Jan 11 2011

Homeopathy for Malaria

For those “shruggies” who still cling to the naive notion that there is no harm in worthless medicine, we have an update on promotion of homeopathic products for the prevention of malaria in sub saharan Africa. The General Pharmaceutical Council (GPhC) of the UK decided to drop their investigation of complaints against pharmacies that were recommending worthless treatments instead of proven and effective drugs for malaria prophylaxis.

Homeopathy is a prescientific philosophy-based system of treatment whose central ideas have been long discredited. Preparations are diluted to the point that there is essentially no active ingredients left behind, and so they are literally nothing but sugar pills or placebos. What’s more, there has been extensive clinical studies of homeopathy, most of it useless, but the well-controlled trials show that homeopathy does not work – for anything.

I did a literature search for homeopathic studies with malaria, and found one animal study published in the journal Homeopathy. The methods are pretty sparse, but there is no indication of blinding, and in any case the study is in mice, not people. Despite the highly preliminary nature of this one study, the authors conclude:

Although the mechanism of action is unknown, these agents would be good candidates as alternative or complementary medications in the treatment of malaria.

I would hope that such a statement would not get beyond peer-review in a real medical journal that was not ideologically dedicated to the promotion of a specific pseudoscience. At best this one study might indicate that “further research is warranted” – even for a plausible treatment, which homeopathy is not. It indicates the endemic problem with so-called complementary and alternative medicine (CAM) to base clinical treatments on the thinnest of justifications, and to treat preliminary and exploratory studies as adequate for “evidence-based medicine.” They apparently missed the memo that most preliminary studies are, in fact, wrong or misleading in their conclusions.

And that was the totality of the published evidence for homeopathy and malaria. I’m sure I am missing some obscure studies just by searching on “homeopathy” and “malaria” but that search should capture any relevant studies published in respectable journals. That search otherwise just brought up commentary, and one case report (in Swedish) of Swedes becoming ill from relying on homeopathy for malaria prevention.

I doubt I am missing any evidence, since the BBC provides the following quote in their article:

At the time the head of the Royal London Homeopathic Hospital Dr Peter Fisher told Newsnight “there is absolutely no reason to think that homeopathy works to prevent malaria… people may even die of malaria if they follow this advice”.

Fisher is a notorious apologist for homeopathy, and I’m sure if he had any evidence up his sleeve for homeopathy and malaria he wouldn’t roll over so easily on admitting that it’s worthless and dangerous.

In response to their own investigation, Sense about Science submitted a complaint to the GPhC against pharmacies recommending homeopathy to prevent malaria for those traveling to endemic areas in Africa. Now the GPhC has dropped their investigation, citing two reasons:

First the GPhC says that Ainsworths’ pharmacist Anthony Pinkus has taken “remedial action” to prevent what happened in 2006 ever happening ever again.

The second point the GPhC makes is that the allegation about Ainsworths “would fall below the current threshold criteria for referral to the investigating committee”.

The test is now whether a pharmacist is being “reckless with the safety and wellbeing of others”.

It is difficult to conceive of a more lame response than that. The first point is essentially that they will not regulate the pharmacies because they agreed to regulate themselves. That is as reassuring as a career criminal promising a judge that he’s sorry and won’t commit crimes anymore. How about a nice hefty fine as incentive, and to let the industry know that regulation is serious and has teeth? Now they have every reason to believe that regulation is not to be feared.

The second point is laughable – recommending that people rely upon worthless treatments instead of proven effective treatments for a serious and potentially fatal illness is the very definition of being “reckless with the safety and wellbeing of others”. If this case does not meet the criteria, then what will? Do pharmacists have to dispense actual poison?

This episode is a massive fail for the GPhC and for health care regulation in the UK. There is always the ray of hope in these cases that such abject failure will at least spark public outrage and perhaps motivate some politicians to action. I’m not holding my breath – I don’t think we are quite there yet with the public perception of homeopathy. But we are moving in that direction, after a number of high-profile smackdowns, especially in the UK.

This episode also brings up another point, and I think partly explains Fisher’s willingness to criticize pharmacists selling homeopathic products for malaria: There is a building cognitive dissonance within the homeopathic community regarding research. The clinical research clearly shows that homeopathic products do not work. Homeopaths often defend this with special pleading, saying that “cookie cutter” treatments are not in line with homeopathic philosophy, which requires personalized treatments. Of course, “personalized treatment” also means a consultation with a homeopath. There is no evidence that personalized homeopathic treatments work either, but if that defense is true then any homeopathic product on the shelf must be worthless.

So in defending themselves against the evidence for lack of efficacy of homeopathy, homeopaths have undercut the entire homeopathic pharmacy industry. Perhaps we are seeing the result of a brewing internal fight between homeopaths and the producers of homeopathic products. Of course, this is akin to a fight between solar and sidereal astrologers.

Conclusion

We can say with confidence that homeopathic products are worthless in general, and specifically for malaria prevention or treatment. There is certainly no credible evidence to support their use. Recommending homeopathic products to prevent malaria is malpractice and puts people at unnecessary risk of disease. It is shocking that the GPhC would so callously disregard the public health concern here – one that they are specifically charged with regulating. They have failed the public they are supposed to protect and should be called out on their failure.

The pharmacies that were let off the hook should be also. Perhaps a boycott of Ainsworths, one of the pharmacies involved, would get their attention. I would boycott any pharmacy that sold homeopathic products alongside actual medicine.

One funny aside, the BBC reports:

BBC News contacted Ainsworths for a response. A spokesman said: “We do not make comments to the media.”

Reader Chris who e-mailed me this story pointed out that if they do not make comments to the media, why do they have a spokesman?

21 responses so far

21 Responses to “Homeopathy for Malaria”

  1. wrysmileon 11 Jan 2011 at 8:52 am

    Talking of smackdowns this is the BBC newsnight report from the 4th of Jan with Simon Singh. There’s some undercover footage of a homeopath offering pills for malaria who actually says that she’s just plucking the figures she’s just quoted out of thin air.

    http://www.youtube.com/watch?v=qgHRWB6-k-Q

  2. tmac57on 11 Jan 2011 at 10:16 am

    The BBC News reports a breaking story:

    The UK’s GPhC,said today that ” We are trying a novel approach” to regulation of the pharmaceutical outlets in the country. The new, so-called ‘Do nothing’ approach was inspired by Homeopathy itself according to GPhC’s spokesperson Farley Cottingley.”We felt like there was suggestive evidence that a ‘like cures like’ regulatory paradigm could be effective in this case” said Cottingley. The idea seems to be that if Homeopathy is merely water,and has no efficacy, then best way to regulate Homeopathy is in fact to do nothing.BBC News has contacted the former spokesman, Nostrum Shakely ,for Ainsworth Pharmacies (who lost his job for lack of something to do) and asked him how the new change will affect the chain.Shakely said that he has spoken to some of the pharmacists from his former employer,and they report that although they still believe that Homeopathy may be useful,that some of them are beginning to have a kind of “memory energy” that possibly, it’s a bad idea.
    BBC News will continue to follow this breaking story as it develops.

  3. Tim Farleyon 11 Jan 2011 at 10:24 am

    I really think the answer to the question “what’s the harm in homeopathy” is pretty clear at this point, it’s a shame we have to keep hammering on it like this. But we do.

  4. Jim Shaveron 11 Jan 2011 at 10:37 am

    Steve, honestly, do you ever feel like Yossarian in Catch-22? I mean, is the whole freaking world insane?! How is it that the obvious absurdity of this stuff is so profoundly lost on so many?

    For the homeopaths themselves, it’s like they’re a bunch of little kids who decided to play “science”, because they thought it sounded cool, and who cares what the grown-ups say about it anyway?

  5. mkimble1on 11 Jan 2011 at 10:50 am

    I think from talking to people I know, that they confuse homeopathy with natural remedies. They don’t know the underlying principles of homeopathy re: The Law of Similars and Dilutions. It would be interesting to present users with a multiple choice questionnaire asking them to check boxes next to various statements that they think homeopathy is.

  6. Tim Farleyon 11 Jan 2011 at 4:04 pm

    mkimble1: Indeed. We had some folks show up at Skeptics in the Pub in Atlanta, who got mad at us because we were making fun of homeopathy. They said they were skeptics but used homeopathic medications.

    I explained to them how true homeopathic nostrums are made. They were stunned. Nobody had ever explained it to them, and at first they didn’t believe me.

  7. tmac57on 11 Jan 2011 at 5:58 pm

    To hear some of the damage that Wakefield has caused,listen to this segment of Science Friday where Ira interviews Dr. Paul Offit about his book ‘Deadly Choices’. A Caller named Leslie is a prime example of the culture of very confident but misinformed parents out there that have been bamboozled by this dangerous fraud.

  8. tmac57on 12 Jan 2011 at 9:36 am

    Sorry,my last comment was for the Wakefield thread.

  9. Dianeon 12 Jan 2011 at 4:25 pm

    Funny, because I recently read a horrifying article in the National Peace Corps Association magazine about a former Peace Corps volunteer who was treating malaria patients in her host country with homeopathy, because it was cheaper, safer (no side effects!), and easier to obtain than medicines.

    As a former PCV myself, I sympathize with the desire to help people who do not have access to medicine, but clearly homeopathy is not the way to do it! I wrote an angry letter to the magazine about their irresponsibility in writing a laudatory piece about this misguided woman and they said they would print the letter though I haven’t seen it yet.

  10. sonicon 12 Jan 2011 at 5:53 pm

    OK, I get to play devil’s advocate again.
    But this really is interesting–

    http://www.physorg.com/news/2010-12-placebos-deception.html

    “Researchers at Harvard Medical School’s Osher Research Center and Beth Israel Deaconess Medical Center (BIDMC) have found that placebos work even when administered without the seemingly requisite deception.”…
    “Nevertheless,” says Kaptchuk, “these findings suggest that rather than mere positive thinking, there may be significant benefit to the very performance of medical ritual.

    If true, the claims that seeing a homeopath is of value maybe more factual than one might think.

    (This study was done with IBS patients, not malaria- I’ll take the medicine– still an interesting result).

  11. nybgruson 12 Jan 2011 at 6:30 pm

    @sonic:

    that study has already been addressed at SBM here:

    http://www.sciencebasedmedicine.org/?p=9339

    Seeking a homeopath still has no value. If you want to take that study at face value it should lead us to administer actual medicine in a different way, not endorse or condone quackery and pseudoscience* as respectable treatment modalities.

    *I shudder to even call homeopathy “pseudoscience” because just that term still contains 10^23 times more “science” than homeopathy does.

  12. stompsfrogson 13 Jan 2011 at 1:25 pm

    Homeopathic spokesman is as effective as homeopathic medicine.

    Truly priceless.

  13. sonicon 13 Jan 2011 at 3:01 pm

    nybgrus-
    Thanks for the link.
    Of course no study will make a therapy workable or not.
    In this case they are pointing to the possibility that the rituals associated with healing may have an effect on the actual healing.
    I don’t know all the factors that go into why someone gets sick and another does not, I don’t know why some get well and others don’t.
    Germs, for example, seem a necessary but not sufficient cause of certain diseases. I’m not sure what all the sufficient causes are, and therefore I would have to admit that I don’t know what all the means of changing those conditions might be (those would be valid therapies).
    Do the rituals matter, and if so, how much?
    I don’t know.
    If the ritual does matter, then what would one do with this fact?
    I don’t know.
    In the meantime I would prefer quinine in the appropriate form if I get malaria.

  14. BillyJoe7on 13 Jan 2011 at 11:28 pm

    sonic,

    The point is that the study you linked to still decieved the patients.

  15. sonicon 14 Jan 2011 at 2:30 am

    There was no deception about what was in the pills.

    From an interview with the researcher-
    http://blogs.plos.org/neurotribes/2010/12/22/meet-the-ethical-placebo-a-story-that-heals/
    “One of the assumptions that we made in this study, however, is that you have to offer the patients a convincing rationale to use placebos as well as giving them a pill. That’s the next thing we have to test.”

    They were testing a ‘ritual’ of medicine- a regularly scheduled pill and a rationale. If these results are indicative of a real phenomena, then we can say that the act of taking a pill for a reason might be as important as what is in the pill and what the person thinks is in the pill in some situations.
    It is generally thought that what the person thinks is in the pill matters.
    Now they need to study which parts of the ritual matter…
    I don’t know how this will come out, but I find the possibilities interesting. I know that in sport ritual is used by the great players as a means to improve performance.
    I’m not sure why this couldn’t work for some afflictions (like IBS) that are basically a performance problem. (Do you like the joke?)

  16. eiskrystalon 14 Jan 2011 at 4:03 am

    -there may be significant benefit to the very performance of medical ritual.-

    Yes, but do the malaria and mosquitos know?

  17. BillyJoe7on 14 Jan 2011 at 11:42 pm

    Sonic,

    They recruited patients with advertisements that indicated this was to be a mind/body experiment. This is called recruitment bias – they would tend to get volunteers who are interested in mind/body medicine and very likely volunteers who believe in mind/body medicine.
    They also told the patients all sorts of things about what the placebo reponse is capable of – the very thing they are going to be testing for.

  18. _Arthuron 15 Jan 2011 at 3:08 pm

    Wasn’t Malaria the very first illness that homeopathy attempted to cure ? The original research, such as it was, was done by Hanneman Himself.

  19. sonicon 16 Jan 2011 at 9:20 pm

    BillyJoe7-
    They wanted to know if telling people there was no active ingredient in the pill would make a difference. Apparently not so much– which might explain why the decades of telling people that homeopathic medicine has no active ingredient hasn’t stopped it from selling.

    Is there anyone who doesn’t believe in mind/body medicine?
    If the mind is the body, then obviously there must be mind/body medicine.
    If the mind is not just the body, then it is clear that whatever it is, the mind can change a body.
    What percentage of the people would disagree?

  20. BillyJoe7on 16 Jan 2011 at 10:25 pm

    sonic,

    What they told things about the placebo effect which are euither speculative or not true, and they recruited volunteers for the study describing it as a study on mind/body medicine. It is possible that not telling them they are taking placebo would have the same effect as telling them that it is a placebo but also misleading tham about what a placebo can do and recruiting volunteers who are tuned into mind/body medicine.

    “Is there anyone who doesn’t believe in mind/body medicine?”

    I’m talking about Mind/Body Medicine such as energy medicine and other alternative medicine for which there is no evidence of effect and which is the result of magical thingking.

  21. sonicon 17 Jan 2011 at 1:07 am

    BillyJoe7-
    I agree that what the researchers told the subjects could effect the outcome of the experiment. Based on the interview I linked to, I would say that altering the instructions would be one of the next things to test.

    I would agree that something that doesn’t work, doesn’t work.

    However; in looking at DNA, for example, we can make interesting discoveries by analyzing it in various ways (a long molecule, a set of genes, a holder of information…) Of course each of these is incomplete analogy.
    I believe these researchers are viewing medical practice as ritual (no doubt an analogy) and seeing if they can learn anything valuable.
    I hope they do.

    This is now far afield from malaria- sorry for going so off-topic. I’ll stop here.

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