Be careful what you wish for. In the last few decades purveyors of dubious medical treatments and products have been trying to go mainstream, and they have had some unfortunate success. They asked for serious scientific investigation into their claims – and they got it. They asked to be treated like real medicine (but not really, they only want the trappings of legitimacy, not the substance), and when they actually are treated with the standards similar to science-based medicine, they cry foul.
The response of the fake-medicine lobby is not to alter their claims to fit the evidence, or to carry out better studies, or to clean up their act when problems are brought to their attention – but to attack their critics.
Homeopathy is perhaps the best example of this behavior. Homeopathy’s biggest marketing advantage is that most people don’t know what it really is. They think it’s “natural” medicine or herbs. That is why, during homeopathy awareness week, I was happy enough to oblige. I want people to know exactly what homeopathy is – sugar pills. They are placebos on which the equivalent of a magical ritual has been cast. Active ingredients, which themselves are as fanciful as fairy dust, are diluted into non-existence.
Not surprisingly, when tested in well-designed double blind placebo controlled trials, homeopathic placebos are indistinguishable from regular placebos. Homeopathy, put simply, doesn’t work.
Edzard Ernst, until recently a professor of complementary medicine at Exeter University, published a systematic review of systematic reviews of homeopathic products. He honestly asked a very important question – Homeopathy: what does the “best” evidence tell us? The answer he found:
The findings of currently available Cochrane reviews of studies of homeopathy do not show that homeopathic medicines have effects beyond placebo.
He is not the only one to have looked at the evidence and come to this conclusion (remember – his review was of other reviews). For example, a recent systematic review of homeopathic treatments for dermatological conditions concluded:
Reviewed trials of homoeopathic treatments for cutaneous diseases were highly variable in methods and quality. We did not find sufficient evidence from these studies that homoeopathy is clearly efficacious for any single dermatological condition.
In fact, the evidence does not support the conclusion that homeopathy is effective for anything.
Ernst began his career in a homeopathic hospital and is highly familiar with the practice of homeopathy. He set out to see what the evidence for CAM modalities actually showed. For his trouble he has become a pariah of the CAM world, who have attacked him personally for simply reporting the evidence. It has recently come to light, in fact, that a consortium of German homeopathic companies have been paying a blogger to attack Ernst, and other critics of homeopathy.
Journalist Jens Lubbadeh published his findings in the German newspaper Süddeutsche Zeitung, but agreed to publish an English translation on the website Quackometer. He reports:
(Claus) Fritzsche himselfs openly admits the “sponsorship” of his CAM-Media.Watch-blog (www.cam-media-watch.de) by the manufacturers. In august 2011 he wrote for the sake of “transparency”: “The companies Deutsche Homöopathie-Union (DHU) [the biggest German pill manufacturer] and Biologische Heilmittel Heel (www.heel.de) support CAM Media.Watch financially”. Other sponsors include: Staufen Pharma (www.staufen-pharma.de), WALA Heilmittel (www.wala.de/english/), Weleda (www.weleda.com), Hevert (www.hevert.de/_#/). In total, Fritzsche receives 43.000 Euro annually from these six manufacturers of homeopathic products.
The irony in this is profound. Defenders of dubious medical claims are quick to accuse promoters of science-based medicine of being “pharma shills” (what David Gorksi calls the “pharma-shill gambit”). I am the target of this accusation on a regular basis. It seems that within the CAM community it is just assumed that any critics of pseudoscience in medicine are being paid off by “Big Pharma.” This is simply not true. SBM is not sponsored by any company and we have no ties to the pharmaceutical industry. The site is completely paid for by The New England Skeptical Society, which is a non-profit educational organization (meaning the bandwidth is covered by the NESS, authors and editors are unpaid volunteers). We are also sponsored by the James Randi Educational Foundation, also a non-profit educational organization which shares our views.
This is not to say that pharmaceutical companies are not guilty of shenanigans. There have been many high profile judgments and fines against pharmaceutical companies, and we are quick to criticize them for trying to distort science and the communication of science in their favor. As far as I know, however, they don’t directly pay journalists to attack their critics. These homeopathic companies, however, admit that they do pay a journalist who happens to viciously attack critics of homeopathy. Strangely, the usual internet CAM proponents have been silent on this issue.
Perhaps the proponents of homeopathy are getting desperate. Homeopathy is like a mushroom, it thrives in the dark. It is withering a bit in the light of the attention that it has drawn upon itself. In 2010 the House of Commons Science and Technology Committee (STC) released a report, Evidence Check 2: Homeopathy, in which they recommend that the NHS stop funding homeopathy. They concluded that homeopathy can’t work, doesn’t work, and is essentially witchcraft.
Homeopaths tried to counter with a Swiss report on homeopathy – trumped up by homeopaths – but that reports has been exposed as flawed and biased.
Now homeopathic products are coming under fire in the Eurozone. It seems that many homeopathic products are illegal – they are in violation of existing regulations because they are making unsupported claims. The Guardian reports:
Faced with an MHRA crackdown on unlicensed medicines, one of Britain’s leading manufacturers of homeopathic remedies has indicated it would be prepared to relabel its products ‘confectionery’ to circumvent regulation.
So they will start selling sugar pills as sugar, rather than medicine, as long as they can keep them on the market.
Homeopathic products have an easier time in the US, where they are automatically approved as drugs and regulated by the FDA. This is a scandal that needs to be reversed, but meanwhile the FDA still can regulate the quality of homeopathic manufacturing. The result is a bit surreal – the FDA ensuring that fairy dust is properly handled, but the results can still be illuminating. For example, when examining the manufacturing process at a large UK homeopathic manufacturer, A Nelson & Co., Ltd., they found a number of violations.
They discovered that glass was finding its way into the product. The company was not sufficiently clearing broken glass from the assembly line. They also found that their instruments were not being calibrated as sufficient intervals. These are generic quality assurances that have nothing to do with whether or not homeopathy actually works. It is important to keep glass shards out of pills, but it’s hard to think of anything less important than the calibration of a gas chromatograph in a homeopathic factory. That’s like saying the design problem with the Titanic was that the deck was not varnished properly.
More interesting is that the FDA inspectors found:
“b. The investigator also observed for Batch #36659 that one out of every six bottles did not receive the dose of active homeopathic drug solution due to the wobbling and vibration of the bottle assembly during filling of the active ingredient. The active ingredient was instead seen dripping down the outside of the vial assembly. Your firm lacked controls to ensure that the active ingredient is delivered to every bottle.”
One in six bottles didn’t get their dose of nothing, I mean “active ingredient.” Homeopaths did not seem to notice this manufacturing defect.
I may sound like a broken record, but it needs to be said often – homeopathy is pure pseudoscience. There is nothing in homeopathic products and they are completely ineffective as medicine. In my opinion the conclusion is ineluctable – homeopathy is a fraud being perpetrated on the public worldwide. Governments and regulatory agencies that are supposed to protect the public from medical fraud have failed to do so. Those, like Edzard Ernst, who are pointing out this blatant reality – that sugar pills are not effective medicine – are being attacked for their troubles.
All we want is what homeopathy proponents say they want, and honest look at the science and the evidence and letting that dictate practice and regulation. At the very least the public needs to have proper informed consent about what homeopathy is and what the best evidence shows.