Jun 07 2018

Homeopathy Loses NHS Case

The National Health Service (NHS) in England decided in November 2017 to stop funding homeopathic treatments. That was an excellent decision, made for the right reasons – “lack of robust evidence of clinical effectiveness”. While I think that is an understatement, it is true enough, and is sufficient justification for any modern health care system to abandon homeopathy.

Now a High Court Judge has affirmed that decision by the NHS. Why was a judge even involved? Because the British Homeopathic Association (BHA) sued the NHS over that decision.

Legally, this case was fairly straight forward. The judge was  clear to point out that it was not his job to review the scientific evidence regarding homeopathy. The BHA argued in court that there is “plain evidence that homeopathic treatment does work in particular cases”. That is complete nonsense – homeopathy is nothing but magic potions, with no scientific plausibility, and the scientific evidence clearly shows that it does not work for anything.

But the judge did not have to get into that in court, which is appropriate. It should not be for a judge to make scientific decisions like that. His job was to answer the BHA complaint that the NHS was being unfair in their decision. The judge ruled, however, that the NHS process was “fair and balanced” and that “there was no evidence of ‘bias or predetermination'”.

I do worry when such issues come up before courts or regulatory bodies. It is easy to make the claim of bias against those who are simply following the evidence. It would, for example, be easy to make the case that I am “biased” against homeopathy. After all, I have been regularly trashing the pseudoscience for years. But in reality I am just following logic and evidence. Correctly stating that something is pseudoscience is not a bias when it is the logical conclusion of a fair process.

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May 15 2018

Homeopathic Nosodes

Homeopathy is bunk. Most people I encounter who disagree with this statement do not actually know what homeopathy is. They think it is some kind of herbalism or natural medicine. No – it is a prescientific superstition-based system of magic potions.

The basic idea is that you start with a fanciful treatment based on notions like sympathetic magic and incidental characteristics (like hair color). Then you dilute that fanciful treatment out of existence – so it doesn’t really matter anyway. Homeopathy is literally nothing, but homeopaths believe that the magical “essence” of the substance remains.

Unsurprisingly, clinical trials of homeopathic potions have convincingly shown that homeopathy works for nothing. So it can’t work, and in fact it doesn’t work.

So why is homeopathy still a thing? That is a fascinating question dealing with culture, human psychology, and political failure.

There is also an aspect of homeopathy that dovetails with another pseudoscience – the anti-vaccine movement. Homeopathic nosodes, which are just as useless as all other homeopathic potions, are offered as a substitute for vaccines. This way you not only waste money on a worthless health scam, you also forgo safe and effective medicine – a nice double whammy.

Nosodes are prepared by taking body fluid from a diseased person or animal and then diluting it so that you have – water. This water is then given to prevent the disease that the person or animal from which the fluid was taken had.

In addition to giving fake medicine instead of effective medicine to prevent a serious and communicable disease, there is some risk to the preparation process itself. Homeopaths are making nosodes of HIV, ebola, Hepatitis, and other serious infectious diseases. That’s right – their answer to the HIV epidemic in Africa, or to ebola outbreaks, is to give their fake medicine.

Are there any clinical trials of homeopathic nosodes that show they work? No. Homeopaths largely rely upon what they call a “homeopathic pathogenetic trials.” This is a great example of pseudoscience, because it follows some of the forms of real science, but isn’t doing actual science.

Here is one of an HIV nosode – they basically give 15 volunteers water, I mean an HIV nosode, and 7 volunteers water, I mean placebo. The volunteers are trained to record every symptom they experience. Over four weeks the HIV nosode water group recorded 130 symptoms, while the placebo water group recorded 60 symptoms. Those ratio’s are remarkably similar to the number of people in each group – twice as many people reported twice as many random symptoms. Shocking.

This is what passes for science in homeopathy. What they rarely do are actual efficacy trials designed to answer the real question – do the potions work? When high quality efficacy trials of homeopathy are done, they usually turn out negative, and systematic reviews have all been negative. So they mostly don’t bother with such trials, instead doing their HPTs, and observational trials, or looking at markers, so that they can pretend they are doing science.

This nonsense isn’t limited to humans. Recently there was outrage over homeopathic nosodes given to pets. These cats and dogs might get serious and preventable diseases because their owners relied on homeopathic nosodes they purchased on Amazon instead of real vaccines.

Opting for homeopathic remedies in favour of vaccines can be the cause of fatal viral diseases including parvovirus and herpes virus, the RSPCA said.

The former kills nine in 10 dogs who contract it, the latter can prompt a pregnant dog to abort her puppies or kill an entire litter of young puppies to die over 24 hours.

The British Veterinary Association said that skipping vaccinations can also be the cause of zoonotic diseases, such as canine leptospirosis, which can be infectious to humans.

Allowing people to die from fake vaccines is one thing, but you cross a line when you allow cats and dogs to die from preventable infections.

What I don’t get is the unwillingness to properly deal with homeopathy from a regulatory standpoint. Why is the political will lacking? It seems that part of the problem is that many politicians are not scientists or even minimally scientifically literate. But odds are most still realize that homeopathy is snake oil, or at least would listen to the overwhelming scientific consensus that homeopathy is snake oil.

There just doesn’t seem to be any political incentive to do so. This is a manifestation of a broken political system, where there is insufficient motivation to do something so obviously beneficial and correct like banning 100% fake medicine. But I also think this is a failure of the scientific and academic communities. There is a paucity of outrage at the infiltration of pseudoscience into our culture and our medical system. That is our fault. And if we lack proper outrage, how can we expect others to have it?

The underlying problem is that many snake oils like homeopathy fly under the radar. Many doctors don’t know what it is, do not know how much it has insinuated itself into the system, and don’t know the regulations. They are happy to ignore it and assume it is a small and benign fringe. They are wrong. This situation is easily remedied through education. Once properly informed, most health care professionals are properly outraged. Let’s have more of that.

 

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Feb 09 2018

Ontario College Plans Program in Homeopathy

Here we go again.

If you are in a decision-making position at an institution of higher learning than you have a responsibility to understand and protect the academic reputation of that institution. Further, such institutions (many of which, as in this case, are publicly funded) have a responsibility to society, to promote academic standards and legitimacy. At the very least such institutions should not be promoting pseudoscience, or dressing up any nonsense as if it were real.

Georgian College in Ontario has approved funds and plans to open a program that will teach homeopathy as if it is real medicine. Teaching any pseudoscience is an outrage, but when it is medical pseudoscience there is also arguably another layer of malfeasance because the connection to real harm is more direct.

I know this is old territory here, but for review: Homeopathy is a prescientific philosophy-based system based on magical thinking. Its core ideas were never valid, and have never been supported by science. Essentially, homeopathy uses fanciful treatments that are based on silly ideas, such as the personality of the patient, but also “sympathetic magic.” The belief is that homeopathic remedies contain the magical essence of symptoms and can be used to cure those same symptoms.

Then, doubling down on the idea of magical essence, all actual substances are diluted out of existence, so that only the essence remains. Therefore, in reality, only water remains. Homeopathy is literally treating people with magic water created with rituals resembling witchcraft, and without the tiniest bit of scientific legitimacy.

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Sep 14 2017

India Opens Homeopathy Laboratory

homeopathy-803_250pxAs I continue my efforts to fight against pseudoscience in medicine, I often ask myself – how bad can it theoretically get? I have had this discussion with others as well, some of whom argue that we should not worry because science will win out in the long run. Science is self-corrective, and pseudoscience will become marginalized over time. I hope this optimistic view is correct, but I am not reassured by the evidence.

Let’s consider a recent article in the Hindustan Times, written completely without skepticism or irony, which details how the government of India has opened a state-of-the art laboratory to study homeopathy.

Howrah-based Centre of Excellence in Fundamental Research in Homoeopathy will also undertake fundamental research studies in homoeopathy with an interdisciplinary approach.

“This institute has undertaken several clinical research studies such as autism, psoriasis, vitiligo, breast cancer, hypertension, migraine etc. along with proving of new drugs in homoeopathy with their clinical validations,” said Naik.

The lab will support PhD students in homeopathy and focus on research into viral and other infectious diseases. This is all part of the Ministry of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH). In India, pseudoscience in medicine, including homeopathy, have been fully institutionalized and are explicitly endorsed by the government.

This is how bad it can get.

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Jul 21 2017

Homeopathy Takes a Hit in the UK and Australia

dilutionI have long considered homeopathy to be the softest of targets for skeptics, especially in the area of alternative medicine. Homeopathy is 100% pure nonsense. It is a pre-scientific magical form of medicine that has no legitimate place in the modern world.

Further, homeopathy is particularly vulnerable because most people do not know how silly it is. They think it is natural or herbal medicine, but it’s not. Homeopathy involves taking fanciful treatments and then diluting them out of existence, based on the notion that the essence of the substance will be left behind and magically cure whatever ails you.

This means that simply educating the public about what homeopathy actually is can be an effective way to reduce its popularity. Knowledge is not sufficient, however, because there is no limit to what people are capable of believing. Nonsense is rarely eradicated entirely, but we can certainly restrict it to the fringe where it belongs.

Homeopathy in Australia

In 2015 the Australian National Health and Medical Research Council (NHMRC) concluding that homeopathic treatments were worthless, and that the scientific evidence has not shown that they work for any single indication.

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Oct 11 2016

Is It Ethical to Study Homeopathy?

homeopathy-nosodesA Canadian academic, Dr. Mark Loeb, who is a respected infectious disease researcher who knows how to conduct high quality research, wants to study homeopathic nosodes. Nosodes are essentially homeopathic vaccines.

Tim Caulfield, a Canadian professor of health law and policy, thinks the study is misguided and unethical. The two are having a respectful public debate about the risks and merits of doing such a study.

David Gorski and I have actually published in the peer-reviewed literature on the broader question of studying alternative medicine: Clinical trials of integrative medicine: testing whether magic works? It is a bit of a dilemma, and we are seeing that exact dilemma play out on the question of this specific proposed study.

Homeopathy is Pseudoscience

For quick background, both sides in this debate agree that homeopathy is 100% pseudoscientific nonsense. Homeopathy was invented by one person, Samuel Hahnemann, about 200 years ago. It was not based on any scientific research or knowledge base, it did not develop out of emerging knowledge of biology or physiology. It was simply invented out of whole cloth based loosely on the superstitious belief in sympathetic magic – the notion that substances contain a mysterious “essence” that can be transferred to the body and stimulate the life force.

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Jul 08 2016

Should We Ban Homeopathy for Animals?

homeopathy-veterinarianYes. Yes we should.

This is an interesting idea I had not previously considered. Danny Chambers is a UK veterinarian from Devon who started a Change.org petition to ban the veterinary use of homeopathy in the UK. He has 1,000 signatures from UK vets so far (out of the 22,000 total UK vets).

Chambers said:

“We think vets these days should be offering 21st Century medicine,” he told BBC News.

“It’s been shown that homeopathy doesn’t work, so it probably shouldn’t be offered any more even if it is offered with good intentions.”

It is absolutely clear that homeopathy is worthless. This is among the most solid conclusions in all of medical science. First, there is no possible way according to our current understanding of physics, chemistry, and physiology that homeopathic potions can have any biological effect. It’s not just unknown – we have very good reasons to conclude that homeopathy cannot work (follow the link above for more details if you are unfamiliar with these reasons).

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Feb 22 2016

The Evidence Says – Homeopathy Does Not Work

airguitarIn a recent blog post for the BMJ, Paul Glasziou wrote about the recent Australian review of homeopathic remedies of which he was head:

…I lost interest after looking at the 57 systematic reviews (on 68 conditions) which contained 176 individual studies and finding no discernible convincing effects beyond placebo.

He is not the first person to look at the totality of clinical evidence for homeopathy and find it wanting. Glasziou was chair of the working party that produced the 2015 NHMRC report on homeopathy, which concluded:

Based on the assessment of the evidence of effectiveness of homeopathy, NHMRC concludes that there are no health conditions for which there is reliable evidence that homeopathy is effective.

So, after more than two centuries, and thousands of studies in total, no homeopathic treatment has crossed over the line of what would generally be considered sufficient evidence to prove that it works. That is very telling. I liken the evidence to other dubious claims, such as ESP. After a century of research and thousands of studies there is no clear evidence that ESP is real.

For both homeopathy and ESP there is a great deal of noise, but no clear signal. There are many flawed or small studies, but no repeatable high quality studies. Continue Reading »

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Nov 13 2015

Homeopathy on the Ropes

The British National Health Service (NHS) is considering blacklisting homeopathy prescriptions from general practitioners. While this would have an overall small effect on the homeopathy market, it is politically potentially very significant.

The NHS currently spends about £4m on homeopathy each year, of which only £110,000 is from GP prescriptions. The rest is from homeopathic hospitals (yes, hospitals). The real market, however, is in over the counter homeopathic products.

In the UK, Europe and the US homeopathy has ballooned into a multi-billion dollar industry. It is now potentially, it seems, the victim of its own success. When it was smaller it essentially flew under the radar – regulators and politicians didn’t think it was worth spending political capital to reign in a fringe treatment that people either wanted or did not know or care about.

In the US the FDA specifically decided to let the homeopathic industry regulate itself, because it was simply too small for them to spend their resources on. That has now changed.

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Sep 18 2015

Lobbying for Quackery

The American Association of Naturopathic Physicians is lobbying Congress to pay naturopaths to treat vetarans, specifically for chronic pain. This, of course, goes beyond “health care freedom” (which itself is dubious) and is asking for taxpayer dollars to be spent on unproven and pseudoscientific treatments.

The open letter does not mention specific treatments that naturopaths would offer.  Instead it fearmongers about pharmacological treatments for pain. It is certainly true that opiates are a double-edged sword. They are powerful pain killers, but long term use causes dependence, tolerance, and may complicate pain management. Science-based physicians are well aware of this, and use a variety of approaches to minimize opiate use for chronic pain.

The letter claims that naturopaths have unique “natural” therapies that can effectively treat pain. This is one of the core myths of “alternative” medicine – if there were a treatment that objectively worked, it would be incorporated into mainstream medicine.

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