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

homeopathy

Our new book entitled MORE HARM THAN GOOD? THE MORAL MAZE OF COMPLEMENTARY AND ALTERNATIVE MEDICINE is out. At the moment merely as an e-book, but in a few days the paperback will be available too. Yesterday, Kevin Smith and I were invited to a press briefing at the London SCIENCE MEDIA CENTRE.

On this occasion, Kevin and I explained to the journalists what our book is about. Essentially, it is an analysis of the many ethical issues in alternative medicine. We picked out just a few points which we thought might be of interest. I briefly discussed the fact that much of the research in this area is misleading to the point of being unethical. Kevin explained that this also applies to education and discussed the ethics of commerce.

In the latter context, Kevin briefly mentioned Prince Charles because he had come out with a range of ‘Dutchy Originals Herbal Tinctures’. I never mentioned Charles with a single word, and neither did the subsequent discussion focus on him.

Altogether, we all thought that the press briefing went well. We had good questions, and the journalists showed keen interest in our ethical perspective on alternative medicine.

This morning, I am surprised to see that THE TELEGRAPH, THE DAILY MAIL and apparently also the EXPRESS (I haven’t seen it yet) all carry articles about my alleged war with Prince Charles. The TELEGRAPH’s headline is: Professor reignites war with Prince Charles over homeopathy support. 

While it is, of course, entirely fine that the press reports about this particular aspect, I find it nevertheless disappointing that the essential messages of our book were lost. Nobody can be truly surprised about this, I think.

The real surprise lies elsewhere.

The newspapers cite Clarence House coming to the defence of Prince Charles. A spokesperson is quoted stating “Unfortunately the book misunderstands and misrepresents this position which The Prince has reached after years of talking to experts in many different areas of medicine.”

Yes, that is surprising!

Our book only became available hours before this comment was made. Someone in Clarence House must be a very fast reader.

On their website, the British Homeopathic Association (BHA) have launched their annual winter appeal. Its theme this year is ‘building a better future for homeopathy’. The appeal is aimed at the following specific goals:

  • Continuously fighting to retain NHS services in the UK by supporting local patients & groups and providing swift media responses employing experts in areas such as media, politics, law and reputation management for ultimate effectiveness. Currently undertaking a legal challenge to NHS England
  • Establishing charitable homeopathic clinics throughout the UK, with clinics currently in Norwich, York, Bath, Edinburgh and looking at developing other clinics in Liverpool, Wales, Oxford and London in 2018.
  • Making further investment to enhance our digital presence and promotion of key messages.
  • Continuoustly improving our website to make it the place for information on homeopathy from finding practitioners to finding the latest Health & Homeopathy online.
  • Investing in research and education to keep homeopathy strong in the long term, increasing the number of healthcare professionals using homeopathy in their everyday practice.
  • Taking homeopathy to the people and growing our community of supporters with public events, local events and national promotion.

I have to say, I find this almost touching in its naivety. I imagine another lobby group, say the cigarette industry, launching a winter appeal: BUILDING A BETTER FUTURE FOR CIGARETTES.

Do I hear you object?

Cigarettes are unhealthy and not a medical treatment!!!

Quite so! Homeopathy is also unhealthy and not a medical treatment, I would argue. Sure, highly dilute homeopathics do not kill you, but homeopathy easily can. We have seen this on this blog many times. Homeopathy kills when it is advocated and consequently used as an alternative therapy for a life-threatening disease; there is no question about it. And there also is no question about the fact that this happens with depressing regularity. If you doubt it, just read some of my previous posts on the subject.

In any case, an appeal by a medical association should not be for its own benefit (homeopathy); it should be for patients (patients tempted to try homeopathy), I would suggest. So, lets design the goals of an appeal for patients along the lines of the above appeal – except our appeal has to actually be in the best interest of vulnerable patients.

Here we go:

  • Continually fighting to stop homeopathy on the NHS. As homeopathy does not generate more good than harm (no ineffective therapy can ever do that), we have a moral, legal and ethical duty to use our scarce resources such that they create the maximum benefit; and this means we cannot use them for homeopathy.
  • Establishing charitable organisations that educate the public about science and evidence. Too many consumers are still falling victim to the pseudo-science of charlatans who mislead people for their own profit.
  • Making further investments to combating the plethora of unethical misinformation by self-interested quacks and organisations many of which even have charitable status.
  • Continually improving websites that truthfully inform the public, politicians, journalists and others about medicine, science and healthcare.
  • Investing in research and education to keep science and evidence-based medicine strong, for the benefit of vulnerable patients and in the interest of progress.
  • Taking the science agenda to the people and growing the community of science-literate supporters on a local, national and international level.

As I had to follow the lines of the BHA, these goals are regrettably not perfect – but I am sure they are a whole lot better than the BHA original!

This survey assessed chiropractic (DC) and naturopathic “doctors”‘ (ND) knowledge, attitudes, and behaviour with respect to the pediatric patients in their practice. Cross-sectional surveys were developed in collaboration with DC and ND educators. Surveys were sent to randomly selected DCs and NDs in Ontario, Canada in 2004, and a national online survey was conducted in 2014. Data were analyzed using descriptive statistics, t-tests, non-parametric tests, and linear regression.

Response rates for DCs were n = 172 (34%) in 2004, n = 553 (15.5%) in 2014, and for NDs, n = 171 (36%) in 2004, n = 162 (7%) in 2014. In 2014, 366 (78.4%) of DCs and 83 (61%) of NDs saw one or more paediatric patients per week. Paediatric training was rated as inadequate by most respondents in both 2004 and 2014, with most respondents (n = 643, 89.9%) seeking post-graduate training by 2014. About half of DCs (51.7% in 2004, 49.2% in 2014) and one fifth of NDs (21% in 2004 and 23% in 2014) reported they received no hands-on clinical paediatric training. Only a minority of practitioners felt their hands-on paediatric training was adequate (somewhat or very) for their needs: DCs: 10.6% in 2004, 15.6% in 2014; NDs: 10% in 2004 and 19% in 2014. Respondents’ comfort in treating children and youth is based on experience and post-graduate training. Both DCs and NDs that see children and youth in their practices address a broad array of paediatric health concerns, from well child care and preventative health, to mild and serious illness.

The authors included two ‘case studies’ of conditions frequently treated by DCs and NDs:

Case study 1: colic

DC practitioners’ primary treatment focus (314 respondents) would be to use spinal manipulation (78.3%) if physical assessment suggests utility, diet changes (14.6% for child, 6.1% for mom if breast feeding), and massage (16.9%). ND practitioners (95 respondents) would assess and treat primarily with diet changes (62% for child including prescribing probiotics; 48% for mom if breast feeding), homeopathy (46%), weak herbal or tea preparations (19%), and use topical castor oil (packs or massage) (18%). In 2014, 65.9% of DCs and 59% of NDs believe (somewhat or very much) that concurrent treatment by a medical practitioner would be of benefit; 64.0% of DCs and 60% of NDs would refer the patient to another health care practitioner (practitioner type not specified).

Case study 2: acute otitis media

In 2014, almost all practitioners identified this as otitis media (in 2004, the DCs had a profession-specific question); DCs were more cautious about the value of their care for it relative to the NDs (DCs, 46.2% care will help patient very much, NDs, 95%). For treatment, DCs would primarily use spinal manipulation (98.5%) if indicated after assessment, massage (19.5%), dietary modifications (17.6%), and 3.8% would specifically refer to an MD for an antibiotic prescription. ND-preferred treatments were NHP products (79%), dietary modifications (66%), ear drops (60%), homeopathic remedies (18%), and 10% would prescribe antibiotics right away or after a few days. In 2014, 86.3% of DCs and 75% of NDs believe the patient would benefit (somewhat or very much) from concurrent treatment by a conventional medical practitioner; 81.7% of DCs and 58% of NDs would refer the patient to another health care provider.

The authors concluded that although the response rate in 2014 is low, the concerns identified a decade earlier remain. The majority of responding DCs and NDs see infants, children, and youth for a variety of health conditions and issues, but self-assess their undergraduate paediatric training as inadequate. We encourage augmented paediatric educational content be included as core curriculum for DCs and NDs and suggest collaboration with institutions/organizations with expertise in paediatric education to facilitate curriculum development, especially in areas that affect patient safety.

I find these data positively scary:

  • Despite calling themselves ‘doctors’, they are nothing of the sort.
  • DCs and NCs are not adequately educated or trained to treat children.
  • They nevertheless often do so, presumably because this constitutes a significant part of their income.
  • Even if they felt confident to be adequately trained, we need to remember that their therapeutic repertoire is wholly useless for treating sick children effectively and responsibly.
  • Therefore, harm to children is almost inevitable.
  • To this, we must add the risk of incompetent advice from CDs and NDs – just think of immunisations.

The only conclusion I can draw is this: chiropractors and naturopaths should keep their hands off our kids!

This is the title of an editorial by Alan Schmukler. You probably remember him; I have featured him before, for instance here, here, and here. This is what was recently on Schmukler’s mind (I have added a few references referring to comments of mine added below):

England’s National Health Service (NHS) is proposing that NHS doctors no longer be permitted to prescribe homeopathic remedies [1]… They claim lack of evidence for effectiveness. Anyone who’s been remotely conscious the last 10 years will see this as a pretext. Homeopathy is practiced by board certified physicians in clinics and hospitals around the world [2]. The massive Swiss review of homeopathy, found it effective, safe and economical, and the Swiss incorporated homeopathy into their national health care system [3]…

The reason given for banning homeopathy and these nutrients is a lie. Why would the NHS ban safe, effective and affordable healing methods? [4] Without these methods, all that is left are prescription drugs. Apparently, someone at the  NHS has an interest in pushing expensive prescription drugs [5], rather than safer and cheaper alternatives. That someone, also wishes to deny people freedom of choice in medicine [6]. I say “someone”, because organizations don’t make decisions, people do. Who is that someone?  In looking for a suspect, we might ask, who is the chief executive of the organization? Who introduced this plan and is promoting it? Who at the NHS has the political clout?  Who was it that recently declared: “Homeopathy is a placebo and a misuse of scarce NHS funds which could better be devoted to treatments that work”.

The quote is from Simon Stevens, NHS England’s chief executive. He got the job in 2014, after ten years as a top executive at UnitedHealth, the largest health insurance company in America. His past work experiences and current activities show that he favors privatization [7]. That would make him an odd choice to run a healthcare system based on socialized medicine. In fact, he has been moving the NHS towards privatization and the corporate, profit based American model. [8] The last thing a privatizer in healthcare would want, are non-proprietary medicines, for which you can’t charge exorbitant fees [9]. Banning homeopathy on the NHS is just one small part of a larger plan to maximize corporate profits by letting corporations own and control the health care system [10].  Before they can do this, they have to eliminate alternative methods of treatment.

Personally, I think Schmukler is wrong – here is why:

1 The current argument is not about what doctors are permitted to do, but about what the NHS should do with our tax money.

2 Argumentum ad populum

3 Oh dear! Anyone who uses this report as evidence must be desperate – see for instance here.

4 Why indeed? Except highly dilute homeopathic remedies are pure placebos.

5 Maybe ‘someone’ merely wants to use effective medications rather than placebos.

6 Freedom of choice is a nonsense, if it is not guided by sound evidence – see here.

7 No, that’s Jeremy Hunt! But in any case privatisation might be more profitable with homeopathy – much higher profit margins without any investment into R&D.

8 No, this is Hunt again!

9 Homeopathic remedies are ideal for making vast profits: no research, no development, no cost for raw material, etc., etc.

10 I am sure Boiron et al would not mind stepping into the gap.

I very much look forward to the next outburst of Alan Schmukler and hope he will manage to think a bit clearer by then.

We have discussed the NHMRC report on homeopathy several times – see, for instance, here, here and here. Perhaps understandably, homeopaths have great difficulties accepting its negative findings, and have complained about it ever since it was published. Now, a very detailed and well-researched analysis has become available of both the report and its criticism. Here I take the liberty to copy and (clumsily) translate its conclusions; if you can read German, I highly recommend studying the full document.

START OF MY TRANSLATION

The criticism of the NHMRC review is very voluminous and highlights many different aspects of the background, the methodology, the execution and the unwanted results from a homeopathic perspective. The very engaging discussions in the general public about this document and its flaws are, however, relatively meaningless: the NHMRC arrives at exactly the same conclusions as the employee of the Homeopathic Research Institute (HRI), Mathie, in his reviews of 2014 and 2017.

In both reviews, Mathie evaluated a total of 107 primary studies and found only 2 trials that could be rated as qualitatively good, that is to say constituting reliable evidence. Mathie did upgrade 2 further studies to the category of reliable evidence, however, this was in violation of the procedures proscribed in the study protocol.

The criticism of the NHMRC review was not able to make a single valid rebuttal. No condition could be identified for which homeopathy is clearly superior to placebo. This is all the more important, as Mathie avoided the mistakes that constituted the most prominent alleged criticisms of the NHMRC report.

  • Since Mathie and most of his co-authors are affiliated with organisations of homeopathy, an anti-homeopathy bias can be excluded.
  • Mathie conducted classic reviews and even differentiated between individualised and non-individualised homeopathy.
  • Mathie did not exclude studies below a certain sample size.

Yet, in both reviews, he draws the same conclusion.

In view of the truly independent replications of an employee of the HRI, we can be sure that there are, in fact, no solid proofs for the effectiveness of homeopathy. The claim of a  strong efficacy, equivalent to conventional medicines, that is made by homeopathy’s advocates is therefore not true.

END OF MY TRANSLATION

And here is the original German text:

Die Kritik an dem Review des NHMRC ist sehr umfangreich und beleuchtet sehr viele verschiedene Facetten über das Umfeld, die Methodik und die Durchführung sowie das aus Sicht der Homöopathen unerwünschte Ergebnis selbst. Die in der Öffentlichkeit sehr engagierte Diskussion um diese Arbeit und ihre möglichen Unzulänglichkeiten sind jedoch relativ bedeutungslos: Das NHMRC kommt zu genau dem gleichen Ergebnis wie Mathie als Mitarbeiter des HRI in seinen in 2014 und 2017 veröffentlichten systematischen Reviews:

Insgesamt hat Mathie in beiden Reviews 107 Einzelstudien untersucht und fand nur zwei Studien, die als qualitativ gut („low risk of bias“), also als zuverlässige Evidenz betrachtet werden können. Mathie hat zwar vier weitere Studien zur zuverlässigen Evidenz aufgewertet, was allerdings im Widerspruch zu den üblichen Vorgehensweisen steht und im Studienprotokoll nicht vorgesehen war.

Die Kritik am Review des NHMRC hat keinen einzigen Punkt fundiert widerlegen können. Man konnte keine Indikation finden, bei der sich die Homöopathie als klar über Placebo hinaus wirksam erwiesen hätte. Diese Punkte sind umso bedeutsamer, weil Mathie die am NHMRC hauptsächlich kritisierten Fehler nicht gemacht hat:

  • Als Mitarbeiter des HRI und mit Autoren, die überwiegend für Homöopathie-affine Organisationen arbeiten, ist eine Voreingenommenheit gegen die Homöopathie auszuschließen.
  • Mathie hat klassische Reviews ausgeführt, sogar getrennt zwischen einzelnen Ausprägungen (individualisierte Homöopathie und nicht-individualisierte Homöopathie).
  • Mathie hat keine Größenbeschränkung der Studien berücksichtigt.

Er kommt aber dennoch zweimal zum gleichen Ergebnis wie das NHMRC.

Angesichts der wirklich als unabhängig anzusehenden Bestätigung der Ergebnisse des NHMRC durch einen Mitarbeiter des Homeopathy Research Institute kann man sicher davon ausgehen, dass es tatsächlich keine belastbaren Wirkungsnachweise für die Homöopathie gibt und dass die von ihren Anhängern behauptete starke, der konventionellen Medizin gleichwertige oder gar überlegene Wirksamkeit der Homöopathie nicht gegeben ist.

I do apologise for my clumsy translation and once again encourage those who can to study the detailed original in full.

My conclusion of this (and indeed of virtually all criticism of homeopathy) is that homeopaths are just as unable to accept criticism as an evangelic believer is going to accept any rational argument against his belief. In other words, regardless of how convincing the evidence, homeopaths will always dismiss it – or, to put it in a nutshell: HOMEOPATHY IS A CULT.

In 2017, Medline listed just over 1800 articles on ‘complementary alternative medicine’. If you find this number impressively high, consider that, for ‘surgery’ (a subject that has often been branded as less that active in conducting research), there were almost 18 000 Medline-listed papers.

So, the research activity in CAM is relatively small. Vis a vis the plethora of open questions, this inactivity is perhaps lamentable. What I find much more regrettable, however, is the near total lack of investigations into the ethical issues in CAM. In 2017, there were just 11 articles on Medline on ‘ethics and CAM’ (24393 articles on ‘ethics and surgery’).

One of the 11 papers that tackled the ethics directly and that was (in my opinion) one of the best is this article. Here is its concluding paragraph:

When we encounter patients who use or consider the use of complementary and/or alternative medicine, we should respect their autonomy while also fulfilling our obligations of beneficence and nonmaleficence. Physicians should become more knowledgeable about research on CAM therapies and approach discussions in an open, nonjudgmental manner to enhance patient trust. In situations where there is little risk of harm and the possibility of benefit, supporting a patient in their interest in complementary therapies can strengthen the patient-physician relationship. However, when a patient’s desire to utilize alternative therapies poses a health risk, physicians have the ethical obligation to skillfully counsel the patient toward those therapies that are medically appropriate.

I have had a long-lasting and keen interest in the ethics of CAM which resulted in the publication of many papers. Here is a selection:

Problems with ethical approval and how to fix them: lessons from three trials in rheumatoid arthritis.

‘Complementary & Alternative Medicine’ (CAM): Ethical And Policy Issues.

Pharmacists and homeopathic remedies.

No obligation to report adverse effects in British complementary and alternative medicine: evidence for double standards.

Homeopathy, a “helpful placebo” or an unethical intervention?

Advice offered by practitioners of complementary/ alternative medicine: an important ethical issue.

The ethics of British professional homoeopaths.

Evidence-based practice in British complementary and alternative medicine: double standards?

Ethics of complementary medicine: practical issues.

The ethics of chiropractic.

Reporting of ethical standards: differences between complementary and orthodox medicine journals?

Informed consent: a potential dilemma for complementary medicine.

Ethical problems arising in evidence based complementary and alternative medicine.

Complementary medicine: implications for informed consent in general practice.

Ethics and complementary and alternative medicine.

Research ethics questioned in Qigong study.

Informed consent in complementary and alternative medicine.

The ethics of complementary medicine.

For most of the time conducting this research, I felt that I was almost alone in realising the importance of this topic. And all this time, I was convinced that the subject needed more attention and recognition. Therefore, I teamed up with with the excellent ethicist Kevin Smith from the University of Dundee, and together we spent the best part of 2017 writing about it.

Our book is entitled ‘MORE HARM THAN GOOD? THE MORAL MAZE OF COMPLEMENTARY AND ALTERNATIVE MEDICINE’ and will be published shortly by Springer.

Product Details

It is an attempt to highlight some of the most important topics in this broad and under-researched area. While working on it, I was continually struck by the fact that most of the issues we have been struggling with on this blog are, in the final analysis, ethical by nature.

My hope is that, in 2018, we will see many more high quality papers filling the almost total void of ethical perspectives on CAM. In my view, it is unquestionably an area that needs to be addressed with some urgency.

What better to give to you for the holidays than your very own CHRISTMAS SURVIVAL KIT? This article by Eileen Scullion, Registered Homeopath LicISH ISHom with the Irish Society of Homeopaths explains. Sadly, its recommendations lack sections detailing the evidence for the claims made. Therefore, I have taken the liberty of adding my short scientific assessments (IN BOLD CAPITAL LETTERS):

START OF QUOTE

1. Over indulgence

Nux Vomica – For symptoms that arise after over indulgence and excess in food, alcohol, tobacco and coffee. The person suffers from headaches, indigestion, nausea and irritability and symptoms are worse in the morning or after eating.

Arsenicum – For symptoms of diarrhea, vomiting, cramps where you suspect food poisoning.

ZERO PLAUSIBILITY, NO EVIDENCE FOR EFFECTIVENESS.

2. Stress & Anxiety

Argentum Nitricum – Anxiety from worry that it won’t work out – What if the turkey burns? What if the electric goes out? What if the gifts don’t arrive on time? There is a great sense of urgency, hurriedness and worrying about everything with sleepless nights of tossing and turning.

ZERO PLAUSIBILITY, NO EVIDENCE FOR EFFECTIVENESS.

3. Sleep problems

Coffea – Sleeplessness from excitement. For the kids who just can’t sleep in anticipation of Santa’s arrival.

ZERO PLAUSIBILITY, NO EVIDENCE FOR EFFECTIVENESS.

4. Anger and resentment

Staphysagria – If you are feeling angry and resentful and are suffering in silence, or have difficulty in saying no but feel walked over, then this is an excellent remedy to help verbalise things or process your emotions.   Pent up emotions can also be accompanied with urinary tract infections where this remedy fits the symptoms.

ZERO PLAUSIBILITY, NO EVIDENCE FOR EFFECTIVENESS.

5. Colds

Aconite – If caught at the early stage, nip those colds in the bud that come on suddenly after exposure to cold dry winds or getting chilled.

ZERO PLAUSIBILITY, NO EVIDENCE FOR EFFECTIVENESS.

END OF QUOTE

As the ‘survival kit’ turns out to be pure speculation, fantasy and wishful thinking, let’s join into the seasonal fun and add some equally evidence-based homeopathic treatments of our own.

1. World peace

We all live in dangerous times, but the way to world peace could be guaranteed by this homeopathic remedy: Donald Trump C30. It is manufactured by exposing a glass of distilled water to a picture of the US president for about 30 minutes and then potentising the mother tincture 30 times in the time-tested way of homeopathy.

2. Fuzzy head

After all the booze and laziness over the holidays, one is bound to feel oddly fuzzy, incoherent and unfocussed. My homeopathic remedy for this complaint is HRH C200. You can make it yourself: take a vial of distilled water to a public library, find Prince Charles’ book ‘Harmony‘ (do not buy this book! it is expensive and not worth it), put the vial between its pages and shake vigorously. Subsequently return the book to its shelve and potentise your mother tincture 200 times.

3. Poverty

Yes, Christmas is expensive! If your bank account is now empty, don’t worry: homeopathy can help. Take your last fiver, cut a tiny bit off, grind it down in some sugar, put the mixture in distilled water, and your mother tincture is ready. You can then potentise it in the usual way; if you want to become a millionaire use the £ C30 potency; if you prefer to be a billionaire, I recommend the £ C200 dilution.

I must stop myself here, because I hope you, the reader of this post, will now chip in. If you are suffering from any symptom at all, please use your imagination and, based on the ‘like cures like’ principle, design your very own homeopathic cure.

Yes, that’s my Christmas challenge.

Have fun!

On their  website, the US Food and Drug Administration (FDA) has recently published a statement on homeopathy which, I think, is important enough to get cited extensively:

… Food and Drug Administration proposed a new, risk-based enforcement approach to drug products labeled as homeopathic. To protect consumers who choose to use homeopathic products, this proposed new approach would update the FDA’s existing policy to better address situations where homeopathic treatments are being marketed for serious diseases and/or conditions but where the products have not been shown to offer clinical benefits. It also covers situations where products labeled as homeopathic contain potentially harmful ingredients or do not meet current good manufacturing practices…

The FDA’s proposed approach prioritizes enforcement and regulatory actions involving unapproved drug products labeled as homeopathic that have the greatest potential to cause risk to patients…  The FDA intends to focus its enforcement authorities on the following kinds of products:

  • products with reported safety concerns;
  • products that contain or claim to contain ingredients associated with potentially significant safety concerns;
  • products for routes of administration other than oral and topical;
  • products intended to be used for the prevention or treatment of serious and/or life-threatening diseases and conditions;
  • products for vulnerable populations; and
  • products that do not meet standards of quality, strength or purity as required under the law.

Examples of products that may be subject to the enforcement priorities in the draft guidance are infant and children’s products labeled to contain ingredients associated with potentially significant safety concerns, such as belladonna and nux vomica; and products marketed for serious conditions, such as cancer and heart disease.

While the FDA considers comments to the draft guidance, the FDA intends to examine how the agency is implementing its current compliance policy. Given the concerns about the proliferation of potentially ineffective and harmful products labeled as homeopathic, the FDA will consider taking additional enforcement and/or regulatory actions, consistent with the current enforcement policies, which also align with the risk-based categories described in the draft guidance, in the interest of protecting the public…

Until relatively recently, homeopathy was a small market for specialized products. Over the last decade, the homeopathic drug market has grown exponentially, resulting in a nearly $3 billion industry that exposes more patients to potential risks associated with the proliferation of unproven, untested products and unsubstantiated health claims. During this time, the FDA has seen a corresponding increase in safety concerns, including serious adverse events, associated with drug products labeled as homeopathic. In addition, the agency has also found an increasing number of poorly manufactured products that contain potentially dangerous amounts of active ingredients that can create additional risks.

In September 2016, the FDA warned against the use of homeopathic teething tablets and gels containing belladonna, a toxic substance that has an unpredictable response in children under two years of age, after the products were associated with serious adverse events, including seizures and deaths, in infants and children. An FDA lab analysis later confirmed that certain homeopathic teething tablets contained elevated and inconsistent levels of belladonna. A similar issue occurred in 2010 when Hyland’s Teething Tablets were found to contain varying amounts of belladonna. An FDA inspection of that product’s manufacturing facility indicated substandard control of the product’s manufacturing.

The FDA has issued warnings related to a number of other homeopathic drug products over the past several years. These include certain homeopathic zinc-containing intranasal products that may cause a loss of sense of smell, homeopathic asthma products that have not been shown to be effective in treating asthma and various homeopathic drug products labeled to contain potentially toxic ingredients, like nux vomica, which contains strychnine (a highly toxic, well-studied poison often used to kill rodents).

“Homeopathic products have not been approved by the FDA for any use and may not meet modern standards for safety, effectiveness and quality,” said Janet Woodcock, M.D., director of the FDA’s Center for Drug Evaluation and Research. “The draft guidance is an important step forward in the agency’s work to protect patients from unproven and potentially dangerous products.”…

The FDA is not alone in reexamining its approach to homeopathy. In November 2016, the Federal Trade Commission (FTC) announced a new enforcement policy explaining that they will hold efficacy and safety claims for over-the-counter homeopathic drugs to the same standard as other products making similar health claims. Notably, the FTC said that companies must have competent and reliable scientific evidence for health-related claims, including claims that a product can treat specific conditions…

END OF QUOTE

US homeopaths were quick to respond, as reported here:

The National Center for Homeopathy’s board of directors stated:

The National Center for Homeopathy supports the FDA’s efforts to ensure safety and good manufacturing practices in the industry. We are committed to working with industry partners to protect consumer access to homeopathic medicines, and we are hopeful that this action will not impede access. Homeopathic medicines are safe, gentle and effective when products are manufactured in accordance with HPUS (Homoeopathic Pharmacopoeia of the United States) guidelines under CGMPs (Current Good Manufacturing Practices). We welcome the opportunity to educate consumers and healthcare professionals about the unique aspects of homeopathic medicine.

Of course, the unique aspect of homeopathic medicines undoubtedly is that they usually contain no active molecules and therefore do not work. But somehow, I doubt that the NCH was thinking of telling consumers the truth.

The NCH statement is tame in comparison with the NCH’s response to the FDA’s actions during the homeopathic teething investigation last year. Prior to the recall, the FDA issued a warning to consumers, which the NCH dubbed as “arbitrary and capricious.” The NCH went on to say that the FDA’s warning led to “exaggerated fear mongering” in the media and a “public scare” that threatened access to homeopathic products. “[G]roups interested in seeing homeopathy destroyed continue to hammer away at the system—making exaggerated claims that create misunderstandings about and limit consumer access,” the NCH wrote [emphasis theirs].

And this response is tame compared to what a prominent US homeopaths claimed at the time:

“It’s time to hold these people accountable. There are laws in every country against officials taking bribes and malfeasance in office. Write to your legislators and demand that they investigate and bring these criminals to justice. Send them the links to hundreds of homeopathy studies, including disease prevention with homeopathy, at the end of this article.   Tell them that the regulatory agencies are protecting Pharma profits, not the public.

Meanwhile, let us insist that pharmaceutical drugs be labeled honestly, like this:

“This drug was tested by the same company that profits from it, and which company has been fined millions of dollars in the past for lying about test results. This drug does not cure any medical condition, but only suppresses symptoms which may ultimately make the patient sicker. This drug has already  killed or injured X  number of people.”

The outrage is understandable for two reasons, I think:

  1. even homeopaths cannot deny that the days of unchecked claims are counted;
  2. against rage of this sort homeopathic remedies are obviously not working.

Electrohomeopathy is a version of homeopathy few people know about. Allow me to explain:

Cesare Mattei (1809–1896), an Italian count, was interested in homeopathy. Mattei believed that fermented plants gave off ‘electrical’ energy that could be used to cure illness. He also believed that every illness had a cure provided in the vegetable kingdom by God. He began to develop his system from 1849. The large bottles are labelled ”Red”, ”Green”, “White”, “Yellow” and “Blue” so the actual ingredients remained a secret. Ointments were made up with ingredients from the small and large bottles. The vial labelled “Canceroso 5” was used for bruises, cancers, chilblains, hair loss, skin diseases and varicose veins, among other conditions. Although dismissed by the medical profession as quackery, Mattei’s system was popular. It formed part of the treatment at St Saviour’s Cancer Hospital in London from 1873.

Wikipedia offers more informing us that:

“… Mattei, a nobleman living in a castle in the vicinity of Bologna studied natural science, anatomy, physiology, pathology, chemistry and botany. He ultimately focused on the supposed therapeutic power of “electricity” in botanical extracts. Mattei made bold, unsupported claims for the efficacy of his treatments, including the claim that his treatments offered a nonsurgical alternative to cancer. His treatment regimens were met with scepticism by mainstream medicine:

The electrohomeopathic system is an invention of Count Mattei who prates of “red”, “blue”, and “green” electricity, a theory that, in spite of its utter idiocy, has attracted a considerable following and earned a large fortune for its chief promoter.

Notwithstanding criticisms, including a challenge by the British medical establishment to the claimed success of his cancer treatments,  electrohomeopathy (or Matteism, as it was sometimes known at the time) had adherents in Germany, France, the USA and the UK by the beginning of the 20th century; electrohomeopathy had been the subject of approximately 100 publications and there were three journals dedicated to it.

Remedies are derived from what are said to be the active micro nutrients or mineral salts of certain plants. One contemporary account of the process of producing electrohomeopathic remedies was as follows:

As to the nature of his remedies we learn … that … they are manufactured from certain herbs, and that the directions for the preparation of the necessary dilutions are given in the ordinary jargon of homeopathy. The globules and liquids, however, are “instinct with a potent, vital, electrical force, which enables them to work wonders”. This process of “fixing the electrical principle” is carried on in the secret central chamber of a Neo-Moorish castle which Count Mattei has built for himself in the Bolognese Apennines… The “red electricity” and “white electricity” supposed to be “fixed” in these “vegetable compounds” are in their very nomenclature and suggestion poor and miserable fictions.

According to Mattei’s own ideas however, every disease originates in the change of blood or of the lymphatic system or both, and remedies can therefore be mainly divided into two broad categories to be used in response to the dominant affected system. Mattei wrote that having obtained plant extracts, he was “able to determine in the liquid vegetable electricity”. Allied to his theories and therapies were elements of Chinese medicine, of medical humours, of apparent Brownianism, as well as modified versions of Samuel Hahnemann‘s homeopathic principles. Electrohomeopathy has some associations with Spagyric medicine, a holistic medical philosophy claimed to be the practical application of alchemy in medical treatment, so that the principle of modern electrohomeopathy is that disease is typically multi-organic in cause or effect and therefore requires holistic treatment that is at once both complex and natural.”

END OF QUOTE

If one would assume that electrohomeopathy is nothing more than a bizarre and long-forgotten chapter in the colourful history of homeopathy, one would be mistaken; it is still used and promoted by enthusiasts who continue to make bold claims. This article, for instance, informs us that:

  • Electro Homeopathic remedies tone up the brain and the nerves through which overall body processes are controlled and strengthen the digestion process.
  • The tablets provide food for the red blood cells and provide nourishment for the white corpuscles of the lymph and the blood.
  • They provide the useful elements to the plasma of the blood and provide required nutrients for the cells of which tissues are made.
  • They enhance the eviction through the skin and other modes and unnecessary substances which disturb the function and health of the body.
  • They cure the diseases and are helpful to the patients who use them.
  • They are curative as well as palliatives.
  • They are helpful in curing the serious diseases whether it is acute or chronic, non-surgical or surgical, for women, men, and children. They provide 100 percent cure.
  • They cure diseases such as tuberculosis, cancer, fistula, and cancer. They can cure these diseases without operation.
  • They cure all type of infectious diseases with certainty and are also helpful in prophylactics in the epidemics.

This article also provides even more specific claims:

Here are the 5 best Electro Homeopathic medicines for curing kidney stones –

  • Berberis Vulgaris – is the best medicine for left-sided kidney stones
  • Cantharis Vesicatoria– is one of the best medicine for kidney stones with burning in urine
  • Lycopodium – is the best remedy for right-sided kidney stones
  • Sarsaparilla – is the best medicine for kidney stones with white sand in urine
  • Benzoic Acid – is best homeopathic medicine for renal calculi…

The aforesaid homeopathic medicines for kidney stones have been found to be very effective in getting these stones out of the system. It does not mean that only these medicines are used.

What all of this highlights yet again is this, I think:

  • There are many seriously deluded people out there who are totally ignorant of medicine, healthcare and science.
  • To a desperate patient, these quacks can seem reasonable in their pretence of medical competence.
  • Loons make very specific health claims (even about very serious conditions), thus endangering the lives of the many gullible people who believe them.
  • Even though this has been known and well-documented for many years, t here seems to be nobody stopping the deluded pretenders in their tracks; the public therefore remains largely unprotected from their fraudulent and harmful acts.
  • In particular, the allegedly more reasonable end of the ‘alt med community’ does nothing to limit the harm done by such charlatans – on the contrary, whether knowingly or not, groups such as doctors of ‘integrative medicine’ lend significant support to them.

The common cold is a perfect condition for providers of alternative medicine:

  • it is prevalent (good money to be earned),
  • it is not normally dangerous,
  • it nevertheless reduces quality of life and thus patients look for a treatment,
  • there probably is not a single alternative therapy that does not claim to be effective for it,
  • it is gone after about a week, treated or not.

But is there an alternative therapy that does actually work? An article by the Cochrane Collaboration provides an excellent overview. It includes conventional as well as alternative treatments; here I have merely copied the passages related to the latter:

VITAMIN C

There was great excitement in the 1970s when Linus Pauling, (a Nobel laureate twice over), concluded from placebo-controlled trials that Vitamin C could prevent and alleviate the common cold. Further research followed and a Cochrane review, published in 2013, found 29 clinical trials, involving 11,306 participants. Unfortunately, the review did not confirm Pauling’s findings. Taking regular Vitamin C did not reduce the incidence of colds in the general population, although there was a modest reduction in the duration and severity of symptoms. The only people who appeared to derive some benefit were those who undertook short bursts of extreme exercise, such as marathon runners and skiers. In this group the risk of getting a cold was halved.

Trials looking at taking high dose Vitamin C at the onset of cold symptoms showed no consistent effect on the duration and severity of symptoms and more research is needed to clarify these findings.

ECHINACEA

Echinacea is widely used in Europe and North America for common colds. A Cochrane review (2014) showed that some Echinacea products may be more effective than placebo in treating colds but the overall evidence for clinically relevant effects was weak. There was some evidence of a small preventative effect.

INHALATIONS

Inhaled steam has been used for decades (see earlier reference to my childhood humiliation!) thinking that it helps drain away mucus more effectively and possibly destroys the cold virus. A Cochrane review (2017) of six trials with 387 participants showed no consistent benefit for this intervention.

GARLIC

A single trial with 146 participants showed that taking garlic every day for three months might prevent occurrences of the common cold but the evidence was of low quality and more research is needed to validate this finding. (Cochrane review 2014.)

END OF QUOTE

The article obviously focuses only on such therapies for which Cochrane reviews have been published. What about other treatments? As I already mentioned, if we believe the promoters of alternative medicine, the list is long. But fortunately, we do not believe them and want to see the evidence.

HOMEOPATHY

Unsurprisingly, the evidence is not good. One of my posts even expressed the fear that it might involve scientific misconduct.

CHIROPRACTIC

Yes, some chiropractors claim that their manipulations are effective for the common cold. But, as with almost all of their claims, this cannot be taken seriously; the assumption is bogus.

CHINESE HERBAL MEDICINES

A systematic review concluded that their use for common cold is not supported by robust evidence.

SAUNA

Ages ago, I published a small study with promising results:

Twenty-five volunteers were submitted to sauna bathing, with 25 controls abstaining from this or comparable procedures. In both groups the frequency, duration and severity of common colds were recorded for six months. There were significantly fewer episodes of common cold in the sauna group. This was found particularly during the last three months of the study period when the incidence was roughly halved compared to controls. The mean duration and average severity of common colds did not differ significantly between the groups. It is concluded that regular sauna bathing probably reduces the incidence of common colds, but further studies are needed to prove this.

Sadly, the findings were never replicated.

 

MY CONCLUSION

Grin and bear it!

(That is the cold as well as the myriad of false claims made by enthusiasts of alternative medicine)

 

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