MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

The UK ‘Faculty of Homeopathy’ (FoH) is the professional body of British doctors who specialise in homeopathy. As doctors, FoH members have been to medical school and should know about evidence, science etc., I had always thought. But perhaps I was mistaken?

The FoH has a website with an interesting new post entitled ‘Scientific evidence and Homeopathy’. Here I have copied the section on CLINICAL TRIALS OF HOMEOPATHY. I have read it several times and must admit: it is a masterpiece, in my view – not a masterpiece in accurate reporting, but a masterpiece in misleading the public. The first and most obvious thing that struck me is the fact that is cites not a single clinical trial. But read for yourself (the numbers in round brackets were inserted by me and refer to my comments below):

START OF QUOTE

By August 2017 1,138 clinical trials of homeopathy had been published (1). Details can be found on the CORE-HOM database also maintained by the Carstens Foundation and accessible without charge: http://archiv.carstens-stiftung.de/core-hom

Four (2) systematic review/meta-analyses of homeopathy for all conditions have been published.[26],[27],[28]  Of these, three (3) reached a positive conclusion: that there is evidence that homeopathy is clinically effective (4). The exception is the review by Shang et al.46  This meta-analysis was controversial, particularly because its conclusions were based on only eight clinical trials whose identity was concealed until several months after the publication, precluding informed examination of its results (5) (6). The only undisputed conclusion (7) of this paper is that clinical trials of homeopathy are of higher quality than matched trials of conventional medicine: of 110 clinical trials each of homeopathy and conventional medicine, 21 trials of homeopathy but only 9 trials of conventional medicine were of ‘higher quality’.[29] [30]

A leading Swedish medical researcher (8) remarked: To conclude that homeopathy lacks clinical effect, more than 90% of the available clinical trials had to be dis­regarded.  Alternatively, flawed statistical methods had to be applied.”[31] Higher quality equates to less risk of bias, Mathie et al analysed randomized clinical trials of individualized homeopathy, showing that the highest quality trials yielded positive results (9).[32]

Systematic reviews of randomized controlled trials of homeopathy in specific clinical situations have also yielded positive results, including: allergies and upper respiratory tract infections (2 systematic reviews),[33],[34] (10) (11) Arnica in knee surgery,[35] (12) Childhood diarrhoea,[36] Post-operative ileus,[37] (13) Rheumatic diseases,[38] (14) Seasonal allergic rhinitis (hay fever) (2 systematic reviews),[39] [40] (15) (16) and vertigo.[41] (17)

END OF QUOTE

MY COMMENTS:

  1. This is a wild exaggeration which was made possible by counting all sorts of clinical reports as ‘clinical trials’. A clinical trial  “follows a pre-defined plan or protocol to evaluate the effects of a medical or behavioral intervention on health outcomes.” This would exclude most observational studies, case series, case reports. However, the figure cited here includes such reports.
  2. The author cites only three!
  3. Does the author mean ‘two’?
  4. This is not quite true! I have dedicated an entire post to this issue.
  5. True, the Shang meta-analysis has been criticised – but exclusively by homeopaths who, for obvious reasons, were unable to accept its negative findings. In fact, it is a solid piece of research.
  6. Why does the author not mention the most recent systematic review of homeopathy?  Perhaps because it concluded: 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.
  7. Really? Undisputed? Even by the logic of the author’s last sentence, this would be disputed.
  8. The ‘leading researcher’ is Prof Hahn who has featured many times on my blog. He seems to be more than a little unhinged when it comes to the topic of homeopathy.
  9. The author forgot to mention that Mathie – who was sponsored by the British Homeopathic Association – included this little caveat in his conclusions: The low or unclear overall quality of the evidence prompts caution in interpreting the findings.
  10. Reference 33 is the infamous ‘Swiss report’ that has been shown to be fatally flawed over and over again.
  11. Reference 34 refers to a review that fails to adhere to almost all the criteria of a systematic review.
  12. This review concluded: In all three trials, patients receiving homeopathic arnica showed a trend towards less postoperative swelling compared to patients receiving placebo. However, a significant difference in favour of homeopathic arnica was only found in the CLR trial. Only a deluded homeopath can call this a ‘positive result’.
  13. This is a systematic review by my team. It showed that several flawed trials produced a false positive result, while the only large multicentre trial was negative. Our conclusions therefore include the statement that  several caveats preclude a definitive judgment. Only a deluded homeopath can call this a ‘positive result’.
  14. This reference refers to the following abstract: Despite a growing interest in uncovering the basic mechanisms of arthritis, medical treatment remains symptomatic. Current medical treatments do not consistently halt the long-term progression of these diseases, and surgery may still be needed to restore mechanical function in large joints. Patients with rheumatic syndromes often seek alternative therapies, with homeopathy being one of the most frequent. Homeopathy is one of the most frequently used complementary therapies worldwide. Only a deluded homeopath can call this a ‘positive result’.
  15. The first reference refers to a paper where the author analysed three of his own studies.
  16. Reference 40 refers to a review that fails to adhere to almost all the criteria of a systematic review.
  17. This reference refers to a review of Vertigoheel@ that includes observational studies. One of its authors was an employee of the manufacturer of the product. Vertigoheel is not a homeopathic remedy (it does not adhere to the ‘like cures like’ principle) but a homotoxicologic product. Homotoxicology is a method inspired by homeopathy which was developed by Hans Heinrich Reckeweg (1905 – 1985). He believed that all or most illness is caused by an overload of toxins in the body. The toxins originate, according to Reckeweg, both from the environment and from the malfunction of physiological processes within the body. His treatment consists mainly in applying homeopathic remedies which usually consist of combinations of single remedies, because health cannot be achieved without ridding the body of toxins. The largest manufacturer and promoter of remedies used in homotoxicology is the German firm Heel. Our own systematic review of RCTs of homotoxicology included 7 trials which were mostly of a high methodological standard, according to the Jadad score. The trials tested the efficacy of seven different medicines for seven different indications. The results were positive in all but one study. Important flaws were found in all trials. These render the results of the primary studies less reliable than their high Jadad scores might suggest. Despite mostly positive findings and high ratings on the Jadad score, the placebo-controlled, randomised clinical trials of homotoxicology fail to demonstrate the efficacy of this therapeutic approach.

So!

What do we make of all this?

To say that it is disappointing would, I think, be an understatement. The FoH is not supposed to be a lobby group of amateurs ignorant of science and evidence; it is a recognised professional organisation who must behave ethically. Patients and consumers should be able to trust the FoH. The fact that the FoH publish misinformation on such a scale should, in my view, be a matter for the General Medical Council.

9 Responses to Should the ‘Faculty of Homeopathy’ be reported to the General Medical Council?

  • The GMC (of which I have been an associate member) is responsible for regulating practitioners, not practice, or institutions. (Is the FoH a charity?)

    It is members of the FoH, or indeed, any registered medical practitioner, who should be reported to the GMC if they are considered to heve breached the GMC guidance on ‘Good Medical Practice’ (See GMC’s web site).

    I have tried to get the BMA on board making relevant complaints, but it is a matter of individual patients complaining I’m afraid. If any can be identified, put them in touch with me and I will see what might be done.

    Any perceived misdemeanour will have to be contray to GMP. IMHO the most practical way forward is to complain that the registered medical practitioner has failed to obtain properly informed consent – almost certainly they have not done so, if the above FoH posting on the ‘science’ of homeopathy is anything to go by.

    All medically qualified homeopaths must (and others, should) advise patients: “There is no reproducible plausible evidence accepted by the consensus of the scientific and medical communities that the remedies/pills I am prescribing you will make any difference to the condition from which you are suffering, but it is my belief they may, and I prescribe on that basis.”

    For some reason, homeopaths are reluctant to tell patients this. It is that lack of integrity which brings the medical profession into disrepute. The GMC should be concerned, but is under influence from PoI (persons of importance).
    And those persons include Secrtetary of State for Health Hunt!

    The GMC’s GMP also makes clear that doctors should do their best for their patients. Misleading them is hardly of the best.

    • apparently, the Faculty of Homeopathy is a General Medical Council Designated Body with responsibility for the quality assurance and relicensing of doctors.
      this is directly from the FoH’s website (https://facultyofhomeopathy.org/about/):
      The Faculty of Homeopathy was founded in 1844 and is the registering body for statutorily regulated healthcare professionals who integrate homeopathy into their practice.
      It also delivers internationally recognised training in homeopathy for doctors, dentists, pharmacists, nurses, vets and other healthcare professionals. Training courses are provided at our accredited teaching centres in the UK and overseas. Members state that homeopathy has increased their ability to care for their patients and broadened their knowledge of medicine and health.
      The Faculty was incorporated by an Act of Parliament in 1950. The Act recognises the Faculty’s role in regulating the education, training and practice of homeopathy by the medical profession. Amendments to the Byelaws and Regulations over the years have extended the Faculty’s role to include other statutorily registered healthcare professionals.
      In 2013, the General Medical Council recognised the Faculty as an official designated body for the revalidation of doctors.
      The Faculty Act
      The Faculty was incorporated by an Act of Parliament in 1950. The Act recognises the Faculty’s role in regulating the education, training and practice of homeopathy by the medical profession. Amendments to the Byelaws and Regulations over the years have extended the Faculty’s role to include other statutorily registered healthcare professionals.

  • This meta-analysis was controversial, particularly because its conclusions were based on only eight clinical trials whose identity was concealed until several months after the publication, precluding informed examination of its results (5) (6).

    The pejorative language is to be expected, of course, but it should be noted that Shang et al. specified the eight trials in the same issue of The Lancet in which it was pointed out they had been omitted (Volume 366, No. 9503, p2083–2085, 17 December 2005).

    The only undisputed conclusion (7) of this paper is that clinical trials of homeopathy are of higher quality than matched trials of conventional medicine: of 110 clinical trials each of homeopathy and conventional medicine, 21 trials of homeopathy but only 9 trials of conventional medicine were of ‘higher quality’.

    How many times does the reason for this need to be explained to homeopaths?

    • I can’t help thinking homeopaths must feel that every time someone actually reads one of their references, that person is cheating! I’ve dedicated a whole website to such ‘evidence’ and none of it is fit for purpose. But then, as the saying goes, if a lie is repeated often enough it becomes the truth.

      Niall

  • It is important to be precise, as so many camists use language to mislead.
    An above posting states: “Apparently, the Faculty of Homeopathy is a General Medical Council Designated Body with responsibility for the quality assurance and relicensing of doctors.”
    Not so.

    The FoH web site states: “The Faculty of Homeopathy was founded in 1844 and is the registering body for statutorily regulated healthcare professionals who integrate homeopathy into their practice.”
    The FoH may have such a register of homeopaths, but it does not relicence doctors.
    That remains the responsibility of the GMC.

    To be licenced, a doctor must be appraised in respect of the practice they carry out, and that constitutes their revalidation. It is the doctor who is appraised, and their licence to practice which is revalidated. The practice itself is not validated (and certainly not endorsed).

    The FoH claims: “In 2013, the General Medical Council recognised the Faculty as an official designated body for the revalidation of doctors.”
    True, the FoH provides appraisers, and their reports facilitate revalidation of the practitioner, but unless the complexities of regulation are properly understood, the importance of the FoH could be misunderstood and misrepresented. Some might intend that to be the case.

    The FoH itself does not revalidate doctors. It is a body designated as facilitating revalidation. The GMC is responsible FOR revalidation.
    Aploogies for shouting, but language is important!

  • I checked the statistics. The FOH boasts ‘more than 700 members worldwide’. In July this year the GMC had 191,680 fully licensed doctors. So removing the GMC registration from the (maximum) 0.37 % of registered doctors who are reality deniers would make little or no difference to the numbers of proper doctors and would demonstrate the GMC is capable of critical thinking.

  • Just for the files: My letter to Dr. Peter Fisher about some misleading information on systematic reviews. This is forwarded to him via his uclh-email.

    Dear Dr. Peter Fisher,

    as one of the better known German critics of homeopathy I would like to comment on the newly designed page ‘Scientific evidence and Homeopathy” which is credited to you on the Faculty of Homeopathy’s website.

    The information you provide looks misleading on more than one occasion, but I want to focus on just one major issue this time. You state, that there are four systematic reviews on homeopathy in total which all but one reached positive conclusions. Sorry to say, Dr. Fisher, this is wrong and misleading: there are not four but eight systematic reviews and they all more or less come to the same not so positive conclusion. These are:

    (1) Kleijnen (1991):
    “At the moment the evidence of clinical trials is positive but not sufficient to draw definitive conclusions because most trials are of low methodological quality and because of the unknown role of publication bias.” [1]

    (2) Linde (1997):
    “However, we found insufficient evidence from these studies that homeopathy is clearly efficacious for any single clinical condition.” [2]

    (3) Linde (1998)
    “The results of the available randomized controlled trials suggest that individualized homeopathy has an effect over placebo. The evidence, however, is not convincing because of methodological shortcomings and inconsistencies” [3]

    (4) Cucherat, (2000):
    “There is some evidence that homeopathic treatments are more effective than placebo; however, the strength of this evidence is low because of the low methodological quality of the trials. Studies of high methodological quality were more likely to be negative than the lower quality studies.”[4]

    (5) Shang (2005):
    “… there was weak evidence for a specific effect of homeopathic remedies (…) This finding is compatible with the notion that the clinical effects of ho0meopathy are placebo effects”[5]

    (6) Mathie (2014):
    “Medicines prescribed in individualised homeopathy may have small, specific treatment effects. (…) The low and unclear overall quality of the evidence prompts caution in interpreting the findings.”[6]

    (7) NHMRC (2015):
    “There is no reliable evidence that homeopathy is effective for treating health conditions”[7]

    (8) Mathie (2017):
    “The quality of the body of evidence is low. A meta-analysis of all extractable data leads to rejection of our null hypothesis [that the main outcome of treatment using non-individualised homeopathic medicine is indistinguishable from placebo] but analysis of a small subgroup of reliable evidence does not support that rejection. Reliable evidence is lacking in condition-specific meta-analyses, precluding relevant conclusions.”[8]

    All this boils down to pretty much the same thing: If you look at the evidence in total, you may get the impression there is some benefit. But on a closer look, accounting for quality, or trying to pinpoint who under what condition might benefit thereof, this positive impression evaporates and proves unreliable. In a nutshell: There is no reliable evidence, that homeopathy works better than placebo.

    Please note how all the papers fall in line, including the most criticised papers of Shang and the NHMRC as well as Mathie’s, who works for the Homeopathy Research Institute, I understand, and should not be biased against homeopathy.

    I would suppose you change the sections of your page mentioned above before someone might be led into the wrong direction and draws conclusions from the information you provide which might prove unfortunate for his condition.

    Yours sincerely
    Dr. Norbert Aust

    References:

    [1] Kleijnen J, Knipschild P, ter Riet G: Clinical trials of homeopathy, BMJ 1991; 302:316-23

    [2] Linde K, Clausius N, Ramirez G et al.: Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials, The Lancet 1997;350:834-43

    [3] Linke K, Melchart D: Randomized controlled trials of individualized homeopathy: A state-of-the-art review, Journal of Alternative and Complementary Medicine 1998; 4(4):371-388

    [4] Cucherat M, Haugh MC, Gooch M et al.: Evidence of clinical efficacy of homeopathy, Eur. J Clin Pharmacol 2000;56:27-33

    [5] Shang A, Huwiler-Müntener K, Nartey L et al.L Are the clinical effects of homeopathy placebo effects? Comparative study of placebo-controlled trials of homeopathy and allopathy, Lancet 2005;366:726-32

    [6] Mathie RT, Lloyd SM, Legg LA et al.: Randomised placebo-controlled trials of individualised homeopathic treatment: systematic review and meta-analysis, Systematic Reviews 2014;3:142

    [7] National Health and Medical Research Council. 2015. NHMRC Information Paper: Evidence on the effectiveness of homeopathy for treating health conditions. Canberra: NHMRC;2015

    [8] Mathie RT, Rampersad N, Legg LA et al.: Randomised, double blind, placebo-controlled trials of non-individualised homeopathic treatment: Systematic review and meta-analysis, Systematic Reviews 2017;6:663

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