As the year draws to a close, I’d like to pay tribute to my many fans who use alternative therapies, especially those who have kindly commented on my various posts over the ten months since I started this blog. I’ve selected some of those comments for display in my new ‘Quackolades’ column below left. It’s my way of saying thank you for making my case better than I could. Please keep them coming.
One thing that struck me while sifting through them was how many have suggested that I don’t know anything about homeopathy. It’s a curious comment because I have used homeopathy myself and I have read extensively about it. I have my own well-thumbed copy of Hahnemann’s Organon, I have read numerous pro and anti articles on the web. I’ve also read a number of reports of clinical trials, systematic reviews and meta-analyses. In my very popular post entitled Homeopathy is crap, I give a fairly detailed explanation of what homeopathy is and I include helpful and well-referenced information about how the remedies are devised, manufactured and prescribed. Although I’ve had many somewhat animated responses to this article from defenders of the faith, not one has suggested I’ve got any of this information wrong. All things considered, I am surely better informed that the typical user of homeopathy. But I don’t see any of them getting called ‘ignorant’ by homeopaths when they post their worthless observations that it worked for them all over the web.
At least I’m in good company. Edzard Ernst, MD, PhD, FMedSci, FRCP, FRCPEd, is the world’s first Professor of Complementary Medicine. He trained at a homeopathic hospital in Germany and has spent years conducting scientific research into homeopathy and other therapies. But an article on homeopathy co-authored by Ernst and Professor Michael Baum for The American Journal of Medicine, “reflects a complete ignorance of homeopathy and the range of studies that support its effectiveness,” according to homeopath Amy Lansky, PhD. (Lansky is a former computer scientist who became a homeopath. “As a scientist I recognize that homeopathy is implausible. But I’ve seen it cure my son,” she told Psychology Today magazine. Her son had been diagnosed as autistic.)
What on earth did the esteemed Professors do to be accused of ignorance of homeopathy?
Alas, the evidence is there for all to see and I have to agree with Amy about part of it: Professors Ernst and Baum did very ignorantly replace the invented word ‘potentization’, which refers to the notion that remedies are made potent by serial dilution and shaking, with the invented word ‘potentation’ in the one instance of their using the word in the article. Ignorant bastards! You certainly got them on that one, Amy!
She’s on somewhat shakier ground with the other limb of her attack. Here it is in full:
The authors also insist on citing a single negative meta-analysis study that has already been shown to be methodologically flawed , while ignoring many positive studies in respected publications, including two other meta-analyses that showed positive results [3—8].
I love the emotive phrasing here. The authors insist on citing one study, do they?
More perturbing is the dishonesty of it. Reading Amy Lansky’s review of the article, one would be forgiven for thinking that the authors only cite the Shang et al 2005 metanalysis as proof that homeopathy doesn’t work. They do not. Please read the article properly. It’s actually very good.
Secondly, Lanky’s assertion that Shang’s study has “already been shown to be methodologically flawed,” is highly contentious and unsupported. OK, she links to the The Journal of Alternative and Complementary Medicine, which apparently carries a couple of articles criticising the study but, unless you are a subscriber to that journal, you can’t see them.
For those that aren’t familiar with Shang, I’ll repeat what I said in a previous blog. In a nutshell :
Starting with 110 homoeopathy trials and 110 matched conventional medicine trials, Shang ruthlessly excluded any trials that didn’t involve a sufficiently large number of participants and didn’t meet his high benchmark for quality i.e. decent blinding and proper randomisation. He ended up with a mere 8 trials for homeopathy and 6 for conventional medicine and they were unmatched i.e. the homeopathy trials were for different ailments than the conventional trials. The results on how the treatments compared against placebo gave very weak evidence for homeopathy and very strong evidence for conventional medicine. Shang concluded that:
This finding is compatible with the notion that the clinical effects of homoeopathy are placebo effects.
Now, what about the two other metanalyses Lansky claims “showed positive results”?
It’s not entirely clear whether Lansing intends to include the Klaus Linde et al 1997 study, which seems to be the all-time favourite of homeopaths because of one sentence contained in the abstract. This is the sentence:
The results of our meta-analysis are not compatible with the hypothesis that the clinical effects of homeopathy are completely due to placebo.
Funnily enough, homeopaths tend to forget about the following sentence:
However, we found insufficient evidence from these studies that homeopathy is clearly efficacious for any single clinical condition.
They also forget to mention Linde’s 1999 follow-up paper, which said:
The evidence of bias [in homeopathic trials] weakens the findings of our original meta-analysis. Since we completed our literature search in 1995, a considerable number of new homeopathy trials have been published. The fact that a number of the new high-quality trials… have negative results, and a recent update of our review for the most “original” subtype of homeopathy (classical or individualized homeopathy), seem to confirm the finding that more rigorous trials have less-promising results. It seems, therefore, likely that our meta-analysis at least overestimated the effects of homeopathic treatments.
As I said, it’s not clear whether whether Amy Lansky means to include the Linde study as positive evidence because she seems to have got a bit muddled. She gives the full reference for the Linde study of 1997 but, intead of linking to it, she links to a brief article of the same name by Klaus Linde and Wayne Jonas published in the Lancet 8 years later and saying this:
We agree (with Shang et al) that homoeopathy is highly implausible and that the evidence from placebo-controlled trials is not robust.
Our 1997 meta-analysis has unfortunately been misused by homoeopaths as evidence that their therapy is proven.
Neither the 1997 study nor the 2005 article would seem to add anything to the homeopath’s armoury — quite the opposite, in fact. But whatever Amy Lansky intended, I am grateful to her for unearthing such a gem of a quote from Klaus Linde, which I will repeat ad nauseum whenever someone tries to claim Linde for homeopathy in future.
Another metanalysis that “showed positive results” (let me stress that those are Amy’s exact words) is the one conducted by Kleijnen et al back in 1991(!). This one covered 107 controlled trials and concludes thus:
At the moment the evidence of clinical trials is positive but not sufficient to draw definitive conclusions because most trials are of low methodological quality and because of the unknown role of publication bias.
That then, is what Amy Lansing PhD, calls “positive evidence for homeopathy” and a reason to call Professor Ezard Ernst, in spite of his many years analysing the evidence for and against homeopathy, “ignorant”. How the fuck did this woman get a PhD?
And while we’re on the subject of scientific evidence, Jayne Thomas of the Society of Homeopaths, in this TV discussion, claims:
There are five large meta-analyses that show that it does work and these will include trials of perhaps 89 in one and 110 in another trial.
She doesn’t name these meta analyses but, interestingly, the Linde 1997 study covered 89 trials and the Shang 2005 study had 110. As we’ve seen, neither of these provide evidence that homeopathy “does work well”. Au contraire!
Why do homeopaths bother to claim that there is good scientific evidence for homeopathy when such claims can so easily be checked, leaving those who make them looking stupid or deluded or just plain liars? Answers on the back of an arnica leaf, please.
Speaking for myself, I am satisfied that if the totality of evidence is considered, the overwhelming weight of it reveals that homeopathy is no more effective than placebo and in cases of serious conditions that are not placebo-responsive, homeopathy is not effective at all. I don’t need to read every single published paper on the subject to know this because I’ve heard it from numerous different sources who, unlike those who make a living from homeopathy, have no axe to grind one way or the other.
Or not a very big axe anyway. The US National Center for Complementary and Alternative Medicine (NCCAM), for example, is funded to
• Explore complementary and alternative healing practices in the context of rigorous science.
• Train complementary and alternative medicine researchers.
• Disseminate authoritative information to the public and professionals.
But the best it can say about homeopathy, apparently, is
Most analyses have concluded that there is little evidence to support homeopathy as an effective treatment for any specific condition; although, some studies have reported positive findings.
Which we all knew already.
The moral here is that anyone can cherry-pick a single trial that shows some positive evidence but the mere fact of a positive result proves nothing.
So here’s a tip to those commenters who accuse me of ignorance: make your feedback constructive by pointing out exactly what I’ve said about homeopathy that you think I’ve got wrong and then do as I’ve done in my various posts on homeopathy and provide evidence to support your argument. Deal?
But forget about pointing me to this or that clinical study that “proves” homeopathy works. It doesn’t. (For a terrific recent example of homeopaths fudging over evidence see The Lay Scientist on the British Homeopathic Association’s press statement on the House of Commons’ Science and Technology Select Committee’s evidence check.) The totality of evidence tells us that homeopathy is a crock and nobody is sorrier that I am that this is the case.
I mean, why would anybody mind if homeopathy did actually cure anything? Anything that has a positive, safe and effective impact on people’s health would be welcomed as heartily as penicillin was. If homeopathy was only as effective as its proponents claim, it would save our publicly funded health service a fortune. Pharmaceuticals that have taken years and cost millions to research and develop could be replaced by homeopathic remedies produced at a fraction of the cost. Hell, if only homeopathy could be proven to work, it would revolutionise the healthcare systems and many of us who lack the cerebral power to make it as real doctors would happily train as homeopaths and make a living from it with a clear conscience. It would be brilliant!