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

pseudo-science

A ‘RAZOR’ is an argument for “shaving off” unlikely or implausible explanations or arguments. Who would, in this context, not think of alternative therapies and the explanations provided for them? And who could deny that homeopathy, in particular, is crying out for its very own razor?

I am, of course, inspired by 4 existing razors:

Occam’s Razor: Among competing hypotheses, the one with the fewest assumptions is likely to be the correct one.

Hitchens’s Razor: What can be asserted without evidence can be dismissed without evidence.

Hanlon’s Razor: Never attribute to malice what can adequately explained by stupidity.

Alder’s Razor: What cannot be settled by experiment is not worth debating.

To those of my readers who fail to see the relationship to homeopathy, I offer the following explanations:

OCCAM

Homeopaths claim that the explanation for homeopathy’s mode of action is the ‘memory of water’ theory which is now supported, they say, by all sorts of basic science from water structure to nano-particles. Even if true [which it is not], this explanation relies on a whole series of further assumptions, for instance, about how nano-particles bring about any clinical outcome. The competing hypothesis is that the benefit experienced by patients after homeopathy is due to non-specific or context effects such as the placebo effect, the empathetic consultation etc. We have therefore one single hypothesis (i. e. homeopathy works via non-specific effects which is even supported by experimental data) against a myriad of postulates which are largely speculative. Occam’s Razor holds that the explanation with the least assumptions is likely to be correct.

HITCHENS

Homeopaths claim that their remedies are more than a placebo. To support their claim, they have no good evidence but rely on cherry-picking and misrepresenting the available data. Hitchen’s Razor suggests that, as long as they don’t come up with evidence, we can dismiss these claims without even attempting to prove the cherry-pickers wrong.

HANLON

Homeopaths have given us plenty of evidence (for instance, on this blog) for the fact that they often have a somewhat disturbed relationship with the truth. One might think that this is because they are maliciously trying to mislead us. According to Halon’s Razor, it is more likely that they are just stupid.

ALDER

Homeopaths regularly claim that, as long as there is no proof that homeopathy does not work, there must be an open debate about the issues involved and, as long as there are genuine debates and doubts, we must continue to make homeopathy available to all. Alder’ s Razor, however, suggests otherwise: there have been many tests of homeopathy; their results have failed to settle the matter in favour of homeopathy; therefore we can forget about the whole thing, stop debating it, and close the issue.

So, what about the razor promised in the title of this post? Here it comes; it is an attempt to synthesize the 4 razors above and apply them to homeopathy. I will call it (somewhat pompously) ‘Ernst’s Razor’ and I have tried to formulate it such that it can be applied to most other bogus treatments simply by exchanging one single word:

INSTEAD OF RELYING ON EVIDENCE, HOMEOPATHY’S SURVIVAL DEPENDS ON MULTIPLE ASSUMPTIONS, LIES, IGNORANCE AND STUPIDITY.

We have heard often, here and elsewhere, that chiropractic is neither effective nor safe. But now I found that it is not useless after all!!! It is an effective preventative measure against infections like the common cold and the flu.

You find this hard to believe? But it must be true!

It is the message given to chiropractors on this website:

Chiropractic care raises your body’s natural resistance to disease by removing serious interference to its proper function, vertebral subluxations. For that reason, it’s important to explain to clients that their lymphatic system is basically their body’s drainage system. Lymph is a clear fluid composed of immune cells and the greater lymphatic system is made up of a network of ducts and lymph nodes that help filter out viruses, bacteria, and other harmful elements. Remind your patients that when they go to a medical doctor and complain of a cold or the flu, the first thing he or she checks is their lymph glands, feeling for enlarged lymph nodes on the neck under the jaw. Enlarged nodes, or swollen glands as we often call them, are a sign that the lymphatic system is actively fighting an infection or imbalance.
 
Here’s where chiropractic care comes in: when the body is healthy and working correctly, the bad things your lymph nodes collects drains out through the lymph ducts, some of which are located along the spine and in the neck. But when the neck and spine are out of alignment from muscle tension, a musculoskeletal condition or other injury, those lymph ducts can become blocked and congested. Fortunately, chiropractic adjustments restore the neck and spine to proper alignment, taking pressure off of the congested lymph ducts. That allows the lymphatic system to start flowing and working correctly again, naturally decongesting and helping your body’s immune system to work properly in the fight against colds, flu, and illness.
 
It’s hard to quantify the health benefits of a strong immune system, but one recent study found that patients who had chiropractic adjustments had a 200-400% stronger immune system than those who weren’t adjusted. Another study published in the Journal of Vertebral Subluxation Research showed that regular chiropractic care resulted in a 15% average decrease in the incidence of colds and the flu. For that reason, regular chiropractic adjustment and lymphatic massage will help keep a patient’s immune system strong and functioning optimally, and even will help minimize the symptoms and speed recovery once a patient already comes down with the flu.

And you thought that chiropractors had all but given up the notion of ‘subluxation’? No, they haven’t!

Subluxations are real, alive and kicking!

The germ theory of disease is false!

Chiropractic adjustments are the only cure and prevention!

Immunisations are just poison in your body!

What, I have not convinced you? Then you are not a chiropractor, perhaps?

You say they make numerous such claims because it keeps them in clover? Oh, you are cynical – shame on you!

Recently I have focussed several posts on well-known homeopaths and proponents of homeopathy; they include 6 prominent defenders of this therapy:

Dr Peter Fisher, the Queen’s homeopath,

Dr Michael Dixon, GP, chair of the NHS Alliance, the College of Medicine  and holder of many other posts,

Prof Michael Frass, intensive care physician at the University of Vienna,

Christian Boiron, general manager of Boiron, the world’s largest homeopathic manufacturer,

Christophe Merville, lead pharmacist at Boiron,

Dana Ullman, US homeopath and entrepreneur.

This inevitably begs the question what these people might have in common. After some consideration, I think, there are the following common denominators (you might see others; if so, please let me know):

  1. Most have conflicts of interest, yet try to hide this fact as best as they can, a circumstance which could be seen as less than honest.
  2. Most are quick of accusing critics of homeopathy of dishonesty and harbour conspiracy theories of various kinds.
  3. Most seem unable to think critically.
  4. They never criticise each other, not even for demonstrably wrong remarks or actions.
  5. Most use fallacious arguments regularly.
  6. Most rely on cherry-picking their evidence.
  7. Most display anti-scientific tendencies, yet rely on ‘cutting edge science’ as soon as they can interpret it in favour of homeopathy.
  8. They seem to be unable to learn in the light of new evidence.
  9. They seem never able to change their mind about things related to homeopathy.
  10. This gives them a distinct flair of fanaticism and arrogance.
  11. Most seem to have an odd attitude towards medical ethics.
  12. Most try to mislead the public by claiming things which are evidently not true.

The last point is, in my view, the most striking, important and disturbing issue. I ask myself what reasons these individuals have to tell untruths and whether ‘telling untruths’ is the same as ‘telling lies’. The first part of this question seems to be answered by the fact that most have powerful conflicts of interest; that is to say their livelihood depends on misleading the public about homeopathy. But are they lying or telling untruths?

This is a potentially important difference, I think.

An untruth is a statement which is false. By contrast, a lie is a false statement made with deliberate intent to deceive. So, are the untruths issued by the above-named homeopaths lies or untruths?

I would not dare to decide on the answer of this question…but hope my readers have some suggestions.

The authors of a recent paper inform us that Reiki is a Japanese system of energy healing that has been used for over 2 500 years. It involves the transfer of energy from the practitioner to the receiver, which promotes healing, and can be done by either contact or non-contact methods. Both the receiver and the practitioner may feel the energy in various forms (warmth, cold, tingling, vibration, pulsations and/or floating sensations). Reiki can also be self-administered if one is a Reiki practitioner. Reiki is mainly used to address stress, anxiety, and pain reduction while also promoting a sense of well-being and improving quality of life.

Such statements should make us weary: what is presented here as fact is nothing more than conjecture – and very, very implausible conjecture too. Anyone who writes stuff like this in the introduction of a scientific paper is, in my view, unlikely to be objective and could be well on the way to present some nasty piece of pseudo-science.

But I am, of course, pre-judging the issue; let’s have a quick look at the article itself.

The purpose of this study was to determine the effects of a 20-week structured self-Reiki program on stress reduction and relaxation in college students. Students were recruited from Stockton University and sessions were conducted in the privacy of their residence. Twenty students completed the entire study consisting of 20 weeks of self-Reiki done twice weekly. Each participant completed a Reiki Baseline Credibility Scale, a Reiki Expectancy Scale, and a Perceived Stress Scale (PSS) after acceptance into the study. The PSS was completed every four weeks once the interventions were initiated. A global assessment questionnaire was completed at the end of the study. Logs summarizing the outcome of each session were submitted at the end of the study.

With the exception of three participants, participants believed that Reiki is a credible technique for reducing stress levels. Except for two participants, participants agreed that Reiki would be effective in reducing stress levels. All participants experienced stress within the month prior to completing the initial PSS. There was a significant reduction in stress levels from pre-study to post-study. There was a correlation between self-rating of improvement and final PSS scores. With one exception, stress levels at 20 weeks did not return to pre-study stress levels.

The authors concluded that this study supports the hypothesis that the calming effect of Reiki may be achieved through the use of self-Reiki.

QED – my suspicions were fully confirmed. This study shows precisely nothing, and it certainly does not support any hypothesis regarding Reiki.

If we recruited 20 volunteers who were sufficiently gullible to believe that watching an ice-cube slowly melting in the kitchen sink, or anything else that we can think of, has profound effects on their vital energy, or chi, or karma, or anything else, we would almost certaily generate similar results.

My conclusion is therefore very different from those of the original authors: THIS STUDY SUPPORTS THE HYPOTHESIS THAT GULLIBLE PEOPLE CAN BE EASILY MISLEAD ABOUT BOGUS THERAPIES WITH PSEUDO-SCIENTIFIC STUDIES BY IRRESPONSIBLE WOULD-BE SCIENTISTS.

Anyone who has looked into the discussions around homeopathy for more than 10 minutes will have come across Dana Ullman (DU). Some 15 years ago, I had the pleasure to meet him in person during a conference in Boston. After the brief chat, I asked a UK homeopath who this bizarre person was. “Oh Dana!” he replied “Dana is alright.”

But is he? Let’s have a look at the evidence.

There are very few papers by DU listed in Medline, and most of these articles are simply opinion pieces. The opinions DU expresses there (or anywhere else) are usually not supported by good evidence; some of them are even outright dangerous. Here are a few quotes:

“…homeopathic care is cost effective…”

“…homeopathic medicines are effective…”

“…homeopathic medicine may play a useful role as an adjunctive and/or alternative therapy [for HIV infections]”

“[There are]…significant effects of homeopathic treatment in allergic patients.”

Occasionally, DU writes little essays full of utter nonsense, logical fallacies and falsehoods for HUFFPOST where he is nevertheless characterised in glowing terms: Dana Ullman, M.P.H. (Masters in Public Health, U.C. Berkeley), CCH (Certification in Classical Homeopathy) is “homeopathic.com” and is widely recognized as the foremost spokesperson for homeopathic medicine in the U.S.

Wikipedia, however, is more critical and cites the opinion of a judge who was presiding over a class action against a US homeopathic producer in which DU had been called as an expert witness: The Defendant presented the testimony of Gregory Dana Ullman who is a homeopathic practitioner. He outlined the theory of homeopathic treatment and presented his opinion as to the value and effectiveness of homeopathic remedies. The Court found Mr. Ullman’s testimony to be not credible. Mr. Ullman’s bias in favor of homeopathy and against conventional medicine was readily apparent from his testimony. He admitted that he was not an impartial expert but rather is a passionate advocate of homeopathy. He posted on Twitter that he views conventional medicine as witchcraft. He opined that conventional medical science cannot be trusted…Mr. Ullman’s testimony was unhelpful in understanding the purported efficacy of the ingredients of SnoreStop to reduce the symptoms of snoring. Although he is familiar with the theory of homeopathic treatment, his opinions regarding its effectiveness was unsupported and biased. The Court gave no weight to his testimony.

The Encyclopedia of Americam Loons is even more poignant and describes DU as: A master of cognitive dissonance and memory bias, Ullman seems clinically unable to grasp the possibility that he may be wrong. Combined with a lack of understanding of science or medicine – and the possession of certain marketing skills – what we end up with is rather insidious.

Anyone who has debated with DU will have to concur with the claim that he fails to understand science or medicine. If you don’t believe me, please read his recent comments on the post about Prof Frass on this blog where he excels in producing one fallacy after the next (if he were on a mission to give homeopathy a bad name, he would be doing a sterling job!).

Despite all this abysmal ignorance, DU has one undisputed and outstanding talent: the knack of getting on people’s nerves and thus driving rational thinkers to distraction. In this way he even managed to be headlined as an ‘idiot‘!

I find it tempting to agree with the many experts who have called him an idiot, a moron or a laughing stock but, for now, I will resist that temptation. On the contrary, I want point out that he is much more cunning and clever than we give him credit for: after all, he runs a thriving business and lives off the nonsense he produces. To my mind, this is not idiotic; devious and unethical surely, but not idiotic nor laughable!

Homeopathy seems to attract some kind of miracle worker. Elsewhere I have, for instance, reported the curious case of Prof Claudia Witt who published more than anyone on homeopathy in recent years without hardly ever arriving at a negative conclusion. Recently, I came across a researcher with an even better track record: Prof Michael Frass.

Wikipedia describes his achievements as follows: “Michael Frass studied medicine from 1972 to 1978 at the Medical University of Vienna followed by visits abroad at the Pasteur Institute, Paris and at the Porter Memorial Hospital (USA). Since March 2004 he directs the Outpatients Unit of Homeopathy for Malign Diseases at the Department Clinic for Internal of Medicine I at the Medical University of Vienna. Since 2005 Frass also works as a coordinator of the lecture series Homeopathy at the Medical University of Vienna. Beginning with the winter semester 2001/02 he is the coordinator of a lecture series Basics and practise of complementary medical methods at the Medical University of Vienna. From 2002 to 2005 he led the Ludwig Boltzmanm Institute of Homeopathy. Since 2005 Frass is president of the Institute for Homeopathic Research. Actually he works at the Division of Oncology at the Department of Medicine I in Vienna. He is First Chairman of the Scientific Society for Homeopathy (WissHom), founded in 2010, president of the Umbrella organization of Austrian Doctors for Holistic Medicine.”

He directs the WHAT? The Outpatients Unit of Homeopathy for Malign Diseases at the Department Clinic for Internal of Medicine I at the Medical University of Vienna? This is my former medical school, and I had no idea that such a unit even existed – but, of course, I left in 1993 for Exeter (a few months ago, I followed an invitation to give a lecture on homeopathy at the Medical University of Vienna ; sadly neither Prof Frass nor anyone of his team attended).

And what about the Scientific Society for Homeopathy? I am sure that the name of this organisation will make some people wonder. From the society’s website, we learn that “the intention of WissHom is to contribute to the progress of medicine and to the collective good. To this end, WissHom intents to further develop homeopathy both practically and theoretically. It will be WissHom’s task to breathe life into this committed objective.”

Breathing life into homeopathy seems exactly what Prof Frass does. He seems to have found his way to homeopathy relatively late in his career (the 1st Medline-listed article was published only in 2003) but he has nevertheless published many studies on this subject (I use the term ‘study’ here to describe both clinical, pre-clinical and basic research papers); in total, I found 12 such articles on Medline. They cover extremely diverse areas and a wide range of methodologies. Yet they all have one remarkable feature in common: they arrive at positive conclusions.

You find this hard to believe? Join the club!

But it is undeniably true, here are the conclusions (or the bit that comes close to a conclusion) from the Medline-listed abstracts (only the headings in capital letters are mine, and they simply depict the nature of the paper)

AN RCT WITH CANCER PATIENTS (2015)

Results suggest that the global health status and subjective wellbeing of cancer patients improve significantly when adjunct classical homeopathic treatment is administered in addition to conventional therapy.

TWO CASE REPORTS OF HOMEOPATHICALLY TREATED INTOXICATIONS (2014)

Based on the 2 cases, including 1 extreme situation, we suggest that adjunctive homeopathic treatment has a role in the treatment of acute Amanita phalloides-induced toxicity following mushroom poisoning. Additional studies may clarify a more precise dosing regimen, standardization, and better acceptance of homeopathic medicine in the intensive care setting.

RETORSPECTIVE ANALYSIS OF CANER SURVIVAL UNDER HOMEOPATHIC TREATMENT (2014)

Extended survival time in this sample of cancer patients with fatal prognosis but additive homeopathic treatment is interesting. However, findings are based on a small sample, and with only limited data available about patient and treatment characteristics. The relationship between homeopathic treatment and survival time requires prospective investigation in larger samples possibly using matched-pair control analysis or randomized trials.

OBSERVATIONAL STUDY OF HOMEOPATHIC TREATMENT FOR ALLERGIES (2012)

The symptoms of patients undergoing homeopathic treatment were shown to improve substantially and conventional medication dosage could be substantially reduced. While the real-life effect assessed indicates that there is a potential for enhancing therapeutic measures and reducing healthcare cost, it does not allow to draw conclusions as to the efficacy of homeopathic treatment per se.

IN-VITRO STUDY OF THE EFFECTS OF HOMEOPATHICS ON HELIOBACTER PYLORI (2010)

The data suggest that both drugs prepared in ethanolic solution are potent inhibitors of H. pylori induced gene expression.

SYSTEMATIC REVIEW OF HOMEOPATHY FOR RESPIRATORY ALLERGIES (2010)

Most of these clinical studies have been deemed to be high quality trials, according to the three most commonly referenced meta-analyses of homeopathic research. Basic in vitro experimental studies also provide evidence that the effects of homeopathy differ from placebo.

CASE SERIES OF PATIENTS TREATED WITH HOMEOPATHIC PETROLEUM (2008)

This study is based on 25 well documented reports of cases which responded well to treatment with Petroleum.

ANIMAL EXPERIMENT WITH HOMEOPATHY ( 2008)

Animals treated with the standard test solution thyroxine 10(-30) metamorphosed more slowly than the control animals, ie the effect of the homeopathically prepared thyroxine was opposed to the usual physiological effect of molecular thyroxine.

OVERVIEW OF HOMEOPATHIC TREATMENT IN INTENSIVE CARE (2005)

Our report suggests that homeopathy may be applicable even for critically ill patients.

RCT OF HOMEOPATHY FOR SEVERE SEPSIS (2005)

Our data suggest that homeopathic treatment may be a useful additional therapeutic measure with a long-term benefit for severely septic patients admitted to the intensive care unit. A constraint to wider application of this method is the limited number of trained homeopaths.

RCT OF HOMEOPATHY FOR COPD (2005)

These data suggest that potentized (diluted and vigorously shaken) potassium dichromate may help to decrease the amount of stringy tracheal secretions in COPD patients.

ANIMAL STUDY OF A HOMEOPATHIC REMEDY (2003)

These animals reacted to the homeopathically prepared thyroxine with a slowing down of metamorphosis, even when they had not been prestimulated with a molecular dose of the hormone. This effect was observed in all 3 laboratories and is consistent with the results of previous studies.

Surprised?

So am I!

How can homeopathy produce nothing but positive results in the hands of this researcher? How can it work in so many entirely different conditions? How is it possible that homeopathic remedies are better than placebo regardless of the methodology used? Why does homeopathy, in the hands of Prof Frass, not even once produce a result that disappoints the aspirations of homeopaths and its advocates? Why are these sensational results almost invariably published in very minor journals? Crucially, why has not one of the findings (as far as I can see) ever been independently reproduced?

I do not know the answers to these questions.

If anyone does, I would like to hear them.

Homeopathy has its fair share of lunes who are unable to make a reasonable case for it without telling overt falsehoods; we have seen some of then on this blog, for sure. Therefore I was encouraged to finally find a well-argued, rational defence of homeopathy. It comes from an unlikely source – Christian Boiron (CB) is the General Manager of the world’s largest manufacturer of homeopathics ‘BOIRON’ with a turn-over of more than 600 million Euros annually. Some would have thought he could be a trifle biased, but no – judge for yourself.

In a recent, short interview (unfortunately it is in French, so you have to trust my translations) CB rightly pointed out that “Il y a un Ku Klux Klan contre l’homéopathie” THERE IS A KU KLUX KLAN AGAINST HOMEOPATHY. About time that someone calls a spade a spade, I’d say. I think others have previously called those who doubt the miracle of homeopathy ‘fascists’ – but ‘KKK’ is much better, more to the point. Sceptics have indeed a long and infamous habit of stringing everyone who disagrees with their views up on a tree.

The interview refers to the report from the Australian NHMRC which showed that homeopathy is not effective and can even be dangerous. How can this be? Fortunately CB knows the answer: “…personne ne comprend rien”. The panel members were all ignorant! Thanks for clearing that up CB; were they also members of the KKK?

After all, homeopathy is 200 years old, it is now well-grounded in science and accepted throughout the world (“L’homéopathie, qui a 200 ans, évolue avec les connaissances de la science. La France l’a relancée dans un axe totalement scientifique et lui a donné une reconnaissance mondiale”) That surely needed to be said, and don’t you KKK members dare pointing out the occasional fallacy here! Because CB is the first to be critical (“Je suis le premier à être le plus critique”).

What about studies of homeopathy that fail to be as convincingly positive as CB might have hoped? “Quand on dit qu’il faut démontrer en médecine et que la médecine est une pratique scientifique ce sont deux idioties.” Yes, well said CB, the assumption that medicine should become scientific is indeed idiotic. Medicine is about individuals, not statistics; Hahnemann realised this, of course, and thus showed us the way to the future in health care.

And to finish this elating encounter with one of the brightest buttons in any homeopathic drawer: “On croit savoir énormément de choses alors qu’il y a beaucoup qu’on méconnait”. ONE THINKS ONE KNOWS A LOT BUT THERE IS PLENTY ONE MISUNDERSTANDS”

I think even those terrible KKK members amongst my readers might agree with CB here, particularly if this remark introspectively refers to himself.

***a note to homeopaths and their libel lawyers: this post is SATIRE

No, I kid you not!

This abstract was actually published in the leading chiro-journal. The authors include three professors from the Canadian Memorial Chiropractic College, Research, Toronto, Canada. Its title is impressive but made my alarm bells ring a bit:

A Randomized Pragmatic Clinical Trial of Chiropractic Care for Headaches With and Without a Self-Acupressure Pillow.

And the actual texts does not disappoint those looking for of pure pseudo-science:

The purpose of this study was to determine if the addition of a self-acupressure pillow (SAP) to typical chiropractic treatment results in significantly greater improvement in tension-type and cervicogenic headache sufferers.

METHODS:

A pragmatic randomized clinical trial was conducted in a chiropractic college teaching clinic. Thirty-four subjects, including tension-type and cervicogenic headache sufferers, 21 to 60 years of age, male or female, completed the study. Group A (n = 15) received typical chiropractic care only (manual therapy and exercises), and group B (n = 19) received typical chiropractic care with daily home use of the SAP. The intervention period was 4 weeks. The main outcome measure was headache frequency. Satisfaction and relief scores were obtained from subjects in the SAP group. Analysis of variance was used to analyze the intergroup comparisons.

RESULTS:

Owing to failure of randomization to produce group equivalence on weekly headache frequency, analysis of covariance was performed showing a trend (P = .07) favoring the chiropractic-only group; however, this was not statistically significant. Group A obtained a 46% reduction of weekly headache frequency (t = 3.1, P = .002; d = 1.22). The number of subjects in group A achieving a reduction in headaches greater than 40% was 71%, while for group B, this was 28%. The mean benefit score (0-3) in group B of the use of the SAP was 1.2 (.86). The mean satisfaction rating of users of the SAP was 10.4 (2.7) out of 15 (63%).

CONCLUSION:

This study suggests that chiropractic care may reduce frequency of headaches in patients with chronic tension-type and cervicogenic headache. The use of a self-acupressure pillow (Dr Zaxx device) may help those with headache and headache pain relief as well as producing moderately high satisfaction with use.

Where to begin?

Perhaps it is best, if I simply concentrated on the bizarre research question: is chiropractic care plus the largely uncontrolled use of an ‘acupressure cushion’ better than chiropractic care alone? To savour the lunacy of it, we need to consider that:

  • chiropractic is not plausible;
  • chiropractic care is not proven to be effective for headaches;
  • acupressure is not plausible;
  • acupressure is not proven to be effective;
  • a self-administered acupressure cushion is also unproven and even less plausible;

This, I fear, renders the study one of the most nonsensical trials I have seen for a very long time. To make the bonanza in pseudo-science complete, the article is supplemented with a most bizarre conclusion about the effectiveness of chiropractic (which, of cause, cannot be examined in a trial of chiro vs chiro).

All this leads me to fear that:

  • the best journal of chiropractic is rubbish;
  • a professorship in a chiro school may not mean that the professor has the slightest idea about research methodology;
  • chiropractors will try to squeeze a conclusion that is favourable for their trade even out of a dead horse.

We could have expected it, couldn’t we? With so much homeopathy in the press lately, Dr Dixon (we have seen him on this blog before, for instance here, here and here) had to comment. His article in yesterday’s NURSING IN PRACTICE is far too perfect to abbreviate it; I just have to cite it in full (only the reference numbers are mine and refer to my comments below).

HERE WE GO

Should homeopathy be blacklisted in general practice?

I have not prescribed them myself but I know of many GPs and patients who find homeopathic preparations helpful, especially in clinical areas where there is no satisfactory conventional treatment [1]. They are cheap and entirely safe [2], which cannot always be said of conventional treatment [3]. Is the concern about cost? That is implausible as GP prescriptions cost a mere £100,000 per annum, approximately £10 per UK General Practice but effectively less as some patients will be paying for them and they may reduce other prescriptions or medical costs [4]. Is it about evidence? [5] Possibly, and that is because the necessary pragmatic trials on comparative cost effectiveness have never been done [6]. Homeopathy thus joins the frequently quoted 25% of general practice activity that has an insufficient evidence base… So, why not do the research rather than single out homeopathy for blacklisting [7]? Apparently, because it irritates a powerful fraternity of “scientists” [8] with a narrow biomedical perspective on health and healing, who feel the need to impose their atheism [9] on others. They seem opposed to “patient-centred medicine” which factors in the mindset, culture, history, wishes and hopes of each patient, and a wider concept of science that might take account of them [10]. Led by the World Health Organization, many countries are examining the appropriate role of complementary and traditional medicine (CAM). Indian Prime Minister Modi has created the first minister for medicine in this area (called AYUSH with the “H” standing for homeopathy). Australia, whose government and medical deans (unlike the UK ) are not intimidated by this breed of scientific fundamentalism, has invested money in research, regulated its herbal [11] practitioners and created important trade links with China in this area [12]. Meanwhile the UK invests 0% of its research budget on CAM and appears to have a closed mind [13]. General practice is at its best a subtle and complex blend of science and art combined in a heady mixture, which recognises personal belief and perspective and respects differences [14]. Blacklisting homeopathy would be the thin edge of the wedge. It would be a mean-minded act of outside interference by many who do not treat patients themselves, denying patient choice and signifying a new age of intolerance and interference [15]. It is a threat to the autonomy of general practice that should concern every GP and patient whatever their views on homeopathy [16].

About the Author

Mike Dixon

Chairman of the NHS Alliance and a GP

Mike Dixon, chairman of the NHS Alliance and a GP at College Surgery in Cullompton, Devon and a Royal College of General Practitioners presidential candidate.

END OF QUOTE AND BEGINNING OF MY DELIBERATELY BRIEF COMMENTS

  1. Whenever this argument comes up, people fail to cite an example. Are they afraid that we would point out what can be done for such a patient other than prescribing placebos?
  2. Actually, they are extremely expensive considering that they are just lactose or water. And the claim that homeopathy is safe merely displays an embarrassing lack of knowledge; see the many posts on this blog that deal with this issue.
  3. Classical ‘tu quoque’ fallacy; display of the ignorance of the risk/benefit concept for judging the value of medical interventions.
  4. Display of ignorance regarding the actual evidence, see here, for instance.
  5. Yes, it’s the evidence but also it’s the biological implausibility and the fact that disregarding it undermines rationality in general.
  6. Pure ignorance again, see my point 4.
  7. Are ~ 300 clinical trials and about 100 systematic reviews not enough? How much more money needs to be wasted?
  8. It seems that Dixon has a problem with science and those who pursue it to improve future health care for the benefit of patients.
  9. Does Dixon admit that homeopathy is a religion?
  10. Patient-centred medicine which factors in the mindset, culture, history, wishes and hopes of each patient, and a wider concept of science that might take account of them – does Dixon not know that all good medicine fits this description, but homeopathy certainly does not?
  11. Every one with an IQ above 50 knows by now that herbal is not homeopathic; is Dixon the exception?
  12. What about the Australian report which concluded that “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. People who are considering whether to use homeopathy should first get advice from a registered health practitioner. Those who use homeopathy should tell their health practitioner and should keep taking any prescribed treatments.”
  13. This is simply not true, and Dixon should know it.
  14. No reason to include disproven nonsense like homeopathy.
  15. Intolerance is on Dixon’s side, I think. Improving health care by abandoning disproven therapies in favour of evidence-based treatments is no interference, it’s progress.
  16. This can only be true, if we misunderstand autonomy as arbitrariness without rules, checks, ethics and controls. Good general practice has, like all medicine, be in the best interest of patients. An obsolete, expensive, unsafe, ineffective and implausible treatment is clearly not.

A friend alerted me to this website: Hungarian Academy of Sciences statement proposing the same scientific standards for homeopathic drug registration as for normal drugs

Members of the Section of Medical Sciences of the Hungarian Academy of Sciences (HAS) voted unanimously on 9 November 2015 for supporting the earlier proposal of the Royal Swedish Academy of Sciences. The Swedish statement requested that the homeopathic remedies should go through the same efficacy trials as normal drugs should.

The Hungarian statement refers to various recent scientific statements for example to the study of the Australian Government’s National Health and Medical Research Council that analysed 175 publications and concluded that there was no reasonable scientific proof for the efficacy of homeopathy for any health conditions. The HAS also refers to the European Academies Science Advisory Council that is allegedly considering an investigation among the academies of the UN countries about this topic. The statement points out that another Hungarian scientific body (Health Science Committee – Egészségügyi Tudományos Tanács) had made a similar statement already in 1991 and opposed using and registering those drugs for that efficacy had not been proved and that had not gone through adequate research procedures.

József Mandl – biochemist, member of HAS, president of Health Science Committee said: “The Australian and Swedish statements had raised the interest of the Hungarian scientific community and now members of the Medical Sciences Section of the Hungarian Academy of Sciences voted unanimously to join the Swedish initiation… Science has well defined, rigorous methods and systems. Homeopathy can’t be fitted to these. Homeopathic remedies don’t meet the criteria of evidence based medicine. There might be various hypotheses, theories, but everything should be proved. This is what science means and this is what we would like to highlight now.”

Well said, indeed!

It is high time that the authorities concede that there can be only one standard in medicine regulation. The ‘free ride’ homeopathy has had for 200 years must now come to an end.

This notion also seems to be increasingly supported by the legal profession. An Australian lawyer just published this abstract:

The 2010 report of the United Kingdom Science and Technology Committee of the House of Commons and the 2015 report of the Australian National Health and Medical Research Council have overtaken in significance the uncritical Swiss report of 2012 and have gone a long way to changing the environment of tolerance toward proselytising claims of efficacy in respect of homeopathy. The inquiry being undertaken in the United States by the Food and Drug Administration during 2015 may accelerate this trend. An outcome of the reports and inquiries has been a series of decisions from advertising regulators and by courts rejecting medically unjustifiable claims in respect of the efficacy of homeopathy. Class actions have also been initiated in North America against manufacturers of homeopathic products. The changing legal and regulatory environment is generating an increasingly scientifically marginalised existence for homeopathy. That new environment is starting to provide effective inhibition of assertions on behalf of homeopathy and other health modalities whose claims to therapeutic efficacy cannot be justified by reference to the principles of evidence-based health care. This has the potential to reduce the financial support that is provided by insurers and governments toward homeopathy and to result in serious liability exposure for practitioners, manufacturers and those who purvey homeopathic products, potentially including pharmacists. In addition, it may give a fillip to a form of regulation of homeopaths if law reform to regulate unregistered health practitioners gathers momentum, as is taking place in Australia.

As though this is not enough, today it was reported that the UK NHS is considering to blacklist homeopathic remedies:

The Good Thinking Society has been campaigning for homeopathy to be added to the NHS blacklist – known formally as Schedule 1 – of drugs that cannot be prescribed by GPs. Drugs can be blacklisted if there are cheaper alternatives or if the medicine is not effective. After the Good Thinking Society threatened to take their case to the courts, Department of Health legal advisers replied in emails that ministers had “decided to conduct a consultation”. Officials have now confirmed this will take place in 2016.

It seems to me that the position of homeopathy as a form of health care is less and less tenable. Its place is in the history books. To satisfy the need for consumer/patient choice, the remedies should be moved to the confectionary shelves of the supermarkets.

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