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

homeopathy

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I ought to admit to a conflict of interest regarding today’s post:

I am not a fan of Mr Corbyn!

He fooled us prior to the Referendum claiming he was backing Remain and subsequently campaigned less than half-heartedly for it. Not least thanks to him and his sham of a campaign Leave won the referendum. Subsequently, the UK embarked on a bonanza of self-destruction and a frenzy of xenophobia which changed the UK beyond recognition. Currently, Mr Corbyn is doing the same trick again. He had to concede in the Labour manifesto that his party would eventually support a People’s Vote, and now he bends over backwards to avoid doing anything remotely like it. This strategy, together with his rather non-transparent stance on anti-Semitism does it for me. I could not vote for Corbyn in a million years now.

NOTHING TO DO WITH ALTERNATIVE MEDICINE!, I hear you exclaim.

Yes, you are right – but this has:

Some time ago, Corbyn tweeted ‘I believe that homeopathy works for some ppl and that it compliments ‘convential’ meds. they both come from organic matter…’

Excuse my frankness, but I find this short tweet embarrassingly stupid (regardless of who authored it).

Apart from two spelling mistakes, it contains several fundamental errors and fallacies:

  • Corbyn seems to think that, because some people experience improvement after taking a homeopathic remedy, homeopathy is effective. Does he also believe that the crowing of a cock makes the sun rise in the morning? The statement shows a most irritating lack of understanding as to what constitutes medical evidence and what not. That it was made by a politician makes it only worse.
  • Corbyn also tells us that homeopathy is an appropriate adjunct to conventional healthcare. His impression is based on the fact that ‘it works for some people’. This assumption reveals a naivety that is deplorable in a politician who evidently thinks himself sufficiently well-informed to tweet about the matter.
  • The final straw is Corbyn’s little afterthought: they both come from organic matter. Many conventional medicines come from inorganic matter. And homeopathic remedies? Yes, many also come from inorganic materials.

Yes, I know, you probably think me a bit pedantic here. As I said, I have strong misgivings against Mr Corbyn.

But, even leaving my prejudice aside, I do think that politicians and other people of influence should comment on issues only after they informed themselves about them sufficiently to make good sense. Otherwise they are in danger to merely disclose their ineptitude in the same way as Corbyn did when he wrote the above tweet.

 

I stared my Exeter post in October 1993. It took the best part of a year to set up a research team, find rooms etc. So, our research began in earnest only mid 1994. From the very outset, it was clear to me that investigating the risks of so-called alternative medicine (SCAM) should be our priority. The reason, I felt, was simple: SCAM was being used a million times every day; therefore it was an ethical imperative to check whether these treatments were as really safe as most people seemed to believe.

In the course of this line of investigation, we did discover many surprises (and lost many friends). One of the very first revelation was that homeopathy might not be harmless. Our initial results on this topic were published in this 1995 article. In view of the still ongoing debate about homeopathy, I’d like to re-publish the short paper here:

Homoeopathic remedies are believed by doctors and patients to be almost totally safe. Is homoeopathic advice safe, for example on the subject of immunization? In order to answer this question, a questionnaire survey was undertaken in 1995 of all 45 homoeopaths listed in the Exeter ‘yellow pages’ business directory. A total of 23 replies (51%) were received, 10 from medically qualified and 13 from non-medically qualified homoeopaths.

The homoeopaths were asked to suggest which conditions they perceived as being most responsive to homoeopathy. The three most frequently cited conditions were allergies (suggested by 10 respondents), gynaecological problems (seven) and bowel problems (five).

They were then asked to estimate the proportion of patients that were referred to them by orthodox doctors and the proportion that they referred to orthodox doctors. The mean estimated percentages were 1 % and 8%, respectively. The 23 respondents estimated that they spent a mean of 73 minutes on the first consultation.

The homoeopaths were asked whether they used or recommended orthodox immunization for children and whether they only used and recommended homoeopathic immunization. Seven of the 10 homoeopaths who were medically qualified recommended orthodox immunization but none of the 13 non-medically qualified homoeopaths did. One non-medically qualified homoeopath only used and recommended homoeopathic immunization.

Homoeopaths have been reported as being against orthodox immunization’ and advocating homoeopathic immunization for which no evidence of effectiveness exists. As yet there has been no attempt in the United Kingdom to monitor homoeopaths’ attitudes in this respect. The above findings imply that there may be a problem. The British homoeopathic doctors’ organization (the Faculty of Homoeopathy) has distanced itself from the polemic of other homoeopaths against orthodox immunization, and editorials in the British Homoeopathic Journal call the abandonment of mass immunization ‘criminally irresponsible’ and ‘most unfortunate, in that it will be seen by most people as irresponsible and poorly based’.’

Homoeopathic remedies may be safe, but do all homoeopaths merit this attribute?

This tiny and seemingly insignificant piece of research triggered debate and research (my group must have published well over 100 papers in the years that followed) that continue to the present day. The debate has spread to many other countries and now involves numerous forms of SCAM other than just homeopathy. It relates to many complex issues such as the competence of SCAM practitioners, their ethical standards, education, regulation, trustworthiness and the risk of neglect.

Looking back, it feels odd that, at least for me, all this started with such a humble investigation almost a quarter of a century ago. Looking towards the future, I predict that we have so far merely seen the tip of the iceberg. The investigation of the risks of SCAM has finally started in earnest and will, I am sure, continue thus leading to a better protection of patients and consumers from charlatans and their bogus claims.

In a previous post, I have tried to explain that someone could be an expert in certain aspects of homeopathy; for instance, one could be an expert:

  • in the history of homeopathy,
  • in the manufacture of homeopathics,
  • in the research of homeopathy.

But can anyone really be an expert in homeopathy in a more general sense?

Are homeopaths experts in homeopathy?

OF COURSE THEY ARE!!!

What is he talking about?, I hear homeopathy-fans exclaim.

Yet, I am not so sure.

Can one be an expert in something that is fundamentally flawed or wrong?

Can one be an expert in flying carpets?

Can one be an expert in quantum healing?

Can one be an expert in clod fusion?

Can one be an expert in astrology?

Can one be an expert in telekinetics?

Can one be an expert in tea-leaf reading?

I am not sure that classical homeopaths can rightfully called experts in classical homeopathy (there are so many forms of homeopathy that, for the purpose of this discussion, I need to focus on the classical Hahnemannian version).

An expert is a person who is very knowledgeable about or skilful in a particular area. An expert in any medical field (say neurology, gynaecology, nephrology or oncology) would need to have sound knowledge and practical skills in areas including:

  • organ-specific anatomy,
  • organ-specific physiology,
  • organ-specific pathophysiology,
  • nosology of the medical field,
  • disease-specific diagnostics,
  • disease-specific etiology,
  • disease-specific therapy,
  • etc.

None of the listed items apply to classical homeopathy. There are no homeopathic diseases, homeopathy is largely detached from knowledge in anatomy, physiology and pathophysiology, homeopathy disregards the current knowledge of etiology, homeopathy does not apply current criteria of diagnostics, homeopathy offers no rational mode of action for its interventions.

An expert in any medical field would need to:

  • deal with facts,
  • be able to show the effectiveness of his methods,
  • be part of an area that makes progress,
  • benefit from advances made elsewhere in medicine,
  • would associate with other disciplines,
  • understand the principles of evidence-based medicine,
  • etc.

None of these features apply to a classical homeopath. Homeopaths substitute facts for fantasy and wishful thinking, homeopaths cannot rely on sound evidence regarding the effectiveness of their therapy, classical homeopaths are not interested in progressing their field but religiously adhere to Hahnemann’s dogma, homeopaths do not benefit from the advances made in other areas of medicine, homeopaths pursue their sectarian activities in near-complete isolation, homeopaths make a mockery of evidence-based medicine.

Collectively, these considerations would seem to indicate that an expert in homeopathy is a contradiction in terms. Either you are an expert, or you are a homeopath. To be both seems an impossibility – or, to put it bluntly, an ‘expert’ in homeopathy is an adept in nonsense and a virtuoso in ignorance.

Researchers tend to report only studies that are positive, while leaving negative trials unpublished. This publication bias can mislead us when looking at the totality of the published data. One solution to this problem is the p-curve. A significant p-value indicates that obtaining the result within the null distribution is improbable. The p-curve is the distribution of statistically significant p-values for a set of studies (ps < .05). Because only true effects are expected to generate right-skewed p-curves – containing more low (.01s) than high (.04s) significant p-values – only right-skewed p-curves are diagnostic of evidential value. By telling us whether we can rule out selective reporting as the sole explanation for a set of findings, p-curve offers a solution to the age-old inferential problems caused by file-drawers of failed studies and analyses.

The authors of this article tested the distributions of sets of statistically significant p-values from placebo-controlled studies of homeopathic ultramolecular dilutions. Such dilute mixtures are unlikely to contain a single molecule of an active substance. The researchers tested whether p-curve accurately rejects the evidential value of significant results obtained in placebo-controlled clinical trials of homeopathic ultramolecular dilutions.

Their inclusion criteria were as follows:

  1. Study is accessible to the authors.
  2. Study is a clinical trial comparing ultramolecular dilutions to placebo.
  3. Study is randomized, with randomization method specified.
  4. Study is double-blinded.
  5. Study design and methodology result in interpretable findings (e.g., an appropriate statistical test is used).
  6. Study reports a test statistic for the hypothesis of interest.
  7. Study reports a discrete p-value or a test statistic from which a p-value can be derived.
  8. Study reports a p-value independent of other p-values in p-curve.

The first 20 studies, in the order of search output, that met the inclusion criteria were used for analysis.

The researchers found that p-curve analysis accurately rejects the evidential value of statistically significant results from placebo-controlled, homeopathic ultramolecular dilution trials (1st graph below). This result indicates that replications of the trials are not expected to replicate a statistically significant result. A subsequent p-curve analysis was performed using the second significant p-value listed in the studies, if a second p-value was reported, to examine the robustness of initial results. P-curve rejects evidential value with greater statistical significance (2nd graph below). In essence, this seems to indicate that those studies of highly diluted homeopathics that reported positive findings, i. e. homeopathy is better than placebo, are false-positive results due to error, bias or fraud.

The authors’ conclusion: Our results suggest that p-curve can accurately detect when sets of statistically significant results lack evidential value.

True effects with significant non-central distributions would have a greater density of low p-values than high p-values resulting in a right-skewed p-curve (like the dotted green lines in the above graphs). The fact that such a shape is not observed for studies of homeopathy confirms the many analyses previously demonstrating that ULTRAMOLECULAR HOMEOPATHIC REMEDIES ARE PLACEBOS.

Ever since Samuel Hahnemann, the German physician who invented homeopathy, gave a lecture on the subject in the mid-1810s, homeopathy has been used for treating animals. Initially, veterinary medical schools tended to reject homoeopathy as implausible, and the number of veterinary homeopaths remained small. In the 1920ies, however, veterinary homoeopathy was revived in Germany, and in 1936, members of the “Studiengemeinschaft für tierärztliche Homöopathie” (Study Group for Veterinary Homoeopathy)  started to investigate homeopathy systematically.

Today, veterinary homeopathy is popular not least because of the general boom in so-called alternative medicine (SCAM). Prince Charles is just one of many prominent advocates who claims to treat animals with homeopathy. In many countries, veterinary homeopaths have their own professional organisations, while elsewhere veterinarians are banned from practicing homeopathy. In the UK, only veterinarians are currently allowed to use homeopathy on animals (but ironically, anyone regardless of background can use it on human patients).

Considering the implausibility of its assumptions, it seems unlikely that homeopathic remedies can be anything other than placebos. Yet homeopaths and their followers regularly produce clinical trials that seem to suggest efficacy. Today, there are about 500 controlled clinical trials of homeopathy (mostly on humans), and it is no surprise that, purely by chance, some of them show positive results. To avoid being misled by random findings, cherry-picking, or flawed science, we ought to critically evaluate the totality of the available evidence. In other words, we should rely not on single studies but on systematic reviews of all reliable trials.

A 2015 systematic review by ardent homeopaths tested the hypothesis that the outcome of veterinary homeopathic treatments is distinguishable from placebos. A total of 15 trials could be included, but only two comprised reliable evidence without overt vested interest. The authors concluded that there is “very limited evidence that clinical intervention in animals using homeopathic medicines is distinguishable from corresponding intervention using placebos.”

A more recent systematic review compared the efficacy of homeopathy to that of antibiotics in cattle, pigs and poultry. A total number of 52 trials were included of which 28 were in favour of homeopathy and 22 showed no effect. No study had been independently replicated. The authors concluded that “the use of homeopathy cannot claim to have sufficient prognostic validity where efficacy is concerned.”

Discussing this somewhat unclear and contradictory findings of trials of homeopathy for animals, Lee et al concluded that “…it is overwhelmingly likely that small effects observed in the RCTs and systematic reviews are the result of residual bias in the trials.” To this, I might add that ‘publication bias’, i. e. the phenomenon that negative trials often remain unpublished, might be the reason why systematic reviews of homeopathy are never entirely negative.

In recent years, several scientific bodies have assessed the evidence on homeopathy and published statements about it. Here are the key passages from some of these ‘official verdicts’:

 “The principles of homeopathy contradict known chemical, physical and biological laws and persuasive scientific trials proving its effectiveness are not available”

Russian Academy of Sciences, Russia

Homeopathy should not be used to treat health conditions that are chronic, serious, or could become serious. People who choose homeopathy may put their health at risk if they reject or delay treatments for which there is good evidence for safety and effectiveness.

National Health and Medical Research Council, Australia

“These products are not supported by scientific evidence.”

Health Canada, Canada

“Homeopathic remedies don’t meet the criteria of evidence-based medicine.”

Hungarian Academy of Sciences, Hungary

“The incorporation of anthroposophical and homeopathic products in the Swedish directive on medicinal products would run counter to several of the fundamental principles regarding medicinal products and evidence-based medicine.”

Swedish Academy of Sciences, Sweden

There is little evidence to support homeopathy as an effective treatment for any specific condition

National Centre for Complementary and Integrative Health, USA

There is no good-quality evidence that homeopathy is effective as a treatment for any health condition

National Health Service, UK

Homeopathic remedies perform no better than placebos, and the principles on which homeopathy is based are “scientifically implausible”

House of Commons Science and Technology Committee, UK

“Homeopathy has not definitively proven its efficacy in any specific indication or clinical situation.”

Ministry of Health, Spain

“… homeopathy should be treated as one of the unscientific methods of the so called ‘alternative medicine’, which proposes worthless products without scientifically proven efficacy.”

National Medical Council, Poland

“… there is no valid empirical proof of the efficacy of homeopathy beyond the placebo effect.”

Federaal Kenniscentrum voor de Gezondheidszorg, Belgium

As they are usually far too dilute to contain anything, homeopathic remedies are generally harmless, provided they are produced according to good manufacturing practice (which is not always the case). Unfortunately, however, this harmlessness does not necessarily apply to homeopathy in general. When employed to replace an effective therapy, even the most innocent but ineffective treatment can become life-threatening. Since homeopaths recommend their remedies for even the most serious conditions, this is by no means a theoretical consideration. I have therefore often stated that HOMEOPATHICS MIGHT BE HARMLESS, BUT HOMEOPATHS CERTAINLY ARE NOT.

It follows that an independent risk/benefit analysis of homeopathy fails to arrive at a positive conclusion. In other words, homeopathy has not been shown to generate more good than harm. In turn, this means that homeopathy has no place in veterinary (or human) evidence-based medicine.

Did we not have a flurry of systematic reviews of homeopathy in recent months?

And were they not a great disappointment to homeopaths and their patients?

Just as we thought that this is more than enough evidence to show that homeopathy is not effective, here comes another one.

This new review evaluated RCTs of non-individualised homeopathic treatment (NIHT) in which the control group received treatments other than placebo (OTP). Specifically, its aim was to determine the comparative effectiveness of NIHT on health-related outcomes for any given condition.

For each eligible trial, published in the peer-reviewed literature up to the end of 2016, the authors assessed its risk of bias (internal validity) using the seven-domain Cochrane tool, and its relative pragmatic or explanatory attitude (external validity) using the 10-domain PRECIS tool. The researchers grouped RCTs by whether these examined homeopathy as an alternative treatment (study design 1a), adjunctively with another intervention (design 1b), or compared with no intervention (design 2). RCTs were sub-categorised as superiority trials or equivalence/non-inferiority trials. For each RCT, a single ‘main outcome measure’ was selected to use in meta-analysis.

Seventeen RCTs, representing 15 different medical conditions, were eligible for inclusion. Three of the trials were more pragmatic than explanatory, two were more explanatory than pragmatic, and 12 were equally pragmatic and explanatory. Fourteen trials were rated ‘high risk of bias’ overall; the other three trials were rated ‘uncertain risk of bias’ overall. Ten trials had data that were extractable for meta-analysis. Significant heterogeneity undermined the planned meta-analyses or their meaningful interpretation. For the three equivalence or non-inferiority trials with extractable data, the small, non-significant, pooled effect size was consistent with a conclusion that NIHT did not differ from treatment by a comparator (Ginkgo biloba or betahistine) for vertigo or (cromolyn sodium) for seasonal allergic rhinitis.

The authors concluded that the current data preclude a decisive conclusion about the comparative effectiveness of NIHT. Generalisability of findings is restricted by the limited external validity identified overall. The highest intrinsic quality was observed in the equivalence and non-inferiority trials of NIHT.

I do admire the authors’ tenacity in meta-analysing homeopathy trials and empathise with their sadness of the multitude of negative results they thus have to publish. However, I do disagree with their conclusions. In my view, at least two firm conclusions ARE possible:

  1. This dataset confirms yet again that the methodological quality of homeopathy trials is lousy.
  2. The totality of the trial evidence analysed here fails to show that non-individualised homeopathy is effective.

In case you wonder why the authors are not more outspoken about their own findings, perhaps you need to read their statement of conflicts of interest:

Authors RTM, YYYF, PV and AKLT are (or were) associated with a homeopathy organisation whose significant aim is to clarify and extend an evidence base in homeopathy. RTM holds an independent research consultancy contract with the Deutsche Homöopathie-Union, Karlsruhe, Germany. YYYF and AKLT belong to Living Homeopathy Ltd., which has contributed funding to some (but not this current) HRI project work. RTM and PV have no other relationships or activities that could appear to have influenced the submitted work. JRTD had no support from any organisation for the submitted work; in the last 3 years, and for activities outside the submitted study, he received personal fees, royalties or out-of-pocket expenses for advisory work, invitational lectures, use of rating scales, published book chapters or committee membership; he receives royalties from Springer Publishing Company for his book, A Century of Homeopaths: Their Influence on Medicine and Health. JTRD has no other relationships or activities that could appear to have influenced the submitted study.

If one had wanted to add insult to injury, one could have added that, if, despite such conflicts of interest, the overall result of this new review turned out to be not positive, the evidence must be truly negative.

In 2004, my team published a review analysing the diversity of so-called alternative medicine (SCAM) research published in one single year (2002) across 7 European countries (Germany, United Kingdom, Italy, France, Spain, Netherlands, Belgium) and the US. In total 652 abstracts of articles were assessed. Germany and the UK were the only two European countries to publish in excess of 100 articles in that year (Germany: 137, UK: 183). The majority of articles were non-systematic reviews and comments, analytical studies and surveys. The UK carried out more surveys than any of the other countries and also published the largest number of systematic reviews. Germany, the UK and the US covered the widest range of interests across various SCAM modalities and investigated the safety of CAM. We concluded that important national differences exist in terms of the nature of SCAM research. This raises important questions regarding the reasons for such differences.

One striking difference was the fact that, compared to the UK, Germany had published far less research on SCAM that failed to report a positive result (4% versus 14%). Ever since, I have wondered why. Perhaps it has something to do with the biggest sponsor of SCAM research in Germany: THE CARSTENS STIFTUNG?

The Carstens Foundation (CF) was created by the former German President, Prof. Dr. Karl Carstens and his wife, Dr. Veronica Carstens. Karl Carstens (1914-1992) was the 5th President of federal Germany, from 1979 to 1984. Veronica Carstens (1923-2012) was a doctor of Internal Medicine with an interest in natural medicine and homeopathy in particular. She is quoted by the CF stating: „Der Arzt und die Ärztin der Zukunft sollen zwei Sprachen sprechen, die der Schulmedizin und die der Naturheilkunde und Homöopathie. Sie sollen im Einzelfall entscheiden können, welche Methode die besten Heilungschancen für den Patienten bietet.“ (Future doctors should speak two languages, that of ‘school medicine’ [Hahnemann’s derogatory term for conventional medicine] and that of naturopathy and homeopathy. They should be able to decide on a case by case basis which method offers the best chances of a cure for the patient.***)

Together, the two Carstens created the CF with the goal of sponsoring SCAM in Germany. More than 35 million € have so far been spent on more than 100 projects, fellowships, dissertations, an own publishing house, and a patient societyNatur und Medizin” (currently ~23 000 members) with the task of promoting SCAM. Projects the CF proudly list as their ‘milestones’ include: 

  • an outpatient clinic of natural medicine for cancer
  • a project ‘Natural medicine and homeopathy for children and adolescents’.

The primary focus of the CF clearly is homeopathy, and it is in this area where their anti-science bias gets most obvious. I do invite everyone who reads German to have a look at their website and be amazed at the plethora of misleading claims.

Their expert for all things homeopathic is Dr Jens Behnke (‘Referent für Homöopathieforschung bei der Karl und Veronica Carstens-Stiftung: Evidenzbasierte Medizin, CAM, klinische Forschung, Grundlagenforschung’). He is not a medical doctor but has a doctorate from the ‘Kulturwissenschaftlichen Fakultät der Europa-Universität Viadrina’ entitled ‘Wissenschaft und Weltanschauung. Eine epistemologische Analyse des Paradigmenstreits in der Homöopathieforschung’ (Science and world view. An epistemological analysis of the paradigm-quarrel in homeopathy research). His supervisor was Prof Harald Walach who has long been close to the CF.

Behnke claims to be an expert in EBM, clinical research and basic research but, intriguingly, he has not a single Medline-listed publication to his name. So, we only have his dissertation to assess his expertise.

The very 1st sentence of his dissertation is noteworthy, in my view: Die Homöopathie ist eine Therapiemethode, die seit mehr als 200 Jahren praktiziert wird und eine beträchtliche Zahl an Heilungserfolgen vorzuweisen hat (Homeopathy is a therapeutic method, that is being used since more than 200 years and which is supported by a remarkable number of therapeutic successes). In essence, the dissertation dismisses the scientific approach for evaluating homeopathy as well as the current best evidence that shows homeopathy to be ineffective.

Behnke dismisses my own research on homeopathy without even considering it. He first claims to have found an error in one of my systematic reviews and then states: Die Fragwürdigkeit der oben angeführten Methoden rechtfertigt das Übergehen sämtlicher Publikationen dieses Autors im Rahmen dieser Arbeit. Wenn einem Wissenschaftler die aufgezeigte absichtliche Falschdarstellung aufgrund von Voreingenommenheit nachgewiesen werden kann, sind seine Ergebnisse, wenn überhaupt, nur nach vorheriger systematischer Überprüfung sämtlicher Originalpublikationen und Daten, auf die sie sich beziehen, verwertbar. Essentially, he claims that, because he has found one error, the rest cannot be trusted and therefore he is entitled to reject the lot.

In the same dissertation, we read the following: Ernst konstatiert in allen … Arbeiten zur Homöopathie ausnahmslos, dass es keinerlei belastbare Hinweise auf eine Wirksamkeit homöopathischer Arzneimittel über Placeboeffekte hinaus gebe (Ernst states in all publications on homeopathy without exception that no solid suggestions exist at all for an effectiveness of homeopathic remedies). However, it is demonstrably wrong that all of my papers arrive at a negative judgement of homeopathy’s effectiveness; here are three that spring into my mind:

So, applying Behnke’s own logic outlined above, one should argue that, because I have found one error in his research, the rest of what Behnke will (perhaps one day be able to) publish cannot be trusted and therefore I am entitled to reject the lot.

That would, of course, be tantamount to adopting the stupidity of one’s own opponents. So, I will certainly not do that; instead, I will wait patiently for the sound science that Dr Behnke (and indeed the CF) might eventually produce.

 

***phraseology that is strikingly similar to that of Rudolf Hess on the same subject.

The Journal of Experimental Therapeutics and Oncology states that it is devoted to the rapid publication of innovative preclinical investigations on therapeutic agents against cancer and pertinent findings of experimental and clinical oncology. In the journal you will find review articles, original articles, and short communications on all areas of cancer research, including but not limited to preclinical experimental therapeutics; anticancer drug development; cancer biochemistry; biotechnology; carcinogenesis; cancer cytogenetics; clinical oncology; cytokine biology; epidemiology; molecular biology; pathology; pharmacology; tumor cell biology; and experimental oncology.

After reading an article entitled ‘How homeopathic medicine works in cancer treatment: deep insight from clinical to experimental studies’ in its latest issue, I doubt that the journal is devoted to anything.

Here is the abstract:

In the current scenario of medical sciences, homeopathy, the most popular system of therapy, is recognized as one of the components of complementary and alternative medicine (CAM) across the world. Despite, a long debate is continuing whether homeopathy is just a placebo or more than it, homeopathy has been considered to be safe and cost-effectiveness therapeutic modality. A number of human ailments ranging from common to serious have been treated with homeopathy. However, selection of appropriate medicines against a disease is cumbersome task as total spectrum of symptoms of a patient guides this process. Available data suggest that homeopathy has potency not only to treat various types of cancers but also to reduce the side effects caused by standard therapeutic modalities like chemotherapy, radiotherapy or surgery. Although homeopathy has been widely used for management of cancers, its efficacy is still under question. In the present review, the anti-cancer effect of various homeopathic drugs against different kinds of cancers has been discussed and future course of action has also been suggested.

I do wonder what possessed the reviewers of this paper and the editors of the journal to allow such dangerous (and badly written) rubbish to get published. Do they not know that:

  1. homeopathy is a placebo therapy,
  2. homeopathy can not cure any cancer,
  3. cancer patients are highly vulnerable to false hope,
  4. such an article endangers the lives of many cancer patients,
  5. they have an ethical, moral and possibly legal duty to prevent such mistakes?

What makes this paper even more upsetting is the fact that one of its authors is affiliated with the Department of Health Research, Ministry of Health and Family Welfare, Government of India.

Family welfare my foot!

This certainly is one of the worst violations of healthcare and publication ethic that I have come across for a long time.

 

Highly diluted homeopathic remedies are pure placebos! This is what the best evidence clearly shows. Ergo they cannot be shown in a rigorous study to have effects that differ from placebo.  But now there is a study that seems to contradict this widely accepted conclusion.

Can someone please help me to understand what is going on?

In this double-blind, placebo-controlled RCT, 60 patients suffering from insomnia were treated either individualised homeopathy (IH) or placebo for 3 months. Patient-administered sleep diary and Insomnia Severity Index (ISI) were used the primary and secondary outcomes respectively, measured at baseline, and after 3 months.

Five patients dropped out (verum:2,control:3).Intention to treat sample (n=60) was analysed. Trial arms were comparable at baseline. In the verum group, except sleep diary item 3 (P= 0.371), rest of the outcomes improved significantly (all P < 0.01). In the control group, there were significant improvements in diary item 6 and ISI score (P < 0.01) and just significant improvement in item 5 (P= 0.018). Group differences were significant for items 4, 5 and 6(P < 0.01) and just significant (P= 0.014) for ISI score with moderate to large effect sizes; but non-significant (P > 0.01) for rest of the outcomes.

The authors concluded that in this double-blind, randomized, prospective, placebo-controlled, two parallel arms clinical trial conducted on 60 patients suffering from insomnia, there was statistically significant difference measured in sleep efficiency, total sleep time, time in bed, and ISI score in favour of homeopathy over placebo with moderate to large effect sizes. Group differences were non-significant for rest of the outcomes(i.e. latency to fall asleep, minutes awake in middle of night and minutes awake too early). Individualized homeopathy seemed to produce significantly better effect than placebo. Independent replications and adequately powered trials with enhanced methodological rigor are warranted.

I have studied this article in some detail; its methodology is nicely and fully described in the original paper. To my amazement, I cannot find a flaw that is worth mentioning. Sure, the sample was small, the treatment time short, the outcome measure subjective, the paper comes from a dubious journal, the authors have a clear conflict of interest, even though they deny it – but none of these limitations has the potential to conclusively explain the positive result.

In view of what I stated above and considering what the clinical evidence so far tells us, this is most puzzling.

A 2010 systematic review authored by proponents of homeopathy  included 4 RCTs comparing homeopathic medicines to placebo. All involved small patient numbers and were of low methodological quality. None demonstrated a statistically significant difference in outcomes between groups.

My own 2011 not Medline-listed review (Focus on Alternative and Complementary Therapies Volume 16(3) September 2011 195–199) included several additional studies. Here is its abstract:

The aim of this review was the critical evaluation of evidence for the effectiveness of homeopathy for insomnia and sleep-related disorders. A search of MEDLINE, AMED, CINAHL, EMBASE and Cochrane Central Register was conducted to find RCTs using any form of homeopathy for the treatment of insomnia or sleep-related disorders. Data were extracted according to pre-defined criteria; risk of bias was assessed using Cochrane criteria. Six randomised, placebo-controlled trials met the inclusion criteria. Two studies used individualised homeopathy, and four used standardised homeopathic treatment. All studies had significant flaws; small sample size was the most prevalent limitation. The results of one study suggested that homeopathic remedies were superior to placebo; however, five trials found no significant differences between homeopathy and placebo for any of the main outcomes. Evidence from RCTs does not show homeopathy to be an effective treatment for insomnia and sleep-related disorders.

It follows that the new trial contradicts previously published evidence. In addition, it clearly lacks plausibility, as the remedies used were highly diluted and therefore should be pure placebos. So, what could be the explanation of the new, positive result?

As far as I can see, there are the following possibilities:

  • fraud,
  • coincidence,
  • some undetected/undisclosed bias,
  • homeopathy works after all.

I would be most grateful, if someone could help solving this puzzle for me (if needed, I can send you the full text of the new article for assessment).

On this blog, many of us have been frightfully critical of Dana Ullman; some were even harsh and demeaning. Meanwhile, I have spent some time on-line to study the man more closely. And yes, I have changed my mind (despite all the insults he has hurled at me).

Guys, we (and the US judge who made that nasty comment about Dana) have done him wrong!

So wrong!

For instance, did you know he has written a thesis at UC Berkeley? Here is its summary:

In the Approach of this paper, this writer introduced his own Approach to the world. His subjective goals, needs, attitudes, and beliefs were presented. The subjective attitude was considered the source of his understanding himself and the universe. Then, the goals of this paper, the definitions of terms (beliefs), and the questions to be answered were discussed. To understand as much of oneself and the universe as possible was our goal, need, and scientific endeavor. Within this infinite realm, we specifically sought to understand the learning process and, in particular, to investigate why a person learns some things and not others. To help put our question into a workable framework, we introduced the concepts Approach, Method, and Content as sub-processes of the learning process.           

In our Method we chose the Behavior Psychologist as an example to help understand a person’s use of the Approach, Method, and Content in the learning process and in the way they affect what a person learns and doesn’t learn.

The Approach and Method led us into the Content – the answers to our questions.* Our answers emphasized the subjective nature of all things. We discovered a symbiotic relationship between the three sub-processes. The Approach was recognized as particularly important because it manifested into a question that predisposed limits upon the Method to study it and the Content it could find. From this disposition, we found that a person’s Approach plays a large role in determining what a person learns and doesn’t learn. Finally, we introduced some methods to better understand one’s Approach in order to help a person lead chimself to a deeper awareness of chimself and a greater comprehension of worldly phenomena. In this way, we hope we have helped chim expand the bounds of what che can learn and also helped chim understand why che doesn’t learn.

If I am not mistaken, this piece of research is not just brilliant, it also earned Dana the master’s degree in public health that he likes to mention so often.

Amongst the many informative sources that I found, his own website tells it best, I think. Here is an excerpt:

Dana Ullman, MPH, CCH, (MPH = Masters in Public Health, U.C. Berkeley;  CCH = Certified in Classical Homeopathy) has authored 10 books on homeopathy and is one of America’s leading advocates for homeopathy, and he has authored chapters on homeopathic medicine in three medical textbooks. He has served on advisory boards of alternative medicine institutes at Harvard and Columbia (you can learn more about him at this link; see About Dana Ullman, MPH, CCH).

Dana Ullman, MPH, CCH, provides phone and email consultation OR he can provide a personalized referral to leading homeopaths in North America (and often in many other countries in the world). There is a $45 fee for a 10-minute conversation, and there is a $40 additional fee for each 10 minute. Call or email to make an appointment for this conversation, or if you want, everything can be done online. You will need to provide us with a Visa, MasterCard, American Express, or Discover cards for payment….or payment can be made via PayPal to email@homeopathic.com.  Dana is also able to accept “Wellness Cards” and from “Health Savings Accounts” (credit cards sometimes given to employees for “health services”).

Generally, a homeopath seeks to prescribe a “homeopathic constitutional medicine” that will strengthen a person’s overall level of health.  This consultation delves into a person’s family history, his/her own health history, and the totality of physical and psychological symptoms and characteristics.  In most cases, this first consultation takes one-hour, costing $245.00, though people with a complex health condition may require more time.  Follow-ups are usually 10 minutes to 40 minutes (or $45 to $165), with follow-ups vary depending upon the complexity of a person’s health…and some follow-ups will require more than 40 minutes.

Dana Ullman provides personalized and individualized homeopathic treatment for people with a wide variety of acute and chronic health problems.  He regularly treats infants and children with either physical or psychological challenges, from chronic ear infections to various ADD/ADHD or autistic spectrum problems (Dana’s book on Homeopathic Medicines for Children and Infants was published in 1991).  Dana also treats people with a wide variety of pain syndromes, including people with fibromyalgia and arthritic disorders, shingles or sciatica, and headaches (Dana co-authored a chapter in a leading conventional medical textbook on pain management, called “Weiner’s Pain Management”).  Dana also treats people in various stages of cancer (Dana was the lead author written with three medical doctor a chapter on homeopathy and cancer care in a textbook published by Oxford University Press called “Integrative Oncology”).  Dana provide “adjunctive health care” that is in addition to whatever other health or medical care the person is receiving (many of his patients use an integration of conventional and homeopathic medicines).

Dana Ullman provides homeopathic treatment via phone, Skype, and in our Berkeley office! You will need to phone or email us (email@homeopathic.com) to set-up an appointment. Please clarify if you prefer an in-office or on-telephone or Skype appointment.

Also, if you have questions about homeopathy, specific homeopathic medicines, the care that you have received from a homeopath, how to best learn homeopathy, what homeopathic research exists, or many other subjects in this field, you may benefit from a personal consultation with Dana Ullman, MPH, CCH. Call or email us to set up a phone appointment. An email conversation is also possible, but this tends to require more time than an interactive discussion.

You might frown upon telephone consultations. But stop being so sceptical, Dana is sacrificing his precious time to help as many patients as he can – even those with AIDS, autism or cancer. Does that not deserve some respect?

And look at his many achievements: 10 own books! 3 chapters is medical textbooks! What, you ask which textbooks? Here they are:

  1. Homeopathic Medicine: Principles and Research, in Complementary and Alternative Veterinary Medicine: Principles and Practice, edited by Allen M. Schoen, DVM, and Susan G. Wynn, DVM, PhD, New York: Mosby, 1998.
  2. Homeopathy (co-authored with Michael Loes, MD), in Weiner’s Pain Management: A Practical Guide for Clinicians, edited by M. V. Boswell and B. E. Cole, 7th edition, New York: Taylor and Francis, 2006.
  3. Homeopathy for Primary and Adjunctive Cancer Therapy (co-authored with Menacham Oberbaum, MD, Iris Bell, MD, PhD, and Shepherd Roee Singer, MD), in Integrative Oncology, edited by Andrew Weil, MD and Donald Abrams, MD, published in March, 2009, by Oxford University Press.

Not impressed?

In this case, you suffer from closed-mindedness and denialism.

You might need help!

Phone Dana, he will prescribe a cure (and ameliorate his income).

 

 

[*I have noticed that, in the past, some of my readers seem to have difficulties in detecting satire; for them I should disclose: THIS POST IS PURE SATIRE!]
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