I was just in the process of thinking about another entry on the loss of our civil liberties when Jenni Russell in the Guardian did it for me. Her piece in today’s paper, Even if you’ve nothing to hide, there’s plenty to fear should be required reading for every British citizen.
Correction: every global citizen.
“We read the world wrong and say that it deceives us.”
Rabindranath Tagore
The homeophobes (a term coined by Jeanette Winterson in her Guardian article In Defence of Homeopathy this week) really seem to have the bit between their teeth these days. Yesterday’s publication of The Lancet revealed a comment piece penned by none other than Ben Goldacre, which he supplemented by a more emotive piece, A Kind of Magic?, saying much the same thing in the Guardian.
While recognising the utter pointlessness of arguing back – irreconcilable systems of thought can’t be reconciled in each other’s terms but only by a system of higher order, a metatheory that can encompass both (see Unscientific Attachment for more on this) – I felt Goldacre has had things his own way for quite long enough and it was time to send a letter to the Guardian. Whether it’s published or not is another matter, of course, but here it is in any case.
Sirs
In his November 16 Bad Science article A Kind of Magic?, Ben Goldacre writes: “This is all good fun, but my adamant stance, that I absolutely lack any authority, is key: because this is not about one man’s opinion …”
Unfortunately Dr Goldacre seems somewhat deluded on this point. This is very much about one man’s opinion (and a few others like him). He seems very fond of assuming the mantle of ‘science’ and claiming to speak in its name. However, ‘science’ does not speak with one voice – if it did, it wouldn’t be science – and his oft-repeated mantra that homeopathy avoids scientific scrutiny and that there’s no proof for its efficacy is complete nonscience. There are many people within the boundaries of what Dr Goldacre might define as ‘science’ working hard on the subject, and a large number of high quality trials testing the therapy in terms of its principles as well as its remedies have now been published.
So many, in fact, that the 2005 Shang et al meta-analysis which featured in The Lancet’s last attempt to dismiss homeopathy identified 110 which matched their stringent criteria for inclusion. Why that 110 was reduced to 8 unidentified trials in the final analysis still remains to be answered. At the very least this was a violation of transparency which should never have passed peer review. The analysis also failed to make any comparison between the homeopathic and conventional trials it finally selected. Could that be because there was no statistical difference between the two interventions? So if homeopathy is nothing but placebo, and conventional medicine no better, why is the NHS teetering towards bankruptcy because of the amount it has to spend on drugs, which, according to a 2000 study in the Journal of the American Medical Association, are responsible for over 106,000 deaths annually in the US through side effects alone? We should all be on placebo!
Dr Goldacre holds up randomized controlled trials as the gold standard in evidence-based medicine but seems to forget that these are what they are – trials. It’s estimated that up to one fifth of all new prescription drugs may eventually be recalled or produce potentially harmful side effects (JAMA again, 2002). A 20% failure rate is not much of a gold standard. The gold standard for evidence-based medicine is surely “does it work in practice”? There are now several large-scale long-term clinical studies of homeopathy showing that it not only produces outcomes comparable with conventional medicine, but in some cases (a 2005 German study by Witt et al) better. A 2002 literature review by an Italian Advisory Board came to the same conclusion.
His adherence to the dogma that homeopathy’s use of extreme dilutions renders any potential action impossible is mistaking the map for the territory and ” … relies on a quaint old idea from the nineteenth century that the ONLY way that the property of water can be affected or changed is by incorporating foreign molecules. This is the Avogadro-limit high-school level chemistry argument. To a materials scientist this notion is absurd, since the fundamental paradigm of materials-science is that the structure-property relationship is the basic determinant of everything. It is a fact that the structure of water and therefore the informational content of water can be altered in infinite ways.” ?(Prof Rustum Roy PhD, Evan Pugh Professor of the Solid State Emeritus; Professor of Science, Technology and Society Emeritus; Professor of Geochemistry Emeritus, Pennsylvania State University).
Dr Goldacre may not value patient choice, but the interests of evidence-based medicine alone would seem to be demanding that he indulge in a little more scientific study and a little less opinionated prejudice. The research is all there and it would be kind of tragic if a valid and effective therapeutic option were lost to us for no good reason other than that it violates our present consensus conception of how the world works. The core of the scientific method is that if the evidence contradicts the theory then it’s the theory that gets questioned.
Yours etc
“There are two ways to be fooled. One is to believe what isn’t true; the other is to refuse to believe what is true.”
Søren Kierkegaard
“The opposite of a fact is falsehood, but the opposite of one profound truth may very well be another profound truth.”
Niels Bohr
“The world of homeopathic research is moving in the direction of investigating its rational, explicable, demonstrable, reproducible aspects and neglecting the more controversial and doubtful aspects. The purpose of this publication is to review the extensive literature available, and draw the reader’s attention to studies that comply with the strictest scientific methodologies.”
This Italian literature review, published in 2002, is available in English translation from the Italian homeopathic pharmacy Guna, and presents a comprehensive review of the trials of the last decade, summarised by an Advisory Board which includes professors in Immunology, Pharmacology, General Surgery, Clinical Morphology and Anatomy, Human Physiology, Psychiatry and Neurology from universities and medical schools in Italy, the US, Germany and Poland. Some salient quotations from the study:
“A number of large-scale studies designed to evaluate the huge amount of homeopathic literature have been conducted, especially in the last 10 years. Organisations and institutes of great international prestige and importance have dealt with the issue of homeopathy. All of them have concluded that homeopathy possesses therapeutic efficacy.” (Overview of Human Clinical Trials, p29)
“… most of the members of the medical profession and the media have failed to perceive the existence of this body of studies, which demonstrate the therapeutic efficacy of homeopathic medicines. The aim of the present volume was to fill this lack of information by a compendium made of some of the latest and most significant literature in the field.
Very briefly, a large body of studies demonstrates that the efficacy of homeopathic medicines is not due to the “mythical” placebo effect, thus finally dispelling a series of superficial, prejudiced attitudes.
“Among these, a set of studies compare homeopathic vs allopathic medicines. These trials were conducted in accordance with Helsinki Declaration on the therapeutic efficacy.
Most of the best studies relate to the branch of homeopathy known as homotoxicology which, with its pragmatic attitude and rejection of therapeutic extremism, seems to meet current demand for integrated medicine most effectively.
These studies demonstrate that the effect of homeopathic medicines may be at least similar to that of the allopathic reference drug used for the same disorder. They also confirm that homeopathic medicines, unlike allopathic drugs, rarely produce side effects. Finally, they show that homeopathic remedies are usually cheaper,and in some cases much cheaper, than the corresponding conventional treatment.
“Everybody is entitled to his own opinion and can deny the evidence, even when faced with the clearest proof. But who hold public and institutional offices and responsibilities have the duty to analyse actively all the body of information that may improve the patient’s quality of life.
[…]
“It may seem paradoxical that tiny amounts of an active constituent (diluted by the very special process of homeopathic production) can produce effects on living beings, but this is evidently a scientific fact.
Science acts on the basis of objective, verifiable observations; if the event demonstrated cannot be interpreted by a theory, it is the theory that needs to be revised. This is the principle behind the progress of science.” (Conclusions, p87-88)
This study was published in 2002. In 2005, the World Health Organisation were in the process of compiling what was believed to be a largely positive report on homeopathy, and which was apparently leaked to The Lancet in advance of its publication of the Shang et al meta-analysis. According to Dr Peter Fisher, Director of Research at the Royal London Homeopathic Hospital and the Queen’s homeopath:
“The same issue of The Lancet featured a leak of the World Health Organisation’s (WHO) draft report on homeopathy. The WHO document was apparently leaked to The Lancet by Dutch and Belgian doctors hostile to homeopathy; their comments and the (hostile) comments of Prof. Edzard Ernst of the University of Exeter were published. Dr Xiaorui Zhang, Traditional Medicine Coordinator of WHO, who is responsible for the report, was also interviewed, but declined to comment on a leaked, confidential draft. This leak came only 2 days after The Times of London published, as its front page lead, a remarkably similar story: a leak of the Smallwood Enquiry on The Role of Complementary and Alternative Medicine in the NHS commissioned by The Prince of Wales’ Foundation for Integrated Health. It is ironic that the editor of The Lancet, Dr Richard Horton, wrote to The Times accusing Prof. Ernst of having ‘broken every code of scientific behaviour’ for leaking the draft report of the Smallwood Enquiry (and incidentally describing complementary medicine as ‘a largely pernicious influence… preying on the fears and uncertainties of the sick’), while simultaneously doing the same to the WHO report in his own journal!
“Dr Horton also wrote an open letter to the UK Secretary of State for Health, Patricia Hewitt and the Chairman of the National Institute for Clinical Excellence (NICE) Prof. Sir Michael Rawlings, calling for the use of homeopathy in the NHS to be reviewed in light of this publication.”
What we appear to be looking at here is a very deliberate attempt to discredit homeopathy, allowing prejudice to hold sway over the results of scientific studies and making a mockery of evidence-based medicine. Not only are these individuals attempting to mislead the medical profession and general public, but are trying to deprive them of the right to choose and use a healthcare modality which is rapidly being reliably demonstrated as at least as effective as conventional medicine, and in some instances, more so. Futher, one that is also proving itself to be considerably cheaper than the present model and highly unlikely to kill upwards of 106,000 people per annum (in the US alone – Journal of the American Medical Association 2000;284:483-485) just through the side effects of the medication.
If The Lancet remains true to previous form in its next issue on homeopathy, then it doesn’t look like it has much future as a respected scientific journal under its present stewardship. That’s a shame, as it’s one of the oldest peer-reviewed medical journals in the world (founded in 1823). Homeopathy will survive, as it has done for longer than The Lancet despite all previous attempts to suppress it, because the truth has a way of finding its way out regardless.
If you support freedom of choice in healthcare and have had good experience of homeopathic treatment, you can register your support by signing the “homeopathy worked for me” declaration.
“In a time of universal deceit, telling the truth becomes a revolutionary act.”
George Orwell
“Research is subordinated (not to a long-term social benefit) but to an immediate commercial profit. Currently, disease (not health) is one of the major sources of profit for the pharmaceutical industry, and the doctors are willing agents of those profits.”
Dr Pierre Bosquet, Nouvelle Critique, France, May 1961
As The Lancet prepares to publish another issue on homeopathy, this seems a suitable moment to republish a blog entry from 18 months ago which described the highly irregular context forming the backdrop to the publication of the seriously flawed study (Shang et al. ‘Are the clinical effects of homeopathy placebo effects? Comparative study of placebo controlled trials of homeopathy and allopathy’ The Lancet 2005;366 (9487):726-733) which claimed to support the conclusion that the effects of homeopathy are no more than placebo.
Further details on the study itself, analyses of it’s principal failings, and the reaction it provoked among serious researchers can be found on the Myths and Misconceptions page.
The Shang et al meta-analysis was an offshoot from a Swiss government study, the Programm Evaluation Komplementärmedizin (PEK), which was designed to allow politicians to assess whether or not five complementary therapies – anthroposophical medicine, homeopathy, neural therapy, phytotherapy and traditional Chinese herbal therapy – should be included in the list of services covered by the Swiss compulsory health insurance scheme (KLV). The cost of complementary therapies were, until 1998, reimbursed under the basic national scheme, but a change in the regulations in 1998 put the decision over which therapies were or were not valid for reimbursement in the hands of the Swiss Department of Internal Affairs (EDI). Public outcry forced the government to back-peddle and the five most popular therapies were reinstated in the KLV scheme from 1999 to 2005, on condition that each therapy was provided by FMH-certified physicians only, and that a simultaneous study in each therapy’s effectiveness was carried out (the PEK study). The decision on whether the therapies were retained within the basic health insurance scheme after 2005 would depend on the demonstration of their efficacy, appropriateness and cost effectiveness.
The study was set up under the Federal Office of Social Insurance (BSV) with a well-defined management structure and review board of internationally-acknowledged experts. It received widespread praise for the quality of its design and the degree of cooperation and transparency amongst its participants. As each area of the study began publishing their findings, the project was cited as an exemplar for future CAM research.
But as the extent of the findings in favour of the five therapies began to become clear, in 2004 PEK’s management structure was abruptly changed and the control of the study was passed to the Federal Office of Health (BAG). From that point onward, many attempts were made to interfere with and derail its emerging conclusions. Transparency was immediately compromised. Economic data showing the cost benefits of CAM were suppressed. The economist preparing to present the results of his work was dismissed without reason and placed under a gagging order. Other departments were prevented from publishing their work.
One member of the PEK steering committee, Dr med Peter Heusser, was so disgusted by what he witnessed that he has written an account of what happened, Medizin und Macht am Beispiel des Programms Evaluation Komplementärmedizin PEK (currently only available in German, but machine-translated here), and this brief summary is drawn largely from his account.
The Swiss authorities – both the government and the Federal Office of Health (BAG) – tried to sweep the PEK study under the carpet. A conference scheduled for April 2005 to present and discuss its results had to be cancelled because the Federal Office of Health prevented the publication of the study data. Some collaborators were even coerced into deleting all PEK-related data from their computers. The final meeting of the PEK international review board (six professors from Switzerland, Germany, Denmark and the UK responsible for the scientific quality of the study), scheduled for June 2005 for a final assessment of the project, was cancelled. (The review board eventually produced a summary report in September, which is highly critical of the political interference in the study.) Many contributors had their contracts terminated before their work could be completed. The recommendation in the final draft that homeopathy, anthroposophical medicine and herbal medicine should stay in the compulsory health insurance scheme was deleted in the final publication.
The Swiss government pre-emptively decided to exclude all CAM therapies from the compulsory health insurance scheme as of 30 June 2005, effectively ignoring not just the weight of scientific findings and economic benefits (which could save SFr millions on the health budget) which were emerging from the still-to-be-completed PEK study, but also the weight of Swiss public opinion.
In this context, the appearance of the Shang et al meta-analysis in The Lancet two months later – notably pre-empting the final report from the PEK international review board – can do little else but appear even more biased and reverse-engineered than it does already in its own right (see Myths and Misconceptions). A letter to The Lancet from the Swiss Association of Homeopathic Physicians raising objections to the study was not even granted publication.
None of this – aside from the initial frenzy surrounding the announcement of the conclusions of the meta-analysis on homeopathy – appears to have raised so much as a whisper from the English-speaking international media. Even in Switzerland it was only reported piecemeal so the full extent of what happened was not readily apparent.
Perhaps it’s worth noting that Switzerland is ranked as 8th most competitive nation in the 2005 World Competitiveness Yearbook. (In comparison, the UK came 22nd.) And it’s also ranked 8th in terms of the major exporting countries of chemical and pharmaceutical products. Around 5% of current global pharmaceutical R&D is attributable to Swiss companies. Just one of these companies, Roche Holding AG, parent company of Roche Pharmaceuticals, the manufacturers of the anti-viral drug Tamiflu, reported 2006 net income which was greater than the entire gross domestic product – that is, the value of all final goods and services produced within a nation in a given year – of the bottom 119 nations of the World Bank’s 183-nation rankings in 2005.
Since many university medical research laboratories would cease to exist without the support of the pharmaceutical industry, it’s perhaps no surprise that “at the end of 2004, professors of the medical faculties had expressed the intention at a meeting of the Swiss Academy of Medical Sciences … to do everything in their power to prevent complementary medicine remaining in the basic insurance. A dean voiced the prevailing opinion: “We must provide hand grenades [literal quotation, personal communication of a participant of that conference] against complementary medicine.”” (Dr med Peter Heusser).
Against the backdrop of more and more high-quality studies demonstrating the clinical effectiveness of homeopathy in practice, it will be interesting to see if The Lancet can recover its scientific credibility this time around, or whether this will turn out to be yet another ill-conceived attempt at a hatchet job jumping on the Colquhoun-Goldacre bandwagon.
“The prerequisite for today’s medical policy is naturally the currently predominant system of medicine. The sick are the source of income, therefore it is necessary for sick people to be there, yes, it proves advantageous if one makes the people artificially sick.”
Dr med Steintl: ‘International Medical Policy’, 1938, Berlin
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Thanks to the current insanity revolving around homeopathy in this country, in both media and blogosphere, it's become necessary to insult your intelligence by explicitly drawing your attention to the obvious fact that any views or advice in this weblog/website are, unless stated otherwise, the opinions of the author alone and should not be taken as a substitute for medical advice or treatment. If you choose to take anything from here that might be construed as advice, you do so entirely under your own recognisance and responsibility.
smeddum.net - Blog: Confessions of a Serial Prover. Weblog on homeopathy, health and related subjects by homeopathic practitioner Wendy Howard
