Given that it is Homeopathy Awareness Week again, I thought it would be worth exploring how Homeopaths mislead us about science and evidence.
So, from that site of uniformly misleading health advice, What Doctors Don’t Tell You, we learn that,
Homeopathy has a ‘clinically relevant’ effect way beyond placebo
Critics have always dismissed homeopathy as offering nothing more than a placebo effect – you just think it’s making you better. A new study has proved them wrong. Classical homeopathy has clear benefits to cancer patients that are “clinically relevant and statistically significant”, say researchers.
This is of course wrong. And as always, when homeopaths are wrong they are wrong in interesting ways that illuminate the nature of science and evidence.
The paper in Question (Classical homeopathy in the treatment of cancer patients – a prospective observational study of two independent cohorts, Rostock et al.) was recently published in the open access online journal BMC Cancer. The study was conducted in Switzerland and Germany and tried two compare to groups of patients undergoing treatment for cancer. All patients in the study were undergoing conventional treatment for a range of cancers. However, 259 of them had chosen to attend a hospital that also gave them a homeopathic sugar pill. Another 380 patient had chosen to attend hospitals that only gave conventional treatments. The purpose of the study was to see if any differences emerged between the groups such as in their quality of life, levels of fatigue and depression and also their satisfaction with their treatments.
It is possible with this sort of observational study to get some evidence regarding the effectiveness of treatments, but you have to be very careful. The reasons for this are that there may be very many differences between the groups apart from what hospital they attended. The gold standard of trials involves randomisation where the patient does not get a choice as to which arm of the study they are in – a coin is tossed. This should smooth out differences if you have enough patients. The other ‘gold standard’ method is to blind the participants. They are randomly assigned to an arm, but also not told which arm they are in. This reduced biases where patients may prefer one treatment or another and so feel differently in their satisfaction.
The researchers knew this was a problem but realised that there were practical difficulties in blinding and randomising – so, they chose the next best option – a matched pair analysis.
Matching pairs involves finding people in both groups who appear to be very similar in lots of key area such as age, type of cancer, stage of disease, stage of treatment, occupation, income and so on. The more factors you can match up the more confident you can be that the differences are due to the treatment and not due to some unmatched quantity, such as alcohol consumption.
The researchers intended to do this, as without having matched pair it is near impossible to draw conclusions from this sort of observational study.
What the researchers saw was indeed very large differences between the groups. They say,
Patients in the two groups differed in several sociodemographic and disease variables. Homeopathy patients were younger (54 vs. 60 years), had a much higher level of post-16 education (post secondary school/A-level, 54% vs. 25%), and were more likely to be white collar workers or in self-employed jobs (workers, employees 48% vs. 75%).
In both groups the most frequent tumour diagnosis was breast cancer (32% HG vs. 37% CG). In CG more patients with colorectal cancer were found (15% vs. 7%), while more patients with prostate cancer (7% vs. 3%) or melanoma (5% vs. 1%) sought the complementary homeopathic treatment. Patients from the HG were more likely to have a more severe diagnosis or progressed tumour stage (stage I-III only 30% vs. 43% in CG). Homeopathy patients also had a longer elapsed time since their first diagnosis (10 months vs. 3 months), and were more likely to have already had some previous cancer treatment (50% chemotherapy vs. 33%)
In other words, the groups were chalk and cheese.
Indeed, so different were the groups that the authors only managed to match 11 pairs out of the hundreds of participants. The authors noted that this was far too small a group to do an analysis and so none could be done.
In other words, the study failed.
But that has never stopped a group of homeopaths from drawing positive conclusions.
Although it was quite clear that the groups were very different and unmatchable, the authors go on the conclude things like,
During homeopathic care we saw a significant and stable improvement in QoL which, as measured by the FACT G, is sizeable at more than half a standard deviation. We do not see a comparable increase in QoL in the conventionally treated cohort. Such an effect size of more than half a standard deviation is by all standards a clinically relevant improvement.
It is from statements such as these that the homeopaths are able to say things like “A new study has proved [the sceptics] wrong.”
But this is a complete misunderstanding of the meaning of statistical significance.
I remember from my earliest scientific education learning about how important it was to understand the difference between precision in an experiment and accuracy. Precision is a measure of how good your measurement techniques are. Accuracy is a measure of how close your answer is to the truth. Both sorts of errors can mislead. But understanding your accuracy is always the most difficult and most important. And that is because accuracy is a measure of the biases in your experiment and that is not always clear. My decades old wooden ruler may have shrunk over time, and I still may feel its precision is millimetre good, but its accuracy cannot be relied upon to any degree as I do not know how much it has distorted unless I take care to check it.
And that is what these researchers are doing. They are now ignoring that the trial is now a tool full of difficult to quantify biases. There are so many differences between the groups that it is not possible to untangle what is the effect of the treatment and what is mere artefact.
And the tragedy is, of course, is that the whole trail is a pantomime as we know homeopathic sugar pills cannot have specific effects. Any effects from the homeopathic group may well just be a placebo effect from the extra two weeks they had in hospital. The authors do go so much as to admit this possibility.
But there are a few pieces of data that we ought to be alarmed about. There are differences between the groups that should concern.
In the patients that were in the conventional hospital, only 6.6% received no conventional treatment, whereas in the homeopathic group the corresponding figure was 25.6%. Whilst this large difference may be due to the fact that the group in the homeopathic hospitals were more advanced in their treatment regimes and so may have run out of conventional options. However, it is also noted that “10% of the [Homeopathic Group] had an indication for treatment from an oncological point of view but had refused it.”
It might be worth noting that 23% of the homeopathy group died compared to 20% in the conventional group. Of course, I cannot say whether this is a meaningful result and am reluctant to draw conclusions.
And here is the big thing. The one conclusion that I can draw is that there is evidence here that a significant number of people offered homeopathy as a complementary therapy to mainstream therapy refuse genuine therapies when they might save their lives.
That is a horrible possibility that ought to send shock waves through the supporters of co-called Integrated Medicine, such as the College of Medicine. Their good intentions to ‘blend the best of mainstream and CAM’ might actually be doing measurable harm by sucking people into the intellectual black hole of superstitious and pseudoscientific treatments.
If the study is not good enough to prove that homeopathy works then it’s not good enough to prove it doesn’t.
The only value this paper has is to show that some people are idiotic enough to choose homeopathy alone and ride the Penelope Dingle Deathglide.
That’s the choice you claim you would make. This would have the same effect in you, of allowing you to enjoy the full benefits of cancer running its full untreated natural history.
P.S. LCN did not say the study shows homeopathy does not work. He did note the higher death rate in the HG group. You cannot formally conclude that homeopathy caused a higher death rate, but its doing so is consonant with everything we know about biology. Even a crap study can generate a piece I’d data that would merit further investigation. In this instance there is a hint of a higher death rate and the study has found loons who choose only homeopathy. They could be studied further to see whether the death rate really is higher.
But, this study was always going to be crap. The only thing that should have been published is the fact that a study of this type could not yield usable data. The authors could not get enough matched pairs. The entire thrust of its reporting should have been a methodological warning to other researchers not to try this again.
Instead we typically see dogmatically convinced authors spinning their useless study to the nth degree in order to create friendly headlines. This is utterly cynical and sickening.
Are you brave enough to question why they world present a useless study in a positive light?
Mr. Duck and his ilk…please point to ANY study published ANYWHERE that shows that at least 38% patients with pancreatic cancer lived five years after diagnosis, as was observed in this trial:
Chatterjee A, Biswas J, Chatterjee A, Bhattacharya S, Mukhopadhyay B, Mandal S. Psorinum therapy in treating stomach, gall bladder, pancreatic, and liver cancers: a prospective clinical study. Evid Based Complement Alternat Med. 2011;2011:724743. http://www.hindawi.com/journals/ecam/2011/724743.html An abstract of the above study was published in the JOURNAL OF CLINICAL ONCOLOGY, one of the most respected cancer journals in the world (impact factor = 17.793) http://tinyurl.com/4q4n4jx
And yeah…this study was not double-blind or placebo controlled…and as such, it was real medicine care. Just SHOW us all where conventional medical treatment was at least as good as this homeopathic treatment…
Welcome back Dana,
Before we kick off, have you managed to work out yet how your nanoparticle theory can explain homeopathic dolphin sonar? The last time we left it you said that this remedy might need another mechanism? I was wondering how many mechanisms do you think homeopathy needs to explain it?
Secondly, a warning – you are deviating from the discussion – you may be deleted if you persist.
But, for now, to address your point. I would first like to ask how you feel about this being a non-individualised study? Seeing as you always play down negative studies that are not individualised insisting homeopathy has to be tailored to each patient, surely you would see this study as not real homeopathy?
Secondly, you are quite right – the study design is very poor and the authors themselves say “it cannot be concluded that Psorinum Therapy is effective in improving the survival and the quality of life of the participants”.
Would you like to disagree and assert this study shows that that the homeopathic treatments is effective?
As for the survival rates, the fact that the survival curves for all cancer types look very similar looks very fishy to me. Of course, being an uncontrolled trial we have no idea what effect the recruitment procedures would have on outcome. If these results were real, then even with these small numbers of participants, a controlled trial could have shown dramatic effects. That this trial was not controlled begs the question why not?
Given the extreme implausibility of the a) treatment and b) the claimed results and c) the poor trial design, no one in their right mind would take this seriously.
I am no scientist, but I must confess I’m confused by the abstract Mr Ullman has linked to. (I confess I haven’t tried to read the full paper).
Quite apart from the distasteful nature of the contents of the anti-cancer “drug” (an alcoholic extract of scabies, scrub, slough, and pus cells – yum!), I note: “The drug psorinum … was administered orally at 0.01ml-0.02 ml/Kg body weight as a single dose in empty stomach per day and ongoing to all the participants *along with allopathic* and homeopathic supportive cares. … These participants *did not receive any other conventional or investigational cancer treatments*”. Did they or didn’t they receive other treatment beside psorinum? Or am I missing something here?
Mr. Duck…Isn’t it interesting that you threaten to delete my above post because it is not on the topic of this article (cancer and homeopathy?)…and yet, you bring up “dolphin sonar.” Too typical of you.
As for the Psorinum study…homeopaths generally observe much better results when homeopathic medicines are individualized to the person, not the disease, but there are exceptions to this general rule, just as Oscillocinum studies for influenza have shown and Kali bi (potassium dichromate) has shown for people with COPD (see CHEST, 2005, by M. Frass, et al). Does your “science” not allow exceptions to general rules?
Because the vast majority of patients in the Psorinum study were in 3rd or 4th stages of their cancer, the study did allow both homeopathic and allopathic treatment (except no chemo or radiation)…but the ONE thing that was different with THESE patients was Psorinum treatment. I have previously asked you to provide any evidence anywhere, and you haven’t responded yet.
It is intriguing that you have chosen to interpret consistency of results (in terms of impressive longevity) as something to be suspicious. I assume that you’ve also seen another study on patients with advanced non-small cell lung cancer. You really seem to hate it when people get benefit from homeopathic medicines. My condolences.
As for the above cancer study by Rostock, et al., the study’s primary measures were quality of life issues, and the results favored homeopathy, but as the researchers noted, there were differences between groups. It is inaccurate to say or suggest that the homeopathic treatment “failed” (that some serious spin on this study).
I ask again: Please give any referenced study that
I did not say the homeopathic treatment failed (that is of course undoubted). What I did say about was that the trial methodology failed. And as consequence, the data is worthless. That the authors barge on with conclusions anyway suggests an agenda.
And as for your special pleading regarding non-individualised trials, it would appear to me that your selection criteria for when it is acceptable to have non-individualised trials is when the results can be spun positively.
As for the Psorinum study, it is quite unbelievable that the authors do not comment and the suspiciously similar results for all cancer types and the suspiciously good results. For this to be true would be the breakthrough of the decade. To me it looks like we should dismiss this as partisan research, conducted poorly with highly suspicious outcomes. Do you want me to spell it out?
Cool…I’m glad that you realize the possibility that homeopathic medicines in the treatment of certain advanced cancers IS a “breakthrough of the decade.”
DUllman, if homeopathy successfully treated cancer it would be more than the breakthrough of the decade it would literally be a miracle. But you seem to misunderstand how conditional clauses work. “If” my aunty had balls she’d be my uncle.
Now, do you wish to comment on how this study fell from abstract in normal journal to paper in woo-fanzine ghetto journal?
Do you wish to tell us that you support the use of homeopathy instead of ARVs in the treatment of HIV and AIDS?
I think one of the reasons you sustain the constant flow of boosterism that flows from your fingers and lips is that if you shut the fuck up for even a split second you might actually start to reflect on how dangerous are the ideas you promulgate. The one thing you cannot afford is self-aware recognition. Everything you say is the panicked whistling of a man on a tightrope who absolutely cannot afford to look down.
Dana – I would have a modicum of respect for you if you merely defended your beliefs. That you chose to constantly mis-attribute and word game just makes you a twat.
What happened to the 11 matched pairs? If they are going to natter on about the nonstudy, why omit the only observational data you have, even if in(non)significant? The absence makes me wonder if the pairwise comparison was dreadfully damning to homeopathy. The study should have been published in that excellent online journal, “The Onion”, except they have higher standards.
Keep it coming, Andy. I learn more about the positive effects of homeopathy frojm you than I do from most pro homeopathy reports. The laughable part of your article is what’s getting to be just plain tiresome, you commit the same errors you accuse us homeopaths of, you blurt out your assumptions and then desperately try to back them up with same old tired assumption that the supramolecular structuring of the homeoapthic remedy can’t have any biological effects.
What has got you so and your little peanut gallery here so rattled is that a growing number of top material scientists such as Profs. Roy and Hoover at Penn State, William Tiller at Stanford and Prof. Martin Chaplin at LSBU have been deciperhing the phsyics of the homeoathic remedy that in turn explains why a growing number of biochemists such as Jacques Benveniste, Moshe Frenkel, Prof. Madeleine Ennis (Queens University of Belfast) and Nobel laureate Luc Montagnier are indeed finding that these substances have biological effects.
And so when confronted with these reports, you squirm and complain that these scientists two (sic) must be quacks.
“Growing number”? At least two of those familiar old crackpots you mention are dead, John. Or has the homeopathy fairy resurrected them with a sprinkling of her supramolecular fairy dust? That would be rattling.
Comment removed as it is abusive, personal attack and adds nothing to the debate. If Mr Benneth wants to discuss the issues raised in the post then please do.
Don’t forget David Bohm, who was a patient of my homeopath:)
There is no conclusion you can legitimately draw from the study under discussion here. What do you think this study shows?
“Patients in the two groups differed in several sociodemographic and disease variables. Homeopathy patients […] had a much higher level of post-16 education (post secondary school/A-level, 54% vs. 25%), and were more likely to be white collar workers or in self-employed jobs (workers, employees 48% vs. 75%).”
Curious. What does this tell us about our education system?
@ John Benneth
I don’t think your response addresses the key argument here, which is about the scientific validity of this study. Of course any rational person will grant that if a study shows something which contradicts our previous assumptions then it is our assumptions that we must question.
However, in this study the only valid conclusions would arise from a cautious analysis of the actual results from the 11 paired subjects, including the question as to whether any differences reached statistical significance.
I look forward to your comments on this particular question.
Given that a significant number of the patients in this trial appear to have had fairly advanced cancers, I would tend to disagree with your statement, in the penultimate paragraph of an otherwise excellent piece, that those individuals who chose homeopathy were refusing ‘genuine treatments that might save their lives’. I think we all know that ‘genuine treatments’ do not save the lives of such patients; they may extend life briefly but – in most cases – they do so at a very considerable cost. I fully understand those who refuse last ditch orthodox treatment, and would myself opt for palliative care; as would the majority of my oncology colleagues.
You may find it of interest that the only development in oncology that really has changed the TI of treatment recently is the addition of CR-3 agonists to mAb therapy. I call them CR-3 agonists as if I had described their provenance (they are yeast extracts), you would probably have automatically rejected the possibility. If you have time, however, I recommend a quick literature search; or you could go to http://www.biotherapharma.com
I wonder if the authors thought of randomizing the patients into two groups receiving homoeopathy and placebo and blinding the person dispensing the pills to their origin. A double-blinded, randomized clinical trial – surely that’s what they were after?…
Ah, scratch that, I understand why the study design precluded the randomization and blinding. Such trial could be conducted in a traditional hospital, but I don’t see homoeopaths rushing to conduct it somehow.
i enjoy the intellectual balck hole, and do not baulk to point it out.
the one who publishes this cannot only want to balcken his name, can he not ?
the situation is grave, but i quote: not serious.
keep it up !
“HG were more likely to have a more severe diagnosis or progressed tumour stage”
Bearing in mind they chose H in addition to – not instead of – C, I’d say the education system has less to do with their choice than their emotional state at the time.
Dana said “Frass”! Dana said “Frass”!!
I think I get to shout “BAZINGA!!”
LCN, do I win a prize for my spooky ability to predict what DUllman will do?
I also find it funny that DU cites for us a study that was an abstract in a proper journal, where there will have been little or no peer-review, but then the full paper fell all the way down the hierarchical tree of journal quality to find a home in Evid Based Complement Alternat Med. which lies in the mulched leaf litter rotting on the floor of the great forest of modern scientific literature. I think that pretty much guarantees it stinks of decay.
Well done, Dana, we like to see you dance but it’s even funnier when you keep the rhythm by shooting at your own feet. It spares us from wasting ammunition.
Now, I risk further derail, but we should not miss the opportunity while DU walks among us. LCN, did DUllman ever answer those questions you kept asking on Twitter about whether he supports use of homeopathy for AIDS and HIV?
P.S. The rational mind does not judge someone on the basis of a name they were born to. But the superstitious mind of a homeopath must surely find some weird synchronicity in that fact that the word Frass is the technical term for fly shit.
I say this only in the same spirit that I recall that the letters DU represent something dense, dangerous and toxic. The rational mind draws no conclusions but the superstitious mind might do so.
Poor Dana is terribly keen that we keep the posts on these individual blogs “on-topic”. This blog was about using homeopathy in cancer patients. I asked Dana a question that was on-topic and applied to a study he had advanced as evidence. He has not answered that question. I’ll try again.
re: Chatterjee A et al.
DUllman, do you wish to comment on how this study fell from abstract in normal journal to paper in woo-fanzine ghetto journal?
And it was still he who interjected with, “Frass!”. I’m sure he can’t help it. It’s like a version of Tourette’s.
EVERYTHING to do with homeopathy is rubbish, voodoo, hocus pocus, and entirely fraudulent and relies entirely on the placebo effect or the natural course of the disease!!! The homeopathic treatment fo type 1 diabetes – a pine box and six feet of dirt!!!!!!
“During homeopathic care we saw a significant and stable improvement in QoL which, as measured by the FACT G, is sizeable at more than half a standard deviation. We do not see a comparable increase in QoL in the conventionally treated cohort. Such an effect size of more than half a standard deviation is by all standards a clinically relevant improvement.”
Half of a standard deviation cannot be statistically significant by definition. It essentially is a null statement unless proper calculations are carried out to determine a p value, which they haven’t done. If they wanted to prove something then maybe they should actually analyse their data instead of quoting random figures.
“Half of a standard deviation cannot be statistically significant by definition”
I don’t think that’s right although I agree with the rest of what you said. Two groups can statisticall significantly differ by no more than half a standard deviation for the group provided the standard errors of the group means are small enough, which is to say provided the groups are large enough for us to estimate with great accuracy the values of their means.
This is why people will continue to be confused and why studies will not work. They are relying on the ‘flip of a coin’ to determine how the study will be carried out on the patient… seriously?!
Why don’t they truly randomize each variable by choosing patients that reflect the opposites of each other?
It all seems illogical to me, or maybe I’m missing something…
[edit to remove spam link]
You are missing something.
The “Treatment for xxxxx” was an amusing, though worrying, read
Actually, this is pretty funny and is worth highlighting;
“truly randomize…by choosing”
I was contributing to the discussion and leaving a link at the end, I don’t see how this is spam and I’m sure you love treating all your readers like this.
Please grow up.
There appears to be quite a bit you are not getting.
Andy Mr.Quack or Mr. Duck ad-hominem
Homeopathy is a natural way of treating immune system