Cochrane Reviews of Homeopathy

February 5, 2010 at 6:34 pm (Alternative Medicine, Homeopathy) (, , , , , , , , , )

Is there enough evidence in favour of homeopathy for it to be used for ADHD, asthma, or dementia? The best way to find out is probably to conduct a systematic review. Fortunately, someone has already done this for each of these conditions – and for others.

In December last year, I commented on a discussion on the Think Humanism Forum. It had been pointed out by an advocate of homeopathy that “Studies in support of Homeopathy have been published in […] journals” and a list followed. One of the items listed was “Cochrane”, so I thought I’d take a little look at Cochrane Reviews of Homeopathy.

I used “homeopathy” as a search term on Google, limiting the search to the Cochrane website, and posted from the plain language summary of each review.The first page of Google results contained 10 results, and 5 of these were reviews.

One Homeopathic remedies (potencies) aim to minimise the risk of adverse effects. There are different types that may be used for asthma, such as classical homeopathy (tailored to an individual’s symptoms) or isopathy (for example using a dilution of an agent that causes an allergy, such as pollen). The review of trials found that the type of homeopathy varied between the studies, that the study designs used in the trials were varied and that no strong evidence existed that usual forms of homeopathy for asthma are effective. There has been only a limited attempt to measure a ‘package of care’ effect (i.e., the effect of the medication as well as the consultation, which is considered a vital part of individualised homeopathic practice). Until stronger evidence exists for the use of homeopathy in the treatment of asthma, we are unable to make recommendations about homeopathic treatment.

It looks to me as if claims that homeopathy can be used to “treat”, “help with”, or “cure” asthma are unfounded and inappropriate.

Two Dementia is a distressing illness that has major implications for individuals with the disease and their carers. Homeopathy is a popular type of complementary medicine. It is however controversial because although there is some evidence that it is not just a placebo, no one understands how it could work. The researchers did not find any good quality trials and so cannot say whether it is or is not effective for treating this condition. As no information is available on how much homeopathy is used for dementia, it is difficult to say whether it is important to conduct more trials.

The researchers did not find any good quality trials studying homeopathy for dementia. Why, if this is the case, can I find homeopathic remedies for dementia that are available on the internet? Some are even listed by the University of Maryland Medical Center website.

Three This review aimed to assess the evidence for homeopathy as an intervention for attention deficit/hyperactivity disorder. Four trials were retrieved and assessed with mixed results. Overall the results of this review found no evidence of effectiveness for homeopathy for the global symptoms, core symptoms or related outcomes of attention deficit/hyperactivity disorder.

Another Cochrane review, another strike. I make that three now – if this were Baseball, it would now be game over for homeopathy. No evidence of effectiveness for homeopathy. It doesn’t get much clearer than that.

Four This review looked at whether these [homeopathic] medicines could help patients with problems caused by cancer treatments […]  Two studies with low risk of bias demonstrated benefit: one with 254 participants demonstrated benefits from calendula ointment in the prevention of radiotherapy-induced dermatitis, and another with 32 participants demonstrated benefits from Traumeel S (a complex homeopathic medicine) […] These trials need replicating. Two other studies reported positive results, although the risk of bias was unclear, and four further studies reported negative results. […].

Eight studies. Only two studies with low risk of bias showed benefit. Two further studies that weren’t well-designed enough to be reliable showed benefit. Four studies were negative.

Five The review of trials found there was not enough evidence to show the effect of a homoeopathy as a method of induction. More research is needed.

The first review found no strong evidence in favour of homeopathy for asthma. The second review couldn’t find a single good quality trial – perhaps this should be seen as an indictment of homeopathic research, or perhaps it should be seen as an indictment of those who promote homeopathy for dementia. The third review found no evidence of effectiveness of homeopathy for ADHD.

One review found two of eight trials showing benefit, two trials where bias was unclear and four trials that were negative. To me, this seemed the most positive review – yet only half of the trials showed benefit and of those trials only half had a low risk of bias.

The final trial found insufficient evidence to recommend the use of homoeopathy as a method of induction.

If any medical (or pseudomedical) practitioner wishes to recommend homeopathy for ADHD, asthma, induction of labour, dementia, or side-effects of cancer treatments then I think that they should first provide good evidence that their choice of treatment is effective.

The same applies to any manufacturer or vendor of homeopathic remedies. If they produce or sell a remedy that is for a specific condition, they should show us the evidence of efficacy.

Note for commenters: posting single studies to ‘prove’ homeopathy works in response to this post will not trump the evidence from systematic reviews. The responses to your ‘proof’ might be quite entertaining though, so please do feel free to post your cherry-picked research should you wish to do so.

55 Comments

  1. Oliver Dowding said,

    Note for commenters: posting single studies to ‘prove’ homeopathy works in response to this post will not trump the evidence from systematic reviews. The responses to your ‘proof’ might be quite entertaining though, so please do feel free to post your cherry-picked research should you wish to do so.

    I expect you to say no less than this, for fear that you might end up with people who have had success offering to disagree with you. But then you are happy to believe that they got better by placebo action. And I imagine you’re not happy for them to try using homoeopathy alongside whatever solution you might have for these ailments. All to be administered, of course, by a qualified homoeopath, who just may possibly also been a qualified doctor in previous role.

    So, you concentrate on what you think won’t work, I’ll listen to equally cynical and sceptical people who have resorted to homoeopathy after the conventional world failed them, and had great success, sometimes at a very early stage in using homoeopathy. This doesn’t mean that it works that everyone, I fully accept that. In the same way that I’m fully aware that conventional medicine most definitely hasn’t worked for everybody who has taken that as their route to better health.

    You will of course have the same objection as you do to everybody else who claims success with homoeopathy, which is that it doesn’t conform to an RCT, and that it can’t possibly be that a single homoeopath can find a single solution to a single person’s illness. Instead you assume that health conforms to some identifiable spectrum without individuality. For some people, unable to be made better by conventional medicine, homoeopathy appears to deliver them a positive result. I’m not in a rush to deny them something that gives them the health that the rest of us cherish.

  2. AndyD said,

    Traumeel S is hardly homeopathic in the usual sense of the word. With a complex mix of ingredieints, some with dilutions as low as 2X (1:100), I suspect Hahnemann would be horrified to have it labelled as such. Beneficial effects from this product have plausibility. Of course with that comes the plausibility of side effects too.

    The particular calendula product isn’t named in this summary but some popular “homeopathic” calendula ointments have dilutions as low as 1X (1:10). Again, Hahnemann’s spirit must be screaming at the abuse of his system of healing.

  3. Michael K Gray said,

    Homeopathy is expensive water.
    It has been shown to cure mild thirst, and a distended wallet.

    (But appears to have the severe side-effect of grossly exacerbating a patient’s gullibility as well as rendering them totally askeptical.)

  4. Mojo said,

    “The best way to find out is probably to conduct a systematic review.”

    Of course, even better is to conduct a review that includes a positive trial that appears to have nothing to do with homoeopathy.

  5. Oliver Dowding said,

    Mr Gray – you are wrong.
    Plenty of support to say so but if you choose not to believe it that is your choice. Enjoy your allopathic option and I hope you don’t become a statistic for the side effects etc etc.

    Well done mojo…..one example. The link delivered only contact info. Re-study the way animals respond, the professionally trained vets observe the success, etc. As before, the uncomfortable truth is animals don’t lie, and its not chance that they got better, nor biased observation from the keeper or vet…….how can it be with hundreds of thousands? Maybe you could usefully invite yourself to go see?

  6. Mojo said,

    “the uncomfortable truth is animals don’t lie”

    Actually, they don’t say much at all. They certainly don’t say that they are feeling better. Do you think it is possible that the “professionally trained vets [who] observe the success” might know that the animals have been treated?

  7. Mojo said,

    “The link delivered only contact info.”

    Try scrolling down a bit.

  8. Oliver Dowding said,

    “Actually, they don’t say much at all. They certainly don’t say that they are feeling better. Do you think it is possible that the “professionally trained vets [who] observe the success” might know that the animals have been treated?”

    Of course it is! Just a same as with allopathic drugs! Vets using allopathic drugs know that the animals have been treated. Is that why they get better?

    Is no point trying to twist yourselves in knots, in some vain attempt to dismiss and honest animals response, and try to pretend that it lied in recovering from illness. Equally, there is no point trying to pretend that hundreds, nay thousands, of vets, doctors, and lay practitioners are all being duped by mischievous animals pretending to get better. It’s a jolly good job that they’re not cynical or sceptical.

  9. nobby said,

    i think your missing the point mr dowding. it has nothing to do with the animals its the people observing them and assuming what caused them to get better, that is the problem.

    confirmation bias for example is very common. it is why research like RCT’s are very important as they try and eradicate amongst of things the many types of bias interpretation. you can argue that concepts like confirmation bias do not exist or is not applicable to what you or others have observered, but you cannot prove it.

    like when you say “Maybe you could usefully invite yourself to go see” at the end of that sentence. it implies that somehow you will see what everyone else has been seeing and injects bias into it. just like the skeptical and cynical people you say who have turned to homeopathy. they are just as open to bias as each of are but they are on the recieving end of a barrage of bias no doubt . its the nature of homeopathy to assert that it works. if one remedy does not work then try another and another until something happens. the problem they say is not with homeopathy or the remedy its with finding the right one. or basicaly plug away until something happens,goes away on its own or some other intervention works that they can claim was done by the remedy .

    i was recently asked to do a test by a homeopath. they said take a remedy of my choice but they also wanted me to change my diet. they failed to comprehend how changing my diet could influence the result that homepathy works? what do you think?

  10. Oliver Dowding said,

    Nobby, what a strange thing to say. If it’s nothing to do with the animals, and all to do with the people watching them, whatever powers are you suggesting that I have? The power to stare them into getting better? Presumably you mean, this must be a power possessed by everybody treats their animals with homoeopathic medicine? What a powerful lot we must be.

    I’ll say something else here, which I’ve said many times before, and nobody has ever responded to, which of course tells its own story. If the animals get better on their own, and it’s nothing to do with the remedy that we administered, then why don’t you go and suggest to all the other farmers who give their animals drugs, and all the pet owners, and all the vets to treat animals without drugs but instead use homoeopathy, that they stop using drugs, and just “observe” they’re animals better? You can then also give the RSPCA, and others, the tipoff that they’re going to find serious cases of animal cruelty wherever you are imparting your advice.

    One final thing. You presume that just because you might change something in your diet, along with receiving a homoeopathic remedy that is the diet that will likely be the reason that your health improves, or at the least that you won’t be able to define which was the successful one. You’re quite right, and I’m not going to attempt to dissuade you. So when you go down to the doctor, the conventional varieties are you of course, as it is for me, and they suggest that along with whatever treatment they recommend, you change your diet as well, do you ignore the dietary advice, simply go to the medication? I don’t suppose most people do, and hence they skew the doctor’s opinion about what made them better.

    So we go on……………………… and on…………………

  11. jdc325 said,

    Nobby wrote:

    i think your missing the point mr dowding. it has nothing to do with the animals its the people observing them and assuming what caused them to get better, that is the problem.

    Oliver wrote:

    Nobby, what a strange thing to say. If it’s nothing to do with the animals, and all to do with the people watching them, whatever powers are you suggesting that I have? The power to stare them into getting better? Presumably you mean, this must be a power possessed by everybody treats their animals with homoeopathic medicine? What a powerful lot we must be.

    Oliver – I think you are still missing the point. You were claiming that animals could not be biased. Nobby, like others, has pointed out that irrespective of the potential or otherwise for cognitive bias in animals, there most certainly is the potential for cognitive bias in those observing the animals. No suggestion at all that you possess magic staring powers.

  12. Oliver Dowding said,

    I quite agree, that there is the potential.

    However, as I said countless times before, 500 animals, 15 years. Some potential..! . I accept that you are never going to accept, but I do accept that my cows and their offspring accepted.

    And as ever, you’re refusing to answer me why all these animals, over such an extended period, got better on their own, if you truly believe that there is nothing of any medicinal value in the homoeopathic remedy. Tricky one, isn’t it?

    If you still insist on calling it a placebo, how’s about you start marketing it all the other farmers and animal keepers, who currently use pharmaceutical drugs? I’m sure that they will be delighted if their animals get better for the sake of a spoonful of sugar. They may even call you Mary Poppins.

  13. jdc325 said,

    “However, as I said countless times before, 500 animals, 15 years.”
    Reports of observers noting effects in uncontrolled ‘trials’ are subject to bias no matter how many animals or observers there are and no matter how long these uncontrolled ‘trials’ are conducted for. If you don’t control for bias, then your results are unreliable regardless of numbers of subjects.

  14. Oliver Dowding said,

    Does that therefore mean so are all the results from a similar herd of cows and offspring which are treated with drugs and antibiotics to be considered invalid? Why would the owner and herdsman there not be likely to exhibit bias?

    Equally, if you are so sure that my results are simply observer bias, that must infer you would suggest the farmer using non-homoeopathic methods should desist and save his money, because he could give his cows what you refer to as sugar pills (we used liquid versions so no sugar here) and wish them to get well again?

    Alternatively you may like to suggest why my cows and their offspring recovered so successfully so quickly and so often?

    I sense I am dealing with a slippery worm here!

  15. Cybertiger said,

    Olly sensitively said,

    “I sense I am dealing with a slippery worm here!”

    And I sensibly contend that in jdc253 you are dealing with a toad with a synaptic quotient typical of that slippery species.

    PS. For your information, Herr Dreary Draust, slithery commentator on all things drippy, is currently whacking homeopaths with handbags … it’s hilarious … if you can really be bothered.

    http://draust.wordpress.com/2010/02/09/hilarious-homeopathic-handbaggery/

  16. Benji said,

    cybertiger.

    Lolz.

  17. Cybertiger said,

    An urban dictionary definition of,

    lolz

    “A term for LOL (meaning ‘laugh out loud’ in chat-speak), usually typed by mindless ditzes who can’t speak right.”

  18. Cybertiger said,

    Blagging, blogging cybertoads don’t like cybertigers … which is why at Chez Draust, Herr u Frau Dreary, have switched on the tiger-mangler (cybercensor) … in herpetological sympathy, no doubt, with the silly-slithy- black-critter resident at Blog-Toad Hall.

    http://www.blacktriangle.org/blog/

  19. Benji said,

    cybertiger.

    hows the enforced redundancy going for you?

  20. jdc325 said,

    “Does that therefore mean so are all the results from a similar herd of cows and offspring which are treated with drugs and antibiotics to be considered invalid? Why would the owner and herdsman there not be likely to exhibit bias?”
    Yes, they would be considered invalid. No, the owner and herdsman there would not be considered unlikely to be prone to bias.

    To find out whether a treatment works, you need to conduct well-designed studies. Randomisation is an important element and would ideally be part of your study, as would blinding. This applies whether you are studying conventional or magical medicine.

    “Equally, if you are so sure that my results are simply observer bias, that must infer you would suggest the farmer using non-homoeopathic methods should desist and save his money, because he could give his cows what you refer to as sugar pills (we used liquid versions so no sugar here) and wish them to get well again?”
    No, it is not true that I should suggest that farmers using non-homeopathic methods should desist from using them and switch to homeopathy. What I should suggest is that whatever method they choose to use should be properly tested. I’m not in favour of untested treatments, be they homeopathic or any other kind of treatment.

    “Alternatively you may like to suggest why my cows and their offspring recovered so successfully so quickly and so often?”
    I don’t know whether your cows and their offspring did recover quickly and often – let alone why they should have done so. Unless you have a control group then how do you know the treatment was successful? Rather than suggest a possible reason for purported improvement, I would suggest that you endeavour to discover whether your animals recover more quickly when you use homeopathy. I would suggest that your efforts should be directed toward randomised, blinded trials. Unless they’ve already been done – in which case you can use the existing literature to judge whether a treatment is effective or not.

    “I sense I am dealing with a slippery worm here!”
    I think that is uncalled for. Can you please point out where I have been “slippery”? I don’t think my posts or my comments have been evasive or dishonest. I would appreciate it if you could identify where I have acted in a “slippery” manner.

  21. Oliver Dowding said,

    “To find out whether a treatment works, you need to conduct well-designed studies. Randomisation is an important element and would ideally be part of your study, as would blinding. This applies whether you are studying conventional or magical medicine.”
    This is your way of dealing with your medicine. I presume this is acceptable, because most of the things that modern “medicine” deals with our broad spectrum drugs. There is no doubting in my mind, and that of hundreds of thousands of other confident supporters, and many other “alternative medicines”, that the patient is treated as an individual, their symptoms assessed individually, and their remedy matched individually. This does not lend itself to the process of taking 100 people and splitting them into groups calling one the control group and the other the placebo group. It is perfectly clear to all who study homoeopathy, understand its mechanics, understand its medical action, and most importantly understand the reaction, that there is no way that one can conduct trials for the vast majority of remedies. There may be one or two where it might apply, as you realise I’m not a homoeopath, and do not have a deep knowledge of every single remedy and every single illness. Therefore, you are unwilling to accept this situation, and that this is how homoeopathy works, and therefore we’re never going to persuade you otherwise. In fact, I don’t see much point in trying to. Equally, however, I don’t see why you should have the desire to abolish something, which hundreds of thousands of people are perfectly content with, understand that it works both from personal experience and also from administering to their patients. You and others cite various reasons why you would like this, but refused to discuss or comment upon various deficiencies of conventional medicine. Such as, the large number of medicines prescribed for something, which they were never trialled and tested, known as off-label use. Ditto, there is ample reporting of the large numbers of people who die as a consequence of medical error, or suffer long-term or short-term side-effects from the use of medical drugs. I could go on. One might say that one can choose what sort of medication one wishes to take, and that we don’t have only one way of thinking about the problem and its solutions. If we did think like this, it’s quite clear that we wouldn’t have had a vast number of the inventions we already have. Imagine that people had taken the example of Icarus, and nobody had ever gone on to develop anything to do with aerial flight. We are simply evolving our thought processes and our understanding of how our bodies operate, being the most complicated of machines ever created, and about which we know a tiny fraction.

    “No, it is not true that I should suggest that farmers using non-homeopathic methods should desist from using them and switch to homeopathy. What I should suggest is that whatever method they choose to use should be properly tested. I’m not in favour of untested treatments, be they homeopathic or any other kind of treatment.”
    There was an error in my post this comment, in that I meant to say “that farmers using homoeopathic methods should desist…..” My comments above refer to why we consider homoeopathy is adequately tested and does deliver adequate results, and therefore it is acceptable to use. The observation which you haven’t commented upon, is the one that suggests that as there is nothing in the sugar pill and the animals are getting better through the use of placebo treatment, and therefore why not suggest to all conventional farmers that they stop using their conventional medicine and use the same sugar pill that seems to be effective for the farmers are using the homoeopathic treatment? I know the answer, and so do you. Because the animals will still suffer, the farmer will have the RSPCA on his farm (quite correctly) and will be very quickly resorting to using his conventional medicine, for which use I have no problem, other than where it might then lead to some form of resistance to antibiotics.

    “I don’t know whether your cows and their offspring did recover quickly and often – let alone why they should have done so. Unless you have a control group then how do you know the treatment was successful? Rather than suggest a possible reason for purported improvement, I would suggest that you endeavour to discover whether your animals recover more quickly when you use homeopathy. I would suggest that your efforts should be directed toward randomised, blinded trials. Unless they’ve already been done – in which case you can use the existing literature to judge whether a treatment is effective or not.”
    I thank you for your suggestion on how I might undertake trials, and presumably so might any other farmer keeping his animals and treating them with a lot of homoeopathic remedies. I can only tell you that we know the success was achieved, because we kept a very close watch on every animal treated, and remembering that we had 500 animals on the farm at any one time over a period of 15 years, and we noted what got better from what treatment and what did not. This may not conform to your idea of an acceptable method of trialling a product, but it did very nicely for us, and it does very nicely for everybody else who’s learned how homoeopathy works, and when it works. Nonetheless, I wouldn’t wish to be churlish, and I thank you feel suggestion.

    “I think that is uncalled for. Can you please point out where I have been “slippery”? I don’t think my posts or my comments have been evasive or dishonest. I would appreciate it if you could identify where I have acted in a “slippery” manner.”
    I’m sorry if you think this is uncalled for, and if it makes you feel better then I apologise. The reason that I made my statement referred to the fact that you, and many many like you, such as most of those in Red Lion Square on the 30th January, tend to apply the wrong criteria, and seek the wrong methods to establish efficacy of homoeopathy, which efficacy has already been tested for over many decades and is widely understood. The use of the word referred to the fact that you tend to only refer to the little bits of what I, and other people, might say, with which you think you can pick an argument. As I have said before, in various places, I don’t understand how that works, and I’m quite happy to use it because I know that others have shown it to work. The same applies to many other modern inventions, which we all use and take for granted. One could also make mention of much which is invested in, over which we know absolutely nothing before we make the research investment, a huge number of such research projects delivering no benefit at all, but a few proving spectacularly successful. Until we step beyond our current level of understanding, were never going to become better or knowledgeable than we currently are, surely? I understood that to be one of the reasons why science existed, to stretch the boundaries of knowledge and challenge current paradigms.

    I wonder which sentences or paragraphs you will choose to comment on, and which ones you’ll ignore?

  22. jdc325 said,

    “There is no doubting in my mind, and that of hundreds of thousands of other confident supporters, and many other “alternative medicines”, that the patient is treated as an individual, their symptoms assessed individually, and their remedy matched individually. This does not lend itself to the process of taking 100 people and splitting them into groups calling one the control group and the other the placebo group. It is perfectly clear to all who study homoeopathy, understand its mechanics, understand its medical action, and most importantly understand the reaction, that there is no way that one can conduct trials for the vast majority of remedies.”

    So, what you’re saying is that homeopathy can’t be tested in trials because it must be individualised? I suggest you look at the reviews of trials of individualised homeopathy. Have you read Linde and Melchart? (Bascially, individualized homeopathy seemed to be more effective than placebo, but when the analysis was restricted to the methodologically best trials no significant effect was seen.) You can conduct trials of individualised homeopathy – and these trials have already been conducted. The results don’t look too promising to me. Your interpretation of the existing trials might differ from mine but please do not pretend that these trials do not exist or are impossible to conduct.

    “…as there is nothing in the sugar pill and the animals are getting better through the use of placebo treatment, and therefore why not suggest to all conventional farmers that they stop using their conventional medicine and use the same sugar pill that seems to be effective for the farmers are using the homoeopathic treatment?”

    Witholding a treatment that works is unethical and cruel. Choosing homeopathic medicine over evidence-based medicine where EBM is available is probably unethical and cruel as it bascially amounts to the same thing – witholding treatment and giving the animal nothing. Where no treatment that works is available, there’s no treatment that you can give. Where a treatment exists that works and is available it should be used – whether it is considered ‘conventional’ or not. I fail to see why you think that I should suggest that effective treatment should be withheld in favour of an inert placebo treatment. As a supporter of homeopathy, surely that is what you are suggesting.
    The placebo effect is sometimes used to denote ‘effects other than that ascribed to an active treatment’ and this is perhaps understandable. When a trial is reported as finding that a remedy “has no benefit above placebo” it is not usually stated explicitly that the results of the remedy and the placebo effect are both affected by various biases (i.e., that several factors other than plabeco effect and effect of the treatments may be in part responsible for the results seen). There is a critique of Beecher’s paper on placebo that includes the following: “False impressions of placebo effects can be produced in various ways. Spontaneous improvement, fluctuation of symptoms, regression to the mean, additional treatment, conditional switching of placebo treatment, scaling bias, irrelevant response variables, answers of politeness, experimental subordination, conditioned answers, neurotic or psychotic misjudgment, psychosomatic phenomena, misquotation, etc.” The observation of improvements seen in animals or humans can be partly due to a combination of the above-listed factors as well as the placebo effect and the effect of a treatment given. The reason placebo-controlled trials are conducted is to try to find out whether giving a specific active treatment produces a greater improvement than that seen in animals or humans given an inert treatment. The improvements in the group given an inert treatment cannot be due to the treatment, as it is inert. Improvements in the group given the ‘active’ treatment that are no more impressive than those in the group given the inert treatment are unlikely to be due to the ‘active’ treatment.

  23. jdc325 said,

    “I wonder which sentences or paragraphs you will choose to comment on, and which ones you’ll ignore?”
    I apologise for not quoting every single one of the 1200+ words you have posted, but my responses are already so long as to be off-putting to all but the most dedicated reader. I think I have engaged with most of the points you have been making, but if there is any particular point you would like to receive feedback on then please feel free to highlight that point and ask for a response.

  24. jdc325 said,

    I don’t see why you should have the desire to abolish something, which hundreds of thousands of people are perfectly content with, understand that it works both from personal experience and also from administering to their patients. You and others cite various reasons why you would like this, but refused to discuss or comment upon various deficiencies of conventional medicine.

    I don’t wish to abolish homeopathy. I am quite happy for people to choose to use homeopathy to treat themselves as long as their choice is an informed one – and they must be given the evidence in order to make an informed choice. If people want to treat their aches and pains or coughs and colds with expensive magic water, then that probably could be seen as a tax on scientific ignorance. (I have slightly different feelings when it comes to, say, people wishing to provide homeopathy as an alternative to malarial prophylaxis or ARV treatment for HIV/Aids.)

    “Personal experience” is notoriously unreliable and not a good giude as to whether a treatment works. This also applies to the personal experience of administering to patients.

    I haven’t cited various reasons why I would like to see homeopathy abolished, I have simply pointed out (a) what homeoapthy is and (b) that the evidence suggests it has no benefit beyond placebo.

    I haven’t refused to discuss or comment upon various deficiencies of conventional medicine. While this blog post is about whether or not homeoapthy works rather than being about whether or not there are problems with conventional medicine, I have on occasion addressed some of the issues around conventional medicine particularly in relation to the pharmaceutical industry. In this post: link I am critical of pharmaceutical companies, and supplement manufacturers, for promoting a simple narrative in order to sell pills. I also pointed out that: “In the case of Big Pharma, Ben Goldacre has described the “dodgy behaviour”, the “$600 billion pharma industry”, and the publication bias made clear by a paper in the New England Journal of Medicine.” I also alluded to the commercial involvement of pharmaceutical companies in research and (more importantly, in my opinion) the poor quality of some of the research. I might also add that my blog post Big Pharma: Pill Pushers is less than complimentary about the industry.

  25. phayes said,

    “The researchers did not find any good quality trials and so cannot say whether it is or is not effective for treating this condition.” etc.

    The first part of that is tautologically correct: it is not possible to find good quality clinical trials of homeopathy. Such things cannot exist. The second part isn’t merely incorrect – it is deluded.

    “The best way to find out is probably to conduct a systematic review…”

    …of GCSE science textbooks.

  26. jdc325 said,

    “The first part of that is tautologically correct: it is not possible to find good quality clinical trials of homeopathy. Such things cannot exist.”
    I think I would disagree with this – it should be perfectly possible for researchers to conduct good quality trials of homeopathy. That the best quality trials show no effect is exactly what I would expect to see, given that homeopathy is utterly implausible.

  27. phayes said,

    So utterly implausible in fact that a positive result from such a clinical trial (or trials) could not be interpreted as evidence in support of the absurd hypotheses that motivated it. Research which is (at best) capable only of producing weak confirmation of what is already known is not “good quality” research – it is not scientific research at all.

    “I think I would disagree with this”

    I know – and it’s not just you of course. I’ve no idea what’s gotten into the sceptic community lately but all this homeopathy clinical trial angelology is very disconcerting. Just because some ghastly deluded Cochrane authors appear to think it’s okay to throw out a few centuries worth of physics, chemistry and biology in order to raise an absurd pseudoscience’s prior probability off the floor doesn’t mean it’s right to do so.

  28. jdc325 said,

    I can see your point and I think the argument that we should use Science-Based Medicine rather than Evidence-Based Medicine is an interesting one (and a position that I may yet be converted to). I would point out, though, that I have yet to see a systematic review of homeopathy that actually endorses it. That the best available evidence says homeopathy is no better than placebo supports the conclusion that such an implausible treatment is extremely unlikely to work.

    Remedies that contain ‘active’ ingredients may have some effect, but there’s an argument about whether they’re actually ‘homeopathic’…

  29. wakeupplease said,

    I think this letter in the times is a very good reason for why we should not trust “science based medicine”. It also reaises the point that science is like any other part of the life of humans, that is that people, AKA scientists, want to maintain their comfort zone and not go against the general order of things. The words “he who pays the piper….” come to mind.

    http://www.timesonline.co.uk/tol/comment/letters/article7019709.ece

  30. jdc325 said,

    There may well be “scientists [who] want to maintain their comfort zone and not go against the general order of things” but there are also journals that welcome research that challenges the prevailing orthodoxy. Nature, the Lancet et al quite often publish articles that are speculative and controversial.

    If you won’t trust science-based medicine (or evidence-based medicine) then how will you decide what is true?

  31. Oliver Dowding said,

    The letter in The Times was spot on.

    With regard to the general debate on this forum, I have said pretty much all I can. We’re clearly not going to agree, and I still maintain that the conventional paradigms on medicine and research do not suit exploration and research for homoeopathy. We can argue this one until the cows come home!

    The one point I would just make another observation on is this.

    “Personal experience” is notoriously unreliable and not a good guide as to whether a treatment works. This also applies to the personal experience of administering to patients.

    You and other sceptics may think that personal experience counts for nothing. You may even think of this in terms of the person administering treatments to livestock and other animals. However, if you are of the opinion or 15 years, more than 10 different herdsmen and calf rearers were all fudging the result is that they all saw with their own eyes, in 500 different animals kept on the same farm, then I will have to leave you thinking that. We all knew when things were working, we all knew that we didn’t need to resort to modern drugs, but we weren’t afraid to use them in certain cases.

  32. Cybertiger said,

    Is jdc523 on something, carrot juice or summat?

  33. Chris Denton said,

    Re. Evidence Based Medicine vs. Science Based Medicine.

    This blog post makes phayes’ point quite well. It argues that EBM is only useful when there is a plausible mechanism to the therapy being tested.

    They also make a good point specifically about homeopathy:
    “The “infinitesimals” claim alone is the equivalent of a proposal for a perpetual motion machine.”

    Would you fund research into a perpetual motion machine even though the second law of thermodynamics means it is impossible?

    Would you fund research into homeopathy even though the second law of thermodynamics means it is impossible?

    Surely the rational answer to both those question should be no?

    p.s. I got the above link from someone but can’t remember who (it might even have been jdc).

  34. phayes said,

    “I can see your point and I think the argument that we should use Science-Based Medicine rather than Evidence-Based Medicine is an interesting one (and a position that I may yet be converted to).”

    Well I hope you don’t leave yourself exposed to this “pseudoscientist’s fork” until it’s too late, jdc. :)

  35. jdc325 said,

    “I still maintain that the conventional paradigms on medicine and research do not suit exploration and research for homoeopathy.”
    And I have pointed out not only that individualised homeopathy can be tested in RCTs, but also that it has been. You seem to have ignored this point. You can assert as loudly and as often as you like that “conventional research paradigms do not suit homeopathy”, but there is no basis for this assertion – and there is evidence in the form of the available RCTs (and systematic reviews of RCTs) of individualised homeopathy that homeopathy can be tested using “conventional research paradigms”.
    This argument amounts to: ‘You can’t test it’; ‘We have tested it – here are the results’; ‘You can’t test it’.

    “We all knew when things were working, we all knew that we didn’t need to resort to modern drugs…”
    And how did you ‘know’ these things? These seem to be assumptions rather than things you know. Unless you test your hunches, you don’t know whether they are right or not.

  36. jdc325 said,

    “Well I hope you don’t leave yourself exposed to this “pseudoscientist’s fork” until it’s too late, jdc.”
    Well, as long as people are arguing for science-based medicine rather than evidence-based medicine I’ll be considering their arguments.

  37. jdc325 said,

    @Chris Denton
    Thanks for commenting. I’m afraid my spam filter grabbed your comment for some reason and I’ve only just seen it and fished it out.

    “Would you fund research into homeopathy even though the second law of thermodynamics means it is impossible?”
    No, I wouldn’t fund such research. I’d argue that quite enough research has been conducted into homeopathy. We already have RCTs and systematic reviews of RCTs and a systematic review of systematic reviews – and after all this we still haven’t found good evidence that homeopathy is effective. It’s probably time to move on and stop wasting resources on researching homeopathy. I would say that some of the research that has been conducted has been of good quality. Whether it was worthwhile is another matter.
    I’d also make the point that plenty of this research has been conducted at the taxpayer’s expense – if the manufacturers of homeopathic remedies wish to conduct further research then that is a matter for them. I think that public money, though, would be better spent researching treatments that might actually work.

  38. wakeupplease said,

    This is quite an interesting piece. Really sums up quite nicely the attitude prevelent here.

    http://www.ucl.ac.uk/Pharmacology/dc-bits/holmes-deconstruction-ebhc-06.pdf

  39. jdc325 said,

    The Holmes article is quite interesting. As are these posts: link & link.

  40. Oliver Dowding said,

    If you think my point (no.31) means nothing and is quite possibly multiple repeated biased observation, remembering that the animals were often treated by one person and the impact monitored by another, then you demonstrate to me that you will find every way except your confounded RCT option.

    Very disappointing. But hey ho, I made the journey, came, saw, but am yet to conquer…..it seems

  41. jdc325 said,

    I’m sorry Oliver – but I don’t quite see what your point is here: “you demonstrate to me that you will find every way except your confounded RCT option.”

    That animals were often treated by one person and observed by another means little if both knew how the animal had been treated – is this the case, or was there blinding?

  42. Oliver Dowding said,

    Yes they were blinded in as much as one person (junior or relief herdsman) often did not know the treatment administered by the other. I’d be surprised if this will satisfy you, and so 15 years successful treatments now count as people being fooled by animals! Or themselves.

    I think not. Thousands like me think not. Many many people trained to your level of academic qualification think not. And so on….

  43. jdc325 said,

    “I think not. Thousands like me think not. Many many people trained to your level of academic qualification think not.”
    That’s not saying much – I wouldn’t be all that surprised “if many, many people” with qualifications no more impressive than a GCSE grade ‘C’ in dual-award science thought that homeopathy worked. They’d still be wrong though.

  44. jdc325 said,

    “Yes they were blinded in as much as one person (junior or relief herdsman) often did not know the treatment administered by the other.”
    Now this is actually interesting – it seems that you have been conducting single-blinded, uncontrolled trials of homeopathy. Add a control, blind all observers, and randomise the trial subjects to ‘homeopathy’ and ‘control’ groups and you might be getting somewhere. Good luck.

    Of course, such trials have already been conducted and the results do not support homeopathy.

  45. Oliver Dowding said,

    “They’d still be wrong though”
    Oh no they wouldn’t.

    “Add a control, blind all observers, and randomise the trial subjects to ‘homeopathy’ and ‘control’ groups and you might be getting somewhere. Good luck.”
    I beg to differ, and politely suggest that you don’t understand how homoeopathy works, and that mitigate against your being able to understand how it is tested and proven. Trials to test it will never operate within your paradigm.

    “Of course, such trials have already been conducted and the results do not support homeopathy.”
    If this is the case, what reasoning do you use to explain how so many animals, not just the 500 or so that I was keeping at any one time, but the hundreds of thousands treated elsewhere in the world, can have recovered their health?
    Do you rely solely upon placebo?
    Or that they “just got better”?
    There must be a reason.

  46. Oliver Dowding said,

    Oh no, and then guess what I’ve read? Seems that we can’t believe everything we’ve read about pharmaceutical research. Which I understand will not be a surprise to anyone on this blog, but it makes you think, and it’s a sad indictment of the big-money pharmaceutical arena.
    http://blogs.wsj.com/health/2010/01/15/feds-accuse-doc-of-faking-research-on-pfizer-merck-drugs/

  47. jdc325 said,

    “Add a control, blind all observers, and randomise the trial subjects to ‘homeopathy’ and ‘control’ groups and you might be getting somewhere. Good luck.”
    I beg to differ, and politely suggest that you don’t understand how homoeopathy works, and that mitigate against your being able to understand how it is tested and proven. Trials to test it will never operate within your paradigm.

    OK, what have I misunderstood about how homeopathy ‘works’? How is it ‘tested and proven’? Why will trials to test it ‘never operate within my paradigm’?

    “Of course, such trials have already been conducted and the results do not support homeopathy.”
    If this is the case, what reasoning do you use to explain how so many animals, not just the 500 or so that I was keeping at any one time, but the hundreds of thousands treated elsewhere in the world, can have recovered their health?
    Do you rely solely upon placebo?
    Or that they “just got better”?
    There must be a reason.

    There are several possible reasons for the perceived improvements in animals treated with homeopathy, all of which are more likely reasons for the perceived improvement than homeopathy. I have listed these reasons more than once, and have drawn your attention to them to ensure that they have not escaped your notice. You seem intent on ignoring them.

    Oh no, and then guess what I’ve read? Seems that we can’t believe everything we’ve read about pharmaceutical research. Which I understand will not be a surprise to anyone on this blog, but it makes you think, and it’s a sad indictment of the big-money pharmaceutical arena.
    http://blogs.wsj.com/health/2010/01/15/feds-accuse-doc-of-faking-research-on-pfizer-merck-drugs/

    Completely irrelevant to the topic at hand. We are discussing the lack of evidence of efficacy for homeopathy. We are not discussing bad behaviour in pharmaceutical research. Do you believe that allegations of bad behaviour in research of pharmaceutical drugs is somehow proof of the efficacy of homeopathy? It is, of course, no such thing. If you have concerns about the flaws of systematic reviews of homeopathy then please feel free to air them. If you are aware of bad behaviour by researchers studying homeopathy, then please feel free to bring attention to any such alleged bad behaviour. Simply posting a link to discussion of allegations of impropriety in research on drugs made by Pfizer or Merck adds nothing to our discussion of the Cochrane Reviews of homeopathy.

  48. nobby said,

    ” and that it can’t possibly be that a single homoeopath can find a single solution to a single person’s illness. Instead you assume that health conforms to some identifiable spectrum without individuality..”
    quote taken from your first post mr dowding.

    maybe you should read the evidence submitted by the Alliance of Registered Homeopaths to the Science and Technology Committee in the written evidence part which says :
    “This hypotheses doesn’t explain how mastitis in cattle for example, can be controlled by placing drops of a selected remedy in the drinking water accessed by the entire herd.”

    or by yourself quoted from a talk given at Science and Homeopathy Conference 18th June 2008. which says:

    “We had some immediate successes, with such as Baccillinum for ringworm”

    and

    “We also placed in the water troughs some of the general remedies, for whole-herd or group coverage, a practice known as using nosodes. These were applied maybe weekly, at about 5ml per water trough, which typically held 200-500 gallons of water.”

    it is a shame i cannot find a link to a letter sent to evan harris mp that the 1023 stunt was stupid as homeopathy is an individualised medicene.

    not much individuality going on there is there?

    have you ever heard of the horse “clever hans”? he could maths and other intellectual tasks. people used to think the horse really could do it. even a commission came to the same conclusion until it was finally understood what the mechanism was and sucessfully debunked. there was no fraud involved, no deception used to decieve people, it was not even a trick. it was a simple bias mechanism, but still some people refused to except that it was a form of bias and they carried on believing the horse could count .

    just to make it clear i am not suggesting that the “observer expectancy effect” is anyway directly related. the point is some people refuse to except any evidence/explanation no matter how plausable or factual other than what they see with their own eyes….

    sry jdc as it is off topic.

  49. Oliver Dowding said,

    “There are several possible reasons for the perceived improvements in animals treated with homeopathy, all of which are more likely reasons for the perceived improvement than homeopathy. I have listed these reasons more than once, and have drawn your attention to them to ensure that they have not escaped your notice. You seem intent on ignoring them.”

    I’m definitely not ignoring these comments, it’s just that they’re so laughable as to be worth no comment. The sort of diseases that I’m talking about, including the dreaded mastitis, just don’t get better on their own, and if you don’t realise that I’d be very surprised. Certainly not in the numbers of cows treated on the number of occasions, we did so. But this is why I say to you that your idea of how a trial would be run is not relevant. We don’t suddenly get 50 cases of mastitis on any one day, to allow us to be able to split the group into two and give half nothing and half a homoeopathic remedy. We treated, each cow on its own merits, assessed each day, while under treatment, remedies changed if necessary, etc. This is why we give them homoeopathic remedies and not sugar pills.

    I would also remind you that recovery was not perceived as you suggest, but really happened, time after time after time after time. Multiple numbers of staff administering the remedies, multiple types of cow, etc. Whilst not no doubt conforming to your idea of a RCT, but I suggest this is a great deal better than coincidence or chance.

    Much as you say that I’m ignoring your comments, I haven’t noticed you agreeing that you’d like to spend some time that a veterinary homoeopath. Given that they are medically trained, I’m sure they’d be able to better explain what they are doing and why it works than I would be able to do. I can give you the contact details of somebody who would probably be able to arrange this.

    I’ll leave the vaccine question to another place, and accept that it’s not relevant to this debate.

    Thank you for your contribution, Nobby. You are quite right, I can’t explain in scientific terms how administering remedies through the water troughs works, but I do understand that it does. You are absolutely right that on this basis, the remedy is not being individualised. That does not in anyway diminish its efficacy, nor mean that individual selection is any less valid. There are many ways to practice this science! It’s unfortunate that some people demand to know how it works, rather than that it does work. As I said before, I don’t demand to know the way in which this computer is able to record the message to you, but I’m quite happy to accept that it does.

    On a similar footing, as I’ve offered commentary on it before, I’ve no idea how the large hadron collider works, or even whether there is a slight chance that it might deliver anything of value, but some scientists have managed to persuade some politicians to invest millions and millions of pounds chasing what is no more than a theory, albeit maybe with some basis for expectation. I’m sure with a similar amount of money could demonstrate an enormous amount that would be off enormous value to people.

  50. phayes said,

    “This blog post makes phayes’ point quite well.”

    Yes, thanks for that link Chris Denton – it’s very good – although I would’ve added a warning that if homeopathy RCTs continue it’s possible that one or more of them will produce ‘strong’ positive results.

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