MD, PhD, FMedSci, FSB, FRCP, FRCPEd

conflict of interest

The global Homeopathy Product Market has recently been projected to increase by 18.2% during the forecast period 2016-2024. Considering that highly diluted homeopathic remedies are pure placebos, this is remarkable, I think.

But why? Why are consumers spending their money on ineffective treatments?

The answer is probably complex, and there are many factors to explain this puzzling phenomenon. One of them is the constant and clever marketing of homeopathy. This website, for instance, claims that homeopathy can be used for first aid. Below I have copied the remedy in question, the potency best suited, and the conditions to be treated.

START OF QUOTE

1. ARNICA MONT. 30 – bruises, contusions, injuries, shock.

2. HYPERICUM 200 – injuries to parts rich in nerve-supply, laceration, also preventive for tetanus.

3. LEDUM PAL 30-punctured wounds, black eye. Also preventive for tetanus.

4. RHUS TOX 30 – sprains and strains, muscular pains.

5. RUT A GRA V. 30 – bruised periosteum, bones and injury to ligaments.

6. CANTHARIS 30 } for burns

7. URTICA URENS 6 } for burns

8 HEPAR SULPH 200 – septic wounds extremely painful and tender.

9. SILICIA 30 – sepsis.

FEVER, HEADACHE, COLD-DRUGS

1. ACONITE NAP. 30 – sudden high fever with chill, bad effects of fear, shock.

2. ARSENIC ALB 30 – colds, food poisoning.

3. BELLADONNA 30 – high fever, sunstroke, earache,

4. BRYONIA ALB. 30 – fever with cold, biliousness and constipation.

5. GELSEMIUM 30•-high fever with chill, influenza, cold.

6. PULSATILLA 30 – for cold, indigestion, after fatty food.

OTHER DRUGS

1 CARBO VEG. 30 – flatulence and indigestion.

2. CHAMOMILLA 30 – teething children with various troubles.

3. CINA 30 – worms

4. COFFF A 30 – sleeplessness 5. GLONOINE 6 – sunstroke, headache, high b16dd-pressure.

6. H AMAMELLIS 30 – bleeding from veins-dark blood.

7. IPECACUANHA 30– nausea vomiting, also for haemorrhages.

8. NUX VOMICA 30- biliousness, constipation, dysentery.

9. PODOPHYLLUM 30 – diarrhoea

10. PHOSPHORUS 30 – haemorrhage with bright red blood.

EXTERNAL APPLICATIONS

1. ARNICA OINT } for injuries where skin not broken

2. HYPERICUM OINT }for injuries where skin not broken

3. CALENDULA OINT. – for open wounds.

4. MULLIEN OIL – for earache

5. PLANTAGO MAJ. for toothache

BESIDES THE ABOVE DRUGS THE TWELVE TISSUE WILL ALSO BE USEFUL AS FIRST-AID DRUGS WHEN

PER INDICATIONS.

HOMEOPATHIC PROPHYLACTICS

Diseases or Condition Preventive medicine
Chicken Pox Ant.tart and Malandrinum
Cholera Ars.alb and Ver.alb.
Diphtheria Diphtherinum
Measles Morbilinum
Herpes Variolinum
Influenza Influenzinum
Whooping Cough Drosera, Pertussin
Mumps Pilocarpine and Parotidinum
Poliomyelitis Lathyrus Sativus and Plumbum
Small Pox Variolinum and Malandrinum
Tetanus Ledum, Hypericum
Typhoid Baptisia Q, Typhoidinum
Vaccination Ill effects Thuja
Rabies Hydrophobinum
Tuberculosis Tuberculinum Bov.

END OF QUOTE

You must admit that this is impressive. Imagine someone reading this – is it not understandable that consumers try homeopathy?

If this website were an exception or an extreme case – but it is not! Information like this is available on the Internet and elsewhere a million times over. And there is no doubt that such information is a risk factor for public health.

What is needed is factual information presented such that consumers can understand it. In my view, this would be an important contribution to public health – so important, in fact, that I have just published a book with exactly this aim. I hope that many consumers will learn about it.

We live in interesting, if they were not so frightening, one could almost say amusing times!

Politicians who previously have criticised Trump for his unacceptable deeds, behaviour and statements can now be seen to bend over backwards to join his band-waggon. They don’t know where the waggon is heading but they don’t want to be left behind. A prime example is UK’s Boris Johnson who now even criticises other politicians for having more back-bone than himself and therefore being less enthusiastic about America’s future leader.

But this is not a political blog, and I will therefore try to focus on matters related to alternative medicine.

The first band-waggon jumpers were, as far as I can see, the guys from NATURAL NEWS; I reported about them in a previous blog and therefore will not go over this again.

More indicative of the things to come is the article by John Weeks, the recently appointed editor of JACM. John also featured on this blog before, and now he has published an article in Huffpo entitled  “Trumpism and the Bigotry of the Antagonists to Integrative Medicine and Health”. In it he takes a very different approach to the matter of Trump and alt med; he states that:

The group, from Australia, USA and Great Britain – the 3 last two named Gorski and Ernst – each used Trumpian tactics. One pre-emptively names the report as “one of the most blatant examples of quackacademic confabulation I have seen in ages.” Another’s label is “tooth fairy science.” Like the Florida judge deemed mistrustful to Trump by his heritage, the study is questioned based on the professional background of two members of the team: “If you want to know why NCCIH supports so much pseudoscience, look no further than it having chiropractors and naturopaths in high ranking positions.” Never mind that each of these NIH employees has a separate research doctorate along with a clinical doctorate.

The study is then blasted for coming from the NIH National Center for Complementary and Integrative Health – once again de-faming the work based on origin rather than substance. The study is “worthless.” The NIH team “actively misleading” the public. These scientists’ tools apparently “exaggerations, sloppy research and misleading conclusions.” The NIH scientists are “”sincerely deluded cranks.” Such name-calling—and particularly the routine attributions of quackery—recall Trump’s epithets placed on each of his opponents, for example “Crooked Hillary.”

(I discussed the paper in question here)

Isn’t that hilarious?

In the Trump-era, one no longer seems to need good evidence, critical thinking or even just plain logic; words suffice, even if they are nonsensical.

The principle is adorably simple and effective:

  • you are faced with some criticism,
  • you find it hard to argue against it,
  • therefore you elect to attack your critic personally,
  • you claim that the criticism is insulting,
  • you re-name any criticism ‘TRUMPISM’,
  • and all is forgiven!

Weeks is not even original; others have used this method before him. In fact, advocates of alternative medicine thrive on ad hominem attacks, and without them they would go nowhere.

What they fail to realise in this particular case is that, in the final analysis, Donald Trump is one of theirs.

You don’t follow me?

Let me explain:

White middle-class American males are desperate; they see themselves close to bankruptcy. To remedy the problem, they had to elect someone who knows all about bankruptcies, someone who has been bankrupted several times before – because LIKE CURES LIKE!

Get it now?

This is the title of a lecture I was asked to give yesterday to an audience of palliative cancer care professionals. During the last days, I have therefore thought about the Anderson-tale quite a bit. For those who don’t know the story (is there such a person?), it is a tale about two con-men who promise the emperor new clothes which, they claim, are invisible to anyone who is incompetent or stupid. When the Emperor parades before his subjects in his new clothes, no one dares to say that he is, in fact, naked. Finally, a child cries out, “But he isn’t wearing anything at all!”

The story is obviously a metaphor for a scenario where something is generally accepted as being good simply because nobody has the courage or insight to oppose popular opinion – nobody except a naïve child, that is. It is a fitting tale for alternative medicine and a superb one to depict my own personal history.

It got more fascinating the more I thought about it. As a metaphor for alternative medicine it offers at least four different perspectives:

  • The quacks seem to get away with even the most obvious lies.
  • The VIP is too gullible and vain to realise that he is being done.
  • The sycophants are happy to play along because they hope to benefit from not speaking the truth.
  • The child has not yet learnt how to ‘play along’ and therefore speaks the truth without a second thought.

The parallels to the current boom in alternative medicine are, I think, so striking that I do hardly need to explain them. The parallels to my own past, however, might require some explanation.

During the last 25 years, I have met more quacks making false claims than I care to remember. Some virtually sold the emperor clothes that were non-existent. One even offered him a report that suggested that the UK’s ailing healthcare system could be saved by maximizing the use of bogus therapies, such as homeopathy, for serious illnesses – more about that in a minute.

I even once had the honour to meet the emperor, our Queen – and it is not she who I here refer to. She was not at all gullible. The emperor I mean is actually our future emperor, the Queen’s son. He has provided us with ample evidence to doubt his intelligence, and it is he who has fallen for the con-men I refer to.

The sycophants are those ‘experts’ who Charles tends to assemble around him. They do know better, I think, but they do not tell him the truth because they know that people like Charles cannot tolerate any facts that fail to confirm his views. So they duly applaud even the silliest of notions hoping to keep their place in the entourage.

And the naïve child? Yes, of course, that’s me. When I arrived in Exeter 23 years ago, I did think that I was appointed to employ science as a tool to find the truth. Once I had done the research, I shouted: “But he isn’t wearing anything at all!” – metaphorically speaking, of course.

And that was something neither the emperor nor the sycophants could tolerate. When I said what had to be said about the ‘Smallwood Report’, the combined effort of the emperor and his sycophants put an end to my activities in Exeter.

Yes, in relation to alternative medicine, the story of THE EMPEROR’S NEW CLOTHES could be most interesting!

But did the palliative care experts invite me to tell it?

The more I thought about it, the more I doubted this.

Eventually, I arrived at the conclusion they wanted to hear about the evidence for or against alternative treatments for cancer. A pity really, because arguably the other aspect are much more entertaining.

 

 

I have been alerted to the fact that my former medical school in Munich at one of Germany’s highest-ranked universities is currently running an elective course in homeopathy. For those who do not read German (the original announcement [apparently posted all over Munich university hospitals] is copied below), it teaches the use of homeopathy in/for:

  • INTERNAL MEDICINE
  • NEONATOLOGY
  • SINUSITIS
  • RECURRENT OTITIS MEDIA
  • INSOMNIA
  • PALLIATION OF RESPIRATORY PROBLEMS
  • PROSTATE CANCER
  • POST-TRAUMATIC SYNDROMES
  • BIPOLAR DISEASE
  • MULTIMORBID PATIENTS WITH UVEITIS
  • COUGH
  • DISEASES OF THE FEMALE BREAST
  • SUPPORTIVE CANCER CARE
  • PAEDIATRIC ASTHMA

The course is being organised by Dr. med. Sigrid Kruse, von Haunersches Kinderspital des Klinikums der Universität München in co-operation with the ‘Landesverband Bayern des Deutschen Zentralvereins homöopathischer Ärzte’. The lecturers of this course seem to be mostly homeopaths from practices in and around Munich.

This article provides further explanations:

The project „Homeopathy in pediatrics“ was established in the Dr. von Hauner’s Children’s Hospital University of Munich in 1995 to integrate homeopathy into a university hospital. Selected children (outpatients and in the wards) are treated conventionally and homeopathically. The Karl and Veronica Carstens-Foundation initially financed the project over six years. An association of parents, whose children were treated for cancer, funded the project for one year. Since 2002, for the first time in Germany, the National Health Insurance is providing the financial background for two consultants for Homeopathy at this University hospital.

Who are we?

Dr. Mira Dorcsi-Ulrich, who initiated the project and carries out the supervision. She is a pediatrician in her own practice with 23 years of experience.

Dr. Sigrid Kruse has managed to integrate homeopathy into the clinic, starting at first in 1995 as a resident for pediatrics. Now she fulfills the requests of doctors and parents in the wards demanding concomitant homeopathic treatment.

Dr. Christian Lucae mainly treats the outpatients while focussing on his research project with children showing attention-deficit-hyperactivity-syndrome (ADHS).

Concomitant homeopathic therapy was successful in the following cases: intracerebral bleeding 3rd degree in premature babies, drug withdrawal in neonates addicted mothers, epilepsy, handicapped children, ADHS, migraine, tic, recurrent infections, asthma and atopic eczema, complications in wound healing and other problems. Homeopathic treatment of children parallel to conventional methods is particularly well accepted in the treatment of cancer. The side effects of oncological treatment like vomiting and stomatitis can be relieved, aggressions and anxiety intercepted and life quality improved.

END OF QUOTE

Which journal with a modicum of self-respect or rigor allows a homeopath to publish anything like the last paragraph without providing a jot of evidence? The answer is the ‘ALLGEMEINE HOMOEOPATHISCHE ZEITUNG’ – no further explanation needed, I think.

Courses like the one above, run at university level, make me first a little speechless and then more than a little angry. Medical schools should have other roles than teaching impressionable students things that fly in the face of science and evidence. They should guide them to become responsible doctors not misguide them to turn into irresponsible quacks. The fact that this comes from the medical school where I,  many years ago, studied, graduated, worked and made both my MD and PhD theses renders the whole thing painfully sad for me personally.

But let’s not get depressed… ‘always look on the bright side of life’!!!

Luckily, there are glimpses of a bright side here. For instance, the fact that doctor Quak is one of the lecturers of this course (see below) is not without jollity, I must admit. Also amusing – at least to me – is be the vision of Dr. med. Mira Dorcsi-Ulrich (see below) standing in front of her students explaining the findings of one of the few RCT of individualised homeopathy for paediatric asthma. This study from my team found no evidence that “adjunctive homeopathic remedies, as prescribed by experienced homeopathic practitioners, are superior to placebo in improving the quality of life of children with mild to moderate asthma in addition to conventional treatment in primary care.”

——————————————————————————————————————————————

Here is the German original announcement of the course:

RINGVORLESUNG IM WINTERSEMESTER 2016/2017
HOMÖOPATHIE VON DER THEORIE ZUR PRAXIS MIT PRAXISBEISPIELEN UND PATIENTENVORSTELLUNGEN

1. 20.10.2016 … IN DER INNEREN MEDIZIN: MÖGLICHKEITEN UND GRENZEN Dr. med. Ulf Riker
2. 27.10.2016 … IN DER NEONATOLOGIE: IKTERUS, ASPHYXIE UND UNRUHE Dr. med. Monika Grasser
3. 03.11.2016 … BEI PATIENTEN MIT SINUSITIS Dr. med. Michael Schreiner
4. 10.11.2016 … BEI KINDERN MIT REZIDIVIERENDER OTITIS MEDIA Dr. med. Christian Lucae
5. 17.11.2016 … BEI SCHLAFSTÖRUNGEN Dr. med. Brigitte Seul
6. 24.11.2016 … BEI PALLIATIV-PATIENTEN MIT RESPIRATORISCHEN PROBLEMEN Herbert Michalczyk
7. 01.12.2016 … IN DER BEGLEITUNG VON PATIENTEN MIT EINEM PROSTATA-CARCINOM Uwe Kraemer-Hoenes
8. 08.12.2016 … BEI POSTTRAUMATISCHER BELASTUNGS-STÖRUNG Dr. med. Ingrid Pfanzelt
9. 15.12.2016 … BEI EINER PATIENTIN MIT BIPOLARER AFFEKTIVER STÖRUNG Dr. med. Stephan Gerke
10. 12.01.2017 … BEI EINEM MULTIMORBIDEN PATIENTEN MIT UVEITIS Dr. med. Thomas Quak
11. 19.01.2017 … BEI PATIENTEN MIT HUSTEN Dr. med. Renate Grötsch
12. 26.01.2017 … BEI ERKRANKUNGEN DER WEIBLICHEN BRUST Dr. med. Ute Bullemer
13. 02.02.2017 … IN DER BEGLEITUNG VON KREBSPATIENTEN MIT Q-POTENZEN Miclós Takács
15. 09.02.2017… BEI KINDERN MIT ASTHMA BRONCHIALE Dr. med. Mira Dorcsi-Ulrich
Organisation: Dr. med. Sigrid Kruse, Dr. von Haunersches Kinderspital des Klinikums der Universität München
E-Mail: sigrid.kruse@med.uni-muenchen.de in Zusammenarbeit mit dem Landesverband Bayern des Deutschen Zentralvereins homöopathischer Ärzte,

During the last two decades, I have had ample occasion to study the pseudo-arguments of charlatans when trying to defend the indefensible. Here I will try to disclose some of them in the hope that this might help others to identify charlatans more easily and to react accordingly.

Let’s say someone publishes a document showing evidence that homeopathy is a useless therapy. Naturally, this will annoy the many believers in homeopathy, and they will counter by attempting to make a range of points:

  1. THEY WILL STATE THAT THERE IS EVIDENCE TO THE CONTRARY. For instance, proponents of homeopathy can produce studies that seem to ‘prove’ homeopathy’s efficacy. The facts that these are flawed or irreproducible, and that the totality of the evidence is not positive does hardly ever bother them. Charlatans are born cherry-pickers.
  2. THEY WILL SUGGEST THAT THE EXISTING EVIDENCE HAS BEEN MIS-QUOTED. Often they will cite out of context from original studies one or two sentences which seem to indicate that they are correct. Any reminders that these quotes are meaningless fall on deaf ears.
  3. THEY WILL SAY THAT THE PUBLISHED EVIDENCE WAS MISINTERPRETED. Often the evidence is complex and can therefore be open to interpretation. Charlatans use this fact and spin the evidence such that it suits their needs. Charlatans are spin-doctors.
  4. THEY WILL SAY THAT SCIENTIFIC EVIDENCE IS OVER-RULED BY CENTURIES OF EXPERIENCE. The notion that millions of satisfied customers cannot be wrong is used frequently to distract from negative evidence. The fact that such experience can be due to a host of non-specific effects, the natural history of the condition or regression to the mean will not convince the charlatan.
  5. THEY WILL SUGGEST THAT THE AUTHOR IS PAID BY BIG PHARMA TO TRASH HOMEOPATHY. Whenever seemingly reasonable arguments have been exhausted, overtly irrational notions or blatant lies will come into play. The allegation that anyone criticising homeopathy is corrupt is one of the most popular such notion. The truth does not have a high value in charlatanry.
  6. THEY WILL SAY THAT THE CRITIC HAS NO TRAINING IN HOMEOPATHY AND IS THUS NOT COMPETENT. Equally popular is the claim that only trained and experienced homeopaths are able to judge over homeopathy. This pseudo-argument is most handy: experienced homeopaths are invariably believers, and the notion essentially claims that only those who believe in it can judge homeopathy. In other words, criticism of homeopathy is by definition invalid.
  7. THEY WILL SAY THAT THE CRITIC HAS PREVIOUSLY BEEN CRITICISED FOR HIS POOR RESEARCH. Similarly, homeopaths might claim that the critic is someone who is being criticised for being a very bad scientist; therefore, it would be a mistake to trust anything he or she says. Ad hominem is the name of the game!
  8. THEY WILL TRY TO RIDICULE THE CRITIC. Readers of this blog will have noticed how some commentators belittle their opponents by giving them laughable nicknames thus undermining their authority. The obvious aim is to make them look less than credible. Charlatans are like little children.
  9. THEY WILL CLAIM THAT IN OTHER AREAS OF HEALTHCARE THE EVIDENCE IS ALSO NOT CONVINCING. The ‘tu quoque’ fallacy is popular for distracting from the embarrassingly negative evidence in quackery – never mind that problems in the aviation industry are no argument for using flying carpets.
  10. THEY WILL POINT OUT HOW SAFE HOMEOPATHY IS COMPARED TO OTHER DRUGS. This is another form of the ‘tu quoque’ fallacy; it works very well for distracting from the problems with homeopathy and regularly convinces lay people.
  11. THEY WILL SAY THAT MEDICAL RESEARCH IS GENERALLY SO FLAWED THAT IT CANNOT BE TRUSTED. The fact that some medical research is less than rigorous is used here to claim that evidence in general is unreliable. The best solution is therefore to go by experience – a big step into the dark ages, but charlatans don’t seem to mind.
  12. THEY WILL REVERSE THE BURDEN OF PROOF. Homeopathy (or any other alternative therapy) may not have been proven to be effective, they claim, but it has not been proven to be ineffective. Therefore, they say, we must give it the benefit of the doubt. The facts that a) science cannot prove a negative and that b) we therefore should use those treatments that are supported by positive evidence is being ignored by charlatans.

These 12 pseudo-arguments are in my experience the most common defences of charlatanry. I am sure there are others – and I would be delighted if you did elaborate on them in the comments section below. Thanks!

Stable angina is a symptom of coronary heart disease which, in turn, is amongst the most frequent causes of death in developed countries. It is an alarm bell to any responsible clinician and requires causal, often life-saving treatments of which we today have several options. The last thing a patient needs in this condition is ACUPUNCTURE, I would say.

Yet acupuncture is precisely the therapy such patients might be tempted to employ.

Why?

Because irresponsible or criminally naïve acupuncturists advertise it!

Take this website, for instance; it informs us that a meta-analysis of eight clinical trials conducted between 2000 and 2014 demonstrates the efficacy of acupuncture for the treatment of stable angina. In all eight clinical trials, patients treated with acupuncture experienced a greater rate of angina relief than those in the control group treated with conventional drug therapies (90.1% vs 75.7%)….

I imagine that this sounds very convincing to patients and I fear that many might opt for acupuncture instead of potentially invasive/unpleasant but life-saving intervention. The original meta-analysis to which the above promotion referred to is equally optimistic. Here is its abstract:

Angina pectoris is a common symptom imperiling patients’ life quality. The aim of this study is to evaluate the efficacy and safety of acupuncture for stable angina pectoris. Clinical randomized-controlled trials (RCTs) comparing the efficacy of acupuncture to conventional drugs in patients with stable angina pectoris were searched using the following database of PubMed, Medline, Wanfang and CNKI. Overall odds ratio (ORs) and weighted mean difference (MD) with their 95% confidence intervals (CI) were calculated by using fixed- or random-effect models depending on the heterogeneity of the included trials. Total 8 RCTs, including 640 angina pectoris cases with 372 patients received acupuncture therapy and 268 patients received conventional drugs, were included. Overall, our result showed that acupuncture significantly increased the clinical curative effects in the relief of angina symptoms (OR=2.89, 95% CI=1.87-4.47, P<0.00001) and improved the electrocardiography (OR=1.83, 95% CI=1.23-2.71, P=0.003), indicating that acupuncture therapy was superior to conventional drugs. Although there was no significant difference in overall effective rate relating reduction of nitroglycerin between two groups (OR=2.13, 95% CI=0.90-5.07, P=0.09), a significant reduction on nitroglycerin consumption in acupuncture group was found (MD=-0.44, 95% CI=-0.64, -0.24, P<0.0001). Furthermore, the time to onset of angina relief was longer for acupuncture therapy than for traditional medicines (MD=2.44, 95% CI=1.64-3.24, P<0.00001, min). No adverse effects associated with acupuncture therapy were found. Acupuncture may be an effective therapy for stable angina pectoris. More clinical trials are needed to systematically assess the role of acupuncture in angina pectoris.

In the discussion section of the full paper, the authors explain that their analysis has several weaknesses:

Several limitations were presented in this meta-analysis. Firstly, conventional drugs in control group were different, this may bring some deviation. Secondly, for outcome of the time to onset of angina relief with acupuncture, only one trial included. Thirdly, the result of some outcomes presented in different expression method such as nitroglycerin consumption. Fourthly, acupuncture combined with traditional medicines or other factors may play a role in angina pectoris.

However, this does not deter them to conclude on a positive note:

In conclusion, we found that acupuncture therapy was superior to the conventional drugs in increasing the clinical curative effects of angina relief, improving the electrocardiography, and reducing the nitroglycerin consumption, indicating that acupuncture therapy may be effective and safe for treating stable angina pectoris. However, further clinical trials are needed to systematically and comprehensively evaluate acupuncture therapy in angina pectoris.

So, why do I find this irresponsibly and dangerously misleading?

Here a just a few reasons why this meta-analysis should not be trusted:

  • There was no systematic attempt to evaluate the methodological rigor of the primary studies; any meta-analysis MUST include such an assessment, or else it is not worth the paper it was printed on.
  • The primary studies all look extremely weak; this means they are likely to be false-positive.
  • They often assessed not acupuncture alone but in combination with other treatments; consequently the findings cannot be attributed to acupuncture.
  • All the primary studies originate from China; we have seen previously (see here and here) that Chinese acupuncture trials deliver nothing but positive results which means that their results cannot be trusted: they are false-positive.

My conclusion: the authors, editors and reviewers responsible for this article should be ashamed; they committed or allowed scientific misconduct, mislead the public and endangered patients’ lives.

This new study is amazing in several respects. It was conducted in Spain by otolaryngologists, and one of its authors is an employee of Boiron, the world’s biggest manufacturer of homeopathic products. It was designed as a double blind, placebo-controlled RCT. Patients aged 2 months to 12 years suffering from otitis media with effusion (OME), as diagnosed by pneumatic otoscopy (PNO) and tympanometry, were randomized into two groups. Both groups received aerosol therapy (mucolytics and corticosteroids). In addition, the experimental group received a homeopathic remedy of Agraphis nutans 5CH, Thuya Occidentalis 5CH, Kalium muriaticum 9CH and Arsenicum iodatum. The placebo group received placebos instead. Both of the treatments were continued for 3 months. Patients were evaluated by PNO examination and tympanometry at baseline, at 45 and 90 days.

A total of 97 patients were enrolled in this study. In the homeopathy group, 61.9% of individuals were cured according to PNO results by the 3rd visit compared with 56.8% of patients treated with placebo. 4.8% of patients in the homeopathy group suffered a recurrence (positive PNO in the 2nd visit changed to negative in the 3rd visit), while 11.4% did in the placebo group. These inter-group differences were not statistically significant. Adverse events were distributed similarly, except in the case of upper respiratory tract infections, which were less frequent in homeopathic group.

The authors of this new RCT concluded that the homeopathic scheme used as adjuvant treatment cannot be claimed to be an effective treatment in children with OME.

No surprises then – we already know that homeopathic remedies are placebos!

Sure, but at least two amazing features need to be pointed out:

  • I am delighted that the authors did not try to spin the results such that they appear to be positive. Some investigators might have emphasised the fact that there was a (non-significant) trend in favour of homeopathy, and that, for a secondary outcome measure (upper respiratory infections), it even reached the level of statistical significance.
  • Considering that this study was obviously Boiron-sponsored and its list of authors included an employee of this firm, such honesty can’t have been easy to maintain.
  • The design of this RCT is also worth a mention: most alt med proponents seem to think that ‘adjunctive’ use of alt med needs to be tested via the infamous ‘A+B vs B’ design which fails to control for placebo effects and therefore invariably produces false positive findings. The authors of this trial did the right thing by randomising their patients into usual care + homeopathy vs usual care + placebo. This is very simple and has the advantage to actually provide a meaningful result.

In view of all this, I raise my hat to the Spanish researchers: very well done!!!

If all trials of homeopathy were conducted and reported in this honourable fashion, the collective evidence would be in a much better state and far less confusing.

I have warned you before to be sceptical about Chinese studies. This is what I posted on this blog more than 2 years ago, for instance:

Imagine an area of therapeutics where 100% of all findings of hypothesis-testing research are positive, i.e. come to the conclusion that the treatment in question is effective. Theoretically, this could mean that the therapy is a miracle cure which is useful for every single condition in every single setting. But sadly, there are no miracle cures. Therefore something must be badly and worryingly amiss with the research in an area that generates 100% positive results.

Acupuncture is such an area; we and others have shown that Chinese trials of acupuncture hardly ever produce a negative finding. In other words, one does not need to read the paper, one already knows that it is positive – even more extreme: one does not need to conduct the study, one already knows the result before the research has started. But you might not believe my research nor that of others. We might be chauvinist bastards who want to discredit Chinese science. In this case, you might perhaps believe Chinese researchers.

In this systematic review, all randomized controlled trials (RCTs) of acupuncture published in Chinese journals were identified by a team of Chinese scientists. A total of 840 RCTs were found, including 727 RCTs comparing acupuncture with conventional treatment, 51 RCTs with no treatment controls, and 62 RCTs with sham-acupuncture controls. Among theses 840 RCTs, 838 studies (99.8%) reported positive results from primary outcomes and two trials (0.2%) reported negative results. The percentages of RCTs concealment of the information on withdraws or sample size calculations were 43.7%, 5.9%, 4.9%, 9.9%, and 1.7% respectively.

The authors concluded that publication bias might be major issue in RCTs on acupuncture published in Chinese journals reported, which is related to high risk of bias. We suggest that all trials should be prospectively registered in international trial registry in future.

END OF QUOTE

Now an even more compelling reason emerged for taking evidence from China with a pinch of salt:

A recent survey of clinical trials in China has revealed fraudulent practice on a massive scale. China’s food and drug regulator carried out a one-year review of clinical trials. They concluded that more than 80 percent of clinical data is “fabricated“. The review evaluated data from 1,622 clinical trial programs of new pharmaceutical drugs awaiting regulator approval for mass production. Officials are now warning that further evidence malpractice could still emerge in the scandal.
According to the report, much of the data gathered in clinical trials are incomplete, failed to meet analysis requirements or were untraceable. Some companies were suspected of deliberately hiding or deleting records of adverse effects, and tampering with data that did not meet expectations.

“Clinical data fabrication was an open secret even before the inspection,” the paper quoted an unnamed hospital chief as saying. Contract research organizations seem have become “accomplices in data fabrication due to cutthroat competition and economic motivation.”

A doctor at a top hospital in the northern city of Xian said the problem doesn’t lie with insufficient regulations governing clinical trials data, but with the failure to implement them. “There are national standards for clinical trials in the development of Western pharmaceuticals,” he said. “Clinical trials must be carried out in three phases, and they must be assessed at the very least for safety,” he said. “But I don’t know what happened here.”

Public safety problems in China aren’t limited to the pharmaceutical industry and the figure of 80 percent is unlikely to surprise many in a country where citizens routinely engage in the bulk-buying of overseas-made goods like infant formula powder. Guangdong-based rights activist Mai Ke said there is an all-pervasive culture of fakery across all products made in the country. “It’s not just the medicines,” Mai said. “In China, everything is fake, and if there’s a profit in pharmaceuticals, then someone’s going to fake them too.” He said the problem also extends to traditional Chinese medicines, which are widely used in conjunction with Western pharmaceuticals across the healthcare system.
“It’s just harder to regulate the fakes with traditional medicines than it is with Western pharmaceuticals, which have strict manufacturing guidelines,” he said.

According to Luo, academic ethics is an underdeveloped field in China, leading to an academic culture that is accepting of manipulation of data. “I don’t think that the 80 percent figure is overstated,” Luo said.

And what should we conclude from all this?

I find it very difficult to reach a verdict that does not sound hopelessly chauvinistic but feel that we have little choice but to distrust the evidence that originates from China. At the very minimum, I think, we must scrutinise it thoroughly; whenever it looks too good to be true, we ought to discard it as unreliable and await independent replications.

Bogus claims of alternative therapists are legion, particularly in homeopathy. But bogus claims are neither ethical nor legal. Homeopathy works for no human condition, and therefore any medical claim made for homeopathy is unethical, false, misleading and illegal.

This is not just my view (after studying the subject for more than two decades) but also that of the UK regulators. In case you doubt it, please read the full notice which the UK ‘Advertising Standards Authority’ has just published (dated 29/9/2016):

This week, our sister organisation, the Committee of Advertising Practice (CAP) Compliance team has written to homeopaths across the UK to remind them of the rules that govern what they can and can’t say in their marketing materials, including on their websites.

Homeopathy is based on the principle of treating like with like; in other words a substance which causes certain symptoms can also help remove those symptoms when it is diluted heavily in water before being consumed. Practitioners believe that this stimulates the body to heal itself. However, to date, despite having considered a body of evidence, neither us nor CAP has seen robust evidence that homeopathy works. Practitioners should therefore avoid making direct or implied claims that homeopathy can treat medical conditions.  

We have no intention of restricting the ability of practitioners to advertise legitimate and legal services, nor do we seek to restrict the right of individuals to choose treatment. However, when advertisers make claims about these products or services, in all sectors, they must hold appropriate evidence to back up those claims. If they do not, then we have a responsibility to intervene to protect consumers by ensuring that those ads are amended or withdrawn.

If you are a practicing homeopath, please ensure that you carefully read CAP’s advice and guidance. It includes a non-exhaustive list of the types of claims you can and can’t make. You will then need to make changes, as necessary, to your marketing materials, including on your website, if you have one. 

Further guidance can be found on the Society of Homeopaths’ website. We have worked closely with the Society over the course of the last year, to help them produce detailed guidance to support their members.

If you are a homeopath but have not received a letter from us, please download a copy here, together with supporting FAQs about Advertising Regulation.

I think this notice speaks for itself. All I want to add at this stage is my hope that UK homeopaths comply asap to avoid getting penalised and – much more importantly – to avoid continuing to mislead consumers.

Over on ‘SPECTATOR HEALTH’, we have an interesting discussion (again) about homeopathy. The comments so far were not short of personal attacks but this one by someone who called himself (courageously) ‘Larry M’ took the biscuit. It is so characteristic of deluded homeopathy apologists that I simply have to share it with you:

Ernst grew up with homeopathy [1], saw how well it worked [2], and chose to become a so-called expert in alternative medicine [3]. To his surprise, he met with professional disapproval [4]. Being the weak ego-driven person that he is [5], he saw an opportunity to still come out on top. He sold his soul in exchange for the notoriety that he now receives for being the crotchety old homeopathy hater that he has become [6]. As with all homeopathy haters, his fundamentalist zeal [7] is evidence of his secret self-loathing [8] and fear that his true beliefs will be found out [9]. It’s no different than the evangelical preacher who rails against gays only to be eventually found out to be a closeted gay [10].

There is not much that makes me speechless these days, but this comment almost did. There is someone who clearly does not even know me and he takes it upon himself to interpret and re-invent my past, my motives and my actions at will. How deluded is that?

After re-reading the comment, I began to see the funny side of it, had a giggle and decided to add a few elements of truth in the form of this blog-post. So I took the liberty to insert some reference numbers into Larry’s text which refer to my brief points below.

  1. This is at least partly true; our family doctor was a prominent homeopath. Whenever one of us was truly ill, he employed conventional treatments.
  2. I was impressed as a young physician working in a homeopathic hospital to see that patients improved on homeopathy – even though, at medical school, I had been told that the remedies were pure placebos. This contradiction fascinated me, and I began to do some own research into the subject.
  3. I did not ‘choose’, I had a genuine interest; and I don’t think that I am a ‘so called’ expert – after 2 decades of research and hundreds of papers, this attribute seems a trifle unfitting.
  4. The disapproval came from the homeopathy fans who were irritated that someone had the audacity to undertake a truly CRITICAL assessment of their treatments and actions.
  5. The amateur psychology here speaks for itself, I think.
  6. Yes, I am no spring chicken! But I am not a ‘hater’ of anything – I try to create progress by convincing people that it is prudent to go for treatments that are evidence-based and avoid those that do not generate more good than harm.
  7. This attitude is not a ‘fundamental zeal’, it is the only responsible way forward.
  8. This made me laugh out loud! Nothing could be further from the truth.
  9. My ‘true belief’ is that patients deserve the best treatments available. I have no fear of being ‘found out’; on the contrary, during my career I stood up to several challenges of influential people who tried to trip me up.
  10. This is hilarious – does Larry not feel how pompously ridiculous and ridiculously pompous he truly is?

This might be all too trivial, if such personal attacks were not an almost daily event. The best I can do with them, I have concluded, is to expose them for what they are and demonstrate how dangerously deluded the advocates of quackery really are. In this way, I can perhaps minimize the harm these people do to public health and medical progress.

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