Liverpool NHS Primary Care Trust funds a Department of Homeopathy, one the last four remaining publicly funded homeopathic hospitals in the UK. It publicises that the clinic in the Old Swan Health Centre can offer homeopathic treatments for everything from arthritis to depression and bowel disorders. There is no good evidence that this is an effective use of public money. Indeed, as was reported in the Guardian yesterday, it looks like the few doctors who support the use of this 19th Century quackery in a modern healthcare system have to depend on misleading representations of the research data in order to justify the expenditure.
Once you appear to believe in one set of nonsense, then you are likely to get involved in all sorts of daft treatments. The Liverpool homeopathy department does not make an exception. On its web page, it tells us that it also offers,
a complementary cancer care service using Iscador which is a mistletoe based anti-cancer treatment. Iscador has been in use as a treatment for cancer since the 1920’s. It is in widespread use in Germany and Switzerland where it is one of the most widely used anti cancer therapies.
Iscador is not a homeopathic treatment, but an approach advocated by one of the greatest mystics and quacks of the 20th Century, Rudolf Steiner.
Steiner was a homeopath who took the ideas of Hahnemann and developed a whole new mystical approach to medicine – anthroposophical medicine. Its pretty bonkers stuff with astral bodies, angels and spirits being at the heart of not only his medicine, but also his beliefs in agriculture. His biodynamic methods involved making fertiliser out of cat skulls and deer bladders. Astrology was central to his thinking. He proposed mistletoe as a cancer treatment as it grows on trees like a cancer. And given his homeopathic beliefs of ‘like cures like’ that was enough evidence for him to get cracking. That is it.
Steiner’s preparation techniques for many of his potions were quite strange. If your farm gets infested with mice, Steiner tells us to “catch a fairly young mouse and skin it . . . at a time when Venus is in the sign of Scorpio”, then to burn the skin and scatter the ash over our fields. “Henceforth, your mice will avoid the field.” For fertilizer you can use a cow horn with crushed quartz and burying it in the field you wish to help. Similarly, mistletoe preparations for cancer treatment needs a mixture of mistletoe sap collected both in the Summer and the Winter. Steiner is quite simply an advocate of voodoo and Liverpool NHS PCT appears to happy to adopt it.
Because Steiner’s beliefs have become very popular in mystical circles, most notably through the schools that follow his equally batty educational philosophy, mistletoe has been used as a popular treatment of cancer with many advocates.
But is there any evidence that it actually works? As usual, when we have a crank cure we will find lot of small studies or deeply flawed studies that make up an evidence base. The studies have been reviewed and there is very little convincing evidence that this treatment does anything for the patient. This is odd given that Liverpool NHS PCT tell us that Iscador can induce cell death in cancer cells, allows immune cell populations affected by cancer to regenerate and protects the DNA of healthy cells. Patients are supposed to “feel better and stronger, sleep better and have less pain”.
In 2006, Edzard Ernst, Professor of Complementary Medicine gave a very straightforward message in the BMJ,
Mistletoe has been tested extensively as a treatment for cancer, but the most reliable randomised controlled trials fail to show benefit, and some reports show considerable potential for harm. The costs of regular mistletoe injections are high. I therefore recommend mistletoe as a Christmas decoration and for kissing under but not as an anticancer drug. At the risk of upsetting many proponents of alternative medicine, I also contend that intuition is no substitute for evidence.
The current Cochrane review of the evidence (2010) shows that despite there being many studies of mistletoe therapy, the trials tend to be of poor quality with lack of randomisation, and poor reporting quality.
The evidence from RCTs to support the view that the application of mistletoe extracts has impact on survival or leads to an improved ability to fight cancer or to withstand anticancer treatments is weak. Nevertheless, there is some evidence that mistletoe extracts may offer benefits on measures of QOL during chemotherapy for breast cancer, but these results need replication.
A review by Ostermann, Raak and Büssing (2009), despite coming to a fairly positive but qualified conslusion about mistletoe, found evidence of significant publication bias by looking at funnel plots. Funnel plots are graphs of the treatment effects found in studies plotted against study size. If researchers are fairly publishing their results it should have a symmetrical shape. If it is skewed, it suggests researchers are withholding less favourable results from publication and, hence, reviews of all studies may conclude that there is a stronger effect than there really is. This is what Osterman saw in the studies of mistletoe.
There are other problems too. Patients who receive mistletoe therapy may suffer from distinct (but apparently fairly mild side effects) such as skin reactions at the injection site. This has the effect that patients enrolled into trials can easily find out if they had the real treatment or a placebo. Knowing whether you received a placebo or not makes it more likely for you to misreport your experiences – that is why trials must be blinded. Hence, we would expect even blinded trials to overstate their benefits.
Given that this is a therapy that was invented from a mystical ramblings of a irrational mind and that its use based on an evidence base riddled with poor quality studies, it would be safe to conclude that mistletoe therapy is of little or no value.
We regularly hear how cancer patients in the NHS are denied therapies because they do not prove to be cost effective under the NICE guidelines. It is quite right that all treatments are subject to scrutiny to ensure public money is being spent in the best manner. Somehow, so called complementary therapies slip under this hurdle and patients are being injected in Liverpool with a drug that is almost certainly worthless. It is not cheap either. The brand of mistletoe injection used by Liverpool PCT is made by Weleda, the company founded by Steiner in the 1920s to flog his preparations. It is still in private hands and based in Switzerland (like all the best Pharma companies) and produces homeopathic, biodynamic and anthroposophical products based on the crackpot mysticism of Steiner. It operates in 53 countries and has over 2,000 employees. Its revenues are hundreds of millions (about $300 million in 2005) and the majority of its pharmaceutical revenue came from mistletoe treatments. I can see no obvious reason why its claims should be treated with less rigour than its Swiss neighbours when it comes to flogging drugs to the NHS.
From the homeopathy page at weleda.co.uk:
"Homeopathy does not treat diseases but, rather, individuals with specific symptom pictures."
Then two paragraphs down:
"The theory and philosophy of Homeopathy is far more complex than has been detailed here – however such knowledge is not essential in order to use Homeopathic medicines for every-day ailments. For more complex ailments please seek the advice of a Doctor who specialises in Homeopathy"
And further down:
"For minor, self-limiting conditions, self-help or counter-prescribing is applicable – as with conventional medicines."
Black is white, up is down, round is square.
Don’t forget charmed and strange
You say 'Given that this is a therapy that was invented from a mystical view of the world and that is riddled with poor studies, it would be safe to conclude that mistletoe therapy is of little or no value.' But I wonder if we can dismiss it's effectiveness if no decent studies have been performed? We surely can't know either way without evidence.
From an idiot,
Megan- we have no decent studies performed on the existence of pink unicorns and leprechauns, does this mean we should assume that they exist too?
It is up to those who make claims to back them up- where these treatments are potentially hazardous and for such critical illnesses such as cancer- where delaying conventional treatment for made up rubbish such as this has killed many people already, this evidence is critical before it is allowed to be supplied.
Megan said: "I wonder if we can dismiss it's effectiveness if no decent studies have been performed?"
I have a cure for cancer: Instead of eating your lamb chop, suck the marrow out of the transected bone.
Hey, don't dismiss it – no decent studies have been performed yet. 😉
I understand that it is the job of people making quacky claims to back them up. What I am saying is that their appears to be no evidence either way. While in practical, logical and financial terms it is preferable not to give a treatment because it has no evidence base, from a scientific point of view the possibility that it works cannot be dismissed. It is an unanswered question. If you don't understand this, you are missing a fundamental point of scientific enquiry.
Megan – not all claims are equal. On what basis do we believe that Steiner's claims might actually be true? Since he came to his beliefs in mistletoe through nothing but mystical intuition it would indeed appear to be miraculous if they were true.
To put it another way: there is no evidence to suggest there is not a tiger in my kitchen right now. That does not mean that it is likely that there is a tiger in my kitcehn.
kind of OT, sorry, but spotted this just now – http://www.mumsnet.com/Talk/allergies/910397-nhs-direct-advice
someone reports ringing NHS Direct for advice on dealing with after effects of allergic reaction in young child and being asked if they had ever thought of homeopathy…
obviously difficult to verify but worrying if true
To gain some understanding of the confusion felt by CAM supporters/ practitioners at their attempt to better the plight of patients’ illness with CAM alongside usual medical care (evidence based or not) and develop insight into the vehemence of anti -CAM sentiment you might find this link of assistance, but then again you might not? http://www.alice-miller.com/video.php suggest you click on the ‘roots of violence are NOT unknown’ offering or check out the home page? http://www.alice-miller.com . It can sometimes appears a great big stick is being used to attempt to beat submission from disobedient CAM supporters, for them to refrain from detracting/ questioning the fashionable dogma espoused by the current swathe of vociferous authoritarian ‘fashionistas’? (The History of medicine is littered with discarded fashions) Looks like a parallel to contemporary political manoeuvres and even the ‘QOF stick’ in General Practice? Might even shine a light on pan-specialty ‘functional illnesses’- which are a huge drain on ‘NHS tax paid’ resources?
Rejecting hypotheses based on incredulity is unscientific, unethical and endangers the public interest. Megan is quite right. History of science abounds with examples of such institutionalised prejudice impeding progress.
With cancer treatment we should remember the Hippocratic oath: DO NO HARM, and give first preference to ideas that create and sustain health, rather than poison the organism. The War on Cancer waged through chemotherapy and surgery is lost – time for open-minds at least from you sceptics.
If you all find it hard to believe Steiner’s elementary idea that lunar cycles affect nature (and therefore growth), you could try my Biodynamics 101 course which starts with 6-hour fieldwork trial where you chain yourselves to the seaward end of a breakwater at low-tide 🙂 but hey don’t – you guys are too much fun..
Rejecting hypotheses based on mere incredulity may well be unscientific, but accepting hypotheses on credulity is far worse.
If you actually read my article you will note that I reject the mistletoe hypothesis on both a) its absurd origins and b) the lack of any credible and convincing evidence that it might be true.
Merely believing it is true because it is possible is also a way in which scientific progress can be hindered.
@bemused, a belief is not a hypothesis.
Well it’s incredulous to me that no reputable academic institution has not completed the requisite trials if there is even a suggestion of a result in the case of cancer. Despite all the millions of pounds going into conventional research, the public are still faced with the same choice of radiotherapy, chemotherapy and surgery. I would suggest that there are very few people who have any idea of what is actually being researched and what advances are being made in this field. Every few years there is a media report about some new advance with the caution that many years of research are required before a treatment can be expected. Years pass with no word of any failure or success. There is much talk about the lack of evidence in homeopathy yet it would be a simple matter to prove its effectiveness. A double-blind randomised trial using homeopathically prepared allergen such as pollen to show that the homeopathic preparation at least (if not the method traditional method of prescription) does have a therapeutic effect. The question is who would carry out the research? If the research is carried out by proponents or practitioners of homeopathy it is disregarded as being biased or discredited by those with vested interests as of “poor quality”.
Interesting that a search on the Liverpool PCT site for iscador finds 2 pages. One of the pages does not have iscador on it, and the other page has been taken down.
Well done, Andy!
However, there is still quite a lot that they ought to, but haven’t, taken down yet.
If you want to check, here are the edited pages:
Amazing that I make an observation at 10:34 within a couple of hours @zeno001 has tweeted the missing pages.
Would the Pope recognize this as a sainthood qualifying miracle?
You sir mistake categories for treatments. Radiotherapy for eg can involve multitudinous different treatments using differing isotopes and different parts of the electro magnetic spectrum. X-rays, gamma rays etc, etc. Similarly any chemical treatment falls under ‘chemotherapy’ it is an extraordinarily broad tent that one. I suppose you have failed to notice Immunotherapy, as used in the successful treatment of melanoma for eg that teaches the body to reject melanoma cells. Or Phototherapy for melanoma and other cancers available to fibre optics, where a substance that is caged is put into the body generally or into the local area and a specific wavelength of laser light is used to uncage the active substance but only where the laser shines which means no side effects from whole body treatment.
So your statement of no progress in cancer treatment is not just a category error it displays manifest ignorance of a host of treatments developed and rolled out into the clinic in recent years. I may be a biological scientist but I learned of all of them from the popular scientific and generally popular press not specialist literature.
Then there is Pharmacogenetics, using genetic profiling to select precisely which treatments will be effective or to make a treatment more effective. For eg at the University of Dundee they did a trial of cisplatin, one of the best chemotherapy agents. It looked at cytochrome P450 gene alleles. These genes sit in your liver and aid detoxification. They also break down drugs and in many cases the chemical changes they make to drugs actually generate the active form. In the case of cisplatin it is breakdown that is involved. People split into 3 groups: fast, normal and slow in terms of how quickly their c-P450’s break down cisplatin. This matters because if you are a fast breaker down then a standard dose will not be enough for you as your plasma levels of the drug will not remain high enough for long enough. For slow breakers down the opposite is true, a standard dose is too much and so they will suffer more side effects and be sicker. By profiling people you can adjust the dose, more for fast and less for slow to ensure everyone gets the correct active dose. In addition they have discovered that what time of day the drug is delivered matters because your normal daily rhythms have effects on blood levels of the drug too. So cancer clinics now work around the clock treating profiled patients at the best time for them. So no need for new drugs as we are zeroing in on how to make existing drugs work better and much more often.
well, its funny what i read. My mom been diagnosed with ovarian cancer 5 years ago. Since than she got 6 different chemotherapies, each of them between 4 and 6 times.So on average she got 32 chemos.
NONE of them helped her. It totally killed her strong body and immune system.Now she has been send to paliative care, cos doctors gave up on her.They laughed me off when i mentioned alternative therapy(Poland for you).I went to this homeopath doctor to get Iscador, as moms mate taken it and her markers went down from 120 to 5!! Mom wasnt too impressed by the doc, but in a waiting are we met a woman and her daughter, who has her cancer spreading to every organ, paliative care etc. Very similar to my mom. She started taking Iscador injections 3 months ago and now cancer stopped, she looked good to me, she was active, happy, talkative etc. She said, she wouldnt be here if it wasnt Iscador. Plus mom taken now 3rd injections, and she started to shout at me(good sign,as she is better), started to watch tv, started to eat as much as me(before she wouldnt eat at all), started to ssleep more(before she slept 2 hours and now 7 hours), she stopped using painkillers for her liver(before she was using Tramal) and started to walk to toilet by herself….
I think this is enough of the evidence for me, to know this is working well!!!
Plus doctors CLEARLY have no bleeding clue about treating cancer, cos if they did so many people wouldnt be still dying in the 21st century!!!! So if you cant help people, why putting down alternative therapy…and since every single body is different, it may actually respond to different natural product!!
In my opinion, since god created the world, he created all the answers and questions in the nature…So why changing and playing with what we got and apreciate that???? Why making it different!!
Its like trying to change the apple to look like a pear, but still taste like an apple…
Some people here will say I am thick, but i am only telling you my thoughts and what i see for myself…
So I really dont understand, why so many people, cant accept someones opinion and experience…
Why pharmaceutical business makes like 6 bilion quid and is the most lucrative business fudning so many goverments!!!
Inventing illnesses and producting medicines, so they will soon start controling the population!!
Think the future will be based on immunological therapy/treatments…
I think cancer as well as HIV/AIDS its all the same root.
But what do I know!!!
I just agree to disagree.
Only in Liverpool…
Feb 2017. Liverpool Clinical Commissioning Group, which took over the old PCT, is currently being investigated by the NHS executive for giving a lucrative contract to a private health services company.