MD, PhD, FMedSci, FSB, FRCP, FRCPEd

experience

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Dr Gabriella Day is a GP in England who describes herself and her beliefs as follows: “I began training in homeopathy as it is clear that for many conditions conventional treatment options are not effective and can have unwanted side effects. It seemed to me that there must be another way to help people suffering from symptoms such as these… I believe in whole person medicine. No illness exists in isolation. The human body is immensely sophisticated and complicated and we do not understand it fully. Therefore the illness cannot be separated from the person suffering the disease. This may be as simple as stress impairing the immune system to far more complex interactions. Homeopathic treatment seeks to match the underlying disturbance in the system and stimulate the body to correct itself.”

I do not know Dr Day, but she caught my attention recently when she published an article in THE HIPPOCRATIC POST (I had never heard of this publication before!). It is, I think, sufficiently noteworthy to show you some excerpts (the references [in square brackets] were added by me, and they refer to my comments below):

START OF QUOTES

…Homeopathy can be helpful for pretty much any condition [1], whether as the main treatment [1], as a complement to a conventional treatment [2] to speed up the healing process [1], or to lessen the side-effects of a pharmacological medication [1]. It can be helpful in the treatment of emotional problems [1], physical problems [1] and for multi-morbidity patients [1]. I find it an invaluable tool in my GP’s toolbox and regularly see the benefits of homeopathy in the patients I treat [3]…

There are many conditions for which I have found homeopathy to be effective [1]… There are, however, a multitude of symptomatic treatments available to suppress symptoms, both on prescription and over-the-counter. Most symptoms experienced by patients in this context result from the body’s attempt to eliminate the infection. Our immune systems have spent thousands of years refining this response; therefore it seems counter-intuitive to suppress it [4].
For these types of acute conditions homeopathy can work with the body to support it [1]. For instance, homeopathic Arsenicum album (arsenic) is a classic remedy for diarrhoea and vomiting that can be taken alongside essential oral rehydration [1]. And in influenza I’ve found Eupatorium perfoliatum (ague or feverwort) to be very helpful if the patient is suffering with bony pain [3].
…Unless it is clinically imperative for a pharmacological intervention, I will always consider homeopathy first [5] and have successfully prescribed the homeopathic remedy Nux vomica (strychnine) for women suffering from morning sickness [5]. Problems associated with breastfeeding such as mastitis have also responded well to the classic remedies Belladonna (deadly nightshade) and Phytolacca (pokeweed), while I have found Urtica urens (dog nettle) effective in switching off the milk supply to prevent engorgement when the mother stops breastfeeding [3].
…“heart sink” patients are clearly suffering from pain and discomfort, which is blighting their lives. This is understandably frustrating for them, for they know full well something is awry but there is no medical evidence for this… Homeopathy affords me another approach in trying to help these patients [1,3]. It doesn’t work for them all, but I’m frequently surprised at how many it does help [3].

Positive side-effects

The beauty of homeopathy is that it combines mental and emotional symptoms with physical symptoms [3]. When the right remedy is found it appears to stimulate the body to recognise how it is being dysfunctional and corrects this, with no suppression, just a correction of the underlying disturbance [3]. Thus homeopathy not only eliminates unwanted symptoms [1], it dramatically improves a patient’s overall well-being [1].
…homeopathy… enables me to reduce the number of painkillers and other drugs I’m prescribing [1,3]. This is particularly true for older multi-morbidity, polypharmacy patients [1] who are often taking huge amounts of medication.
Contrary to what most homeopaths will tell you, I believe homeopathic treatment does have side-effects – positive side-effects! [1] It fosters an enhanced doctor patient relationship [1]. The process of eliciting the relevant information to select a remedy enables me to better understand the patient’s condition and helps me to get to know them better [3]. And the patient, seeing that the doctor is interested in the idiosyncrasies and detail of their disease, finds themselves heard and understood [3]. In short, since training in homeopathy I enjoy my job as a GP and my relationship with patients so much more [3].
Dr Gabriella Day BSc, MBBS, MRCP, DCH, MRCGP, MFHom

END OF QUOTES

MY COMMENTS:

  1. statement without good evidence,
  2. Hahnemann was vehemently against combining homeopathy with other treatments and called clinicians who disregarded this ‘traitors’,
  3. statement of belief,
  4. wrong assumption,
  5. questionable ethics.

I have recently attempted to slip into the brain of lay-homeopaths and shown how illogical, misguided and wrong the arguments of such enthusiasts really are. Surely, the logic of a doctor homeopath must be better, I then thought. Once you have studied medicine, you have learnt an awful lot of things about the body, disease, therapy, etc., etc., I felt.

Judging from the above article, I might have been wrong.

It has been pointed out that many of the discussions we have on this blog are like pigeon chess. The term comes from a comment made by Scott D. Weitzenhoffer about Evolution vs. Creationism: An introduction: “Debating creationists on the topic of evolution is rather like trying to play chess with a pigeon — it knocks the pieces over, craps on the board, and flies back to its flock to claim victory.”

Debating a fan of alternative medicine is frequently just like that: ignorant of the basics of science and logic, he nevertheless insists on playing with you, knocks over the pieces, defecates on the board, flies back to his flock to boast of victory, only to come back a little later to start over again.

The sequence of events is comically stereotypical: in order to start this game, the evangelist of alternative medicine does his best to appear rational and interested in the subject. Once a discussion has commenced, he begins to make more and more irrational claims. When asked to provide evidence for them, he evades the challenge. Instead, he issues all sorts of accusations to you. Some of the favourites include:

  • being not competent to discuss the issue at hand,
  • having a closed mind,
  • being paid by BIG PHARMA,

As the accusations continue, it can be almost impossible to remain polite. Your reminders to produce evidence for the evangelist’s irrational claims become more and more pressing. He then decides to focus on a triviality and pesters you with questions about it which are too silly to answer. Consequently, the temperature of the exchange rises until his accusations become offensive or turn into overt insults (in the past I have sometimes deleted insulting comments and I intend to continue doing this on hopefully rare occasions). The aims of the evangelist are 1) to arrive at a point where you lose your temper and 2) to distract from the fact that he is unable to provide any evidence for his outlandish claims. Eventually your patience is exhausted and you finally start paying him back in the same coinage as he dispensed.

At this stage, the evangelist indignantly shouts:

  • YOU HAVE INSULTED ME!!!
  • YOU HAVE INSULTED ANYONE WHO DISAGREES WITH YOU!!!
  • THIS SHOWS WHAT A BAD, BAD PERSON YOU ARE!!!

Consequently, you give him a real piece of your mind and tell him what you really think of people who are belligerent,  ignorant on their chosen subject, provocatively irrational and unable or unwilling to learn. The reaction of the evangelist is predictable: he says THAT’S IT, I AM NOT TALKING TO YOU ANYMORE, announces that he is the winner of the argument, and flies off triumphantly promising never to return.

Finally!

We all give a sigh of relief. The evangelist has now returned to his fellow conspiracy theorists where he defames you the best he can. Eventually he disappoints your hope of peace and rationality by returning to the table. He pretends nothing has happened and starts over again.

So, what is the solution?

I am not sure there is an ideal way out.

Personally I intend to do the following in future (and I invite others to follow my example): before I reach the point where I lose my temper completely and regrettably, I will refer the evangelist to this blog post entitled ‘A method of ending discussions with belligerent twits’. At the same time, I will inform him (rarely it is a ‘her’) that I am about to break off the discussion with him because I fear that otherwise I might be openly rude, and perhaps even tell him: YOU ARE A FLAMING IDIOT WHO POSTS FAR TO MUCH NONSENSE TO BE TAKEN SERIOUSLY.

This, I hope will get my message across without actually ever tempting me to post a rude word again.

Failing this, I will block him completely, a measure to which so far I only needed rarely to resort.

On this blog, we have had (mostly unproductive) discussions with homeopath so often that sometimes they sound like a broken disk. I don’t want to add to this kerfuffle; what I hope to do today is to summarise  a certain line of argument which, from the homeopaths’ point of view, seems entirely logical. I do this in the form of a fictitious conversation between a scientist (S) and a classical homeopath (H). My aim is to make the reader understand homeopaths better so that, future debates might be better informed.

HERE WE GO:

S: I have studied the evidence from studies of homeopathy in some detail, and I have to tell you, it fails to show that homeopathy works.

H: This is not true! We have plenty of evidence to prove that patients get better after seeing a homeopath.

S: Yes, but this is not because of the remedy; it is due to non-specific effect like the empathetic consultation with a homeopath. If one controls for these factors in adequately designed trials, the result usually is negative.

I will re-phrase my claim: the evidence fails to show that highly diluted homeopathic remedies are more effective than placebos.

H: I disagree, there are positive studies as well.

S: Let’s not cherry pick. We must always consider the totality of the reliable evidence. We now have a meta-analysis published by homeopaths that demonstrates the ineffectiveness of homeopathy quite clearly.

H: This is because homeopathy was not used correctly in the primary trials. Homeopathy must be individualised for each unique patient; no two cases are alike! Remember: homeopathy is based on the principle that like cures like!!!

S: Are you saying that all other forms of using homeopathy are wrong?

H: They are certainly not adhering to what Hahnemann told us to do; therefore you cannot take their ineffectiveness as proof that homeopathy does not work.

S: This means that much, if not most of homeopathy as it is used today is to be condemned as fake.

H: I would not go that far, but it is definitely not the real thing; it does not obey the law of similars.

S: Let’s leave this to one side for the moment. If you insist on individualised homeopathy, I must tell you that this approach can also be tested in clinical trials.

H: I know; and there is a meta-analysis which proves that it is effective.

S: Not quite; it concluded that medicines prescribed in individualised homeopathy may have small, specific treatment effects. Findings are consistent with sub-group data available in a previous ‘global’ systematic review. The low or unclear overall quality of the evidence prompts caution in interpreting the findings. New high-quality RCT research is necessary to enable more decisive interpretation.

If you call this a proof of efficacy, I would have to disagree with you. The effect was tiny and at least two of the best studies relevant to the subject were left out. If anything, this paper is yet another proof that homeopathy is useless!

H: You simply don’t understand homeopathy enough to say that. I tried to tell you that the remedy must be carefully chosen to fit each unique patient. This is a very difficult task, and sometimes it is not successful – mainly because the homeopaths employed in clinical trials are not skilled enough to find it. This means that, in these studies, we will always have a certain failure rate which, in turn, is responsible for the small average effect size.

S: But these studies are always conducted by experienced homeopaths, and only the very best, most experienced homeopaths were chosen to cooperate in them. Your argument that the trials are negative because of the ineffectiveness of the homeopaths – rather than the ineffectiveness of homeopathy – is therefore nonsense.

H: This is what you say because you don’t understand homeopathy!

S: No, it is what you say because you don’t understand science. How else would you prove that your hypothesis is correct?

H: Simple! Just look at individual cases from the primary studies within this meta-analysis . You will see that there are always patients who did improve. These cases are the proof we need. The method of the RCT is only good for defining average effects; this is not what we should be looking at, and it is certainly not what homeopaths are interested in.

S: Are you saying that the method of the RCT is wrong?

H: It is not always wrong. Some RCTs of homeopathy are positive and do very clearly prove that homeopathy works. These are obviously the studies where homeopathy has been applied correctly. We have to make a meta-analysis of such trials, and you will see that the result turns out to be positive.

S: So, you claim that all the positive studies have used the correct method, while all the negative ones have used homeopathy incorrectly.

H: If you insist to put it like that, yes.

S: I see, you define a trial to have used homeopathy correctly by its result. Essentially you accept science only if it generates the outcome you like.

H: Yes, that sounds odd to you – because you don’t understand enough of homeopathy.

S: No, what you seem to insist on is nothing short of double standards. Or would you accept a drug company claiming: some patients did feel better after taking our new drug, and this is proof that it works?

H: You see, not understanding homeopathy leads to serious errors.

S: I give up.

To honour Hahnemann’s birthday, a National Convention was held yesterday on ‘World Homeopathy Day’ in New Delhi. The theme of the convention is “Enhancing Quality Research in Homeopathy through scientific evidence and rich clinical experiences”. They could have done with this new study of Influenzinum 9C, it seems to me. This is a homeopathic remedy made from the current influenza vaccine. Influenzinum 9C, also known as homeopathic flu nosode. It is claimed to:

  • strengthen the body and increase its resistance to the season’s flu viruses,
  • protect against cold & flu symptoms such as body aches, nausea, chills, fever, headaches, sore throat, coughs, and congestion,
  • enforce the flu vaccine’s action if you have opted for the flu shot,
  • deal with aftereffects of the flu, and
  • alleviate adverse effects of the flu shot.

As these are the claims made by homeopaths (here is but one example of many: “I’ve been using this for over 30 years for my family, and we have never had the flu!”), French researchers have tested whether Influenzinum works. They just published the results of the first study examining the effectiveness of Influenzinum against influenza-like illnesses.

They conducted a retrospective cohort study during winter 2014-2015. After influenza epidemic, a self-assessment questionnaire was offered to patients presenting for a consultation. The primary endpoint was the declaration of an influenza-like illness. The exposed patients (treated by Influenzinum) were matched to two non-exposed patients (untreated) with a propensity score. A conditional logistic model expressed influenza-like illness risk reduction provided by the Influenzinum.

The cohort included 3514 patients recruited from 46 general practitioners. After matching, the treated group (n=2041) and the untreated group (n=482) did not differ on variables collected. Thus Influenzinum preventive therapy did not significantly alter the likelihood of influenza-like illness.

The authors concluded that Influenzinum preventive therapy did not appear effective in preventing influenza-like illness.

This can be no surprise to anyone you knows what ‘C9’ means: it signifies a dilution of 1: 1 000 000 000 000 000 000 (plus 9 times vigorous shaking, of course).

I am sure that some homeopaths will now question whether Influenzinum is truly homeopathic. Is it based on the ‘like cures like’ principle? Before some clever Dick comments ‘THIS SHOWS THAT PROF ERNST HAS NOT GOT A CLUE ABOUT HOMEOPATHY’, please let me point out that it was not I but the homeopaths who insisted in labelling Influenzinum ‘homeopathic’ (see, for instance, here: “Influenzinum Dose is a homoeopathic medicine created by Laboratoire Boiron. Single dose to be consumed in one step. This homoeopathic medicine is generally used as a substitute for the flu vaccine”). AND WHO AM I TO QUESTION THE AUTHORITY OF BOIRON???

Homeopaths have, as I reported previously, claimed to be able to ‘cure’ homosexuality. This is why I was less amazed than you might be when I came across a comment about a woman who tried a homeopathic solution called Dr. Reckeweg R20 Glandular Drops for Women. Nonetheless, the story is so remarkable that I cannot resist sharing it with you.

The solution promises to fix pituitary dysfunction, goiters, obesity, Grave’s diseases, Addison’s disease, and “lesbian tendencies.” The product also brags that it is “derived and potentised from fetal tissues.”

A much more detailed description of the remedy in question can be found here:

Dr. Reckeweg R20 Glandular drops for women, goitre, endocrine dysfunction, Graves disease, addisons disease, Adiposity (Overweight)

Dr Reckeweg R20 Glandular drops are indicated for frigidity in women. Dr.Reckeweg R20 drops treats endocrine dysfunction in women through individual remedies like Glandulae suprarenaises, Hypophysis that is derived and potentised from fetal tissues based on Arndt-Schulz principle. Also indicated for growth disturbances, obesity due to pituitary dysfunction, Goiter (swelling in neck due to thyroid enlargement), Grave’s diseases (auto immune disease from hyperthyroidism), Addison’s disease (due to deficient hormones from adrenal cortex), myxoedema (swelling due to under active thyroid glands), etc.

Introduction The disorders of glands in the human body can affect the physiological functions due to excess or deficient hormones. This occurs when glands like the adrenal or pituitary do not function properly resulting in too much or too little hormones being released. This includes important HORMONEs like cortisol aldosterone and sex hormones produced by adrenal gland and Growth hormone, Prolactin, Adrenocorticotropin (ACTH), Thyroid-stimulating hormone (TSH). For example too much aldosterone increases blood pressure whereas Adrenal insufficiency results in fatigue, muscle weakness, decreased appetite, and weight loss. Pituitary glandtumor is another manifestation of The disorders of glands in the human body and is fairly common in adults.

About Dr.Reckeweg R 20 drops is a popular homeopathic medicine to treat disorders of glands in human body and acts through a proprietary blend of several homeopathic herbs (available in drops). It has key Ingredients like hypophysis, pancreas etc that act on endocrine dysfunction, obesity that is caused due to pituitary dysfunction, growth disturbances. It is also indicated for swelling of the neck resulting from enlargement of the thyroid gland (goiter), swelling of the neck and protrusion of the eyes resulting from an overactive thyroid gland (Graves disease), disease characterized by progressive anemia, low blood pressure, great weakness, and bronze discoloration of the skin (Addisons disease) and swelling of the skin and underlying tissues giving a waxy consistency (myxoedema).

Indicated for following medical conditions Adiposity (Overweight), Disturbances of endocrive gland, Disturbances of gland,Obesity (Overweight)

INGREDIENTS: Dr.Reckeweg R 20 drops for women contains: Glandulae Thymi D12, Thyreoidinum D12, Hypophysis D12, Pancreas D12, Glandulae Supratenales D12, Ovaria D12 In R 20.

How the ingredients in Dr.Reckeweg R 20 drop work? The key properties in Dr.Reckeweg R 20 drops are derived from the following ingredients to treat disorders of glands in women

Glandulae suprarenales – treats abnormal physical weakness (asthenia), reduction of weight and condition causing abnormal weakness of certain muscles (myasthenia). It also treats asthma, allergic conditions, deficiency of glucose in the bloodstream (hypoglycaemia) and abnormal increase in muscle tension and a reduced ability of a muscle to stretch (hypertonia).

Hypophysis – it helps to control internal secretion, contents of the lactic acid in blood, mineralization and fluidic content of body.

Pancreas – treats pancreatic diabetes and stimulates production of the digestive secretions.

Testes (male) or Ovaria (female) – treats disorders of glands in human body such as senility (condition of being senile i.e. old age), inclining potency (male’s ability to achieve an erection or to reach orgasm), faulty memory, functional disturbances of glands. It also treats depression, inferiority complex, and condition in which one or both of the testes fail to descend from the abdomen (cryptorchidism), nocturnal involuntary urination (enuresis) and sexual dysfunction to maintain an erection of the penis (impotency).

Treats the failure of a female to respond to sexual stimulus (frigidity), lesbian tendencies, congestion and faulty circulation

It also reduces the hyperactivity of pituitary (hypophysis).

Glandulae thyme – treats exhaustion and congenital disorder arising from a chromosome defect, causing intellectual impairment and physical abnormalities (mongolism).

Thyreoidinum – it regulates thyroid gland, myxoedema, and interrupted development of the thyroid gland. It also treats condition of having low body temperature (hypothermy), excess of cholesterol in the bloodstream (hypercholesterolaemia) and retarded intellectual development.

DOSAGE: Generally 3 times daily 10 to 15 drops of Dr.Reckeweg R 20 in some water.

Complimentary medicines to R20: R26 drops (to increase reactivity after debilitating illness), R59 (in obesity)

SIZE:. 22 ML sealed Bottle

Encouraged by such scientific-sounding words, the women in question gives the remedy a try. By day four of the treatment, she writes, “At 3 AM, I find myself singing along to ‘You wanna see cunt, you wanna see pussy’ with someone else’s lipstick on my face.”

The conclusion of the author of the article is this: “So it looks like homeopathic fetus water does not in fact cure lesbianism. Still, as far as gay conversion therapy treatments go, it’s pretty tame — there’s no exorcism or electrocution, at least.”

I am sure by now you wonder about the Reckeweg remedy line. Here are two short paragraphs from my book to explain:

Dr. Reckeweg was a German homeopathic physician who practised complex homeopathy and developed homotoxicology as well as homaccorde, i. e. the administration of multiple potencies of the same remedies in one single preparation. He started a commercially successful line of combination remedies. The remedies are recommended for conventional diagnostic indications, but treated with homeopathically manufactured mixtures. According to proponents, they therefore built a bridge between conventional and homeopathic medicine. In the early 1970s, Reckeweg sold 50% of his company to the Delton Group and moved to the US.

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.

And to put some icing on this cake: Heel was, of course, one of the firms who financed a journalist for systematically defaming me (more here, here and here).

Prof Walach has featured on this blog before, for instance here, and here. He is a psychologist by training and a vocal and prominent advocate of several bogus treatments, including homeopathy. He also is the editor in chief of the journal ‘Complementary Medicine Research’ and regularly uses this position to sing the praise of homeopathy. There is a degree of mystery about his affiliation: he informed me about 10 months ago that he has left his post at the Europa Universität Viadrina, Frankfurt/Oder (“Dass ich als “ehemaliger Professor” geführt werde liegt daran, dass ich  Ende Januar aufgehört habe. Meine Stelle ist ausgelaufen und ich habe
sie nicht mehr verlängert.”). Yet all, even his recent papers still carry this address.

His latest article is entitled ‘The future of homeopathy’ is no exception. It is remarkable not just because of the mysterious affiliation but also – and mostly – because of its content. Here is my translation of a brief passage from this paper [I added some numbers in square brackets which refer to footnotes below].

START OF MY TRANSLATION

It is entirely undisputed that homeopathy with its therapeutic principles runs against the mainstream of science; and in this, Weymayr [1] is correct. However, to build on this fact a veritable research prohibition, such as the ‘scientability-concept’ suggests, is not just wrong from a science theoretical perspective, but… also discloses a dogmatic and unscientific stance.

If we see things soberly, homeopathy is – from a science theory point of view – an anomaly: empiric data prove that effects appear regularly and more and more frequently [2].  This is being demonstrated with meta-analyses of placebo-controlled clinical trials. And this also shows with our own provings, which conform well with the newly developed standards as well as with the newer provings. Effects are furthermore noted with such frequency in animal and plant-based studies. Contrary to often voiced statements, there are also models which produce replicated effects – for instance the model of children with ADHD which is currently being replicated. Repeatedly high quality pilot studies emerge, such as the one by Gassmann et al., which show that unexpected effects also appear with higher potencies, documented with objective methods. Homeopathy proves itself as useful in large pragmatic trials of which we, however, have far too few. And let’s not forget: homeopathy is pragmatically useful. Even though aggravations do occur occasionally during homeopathic treatments, the claim that homeopathy is dangerous is a careless interpretation of the data. [3]

In what way is homeopathy an anomaly? I have already years ago argued that the signature of the data does not suggest that we are dealing with a classical local effect. This would be an effect which would conform with the usual criterion of causality and would thus be stable, regular and more and more evident with improved experimentation. It is unnecessary to repeat this argument [4] for the purpose of this editorial. But precisely the question of the classic causal effect is the controversy. And exactly this is the issue used by the new wave of critic of homeopathy which is openly aimed at the demise of homeopathy. This situation occurs because also the homeopaths are victims of the misapprehension  that homeopathy is based on a classic causal process. But this assumption is most likely wrong, and homeopaths would be well-advised on the one side to point to the empiric evidence, and on the other side to practice theoretical chastity making clear that, for the time being, we have not a clue how homeopathy functions. This is the typical situation when a scientific anomaly occurs…

My prognosis would be: if we stop to misunderstand homeopathy as a classic causal phenomenon and instead view and research it as a non-classical phenomenon, homeopathy would have a chance and science would get richer by a new category of phenomena. This approach will prompt criticism, because it renders the world more complex rather than simpler. But this cannot be changed. Perhaps a new era of therapeutics might even emerge which does not abolish the molecular paradigm but makes it appear as one of several possibilities. [5]

END OF MY TRANSLATION

For those of you who can read German, here is the original text with references:

Dass die Homöopathie mit ihren therapeutischen Prinzipien dem Hauptstrom der Wissenschaft immer schon zuwiderlief, ist völlig unbestritten, und darin hat Weymayr recht. Aber auf dieser Tatsache ein regelrechtes «Forschungsverbot» aufbauen zu wollen, wie es das Szientabilitätskonzept vorsieht, das ist nicht nur wissenschaftstheoretisch absolut falsch, wie wir in einer Replik gezeigt haben [2], sondern offenbart auch eine dogmatische und unwissenschaftliche Einstellung.

Wenn man die Sache nüchtern sieht, ist die Homöopathie – wissenschaftstheoretisch betrachtet – eine Anomalie [3]: Empirische Daten belegen, dass immer wieder und insgesamt häufiger als zufällig erwartet Effekte auftreten. Das zeigen Meta-Analysen placebokontrollierter klinischer Studien [4,5,6]. Und das zeigt sich sowohl in unseren eigenen Arzneimittel-Prüfungen [7], die im Übrigen den erst neuerdings entwickelten Standards gut entsprechen [8], als auch in neueren Prüfungen [9]. Auch in Tierexperimenten [10,11,12,13] und in Pflanzenstudien [14,15,16] treten Effekte in solcher Häufigkeit auf. Entgegen oft gehörten Äußerungen gibt es durchaus auch Modelle, die replizierte Effekte ergeben – etwa das Modell homöopathischer Behandlung von Kindern mit Aufmerksamkeitsdefizit-/Hyperaktivitätssyndrom [17,18], das gerade repliziert wird [19]. Immer wieder gibt es qualitativ hochwertige Pilotstudien, wie die unlängst publizierte von Gassmann et al. [20], die zeigen, dass unerwartete Effekte auch unter höheren Potenzen und dokumentiert mit objektiven Methoden zu beobachten sind. Homöopathie erweist sich in großen pragmatischen Studien, von denen es allerdings viel zu wenige gibt, als nützlich [21,22,23]. Und nicht zu vergessen: Homöopathie ist pragmatisch hilfreich [24,25,26,27]. Zwar kommt es bei homöopathischer Behandlung gelegentlich zu einer Erstverschlimmerung [28,29], aber die Behauptung, Homöopathie sei gefährlich [30], ist eine fahrlässige Interpretation der Daten [31].

Inwiefern ist die Homöopathie dann eine Anomalie? Ich habe schon vor Jahren argumentiert, dass die Signatur der Daten in der Homöopathie nicht dafür spricht, dass wir es mit einem klassischen, lokalen Effekt zu tun haben [32]. Das wäre ein Effekt, der dem gewöhnlichen Kriterium der Kausalität entspräche und somit stabil, regelmäßig und bei immer besserer Experimentierkunst immer deutlicher hervorträte. Dieses Argument jetzt wieder aufzurollen, ist im Rahmen eines Editorials müßig. Aber genau die Frage nach einem klassisch-kausalen Effekt ist letztlich der Stein des Anstoßes. Und genau diesen Anstoß nimmt nun die neue Welle der Homöopathiekritik, die erklärtermaßen auf die Abschaffung der Homöopathie abzielt, zu ihrem Anlass. Diese Situation ergibt sich, weil auch die Homöopathen dem Selbstmissverständnis aufsitzen, Homöopathie sei ein klassisch-kausaler Prozess. Das ist höchstwahrscheinlich falsch, und die Homöopathie wäre gut beraten, einerseits auf die empirischen Befunde hinzuweisen und auf der anderen Seite theoretische Enthaltsamkeit zu üben und klarzulegen, dass wir vorläufig keinerlei Ahnung haben, wie Homöopathie funktioniert. Das ist die typische Situation, wenn eine wissenschaftliche Anomalie vorliegt…

Meine Prognose wäre: Wenn wir aufhören, die Homöopathie als klassisches Phänomen misszuverstehen, und sie stattdessen als ein mögliches nichtklassisches Phänomen betrachten und beforschen, dann hat die Homöopathie eine Chance und die Wissenschaft wird um eine neue Kategorie von Phänomenen reicher. Dieser Ansatz wird Kritik hervorrufen, denn er macht die Welt eher komplexer als einfacher. Aber das lässt sich nicht ändern. Vielleicht kann sogar eine neue Ära der Therapie beginnen, die das molekulare Paradigma nicht abschafft, aber als eine von mehreren Möglichkeiten erscheinen lässt.


Rather than commenting on this text in full detail, I simply want to provide a few explanations [they refer to the numbers in square brackets inserted by me into my translation] in order to facilitate understanding. I hope, however, that my readers will comment as much as they feel like.

1) Weymayr argued that certain fields lack plausibility to a degree that they do not merit being investigated. Here is an abstract of an article by him:

Evidence-based medicine (EbM) has proved to be very useful in healthcare; thanks to its methodology the reliability of our knowledge of the benefits and harms of interventions can be assessed. This at least applies to interventions which are based on a plausible concept for their mechanism of action and which have already achieved positive effects in experiments and simple studies. However, for interventions whose concepts contradict scientific findings EbM has proved to be unsuitable; it has not been able to prevent that they are still regarded as effective amongst wide parts of the population and medical experts. Particularly homeopathy has managed to even present itself as scientifically justified by using EbM. With the aim of highlighting the speculative character of homeopathy and other procedures and of preventing EbM from getting damaged, the concept of scientability is introduced in this article. This concept only approves of clinical studies if the intervention that is to be tested does not contradict definite scientific findings.

2) A scientific anomaly is “something which cannot be explained by currently accepted scientific theories. Sometimes the new phenomenon leads to new rules or theories, e.g., the discovery of x-rays and radiation.

3) Even a minimal amount of critical thinking leads to the conclusion that the claims made about homeopathy in this paragraph are mostly not true or exaggerated. On this blog, there is plenty of evidence to contradict Walach on all the points he made here.

4) Walach’s argument is detailed in this article:

Among homeopaths the common idea about a working hypothesis for homeopathic effects seems to be that, during the potentization process, ‘information’ or ‘energy’ is being preserved or even enhanced in homeopathic remedies. The organism is said to be able to pick up this information, which in turn will stimulate the organism into a self-healing response. According to this view the decisive element of homeopathic therapy is the remedy which locally contains and conveys this information. I question this view for empirical and theoretical reasons. Empirical research has shown a repetitive pattern, in fundamental and clinical research alike: there are many anomalies in high-dilution research and clinical homeopathic trials which will set any observing researcher thinking. But no single paradigm has proved stable enough in order to produce repeatable results independent of the researcher. I conclude that the database is too weak and contradictory to substantiate a local interpretation of homeopathy, in which the remedy is endowed with causal-informational content irrespective of the circumstances. I propose a non-local interpretation to understand the anomalies along the lines of Jung’s notion of synchronicity and make some predictions following this analysis.

5) In a nutshell, Walach seems to be saying:

  • the empirical evidence for homeopathy is strong;
  • nobody understands the mechanisms by which the effects of homeopathy are brought about;
  • if we all claim that homeopathy is a ‘scientific anomaly’ which operates according to Jung’s notion of synchronicity, the discrepancy between strong evidence and lack of plausible explanation disappears and everyone can be happy.

This is wrong for the following reasons, in my view:

  • the evidence is not strong but negative or extremely weak;
  • we understand very well that the effects of homeopathy are due to non-specific effects;
  • therefore there is no need for a new paradigm;
  • Jung’s notion of synchronicity is pure speculation and not applicable to therapeutics.

In summary, Prof Walach would do well to stop philosophising about homeopathy, read up about critical analysis, fine-tune his BS-detector and familiarise himself with Occam’s razor.

 

The objective of the ‘Portland Centre for Integrative Medicine’ in Bristol, UK is to “offer an Integrative Medicine (IM) approach to healthcare that seeks to deliver the best complementary care and lifestyle approaches”. Specifically, they

  • “Aim to maximise individual choice and care to improve health, wellbeing and quality of life
  • Support a whole person care approach through a working collaboration between people and practitioners to improve health and well-being
  • Work to raise awareness about IM and increasing the availability of quality IM services for service users and their referring clinicians
  • Support ‘Self Care Strategies’ across the South West by promoting and supporting self-care and self-management of health and well-being by using healthy living solutions
  • Offer a centre for academic excellence for IM education and training, research and evaluation.”

Academic excellence does not normally entail telling porkies – but the Portland Centre seems willing to make an exception for a good cause: homeopathy. At least, this is the impression I got when reading their recent post entitled HOMEOPATHY, THE FACTS (surprisingly similar title as my latest book: HOMEOPATHY, THE UNDILUTED FACTS). The 6 ‘Portland facts’ turn out to be so surprising that I could simply not resist copying them here:

START OF QUOTE

1 It’s more than just a placebo

Homeopathy has been used successfully on babies, young children and animals. In these cases, the patients have no idea what medication they are taking, so the placebo argument does not hold.

2 Homeopathy costs the NHS very little

The total amount spent on Homeopathy in the NHS is approximately £4 million per year, representing less than 1% of the total NHS budget. In contrast, the NHS spends £282 million annually on anti-depressants which one study suggests only benefit 11% of patients diagnosed with depression.

3 Homeopathy is more than a passing fad

Homeopathy has been used for over 200 years and has been available on the NHS since the health service was formed in 1948. It is an important part of the health systems in many European countries including France, Germany and Italy.

4 Homeopathy is safe

When used approximately the practice is extremely safe as it produces no dangerous side-effects and can be used in conjunction with conventional medicines. In comparison, the European Commission estimated in 2008 that adverse reactions to conventional drugs kill 197,000 EU citizens each year.

5 Many treatments have limited evidence

A clinical evidence surgery carried out by the British Medical Journal found that out of 3000 medical treatments 50% were classified as having “unknown effectiveness”.

6 In support of high dilutions

What I can say now is that the high dilutions are right. High dilutions of something are not nothing. They are water structures which mimic the original molecules. It’s no pseudoscience. It’s no quackery. These are real phenomena which deserve further study,” Professional Luc Montagnier, French virologist and Nobel Laureate speaking in 2010.

END OF QUOTE

Regular readers of this blog will not really need any comments; in their absurdity, the 6 ‘Portland facts’ speak almost for themselves. For those who are not regulars, let me briefly add a few words (in doing so, I follow the numbering above).

1) The most comprehensive and independent review of the evidence in the history of homeopathy has failed to confirm that homeopathy has any therapeutic effects beyond placebo. This applies to kids as much as it applies to animals. Placebo effects in animals and kids are well documented.

2) Much more important than the costs of homeopathy is the fact that the continued use of homeopathy on the NHS makes a mockery of the principles of EBM. Either we believe in evidence (in which case, homeopathy has no place in the NHS), or we don’t (in which case, anything goes and we regress to the dark ages of healthcare).

3) Appeal to tradition is a classic fallacy and not an argument in support of anything.

4) Most, but not all, homeopathic remedies are safe. However, homeopaths are often very unsafe, for instance when they insist to treat life-threatening conditions with their placebos, or when they advice against vaccinating children. Conventional medicines can certainly cause harm but, on balance, they unquestionably generate more good than harm – and this is clearly not the case for homeopathy.

5) Tu quoque is another classic fallacy and no argument in favour of homeopathy. EBM is a relatively new concept and progress in conventional medicine is now breathtakingly fast. By contrast, homeopathy did not progress since the days Hahnemann invented it.

6) The appeal to authority is yet another classic fallacy. The ‘Montagnier story’ merely shows that even Nobel laureates can make foolish mistakes, particularly if they venture outside their area of expertise. Poor Montaigner lost all credibility since he embarked on high dilutions.

I hope that you had as much fun reading the ‘Portland porkies’ as I had commenting on them. I think they are hilarious, particularly if we consider that the Portland Centre is the direct successor of the Bristol Homeopathic Hospital. Here is what Wikipedia has to say about this institution:

“Bristol Homeopathic Hospital was a hospital in the city of Bristol in south-west England, specializing in homeopathic treatments. It was founded in 1852 but had a history as a dispensary dating back to 1832.[1] It later became a National Health Service hospital.

From 1925, the hospital was based in its own building, Cotham House,[2] in the Cotham area of Bristol. On 7 January 2013 the hospital moved operations from Cotham to the South Bristol Community Hospital.[3] In-patient services had been provided at Cotham House until 1986, when they were moved to the Bristol Eye Hospital, with out-patients continuing at Cotham House.[2][3]

Homeopathic services ceased at the Hospital in October 2015,[4][5] partly in response to a campaign against the public funding of homeopathy lead by the Good Thinking Society[6] and public figures such as Simon Singh and Edzard Ernst. University Hospitals Bristol confirmed to the Clinical Commissioning Group that it would cease to offer homeopathic therapies from October 2015, at which point homeopathic therapies would no longer be included in the contract.[5]

Homeopathic services in the Bristol area were relocated to the Portland Centre for Integrative Medicine, described as “a new independent social enterprise.”[5] In response to a FOI request, Bristol Clinical Commissioning Group revealed that “there are currently no (NHS) contracts for homeopathy in place with the Portland Centre.”[5]

END OF WIKI QUOTE

Of course, this Wiki page is slightly misleading on at least one issue (No, I don’t mean the fact that I am called a ‘public figure’ rather than a professor and expert in alternative medicine who has published more on the subject than anyone else): Hospitals are never closed in response to a campaign (as far as I know) but hospitals might get closed because of what a campaign discloses. In the Bristol case, the campaign disclosed that there is no good evidence for homeopathy (see above) and therefore no good reason to carry on wasting scarce NHS funds on it – perhaps just a slight but, I think, important difference!

Back to the 6 ‘Portland porkies’.

As we have seen, they are nowhere close to real facts – but they certainly are funny.

While studying the services offered by the Portland Centre, I found a course on ‘creative writing’. Aha, I thought, this must be the explanation: the 6 ‘Portland porkies’ are not the result of research, study or knowledge. Far from it! They clearly are the fruits of exceedingly creative writing.

So, well done Portland Centre: at least one of your aims seems to be within reach!

‘The use of a harmless alternative therapy is not necessarily wrong. Even if the treatment itself is just a placebo, it can help many patients. Some patients feel better with it, and it would be arrogant, high-handed and less than compassionate to reject such therapies simply because they are not supported by sufficient scientific evidence’.

How often have I heard this notion in one or another form?

I hear such words almost every day.

Arguments along these lines are difficult to counter. Any attempt to do so is likely to make us look blinkered, high-handed and less than compassionate.

Yet we all – well almost all – know that the notion is wrong. Not only that, it can be dangerous.

I will try to explain this with a concrete example of a patient employing a harmless alternative remedy with great success… until… well, you’ll see.

The patient is a married women with two kids. She is well known to her doctor because she has suffered from a range of symptoms for years, and the doctor – despite extensive tests – could never find anything really wrong with her. He knows about his patient’s significant psychological problems and has, on occasion, been tempted to prescribe tranquilizers or anti-depressants. Before he does so, however, he tells her to try Rescue Remedies@ (homeopathically diluted placebos from the range of Bach Flower Remedies). The patient is generally ‘alternatively inclined’, seems delighted with this suggestion and only too keen to give it a try.

After a couple of weeks, she reports that the Rescue Remedies (RR) are helping her. She says she can cope much better with stressful situations and has less severe and less frequent headaches or other symptoms. As she embarks on a long period of taking RR more or less regularly, she becomes convinced that the RR are highly effective and uses them whenever needed with apparent success. This goes on for months, and everyone is happy: the patient feels she has finally found a ‘medication that works’, and the doctor (who knows only too well that RR are placebos) is pleased that his patient is suffering less without needing real medication.

Then, a few months later, the patient notices that the RR are becoming less and less effective. Not only that, she also thinks that her headaches have changed and are becoming more intense. As she has been conditioned to believe that the RR are highly effective, she continues to take them. Her doctor too agrees and encourages her to carry on as before. But the pain gets worse and worse. When she develops other symptoms, her doctor initially tries to trivialise them, until they cannot be trivialised any longer. He eventually sends her to a specialist.

The patient has to wait a couple of weeks until an appointment can be arranged. The specialist orders a few tests which take a further two weeks. Finally, he diagnoses a malignant, possibly fast growing brain tumour. The patient has a poor prognosis but nevertheless agrees to an operation. Thereafter, she is paralysed on one side, needs 24-hour care, and dies 4 weeks post-operatively.

The surgeon is certain that, had he seen the patient several months earlier, the prognosis would have been incomparably better and her life could have been saved.

I suspect that most seasoned physicians have encountered stories which are not dissimilar. Fortunately they often do not end as tragically as this one. We tend to put them aside, and the next time the situation arises where a patient reports benefit from a bogus treatment we think: ‘Even if the treatment itself is just a placebo, it might help. Some patients feel better with it, and it would be arrogant, high-handed and less than compassionate to reject this ‘feel-good factor’.

I hope my story might persuade you that this notion is not necessarily correct.

If you are unable to make your patient feel better without resorting to quackery, my advice is to become a pathologist!!!

Wellness?

Yes, it’s a new buzz-word in the realm of alternative medicine – actually, not so new; it’s been around for years and seems to attract charlatans of all imaginable types.

But what precisely is it?

The authors of this paper explain: “While the concept of wellness is still evolving, it is generally recognized that wellness is a holistic concept best represented as a continuum, with sickness, premature death, disability, and reactive approaches to health on one side and high-level wellness, enhanced health, and proactive approaches to health and well-being on the other. It is further acknowledged that wellness is multidimensional and includes physiologic, psychological, social, ecologic, and economic dimensions. These multiple dimensions make wellness difficult to accurately assess as multiple subjective and objective measures are required to account for the different dimensions. Thus, the assessment of wellness in individuals may include a variety of factors, including assessment of physiologic functioning, anthropometry, happiness, depression, anxiety, mood, sleep, health symptoms, toxic load, neurocognitive function, socioeconomic status, social connectivity, and perceived self-efficacy.”

Sounds a bit woolly?

I agree! It sounds like a gimmick for getting at the cash of the gullible public.

Is there money to be made with ‘wellness’?

Sure! Lots!

For instance, with so-called ‘wellness retreats’.

Wellness retreats are all the rage. They use all sorts of bogus therapies within luxurious holiday settings for the ‘well to do’ end of our societies.

But is there any science behind this approach?

Few studies have evaluated the effect of retreat experiences, and no published studies have reported health outcomes. The objective of this new study therefore was to assess the effect of a week-long wellness-retreat experience in wellness tourists. The study was designed as a longitudinal observational study without a control group. Outcomes were assessed upon arrival and departure and 6 weeks after the retreat. The intervention was a ‘holistic, 1-week, residential, retreat experience that included many educational, therapeutic, and leisure activities and an organic, mostly plant-based diet’.

The outcome measures included anthropometric measures, urinary pesticide metabolites, a food and health symptom questionnaire, the Five Factor Wellness Inventory, the General Self Efficacy questionnaire, the Pittsburgh Insomnia Rating Scale, the Depression Anxiety Stress Scale, the Profile of Mood States, and the Cogstate cognitive function test battery.

Statistically significant improvements were seen in almost all measures after 1 week. Many of these improvements were also sustained at 6 weeks. There were statistically significant improvements in all anthropometric measures after 1 week, with reductions in abdominal girth, weight, and average systolic and diastolic pressure. Statistically significant improvements were also noted in psychological and health symptom measures. Urinary pesticide metabolites were detected in pooled urine samples before the retreat and were undetectable after the retreat.

The authors concluded that “the retreat experiences can lead to substantial improvements in multiple dimensions of health and well-being that are maintained for 6 weeks. Further research that includes objective biomarkers and economic measures in different populations is required to determine the mechanisms of these effects and assess the value and relevance of retreat experiences to clinicians and health insurers.”

IS THIS GOOD OR BAD RESEARCH?

Let’s apply my checklist from the previous post:

  • published in one of the many dodgy CAM journals? YES
  • single author? NO
  • authors are known to be proponents of the treatment tested? YES
  • author has previously published only positive studies of the therapy in question? YES
  • lack of plausible rationale for the study? YES
  • lack of plausible rationale for the therapy that is being tested? YES
  • stated aim of the study is ‘to demonstrate the effectiveness of…’ ? NO
  • stated aim ‘to establish the effectiveness AND SAFETY of…’? NO
  • text full of mistakes, e. g. spelling, grammar, etc.? NO
  • sample size is tiny? YES
  • pilot study reporting anything other than the feasibility of a definitive trial? NO
  • methods not described in sufficient detail? YES
  • mismatch between aim, method, and conclusions of the study? YES
  • results presented only as a graph? NO
  • statistical approach inadequate or not sufficiently detailed? NO
  • discussion without critical input? NO
  • lack of disclosures of ethics, funding or conflicts of interest? NO
  • conclusions which are not based on the results? YES

To me, this rough and ready assessment indicates that there are too many warning signals for characterising this as a rigorous study. It looks a lot like pseudo-science, I fear.

But these are at best formal markers. More important is the fact that the whole idea of measuring the effects of a ‘wellness retreat’ makes little sense, particularly in the absence of a control group. If we take a few people out of their usual, stressful work-environment and put them into a nice and luxurious holiday atmosphere where they get papered, eat better food, exercise more, sleep better and relax a lot – what would we expect after one week?

Yes, precisely! We would expect that almost anything measurable has changed for the better!

In fact, this result is so predictable that it is hardly worth documenting. Crucially, the outcome has very little to do with wellness, holism, or alternative medicine.

My conclusion: wellness not only attracts charlatans, entrepreneurs and windbags, it also is firmly steeped in pseudoscience.

 

 

 

One of the questions I hear frequently is ‘HOW CAN I BE SURE THIS STUDY IS SOUND’? Even though I have spent much of my professional life on this issue, I am invariably struggling to provide an answer. Firstly, because a comprehensive reply must inevitably have the size of a book, perhaps even several books. And secondly, to most lay people, the reply would be intensely boring, I am afraid.

Yet many readers of this blog evidently search for some guidance – so, let me try to provide a few indicators – indicators, not more!!! – as to what might signify a good and a poor clinical trial (other types of research would need different criteria).

INDICATORS SUGGESTIVE OF A GOOD CLINICAL TRIAL

  • Author from a respected institution.
  • Article published in a respected journal.
  • A clear research question.
  • Full description of the methods used such that an independent researcher could repeat the study.
  • Randomisation of study participants into experimental and control groups.
  • Use of a placebo in the control group where possible.
  • Blinding of patients.
  • Blinding of investigators, including clinicians administering the treatments.
  • Clear definition of a primary outcome measure.
  • Sufficiently large sample size demonstrated with a power calculation.
  • Adequate statistical analyses.
  • Clear presentation of the data such that an independent assessor can check them.
  • Understandable write-up of the entire study.
  • A discussion that puts the study into the context of all the important previous work in this area.
  • Self-critical analysis of the study design, conduct and interpretation of the results.
  • Cautious conclusion which are strictly based on the data presented.
  • Full disclosure of ethics approval and informed consent,
  • Full disclosure of funding sources.
  • Full disclosure of conflicts of interest.
  • List of references is up-to-date and includes also studies that contradict the authors’ findings.

I told you this would be boring! Not only that, but each bullet point is far too short to make real sense, and any full explanation would be even more boring to a lay person, I am sure.

What might be a little more fun is to list features of a clinical trial that might signify a poor study. So, let’s try that.

WARNIG SIGNALS INDICATING A POOR CLINICAL TRIAL

  • published in one of the many dodgy CAM journals (or in a book, blog or similar),
  • single author,
  • authors are known to be proponents of the treatment tested,
  • author has previously published only positive studies of the therapy in question (or member of my ‘ALT MED HALL OF FAME’),
  • lack of plausible rationale for the study,
  • lack of plausible rationale for the therapy that is being tested,
  • stated aim of the study is ‘to demonstrate the effectiveness of…’ (clinical trials are for testing, not demonstrating effectiveness or efficacy),
  • stated aim ‘to establish the effectiveness AND SAFETY of…’ (even large trials are usually far too small for establishing the safety of an intervention),
  • text full of mistakes, e. g. spelling, grammar, etc.
  • sample size is tiny,
  • pilot study reporting anything other than the feasibility of a definitive trial,
  • methods not described in sufficient detail,
  • mismatch between aim, method, and conclusions of the study,
  • results presented only as a graph (rather than figures which others can re-calculate),
  • statistical approach inadequate or not sufficiently detailed,
  • discussion without critical input,
  • lack of disclosures of ethics, funding or conflicts of interest,
  • conclusions which are not based on the results.

The problem here (as above) is that one would need to write at least an entire chapter on each point to render it comprehensible. Without further detailed explanations, the issues raised remain rather abstract or nebulous. Another problem is that both of the above lists are, of course, far from complete; they are merely an expression of my own experience in assessing clinical trials.

Despite these caveats, I hope that those readers who are not complete novices to the critical evaluation of clinical trials might be able to use my ‘warning signals’ as a form of check list that helps them to tell the chaff from the wheat.

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