I’ve lost count of how many self-pitying blogposts by homeopaths I’ve seen begin with those words. The assault on homeopathy is continuing relentlessly and the poor homeopaths don’t know what’s hit them. I’m sure I’m not the only one who feels a bit sorry for them.

Only joking. Didn’t you just love watching Tom Dolphin’s turn at the BMA conference recently? For those who missed it, Dolphin — who is deputy chairman of the BMA’s Junior Doctors Committee — announced that, contrary to his headline-grabbing comments back in May, homeopathy isn’t witchcraft after all. He graciously apologised for the offence caused to all the witches who’d objected to the association with homeopathy. “I take it back — it isn’t witchcraft”, said a contrite Dolphin, before going on to explain what homeopathy really is.

It’s nonsense on stilts. It’s pernicious nonsense that feeds a rising wave of irrationality that threatens to overwhelm the hard won gains of the Enlightenment and the scientific method. We risk as a society slipping back into a state of magical thinking when made up science passes for rational discourse and wishing for something to be true passes for proof.

Amen to that and the motion to stop funding homeopathy was carried overwhelmingly. The only surprise — apart from the fact that it’s taken them this long to get this far — being that anyone voted against it. Most of the speeches against the motion were the usual pap: “paucity of evidence does not amount to lack of efficacy,” whined one speaker, ignoring the wealth of evidence of hundreds of clinical trials; “It works — ask the people of anywhere in the world,” bleated another.

But the speeches against weren’t all that bad. Here’s London GP, Paddy Glackin:

I’ve got a group of patients who go to the homeopathic hospital and it’s a great relief to me that they do because, frankly, I’ve got nothing else to offer them. I am completely stuck while they have found a place where they are getting better and if we remove NHS funding I don’t know what I’m going to do with them because they have been extenisvely investigated, extensively managed and the only person they are getting benefit from is the guy who waves some water in their face and is really sweet to them once a month. That keeps them well.

That the homeopathic hospitals should serve as place where doctors can dump untreatable patients is probably the best argument for continuing to fund homeopathy on the NHS. But even if the NHS had infinite resources, I still wouldn’t support it because homeopathy is indeed ‘nonsense on stilts’ and it’s time we stopped pretending otherwise.

Enough already!

I recall the feminist conferences I attended in the 1970s and the fervent discussions we had about how the NHS was failing us. The ideas that were floated at the time contributed to the change in the culture of the doctor-patient relationship we’ve witnessed over the past few decades. These days we demand that our doctors are honest with us, that they listen to us and take us seriously and aren’t paternalistic and condescencing…don’t we?

A few years ago, I attended a talk given by Dr David Reilly, who qualified as a doctor of proper medicine but now works at the Glasgow Homeopathic Hospital. Dr Reilly started his talk by claiming there were some 200 positive trials for homeopathy. Thereafter he refused point blank to talk about homeopathy and he disregarded any challenges to the principles of homeopathy from the audience, stating he hadn’t come to discuss it. What he’d come to talk about was the work of the Glasgow Homeopathic Hospital and what he took an hour to say could be summed up thus:

Give some people a lovely, tranquil environment, a lot of time, a listening ear and a good bedside manner and they start to feel better.

This works regardless of whether any remedy prescribed has any active ingredients and we know, of course, that homeopathic remedies don’t. The reason I remember Dr Reilly’s talk so well was because it echoed precisely what we’d said at those meetings over thirty years ago and it has absolutely nothing to do with homeopathy. Back then, we all felt the NHS had an ugly paternalistic face and that it treated us something like the pie cases on a Fray Bentos assembly line, filling us with drugs instead of steak and kidney and sending us on our way. What we wanted to happen was something like this:

(1) Train doctors to ask sensitive questions to help patients get everything off their chest and to listen intently while patients prattle on about themselves.
(2) Allow doctors to spend an hour with each patient every visit.

Sorted. No need to refer anyone to a homeoquack so we can stop funding them pronto.

We knew then as we know now that the second requirement wouldn’t be fulfilled any time soon in a publicly-funded health care system, and that this would obviously impact negatively on the first requirement. Thus the new and improved generation of today’s GPs still end up, as Dr Paddy Glackin suggested in his speech, prescribing too many unnecessary meds that don’t work anyway and don’t get rid of chronically unwell patients who have nowhere else to go. That’s what the homeopathic hospitals are for.

Crikey, I could almost talk myself round into supporting them, were it not for the fact that I am haunted by the spectre of my dying mother being ejected from an NHS hospital without them even changing her nappy and with a fucking cannula still stuck in her arm because they were so short of beds and staff. Wanting to get rid of patients because you don’t know what else to do with them isn’t reason enough to lie to them and to spend £4 million out of the public purse annually financing the lie. As I once heard oncologist Prof Michael Baum say to a hysterical homeopathy user, “You can buy your homeopathy if you want but you can’t have it at the expense of other women’s lives”. It may only be a tiny portion of the NHS budget — as they never stop reminding us — but you can buy a lot of Tamoxifen for that.

It might seem callous to suggest that people who want the NHS to fund their homeopathy should buy themselves a tube of Smarties and ring the Samaritans for a nice chat instead. But these are hard times and if the NHS can’t afford proper meds, it needs to stop wasting money on pretend ones. It also needs to have the debate on the placebo effect that Martin Robbins called for in the Guardian recently. Perhaps most importantly, it needs to work out how to harness the benefits of the homeopathic consultation for the good of all patients. Just to reiterate: the benefis have nothing to do with homeopathic remedies. Let’s stop pretending that every health problem has an ingestible solution. That’s what homeopaths do and it’s a load of crap.

What’s next?

No doubt there are some who think that, once the NHS stops funding homeopathy and once Boots and other chemist shops stop presenting the remedies as if they do indeed have ‘therapeutic indications’, then there’d be nothing left for skeptics to do and we’ll shut up and move on to something else. But they’d be wrong. The problem is that homeopaths are liars. Yes, I know a lot of the lies are unintentional because they are delusional but for others there is no excuse. Take, for example, the oft-repeated claim of the “five systematic reviews” that supposedly amount to evidence for homeopathy. This lie is as common as pigeon shit and easily exposed for being exactly that. I caught and exposed the odious American homeoquack Dana Ullman repeating it here and in a previous blog I did the same favour for Jayne Thomas of the Society of Homeopaths, who had the audacity to repeat the falsehood on national TV. Martin did an excellent job in another Guardian column more recently.

Talking of the Society of Homeopaths, apart from telling porkies on national TV and bullying skeptics who tell the truth about them, what exactly is it for? Browsing the Society’s website, I came across its Code of Ethics and Practice and skimmed through it. One line leaped out at me:

“No advertising may be used which expressly or implicitly claims to cure named diseases”.

Quite right too. However, given the dishonesty that is the very essence of the whole cult of homeopathy, I wasn’t particularly surprised to come across this claim on a member’s website (actually the first hit on Google after entering ‘registered with the Society of Homeoapths’):

Basically any condition you would see a GP for can be treated homeopathically.

It doesn’t name any diseases, it simply claims to be able to treat any condition under the sun. WTF??

I am approaching the age my mother was at when she discovered the lump in her breast that turned out to be a malignant tumour necessitating a mastectomy, which allowed her to live for another 30 years. If only she’d seen a homeopath instead of her GP, eh?  She might have saved herself a lot of trouble and just died a slow, agonising premature death like Penelope Dingle did.

Yes, people should be free to make their own choices about health as long as they fund their more eccentric choices out of their own pockets rather than everyone else’s. Does that mean that UK homeopaths working outside of the NHS should be able to say whatever nonsense they like on their websites and in their promotional literature? I think not. Thanks to the efforts of skeptics fed up with seeing desperate people being conned by unscrupulous quacks, the chiropractic ‘profession’ now has to mind its ps and qs. It’s high time the homeopaths got a piece of the action.

You may be wondering what possessed me to spend a day listening to a bunch of quacks talking piffle. Having done it, I’m wondering the same. The best I can say is that I went for the same reason I once consented to an examination by a chiropractor, wore a niqab and gave birth at home (not all at the same time) and why I might yet have a reiki massage and do the alpha course: I wanted to see what it was like. I saw it as part of the rich tapestry of out-of-the-ordinary experiences that life has to offer. What could be more bizarre than to sit listening to “top PhD research scientists” talk about one of the loopiest of all quack therapies as if there was a serious chance it could revolutionise health care systems in the developed world?

The conference, organised by the very scary Jayney Goddard of the Complementary Medical Association, was promoted thus:

Jayney Goddard ‘Homeopathy is nothing more than placebo! It doesn’t work and homeopaths are cynically ripping off vulnerable people!’ We’ve all seen these ridiculous headlines. So, if you are as fed up as we are of hearing this constant nonsense, do come along to the 2010 “Scientific Research in Homeopathy” Conference. This is a not-for-profit event that will give you the proof you need to effectively counter these arguments.

Jayney opened the conference with the declaration that, “Homeopathy is weird. We know it works but we don’t know how,” and promised us speakers “at the zenith of their profession.”

Are you ready?

Lionel Milgrom

Call me naive, but when I go to conferences I expect to hear professional presentations in keeping with the theme of the event.

I’d never seen or heard Dr Milgrom perform live before and I initially mistook him for some cocky little barrow boy from Billingsgate market who’d wandered in by mistake. But, according to the conference website, he’d had a “a long career as an academic research scientist”. Blimey, as Milgrom would probably say, he certainly kept his scientific credentials well-hidden during the hissy-fit he gave in lieu of a presentation.

The list of targets was predictable enough: Edzard Ernst, Richard Dawkins, David Colquhoun, Michael Baum, Simon Singh and Ben Goldacre all came in for a tongue-lashing as did the Sense about Science charity, with a special mention for the charity’s founder, Lord Taverne: “Dick by name, dick by nature,” spat Milgrom, to approving sniggers from the audience. But the main target for his venom was Evan Harris. “I’ve always voted Lib Dem before,” he snivelled, “but I never will again.” He announced that he’d written to Nick Clegg requesting that Evan be censured — “and I really hope he is!” See gimpyblog for a look at the letter.

It seemed a curious decision to kick off a purportedly serious conference about homeopathy and scientific research with a session that was little more than a rant about “the new fundamentalism”, as Milgrom describes the growing opposition to the unethical promotion and public funding of scientifically unsupported therapies. It also seemed curious that he should give a presentation that, as far as I can see,  was virtually identical to the one he gave at the first such conference two years ago (available here or, for anyone who’d prefer to read the same old guff in article form, try here). As an update on his last rant, we’d been promised a “critique” of the article by Michael Baum and Edzard Ernst on the truth about homeopathy, but nothing that could reasonably described as a critique took place.

It will come as no surprise that Milgrom gave the usual quackish misrepresentation of what was happening in the BCA v Simon Singh libel case (in spite of Jack of Kent’s hilarious post about him last year), sneered at the 10:23 event and at skeptic bloggers in general. And, of course, he called the meta-analysis by Shang et al (the one that reveals homeopathy to be the biggest cock and bull story since the virgin birth) the “best example of bad science worthy of Ben Goldacre”, which is what he said last time (see apgaylard), and which is, of course, nonsense. There were a few criticisms of the Shang paper but these have been more than adequately answered and, anyway, they had no effect on the truth of Shang’s conclusions. Milgrom is not the type of quack who would let the truth get in the way of good story, however.

If anyone’s interested in any of the…ahem…‘scientific’ content of Milgrom’s slot, I suggest you go and read Andy Lewis’s superb article about what he said at the previous conference and if that isn’t enough for you, I can recommend Shpalman’s collection of articles on Milgrom. As far as I’m concerned, he’s a waste of space and I’m not going to waste any more of my time on him.

19.4.2010: Edited to add link so you can read Milgrom’s rant now published on some quack website. Don’t all rush.

Alex Tournier

The demeanour of this charming Frenchman couldn’t have been more of a contrast to that of the horrendous Milgrom. Not only did he not slag anyone off but his was one of only two presentations at the conference that contained some science and it is rather sad that someone so well qualified is wasting their time on homeopathy. Dr Tournier is a biophysicist and a research fellow for Cancer Research UK. He is also chair of the Homeopathy Research Institute.

I don’t propose to say much about the content of his presentation because, although I took copious notes, I don’t have a copy of the slides he used. (Copies of all the presentations were promised to attendees; none have so far materialised.) Even with the slides, I found his argument difficult to follow and it was even more difficult to take him seriously after he’d introduced his session with probably the daftest remark made by any of the speakers during the entire day, which is that the principle of like treating like — the ‘Law of Similars’ — is “pretty uncontroversial”.

Say what?

It isn’t the first time I’ve heard a quack from a scientific background mention vaccines in the same breath as homeopathy and, coming from people like that, I can’t see the comparison as anything other than dishonest. I know a lot of homeopaths say things like, ‘homeopathy works by stimulating the body’s own healing power’, but they’re just stupid. That’s not an explanation!

Surely the ‘treat like with like’ — sympathetic magic — idea is every bit as controversial as the ‘more dilute = more potent’ nonsense. (The latter is what Alex Tournier described as the ‘Achilles heel’ of any theory of homeopathy, when really it’s just the part that most easily lends itself to ridicule.) The ‘Law of Similars’ has always been a huge stumbling block to acceptance as far as I’m concerned and I still await answers to the questions about it I have posed several times already in previous posts.

Tournier soon made his second ludicrous and dishonest assertion of the day, which was that homeopathy’s detractors never pick up on the similarity of the high dilutions principle and hormesis. Oh, good grief! I may not have a PhD in biophysics but even I know the difference between something and nothing.

Another reason why I didn’t expect to be blown away by Tournier’s presentation is that I’d read Gimpy’s analysis of what he said last time. To quote Gimpy,

…he indulges in the familiar deceit, misinterpretations and hypocrisy of homeopaths when it comes to evaluating scientific approaches to homeopathy

Exactly.

Anyway, as I can’t bring Tournier’s presentation to you, I’ll just c & p what he said in the pre-conference information and move on. (I’d skip it if I were you.)

There is presently no accepted scientific theory of how the high-dilutions involved in homeopathy might carry any physical effect, let alone a therapeutic effect. Several lines of enquiry have been followed over the years with little success. There is currently a great need for a testable theory of high-dilutions, such a theory might be that of Quantum Coherence Domains (QCDs).

Giuliano Preparata (1942-2000), an Italian theoretical physicist at the university of Milan, hypothesised the presence of QCDs in room temperature condense matter. QCDs emerged out of Preparata’s extension of Quantum Electro-Dynamics to include interactions with external Electromagnetic (EM) fields. In the case of water these hypothesised QCDs would be small volumes of water each one acting as a single quantumly coherent entity.

These QCDs have interesting properties in terms of a potential explanation of the phenomena linked to high-dilutions. These QCDs are predicted to capture the EM fields present at the time of their creation. This process could, in principle, capture the specific EM signature of any given substance. The serial dilution/succussion process involved in homeopathy could then be seen as a way of propagating QCDs around a sample (through succussions or, equivalently, vortexing) and eventually removing all trace of the original substance (through dilutions).

QCDs are currently being investigated as a potential explanation of a number of anomalous behaviours reported in experiments investigating solvation effects. In the context of high-dilutions a number of experiments have already reported some effects, although not in a fully reproducible way.

I will present an overview of the theory of QCDs and how, when applied to homeopathy, it offers a framework through which many of the observed phenomena can be investigated and potentially explained.

Kate Chatfield

Chatfield’s name will be familiar to anyone who’s been following David Colquhoun’s campaign against quackademia (snigger). She still leads an MSc course at Uclan but it’s only in homeopathy by e-learning, which would explain why Chatfield, who described herself as a “philosopher not a scientist” is considered qualified to take it.

Obviously, as she’s not a scientist, her session wasn’t remotely connected to science. Instead she promised, in her session, to address the question of whether it is unethical to prescribe homeopathy. Chatfield, a homeopath, concluded that it isn’t. Fancy that.

Steven Cartwright

How lucky am I that Azneo has produced a very nice wee blog post on the same presentation — right down to the quote from Sir Arthur Conan Doyle — given by Cartwright at another venue! Before you click on the link, allow me to indulge in a bit of blatant well-poisoning.

I’m sorry but I just have to share with you some bits from an article by the same Dr Steven Cartwright that was published in The Homeopath magazine in 1996.

Cartwright had several years experience as a homeopath and four years involvement in shamanism, when he travelled to Peru to learn about the shamanic healing practices of a tribe of Amazon Indians. He “knew intuitively that there were important connections between shamanism and homeopathy”.

My favourite bit is his description of how a shaman deals with a sick person who comes to see him and how it may take several visits before the shaman ‘sees’ what is wrong with the person.

The shaman would say that the spirits have shown him. And in that moment of ‘seeing’ the cure takes place. The singing that follows, the plant infusions that are given, all help; but unless the shaman has ‘seen’, no cure can take place.

This all sounds fair enough, doesn’t it? We are talking about a primitive people living in the Amazon rainforest, after all. I don’t suppose too many of them get the chance to go to university, unlike Steven Cartwright who, according to his conference profile, gained his PhD from Edinburgh University and spent many years as a research biochemist at Oxford University before discovering homeopathy. He continues:

The parallels with homeopathy were unmistakable. A patient can come several times to the homeopath, but only when we ‘see’ the nature of the patient’s sickness, only when we understand, can and does, cure take place…For the shaman it is the spirits who help him to ‘see’. The homeopath has only symptoms to help him or her to ‘see’. And intuition.

Now here’s the bit that made my jaw drop:

For those of us who do not follow the way of the shaman, there is a symbolic system above all others which is so versatile and which tells us so much about a patient and their state of being, including their heredity, even before they tell us their story, that it is invaluable as an aid to coming to the meaning of sickness; and that symbolic system is astrology. Astrology gives us access directly at the level of meaning, rather than manifestation, and that, to my mind, is its great value.

I’ve since learned that astrology — sorry, I mean medical astrology — is considered quite appropriate for incorporation into the homeoquack’s armoury. I am so tempted to book a consultation with Steven Cartwright just to hear him talk about ‘Mars in Scorpio rising’ or some such twaddle.

You may be wondering why somebody like this was speaking at a conference that has the word ‘science’ in the title. The answer is that he’s been involved in “experimental work at the Cherwell Innovation Centre in Oxford aimed at developing assay systems for homeopathic potencies as well as demonstrating changes in solution on succession, which it is hoped will eventually lead to an explanation of the mechanism of action of homeopathy”.

Steven Cartwright, bless him, comes over as a really sweet and personable man but he doesn’t half talk some hogwash. Here’s a sample taken down verbatim from his session:

Has anyone here given a remedy and it hasn’t worked, then given the same remedy further down the line and it has worked? (Murmers of assent.)

What’s happening?

The indications are that potencies oscillate in their effectiveness over time…What if James Maddox and James Randi had come to Benveniste’s lab on a day when the strength of the potency was at its lowest? And if they’d come when the strength of a remedy was at a peak, I wouldn’t be standing here now because Benveniste would have won the Nobel prize and it would all have been sorted.

OK, go away and read that other blog now, if you’re interested enough in what Dr Cartwright has to say. (As an alternative, I’d recommend yesterday’s interesting post by Prof Stephen Curry: Homeopathy and the Structure of Memory.)

By the way, if anyone doesn’t know the story of Benveniste, you could do worse than watch the 2002 Horizon documentary on homeopathy, which is now on youtube. The advantage of this is you get to see and hear Benveniste himself talk and he’s dead sexy. Well, just dead now, of course. Milgrom’s in it too.

Edited to add: Or see the Bienveniste story told in cartoon strip here — superb!

Oliver Dowding

We have huge “constituencies” of satisfied users consistently proving beneficial outcomes. These are satisfied users who generally have four legs, but in some cases, only two, and all come from the animal kingdom. Whilst not widely practised in this country, there are a great many more animal users of homoeopathy than sceptics are prepared to accept.

Yes, I know. This extract from Dowding’s conference profile is just begging for ridicule. You’re right, Oliver, I do not accept. Just put me in touch with some of these four-legged “users” and let them tell me themselves how satisfied they really are.

There is more of the same on this website, which he directed us to.

This article is written from the experiences I had in keeping 500 head of dairy livestock for 14 years, whilst managing the farm under organic principles.  I was meeting many health challenges that they faced, which we primarily resolved with homoeopathic remedies.  The overriding outcome and opinion formed was that cows are not inherent liars or fraudulent creatures!  They have no axe to grind, nor a commercial position to maintain or enhance.

There’s not more much I can say about this former dairy farmer, who was yet another speaker at this so-called science conference who began his session by declaring he wasn’t a scientist, had no degree of any sort in fact but he had “spent a lifetime doing things”. Well, that’s nice to know.

Dowding was as sour as Cartwright was sweet. Allopathic medicine is failing on a big scale, he told us, and we need alternatives. I’m sure he knew he was singing (or, rather, reading his speech word for word) to the choir but that didn’t stop him.

Like Lionel Milgrom, he felt the need to have a cathartic rant at the usual suspects — mainly Ben Goldacre — but also at the more humble everyday folk who like to challenge the promotion of dangerous nonsense on the web under “ridiculous pseudonyms”. I can’t think who he means. Strangely, the one he chose to focus on was my friend, Margaret Nelson, who makes no attempt to hide her identity in making her brief comment on libdemvoice.org, which Dowding read out because it ends with this throwaway line:

Oh, and if Oliver’s use of homeopathic “treatments” for his livestock causes them any suffering, he’s liable to be prosecuted on animal welfare grounds because it’s not treatment at all.

Dowding, to my astonishment, then read out his entire response, which is nearly a thousand words long! How surreal was it to be at a conference supposedly about scientific research listening to Worzel Gummidge read out some squabble he’d had on the internet? Honestly, it felt utterly bizarre. I will add that I go to quite a few meetings and conferences and if the humanists and skeptics I hear at them behaved like some of these people did, I’d have nothing to do with them.

Anyway, Worzel said nothing that was worth reproducing here so I’ll move swiftly on.

Clare Relton

During the conference, two conflicting views were expressed on the state of scientific evidence for homeopathy. One view is that there is loads of good quality scientific evidence that homeopathy works (Milgrom) and the other view was that there isn’t (Relton — though, in fairness, she implied this rather than said it in as many words).

Milgrom repeated the lie that “there are many good quality scientific trials and meta-analyses showing that homeopathy can demonstrate clinically observable effects over and above placebo”. Relton, on the other hand, while stating that since 1945 there have been some 200 RCTs published on homeopathy and that a new one lands on her desk every couple of weeks, repeated the argument so beloved of altmed devotees, which is that “lack of evidence of effectiveness is not the same as evidence of lack of effectiveness”.

Indeed it isn’t and it’s a perfectly reasonable thing to say in relation to a therapy that — unlike homeopathy — is scientifically plausible but hasn’t been trialled extensively. When a treatment that — unlike homeopathy —  doesn’t flout any fundamental laws of physics but — unlike homeopathy — hasn’t been subjected to rigorous scientific testing, then of course we can’t know for certain whether it works or not.

Take, for example, the extract from the foxglove plant, digitalis, which was originally part of an old folk remedy for heart disease and which is still used by homeopaths “for people who are prone to heart and circulatory disorders. The remedy is considered particularly appropriate if symptoms are accompanied by a fear of death, or a fear that moving — especially walking — may cause the heart to stop beating”.

For more than two centuries digitalis (digoxin) was considered a life-saver by physicians practising orthodox medicine as well.

…doctors based their ideas on their clinical experience and intuition, and knew that digoxin saved lives. They could see it working. The 1997 trial showed that doctors had been wrong on this point for two centuries. People who took digoxin lived no longer than those who swallowed a placebo. That was not because it was less ‘natural’ than chewing on a foxglove, simply because the effect of the active compound on the human body was not as miraculous as intuition suggested.”

Druin Burch,Taking the Medicine p. 237

When it comes to a therapy that has been tested in a couple of hundred RCTs and when the better quality trials demonstrate an effect no better than placebo….well, if that isn’t evidence of lack of effectiveness, I don’t know what is.

But for homeopaths — or any other breed of quack for that matter — if the science tells us something we don’t like, then there is something wrong with the science. Clare Relton used her slot to talk about clinical trials — the subject of her recently completed PhD. She was the most engaging speaker at the conference and her presentation was the only one I found vaguely interesting, though not as interesting as her story of how she flunked science at age 13, got a “motley collection of GCSEs” yet ended up being employed by the NHS to provide homeopathic treatment and is now a research fellow at Sheffield. She said she found the fact that she now earns her living from science “intriguing” and, having heard her presentation, so do I.

She mentioned her extensive experience of treating menopausal women with homeopathy. As someone who’s spent the best part of a year finding out just how bad the menopause sucks and how it can ruin one’s social life, I had no trouble imagining how nice it would be to spend an hour in the company of this charismatic woman. I could envisage her listening intently, maybe even holding my hand as she nodded sympathetically. Then she would prescribe an individualised remedy — a remedy just for me — devised after careful consideration of everything from my food preferences to my phobias (for a list of questions used in homeopathic consultations, see here). I have not the slightest doubt that if anyone can cure my menopause, Clare Relton can. A series of appointments with her and I’m sure the hot flushes would lessen in frequency and eventually disappear altogether. Yep, I’m convinced of it.

Anyway. Dr Relton talked about perceived shortcomings of RCTs and about her pioneering work on a new trial design: Relton et al BMJ. 2010 Mar 19;340:c1066. doi: 10.1136/bmj.c1066. Rethinking pragmatic randomised controlled trials: introducing the “cohort multiple randomised controlled trial” design.

Here’s an extract from the article:

We have obtained ethical approval for and have conducted a pilot study of the cmRCT design. (Relton C. A new design for pragmatic RCTs: a “patient cohort” RCT of treatment by a homeopath for menopausal hot flushes. [PhD thesis] ISRCTN 0287542. University of Sheffield, 2009.)

In this pilot, a large observational cohort of 856 women aged 45-64 was recruited and their outcomes measured. A total of 72 women reported frequent or severe menopausal hot flushes, or both. Of these 72 women, 48 were eligible for the trial treatment (NA) and 24 were randomly selected to be offered the treatment (nA). The outcomes of the randomly selected patients were then compared with the outcomes of those eligible patients not randomly selected (NA – nA) using both intention to treat analysis and CACE analysis.20 Patients were not told about the treatments that they were not randomly selected to be offered.

Now, here’s how she described to the conference audience, what she’d told the women selected to be offered the treatment:

There is a treatment that we think might benefit you but we are not sure. There doesn’t appear to be any risks because it is homeopathic, although there is not much evidence about it.

I don’t pretend to be any kind of expert in these matters but even I managed to spot a teensy-weensy problem with that scenario. We know by now (and, indeed, have known for more than 200 years) that the mere belief that a medical intervention is taking place can result in an improvement (or worsening) in some medical conditions. That’s why trials have control groups and why both groups are blinded. Isn’t comparing a group who know they are being treated to a group who know they aren’t, asking for bias? What am I missing here? I hope someone will be able to explain it to me — preferably someone who knows what they are talking about.

If you’re wondering why I didn’t pose this question to Dr Relton at the time, it’s because we were forbidden by Janey Goddard from asking questions in the sessions. The conference wasn’t an occasion at which conferring was encouraged until a brief all-speaker panel session at the end. Goddard said it was more “holistic” (yes, she really said that!) to save questions until the end of the day when, inevitably, there were too many — mostly daft — questions for the time allotted.

During her slot Relton also highlighted, with the help of the BMJ pie chart, “how little we know about the effectiveness of NHS-funded healthcare”. To her credit, she didn’t do what I’ve mostly seen quacks do with that pie-chart and claim that it refers only to conventional medicine when it fact it refers to all commonly used treatments including the one Dr Relton has spent years practising. She focussed very much on the 51% of treatments of unknown effectiveness (treatments “for which there are currently insufficient data or data of inadequate quality”) without mentioning the criteria on which treatments were included or left out so I’m not sure what point she was making. Funnily enough, she made no mention at all of the 13% of treatments of proven effectiveness and of the fact that homeopathy was not included amongst them.

Dr Rob Verkerk

Verkerk is a “compelling speaker who is also extremely personable,” said the pre-conference publicity. In fact, Verkerk, who has a PhD in something to do with agriculture comes across a dreary, whingeing and obnoxious gobshite, very much in the Milgrom mould. He is the Executive Director of the Alliance for Natural Health — whatever that is — and, like many of the presentations at this ‘Scientific Research in Homeopathy’ conference, his had nothing much to do with scientific research but, like Clare Relton’s session, focussed much more on dissing the methodology employed by scientific researchers because it doesn’t suit quack remedies.

He quickly endeared himself to the audience with a hilarious joke that went something like this: “It’s important to declare one’s biases and my bias is that I don’t like pharmaceuticals a lot”. His second bias is that he doesn’t like “corporate imperialism”. I’m sure you can work out one of his favourite themes from those two biases and his argument was so tired, I’m not even going to go there.

My interest was piqued when he informed us that “energy-based medicine” is central to some ancient tradition or other and that the only people who don’t understand it are orthodox physicians. But my hope that he was going to give some sort of explanation of this energy-based medicine was not realised, alas. Instead he told us his third bias is Ben Goldacre, whom he doesn’t think is a very good doctor or scientist. But then Dr Verkerk evidently doesn’t think that any doctor or scientist who considers the totality of available evidence for quack remedies and concludes that they are basically crap, is a very good doctor or scientist.

Verkerk talked about the difference between efficacy in the “ideal experimental world” and effectiveness in the “real world”. As every quack knows, the methods of research favoured by scientists tend to demonstrate a lack of efficacy in quack therapies and this, he whined, is mainly because scientific researchers ignore clinical experience, which isn’t what David Sackett intended at all. No, indeed! Then again, I don’t think he intended that clinical trials should be cherry-picked and the larger, better quality ones ignored. In his 1996 article in the BMJ, (which Verkerk mendaciously referred to as a “complaint” that clinical experience is being disregarded), Sackett said,

Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.

It follows that, as the best clinical evidence from systematic research of homeopathy shows it’s a crock, NHS funding for it should be withdrawn immediately.

Of course, Verkerk also had a go at Edzard Ernst. He went on about Edzard rather a lot, in fact. To give a flavour of what he said and the tone in which he said it, this is Verkerk reading from a systematic review of RCTs of individualised herbal medicine conducted by “Ernst and his chums”, in 2007.

“There is a sparsity of evidence regarding the effectiveness of individualised herbal medicine and no convincing evidence to support the use of individualised herbal medicine in any indication”…so says God! And it is utter rubbish! If only he was to look at what’s happening in a clinical environment…

If this conjures up a picture of a surly adolescent having a tantrum, I’ve succeeded in conveying my own impression of Verkerk’s session. If not, you might like to look at Verkerk’s written response to the same systematic review, in which he says pretty much the same thing and in the same way as he did at the conference.

Scientists like Prof Ernst have become so introspective over their worship of their reductionist methods that they fail to see how they do or don’t relate to the much, much bigger picture of how extremely complex and diverse natural substances interplay with even more complex and diverse genomes. This truly is an abuse of science.

Worship of reductionist methods? Enough already! I really can’t be bothered to transcribe the rest of what this guy said. Let’s just consider that the pre-conference publicity said the main purpose of Verkerk’s session was to “outline a potential way forward aimed at facilitating greater acceptance and uptake of homeopathy by mainstream medicine”.

This is what he said in conclusion:

It is time to park some of the thinking on efficacy. It ties up a huge amount of resources. If they want to do it, that’s fine, but the work is done so consistently badly and inappropriately that, most of the time, it’s not worth it…We need to be thinking about mechanisms but it’s not not the end of the line if we don’t have one. We need to focus on finding better tools to measure what is going in a clinical environment. We have to translate that patient experience and find better ways of translating what’s happening at a clinical level into a so-called scientific approach.

In other words, stop worrying about how it works; the way scientists do science sucks and we just need to find ways of making all our anecdotes look like convincing evidence. Clare Relton said pretty much the same thing — she just said it in a nicer way.

Conclusion

The conference has been described as a “huge success” but only, so far as I know, by the person who organised it. It’s not clear what criteria she is basing her judgment on but probably that people enjoyed it as a social occasion. One thing I can be sure of: not a single person left that conference equipped to “effectively counter” the arguments against homeopathy as a therapy or against its provision on the NHS.

Something I hoped to gain from the day was a better understanding of why people so passionately believed in such an implausible idea. Is there something more going on here (I mean psychologically, not with homeopathy) than the naive post hoc ergo propter hoc assumption?

I don’t think so.

I think we already know the factors that come into play: perhaps the most important one is that bad experiences with proper medicine make one more disposed to wanting any alternative to work, however batty it sounds. The apparently miraculous recovery of a loved one (or oneself) when nothing else had worked — as was the case with Relton’s son’s chronic ear infections, which hadn’t responded to antibiotics but got better after getting homeopathic treatment — can provoke an ephiphany and I use that word deliberately. The conversion to homeopathy is closer to a religious experience than it is to anything else, just as homeopathy is more like a religion or cult than it is like a proper health discipline. I don’t think faith in homeopathy can be explained by any new insight into the human condition that has thus far eluded us.

And, of course, once someone has invested days, months or years and a considerable amount of money to becoming a homeopath and especially once they’ve found they can make some sort of living out of it, their minds become resolutely closed to the possibility that they can be wrong about it. (By the way, in my usual spirit of open-minded enquiry, I wouldn’t mind doing this two-day beginners’ course at the Centre for Homeopathic Education, if only it didn’t cost £250. Any offers to fund me?)

Talking of money, I will say that if the conference had really lived up to the title and the promises, i.e. if it had really been about scientific research, if the speakers had really been top PhD scientists and at the zenith of their profession and if it had really equipped people to effectively counter what are really very simple arguments, then it would have been a fantastic bargain at £58.

As it is, the best thing I got out of it was a rather nice goody bag which, once I’d binned the contents, proved quite useful on my next trip to Sainsbury’s.

And to all those who argue that homeopathic remedies are individualised, that it needs a consultation with a homeopath to build up a ‘symptom picture’ and that getting the remedy and dosage right is highly skilled work for which homeopaths are comprehensively trained, I trust you will join the campaign because otherwise you’ll look a bit silly.

Do you realise that the boxes containing homeopathic remedies aren’t kept behind the counter but sit openly the shelves at Boots, that they contain no information whatsoever about what they might treat and that Boots do not require their sales staff and pharmacists to be qualified homeopaths? The result is that customers self-prescribe and, because many inevitably get the remedy and dosage wrong, they end up thinking homeopathy doesn’t work. Imagine that!

‘Customer choice’ doesn’t justify the stocking of this shite. Some fifteen years ago, I was naive enough to buy homeopathic remedies from Boots precisely because they were stocked by what I considered to be a reputable chemist that I could trust. I certainly would not have chosen to buy a homeopathic remedy had I known they contain no active ingredients. That’s not customer choice – it’s customer conning. It’s a scam and I want my money back. Back in the mid-nineties, there would be a chart sitting on the shelf next to the homeopathic remedies Boots were selling, where you could look up what each remedy supposedly treated. Nowadays there is nothing. I wonder why? Nothing to do with the fact that they are just sugar pills, I’m sure.

I’m delighted the 10:23 campaign is getting so much publicity. If it brings to the attention of a few more people the fact that there really is nothing in it and they don’t waste their money like I did, it will have been worthwhile.

The stocking of sugar pills in a manner that misleads customers into thinking they are genuinely therapeutic remedies isn’t the only sin Boots has to answer for. The Boots Learning Store section on alternative medicine beggars belief. I’ve mentioned this appalling website before (as have other bloggers) and today I fired off a complaint about it. I’d already submitted a few comments using the online comments form but, as all you get if you do that is an automatic message saying ‘thanks’, I decided to take it higher. Here’s the main body of my letter of complaint:

Given both the seriousness of my observations and the fact that I have neither received any response to indicate that any changes to the information contained in this website were under consideration, I have decided to resubmit these comments as an official complaint to which I would appreciate a considered response from you.

1. On the comparison between homeopathy and conventional medicine

On 11th January I submitted the following comment:

“I note that the Learning Store purports to be an educational website – indeed, it claims to be “an excellent way to share our expertise and knowledge with teachers and pupils in a way that will stimulate and enthuse the learning process.”

With this in mind, I read through the entire 16+ section on alternative medicine and I have a number of concerns about it. I would like, in this communication, to put just one of these to you.

It is misleading about conventional medicine.

For example, under the heading of ‘holistic healing’, it states that “Holistic healing considers the whole person and how they interact with their environment. It does not just focus on the illness.” The implication here is that only practitioners of alternative medicine ‘consider the whole person’, while doctors do not. I believe this is unsupportable. In my experience, doctors ask whatever questions are necessary to make a diagnosis and this very often includes questions about lifestyle. Also, treatment will often involve a multi–disciplinary approach. In my experience, this is not the case with practitioners of alternative medicine.

Under the heading ‘Conventional v Homeopathy’, it states. “The homeopathic remedies here are picked out very generally and true homeopathy would involve a lengthy consultation where the individual consultation would be discussed.” No such qualification is made for conventional medicine. But it is obvious that the conventional remedies featured are also “picked out very generally”, so why not say so?

I understand that homeopathic consultations can take an hour while a consultation with an NHS GP may last only a matter of minutes. However, as the totality of evidence that we have at present tells us that homeopathy, if it is effective at all, works only as a placebo for conditions that are placebo–responsive and, bearing in mind that, Paul Bennett, Professional Standards Director at Boots admitted to the House of Commons Science and Technology sub–Committee that he had “no evidence to suggest that (homeopathic remedies) are efficacious”, it seems reasonable to conclude that it is the consultation itself that is beneficial to patients rather than whatever homeopathic remedy is prescribed.

My main objection to the way the Learning Store website presents homeopathy and compares it to conventional medicine, is that it does so in such a way as to make homeopathy seem a better choice in the first instance and this is potentially dangerous. I would therefore request that you remove from the section on alternative medicine, the misleading references to conventional medicine that I have specified.”

2. On ‘like cures like’

On 16th January, I submitted the following comment:

“Under the heading of ‘homeopathy’ we are told that, “Homeopathy is based on the philosophy of like cures like. An illness is treated by a substance capable of producing similar symptoms.” We are shown a picture of a man who has obvious cold symptoms and invited to guess which, out of a choice of three ingredients ¬ belladonna, onion and foxglove (digitalis) – used in homeopathic remedies, might be the appropriate one for treating a cold.

The correct answer, we are told is, onion. I presume the reasoning is that, because onions produce tear-jerking sulfoxides, they are deemed a suitable remedy for a condition that has watering eyes as a symptom.

Given that the object of the website is educational, I would suggest you add a rider to this section of the website, reminding the young students who are your target audience that the notion that “like cures like” is a pre-science idea that remains unproven and that homeopathy was invented before Louis Pasteur demonstrated germ theory and that, anyway, we know nowadays that nothing cures a common cold. I suggest the assertion on the Learning Store website that the onion remedy, Allium Cepa 30C, “helps treat a common cold”, could mislead young people into believing that it actually does treat a common cold, so I request that this statement be changed to one that is more accurate. For example, you could state that Allium Cepa 30c supposedly helps to treat a common cold but you have no evidence to this effect.

On the same page of the website I am particularly interested in one of the ingredients you say doesn’t help treat a cold: belladonna. According to Wikipedia, belladonna can cause “sensitivity to light, blurred vision, tachycardia, loss of balance, staggering, headache, rash, flushing, dry mouth and throat, slurred speech, urinary retention, constipation, confusion, hallucinations, delirium, and convulsions”. In keeping with the “like cures like” idea (as the website explains it using the onions remedy as an example), a dilution of belladonna would, presumably, be used to treat one or other of these symptoms.

Yet on this page, we are told that belladonna 30C can be used to “help treat ear pain”; in a different section, under the heading Effectiveness of Homeopathy, we are told that belladonna is “used to treat acne” and on the last section under the heading Conventional v Homeopathic, we are told that belladonna might treat influenza. I am mystified as to how any of these examples accord with the philosophy that “like cures like”, nor why belladonna might be used with influenza but not with colds. I don’t think it will be clear to your target audience either, so would suggest you give some thought to revising that part of the website to make it more appropriately educational.”

3. On the comparison with enzymes and the ‘Vital Force’

On 21st January I submitted the following comment:

“Further to my recent comments, I would like to raise an additional concern or two about the Learning Store website with a couple of further examples of misinformation.

Under the heading ‘Effectiveness of Homeopathy’, we are told that

“Homeopathic medicines may be compared to chemical catalysts. The amount of the catalyst is less critical than its form or quality. Enzymes are biological catalysts.”

The information preceding this talks of homeopathic dilutions of up to 100C. Homeopaths themselves readily acknowledge that homeopathic remedies typically lack even a single molecule of the original ingredient. So to compare it to an enzyme would seem to be misleading and at variance with the educational objective of the Learning Store website.

You may as well compare a sponge with a kettle. If you want to suggest that a sponge boils water as well as a kettle does, even though we’ve never seen it happen, you need to explain how the sponge does this – not just say ‘it can be compared to a kettle’. I realise it’s not a perfect analogy because at least a sponge is useful in other ways but I trust you get my point. I therefore suggest this comparison of homeopathy with chemical catalysts be removed.

On the next page of the website, we are told:

“The Vital Force is energy within the body keeping it healthy and helping to fight disease. Homeopathic remedies energise the vital force.”

Given the educational purpose of the Learning Store website, I don’t think you make it clear that the ‘vital force’ was a figment of Samuel Hahnemann’s imagination and that it doesn’t exist as such in reality. In any event, you don’t explain how homeopathic remedies “energise the vital force” and this explanation would seem to contradict the one on the previous page which compares homeopathic remedies to chemical catalysts. So I would suggest you make some amendment here. Perhaps point out that the vital force was just a story invented centuries ago when we didn’t know any better?”

That I have only specified these concerns shouldn’t be taken to mean that I don’t have others. In truth, I believe that the whole section on alternative medicine, together with the study notes provided is seriously misleading, and would question its inclusion in the website. The fact that there is a unit on alternative medicine in the syllabus for the GCSE Science and Public Understanding AS Module 1, does not justify it, particularly as so much of the information you provide is mendacious or just plain wrong.

I look forward to hearing from you.

But I’m not holding my breath.

11/2/10 Update

Well, it didn’t take long following my complaint to Boots about the Alternative Medicine section altogether on the Learning Store website, for the section to be removed altogether. Not that I am taking all the credit for it. As Andy Wilson comments below, the Merseyside Skeptics lodged an official complaint about the same website to the Medicines and Healthcare products Regulatory Agency (MHRA).

To date, I’ve never had more than this standard acknowledgement.

Your enquiry has been referred to one of our team for a response and we’ll be contacting you as soon as possible. I would, however, like to reassure you that your enquiry is very important to us and I thank you for your patience whilst we are looking into this further.”

It seems that while they were looking into it further, they realised that the (unnamed) course the altmed misinformation had been “designed to support” had ended in 2009. How convenient! So there’s no need to do anything more about it and everyone’s happy.

Just one little thing before we draw a line under the matter.

Here’s what Boots said about the compalint to the MHRA:

Bootslearningstore.com is our educational website for schools and does not support the sale of any specific products. Therefore the information on the site does not breach any advertising laws.”

The altmed section of the site was aimed at students aged 16+. It included the assertion that homeopathic belladonna can treat acne. Boots sells belladonna 30c for about £5. It doesn’t treat acne or anything else because there’s nothing in it. If making a false claim about about a remedy for a condition that affects teenagers on a website aimed at teenagers and run by a company that happens to produce and sell the remedy “does not breach any advertising laws”, then it’s time those laws were revised.

Just saying.