homeopathy
The UK Professional Standards Authority has just made this announcement:
The Professional Standards Authority has suspended the accreditation of the Society of Homeopaths (SoH) following its failure to meet Conditions set by the Authority during 2020. The suspension is effective from today.
Under the Accredited Registers programme, organisations can apply for accreditation of registers they hold of unregulated healthcare practitioners and must meet Standards set by the Authority. The SoH was first accredited in 2014. In February 2020 accreditation was renewed, subject to a Condition that included making its position statements clear that registrants must not practise CEASE, practise or advertise adjunctive therapies, or provide advice on vaccination.
Accreditation of registers is renewed annually, however where there are serious concerns, we conduct an in-year review. We undertook an in-year review of the SoH during the summer of 2020, after concerns were raised in relation to the appointment of a key official. As set out in the outcome of our in-year review three further Conditions were issued, the first two of which were due in October 2020. In December 2020, a Panel met to consider whether these had been met.
We found the Conditions were not met and that the SoH did not fully meet a number of our Standards. In view of the recurrent nature of the concerns, and that several Conditions had already been imposed on the SoH since February 2020, we decided to suspend accreditation.
The suspension will be reviewed after 12 months. To be lifted the SoH will need to demonstrate that it prioritises public protection over professional interests in its handling of complaints and governance processes. If the SoH can demonstrate that this is achieved through fulfilment of the Conditions and Standards earlier than 12 months then we will consider lifting the suspension sooner.
END OF QUOTE
For background information, the following posts might be helpful:
The UK Society of Homeopaths, a hub of anti-vaccination activists? (edzardernst.com)
So sorry, I have been neglecting THE ALTERNATIVE MEDICINE HALL OF FAME of late. I was reminded of its existence when writing my post about Adrian White the other day. Reading the kind comments I received on it, I not only decided to make Adrian an honorary member (for his latter part of his career as an acupuncture researcher, but also to reactivate the idea of the HALL OF FAME in more general terms. And in the course of doing just this, I noticed that I somehow forgot to admit Prof Michael Frass, an omission which I regret and herewith rectify. A warm welcome to both!
In case you are unaware what THE ALTERNATIVE MEDICINE HALL OF FAME is, let me explain: it is a group of researchers who manage to go through (part of) their professional life researching their particular SCAM without ever publishing a negative conclusion about it, or who have other outstanding merits in misleading the public about so-called alternative medicine (SCAM). As of today, we thus have the following experts in the HALL:
Adrian White (acupuncturist, UK)
Michael Frass (homeopath, Austria)
Jens Behnke (research officer, Germany)
John Weeks (editor of JCAM, US)
Deepak Chopra (entrepreneur, Us)
Cheryl Hawk (US chiropractor)
David Peters (osteopathy, homeopathy, UK)
Nicola Robinson (TCM, UK)
Peter Fisher (homeopathy, UK)
Simon Mills (herbal medicine, UK)
Gustav Dobos (various, Germany)
Claudia Witt (homeopathy, Germany and Switzerland)
George Lewith (acupuncture, UK)
John Licciardone (osteopathy, US)
I must say, this is an assembly of international SCAM experts to be proud of – even if I say so myself!
The new member I am proposing to admit today is Dr Jenice Pellow. She is a lecturer in the Department of Complementary Medicine at the University of Johannisburg and already once featured on this blog. But now it seems time to admit this relatively little-known researcher into my HALL OF FAME. Dr Pellow has 11 Medline-listed papers on so-called alternative medicine (SCAM). Allow me to show you some key findings from their abstracts:
- Complementary and alternative medicine (CAM) offers parents various treatment options for this condition [ADHD], including dietary modifications, nutritional supplementation, herbal medicine, and homeopathy. CAM appears to be most effective when prescribed holistically and according to each individual’s characteristic symptoms.
- The homeopathic medicine reduced the sensitivity reaction of cat allergic adults to cat allergen, according to the SPT. Future studies are warranted to further investigate the effect of Cat saliva and Histaminum and their role as a potential therapeutic option for this condition.
- Findings suggest that daily use of the homeopathic complex does have an effect over a 4-wk period on physiological and cognitive arousal at bedtime as well as on sleep onset latency in PI sufferers. Further research on the use of this complex for PI is warranted before any definitive conclusions can be drawn.
- The homeopathic complex used in this study exhibited significant anti-inflammatory and pain-relieving qualities in children with acute viral tonsillitis. No patients reported any adverse effects. These preliminary findings are promising; however, the sample size was small and therefore a definitive conclusion cannot be reached. A larger, more inclusive research study should be undertaken to verify the findings of this study.
- …results suggest the homeopathic complex, together with physiotherapy, can significantly improve symptoms associated with CLBP due to OA.
- This small study showed the potential benefits of individualized homeopathic treatment of binge eating in males, decreasing both the frequency and severity of binging episodes.
- There have been numerous trials and pharmacological studies of specific herbal preparations related to the treatment of low sexual desire.
- Most of the evaluated medicinal plants showed evidence of efficacy in relieving menstrual pain in at least one RCT.
- Results indicated that most participants made use of both complementary and conventional medicines for their infant’s colic; the most commonly used complementary medicine products were homeopathic remedies, probiotics and herbal medicines.
- Promising evidence for the following single supplements were found [for allergic rhinitis]: apple polyphenols, tomato extract, spirulina, chlorophyll c2, honey, conjugated linoleic acid, MSM, isoquercitrin, vitamins C, D and E, as well as probiotics. Combination formulas may also be beneficial, particularly specific probiotic complexes, a mixture of vitamin D3, quercetin and Perilla frutescens, as well as the combination of vitamin D3 and L. reuteri.
- Despite a reported lack of knowledge regarding complementary medicine and limited personal use, participants had an overall positive attitude towards complementary medicine.
I admit that 11 papers in 7 years is not an overwhelming output for a University lecturer. However, please do consider the fact that all of them – particularly the ones on homeopathy which is be the particular focus of Jenice (after all, she is a homeopath) – chime a happy tune for SCAM. I therefore think that Jenice should be admitted to THE ALTERNATIVE MEDICINE HALL OF FAME and hope you agree.
Welcome to ALTERNATIVE MEDICINE HALL OF FAME, Jenice!
As though the UK does not have plenty of organisations promoting so-called alternative medicine (SCAM)! Obviously not – because a new one is about to emerge.
In mid-January, THE COLLEGE OF MEDICINE AND INTEGRATED HEALTH (COMIH) will launch the Integrated Medicine Alliance bringing together the leaders of many complementary health organisations to provide patients, clinicians and policy makers with information on the various complementary modalities, which will be needed in a post COVID-19 world, where:
- patient choice is better respected,
- requirements for evidence of efficacy are more proportionate to the seriousness of the disease and the safety of the intervention,
- and where benefit versus risk are better balanced.
We already saw this in 2020 with the College advocating from the very beginning of the year that people should think about taking Vitamin D, while the National Institute for Clinical Excellence continued to say the evidence was insufficient, but the Secretary of State has now supported it being given to the vulnerable on the basis of the balance between cost, benefit and safety.
Elsewhere we learn more about the Integrated Medicine Alliance (IMA):
The IMA is a group of organisations and individuals that have been brought together for the purpose of encouraging and optimising the best use of complementary therapies alongside conventional healthcare for the benefit of all.
The idea for this group was conceived by Dr Michael Dixon in discussion with colleagues associated with the College of Medicine, and the initial meeting to convene the group was held in February 2019.
The group transitioned through a number of titles before settling on the ‘Integrated Medicine Alliance’ and began work on developing a patient leaflet and a series of information sheets on the key complementary therapies.
It was agreed that in the first instance the IMA should exist under the wing of the College of Medicine, but that in the future it may develop into a formal organisation in its own right, but inevitably maintaining a close relationship with the College of Medicine.
The IMA also offers ‘INFORMATION SHEETS’ on the following modalities:
- Acupuncture
- Alexander Technique
- Aromatherapy
- Herbal Medicine
- Homeopathy
- Hypnotherapy
- Massage
- Naturopathy
- Reflexology
- Reiki
- Tai Chi
- Yoga Therapy
I find those leaflets revealing. They tell us, for example that the Reiki practitioner channels universal energy through their hands to help rebalance each of the body’s energy centres, known as chakras. About homeopathy, we learn that a large corpus of evidence has accumulated which stands the most robust tests of modern science. And about naturopathy, we learn that it includes ozone therapy but is perfectly safe.
Just for the fun of it – and free of charge – let me try to place a few corrections here:
- Reiki healers use their hands to perform what is little more than a party trick.
- The universal energy they claim to direct does not exist.
- The body does not have energy centres.
- Chakras are a figment of imagination.
- The corpus of evidence on homeopathy is by no means large.
- The evidence is flimsy.
- The most robust tests of modern science fail to show that homeopathy is effective beyond placebo.
- Naturopathy is a hotchpotch of treatments most of which are neither natural nor perfectly safe.
One does wonder who writes such drivel for the COMIH, and one shudders to think what else the IMA might be up to.
Today is the day to admit it: we all owe a big THANKS to the worldwide homeopathy community. We should be most grateful to them all for selflessly demonstrating so indisputably something of fundamental importance:
homeopaths do not believe in their own outlandish, science-defying assumptions.
Yes, I really do appreciate the courage and altruism that was required for this epoch-making step!
Perhaps I better explain.
On 10 November, I issued ‘a challenge for all homeopaths of the world‘.
The deal was structured around a homeopathic proving (or, if you wish, around the assumption that highly diluted homeopathic remedies can have any noticable effects) and went as follows:
- you, the convinced homeopath, name the 6 homeopathic remedies that you cannot possibly miss when doing a proving on yourself;
- I order them in the potency you wish (only condition: it must be higher than C12) from a reputable source;
- I have the bottles delivered unopened to a notary where I live;
- the notary fills them into containers marked 1-6 (if you wish, you can send the notary empty containers for that ppurpose);
- the notary keeps the code under lock and key that links the name of the remedies to the numbers 1-6;
- he then mails the coded 6 remedies to you;
- you can use the proving method which you consider best and do as many provings as you like (the only limiting factors are the number of globuli in the containers and the time you have to crack the code);
- I give you 100 days for conducting the provings;
- once you are ready, you send your verdicts to the notary (e.g. 1 = rhus, tox, 2 = sulfur, 3 = arsenic, etc., etc.);
- the notary looks up the code and lets us both know the result.
I am happy to pay all the costs involved in the experiment (notary, remedies, postage, etc.). We can also discuss some of the details of this challenge, in case they run counter to your views on provings, rigorous science, etc.
To make sure we both ‘mean business’, once we both accept these conditions (you can flesh out the missing details as you wish), we both transfer a sum Euro 2 000 to an account with the notary. If you want to increase the sum, please let me know; as I said, we can discuss most of the details of my challenge to suit your needs. If you manage to ‘crack the code’ 1-6, the notary will transfer the sum of Euro 4 000 (your deposit and mine) to your account. If you fail, he will transfer the same amount to my account.
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In my original post, I made it abundantly clear that the entry to the challenge would close at the end of 2020. While it was still open, I did everything I could to let homeopaths know about the challenge. Because homeopathy originated in Germany and is still fairly popular there, I even re-published my challenge in German. In addition, I and others tweeted many times about it (in English, German, French, Spanish and possibly other languages as well), even directly to homeopaths across the globe.
As no homeopath has come forward to take up the challenge in time, and as no sound argument has emerged to convince me that my challenge was unreasonable, unscientific or unfair, it now is an indisputable fact that:
homeopaths do not believe in their own outlandish, science-defying assumptions.
I am most grateful to the worldwide community of homeopaths for heroically documenting the truth so clearly. It can’t have been easy to be so honest at the cost of homeopathy’s reputation. But I believe that this is an important and honourable step into the right direction. It provides essential information for non-homeopaths who want to understand the practice and profession of homeopathy.
MANY THANKS AGAIN
PS
In the interest of progress, please publicise the news as widely as you can.
2020 was certainly a difficult year (please note, I am trying a British understatement here). From the point of view of running this blog, it was sad to lose James Randi (1928 – 2020) who had been the hero of so many sceptics worldwide, and to learn of the passing of Frank Odds (1945-2020) who was a regular, thoughtful commentator here.
Reviewing the topics we tackled, I could mention dozens. But let me pick out just a few themes that I feel might be important.
HOMEOPATHY
Homeopathy continued to have a rough time; the German medical profession has finally realised that homeopathy is treatment with placebos and the German Green Party no longer backs homeopathy. In India, the Supreme Court ruled: Homeopathy must not be sold as a cure of Covid-19, and in the US improved labeling on homeopathic products were introduced. To make matters worse I issued A CHALLENGE FOR ALL HOMEOPATHS OF THE WORLD.
NOVEL SCAMs
On this blog, I like to write about new so-called alternative medicines (SCAMs) that I come accross. Blood letting is not exactly new, but Oh look! Bloodletting is back! Many other ‘innovations’ were equally noteworthy. Here is merely a very short selection of modalities that were new to me:
- Hydrogen-rich water: the new wonder drug?
- Dr. Robin A. Bernhoft and his ‘Bioidentical Hormone Replacement Therapy’ (BHRT)
- The ‘OBERON’: revolutionary invention or dangerous con?
- Qi technology: “scientifically proven to provide EMF Protection” (edzardernst.com)
- ‘DRX9000’ for back pain: a nice little earner for chiropractors and other back pain quacks
- Vibroacoustic Sound Therapy: introducing the ‘healthy vibration of cells’ into the body
- Lakhovsky’s oscillator, the ‘cure all’ that the world forgot
COVID-19
Unquestionably the BIG subject (not just) in SCAM was – is and will be for a while – the pandemic. It prompted quacks of any type to crawl out of the woodwork misleading the public about their offerings. On 24 January, I wrote for the first time about it: Coronavirus epidemic: Why don’t they ask the homeopaths for help? Thereafter, every charlatan seemed to jump on the COVID bandwaggon, even Trump: Trump seems to think that UV might be the answer to the corona-pandemic – could he mean “ultraviolet blood irradiation”? It became difficult to decide who was making a greater fool of themselves, Trump or the homeopaths (Is this the crown of the Corona-idiocy? Nosodes In Prevention And Management Of COVID -19). Few SCAM entrepreneurs (Eight new products aimed at mitigating COVID-19. But do they really work?) were able to resist the opportunity. Snakeoil salesmen were out in force and view COVID-19 as an ‘opportunity’. It is impossible to calculate what impact all this COVID-quackery had, but I fear that many people lost their lives at least in part because of it.
VACCINATION
The unavoidable consequence of the pandemic was that the anti-vaxx brigade sensed that their moment had arrived. Ex-doctor Andrew Wakefield: “Better to die as a free man than live as a slave” (and get vaccinated against Covid-19). Again the ‘charlatan in chief’ made his influence felt through the ‘Trump-Effect’ on vaccination attitudes. Unsurprisingly, the UK ‘Society of Homeopath’ turned out to be an anti-vaxx hub that endangers public health. And where there is anti-vaxx, chiropractors are seldom far: Ever wondered why so many chiropractors are profoundly anti-vax?. All this could be just amusing, but sadly it has the potential to cost lives through Vaccine hesitancy due to so-called alternative medicine (SCAM).
ETHICS
I happen to believe that ethics in SCAM are an important, yet much neglected topic. It is easy to understand why this should be so: adhering to the rules of medical ethics would all but put an end to SCAM. This applies to chiropractic (The lack of chiropractic ethics: “valid consent was not obtained in a single case”), to homeopaths (Ethical homeopathy) and to most other SCAM professions. If I had a wish for the next year(s), it would be that funding agencies focus on research into the many ethical problems posed by the current popularity of SCAM.
CONCLUSION
If I had another wish, it would be that critical thinking becomes a key subject in schools, universities and adult education. Why do so many people make irrational choices? One answer to this question is, because we fail to give this subject the importance it demands. The lack of critical thinking is the reason why we elect leaders who are compulsory lyers, make wrong choices about healthcare, and continue to destroy the planet as though there is no tomorrow. It is high time that we, as a society, realise how fundamentally important critical thinking truly is.
OUTLOOK
Yes, 2020 was difficult: Brexit, COVID-19, anti-vaxx, etc. But it was not all bad (certainly not for me personally), and there is good reason for hope: the globally malign influence of Trump is about to disappear, and we now have several effective vaccines. Common sense, decency and science might triumph after all.
HEALTHY NEW YEAR EVERYONE!
We are living in difficult times, and few things are more difficult than spending the holidays in confinement alone or (possibly worse) with close family. If you do, you need all the help you can get. Here are a few homeopathic remedies (all available from Her Majesty’s homeopathic pharmacy) which, according to the ‘like cures like’ (LCL) axiom of homeopathy, might come in handy:
- Aspirin (Acetylsalicylic Acid) Aspirin is effective for many conditions, for instance, headache. So, taking a high potency homeopathic Aspirin should, according to LCL, give you a headache. It might therefore be helpful for being excused from spending yet another afternoon watching TV with your mother in law. Alternatively, you could, of course, smuggle some drops in her food and solve your problem in this somewhat unethical way.
- Latex vulcani (Latex (condom) In case you want to use the confinement to start a family, this remedy should make it easier to conceive.
- Penicillinum Penicillin kills bacteria, as we all know. Taking homeopathic Penicillium would therefore make you catch a bacterial infection. This could be a welcome change from all this endless talk about viral disease, I am sure.
- Semen humanum In case you do not want to get pregnant, this seems to be the remedy of choice for you.
- Sunlight Blue (Prismatic blue from sunlight) Sunlight Green (Prismatic green from sunlight) Sunlight Orange (Prismatic orange from sunlight) Sunlight Purple (Prismatic purple from sunlight) Sunlight Red (Prismatic Red from Sunlight) Sunlight Yellow (Prismatic yellow from sunlight) Lots of people swear by vitamin D to protect themselves against COVID-19. It is easy to over-dose on this vitamin, and many people will therefore be now suffering from a vitamin D hypervitaminosis with potentially dangerous consequences. If you are worried, I recommend you take all the above remedies. As sunlight normally generates vitamin D in your body, these homeopathics should stop any hypervitaminosis D in its tracks.
- Umbilicus humanus (Umbilical Cord Humanus) Many people have to spend this holiday without their mother. If that affects you deeply, try this remedy.
- Vitamin D (Vitamin D2 + Vitamin D3) Vitamin D2 (Ergocalciferol) Vitamin D3 (Cholecalciferol) If you don’t want to take the sunlight remedies mentioned above for your vitamin D hypervitaminosis (remember: too strong sunlight can cause skin cancer!), try the more direct method of administering homeopathic vitamin D.
So, do take good care of yourselves, stay healthy, don’t over-dose the brandy butter, port, or anything else, and
MERRY CHRISTMAS!
The Indian Supreme Court has ruled this week that homeopathic, ayurvedic and unani practitioners must not prescribe their respective so-called alternative medicines (SCAMs) as a cure for Covid-19.
Specifically, the judges noted that, according to the guidelines issued by the Ayush ministry in March, homeopaths are permitted only to prescribe certain homeopathic medicines as “…preventive, prophylactic, symptom management of Covid-19-like illnesses and add-on interventions to the conventional care”, but not as a cure.
“The high court, however, is right in its observation that no medical practitioner can claim that it can cure Covid-19. There is no such claim in other therapy including allopathy. The high court is right in observing that no claim for cure can be made in homeopathy. Homeopathy is contemplated to be used in preventing and mitigating Covid-19 as is reflected by the advisory and guidelines issued by the ministry of Ayush…,” Justices Ashok Bhushan, R. Subhash Reddy and M.R. Shah stated.
The Supreme Court passed the ruling while disposing of an appeal filed by the Kerala-based Dr AKB Sadbhavana Mission School of Homeo Pharmacy that was aggrieved by Kerala High Court’s direction on August 21 for action against homeopaths who claim cure in homeopathy for Covid-19 patients. However, the Supreme Court judgment established that the Ayush ministry guidelines clearly refer to certain homeopathy medicines as preventive, prophalytic and add-on interventions to the conventional therapy. “The above guidelines refer to homeopathy medicines as medicines for prophylaxis, amelioration and mitigation. The guidelines, however, specifically provide that ‘the prescription has to be given only by institutionally qualified practitioners’,” the bench said.
According to the court, homeopathic practitioners are bound by rules from prescribing medicines as cure for Covid-19. “When statutory regulations themselves prohibit advertisement, there is no occasion for homeopathic medical practitioners to advertise that they are competent to cure Covid-19 disease. When the scientists of the entire world are engaged in research to find out proper medicine/vaccine for Covid-19, there is no occasion for making any observation as contained in the paragraph with regard to homeopathic medical practitioners,the judges stated.
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Meanwhile, the number of COVID-19 cases in India exceeds 10 million, and that of COVID-related death is almost 150 000. If you ask me, promoters of homeopathic remedies should not be allowed to advertise or sell their placebos pretending they are effective for any purpose in connection with COVID-19 (or any other serious disease for that matter) – not as a curative therapy, not for prevention, and not as a symptomatic treatment either.
On this blog we have seen just about every variation of misdemeanors by practitioners of so-called alternative medicine (SCAM). Today, I will propose a scale and rank order of these lamentable behaviours. As we regularly discuss chiropractic and homeopathy here, I decided to use these two professions as examples (but I could, of course, have chosen almost any other SCAM).
- Treating conditions which are not indicated: SCAM practitioners of all types are often asked by their patients to treat conditions which their particular SCAM cannot not affect. Instead of honestly saying so, they frequently apply their SCAM, wait for the natural history of the condition to do its bit, and subsequently claim that their SCAM was effective.
- Over-charging: asking too much money for services or goods is common (not just) in SCAM. It raises the question, what is the right price? There is, of course, no easy answer to it. Over-charging is therefore mostly a judgement call and not something absolute.
- Misleading a patient: there are numerous ways in which patients can be misled by their SCAM practitioners. A chiropractor who uses the Dr title, without explaining that it is not a medical title, is misleading his/her patients. A homeopath who implies that the remedy he/she is selling is a proven treatment is also misleading his/her patients.
- Being economical with the truth: the line between lying (see below) and being economical with the truth is often blurred. In my view, a chiropractor who does not volunteer the information that acute back pain, in most cases, resolves within a few days regardless of whether he/she mapipulates the patient’s spine or not, is economical with the truth. Similarly, a homeopath who does not explain up front that the remedy he/she prescribes does not contain a single active molecule is economical with the truth.
- Employing unreasonably long series of therapy: A chiropractor or homeopath, who treats a patient for months without any improvement in the patient’s condition, should suggest to call it a day. Patients should be given a treatment plan at the first consultation which includes the information when it would be reasonable to stop the SCAM.
- Failing to refer: A chiropractor or homeopath, who treats a patient for months without any improvement in the patient’s condition should refer the patient to another, better suited healthcare provider. Failing to do so is a serious disservice to the patient.
- Unethical behaviour: there are numerous ways SCAM practitioners regularly violate healthcare ethics. The most obvious one, as discussed often before on this blog, is to cut corners around informed consent. A chiropractor might, for instance, not tell his/her patient before sarting the treatment that spinal manipulation is not supported by sound evidence for efficacy or safety. A homeopathy might not explain that homeopathy is generally considered to be implausible and not evidence-based.
- Neglect: medical neglect occurs when patients are harmed or placed at significant risk of harm by gaps in their medical care. If a chiropractor or a homeopath, for instance, claim to be able to effectively treat asthma and fail to insist that all prescribed asthma medications must nevertheless be continued – as both often do – they are guilty of neglect, in my view. Medical neglect can be a reason for starting legal proceedings.
- Lying: knowingly not telling the truth can also be a serious legal issue. An example would be a chiropractor who, after beeing asked by a patient whether neck manipulation can cause harm, answers that it is an entirely safe procedure which has never injured anyone. Similarly, if a homeopaths informs his/her patient that the remedy he/she is prescribing has been extensively tested and found to be effective for the patient’s condition, he must be lying. If these practitioners believe what they tell the patient to be true, they might not technically be lying, but they would be neglecting their ethical duty to be adequately informed and they would therefore present an even greater danger to thier patients.
- Abuse: means to use something for the wrong purpose in a way that is harmful or morally wrong. A chiropractor who tells the mother of a healty child that they need maintenance care in order to prevent them falling ill in the future is abusing her and the child, in my view. Equally, I think that a homeopath, who homeopathically treats a disease that would otherwise be curable with conventional treatments, abuses his patient.
- Fraud: fraud is a legal term referring to dishonest acts that intentionally use deception to illegally deprive another person or entity of money, property, or legal rights. It relies on the use of intentional misrepresentation of fact to accomplish the taking. Arguably, most of the examples listed above are fraud by this definition.
- Sexual misconduct: the term refers to any behaviour which is sexual in nature and which is unwelcome and engaged in without consent. It ranges from unwanted groping to rape. There is, for instance, evidence that sexual misconduct is not a rarety in the realm of chiropractic. I have personally served once as an expert witness against a SCAM practitioner is a court case at the Exeter Crown Court.
The 12 categories listed above are not nearly as clearly defined as one would wish, and there is plenty of overlap. I am not claiming that my suggested ‘scale of misdemeanors by SCAM practitioners‘ or the proposed rank order are as yet optimal or even adequate. I am, however, hoping that readers will help me with their suggestions to improve them. Perhaps your input might then generate a scale of practical use for the future.
We are all prone to fall victim to the ‘post hoc ergo propter hoc’ fallacy. It describes the erroneous assumption that something that happened after an event was cased by that event. The fallacy is essentially due to confusing correlation with causation:
- the sun does not rise because the rooster has crowed;
- yellow colouring of the 2nd and 3rd finger of a smoker is not the cause of lung cancer;
- some children developing autism after vaccinations does not mean that autism is caused by vaccination.
As I said, we are all prone to this sort of thing, even though we know better. Scientists, journal editors and reviewers of medical papers, however, should not allow themselves to be fooled by overt cases of the ‘post hoc ergo propter hoc’ fallacy. And if they do, they have lost all credibility – just like the individuals involved in a recent paper on animal homeopathy.
Pododermatitis in penguins usually occurs after changes in normal activity that result from being held captive. It is also called ‘bumlefoot’ (which fails to reflect the seriousness of the condition) and amounts to one of most frequent and important clinical complications in penguins kept in captivity or in rehabilitation centres.
This veterinary case study reports the use of oral homeopathic treatment on acute and chronic pododermatitis in five Magellanic penguins in a zoological park setting. During treatment, the patients remained in the penguins’ living area, and the effect of the treatment on the progression of their lesions was assessed visually once weekly. The treatment consisted of a combination of Arnica montana and Calcarea carbonica.
After treatment, the appearance of the lesions had noticeably improved: in the majority of penguins there was no longer evidence of infection or edema in the feet. The rate of recovery depended on the initial severity of the lesion. Those penguins that still showed signs of infection nevertheless exhibited a clear diminution of the size and thickness of the lesions. Homeopathic treatment did not cause any side effects.
The authors concluded that homeopathy offers a useful treatment option for pododermatitis in captive penguins, with easy administration and without side effects.
So, the homeopathic treatment happened before the recovery and, according to the ‘post hoc ergo propter hoc’ fallacy, the recovery must have been caused by the therapy!
I know, this is a tempting conclusion for a lay person, but it is also an unjustified one, and the people responsible for this paper are not lay people. Pododermitis does often disappear by itself, particularly if the hygenic conditions under which the penguins had been kept are improved. In any case, it is a potentially life-threatening condition (a bit like an infected bed sore in an immobilised human patient) that can be treated, and one should certainly not let a homeopath deal with it.
I think that the researchers who wrote the article, the journal editor who accepted it for publication, and the referees who reviewed the paper should all bow their heads in shame and go on a basic science course (perhaps a course in medical ethics as well) before they are let anywhere near research again.
In 2012, we published a systematic review of adverse effects of homeopathy. Here is its abstract:
Aim: The aim of this systematic review was to critically evaluate the evidence regarding the adverse effects (AEs) of homeopathy.
Method: Five electronic databases were searched to identify all relevant case reports and case series.
Results: In total, 38 primary reports met our inclusion criteria. Of those, 30 pertained to direct AEs of homeopathic remedies; and eight were related to AEs caused by the substitution of conventional medicine with homeopathy. The total number of patients who experienced AEs of homeopathy amounted to 1159. Overall, AEs ranged from mild-to-severe and included four fatalities. The most common AEs were allergic reactions and intoxications. Rhus toxidendron was the most frequently implicated homeopathic remedy.
Conclusion: Homeopathy has the potential to harm patients and consumers in both direct and indirect ways. Clinicians should be aware of its risks and advise their patients accordingly.
The paper prompted a number of angry reactions from proponents of homeopathy who claimed, for instance, that homeopathic remedies are highly diluted and thus safe. We responded that homeopaths can nevertheless be dangerous to patients through neglect and bad advice by homeopaths, and that not all homeopathic remedies are highly diluted, and that some might be toxic because of poor quality control of the manufacturing process.
Now, a different group of researchers have looked at the problem from a slightly different angle and with different methodologies. This systematic review and meta-analysis by researchers from NAFKAM focused on observational studies, as a substantial amount of the research base for homeopathy are observational.
Eight electronic databases, central webpages and journals were searched for eligible studies, and a total of 1,169 studies were identified, 41 were included in this review. Eighteen studies were included in a meta-analysis that made an overall comparison between homeopathy and control (conventional medicine and herbs).
Eighty-seven percent (n = 35) of the studies reported adverse effects. They were graded as CTCAE 1, 2 or 3 and equally distributed between the intervention and control groups. Homeopathic aggravations (homeopaths believe that, when the optimal remedy is given, patients will experience an aggravation of their presenting symptoms) were reported in 22,5% (n = 9) of the studies and graded as CTCAE 1 or 2. The frequency of adverse effects for control versus homeopathy was statistically significant (P < 0.0001). Analysis of sub-groups indicated that, compared to homeopathy, the number of adverse effects was significantly higher for conventional medicine (P = 0.0001), as well as other complementary therapies (P = 0.05).
The authors concluded that adverse effects of homeopathic remedies are consistently reported in observational studies, while homeopathic aggravations are less documented. This meta-analysis revealed that the proportion of patients experiencing adverse effects was significantly higher when receiving conventional medicine and herbs, compared to patients receiving homeopathy. Nonetheless, the development and implementation of a standardized reporting system of adverse effects in homeopathic studies is warranted in order to facilitate future risk assessments.
While these results are interesting, they have to be taken with a pinch of salt and beg a number of questions:
- Is there proof that aggravations exist at all?
- How can one differentiate them from adverse effects?
- As even placebos are known to cause adverse effects (nocebo effects), how can one be sure that the adverse effects of homeopathy are not nocebo effects?
- Is it a good reason to focus on largely inconclusive observational studies, because a substantial amount of the research base for homeopathy are observational?
- Can one produce conclusive results by meta-analysing inconclusive studies?
For me, the most impressive findings of this review is that in total 86 studies had to be excluded by the authors because they reported no adverse effects or aggravations. I think this renders the interpretation of the evidence from the 41 studies they did include even more flimsy. In fact, I don’t see how any meaningful conclusion can be drawn at all – except of course that many researchers of homeopathy violate the rules of research ethics by not reporting adverse effects in their studies.
As to aggravations, we clearly need to rely on placebo controlled studies, if we want to find out whether they exist at all. This we have done in our 2003 paper:
Homeopathic aggravations have often been described anecdotally. However, few attempts have been made to scientifically verify their existence. This systematic review aimed at comparing the frequency of homeopathic aggravations in the placebo and verum groups of double-blind, randomised clinical trials. Eight independent literature searches were carried out to identify all such trials mentioning either adverse effects or aggravations. All studies thus found were validated and data were extracted by both authors. Twenty-four trials could be included. The average number of aggravations was low. In total, 50 aggravations were attributed to patients treated with placebo and 63 to patients treated with homoeopathically diluted remedies. We conclude that this systematic review does not provide clear evidence that the phenomenon of homeopathic aggravations exists.
What is interesting, from my perspective, is the fact that the NAFKAM authors chose to ignore our 2012 paper completely (even though it is highly relevant to their paper and was not published in an obscure journal) and elected to completely misinterpret the findings of our 2003 paper (stating this about it: Grabia and Ernst reported a total of 103 cases of homeopathic aggravations in 3437 participants (3%), while, in fact, our paper demonstrated that aggravations are a homeopathic figment of imagination).
I wonder why.
In the past, NAFKAM did not have the reputation of doing research that was overtly biased towards homeopathy. Recently, the head of the team retired and was replaced by Miek C. Jong who is a co-author of the present review (plus head of CAMcancer, an organisation of which I am a founding member and which did, I think, some good work in the past). She happens to have a long history as a homeopath or homeopathic researcher and is co-author of many papers in this area. Here are three of her conclusions:
- The prognostic questionnaire proved a reliable tool to rank 11 homeopathic medicines by total scores, based on keynote symptoms. This PMS algorithm can be used for the treatment of PMS/PMDD in clinical practice.
- Both complex homeopathic products led to a comparable reduction of URTIs. In the CalSuli-4-02 group, significantly less URTI-related complaints and symptoms and higher treatment satisfaction and tolerability were detected. The observation that the use of antibiotics was reduced upon treatment with the complex homeopathic medications, without the occurrence of complications, is interesting and warrants further investigations on the potential of CalSuli-4-02 as an antibiotic sparing option.
- Our systematic evaluation demonstrated that the reporting rate of ADRs associated with anthroposophic and homeopathic solutions for injection is very low. Most reported ADRs were listed, and one quarter consisted of local reactions. These findings suggest a low risk profile for solutions for injection as therapeutically applied in anthroposophic medicine and homeopathy.
Could it be that, within NAFKAM, the attitude towards homeopathy has changed?
