MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Today, one day after a homeopathic retailer made headlines for advocating homeopathy as a treatment of measles, is the start of WORLD HOMEOPATHY AWARENESS WEEK. This is an ideal occasion, I think, for raising awareness of the often lamentably poor research that is being conducted in this area.

We have already on this blog discussed some rather meaningless research by Boiron, the world’s largest manufacturer of homeopathic preparations. I concluded my post by asking: “what can possibly be concluded from this article that is relevant to anyone? I did think hard about this question, and here is my considered answer: nothing (other than perhaps the suspicion that homeopathy-research is in a dire state)”. Now a new article has become available which sheds more light on those issues.

With this prospective observational study, the Boiron researchers wanted to determine the “characteristics and management of patients in France consulting allopathic general practitioners (AGPs) and homeopathic general practitioners (HGPs) for influenza-like illness (ILI)”. The investigation was conducted in Paris during the 2009-2010 influenza season. Sixty-five HGPs and 124 AGPs recruited a total of 461 patients with ILI. All the physicians and patients completed questionnaires recording demographic characteristics as well as patients’ symptoms.

Most AGPs (86%), and most patients consulting them (58%) were men; whereas most HGPs (57%), and most patients visiting them (56%) were women. Patients consulting AGPs were seen sooner after the onset of symptoms, and they self-treated more frequently with cough suppressants or expectorants. Patients visiting HGPs were seen later after the onset of symptoms and they self-treated with homeopathic medications more frequently.

At enrollment, headaches, cough, muscle/joint pain, chills/shivering, and nasal discharge/congestion were more common in patients visiting AGPs. 37.1% of all patients consulting AGPs were prescribed at least one homeopathic remedy, and 59.6% of patients visiting HGPs were prescribed at least one conventional medication. Patients’ satisfaction with their treatments did not differ between AGPs and HGPs; it was highest for the sub-group of patients who had been treated exclusively with homeopathy.

The authors draw the following conclusions from these data: In France, homeopathy is widely accepted for the treatment of ILI and does not preclude the use of allopathic medications. However, patients treated with homeopathic medications only are more satisfied with their treatment than other patients.

This  type of article, I think, falls into the category of promotion rather than science; it seems to me as though the investigation was designed not by scientists but by Boiron’s marketing team. The stated aim was to determine the “characteristics and management of patients…“, yet the thinly disguised true purpose is, I fear, to show that patients who receive homeopathic treatment are satisfied with this approach. I have previously pointed out that such findings are akin to demonstrating that people who elect to frequent a vegetarian restaurant tend to not like eating meat. Patients who want to consult a homeopath also want homeopathy; consequently they are happy when they get what they wanted. This is not rocket science, in fact, it is not science at all.

But what about the impressive acceptance of homeopathic remedies by French non-homeopathic doctors? It would, of course, be an ‘argumentum ad populum’ fallacy [which implies that ‘generally accepted’ equals ‘effective’] to assume that this proves the value of homeopathy. Yet this finding nevertheless requires an explanation: why did these doctors chose to employ homeopathy? Was it because they knew it worked? I doubt it! In my view, there are other, more plausible reasons: perhaps their patients asked for or even insisted on it; perhaps they felt that this is better than causing bacterial resistance by prescribing an antibiotic for a viral infection?

While I find this study as useless as the one I previously discussed on this blog, and while I fear that it confirms the all too often doubtful quality of research in this area, it might nevertheless contain a tiny item of interest. The authors report that “at enrollment, headaches, cough, muscle/joint pain, chills/shivering, and nasal discharge/congestion were more common in patients visiting AGPs”. In plain English, this strongly suggests that patients who decide to consult a homeopath are less ill than those who go to see a conventional doctor.

Does that mean that a certain group of individuals frequent homeopaths only when they are not really very sick? Does that indicate that even enthusiasts do not trust homeopathy all that far? Is that perhaps similar to out Royal family who seem to consult real doctors and surgeons when they are truly ill, while keeping a homeopath on stand-by for the rest of the time? These might be relevant research questions for the future; somehow I doubt, however, that the guys in charge of Boiron will ever address them.

8 Responses to More rubbish homeopathic research from Boiron

  • It really is time that journals stopped taking homeopathy research that does not address the yawning evidential chasm that is the principles of homeopathy. We already know it is possible to produce a study that shows homeopathy to be slightly more effective than placebo, and we know the types of bias that can produce this. We know, to a high degree of certainty, that no amount of such studies can be persuasive, because they cannot refute the null hypothesis.

    We are left with the fact that there is no reason to suppose homeopathy should work and no way it can work.

    Without credible proof of the doctrines of similars and potentisation, any other work is a complete waste of time and paper – and unethical, since it cannot possibly deliver the result the study authors set out to deliver.

  • Don’t you have the feeling, that we sceptics are sitting in a sinking boat, fighting a loosing battle or such?

    ‘In France homeopathy is widely accepted for the treatment of ILI … ‘
    and this study will give the next round of ammunition to convince the laymen public that homeopathy is based on sound sicience. You and I know that this study is not science – but how can the public be made to understand? This sutdy can be placed in a nutshell like ‘HGPs are more satisfied with treatment than AGPs’, with a little help of misinterpretation this will burn down to ‘homeopathy outperforms allopathy’ – which may help to convince another group of patients.

    How to make the public aware of the weakness of this evidence?

    To dissect such a study seems easy enough – but how to put it in a similar persuasive nutshell?

    Just have a look (in addition to professor’s points):

    461 patients with (65 + 124) practitioners is less than 2.5 patients per practitioner. Hard to believe, that this is the total number of patients with ILI problems in all of the 2009 / 2010 influenza season that consulted these practioners. The study did not take place in a secluded barely inhabited area of France but in a ‘metropolitan France’, which I understand to be Paris. So apparently there was a selection – but what were the criteria?

    ‘Outcome measures were (1) patient characteristics, (2) demographics and (3) symptoms at baseline, (4) medications prescribed by type of physician and (5) satisfaction with treatment by type of physician and medication’ (numbers added by me). I get it that 80 % of the outcome were in fact inputs by the selection mentioned above, only #5 could be seen as a result.

    This is not very difficult to show – but how to bring this to the public? Professor here has a book out in the marketplace, Ben Goldacre and a few others (including myself – still awaiting professor’s comments though) – but what is the result? All these efforts could be swept away by any homeopath by citing this new ‘evidence’, which the patient will surely not have the means to further investigate into or understand its implications if he would do, so the patient will be convinced by this new evidence anyway.

  • This type of article, I think, falls into the category of promotion rather than science…

    Linde and Melchart made a similar comment about trials of homoeopathy back in 1998: “The motivation for doing trials seems less to be innovation or self-critical evaluation of performance (which is generally considered to be the motivation for good research) but rather justification in front of a hostile scientific establishment.”

  • In response to Guy above, the placebo is just as effective as any technique. The power of the mind is amazing. If it believes something, it acts on it. That is how the mind works. If it believes a homeopathic technique will work, it will. THat’s why some people get results, and others don’t from the exact same technique. And I’m talking across the board here, and not just homeopahtic techniques. It all comes down to the power of belief!

    • the placebo can generate placebo-effects; effective treatments can generate placebo plus specific therapeutic effects. thus placebo-effects are no good justifications for using ineffective treatments.

  • “Does that mean that a certain group of individuals frequent homeopaths only when they are not really very sick? Does that indicate that even enthusiasts do not trust homeopathy all that far? Is that perhaps similar to out Royal family who seem to consult real doctors and surgeons when they are truly ill, while keeping a homeopath on stand-by for the rest of the time? ” I have found this amongst colleagues devoted to “alternative medicine”: they switch from biting sarcasm about “Big Pharma” etc and recommendations about energy practitioners, homeopathy etc to comments on their visits to GP’s, surgical procedures and so on, with no apparent disconnect: I think there is something going on here in the dynamics of human discourse and construction of a social self (identities which will be accepted within the group) that (we) skeptics simply do not grasp: something is being demonstrated -power over against the scientific community? a reserve of peoples’ knowledge? which belongs to a different discourse altogether: a different shared meaning from the shared meaning of “science”. I don’t think a simple lack of critical thinking covers the complexity of the situation.

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