MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Monthly Archives: November 2015

When the British Medical Journal (BMJ) asked me for an interview, I felt very honoured and obliged with great pleasure. The result was published in the BMJ earlier this year. I take the liberty of re-publishing it here on my blog because many of my readers do not see the BMJ, and I think it’s rather fun. Moreover, I hope it might provide my critics with more diverse material for ad hominem attacks – the constant allegations that I am in the pocket of ‘Big Pharma’, that I have never done any original research etc. etc. are getting just too boring.

HERE IT IS

Edzard Ernst is a champion of clear thinking in the often murky waters of alternative medicine. As Britain’s first professor of the subject at Exeter, he investigated claims made by its practitioners and found many to be devoid of supporting evidence. He was productive and highly visible and became a bit of an embarrassment to a craven university administration when he took on the Prince of Wales. He was frozen out, as he explains in his book A Scientist in Wonderland (subtitled A Memoir of Searching for Truth and Finding Trouble). Despite it all he, a German by birth, remains a phlegmatic Anglophile.

What was your earliest ambition?

As a young man I wanted to become a jazz musician. I practised enthusiastically—first on the clarinet, then on the drums—and if it had not been for my mother I might have ended up as a (not all that brilliant) drummer.

Who has been your biggest inspiration?

Hans and Sophie Scholl, two Munich University students and members of the White Rose resistance group who opposed Hitler by distributing leaflets at the university. On 23 February 1943, only five days after their arrest, they were executed.

What was the worst mistake in your career?

Most of my friends thought that leaving my chair in Vienna to become a researcher of alternative medicine was a grave error.

What was your best career move?

Leaving Vienna and becoming a researcher of alternative medicine.

Bevan or Lansley? Who has been the best and the worst health secretary in your lifetime?

Bevan is an undisputed hero who, in my view, cannot possibly be surpassed by the Lansleys of this world. The worst heath secretary will be the one who finally completes the Tory sell off of the NHS.

Who is the person you would most like to thank and why?

My mother for bringing me into this world and for steering me in the right direction with love and determination.

To whom would you most like to apologise?

To all the patients who, day in, day out, become victims of some form of quackery. It should have been my job to warn them and to point them towards treatments that actually work.

If you were given £1m what would you spend it on?

I might start a charity dedicated to counterbalance the overwhelming amount of misinformation about alternative medicine that consumers constantly have to endure.

When are you happiest?

When I manage to give to others in a way that is truly appreciated.

What single unheralded change has made the most difference in your field in your lifetime?

The intervention of the self proclaimed “enemy of the enlightenment” who advocates “integrated medicine” for the NHS that, for the most part, is unmitigated quackery. Prince Charles certainly made a difference in my field, albeit not in a positive way.

Do you support doctor assisted suicide?

Doctors should be able (but not obliged) to assist their patients in this way.

What book should every doctor read?

My memoir, A Scientist In Wonderland, of course. But not really—I find the idea of one book for all doctors a little bizarre.

What poem, song, or passage of prose would you like mourners at your funeral to hear?

When they are about to go home I’d like them to listen to the Bonzo Dog Doo-Dah Band performing “I’m Going to Bring a Watermelon to My Girl Tonight.”

What is your guiltiest pleasure?

Research! During the past 20 years pen pushers of various kinds have managed to make it feel like a guilty pleasure.

If you could be invisible for a day what would you do?

I would try to do some mischief that benefits all of us, such as transferring all bankers’ bonuses to the NHS or vaccinating the children of “anti-vaxxers.”

Clarkson or Clark? Would you rather watch Top Gear or Civilisation? What television programmes do you like?

I have to admit that I do sometimes watch Clarkson, mostly to learn how to avoid coming across like a middle aged chauvinist. If, however, I want to have a good time in front of my TV I watch a Bond film, only to doze off after the opening sequence.

What is your most treasured possession?

My memories of friends and family, of good times and tears of laughter.

What, if anything, are you doing to reduce your carbon footprint?

Wearing one or, if necessary, two extra layers (sometimes even thermal skiing underwear) when an icy wind makes our Suffolk home too cold for comfort.

What personal ambition do you still have?

To be on the BBC Radio 4 programme Desert Island Discs. It would be such a fun way to link life, medicine, and music.

Summarise your personality in three words

Stubborn, compassionate, rational.

Where does alcohol fit into your life?

As a collector of fine Bordeaux wines, I can hardly deny that it often fits very well indeed.

What is your pet hate?

Administrators who seem to think that the prime role of everyone else is to accommodate their whims.

What would be on the menu for your last supper?

As long as the wine for the main course is a Chateau Latour from a good year, I don’t mind.

Do you have any regrets about becoming a doctor and academic?

None whatsoever.

If you weren’t in your present position, what would you be doing instead?

I would probably be sitting behind a drum kit making even more disturbing noises.

A recent article in the LIVERPOOL ECHO caught my eye. It is about the possibility that the NHS in Liverpool might stop funding their homeopathy service . Maybe I should read the LIVERPOOL ECHO more often, because the short article is most revealing.

It first cites the chairman of the local NHS Clinical Commissioning Group, Dr Nadim Fazlani saying that “There is little evidence that homeopathy has a clinical benefit so, as a governing body, our preferred option would be to stop commissioning this service. However, it is important that the people have an opportunity to provide their views before a decision is made.”

Fair enough!

I would like to mention, however, that health care is not a beauty contest or a supermarket shelve. We don’t have popular votes for bone marrow transplants or bypass surgery either. Why? Not because we don’t believe in democracy but because the general public cannot possibly understand medicine well enough. This is why we send some of our kids to medical school and other institutions to help us comprehend and eventually take responsible decisions for us. It is, I think, an ethical imperative to base important health care decisions of this nature on the best evidence and expertise, and it seems foolish to expect the public to have either.

Then the article in the LIVERPOOL ECHO quotes a statement of the Liverpool homeopathy service which is run by GPs Dr Hugh Nielsen and Dr Sue de Lacy: “The patients we see generally have long-standing, complex conditions that are often difficult to treat with conventional medicine. Yet regular audits of our clinic show a very high level of patient satisfaction, with patients consistently reporting an improvement in their health. As experienced doctors trained in homeopathy we see it working every day and that is why we believe Liverpool CCG – and more importantly the patients the CCG serves – is getting excellent value for the relatively small amount of funding the service receives.”

I find this interesting, not least because the arguments used by these two GPs are, in my view, miles better than those we have seen on this blog recently by Christian Boiron, Dana Ullman, Dr Michael Dixon or the Queen’s homeopath Dr Fisher all put together. At least they do not contain blatant lies!

This does not mean, however, that the arguments of the two homeopaths from Liverpool are convincing. They are not – for the following 4 reasons:

  1. True, long-standing, complex conditions are often difficult to treat with conventional medicine. But if they are difficult to treat with real medicine, they surely are even more difficult to treat with fake medicine.
  2. I have no problem believing that their audits show high level of patient satisfaction, with patients consistently reporting an improvement in their health. But we need to be quite clear that these effects are not brought about by the homeopathic remedies which contain zero active ingredients. They are due to the compassion shown by these homeopath. If they prescribed real medicine in addition to providing compassion, their results would in all likelihood be even better.
  3. It is also true that an experienced doctor trained in homeopathy will see it working every day. But the ‘it’ refers not to the remedy, it relates to the compassion – and to convey compassion, we do not need bogus treatments.
  4. It is a little misleading to claim that homeopathy is ‘excellent value’. The remedies contain nothing but lactose, and £ 5-10 for a gram or two of lactose is jolly expensive! So, the remedies are over-priced placebos, and the consultations might be good value.

Despite these counter-arguments, I must congratulate these two GPs from Liverpool: they seem to be so much more honest and intelligent than the defenders of homeopathy mentioned above.

Anyone who has looked into the discussions around homeopathy for more than 10 minutes will have come across Dana Ullman (DU). Some 15 years ago, I had the pleasure to meet him in person during a conference in Boston. After the brief chat, I asked a UK homeopath who this bizarre person was. “Oh Dana!” he replied “Dana is alright.”

But is he? Let’s have a look at the evidence.

There are very few papers by DU listed in Medline, and most of these articles are simply opinion pieces. The opinions DU expresses there (or anywhere else) are usually not supported by good evidence; some of them are even outright dangerous. Here are a few quotes:

“…homeopathic care is cost effective…”

“…homeopathic medicines are effective…”

“…homeopathic medicine may play a useful role as an adjunctive and/or alternative therapy [for HIV infections]”

“[There are]…significant effects of homeopathic treatment in allergic patients.”

Occasionally, DU writes little essays full of utter nonsense, logical fallacies and falsehoods for HUFFPOST where he is nevertheless characterised in glowing terms: Dana Ullman, M.P.H. (Masters in Public Health, U.C. Berkeley), CCH (Certification in Classical Homeopathy) is “homeopathic.com” and is widely recognized as the foremost spokesperson for homeopathic medicine in the U.S.

Wikipedia, however, is more critical and cites the opinion of a judge who was presiding over a class action against a US homeopathic producer in which DU had been called as an expert witness: The Defendant presented the testimony of Gregory Dana Ullman who is a homeopathic practitioner. He outlined the theory of homeopathic treatment and presented his opinion as to the value and effectiveness of homeopathic remedies. The Court found Mr. Ullman’s testimony to be not credible. Mr. Ullman’s bias in favor of homeopathy and against conventional medicine was readily apparent from his testimony. He admitted that he was not an impartial expert but rather is a passionate advocate of homeopathy. He posted on Twitter that he views conventional medicine as witchcraft. He opined that conventional medical science cannot be trusted…Mr. Ullman’s testimony was unhelpful in understanding the purported efficacy of the ingredients of SnoreStop to reduce the symptoms of snoring. Although he is familiar with the theory of homeopathic treatment, his opinions regarding its effectiveness was unsupported and biased. The Court gave no weight to his testimony.

The Encyclopedia of Americam Loons is even more poignant and describes DU as: A master of cognitive dissonance and memory bias, Ullman seems clinically unable to grasp the possibility that he may be wrong. Combined with a lack of understanding of science or medicine – and the possession of certain marketing skills – what we end up with is rather insidious.

Anyone who has debated with DU will have to concur with the claim that he fails to understand science or medicine. If you don’t believe me, please read his recent comments on the post about Prof Frass on this blog where he excels in producing one fallacy after the next (if he were on a mission to give homeopathy a bad name, he would be doing a sterling job!).

Despite all this abysmal ignorance, DU has one undisputed and outstanding talent: the knack of getting on people’s nerves and thus driving rational thinkers to distraction. In this way he even managed to be headlined as an ‘idiot‘!

I find it tempting to agree with the many experts who have called him an idiot, a moron or a laughing stock but, for now, I will resist that temptation. On the contrary, I want point out that he is much more cunning and clever than we give him credit for: after all, he runs a thriving business and lives off the nonsense he produces. To my mind, this is not idiotic; devious and unethical surely, but not idiotic nor laughable!

One of the most common claims of alternative practitioners is that they take a holistic approach to health care. And it is this claim which attracts many consumers. It also makes conventional medicine look bad, reductionist and inhuman, as it implies that mainstream medicine is non-holistic.

The claim can be easily disclosed to be a straw man, because all good medicine was, is and always will be holistic. Moreover, the claim amounts to a falsehood, because much of alternative medicine is everything but holistic. I will try to explain what I mean using the recent example of acupuncture for neck pain, but I could have used almost any other alternative treatment and any other human complaint/condition/disease:

  • chiropractic for back pain;
  • homeopathy for asthma;
  • energy healing for depression;
  • aromatherapy for jet lag;
  • etc. etc.

The recent trial found that adding acupuncture to usual care yields a slightly better outcome than usual care alone. This is hardly a big deal; adding a good cup of tea and a compassionate chat to usual care might have done a similar thing. Acupuncturists, however, will say that their holistic approach is successful.

How holistic is acupuncture?

A ‘Western’ acupuncturist would normally ask what is wrong with the patient; in the case of neck pain, he would probably ask several further questions about the history of the condition, when the pain occurs, what aggravates it etc. Then he might conduct a physical examination of his patient. Eventually, he would get out his needles and start the treatment.

A ‘traditional’ acupuncturist would ask similar questions, feel the pulse, look at the tongue and make a diagnosis in terms of yin and yang imbalance. Eventually, he too would get out his needles and start the treatment.

Is that holistic?

Certainly not! If we look at alternative practitioners in general, we cannot fail to notice that they tend to be the very opposite of holistic. They usually attribute a patients illness to one single cause such as yin/yang imbalance (acupuncture), subluxation (chiropractic), impediment of the life force (homeopathy), etc.

Holistic means that the patient is understood as a whole person. Our neck pain patient might have physical problems such as muscular tension; the acupuncturists might well have realised this and placed their needles accordingly. But neck pain, like most other symptoms, can have many other dimensions:

  • there could be stress;
  • there could be an ergonomically disadvantageous work place;
  • there could be a history of injury;
  • there could be a malformation of the spine;
  • there could be a tumour;
  • there could be an inflammation;
  • there could be many other specific diseases;
  • there could be relationship problems, et. etc.

Of course, the acupuncturists will claim that, during an acupuncture session, they will pick up on all of these. However, in my experience, this is little more than wishful thinking. And even if they did pick up other dimensions of the patient’s complaint, what can they do about it? They can (and often do) give rather amateur advice. This may be meant most kindly but it is rarely optimal.

And what about conventional practitioners, aren’t they even worse?

True, there often is far too much room for improvement. But at least the concept of multifactorial conditions and treatments is deeply ingrained in everyone who has been to medical school. We learn that symptoms/complaints/conditions/diseases are almost invariably multifactorial; they have many causes and contributing factors which can interact in complex ways. Therefore, responsible physicians always consider to treat patients in multifactorial ways; in the case of our neck pain patient:

  • the stress might need a relaxation programme,
  • the work place might need the input of an occupational therapist;
  • in case of an old injury, a physio might be needed;
  • specific conditions might need to be seen by a range of medical specialists;
  • muscular tension could be reduced by a massage therapist;
  • relationship problems might require the help of a psychologist; etc. etc.

I am NOT saying that all of this is necessary in each and every case. But I am saying that, in conventional medicine, both the awareness and the possibility for a professional multidisciplinary approach is well established. You don’t believe me? Ask a physiotherapist or an occupational therapist who refers more patients to them, an acupuncturist or a GP!

Alternative practitioners claim to be holistic and some might even be aware of the complexity of their patients’ symptoms. But, at best, they have an amateur approach to this complexity by dabbling themselves in issuing more or less suited advice. They are not adequately trained to do this job, and they refer very rarely.

My conclusion: professional multidiscipinarity is an approach deeply engrained in conventional medicine (we don’t often call it holism, perhaps because many doctors associate this term with charlatans), and it beats the mostly amateurish pseudo-holism of alternative practitioners any time.

Homeopathy seems to attract some kind of miracle worker. Elsewhere I have, for instance, reported the curious case of Prof Claudia Witt who published more than anyone on homeopathy in recent years without hardly ever arriving at a negative conclusion. Recently, I came across a researcher with an even better track record: Prof Michael Frass.

Wikipedia describes his achievements as follows: “Michael Frass studied medicine from 1972 to 1978 at the Medical University of Vienna followed by visits abroad at the Pasteur Institute, Paris and at the Porter Memorial Hospital (USA). Since March 2004 he directs the Outpatients Unit of Homeopathy for Malign Diseases at the Department Clinic for Internal of Medicine I at the Medical University of Vienna. Since 2005 Frass also works as a coordinator of the lecture series Homeopathy at the Medical University of Vienna. Beginning with the winter semester 2001/02 he is the coordinator of a lecture series Basics and practise of complementary medical methods at the Medical University of Vienna. From 2002 to 2005 he led the Ludwig Boltzmanm Institute of Homeopathy. Since 2005 Frass is president of the Institute for Homeopathic Research. Actually he works at the Division of Oncology at the Department of Medicine I in Vienna. He is First Chairman of the Scientific Society for Homeopathy (WissHom), founded in 2010, president of the Umbrella organization of Austrian Doctors for Holistic Medicine.”

He directs the WHAT? The Outpatients Unit of Homeopathy for Malign Diseases at the Department Clinic for Internal of Medicine I at the Medical University of Vienna? This is my former medical school, and I had no idea that such a unit even existed – but, of course, I left in 1993 for Exeter (a few months ago, I followed an invitation to give a lecture on homeopathy at the Medical University of Vienna ; sadly neither Prof Frass nor anyone of his team attended).

And what about the Scientific Society for Homeopathy? I am sure that the name of this organisation will make some people wonder. From the society’s website, we learn that “the intention of WissHom is to contribute to the progress of medicine and to the collective good. To this end, WissHom intents to further develop homeopathy both practically and theoretically. It will be WissHom’s task to breathe life into this committed objective.”

Breathing life into homeopathy seems exactly what Prof Frass does. He seems to have found his way to homeopathy relatively late in his career (the 1st Medline-listed article was published only in 2003) but he has nevertheless published many studies on this subject (I use the term ‘study’ here to describe both clinical, pre-clinical and basic research papers); in total, I found 12 such articles on Medline. They cover extremely diverse areas and a wide range of methodologies. Yet they all have one remarkable feature in common: they arrive at positive conclusions.

You find this hard to believe? Join the club!

But it is undeniably true, here are the conclusions (or the bit that comes close to a conclusion) from the Medline-listed abstracts (only the headings in capital letters are mine, and they simply depict the nature of the paper)

AN RCT WITH CANCER PATIENTS (2015)

Results suggest that the global health status and subjective wellbeing of cancer patients improve significantly when adjunct classical homeopathic treatment is administered in addition to conventional therapy.

TWO CASE REPORTS OF HOMEOPATHICALLY TREATED INTOXICATIONS (2014)

Based on the 2 cases, including 1 extreme situation, we suggest that adjunctive homeopathic treatment has a role in the treatment of acute Amanita phalloides-induced toxicity following mushroom poisoning. Additional studies may clarify a more precise dosing regimen, standardization, and better acceptance of homeopathic medicine in the intensive care setting.

RETORSPECTIVE ANALYSIS OF CANER SURVIVAL UNDER HOMEOPATHIC TREATMENT (2014)

Extended survival time in this sample of cancer patients with fatal prognosis but additive homeopathic treatment is interesting. However, findings are based on a small sample, and with only limited data available about patient and treatment characteristics. The relationship between homeopathic treatment and survival time requires prospective investigation in larger samples possibly using matched-pair control analysis or randomized trials.

OBSERVATIONAL STUDY OF HOMEOPATHIC TREATMENT FOR ALLERGIES (2012)

The symptoms of patients undergoing homeopathic treatment were shown to improve substantially and conventional medication dosage could be substantially reduced. While the real-life effect assessed indicates that there is a potential for enhancing therapeutic measures and reducing healthcare cost, it does not allow to draw conclusions as to the efficacy of homeopathic treatment per se.

IN-VITRO STUDY OF THE EFFECTS OF HOMEOPATHICS ON HELIOBACTER PYLORI (2010)

The data suggest that both drugs prepared in ethanolic solution are potent inhibitors of H. pylori induced gene expression.

SYSTEMATIC REVIEW OF HOMEOPATHY FOR RESPIRATORY ALLERGIES (2010)

Most of these clinical studies have been deemed to be high quality trials, according to the three most commonly referenced meta-analyses of homeopathic research. Basic in vitro experimental studies also provide evidence that the effects of homeopathy differ from placebo.

CASE SERIES OF PATIENTS TREATED WITH HOMEOPATHIC PETROLEUM (2008)

This study is based on 25 well documented reports of cases which responded well to treatment with Petroleum.

ANIMAL EXPERIMENT WITH HOMEOPATHY ( 2008)

Animals treated with the standard test solution thyroxine 10(-30) metamorphosed more slowly than the control animals, ie the effect of the homeopathically prepared thyroxine was opposed to the usual physiological effect of molecular thyroxine.

OVERVIEW OF HOMEOPATHIC TREATMENT IN INTENSIVE CARE (2005)

Our report suggests that homeopathy may be applicable even for critically ill patients.

RCT OF HOMEOPATHY FOR SEVERE SEPSIS (2005)

Our data suggest that homeopathic treatment may be a useful additional therapeutic measure with a long-term benefit for severely septic patients admitted to the intensive care unit. A constraint to wider application of this method is the limited number of trained homeopaths.

RCT OF HOMEOPATHY FOR COPD (2005)

These data suggest that potentized (diluted and vigorously shaken) potassium dichromate may help to decrease the amount of stringy tracheal secretions in COPD patients.

ANIMAL STUDY OF A HOMEOPATHIC REMEDY (2003)

These animals reacted to the homeopathically prepared thyroxine with a slowing down of metamorphosis, even when they had not been prestimulated with a molecular dose of the hormone. This effect was observed in all 3 laboratories and is consistent with the results of previous studies.

Surprised?

So am I!

How can homeopathy produce nothing but positive results in the hands of this researcher? How can it work in so many entirely different conditions? How is it possible that homeopathic remedies are better than placebo regardless of the methodology used? Why does homeopathy, in the hands of Prof Frass, not even once produce a result that disappoints the aspirations of homeopaths and its advocates? Why are these sensational results almost invariably published in very minor journals? Crucially, why has not one of the findings (as far as I can see) ever been independently reproduced?

I do not know the answers to these questions.

If anyone does, I would like to hear them.

I had thought that I know most alternative therapies. However, Shujing massage was new to me. It seems to be a massage technique from Traditional Chinese Medicine (TCM) along the Yin/Yang concept; a bit like Shiatsu perhaps.

Does it work?

This study might easily be the first to address this question. It was aimed at comparing the efficacy on insomnia between shujing massage therapy and medication with estazolam.

Eighty patients with insomnia were randomized into a shujing massage therapy group and a medication group. The massage was applied along the gallbladder meridian on the temporal area. Pressing and kneading manipulations were performed at Yangbai (GB 14), Benshen (GB 13), Toulinqi (GB 15), Zhengying (GB 17), Chengling (GB 18), Shuaigu (GB 8), and Fengchi (GB 20), etc. one minute at each acupoint. In the medication group, 1 mg estazolam was administered orally half an hour before sleep. The treatments were given once every day in both groups. After one month, the sub-scores and the total score of the Pittsburgh sleep quality index scale (PSQI) and the clinical efficacy were compared between the two groups.

After the intervention, the each sub-score of PSQI was improved as compared with that before treatment in the patients of the two groups. The differences in sleep time and the time for falling into sleep were not significant between the two groups. In the shujing massage group, the scores of sleep quality, sleep efficiency, sleep disturbance and daytime dysfunction, as well as the total score were all lower than those in the medication group. The response rate was 92.1% (35/38) in the shujing massage group and 84. 2% (32/38) in the medication group.

The Chinese authors concluded that Shujing massage therapy achieves the superior efficacy on insomnia compared with the oral administration of estazolam.

Sadly, this study is less conclusive as TCM-enthusiasts may think:

  • the study was not blind; therefore placebo-effects might have produced a false-positive result;
  • any massage is relaxing; therefore the effect could be entirely unrelated to TCM-philosophy;
  • it is likely that the regular ritual of a massage has a beneficial effect on sleep;
  • before we agree with these findings, we should insist on an independent confirmation via a more rigorous study.

I think that, before we accept the ‘efficacy’ of this TCM-treatment, we should see much more convincing evidence.

Homeopathy has its fair share of lunes who are unable to make a reasonable case for it without telling overt falsehoods; we have seen some of then on this blog, for sure. Therefore I was encouraged to finally find a well-argued, rational defence of homeopathy. It comes from an unlikely source – Christian Boiron (CB) is the General Manager of the world’s largest manufacturer of homeopathics ‘BOIRON’ with a turn-over of more than 600 million Euros annually. Some would have thought he could be a trifle biased, but no – judge for yourself.

In a recent, short interview (unfortunately it is in French, so you have to trust my translations) CB rightly pointed out that “Il y a un Ku Klux Klan contre l’homéopathie” THERE IS A KU KLUX KLAN AGAINST HOMEOPATHY. About time that someone calls a spade a spade, I’d say. I think others have previously called those who doubt the miracle of homeopathy ‘fascists’ – but ‘KKK’ is much better, more to the point. Sceptics have indeed a long and infamous habit of stringing everyone who disagrees with their views up on a tree.

The interview refers to the report from the Australian NHMRC which showed that homeopathy is not effective and can even be dangerous. How can this be? Fortunately CB knows the answer: “…personne ne comprend rien”. The panel members were all ignorant! Thanks for clearing that up CB; were they also members of the KKK?

After all, homeopathy is 200 years old, it is now well-grounded in science and accepted throughout the world (“L’homéopathie, qui a 200 ans, évolue avec les connaissances de la science. La France l’a relancée dans un axe totalement scientifique et lui a donné une reconnaissance mondiale”) That surely needed to be said, and don’t you KKK members dare pointing out the occasional fallacy here! Because CB is the first to be critical (“Je suis le premier à être le plus critique”).

What about studies of homeopathy that fail to be as convincingly positive as CB might have hoped? “Quand on dit qu’il faut démontrer en médecine et que la médecine est une pratique scientifique ce sont deux idioties.” Yes, well said CB, the assumption that medicine should become scientific is indeed idiotic. Medicine is about individuals, not statistics; Hahnemann realised this, of course, and thus showed us the way to the future in health care.

And to finish this elating encounter with one of the brightest buttons in any homeopathic drawer: “On croit savoir énormément de choses alors qu’il y a beaucoup qu’on méconnait”. ONE THINKS ONE KNOWS A LOT BUT THERE IS PLENTY ONE MISUNDERSTANDS”

I think even those terrible KKK members amongst my readers might agree with CB here, particularly if this remark introspectively refers to himself.

***a note to homeopaths and their libel lawyers: this post is SATIRE

No, I kid you not!

This abstract was actually published in the leading chiro-journal. The authors include three professors from the Canadian Memorial Chiropractic College, Research, Toronto, Canada. Its title is impressive but made my alarm bells ring a bit:

A Randomized Pragmatic Clinical Trial of Chiropractic Care for Headaches With and Without a Self-Acupressure Pillow.

And the actual texts does not disappoint those looking for of pure pseudo-science:

The purpose of this study was to determine if the addition of a self-acupressure pillow (SAP) to typical chiropractic treatment results in significantly greater improvement in tension-type and cervicogenic headache sufferers.

METHODS:

A pragmatic randomized clinical trial was conducted in a chiropractic college teaching clinic. Thirty-four subjects, including tension-type and cervicogenic headache sufferers, 21 to 60 years of age, male or female, completed the study. Group A (n = 15) received typical chiropractic care only (manual therapy and exercises), and group B (n = 19) received typical chiropractic care with daily home use of the SAP. The intervention period was 4 weeks. The main outcome measure was headache frequency. Satisfaction and relief scores were obtained from subjects in the SAP group. Analysis of variance was used to analyze the intergroup comparisons.

RESULTS:

Owing to failure of randomization to produce group equivalence on weekly headache frequency, analysis of covariance was performed showing a trend (P = .07) favoring the chiropractic-only group; however, this was not statistically significant. Group A obtained a 46% reduction of weekly headache frequency (t = 3.1, P = .002; d = 1.22). The number of subjects in group A achieving a reduction in headaches greater than 40% was 71%, while for group B, this was 28%. The mean benefit score (0-3) in group B of the use of the SAP was 1.2 (.86). The mean satisfaction rating of users of the SAP was 10.4 (2.7) out of 15 (63%).

CONCLUSION:

This study suggests that chiropractic care may reduce frequency of headaches in patients with chronic tension-type and cervicogenic headache. The use of a self-acupressure pillow (Dr Zaxx device) may help those with headache and headache pain relief as well as producing moderately high satisfaction with use.

Where to begin?

Perhaps it is best, if I simply concentrated on the bizarre research question: is chiropractic care plus the largely uncontrolled use of an ‘acupressure cushion’ better than chiropractic care alone? To savour the lunacy of it, we need to consider that:

  • chiropractic is not plausible;
  • chiropractic care is not proven to be effective for headaches;
  • acupressure is not plausible;
  • acupressure is not proven to be effective;
  • a self-administered acupressure cushion is also unproven and even less plausible;

This, I fear, renders the study one of the most nonsensical trials I have seen for a very long time. To make the bonanza in pseudo-science complete, the article is supplemented with a most bizarre conclusion about the effectiveness of chiropractic (which, of cause, cannot be examined in a trial of chiro vs chiro).

All this leads me to fear that:

  • the best journal of chiropractic is rubbish;
  • a professorship in a chiro school may not mean that the professor has the slightest idea about research methodology;
  • chiropractors will try to squeeze a conclusion that is favourable for their trade even out of a dead horse.

We could have expected it, couldn’t we? With so much homeopathy in the press lately, Dr Dixon (we have seen him on this blog before, for instance here, here and here) had to comment. His article in yesterday’s NURSING IN PRACTICE is far too perfect to abbreviate it; I just have to cite it in full (only the reference numbers are mine and refer to my comments below).

HERE WE GO

Should homeopathy be blacklisted in general practice?

I have not prescribed them myself but I know of many GPs and patients who find homeopathic preparations helpful, especially in clinical areas where there is no satisfactory conventional treatment [1]. They are cheap and entirely safe [2], which cannot always be said of conventional treatment [3]. Is the concern about cost? That is implausible as GP prescriptions cost a mere £100,000 per annum, approximately £10 per UK General Practice but effectively less as some patients will be paying for them and they may reduce other prescriptions or medical costs [4]. Is it about evidence? [5] Possibly, and that is because the necessary pragmatic trials on comparative cost effectiveness have never been done [6]. Homeopathy thus joins the frequently quoted 25% of general practice activity that has an insufficient evidence base… So, why not do the research rather than single out homeopathy for blacklisting [7]? Apparently, because it irritates a powerful fraternity of “scientists” [8] with a narrow biomedical perspective on health and healing, who feel the need to impose their atheism [9] on others. They seem opposed to “patient-centred medicine” which factors in the mindset, culture, history, wishes and hopes of each patient, and a wider concept of science that might take account of them [10]. Led by the World Health Organization, many countries are examining the appropriate role of complementary and traditional medicine (CAM). Indian Prime Minister Modi has created the first minister for medicine in this area (called AYUSH with the “H” standing for homeopathy). Australia, whose government and medical deans (unlike the UK ) are not intimidated by this breed of scientific fundamentalism, has invested money in research, regulated its herbal [11] practitioners and created important trade links with China in this area [12]. Meanwhile the UK invests 0% of its research budget on CAM and appears to have a closed mind [13]. General practice is at its best a subtle and complex blend of science and art combined in a heady mixture, which recognises personal belief and perspective and respects differences [14]. Blacklisting homeopathy would be the thin edge of the wedge. It would be a mean-minded act of outside interference by many who do not treat patients themselves, denying patient choice and signifying a new age of intolerance and interference [15]. It is a threat to the autonomy of general practice that should concern every GP and patient whatever their views on homeopathy [16].

About the Author

Mike Dixon

Chairman of the NHS Alliance and a GP

Mike Dixon, chairman of the NHS Alliance and a GP at College Surgery in Cullompton, Devon and a Royal College of General Practitioners presidential candidate.

END OF QUOTE AND BEGINNING OF MY DELIBERATELY BRIEF COMMENTS

  1. Whenever this argument comes up, people fail to cite an example. Are they afraid that we would point out what can be done for such a patient other than prescribing placebos?
  2. Actually, they are extremely expensive considering that they are just lactose or water. And the claim that homeopathy is safe merely displays an embarrassing lack of knowledge; see the many posts on this blog that deal with this issue.
  3. Classical ‘tu quoque’ fallacy; display of the ignorance of the risk/benefit concept for judging the value of medical interventions.
  4. Display of ignorance regarding the actual evidence, see here, for instance.
  5. Yes, it’s the evidence but also it’s the biological implausibility and the fact that disregarding it undermines rationality in general.
  6. Pure ignorance again, see my point 4.
  7. Are ~ 300 clinical trials and about 100 systematic reviews not enough? How much more money needs to be wasted?
  8. It seems that Dixon has a problem with science and those who pursue it to improve future health care for the benefit of patients.
  9. Does Dixon admit that homeopathy is a religion?
  10. Patient-centred medicine which factors in the mindset, culture, history, wishes and hopes of each patient, and a wider concept of science that might take account of them – does Dixon not know that all good medicine fits this description, but homeopathy certainly does not?
  11. Every one with an IQ above 50 knows by now that herbal is not homeopathic; is Dixon the exception?
  12. What about the Australian report which concluded that “Homeopathy should not be used to treat health conditions that are chronic, serious, or could become serious. People who choose homeopathy may put their health at risk if they reject or delay treatments for which there is good evidence for safety and effectiveness. People who are considering whether to use homeopathy should first get advice from a registered health practitioner. Those who use homeopathy should tell their health practitioner and should keep taking any prescribed treatments.”
  13. This is simply not true, and Dixon should know it.
  14. No reason to include disproven nonsense like homeopathy.
  15. Intolerance is on Dixon’s side, I think. Improving health care by abandoning disproven therapies in favour of evidence-based treatments is no interference, it’s progress.
  16. This can only be true, if we misunderstand autonomy as arbitrariness without rules, checks, ethics and controls. Good general practice has, like all medicine, be in the best interest of patients. An obsolete, expensive, unsafe, ineffective and implausible treatment is clearly not.

Not long ago, Peter Fisher fired me from the editorial board of ‘his’ journal ‘HOMEOPATHY’. I thought that this was a surprisingly daft move, particularly as we used to have respect for each other and even published together as co-authors (for instance here). But perhaps I should not have been surprised because, already in 2007, he published an important, potentially libellous falsehood about me.

In this article which he published as Dr. Peter Fisher, Homeopath to Her Majesty, the Queen, he wrote: There is a serious threat to the future of the Royal London Homoeopathic Hospital (RLHH), and we need your help…Lurking behind all this is an orchestrated campaign, including the ’13 doctors letter’, the front page lead in The Times of 23 May 2006, Ernst’s leak of the Smallwood report (also front page lead in The Times, August 2005), and the deeply flawed, but much publicised Lancet meta-analysis of Shang et al…

If you have read my memoir, you will know that even the hostile 13-months investigation by my own university did not find me guilty of the ‘leak’. The Times journalist who interviewed me about the Smallwood report already had the document on his desk when we spoke, and I did not disclose any contents of the report to him. But the truth in homeopathy seems often highly diluted.

More recently, Peter Fisher could be heard on UK radio and TV (for instance here) making further claims which, in my view, are false. Specifically, I am thinking of two of his statements which would mislead the public, if they stood uncorrected:

  1. He said that the studies unanimously show that integrating homeopathy into conventional medicine improves outcomes and saves money.
  2. He also claimed that most of the homeopathic remedies available in the high street still contain small amounts of active ingredients.

POINT NUMBER 1

It seems obvious that adding homeopathy with its lengthy, compassionate encounters to conventional care can easily generate positive outcomes. But costs? I don’t see unanimously positive evidence here at all.

Dr Fisher must know the literature on homeopathy very well. Therefore I assume that he is aware of the most up-to-date systematic review of economic evaluations of this subject. Its authors from the ‘School of Health and Related Research’, University of Sheffield concluded that “it is… not possible to draw firm conclusions based on existing economic evaluations of homeopathy“.

Fisher knows and likes to quote Claudia Witt’s work on homeopathy. Why does he not cite this recent paper then?

OBJECTIVES:

The aim of this study was to compare the health care costs for patients using additional homeopathic treatment (homeopathy group) with the costs for those receiving usual care (control group).

METHODS:

Cost data provided by a large German statutory health insurance company were retrospectively analysed from the societal perspective (primary outcome) and from the statutory health insurance perspective. Patients in both groups were matched using a propensity score matching procedure based on socio-demographic variables as well as costs, number of hospital stays and sick leave days in the previous 12 months. Total cumulative costs over 18 months were compared between the groups with an analysis of covariance (adjusted for baseline costs) across diagnoses and for six specific diagnoses (depression, migraine, allergic rhinitis, asthma, atopic dermatitis, and headache).

RESULTS:

Data from 44,550 patients (67.3% females) were available for analysis. From the societal perspective, total costs after 18 months were higher in the homeopathy group (adj. mean: EUR 7,207.72 [95% CI 7,001.14-7,414.29]) than in the control group (EUR 5,857.56 [5,650.98-6,064.13]; p<0.0001) with the largest differences between groups for productivity loss (homeopathy EUR 3,698.00 [3,586.48-3,809.53] vs. control EUR 3,092.84 [2,981.31-3,204.37]) and outpatient care costs (homeopathy EUR 1,088.25 [1,073.90-1,102.59] vs. control EUR 867.87 [853.52-882.21]). Group differences decreased over time. For all diagnoses, costs were higher in the homeopathy group than in the control group, although this difference was not always statistically significant.

CONCLUSION:

Compared with usual care, additional homeopathic treatment was associated with significantly higher costs. These analyses did not confirm previously observed cost savings resulting from the use of homeopathy in the health care system.

To speak about unanimously positive evidence is simply not true! And Fisher, I suspect, must know it.

POINT NUMBER 2

This point is even clearer, I think. The most commonly used homeopathic potency is surely a ’30C’ – it was already Hahnemann’s favourite. A small statistic proves my point: of the 24 products listed on the Nelson site, 21 are ’30C’ and just three are ‘6C’. For Ainsworths, all 33 of their listed standard products are ’30C’. Helios have 70 ’30C’ products and 27 ‘200C’ products

The likelihood that a ’30C’ contains a single molecule of what it says on the bottle is precisely zero. In fact, this applies already to all remedies beyond ’12C’. Fisher knows that, of course, I assume; if not he should not be a homeopath.

MY CONCLUSION OF ALL THIS

I do not take any pleasure in calling anyone a liar – and it is, of course, far from me to use this word in connection with the Queen’s homeopath. Therefore, in the interest of the scientific truth, medical ethics and honesty, I would like to give Dr Fisher the opportunity to comment on the above issues and herewith invite him to correct the three errors/falsehoods/inaccuracies/misunderstandings mentioned above by supplying the evidence for his statements or by withdrawing them. Then we won’t have to call him names which he might feel are hurtful.

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