MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Another presentation from the 2nd OFFICIAL SIPS CONFERENCE ON PLACEBO STUDIES caught my eye. As it is not available on-line, I have copied here the unabbreviated abstract:

Open-label placebo vs. conventional and alternative medicine – An online study on expected effectiveness 1. Marcel Wilhelm. Philipps-University Marburg, Marburg, Germany. 2. Winfried Rief. Philipps-University Marburg, Marburg, Germany. 3. Frank Euteneuer. Medical School Berlin, Berlin, Germany.

Background: Treatment expectations are a key mechanism in placebo effects. Optimizing these expectations is a main goal in placebo designs but is often based on deception. To address ethical concerns, open-label placebo treatments seem to be effective without deception, although the role of expectations for their effect is rather unclear. Methods: Participants (N=253) who occasionally suffer from headaches were recruited online and randomized to receive one of three hypothetical descriptions of a doctor-patient-situation in which a certain headache treatment is prescribed: 1) conventional medicine, 2) open-label placebo, 3) alternative medicine (homeopathy). Subsequently, participants rated how strongly they expect that the given treatment can be effective. Results: One-way ANOVA revealed differences in expected effectiveness between groups. The highest expected effectiveness occurred in the conventional medicine group, the lowest in the open-label placebo group as well as in the homeopathy group. Potential moderators are discussed, e.g., socioeconomic variables, health literacy, locus of control. Conclusions: Participants expect lower effectiveness of treatment if they are truthfully informed about the inertness of a prescribed treatment (open-label placebo). While the descriptions were otherwise identical, the homeopathy group also scored lower levels of expectancy compared to conventional medicine. Homeopathy can be interpreted as a placebo prescription with deception as it does not contain pharmacologically active substances. The expected effectiveness in the homeopathy group did not differ from open-label placebo. These results suggest that prescribing a placebo while truthfully informing about placebo effects seems to be as feasible as to prescribe homeopathy regarding the expected effectiveness.

I am not sure what these results indicate. However, the fact that the authors describe homeopathy as a ‘placebo prescription with deception’ is definitely interesting.

I wonder whether homeopaths agree.

20 Responses to Homeopathy = a ‘placebo prescription with deception’

  • Blah blah non-individualised blah blah wibble not proper homeopaths blah blah you don’t understand homeopathy yak yak yak reductionist allopathic test yadda yadda yadda Langmuir nanomedicine (just in case Dana turns up)

    That about covers it I think

  • When placebo accomplishes what homeopathy has, I will take notice.

  • NHMRC Finally Release First Report on Homeopathy
    The Homeopathy Research Institute (HRI) welcomes the decision by Australia’s NHMRC to release its first report on homeopathy, produced in 2012.

    After years of NHMRC’s refusing to release the report, researchers, decision-makers and the general public can finally see the full draft of the 2012 Homeopathy Review, in which the author concluded that there is “encouraging evidence for the effectiveness of homeopathy” in five medical conditions.

    We also welcome the valuable clarification provided by NHMRC CEO Prof Anne Kelso, that NHMRC’s second Homeopathy Review published in 2015 “did not conclude that homeopathy was ineffective”, despite claims to that effect in media reports and by anti-homeopathy campaigners.

    HRI will be reviewing the 2012 draft report, The Effectiveness of Homeopathy: an overview review of secondary evidence, carefully over the coming weeks, along with NHMRC’s annotations to the 293-page document.

    “For over three years NHMRC have refused to release their 2012 draft report on homeopathy, despite Freedom of Information requests and even requests by members of the Australian Senate. To see this document finally seeing the light of day is a major win for transparency and public accountability in research.”
    Rachel Roberts, HRI Chief Executive

    For more information see:
    http://www.HRI-Research.org/Australian-Report

    • it changes nothing of importance in terms of the evidence on homeopathy

      • The story about Professor Ernst and our remedy Berlin wall was essentially fake news, engineered by him in order to promote his new book attacking CAM and my company in particular. Even he was surprised how idiotic the media response was. His tactic is to cherry-pick evidence to support his claims of homoeopathy being implausible. Data dredging is bad science, in fact its scientism. He often cites the NHMRC report mentioned below to support his case. They made the same mistake and have been caught out this week by the Ombudsman. This is real news; a government funded agency misusing public funds to mislead the public by burying a report that showed the facts in order to release one that showed what they wanted to demonstrate – sound familiar to you guys!!!. By cherry-picking evidence to make a fake case they have deprived people of access to homoeopathy provided by social welfare and insurance paid systems. It is scandalous. Are you going to stop practising scientism and listen to what Professor Robert Hahn has said about you Edzard? ‘This man should be hung drawn and quartered, how is he allowed to get away with his claims? You have to ignore over 90% of the research to make them”

    • So, tony, what do you believe is the most important message about homeopathy in that unfinished draft report?

      • No Alan, I believe in 35 years of actual experience with thousands of patients. If you have some actual experience to share it would be worth discussing this with you but every time I ask you to share this you change the subject and repeat the same old boring mantra that it doesn’t work. Based on complete ignorance and zero actual knowledge. So here’s a challenge, please describe your own experience of following the laws of homoeopathy and how you practised them. Present an actual case you treated and specify on what criteria you selected the remedy. I’m happy to discuss this but not repeat the same old mantra

        • do you know what the 3 most dangerous words in medicine are?
          IN MY EXPERIENCE!

        • tony, tony, tony… I’m not the one earning a living and making claims for homeopathy here. We all know where the burden of proof lies.

          This isn’t a difficult concept to understand, its it? If a manufacturer of confectionery claims their products are completely non-fattening despite consisting of 100% sugar, we would expect them to provide evidence for their claim, don’t you think?

          But it’s interesting that don’t seem to think the unfinished draft report is worth bothering about – it looks like some of your colleagues went to a lot of trouble over it.

          As always, remember what Prof Feynman said:

          The first principle is that you must not fool yourself – and you are the easiest person to fool.

          Was he wrong?

        • Tony, the plural of “anecdote” is not “data”, as well you know. Because, as you also know, correctly-conducted clinical trials demonstrate homeopathy to be the nonsense it is, you and your ilk are forced to resort to flapping and blustering about personal experience as a way of demonstrating the imaginary healing powers of shaken water. Then there is the oft-repeated mantra of us knowing nothing about homeopathy and never having experienced it, thus our opinions (and by “opinions” homeopaths mean “inconvenient facts”) are of no consequence.

          We know LOTS about homeopathy, Tony. A lot more than you it would seem. Primarily that it is implausible nonsense but let’s address the rest of your argument.

          I’ve never seen a fairy and I know nothing of their biology, anatomy, physiology, sociology or demographics. So, by your logic, I can’t say that fairies don’t exist.

        • Dear Tony,
          talking about challenges:
          Since you are an expert on the topic of homeopathy, I need your advice.
          For several months, I try to understand why pretty much none of the tens of thousands of homeopaths worldwide wants to takes the opportunity to silence us skeptics by simply completing the 50,000 Euro homeopathy-challenge.
          https://www.gwup.org/challenge-home

          Do you have an explanation for this suspicious lack of interest?
          Well I have… but I assume that you won´t like my conclusion.

          So why don´t you put your money where your mouth is and take the challenge yourself?
          But be aware: this test is serious, so anectodes won´t help.

    • Contrary to what you probably try to convey here, these events are NOT proof that homeopathy is good for anything.
      In fact, it doesn’t make homeopaths look good at all, but shows them for the unscientific, cherry-picking hypocrites they quite often are: they only accept evidence that is positive for homeopathy, no matter how flimsy or shoddy it is, while totally ignoring (or even denying) the vastly greater amount of very good evidence that homeopathy is literally nothing.

      And even in this light, getting on their high horse and demanding that an internal draft version of a document be made public sounds like desperate clutching at straws to me.
      From what I see, the NHMRC carefully looked at the available evidence for and against homeopathy, and at one point amended the report to better reflect the latest scientific insights. Those homeopaths should simply stop whining and start looking for a new career – preferably one that doesn’t involve deceiving sick people.

      • You are missing the point completely either because you don’t understand the issue any more than you do homoeopathy or are just, like Professor Robert Hahn says, very poor scientists. When you jump to assumptions rather than examine the actual facts and decide on the outcome you want to promote your tag line with a closed mind this is the result. The problem is that saying it doesn’t make it true.

        NHMRC used public money to produce the report. They put the report out to a consultant who, as it happens was extremely observant of their criteria (largely becasue she helped to design it in the first place) and produced the first report which actually demonstrated a positive benefit for homoeopathy. They took one look at this and did what you guys all do, asked how they could change it to meet their requirement that it doesn’t work. Now, as the late Peter Fisher showed all of you time and again the only way to do this and make it meet your needs is to dredge data like Shand et al and so they copied a well trodden path and produced a second report which showed it didn’t work. What they did was to shift the goalposts until they had excluded over 90% of the research by using fake criteria such as acceptable trial N numbers that were not applicable to allopathic studies according to their own criteria.

        Problem was that they buried the first report and lied about there being a one to Senators from the Australian parliament who they are obliged to account to. Its called fraud.

        • here we go again!
          you are quick with making allegations of fraud – isn’t there a homeopathic remedy against this? should you try Berlin Wall?

        • tony said:

          dredge data like Shand et al

          It’s Shang et al.

          But can you back up your claim they dredged data?

          But what do you think of all the more recent work done by Mathie et al.?

        • “…produced the first report which actually demonstrated a positive benefit for homoeopathy”

          Tony that isn’t right.

          Table 1 of the First Report summarises the evidence for homeopathy for almost 30 health conditions. For most of them the evidence is not in favour of homeopathy (or cannot be determined as there are insufficient studies of appropriate quality etc) and only FIVE were deemed ‘encouraging evidence’ before being corrected in the annotations. The report goes on to highlight why. The term ‘encouraging evidence’ was conflictingly defined AND misapplied because some of the studies relied on were also not strong enough to lead to that conclusion.

          In short the report itself already found that homeopathy could not be recommended for several health conditions before we get onto the conflicted five conditions.

          At best (ignoring the corrections) you could say that the uncorrected draft gave the impression that there was encouraging evidence for cancer treatment symptoms, fibromyalgia, otitis media, post-operative ileus and upper respiratory tract infections. However the whole point of releasing this document was to show that it was flawed and the way in which it was flawed, so we can’t ignore the corrections / annotations.

          There was no need to ‘dredge data’, only to show that the data used couldn’t support that conclusion.

          The report also showed that homeopathy could not be recommended for 24 other conditions because there was
          • no convincing evidence for 13 conditions
          • inconclusive / equivocal evidence for 3 conditions
          • insufficient evidence for 5 conditions and
          • no available evidence to examine for 3 conditions.

          Page 9 of the 294 page PDF summarises this, with an overview summary of each health condition on pages 9-13 (pages viii to xii).

          If you want to believe that this report supports homeopathy you are going to be met with disappointment.

          Jo

    • Why would homeopaths welcome a clarification which says “did not conclude that homeopathy was ineffective” without managing to read to the end of the same paragraph which says the more technically precise “there are no health conditions for which … homeopathy is effective.”

      Here are the two relevant sentences in Anne Kelso’s statement: “Contrary to some claims, the review did not conclude that homeopathy was ineffective. Rather, it stated that “based on the assessment of the evidence of effectiveness of homeopathy, NHMRC concludes that there are no health conditions for which there is reliable evidence that homeopathy is effective.”

      It is slightly fascinating to watch homeopaths wrestling with this one. I’ve also enjoyed their notion that the report says there’s ‘encouraging evidence’ for homeopathy.

      The RCVS and NHS aren’t going to change their approach to homeopathy based on this report – they can read it the same way as we can and it’s still clear that homeopathy shouldn’t be recommended for any health condition.

      Jo

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

If you want to be able to edit your comment for five minutes after you first submit it, you will need to tick the box: “Save my name, email, and website in this browser for the next time I comment.”
Recent Comments

Note that comments can be edited for up to five minutes after they are first submitted but you must tick the box: “Save my name, email, and website in this browser for the next time I comment.”

The most recent comments from all posts can be seen here.

Archives
Categories