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Homeopathy in the ICU?

ResearchBlogging.orgEditor’s note: It’s still a holiday weekend in the United States. I had considered simply taking the day off altogether, particularly since I’m busily working on my talk for TAM8–which (holy crap!) is in a mere three days–but then I figured today’s a good time to resurrect a “classic” (if you will) post that I wrote a few years ago, dust it off, and post it. I decided to do this mainly because I had been planning on bringing this post to SBM at some point right from the very beginning of SBM.

Regular readers of this blog are probably familiar with a certain homeopath named Dana Ullman. So persistent is he in his pseudoscientific arguments for the magic that is homeopathy that fellow SBM blogger Kimball Atwood once postulated a humorous law he dubbed the Dull-Man Law:

In any discussion involving science or medicine, being Dana Ullman loses you the argument immediately…and gets you laughed out of the room.

Kimball then pointed to a number of studies that Ullman likes to cite ad nauseam that supposedly “prove” the efficacy of homeopathy. One study Kimball didn’t mention, however, is a favorite of Ullman’s, one he likes to trot out time and time again. Specifically, it’s a study of homeopathy in the ICU that was published, in all places, in Chest, a respectable journal that, as you might expect, is dedicated to research on diseases of the chest, such as chronic obstructive pulmonary disease (COPD), cardiac disease, and basically any disease that manifests its pathology in the chest, although it primarily deals with critical care. I first learned of this study way back in 2007 from Dr. R. W., who at the time commented quite aptly that the article impressed him with just how far into the medical mainstream woo has penetrated, while retired doc also expressed his dismay.

Although I do feel a bit guilty not providing you with more original peerless prose pontificating on medical pseudoscience that you know and (hopefully) love, this article is constantly trotted out by homeopaths, even five years later, and that makes it worth updating an older post from another source. So here’s the abstract:

Influence of Potassium Dichromate on Tracheal Secretions in Critically Ill Patients.

Michael Frass, MD; Christoph Dielacher, RN; Manfred Linkesch, MD; Christian Endler, PhD; Ilse Muchitsch, PhD; Ernst Schuster, PhD and Alan Kaye, MD. Chest. 2005;127:936-941.

* From the Ludwig Boltzmann Institute for Homeopathy (Drs. Frass, Endler, and Muchitsch), Vienna, Austria; II Department of Internal Medicine (Mr. Dielacher and Dr. Linkesch); Department of Medical Computer Sciences (Dr. Schuster), University of Vienna, Vienna, Austria; and Department of Anesthesiology (Dr. Kaye), Texas Tech University Lubbock, TX.

Background: Stringy, tenacious tracheal secretions may prevent extubation in patients weaned from the respirator. This prospective, randomized, double-blind, placebo-controlled study with parallel assignment was performed to assess the influence of sublingually administered potassium dichromate C30 on the amount of tenacious, stringy tracheal secretions in critically ill patients with a history of tobacco use and COPD.

Methods: In this study, 50 patients breathing spontaneously with continuous positive airway pressure were receiving either potassium dichromate C30 globules (group 1) [Deutsche Homöopathie-Union, Pharmaceutical Company; Karlsruhe, Germany] or placebo (group 2). Five globules were administered twice daily at intervals of 12 h. The amount of tracheal secretions on day 2 after the start of the study as well as the time for successful extubation and length of stay in the ICU were recorded.

Results: The amount of tracheal secretions was reduced significantly in group 1 (p < 0.0001). Extubation could be performed significantly earlier in group 1 (p < 0.0001). Similarly, length of stay was significantly shorter in group 1 (4.20 ± 1.61 days vs 7.68 ± 3.60 days, p < 0.0001 [mean ± SD]).

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

Holy homeopathy, Batman! Does this study mean that homeopathy actually works for critically ill patients in the ICU? Not so fast there, Robin. Let’s take a look.

First off, the title is interesting. Note how the word “homeopathy” or “homeopathic” does not appear. In fact, no derivative of the word “homeopathy” appears anywhere in the abstract. True, the Ludwig Boltzmann Institute for Homeopathy is mentioned in the institutional affiliations, but that would be easily missed by someone perusing the abstract. It’s almost as though the writers were trying to get this in under the radar. After all, most doctors don’t know much about homeopathy, which means that they don’t know much about what a “30C” dilution is or that such a dilution dilutes a substance to the point where there almost certainly isn’t a single molecule left.

First a word about the methods: Apparently in homeopathy lore, potassium dichromate is useful for treating thick respiratory secretions. On what basis, I don’t know. From where I come from, potassium dichromate is a nasty chemical; it’s a powerful oxidizing agent. Indeed, it’s sometimes used to clean laboratory glassware, although I never used it for that. It’s also used in photography and screen printing. It’s pretty toxic stuff and can cause a nasty dermatitis. Given all that, it’s a good thing that this stuff was diluted to nonexistence before being administered to patients sublingually (under the tongue)! If it weren’t, it could have caused some damage.

This all makes me wonder how this study ever got past the Institutional Review Board (IRB). After all, if there’s active ingredient left over, then the study would be proposing to give a toxic substance to patients on ventilators in an ICU. If the investigators made it very clear to the IRB that the dilution would be such that there would be no potassium dichromate left, then the IRB should have asked about the ethics of giving both experimental groups what is, in essence, a placebo. More disturbing is that the investigators stopped the administration of β-agonist bronchodilators to these patients before they were started on placebo or treatment, in order “to avoid any potential influence and/or interaction.” Again, if there is potassium dichromate in the homeopathic remedy, then why did the IRB allow the investigators to administer it in the first place with no supporting evidence, either in clinical or animal models, that it might have an effect? If there is no potassium dichromate in the homeopathic remedy, then stopping effective medications in both study groups strikes me as unethical. In fact, the investigators essentially admit that it is diluted to nothing:

In homeopathic concentrations, potassium dichromate acts primarily by its mucolytic properties. In this study, we used a preparation of C30, which is equivalent to a potentiation of 30 dilutions, in which each of the 30 dilution steps is followed by subsequent vigorous succussions. Therefore, the above-described toxic effects were eliminated. In addition, the original orange-red color disappeared during the preparation. Onset of action may vary from patient to patient but is generally observed within 24 to 48 h.

What “above described toxic effects,” you ask? None, really. The investigators didn’t describe any potential toxic effects from potassium dichromate until the discussion section. Apparently, the reviewers didn’t read this study too carefully (which is, of course, one possible explanation for such woo making it into a journal with an impact factor of 4.008). Be that as it may, let’s look at the patient characteristics, shall we?

First, there were only 25 patients in each group, which is a pretty small number for anything other than a pilot study. You have to remember that, when studies are small, spurious results are more likely to occur. At first glance, the patient characteristics in this table appear pretty well balanced. At first glance. Actually, this is a good example of when statistical nonsignificance doesn’t necessarily mean clinically nonsignificant. For one thing, the stage of COPD in the control group was higher than that of the treatment group (1.20 ± 0.5 versus 1.08 ± 0.4, p=0.178). This seems very odd, because both groups are listed as having mild COPD by this criteria, given that the COPD stages run from 0 to 3, with 0 being normal lung function and 1 being the least severe. If the average COPD stage for each group was close to 1, then why did the patients have such difficulty coming off the ventilator? Something’s odd there, since the mean FEV1 (forced expiratory volume in 1 second) was 54.0 ± 5.3% in the potassium dichromate group and 52.4 ± 5.5% in the control group, both of which are very close to the range of stage 2 COPD (FEV1 between 35% and 49%). In other words, it would seem that most of the patients were bad stage 1 patients.

A more interesting difference, however, and potentially more likely to influence the results of the study comes when you look at the number of patients who were on home oxygen before being hospitalized and developing respiratory failure. In the control group, 9/25 patients were on chronic home oxygen, whereas in the potassium dichromate group, only 5/25 were on home oxygen. Leaving aside that both numbers seem very high for two groups whose COPD scores are 1.2 or below given that it’s usually patients with stage 3 COPD who require home oxygen, it is clear that the control group had nearly twice the number of patients who were on home oxygen before admission. This seems inconsistent with a small difference in the COPD score, and the low COPD scores seem inconsistent with such severe exacerbations. After all, the definition of stage 1 COPD is:

Often minimal shortness of breath with or without cough and/or sputum. Usually goes unrecognized that lung function is abnormal.

Essentially no patients with stage 1 COPD need home oxygen. Ditto stage 2 COPD, which is defined:

Often moderate or severe shortness of breath on exertion, with or without cough, sputum or dyspnea. Often the first stage at which medical attention is sought due to chronic respiratory symptoms or an exacerbation

By the measurements listed, the average patient in both groups had at worst slightly worse than stage 1 COPD, which makes it odd indeed that 36% and 20% of the control and potassium dichromate groups, respectively, were on home oxygen. Let’s just put it this way. Needing home oxygen is a good marker for one of two things: either more severe COPD or other concurrent lung conditions. Those four extra patients on home oxygen could potentially account for the longer time to extubation and longer length of stay in the hospital in the control group. We can’t tell if they do or not because the data isn’t presented in such a way to allow us to do so. It’s possible that the differences in patients on oxygen before admission made a difference. It’s also possible that this is just a spurious result from a relatively small study. Or, it’s possible that it might be correct and there might really be an effect, but this latter scenario is unlikely given the flaws in the study and the fact that no homeopath has yet explained a mechanism by which something like homeopathic potassium dichromate might do a single thing to eliminate secretions–or anything else, for that matter.

The bottom line is that, contrary to Dana Ullman’s representation of this study as slam-dunk evidence of the efficacy of homeopathy, it’s nothing more than a very questionable study in which it is unclear whether the treatment and control groups were truly comparable. The homeopaths’ conclusion would be hilarious were it not so sad that such woo has found its way into otherwise reputable journals:

The present study suggests that potassium dichromate C30 may be able to minimize the amount of tracheal secretions and therefore to allow earlier extubation when compared to placebo. Since the potentiation (dilution and vigorously shaking) of the study drug beyond the Avogadro number imposes no interaction with the patient’s metabolism, and due to the low cost of the drug, its use in the ICU may be beneficial, minimizing morbidity and mortality. Studies give some insight into the potential way of action of homeopathically prepared drugs. Cluster-cluster aggregation phenomena in aqueous solutions of fullerene-cyclodextrin conjugates, β-cyclodextrin, sodium chloride, sodium guanosine monophosphate, and a DNA oligonucleotide revealed that there are larger aggregates existent in dilute aqueous solutions than in more concentrated solutions.20 In another study, ultra-high dilutions of lithium chloride and sodium chloride (10-30 g cm-3) have been irradiated by x-rays and gamma-rays at 77 K, then progressively rewarmed to room temperature. During that phase, their thermoluminescence has been studied and it was found that, despite their dilution beyond the Avogadro number, the emitted light was specific of the original salts dissolved initially.

This is the first scientific study of the effect of potassium dichromate on tracheal secretions. While the mechanism of potentized (diluted and vigorously shaken) drugs still remains subject to research, several articles describe its clinical usefulness. The effect may be best explained by cybernetics, which means that the information of the homeopathic drug acts consensually on the regulator. Thereby, the body regains its original property to regulate physical parameters.

First off, it’s nice to see that the investigators essentially admit that diluting above Avogadro’s number eliminates any trace of the compound. It is, however, unclear why they brought up ultrahigh dilution solutions irradiated at 77 Kelvin (or -196° C) and then rewarmed. First off, 10 to 30 molecules per cc is an incredibly concentrated solution in homeopathic terms. Second, homeopaths don’t cool their solutions down to the temperature of liquid nitrogen, irradiate them, and then slowly rewarm them, making me doubt very much the relevance of the experiment to anything that homeopaths do. But the part about cybernetics cracks me up. That one was clearly pulled out of someone’s hat (or perhaps out of their nether regions); yet it got by the reviewer.

As much fun as I have deconstructing such studies, hoping in vain for a good study but inevitably being disappointed, it is still disconcerting to see this sort of study published in Chest. More disturbing still is that an IRB allowed such a study of a useless medication on intubated ICU patients with COPD. It just goes to show that peer review is not perfect. It may remain the best bulwark against pseudoscience, but it’s only as good as the reviewers, and it’s not a foolproof guarantee against pseudoscience. As you can see from this study, it’s making its way into even the ICU, which is one place where evidence-based medicine should rule supreme and in which there should be no place for woo or quackery. What I fear is that, as more and more pseudoscience and non-evidence-based woo invades medical school, the dividing line between evidence-based medicine and woo will blur even more, and, as the older generations of physicians retire, the newer generation, who has been exposed to woo in medical school, will be less willing or able to call a duck a duck when they see it. Quack quack.

REFERENCE:

Frass, M. (2005). Influence of Potassium Dichromate on Tracheal Secretions in Critically Ill Patients Chest, 127 (3), 936-941 DOI: 10.1378/chest.127.3.936

Posted in: Clinical Trials, Homeopathy

Leave a Comment (68) ↓

68 thoughts on “Homeopathy in the ICU?

  1. This one was unbelievable. I blogged it briefly in 2007 at http://www.dcscience.net/?p=206

    I also wrote a letter to the editor of Chest, which they published (see http://www.dcscience.net/colquhoun-chest-2007.pdf ) but the journal showed little sign of repentence and gave the last word to the quacks.

    This sort of curruption if real journals with pseudooscience is more worrying to me than any High Street homeopath.

  2. squirrelelite says:

    I was curious about those mucolytic properties, so I checked in Wikipedia.

    A mucolytic agent or expectorant is any agent which dissolves thick mucus and is usually used to help relieve respiratory difficulties. It does so by hydrolyzing glycosaminoglycans, tending to break down/lower the viscosity of mucin-containing body secretions/components.

    Sounds like an easy test to do in a lab without taking ICU patients off effective medications just to see. Did they cite any references that demonstrate a superior mucolytic effect over, say, just plain distilled water?

    The cybernetic effect sounds like sheer hand waving since, as far as I know, no one has yet demonstrated this homeopathic information storage and retrieval.

    Are they also working on a homeopathic quantum computer to replace your “friend”?

  3. Draal says:

    Dr. Gorski, there is likely an error of the analysis of the conclusion. The ultra high dilution of lithium chloride (10-30 g cm-3) should be interpreted as 10^-30 g/cm^3, not 10-30 molecules in a cc. Rather it roughly is approximate to one part per 10^30 which is close to 1 molecule in 150 liters of water (doing mental math after the 4th, ouch).

  4. Draal says:

    Ok, 1 part per 3300 liters is probable a little more accurate but you get the idea that 10-30 per cc is off by a factor of 10,000.
    Or, whatever.

  5. nitpicking says:

    Cluster-cluster aggregation phenomena in aqueous solutions of fullerene-cyclodextrin conjugates, β-cyclodextrin, sodium chloride, sodium guanosine monophosphate, and a DNA oligonucleotide revealed that there are larger aggregates existent in dilute aqueous solutions than in more concentrated solutions.20

    Admittedly I only took three years of organic chemistry and one year of graduate biochem, but …. what?

    Fullerenes? Buckyballs? What does C60 have to do with anything? And what do “dilute aqueous solutions” have to do with homeopathic “solutions” (that is, pure water)?

    Unfortunately, the reference appears to be to Samal, S, Geckeler, KE Unexpected solute aggregation in water on dilution. Chem Commun 2001;,2224-2225, and I don’t have access to Chemical Communications to figure out what the heck they’re talking about.

  6. DanaUllman says:

    Gorski, Gorski, Gorski,

    Thank you for acknowledging that you do not know on what basis homeopaths have chosen to use this drug in the treatment of people with thick tracheal secretions. In so doing, you are PROVING how little you know about homeopathy. You do not seem to know or understand one of the most basic principles of homeopathy. Have you ever read a book on homeopathy…heck, have you ever read a simple introduction to homeopathy (other than those written by your ilk of “medical fundamentalists” and “deniers of science”)?

    If you have read ANY article, it seems that you still did not understand it…and you have just verified it. Thanx for this verification…

    It seems that you do not know that the vast majority of homeopathic medicines undergo experiments called “drug provings,” that is, experiments in human toxicology to determine what a substance CAUSES in overdose. Whatever a substance causes in overdose, it will help to cure in homeopathic dose.

    Now, I bet that you (and most of your ilk who read this silly site of people pretending to be knowledgeable) don’t know the common doses used in homeopathic provings. This is simply more evidence of your ignorance…but you’re so good in not letting your ignorance get in the way of your arm-chair theorizing.

    It is interesting how you deem double-blind studies in toxicology to be “homeopathic lore.” Hmmmm. You gotta get a job at Fox News because you are too good at pretending to be “fair and balanced” and in the “no spin zone,” even though you only convince the tea party contingent and their ilk.

    But the icing on the cake is your decision to avoid reference to the chart of RESULTS of this trial. Therefore, PLEASE tell us all what the results of this trial would be if you took out the FIVE best responders to the homeopathic medicine.

    If you really think that the treatment and the control group were not adequately matched…and if this difference was FIVE subjects, please tell us all what results would be left? Come on…tell us all.

  7. DanaUllman says:

    How dare CHEST publish research that shows positive results from a homeopathic medicine…and how “unethical” to give any credence to homeopathy!? Gorski is actually upset that anyone would allow a medical journal to publish positive results from anything other than conventional drugs. Awwwww…

    It seems that Gorski would prefer if people with COPD suffered more…and spent more time in the hospital. The length of stay in the hospital in the homeopathic treated group was almost HALF that of the placebo group…and we must assume that Gorski considers this a BAD result. Wow, what a humanitarian.

    And I couldn’t help but notice that Gorski didn’t mention that this study was conducted at the University of Vienna Hospital. You’re gonna need more tar in order for your mis-logic to stick.

    By the way, David C’s letter to the editor was a laugher. He too was shocked that this research was published, even though his letter didn’t mention a single solid critique of the study itself

  8. DanaUllman says:

    Wow…this silence is LOUD! I guess Gorski (and others) now actually have to READ the study…and even have to learn something about homeopathy (finally). See bubble, see bubble burst.

  9. dwpeabody says:

    Some times you have to be thankful for people like Dana, I think he does his own cause more harm than evidence ever could.
    The words that spring to mind when I read his replies about like curing like without a jot of evidence are: Sad, Pathetic and desperate.
    Even if this study did not have obvious flaws it would not prove anything until several larger studies began to replicate the result. You can not base opinions on a few flawed/poorly controlled studies when the majority of scientific theory & trials are against your position.

    I think Dana needs to look into the sunk costs fallacy and cut his losses. I’m sure he could still make a fantastic Novelist in the fiction category.

  10. DevoutCatalyst says:

    I had sauerkraut ice cream for supper last night and dreamt that Dana Ullman was a strawman sockpuppet of David Gorski. Ever notice how Ullman magically appears when David posts about homeopathy? Hah, but alas, it’s just a man and his water betraying the melting witch voices of Hahnemann and his latter day wet dreamers. Say, Dana, how come homeopathy doesn’t sponsor NASCAR? Viagra does ! Proof positive to your way of thinking that allopathy gives us the best boners in the business, and the only boner your side gets is the space between your smiling ears. Bonjour !!!

  11. JJ from Cowtown says:

    D.Ullman…

    “homeopathic medicines undergo [...] experiments in human toxicology to determine what a substance CAUSES in overdose. [...] Whatever a substance causes in overdose, it will help to cure in homeopathic dose. ”

    So once you figure out the LD50 you can cure death itself?

    …also, ignoring how that explanation holds little water, the study goes out of its way to point out that no toxic substances are actually in use at C30…

  12. DanaUllman says:

    That was so predictable! Attack the messenger, not the message!

    Or heck, bring LSD into the discussion (out of thin air).

    James Randi is impressed with your misdirection.

    As for mechanism of action, is ANYONE really saying or even suggesting that you know the mechanism of all most of the conventional drugs in use today? Come on, say it.

  13. dwpeabody says:

    Not knowing the exact mechanism of action is quite different than proposing a mechanism that has no basis in science. It’s a non sequitur and does not for one second validate homeopathy.

    Just saying “like cures like” with no supporting theory behind it is a meaningless statement, it is a failed hypothesis.

  14. qetzal says:

    FWIW, using the given mean and SD, and the fact that COPD stage can only be 1, 2, or 3, it’s easy to figure out the distribution of patients in each group.

    The control group consisted of 21 Stage 1 patients, 3 Stage 2 patients, and 1 Stage 3 patient. The treatment group consisted for 24 Stage 1 patients and 1 Stage 2 patient.

    What I’d like to know is why these patients were intubated. Is it normal to have to intubate Stage 1 COPD patients? Or was there some acute event that necessitated intubation? The first sentence of the Patients section of Materials and Methods states:

    Due to the severity of the acute respiratory failure, patients received controlled mechanical ventilation with a respirator (Servo 900C; Siemens Elema; Solna, Sweden) between 3 days and 7 days before study enrollment in a university hospital.

    To me, that sounds like these were (mostly) borderline mild COPD patients who had an acute respiratory failure for some reason, which required hospitalization and intubation. They were apparently enrolled in the study subsequent to those events. If so, isn’t it important to evaluate the causes and/or severity of the acute failures, and determine if there were important differences between groups? Seems at least as relevant as COPD stage and FEV1 prior to the acute failure.

    I do note, however, that the in-hospital values in Table 1 are pretty similar between groups. If those are “post-failure” values, then perhaps they address the above concern (assuming, of course, that any clinically significant group-wise differences would be apparent from those parameters).

    In any case, I think it’s only fair to acknowledge Dana Ullman’s point. From the numbers in Table 2, I think it’s extremely unlikely that any of the significant differences would become non-significant just by excluding a few outliers (from either group). In particular, Table 2 indicates that none of the control group patients could be extubated prior to day 3 or discharged prior to day 4. In contrast, extubation and discharge in the treated group averaged day 3 and 4, respectively.

    As far as I can see, this study seems to be a reasonably solid study in favor of homeopathy. It’s got some flaws, but I suspect we could find at least as many flaws in a large majority of comparable studies of ‘conventional’ treatments in a journal like Chest.

    And yet, I’m not persuaded in the least that homeopathy really “worked” in this study. This is no different than any other small scale blinded study. Even with no bias whatsoever, such studies will occasionally appear positive by sheer coincidence. We see it happening with drugs all the time. Drug candidates that seemed to work great in Phase II turn out to be no better than placebo in Phase III. And that’s without even considering that homeopathy is physically and physiologically impossible based on our current understanding.

    When the Ullmans of the world can point to a single homeopathic treatment that works repeatedly in different clinics, in a defined set of patients, I’ll sit up and take notice. Until then, all the occasional, one-off successes will never be enough to show that homeopathy works.

  15. qetzal says:

    Typo: The treated group consisted of 24 Stage 1 patients and 1 Stage 3 patient.

  16. WilliamLawrenceUtridge says:

    The funny thing is, if homeopathic preparations (I guess via the shaking?) actually result in essentially large clusters of molecules in very dilute solution (i.e. a small number of large clusters of molecules rather than a large number of individual molecules, distributed evenly throughout a solution), that means you’re even less likely to get even a single molecule than you would if the molecules were simply spread out like in a saturated sodium chloride solution. This actually makes more problems, since you’re less likely to get one of these balls of molecules even sooner (let alone how somehow getting one of those balls of molecules would help more than simply getting a solution of individual molecules).

    Dana:

    1) Calling homeopathic preparations a drug is a stretch.

    2) Understanding how homeopaths choose their products (getting a bunch of people to take a large dose and noting responses) doesn’t help understand how getting a tiny dose would help. Your assumption has an unproven premise – that a symptom-causing dose would relieve that symptom when given in nonexistent doses.

    3) Dr. Gorski’s complaint is clear from the beginning – this is a low-n, unreplicated trial. With only 50 people, particularly 25 people split into two unequal groups with different characteristics from their randomization, it’s far easier to see a false effect.

    4) The criticisms raised are of methods – the methods of the study (particularly lack of comparability at baseline, a significant problem for a low-n study) and the nonsensical preparation of the homeopathic remedy (in addition to the standard methods – shaking and dilution, why freeze, irradiate and rewarm?).

    5) Dr. Colquhoun’s letter does indeed have a critique – that the “therapeutic agent” (potassium dichromate) wasn’t actually received by any patients given the dilution was past the point of containing a single molecule. His criticism is clearly stated in the statement “The fact of the matter is that the medicine contained no medicine.” He goes on to criticize a fairly standard reply by homeopaths – the memory of water – which if true would allow them to avoid the “medicine contains no medicine” criticism.

    6) JJ mentioned LD50, which is different from LSD. LD50 is (correct me if I’m wrong) the lethal dose for 50% of the population, also known as the medial lethal dose (http://en.wikipedia.org/wiki/Median_lethal_dose). LSD is the hallucinogen lysergic acid diethylamide (http://en.wikipedia.org/wiki/Lysergic_acid_diethylamide).

    7) Your assertion that we don’t know the mechanism for most drugs ignores the fact that we have a probable mechanism for them to work – the drug interacts and interlocks with proteins and receptors in a dose-dependent manner to alter biological processes. By analogy – I don’t know exactly how paper is prepared, but I do know it is by manipulating the chemical and physical properties of lignin. I’ve got a probable general mechanism even if I don’t know the exact details. Homeopathy lacks this.

    8) You are calling people out for not replying to your comment after less than an hour. This isn’t exactly a riveting topic, and it’s a reprint of a past post. No-one really cares, so relax.

    Also, I still have some questions – what is your proposed mechanism for homeopathy to work? Is it information? How is the information stored? How is it transmitted? How is it conveyed? Is it quantum mechanics? How do the quantum effects avoid getting washed out once you get to scales beyond subatomic particles? How is it that water has a memory, but most homeopathic preparations are given in the form of a small bead of sugar? If water has a memory, how is it transferred to a totally different material (from a liquid to a crystalline ball)? Have there been any trials in which patients or homeopaths have reliably been able to differentiate between actual homeopathic preparations and simple sugar pills that have never been exposed to homeopathically prepared liquids?

    I’ve posed these questions before, but never received an answer. I look forward to your reply; I assume it’ll arrive in less than an hour.

  17. Adam_Y says:

    As for mechanism of action, is ANYONE really saying or even suggesting that you know the mechanism of all most of the conventional drugs in use today? Come on, say it.

    Yes we do. At a fundamental level every single pharmaceutical drug obeys one simple law. The law of mass action.

  18. Peter Lipson says:

    I have never been more amused than when Dana confused LSD and LD50.

  19. bcorden says:

    Thanks for this analysis. I got upset with this study when it was used to get approval for C30 potassium dichromate for the use in our community hospital ICU (P&T Committee). I was the only one to vote against it. In calculating the size of a vessel that would hold one atom at a C30 dilution (shaken, not stirred) it came out to be a sphere with a radius somewhere around the orbit of Mars. I’m still trying to get it off the formulary since it has never actually been used.
    BTW, there has never been a follow-up study or anyone who tried to duplicate these fantastic results.

    “Dear loved one, we are going to give your daddy some water. It is going to make him better. (and it only costs $250 a shot)”

  20. David Gorski says:

    @Peter Lipson

    I agree. It’s so amusing that I didn’t bother to reply. I was too busy laughing.

  21. Harriet Hall says:

    I was already laughing when he started talking about ad hominems. Go back and read his initial comments. All he does is disparage Dr. Gorski.

  22. But, but … it’s so small! RCTs that teensy can’t prove anything even if they’re perfectly designed and executed. Abnormalities in just a couple of subjects start throwing the numbers off.

    All you can do with a very small study is think about maybe doing another one. Maybe. Unless we’re talking about a small homeopathy study, in which case you should just say bollocks and go for a pint.

  23. LSD, LD50 … you say toe-may-toe …

  24. DanaUllman says:

    I too am laughing at my typo.

    The issue of LD50 has NOTHING to do with homeopathy because we do not use such doses (you do!).

    I did notice that, as yet, nobody here seems to know what dose homeopaths use when they conduct the “drug provings”. Come on now…is anyone out there a little knowledgeable? Probably not. This is not a personal attack; this is fact that you folks continually verify.

    WilliamLawrence…is one of the few honest people here…and possibly the only one who has read the article in CHEST.

    His questions about how homeopathic medicines work are partially answered in the work of Martin Chaplin, V. Elia, Rustom Roy, and Luc Montagnier (you can hear his latest speech that he gave at a conference with numerous Nobel Laureates:
    http://eurovision3.feedroom.com/?skin=showcase&fr_chl=ff514afb93462930eb1c755a400a1693571be6d7

    It is laughable that you folks still say that there is “nothing” in homeopathic medicines despite the numerous basic sciences trials (including a large number that have been replicated)…as well as the body of clinical trials (respiratory allergies, childhood diarrhea, influenza, fibromyaglia).

    You can review my recent article (with Michael Frass, MD, lead author of the CHEST article) at http://www.altmedrev.com (article #6).

    But heck, you folks actually think that all water is the same…and you seem so arrogant to assume that shaking solutions has no effects…THAT is being deaf, dumb, and blind…but that is what a closed mind will do for ya.

  25. David Gorski says:

    Dana, Dana, Dana, thanks for the blogging material, either here or at my other locale. ;-)

  26. ShanefromAus says:

    Dana I followed the altmedrev link to your article and to your website.

    Your website is an obvious commercial enterprise and I think the first comment I would make is that you should declare your obvious pecuniary interest in the same way all the alleged big pharma shills on this website have to.

    The fact that you dont made me wonder why.

    I then started to read your article:

    A Review of Homeopathic Research in the
    Treatment of Respiratory Allergies

    I was interested to read your first statement.

    “There is actually a larger body of clinical3,5,6 and
    basic science7,8 research that has tested homeopathic
    medicines than most people realize.”

    Following through your references I found reference 3:

    Ullman D. The Homeopathic Revolution:
    Why Famous People and Cultural Heroes
    Choose Homeopathy. Berkeley, CA:
    North Atlantic Books; 2007.

    This is your scientific evidence? Celebrity endorsement???

    refernece 5
    Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials.
    INTERPRETATION: The results of our meta-analysis are not compatible with the hypothesis that the clinical effects of homeopathy are completely due to placebo. However, we found insufficient evidence from these studies that homeopathy is clearly efficacious for any single clinical condition. Further research on homeopathy is warranted provided it is rigorous and systematic.

    - insufficient evidence???

    reference 6 doesnt appear to exist on the web apart from your article reference.

    reference 7 – No idea if this is a credible journal or not.

    The in vitro evidence for an effect of high homeopathic potencies–a systematic review of the literature
    CONCLUSIONS: Even experiments with a high methodological standard could demonstrate an effect of high potencies. No positive result was stable enough to be reproduced by all investigators. A general adoption of succussed controls, randomization and blinding would strengthen the evidence of future experiments.

    Unable to reproduce findings. Isnt positive evidence for a theory the fact that other workers CAN reproduce your findings?

    A link to the above paper in pubmed also turned up this study.

    A systematic review of the quality of homeopathic pathogenetic trials published from 1945 to 1995.

    It is a study related to what you call ‘provings’ The concept you claim above that people here dont understand.

    CONCLUSIONS: The HPTs were generally of low methodological quality. There is a high incidence of pathogenetic effects in publications and volunteers but this could be attributable to design flaws. Homeopathic medicines, tested in HPTs, appear safe. The central question of whether homeopathic medicines in high dilutions can provoke effects in healthy volunteers has not yet been definitively answered, because of methodological weaknesses of the reports. Improvement of the method and reporting of results of HPTs are required.

    And another link to this:
    Quality assessment of physical research in homeopathy.

    RESULTS: Most publications were of low quality (SAPEH 7, including 2 points for adequate controls). These report 3 experiments (1 NMR, 2 black boxes), of which 2 claim specific features for homeopathic remedies, as does the only medium-quality experiment with sufficient controls. CONCLUSIONS: Most physical experiments of homeopathic preparations were performed with inadequate controls or had other serious flaws that prevented any meaningful conclusion. Except for those of high quality, all experiments should be repeated using stricter methodology and standardization before they are accepted as indications of special features of homeopathic potencies.

    30 minutes searching and not one positive or difinitive paper to support your contention that:

    “There is actually a larger body of clinical3,5,6 and
    basic science7,8 research that has tested homeopathic
    medicines than most people realize.”

    And then it struck me, what a clever use of words –

    There is quite a large body of clinical and basic science that has tested homeopathic
    medicines – and none of the references or papers actually SUPPORT it. Did you miss that bit when you were writing it??

    If you are using such disengenuous means to mislead the reader at the very start of the article I realised that you are not a genuine researcher nor using credible or honourable science. I decided not to waste any more energy on this.

    In light of this I doubt anything you say or claim can be taken seriously, in particular the condescending tone you take with your interlocutors it doesnt attest to a good character.

  27. dwpeabody says:

    “It is laughable that you folks still say that there is “nothing” in homeopathic medicines despite the numerous basic sciences trials (including a large number that have been replicated)…as well as the body of clinical trials (respiratory allergies, childhood diarrhea, influenza, fibromyaglia).”

    I was about to call that out as complete lies…. However he is being quite honest. There have been many trials unfortunately they almost all show no effect.

  28. WilliamLawrenceUtridge says:

    Dana, that’s a talk. Do you have anything peer-reviewed, that has been tested repeatedly and replicated?

    What exactly is Chaplin et al.’s purported mechanism? Can you summarize it? Where is their research base? Again, peer-reviewed, because even though it’s a movie on the Nobel Prize website, it’s still not a journal article.

    The reason an LD50 is important is because we know, we can demonstrate, that medicines have proven effects and we have to know what the toxicity is in order to establish a therapeutic index and a risk:benefit ratio. Homeopathy, on the other hand, has difficulty establishing any sort of efficacy with any consistency – and this is despite just how easy it would be to run a truly strong randomized controlled trial.

    I’ve read your allergies paper. You cite papers like the very one criticized in this article – single experiments, without replication, by the same lab, showing equivocal results, with low numbers of subjects. No large-scale studies that would be seen as convincing, where idiosyncrasies in a small number of subjects can throw off the readings (and much harder to conduct, therefore a fairer test of type I and type II errors). While you cite small-n designs, the Cochrane Collaboration links and analyzes multiple studies with thousands of subjects. Their reviews tend to be much worse and conclude negatively on homeopathy – at best, more and better controlled research is required, not that it works. See, for instance, http://www.ncbi.nlm.nih.gov/pubmed/14973954, http://www.ncbi.nlm.nih.gov/pubmed/12535487, http://www.ncbi.nlm.nih.gov/pubmed/14583972.

    Finally – does it matter what dose is used in a proving (wikipedia says 30C, making it somewhat circular)? There is still a basic failing you haven’t addressed – on what basis is there any belief that a high dose (relative to a homeopathic preparation) will induce an opposite response to a low dose? We know it can’t be hormesis, because it still requires a measurable amount of the drug or stimulus – and we know homeopathic preparations frequently have none.

    You chortling and chuckling over our ignorance, while consistently dodging actual, serious questions, suggests the weakness of your position and inability to actually answer anything (i.e. why shake the water then splash it on sugar? How does the “information” or whatever provides the therapeutic effect transfer from liquid to crystalline sugar?). This is in addition to your apparently quite basic lack of understanding of medicine and clinical trials. Tests to establish homeopathy is, or is not, effective, would be trivial. It is quite possibly the easiest treatment to concoct a placebo for, why hasn’t this been done, and why do the highest-quality trials suggest that homeopathy has no effect?

  29. pmoran says:

    Dana, why do you really have such a staunch belief in homeopathy? I am confident that predates any of these supposedly confirmatory scientific studies, just as we have many, many reasons, other than the commonly alleged biases, for not taking them very seriously.

    You presumably have seen it work in practice. Is that the case? If so, can you give us examples?

  30. WilliamLawrenceUtridge says:

    @sciencemom

    That’s actually a good start. Wonder if it’ll get published.

    I find the concentration (12C) curious. The trial website (http://www.charite.de/epidemiologie/english/projects/HAMSV.html) statses “This trial will examine whether the oral application of a high potency homeopathic medication…

    Why pick 12C? I thought the more the dilution, the more potent the remedy. Why not use the big guns, 200C or 1000C? Hahnemann claimed 30C was the standard. 12C means the preparation could still have a single molecule left in the preparation. Is it to have it both ways? If it works – skeptics could claim it was because there was still some molecules left. If it doesn’t, homeopaths could claim it wasn’t potent enough. Seems like a wiggle-room trial, why not compare multiple dilations? Still, that’s an n of 450, isn’t it? 30 subjects * 15 sites? Better than 50.

  31. Dr Benway says:

    Second, homeopaths don’t cool their solutions down to the temperature of liquid nitrogen, irradiate them, and then slowly rewarm them, making me doubt very much the relevance of the experiment to anything that homeopaths do.

    It’s very sciency.

  32. Dr Benway says:

    I too am laughing at my typo.

    The issue of LD50 has NOTHING to do with homeopathy because we do not use such doses (you do!).

    LOL, “typo.” Nice try.

    Maybe you Googled “LD50.” But you didn’t understand what you read.

    You’re delusional if you believe MDs are killing half their patients each day.

  33. Adam_Y says:

    But heck, you folks actually think that all water is the same…

    Fine then what are they? Name all the forms of water. Describe to me what they are and what they look like.

  34. DevoutCatalyst says:

    Perrier, serially diluted and succussed, makes a good fire extinguisher. With its memory of carbon dioxide, it’s not just water, now, is it?

  35. Mojo says:

    It seems that you do not know that the vast majority of homeopathic medicines undergo experiments called “drug provings,” that is, experiments in human toxicology to determine what a substance CAUSES in overdose. Whatever a substance causes in overdose, it will help to cure in homeopathic dose.

    Another thing that people might not know is that the vast majority of “provings” are in fact carried out using the diluted remedies, not (as the above might suggest) large doses of the actual substance. See Hahnemann in the Organon (5th edition, aphorism 128), where he prescribes proving using 30C remedies:

    The most recent observations have shown that medicinal substances, when taken in their crude state by the experimenter for the purpose of testing their peculiar effects, do not exhibit nearly the full amount of the powers that lie hidden in them which they do when they are taken for the same object in high dilutions potentized by proper trituration and succussion, by which simple operations the powers which in their crude state lay hidden, and, as it were, dormant, are developed and roused into activity to an incredible extent. In this manner we now find it best to investigate the medicinal powers even of such substances as are deemed weak, and the plan we adopt is to give to the experimenter, on an empty stomach, daily from four to six very small globules of the thirtieth potentized dilution of such a substance, moistened with a little water, and let him continue this for several days.

    As a result, “provings” characteristically record the symptoms that result from not giving the substance to the subjects.

    It is also interesting that Dana does not appear to consider that individualising the remedy to the patients (by considering more than the mere fact that they were suffering from COPD) was necessary in this case. Whatever happened to “homeopathy treats the patient, not the disease”?

  36. relativitydrive says:

    I’m in the real world here. Dana, are you?

    But seriously, are you Dana? Do know know what year it is?

    Are you Marty McFly? He travelled to this exact date in Back to the Future after hitting 88mph in a pimped out Delorean in 1985.

  37. relativitydrive says:

    Ops I got that wrong. October 21st 2015. Still holds though.

  38. Mojo says:

    @WilliamLawrenceUtridge

    There is still a basic failing you haven’t addressed – on what basis is there any belief that a high dose (relative to a homeopathic preparation) will induce an opposite response to a low dose? We know it can’t be hormesis, because it still requires a measurable amount of the drug or stimulus – and we know homeopathic preparations frequently have none.

    Well, they don’t actually believe that. The basic principle of homoeopathy is that disease is treated by a remedy thad produces the same symptoms as those exhibited by the patient – not a remedy made from something that produces the symptoms. It is the diluted remedies themselves, not material doses of the substances they are made from, that are tested in “provings”. So there’s another reason that hormesis is irrelevant here.

    Double-blinded placebo controlled provings have been carried out, by the way, for example:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1884394/

  39. squirrelelite says:

    @Mojo,

    Interesting link. At least the title was honest:

    Ultramolecular homeopathy has no observable clinical effects. A randomized, double-blind, placebo-controlled proving trial of Belladonna 30C

    and the

    Conclusion
    Ultramolecular homeopathy had no observable clinical effects.

    I did get a good chuckle out of one comment in the discussion:

    Lifestyle factors may colour the outcome, e.g. Belladonna-related symptoms of ‘headache’ and ‘sinking and rising sensation in his head’ were reported following high alcohol intake the previous evening.

    In other words, if you ingest too much “proof” your “proving” may be affected. :)

    Which, of course, leads to the all too frequent EBM conclusion that

    Despite this being a clearly negative study for homeopathy, surveys confirm that patients use and continue to use homeopathy [2], and feel satisfied with their treatment [37]. Therefore future research should focus on the ideal approach through which to study homeopathy, with a shift towards understanding those factors such as the therapeutic relationship and the process of the homeopathic consultation [38, 39] that may mediate the apparent success of the homeopathic process.

    Or, we didn’t find anything significant this time either, but there may be something interesting in the noise, so let’s try to find a way to redo the experiment where we might get lucky and actually see something.

  40. Kamomilla says:

    I am just curious about the randomization process in the Chest-paper. Quote:

    “Patients were sequentially randomized into two groups: group 1 received the therapeutic agent, and group 2 received according to a computer-generated code. An independent physician not involved into the study held the code.”

    I don’t understand the sentence after the “:”. I do understand that group 1 received the actual…erm…intervention, or rather “intervention”, but – “group two received according to a computer-generated code”? Is this just a typo, or what does this mean? Am I missing something?

  41. MedTek says:

    I used Potassium Dichromate oh so many years ago, indeed for cleaning glassware. It is some very nasty stuff. If I remember correctly it gets very hot in reaction. Good stuff for getting those burned on substances out of test tubes.

    I fail to see how undiluted Potassium Dichromate would cause thickened mucus secretions in the respiratory tract. I suppose during some homeopathic “proving” (again, I have to laugh at this word, which is actually likely a misunderstanding of the German Prüfung, meaning “test”- proving nothing) someone noticed that their nose got runny, or something. Still, this does nothing for “like cures like”, so I guess it’s just another example of “make shit up”.

    Oh yes, did I mention that it’s also classed as a carcinogen?

    It’s also apparently used in HeadOn.

    I can’t *wait* to see what string of childish insults Dana trots out in response to this. Maybe I’ll luck out and he’ll just ignore me.

  42. Dr Benway says:

    Kamomilla, good pick up.

    I assumed the non-homeopathy group received a placebo visually indistinguishable from the therapeutic agent so everyone involved would be blinded. Now I wonder how effective the blinding was for this study.

  43. SuntoryBoss says:

    Mojo is absolutely right when he observes that:

    “It is also interesting that Dana does not appear to consider that individualising the remedy to the patients (by considering more than the mere fact that they were suffering from COPD) was necessary in this case. Whatever happened to “homeopathy treats the patient, not the disease”?”

    The most common bleat of homeopushers when a study doesn’t show any effect is the lack of individualisation. Oddly, the same lack of individualisation doesn’t seem to put them off trumpetting studies that do appear to show a result in their favour.

    Just more intellectual dishonesty. Dana, you need to nail your colours to the mast; either studies need to be individualised (in which case shut up about this Chest one which you tirelessly tout), or they don’t (in which case you need to stop claiming they do to explain away the plethora of studies that show you’re touting snake oil.

  44. Mojo says:

    The most common bleat of homeopushers when a study doesn’t show any effect is the lack of individualisation. Oddly, the same lack of individualisation doesn’t seem to put them off trumpetting studies that do appear to show a result in their favour.

    And oddly (;)) when the results of trials of individualised homoeopathy are carried out the results don’t seem to be any different from trials of non-individualised homoeopathy.

  45. Mojo says:

    Sorry – I messed up the formatting there…

    The first paragraph is a quotation from SuntoryBoss, the bit at the end is mine.

  46. DanaUllman says:

    You folks crack me up. Some people assert that they cannot understand how potassium dichromate could cause tracheal secretions…perhaps your lack of training in toxicology may explain it; and yet, you folks love to dwell in your own ignorance…and yet, you folks love to exude arrogance. What a bad bad combination of character flaws. This is not a personal attack; it is a statement of your observed behavior.

    It is indeed rare when a single homeopathic medicine can be used effectively for different people with the same disease due to the necessity for individualization of treatment. However, there are some exceptions to the rule, and this study in CHEST has verified this.

    The use of OSCILLOCOCCINUM in the treatment of the flu is another example, as long as it is prescribed within 48 hours of onset of the flu…and four large studies have confirmed that its results are better than placebo.

    It is fun to watch you folks try to fit square pegs into round holes as you lamely try to understand homeopathy, but your straw man attacks are way too obvious.

  47. Mojo says:

    The use of OSCILLOCOCCINUM [there's no need to shout] in the treatment of the flu is another example, as long as it is prescribed within 48 hours of onset of the flu…and four large studies have confirmed that its results are better than placebo.

    The Cocrane review of studies of Oscillococcinum for preventing and treating influenza and influenza-like syndromes, which presumably looked at the same four studies, concluded that “taking homoeopathic Oscillococcinum once you have influenza might shorten the illness, but more research is needed.” I think I’ll go with their assessment rather than yours.

  48. weing says:

    I’m sorry but this pilot study does not convince me. The noise is way too high to get any signal out of it. Only a homeopath would find it convincing. But he wouldn’t need the study anyway to continue on his merry way.

  49. pmoran says:

    Dana: “The use of OSCILLOCOCCINUM in the treatment of the flu is another example, as long as it is prescribed within 48 hours of onset of the flu…and four large studies have confirmed that its results are better than placebo.”

    Dana, give everyone a laugh. Explain what this homeopathic preparation is, and how it was discovered, how it is made, and, if you can, what its current rationale is.

    Readers can then make up their own minds up as to what weight to afford these studies, knowing how often clinical studies give conflicting results and are responsive to researcher and publisher biases.

    You have not answered my query as to how your belief in homeopathy arose. Such certainties as yours requires some understanding, with homeopathic science being so shaky in so many respects.

  50. Mojo says:

    …and yet, you folks love to exude arrogance.

    Someone owes me a new irony meter.

  51. Composer99 says:

    Dana continues to substitute his “statements of your observed behaviour” for answers of substance.

    Also, which four studies support Oscilococcinium? Got links (preferably direct to the studies themselves and not through your/other people’s commercial sites)?

    What is fun is watching you try to twist around the 227 kg gorilla of basic physical properties of matter and energy trying to justify homeopathy in the face of its obvious contradiction of same.

    And yet you’re accusing supporters of science-based medicine of fitting square pegs into round holes?

  52. weing says:

    I don’t know why this is held up in moderation but I am reposting this to Dana.

    I’m sorry but this pilot study does not convince me. The noise is way too high to get any signal out of it. Only a homeopath would find it convincing. But he wouldn’t need the study anyway to continue on his merry way.

  53. DanaUllman says:

    If anyone out there is seriously interested in evaluating clinical research that has been deemed by independent parties to be “high quality” and that have been published in conventional high impact journals, check out this article:

    http://www.thorne.com/altmedrev/.fulltext/15/1/48.pdf

    And yeah…I co-authored it with Michael Frass, MD, of the Medical University of Vienna, who was the lead author of the COPD study.

    Don’t ya hate it when high quality research published in high impact journals confirm the efficacy of homeopathic medicines?

    And now, another Nobel Prize-winner comes out of the medicine closet with additional support for homeopathy. Are you now going to call Luc Montagnier a “homeopathic researcher”?! What classic logic: whoever conducts a positive study testing homeopathic doses is deemed a “homeopathic researcher” and is then deemed to be a “witch.”

    I love it (!) when the BMA goes on a witchhunt…’cause whenever you go on a witchhunt, you find witches. Are they going to go after the Jews next? And who’s next?

  54. Mojo says:

    I thought I’d posted this yesterday, but there’s no sign of it. I’ll try again.

    The use of OSCILLOCOCCINUM [there's no need to shout] in the treatment of the flu is another example, as long as it is prescribed within 48 hours of onset of the flu…and four large studies have confirmed that its results are better than placebo.

    The Cochrane review of trials of Oscillococcinum for preventing and treating influenza, which presumably considered those four large studies, concluded that “taking homoeopathic Oscillococcinum once you have influenza might shorten the illness, but more research is needed.” I think I’ll take their assessment over yours.

  55. Mojo says:

    Are they going to go after the Jews next?

    I call Godwin’s.

  56. weing says:

    If you think high impact journals don’t publish crap, then you are sorely mistaken. Just look at your homeopathic papers. Mark Crislip, on his recent podcast, mentioned how a study that did not use a control group got through the craps and got published in a prestigious ID journal. The adage “caveat emptor” applies here as well. The reader should beware, as the authors are trying to sell them something.

  57. WilliamLawrenceUtridge says:

    Dana – you are a liar. What I hate is people who misrepresent science to serve their own agenda. For instance, the Cochrane review of the use of Oscillococcinum against influenza states:

    Though promising, the data were not strong enough to make a general recommendation to use Oscillococcinum for first-line treatment of influenza and influenza-like syndromes. Further research is warranted but the required sample sizes are large. Current evidence does not support a preventative effect of Oscillococcinum-like homeopathic medicines in influenza and influenza-like syndromes.

    http://www.ncbi.nlm.nih.gov/pubmed/19588329

    The funny thing is, the research base for recommending Oscillococcinum has actually gotten worse. The 2000 Cochrane review stated:

    Oscillococcinum probably reduces the duration of illness in patients presenting with influenza symptoms. Though promising, the data are not strong enough to make a general recommendation to use Oscillococcinum for first-line treatment of influenza and influenza-like syndrome. Further research is warranted but required sample sizes are large. Current evidence does not support a preventative effect of homeopathy in influenza and influenza-like syndromes.

    Note that the updates, starting with the next one in 2004, eliminated the “probably” but retained the rest. In fact, nothing has changed in that time – the number of trials didn’t increase, nor did the number of subjects. Despite their “amazing and powerful” treatments, apparently no homeopaths bothered to fund any more high-quality trials. And even if effective, the preparations at best reduced the duration by a quarter of a day. This is not the kind of medicine to use in an ICU. Further, that review was actually withdrawn in 2009 – so in spite of you quoting it favourably as “promising”, it is dishonest on several levels. It’s not particularly favourable, it’s not clearly demonstrating Oscillococcinum is effective, and it’s not even endorsed by the authors. Yet still, your approach is not to honestly quote the opinions of the author, but to engage in the most egregious cherry-picking of whatever happens to support your point. You are not an honest man or researcher.

    If you want a statement about observed behaviour, I observe that you are willing to dishonestly report the actual scientific literature to serve your own needs, and either don’t understand, or don’t care, about the actual limitations of the evidence you cite. You either don’t understand, or don’t care about the differences between prospective or exploratory trials versus clinical trials.

    I also observe that you consistently fail to answer basic questions posed to you – what causes the homeopathic effect? If it is cybernetics, where is the signal, where is the receiver? If it’s quantum mechanics, how does the effect avoid being washed out at supra-molecular scales? What are Luc Montagnier’s reasons for believing in homeopathy? Just name-dropping is an argument from authority, and is yet more evidence that you are unable to substantially support your points.

    Authoring a review article, published in a friendly magazine, isn’t particularly impressive to me. Now, if you could actually run a well-controlled clinical trial that actually demonstrated a consistent, replicable result, one that could become part of a series of consistently reported results, then I might be impressed. But it is apparent you are too busy promoting your work on the internet to be bothered with the truly difficult work of running a large-scale RCT that could actually say something meaningful about homeopathy. I would venture that like most homeopaths, you’re afraid of the results.

  58. SuntoryBoss says:

    @Dana Ullman

    “It is indeed rare when a single homeopathic medicine can be used effectively for different people with the same disease due to the necessity for individualization of treatment. However, there are some exceptions to the rule, and this study in CHEST has verified this.”

    Right, so they *do* need to be individualised…except when they don’t. Let me guess, the “don’t” set exactly matches the tiny number of undividualised studies you’ve persuaded yourself you can see a glimmer of positivity in if you squint really hard, and the “do” set exactly matches the massive number of studies showing no effect over placebo?

    What a coincidence!

    Except…except the “don’t” set presumably also encompasses the vast number of completely unidividualised “remedies” you sell on your website. Seems to me as though there’s more exception than rule when there’s a few quid to be made.

  59. WilliamLawrenceUtridge says:

    @Dana

    Also, regarding that homeopathy and allergies treatment you are crowing about. Allow me to comment.

    homeopathic medicines utilize much smaller doses

    A much more accurate way of putting it would be homeopathy doesn’t use any doses as many homeopathic preparations are expected to contain zero molecules.

    From a homeopathic perspective, one of the great misunderstandings about allergies is the assumption that the allergen (e.g., the cat dander, pollen, or house dust mite) is “the problem.” Instead, the allergen is the trigger and the allergic person’s body is the loaded gun. Rather than treating and suppressing the person’s symptoms or avoiding the allergen as a means of staying healthy, homeopaths seek to find the homeopathic medicine that will strengthen the individual’s defense system. No studies, however, have evaluated the efficacy of long-term homeopathic “constitutional” treatment. Instead, clinical trials have evaluated the use of homeopathic medicines for treating various acute allergy symptoms, usually over a one- to three-month period.

    It was mainstream science, not homeopathy, that turned up the realization the immune over-reaction is the problem. This statement also says that homeopaths “strengthen the individual’s defence system” – may I point out that if homeopathy was actually effective, this would make things worse? Further, this has the frequently used implicit criticism that medicine “only treats the symptoms” rather than the problem. It then goes on to state that homeopaths have only evaluated their ability to treat symptoms, never the problem. Making them hypocrites and illustrating the cherry-picking and incoherent nature of homeopathic “research”, as well as advocating for an untested treatment modality.

    A randomized, controlled trial (RCT) of hay fever patients compared the effectiveness of a homeopathic preparation of Galphimia glauca (Galphimia 6C)… What is particularly interesting about this study is the researchers also compared these two preparations with a dose of Galphimia diluted 1:10 six times without the common procedure of succession…only the correctly manufactured homeopathic medicine that was both diluted and succussed was effective in reducing nasal and ocular symptoms.

    At 6C, this isn’t homeopathy, it’s allergen immunotherapy – systematic exposure to an allergen to diminish reaction. Also, when you don’t success (i.e. mix) the solutions, one would expect that the procedure much more rapidly dilutes since you would expect settling. This result is far more easily explained through conventional science than through homeopathy. In fact, the next two studies discussed that give preparation information use 4X and 6X (that is, four and six 10:1 dilutions). Again, this is allergen immunotherapy, a conventional treatment. It’s not homeopathy, unless you expand the definition to a meaningless degree. That’s like calling an aspirin a 1X homeopathic preparation because it’s ASA mixed with filler. Where are the “more potent” 12C, 30C and 200C dilutions advocated by homeopaths? I could see why Shang would not include this study in their meta-analysis, because it is not homeopathy.

  60. WilliamLawrenceUtridge says:

    @Dana

    Next is a series of studies by David Reilly. They actually look OK – a pilot study followed by a RCT. However, I can’t find the pilot study (not looking very hard, it was published in the British Homeopathy Journal in 1985) and the RCT contains the words “The significance of this response was increased when results were corrected for pollen count and the response was associated with a halving of the need for antihistamines.” This begs the question, how significant was this response before these “corrections”?

    The review article cites Lewith et al 2002 as a favourable trial for homeopathy, completely ignoring the results (There was no difference in most outcomes between placebo and homoeopathic immunotherapy) and conclusion (Homoeopathic immunotherapy is not effective in the treatment of patients with asthma. The different patterns of change between homoeopathic immunotherapy and placebo over the course of the study are unexplained). This, Dana, underscores a point known as “fishing” – using multiple tests, and citing the favourable ones at the expense of the ones showing no difference. And even if effective, this emphasizes another point – homeopathic preparations may show a statistical improvement, but is it a clinical one? White et al 2003 is next summarized, which shows the same pattern – no clinical improvement of note, with statistical differences only found by interpreting subscales – and those improvements were relative, and small.

    Next is Aabel 2001, again finding no significant differences, except for one point in the middle of the study. More cherry-picking, ignoring alternative explanations, and the overall conclusion – no significant differences! The following study, Launsø et al 2006, found homeopathy no more effective than conventional treatment – but by using a retrospective comparison of homeopathic and conventional practitioners. Lacking randomization, (and based on self-report only!) the most parsimonious explanation I can see is that the group visiting a homeopath had less severe allergies and that self-selection (since patients were not blinded and could choose which practitioner they wanted to see) was an enormous confound.

    Next is Frenkel & Hermoni, 2002, a retrospective analysis. Lacking a control group, all you can say is that people changed their behaviour – in this case, reducing the number of medications taken. Given homeopaths discourage taking medication, medication often has unpleasant side-effects and allergies are not life-threatening, it’s hardly surprising and not at all convincing that patients reduced their medication – saving $8 per month at the same time!

  61. DanaUllman says:

    How totally disengenuous, William! Instead of referencing or discussion any of the studies that independent researchers have deemed to be “high quality,” you only chose to discuss the others, except the series of studies by Reilly which you conveniently ignore mentioning that TWO were published in the BMJ and ONE was published in the LANCET. And of course, you neglected to make reference to either of the editorials published about these studies in these journals.

    How convenient!

    And you have the total chutzpah to call me a liar! Ha! You’ve proven your lack of integrity and intellect.

    THIS is why it is useless to enter into further discussion with you.

  62. pmoran says:

    “High quality” means that there is nothing obviously wrong with the studies, not that they must be accepted as gospel or interpreted in the way the authors wish. Nor does publication in high profile journals.

    There are many ways in which error, and conscious and unconscious biases can produce spurious “positive” results. yet not be obvious from the published data.

    Dana, you seem paranoid enough to assume that this is just another fiction with which to persecute homeopathy. Not so, we have learnt this from clinical strudies funded by drug companies, also a long history of inexplicable conflict between mainstream studies.

  63. Mojo says:

    And of course, you neglected to make reference to either of the editorials published about these studies in these journals.

    What do the editorials have to do with anything?

  64. qetzal says:

    I had the same thought as WLU (see his comment above from 09 Jul 2010 at 10:29 am). Those allergy studies by Wiesenauer et al. that Ullman cites didn’t sound like homeopathy at all to me.

    It’s also worth noting that the first cited study (ref. 19 in Ullman’s review) did not use “Galphimia
    6C”
    , as Ullman repeated states. As Wiesenauer et al. clearly state in their title, they used “Galphimia
    potentiation D6
    .” In other words, serial dilution in steps of 10 (Decimal), not 100. Which makes sense, of course. Why would Wiesenauer compare a 6C potentiation of Galphimia at a final dilution of 10-12 to a non-potentiated dilution of only 10-6?

    It’s a relatively minor error on Ullman’s part, of course. I’ve made errors at least as embarassing in the past as well. But it reinforces the point that any effect of those preparations seems consistent with standard immune desensitization to low doses of an allergen.

    This leads to a question – for Dr. Ullman or anyone else: what is the “0X” starting material that is used to make homeopathy preparations? Taking the case of potassium dichromate from the Chest article, is the first step of making the C30 prep simply dissolving 1g K2Cr2O7 in 99g H2O? Is it similiar for something like 6X Galphimia – start by adding 1g dried or ground up plant matter to 9g diluent?

  65. Mojo says:

    This leads to a question – for Dr. Ullman or anyone else: what is the “0X” starting material that is used to make homeopathy preparations?

    I don’t think I’ve seen any definitive statement about the amount of material that should be present in the starting solution from which homoepathic remedies are made. It probably differs from one remedy to another – in the case of plant remedies the whole plant is mashed up and steeped in a water/alcohol mixture for a few weeks to produce a “mother tincture”. I don’t recall seeing any indication of the concentration of a mother tincture. Perhaps homoeopaths consider the number of potentisations to be more important that the concentration?

  66. qetzal says:

    Perhaps. It doesn’t really matter if it’s K2Cr4O7 being diluted to 10^-60 (30C). But it could matter a lot for something like Galphimia that’s only diluted to 10^-6 and could be acting essentially as a conventional allergen immunotherapy. That’s really why I was curious.

  67. WilliamLawrenceUtridge says:

    Dana:

    The purpose of my comments are not to provide the ultimate takedown of homeopathy. My comments point out that the review article you are citing as triumphant evidence of victory simply isn’t. The article assembles a heterogenous collection of articles, many of which are not exactly a slam-dunk. It collects a wide series of single articles, addressing a wide series of conditions. The studies I’ve looked at so far haven’t converted on a single, coherent, powerful, and above all, clinically meaningful result. Multiple comparisons flaw some of the studies, while others ignore alternative explanations and in no case is there an unequivocal, clinically meaningful result.

    Again, what is needed for such an improbable claim as homeopathy, is a series pf replicable trial results. Even a series of results that consistently fail but at least show one single consistent pattern, would go a long way towards homeopathy having a true biochemical effect. You were praising me a while ago for my honesty, but now you are criticizing me for lying. The difference seems to be your ability to take my comments to support your beliefs.

    I admit there are good quality studies where I can’t find obvious flaws based on the abstracts. But I’m also pointing out that we can’t draw powerful conclusions from them. To disparate, too many comparisons, too many failed main tests, too little replication with consistent results. Your article suggests possible starting points for future research. It certainly doesn’t prove homeopathy is a clinically proven intervention.

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