Numerous charities in the UK, US and elsewhere abuse their charitable status to misinform the pubic about alternative medicine. As the BMJ today published an article on one this organisation, I have chosen HOMEOPATHS WITHOUT BORDERS as an example – from a disturbingly vast choice, I hasten to add.
Sounds good, doesn’t it? HOMEOPATHS WITHOUT BORDERS (HWB). Unless, of course, you happen to know that this organisation has nothing whatsoever to do with the much-admired ‘Medicine without Borders’. HWB and its numerous national branches promote the use of homeopathic remedies worldwide, particularly in disaster-stricken and extremely poor areas. On their website, they state: When disaster strikes or in times of crisis, homeopathy can provide effective treatment for acute anxiety and the after effects of shock and trauma. No, no, no! Homeopathy is a placebo-therapy; it is not effective for anxiety or anything else, crisis or no crisis.
To get an impression about their activities, here are HWB’s projects for 2013:
- We plan to train as many as 40 additional Homeopathe Communautaires in 2013.
- We’ll support the Homeopathe Communautaires as they grow with study groups and ongoing clinical support provided by our volunteer homeopaths.
- The 2012 graduates of the Fundamentals program will become teachers, moving HWB toward achieving our vision of Haitians teaching Haitians.
- We hope to bring continuing homeopathic medical care to the people of Haiti, reaching nearly three times as many people as we did in 2012.
- We plan to initiate a training program in 2013 for Haitian midwives and birth attendants for homeopathic therapeutics in pregnancy, delivery and postpartum care.
All of this looks to me as though HWB should be re-named into HOMEOPATHS WITHOUT SCRUPLES! Under the guise of some humanitarian activity, they seem to promote misinformation about a disproven treatment for some of the most vulnerable people in the world. I cannot imagine many things that are more despicable than that.
David Shaw, senior research fellow, Institute for Biomedical Ethics, University of Basel, Switzerland, has just published the above-mentioned BMJ-article on HWB. He discloses their activities as deeply unethical and concludes: Despite Homeopaths Without Borders’ claims to the contrary, “homeopathic humanitarian help” is a contradiction in terms. Although providing food, water, and solace to people in areas affected by wars and natural disasters certainly constitutes valuable humanitarian work, any homeopathic treatment deceives patients into thinking they are receiving real treatment when they are not. Furthermore, training local people as homeopaths in affected areas amounts to exploiting vulnerable people to increase the reach of homeopathy. Much as an opportunistic infection can take hold when a person’s immune system is weakened, so Homeopaths Without Borders strikes when a country is weakened by a disaster. However, infections are expunged once the immune system recovers but Homeopaths Without Borders’ methods ensure that homeopathy persists in these countries long after the initial catastrophe has passed. Homeopathy is neither helpful nor humanitarian, and to claim otherwise to the victims of disasters amounts to exploitation of those in need of genuine aid.
I strongly recommend reading the article in full.
And lastly: can I encourage readers to post their experience with and knowledge of other woo-infested charities, please?
74 Responses to Drowning in a sea of misinformation. Part 9: ‘Homeopaths Without Borders’
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Well, of course there’s an Acupuncturists Without Borders: http://www.acuwithoutborders.org
now, why does this not surprise me?
what do they do?
Stab people for fun and profit?
Although itself not a real charity, the ‘Genesis II Church’ of Miracle Mineral Supplement promotor Jim Humble managed to trick some actual charities in doing a field test with MMS against Malaria in Uganda. Some Youtube videos are being spread as proof that this has happened. Those charities, The Ugandan Red Cross Society and The Water Reference Center, have dissociated themselves from this ‘test’ but don’t like to comment on their actual involvement, when asked. You can read more about this on my blog: What did the Ugandan Red Cross Society know about “the ‘miracle’ solution to defeat malaria” Video?.
Try these:
http://www.homeopathybotswana.com/
http://www.scotsontechnique.com/
Professor Ernst wrote: “…can I encourage readers to post their experience with and knowledge of other woo-infested charities, please?”
Let’s not forget ‘Hands for Heroes’ which provides ‘free’ chiropractic care to war veterans (a £50 deposit is required to show “a serious commitment on the part of the veteran to wanting to improve their health” and “to prevent abuse of the valuable care being donated by not turning up for scheduled visits”). I can’t find its charity registration number, but it does seem to be a charity of sorts. Interestingly, the UK Ministry of Defence takes a dim view of it:
http://www.ebm-first.com/chiropractic/uk-chiropractic-issues/2067-hands-for-heroes-ministry-of-defence-refuses-free-chiropractic-care-worth-p45-million-for-veterans.html
Bearing in mind that the majority of chiropractors in the UK base their practices on subluxation-based pseudoscience, what the ‘charity’ doesn’t warn about on its website is the slippery chiropractic “bait and switch”:
http://www.dcscience.net/?p=1516
Any unfortunate UK war veterans who do end up being ensnared by chiropractic quackery won’t have any recourse to official protection as the chiropractic regulator in the UK, the General Chiropractic Council, apparently allows chiropractic quackery to flourish.
The theme for this year’s ‘World Homeopathy Awareness Week’ was ‘Homeopathy for Disaster & Trauma’.
Check out its Facebook page for examples of shamelessly outlandish irresponsibility.
homeopathy for disaster? homeopathy IS a disaster, particularly for underdeveloped countries!
Dr. Ernst is homeopathy in general disproven? Some of the best reviews say that the studies have been inconclusive..
For example :Cohrane review
There is insufficient good evidence to enable robust conclusions to be made about Oscillococcinum® in the prevention or treatment of influenza and influenza-like illness. Our findings do not rule out the possibility that Oscillococcinum® could have a clinically useful treatment effect but, given the low quality of the eligible studies, the evidence is not compelling. There was no evidence of clinically important harms due to Oscillococcinum®.
yes;
the Cochrane review you cite is, I think, retracted.
“There is insufficient good evidence to enable robust conclusions to be made about Oscillococcinum® in the prevention or treatment of influenza and influenza-like illness. Our findings do not rule out the possibility that Oscillococcinum® could have a clinically useful treatment effect but, given the low quality of the eligible studies, the evidence is not compelling.”
I think that shows it’s unlikely that Oscillococcinum works. If it did, the studies would have shown it, at least to some extent, but the fact that there was no clear evidence that it works strongly suggests that it doesn’t.
Is that good enough to state that it’s disproven? All I can say is that based on those findings, I won’t be bothering to buy it.
Annette said:
You’d be amazed at the spin homeopathists are able to put on results like that…
You should read the results and the conclusion and understand the reasoning – Do not jump to conclusions if you have not read the actual papers because everybody else says the same thing……..
The authors say that what made the study positive but inconclusive is the low quality of studies – thats why they cannot rule out it is working.
These are the results – read yourself.
“The overall standard of trial reporting was poor and hence many important methodological aspects of the trials had unclear risk of bias. There was no statistically significant difference between the effects of Oscillococcinum® and placebo in the prevention of influenza-like illness: risk ratio (RR) 0.48, 95% confidence interval (CI) 0.17 to 1.34, P = 0.16. Two treatment trials (judged as ‘low quality’) reported sufficient information to allow full data extraction: 48 hours after commencing treatment, there was an absolute risk reduction of 7.7% in the frequency of symptom relief with Oscillococcinum® compared with that of placebo (risk difference (RD) 0.077; 95% CI 0.03 to 0.12); the RR was 1.86 (95% CI 1.27 to 2.73; P = 0.001). A significant but lesser effect was observed at three days (RR 1.27, 95% CI 1.03 to 1.56; P = 0.03), and no significant difference between the groups was noted at four days (RR 1.11, 95% CI 0.98 to 1.27; P = 0.10) or at five days (RR 1.06; 95% CI 0.96 to 1.16; P = 0.25). One of the six studies reported one patient who suffered an adverse effect (headache) from taking Oscillococcinum®.”
The conclusion was that there is not sufficient evidence to say that it works. That’s a negative result.
No it is not – check for yourself
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001957.pub5/abstract;jsessionid=8A70EB5433877988636B43D9A92055B3.d04t03?systemMessage=Wiley+Online+Library+will+be+unavailable+for+approximately+4+hours+between+09%3A00+EDT+and+14%3A00+EDT+on+Saturday%2C+28+September+2013+as+we+make+upgrades+to+improve+our+services+to+you.+There+will+also+be+some+delays+to+online+publishing+between+25+to+28+September+2013.+We+apologize+for+the+inconvenience+and+appreciate+your+patience.+Thank+you+for+using+Wiley+Online+Library%21
you are absolutely right! the one that was withdrawn was Vickers et al on the same subject.
so is homeopathy disproven?
strictly speaking, science cannot prove a negative. but there comes a moment when something is as good as disproven and we then use the term in a more casual sense.
specifically with homeopathy, there could always be a different potency that might work or a different condition for which it might be effective. in such a situation, it may be wise to take into account plausibility which, for homeopathy, approaches zero.
as to the Cochrane review, I have strong reservations: the authors are all very strong believers, the studies are poor and Boiron-sponsored, the effect is tiny, etc.
to summarise the situation:
Not only is there no proof homeopathy works, there is no way it can work, and no reason to suppose it might
If I know better I would have thought that this post was an article from The Onion 🙂
The most quackmungous charity I can think of is canceractive, but hmc21 and the homeopathy action trust both exist primarily to further the commercial interests of their officers and trustees.
Well, Irene you don’t seem to be reading a lot of papers… Don’t you ?
Dr, Ernst the fact “the authors are all very strong believers,” invalidates their findings and the integrity of their review ? By the same mode of thinking non believers findings are equally inherently invalidated?
The Boiron sponsored studies argument as well .. By the same mode of thinking , whatever research is sponsored by a pharma company is automatically unreliable vaccines, antibiotics etc ?
The quality of the studies is another issue : they do not prove, they do not disprove the specific homeopathic preparation either – you cannot really arrive to valid assumptions. Not because they tried to prove something negative but because they found reasons to suspect that it might be working but not supported by quality studies.
The “no reason to work argument” therefore it does not —- is a logical fallacy according to any decent logician ( or mathematician ) you can ask. No reason to work among the ones we already know. Even if Montagner and Roy did not exist there has been research in this area about high dilutions despite the intellectual terrorism against this kind of research –as Montagnier said.
George, your perseverance (http://dictionary.reference.com/browse/perseverance) is admirable. You make Don Quixote proud.
I am sorry to fall for the temptation and resort to sarcasm but it is the only way to respond to your attempts at reasoning.
It is easier to reply that way – providing sound arguments is harder . (Im not that naive to believe that I will change your minds here – it is like another religion – ( nothing wrong with religious beliefs )
I m just interested in hearing the best argument from the “skeptics” point of view – curiosity.
OK George, I’ll offer you the sceptic’s summary: Homeopathy has not been shown to work, has frequently been shown /not to/ work, and has no known method by which it could possibly work. The few studies that suggest it might sometimes sort of work tend have small effects, dubious methods, and significant conflicts of interest.
As you rightly observe, a conflict of interest or two does not mean a study is worthless. As you rightly observe, lacking a known method of action is not itself sufficient grounds to reject a treatment. These isolated arguments are technically correct, but they are insufficient to shift the overwhelming balance of evidence pointing toward homeopathy having no effect beyond placebo.
Lacking quality evidence and lacking plausible methods of action, on what basis do you propose we continue to view homeopathy as potentially effective?
The problem is that the argument “lacking plausible methods of action” is a fallacy in Logic. For a simple reason : one equates what s/he has no information about to what actually is or it could be. Science would not have progressed if it had adopted the principle that no investigation should be done if plausibility can not be established based on the current knowledge. And there are scientists who believe that there is evidence for high dilutions.
Regarding the evidence : not all researchers involved in homeopathy research believe that the evidence shows = placebo. You can verify it yourself in the internet.
Even the Shang review is highly problematic
http://www.ncbi.nlm.nih.gov/pubmed/18834714
All trials were highly heterogeneous (I2=62.2%). Homeopathy had a significant effect beyond placebo (OR=0.76; 95% CI: 0.59-0.99; p=0.039). When the set of analyzed trials was successively restricted to larger patient numbers, the ORs varied moderately (median: 0.82, range: 0.71-1.02) and the P-values increased steadily (median: 0.16, range: 0.03-0.93), including Shang’s results for the eight largest trials (OR=0.88, CI: 0.66-1.18; P=0.41). Shang’s negative results were mainly influenced by one single trial on preventing muscle soreness in 400 long-distance runners.
If you are interested I could tell you why a single trial on preventing muscle soreness in 400 long-distance runners is categorized that way.
Furthermore, it is not only the placebo trials that counts as evidence to justify research but also the fact that so many people report so positive results; this does not “prove” or even justifies the method but it is a strong reason to do more research.
it is wise, in health care, to regard everything as un/disproven that is not proven.
it is virtually impossible to prove a negative in science.
Your appeal to “scientists who believe that there is evidence for high dilutions” is also a fallacy in logic, for a number of reasons. First, it’s an appeal to authority. Second, you don’t name any of these “scientists who believe that there is evidence for high dilutions” so there is no way of knowing whether they are appropriately qualified. Third, because you haven’t named them, or cited work they have published which details their reasons for believing that “there is evidence for high dilutions”, we have no way of knowing whether their belief is justified.
And fourthly, and most importantly, even if in vitro effects of “high dilutions” were proven, it would not mean that homoeopathy works, because that is a different question, and one that can only be answered by testing homoeopathy in clinical trials.
But perhaps not as problematic as you suggest (you can, as you say, “verify it yourself in the internet”). See, for example here, or see Wilson P. Analysis of a re-analysis of a meta-analysis: in defence of Shang et al. Homeopathy. 2009 Apr;98(2):127-8, the text of which can be found here (see also the comments).
Note also that the study you cite states that its “results do neither prove that homeopathic medicines are superior to placebo nor do they prove the opposite.”
Can you name some “researchers” who have concluded that it works better than placebo, and cite papers in which they have concluded this?
You don’t need to: anyone who is interested can find out by reading the Shang paper, which sets out its methods.
The question was “Lacking quality evidence and lacking plausible methods of action, on what basis do you propose we continue to view homeopathy as potentially effective?”
That’s why I said that the argument is a fallacy in logic – look above why.
Everybody knows about Roy and Montagnier research and Beneviste whose work had been replicated. I m not saying that it has been proven though..
It is so funny when one points out the plausibility of homeopathy based on this research “skeptics” who previously said but “there is no reason for homeopathy to work” now say —–no —-the most important is the clinical evidence.
Anyhow I always have high expectations when I m trying to read the skeptics blogs about the support for Shang review – for example to find out something I did not know —and the level is lower than……wikipedia.
The equivalent of Shang review regarding the “single trial on preventing muscle soreness in 400 long-distance runners” could be to design a study where you give an X medication for anxiety neurosis and when you see that it does not work – you conclude that not only the x medication but also the entire conventional western medicine is ..useless. And all the other studies previously shown positive for western medicine must be wrong…because ONE study showed negative .What a great science !!
It is not the number of participants ONLY which makes a study eligible for inclusion but its design and expectations and compliance with the principles of the method one tests – no serious homeopaths would really expect to show positive results for this trial.
From looking above, it would appear to be because you ignored the bit that said “lacking quality evidence”. That’s what is known as the “straw man” fallacy.
Shang actually did more than looking at “ONE study”, or even looking at the studies that came within its definition of higher quality studies. You are using the “straw man” fallacy again.
If you want to know about Roy’s work on distinguishing homoeopathic remedies from stock solvent, I suggest that you track down this, and read it.
Who told a Canadian TV program that his research cannot be extrapolated to the products used in homeopathy.
[citation needed]
No, the clinical research has always been the most important evidence as to whether it works. The other stuff just makes homoeopathy implausible (and “so funny”).
And as always you are unable to respond to the arguments from “the skeptics blogs” with anything beyond an attempt at an insult.
If “skeptics blogs” are a problem for you, why not restrict yourself to the text that was published in Homeopathy? I’ve given you the reference and a link to the blog where you can find the text.
Mojo it is better to think for yourself and stop copying what other people say.
Trying to respond to the question why research on homeopathy is justified I gave 2 valid reasons –
1. research about its plausibility has been done from several scientists including montagier who said
“I can’t say that homeopathy is right in everything. What I can say now is that the high dilutions are right. High dilutions of something are not nothing. They are water structures which mimic the original molecules””
(Now if you think that this statement means that his work has nothing to do with homeopathy even partly then you are in denial – and this is worse than the lowest quack you are making fun of .)
I know that there are conflicting opinions on Roy work – it shows though that there has been research on the subject. That was my point.
And 2. Evaluation of clinical evidence and problematic reviews – Shang see above..
You did not reply to any of these in your own words – you just copy and paste links –so I don’t know who is irrational here ..
George, it looks as if “irrational” is another word you need to up the definition of. There is nothing irrational about citing and linking to material that supports an argument.
Did you read the material I linked to about the Shang paper? Do you have any comment on it?
Did you read the paper itself, or do you regard reading the paper you are commenting on as “irrational” as well? I ask because, from your comments about it on this blog, you don’t seem to know what Shang did.
Montagnier has made conflicting comments in interviews about whether his work supports homoeopathy. If that’s all you have then you don’t have much. Does any of his published work even mention homoeopathy?
It really isn’t enough to say that research has been done; the important thing is the results of that research. What robust results do you have that support homoeopathy?
If you believe what Montagnier says in his interview his work is related to homeopathy – it is not on homeopathy exclusively…..
Of course the mechanism of action – if any – is not known – but I think the positive / inconclusive results in meta analyses, the problematic negative reviews , the increasing popularity , and the anecdotal evidence favorable to homeopathy justify any decision for more research -that was the question I was asked.
If you believe what Montagnier says in his interview his work is related to homeopathy – it is not on homeopathy exclusively…..
Of course the mechanism of action – if any – is not known – but I think the positive / inconclusive results in meta analyses, the problematic negative reviews , the increasing popularity , and the anecdotal evidence favorable to homeopathy justify any decision for more research -that was the question I was asked.
I disagree: ~200 years of research without proof + lack of plausibility [even if Montagnier is completely correct, homeopathy’s alleged clinical effects still totally lack plausibility] means that this is a fish dead in the water and we should invest scarce research funds into more promising projects.
And if you believe what the Canadian program quoted, it cannot be extrapolated to the products used in homeopathy. This seems more in line with his reported results, which found effects mostly at dilutions equivalent to about 8-12X, with a single experiment showing effects up to about 18X; these are all below the level (24X) at which there would be nothing from the original solution left.
Interesting characterisations. Wouldn’t it be just as valid to talk about “the negative / inconclusive results in meta analyses, [and] the problematic positive reviews”? The Linde analysis, for example, is only “problematic” in the minds of homoeopaths, and the most positive review/analysis was later described by its authors as having “at least overestimated the effects of homeopathic treatments”.
The anecdotal evidence, with its spectacular and self-evident results, is certainly contradicted by controlled trials, which at best report marginal differences. And as for your appeal to popularity…
That’s why I said before that part of his research is related to homeopathy.
Still Linde and Jonas do not think that homeopathy = only placebo – you know that.
There are so control trials which show positive but for some magical reason every trial positive for homeopathy must be wrong…
Would that be the Linde and Jonas who said that their work “has unfortunately been misused by homoeopaths as evidence that their therapy is proven”, and one of whom has more recently been quoted as saying, “Wir können unsere damalige Schlussfolgerung so nicht mehr aufrechterhalten, denn die positiven Ergebnisse könnten auch durch Fehler in den Studien bedingt sein.”
in case someone wants a translation of the German statement: “we cannot maintain out conclusions from then, because the positive findings might be due to mistakes in the studies”.
This is about their qualification of the study. This review did NOT conclude that Homeopathy = placebo. They are talkkng about the degree of efficacy.
And in the Lancet, objecting and disputing Shang’s findings about the end of homeopathy they wrote that homeopathy = placebo is a significant overstatement and there is evidence that homeopathy might be effective is some conditions.
I do understrand , respect and examine your views ( because I m curious ), Dr. Ernst
but saying that every researcher concurs with you is obviously false.
and where did I say that ‘every researcher concurs with me’???
there is never complete agreement on anything; it is about a consensus amongst experts who have no axe to grind.
You got it all mixed up again, George.
There is nothing to prove when it comes to homeopathy. That time has long passed.
Any scientific trial (or attempt at such) concluding that there is or might be an effect of homeopathic remedies beyond placebo effect caused by wishful thinking and the effect of the seductive, verbal conjuring of the homeopathic practitioner must therefore be erroneously interpreted.
Why?
Because homeopathic remedies do not contain any active substance, energy or structure that can influence a living organism in any way.
Any attempts at proving otherwise have failed. Nothing can or will explain such an effect. Saying that this purported effect can not (yet) be explained by science is nonsense. Why then attempt to use scientific approach? That is an oxymoron.
Or to put it otherwise:
Only magic can explain any effect of homeopathic remedies on living organisms.
Magic does not exist (otherwise it would not be magic, right?).
Conjurers sometimes call themselves magicians but their art is one of deception, not magic. The same applies to homeopaths, they are little more than conjurers.
In my opinion the sale and application of homeopathy to human or veterinary ailments with a promise of medical benefit is nothing less than fraud even when practiced in good, albeit mistaken faith.
I think your thinking is magical. There are plenty of studies who show effects over placebo for homeopathy.
Especially when you believe that :
“Saying that this purported effect can not (yet) be explained by science is nonsense. Why then attempt to use scientific approach? That is an oxymoron.”
For instance, the mechanism of anti depressants “can not (yet) be explained by science” maybe you can write and tell the researchers who look for a mechanism:
“Why then attempt to use scientific approach? That is an oxymoron”
yes, of course, there are such studies. at a 5% level of significance, one would expect 10 of the ~200 studies to be positive. then factor in publication bias and the 10 might easily grow to 50. the question is what does the totality of the most reliable trials tell us.
What matters – and you know that better than I know – is not the number of studies but their quality design and meaning.
For instance, in Shang’s case one single trial on preventing muscle soreness in N 5 400 long-distance runners influenced his results when it is well known that homeopathic treatment is not typically used to healthy individuals to prevent a condition.
It is like conducting a large study to treat anxiety neurosis with anti depressants and when you fail to declare all western medicine useless.
who said it’s not used for preventing DOMS?
are you an experienced homeopath or a marathon runner?
No there are not.
There are plenty of studies that are in one way or another erroneously interpreted to show said effects but they are all lacking in several ways.
We seem to have to feed this with to you with a spoon.
The most important and critical failure of homeopathy is the lack of the basic prerequisite in any hypothesis testing, that a mechanism of action can be postulated. Lacking this essential requirement, you may continue to perform of trials on the effects of homeopathy, till hell freezes over. You can still not draw the conclusion that it works even if several of your trials will most surely suggest that you may revoke the null hypothesis that homeopathic remedies do not work.
Paraphrasing what Edzard said, this would be similar to throwing a die a hundred times and saying that because you got plenty of sixes then that explains why the oil price is rising.
Your attempt at an argument about antidepressants falls dead due to the simple fact that they do contain substances other than inert fillers that are or may be active in humans and that mechanisms of their action can be postulated. Whether they truly work as advertised is another matter, which has nothing to do with whether remedies work. Should a brand of antidepressants be proven to contain nothing but inert filler substance, then it will be equivalent to a homeopathic remedy, not a drug. The producers would very likely be sued for fraud and whatnot. So why is nobody suing Boiron, Ainsworths etc.????
Björn Geir said:
The other main homeopathy manufacturer in the UK, Nelsons, were caught by the FDA not putting any of their magic ‘potentised’ water onto one in six of their bottles of sugar pills on their production line – it dripped down the outside of the bottle. Who knows how long this had been going on for, but there seems to be no record of one in six customers complaining the product didn’t work (and Boots didn’t seem at all concerned).
But don’t ask about the glass fragments!
“There are plenty of studies who show effects over placebo for homeopathy”
Name one…
You mean besides
Jacobs Homeopathy for childhood diarrhea: combined results and metaanalysis from three randomized, controlled clinical trials——–.similar design and protocols used in placebo control trials in conventional medicine is favorable to homeopathy) ?
Here are 2 more:
— Frass, M, Dielacher, C, Linkesch, M, et al. Influence of potassium dichromate on tracheal secretions in critically ill patients, Chest, March, 2005;127:936-941.
— Bell IR, Lewis II DA, Brooks AJ, et al. Improved clinical status in fibromyalgia patients treated with individualized homeopathic remedies versus placebo, Rheumatology. 2004:1111-5.
Here’s a systematic review of homoeopathy for the treatment of fibromyalgia, published 6 years after the single small trial you cite:
The particular fibromyalgia paper you cite has also been discussed, along with the rest of the literature, here. Note, for example, the comments about the small size of the trial, and about “several flaws in the randomization in characteristics that are important disease endpoints, which means that the two groups aren’t the same when it comes to severity”.
As for the Frass paper, see here. Note again the small size of the study, and the differences at the start of the trial in COPD stage and use of home oxygen between the active and placebo groups.
This post triggered me to analyse the referenced paper by Frass et al. Result: This study is not valid and the authors’ conclusion, that potassium dichromate may be helpful in this condition has no basis.
Here is why:
First outcome measure is the amount of sputum removed from the patients on day #2 after application of the remedy. But this is not given as a total amount of secretion on day #2 but an average rating of only three (out of seven) suction procedures, that is, less than half of the available data found their way into the result. The criteria for the selection are not given in the paper. Thus the total amount of sputum was not included in the result and there is no clear relationship between any patient’s condition and his rating.
The fact that there is something fishy with the rating of the amount of sputum is corroborated by further data: In both groubs all the patients required two to four additional removal of sputum – in fact the homeopathy group required more removal procedures – but in the homeopathy group 13 of 25 patients were rated ‘mild’ and only 1 as ‘severe’ whereas in the placebogroup rating was just the opposite, 2 patients ‘mild’ and 13 ‘severe’.
Second measure was the time to extubation. There were five requirements given that had to be met to try extubation. But two of them were completely independent of the amount of sputum (alertness and presence of gagging reflex), the other three were only mildly connected to the amount of sputum in an intubated patient(breathing frequency, remaining pressure, oxygen concentration). The authors themselves detailed, that extubation was postponed on occasion for other reasons than considered in the study. The authors give the times to extubation as being longer in the placebogroup, but not the criterion that was not met and prohibited extubation. This figure may well be attributed to reasons outside the study.
The third measure was the time the patent spent in the emergency ward. This was directly connected to the time to extubation and thus provides no additional information.
Conclusion:
The measures do not reflect the impact of the homeopathic remedy on the amount of secretion. Thus the study is not valid to draw any conclusion as to the efficacy of the drug.
For more details refer to my blog with the full analysis (in German): http://www.beweisaufnahme-homoeopathie.de/?page_id=1054
Thanks Mojo for the links.
Recently I did review Bell’s paper on Fibromyalgia. If you can read German, here is the link:
http://www.beweisaufnahme-homoeopathie.de/?p=978
My main criticism:
In her unadjusted data – she reported nine different outcomes – each and every confidence interval included 0.0 somewhere not too far off the center of this interval. Conclusion: Just the opposite of her positive conclusions would be just as probable from her data. Only after some covariate adjustment she could produce some significant results – without applying Bonferroni corrections, that is.
Thanks because Mojo links of discussion are not so serious criticisms of the study. I will explain later. However, before I tell you specifically about your concern I wonder :
This is a typical method in statistics applying in placebo control trials both in conventional and homeopathic research – why do you object these applications only in homeopathic research? By your standards almost all placebo control trials in both conventional and homeopathic medicine are useless….
What “is a typical method in statistics applying in placebo control trials both in conventional and homeopathic research”? Are you referring to the flaws in randomization or the small sample sizes, or something else? And, whatever it is that you are claiming “is a typical method”, can you provide evidence that this is the case “both in conventional and homeopathic research”?
“Thanks because Mojo links of discussion are not so serious criticisms of the study”
Not so serious? Seems something is wrong with my understanding of English …
I do not know of the magnitude of the problem with significance in conventional medicine. My view on significance is of concern only for studies with quite small effect sizes. But it would perfectly fit with my notion of some useless (EBM-) remedies in the field. If studies outside of homeopathy suffer the same problem, I cannot tell.
But the next issue of FACT will contain a paper of mine where I present my point of view on requirements for internal validity of trials.
Maybe Mojo has to explain what the flaws are because the links are not specific – Can you explain in your own words?
Regarding the statistical “problems” : what is a small effect size ? statistical tools are applied the same way in all studies homeopathic or conventional trials.
These are standard methods to measure effects and there is not such a thing as small effect …small compared to what ? To the conventional limit the statistical apps use? How do you know it is small if you have not compared with the reality in converional medical research ?
In conventional trials the pharma companies say the approved medications work only on 45 percent of patients..
It is quite magical thinking to measure a methods effectivness with standard statistical tools and if you find significant effects according to these ( standard tools ) to declare the effect …..small..therefore not existent – without even knowing the reality and the data in medical research about placebo control trials ..
45% > 0%
Do you understand what that means for placebo control trials ?
Anyhow can you explain the “flaws” of the randomization which all the high impact journals fail to ……detect every time they published a trial favoring homeopathic treatment ?
I m really curious.
Yes. If something works in 45% of patients, then the effect wil be demonstrable in placebo controlled trials. If it works in 0% of patients, then the effect will not be demonstrable. See Shang et al. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet. 2005 Aug 27-Sep 2;366(9487):726-32, which demonstrated this by comparing studies of homoeopathy with studies of medications that, according to you, works in 45% of patients, and found that when bias was taken into account “there was weak evidence for a specific effect of homoeopathic remedies, but strong evidence for specific effects of conventional interventions”.
You’re attacking a strawman argument. The fact that it doesn’t work doesn’t mean that trials that produce positive results have problemas with their randomization. They could have, for example, problems with blinding, there could be a variety of confounding factors involved.
And, even for a completely ineffective treatment, perfectly designed and conducted trials will come up with a positive result one time in 20, because the test for statistical significance is that there is only that probablility that the result has come about through chance.
And don’t forget about the “file drawer effect”.
George, before we continue, just update your knowledge on statistics, for instance: http://en.wikipedia.org/wiki/Effect_size
And while you are at it, get some information on statistical independence: http://en.wikipedia.org/wiki/Independence_(probability_theory)
Wow! I did not known all that !!!
And? ……..?
“And? ……..?”
Review our recent discussions.
What are you talking about ? And you are saying that homeopaths and other quacks subscribe to magical thinking ?
I m afraid that you don’t want to answer :
You want to measure a methods effectiveness with standard statistical tools applied to a typical placebo control trial and if you find significant effects according to these ( standard tools used in conventional and homeopathic trials ) you declare the effect …..small….therefore not existent ? without even knowing the reality and the data in medical research about placebo control trials
But maybe you want to email all the prestigious journals which use these methods for conventional and other research so they can also update their knowledge in statistics as well..Good luck ..After all, all medical research regarding placebo control trials might be proven useless through your …discoveries……..
—–I’m sure mojo will inform me about the specific flaws of the randomization of the paper –
Mojo according to Nobert criteria for placebo control trials , the Shang review on placebo control trials in conventional medicine does not show any significant effect – they use the same statistical methods as trials in homeopathy.
Therefore the entire paper -according to him- is useless.
I would say, wait till this paper is published, then read it (I will be allowed to post the text on my website once it is published, if I understood the copyright issues properly) and only then let us continue discussing.
Hopeless case. I give up.