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Homeopathy’s Recent Woes

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.

Conclusion

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.

Posted in: Homeopathy

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51 thoughts on “Homeopathy’s Recent Woes

  1. cervantes says:

    ” As far as I know, however, they don’t directly pay journalists to attack their critics. . . .”

    I’m not sure the blogger in question merits the label “Journalist.” And it certainly wouldn’t surprise me if pharmaceutical companies pay bloggers and otherwise have social media strategies for promoting their products and responding to their critics. And even if they don’t directly pay journalists, they have directly paid physicians to say things to journalists which the “journalist” then dutifully wrote down. I’m not saying they are universally as sleazy as homeopaths, but they have been on particular occasions.

  2. WilliamLawrenceUtridge says:

    Strangely, the usual internet CAM proponents have been silent on this issue.

    I think you mean “Unsurprisingly” there :)

  3. ama says:

    Hi, all,

    was away for a long time. As I am investigating the new affairs, I can add some information.

    Steven Novella writes: “homeopathy is pure pseudoscience”. It is more than that. It is plain fraud, not only with respect to medical topics, also in a plainly criminal one: in media.

    Here you see a graphic translation

    http://transgallaxys.com/~aktenschrank/Mietmaul_Claus_Fritzsche_aufgeflogen/dramatische_Verluste_der_Homeoeopathika_Umsaetze_inflationsbereinigte_Zahlen_normiert.jpg

    of sales figures I analyzed in

    http://transgallaxys.com/~kanzlerzwo/index.php?topic=7581.msg17455#msg17455

    The figures can be obtained from the “Bundesverband der Pharmazeutischen Industrie e.V”. They are OFFICIAL figures of that national industry association, reaching back to the year 2000.

    In their brochures, online available as PDFs, the sales figures for various branches and niches are given. So it is easy to compute the figures and the derative figures on your own.

    Looking at the raw vaules of the sales figures is misleading. Why? Answer: Because the numbers go up.

    To get a correct view of the development of the sales, one needs to adjust to a common base. i.e. to normalize with the inflation rate. The line “Nullwachstum” is the line of a start value in the year 2000, followed year by year, correcting it with the summed-up inflation-rate.

    You see a lot of red. Even more than 8 percent of losses BELOW inflation rate during the last decade.

    Again, keep in mind that these figures are derived from OFFICIAL publications of the industry. The manufacturers of homeopathic and anthroposophic “remedies” would have to use witchcraft to change these figures..

    So, with the official figures given bey the pharmaceutical industry, it can be shown in some few minutes that the sales of the homeopathic and anthroposophic industry are NOT as we are made believe in the media.

    NOTE: The graphics covers the development of the homeopathic remedies sales, NOT the sales of the anthroposophic ones.
    NOTE: Compared with inflation rate, anthroposophic remedies did have a notable growth.

    BUT: We have to look at something else: at the media, which with a thunder like from a Bison herd, makes the public believe that homeopathy is gaining acceptance. How can on one side homeopathy gain acceptance, and bloom, when on the other side the sales figures show a dramatic decline!?

    There is a BIG discrepancy. The cause is simple to detect: the media articles, AND A LOT of extra magazine productions, are paid by the industry, by the manufacturers. Such publications must carry the remark “advertisement”. But they do not. They are illegal.

    The official figures by the national asscociation of the pharmaceutical industry uncover the fact, that the media are committing a large-scale crime and are paid by the manufacturers.

    All the many, many, many, articles and comments in newspapers, magazines, blogs, forums, etc., etc. etc., are scams, are forgeries, are ONE BIG FRAUD.

    This fact we would not know if Claus Fritzsche, the hired hitman, had not overdone it. We ignored Fritzsche all those years. Because we knew he was completely unimportant. We were right. Of course, we were.

    Fritzsche is not of interest. He never was and never will be. But the ones who pay him, they are. And we are on their heels. They can thank Fritzsche for the wonderful hints his incredible stupidity has led the investigators to. He is the last nail of the coffin of the homeopathic industry. Without him, without their greed and their high criminal energy to pay him, we would not have looked at these figures so closely.

    The sales figures by the national “Bundesverband der Pharmazeutischen Industrie e.V”, THEY crack the fraud of the homeopathic industry and of their paid media accomplices.

    The dimension, the criminality, and all the consequences of THIS FRAUD still has not reached the heads of the journalists. As in the past, we will have to carry them to understand the matter. Give the journalists a kick in their behinds. Show them the figures. Show them the facts. And, if they do not understand (well, they are only journalists…), then do publish these things in your articles, in blogs, on forums, in web-sites – wherever.

    Homeopathy is nothing but a fraud, a medical fraud AND a media fraud.

  4. Skeptico says:

    The active ingredient was instead seen dripping down the outside of the vial assembly.

    That explains why Homeopathic Drugs were found in US Drinking Water – some of the homeopathic solution must have been flushed down the drain.

  5. cervantes says:

    Hey Skeptico, that’s pretty funny. I wonder what the homeopathic remedy would be for dehydration? (Not an original thought.)

  6. jli says:

    ……they are completely ineffective as medicine.

    Which their own data suggest in painstaking clarity: http://anaximperator.wordpress.com/2012/08/22/homeopathy-endorsed-by-asco-not-really/

  7. Harriet Hall says:

    Dr. Edzard Ernst was trained to practice various forms of alternative medicine. Then he got a PhD and became the world’s first professor of complementary medicine. He formed a research group to study which alternative methods worked and which didn’t. This group has been incredibly prolific and has held to rigorous scientific standards. They found very little evidence for any alternative method. People who understand and support science love Ernst; advocates of alternative medicine uniformly hate him. He ran afoul of an organization supported by Prince Charles and was essentially forced into retirement for political reasons. This new persecution by homeopaths is easily explained: Ernst has shown that their emperor has no clothes, and they have no weapons left but personal attacks.

  8. Harriet Hall says:

    “The site is completely paid for by The New England Skeptical Society”

    I hope no one will misinterpret this. The website is paid for. The writers do not receive pay of any kind.

  9. Good point, Harriet – I made a clarification to make it crystal clear in the post.

  10. Chris Repetsky says:

    I guess I just fail to see how legitimate scientists and medical personnel can still take Homeopathy seriously. I’ve been fighting against pseudoscience and quackery ever since I became a medical student, and to this day it still boggles my mind how such intelligent people can accept these forms of quackery.

    Maybe as I get older, I’ll become more jaded.

  11. @Chris, it is bizarre. It’s sold along side legitimate medications in big name pharmacies across the US. Who cares about science when money is at hand? :)

  12. Old_skeptic says:

    “There is nothing in homeopathic products.”

    This is not always the case — at least not in the United States.

    Homeopathic “drugs” in the United States are not required to be highly diluted, and some products labeled as homeopathic actually contain substantial amounts of active ingredients.

    Just examine a package of Cold-Eeze lozenges if you don’t believe this.

    Cold-Eeze lozenges are labeled as homeopathic, but they contain as much zinc as many zinc dietary supplements do. Apparently, this is legal. And it gives the Cold-Eeze people an advantage over companies that sell zinc dietary supplements. The Cold-Eeze people can claim on their package labels that their product treats colds. Companies that sell zinc dietary supplements would be breaking the law if they made the same claim. It’s illegal to say that a dietary supplement treats a disease; it’s not illegal to do this for a homeopathic remedy.

  13. Scott says:

    @ Old_skeptic:

    It truly is ironic that the remedies which are both most potentially dangerous, and have at least some chance of being efficacious, are those homeopathic principles would claim are the least potent. And also the ones which don’t lend any support to homeopathy even if they did happen to be efficacious by chance.

  14. pmoran says:

    Jli……they are completely ineffective as medicine.

    Which their own data suggest in painstaking clarity: http://anaximperator.wordpress.com/2012/08/22/homeopathy-endorsed-by-asco-not-really/

    Actually the five year survival rates and remission rates described in this study are startling for these kinds of inoperable cancer. Either there have been numerous errors in diagnostic procedures or some other major foul-up, or this homeopathic preparation is the best treatment yet for these kinds of cancer.

    The only thing that stands out is poor provenance (no dates or other details shown) and consistency in two pairs of CT scans said to show disappearance of cancer. One patient has mysteriously lost all their subcutaneous fat even while their gall-bladder cancer is supposed to have disappeared. The other scan could show disappearance of an infiltrative stomach cancer.

    If this study was performed in a major Western centre I would not be too bothered by the lack of a suitable control group because we don’t normally have to control for the possibility of 20-30% levels of diagnostic inaccuracy, and outcomes with such cancers are normally very predictable.

    A proper function for the NCCAM would be for it to ask for access to these cases and all the documentation. the study will undoubtedly become part of “alternative” lore.

  15. geo says:

    “Not surprisingly, when tested in well-designed double blind placebo controlled trials, homeopathic placebos are indistinguishable from regular placebos.”

    Does anyone know of any good studies on the impact of placebo, response bias, etc on widely used subjective measures like SF-36 scores, EQ-5d, etc.

    It seems that a number of trials of ‘mainstream’ treatments are still rather poor at accounting for problems related to response bias, etc (especially for behavioural or talking therapies), and that the data collected from homeopathic trials could be a helpful guide for what sort of improvements in subjective scores should be discounted before any treatment was viewed as offering ‘real’ benefits or value for money.

  16. Lytrigian says:

    It’s true about some homeopathic remedies having actual ingredients in them. It’s not too uncommon to see potentizations as low as 1X. As long as it’s done according to accepted homeopathic procedures, you can market it as a homeopathic drug with all the legal protections that come with it. I’ve even seen “homeopathic” products with higher concentrations of mercury than permitted in drinking water. (That was Ring Relief as of 2010; I suspect they’ve changed the formula since then. Based on what I wrote at the time they used to have “merc. solub.” at 8X; now it’s 13X and only in their “Fast Dissolving Tablets”. Their ear drops also used to contain benzalkonium chloride, but that’s no longer listed.)

  17. Jan Willem Nienhuys says:

    It’s true about some homeopathic remedies having actual ingredients in them.

    In fact, in some case homeopathic remedies contian a lot of ‘mother tincture’. When the law says that you may sell as ‘homeopathic medicine’ anything that is preprared in accordance with a homeopathic pharmacopea, then mother tincture is also homeopathy. So one can buy Arnica ointment (in the Netherlands and presumably the rest of the EU) containing 30% mother tincture.

    It is not clear why homeopathy is associated with ‘natural’ and ‘herbal’. I suspect the energetic advertising by homeopathic pharamaceutical companies.

    I always wonder about physicians who are also homeopath. They probably got e medical education and an MD diploma before writing out their first homeopathic prescription as MD. So what convinced them to do so? Not experience as MD, I guess. Does anyone know? Incidentally, how menay homeopathic physicians are there in the USA? Is there an association for homeopathic MDs? Are there MDs committing homeopathy without being member of such a union? Are there many mixers (MDs that use many different treatments such as acupuncture AND homeopathy AND megadoses vitamin AND herbal therapy AND Ayurvedic medicine AND chiropractic AND colonics AND (etc. etc.)?

    Or is it maybe curiosity in combination with (1) deception to not being able to treat many common complaints and (2) enthousiastic stories by colleagues?

  18. DanaUllman says:

    It is so easy to set-up a straw man and knock him down. And it is interesting how Steve considers the report on homeopathy by the Swiss government as “flawed” and yet ignores the much more damning critiques of the UK’s Science and Technology Report on homeopathy and the Shang, et al review of research in the Lancet (2005).

    If your site here is trying to create high standards for scientific analysis, your extreme bias is showing, though I know that we ALL know this severe limitation to this site and to the primary authors of blogs here.

    Where was the reference to the critique of that UK report that proved that the results of the review of homeopathic research is totally dependent upon what studies the researchers choose (selectively!) to include or not include (can you really believe that there has NEVER been a study using conventional drugs to treat people with polyarthritis?…yeah, no one can believe that, and yet, that was the excuse used to throw out and totally ignored by Shang on one large “high quality” study with positive results on the homeopathic treatment for this condition): Lüdtke R, Rutten ALB. The conclusions on the effectiveness of homeopathy highly depend on the set of analyzed trials. Journal of Clinical Epidemiology. October 2008. doi: 10.1016/j.jclinepi.2008.06/015.

    And it is cute that Steve quoted a review of dermatological ailments and found “no studies” that found homeopathy effective for any condition. Did they not see a study conducted by that “advocate” (?) of homeopathy, E. Ernst: Ernst, E, Saradeth, T, and Resch, KL, Complementary Treatment of Varicose Veins – A Randomised, Place¬bo-controlled, Double-blind Trial. Phlebology (1990)5,157-163.

    Heck, although Ernst does his best to avoid reviewing research where homeopathic studies are strong (such as in respiratory allergies), even one of Ernst’s metaanalyses showed positive results for homeopathic potencies lower than 12C (and yet, does he or any of you at this website use homeopathic low potencies?)
    Ernst conducted a review of clinical studies on patients undergoing abdominal surgery. Ernst and his team then noted that some of the “higher quality” studies showed a negative result from homeopathic treatment, but such results only influenced the studies that were with homeopathic potencies greater than 12C.
    Barnes, J, Resch, KL, Ernst, E, “Homeopathy for Post-Operative Ileus: A Meta-Analysis,” Journal of Clinical Gastroenterology, 1997, 25: 628-633.

    If I can show that research conducted by extreme skeptics of homeopathy show positive results, imagine what I can do if I choose to recount the high quality studies conducted by good scientists…

  19. Dana, I don’t think you should expect a legitimate response. You push placebo crap homeopathy on Twitter all day long. You’re an unqualified, uneducated know-nothing. You’re also paid by homeopathic companies that find no ethical concern with selling people a product that does nothing.

    You simply don’t matter.

  20. Seriously, you’re scum. I just went to your crappy website. You charge people $45 for 10 minutes of “homeopathic counseling.” You should be put in jail. You are a horrible scumbag. You perform a ridiculously impossible form of witchcraft, you systematically lie about it, and you effectively kill sick people with otherwise treatable conditions.

    How on earth is this Dana Ullman not found guilty of HEALTH FRAUD and put in jail?

  21. Quill says:

    @SkepticalHealth: I don’t think Dana cares about a “legitimate” response as much as any response at all. From the trail he’s left here he appears to be a simple propagandist, one suited to the times, where it doesn’t take much to sell something of no value for a dear price. His second paragraph up there, with the “ALL” bolded, is classic propaganda of the bandwagon type with glittering generalities and name calling.

    I wouldn’t pay him anything for “homeopathic counseling” as there is no such thing but I bet, as you note, that companies that make homeopathic products pay him to keep the buzz alive and work to make new people believe the hype.

  22. Chris Repetsky says:

    Went to the website.

    “Evidence Based Homeopathy” is the best thing I’ve heard all day.

  23. pmoran says:

    If I can show that research conducted by extreme skeptics of homeopathy show positive results, imagine what I can do if I choose to recount the high quality studies conducted by good scientists…

    The mind does boggle. Cherry-picking can indeed work wonders on the evidence but, sadly, the negative studies have to count too, Dana.

    Drug efficacy is judged by consistent performance in multiple independent clinical studies, and this is where homeopathic methods fall well short, as might be predicted from its implausibility. Even therapeutic touch and remote healing can produce a few “positive” studies.

  24. Edwin says:

    Dana, is there any study, any research that you have ever found that you won’t distort, misinterpret, or spin in order to promote your BS CAM claims? Why do you even bother to show up on sites like this – sites that discuss actual, honest science?

    Seriously, go back to misinforming people on HuffPo. At least there you can be assured of finding an audience full of the ‘worried well’ who will listen to the garbage that falls from your mouth almost daily.

  25. phayes says:

    “If I can show that research conducted by extreme skeptics of homeopathy show positive results, imagine what I can do if I choose to recount the high quality studies conducted by good scientists…” –DanaUllman.

    Imagine instead showing your ‘high quality study’ results to a mild skeptic who’s aware of how extreme your claims are. Good scientists don’t do studies of homeopathy: they know that such things are futile cargo cult science because any positive results must be interpreted as evidence of error rather than of homeopathic efficacy.

  26. Jan Willem Nienhuys says:

    dixit Ullman:

    the report on homeopathy by the Swiss government as “flawed”

    but he refers to

    Homeopaths tried to counter with a Swiss report on homeopathy – trumped up by homeopaths – but that report has been exposed as flawed and biased.

    Ullman misquotes. It isn’t a ‘report by the Swiss government’. It is the result of Swiss government committee asking among others a bunch of partly German homeopaths to present their views, and concluding afterwards (2005) that the submitted views were biased. Ullman has probably only seen an English expanded translation of that homeopathic view, published in Germany.

    So
    1. the homeopathic authors were biased, as has been stated by a Swiss government committee.
    2. Ernst (ch. 9) and I myself (ch. 10) have observed from the text itself how biased it is
    3. Ullman gives a biased representation of the report

    I conclude that homeopaths are apparently not ashamed to present their case in an utterly biased fashion in situations that anyone who can read and who has internet access can see that they are selecting evidence. I think it is prudent to discount any research done by representatives of this selective sect. If they are so barefaced selective in public, then nobody knows what is really going on when they sit behind their desk and try to make sense from a huge mountain of ‘data’ collected in their ‘reserarch’.

    The homeopathic Materia Medica are filled with approximately 1,000,000 combinations of a highly diluted product given to healthy volunteers, and subsequent ‘symptoms’. Let those homeopaths think up a simple test of just one of these, properly randomized and blinded, and then we might take them serious again. But it is my experience that homeopaths quickly run away if you suggest this. Typically it goes like: ‘if you would only take XYZ in a Clot potency, you would be immediately convinced’. If you then counter with ‘if I give XYZ in a Clot potency to many people and a placebo to an equal number of other people in a properly blinded and randomized fashion, how are you going to tell them apart, and how many errors you think you will make?’ then I never get an answer. Anyone knows that Randi would pay his million if you could do such a test and succeed. From this I conclude that the homeopaths actually don’t even believe their own theories.

    Dowsers and astrologers at least sometimes consent to tests, and people like Ogilvy too. They fail, but at least they appear to believe in their own abilities. The homeopaths don’t believe in their own theories and still treat people. Probably there are psychiatric terms for such behavior, but I’m not a physician, let alone a psychiatrist so I’ll leave it at that.

  27. papertrail says:

    DanaUllman said:

    “And it is cute that Steve quoted a review of dermatological ailments and found “no studies” that found homeopathy effective for any condition. Did they not see a study conducted by that “advocate” (?) of homeopathy, E. Ernst: Ernst, E, Saradeth, T, and Resch, KL, Complementary Treatment of Varicose Veins – A Randomised, Place¬bo-controlled, Double-blind Trial. Phlebology (1990)5,157-163.

    Isn’t it cute that Dana Ullman tries to defend homeopathy with a study that no one can find to examine (at least not easily) and that was only “homeopathic” in name?

    Some people on James Randi’s forum were trying to find this study online, to no avail, but someone contacted Edzard Ernst to see if it even existed. Ernst reportedly said this: “The homeopathic study did take place. We tested a remedy that contained several plant substances in undiluted form. So,it was only nominally a homeopathic preparation.” http://forums.randi.org/showthread.php?t=232071

    Isn’t it cute that “homeopathic” can refer to anything that is diluted at least 1:10 and shaken vigorously?

  28. Jan Willem Nienhuys says:

    PS. The prerequisite of a review or a meta-analysis is that one can trust that the researchers are not too biased. That is why I set no great store by any review of papers in homeopathy. Whatever joint effect they might show, the parsimonious explanation is that one is seeing the effects of extreme bias working in many different ways.

  29. jli says:

    @ pmoran

    Thank you for your comments to me, and sorry for not responding sooner. It is true that these survival rates look impressive, and that there are lots of other questions that could/should be raised about the study. You are right about the CT-scans. It reminds me of the “Simoncini” CT-scans, that you cover in your blog article on how to read cancer cure testimonials.

    I can add that reading CT/MRI-scans isn’t always that straight forward, and this may influence staging. There is also a question of why stage 2 cancers would be considered inoperable. I don’t know enough about upper GI-surgery to know if this is a real concern.

    Also histopathological diagnosis of malignancy on a biopsy is not always that straight forward. This is probably only a minor (if any) source of bias in this study.

    Also that the criteria of not receiving conventional/experimental treatment being based on questioning the patients could be a bias.

  30. geo says:

    “The prerequisite of a review or a meta-analysis is that one can trust that the researchers are not too biased. That is why I set no great store by any review of papers in homeopathy. Whatever joint effect they might show, the parsimonious explanation is that one is seeing the effects of extreme bias working in many different ways.”

    I think that we should try to trust researchers as little as is possible. While homoeopaths are likely to use every trick possible to make their treatments seem effective, the same could be said for pharmaceutical companies, lots of researchers with a pet theory, etc.

    One of the wonderful things about research in to the efficacy of homeopathy is that it should have provided us with lots of information about the sort of results one should expect from trials of an ineffective treatment run by those who want positive results.

    One of the problems I have with ‘science based medicine’ over ‘evidence based medicine’ is that our understanding of plausibility can be shaped by cultural assumptions, prejudices, innate cognitive distortions, etc. While ‘evidence based medicine’ can be used to argue that homoeopathy is worthwhile, I would prefer to take an evidence based approach which recognised that the evidence in support of a treatment needs to be more compelling than that which can be produced for homoeopathy (the history of constitution of which make it a pretty perfect placebo). Making exceptions for those ‘treatments’ which are so obviously quackery, could let less obvious forms of quackery claim to be ‘science based medicine’, particularly if they conform to the prejudices and cultural assumptions of those in positions of medical authority.

    Also, I want to repeat a question I asked earlier, in case anyone has any ideas:

    “Does anyone know of any good studies on the impact of placebo, response bias, etc on widely used subjective measures like SF-36 scores, EQ-5d, etc?

    “It seems that a number of trials of ‘mainstream’ treatments are still rather poor at accounting for problems related to response bias, etc (especially for behavioural or talking therapies), and that the data collected from homeopathic trials could be a helpful guide for what sort of improvements in subjective scores should be discounted before any treatment was viewed as offering ‘real’ benefits or value for money.”

  31. Narad says:

    Seriously, go back to misinforming people on HuffPo. At least there you can be assured of finding an audience full of the ‘worried well’ who will listen to the garbage that falls from your mouth almost daily.

    He actually fares pretty poorly over there, as well.

  32. pmoran says:

    Geo, the notion that placebo cohorts will report subjective benefits at a constant rate, as most of us once believed, is probably no longer tenable. While about 30% is a usual figure, a number of stuides have shown how such reporting can be titrated up or down depending upon patient expectations. 50@, possibly 60% response rates are attainable.

  33. geo says:

    @ pmoran: That’s one of the reasons why I think that the results from non-blinded homoeopathy trials can be helpful, as patients get time with a clinician who genuinely believes that the placebo they are giving to patients is going to be helpful.

    There certainly do seem to be lots of complicating factors surrounding the impact placebo has upon subjective reports of health – one paper I was reading recently suggested that if a ‘treatment’ involves the patient feeling that they are contributing and working towards improvements in their own health that subjective reports tend to show greater improvement. While there’s always the possibility that placebos can generate real improvements in health via psychosocial mechanisms, to me it seems that most of the subjectively reported improvements are not ‘real’, and occur as a result of more prosaic things, like a desire to be positive, or polite about those who have tried to help, and tend not to lead to significant improvements in external measures of capacity, like hours worked or activity levels, than one might expect had some genuine improvement occurred.

    Seeing as subjective measures are often used to assess the efficacy and cost effectiveness of more plausible treatments, commonly without using an appropriate placebo control group if it’s a non-drug intervention, shouldn’t we have some way of discounting subjectively reported improvements to treatments? Particularly as trials are often run by researchers who have a vested interest in the efficacy of the treatment they have developed and are testing? Is anyone aware of any good work in this area? It seems interesting and important to me, but I’ve struggled to find much really sold research.

  34. mousethatroared says:

    Just wanted to second Old-skeptic. Arnica salve is sold as homeopathic here in the U.S. , but usually is low dilution, so it is actually an herbal remedy.

    I was recently cruising a scleroderma forum for hand pain insight when a health food store remedy, Traumeel ointment, came up. A quick search showed that Traumeel is a “homeopathic” remedy for pain but most of the dilutions of herbs on the list are 1x to 3x.

    from amazon “Active Ingredients: Each 100 g contains: Calendula officinalis 1X 1.5 g, Hamamelis virginiana 1X 1.5 g, Arnica montana, radix 3X 1.5 g, Aconitum napellus 3X 1 g, Belladonna 3X 1 g, Bellis perennis 1X 0.5 g, Chamomilla 1X 0.5 g, Echinacea 1X 0.5 g, Echinacea purpurea 1X 0.5 g, Millefolium 1X 0.3 g, Hepar sulphuris calcareum 8X 0.25 g, Mercurius solubilis 8X 0.12 g, Symphytum officinale 4X 0.1 g, Hypericum perforatum 6X 0.09 g;”

    Belladona? I don’t know enough about dilutions or herbs to know how dangerous that is.

    Both of these remedies have been topical. I don’t know how much is absorbed through the skin or if there are oral medication with such low dilutions.

  35. BillyJoe says:

    geo,

    The only way that I can think of is to have panels of experts on clinical trial protocol who must approve a trial before it can proceed. This would reduce, perhaps even eliminate, the number of trials which can’t possibly tell us anything because they are so poorly designed. However, whenever I’ve made that suggestion its always met with stondy silence. Perhaps I’m missing something.

  36. geo says:

    @ BillyJoe – there’s still the danger of appointing experts who share similar biases, but certainly publishing protocols at the start of a trial limits some of the problems we face. Saying that, I have just been looking at one recent RCT which made a number of dramatic changes from it’s protocol for the final paper, which seems likely to have had profound impact upon the way in which it’s results were interpreted.

    In more cynical moments, I suspect that a lot of those working in medicine are rather keen to keep taking credit for the placebo affect, even if it does lead to a misallocation of resources and an inaccurate view of the efficacy of treatments. That could explain the stony silence.

  37. Sadly, it’s become politically correct to investigate nonsense.

  38. BillyJoe says:

    geo,

    The setting up of a template clincal trial protocol would have to be transparent and debated back and forth till a consensus was reached amonst experts in the field. Why would this be a problem? Why, in fact, wouldn’t it be a solution? My recollection is that ninety percent of clinical trials are flawed. Think of the savings and the rewards.

    And, yeah, the stoney silence bothers me, though I’m not about to cast stones because I frankly don’t know the reason why this can’t be done. If there is something intrinsically wrong with that suggestion, I’d like to know what it is.

  39. mousethatroared says:

    @BillyJoe – I suspect that the silences is due to the subject being very complex and hard to sum up in a comment box… for instance you mention wasting money, but whose money are we talking about? I don’t know much about clinical trials, but some are funded privately, while some by government agencies, yes? Private agencies are generally free to waste their money as they see fit.

    Possibly strict general controls on the criteria for clinical trials would hinder discovery in some cases. Sometimes processes just don’t respond well to strict templates, they need to be customized for individual situations.

    I don’t know, it’s an interesting question…but seems kinda big.

  40. geo says:

    @ Billyjoe: I wasn’t saying that it would be a problem, I think it would be likely to be a big improvement on what we have now; I was just pointing out that it would be unlikely to be perfect. It seems difficult to have genuinely open and ongoing debate imposed upon these sorts of matters – political considerations often seem to get in the way, and it’s easy to imagine that a panel of ‘experts’ on a particular treatment could be influenced by a desire to be experts in a treatment which was effective, rather than quackery.

    I’m don’t know what percent of clinical trials can be fairly classed as being seriously flawed (I’d hope it would be less than 90%!), but so long as researchers can make a career from producing misleading work it will go on happening. I’d like to see a bit more accountability.

    I was just reading a new post from Jim Coyne which seems to touch upon some of the issues I was concerned about, and others here have mentioned, including the danger of shared biases in experts of a particular area: http://www.psychologytoday.com/blog/the-skeptical-sleuth/201203/faux-evidence-based-behavioral-medicine-its-worst-part-i

  41. phayes says:

    @BillyJoe: “The only way that I can think of is to have panels of experts on clinical trial protocol who must approve a trial before it can proceed. This would reduce, perhaps even eliminate, the number of trials which can’t possibly tell us anything because they are so poorly designed. However, whenever I’ve made that suggestion its always met with stondy silence. Perhaps I’m missing something.”

    The appropriately LHC-sized bill for a CT design capable of pushing the prior probability of error below the prior probability of ultra-dilute homeopathic efficacy would be enough to silence anyone.

  42. BillyJoe says:

    Michelle,

    The problem is that there is only so much money to go around and only so much manpower to use that money. It’s time this money and manpower was used efficiently, whether private or public. Private trials shouldn’t get published unless they first passed muster with the expert panel.

    “Possibly strict general controls on the criteria for clinical trials would hinder discovery in some cases. Sometimes processes just don’t respond well to strict templates, they need to be customized for individual situations.”

    Hmmm…that is what I would expect to hear from a CAM proponent :(
    (you can’t apply RCT to homoeopathy, for example)

    “I suspect that the silences is due to the subject being very complex ”

    But well conducted RCTs are being done, so the template is actually already out there. It’s complicated, but not that complicated.

  43. BillyJoe says:

    geo,

    “I was just reading a new post from Jim Coyne which seems to touch upon some of the issues I was concerned about, and others here have mentioned, including the danger of shared biases in experts of a particular area”

    Well, psychology is always going to be a little problematic, being a great deal less sciency than most areas of science. But it would seem to me that it should not be too hard to get a consensus of experts on clinical trial design that would satisfy most scientifically minded individuals. Trial design and faults and fatal errors in clincal trial design have been spoken about extensively in these blogs and I would hazard a guess that most who have educated themselves in these blogs would have a pretty good idea of what a good trial design looks like – and especially what a bad trial design looks like. As I said, it’s complicated, but not that complicated.

  44. BillyJoe says:

    phayes,

    “The appropriately LHC-sized bill for a CT design capable of pushing the prior probability of error below the prior probability of ultra-dilute homeopathic efficacy would be enough to silence anyone.”

    :D

    Appendum: The probability that your proposed trial will be approved by the expert panel will always be less than the prior probability of your proposed treatment.

  45. mousethatroared says:

    @BillyJoe “Hmmm…that is what I would expect to hear from a CAM proponent
    (you can’t apply RCT to homoeopathy, for example)”

    Tsk, Tsk BillyJoe, just because an argument could be used to defend CAM, does not make the argument wrong.

    I was thinking more along the lines of preliminary research that might use smaller sample sizes just to see if some drug or therapy has a noticeable enough effect to invest in larger sample sizes, areas where ethical concerns mean you can’t use a control group…or possibly serendipitous discoveries (oh look we noticed this other odd effect when doing a clinical trial for this therapy) not so much defending homeopathy.

    But once again, I am way outside my knowledge. I was just throwing out ideas to see if folks with more knowledge would pick something up.

    Maybe it’s just easier for EBM proponents to complain about THAT dreadful CAM than to do the work of agreeing to meaningful standards that hold the risk of impacting how THEIR research is done.

    Watching conventional medicine’s slow adoption of information technology has not exactly given the impression of a group of people driven to improve their processes. But without knowing more about how research is done, I can’t really judge if the same issues are involved there.

  46. geo says:

    “Well, psychology is always going to be a little problematic, being a great deal less sciency than most areas of science. But it would seem to me that it should not be too hard to get a consensus of experts on clinical trial design that would satisfy most scientifically minded individuals. Trial design and faults and fatal errors in clincal trial design have been spoken about extensively in these blogs and I would hazard a guess that most who have educated themselves in these blogs would have a pretty good idea of what a good trial design looks like – and especially what a bad trial design looks like. As I said, it’s complicated, but not that complicated.”

    Yeah – complexity shouldn’t serve as a blanket justification for incompetence, or a misleading presentation of results.

    A lot of medical research seems to be as much social as hard science, and medical research often has profound political and moral consequences. There are some particular problems with psychology, but the way in which the biopsychosocial approach to medicine is now being used means that these problems can end up affecting almost all patients. In Britain, a biopsychosocial approach (and related dodgy research) is being used as a justification for steep cutbacks in support for the sick and disabled (Margaret McCartney has been covering this in the BMJ eg: http://www.bmj.com/content/345/bmj.e5347.full?ijkey=hCXfT1z84M6BopW&keytype=ref, but there’s lots of other pieces from the media, disability groups, etc). Badly done ‘mainstream’ medical research can easily become influential if it serves the interests of those in power.

  47. mousethatroared says:

    Me “I suspect that the silences is due to the subject being very complex ”
    BillyJoe – “But well conducted RCTs are being done, so the template is actually already out there. It’s complicated, but not that complicated.”

    Sorry for the dual posts, but it just occurred to me…this isn’t what I meant to say. I meant it may be too complex a topic to easily discuss in a blog comment box, not that it was to complex to figure out.

  48. ParrotSlave says:

    The people who do the actual physical manufacture of the homeopathic “remedies” could not possibly all be members of the homeopathic cult. There is no way on Darwin’s green earth that any normal person could possibly be doing “succussions” time and again. Someone with a healthy touch of avarice is bound to have said, “This is ridiculous; there’s nothing in it anyway. I can save a lot of time and money if I just skip all the steps and go straight from, say, lactose to final pill. There’s no way anyone could possibly ever tell the difference.”

    In other words, think about the businessman: when Mr. Businessman looks at what he’s being ordered to do–take something, dilute it a certain way, dilute it again and again and again–if he has a mind at all, he’d be bound to snap that it’s absurd. Sooner or later, some businessmen with minds are bound to have become involved. It’s a dream business for the Mafia. The businessman would have a choice: he could pour the lactose directly into the machine that makes the pills, or he can go through all those ludicrous hoops. Nobody is looking. What do you think he’s going to do? I would wager that a good percentage of the homeopathic “remedies” on the market are fake fakes.

    I would love to see the looks on their faces if homeopaths found out, for sure, that none of their remedies from some major companies have even been “homeopathic” all this time

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