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ASA Smacks Down Homeopathy

It is always gratifying to see regulatory agencies actually do their job. If those regulatory agencies whose job it is to protect the public from false or harmful medical advertising, products, or services thoroughly did their job, so-called “alternative medicine” would cease to exist.

Recently the Advertising Standards Authority (ASA) in the UK issued a judgment about advertising for homeopathy, specifically by the Society of Homeopaths. They had been receiving a number of complaints. After thorough investigation, and considering the response from the homeopaths, they came to two basic conclusions: homeopaths are engaging in false advertising by claiming that homeopathy is a proven treatment for specific indications when the evidence does not support those claims, and homeopaths sometimes “discourage essential medical treatment for conditions for which medical supervision should be sought.”

The ASA specifically investigated the following advertising and claims:

1. ad (a) could discourage essential treatment for depression, a medical condition for which medical supervision should be sought, and misleadingly implied that homeopathic remedies could alleviate symptoms of depression;

2. ad (b) could discourage essential treatment for conditions for which medical supervision should be sought; and

3. the claims in ad (b) that homeopathy could treat the following medical conditions were misleading and could be substantiated:

a. Allergies and upper respiratory tract infections;

b. Ankle sprain;

c. Bronchitis;

d. Childhood diarrhoea;

e. Chronic fatigue;

f. Ear infections;

g. Fibromyalgia;

h. Hay fever;

i. Influenza;

j. Osteoarthritis;

k. Premenstrual syndrome;

l. Rheumatic diseases;

m. Sinusitis;

n. Vertigo.

After reviewing the evidence provided by the Society for Homeopaths each decision was upheld. In other words, the Society was given the opportunity to provide evidence to substantiate their claims. After reviewing that evidence the ASA concluded that the evidence did not adequately support the efficacy claims being made. (For some reason a specific description of the evidence for Vertigo is missing from the page, which seems like a simple oversight.)

I agree with their assessment of the evidence provided. It reminds me of the British Chiropractic Association’s response to Simon Singh. They provided a list of references to support their claims for efficacy for chiropractic for a number of pediatric indications. When I reviewed that evidence, however, I found that it did not support the efficacy claims being made, and was highly cherry picked and misleading.

What this clearly demonstrates, in my opinion, is that homeopaths (even those heading major homeopathic institutions) have a very different idea about evidence in medicine than does mainstream medicine (and certainly than we do at SBM). They accept far lower standards of evidence than is generally accepted by the scientific community. The fact that they offered such weak evidence to back their claims demonstrates this unequivocally.

However, I do have a concern about the process of the ASA. They seemed to consider only the evidence provided by the homeopaths. This is not adequate, as such evidence is clearly cherry picked (and even then wasn’t convincing). An independent literature search for at least systematic reviews would put the evidence into better context.

The document does reference other sources in their decision, but not when reviewing the evidence for specific indications. Let’s consider one example, the use of homeopathy in childhood diarrhea. The ASA wrote:

The Society of Homeopaths provided one study to substantiate the claim that there was sufficient research evidence to support the use of homeopathic treatment for childhood diarrhoea. A meta analysis had been conducted on three double-blind trials on a total of 242 children. Children received either an individualised homeopathic medicine or a placebo. The authors concluded that individualised homeopathic treatment decreased the duration of acute childhood diarrhoea. However, our expert considered that the use of individualised homeopathic treatments was problematic because it meant the materials in the ‘active’ arm of the studies were not identical. He considered this meant the studies were assessing effectiveness rather than efficacy and therefore the evidence was not sufficient to support efficacy claims for homeopathy for the treatment of childhood diarrhoea. We therefore concluded the claim was misleading and had not been substantiated.

This one meta-analysis of three studies can only be the Jacobs 2003 review of three clinical studies of homeopathy for diarrhea. I have had this reference cited to me by homeopaths before. Jacobs concluded:

The results from these studies confirm that individualized homeopathic treatment decreases the duration of acute childhood diarrhea and suggest that larger sample sizes be used in future homeopathic research to ensure adequate statistical power. Homeopathy should be considered for use as an adjunct to oral rehydration for this illness.

However – other reviewers (Altunç U, Pittler MH, Ernst E) looked at the same studies and concluded:

The evidence for attention-deficit/hyperactivity disorder and acute childhood diarrhea is mixed, showing both positive and negative results for their respective main outcome measures.

Further, a 2006 study by Jacobs of homeopathic combination therapy was entirely negative.

So – the Society for Homeopaths referred to the 2003 review that was positive, despite the fact that other reviews of the same data were negative, and a high-quality follow up study by the same author, Jacobs, was negative. The ASA reviewers would not know this, however, unless they did their own literature search or consulted independent experts to do so.

Conclusion

We can conclude a few things from this episode:

- When the actual scientific evidence is examined, homeopathy has not demonstrated efficacy for any indication. Homeopaths can’t seem to prove their point even when they are given free reign to cherry pick the published studies.

- Homeopaths appear to accept any level of evidence as support for homeopathy, even when that evidence is completely inadequate, and even when better evidence clearly demonstrates lack of efficacy. The unavoidable conclusion is that homeopathy is not a science-based profession.

- Homeopaths engage in deceptive advertising that is potentially harmful to the public.

There is also a broader lesson to take from this example – don’t believe proponents of so-called “alternative medicine” when they make the “what’s the harm” argument. This is the “Trojan Horse” strategy that David Gorski has pointed out before. CAM proponents get their foot in the door of academia, hospitals, or regulatory acceptance by presenting a very benign picture of what they do. Typically they present themselves as simply “integrating” benign symptomatic treatment into mainstream medicine.

This is the Trojan Horse – once they are inside the gates, the horse opens up and out comes rank pseudoscience making unwarranted efficacy claims and scaring patients away from science-based therapies.

Evidence of this behavior is there to see for anyone who cares to look, and this latest assessment by the ASA is simply more evidence. This evidence can be found just by looking on the internet. Behind closed doors, the situation is far worse. Remember the homeopathy sting in which UK homeopaths were consulted and found to be offering ineffective homeopathic potions instead of effective medications for the prevention of malaria.

Don’t believe the “integrative, complementary” marketing deception. Proponents of these dubious treatments want to replace science-based effective treatments with their magic potions.

Posted in: Homeopathy, Politics and Regulation

Leave a Comment (44) ↓

44 thoughts on “ASA Smacks Down Homeopathy

  1. Malcolm says:

    3b is missing a not before substantiated

  2. Badly Shaved Monkey says:

    Steve

    You say;

    “However, I do have a concern about the process of the ASA. They seemed to consider only the evidence provided by the homeopaths.”

    I think this stems from the specific remit of the ASA. According to the ASA, the advertiser must hold robust evidence to support their marketing claim. When this is challenged, the ASA asks the advertiser for its evidence. This is not the same as independently reviewing all the available evidence themselves. However, if a complainant pointed out to the ASA that there was strong disconfirmatory evidence, I am sure that would inform their judgement. It would be important, therefore, for complainants to present this evidence as an aid to the ASA, you know, just to be helpful.

  3. Monkey – I agree that’s the case. My point is, it is a flawed process because it allows for cherry picking.

    It would work if as a first round the advertiser has to provide their evidence. If that is lacking, then the ASA can make a judgement. If the evidence appears convincing, however, that should not be accepted as the final word, and that should trigger a second round of independent assessment of the evidence (not just that evidence provided by the advertiser).

    1. Badly Shaved Monkey says:

      And in turn, I agree with you.

      If I understand you correctly, the crux of what you are saying lies here;

      “If the evidence appears convincing…”

      With the SoH, try as they might their evidence was not convincing to the ASA so the additional iteration was not required.

      So, far the ASA has done a pretty good job of not being bamboozled by SCAMmy advertisers’ typical level of evidence. In this they have done a far better job than authorities in other areas.

      One factor is that the evidence held by SCAMsters is routinely so pathetic that even a passing knowledge of how to judge scientific evidence is enough to dismiss their claims. Our problem is that the masters of national health-care and quackademic administrators lack this very basic skill.

      The ASA often finds itself up against properly clever and cunning people in the big cosmetics firms who use a fair amount of skill to tread a careful line just on the permissible side of what they would like to claim. SCAMsters are actually pretty dumb. They ‘know’ they’re right and use evidence merely as window-dressing. Some other organisations know that they are, shall we say, pushing the limits of veracity and it takes skill to do that competently.

    2. Beamup says:

      Do we know that the ASA wouldn’t in fact have done so? They didn’t find that the homeopaths’ evidence was even prima facie sufficient on any count, so this judgement doesn’t show what they would have done if it had been. Unless you have some other knowledge of how they work, we don’t know whether they would have gone to that second round or not.

      1. Alan Henness says:

        Beamup said:

        Do we know that the ASA wouldn’t in fact have done so?

        I think the ASA are pretty switched on about this and we know they have done it for previous cases.

        For example, in our recent complaint about the Royal London Hospital for Integrated Medicine (the re-named London Homeopathic Hospital) for their acupuncture leaflet, they said:

        Four of the papers sent by RLHIM were systematic reviews of acupuncture studies, undertaken by the Cochrane Collaboration. We understood that there were further systematic reviews of acupuncture studies by the Cochrane Collaboration which were relevant to the claims in the ads; we also sent those to the expert for assessment.

  4. Eugenie Mielczarek says:

    Steve , thank you for the update on efforts by the ASA in the UK to expose the claims by homeopaths. Unfortunately NIH’s NCCAM has continued to award grants to colleges graduating non-evidenced based practitioners which include training in homeopathy. One example, over the last 8 years the National College of Natural Medicine has received about $2.4 million. SBM readers can.Link to NCNM’s website and read ads for the Unda brand of homeopathic energetic medicines and purchase their homeopathic flash cards.
    Eugenie Mielczarek

  5. Harriet Hall says:

    I have one quibble. You say that with adequate regulation, alternative medicine would cease to exist. I doubt that: I think it would only go underground. During prohibition, alcohol didn’t cease to exist. Until the human brain evolves to prefer scientific thinking to magical thinking, alternative medicine will always be with us in one form or another.

    1. wolf 10 says:

      The NSA will catch them.

    2. Janet Camp says:

      I was thinking the same thing, but on balance, I think it’s better if SCAM goes underground–at least I wouldn’t have to walk past the brand new “Small Stones Wellness Center” on my way to appointments with real doctors at my regional Medical Center.

    3. Cheri Thomas says:

      Stupid people will find a way to do stupid things, but that is not a reason for the government to tacitly condone them.

  6. This adjudication was actually made some time ago, and several lead cases have been adjudicated since, the published adjudication is the outcome of an appeal.

    The ASA reviews the evidence provided, which must specifically support the claims made, and for medical claims must be in the form science would normally accept.

    1. Scratch that about it being an appeal. The rest stands: they adopt a gratifyingly robust approach to claims made (I have had a goodly number of complaints upheld, some of which were defended and the defence not accepted because it amounted to cherry-picked rubbish).

      1. Alan Henness says:

        You’re getting confused, Guy! :-)

        There were two adjudications today: one was the revised adjudication against H:MC21 (Homeopathy for the 21st Century [sic]), after they appealed their original adjudication that was published in 2011. I was one of six complainants.

        The one Steven is talking about is the ASA’s second ‘master’ adjudication, intended to set the standard for homeopaths – they have now examined the evidence and found it sadly lacking. Although this was not one of my complaints, it was as a result of our first campaign to encourage supporters to report misleading claims on homeopaths’ websites.

        This really is the end of the road for them – they must not start to comply. For further details, see our website: Landmark decisions for homeopaths – The Nightingale Collaboration

        1. I believe I acknowledged this confusion, maybe the followup has not been published yet.

  7. Harriet – you are correct – I meant that it would cease to exist as a legal entity. It would be forced to go back to the shadows on the fringe.

    1. Badly Shaved Monkey says:

      And people feel a driving need for alcohol (and drugs) so there is huge money to be made from illicit trade. Clandestine sugar pillers would have a pretty tough time.

  8. Pareidolius says:

    With prohibition and ineffective option, this leaves peer-reviewed studies and searing mockery as our main weapons . . . oh, and maybe the comfy chair.

  9. Egstra says:

    “oh, and maybe the comfy chair.”

    Not the comfy chair! How about the Spanish Inquisition? Nobody expects that.

  10. WilliamLawrenceUtridge says:

    3b is missing a not before substantiated

    That appears to be an irritating error in the source document.

    1. Stopthequacks says:

      In the context of the adjudication I think it is correct not an error.
      On the ASA site this list headed Issues is preceded by the words
      The ASA challenged whether
      If I read that right it makes perfect sense, it’s just in abstracting it here the context was a little ambiguous.

  11. Zeno says:

    Our latest newsletter gives some of the background to both adjudications today and progress we’re making: Landmark decisions for homeopaths – The Nightingale Collaboration.

  12. Triple Bee says:

    On the SOH website, if you click on “news”, they have a link (left side navigation, the last item in the list) for Homeopathy offers alternative relief for hay fever sufferers. I suspect they haven’t completed cleaning up their site. :)

  13. Triple Bee says:

    And, for those interested, the SOH was (is?) welcoming the ASA‘s “evidenced-based look at Homeopathy”.

    I suspect they’re currently writing up a new press release to thank the ASA for the clarification and they’ll talk about how they look forward to being able to eliminate the SOH’s advertising budget.

    It isn’t a big change for the SOH to go from advertising nothing to advertising nothing.

  14. Carl says:

    I am sure it would survive, as do raw milk co-ops, chickenpox pops, and that gross moldy tea. But at least it wouldn’t be on the shelf in retail stores where people of average intelligence might mistake it for a respectable product. People would have to go well out of their way to get scammed.

    And I wouldn’t have to see it and get p#@$ed off about it so often. Every time I see a promo display full of oscilloscamium, I interpret it as the store telling me “we’re guessing that you are dumb enough to fall for this”.

  15. Alan Henness says:

    Anyone else finding it nigh-on impossible to post a comment more than a couple of lines long? As this edit box increases in size, the details boxes and the ‘Post Comment’ button disappear off the bottom. Happens in Chrome, FF and IE. Is it a known issue?

    1. windriven says:

      It is a known problem and is being investigated.

    2. Carl says:

      Yeah, it hardly works on my phone at all. A good desktop browser will already let you resize text boxes, so this automated thing isn’t even necessary when it isn’t causing problems.

      I think programmers invented “responsive” as a euphemism for “unstable”.

  16. Stephen H says:

    This is heartening, but leaves some questions.

    1. What claims can homoeopaths continue to make?
    2. What can they still say in their advertising?
    3. Can the same action be directed against other quackery, such as acupuncture and chiropracty?

    1. Alan Henness says:

      The ASA have previously issued guidance, the main document being: .

      Although the SoH adjudication didn’t cover all the conditions we see homeopaths claiming, it does cover quite a few. Also, this really just adds to and reinforces their previous guidance. However, I suspect some homeopaths will see this as a green light to claim conditions not covered by this adjudication. That would be a mistake and likely to get them into trouble. The H:MC21 adjudication on the same day also reinforces that there are no conditions for which there is any evidence, knocks down the Swiss homeopathy report and other evidence they supplied.

      Taken together, there is still not a jot of evidence that meets the ASA’s standards, so they can make no claims.

      The ASA has issued specific guidance on many other altmed and advertisers have to abide by that. It is flawed in some cases: eg the guidance on chiropractic and osteopathy is based on the flawed Bronfort report, but we’ve been able to make progress with these and other therapies. Our recent adjudications against the Royal London Hospital for Integrated Medicine for their acupuncture, hypnotherapy, craniosacral and reflexology leaflets have all helped put pressure on large numbers of practitioners. There’s much more to do, though…

  17. Stopthequacks says:

    An interesting and timely post by Edzard
    http://edzardernst.com/2013/07/alternative-medicine-is-it-a-cult/

    I think he is right.

  18. Bryan Bartens says:

    @HH: Altmed would undoubtedly go underground if regulatory agencies were to do there job, but “the human” brain doesn’t need any more evolving for people to prefer science over magic. Former CAM-professor Edzard Ernst is living proof of that.

  19. Depression
    Evidence-based Complementary & Alternative Medicine
    Homeopathic LM potencies Vs Fluoxetine for Depression (2009)
    http://www.csoh.ca/News_2009-09_eCAM_Depression.pdf

    Allergy
    British Medical Journal
    Potentised Allergan 30c Vs Placebo in allergic rhinitis (2000)
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC27460/pdf/471.pdf
    n=51, significant improvement in nasal airflow compared to placebo

    1. Alan Henness says:

      Nancy

      It’s not us you need to convince (although you have so far been utterly unable to provide any good evidence that would convince any critical thinker), but perhaps you could say whether the Society of Homeopaths included your evidence in their submission to the ASA or, if not, why not?

    2. WilliamLawrenceUtridge says:

      Considering antidepressants are recognized as only useful in the treatment of severe depression, this study included an undefined number of patients with moderate depression, and the homeopathic preparation showed the same results as the antidepressant, you’ve basically proven that homeopathy is about as effective as another fairly ineffective treatment. Particularly given the effects of fluoxetine aren’t necessarily visible until over a month of taking it. Not to mention, did you notice the flow chart on page 4? 5 out of the original 48 patients assigned to homeopathy were exlcuded from the final analysis due to clinical worsening (compared to 1 in the fluoxetine group) and 10 were lost in follow-up (compared to 8). So, when you plan a study of 91 patients, end up with 55, and you’ve excluded five times the number of patients from the homeopathy group because they’re not doing well, perhaps you end up with a biased final result. The paper says it tests for this, but I wonder…

      There don’t seem to be many review articles on pubmed, suggesting that there’s not much research in the area (what little there is, is hardly promising), thank the FSM.

      Your paper on rhinitis is 10 years old. The thing about individual papers is you can pick the ones you like, and discard the ones you don’t. That’s why systematic reviews are superior evidence. In this case, the results are not good.

      I get it, you need to justify your practice intellectually, because otherwise your professional life has been a complete waste of time, and ethically, because otherwise you’re charging people for worthless sugar pills. May I suggest changing professions?

  20. Narad says:

    They also used nonstandard MADRS definitions in order to get “Moderate to Severe” into the title, as I recall.

    1. WilliamLawrenceUtridge says:

      They did indeed!

  21. s says:

    It actually makes sense to ask the author of the ad for substantiation first. Often, they can’t provide it, as here, and that can end the investigation. If they do provide something, it can be checked. This save resources.

    1. Alan Henness says:

      Indeed. If an advertiser makes a claim, yet can’t substantiate it when challenged, you have to ask why he/she made the claim in the first place…

      The problem that many homeopathists, etc have trouble with is the standard of evidence. Many would like the ASA to accept anecdotes (or patients experiences, as they sometimes call them) as valid evidence. They just can’t see the problem with that.

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