It is always gratifying to see regulatory agencies actually do their job. If those regulatory agencies whose job it is to protect the public from false or harmful medical advertising, products, or services thoroughly did their job, so-called “alternative medicine” would cease to exist.
Recently the Advertising Standards Authority (ASA) in the UK issued a judgment about advertising for homeopathy, specifically by the Society of Homeopaths. They had been receiving a number of complaints. After thorough investigation, and considering the response from the homeopaths, they came to two basic conclusions: homeopaths are engaging in false advertising by claiming that homeopathy is a proven treatment for specific indications when the evidence does not support those claims, and homeopaths sometimes “discourage essential medical treatment for conditions for which medical supervision should be sought.”
The ASA specifically investigated the following advertising and claims:
1. ad (a) could discourage essential treatment for depression, a medical condition for which medical supervision should be sought, and misleadingly implied that homeopathic remedies could alleviate symptoms of depression;
2. ad (b) could discourage essential treatment for conditions for which medical supervision should be sought; and
3. the claims in ad (b) that homeopathy could treat the following medical conditions were misleading and could be substantiated:
a. Allergies and upper respiratory tract infections;
b. Ankle sprain;
c. Bronchitis;
d. Childhood diarrhoea;
e. Chronic fatigue;
f. Ear infections;
g. Fibromyalgia;
h. Hay fever;
i. Influenza;
j. Osteoarthritis;
k. Premenstrual syndrome;
l. Rheumatic diseases;
m. Sinusitis;
n. Vertigo.
After reviewing the evidence provided by the Society for Homeopaths each decision was upheld. In other words, the Society was given the opportunity to provide evidence to substantiate their claims. After reviewing that evidence the ASA concluded that the evidence did not adequately support the efficacy claims being made. (For some reason a specific description of the evidence for Vertigo is missing from the page, which seems like a simple oversight.)
I agree with their assessment of the evidence provided. It reminds me of the British Chiropractic Association’s response to Simon Singh. They provided a list of references to support their claims for efficacy for chiropractic for a number of pediatric indications. When I reviewed that evidence, however, I found that it did not support the efficacy claims being made, and was highly cherry picked and misleading.
What this clearly demonstrates, in my opinion, is that homeopaths (even those heading major homeopathic institutions) have a very different idea about evidence in medicine than does mainstream medicine (and certainly than we do at SBM). They accept far lower standards of evidence than is generally accepted by the scientific community. The fact that they offered such weak evidence to back their claims demonstrates this unequivocally.
However, I do have a concern about the process of the ASA. They seemed to consider only the evidence provided by the homeopaths. This is not adequate, as such evidence is clearly cherry picked (and even then wasn’t convincing). An independent literature search for at least systematic reviews would put the evidence into better context.
The document does reference other sources in their decision, but not when reviewing the evidence for specific indications. Let’s consider one example, the use of homeopathy in childhood diarrhea. The ASA wrote:
The Society of Homeopaths provided one study to substantiate the claim that there was sufficient research evidence to support the use of homeopathic treatment for childhood diarrhoea. A meta analysis had been conducted on three double-blind trials on a total of 242 children. Children received either an individualised homeopathic medicine or a placebo. The authors concluded that individualised homeopathic treatment decreased the duration of acute childhood diarrhoea. However, our expert considered that the use of individualised homeopathic treatments was problematic because it meant the materials in the ‘active’ arm of the studies were not identical. He considered this meant the studies were assessing effectiveness rather than efficacy and therefore the evidence was not sufficient to support efficacy claims for homeopathy for the treatment of childhood diarrhoea. We therefore concluded the claim was misleading and had not been substantiated.
This one meta-analysis of three studies can only be the Jacobs 2003 review of three clinical studies of homeopathy for diarrhea. I have had this reference cited to me by homeopaths before. Jacobs concluded:
The results from these studies confirm that individualized homeopathic treatment decreases the duration of acute childhood diarrhea and suggest that larger sample sizes be used in future homeopathic research to ensure adequate statistical power. Homeopathy should be considered for use as an adjunct to oral rehydration for this illness.
However – other reviewers (Altunç U, Pittler MH, Ernst E) looked at the same studies and concluded:
The evidence for attention-deficit/hyperactivity disorder and acute childhood diarrhea is mixed, showing both positive and negative results for their respective main outcome measures.
Further, a 2006 study by Jacobs of homeopathic combination therapy was entirely negative.
So – the Society for Homeopaths referred to the 2003 review that was positive, despite the fact that other reviews of the same data were negative, and a high-quality follow up study by the same author, Jacobs, was negative. The ASA reviewers would not know this, however, unless they did their own literature search or consulted independent experts to do so.
Conclusion
We can conclude a few things from this episode:
– When the actual scientific evidence is examined, homeopathy has not demonstrated efficacy for any indication. Homeopaths can’t seem to prove their point even when they are given free reign to cherry pick the published studies.
– Homeopaths appear to accept any level of evidence as support for homeopathy, even when that evidence is completely inadequate, and even when better evidence clearly demonstrates lack of efficacy. The unavoidable conclusion is that homeopathy is not a science-based profession.
– Homeopaths engage in deceptive advertising that is potentially harmful to the public.
There is also a broader lesson to take from this example – don’t believe proponents of so-called “alternative medicine” when they make the “what’s the harm” argument. This is the “Trojan Horse” strategy that David Gorski has pointed out before. CAM proponents get their foot in the door of academia, hospitals, or regulatory acceptance by presenting a very benign picture of what they do. Typically they present themselves as simply “integrating” benign symptomatic treatment into mainstream medicine.
This is the Trojan Horse – once they are inside the gates, the horse opens up and out comes rank pseudoscience making unwarranted efficacy claims and scaring patients away from science-based therapies.
Evidence of this behavior is there to see for anyone who cares to look, and this latest assessment by the ASA is simply more evidence. This evidence can be found just by looking on the internet. Behind closed doors, the situation is far worse. Remember the homeopathy sting in which UK homeopaths were consulted and found to be offering ineffective homeopathic potions instead of effective medications for the prevention of malaria.
Don’t believe the “integrative, complementary” marketing deception. Proponents of these dubious treatments want to replace science-based effective treatments with their magic potions.