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Without Borders

Take up the White Man’s burden–
The savage wars of peace–
Fill full the mouth of Famine
And bid the sickness cease;
And when your goal is nearest
The end for others sought,
Watch CAM and woo Folly
Bring all your hopes to nought.

The White Man’s burden, a bit of racism from the 19th century:

The term “the white man’s burden” has been interpreted as racist, or taken as a metaphor for a condescending view of non-Western national culture and economic traditions, identified as a sense of European ascendancy which has been called “cultural imperialism.” An alternative interpretation is the philanthropic view, common in Kipling’s formative years, that the rich have a moral duty and obligation to help “the poor” “better” themselves whether the poor want the help or not. The term “the white man’s burden” has been interpreted as racist, or taken as a metaphor for a condescending view of non-Western national culture and economic traditions, identified as a sense of European ascendancy which has been called “cultural imperialism.” An alternative interpretation is the philanthropic view, common in Kipling’s formative years, that the rich have a moral duty and obligation to help “the poor” “better” themselves whether the poor want the help or not.

I will let the commentators debate the meaning of the poem. There are places in the world so devastated by poverty, disease and political corruption that it may be beyond the capacity of the local populations to overcome. They need outside help. Certainly, the impulse to help those less fortunate than yourselves is a noble tradition. Haiti, Central America and Uganda are parts of the world that need assistance in overcoming an incredible number of problems to reach even a basic level of material support for its population.

What better way to help people in dire need of the basic requirements for health and material well being than to provide them with Western SCAMs?  At least in the industrialized West, we have options. If acupuncture or homeopathy or reiki does not take care of our problem or our diseases worsen, we are a quick trip away from the ER.  We may not be able to afford the care, health care being the number one cause of bankruptcy in the US, but at least effective health care is available. Other societies do not have that option. Often their one point of contact with health care  providers and/or shamans is their only contact and there is no infrastructure to take care of the ill.  Uganda spends $135 per capita on health care,  and has 0.047  physicians per 1,000 people. 1,500 doctors for a population of 35 million. Haiti spends  $82 per capita. I spend more each year on my daily peanut butter and jelly sandwich for lunch ($1.10)  By comparison, the US spends $6,000 a year per capita on health care.

These are societies where small amounts of money spent carefully can have enormous impact. Relatively small amounts of money can do enormous good in impoverished parts of the world. Ten dollars can buy a mosquito net and prevent malaria.  The measles vaccine costs less than a dollar a dose and can prevent devastating outbreaks of disease.  One hundred dollars  can provide the hungry with 2 chickens and a goat. So why spend the money on nonsense?  I know it is a false choice.  Just because money is being spent on something useless like homeopathy or acupuncture does not mean that the same money would go to a more rational choice if it were otherwise available.

In medicine we are aware of the ethical issues in treating vulnerable populations.  The poor and uneducated do not have the resources to separate fact from fiction and may lack the background to make truly informed decisions.

Yet none of this stops the sCAM believers from exporting their nonsense to the poor, the hungry, the under educated and the desperate.

Research

The only thing necessary for the triumph of disease is for good men to do homeopathy.

EDMUND BURKE.  Sort of.

Diarrhea is a major source of morbidity and mortality in large parts of the world, the second (I originally wrote number 2)  cause of infant death in the world.  Treatment and prevention of diarrheal illness is key to decreasing infant mortality world wide.  How might I make a major impact?  Provide clean water?  Rotavirus vaccination? Wait, I have it! Let’s give random homeopathic medications to the children in the slums of Nicaragua and compare it to placebo and see if it helps their diarrhea.  Treatment of acute childhood diarrhea with homeopathic medicine: a randomized clinical trial in Nicaragua did just that.

So what did they use for treatments of diarrhea and why (besides normal hydration)?

Who had oversight on this study? From the paper:

Informed consent was obtained from the parent or guardian using a disclosure statement that had been approved by the human subjects review committee of the University of Washington.”

One third of Nicaraguans are illiterate and only half get a fifth grade education. I would think, obviously erroneously, University of Washington would recognize that the parents of children in Nicaraguan slums may not have the background to understand informed consent or the essential irrationality, er, science,  of homeopathic nostrums, and one would hope that the University  of Washington would be interested in protecting those who cannot protect themselves.   Evidently not, since their faculty continues to export magic to vulnerable  children and adults in third world countries. Not yet ethically Tuskegee level research, but they are working on it.

I understand that one persons lapse in medical and scientific understanding is another’s opportunity for a nationally syndicated television show, but they might have well piled the money spent on the study and burned it for all the good it did the subjects and the medical literature.  At least they could have used the heat to pasteurize some milk.

Homeopaths Without Borders. Or sense.

Men never do bad medicine so completely and cheerfully as when they do it from a homeopathic conviction.

BLAISE PASCAL. Kind of.

Doctors Without Borders,  also known as Médecins Sans Frontières, is an organization that sends physicians to some of the most needy parts of the world.   Using the style, but not the substance of Doctors without Borders, is Homeopaths without Borders, or, as the RationalWiki called it, Médecins Sans Médicaments.  Their goal is to send homeopathic care to those in need.  Based in Florida, it appears to be the work of one homeopath and almost all its work is in Haiti.

“the poor health of the people here is striking. So many girls and women have vaginal infections. So many children have infected cuts. So many men have reddened eyes, rotten teeth, and injuries that are healing badly. The nurses and docs here are as dedicated as anywhere else, but they lack supplies, and they don’t have medicines.”

They need help.  Shall we provide money for antibiotics? Dental Care? Good nutrition?  Clean water?

So lets supply them with water, and not even enough to wash those infected cuts.  I have to admit this brings conflicting emotions.  I have to admire anyone who will take the time to go to a disaster like Haiti and work to help those in need.  On the other hand, they offer nothing but false hope and magic, so cannot make the lives of Haitians any better. Time, money and resources, which could be used so much more productively, wasted.  I see many patients who have pissed away their lives and opportunity with heroin or alcohol or other bad choices.

“Look, if you had one shot, or one opportunity
To seize everything you ever wanted-One moment
Would you capture it or just let it slip?
Give effective therapy or a homeopathy? “

M. Mather. Sort of.

Wasted opportunities always inspires angst. So does Médecins Sans Médicaments.

It does show how powerful delusional states can be for believers of nonsense, since as RationalWiki states “Essentially, they go to nations with sub-standard healthcare, and dilute it even more to make it 10-430 times as good as the healthcare in wealthier nations.”

PanAfrican Acupuncture Project

The evil that is in the world almost always comes of ignorance, and good intentions may do as much harm as malevolence if they lack understanding.

ALBERT CAMUS, The Plague

How best to spend very limited resources and maximize the health in Uganda, where AIDS, malaria, and Tb are endemic and have devastated the country?  Mosquito nets and condoms would be a good start to prevent these blood and mosquito borne illnesses.  Naw.  That might actually improve peoples lives.  Or we could use acupuncture instead:

“The PanAfrican Acupuncture Project trains healthcare workers in Africa to use simple and effective acupuncture techniques that enable them to treat the devastating and debilitating symptoms associated with HIV/AIDS, malaria, and TB.”

Again, I do admire the urge to go to Africa and help others.  They ask for donations and trainers on the website, expecting the trainers to provide their own airfare and $3,000 (aka 300 mosquito nets) to cover their own costs.  No small commitment. Of course, they provide a vulnerable population worthless magic, and I can only imagine what four grand could provide for clean water or malaria nets, interventions  that would actually benefit the Ugandans.

But what is scary is the web page.  Uganda is rife with HIV, which is spread, by, hmmmm, lets see, sex, blood and needles. Unsterilized needles.  In Africa, reuse of needles has been common, often due to lack of resources for sterilization, and has helped to spread HIV and perhaps other infectious diseases. So they have photos of people sticking needles into patients who could and do have HIV. Not a glove to be seen. Remember that blood borne illnesses are spread with acupuncture needles: Hepatitis B, hepatitis C and, rarely in the West, HIV.  It is rare to spread these diseases where good technique is followed scrupulously.  Poor societies are not known for the resources that allow them to fastidiously take care of proper cleaning.  Would anyone besides me worry that some acupuncture needles have a chance of being reused after poking an HIV positive patient?

As best as I can tell from the website, they are training people to potentially spread HIV between patients when and if sterilization breaks down and placing the acupuncturist at small, but real, risk should a needle stick injury occur.  The have trained over 100 local acupuncturists and hope to spread acupuncture, and the occasional blood borne viral illness, beyond Uganda to other African countries.  No benefit and all risk. The PanAfrican Acupuncture Project may have a commitment to philanthropy, but I am not convinced they have a commitment to preventing disease transmission.

“Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore.
Send these, the homeless, tempest-tost to me,
I lift my lamp beside the golden door!”
And waste their resources and health with CAM.

There are Chiropractors Without Borders and Naturopaths Without Borders who have three principles:

  • Health care is a human right for all, not a privilege for the few.
  • Everyone deserves the best healthcare, regardless of finances.
  • Naturopathic Medicine is well suited for resource-poor settings.

Unfortunately, the third has no relationship to the first two.

There is Reiki Without Borders and Herbalists without Borders fortunately for the third world,  all seem to be the work of a few individuals, although Haiti appears to be the common destination.  Poor Haitians. They really need a border.

The West has a long and sordid history of exporting disaster to the third world.  It is nice to know that sCAMsters,  even if only a very small subset, are continuing the time honored tradition of maltreatment of indigenous peoples in the name of helping them.

Fortunately there are doctors, nurses, engineers, teachers, chemists and scientists without borders, who can offer substantive help.  Even Clowns without Borders would have something to offer, although not for everyone.

People aren’t either wicked or noble. They’re like chef’s salads, with good things and bad things chopped and mixed together in a vinaigrette of confusion and conflict and alternative medicine.

DANIEL HANDLER (as Lemony Snicket). Sort of.

Posted in: Acupuncture, Homeopathy, Naturopathy

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22 thoughts on “Without Borders

  1. ConspicuousCarl says:

    Holy schniekies, there’s a lot to be said here.

    The complex relationship between racism and philanthropy has so many incarnations. Kipling is definitely a good one to start with (read “The Stranger” if you have any doubts about his inner feelings), as are many 18th-century writers who were both racist and opposed to slavery to different degrees in spite of that.

    Then we have some modern liberals who sometimes start with philanthropic intentions, and end up expressing racism without noticing that they have drifted into condescension.

    The truly annoying event is when an unwittingly racist idiot actually accuses potentially helpful people of racism. Don’t try to get Africans off of their religious delusions about medicine, because you aren’t respecting the fact that Africans like to live (and, apparently, die) that way!

    But before any of that is a real problem to be dealt with, we need to get “CAM” under control in our own countries. We do no favors to Africa by allowing nonsense to be dumped on countries with poor historical scientific education. There really isn’t any good reason why something insane like homeopathy shouldn’t be banned just as we would ban the sale of completely useless and/or untested drugs from Pfizer.

    Once we get rid of the DSHEA nonsense, we will have a legal precedent to ask for the UN to ban exports of nonsense to Africa.

    Can I try the quoting thing?

    mumble mumble mumble mumble mumble homeopathy mumble mumble mumble. BOB DYLAN as far as I can tell

  2. windriven says:

    It seems impossible to stamp out quackery in civilizations with educated populations. How then to prevent the spread of quackery among peoples with little education and long histories of reliance on herbalists and spiritualists?

    Most people may well be chopped salads. But some of the salads are mostly St. John’s Wort and calendula – they might look appetizing but they are nutritionally deficient and they taste like merde.

  3. windriven says:

    @Conspicuous Carl

    I had the misfortune of seeing the ossified remains of Bob Dylan in concert near Portland a year or two ago. I think your quote may have come from that concert. Dylan sounded like Popeye rapping – but less intelligible.

  4. Jan Willem Nienhuys says:

    Based in Florida, it appears to be the work of one homeopath and almost all their work is in Haiti.

    This refers to the US HWB, but the international HWB is much larger:
    On the website of the Dutch branch Homeopaten zonder grenzen
    http://www.hzg.nl/
    I count 5 physicians, one of whom is allowed to give lessons homeopathy (without credit, hence only a few students) in a university and one other is a surgeon and a third is a child psychiatrist who is known to prescribe homeopathically diluted helium for autism. Besides, there are 23 people on their website who are advertised as ‘homeopath’. They have projects in Ghana, Bosnia-Hercegovina, Benin, Georgia and Uganda.

    The French Homéopathes sans Frontières (in existence since 1984 or 1993) is active in 12 countries, see
    http://www.hsf-france.com/pages/missions/missions.html
    It is headed by a physician Michèle Serrand. Other physicans active there (as found by me):
    Francine WOITIER, Dr Michel PONTIS, Jean-François Masson, Dr Catherine GAUCHER (dermatologue homéopathe-acupuncteur), Dr. Frederic Rérolle, Dr Christine ARNOUX. The organisation claims to have 400 members, see http://www.associations-medicales.com/reponse/fiche.asp?code=&idassos=202392|
    There are probably many more physicians, because ‘homeopathy’ ius more or less a recognized specialism in France: if you look up a homeopathic doctor in the officlal registry, you will find ‘homeopath’ noted there.

    There is a Swiss organisation Homéopathes autour du monde Suisse, with projects in Gambia, Armeia, Tuareg, Sri Lanka (tsunami relief)

    In Germany there is Homöopathen ohne Grenzen
    http://homoeopathenohnegrenzen.de/home/
    with projects in Bolivia, Mostyar, Bam, Sierra Leone, Macedonia, Togo, Honduras, Serajevo, Sri Lanka (tsunami) (this includes past projects)
    190 members, in existence since 1997.
    President and vice-president both are homeopaths but not physicians
    They claim that physicians are member, but I cannot find them.

    These people offer homeopathic remedies agaisnt malaria, also as profylaxis, which I consider as outright criminal.

  5. Jan Willem Nienhuys says:

    My contribution is ‘awaiting morderation’ and it contains an inaccuracy. The guy that is mentioned on the site of HZG as ‘surgeon’ is born in 1931 (so he is about 80) and his surgeon-licence has expired. I cannot find any indication that he is still practicing.

  6. Wolfy says:

    Great article.

    “The poor and uneducated do not have the resources to separate fact from fiction and may lack the background to make truly informed decisions.”

    I might add. . .often times the rich and pseudo-educated in the United States don’t have the brain capacity to also separate fact from fiction. Cases in point: Suzanne Somers, Jenny McCarthy, etc. . .

  7. windriven says:

    @Jan Willem Nienhuys

    “homeopathically diluted helium for autism”

    That is a new one on me! Helium is present in the Earth’s atmosphere at about 5.2PPM – hugely potent by homeopathic standards. How do they achieve more dilute mixtures? What is the diluent? Does it make their voices only a tiny bit more squeaky? Can you point us to more information on this strange bit of quackery?

  8. Jan Willem Nienhuys says:

    Preparation of homeopathic helium probably goes as follows: the helium bubbles through water or alcohol, and after that this fluid is subject to the usual dilution and succussion steps (in the same way as homeopathic X Rays are prepared) probably to 30K or 30C. 30K means diluted with the Korsakov method, see

    http://www.homeowatch.org/history/oscillo.html

    I actually asked this psychiatrist if there had been ‘provings’ of helium. He answered me by e-mailing me that I should consult a book by Jan Scholten, http://www.amazon.com/Homoeopathy-Elements-Jan-Scholten-MD/dp/907481705X

    He also stated that nowadays there are other methods to establish what one should use homeopathic dilutions for.

    The idea of helium for autism is of course that helium doesn’t react with other substances, so it is the perfect treatment for a child that cannot communicate well, it least, if the child conforms to the heliumn drug picture (whatever that is).

  9. norrisL says:

    Homeopaths without borders, what next from these twits? I have been engaged in a prolonged forum dispute on the Australian Veterinary Association forum regarding giving credence to the quacks in our profession and the arguments they come up with drive me nuts. One “vet”, Clare Middle, quoted a link to definitively proven, properly conducted scientific studies proving the effectiveness of homeopathy. What she quoted was the usual homeopath rubbish. It was obvious that she hadn’t even opened the link that she quoted.

    I find it hard to believe that these people actually believe what they write.

    I have found evidence that homeopaths are actually extremely intelligent people. It comes as the following quote from George Orwell:

    There are some ideas so wrong that only a very intelligent person could possibly believe them.

    Stuart

  10. Toiletman says:

    The situation in sub saharan africa is out of control. The local authorities either don’t care or lack education. It doesn’t need to take a lot of intelligence and education to be the leader of a tribe-based militia but when the militia and its tribe win, that person will become president. The local populations are incredibly ethnocentristic (ethno = tribe in this case) and in opposite to poor Asian nations like Vietnam or India, there is also no desire to obtain education. It’s not regarded highly overthere because it’s not in the tradition. One consequence is the exploding population that worsens the problem more and more.

    Now we are in a dilemma. Do we help with medicine and food and further excerbate the population explosion or do we just sit and watch them dying in masses. Both alternatives definately have an unpleasant after taste. What can we do? Nothing it seems. All alternatives that would really make a difference are highly authoritarian and repressive in nature. One example would be forced sterilisation after the second child in return for developement help. These solutions are not exactly racist as race is not the decisive factor but let’s call it Euro + East Asian superiority thinking. Definately not a nice situation. Whatever we will decide to do, it will have its consequences…

  11. Harriet Hall says:

    @Jan Willem Nienhuys,

    Thanks for the explanation of homeopathic helium. Now, can you explain how they prepare a remedy from eclipsed moonlight? I am not making this up.

  12. Jan Willem Nienhuys says:

    If the moon eclipses, it is at best dark red, so you can make a remedy out of it the same way as you make a remedy out of Jupiter rays (Lux Jupiteris stellae errantis)

    http://www.interhomeopathy.org/fr-jupiter-rays-preliminary-presentation-of-proving-results

    In the Netherlands there is even a guy who has made a remedy out of a specific Black Hole (at least he thinks it is a black hole). For this so-called Remedy Makers are used. These are a kind of copying machines, that can either transfer the ‘frequency energy’ from their memory to a solvent, or from a known remedy to a solvent, or directly (across any distance to the patient) or that makes out of hair or a piece of written paper of the patient a remedy, but they have also the possibility to change a written prescription into a remedy. So you just write the name of a known black hole on a piece of paper, and use the remedy maker.

  13. Most excellent article. Although, if I were Eminem, I’d come after you for obliquely referring to his real first name, Marshall.

    It seems to me, one other danger of the export of ineffective remedies disguises as philanthropic medicine is the risk of the recipients getting a poor impression of all NGOs offering medical care. Imagine, begging rides on poor roads with your sick child, then waiting in line for hours in the hopes of getting some medicine that will help, only to be given homeopathy. Next time you are sick, are you going to make the effort? Are you going to suggest that friends and neighbors make the effort?

    Worse yet, what if the “treatment” actually makes the patient sicker? Most, likely, the repercussions of that could effect the work of all the NGOs in the area and possibly further limit the availability of healthcare in the area.

    Also, somebody should probably shoot me, but…Haitians are generally not indigenous people. Sorry, sorry, sorry.

  14. Toiletman “The local populations are incredibly ethnocentristic (ethno = tribe in this case) and in opposite to poor Asian nations like Vietnam or India, there is also no desire to obtain education. It’s not regarded highly overthere because it’s not in the tradition.”

    Umm, who says? That’s a whole lot of “analysis” to state as fact without any sources at all to back it up.

    “A parallel factor at work is fecundity, equal to or higher than 5 children per woman. This is two to three times higher as in the rest of the world, an important factor being that four out of five African women live in countries where there is little access to contraception. Indeed less than 20% of women use modern contraceptive methods, as against 60% or more in Latin America and Asia.”

    http://www.sciencedaily.com/releases/2008/01/080108100018.htm

    Perhaps, instead of starting with forced sterilization, one could consider adequate access to birth control as a possible tool in controlling population growth.

  15. Jan Willem Nienhuys says:

    In the Netherlands there is even a guy who has made a remedy out of a specific Black Hole

    @Harriet Hall

    This physician’s website is here, and if you scroll down to the picture of the Crab Nebula (which he calles a supernova), you see a little below that (in translation)

    Thus somewhere in the middle of October 2009 I got the idea to potentiate supernovae and black holes

    Somewhat further down he speculates on the basis that black holes suck in everything:

    My new theory is now: even although black holes are millions of light years away from us, this can have the effect on extremely senesitive people that they are sucked empty, energetically. So by treating such a person with for instance XTE J1819-254 30K I maybe could see to it vthat this person doesn’t lose any more energy to this black hole.

    I am not making this up. you can easily spot where he has the name of that object follwed by 30K, even if you don’t know Dutch.

    It’s incredible that such a person ever was able to finish university.

  16. BillyJoe says:

    Mixing it up:

    There is a medical doctor in my home state who uses a pendulum to decide which conventional medication to give a patient. He gets them to say the name of the medicine while swinging a pendulum. From the movements of the pendulum he can tell if the medicine will help.

  17. JPZ says:

    @ Mark Crislip

    Regarding the Nicaragua study, you may want to add that international trials (US research done ex US) require review of informed consent process by the local Board of Health. This review is to specifically prevent the problems you outlined.

  18. Mark Crislip says:

    @ Billy Joe

    Seems better than the methods by which many docs choose an antibiotic, or am I just a bitter, cynical old fart?

  19. How much of the culture of alternative medicine do the volunteers peddle along with crab nebula (!) magic water and what not? If they are also preaching Wakefield’s gospel, for example, then they are doing far more long-term damage than the immediate harm. People might refuse treatment when the real doctors arrive.

    Would it be possible to get the Nicaraguan business past a review board if the trials took place in the US? I have to admit that if the only option to help my desperately ill child was to sign a consent form randomizing her into either receiving water or receiving actual medicine, I would sign in a heartbeat with the hope that she would get the medicine. The entire premise is disgustingly coercive.

  20. Jan Willem Nienhuys says:

    Some time ago I have studied all diarrhoea studies of Jennifer Jacobs et al. There were four of them.

    Nicaragua 1990, published 1993. 16 verum, 17 placebo. Non significant.

    Nicaragua 1991, published 1994. 40 verum, 41 placebo. Significant; p just below 0.05

    Nepal 1994, published 2000. 64 verum, 52 placebo. Two outcome measures significant.

    Meta-analyse of these three, 2005

    Honduras 2004, published 2006. 145 verum, 147 placebo, not significant.

    Several skeptical comments have been voiced, namely:
    http://www.sciencebasedmedicine.org/?p=460 (Homeocracy)
    http://www.sciencebasedmedicine.org/?p=472 (Homeocracy II)
    http://www.sciencebasedmedicine.org/?p=495 (Homeocracy 3)
    http://www.sciencebasedmedicine.org/?p=508 (Homecracy IV)

    and also
    http://www.sciencebasedmedicine.org/?p=82

    First of all, children who had been taking regular medication were not admitted. Children who were too sick were sent to the hospital. All children in the trial received standard oral rehydration treatment. In the first three trials they all got tiny sugar pills after an extensive homeopathic consultation. During production
    the pills had been sprayed with an alcohol water mixture, and then left to dry. The only difference between verum and placebo was the verum alcohol had been the result of a certain preparation ritual, and the placebo alcohol was not ritualistically prepared. The actual rituals are of course unimportant, but there were many of them.

    I can’t really see how one can think that the children in the trial lacked any kind of regular treatment. Actually in many cases their stool was bacteriologically analysed, which one could call an extra service.

    In the fourth trial the difference between verum and placebo was about the same, except that for the preparation of the pills (actually tablets) a mixture of alcohols from different rituals (the arsenic ritual, the sulphur ritual, the chalk ritual) were combined. In the first three trials the homeopathic healers talked a long time with the parents to determine which ritual was appropriate. In the fourth trial all this talking was skipped, and all ‘verums’ gat the same kind of tablet.

    My criticism of the trials is that if you look carefully, the results were all due to some post trial reinterpretation of data. All trials reported small differences of doubtful clinical significance. The second trial actually had five outcome measures, and only ‘two consecutive days with less than two fluid stools’ produced the significant result.

    The third trial contains conflicting data. Before the trial two primary endpoints were chosen, but in the paper one doesn’t find what their results were! The first primary end point was again time to ‘two consecutive days with less than two fluid stools’. Clear enough, you’d think. The authors present a log rank test of a Kaplan Meier survival plot. Only by reading the meta-analysis one finds that the first primary end was non-significant. About the second primary end point no p-value is reported. The paper presents an orgy of different ways to look at the results.

    The first trial is presented as a pilot. I smell a rat. There is an easy trick to get nice results. You do a trial, but instead of collecting data and breaking the code only after all data are in, you look earlier. If per chance after a modest number of patients you have ‘reached signifiance’ you stop right away. If after a modest number of patients you can see that a miracle is needed to turn it into a success, you stop too, and call it a pilot. With this simple trick one can raise the probability of getting a ‘significant result’ in your favor.

    In the ‘meta-analysis’, where the authors combine their own prior investigations, the endpoints are subtly changed again.

    Then finally, the fourth trial. Having a trained homeopath listen to a mother for probably half an hour, and then using a computer to select a remedy is very impractical. So in the fourth trial all children got two combination tablets, and no talk, quite contrary to the original homeopathic teaching, but completely in agreement with Big Homeopathic Pharma which sells such combination preparations OTC for specific indications. The number of patients was larger than in all previous investigations together. With small numbers it is easier to bend results a little, especially if you can bend them differently in each separate trial. But with large numbers one’s result is more robust. And this fourth trial came out non-significant.

    The reaction of the authors is telling. They investigate about 10 different external influences which may have confused the issue. Now if someone is willing to do that in public, how many times will s/he have tried to rearrange the data to make them look nicer before sending in the paper for publication? Even the Hondurese micro world was blamed: ‘Another possibility is that the pathogens … in this study were less susceptible to homeopathic therapy in general, or to this specific combination therapy in particular.’ So four kinds of Hondurese virus, four species of Hondurese bacteria and five types of Hondurese parasites all conspired to ignore spiritual homeopathic dilutions. How dare they!

    The simple conclusion should have been: homeopathy doesn’t work for diarrhoea, period.

    Summarizing: if you scrutinize all these five papers together, you will see that the positive effects reported are probably the result of patient post hoc shuffling of data, choosing and modifying endpoints and methods of calculation. They are a far cry from the simple set up of decent hypothesis testing: one simple hypothesis, one simple endpoint, and precisely one p-value.

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