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‚Ķ 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?

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