs a balanced spectrum of light to help it function properly. The most effective way of getting light into the brain is through the eyes (optic nerve). The flicker helps the brain to assimilate the light. This treatment is used for a wide range of problems/disorders but the most obvious benefit for [Child's Name] is the way it balances her otherwise unbalanced internal mechanisms.

Pseudoscience at some of its best. Getting light into the brain through the eyes and optic nerve?
I find this highly exploitative. The same child is subjected to another treatment,

Auditory Integration Training (AIT) is a method of expanding the range of sounds a person hears and training the brain to process sound properly. We all process sound much more effectively in our brains if our hearing is dominant on the right.

For AIT treatments you sit comfortably and listen through headphones to a variety of music. The music can be Bob Marley, Abba, Bob Dylan, jazz, or sometimes a classical piece but it’s played through a machine called an Audiokinetron. The Audiokinetron filters out aspects of the music in a random fashion so that someone like [Child's Name], who has trained herself to filter out sounds she finds uncomfortable, cannot predict how the sound will change. This sounds like an unpleasant thing to put someone who is sound sensitive through but she actually enjoys it and understands its value. At first the sound is channelled into both ears at the same volume but halfway through the course of treatment the volume is set to play louder in the right ear than the left. This re-trains the brain into right dominance; the most effective and accurate type of hearing.

It would be easy to make a joke about subjecting a child to weird Abba/Marley/Dylan remixes, but I find this far too disturbing. The National Autistic Society has this to say about AIT,

Mudford and Cullen (2005), Romanczyk et al (2004), and Sinha et al (2004) raise concerns regarding limitations of research findings including flaws that they argue limit interpretation of the data, questions regarding clinical significance, lack of replicability, and small sample size. Romanczyk et al (2004) also cite reports of negative side effects which they argue raise ethical questions concerning the use of this procedure with people with autism. AIT is one of the more expensive treatment options for people with autism (Simpson et al, 2005). Furthermore as Simpson et al (2005) point out AIT uses equipment capable of producing sounds at decibels that may be harmful to a persons auditory system, and therefore it is important that the intervention only occur under the direction of a trained AIT specialist.

Romanczyk et al (2004) conclude that the nonstandardised and unregulated manner in which AIT is practised may place those seeking this treatment at risk.

I have a feeling that life's 4 living are going to bring a lot of scrutiny upon themselves. And that looks like it is not a moment too soon.

Labels: BPSDB, life's 4 living

 

Hawley Harvey Crippen (1863-1910) was an American homeopath who was born to Andresee Skinner and Myron Augustus Crippen. He trained as a homeopath and joined a homeopathic pharmaceutical company.

In 1910, he emigrated with his second wife, Cora Turner , to England where he was unable to practice as a Doctor as the authorities would not recognise his credentials. Turner was a music hall singer who openly had affairs. The couple struggled by on a meagre income, until one day, his wife disappeared. Crippen told friends that she had returned to America and had later died there.

Subsequently, Crippen took a lover, Ethel Le Neve. However, a friend of Turner's, Vulcana the Strongwoman, had doubts about the whereabouts of Crippen's wife and alerted the police. The police searched Crippen's house but found nothing.

Shortly afterwards, Crippen and Le Neve, got on a steamer and headed back towards Canada. The police, suspicious of the sudden departure, searched the house four more times and found the partial remains of a woman under the brick floor of the basement. The police used a new fangled piece of technology called the 'wireless' to alert the steamer that they had a suspect murdered on board. On arrival in Canada, the pair were arrested and returned to England. Crippen said on his arrest "Thank God it's over. The suspense has been too great. I couldn't stand it any longer."

The trial uncovered many alarming facts, such as how the homeopath had severed the victim's head and thrown it off a ship in the English Channel in a handbag. Various other body parts had been burned and dissolved in acid.

Crippen was hanged in Pentonville Prison.

Thanks to Sue Young Homeopathy for format ideas. And a note to Dana Ullman - Maybe you can add this to the second volume of The Homeopathic Revolution: Why Famous People and Cultural Heroes Choose Homeopathy.

 

Figure1. The Quackometer Quackery Quadrants

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

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

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

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

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

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

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

Figure 2. The Realm of Evidence Based Medicine

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

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

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

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

Figure 3. Where Homeopathic Treatments lie in the Quackery Quadrants

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

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

In Hume's words,

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

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

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

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

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

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

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

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

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

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

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

Figure 5. Direction of Investigations into implausible treatments

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

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

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

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

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

Labels: evidence based medicine, homeopathy, pseudoscience