MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Monthly Archives: December 2015

At this time of the year, journalists like to review what has happened during the previous year. I am not a journalist, just an alt med researcher, and I don’t want to review the 10 most important events but the non-events, that is 10 relevant things that should have happened in the realm of alt med but unfortunately didn’t happen. Needless to say: my choice is subjective, personal and highly biased.

Here we go, in no particular order:

WHO

In 2014, the WHO published the WHO TRADITIONAL MEDICINE STRATEGY 2014 – 2023. Amazingly, it has all the hallmarks of a promotional document that lacks critical input: “The strategy aims to support Member States in developing proactive policies and implementing action plans that will strengthen the role TM plays in keeping populations healthy.” In my view, those officials within the WHO who are capable of critical assessment should have spotted the danger of this strategy and, by 2015, have managed to withdraw this shameful paper, as it can only discredit this otherwise reputable organisation.

BCA

After suing my friend Simon Singh and losing the case, lots of money and even more reputation, the BCA and the chiropractic profession at large should have not only apologised to Simon but also taken more decisive actions to ensure that chiropractors around the world stop misleading the public about what they can contribute to human health. Sadly this blog has shown more than once that bogus claims still abound and chiropractors are still unable to criticise even the most extreme excesses of quackery in their ranks.

HOMEOPATHY

The International Council for Homeopathy (ICH) “is the international professional platform representing professional homeopaths and the practice of homeopathy around the world. ICH presently consists of 31 professional associations of homeopaths from 28 countries in four continents, and aims eventually to have member associations in all continents. Through networking and dialogue, members of ICH engage in the promotion and evaluation of the status of homeopathy in every part of the world; with emphasis on the development of international guidelines promoting freedom of access to the highest possible standard of homeopathic care.” With such high, self-declared aims, the ICH would have been in the ideal position to inform its members that the most transparent and thorough investigation of homeopathy 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.” Sadly, homeopaths all over the world prefer to go into a state of denial and carry on as before – to the detriment of public health worldwide.

FISHER

Peter Fisher, the homeopath of the Queen, has been shown to have published an important lie about me. In the interest of honesty, of his reputation and that of homeopathy, he should have retracted it and apologised. The fact that he has chosen to remain silent is, I think, a telling tale about the standards of truth in homeopathy.

PRINCE CHARLES

Prince Charles is one of the most prominent promoters of INTEGRATED MEDICINE. He may not have the wit to understand the issues involved but he certainly has access to the best advisors money can buy. By now, he should have realised that the yes-men he has been using are not up to the job of providing reasonable advice on alt med. Therefore he should have recruited proper experts who would have told him that adding unproven treatments to evidence-based medicine is not going to be an improvement. Sadly, Charles’ promotion of quackery continues unabated.

BOIRON

Christian Boiron, the General Manager of the world’s largest manufacturer of homeopathic remedies, ‘BOIRON’, recently stated that the critics of homeopathy are like the Ku Klux Klan. This embarrassing statement reflects a level of stupidity and arrogance that can only be harmful to his firm and homeopathy in general. The fact that it was not withdrawn does not bode well for either of them.

ULLMAN

Dan Ullman is one of the tireless [and tiresome] entrepreneurs in US homeopathy. I recently dedicated a blog-post to him where he commented copiously and was subsequently shown to be wrong on many issues. This would have been the right moment for him to give up selling bogus drugs and misleading literature. Unfortunately, the comments did not offer any hope that fanatics like him can be brought to their senses. This sad course of events suggests, I fear, that homeopathic delusions of this nature are too severe to cure.

SCIENTIFIC FRAUD

During these discussions, one commentator provided disturbing suspicions that one of the recent ‘flag-ship’ evidence for homeopathy might be fraudulent. The author of the paper in question, who had been a keen participant of the discussions, should have responded and argued his case. Instead his comments on this blog abruptly stopped, a fact that most experts might interpret as an admission of guilt.

SMITH

My Vice Chancellor at Exeter, Steve Smith, should have read 2015 my memoire, which suggests that he behaved less than honourably, and he should then have responded to it. Instead, Exeter opted to ignore not only my book but also the award of the John Maddox Prize 2015. It is up to the reader to decide how this non-action ought to be interpreted.

PHARMACISTS

The ‘INTERNATIONAL PHARMACEUTICAL FEDERATION’ has the slogan ‘advancing pharmacy worldwide’ in their logo. Therefore it seems to be the right organisation to remind pharmacists across the globe that they are not shopkeepers but a healthcare profession with ethical codes and moral responsibilities. Therefore they should have reminded community pharmacists, pharmacy chains and other interested parties that selling disproven remedies like homeopathy, Bach Flower Remedies, ineffective cough syrups etc. is a violation of pharmacists’ codes of ethics.

Any post about non-events and missed opportunities is a somewhat frustrating affaire. At the same time, it also offers hope: perhaps 2016 will see (some of) them happening?

It is Christmas time – one cannot possibly fail to realise it, if only by listening to the perennial reports about our hospitals and GP surgeries being over-stretched to breaking point.

Will we cope?

Sure we will – after all, we can rely on our homeopaths! Yet again, they are at the ready to help out and prevent a disaster.

What, you don’t believe me? But it must be true, just look at this tiny selection of what homeopaths currently say on the internet:

Where to begin… Let’s start with my favorite holiday event: Eating-To-Excess.  From there we slide over to the Too-Much-Drinking Marathon, the Suicidal Depression Derby, the Slipping On Ice, Falling Off Ladders and Sleep Deprivation Triathlon… the World Series of Overwork, Tension Headaches, Anxiety About Seeing Your Relatives and… maybe we should just cancel this holiday altogether! Fortunately, homeopathy can help. 

Stressed before Christmas?  Well the good news is that many of these emotions can quickly be tackled with Homeopathy, helping you relax and get back into the swing of the festive season…

Here’s how homeopathy can help make your Christmas a happy one…Consultation fees vary from homeopath to homeopath – please ring us for details and to book an appointment.

Give the gift of health this Christmas with our Homeopathy Gift Sets. These sets have been carefully put together by registered homeopathy Jenny Livingstone M.A., R.S.Hom. There are three kits to choose from: the first aid kit for those little emergencies, the travellers kit for those on the road and for our mums to be – the birthing kit. The kits are priced at £45…

THE HOMEOPATHIC CHRISTMAS SURVIVAL KIT: Christmas is a great time for catching up with friends and family, taking time out to enjoy the festive season and of course partying! It can also be a time of stress physically and emotionally as we rally hard to create the perfect day and cope with situations outside our comfort zone. There is the pressure of shopping, dealing with relatives and in laws, coping with the cold weather conditions, worrying about finances, perhaps coping with feelings of sadness or loneliness and over indulging in food and wine which wreaks havoc on our digestive system. For these type of situations Homeopathy can help bring relief on a number of levels whether for acute periods of physical or emotional stress, or longer term it can be a great support for those grieving or suffering from depression or confidence issues.

Homeopathy can be very helpful and healing during this time of the year. I have heard some homeopaths talk about their practice being quite busy during the holiday months, November thru January. Issues, emotions, situations, responses, reactions, and physical complaints and concerns may come more to the surface than at other times of the year. Because they are more accessible and right there on the surface, it may be a good time to come for homeopathic care.

And whatever you do, don’t forget your pet: With Christmas time just around the corner, I thought it may be worthwhile to draw attention to some of the hazards that can face our pets during this festive season.

END OF QUOTES

Convinced? Well, I am!

It’s Christmas – so, let’s not be cynical!

If our health care does not break down completely this time, it surely is due to the altruistic sacrifice of the nation’s homeopath.

(My only worry is: how will we cope next year when those awful, nasty sceptics, scientist and rational thinkers will no doubt have succeeded in insisting that even homeopaths need evidence for their claims?)

HAPPY, HEALTHY HOLIDAYS EVERYONE!!!

(And don’t forget your Nux Vomica for the detox next week)

Researching and reporting shocking stories like this one can only make me more enemies, I know. Yet I do think they need to be told; if we cannot learn from history, what hope is there?

I first became aware of Sigmund Rascher‘s work when I was studying the effects of temperature on blood rheology at the University of Munich. I then leant of Rascher’s unspeakably cruel experiments on exposing humans to extreme hypothermia in the Dachau concentration camp. Many of his ‘volunteers’ had lost their lives, and the SS-doctor Rascher later became the symbol of a ‘Nazi doctor from hell’. In 1990, R L Berger aptly described Rascher and his sadistic pseudo-science in his NEJM article:

“Sigmund Rascher was born in 1909. He started his medical studies in 1930 and joined both the Nazi party and the storm troopers (the SA) three years later. After a volunteer internship, Rascher served for three years as an unpaid surgical assistant. He was barred temporarily from the University of Munich for suspected Communist sympathies. In 1939, the young doctor denounced his physician father, joined the SS, and was inducted into the Luftwaffe. A liaison with and eventual marriage to Nini Diehl, a widow 15 years his senior who was a one-time cabaret singer but also the former secretary and possibly mistress of the Reichsführer, gained Rascher direct access to Himmler. A strange partnership evolved between the junior medical officer and one of the highest officials of the Third Reich. One week after their first meeting, Rascher presented a “Report on the Development and Solution to Some of the Reichsführer’s Assigned Tasks During a Discussion Held on April 24, 1939.” The title of this paper foretold the character of the ensuing relationship between the two men. Because of Rascher’s servile and ingratiating approach to Himmler, his “connections were so strong that practically every superior trembled in fear of the intriguing Rascher who consequently held a position of enormous power.

Rascher’s short investigative career included a leading role in the infamous high-altitude experiments on humans at Dachau, which resulted in 70 to 80 deaths. He was also involved in testing a plant extract as a cure for cancer. The genesis of this project illustrates Rascher’s style and influence. Professor Blome, the deputy health minister and plenipotentiary for cancer research, favored testing the extract in mice. Rascher insisted on experiments in humans. Himmler sided with Rascher. A Human Cancer Testing Station was set up at Dachau. The deputy health minister collaborated on the project, held approximately 20 meetings with Rascher, and visited the junior officer at Dachau several times.

Another of Rascher’s major research efforts focused on the introduction of a pectin-based preparation, Polygal, to promote blood clotting. He predicted that the prophylactic use of Polygal tablets would reduce bleeding from wounds sustained in combat or during surgical procedures. The agent was also recommended for the control of spontaneous gastrointestinal and pulmonary hemorrhages. Combat wounds were simulated by the amputation of the viable extremities of camp prisoners without anesthesia or by shooting the prisoners through the neck and chest.

Rascher also claimed that oral premedication with Polygal minimized bleeding during major surgical procedures, rendering hemostatic clips or ligatures unnecessary and shortening operating times. He published an enthusiastic article about his clinical experience with Polygal, without specifying the nature of some of the trials in humans. The paper concluded, “The tests of this medicine ‘Polygal 10’ showed no failures under the most varied circumstances.” Rascher also formed a company to manufacture Polygal and used prisoners to work in the factory. A prisoner who was later liberated testified that Rascher’s enthusiasm for Polygal’s antiinfectious properties was probably sparked by news of the introduction of penicillin by the Allies and by his eagerness to reap fame and receive the award established for inventing a German equivalent. He initiated experiments in humans apparently without any preliminary laboratory testing. In one experiment, pus was injected into the legs of prisoners. The experimental group was given Polygal. The controls received no treatment. Information filtered to Dr. Kurt Plotner, Rascher’s physician rival, that the controls were given large, deep subcutaneous inoculations, whereas the victims in the experiments received smaller volumes of pus injected intracutaneously. Plotner reportedly investigated the matter and discovered that the Polygal used was saline colored with a fluorescent dye.

The frequent references to Rascher in top-level documents indicate that this junior medical officer attracted extraordinary attention from Germany’s highest officials. His work was reported even to Hitler, who was pleased with the accounts. Rascher was not well regarded in professional circles, however, and his superiors repeatedly expressed reservations about his performance. In one encounter, Professor Karl Gebhardt, a general in the SS and Himmler’s personal physician, told Rascher in connection with his experiments on hypothermia through exposure to cold air that “the report was unscientific; if a student of the second term dared submit a treatise of the kind [Gebhardt] would throw him out.” Despite Himmler’s strong support, Rascher was rejected for faculty positions at several universities. A book by German scientists on the accomplishments of German aviation medicine during the war devoted an entire chapter to hypothermia but failed to mention Rascher’s name or his work.”

For those who can stomach the sickening tale, a very detailed biography of Rascher is available here.

I had hoped to never hear of this monster of a man again – yet, more recently, I came across Rascher in the context of alternative medicine. Rascher had been brought up in Rudolf Steiner’s anthroposophical tradition, and his very first ‘research’ project was on a alternantive blood test developed in anthroposophy.

A close friend of Rascher, the anthroposoph and chemist Ehrenfried Pfeiffer had developed a bizarre diagnostic method using copper chloride crystallization of blood and other materials. This copper chloride biocrystallization (CCBC) became the subject of Rascher’s dissertation in Munich. Rascher first tried the CCBC for diagnosing pregnancies and later for detecting early cancer (incidentally, he conducted this work in the very same building where I worked for many years, about half a century later). The CCBC involves a visual evaluation of copper crystals which form with blood or other fluids; the method is, of course, wide open to interpretation. Bizarrely, the CCBC is still used by some anthroposophical or homeopathic doctors today – see, for instance, this recent article or this website, this website or this website which explains:

“Hierbei werden einige Tropfen Blut mit Kupferchlorid in einer Klimakammer zur Kristallisation gebracht.
Jahrzehntelange Erfahrung ermöglicht eine ganz frühe Hinweisdiagnostik sowohl für alle Funktionsschwächen der Organe, auch z.B. der Drüsen, als auch für eine Krebserkrankung. Diese kann oft so früh erkannt werden, daß sie sich mit keiner anderen Methode sichern läßt.” My translation: “A few drops of blood are brought to crystallisation with copper chloride in a climate chamber. Decades of experience allow a very early diagnosis of all functional weaknesses of the organs and glands as well as of cancer. Cancer can often be detected earlier than with any other method.”

The reference to ‘decades of experience’ is more than ironic because the evidence suggesting that the CCBC might be valid originates from Rascher’s work in the 1930s; to the best of my knowledge no other ‘validation’ of the CCBC has ever become available. With his initial thesis, Rascher had produced amazingly positive results and subsequently lobbied to get an official research grant for testing the CCBC’s usefulness in cancer diagnosis. Intriguingly, he had to disguise the CCBC’s connection to anthroposophy; even though taken by most other alternative medicines, the Nazis had banned the Steiner cult.

Most but not all of Rascher’s research was conducted in the Dachau concentration camp where in 1941 a research unit was established in ‘block 5’ which, according to Rascher’s biographer, Sigfried Baer, contained his department and a homeopathic research unit led by Hanno von Weyherns and Rudolf Brachtel (1909-1988). I found the following relevant comment about von Weyherns: “Zu Jahresbeginn 1941 wurde in der Krankenabteilung eine Versuchsstation eingerichtet, in der 114 registrierte Tuberkulosekranke homöopathisch behandelt wurden. Leitender Arzt war von Weyherns. Er erprobte im Februar biochemische Mittel an Häftlingen.” My translation: At the beginning of 1941, an experimental unit was established in the sick-quarters in which 114 patients with TB were treated homeopathically. The chief physician was von Weyherns. In February, he tested Schuessler Salts [a derivative of homeopathy still popular in Germany today] on prisoners.

Today, all experts believe Rascher’s results, even those on CCBC, to be fraudulent. Rascher seems to have been not merely an over-ambitious yet mediocre physician turned sadistic slaughterer of innocent prisoners, he also was a serial falsifier of research data. It is likely that his fraudulent thesis on the anthroposophic blood test set him off on a life-long career of consummate research misconduct.

Before the end of the Third Reich, Rascher lost the support of Himmler and was imprisoned for a string of offences which were largely unrelated to his ‘research’. He was eventually brought back to the place of his worst atrocities, the concentration camp in Dachau. Days before the liberation of the camp by the US forces, Rascher was executed under somewhat mysterious circumstances. In my view, the CCBC should have vanished with him.

The US homeopath Alan V Schmukler has been the subject of one post on this blog already. Here, to remind everyone, is his fascinating background again:

He attended Temple University, where he added humanistic psychology to his passions. After graduating Summa Cum Laude, Phi Beta Kappa and President’s Scholar, he spent several years doing workshops in human relations. Alan also studied respiratory therapy and worked for three years at Einstein Hospital in Philadelphia. Those thousands of hours in the intensive care and emergency rooms taught him both the strengths and limitations of conventional medicine.

Schmukler eventually learned about homeopathy in 1991 when he felt he had been cured of an infection with Hepar sulphur, his very own ‘homeopathic epiphany’, it seems. He then founded the Homeopathic Study Group of Metropolitan Philadelphia and helped found and edit Homeopathy News and Views, a popular newsletter. He taught homeopathy for Temple University’s Adult Programs, and has been either studying, writing, lecturing or consulting on homeopathy since 1991. Today, he is Chief Editor of Hpathy.com and of Homeopathy4Everyone and says that his work as Editor is one of his most rewarding experiences.

Schmukler is clearly well-placed to comment on all aspects of homeopathy competently and with great vision. What he says must be taken seriously. And that includes his profound and well-researched opinions regarding homeopathy’s critics. The most recent article by Schmukler is entitled ‘WHEN THE GAME IS OVER’ and it discloses the truth and nothing but the truth about these critics and the worldwide conspiracy against homeopathy. Here is an excerpt from his revelations:

…we still find homeopathy being attacked as placebo, mostly by government officials, academics and the press. There are essentially two categories of critics. The first category consists of individuals who are totally ignorant of homeopathy and just repeating propaganda they’ve been exposed to. The second category is people who know that homeopathy works, but have a vested financial interest in destroying it. When you read about attacks on homeopathy, you have to ask yourself whether you are dealing with pure ignorance, or deceit. Those who deny homeopathy from deceit use the same tactics as those who deny global warming. Just as global warming deniers are financed by the petroleum industry, homeopathy deniers are financed by the pharmaceutical industry. They engage in the same tactics of misinformation using surrogates in academia, in the media and in government.

So here we have it!

Two categories of critics!!!

THE IGNORANT and THE CORRUPT!

I am so glad Schmukler did find this out through his research and said it with such clarity. It needed to se said! And I am surprised how simple it all becomes, once one has the guidance from someone in the know.

The opposition to homeopathy has nothing to do with evidence (and as evidence does not come into it, there is also no need to supply evidence for Schmukler’s statements, of course), as some might have speculated. Instead, it all is a huge conspiracy. Makes sense! Why did we not think of this myself?

I applaud Schmukler for putting the defence of homeopathy to a level which must be a new low.

If the Flat Earth Society (FES) really exists at all, I must confess I know nothing about it. Here I use the term ‘FES’ merely as an analogy; you might replace FES with SoH or BHA or BAA or BCA or with most of the other acronyms used in my field of inquiry.

What I do know about is alternative medicine, particularly publications in this area, and the authors of such papers. As it happens, the members of my imaginary FES have a lot in common with the authors of articles on alternative medicine. Their publication policy, for instance, is remarkably simple yet astonishingly effective. Its aim is straight forward: mislead the public. As far as I can see, it is being pursued by just two main strategies.

1 SWAMP THE MARKET WITH TRASH

This is a simple and most successful strategy. It consists of publishing an ever-growing mountain of utter nonsense. Anyone who is  interested in alternative medicine and conducts a search would thus find tons of articles listed in Medline or other databases. This will instantly generate the impression that Flat Earth research is highly active. Those who can bear the pain might even try to read a few of these papers; they will soon give up in despair. Too many are hardly understandable; they are often badly written, lack essential methodological detail, and invariably arrive at positive conclusions.

The strategy can only work, if there are journals who publish such rubbish. I am glad to say, there is no shortage of them! To attain a veneer of credibility, the journals need to be peer-reviewed, of course. This is no real problem, as long as the peer-reviewers are carefully chosen to be ‘cooperative’. The trick is to make sure to ask the authors submitting articles to name two or three uncritical friends who might, one day, be happy to act as peer-reviewers for their own papers. This works very smoothly indeed: one pseudo-scientist is sure to help another in their desire to publish some pseudo-science in a ‘peer-reviewed’ journal.

To oil the system well, we need money, of course. Again, no problem: most of these journals ask for a hefty publication fee.

The result is as obvious as it is satisfying. The journal earns well, the pseudo-researchers can publish their pseudo-research at will, and the peer-reviewers know precisely where to go for a favour when they need one. Crucially, the first hurdle to misleading the public is taken with bravura.

2. REFUTE ANY EVIDENCE THAT IS UNFAVOURABLE

There are, of course, journals which refuse to play along. Annoyingly, they adhere to such old-fashioned things like standards and ethics; they have a peer-review system that is critical and independent; and they don’t rely on pseudo-scientists for their income. Every now and then, such a journal publishes an article on alternative medicine. It goes without saying that, in all likelihood, such an article is of high quality and therefore would not be in favour of Flat Earth assumptions.

This is a serious threat to the aim of the FES. What can be done?

No panic, the solution is simple!

An article is urgently needed to criticise the paper with the unfavourable evidence – never mind that it is of much better quality than the average paper in the Flat Earth-journals. If one looks hard enough, one can find a flaw in almost every article. And if there is none, the FES can always invent one. And if the proper science journal refuses to publish the pseudo-criticism as a comment, there are always enough pseudo-journals that are only too keen to oblige.

The important thing is to get something that vaguely looks like a rebuttal in print (the public will not realise that it is phony!).

Once this aim is achieved, the world is back in order again. As soon as someone dares to cite the high quality, negative evidence, the FES members can all shout with one voice: BUT THIS PAPER HAS BEEN HEAVILY CRITICISED; IT IS NOT RELIABLE! WHOEVER CITED THE PAPER IS ILL-INFORMED AND THEREFORE NOT CREDIBLE.

3. MISSION ACCOMPLISHED

The overall effect is clear. The public, journalists, politicians etc. get the impression that the earth is indeed flat – or, at the very minimum, they are convinced that there is a real scientific debate about the question.

While some chiropractors now do admit that upper neck manipulations can cause severe problems, many of them simply continue to ignore this fact. It is therefore important, I think, to keep alerting both consumers and chiropractors to the risks of spinal manipulations. In this context, a new article seems relevant.

Danish doctors reported a critical case of bilateral vertebral artery dissection (VAD) causing embolic occlusion of the basilar artery (BA) in a patient whose symptoms started after chiropractic Spinal manipulative therapy (cSMT). The patient, a 37-year-old woman, presented with acute onset of neurological symptoms immediately following cSMT in a chiropractic facility. Acute magnetic resonance imaging (MRI) showed ischemic lesions in the right cerebellar hemisphere and occlusion of the cranial part of the BA. Angiography demonstrated bilateral VADs. Symptoms remitted after endovascular therapy, which included dilatation of the left vertebral artery (VA) and extraction of thrombus from the BA. After 6 months, the patient still had minor sensory and cognitive deficits.

The authors concluded that, in severe cases, VAD may be complicated by BA thrombosis, and this case highlights the importance of a fast diagnostic approach and advanced intravascular procedure to obtain good long-term neurological outcome. Furthermore, this case underlines the need to suspect VAD in patients presenting with neurological symptoms following cSMT.

I can already hear the excuses of the chiropractic fraternity:

  • this is just a case report,
  • the risk is very rare,
  • some investigations even deny any risk at all,
  • the risk of many conventional treatments is far greater.
However, these excuses are lame for a number of reasons:
  • as there are no functioning monitoring systems, nobody can tell with certainty how big the risk truly is,
  • the precautionary principle in health care compels us to take even the slightest of suspicions of harm seriously,
  • the risk/benefit principle compels us to ask whether the demonstrable benefits of neck manipulations outweigh its suspected risks.

The last point is perhaps the most important: AS FAR AS I CAN SEE, THERE IS NO INDICATION FOR NECK MANIPULATIONS FOR WHICH THE BENEFIT IS SUFFICIENTLY CERTAIN TO JUSTIFY ANY SUCH RISKS.

In 1790, as Hahnemann was translating the Scottish physician’s, Cullen, ‘Treatise on Materia Medica’, he came across the passage where Cullen explains the actions of Peruvian (or China bark, [Cinchona officinalis]) which contains quinine, an effective treatment of malaria. Hahnemann disagreed with Cullen’s explanation that Cinchona worked through “a tonic effect on the stomach”. Therefore he decided to conduct experiments of his own to prove Cullen wrong.

Hahnemann thus ingested high doses of Cinchona and noticed that subsequently he developed several of the symptoms that are characteristic of malaria. This is how Hahnemann later described his experience:

I took for several days, as an experiment, four drams of good china daily. My feet and finger tips, etc., at first became cold; I became languid and drowsy; my pulse became hard and quick; an intolerable anxiety and trembling (but without rigor); trembling in all limbs; then pulsation in the head, redness in the cheeks, thirst; briefly, all those symptoms which to me are typical of intermittent fever, such as the stupefaction of the senses, a kind of rigidity of all joints, but above all the numb, disagreeable sensation which seems to have its seat in the periosteum over all the bones of the body – all made their appearance. This paroxysm lasted for two or three hours every time, and recurred when I repeated the dose and not otherwise. I discontinued the medicine and I was once more in good health.

Hahnemann repeated this experiment several times and eventually concluded that he had discovered something of great general importance: there seemed to be a similarity between the symptoms of a disease and the symptoms caused by the drug that is effective in treating that very disease.

After several more experiments, Hahnemann became convinced that he had, in fact, discovered a law of nature: similia similibus currentur (often translated as ‘like cures like’ yet meaning ‘like should be cured with like’). This became the basis of homeopathy and is, in fact, its definition.

In 1796, Hahnemann published his theory in an article entitled ‘Essay on a New Principle’. In 1806, he wrote a more detailed treatise ‘The Medicine of Experience’ and, in 1810, the first edition of his major work ‘The Organon’ followed. He continued to revise his ‘Organon’ throughout his long life, which thus saw a total of six editions (the last was only published well after his death).

Since Hahnemann’s days, several attempts have been made to reproduce Hahnemann’s quinine experiment. The results of the most rigorous of these replications have failed to confirm Hahnemann’s original findings: neither Cinchona bark nor its main ingredient, quinine, produce the symptoms of malaria in health individuals.

And what is the explanation?

The dose Hahnemann took contained about 400 to 500 milligrams of quinine. After ingesting it, he felt languid and drowsy (hypotension); he noticed palpitations (ventricular tachycardia), pulsation in the head (headache), redness in cheeks (rash), prostration through limbs (general weakness), thirst (fever) and cold fingers and feet with trembling which are indicative of an allergic reaction. One has to praise Hahnemann’s skills of (self-) observations. Unfortunately, his ability to interpret them correctly was, at least in this particular instance, wanting.

The most likely cause of his symptoms is, according to many experts who have analysed the case in much detail, an allergic reaction to quinine. Hahnemann described his symptoms accurately, yet he was mistaken in his interpretation of the event.

If this conclusion is correct – and I have little doubt that it is – the main assumption of homeopathy, the notion on which the entire school of homeopathy rests, is based on a misunderstanding.

Some time ago, when we published our systematic review about the adverse effects associated with homeopathic remedies, there was an outcry of critics stating that it is not rational to claim, on the one hand, that homeopathic remedies are so dilute that they contain nothing and therefore do nothing and, on the other hand, that homeopathic remedies can cause side-effects. These people should, of course, have known better, but I admit it can be a little confusing. So, let me explain.

Every homeopathic remedy starts as a ‘mother tincture’. That is the undiluted stock prepared according to a homeopathic pharmacopoeia. The mother tincture is then diluted and shaken to give the first ‘potency’. Depending on the potency scale, this could be a ‘C1’ (1:100) or ‘D1’ (1:10). The resulting potency can be potentised again to give the second potency which can be potentised again to give the third potency. And this process of ‘serial dilution’ can be continued ad infinitum (the most common potency is the C30 which is a dilution of 30 times 1 : 100).

All of these remedies are by definition homeopathic, of course; even a mother tincture is strictly speaking a homeopathic remedy.

Now imagine we have a highly toxic stock, for instance, arsenic. This is by no means an extreme example, as many substances used in homeopathy are poisonous. A ‘D1’ of arsenic is both effective and dangerous: it is effective for killing rats and other unwanted creatures, and it is dangerous should a patient take it.

So, now we understand better why homeopathic remedies can, contrary to a common myth, cause direct adverse effects (in addition to the scenario outlined above, they can also be contaminated or adulterated, of course). We also realise that the ‘experts’ who protested against our review of side-effects of homeopathic remedies were either ignorant or stupid or both. Most importantly, we understand, I hope, that when we speak or write about the ineffectiveness of homeopathic remedies, we of course mean those that are too dilute to have any effect at all – and these are certainly the vast majority.

The two dietary supplements chondroitin and glucosamine have been around for some time. They are being promoted mostly for osteoarthritis; some claim that they reduce pain, others even believe that they restore the damaged cartilage and thus reverse the disease process. But neither for a symptomatic nor causal therapy has the evidence so far been truly convincing. A new trial might change this situation.

This study compared the efficacy and safety of chondroitin sulfate plus glucosamine hydrochloride (CS+GH) versus celecoxib in patients with knee osteoarthritis and severe pain.

 TheDouble-blind Multicentre Osteoarthritis interVEntion trial with SYSADOA’ (MOVES) was conducted in France, Germany, Poland and Spain and evaluated treatment with CS+GH versus celecoxib in 606 patients with Kellgren and Lawrence grades 2–3 knee osteoarthritis and moderate-to-severe pain (Western Ontario and McMaster osteoarthritis index (WOMAC) score ≥301; 0–500 scale). Patients were randomised to receive 400 mg CS plus 500 mg GH three times a day or 200 mg celecoxib every day for 6 months. The primary outcome was the mean decrease in WOMAC pain from baseline to 6 months. Secondary outcomes included WOMAC function and stiffness, visual analogue scale for pain, presence of joint swelling/effusion, rescue medication consumption, Outcome Measures in Rheumatology Clinical Trials and Osteoarthritis Research Society International (OMERACT-OARSI) criteria and EuroQoL-5D.

The results show that the adjusted mean change (95% CI) in WOMAC pain was −185.7 (−200.3 to −171.1) (50.1% decrease) with CS+GH and −186.8 (−201.7 to −171.9) (50.2% decrease) with celecoxib, meeting the non-inferiority margin of −40: −1.11 (−22.0 to 19.8; p=0.92). All sensitivity analyses were consistent with that result. At 6 months, 79.7% of patients in the combination group and 79.2% in the celecoxib group fulfilled OMERACT-OARSI criteria. Both groups elicited a reduction >50% in the presence of joint swelling; a similar reduction was seen for effusion. No differences were observed for the other secondary outcomes. Adverse events were rare and similarly distributed between groups.

The authors concluded that CS+GH has comparable efficacy to celecoxib in reducing pain, stiffness, functional limitation and joint swelling/effusion after 6 months in patients with painful knee osteoarthritis, with a good safety profile.

This is a rigorous trial, and I do trust its findings. However, I am not entirely sure what they actually mean: is CS+GH as effective or as ineffective as the COX-2-inhibitor celecoxib? The most recent meta-analysis on the subject found that diclofenac (150 mg/day) was likely to be more effective in alleviating pain than celecoxib (200 mg/day). But that does, of course, not necessarily imply that celecoxib is ineffective.

The other big issue here is safety. COX-2-inhibitors had a bad press because of the risk of cardiovascular side-effects. In comparison, the CS+GH supplement is an almost risk-free alternative. Bearing in mind that we are dealing with long-term treatments here, I think the results of this study might persuade me, had I to choose between these two treatments, to opt for the dietary supplement.

A ‘RAZOR’ is an argument for “shaving off” unlikely or implausible explanations or arguments. Who would, in this context, not think of alternative therapies and the explanations provided for them? And who could deny that homeopathy, in particular, is crying out for its very own razor?

I am, of course, inspired by 4 existing razors:

Occam’s Razor: Among competing hypotheses, the one with the fewest assumptions is likely to be the correct one.

Hitchens’s Razor: What can be asserted without evidence can be dismissed without evidence.

Hanlon’s Razor: Never attribute to malice what can adequately explained by stupidity.

Alder’s Razor: What cannot be settled by experiment is not worth debating.

To those of my readers who fail to see the relationship to homeopathy, I offer the following explanations:

OCCAM

Homeopaths claim that the explanation for homeopathy’s mode of action is the ‘memory of water’ theory which is now supported, they say, by all sorts of basic science from water structure to nano-particles. Even if true [which it is not], this explanation relies on a whole series of further assumptions, for instance, about how nano-particles bring about any clinical outcome. The competing hypothesis is that the benefit experienced by patients after homeopathy is due to non-specific or context effects such as the placebo effect, the empathetic consultation etc. We have therefore one single hypothesis (i. e. homeopathy works via non-specific effects which is even supported by experimental data) against a myriad of postulates which are largely speculative. Occam’s Razor holds that the explanation with the least assumptions is likely to be correct.

HITCHENS

Homeopaths claim that their remedies are more than a placebo. To support their claim, they have no good evidence but rely on cherry-picking and misrepresenting the available data. Hitchen’s Razor suggests that, as long as they don’t come up with evidence, we can dismiss these claims without even attempting to prove the cherry-pickers wrong.

HANLON

Homeopaths have given us plenty of evidence (for instance, on this blog) for the fact that they often have a somewhat disturbed relationship with the truth. One might think that this is because they are maliciously trying to mislead us. According to Halon’s Razor, it is more likely that they are just stupid.

ALDER

Homeopaths regularly claim that, as long as there is no proof that homeopathy does not work, there must be an open debate about the issues involved and, as long as there are genuine debates and doubts, we must continue to make homeopathy available to all. Alder’ s Razor, however, suggests otherwise: there have been many tests of homeopathy; their results have failed to settle the matter in favour of homeopathy; therefore we can forget about the whole thing, stop debating it, and close the issue.

So, what about the razor promised in the title of this post? Here it comes; it is an attempt to synthesize the 4 razors above and apply them to homeopathy. I will call it (somewhat pompously) ‘Ernst’s Razor’ and I have tried to formulate it such that it can be applied to most other bogus treatments simply by exchanging one single word:

INSTEAD OF RELYING ON EVIDENCE, HOMEOPATHY’S SURVIVAL DEPENDS ON MULTIPLE ASSUMPTIONS, LIES, IGNORANCE AND STUPIDITY.

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