MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

Conventional cough syrups do not have the best of reputations – but the repute of homeopathic cough syrups is certainly not encouraging. So what should one do with such a preparation? Forget about it? No, one conducts a clinical trial, of course! Not just any old trial but one where science, ethics and common sense are absent. Here are the essentials of a truly innovative study that, I think, has all of these remarkable qualities:

The present prospective observational study investigated children affected by wet acute cough caused by non-complicated URTIs, comparing those who received the homeopathic syrup versus those treated with the homeopathic syrup plus antibiotic. The aims were: 1) to assess whether the addition of antibiotics to a symptomatic treatment had a role in reducing the severity and duration of acute cough in a pediatric population, as well as in improving cough resolution; 2) to verify the safety of the two treatments. Eighty-five children were enrolled in an open study: 46 children received homeopathic syrup alone for 10 days and 39 children received homeopathic syrup for 10 days plus oral antibiotic treatment (amoxicillin/clavulanate, clarithromycin, and erythromycin) for 7 days. To assess cough severity we used a subjective verbal category-descriptive (VCD) scale. Cough VCD score was significantly (P < 0.001) reduced in both groups starting from the second day of treatment (−0.52 ± 0.66 in the homeopathic syrup group and −0.56 ± 0.55 in children receiving homeopathic syrup plus oral antibiotic treatment). No significant differences in cough severity or resolution were found between the two groups of children in any of the 28 days of the study. After the first week (day 8) cough was completely resolved in more than one-half of patients in both groups. Two children (4.3 %) reported adverse effects in the group treated with the homeopathic syrup alone, versus 9 children (23.1 %) in the group treated with the homeopathic syrup plus antibiotics (P = 0.020).

Conclusions

Our data confirm that the homeopathic treatment in question has potential benefits for cough in children as well, and highlight the strong safety profile of this treatment. Additional antibiotic prescription was not associated with a greater cough reduction, and presented more adverse events than the homeopathic syrup alone.

Let us be clear about what has happened here. I think, the events can be summarised as follows:

  • the researchers come across a homeopathic syrup (anyone who understands respiratory problems and/or therapeutics would be more than a little suspicious of this product, but this team is exceptional),
  • they decide to do a trial with it (a decision which would make some ethicists already quite nervous, but the ethics committee is exceptional too),
  • the question raises, what should the researchers give to the control group?
  • someone has the idea, why not compare our dodgy syrup against something that is equally dodgy, perhaps even a bit unsafe?
  • the researchers are impressed and ask: but what precisely could we use?
  • let’s take antibiotics; they are often used for acute coughs, but the best evidence fails to show that they are helpful and they have, of course, risks,
  • another member of the team adds: let’s use children, they and their mothers are unlikely to understand what we are up to,
  • the team is in agreement,
  • Boiron, the world’s largest producer of homeopathic products, accepts to finance the study,
  • a protocol is written,
  • ethics approval is obtained,
  • the trial is conducted and even published by a journal with the help of peer-reviewers who are less than critical.

And the results of the trial? Contrary to the authors’ conclusion copied above, they show that two bogus treatments are worse that one.

BOB’S YOUR UNCLE!

EVERYONE SEEMS HAPPY: THE RESEARCHERS CAN ADD AN ARTICLE TO THEIR PUBLICATION LIST, BOIRON HAS MORE ‘EVIDENCE’ IN FAVOUR OF HOMEOPATHY, AND THE ETHICS COMMITTEE SLEEP JUST AS SOUNDLY AS THE PEER-REVIEWERS.

22 Responses to Homeopathy: no sense, no science and no ethics

  • “The homeopathic syrup was composed of: Anemone pulsatilla 6 CH, Rumex crispus 6 CH, Bryonia dioica 3 CH, Ipecacuanha 3 CH, Spongia tosta 3 CH, Sticta pulmonaria 3 CH, Antimonium tartaricum 6 CH, Myocarde 6 CH, Coccus cacti 3 CH, Drosera MT.”

    In Europe, ‘CH’ denotes the came dilution as US/UK ‘C’ (for ‘centum’). 1 in 100 repeated six times. 6 x 10>2 or 1 x 10>12 or 1 in 1000,000,000,000. Hahnemann advocated the use of 30C. 6D might not be potentised enough (!). Hahnemann also deprecated the use of poly-pharmacy, in orthodox preparations as well as homeopathic preparations (HP).
    How can it be said this syrup was ‘homeopathic’ at all?
    On what basis were the various individual HPs combined? Why some 3C and some 6C?

    Don’t bother to answer. Edzard’s already answered in the title to this thread.
    The ethics (and efficacy) of using anti-biotics for sore throats is currently robustly deprecated by UK authorities.
    No doubt also by The Faculty of Homeopathy – though as yet I cannot identify where they have made their position clear.

    • While homeopaths can make positive claims it will be homeopathic. If these high concentrations of material are shown to be toxic it will immediately be deemed non homeopathic

  • A cough “syrup” contains, well Syrup – a strong solution of sugars and ?????
    What exactly was in the syrup? Well assuming its this stuff http://www.chestal.com/about/chestalhoney/
    (or similar)

    “Inactive” ingredients listed are “Citric acid, Honey, purified water, sucrose (4.1g per 5 ml – ~80% solution), sodium benzoate”.

    1) Sodium Benzoate – Isn’t that a nasty unnatural preservative, how does the water keep its memory with that in it !!!
    2) 80% sugar solution (4.1 g in 5ml) – just give the kid a chewy toffee to suck!
    3) An obvious control should have been syrup alone with neither Antibiotic or Homeopathic stuff?
    4) Since there is nothing in Homeopathic stuff, they did show that antibiotics are no better vs just having some nice sugary syrup.
    5) Notice that they don’t list the “inactive” ingredients in declining weight order (which they would have to do if this was a food product).

  • Obviously, the right treatement for cough is large spectrum antibiotics. Or maybe it’s right leg amputation. I never remember.

    Those homeopathic studies are doing better and better, no doubt about it.

  • I can’t see a link to the paper, but if the authors really gave a combination of three antibiotics to children when even one wasn’t indicated they should be standing in court to justify their actions.

  • How they determened, whether coughing was due to upper respiratory tract infection, instead of athma, reflux or worms?
    And, of course, did they do all tests, to assure, infection was not viral?

  • The abstract of their previous study which is at http://www.ncbi.nlm.nih.gov/pubmed/23714686 claimed it showed the syrup “was able to effectively reduce cough severity and sputum viscosity” by comparing administration of the homeopathic syrup or a placebo for a week.
    An abstract is too little to decide on the merits of the study, but this later paper suggests their understanding is no good.

  • I just received an email from a homeopathy fan that fits well into the context of this blog, and take the liberty to reproduce it here:
    Dear Dr. Ernst

    I was not only disappointed but perplexed after reading the contents of the interview you gave FOCUS magazine which appeared in their April 2015 issue.

    Firstly with all due respect of your medical degree “hands on” training in homeopathy is far from enough to qualify you as having enough expertise in Homeopathy to comment about it. Did you study it at a reputable homeopathic school for at least three years? Have you been involved in a homeopathic proving? Have you ever been the patient of an experienced classical homeopath? If you were to answer affirmatively to any of these three questions you would not be make misinformed statements like those you made in FOCUS magazine.

    With respect to the Like Cures Like tenet of homeopathy please refer to what Hippocrates said about this theorem. As a practical experiment please do the following: Superficially scald your left and right hands on a hot container in a hot oven. Have two bowls at the ready: one with cold water and one with hot (not enough to burn you but as hot as you can stand the water). After scalding yourself put one hand in the hot water, the other in the cold water. The one in cold water will get immediate relief but will heat up and feel uncomfortable afterwards. The scalded hand submersed in hot water will at first feel “burned” when placed in the bowl with the hot water but then you will get much more relief thereafter. Dry both hands and then rub a bit of lavender oil (this is not homeopathy but aromotherapy) on the hand that was in hot water only.

    Please reply to me after doing this experiment with your findings – I think you will then be able to start back at one of the basics of homeopathy and begin to learn more about the science of it.

    Thanks.

    Best regards…

    • Please, please, please publish more of your fan mail…

    • Professor Edzard, I hope you replied to this imbecile with the entirety of your credentials, but also told this absolute moronic imbecile that they are indeed a waste of space on this fine planet that we cohabit!! It amazes me that this isn’t a more pressing topic to the lay person. If only homeopathy was comparable to a video of a cute little kitten trying to catch a laser dot on a carpet, then the masses would be up in arms!! Or, just maybe, if more people with serious conditions, and I really hope this doesn’t happen, start refusing actual treatment and start using homeopathy the lay person, or the friend or family member, will actually see the firsthand the problem with this useless quackery!! (I had to get the word “quackery” in there somewhere)

      • Ben

        Maybe not the millions of views a cute cat video might get, but ‘Dr’ Charlene Werner’s video explaining homeopathy (apparently) has had a quite respectable 260,000 views:

        https://www.youtube.com/watch?v=kA6rUU0K9xE

        • That is an admirable amount of views indeed. However views don’t mean people care as I’m sure you well know. If people really cared about stopping quackery they would get out there and tell the local politician to do something about it. They would tell their local pharmacy that until they stop selling it they won’t buy their meds there.

          • Oh, I do care and I do a lot to stop quacks making misleading claims and encourage others to do the same. See my website for details.

          • yes, you do more than Ben, as far as I can see.

          • I haven’t claimed to do more than Alan!! All I’ve done is lament over the fact that the lay person either doesn’t actually know what homeopathy is or doesn’t care enough about it to make a change. People like you and Alan, and many others, are very proactive on the subject, which I haven’t denied.

          • I’ve seen your website, it’s very good indeed. I haven’t said you don’t care.

          • When I come across people who use alt-med, I try to explain what alt-med is and how it cannot work. I cite the good prof’s work, and Cochrane has research that shows it does not work. I also do complain to pharmacies, and their governing body, about nonsense homeopathy.

            Some listen, however, many people don’t even know how electricity lights a bulb and just cannot comprehend what I try to say. Einstein was right; human stupidity is infinite.

    • (S)he forgot to mention that you should do this experiment double blinded, professor.

      Reminds me of a childhood joke:
      If you stand with one foot in a bucket of boiling water and the other in a bucket of ice water, on average you will feel fine.

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