/ Health

Your view: do pharmacists and homeopathy mix?

Homeopathy pills in bottles

Our snapshot investigation into pharmacies revealed that 13 out of 20 failed to explain that there’s no clinical evidence that homeopathy works. It proved to be a popular starting point for discussion…

‘As soon as you talk about homeopathy, it divides opinion’, said our senior health researcher, Joanna Pearl, in her introduction to our investigation into pharmacists and homeopathy last week.

How right she was! Chrisb1 dared to open up the discussion by putting forward his view on the safety of homeopathy vs prescription medicine:

‘We should ask ourselves why prescription drugs, taken as prescribed in hospitals, are the fourth leading cause of death in the US and Canada, after cancer, heart disease and strokes. They cause about 10,000 deaths a year in Canada and about 106,000 deaths a year, and over two million serious injuries in the US.’

These statistics, and this view, were widely challenged by other commenters, including Paulj:

‘This isn’t an argument for an alternative such has homeopathy that has dubious, highly questionable evidence. Let’s improve evidence-based medicine rather than flee to non-scientific medicines.’

Guy Chapman believes there’s a reason why we have the term ‘alternative’ medicine:

‘A treatment is alternative only because it cannot be shown to work, or more likely it can be shown with good confidence not to (as with homeopathy). If it can be proven to work, it is no longer alternative, it is medicine.’

Should pharmacists sell homeopathy?

Many commenters – like Sophie Gilbert – think our snapshot investigation indicates a bigger problem with pharmacists selling homeopathy

‘Homeopathy belongs to the same realm as astrology and should not be recommended by pharmacists any more that financial advisers should recommend consulting our horoscopes to see if our investments are going to perform well in future.’

David Colquhoun agrees:

‘It is horrifying that pharmacists give such bad advice. Pharmacists are constantly pushing for a greater role in primary care. Their education seems just not to be good enough to take on that role at the moment. I have known some who are very good, but it seems they are still in a minority. I hope they take these revelations very seriously indeed.’

We even had Dr Ben Goldacre (author of Bad Science and Bad Pharma) join the discussion on Twitter (@bengoldacre):

What do pharmacists have to say?

A few days earlier, we published another Convo outlining the wider research into pharmacists’ advice. Karen joined that debate and made a good point about counter staff:

‘It is very difficult to approach some customers regarding their medicines as they tend to see Counter Assistants as ‘shop girls’ and refuse to take any advice given. It is very rare you get a good response when refusing to sell something to someone.

‘We need to remember that it is the counter staff who spend the most time with our patients and as such should be subjected to the same scrutiny as our pharmacists and technicians.’

On Twitter, pharmacist Joseph Bush (@josephbush) went a step further with his suggestion:

New vs old

The discussion on homeopathy went on to question how both alternative and conventional medicines move with the times. Dieseltaylor thinks that conventional medicine often backtracks:

‘I think one of the bugbears I have is that “proper” medicine has quite a few incidents of “we know we are right” and then in the fullness of time we find that in fact the medical fraternity are quite quite wrong. All I wish for is a little less hubris.’

Ned doesn’t think this made homeopathy any more credible, however:

‘Yes, scientific medicine evolves to take account of new evidence. You can’t do that without changing your advice.

‘By contrast, homeopathy is rigidly based on the unsubstantiated theories of a 19th century crackpot. But it makes a lot of money for pharmacists with little risk of them being sued for actually harming patients, (as long as they don’t advise people against going to a doctor for an effective cure).’

So do you think pharmacists should only recommend remedies backed by scientific evidence? So far, voters in our poll are overwhelmingly in favour, with nearly 80% saying that they should. Cast your vote now if you haven’t already, and tell us what you think about homeopathy being sold in pharmacies in the comments below.

Should pharmacists only recommend remedies backed by scientific evidence?

Yes - pharmacists should only recommend remedies backed by science (68%, 715 Votes)

Maybe - as long as pharmacists make clear it's just their personal opinion (17%, 179 Votes)

No - pharmacists should be free to recommend any remedy, including homeopathy (15%, 158 Votes)

Total Voters: 1,052

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Comments

In trying to maintain control of one of the more emotive Conversations, Patrick made an important point that the contributors might be putting others off from joining in the discussion.

I am disappointed by the lack of input from pharmacists and still hope that they will join in. My suspicion is that pharmacists – who have been through scientific training – might feel rather uncomfortable about being asked for advice, particularly where they are working for an organisation such as a supermarket that might want them to help sell homeopathic products. That’s intended to be slightly provocative, and to hint at my own view concerning homeopathy.

Arny says:
31 May 2013

As a retired community pharmacist and having had my own pharmacy for 29 years I have never advocated the use of homeopathic medicine and can see no scientific reason as to why it should have any place in modern medicine. If it does work it is probably due to the placebo effect or blind faith!

Alan Poole says:
31 May 2013

Homeopathy is for misguided, deluded fools – end of.

The problem is that homoeopathy is essentially a religion. It is not a rational belief system, so countering it with rational arguments only persuades those who are looking in from the outside. Once people are believers, their fellow religious will rapidly arm them with a series of rhetorical tools to avoid the cognitive dissonance generated by reality-based commentary.

Of course many Christians are not biblical literalists and don’t hold with young-earth creationism, or the literal virgin birth, but the evangelical types do and it’s they who tend to make new converts. The average Anglican shrugs and ignores this, as I guess the average casual shopper who pops Arnica when they have a bruise might discount the controversy, but the evangelists of homoeopathy spread dangerous disinformation in order to stir the faithful. They promote an anti-science, anti-vaccination, anti-rationalist agenda that is profoundly dangerous – for example, users of alternative medicines have worse cancer outcomes, because they typically present later, having tried woo first.

That’s why pharmacists and doctors should not touch homeopathy with a ten foot pole. It should be made entirely clear that this is nonsense, it has no validity, it has no parity with medicine. If people are still determined to find and use it then it’s their funeral but it should not be placed alongside medicine or event the largely harmless quackery of miracle diets, unnecessary supplements and the like.

Robin says:
31 May 2013

After 200 years there is no credible evidence for any effect over placebo. Despite many trials the results are no better than placebo. There is no rational mechanism known how it could work, indeed we’d have to change some long standing laws of physics if it did. Scientists would, of course, do so if there was evidence but I won’t be holding my breath. It is also a national disgrace that the NHS spends even 1p on this utter quackery. Instead they spend millions.

The cry is sometimes “What’s the harm?”

It can be lethal, by avoidance of actual medical help. Stupidity can be very dangerous.
http://www.vice.com/en_uk/read/homeopathy-didi

Professor Dame Sally Davies, the Chief Medical Officer has said that she is “perpetually surprised that homeopathy is available on the NHS.” Her professional opinion is that it “is rubbish”.

Sir Mark Walport, the new Chief Scientific Advisor to the government, states: “My view scientifically is absolutely clear: homoeopathy is nonsense, it is non-science. My advice to ministers is clear: that there is no science in homoeopathy. The most it can have is a placebo effect.”

Professor Sir John Beddington, outgoing Chief Scientific Advisor, said the provision of homoeopathic remedies on the NHS was the only occasion during his five years as chief scientific adviser that his views had been “fundamentally ignored” by the Government. He said “The only one I could think of was homoeopathy, which is mad. It has no underpinning of scientific basis. In fact all of the science points to the fact that it is not at all sensible. The clear evidence is saying this is wrong, but homoeopathy is still used on the NHS.”

Endorsing the BMA’s call for funding to end, Dr Tom Dolphin, deputy chairman of the BMA’s junior doctors committee in England said: “Homeopathy is witchcraft. It is a disgrace that nestling between the National Hospital for Neurology and Great Ormond Street [in London] there is a National Hospital for Homeopathy which is paid for by the NHS”

Homeopathy is portrayed by some as controversial. Scientifically, it is not controversial. Scientifically, it is nonsense. The controversy is political, not scientific or medical.

Dr Lionel Milgrom says:
7 June 2013

Interesting ignorance being displayed by most on this site, as a well-attended 3-day international conference on research in homeopathy kicked off between 31st May and 2nd June in Barcelona, clearly demonstrating that homeopathy-bashing is a peculiarly parochial pursuit here in the UK. It is as ignorant and intellectually moribund to declare there is no evidence homeopathy works, as it is to say there is evidence all conventional medicine works.

So, according to the BMJ [1], over 50% of conventional medical procedures funded by the National Health Service (NHS) have little or no basis in science. So, funding these procedures must be even more nonsensical than funding homeopathy, especially as they are much more expensive.

But the wilful ignorance and misdirection gets worse. Thus, much is made by sceptics of the millions ‘wasted’ on homeopathy by the NHS. This is utterly misleading as in 2010, the NHS’s drug bill was a staggering £10.2 billion, £2 billion of which was spent dealing with these drugs’ side effects. NHS spending on homeopathy (including infrastructure) was just £12 million – a mere 0.011% of the total £110 billion NHS budget – of which only a miniscule amount, £152,000, was spent on side-effect-free homeopathic medicines [2-4]. Given this vast disparity, why should the NHS stop funding an incredibly cheap therapeutic modality used and trusted by millions of people throughout the United Kingdom, and half a billion people around the world? Oh yes: it’s all about the science, isn’t it. Well, let’s examine that.

Apparently, there is no scientific basis for homeopathy. However, by end of 2010, 156 Randomised Controlled Trials (RCTs) of homeopathy (on 75 different medical conditions) had been published in peer-reviewed journals. Of these, 41% had a balance of positive evidence, 7% had a balance of negative evidence, and for 52% no conclusions could be drawn either way [5].

A cursory glance at these statistics might cause supporters of homeopathy to rejoice because the ratio of positive to negative trials is clearly in homeopathy’s favour. However, the really interesting statistic here is the number of trials for which no conclusions can be drawn; greater than 50%. Because when one then looks at similar statistics for RCTs of conventional medicine, something odd appears.

So, data obtained from an analysis of 1016 systematic reviews of RCTs of conventional medicine, indicate that 44% of the reviews concluded the interventions studied were likely to be beneficial (positive), 7% concluded that the interventions were likely to be harmful (negative), and 49% reported that the evidence did not support either benefit or harm (non-conclusive) [6].

Sceptics should take careful note of this because obtaining such a similar spread of statistics regardless of the therapeutic modality would suggest:

• Homeopathy fairs no better or worse in RCTs than conventional medicine. Therefore, rejecting homeopathy on the RCT data is false and biased as many conventional drugs/procedures should on that basis be similarly rejected but are not.

• There is something fundamentally wrong with the RCT (and those who claim it to be a ‘gold standard’), when around 50% of all RCTs fail to deliver a clear result [6]. So all that the available scientific evidence suggests is at the very least, there is disagreement over the effects of homeopathic medicines and how ultra-high dilutions work.

Thus, if there was less emotion and more objectivity around he subject of homeopathy, it would be possible to conclude not that it “is nonsense” or “quackery” etc, but that as with many conventional medical procedures, the scientific evidence so far can only indicate homeopathy is of uncertain efficacy. And even if homeopaths were just ‘peddlers’ of placebos (a thoroughly unprofessional comment made by the Chief Medical Officer Prof Dame Sally Davies, as around 400 of her colleagues, fellow medical doctors, practice homeopathy in the NHS: she should apologise to them), homeopathy would still be far cheaper than Prozac, currently favoured by the NHS and, as I am sure most pharmacists are well aware, recently shown to be no better than placebo [7]!

Add this to the by-now, well-known systemic, systematic fraud perpetrated by the pharmaceutical industry (e.g., the real peddling of unlicensed anti-depressants to minors by GSK last year [8]), and the long-term abuse of science that has been going on in medical and pharmacological research [9-11]), then perhaps those who rubbish homeopathy might be well advised to take a more measured attitude towards subjects on which they clearly have no expertise. And perhaps Which might be advised to stick to washing machines, vacuum cleaners, and mobile phones etc.

References
1 See the BMJ site http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp.

2 Call to curb the rising NHS drug bill, 3.04.2008. http://news.bbc.co.uk/2/hi/health/7190267.stm.

3 Boseley S: Adverse drug reactions cost NHS £2 billion. The Guardian, 03.04.2008. http://www.guardian.co.uk/society/2008/apr/03/nhs.drugsandalcohol.

4 Mr O’Brien, response to Q244, House of Commons Science and Technology Committee, Evidence Check 2: Homeopathy (London: The Stationery Office Limited 2010) p Ev73.

5 The Evidence for Homeopathy. British Homeopathic Association. http://www.britishhomeopathic.org.

6 El Dib RP, Atallah AN, Andriolo RB: Mapping the Cochrane evidence for decision making in health care. J Eval Clin Pract 2007;13:689–692. Cartwright N, and Munro E. The limitations of randomized controlled trials in predicting effectiveness J Eval Clin Pract 2010;16:260-266.

7 Kirsch I, et al.: Initial severity and anti-depressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS Med 2008; 5:e45.

8 GlaxoSmithKline to pay $3bn in US drug fraud scandal. BBC News On-line, 2nd July 2012,
http://www.bbc.co.uk/news/world-us-canada-18673220

9 Titus SL, Wells JA, Rhoades LJ: Repairing research integrity. Nature 2008;453:980–982.

10 Fanelli D: How many scientists fabricate and falsify research? A systematic review and meta-analysis of survey data. PLoS One 2009;4:e5738.

11 Naish J: Faking it. Prospect August 2009:63.

Lionel: As you can hardly fail to be aware, issues with the research base for medicine validate homeopathy in precisely the same way plane crashes validate magic carpets.

Nobody has yet come up with a remotely plausible reason to believe homeopathy should work, and every observation to date is consistent with the null hypothesis. In the absence of any credible evidence of a specific effect, homeopaths talk up nonspecific effects and engage in special pleading, pretending that an individualised treatment cannot be systematically investigated (even though cancer researchers are doing just that all the time).

The existence of a large subculture of policy-based evidence making by homeopaths has never been in doubt. It’s claimed status as science is rather more problematic of course.

Oliver Dowding says:
8 June 2013

I see all the same comments from such as Alan Henness, Guy Chapman et al.

The excellent submission from Lionel Milgrom will no doubt be something they brush to one side.

On pharmacists in particular, I strongly recommend they read this report, from the American Journal of Pharmaceutical Education, entitled “Where Does Homeopathy Fit in Pharmacy Practice?”

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1847554/

As for homoeopathy and all those who are dismissing it 100%, I feel pity for you. I always thought scientists were meant to have a broad mind and be open to all things, even if they don’t it first understand how they work, or even except that they do work. Maybe it’s because they fear long held view is being turned upside down? It doesn’t have to be a damage to one’s credibility to admit that what one previously thought is now evidently not the case. Hanging onto a rope when the many threads holding it together are gradually breaking, but hoping enough remain to keep one in safety strikes me as a dangerous position to hold.

I’ve had the argument many times in the past with Guy, Alan and others about my stance on homoeopathy. It’s based entirely upon 15 years treating 500 dairy cows with homoeopathy. In excess of 90% of all conditions were treated, and successfully. This was all overseen by our conventional veterinary surgeons, who, to a man (and woman) were in your sceptical/cynical camp. However, they couldn’t deny the efficacy of what we were doing, or that doing nothing would be either professionally, ethnically, morally or in any other way acceptable. They were all totally aware that had we done nothing, we would have committed animal cruelty and proposed welfare problems for which we would have been prosecuted. They knew that to do nothing would leave the animal in great mortal danger.

I realise that you sceptic/cynics will try to make out that I, and the 15 also people predominantly involved with the animals over that time, were in some way fooled into thinking the homoeopathy was the reason the animal got better. B******s! Nobody should dare call people who worked with my cows and youngstock foolish. If we were, why didn’t the veterinary surgeons react?

As ever, just because you don’t understand the mechanics of physics of how homoeopathy works does not mean that it doesn’t work. It’s also evident that journals are selective about what they publish. http://www.hydrogen2oxygen.net/en/the-death-of-the-placebo-myth-in-%CE%B7omeopathy/

I suggest you could also watch this video on water’s ability to hold memory. It’s uncomfortable territory for many! However, given that it’s comprised of just 2 x hydrogen and 1 x Oxygen atoms, it’s a pretty versatile compound and wit only just beginning to understand its phenomenal capabilities.

That’s probably enough for now.
http://www.hydrogen2oxygen.net/en/scientific-replicable-proof-water-has-memory-video/

[This comment has been edited for breaking our guidelines. Thanks, mods.]

Dr Lionel Milgrom says:
8 June 2013

[This comment has been edited for breaking our guidelines. Please be polite to other commenters. Thanks, mods.]

Dr Milgrom,
I just wanted to congratulate on your posts that were both rational and to the point.

Thank you for that information and your undoubted expertise.

Lionel: Don’t worry, I was not working on the model railway, today I have been mainly singing. In Estonian, in fact.

I don’t know how you have managed to escape the fact that problems with medicine (and its research base) validate homeopathy in precisely the way plane crashes validate magic carpets. Maybe skepticism is new to you? You certainly don’t seem to be a skeptical type, so it would be understandable if you failed to look for logical fallacies.

There is no pogrom, only a call for credible evidence. Feel free to provide it any time, starting with a scientifically robust framework by which homeopathy might plausibly work. I very much enjoyed your legendary “quantum flapdoodle” paper but that was clearly comedy so I look forward to reading your paper in Nature explaining – at last, after more than 200 years – how homeopathy is not, after all, sympathetic magic, placebo effects and cognitive bias.

Lionel Milgrom cites some studies claiming to show homeopathy cures or treats cancer.

“Banerji P, Campbell DR (2008): Cancer patients treated with the Banerji protocols utilising
homoeopathic medicine: A Best Case Series Program of the National Cancer Institute USA.”

The “Banerji protocol” appears to be wishful thinking. The data and claims all source back to the Banerjis, The Banerjis seems to be lead or co-author on all published studies, there was some investigation of this after a 2004 publication but there is virtually nothing outside the CAM-specific (read: credulous) literature. The US National Cancer Institute mentioned the 2004 paper, mentioned that the 2008 study was underway, and haven’t touched it since. ACS, CRUK and other authorities have nothing. This paper is the only paper in PubMed indexed journals on the subject.

“Frenkel M et al. (2010): Cytotoxic effects of ultra-diluted remedies on breast cancer cells,”

This paper (with the Banerjis as co-authors again) contains no statistical analysis and the control solvent also caused cell death (unsurprisingly: it contained alcohol), and contains no analysis separating claimed treatment effect form acknowledged control effect. This constitutes a weak, poorly constructed in vitro experiment, yet it is lauded by homeopaths as strong confirming evidence that homeopathy can cure breast cancer. A medical treatment based on this kind of evidence would not even make it to phase II trial, the result is too weak to get past an ethics review for use in human subjects.

“Canguilhem G. A Vital Rationalist: Selected Writings. New York: Zone Books, 1994” / “Horton R. Georges Canguilhem: philosopher of disease. J Roy Soc Med 1995;88:316”

Milgrom misses the point here. Medicine and science do indeed have limits on their understanding and confidence – which they state. Homeopaths do not do this. They state beliefs as absolute certainties, and regard the mere fact of their being believed as evidence of their veracity. This is in fact one of the errors that Canguilhem says must be guarded against!

What Milgomr is asking for here is essentially the concept that anthroposophists call “cognition based medicine” – it reverses the normal hierarchy of evidence and places subjective experience at the peak. The reason they advocate this is pretty straightforward: the usual hierarchy of evidence places least weight on the type of anecdote which is most easily manipulated by psychological confounders and therefore most likely to be amenable to a positive outcome whether a treatment is valid or not.

Science takes the opposite view. Confounders should be weeded out and the actual measurable therapeutic effect determined. This is not working well for the drug companies, whose claims are often found to be overstated. It is part of the nature of honest science.

Homeopathy does not guard against confounders, it takes them as validation. The inevitable result is confirmation bias, and this is one reason why homeopathy cannot self-correct for error..

Oliver Dowding: Have we met before? I don’t recall, but it’s quite possible.

As always, your conclusion that homeopathy “works” is based on beginning with the assumption that homeopathy works, looking for confirmation, deciding that because homeopathy works it can’t be explained by the null hypothesis, and from this, concluding that homeopathy works.

All that’s missing is any plausible mechanism and any genuine attempt to test, rather than confirm, the hypothesis.

ReallyGoodMedicine says:
9 June 2013

The public should be aware of the work being done by the Banerji Homeopathic Research Foundation in cancer treatment using their Banerji Protocol. Firstly, the links below are to cured cases of brain tumors, lung cancer, osteosarcoma and oesphagael cancer (using homeopathy alone). They include x-rays, CT scans, and histopathology reports. Banerji treats cancer patients in 70 countries around the world.

Cured Cases of Brain Tumors:

http://www.pbhrfindia.org/index.php/case-studies-at-pbhrf/brain-tumor-or-cancer-casestudies/49-cure-of-brain-tumor-casestudy-1

http://www.pbhrfindia.org/index.php/case-studies-at-pbhrf/brain-tumor-or-cancer-casestudies/50-cure-of-brain-tumor-casestudy-2

Cured Cases of Lung Cancer:

http://www.pbhrfindia.org/index.php/case-studies-at-pbhrf/lung-cancer-casestudies-list/47-cure-of-lung-cancer-casestudy-1

click “next” at the bottom of the first page to see the other 5 cases

Cured Cases of Osteosarcoma:

http://www.pbhrfindia.org/index.php/case-studies-at-pbhrf/osteocarcoma-casestudies/45-cure-of-osteosarcoma-casestudy-1

click “next” at bottom of the first page to see the second case study

Cured Cases of Oesophagael Cancer:

http://www.pbhrfindia.org/index.php/case-studies-at-pbhrf/oesophagus-cancer-casestudies/44-cure-of-oesophagus-cancer-casestudy-1

click “next”……..

The U.S. National Institute of Health sponsored two studies on cancer using the Protocol at the world-renowned M.D. Anderson Cancer Center, Texas U. They both concluded that homeopathic remedies kill cancer cells. The second and groundbreaking study showed that four homeopathic remedies kill breast cancer cell lines (homeopathics do not damage other cells or the immune system). The full text (below) cover 9 pages of analysis and graphs and shows the mechanism of action which was the up-regulation and down-regulation by the remedies of specific functions.

http://scepticsbook.com/wp-content/uploads/Cytotoxic-effects-of-homeopathic-remedies-on-breast-cancer-cells-2010.pdf

The abstract can be seen at:

http://www.spandidos-publications.com/ijo/36/2/395

ReallyGoodMedicine says:
9 June 2013

@guy

How sad to see anyone attempting to influence the public away from a system of medicine that is so effective, so safe, so inexpensive and so life-saving. Homeopathy is growing in use at rates of 10% to 30% in countries around the world for those very reasons. I am quite sure we will see its use continuing to grow worldwide for many, many decades to come just as it has over the past 200 years despite all of the efforts of established medicine to stop it!

Alan Henness says:
9 June 2013

Still no good evidence!

Followed by an ad populam fallacy and a non-sequitur.

RGM: All you need now is to provide some credible independent objective evidence that homeopathy is effective, life-saving, or a system of medicine.

And preferable a remotely plausible mechanism by which it might work.

While you’re waiting for that to be published you might want to read up on,logical fallacies, so you can avoid using them.

Dr Lionel Milgrom says:
10 June 2013

Oh Guy, you’re such a tease! Logical fallacies and Estonian trainspotting! Well, I never! Who’d have thought it. Yes, I am a bit of a newcomer to your kind of s(c)(k)epticism. Funny, according to the definitions I’ve read, the term seems to arise from the Greek: ‘skeptomai, which means to think, to look about, to consider, and refers to:

 an attitude of doubt or a disposition to incredulity either in general or toward a particular object;
 The doctrine that true knowledge or knowledge in a particular area is uncertain; or
 The method of suspended judgment, systematic doubt, or criticism.

Sextus Empiricus (2nd century AD), defined scepticism as “The ability to place in antithesis, in any manner whatever, appearances and judgments, and thus … to come first of all to a suspension of judgment and then to mental tranquillity.” So conceived, scepticism is not merely the use of doubt, but is the use of doubt for a particular end: a calmness of the soul, or ataraxia.

Scepticism challenges dogmatism. Dogmatists think they have found ‘the truth’, and proselytise accordingly. The vehemence with which they continually attack homeopathy/CAM suggests they are not seeking ataraxia. Whatever evidence for homeopathy is presented (and there has been some on this thread), dogmatists either totally ignore (a typical tactic) or strenuously deny, followed by smug self-satisfaction at their own closed-mindedness.

So in the Sextus Empiricus sense you are most definitely not a sceptic. You are more like a ‘dogmatist’. But as tends to happen these days, the original meaning of a word gets turned on its head. So, for dogmatist, now read ‘sceptic’ or better, ‘pseudo-sceptic’. As for closed-mindedness, I seem to recall someone saying once that, “A scientist with a closed mind is about as useful as a one-armed trapeze artist with an itchy bum….” Forgive me Guy as I am quite clearly new to this scepticism malarkey, but I conclude you too must have misplaced an arm somewhere in your past and suffer the embarrassment of an irritating fundament. About your arm, I’m afraid there isn’t anything I can do, but as luck would have it, and if you like, I can prescribe a remedy for your itchy bum….Mates rates, of course, Guy.

By the way, I have yet to meet a homeopath who as you say, treats homeopathy as a religion (on the other hand, I know plenty who treat science in that way), or states beliefs with absolute certainty. That is deliberate misrepresentation simply to support your conjecture. Maybe you think this because you concentrate too much on the kind of responses you get from those you annoy, so they appear to hold their views with religious fervour….one gets the same thing from football supporters, so I wouldn’t judge everyone on the basis of those irritated by you. Also, as a philosopher of medicine, Canguilhem was writing about the scientism of some of his medical colleagues, and its continuing pernicious effects on medical practice, something he did for much of his life, so it is you who have missed that point Guy.

Oh yes, about my “quantum flapdoodle’ (so quaint the neologisms you pseudo-sceptics are fond of inventing). It wasn’t just one paper but a string of them, all in properly peer-reviewed journals by at least two referees, some knowing far more quantum physics than either you or I. Just thought I’d mention that, Guy.

A teensy-weensy bit of advice: you do take advice from time to time Guy don’t you? I’m referring to case number 2320; Clive Stuart vs North & South Magazine from New Zealand [1]. Here Stuart successfully complained to the NZ Press Council against the North and South about an article they published which stated: “Homeopathic remedies have failed every randomised, evidence-based scientific study seeking to verify their claims of healing powers.” Such sweeping generalisations that don’t mean much, reminds me of someone….

Anyway, the case hinged on a letter to Stuart from a Dr David St George, Chief Advisor on Integrative Care for the Ministry of Health, who advises the ministry on the development of complementary medicine in New Zealand and its potential integration into the public health system.
Offering his own personal view, Dr St George believed the statement in North & South’s article arose from a misunderstanding of the Lancet study, which had compared 110 published placebo-controlled trials of homeopathy with the same number of published placebo-controlled trials of conventional medical drug treatments. He said most of the 110 homeopathy trials in that study were “randomised, evidence-based scientific studies” which demonstrated an effect beyond a placebo effect.”

Dr St George said there was no debate about whether there were scientific studies demonstrating homeopathy’s therapeutic benefit but rather, whether those studies were of an acceptable methodological quality. The NZ Press Council accepted St George’s opinion and North & South lost.
My point Guy is this. Your stand against all kinds of quackery, and you’re promotion of the primacy of science, reason and logic might seem admirable enough I’m sure. But If Stuart can successfully complain to the NZ press council about misrepresentation of the facts, perhaps some gung-ho-ho homeopaths might just get it into their tiny heads to do the same, so do make sure you get your facts straight Guy.

Bearing in mind that regardless of what anyone says to the contrary, and on the evidence of the Barcelona conference I originally mentioned, research into homeopathy is now an increasingly burgeoning field. The state of play at the moment (and as I pointed out in my first piece but you totally ignored), is that homeopathy fairs no better or worse in RCTs than conventional medicine. Therefore, rejecting homeopathy on the RCT data is false and biased as many conventional drugs/procedures should on that basis be similarly rejected but are not.

Also, there is something fundamentally wrong with the RCT (and those who claim it to be a ‘gold standard’), when around 50% of ALL RCTs fail to deliver a clear result. So all that the available scientific evidence suggests at the moment is that at best, there is disagreement over the effects of homeopathic medicines and how ultra-high dilutions work, NOT “Homeopathic remedies have failed every randomised, evidence-based scientific study seeking to verify their claims of healing powers.”

Thus, a less emotional, more rational Guy, would have to conclude, not that homeopathy “is rubbish” but that AS WITH MANY CONVENTIONAL MEDICAL PROCEDURES, the scientific evidence so far can only indicate homeopathy is of uncertain efficacy. And as with much of science, there is still some way to go before definitive answers will be forthcoming. But having said that, and as any half-decent health practitioner will tell you (conventional medics included), a therapeutic procedure is about what happens to the patient. Seeing however, as you are going to trash whatever is put in front of you anyway, you might as well check these out:-

• The more than two decades of reproducible work by Dr Christian Endler and his group on the use of ultra-high dilutions of thyroxine to inhibit the metamorphosis of tadpoles into frogs [2];
• Dr Stephan Baumgaertner’s work towards developing biological model systems which demonstrate the empirical effects of single homeopathic remedies, and differentiate the effects of different potentised substances [3];
• The exceptional work of Dr Gustavo Bracho and a team from the Finlay Institute in Havana, using homeoprophylaxis to successfully treat leptospirosis in millions of Cubans [4].

Don’t forget Guy, as with most science, you have to kiss a lot of frogs before you find a prince….or princess….you never know: one day, it might happen to you….but then there’s always Estonian trainspotting….

Toodle loo.
References
1. See,http://www.presscouncil.org.nz/display_ruling.php?case_number=2320&utm_source=HEADS-UP+26+APR+-+2+MAY+2013&utm_campaign=SMC+Heads-Up&utm_medium=email
2. Endler P.C., Pongratz W., van Wijk R., Kastberger G., Haidvogl M. Effects of highly diluted succussed thyroxin on metamorphosis of highland frogs. Berlin J Res Hom 1991; 1: 151-160. Zausner C., Lassnig H., Endler P.C., Scherer W., Haidvogl M., Frass M., Kastberger G., Lüdtke R. Die Wirkung von “homöopathisch” zubereitetem Thyroxin auf die Metamorphose von Hochlandamphibien. Ergebnisse einer multizentrischen Kontrollstudie. Perfusion 2002; 17: 268-276. Interuniversitäres Kolleg. Pilotversuch zur unabhängigen Wiederholung einer Studie zur Metamorphose von Amphibienlarven und homöopathisch verdünntes Thyroxin (10e-30) durch G. Bach, Kollegiale Instanz für Komplementärmedizin der Universität Bern. Bericht an das Amt der Steiermärkischen Landesregierung, Fachabteilung 10 A. Graz, 2010. Harrer H. Replication of an experiment on extremely diluted thyroxine and highland amphibians. Homeopathy 2013; 102: 25-30.
3. See for example, Jäger T, Scherr C, Simon M, Heusser P, Baumgartner S. Development of a test system for homeopathic preparations using impaired duckweed (Lemna gibba L.) J Altern Complement Med. 2011 Apr;17(4):315-23.
4. Bracho G, Varela E, Fernández R, et al. Large-scale application of highly-diluted bacteria for Leptospirosis epidemic control. Homeopathy 2010; 99: 156–166.

A brilliant post Dr Milgrom, which begins: “Oh Guy, you’re such a tease!”

I congratulate you.

Thank you.

To Dr. Milgrom,

I cannot thank you enough for your well reasoned informative and I agree “brilliant” comment! Taking this opportunity to express my sincere appreciation for everyone who has taken the time to post here. Enfin….please accept my thumbs up in the highest potency!

ReallyGoodMedicine says:
10 June 2013

@Guy

Gemma Hoefkens, herself, discusses in this video her treatment of terminal brain tumors diagnosed in 1996 when she was just 26 years old:

http://www.youtube.com/watch?v=SqrGW8D-CuU

Her traditional doctors used chemo and radiation but told her those treatments were making her condition worse. They told her she was terminal and asked if she wanted to go home or go into hospice. They also told her there were no other treatments that could help her.

Gemma decided to go home. She also decided to try homeopathy. Today, in 2013, she is a homeopath.

Here’s a special word on the subject expressly for you. It comes from none other than John Benneth himself. We all know how humorous and entertaining John can be so I’m sure that other readers here will enjoy John’s message as much as I do and you will (perhaps).

http://www.youtube.com/watch?feature=player_embedded&v=MrPmjKr7f5Q#!

BTW, true critics amend their views when shown the evidence. The critics of homeopathy KNOW it works and are threatened by that very fact.

ReallyGoodMedicine says:
10 June 2013

@Guy

The video of John Benneth’s message to you on cancer can be seen at:

http://www.youtube.com/watch?v=mrPmjKr7f5Q (the previous link doesn’t work)

ReallyGoodMedicine says:
10 June 2013

@Dr. Milgrom…..

I can only say that I wholeheartedly agree with SAHC’s note to you. Many, many thanks from me also!

@RGM…

Thanks so much for your informative links that help to defend homeopathy so well! I have shared on my blog and facebook pages. Without detractors’ comments, the health care consumer who is seeking more information is able to judge for him/herself.

Kudos!

Lionel: I am flattered but I can hardly hold a candle to you in the teasing department. Actually getting someone to publish a paper apparently claiming macro-scale effects from three-way quantum entanglement of non-quantum objects, and it wasn’t even April 1 – I could never hope to top that.

Yes, skepticism challenges dogmatism. Let’s talk about that.

All investigations of homeopathy by homeopaths that I have seen start from the assumption that Hahnemann was right, seek to confirm that, discard all other possible explanations on the basis that because Hahnemann was right the other explanations are wrong, and thus conclude that Hahnemann was right.

Can you show me the process by which ideas in homeopathy are tested and discarded if wrong? A list of provings that have been retracted? Remedies withdrawn? It is inconceivable that any human endeavour would be infallible.

Can you show me the papers where homeopaths have honestly tested the idea that dilution increases potency, to see whether it is true or not (rather than to confirm their belief that it is)? This would be very easy to do via a controlled trial: different potencies could easily be randomly substituted in a way that would be very easy to blind.

Can you show me the papers where homeopaths have honestly tested the idea that like cures like, to see whether it is true or not (rather than to confirm their belief that it is)? This seem would be very easy to test by randomised substitution of a remedy that supposedly has the opposite effect, and again blinding would be simple to achieve.

Can you tell me the status of the theory that disease is caused by miasms disturbing the vital force? There must by now be a consensus among all homeopaths based on empirical tests that proves it one way or another, but I see homeopaths asserting it is true and others saying it’s not – where is the debate in the literature, how was it settled, and what happened to those who did not accept it?

The Society of Homeopaths says that homeoprophylaxis is nonsense and should not be promoted, but articles in The Homeopath promote it. There was significant controversy about this in 2011 so there must by now have been a debate in the literature and an emergent consensus one way or another. Who is right, the Society of Homeopaths or Tony Pinkus?

Several science and medicine journals have published investigations and review studies on homeopathy. They have looked at the evidence to see if it works or not. Science has offered a reasonably clear view of what would be considered evidence that homeopathy does work, and why the evidence to date is insufficient. Every paper by a homeopath asserts that it works, all studies finding otherwise appear to be rejected on the basis that it works, can you point me to any articles where homeopaths honestly discuss the possibility that it may not work, and what would be considered compelling evidence that homeopathy is in fact wrong?

All I see is a religion. Like cures like and the rest are articles of faith, they are not ideas or theories to be tested and confirmed or refuted. Belief is paramount and cannot be challenged. Anything that “works” for anyone is implicitly valid, and there does not seem to me to be any mechanism for rigorously testing claims such as new provings to establish whether the author is wrong. Feel free to show me the evidence. Being a skeptic, I like to see evidence.

Lionel: As a separate issue, something is of “uncertain efficacy” only if it is plausible. Remote viewing, fortune telling, ear candling and the like are not of “uncertain efficacy”, they are bogus.

One core problem with homeopathy is that there is no explanation of how it might work that is even remotely plausible. Thus, as with hits from cold reading, the possibility of mystical action is sufficiently unlikely that it requires a result that is absolutely inconsistent with anything else, rather than one which stands a 5% chance of coming up positive just by chance alone.

That’s why the average study of homeopathy is unpersuasive. That and the fact that it’s usually incompetently conducted, not least because people who understand the scientific method properly are much less likely to believe in homeopathy.

RGM: The error here is obvious, but not to you. Some cancers – rarely – have spontaneous remission, and some cancers do not recur after initial medical treatment. This is what Stanislaw Burzynski exploits in order to make people believe he has a cure for brain cancer when even his own trials clearly could not provide data to support the claim.

If you think homeopathy cures cancer, you need to explain how. What the “remedy” was, how it acts on the cause even though ti is only associated with a symptom of that cause by a process that is hopelessly unspecific, how it does this despite there being none of the cure in the medicine, how that affects the body physically. There are no remotely plausible explanations for any of these things, only the religious mantra “it works!”.

Ask for solid evidence, all you get is more miracle stories from the faithful. Oh, and vicious personal attacks for daring to question homeopathy, being an obvious “big pharma shill” and so on. The consistant inability of believers to use logically consistent arguments certainly does contribute to the inflamed nature of the debate.

RGM: The only accurate statement Benneth makes is at the end: “this video does not constitute medical advice”.

Lionel Milgrom does make one fair point: When North And South said that “Homeopathic remedies have failed every randomised, evidence-based scientific study seeking to verify their claims of healing powers” they did indeed overstate the case.

In fact, homeopathy only fails when the test is well constructed to eliminate bias. When bias is allowed, it will of course very often pass. This correlation between outcome and study quality has been extensively documented and discussed elsewhere in this thread.

The result of that press complaint have no relevance to the scientific question of whether, and how, homeopathy might work. It’s entirely a matter of whether the statement was accurate – and yes, it was overly simplistic.

That’s a vivid example of why good science always states confidence limits, a fact that quacks shamelessly exploit. Cancer quacks are particularly adept at this. Medicine states median survival and percentage five year survival, and openly discusses the caveats and uncertainties. Cancer quacks shout “I can cure your cancer!” Just don’t ask them about numbers or statistical methodologies.

What homeopaths have never done, and what North And South should have said they have never done, is to refute the null hypothesis.

That is, no study of homeopathy has ever produced a result that cannot be explained by reference to known and verifiable phenomena such as observer bias, natural course of disease, placebo effects and the like.

Homeopaths have also never provided a remotely plausible explanation of how homeopathy supposedly works, any credible proof of the doctrine of similia, any convincing demonstration that their magic dilution processes instil result in any empirical verifiable and persistent change in the solvent and so on.

But they are awfully good at making a biased trial look as if it was not biased, and not half bad at coming up with excuses why they can’t be expected to conduct a proper randomised double-blinded controlled trial.

Dr Lionel Milgrom says:
11 June 2013

You’re welcome SAHC and chrisb1…frankly, I don’t know how you’ve managed to put up with the volume of negativity from these ‘seekers after truth’ for so long. Well, we have to call them something otherwise we might be accused of impoliteness….at least I would be….one of my posts has already been taken down presumably for that offence.

Anyway, respect!

Lionel – It is not up to us to disprove homeopathy but for you and your fellow believers to get together and prove that it works to command respect from the scientific community. Conventional medicine is far from perfect but there is good evidence that some licensed drugs do work well.

Hopefully that is respectful.

Dr Lionel Milgrom says:
12 June 2013

“It is not up to us to disprove homeopathy but for you and your fellow believers to get together and prove that it works to command respect from the scientific community.”

Thank you: with this, I think you have at last verbalised the gigantic hubris under which many on this site labour. And that is proving or disproving how and whether homeopathy works, and gaining the respect of the scientific community have very little to do with patients’ democratic right of access to safe, cost-effective healthcare. Quite clearly many want homeopathy (they have done so for over 200 years). The reason the pseudo-sceptic movement is so rife in the UK is because patients can still have homeopathy on the NHS if they choose to. And it is that which so sticks in the pseudo-sceptical craw.

This all goes back to the high-jacking of the EBM movement in the 1990’s. As originally defined by David Sackett and others who started it, EBM was “an approach to health care that promotes the collection, interpretation, and integration of valid, important and applicable patient-reported, clinician-observed and research-derived evidence. The best available evidence, moderated by patient circumstances and preferences, is to be applied to improve the quality of clinical judgments.” [1] Note: so EBM as originally conceived was a ‘three-legged stool’ of evidence.

However, the possibility of research-derived evidence being able to explain ALL that might be wrong with a patient is a mirage still too difficult to ignore, so that this ‘leg’ of the stool rapidly began to gain prominence in the EBM movement, at the expense of the other two. “So what?” you might think. This is where it goes back to my earlier comments from George Canguilhem and others concerning the dangers of scientism in medical practice.[2] Sackett and others have sensed this too,[3] Sackett warning, “Evidence-based medicine is not restricted to randomised trials and meta-analyses. It involves tracking down the best external evidence with which to answer our clinical questions … if no randomised trial has been carried out for our patient’s predicament, we follow the trail to the next best external evidence and work from there.” [4]

Others also began to warn of the increasing intolerance and disempowerment caused by those promulgating solely research-derived evidence at the expense of all other forms of evidence [5]. Even Sir Michael Rawlins, Chair of NICE, waded into this debate about evidence during his 2008 Harveian Oration with, “RCTs, long regarded as the ‘gold standard’ of evidence, have been put on an undeserved pedestal. Their appearance at the top of hierarchies of evidence is inappropriate; and hierarchies are illusory tools for assessing evidence. They should be replaced by a diversity of approaches that involve analysing the totality of the evidence base.” [6]

Yes, of course conventional medicine is far from perfect. Consider this: the UK House of Commons Public Accounts Committee found that in 2006 alone, at least 2.68 million people were harmed (including fatalities) by conventional medical intervention, representing a staggering 4.5% of the UK population put at risk [7]. Indeed, when this committee published its report, it added the rider that it thought its figures were underestimates (this should be compared with figures for the number of people harmed by homeopathy). Note the date of this report: 7 years before the scandal of the Stafford Hospital.

But as you said, there is also good evidence that some licensed drugs do indeed work well. And (surprise, surprise…) not all homeopathy is perfect: as I have said now on more than one occasion, all that the scientific evidence shows so far is that AS WITH MANY CONVENTIONAL MEDICAL PROCEDURES, homeopathy is of uncertain efficacy. Increasing interest in the field of homeopathy research will quite likely reveal a mechanism for the action of ultra-high dilutions in the not too distant future, which (and here I am flying a kite) might well rely to some extent on the findings of materials science and physical chemistry [8, 9] as part of the explanation. So watch this space….

But here’s a thing: no one can explain exactly paracetamol’s mechanism of action, even though it is one of the world’s leading painkillers (indeed, I recently had cause to be extremely grateful for its analgesic effect….).

So does that mean pharmacists should clear their shelves of all paracetamol-containing medicaments? Of course not, and neither should those who gain relief from their symptoms via homeopathy be denied it. It really is time we had a bit more compassion and ecumenism, and a little less scientism and hubris. Or am I just whistling Dixie…?

References
1. Sackett D. Evidence-Based Medicine: How to Practice and Teach EBM. New York; Churchill-Livingstone, 2000.
2. Leggett JM. Medical Scientism: Good Practice or Fatal Error? J R Soc Med 1997;90:97–101.
3. Cartwright N and Munro E. The limitations of randomised controlled trials in predicting effectiveness. Journal of Evaluation in Clinical Practice 2010;16:260-266.
4. Sackett, DL. et al. (1996) Evidence based medicine: what it is and what it isn’t. BMJ 312 (7023), 13 January, 71-72). This paper is also available at http://cebm.jr2.ox.ac.uk/ebmisisnt.html.
5. Holmes D, Murray SJ, Perron A, and Rail G. Deconstructing the evidence-based discourse in health sciences: truth, power, and fascism. Int J Evid Based Healthc 2006;4:180-6.
6. Rawlins M. De Testimonio: Harveian Oration Delivered to the Royal College of Physicians, London. 16 Oct 2008. Lancet 2008;372:2152-61.
7. Leigh E. A safer place for patients: learning to improve patient safety: 51st report of session 2005-06 report, together with formal minutes, oral, and written evidence. House of Commons papers 831 2005-06, TSO (The Stationery Office). 6 July 2006.
8. Chaplin M. Water Structure and Behaviour. Regularly updated online document at: http://www.lsbu.ac.uk/water/
9. Bell IR, and Koithan M. A model for homeopathic remedy effects: low dose nanoparticles, allostatic cross-adaptation, and time-dependent sensitization in a complex adaptive system. BMC Comp Altern Med 2012; 12:191.

Lionel

It would be good to understand more about the mode of action of paracetamol but at least it is widely agreed that it is effective. At least the dangers associated with overdose are well understood, and fairly well appreciated by the general public.

The dangers and less serious issues with licensed drugs deserve much more attention than they currently receive and it is not necessary to have any great understanding to discover cases of inappropriate use of these drugs. In addition to this, we have patients that visit their GPs expecting to be given drug treatment and GPs who are too willing to comply.

I would be surprised if a mechanism of action for homeopathy can be found but there have been some amazing discoveries in my lifetime. In the meantime, and as I said before, it is up to you and your fellow believers to get together and prove that it works to command respect from the scientific community. The mechanism can come later. I hope that you don’t feel the need to discredit science in any way. I would find it very difficult to be respectful if you did.

Bravo Dr Milgrom, another brilliant post.

Lionel: Hubris – extreme pride or arrogance.

Medicine makes mistakes, owns up to its mistakes, and uses the scientific method to learn from them. It discards treatments without sentiment when they are shown to be ineffective or when a better treatment emerges.

Homeopathy is absolutely and unshakeably convinced it is right, and rejects all conflicting evidence It has no institutionalised self-criticism and no method for self-correction.

Medicine has been open-minded enough to test homeopathy. Homeopathy asserts that medicine is arrogant and close-minded because the result of these tests did not agree with homeopathy’s beliefs. Scientists and skeptics have stated the kind of evidence they would accept as showing they are wrong about homeopathy, and ask in return that homeopaths state what evidence would convince them homeopathy is wrong. Homeopaths accuse them of being arrogant and closed minded, because they refuse to accept homeopaths’ assurances that homeopathy is right.

Hubris. Yes, that really does seem to be at the heart of the problem.

Dr Lionel Milgrom says:
12 June 2013

“Homeopathy is absolutely and unshakeably convinced it is right, and rejects all conflicting evidence It has no institutionalised self-criticism and no method for self-correction.”

First, surely you mean “Homeopaths” not “Homeopathy”. Second I really have no idea what is you are talking about as my experience of homeopathy and homeopaths is the complete opposite of the way you describe it. Sounds like you must have a had a really bad experience or something. There you go

Lionel: You are right, I use the term homeopathy in an ambiguous way, I mean the religion, not the practice, so homeopaths and their passionate believers.

I am pleased to hear there is an openness to error. Can you please cite some examples of remedies that have been discarded because they were found to be wrong?

Also can you show me the process by which it was decided that paper homeopathy, the Korsakovian method and imponderables were either right or wrong, and evidence of the resultant change in usage?

I have never seen a homeopath acknowledge that the doctrines of smilia and potentisation might be wrong (other than as a rhetorical exercise), but of course as they are the core tenets of the religion it is probably too much to expect them to be honestly tested.

ReallyGoodMedicine says:
17 June 2013

chrisb1:

Pls join us at thisissomerset.co.uk/Homeopathic-help-offered-hayfever-victims/story-19273705-detail/story.htm

Thank you for that link ReallyGoodMedicine, I will certainly join you there and avoid the “flak” going on here for a while !!!!!!

thisissomerset.co.uk/Homeopathic-help-offered-hayfever-victims/story-19273705-detail/story.htm

Whatever our viewpoints may be on the merits or otherwise of Homeopathy and the call to withhold funding for this in the NHS, we could and should consider the following before doing so……………

According to the US government’s Office of Technology Assessment (US OTA) — only 10% to 20% of all procedures currently used in medical practice are supported by controlled clinical studies. That’s it — just 10-20 percent!”

As the 5-year relative survival rate for cancer in Australia is now over 60%, it is clear that cytotoxic chemotherapy only makes a minor contribution to cancer survival. To justify the continued and expensive funding and availability of drugs used in cytotoxic chemotherapy, a rigorous evaluation of the cost-effectiveness and impact on quality of life is urgently required.

PMID: 15630849 [PubMed – indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/15630849?ordinalpos=1&itool=Entrez
System2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

A case of getting our own house in order first I would say.

Chrisb1

Do you have access to the the full text of the article in Clinical Oncology, which you have cited? I do, but most of our readers will have access to little useful information.

In a Conversation involving the general public, it would be courteous to provide links to articles that everyone has access to.

Robin says:
1 June 2013

Even if your assertion were true, ie only 10-20% ( which is it?) that’s 100% more evidence that exists for homeopathy. The topic of discussion is homeopathy, attacking something else as a defence doesn’t move the debate forward.

Alan Henness says:
1 June 2013

Chris

Oh dear.

I have previously pointed out to you where the Congressional report got their figures from, but, for the benefit of new readers, I’ll repeat what I told you last year [1]:

“These figures originate two surveys of the prescribing practices of 19 family doctors in the north of England over 2 weeks in 1961 – half a century ago. Fortunately for us, much has changed in the last 50 years and science and medicine have progressed leaps and bounds.

This survey was never intended to assess the degree to which GPs were evidence-based, but rather was looking at controlling prescribing costs in terms of generic versus proprietary drugs.”[2,3]

Imrie et al. go on to say:

“Contrary to the claims, evidence-based practice appears to be prevalent, and it appears to be widely distributed geographically. Evidence for evidence-based practice includes those listed below.

• 96.7% of anesthetic interventions (32% by RCT, UK)13
• approximately 77% of dermatologic out-patient therapy (38% by RCT, Denmark)14
• 64.8% of “major therapeutic interventions” in an internal medicine clinic (57% by RCT, Canada)15
• 95% of surgical interventions in one practice (24% by RCT, UK)16
• 77% of pediatric surgical interventions (11% by RCT, UK)17
• 65% of psychiatric interventions (65% by RCT, UK)18
• 81% of interventions in general practice (25.5% by RCT, UK)19
• 82% of general medical interventions (53% by RCT, UK)20
• 55% of general practice interventions (38% by RCT, Spain)21
• 78% of laparoscopic procedures (50% by RCT, France)22
• 45% of primary hematology-oncology interventions (24% by RCT, US)23
• 84% of internal medicine interventions (50% by RCT, Sweden)24
• 97% of pediatric surgical interventions (26% by RCT, UK)11
• 70% of primary therapeutic decisions in a clinical hematology practice (22% by RCT, UK)25
• 72.5% of interventions in a community pediatric practice (39.9% by RCT, UK)26

They show an average of 76% of interventions are supported by some form of compelling evidence (median = 78%).”

There is good reason to believe that this figure is rising as EBM questions more and more.

That is a massive 80 percentage points greater than homeopathy can muster – and homeopathy is making no progress whatsoever.

References
1 https://conversation.which.co.uk/consumer-rights/nutritional-therapists-advice-worth-the-cost/comment-page-5/#comment-54027
2 Imrie, R., and D.W. Ramey. 2000. “The Evidence for Evidence-based Medicine.” Complementary Therapies in Medicine 8 (2) (June): 123–126. doi:10.1054/ctim.2000.0370.
3 http://www.veterinarywatch.com/CTiM.htm

Chris: You really should study logical fallacies. As in study, not read up with intent to accuse others and avoid self-examination.

Yes Robin,
I am only too aware that this discussion is about Homeopathy, but lest we forget, also about the reliability and accuracy of the advice given by Pharmacists, who are said to be “scientifically trained”; if they give out advice that is inconsistent or erroneous, then their training probably wasn’t as “scientific” as some would have us believe.

In previous posts Robin, it has been mentioned that although Homeopathy is alleged to have little if any science or clinical studies to support its use or efficacy, comparisons have been made that current Medical practices are actually supported by “real science”: I was merely refuting that argument, and providing proof of my assertions.

Alan,
yes you did point that out so thanks, but just to illustrate my point that Medical practices are not supported by science, here are just a few examples……………………
https://sites.google.com/site/skepticalmedicine/medical-practices-unsupported-by-science

In other words, quite a number of medical procedures were practiced, and still are, that have little if any scientific support or proof as to their efficacy, so when we critique Homeopathy, this really is no better than quite a number of medical procedures that have been practiced today or in yesteryear.
When it is mentioned that the NHS could save £132 million on an alleged worthless therapy in Homeopathy, this really should be counter-balanced by the savings that could be made on quite a number of Medical practices in use today.

The British Medical Journal’s “Clinical Evidence” analyzed common medical treatments to evaluate which are supported by sufficient reliable evidence (BMJ, 2007). They reviewed approximately 2,500 treatments and found:

13 percent were found to be beneficial
23 percent were likely to be beneficial
Eight percent were as likely to be harmful as beneficial
Six percent were unlikely to be beneficial
Four percent were likely to be harmful or ineffective.
46 percent were unknown whether they were efficacious or harmful.
http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp

Further, a 2007 study of over 350,000 children found that 78.7 percent of children in hospitals are prescribed drugs that the FDA has not even approved for use in children (Shah, Hall, Goodman, et al, 2007). If this isn’t shocking enough, a survey in England found that 90 percent of infants were prescribed drugs that were not tested for safety or efficacy in infants (Conroy, McIntyre, Choonara, 1999).

The good news about conventional medicine and one of its remarkable features is its history of consistently and repeatedly disproving its own treatments. The fact that only a handful of conventional drugs have survived 30 or more years is strong testament to the fact that conventional medicine is honorable enough to acknowledge its mistakes.

Marcia Angell, MD, a Harvard professor of medicine and former editor of the famed New England Journal of Medicine, has written…………………………

“Over the past two decades the pharmaceutical industry has moved very far from its original high purpose of discovering and producing useful new drugs … Now primarily a marketing machine to sell drugs of dubious benefit, this industry uses its wealth and power to co-opt every institution that might stand in its way, including the US Congress, the FDA, academic medical centers, and the medical profession itself”. (Levi, 2006)

She also goes on to say……………
“It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine. As reprehensible as many industry practices are, I believe the behavior of much of the medical profession is even more culpable”………in her book: “The Truth about Drug Companies”.

All of this is just an attempt to balance the equation between Homeopathy (perceived as quackery by Mainstreamers here) and the quackery of some of the practices of Modern Medicine.

Pulling the plug on the funds for Homeopathy within the NHS, should be balanced with “pulling the plug” on dubious Medical practices currently in use today.

I have said this before and I will say it again: name one (just one) chronic disease that is actually “CURED” by pharmaceuticals.

Alan Henness says:
1 June 2013

Chris

Would you like me to demolish what you say about the bmj Clinical Evidence page now or should I leave you to go away and read it properly first so you can try to understand what it actually says in context, not what you might like to believe it says?

There are, no doubt, some conventional treatments whose evidence is not as sound as it should be. However, as has already pointed out to you, any lack of evidence for some conventional treatments, does nothing to bolster the paucity of evidence for homeopathy.

That problem is resolved by researching those treatments or finding new treatments for those conditions. The situation is made worse – and patients suffering increased – by adding in more treatments for which there is not a jot of good evidence.

Robin says:
1 June 2013

Homeopathy has not been proven to cure or treat anything. Medicine has been proven to treat disease….. Cure in ever case would be great but why would anyone not take a proven medicine to alleviate symptoms, increase quality of life even f it can’t cure. Rather then repeat my arguments please see the initial conversation.

The issue of children being prescribed drugs not licensed for that indication was also discussed. It is a medico legal issue. Not all drugs have been tested on children to the level required by licensing authorities. There is little or no financial incentive, in most cases, for a drug company to go to the expense and facing the ethical issues of experimenting on children when the have a licence allowing use in adults. So do we not treat children, give them nothing? Medical experts review the evidence of use in adults and have to make a tough decision, if that evidence is acceptable to allow use in children. NICE is now issuing some supporting documents, but not yet official guidance, on use of off label prescribing, an important first step to address this problem.

I have no idea if every antibiotic has been tested on both adults and children, but for the purposes of discussion lets pretend one hasn’t. If a child had a potentially lethal infection that this was the only antibiotic that could treat it, what should be done? Let us add to this hypothetical situation by saying the product in adults is highly efficacious with only short term side effects in adults. Of course we cannot be sure the same is absolutely true in children. Do we let the child die because there is no licence for the product? We certainly do not treat with homeopathy .

It would be interesting to know the facts. If any pharmacists/doctors can inform us if, for example, antibiotics have all been licensed and tested in children or not it would be useful to know.

Chris: We’ve already been here. Please stop repeating refuted arguments.

1. The paper in BMJ Clinical Evidence explicitly states that its findings do not reflect how commonly used the treatments are in practice; there is no evidence that those with a poor evidence base are in widespread use and indeed there is good evidence that trials showing lack of effect, which would count as a minus in your analysis, result in treatments being discarded – which is of course the point of a scientific test.

2. By applying a narrow definition of evidence you exclude from evidence-based practice anything where it would be unethical to conduct a randomised controlled trial. Feel free to suggest an ethically defensible framework for randomised double-blind testing surgical excision of cancer. As pointed out in the literature, there are no randomised double blinded trials of parachutes.

3. Regardless, issues with medicine cannot possibly justify using n its place something which not only has much worse evidence but it utterly implausible. Issues with medicine validate homeopathy in precisely the same way plane crashes validate flying carpets;

Homeopathy is rejected because it is not even remotely plausible, all observations are consistent with the null hypothesis, and any other result would conflict with a very large amount of very robust and well-tested science.

Medicine is like a reasonably new Ford Mondeo, and homeopathy is a rusty Austin 7 with no engine or wheels. Pointing to a small dent on the door of the Mondeo and noting that the Austin 7 has no dent in that particular place does nothing to prove that the Austin 7 is a practical everyday car.

Chris: A chronic disease cured by pharmaceuticals? How about syphilis. Oh, wait, medicine cures syphilis so it doesn’t become a chronic disease. Malaria? Oh, wait, no, medicine prevents malaria so it doesn’t become a chronic disease. Measles encephalitis? Oh, wait, no, medicine prevents measles so you don’t develop encephalitis. Acute lymphoblastic leukaemia? No, they only just worked that one out so we don’t know if the cure is permanent.

No, I admit, you got me there. All the claims of medicine to cure chronic disease are indeed problematic (or would be, if they existed). It’s almost as if chronic disease is defined by the fact that it has no root cause that can be cured by an intervention.

Oddly, all the sites claiming to cure chronic disease seem to be promoting quack remedies, and several of the diseases turn out to be completely made up (e.g. “chronic lyme”, “morgellons”). How singular.

One for you now: name one reliably published case where homeopathy has provably and unambiguously cured a single case of any disease.

Alan Henness says:
1 June 2013

Guy

This is a useful comparison between vaccinations and homeopathy: https://twitter.com/zatonski/status/340825730520866816/photo/1

Guy,
you have still not provided any evidence that any prescribed pharmaceutical has been able to cure any chronic disease, so please stop playing the semantics game.

So for those people (thousands if not millions) who suffer from diseases such as:

Motor Neurone Disease,
Osteo Arthritis,
COPD,
Asthma,
Cardiomyopathy,
Chronic renal disease
Coronary artery disease
Crohn’s disease
Diabetes insipidus
Diabetes mellitus types 1 & 2
Dysrhythmias
Epilepsy
Glaucoma
Haemophilia
Hyperlipidaemia
Hypertension
Hypothyroidism
Multiple sclerosis
Parkinson’s disease
Rheumatoid arthritis
Schizophrenia
Systemic lupus erythematosus
Ulcerative colitis

Medication is used as a palliative or to relieve symptoms, NOT to cure the disease.

And the treatment of these is based on EBM, when the cause of the disease is unknown and palliation is the only hope?

Of course you do realize that these diseases are only “managed” and do not necessarily improve the quality of life because they are increasingly degenerative and worsen in time.
Managed diseases mean “repeat business” for pharmaceuticals, and why they are the most profitable business in the World by far.
What someone referred to as “the business with disease”

Nice.

Chris: You are being disingenuous.

Syphilis was once incurable and chronic, now it is curable. The very definition of a chronic disease is one that is not (yet) curable. Some of the diseases you list may one day be curable, some may not, all we know is that the scientific method is what will deliver cures, as it has in the past. In the meantime, treatment for chronic diseases can lead to a near normal life. Type I diabetes, for example, once a death sentence, now not, thanks to a treatment that certainly doesn’t cure it but treats the condition very effectively.

I think most diabetics are quite happy that insulin is available and consider it a pretty good second best in the absence of an actual cure.

Now here’s a list of all the conditions known to be curable by homeopathy:

No contest, I’d say.

I agree with you Guy, insulin was a God-send for the Diabetic, but still only means that you “have to live with” that disease.
On the other hand, it has been demonstrated that Adult-onset-Diabetes can be reversed and eradicated entirely through dietary means. Here…I’ll show you…………
Read this carefully as well……………..please refer to the scientific references at the bottom of the page…………..
http://www.drfuhrman.com/disease/Diabetes.aspx

The fact remains: most all chronic disease is considered incurable by Medical Orthodoxy, and only “managed” by them.

Chris: You seem very determined to miss the point.

A chronic disease is, as I have said several times, defined as one for which there is, as yet, no cure. To ask for the name of a chronic disease that can be cured is, therefore, meaningless and deliberately misleading.

To ask for a chronic disease that is no longer a chronic disease because it is now curable, is the correct question. A good example would be syphilis.

Better still, medicine now prevents many chronic diseases entirely. The incidence of measles encephalitis and its sequelae is very much lower now due to immunisation (though your fellow-travellers seem to think that is a bad thing).

Note also that a chronic disease is one that is not curable *yet*. We have seen in the past that some can be cured, and as research into the genetic triggers for disease progresses there will doubtless be others. Essentially, though, the human body is a fallible organism whose self-replication mechanism is imperfect. It is unlikely that medicine will ever be able to make death optional. That is not a valid criticism of medicine.

So your claim that medicine cannot cure chronic disease but only manage it, albeit to the extend of delivering a near-normal life for people who would otherwise have died in childhood, is a red herring of the worst kind. And it is certainly not a valid argument in support of homeopathy.

ChrisP says:
1 June 2013

I would have thought that directing someone to something that at best works as a placebo can be seen as a very therapeutic interaction as long as the referrer has adequate skill to screen persons who need medical attention and communicates the honest potency as placebo.

I cannot believe any qualified pharmacist would point someone to a homeopathic remedy if they judged them at risk of worse health with out medical intervention.

It seems that many protagonists here feel that the role of a pharmacist or medic is to advise on which product will heal a person.

There a few products that achieve this on their own, most often the most significant part of the healing is being is being given information and offered choice as to how to make an investment in the patient/customer’s own health.

But I am not suggesting homeopathy should be seen as an alternative medicine, the science plainly shows it can be as potent as a placebo , not that it actively heals.

I doubt any doctor or pharmacist would treat an illness as significant as type 1 diabetes with homeopathy alone, whereas many members of the public would genuinely hope they’re chronic stress, indigestion or pain can be solved by homeopathy as it will be safe, not make them experience side effects nor directly kill them, which wrongly (or in some cases rightly) they may believe is always possible of traditional medicine.

Robin says:
1 June 2013

Perhaps this is something of a breakthrough then, you accept homeopathy is only a placebo.

Now we can dispense with the pretence of dilution, tapping on a leather bound book and all the other mumbo jumbo, and just give people who demand it, despite the lack of efficacy, a sugar pill at cost, instead of at great expense ( but still not on the NHS please). Remember giving a placebo won’t necessarily speed up recovery of even minor self limiting conditions although it may alter the persons perception.

The only fly in this non-ointment is some homeopaths are claiming it can treat serious conditions such as cancer, aids, malaria etc. it is clear some are promoting the view that homeopathy is not just a placebo, as an adjunct to medical care, but a primary treatment. Others claims homeopathic “vaccines” have efficacy. Both dangerous and delusional.

The other concern, as the Which? survey shows, is that symptoms of potentially serious illness were overlooked. Researchers were sometimes guided to placebo rather than a GP.

ChrisP says:
1 June 2013

Sorry I think you are confusing my views with ChrisB1’s

Robin,
did I mention that Homeopathy is just a placebo? If so where and what did I say?

I agree with you wholeheartedly when you say that the WHICH survey demonstrated that symptoms of potentially serious illness were overlooked and the researchers were guided to an alleged placebo rather than a GP.
So the fault here lies with the Pharmacists rather than the therapy.

ChrisP says:
1 June 2013

No I considered the placebo effect as beneficial

Robin says:
1 June 2013

Sorry if I misunderstood when you said

But I am not suggesting homeopathy should be seen as an alternative medicine, the science plainly shows it can be as potent as a placebo , not that it actively heals.

I took that as a statement that homeopathy was at best equivalent to a placebo. Placebos are often not very potent at all.

ChrisP: Your views are indeed as confused as Chrisb1’s 🙂

The problem with homeopathy is not that it is a placebo, as such, but that it is pretended to be other than a placebo by homeopaths. There is a strong anti-science, anti-medicine culture among homeopaths, and they make shameless use of bait-and-switch tactics, claiming in public that they would never pretend to cure cancer and would always refer genuinely sick people to a doctor, but then arguing elsewhere that they can cure disease and that homeopathy is a powerful and oppressed form of medicine. Until they become honest, it is too dangerous to let them near sick people. This is not a double-standard, doctors who act unethically are also struck off and kept away from patients.

ChrisP says:
1 June 2013

“I MET THE WOMAN TRYING TO CURE MALARIA WITH SUGAR AND WATER” is not about medical practice or the role of pharmacists, it’s about a snake oil salesperson with a diploma in homeopathy. Anyone who tries to combat infectious disease with only diploma level education is bound to lack grounding in evidence based interventions. This is not adding to the discussion other than to demonstrate the homeopathic ‘remedies’ are often pedaled by people who have no healthcare role.

Robin says:
1 June 2013

The survey found people presenting with persistent cough and asking about homeopathy were not directed to a GP .
So the African example is an extreme example of what has been also shown to be happening in the UK. People with potentially or actually serious conditions being directed to sugar pills not medical help.

Robin,
your comment……………
“The survey found people presenting with persistent cough and asking about homeopathy were not directed to a GP .
So the African example is an extreme example of what has been also shown to be happening in the UK. People with potentially or actually serious conditions being directed to sugar pills not medical help”.

Merely highlights the problem with scientifically trained Pharmacists, rather than Homeopathy itself, does it not?

Robin says:
1 June 2013

No homeopaths do the same. I am just more disappointed that pharmacist would do this too.

Examples of death as a result were cited in the previous conversation.

Robin,
I assume you mean the deaths caused by Homeopathy?
If you would care to point me to that post and the proof of this please.?
Many thanks.

Robin says:
1 June 2013

Let me clarify, deaths as a result of belief in homeopathy (and other alternatives to medicine). It should be clear by now that I consider homeopathic products to be essential sugar or water with no active ingredients. So unless someone choked on the the pills a direct effect is unlikely.

http://www.guardian.co.uk/world/2009/sep/28/homeopathy-baby-death-couple-jailed
Take a look around for more.

Chris: No, it highlights a problem with homeopathy, in that it claims to treat or cure disease.

If I went into a church and said I had a chronic cough and wanted a laying-on of hands, I rather hope the priest would advise me to see a doctor. Sure, a pharmacist should know better, but the problem is in the widespread promotion of a false belief such that asking about it in a pharmacy is viewed as if not normal then at least not totally bizarre.

This is a consequence of both poor training of pharmacy staff and the continued false advertising of homeopaths. Both are a problem, and even if all pharmacists stuck strictly to evidence-based guidelines the false claims of homeopaths would remain a problem because its victims would still find sources of supply.

Robin says:
1 June 2013

I don’t think the level of education is a significant issue. If a Professor of Medicine prescribed homeopathy for malaria it would be equally wrong.

Robin,
so is the “guardian” example of using Homeopathy your only example? or are there more than this?

and Guy, the link you have given on: “here are 437 people who were harmed by someone not thinking critically”.

Well, blow me down with a feather: a total of 438 cases adversely affected by the advice of Homeopathy.

Right, let’s get down to the real figures which you have all ignored: Iatrogenic Medical deaths are the THIRD leading cause of death in the United States behind cancer and heart disease.

For goodness sake: what on earth is wrong with you people, to make such an absurd comparison like this?

Please use some logic and commonsense…………….it will help enormously.

Chris: Yes, if you believe that medically inert sugar pills can cure or prevent disease, and you have a disease that doesn’t go away on its own, you suffer harm.

Like any form of fraud, health fraud has victims.

That is why pharmacists should not be complicit in the fraudulent claims of homeopathy.

Robin says:
1 June 2013

Please think through the implication of your comment i.e, that Homeopathy harms is acceptable. That’s the way it reads to me. It is only a few so not relevant, you argue a numbers game. Do you think accurate data for such harm is readily available in, say most African countries?

This topic is about homeopathy and pharmacists advice. I think the fact that medicine can harm people has been mentioned already and the fact wasn’t disputed or ignored. Doctors have even written books on it that have attracted a lot of attention to the subject.The detail of the numbers and extent were debated. Not for the first time, you miss the point. Ask Which to start a conversation on that topic I’m sure a spirited discussion would ensue.

Robin,
you have an uncanny skill at placing words in my mouth, and restating what I have not actually said.
Congratulations. Well done.

The implication of my comment that Homeopathy harms is acceptable, is only YOUR interpretation of what I have said, and NOT what I actually said.

What I did say, and I’ll repeat this for those with a lack of understanding or have reading comprehension skills, is that there can be NO COMPARISON between the THIRD leading cause of death by Iatrogenic medical means, (running into the hundreds of thousands) and that of Homeopathy.
Pray where are your reasoning skills? and double standards here as you accuse me of “logical fallacy” when the reality is: you are experts in this.

Talking of healing Guy,
only the body heals itself.

If someone is unlucky enough to break their leg, a Doctor will be skilled enough to realign the bones properly, but the actual healing is performed by the body; much in the same way if you cut your finger and prevent it from becoming infected, then the body will self-heal the cut. This is the reason that nutrition works so well in aiding the body to heal: Nutraceuticals. A concept rejected by Medical orthodoxy.

Chris: Your statement is meaningless. “Only the body heals itself”? Really? Unless it’s a bacterial infection, in which case antibiotics do the job. Or a gene therapy. Or a transplant. Or… wait, it is vastly more complex than you make out, isn’t it?

The truth is, we have only a limited understanding of how the immune system works. Virtually everybody who claims to be able to boost the immune system is lying, but medicine does understand how to prevent, treat and cure many diseases.

Homeopathy understands how to prevent, treat or cure no diseases at all.

So it’s no contest, really, and knocking medicine while supporting a completely meritless alternative is really rather silly.

Now come on Guy,
Medical orthodoxy cannot even cure the common cold.
A cold gets better by itself over a short period of time.

Ever wonder why people who suffer from an acute disease generally lose their appetite? because nature has dictated that digestive energy is needed elsewhere in healing, but then you would know nothing about this because you probably haven’t explored that avenue of healing.
Best not to down this road and just leave it at that or we could be here till doomsday.

Chris: Yet another disingenuous response. Medicine can prevent, treat or cure nay diseases, large numbers of which are life-threatening; it can also give years of additional life even where a cure cannot be effected.

Your claim about digestion is blatant misdirection. It’s also woefully simplistic – in some cases people gain appetite because more energy is needed to fight the disease, in other cases the lack of energy becomes a medical emergency and they need intravenous glucose. To pretend that your platitudes represent a profound understanding which medical science lacks is so self-evidently stupid that I hope you were not actually trying to imply that.

A fast-evolving virus with minor self-limiting symptoms is not really at the top of the tree when it comes to targets for urgent research, is it?

And it’s not in the least relevant to homeopathy, which cannot cure anything.

Maria says:
2 June 2013

“Iatrogenic Medical deaths are the THIRD leading cause of death in the United States behind cancer and heart disease.”

As a matter of interest, were all these people who died ‘iatrogenic medical deaths’ suffering from relatively minor conditions before they were killed by the doctors? Or were they sick people who died from complications of surgery and suchlike – people who would have died anyway had they not had any treatment? I trust you can see why the distinction is important.

Maria,
“Iatrogenic” meaning: “Iatrogenic” comes from the Greek language. “Iatros” which means doctor or healer. “Gennan” means “as a result” resulting from the activity of physicians; said of any adverse condition in a patient resulting from treatment by a physician or surgeon.

So “Iatrogenic deaths” means Iatrogenic deaths, or Doctor-induced deaths, or in this case “Medical Doctor-induced deaths”.

The well renowned and respected journal JAMA has admitted this. Please read the links and references that I provided in my earlier post.
Thank you.

Guy,
disingenuous response?
Being a little presumptuous aren’t we?

If you recall that chappie who Medical Doctors have to swear an oath on? um? oh yes: Hippocrates, or the “Hippocratic oath”?

Hippocrates used fasting as a remedy in the successful treatment of many diseases.
“Let food be thy medicine and medicine be thy food”……….not nip down to your local drug store and swallow a load of chemicals.

Chris: No, not in the least. You consistently list the most misleading and largest possible interpretation of any problem with medicine, and you equally consistently refuse to address the fact that by the exact same measures homeopathy comes off massively worse. You are, in effect, advocating changing from something you assert to be 87% wrong, but is in fact much closer to 20% wrong if that, to something which is 100% wrong.

Iatrogenic deaths are a concern to science but must be viewed in context. You have fallen for Gary Null’s false reasoning which holds that a patient who dies during a risky operation for an aneurysm which has a close to 100% chance of killing them in the near future, is a iatrogenic death – whereas the patient has in fact made an informed decision to reduce their chance of death from close to 100% to maybe 5%.

Your relentless focus on the potential harms of medicine while completely ignoring the benefits that balance those harms, is mendacious, especially in the context of your parallel advocacy of a system whose only claim to consideration is that it has no effects at all.

Faced with a homeopathic tablet that they are correctly informed won’t harm them but won’t make them better either – with an informed choice, that is – I wonder how many will choose the homeopathic tablet? That would be worth trying as a clinical study in the persistence of irrational belief.

Your point re Hippocrates is, to use Asimov’s axiom, wronger than wrong. The Hippocratic Oath is no longer used. It has been replaced by the Declaration of Geneva, the swearing of which is optional and only half of British doctors currently choose to swear such an oath. Even if the Hippocratic oath still existed, it would not validate the pre-scientific practices of Hippocrates.

Maria says:
2 June 2013

chrisb1

My command of the Greek language is more than adequate, thank you. I can’t imagine why you felt compelled to explain the meaning of ‘iatrogenic’ to me.

You evidently don’t know the answer to my question and the link you provided doesn’t answer it. I presume the JAMA article you are referring to is the one by Dr Barbara Starfield, entitled ‘Is US Health Really the Best in the World?’, which contains the assertion you keep repeating about iatrogenic deaths being the third biggest cause of death in the US. This article doesn’t entirely answer my question either but it does shed some light on the subject.

The first point to bear in mind is that the article is 13 years old and all of the references – and therefore all of the data used – are even older, in some instances much older.

The second and more important point is that it is intended as an indictment of the American healthcare system, not of any other country’s healthcare system. The author quotes a recent (i.e. late 1998) study comparing the quality of healthcare in 14 developed countries. Of these, the USA was ranked 13th. Interestingly, only Germany – a country where I believe there is greater integration of homeopathy into the healthcare system – was ranked lower. The Starfield paper offers a number of arguments about what exactly is wrong with the US system and makes some comparisons with Japan, which came top in the comparison at a time when homeopathy barely existed in Japan.

Having now read Starfield’s paper and some of the papers she references, I am satisfied that: (1) the high figure of iatrogenic deaths in the USA is (or was) a problem with the American healthcare system and what goes on within it but is not an indictment of modern medicine per se. (2) There is evidence that the causes of the problem are not insurmountable and at least some were already being addressed ten years before Starfield’s paper was published.

All of which makes me wonder why on earth you keep bringing it up in a conversation supposedly about UK pharmacists and what they say about homeopathy.

Maria,
” I can’t imagine why you felt compelled to explain the meaning of ‘iatrogenic’ to me”.

Because you seemed to be at a loss as to know what it meant, so I did you the courtesy of explaining its exact meaning, to avoid any confusion.

“The first point to bear in mind is that the article is 13 years old and all of the references – and therefore all of the data used – are even older, in some instances much older”.

But doesn’t make it any less valid or applicable today, as it is only 13 years old.

“the high figure of iatrogenic deaths in the USA is (or was) a problem with the American healthcare system and what goes on within it but is not an indictment of modern medicine per se”.

You think so? Medicine is on an equal footing and practice in Western countries, so I wouldn’t be at all surprised if this is also the case within Europe. I would wager it occurs on similar lines.

For example………..
A Worldwide phenomenon: whenever medical doctors go on strike, a most interesting phenomenon occurs – death rates go down! In 1976 in Bogota, Columbia medical doctors went on strike for 52 days, with only emergency care available. The death rate dropped by 35%. In 1976 in Los Angeles County a similar doctors’ strike resulted in an 18% drop in mortality. As soon as the strike was over, the death rate went back to normal. A 50% decrease in mortality occurred in Israel in 1973 when there was a one month doctor’s strike! (June 2000 article in the British Medical Journal).

The late Robert Mendelsohn, M.D., while Chairman of the Medical Licensing Committee for the State of Illinois and Associate Professor of Preventive Medicine and Community Health at the University of Illinois School of Medicine, wrote:

. . . “the greatest danger to your health is the doctor who practices Modern Medicine. I believe that Modern Medicine’s treatments for disease are seldom effective, and that they’re often more dangerous than the diseases they’re designed to treat . . . I believe that more than 90% of Modern Medicine could disappear from the face of the earth-doctors, hospital, drugs, and equipment-and the effect on our health would be immediate and beneficial”.

and all of this coming from a Medical Doctor, where some if not all of you even denied this opinion from the former Editor of The England Journal Of Medicine of whom I wrote about in an earlier post.

and you say…………

“All of which makes me wonder why on earth you keep bringing it up in a conversation supposedly about UK pharmacists and what they say about homeopathy”.

Well Maria, if you had been following the conservation/debate you would already know the answer to this.

Chris: Yes, we already know the answer. It’s because you exhibit a single-minded determination to undermine medicine in order to bolster your belief in nonsense.

Guy,
I have said this before. and I will say it again.

I am not attempting to undermine Medicine at all, just trying to balance the equation when Homeopathy, and for that matter it might as well be any other form of Alternative therapy, is critiqued and attacked by people who rely on what they believe is EBM from Medical Orhtodoxy: when this is shown not to be the final word on healthcare.

Btw, my belief in nonsense in latter years has resulted in the cure of chronic back pain which prevented sleep for 3 months, and made me completely immobile. I allowed myself to be under the care of Medicine for 12 months: several differing scan types and blood tests galore, and two Consultants one in Orthopedics and the other a Neurologist. Nothing. Zilch. Worsening condition.

Saw a Naturopath who recommended Vitamin D3 10,000 ius per day: three weeks later, no pain and sound sleep, with normal mobility. Words are here on in ineffable. You wouldn’t understand.

I also know of a number of people who have greatly benefited from Homeopathy in the past.

No study or proof can beat personal experience. None.

[This comment has been removed for breaking our commenting guidelines. Thanks, mods.]

[This comment has been removed for breaking our commenting guidelines. Thanks, mods.]

Chris: Since the two Which? discussions contain numerous examples where it has been clearly and unambiguously shown that you have done all thes things, your protestation to th contrary amount to nothing more than an acknowledgement that you are immune to facts.

This is a near-universal feature among homeopathy believers, of course. Those who ar not immune to facts, are not believers.

Maria says:
3 June 2013

Chris,

I’ve still no idea why you thought I didn’t know what the word ‘iatrogenic’ meant but, in light of your responses, your protest at being patronised by Alan seems somewhat ironic. I should point out that your definition of iatrogenic deaths (‘Medical Doctor-induced deaths’) , which is hardly different from the one I used in my first post (being ‘killed by doctors’), isn’t quite the same as the one used in the ‘well-renowned and respected’ JAMA. That definition includes, for example, ‘medication-error deaths’, meaning patients not taking their medicines in accordance with instructions. In the ten years between 1983 and 1993, a period which saw a decrease in hospital stays and a rise in outpatient visits with a consequent handing over control of medication regimes to patients themselves, there was a 2.57 fold increase in medication-error deaths. This is not an indictment of the meds themselves or, necessarily, of those who prescribe them but of the way healthcare was practised in that country at that time (and may still be, for all we know).

The definition also includes the 80,000/year deaths nosocomial infections (from the Greek ‘nosokomeio’, which means hospital), again not an indictment of doctors, meds or medical procedures but of the hospital environment and hygiene practices.

I’d like to go into more detail about the contents of that article but it would make this post very long and you appear to be uninterested in anything that contradicts what you already believe, which is why you’ve resorted to c&ping from any one of a zillion quack websites that paragraph about the death rate going down when doctors go on strike. The death rate will indeed go down in the short term when doctors go on strike and high-risk life-saving operations are delayed but in the long term it will rise and will keep on rising. For pity’s sake, we only have to look at the life expectancy and death rates in the poorest countries to see what happens when people can’t access doctors and modern medicines. The callousness of the suggestion that not having doctors and modern medicine is somehow good for you, beggars belief.

Btw, I pointed out that the 13-year-old JAMA article uses data that is old. In some cases the data goes back to the 1960s. Unless you know of more recent studies, I don’t see how you can be sure that it just as applicable today and saying you ‘wouldn’t be at all surprised’ if things are the same within Europe doesn’t surprise me at all given your entrenched position regardless of what the evidence tells us. But the notion that medicine is practised the same in all Western countries is contradicted by the very same article which, as I said earlier, contains offers plenty of reasons as to why things are so bad in the US.

Finally, I have been following the debate and, yes, I can see perfectly well that your reason for banging on about the iatrogenic death rate in the USA is to divert attention from the fact that homeopathy is a worthless pre-science cult therapy. What I should have said, perhaps, is that I wonder why on earth you think readers here are dumb enough to fall for it.

Maria,
“That definition includes, for example, ‘medication-error deaths’, meaning patients not taking their medicines in accordance with instructions”.

When it actually means patients taking their medications “as prescribed”.

AND………
” 80,000/year deaths nosocomial infections (from the Greek ‘nosokomeio’, which means hospital), again not an indictment of doctors, meds or medical procedures but of the hospital environment and hygiene practices.

Nosocomial, meaning: acquired or occurring in a hospital; an indictment of Medical practice.
Splitting hairs anyone?

AND…………
“I appear to be uninterested in anything that contradicts what I already believe, which is why I’ve resorted to c&ping from any one of a zillion quack websites that paragraph about the death rate going down when doctors go on strike”.

The facts are indisputable Maria: you are just ignoring them.

AND……….
“The callousness of the suggestion that not having doctors and modern medicine is somehow good for you, beggars belief”.

Did I actually say that? Nope. I refer to an earlier post of mine which commented that some of you are misinterpreting/misrepresenting what I have actually said. Well done.

AND……….
“I can see perfectly well that your reason for banging on about the iatrogenic death rates in the USA is to divert attention from the fact that homeopathy is a worthless pre-science cult therapy”.

Nope. Just to counter the hallowed ground that you and others like you think that Mainstream is.

A case perhaps of: attempting to remove the plank in your own eye, before trying to remove the splinter in my own.

Chris: you have cited papers filed by Wakefield as vindicating him, failing to note that the action failed. You have claimed that only 13% of treatments are backed by science despite the fact that the paper you cited says otherwise as to others cited. You have claimed that the proven link between BRCA1 and cancer is bogus. You have claimed that te Swiss government supports homeopathy depict an authoritative source which explicitly contradicts you.

In these and every other statement you make you show yourself to be wilfully contrarian.

Can you point to a single argument you have made which is valid and honestly reflects the balance of scientific opinion?

Can we please stop attacking one another. Guy Chapman and Chrisb1, consider yourselves on warning – any further comments that break our commenting guidelines will be removed. Healthy debate is welcome, but don’t make it personal.

Guy,
lets just take a look at the “mot juste”.

“I have cited papers filed by Wakefields Attorneys as vindicating him”?

Nope. Just challenging the decision that could lead to vindication.

“I have claimed that only 13% (or thereabouts) of medical treatments are backed by science despite the fact that the paper you cited says otherwise as to others cited”.

Possibly, but not definitely, as a large % of medical treatment is bogus and unnecessary; take the case of unnecessary Angioplasties for example.

” I have claimed that the proven link between BRCA1 and cancer is bogus”.

Nope again, as I stated there is an increased risk and an actual 2% to 3% of breast cancers actually diagnosed because of the BRAC1 and BRAC2 mutations.

“I have claimed that the Swiss government supports homeopathy depict an authoritative source which explicitly contradicts you”.

The Swiss report is irrelevant as to who endorses it, whether this be Government or whoever.

“In these and every other statement you make you show yourself to be wilfully contrarian”.

In your opinion, but not in mine, but then you are entitled to an opinion, even if it is wrong.

“Can I point to a single argument you have made which is valid and honestly reflects the balance of scientific opinion”?

Yes, but time and space do not allow me to do so at the moment, but I do not place much significance on your “scientific opinion”, when I have been posting on how unreliable it is and sometimes quite fraudulent.
Where pray have you been?

I am sorry. I find it vexing refuting a claim point by point only to have it repeated as if the refutation did not exist.

I invite Chris to come and join us in another Conversation – at least one that does not involve medicine and health issues. It would be great to be able to agree on some consumer issues.

My apologies Patrick.
I wasn’t aware that I had made any personal attacks on Guy, but if that is your decision I will abide by what you have said.

Thank you Wavechange I will do just that.
I must say I have admired your sense of neutrality throughout, even though you may not have agreed with anything I have said.

Maria says:
3 June 2013

Chris

Far from ignoring your ‘facts’, I’ve spent quite a bit of time checking them out and reporting what I’ve found. Take, for example, medication-error deaths. I’m afraid it is not up to you to change the definition to fit in with what you already believe.. I gave the definition from the 1998 Lancet paper by Phillips, Christenfeld and Glynn entitled, ‘Increase in US medication-error deaths between 1983 and 1993’, which is specifically about patients NOT taking their medicines as prescribed. This is the source used by the JAMA article that contains the claim you keep repeating about iatrogenic deaths.

Re your callousness.

“Did I actually say that? Nope.”

In effect, yes. You presumably included the quote from Mendelsohn because you agree with it. Mendelsohn stated that doing away with 90% of modern medicine would be beneficial, Utterly, utterly callous.

Thanks. Though I don’t agree with much you have said, I know that it’s unpleasant to be constantly criticised.

Chris, to pick just one point that shows the error in your thinking:

“The Swiss report is irrelevant as to who endorses it, whether this be Government or whoever.”

You presented it as a Swiss government report endorsing homeopathy as cost-effective. I showed you a statement by an official of the Swiss Government specifically refuting that claim and showing that in fact the Swiss government concluded the opposite: that there is no persuasive evidence of efficacy. You assert that this is not significant; in effect you assert that a bunch of Swiss homeopaths writing an extended pleading for their livelihood is not significantly different from an official endorsement by the Swiss government.

Can you see why a report by homeopaths pleading for reimbursement, and a report by the government, are different, and in a significant way? Can you see that claiming the Swiss government concluded homeopathy is cost effective when in fact that concluded the opposite, is a significant error and not a trivial error of attribution?

This is the context of the science you claim to be “unreliable” and “sometimes quite fraudulent”.

Sure, homeopaths think the science refuting homeopathy is fraudulent. If they did not think that, they would not be homeopaths. They are right in the same way that climate change deniers are right – i.e. they are wrong 🙂

Thank you Patrick! Much appreciated.

ReallyGoodMedicine says:
9 June 2013

@ChrisP

What you call “snake oil” is very effective medicine especially when used to treat malaria and other infectious diseases. Here’s a very brief list of documented cures of malaria with homeopathy alone:

1840 – Christian F. Hahnemann treated many cases of malaria in the western U.S.

1846 – W.H. Dickinson treated malaria successfully in the mid-western U.S.

1850 – E.C. Stanton regularly and successfully treated malaria in New York, U.S.A.

1854 – E.U. Jones treated malaria successfully in Massachusetts, U.S.A.

1861 – George Brinton McClellan (a Civil War Major General) was successfully treated for typhoid fever and malaria

1870 – Horace Greeley was successfully treated for malaria

1881 – President James A. Garfield’s wife was successfully treated for malaria

1882 – Henry Edward Lane was successfully treated for malaria after 17 years of allopathic failure

1928 – Homeopathy was used to successfully treat many cases of malaria in Panama

1936 – Thousands of Indian patients were successfully treated for malaria

1950-60 – Albert Schweitzer ordered homeopathic nosodes for use in his hospital at Gabon

1980’s – R. de Andrade Costa, Brazil, developed the Alive nosode for treatment of malaria

1996 – Mother Theresa took homeopathic remedies for malaria

STUDY:

Two homeopathic remedies produce complete clearance of parasites by 28th day and had significant preventative activity (89.2%) which was higher than with pyrimethamine

http://www.ncbi.nlm.nih.gov/PMC/articles/PMC33235391/

RGM: All we need now is some credible independently verifiable objective evidence that homeopathy has cured a single case of a single disease, ever.

Guy, just to illustrate the above you have said: “Until they become honest, (Homeopaths) it is TOO DANGEROUS TO LET THEM NEAR SICK PEOPLE” !!

You know nothing then of one of the leading causes of death in the United States (and probably elsewhere).
http://www.ourcivilisation.com/medicine/usamed/deaths.htm

According to “Death by Medicine”, a study done by Gary Null, PhD; Carolyn Dean, MD; Martin Feldman, MD; Debora Rasio, MD; and Dorothy Smith, PhD; there are 783,936 iatrogenic deaths at the hands of health providers through errors or medical negligence each year.
The figures from the study have never been disproven. Hmmm, I wonder why?

In the United States, figures suggest estimated deaths per year of: [17][18] [19][20]
12,000 due to unnecessary surgery
7,000 due to medication errors in hospitals
20,000 due to other errors in hospitals
80,000 due to nosocomial infections in hospitals
106,000 due to non-error, negative effects of drugs
Based on these figures, iatrogenesis may cause 225,000 deaths per year in the United States (excluding recognizable error).[17]
These estimates are lower than those in an earlier IOM report, which would suggest from 230,000 to 284,000 iatrogenic deaths.[17]
These figures are likely exaggerated, however, as they are based on recorded deaths in hospitals rather than in the general population. Even so, the large gap separating these estimates, deaths from cerebrovascular disease would still suggest that iatrogenic illness constitutes the third-leading cause of death in the United States; heart disease and cancer are the first- and second-leading causes of death, respectively.[17]

17. ^ a b c d Starfield B (July 2000). “Is US health really the best in the world?” (PDF). JAMA 284 (4): 483–5. doi:10.1001/jama.284.4.483. PMID 10904513.
18. ^ Leape L (May 1992). “Unnecessary Surgery”. Annual Review of Public Health 13: 363–383. doi:10.1146/annurev.pu.13.050192.002051.
19. ^ Phillips DP, Christenfeld N, Glynn LM (February 1998). “Increase in US medication-error deaths between 1983 and 1993”. Lancet 351 (9103): 643–4. doi:10.1016/S0140-6736(98)24009-8. PMID 9500322.
20. ^ Lazarou J, Pomeranz BH, Corey PN (April 1998). “Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies”. JAMA 279 (15): 1200–5. doi:10.1001/jama.279.15.1200. PMID 9555760.

and you claim not to allow Homeopaths anywhere near a sick person?

The mind boggles, it really does.

[This comment has been edited for breaking our commenting guidelines. Thanks, mods.]

Chris, this has already been debunked here. As stated previously, this is an analysis of the US healthcare system and the way it is managed and reimbursed, not of medicine., It is also out of date.

Alan, you say…..
“Would you like me to demolish what you say about the bmj Clinical Evidence page now”?

Yes please, bearing in mind this is the BMJ’s own page on clinical evidence, so this should be fun.

/me gets popcorn

Alan Henness says:
1 June 2013

chrisb1

Guy has already given much of it already: https://conversation.which.co.uk/consumer-rights/your-view-do-pharmacists-and-homeopathy-mix/comment-page-1/#comment-1318125

Or are you not claiming that only 13% of all conventional treatments are beneficial?

Robin says:
1 June 2013

🙂 Who’s bringing the homeopathic beer?

(Credit to Mitchell and Webb)

Alan,
Am I claiming that only 13% of all conventional treatments are beneficial?

No. Just not nearly as efficacious or supported by EBM as you would have us believe.

Chris: Disingenuous answer. We already know that 0% of homeopathy is beneficial, what proportion of current clinical interventions do you think are beneficial? As in, proportion of actual interventions applied? And based on what?

Alan Henness says:
1 June 2013

So, do you now understand what that bmj article actually says, do you accept that figure of around 80% and that is 80% more than that for homeopathy.

Robin says:
2 June 2013

Chris, you now agree the figure of 13% is incorrect. In the other conversation you posted a link to a document by the Alliance for natural health, something you clearly support.

——–
The Health-Freedom Movement is working to help promote natural and sustainable healthcare through the use of ‘good science and good law’.
Please read this very carefully…………….
http://www.anh-europe.org/files/100617-SustainableHealthcare_White-Paper.pdf
——-

On page six, para two, they repeat the claim of 13%.

Your assertion they use “good science” is not consistent with your own stated belief this figure is incorrect. In effect you are now arguing with yourself, i.e. citing documents that contradict your own opinion and statements.

In might help the clarity of this discussion if you could answer Alan and tell us if you accept 80% for medicine vs. 0% for homeopathy please.

Alan Henness says:
2 June 2013

chrisb1

I omitted the question mark, but it was clearly three questions to you. Can you answer them, please?

Alan,
yes sorry; been too busy refuting Guy.
“So, do you now understand what that bmj article actually says, do you accept that figure of around 80% and that is 80% more than that for homeopathy”.

There is no need to be patronizing, but yes I do understand what the BMJ article states as clinical evidence, and I stand by what I said in my original reply where I have already answered your questions.

Re’ Homeopathy, I refer to my previous post on its approval and efficacy by the Swiss government to which you have not yet replied, just as you haven’t, or anyone else on the re’ the very large number of Iatrogenic deaths reported by JAMA…..loads of “disagrees”, meaning that those who have actually refute this evidence from a respected Mainstream Journal.
In other words a blanket refusal to accept the facts, otherwise known as bias and prejudice.

May 2012: Homeopathy has been vindicated by the Swiss Government’s Health Technology Assessment (HTA) report. This has now been published in full—Swiss Government finds homeopathy effective and cost efficient.
The much more comprehensive HTA is an established scientific procedure that not only examines efficacy, but also examines ‘real-world effectiveness’, appropriateness, safety and economy. In contrast to the subsidiary sub-study result, which was considered ‘of little relevance for the political decision’, the HTA found that ‘the individual CAM interventions, especially homeopathy, were effective, under Swiss conditions safe and, as far as could be judged from the trial situation, also cost efficient’.

Chris: You have yet to refute a single word I have said. You do not seem to understand the difference between refuting something and repudiating it. You (and other homeopaths) repudiate scientific evidence, but never refute it.

As a perfect case in point, you cite Dana Ullman’s false claims about the Swiss HTA. This report was not a Swiss government report, it was a report to the Swiss government by a bunch of homeopaths, as part of an evidence review process known as PEK.

The conclusion of this process was that funding was *withdrawn*.

The official responsible for the process, Dr. Gurtner, has written in the Swiss Medical Weekkly specifically refuting the claims that (a) this is a Swiss government report and (b) based on this the Swiss government found homeopathy to be cost-effective. Both those claims are lies.

“The report “Homeopathy in healthcare: effectiveness, appropriateness, safety, costs” is not a “Swiss report”” – http://www.smw.ch/content/smw-2012-13723/

This statement directly and unequivocally refutes the claims you made about the Swiss report. That’s refutes in its correct usage: it conclusively proves that your statements are incorrect.

Robin says:
2 June 2013

And Guy had addressed the “Swizz” report, as I now know it has come to be referred to, when you raised it previously.

As I understand it the Swiss have agreed to reimburse some treatments costs for some homeopathic products. They have not seen efficacy data. So they do not endorse efficacy of homeopathy in any way.

Things may change in Switzerland in 2015/17:
Because these therapies did not meet the established criteria for full and permanent inclusion for reimbursement, they ended up with the new, temporary solution again with reimbursement from 2012 until 2017, with the obligation to finally prove compliance of these therapies with the key criteria of efficacy, appropriateness and cost-effectiveness by end of 2015.*

Maybe we can continue the discussion when the Swiss see some efficacy data? 200 years and counting so far.

Meanwhile whatever the Swiss decide this is the UK.

The UK regulators have a very different view. As Guy pointed out above key government advisors, having reviewed the evidence, have also decided homeopathy has no effect other than, at best, a placebo For a Chief Medical Officer to use language such as “it is rubbish:” publicly is noteworthy.

I think the sensible suggestion is to stop the NHS funding homeopathy until some credible data emerges.

*I am not posting a link as an earlier post has been stalled for 12 hrs so far awaiting checking of a link I enclosed- I guess the good people of Which? deserve a day off – the source documents are easy to find.

Robin: I have also linked the statement from Dr. Gurtner refuting the false claims re the Swiss PEK/HTA process. I suspected links may be slow in passing today so I omitted it from my first response to Chris.

The “Swiss report” is a zombie argument. However often you kill it, the undead corpse is just resurrected in the next argument. I guess this will carry on until they have another “final clinching proof of homeopathy”, that was the case with Montagnier, for example.

Alan Henness says:
2 June 2013

chrisb1 said:

“yes sorry; been too busy refuting Guy.”

lol

““So, do you now understand what that bmj article actually says, do you accept that figure of around 80% and that is 80% more than that for homeopathy”.

“There is no need to be patronizing,”

I wasn’t being patronising.

“but yes I do understand what the BMJ article states as clinical evidence, and I stand by what I said in my original reply where I have already answered your questions.”

You previously said, in answer to my summary of Imrie et at. that showed that around 80% of a wide range of treatments are backed by some form of compelling evidence:

“yes you did point that out so thanks, but just to illustrate my point that Medical practices are not supported by science, here are just a few examples”

I hope you are able to see that providing a list of some particular treatments (which I have not verified) that might not have good evidence to back them up does not negate the broad figure of 80% of those that do. But neither does it alter the fact that there is still no good evidence for the efficacy of homeopathy and certainly does not somehow magically raise it above 0%. It remains firmly stuck there.

So, do you accept that the US Government’s Office of Technology Assessment was wrong when it said that only 10% to 20% of conventional treatments were evidence-based and that the actual figure is around 80%?

You also said:

“Re’ Homeopathy, I refer to my previous post on its approval and efficacy by the Swiss government to which you have not yet replied”

I can’t find any other comment by you about the Swiss government report on homeopathy. If the text you quoted from May 2012 was what you said, then I can’t find that anywhere on the Which? website.

However, you said here:

“May 2012: Homeopathy has been vindicated by the Swiss Government’s Health Technology Assessment (HTA) report. This has now been published in full—Swiss Government finds homeopathy effective and cost efficient.
The much more comprehensive HTA is an established scientific procedure that not only examines efficacy, but also examines ‘real-world effectiveness’, appropriateness, safety and economy. In contrast to the subsidiary sub-study result, which was considered ‘of little relevance for the political decision’, the HTA found that ‘the individual CAM interventions, especially homeopathy, were effective, under Swiss conditions safe and, as far as could be judged from the trial situation, also cost efficient’.”

You shouldn’t believe the homeopathic spin and downright misrepresentation that has been put on this. Let’s correct a few things:

1. It was not a Swiss Government report.
2. It was not an HTA.
3. The Swiss Government did not find homeopathy effective and cost effective.
4. An HTA may well be more comprehensive than other scientific procedures, but the Swiss report wasn’t an HTA.
5. The 2011 English publication was not the original submitted report and had been added to by its authors.

How do I now this? Because the Swiss Government have said so. [1]

Felix Gurtner, Federal Office of Public Health FOPH, Health and Accident Insurance Directorate, Bern, Switzerland, had to correct these same errors promulgated by the authors of the homeopathy report.

He stated that the original report was no more than a ‘literature review’ and did not meet the criteria for an HTA:

“As far as homeopathy is concerned, two literature reviews were commissioned: A meta-analysis on homeopathy trials and of matched trials in conventional medicine, and a broad analysis of the literature incorporating publications and unpublished reports on studies of various methodologies (randomised and non-randomised trials, case series, experimental studies). This review was declared to be an HTA by the authors (the final PEK report does not classify the literature reviews as HTA reports) and published later as a book under their responsibility without any consent of the Swiss government or administration. The book by Bonhöft and Matthiessen was later translated into English and published in 2012.” (I have removed his references to avoid confusion with mine.)

The meta-analysis became known as Shang et al. But note that the authors of the report are the ones who (wrongly) called it an HTA and who published without the consent of the Swiss Government.

So, what we have is that a report on homeopathy was commissioned by the Swiss Government, was written by mainly homeopaths who took it upon themselves to ‘reinterpret’ the conclusions of trials for homeopathy, generally declaring them to be more effective that the original authors had concluded based on what they had found and evaluated. They put these re-interpreted conclusions forward as evidence for the efficacy of homeopathy.

This report was criticised in the overall report the PEK wrote:

“For all five assessments, it is very obvious that all or some of the authors have a positive attitude towards the treatments in question or are convinced about their efficacy. Unquestionably, strict proponents of the usual hierarchy of evidence will regard the presented evaluations as scientifically untenable and unreasonably positive (except for some specific aspects of phytotherapy). Even less skeptical academic doctors will regard many interpretations as very optimistic and not scientifically convincing.” [2]

Others have been more forceful in their assessment, with one calling it “a Case Study of Research Misconduct” and concluding:

“The present paper has established that the authors of this report adopted a very unusual strategy in what should have been an impartial evidence appraisal. It appears that their goal was not to provide an independent assessment but to choose criteria that would lead to their chosen conclusion that homeopathy is effective.” [3]

As a direct result of the Swiss homeopathy report, the Swiss Government ended reimbursement of homeopathy (and the other therapies the PEK were considering). This was because the Swiss Government concluded that homeopathy did not meet the requirements of ““Wirksamkeit” (efficacy/effectiveness), “Zweckmässigkeit” (appropriateness / comparative effectiveness / risk-benefit-ratio), and “Wirtschaftlichkeit” (price level / cost impact / cost-effectiveness).”

After a concerted campaign by homeopathists and a referendums, the Swiss Government – because referendums have to be acted upon in Switzerland – had to relax their rules for reimbursement and allow homeopathy back in even though it didn’t meet the requirements – but only for a temporary period. Homeopaths have until 2015 to provide the evidence the Swiss homeopathy report was unable to do and finally show (if they can) that homeopathy is effective, etc. If they cannot do this by 2015, homeopathy will be removed completely (again) from reimbursement in 2017.

1. Gurtner, F. 2012. “The Report ‘Homeopathy in Healthcare: Effectiveness, Appropriateness, Safety, Costs’ Is Not a ‘Swiss Report’.” Swiss Medical Weekly (December 17). doi:10.4414/smw.2012.13723. http://www.smw.ch/content/smw-2012-13723/.

2. “That ‘neutral’ Swiss Homeopathy Report | Zeno’s Blog.” 2013. Accessed June 2. http://www.zenosblog.com/2012/05/that-neutral-swiss-homeopathy-report/. (Translations from Swiss-German by Sven Rudloff.)

3. “SMW – Swiss Medical Weekly – The Swiss Report on Homeopathy – a Case Study of Research Misconduct.” 2012. Accessed June 2. http://www.smw.ch/content/smw-2012-13594/.

Alan Henness says:
2 June 2013

I have posted a comprehensive reply to chrisb1 about the Swiss report, but it contained three links, so it may be delayed…

Alan,
no I haven’t seen your reply to my post about the Swiss report, and where no doubt the links you have provided will quash any suggestion that Homeopathy is is any way therapeutic or remedial.

Btw, I don’t suppose the repudiators of the Swiss report are in any way from the Mainstream fraternity? as the bias/agenda and results/critique will have been predetermined.

“You (and other homeopaths) repudiate scientific evidence, but never refute it”.

But we do question the “validity” of it, and come out trumps most times.

Chris: It is remarkable that you believe you “come up trumps” despite being consistently wrong, and in many cases very obviously so (e.g. your comment about the Swiss situation above).

In this, at least you are consistent with your fellow homeopaths, as evidence the constant repetition of points refuted a thousand times.

You are like the Black Knight of Monty Python fame. And no, we won’t call it a draw.

Robin says:
2 June 2013

Chris, the repudiators are the Swiss government and it’s associated regulators. so if they are considered mainstream you may have a point, but one that only proves how wrong you are. I’ll be generous and say the homeopaths put an awful lot of spin on the story, the facts are there to be seen and do not support you.

In the shell of the proverbial nut:
A group of homeopaths compile a report to support continuation of being paid to distribute sugar and water.
Swiss regular says erm, carry on for now but we need to see proof by 2015 what we have seen isn’t up to the required standard.

It’s – yet again – simple, don’t trust the headlines, check the facts.

Perhaps you will consider that this one ” ’tis but a scratch”?

Alan Henness says:
2 June 2013

Odd, don’t you think chrisb1, that the Swiss Government should be lauded by homeopathists as a reliable, neutral evaluator of the evidence for homeopathy when it’s believed that they supported it, but not when it’s pointed out that this very same neutral Swiss Government had instead decided there was no good scientific evidence for the efficacy homeopathy and that the taxpayer should not be funding it?

I wonder why that should be.

From The Swiss Medical Weekly……………..

“This paper analyses the Swiss report into Homeopathy and concludes that it is scientifically, logically and ethically flawed. Specifically, it contains no new evidence and misinterprets studies previously exposed as weak; creates a new standard of evidence designed to make homeopathy appear effective; and attempts to discredit randomized controlled trials as the gold standard of evidence”.

Of course this a “Medical review” so you wouldn’t really expect anything else would you? and the comment that: ” it is scientifically, logically and ethically flawed. Contains no new evidence and misinterprets studies previously exposed as weak”

Now where have I heard that before?

Oh yes………..Mainstream drug trials/results.

http://www.collective-evolution.com/2012/04/21/cancer-industry-exposed-as-fraud-the-science-is-false/
http://helkeferrie.com/medical-fraud-exposed/

etc etc etc etc etc…………………

Robin: It’s even worse than that (for Chris).

Swiss introduce temporary funding of homeopathy subject to evidence review.
Homeopaths submit a “case study in research misconduct” to said review.
Swiss terminate funding.
Homeopaths launch political campaign, secure funding for another 5 year trial period.
Homeopaths claim that “neutral” Swiss Government found homeopathy as cost-effective leading to funding.

The way the homeopaths spin it is not a misunderstanding, it’s a deliberate misrepresentation. The facts are well enough known but they keep repeating the bogus claim anyway. Dana Ullman repeated it on Forbes a couple of weeks back, despite the fact that he had already seen the letter from the Swiss official explicitly refuting his claims.

It’s not an accident.

Alan Henness says:
2 June 2013

Very strange indeed….

Not.