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

critical thinking

In 2011, the following leading researchers of so-called alternative medicine (SCAM) – no I was not invited – had a meeting in Italy, did a brainstorm and decided what we would need to know about SCAM by 2020 (today, in other words):

They proposed 6 core areas of research that should be investigated to achieve a robust knowledge base and to allow stakeholders to make informed decisions:

  1. Research into the prevalence of SCAM in Europe: Reviews show that we do not know enough about the circumstances in which SCAM is used by Europeans. To enable a common European strategic approach, a clear picture of current use is of the utmost importance.
  2. Research into differences regarding citizens’ attitudes and needs towards SCAM: Citizens are the driver for CAM utilization. Their needs and views on SCAM are a key priority, and their interests must be investigated and addressed in future SCAM research.
  3. Research into safety of SCAM: Safety is a key issue for European citizens. SCAM is considered safe, but reliable data is scarce although urgently needed in order to assess the risk and cost-benefit ratio of SCAM.
  4. Research into the comparative effectiveness of SCAM: Everybody needs to know in what situation SCAM is a reasonable choice. Therefore, we recommend a clear emphasis on concurrent evaluation of the overall effectiveness of SCAM as an additional or alternative treatment strategy in real-world settings.
  5. Research into effects of context and meaning: The impact of effects of context and meaning on the outcome of SCAM treatments must be investigated; it is likely that they are significant.
  6. Research into different models of SCAM health care integration: There are different models of SCAM being integrated into conventional medicine throughout Europe, each with their respective strengths and limitations. These models should be described and concurrently evaluated; innovative models of SCAM provision in health care systems should be one focus for SCAM research.

‘Look, half the work is done! All you need to do is fill in the top part so we can legally say the bottom part.’

The researchers then added:

We also propose a methodological framework for SCAM research. We consider that a framework of mixed methodological approaches is likely to yield the most useful information. In this model, all available research strategies including comparative effectiveness research utilising quantitative and qualitative methods should be considered to enable us to secure the greatest density of knowledge possible. Stakeholders, such as citizens, patients and providers, should be involved in every stage of developing the specific and relevant research questions, study design and the assurance of real-world relevance for the research.

Furthermore, structural and sufficient financial support for research into SCAM is needed to strengthen SCAM research capacity if we wish to understand why it remains so popular within the EU. In order to consider employing SCAM as part of the solution to the health care, health creation and self-care challenges we face by 2020, it is vital to obtain a robust picture of SCAM use and reliable information about its cost, safety and effectiveness in real-world settings. We need to consider the availability, accessibility and affordability of SCAM. We need to engage in research excellence and utilise comparative effectiveness approaches and mixed methods to obtain this data.

Our recommendations are both strategic and methodological. They are presented for the consideration of researchers and funders while being designed to answer the important and implicit questions posed by EU citizens currently using SCAM in apparently increasing numbers. We propose that the EU actively supports an EU-wide strategic approach that facilitates the development of SCAM research. This could be achieved in the first instance through funding a European SCAM coordinating research office dedicated to foster systematic communication between EU governments, public, charitable and industry funders as well as researchers, citizens and other stakeholders. The aim of this office would be to coordinate research strategy developments and research funding opportunities, as well as to document and disseminate international research activities in this field.

With the aim to develop sustainability as second step, a European Centre for SCAM should be established that takes over the monitoring and further development of a coordinated research strategy for SCAM, as well as it should have funds that can be awarded to foster high quality and robust independent research with a focus on citizens health needs and pan-European collaboration.

We wish to establish a solid funding for SCAM research to adequately inform health care and health creation decision-making throughout the EU. This centre would ensure that our vision of a common, strategic and scientifically rigorous approach to SCAM research becomes our legacy and Europe’s reality. We are confident that our recommendations will serve these essential goals for EU citizens.

As I know all of the members of the panel personally, I am not surprised by the content of this document. That does not mean, however, that I do not find it remarkable. In my view, it is remarkable because of the nature of the 6 items that we allegedly need to know by 2020, and because of the fact that, even though none of them seem particularly demanding, today we have clarity or sound information on none of them. I also thought that both the research topics and the research methods were on the woolly side and, to a large degree, avoided what would be standard in conventional medicine. The ‘vision’ of the 13 researchers thus turns out to be the view of 13 partially sighted people on an array of platitudes.

Being just a bit sarcastic, the document could be seen as a plea for letting SCAM researchers:

  • continue to play on their far from level playing field,
  • use their preferred and largely inadequate methodologies,
  • pretend they do cutting edge science,
  • continue to avoid the real issues,
  • enjoy a life free of demanding challenges,
  • have pots of EU money for doing largely useless work.

In a word, I am confident that their recommendations would not have served any essential goals for EU citizens.

What should we make of a discipline whose disciples are unsure of what the discipline is?

Yes, I am talking of chiropractic!

Surely, the inventor of chiropractic has told them what it is. True, DD Palmer left them no end of definitions; here are just 4 to choose from:

  • Chiropractic is the science of healing without drugs.
  • Chiropractic is the art of adjusting by hand all subluxations of the three hundred articulations of the human skeletal frame, more especially the 52 articulations of the spinal column, for the purpose of freeing impinged nerves, as they emanate thru the intervertebral foramina, causing abnormal function, in excess or not, named disease.
  • Chiropractic is a name I originated to designate the science and art of adjusting vertebrae.
  • Chiropractic is a philosophical science; it has solved one of the most profound and perplexing problems of the age, namely, what is life?

Despite this plethora of definitions, chiropractors are still struggling to define their trade. This article, entitled ‘So What Is Chiropractic?’, marks the end of a recent series of papers published in a chiro-journal trying to make progress in this regard. They revealed deeply rooted disagreements within the chiropractic profession about what chiropractic is, and what it should be, as a profession [13, 19, 20], as well as disagreements and variation in relation to education of chiropractors [14, 15] and chiropractic clinical practice [11].

In the opinion of the authors’ paper, it is ironic that, while chiropractic has a strong presence in large parts of the world [3], is taking on increasingly important roles in disability prevention [6, 7, 17], in the military [5] and in interprofessional care [8] as well as growing research capacity [16], discussions about fundamental values and direction of the profession are unresolved. They believe that this unresolved issue creates confusion for stakeholders and threatens to impede professionalization and cultural authority. If chiropractors are to remain relevant in today’s evidence-based healthcare environment, they argue, there is an urgent need to agree on, and further describe, what chiropractic is, what chiropractors do and importantly to provide evidence for value of these activities to patients and societies.

So, what do we make of chiropractic in view of the fact that chiropractors seem to be unsure what it is?

I let you decide.

What is pseudoscience and how can it be differentiated from science? This ‘demarcation problem’ has occupied many of our best minds and which nevertheless is largely unresolved. Two brave academics have recently published a paper aimed at providing organisations within the justice system with an overview of:

a) what science is and is not;

b) what constitutes an empirically driven, theoretically founded, peer-reviewed approach;

c) how to distinguish science from pseudoscience.

In it, they demonstrate that not all information which is presented as comprehensively evaluated is methodologically reliable for use in the justice system. Even though it does not really solve the old demarcation problem, I found their article important and informative and therefore take the liberty of quoting a brief excerpt here:

Organisations within the justice system do use empirically and theoretically supported approaches. However, some implemented approaches lack empirical evidence. In more perturbing cases, police officers, lawyers and judges may resort to pseudoscience – that is, bodies of information that may appear to be scientific but, in reality, lack the characteristics of scientific knowledge. … if members of the justice community are not advised about the publishing process then pseudoscientists can be fairly proficient at providing counterarguments. In addition, pseudoscientists can use several other fallacious arguments to achieve maximum support for their approaches.

For example, pseudoscientists might argue that their approaches are supported by a select number of articles, theses or books, and that they are reliable due to their acceptance by important organisations. However, if upon reading such literature it becomes apparent that there is no empirical or theoretical support, or that the steps leading to the conclusions are not thoroughly justified (be this methodologically or through evaluation), the implementation of their approaches remains merely destitute of vision. In addition, such reference to important organisations – often known as ‘name-dropping’–is detrimental by nature; doing so lends support to the notion that one might be unable to distinguish pseudoscience from science and may not understand the role that science plays in developing better professional practice.

Fallacious arguments from pseudoscientists can also address negative comments in a way that attempts to discourage further criticism from members of the scientific community. They can engage in legal threats and ad hominem attacks – that is, opposition to an argument ‘by questioning the personal circumstances or personal trustworthiness of the arguer who advanced it’. For example, if academics raise concerns regarding a particular pseudoscience without having attended its associated seminars, pseudoscientists might assert that the academics do not have the required understanding and that, as such, their criticism is of no value. If the academics had indeed attended the seminars, the pseudoscientists might instead suggest that their concerns are raised out of obscure or malicious reasons. Pseudoscientists might even state that they are criticised due to their revolutionary approach and refer to a quote dubiously attributed to the German philosopher Arthur Schopenhauer: ‘All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as self-evident’. However, as Sagan rightly points out,

the fact that some geniuses were laughed at does not imply that all who are laughed at are geniuses. They laughed at Columbus, they laughed at Fulton, they laughed at the Wright brothers. But they also laughed at Bozo the Clown.

It’s not (yet) a global emergency, the WHO have announced. But 26 fatalities have today been reported, and soon we will have thousands of people infected with the new coronavirus, experts predict. A vaccine will take at least a year to become available, and experts are alarmed.

But there is no need for panic!

Let’s just ask our homeopaths for help. They are excellent with curing viral infections!

You don’t believe me? But it must be true; take this website, for instance; its message could not be clearer :

… Homeopathic remedies can help you in fighting viral infections effectively… Homeopathy can be effective for viral infections including influenza-like symptoms, viral coughs and serious viral infections like herpes cold sores and genital herpes… The most common oral homeopathic remedy for herpes outbreaks is Rhus Toxicodendron (Rhus Tox in short), which is an extremely diluted form of poison ivy…

Another website offers more detail:

Conventional drugs do not offer comprehensive treatments for viral infections. Certain viruses like Influenza, HIV, etc. have tendencies to mutate (change) very rapidly, thereby lowering the effectiveness of such medicines. Additionally, viruses quickly develop resistance to these drugs, making the development of preventive medicine somewhat challenging. Conventional medications therefore only provide supportive management and suppression of the symptoms.
Homeopathic treatment for viral infections helps ease the symptoms and also enables the body to heal naturally.

Homeopathy treatment for viral infections is steadily gaining popularity as a natural way to deal with viral infections. These medicines help reduce the frequency and intensity of acute symptoms like weakness, fever, body pain, etc. These help with quick recovery. In some cases, they reduce the chances of further complications. Homeopathy treatment for viral infections treats the symptoms not by suppressing them, but by strengthening the immune system. It activates the body’s natural restorative properties by producing symptoms similar to the ones experienced by the patients. This method helps settle underlying internal disturbances in the body. Homeopathy treatment for viral infections also minimizes the weakness and fatigue commonly encountered as an aftermath of the infection.

Viral infections are highly communicable and spread rapidly from one person to another. Homeopathy treatment for viral infections is also preventative and helps reduce the chances of contracting the infection.

Yet another website is equally clear:

For viral ailments with symptoms that are fast and violent, use the following homeopathic remedies: Aconitum and Belladonna.

Aconitum – also known as Devil’s helmet or Queen of All Poisons – is a flowering plant that belongs to the family Ranunculacea. The flowers of this plant are harvested and then processed to treat various ailments, including viral infections.

Belladonna – also known as Deadly Nightshade – is a perennial herbaceous plant – prized for its medicinal benefits. It’s used as a muscle relaxant and pain reliever. The plant contains potent anti-inflammatory properties too. It’s an excellent remedy for viral infections.

What, you are still not convinced? In this case, have a look at what a Devon homeopaths stated only yesterday about the current epidemic:

Panic and anger in Wuhan as China orders city into lockdown.

A Coronavirus is a common virus that causes an infection in your nose, sinuses, or upper throat. Most corona viruses are not dangerous, they can in fact just cause symptoms which look like a mild cold.  Earlier this month though, the World Health Organization identified a new type (2019-nCoV) in China and to date there have been over 500 confirmed cases of this Corona virus with 17 fatalities reported so far this month.  The Media seems to be covering its progress with great relish, causing a lot of panic.

The virus starts with a fever, followed by a dry cough, and then after a week or so this leads to shortness of breath when some patients are hospitalised.  Pneumonia is one complication that can be caused by the virus. Most of the information spread about the virus is gained from these severe cases in hospital.

To protect yourself from any virus, you should boost your own immune symptom with a healthy diet and supplements if necessary.  I recommend the best vitamin C & D supplements you can get.  I also love Fermented Cod Liver Oil and a good Magnesium supplement.  Having homeopathic constitutional treatment is also proven to boost your immune system.

Homeopathic remedies can address every symptom caused by this virus so having an inexpensive homeopathy kit at home is an excellent resource.  I love the First Aid Kit by Helios Pharmacy which also comes with a booklet to guide you on which remedy to choose.  If you have remedies but feel you’re not equipped to use them, get in touch with me and I will send you a free PDF first aid booklet.

Here are a few homeopathic remedies which will be useful to treat viruses such as this one.  If you are confident the remedy is well indicated you need to repeat often in a 30C or 200C until it no longer helps, then move onto another if necessary:

Ferrum-phos: give this at the very first sign of symptoms.  Useful when you just don’t feel well, tired.  Red inflamed eyes, chill with shivering and fever.  Hot, burning eyes.  Worse cold, better rest.

Gelsemium: This is for when your symptoms start to feel more severe, especially if they have come on gradually.  You will feel dull, sluggish, heavy, often with a headache at the back of the neck.  Shivering up and down the spine, aching muscles, burning throat.  Worse cold, better after urination.

Pulsatilla: You will feel Chilly, even in a warm room.  Nose blocked up, bland and thick mucous.  Dry mouth with no thirst.  Changing, shifting symptoms, weepy and sorry for oneself.   You may often have a sore throat or ear ache with viruses.  Worse in a warm room, better in the open air.

Camphora: You will feel very cold, and may have laborious, asthmatic breathing with an accumulation of phlegm in the air tubes, cold, dry skin.  Total exhaustion, with coldness and shivering.  Weak pulse, irritability.  Worse cold.

Phosphorous:  For any virus which affects your lungs.  You may have bloody sputum and crave cold drinks.  Burning, pressure and constriction in the chest; worse lying on the left side or painful side.  Better in company, needing reassurance.

Bryonia: Excellent in pneumonia or pleurisy, especially when the right side is affected.  There is dryness everywhere, dry tongue, with generally a white coating.  There may be pain when breathing or coughing where the patient wants to hold steady as any movement hurts.  Irritable and thirsty.  Better rest, pressure.  Worse excitement, bright lights, noise, touch, movement.

This is outrageous, you claim? You insist that homeopathy is bunk, that homeopaths behave irrationally and their remedies are pure placebos? Placebos are no good for life-threatening infections! Anyone who says otherwise is deluded and irresponsible, you suggest.

I see, you might have a point.

Think of the time when homeopaths travelled to Liberia to cure Ebola. That was a homeopathic disaster, if there ever was one. Have homeopaths learnt their lesson since then? Clearly not: there are still hundreds of websites and books promoting homeopathy even for the most serious viral diseases. Do homeopaths provide sound evidence for their claims? I can see none.

Maybe that’s why nobody asks homeopaths to help with medical emergencies.

Ever since the government in Bavaria has been misguided enough to agree to a research programme testing whether homeopathy has a role in curtailing the over-use of anti-biotics, the subject of homeopathics as a replacement of antibiotics has been revived.

In this paper, homeopaths describe four female cases with recurrent urinary tract infections. The patients were treated successfully with the homeopathic strategy after several conventional approaches revealed no improvement. The follow-up period was a minimum of 3 years and the frequency of episodes with urinary tract infection as well as of antibiotic treatment was documented. Additionally, the patients were asked to assess the treatment outcome retrospectively in a validated questionnaire.

The treatment resulted in a reduction of urinary tract infections and the need for antibiotics from monthly to less than 3 times a year. Three of the four women had no cystitis and related intake of antibiotics for more than 1.5 years. A relapse of symptoms could be treated efficiently with a repetition of the homeopathic remedy. All subjective outcome assessments resulted positive.

The authors concluded that this case series suggests a possible benefit of individualized homeopathic treatment for female patients with recurrent urinary tract infections. Larger observational studies and controlled investigations are warranted. 

Such articles make me quite angry! They have the potential to mislead many patients and, in extreme cases, might even cost lives.

The ‘possible benefit’ of any treatment cannot be demonstrated with such flimsy case series. It has to be shown in properly controlled clinical trials. The findings of case series are confounded by dozens of variables and tell us next to nothing about cause and effect.

Case series make sense when they explore possible new therapeutic avenues. Homeopathy does certainly not fall into this category. The notion that homeopathics might be an alternative to antibiotics has been tested many times before in different settings, in animals, in humans, it vivo and in vitro. This has never generated convincingly positive findings. To re-address it by reporting uncontrolled cases is not just a nonsense; in my view, it is an unethical attempt to mislead us.

About 85% of German children are treated with herbal remedies. Yet, little is known about the effects of such interventions. A new study might tell us more.

This analysis accessed 2063 datasets from the paediatric population in the PhytoVIS data base, screening for information on indication, gender, treatment, co-medication and tolerability. The results suggest that the majority of patients was treated with herbal medicine for the following conditions:

  • common cold,
  • fever,
  • digestive complaints,
  • skin diseases,
  • sleep disturbances
  • anxiety.

The perceived effect of the therapy was rated in 84% of the patients as very good or good without adverse events.

The authors concluded that the results confirm the good clinical effects and safety of herbal medicinal products in this patient population and show that they are widely used in Germany.

If you are a fan of herbal medicine, you will be jubilant. If, on the other hand, you are a critical thinker or a responsible healthcare professional, you might wonder what this database is, why it was set up and how exactly these findings were produced. Here are some details:

The data were collected by means of a retrospective, anonymous, one-off survey consisting of 20 questions on the user’s experience with herbal remedies. The questions included complaints/ disease, information on drug use, concomitant factors/diseases as well as basic patient data. Trained interviewers performed the interviews in pharmacies and doctor’s offices. Data were collected in the Western Part of Germany between April 2014 and December 2016. The only inclusion criterion was the intake of herbal drugs in the last 8 weeks before the individual interview. The primary endpoint was the effect and tolerability of the products according to the user.

And who participated in this survey? If I understand it correctly, the survey is based on a convenience sample of parents using herbal remedies. This means that those parents who had a positive experience tended to volunteer, while those with a negative experience were absent or tended to refuse. (Thus the survey is not far from the scenario I often use where people in a hamburger restaurant are questioned whether they like hamburgers.)

So, there are two very obvious factors other than the effectiveness of herbal remedies determining the results:

  1. selection bias,
  2. lack of objective outcome measure.

This means that conclusions about the clinical effects of herbal remedies in paediatric patients are quite simply not possible on the basis of this survey. So, why do the authors nevertheless draw such conclusions (without a critical discussion of the limitations of their survey)?

Could it have something to do with the sponsor of the research?

The PhytoVIS study was funded by the Kooperation Phytopharmaka GbR Bonn, Germany.

Or could it have something to do with the affiliations of the paper’s authors:

1 Institute of Pharmacy, University of Leipzig, Brüderstr. 34, 04103, Leipzig, Germny. nieberkaren@gmx.de.

2 Kooperation Phytopharmaka GbR, Plittersdorfer Str. 218, 573, Bonn, Germany. nieberkaren@gmx.de.

3 Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.

4 ClinNovis GmbH, Genter Str. 7, 50672, Cologne, Germany.

5 Bayer Consumer Health, Research & Development, Phytomedicines Supply and Development Center, Steigerwald Arzneimittelwerk GmbH, Havelstr. 5, 64295, Darmstadt, Germany.

6 Kooperation Phytopharmaka GbR, Plittersdorfer Str. 218, 53173, Bonn, Germany.

7 Institute of Pharmaceutical Biology, Goethe University Frankfurt, Max-von-Laue-Str. 9, 60438, Frankfurt, Germany.

8 Chair of Naturopathy, University Medicine Rostock, Ernst-Heydemann Str. 6, 18057, Rostock, Germany.

WHAT DO YOU THINK?

Even the NEW SCIENTIST seems alarmed about Gwyneth and her activities:

Psychic readings, energy healing and vampire facials are just a few of the adventures had by actor and alternative health guru Gwyneth Paltrow and her team in her forthcoming Netflix series The Goop Lab. Goop, Paltrow’s natural health company, has already become a byword for unrestrained woo, but the TV series takes things to the next level.

Don’t make the mistake of thinking you can stick your fingers in your ears and pretend it isn’t happening. There is unlikely to be any escape from The Goop Lab after it is released on 24 January, judging by the current explosion of interest in Goop’s latest offering, a candle scented like Paltrow’s vagina, which has reportedly sold out…

Yet, I am sure we got her all wrong!

Good old Gwennie is really one of us – she is a true sceptic!

Think about it; it’s the only explanation.

When she first started dabbling in woo, she only wanted to test us. I’ll just display a few cupping marks and see how they react, she thought.

Image result for gwyneth paltrow, cupping

Then she saw that most people were so gullible that they bought it. Of course, she thought, if they buy it, I might as well take their money. In her attempt to see how far she can push her boat out, she decided to conduct a sceptical experiment and went further and further. This is when she started to focus on her vagina – jade eggs, steaming it, etc. Surely, she thought, eventually they must realise that I am a sceptic taking the Mikey!

But they never did realise it; at least not so far.

So, she decided to do something even more brazen and sell candles to dispense the smell of her vagina in the homes of her fans. That will do it, she felt, now they will realise what I want to achieve with all this.

But what happened? They sold out in no time (actually, both the candles and the gullible public)! That was a surprise even to our Gwennie. She thought she had seen it all, but she was wrong.

Image result for gwenyth paltro, vagina

Now she is trying to think of something even more outrageous – but she admits, it’s not easy. What can be a more obvious and disgusting hoax than filling people’ homes with the smell of my genitals and let them pay through their noses for the pleasure? she asks herself.

Yes, poor old Gwennie is at loss! Stuck in her own vagina, so to speak.

Perhaps you can help her? Please suggest what vaginal gimmick she might sell next to make her position inescapably clear to even the dumbest of the gullible. Just mention your ideas in the comment section below; I have a feeling she is an avid reader of this blog. Gwennie might even show herself generous; if she likes your innovation, she will certainly make it worth your while.

Because, by Jove, she can afford to be generous. Apparently her business is now worth a quarter of a billion US$. But we must not be envious. Knowing that she did all this merely to stimulate sceptical thinking in the general public, you will not be surprised to learn what she intends to do with all this dosh: once she has succeeded in demonstrating to all the gullible pin heads and devotees that she really is on the side of the angles, she will donate all of it to sceptic organisations across the globe.

So, sceptics of the world: stop snarling at my friend Gwennie, rejoice and prepare for a major windfall.

 

I am beginning to think that a devotion to homeopathy is conducive to telling porkies. When I read texts by homeopaths, I almost invariably discover untruths. Take this article on the popularity of homeopathy, for instance:

Worldwide

  • Worldwide, over 200 million people use homeopathy on a regular basis.1, 2
  • Homeopathy is included in the national health systems of a number of countries e.g. Brazil, Chile, India, Mexico, Pakistan, Switzerland.

India

  • India leads in terms of number of people using homeopathy, with 100 million people depending solely on homeopathy for their medical care.1
  • There are over 200,000 registered homeopathic doctors currently, with approximately 12,000 more being added every year.3

Europe

  • 100 million EU citizens, some 29% of the EU’s population, use homeopathic medicines in their day-to-day healthcare.2
  • Homeopathy is practised in 40 out of 42 European countries.4

UK

  • 10% of people in the UK use homeopathy – an estimated 6 million people.5
  • In Britain, the market for homeopathy is growing at around 20% per year.  In 2007, it was estimated to be worth £38m, and is projected to reach £46m in 2012.6
  • There are ~ 400 doctors in the UK that use homeopathy, regulated by the Faculty of Homeopathy and promoted by the British Homeopathic Association.7
  • There are ~1,500 professional homeopaths (non-medically qualified homeopaths) in the UK,8 regulated by the Society of Homeopaths (65%), Alliance of Registered Homeopaths and Homeopathic Medical Association. They largely operate in private practice outside the NHS.
  • See NHS spending on homeopathy

US

  • According to the National Institutes of Health, over 6 million people in the United States use homeopathy, mainly for self-care of specific health conditions.
  • Of those who use homeopathy, ~1 million are children and over 5 million are adults.9, 10

References

  1. Prasad R. Homoeopathy booming in India. Lancet, 2007; 370:1679-80 | Full Text
  2. Homeopathic medicinal products. Commission report to the European Parliament and the Council on the application of Directives 92/73 and 92/74 | Full Text
  3. Ghosh AK. A short history of the development of homeopathy in India. Homeopathy, 2010;99(2):130-6 | PubMed
  4. Legal Status of Traditional Medicine and Complementary/Alternative Medicine: A Worldwide Review, World Health Organization, 2001 | Full Text
  5. Professor Woods of the MHRA, response to Q211, House of Commons Science and Technology Committee hearing of evidence in preparation of Evidence Check 2: Homeopathy report (London: The Stationery Office Limited, 2010) | Full Text
  6. Mintel, Complementary Medicines, April 2007 | Link
  7. Faculty of Homeopathy | Link
  8. Society of Homeopaths | Link
  9. Black LI, et al. Use of Complementary Health Approaches Among Children Aged 4–17 Years in the United States: National Health Interview Survey, 2007–2012. National Health Statistics Reports, 2015; 78: February | Link
  10. Clarke TC, et al. Trends in the Use of Complementary Health Approaches Among Adults: United States, 2002–2012. National Health Statistics Reports, 2015; 79: February | Link

Contrast this with the (as far as I know) only systematic review on the subject:

Aim: To systematically review surveys of 12-month prevalence of homeopathy use by the general population worldwide.

Methods: Studies were identified via database searches to October 2015. Study quality was assessed using a six-item tool. All estimates were in the context of a survey which also reported prevalence of any complementary and alternative medicine use.

Results: A total of 36 surveys were included. Of these, 67% met four of six quality criteria. Twelve-month prevalence of treatment by a homeopath was reported in 24 surveys of adults (median 1.5%, range 0.2-8.2%). Estimates for children were similar to those for adults. Rates in the USA, UK, Australia and Canada all ranged from 0.2% to 2.9% and remained stable over the years surveyed (1986-2012). Twelve-month prevalence of all use of homeopathy (purchase of over-the-counter homeopathic medicines and treatment by a homeopath) was reported in 10 surveys of adults (median 3.9%, range 0.7-9.8%) while a further 11 surveys which did not define the type of homeopathy use reported similar data. Rates in the USA and Australia ranged from 1.7% to 4.4% and remained stable over the years surveyed. The highest use was reported by a survey in Switzerland where homeopathy is covered by mandatory health insurance.

Conclusions: This review summarises 12-month prevalence of homeopathy use from surveys conducted in eleven countries (USA, UK, Australia, Israel, Canada, Switzerland, Norway, Germany, South Korea, Japan and Singapore). Each year a small but significant percentage of these general populations use homeopathy. This includes visits to homeopaths as well as purchase of over-the-counter homeopathic medicines.

Spot some discrepancies?

I wonder why the author (no name was provided) failed to cite the systematic review (it was published by pro-homeopathy researchers in a journal which they surely know – it’s called ‘Homeopathy’!). Perhaps because he/she writes for the ‘Homeopathy Research Institute‘. This organisation states that the HRI is an innovative international charity created to address the need for high quality scientific research in homeopathy. The charity was founded by physicist, Dr Alexander Tournier, who previously worked as an independent researcher for Cancer Research UK, conducting interdisciplinary research at the boundaries between mathematics, physics and biology.

The HRI also claims that the evidence suggests that homeopathy could provide solutions to many of the challenges facing us today – from overuse of antibiotics to spiraling healthcare budgets…

You see, now it all makes sense!

An enthusiast of homeopathy recently posted an overview of systematic reviews of homeopathy concluding that the data we do have point towards homeopathy as having an effect greater than that of placebo:

In recent decades, homeopathy has been examined via a number of clinical trials, the number of which now allow meta-analysis. As we can see from the study findings, the type of homeopathy research (ie, individualized vs non-individualized, placebo-controlled vs non-placebo-controlled) can have a strong influence on the results, although trial quality also has a strong effect.

All meta-analyses performed in at least a somewhat open and rigorous manner have found statistically significant effects. This suggests that homeopathy has a greater-than-placebo effect, or at least a strong trend in that direction, when using data from the totality of homeopathy research, or from individualized, placebo-controlled trials. The meta-analyses with questionable methodology, one of which is undergoing government investigation for academic irregularities, have produced negative results, which have been demonstrated to be a direct result of their exclusion of vast swathes of the homeopathic clinical trial literature (based on arbitrary and unexplained criteria), as well as of their failure to differentiate – as Mathie has done – different types of homeopathic research.

The clinical data are flawed. Issues with methodology used in homeopathy RCTs, combined with a lack of research funding, have produced a lack of high-quality trials and data. However, the data we do have point towards homeopathy as having an effect greater than that of placebo.

There can be no argument with this conclusion, aside from possible new data emerging. Anyone who disputes this is going against the existing set of the highest-quality evidence on homeopathy.

His overview is based on the following publications:

Kleijnen, 19911 All types of homeopathy (eg, single remedy vs combination). Methodological quality assessed; 105 trials. Results: Positive trend, regardless of type of homeopathy; 81 trials were positive, 24 showed no effect.
Linde, 19972 All types of homeopathy. Out of 185 trials, 119 met inclusion criteria; 89 of these had extractable data. Results: OR = 2.45 (95% CI 2.05-2.93).
Ernst, 19983 Individualized homeopathy; 5 trials determined to be high-quality. Results: OR = 0.
Linde, 19985 Individualized homeopathy; 32 trials, 19 of which had extractable data. Results: OR = 1.62 for all trials (95% CI 1.17-2.23). Only high-quality trials produced no significant trend.
Cucherat, 20009 All types of homeopathy; 118 trials, 16 of which met inclusion criteria. Used unusual method of combining p values. Results: All trials = p< 0.000036. Less than 10% dropouts: p<0.084; less than 5% dropouts (higher standards than most trials considered reliable): p<0.08 (non-significant).
Shang, 200511 All types of homeopathy; only 8 trials selected from 21 high-quality trials of 110 selected with unusual criteria. Results: OR = 0.88 (0.65-1.19). Result strongly disputed by statisticians.
Mathie, 201413 Individualized homeopathy; of the analysis pooled data from 22 higher-quality, individualized, double-blind RCTs. Results: OR = 1.53 (1.22-1.91) for all trials pooled; OR = 1.93 (1.16-3.38) for the 3 reliable trials.
NHMRC, 201516 Out of 176 studies, 171 were excluded, leaving only 5 for the study. Investigators used unprecedented methods, did not combine data, and are currently under investigation for outcome shopping. Results: Negative results.
Mathie, 201720 Non-individualized homeopathy; very few higher-quality trials. Results: For 54 trials with extractable data, SMD = -0.33 (-0.44, -0.21). When these were adjusted for publication bias, SMD = -0.16 (-0.46,-0.09). The 3 high-quality trials had non-significant results: SMD = -0.18 (-0.46, +0.09).
Mathie, 201821 Individualized, other-than-placebo-controlled trials; 11 trials found, 8 with extractable data. Results: 4 heterogeneous comparative trials showed a non-significant difference. One trial in this group was positive. Three heterogeneous trials with additive homeopathy showed a statistically significant SMD. No definitive conclusion possible due to trial heterogeneity, poor quality, and low number of trials.
Mathie, 201922 Non-individualized, other-than-placebo-controlled trials; 17 RCTs found, 14 with high risk of bias. Results: Significant heterogeneity prevented much comparison; 3 comparable trials showed a non-significant SMD.

Apart from getting the wrong end of the stick when interpreting the results of these papers (see for instance here, and here), there are other rather embarrassing flaws in this overview:

  1. Many older systematic reviews were omitted (including about 10 of my own papers). This is relevant because the author of the above review went beck until 1991 to find the reviews he included.
  2. Several new papers were missing as well. This is relevant because the author evidently included reviews up to 2019. Here are the key passages from the conclusions of some of them:

homoeopathy as a whole may be considered as a placebo treatment.

We tested whether p-curve accurately rejects the evidential value of significant results obtained in placebo-controlled clinical trials of homeopathic ultramolecular dilutions. Our results suggest that p-curve can accurately detect when sets of statistically significant results lack evidential value.

We found no evidence to support the efficacy of homeopathic medicinal products

no firm conclusions regarding the effectiveness and safety of homeopathy for the treatment of IBS can be drawn.

Due to both qualitative and quantitative inadequacies, proofs supporting individualized homeopathy remained inconclusive.

… the use of homeopathy currently cannot claim to have sufficient prognostic validity where efficacy is concerned.

I am, of course, not saying that this overview amounts to anything like a systematic review. It merely gives you a flavour how trustworthy proponents of homeopathy are when they pretend to provide us with an objective evaluation of the best available evidence.

Chiropractors have a thing about treating children, babies and infants – not, I suspect, because it works but because it fills their bank accounts. To justify this abuse, they seem to go to any lengths – even to extrapolating from anecdote to evidence. This recently published case-report, for instance, described the chiropractic care of a neonate immediately post-partum who had experienced birth trauma.

The attending midwife noted the infant had an asynclitic head presentation at birth and as a result was born with an elongation of the occiput due to cranial molding, bilateral flexion at the elbows and shoulders with decreased range of motion in the cervical spine with tongue and lip tie. Oedema of the occiput with bruising was notable along with hypertonicity of cervical musculature at C1, hypertonicity (bilaterally) of the pectoral and biceps muscles, blanching and tension of lip tie, decreased suck reflex and tongue retraction with sucking, fascial restrictions at the ethmoid bones, at the occipital condyles (bilaterally), as well as at the shoulders and clavicles, bilaterally. An anterior subluxation of left sphenoid was noted.

The infant was cared for with chiropractic including a sphenobasilar adjustment. Following this adjustment, significant reduction in occipital edema was noted along with normal suck pattern and breastfeeding normalized.

The authors concluded that this case report provides supporting evidence that patients suffering from birth trauma may benefit from subluxation-based chiropractic care.

Oh no, this case report provides nothing of the sort! If anything, it shows that some chiropractors are so deluded that they even publish their cases of child abuse. The poor infant would almost certainly have developed at least as well without a chiropractor having come anywhere near him/her. And if the infant had truly been in need of treatment, then not by a chiropractor (who has no knowledge or training in diagnosing or treating a new-born), but by a proper paediatrician.

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