Category Archives: Homeopathy

Debunking “The doctors case for homeopathy” by WDDTY: A case study in critically evaluating internet articles | The Logic of Science

I want to explain the problems with an article found in What Doctors Don’t Tell You (WDDTY) titled “The doctors’ case for homeopathy.” This piece is full of misinformation, and it serves as an ideal case study of what I’ve observed to be WDDTY’s typical behavior. Here’s the full list of problems I found with the article, which I will elaborate on below…

Source: Debunking “The doctors case for homeopathy” by WDDTY: A case study in critically evaluating internet articles | The Logic of Science

Deconstructing Homeopathy Propaganda – Science-Based Medicine

I was recently sent a particular piece of pro-homeopathy propaganda, from a website whose very name is highly biased and misleading, What Doctors Don’t Tell You. The name implies that the medical profession is hiding information from their patients and the public for some nefarious purpose, but the plucky band of rebels who run this website will give you this secret information…

Source: Deconstructing Homeopathy Propaganda – Science-Based Medicine

Homeopathy improves fatigue and pain of cancer patients ten-fold

Few fields demonstrate the exercise of the pseudoscientific method more consistently than homeopathy. Any half-competent editor of a health magazine will be well aware of the red flags, and will steer clear of the junk studies that define the field.

You’ve already spotted the problem, haven’t you? Yes, the editor would have to be half competent. And also they would have to give a shit about facts, rather than their advertising sales.

Homeopathy dramatically improves the mental and physical well-being of cancer patients who are being treated with chemotherapy or radiotherapy, a major new study has discovered.

Really? I wonder who would produce such a study, and where it might get published?

Complementary Therapies in Medicine, 2015; http://dx.doi.org/10.1016/j.ctim.2015.03.004. A low impact factor (2.2) SCAM-specific journal.

“Influence of adjunctive classical homeopathy on global health status and subjective wellbeing in cancer patients – A pragmatic randomized controlled trial”

The word “pragmatic” is a red flag with homeopathy studies: it means that they are engaged in benefit finding, and have deliberately chosen not to try to eliminate many common sources of bias.

Half the 410 cancer patients, who were prescribed individual remedies, reported “significant improvements” in their levels of fatigue and pain, and had better appetites, than those who weren’t given the remedies. Improvements ranged from seven to 14 times in those taking homeopathy, say researchers from the Medical University of Vienna.

Did they indeed. So a group of people who received amateur talk therapy and magic sugar pills, reported subjective benefits, but no objective measures were used. This tells us precisely nothing that we did not already know.

Here’s something else we know: users of SCAM fare worse when they get cancer.  They delay treatment, trying worthless SCAM remedies first, so they present later and with more advanced disease, and even after controlling for that, they still die sooner.

With that in mind, one wonders why the Medical University of Vienna’s IRB approved this trial. Would they approve one on voodoo?  Maybe they would, it would not be the most unethical thing the university ever did, as Prof. Ernst reveals in his excellent A Scientist In Wonderland.

All the patients, who were being treated for stages 3 and 4 cancer, were interviewed every week while they were taking the remedies, and the improvements in the homeopathic group was very noticeable compared to the group who weren’t taking homeopathy.

According to a bunch of homeopaths. Of course the rigorous blinding that ensured that neither patient nor experimenter was aware of which group they were in, and the use of a carefully selected placebo (including controls for the homeopathic “consultation”, which another study shows is the only part of the whole charade that matters).

Oh, wait, no, they don’t appear to have done any of that.

Improvements in overall health were 10 times greater in the homeopathic group over the three weeks the remedies were taken.

Amazing, isn’t it? You wonder how such a striking finding could come out of a decently designed study given that three separate government reviews of homeopathy (Switzerland, UK and Australia) have failed to find a single condition for which it is provably effective.

There are two possibilities here:

  1. All the previous research is wrong, especially that showing that positive results are more likely when the study design is sloppy and less likely when it’s robust; most of physics is wrong; there are two complete parallel systems of action in human biochemistry, one of which has never been identified by scientists; and there is a form of energy that has never been detected or measured, but which has profound effects on human health.
  2. This is another badly-designed study by True Believers seeking to proselytise their faith.

Which is more likely? Answers on a razor please.

Evil ASA 6: H:MC21

This is the sixth of a short series on the examples highlighted in January 2015’s issue of WDDTY as “proof” that the ASA is fundamentally flawed, and as justification for replacing it by a body run by practitioners commercially vested in the claims under evaluation.

H:MC21 conducts a mass protest outside the ASA. Sadly, nobody noticed.

H:MC21

The charity Homeopathy: Medicine for the 21st Century (H:M C2 l) placed an advertisement in a supplement of the New Statesman magazine in 2010. A complaint against it led to a bitter 10-month deliberation,

Whenever WDDTY talk about Sense About Science, they put the word charity in scare quotes. For H:MC21, the scare quotes should be three times the size of the main font, and flashing.

Theopen-quotecharitable purpose close-quote is listed as:

We have been continuing to work with other groups to get the information to the public about the validity of homeopathy and the propagandist nature of the attacks on this therapy. We particularly welcome the initiative by the GRCCT to establish professional accreditation of websites for CAM therapies, and the challenge this offers to bizarre rulings by the ASA.

That’s not a charitable purpose. It’s barely even a political manifesto. The charity raises virtually nothing, spends virtually nothing, and the charitable purpose advances the business interests of the  chief actor, William Alderson.

Ironically, the “propaganda attacks” amount to stating the scientific consensus. The actions of H:MC21 involve cherry-picking, distortion and even outright fabrication. What’s the word? Oh yes: propaganda.

Please do read the adjudication. Note the update comment. H:MC21 did not go quietly, and they still very firmly believe they were right. The ASA showed saintly patience, and received only abuse in return.

The claims adjudicated were:

1. “Homeopathy has a history of success in chronic illness”;

2. “At Bristol Homeopathic Hospital 70.7% of 6,500 patients with chronic conditions benefited from homeopathic treatment and had reduced need for conventional medicine”;

3. “… more randomised controlled trials are positive than negative”; and

4. “In Cuba, an integrated approach to healthcare has led to homeopathy being used to enable 2.3 million, including the elderly, to be cheaply and effectively protected against endemic Leptospirosis”.

The complainants challenged whether the following claims were misleading:

5. “About 6 million people in the UK choose Homeopathy”;

6. “… of the 2,500 most commonly used treatments in the NHS, 51% have unknown effectiveness”;

7. “Even a small increase in spending on homeopathy could produce dramatic benefits, reducing care needs and increasing patient quality of life”;

8. “Sense About Science” is funded by pharmaceutical companies and relies on a strategy of propaganda stunts rather than scientific research”; and

9. “(Trick or Treatment?) has been shown to be scientifically unreliable”.

They also challenged whether the following claims were irresponsible or denigratory:

10. “The NHS spends £2 billion annually on treating adverse side effects of conventional drugs. Homeopathy has no side effects”;

11. “The leading so-called ‘expert’ and critic of homeopathy, Professor Edzard Ernst, has admitted that he has no qualifications in homeopathy”; and

12. “The recent Science and Technology Committee report on homeopathy was voted for by only three MPs”.

The evidence submitted included the “Swiss Report” which is not a Swiss report but is a case study of research misconduct, a customer satisfaction survey masquerading as evidence of efficacy, and sundry other supportive gems mined from the House of Commons Select Committe report whose conclusions (naturally!) they then proceeded to dismiss. Because in their bubble world, only positive outcomes are valid.

It is telling that H:MC21 chose to buy advertising space in a major national magazine, and use it to make an unwarranted personal attack on Professor Edzard ErnstW. a man upon whose academic credentials they cast aspersions – from the position of having absolutely no academic credentials themselves.

I discussed H:MC21’s fallacious response to the ASA on my blog at the time.  Actually Brian Cox has since put it better:

The problem with today’s world is that everyone believes they have the right to express their opinion AND have others listen to it. The correct statement of individual rights is that everyone has the right to an opinion, but crucially, that opinion can be roundly ignored and even made fun of, particularly if it is demonstrably nonsense! – Prof Brian Cox.

So, what did the ASA find?

On the “Swizz report”:

1. Upheld […] The publication’s main conclusion regarding efficacy was drawn from a reconsideration of a previous meta-analysis of qualifying trials which found no significant difference between placebo and homeopathic treatment and had been published in a reputable peer reviewed journal. It featured a reworking of the analysis of the data by considering only therapeutic studies, and removing the prevention studies. This led to the number of significant versus non-significant trials becoming 28 vs. 23, as opposed to 32 vs. 33 in the original publication. The publication’s editors described this as “a truly remarkable result in favour of homeopathy”. Our expert did not agree with this assertion. However, the authors, in the section that discussed the study, stated, “While the above argument does not allow us to draw the reverse conclusion that homeopathy is effective, it does support the claim that the Shang et al (2005a) study does not prove the ineffectiveness of homeopathy”. Our expert agreed with this second statement only.

This is charitable. The document is in fact shockingly poor: the authors have substantial undeclared conflicts of interest and reversed the normal hierarchy of evidence in order to produce the result they stated, at the outset, they wanted.

So, in summary:

We concluded that H:MC21 had not supplied sufficient evidence to substantiate the claim and noted there was a lack of evidence to support claims for its efficacy. We concluded that the ad was misleading.

This is no more or less than the scientific consensus view. Surely WDDTY don’t want the ASA to treat claims according to the belief systems of claimants? So, for example, allowing people who believe in white supremacism, to publish white supremacist advertisements? Where objective standards exist and are generally considered applicable, then they are the right standards, obviously.

2. Upheld. We considered that most readers would interpret the claim “At a Bristol Homeopathic Hospital 70.7% of 6,500 patients with chronic conditions benefited from homeopathic treatment and had reduced need for conventional medicine” to mean that the study demonstrated that over 70% of the patients tested experienced a reduction in the symptoms of their chronic illness following the introduction of homeopathic treatment.

In other words, customer satisfaction is not evidence of efficacy. The core problem that homeopaths can never actually understand, it seems.

3. Upheld […] We considered that within the context of the claim “… more randomised trials are positive than negative”, the 49% of inconclusive results was a significant piece of information and should have been included in the ad because it indicated that under RCT conditions, inconclusive results had occurred more often than positive results.

Controversial? Hardly.

4. Upheld […] We noted evidence had not been supplied to demonstrate that the homeopathic medicine referred to in the report had been shown to be efficacious against Leptospirosis under clinical conditions and therefore considered that the vast reduction in the incidences of the disease had not been shown to be directly attributed to the homeopathic remedy that had been administered. 

Correct: regression to the mean explains the observation, and the claim that Cuba uses homeopathy for leptospirosis is false, they use Vax-Spiral, a vaccine developed in Cuba. H:MC21 are suffering from “kleptospirosis” here.

5. Not upheld We noted the MHRA had informed the Commons Science and Technology Committee that over 10% of the nation chose homeopathic treatments. We considered that this was sufficient to substantiate the claim that six million people in the UK used homeopathy

The figures are incorrect for other reasons, but ASA correctly agreed that H:MC21 had substantiated this claim. Wait, I thought they were supposed to be anti-SCAM and always vote Upheld? This is soooo confusing!

6. Not upheld  We noted the ad claimed “Homeopathy has a growing evidence base, but according to the British Medical Journal, of the 2,500 most commonly used treatments, 51% have unknown effectiveness”. We also noted H:MC21 provided the pages from the BMJ site upon which this claim was based. We considered that, in the context of this ad, the claim invited readers to consider the view expressed in the BMJ article, but did not go so far as to discourage readers from seeking essential treatment for conditions for which medical treatment should be sought.

I disagree with this, but understand the rationale. The problem is that the study on which it is based essentially says that you can’t interpret the figures as H:MC21 do (for example, how would you conduct a randomised controlled trial for emergency repair of ruptured aortic aneurysm?). That said, the study is not as grossly misrepresented as it usually is by quacks and once again the ASA gives the benefit of the doubt to the advertiser.

7. Upheld We noted H:MC21 had not sent sufficiently robust scientific data, including double blinded clinical trials, to substantiate the claim that homeopathy could effectively treat chronic medical conditions.

We sympathise: it’s hard to do when no such good evidence exists, after all. How it must suck to be a homeopath if you actually care about evidence. Ah, wait…

8. Upheld The ASA noted the ad claimed “The leading organisation opposing Homeopathy, Sense About Science is funded by pharmaceutical companies”.

And no evidence was presented. They should have asked WDDTY. Oh, wait, they never present any evidence when making the identical claim either. It’s almost as if there is none.

9. Upheld We read the publication Trick or Treatment and the paper Halloween Science.

Halloween science is William Alderson’s comically bad “peer reviewed” critique of Trick Or Treatment. The latter is a properly published popular science book. The former is, well, a splenetic rant by someone who is suffering acute pain in the feels. I can’t trace any evidence that it’s really peer reviewed, other than passing round a few like-minded mates, which is not the same thing at all

Alderson also wrote a 62 page “critique” of a seven-year-old A4 flyer from  Sense About Science, which still managed not to make a single valid point. He is really good at this.

10. Not upheld We understood that homeopathy had been shown to have no side effects

Again, I’d have Upheld this as the claim is misleading (homeopathy has no effects) but the ASA again gave H:MC21 the benefit of the doubt. Quacks have no gratitude.

11. Not upheld […] we noted Professor Ernst, as a scientific commentator, did not fall under the definition of those parties that were subject to CAP Code rule 3.42 concerning denigration.

Out of scope. Fair enough, though still a shitty trick.

12. Not upheld We noted the Report made a series of policy recommendations about the future of NHS funding for homeopathy and considered that, without further clarification, the claim implied that MPs had disagreed with the scientific conclusions of the report. However, we noted the report and the Committee did not fall under the definition of those parties that were subject to CAP Code rule 3.42 concerning denigration and therefore concluded that the ad did not breach that Code rule.

In other words, H:MC21 lied but it’s out of scope.

with the ASA finding against both the advert and homeopathy, claiming there was no evidence to suggest it had any effect beyond that of a placebo.

Correct. That is the scientific consensus view. Three separate government level reviews (Switzerland, UK and Australia) have concluded it, the National Center for Complementary and Alternative Medicine says it, the NHS says it. It’s a fact. Not liking it does not make it perverse or any less a fact.

You might as well complain when they rule against free energy devices. Actually, being WDDTY, they probably do.

In addition, the ASA rejected a review of 6,500 patients who had received homeopathic treatment at Bristol’s Homeopathic Hospital, stating that the patients’ own assessments of their health were invalid (although it is common practice in conventional medical trials).

No, they did not reject it, they noted that it did not prove the claim that was made of it. The thing about refuted nonsense is that it only ever works once. Having been refuted, the same refutation works every time.

Patient satisfaction does not prove efficacy. Ever. Subjective self-reported scores are accorded low weight in any trial and generally only really useful to compare two active and proven treatments.

H:MC21 also said its other submitted evidence was either lost or edited.

No, it was just bullshit. Again, William Alderson is a world-leading expert on massive outpourings of tendentious nonsense.  He is pretty much the UK’s version of Dana “Mr Uncredible” Ullman.

So, looking at the actual text complained of, and the outcomes, with their mix of upheld and not upheld, did ASA brutally oppress H:MC21, or did they do a fair and even-handed job of picking apart the claims of a propagandist, allowing those items which are defensible, even if wrong? You decide.

Evil ASA 2: Islington Homeopathy Clinic

This is the second of a short series on the examples highlighted in January 2015’s issue of WDDTY as “proof” that the ASA is fundamentally flawed, and as justification for replacing it by a body run by practitioners commercially vested in the claims under evaluation.

Islington Homeopathy Clinic

I-Spy: Woo. How many mutually contradictory alternatives to medicine can you spot in this picture?
I-Spy: Woo. How many mutually contradictory alternatives to medicine can you spot in this picture?

Its website stated that homeopathy”is sanctioned by the UK government and has been an integral part of the National Health Service (NHS) since it was founded in 1948”. The Nightingale Collaboration challenged the statement as it suggested that homeopathy is an effective treatment. In response, the clinic pointed out that Aneurin Bevan, the architect of the NHS, stated that “homeopathic institutions will be enabled to provide their own form of treatment, and the continuity of the characteristics of those institutions will be maintained”.

Please read the adjudication.

The website home page on or about the date complained of said:

Homeopathy is the second most popular system of healing in the world, used by over 30 million people in Europe alone. In 2005, the World Health Organization estimated that homeopathy is the fastest growing healthcare modality in the world with more than half a billion users. It is over 200 years old, was introduced to the U.K. by Dr Quin in 1828, is sanctioned by the UK government and has been an integral part of the National Health Service (NHS) since it was founded in 1948. In November 2000, a House of Lords report on complementary and alternative therapies judged homeopathy to be one of five ‘group one’ therapies (out of thirty examined), with convincing research evidence of effectiveness, suggesting that it should be more widely available on the NHS.

(Archives from before and after the complaint do not differ materially).

In context, then, the claim of Government endorsement is very clearly being used in lieu of evidence of efficacy. In fact, they go one better, citing the House of Lords report in 2000 which found homeopathy to be a “group one” therapy. By which they mean:

The first group embraces what may be called the principal disciplines, two of which, osteopathy and chiropractic, are already regulated in their professional activity and education by Acts of Parliament. The others are acupuncture, herbal medicine and homeopathy. Each of these therapies claims to have an individual diagnostic approach and are seen as the ‘Big 5’ by most of the CAM world.

Oddly, Islington Homeopathic Clinic didn’t identify where in the Lord report they found the suggestion that homeopathy should be more widely available on the NHS. I say oddly, actually it’s because as far as I can tell it isn’t in there. The report deals with regulation. Feel free to point out if this is wrong.

Oddly, too, Islington Homeopathy Clinic didn’t mention the 2010 report by the House of Commons Science and Technology Committee which recommends the precise opposite, and which, unlike the Lords report, actually looks at the validity, not the regulation, of SCAM. Specifically:

23.  The Government should stop allowing the funding of homeopathy on the NHS. (Paragraph 110)

Homeopath in selective-and-misleading-presentation-of-evidence shock.

As to the Bevan quote. That is discussed in Hansard (see commenter Mojo at the Quackometer):

The Secretary of the Faculty also said: The Faculty of Homoeopathy is under an obligation by Act of Parliament to do everything in its power to advance the principles and extend the practice of homoeopathy and the Minister of Health has given assurances that under the National Health Service Act homoeopathic institutions will be enabled to provide their own form of treatment and that the continuity of the characteristics of those institutions will be maintained. For the sake of brevity, I shall not quote a great deal of what Aneurin Bevan said in 1946, when he was engaged on establishing the National Health Service, but he gave various categorical assurances. On 23rd November 1946 he said: If they”— homoeopathic hospitals— are to be brought in it must be the obligation of the Regional Boards in establishing their Management Committee to see that these Management Committees are of a character which maintains the continuity of the characteristics of those institutions. I think that I can give that absolute guarantee, because otherwise it would be an emotional mutilation which nobody could possibly defend. I am afraid that that guarantee has become less than absolute over the years, and I indict the Department of Health and Social Security for that.

Note that the speaker is Tom Ellis (Lab, Wrexham) apparently a homeopathy supporter.

The statement by Bevan does not itself appear in Hansard, nor, int seems, in any of the relevant Bills or Acts. It is taken from a speech, in which Bevan makes only one commitment: that the Management Committees of such homeopathic institutions as are brought in, should maintain their doctrinal purity. No guarantee of continuity is implied int his statement, nor would it be binding or even relevant given the subsequent scientific inquiry demonstrating homeopathy to be clinically ineffective.

In point of fact, the Management Committees have, since they were effectively devolved from NHS control as Trusts, have for the most part abandoned any form of doctrinal purity and adopted instead the omniwoo known as “integrative medicine”. This is hardly the fault of the NHS, as institutions were severed from NHS control by statutory instruments.

It is unequivocally the case that the present statutory framework holds no guarantees in respect of homeopathy. The speeches of Bevan are of no more relevance today than those of Churchill in support of the gold standardW. The road of politics is positively littered with broken promises, even if this was a promise as represented, which is debatable at best.

Were the ASA right to say that this claim of legitimacy was misleading? I think so. Actually I think they were more than fair. They could have expanded it to include the selective presentation of a tangential comment from a Lords report, editorialised without justification to give a conclusion which is firmly contradicted by a directly relevant subsequent Commons report.

The ASA found for the complainant, but it ended up being the best thing that could have happened to the clinic (see box, right), which is seeking to have its site sanctioned by the GRCCT initiative.

It will be interesting how the Quackvertising Standards Association (QSA) handles this. In particular it will be interesting to see what therapeutic claims they endorse.

This will be doubly interesting since the Society of Homeopaths apparently accept the validity of the ASA and have been working with them to provide clear guidance on copy. In fact, they specifically say:

Advertising and Media
38) Members should ensure that they do not allow misleading advertising and information about their practice. Advertising should be honest, decent, legal and truthful (as defined by the Advertising Standards Authority and conforming to the UK Code of Non-Broadcasting Advertising Practice (CAP)). [emphasis added]

That’s the problem with fields like homeopathy where everything is based on opinion instead of empirically testable fact: who’s to say whether the SoH is right, or the defiant homeopath who apparently also believes in (mutually exclusive) chiropractic?

Are West Africans dying needlessly of Ebola for the sake of Pharma profits?

No.

Thanks for reading.

Oh, wait, what? Ah. Rob Verkerk wants to add his peerless insight. Let’s see how that goes. Advance notice: there is a word I am really struggling not to use here. It is a very short word, beginning with C and ending with -unt. Read on, and be prepared to be very very angry.

Visiting Sierra Leone amidst the Ebola crisis is an experience that will remain deeply etched into my memory. The single most outstanding feature is the resilience of the people. Villages like Kigbal have lost about half their population to Ebola, yet the villagers still greeted us with warm, broad smiles-even the now mostly orphaned children. Only when reminded of their loss do the cracks appear and the depth of their loss emerges. One woman has lost four children and her husband to Ebola, while her two remaining children are still fighting for their lives. Despite her pain, she still stood proud and strong, ready for another day.

Rob, one simple question.

What the fuck were you doing in Sierra Leone?

Seriously. What the fuck?

You have no medical qualifications. You are not a doctor. This is a health emergency, and every single person in the area is at risk. Every single Westerner has to be watched and monitored to prevent them bringing the disease back. A westerner who gets infected has to be evacuated, which is a monstrous cost in resources that are already stretched to breaking point.

Have you ever heard of Dr. Martin Salia? Nina Pham RN? Dr. Craig Allen Spencer? Thomas Eric Duncan? Do you read newspapers? Listen to the radio? Watch TV? Do you have access to the internet? Because, and I am really struggling not to shout here, it is blindingly obvious that this is no place to play doctor.

You have gone to a disaster zone, basically as a fucking tourist, and you have gone without the only thing they ACTUALLY NEED: medical skills. You have imposed a cost and a burden on an area already groaning under the weight of a crisis that is barely under control. For what? To boost your own ego and your own profits? Or because you are actually so dangerously deluded that you think your facile remedies for the worried well are a valid intervention?

I am really struggling to think of a third option here, and neither makes you look good.

I also won’t forget the international presence-the logistics personnel organizing medical supplies and protective equipment, the foreign, especially British, army presence, and the fleets of World Health Organization (WHO), US Centers for Disease Control and Prevention (CDC) and Medecins Sans Frontieres (MSF) vehicles and staff.

Indeed. People with, you know, relevant medical expertise. The world’s religions have sent doctors and money. The worlds quacks have sent quacks. And the people of Sierra Leone, assuming good faith, let them in, only to discover that they were there for propaganda.

To the endless credit of the locals, the quacks were not lynched but sent home.

There’s also the sharp contrast between the elaborate foreign aid-built Ebola treatment centres and those built with local money, sometimes with the help of smaller non-governmental organizations. These are often built around vacated schools and community centres, with wooden frames made of tree branches, and walls and ceilings of UNICEF tarpaulin. There are around 200 of these around the country.

Yup. Sierra Leone is dirt poor. Send money, some of the cash you make from the legion of the credulous worried well.

These centres and the logistic operations are the only proven medicine against Ebola so far. They allow people with signs of fever or other symptoms of the deadly virus to be removed from their communities by ambulance, often within minutes of trained health workers-who are monitoring communities continuously-dialing the 117 emergency number on their mobiles.

And let us not forget what a staggering logistical achievement this is, given the infrastructure challenges. It’s a good job no tourists are clogging up the roads. Except you.

Once extracted, these people no longer pose a threat to their community, but are generally facing a 70 to 90 per cent certainty of death if positive for Ebola. Following death, burial is ideally within 24 hours, and a huge countrywide government campaign has been largely successful in re-educating communities to avoid their traditional practices for honouring the dead, which include touching the corpse.

25% to 90% depending on outbreak. Medical care has got survival to around 50/50 in Sierra Leone, which is average for outbreaks with good medical support, thanks to actual doctors (not vitamin pill salesmen, Rob, people with actual medical qualifications).

And the local religious communities have been doing an amazing job training people that this is a bad move, and trying to work out ways of protecting the living while honouring the dead.

Think about that for a minute. Your response is less reality-based than the religious community.

If a person brought to a holding centre tests negative, and has malaria or cholera or even morning sickness from pregnancy-which has similar symptoms to Ebola in the early stages-that person is discharged. Once discharged, though, the sad reality is that the person is now more likely to die of those other diseases or in childbirth, as the country’s healthcare system is stretched to the limits dealing with Ebola.

Correct. That’s why they need more doctors and nurses, not quacks. How many doctors and nurses did you take with you, Rob, and why did you not just send them and stay at home yourself, not being a doctor or a nurse?

Thought not.

Would now be a good time to remind everybody that 365 PEOPLE DIED A BLOODY AND AGONISING DEATH BECAUSE A TRADITIONAL “HEALER” THOUGHT SHE KNEW MORE THAN THE MEDICAL FRATERNITY?

Sorry, I said I wouldn’t shout. But, well.

The care of patients in the treatment and holding centres is largely dictated by the WHO and CDC. But one stunning fact is that their guidelines don’t advocate the use of intravenous (IV) support. This is almost unthinkable, as most Ebola patients suffer chronic dehydration due to severe vomiting and diarrhoea. It’s no surprise that one British police officer who was managing the Ebola patient extraction system and burials referred to these centres as ‘death camps’.

Gosh, I am sure the massive interdisciplinary teams of doctors, nurses, virologists and other medical researchers will be profoundly grateful for your insight, because it’s clear that they won’t have thought about this at all. It’s not as if each health worker has the potential to save a large number of lives, making them a scarce and valuable pool of resource, after all. And there are almost no reports of health workers being infected by needle stick injuries are there?

Frankly, your facile pontifications are about as useful as Matthias Rath in an AIDS epidemic. No, actually less useful: at least he is actually a doctor.

Could more lives be saved? Could more be done to improve outcomes for those struck by Ebola? I believe the answer to both is a resounding’yes’.

No doubt the Nobel Prize is in the post. After all, the WHO only has a few thousand trained staff on the ground. They must be gagging for the input of vitamin salesmen.

The best clinical evidence comes from Sierra Leonean Dr Santigie Sesay, who runs the Hastings treatment centre outside Freetown. After receiving training from the WHO – which recommends no IV in Ebola patients largely because of the risk of needle-stick injuries and cross infection to nursing staff – he and his medical team decided to act otherwise. Given that dehydration is an obvious major issue in these patients, they decided to administer IV dextrose and saline along with broad-spectrum antiobiotics and multivitamins. These simple interventions are consistently saving a further 20 per cent of lives, with the death toll falling from 60 per cent to 40 per cent of confirmed cases of Ebola before and after, respectively, the introduction of these interventions.

They take the risk, they are the ones who may die. I am in awe of their professionalism and dedication. But the average death rate form controlled Ebola outbreaks is only 50%, so it’s a big risk: they are deeply vested in the community and they should be celebrated in the same way as other medical martyrs.

That doesn’t make the WHO advice wrong. There is a reason why we celebrate first responders who enter burning buildings to rescue people. And there is a reason why orders are given against this.

The entire point of a co-ordinated response is to place objective judgments ahead of emotion. And yes, it can look callous, especially to those who have an agenda and don’t bother to think it through.

One can only wonder what would happen if more elaborate nutritional protocols were introduced, ones designed to enhance cellular hydration, modulate the immune system, reduce virus levels in the body and support recovery.

Jesus fucking wept. The period from diagnosis to death or survival is typically a week or so from first symptoms, maybe only a few days from diagnosis, during much of which time the patient is typically  emitting fluids from every bodily orifice.

Do you really think they haven’t thought about the role of hydration?

Seriously?

That is breathtakingly arrogant. Really, monstrous hubris.

Because, you know, there are some pretty smart people on the case. And your “insight” is pretty bloody facile when you consider that the standard of care has reduce fatality from around 90% to around 50% over successive outbreaks. The fatality rate in the Zaire outbreak was 88%, the Sierra Leone outbreak is, as noted, around 50%.

What could they have achieved if only they’d listened to you, eh?

But the current West African Ebola epidemic is as much a health and economic crisis for the region as it is a political tool being manipulated by Western interests. Would it be advantageous for the West to find an inexpensive solution to Ebola that could be administered locally to help break the transmission cycle?

Perhaps they could try talking sternly to it?

Or maybe, you know, they could try something really difficult, like developing a vaccine. And yes, that is staggeringly difficult for this disease.

Because in the end massive multidisciplinary medical teams are not bad at working out the best approach for dealing with a disease, it’s just that delivering the cure or preventative is normally rather harder than sitting in an office writing about it form the perspective of no realistic understanding whatsoever.

Surely not, as the high mortality rates drive fear about Ebola in both West Africa and everywhere else in the world. And bear in mind that GSK’ s vaccine, at the time of writing, is being prepped for release. Is this another example of that well-oiled business model favoured by pharmaceutical interests: first create the problem, then provide the solution? The ultimate travesty is that so many lives are being lost-and many of them perhaps needlessly.

Rob, you are an idiot. A fact-blind, agenda-driven idiot.

Vaccines are not profitable. Vaccines for rare diseases of dirt-poor countries are seriously unprofitable. Two companies have put substantial resources into developing a vaccine that will not make either of them very much money.

Did it not occur to you that they might be doing this because it’s the right thing, rather than for your own motives, profit and ideology?

No, of course it didn’t.

Idiot.

Religion: The latest scientific exploration. Or not.

If there’s one thing that doesn’t seem to trouble Lynne McTaggart, it’s doubt. When her world-view is contradicted by science, then it’s science that’s wrong. MMR-autism link refuted? Not in WDDTY it’s not. Urotherapy is derided nonsense? Not in WDDTY. Intercessory prayer? Let’s have a talk about that.

Lately I’ve been thinking a good deal about how in modern times science and religion have exchanged places. This was initially prompted by an email from What Doctors Don’t Tell You reader about an article in the new Scottish newspaper the National, reporting that Lanarkshire Health Board has stopped referring patients to the Glasgow Integrative Care Centre where they practise homeopathy.

McTaggart could mitigate the obvious falsity of her argument by couching it as opinion, while acknowledging the legitimacy of Simon’s more robust standpoint. But she doesn’t. She insists instead that she is right and the reality-based community wrong.

Yes, this was great news. A review of the evidence and public opinion, which included input from users of the service and from the homeopathy industry, concluded, as such reviews usually do, that there is no credible evidence homeopathy works.

The journo of the story dutifully quoted physicist Simon Singh, Mr Rent-a-Quote on these matters, whose point was that even if lots of people want homeopathy, as they do, “public demand did not necessarily equate to the best public service.” “If lots of people wanted voodoo on the NHS should we have voodoo?” he said. Of course, it is fairly easy to unpick all of his statements, but I’ll focus on just one: If lots of people wanted voodoo on the NHS should we have voodoo?

That’s Doctor Rent-a-Quote to you, sunshine. Unpick his statements? That should be comedy gold. Carry on, I’ve got the popcorn.

The answer to that is, of course, yes.

Er, no it isn’t. No, it really, really isn’t. There are at least three common variants: West African Vodun, Haitian Vodou and Louisiana or New Orleans Voodoo. They share many facets of African shamanic magic, including rituals of dance and myths of spirit possession. The classic voodoo doll is, I believe, primarily associated with the Louisiana version. There’s a mish-mash of traditional African cultures and Christian, especially Catholic elements, and much of what is currently known as voodoo owes its existence to the twin  evils of colonialism and slavery. Continue reading Religion: The latest scientific exploration. Or not.

Chronic Lying Disease part 2

ByjnKcqCcAABtXL[1]In Treatment wars: Chronic Lying Disease we noted a regrettable tendency of quacks to promote the fictional “chronic Lyme disease”.

Note that there is nothing fictional about the symptoms, but as you’ll see in a moment they are generally either (a) hopelessly generic – “symptoms of life” if you will or (b) caused by something else.

Nor is there anything fictional about Lyme disease. It is real, a tick-borne infection caused by the borrelia burgdorferiW bacterium (in the US) or a close relative (in th Europe). The symptoms are characteristic – erythema migrans, a bull’s-eye rash – and the infection can be confirmed pathologically by blood test.

And indeed there is a real thing called post-Lyme syndrome, or post-borrelia syndrome, or “Lyme arthritis”, which is characterised by fatigue and muscular pains, especially, in patients who have had Lyme disease.

No, the fictional disease is chronic Lyme disease, which is a disease diagnosed by quacks and treated using quack treatments, especially long-term antibiotics (ironically WDDTY also fulminates against antibiotics, but promoting mutually contradictory ideas in the same story has never been a problem for the editors).

Continue reading Chronic Lying Disease part 2

How homeopathy might work

How might homeopathy workThe article has referenciness. Several of these references are familiar. As usual TatMaggot doesn’t give the full reference (wouldn’t want to follow journal practice, after all, or make it too easy to debunk her credulous nonsense)`, and references include that peerless source of cutting edge medical discovery, the Daily Mail.

TL;DR summary

In the end, I’m disappointed. After the debunking of the previous WDDTY advertorial on homeopathy and the Banerjis, this amounts to little more than repeating precisely the same refuted claims because TatMaggot believes she’s right so refutation of Benveniste etc. can be ignored. I was hoping for something new to get my skeptical teeth into, this provides nothing new. Not even a new spin on the tired old conspiracy theories. Medicine sometimes fails, therefore unicorns.

The only genuinely new study since the last go-round is ” The potentized homeopathic drug, Lycopodium clavatum (5C and 15C) has anti-cancer effect on hela cells in vitro” (J Acupunct Meridian Stud. 2013 Aug;6(4):180-7).

 

Bang!

 

This has yet to be replicated (as is the case for most homeopathy basic research) and contains, as usual, no evidence of generalisability, no evidence of potential therapeutic effect, no credible rationale for selection of the “remedy” and no evidence that this will be linked to the “similimum” or any other symptomatic presentation.

It’s all the same old long-debunked rubbish. It’s almost as if there is no credible evidence for homeopathy, just a lot of wishful thinking by believers.

Oh, wait…

Seriously? It is just possible that a homeopath might stumble upon a substance that at clinical doses produces a useful effect. Given the sheer number of substances they use, anything else would be statistically improbable. But there’s no compelling evidence of any persistent effect at homeopathic dilutions, no credible evidence that the diluted and potentised “remedies” have any specific clinical effect, and ridiculous quote mining expeditions like this do nothing other than perpetuate the smokescreen of confabulation used by homeopaths to hide the fact that everything about their beliefs is simply wrong.

The first batch of references seem to be drawn from those cited in the Homeopathy journal’s special issue on the memory of water. We can assume that these are the best of the bunch from that issue.

  • Complement Ther Med. 2007 Jun;15(2):128-38 is “The in vitro evidence for an effect of high homeopathic potencies–a systematic review of the literature” by Witt et. al. Witt is paid by a homeopathy promotion body, the Carstens Foundation. This paper reviews primary research into mechanisms for homeopathy, finding 67 experiments of which 1/3 were replicated (i.e. 2/3 were not replicated, in line with the norm for homeopathy). It notes that the designs were inhomogeneous. Witt claims that “[e]ven experiments with a high methodological standard could demonstrate an effect of high potencies” but notes that “[n]o positive result was stable enough to be reproduced by all investigators. So the take-home from this is that believers can produce a positive result, but can’t replicate it.
  • J Therm Anal Calorim, 2004; 75: 815-36 is “New Physico-Chemical Properties of Extremely Diluted Aqueous Solutions” by V. Elia and M. Nicoli. This was discussed in a Bad Science Journal Club. The significance of this is that Elia claims, according to another paper in homeopathy, to have documented an effect which increases over time – i.e. which apparently violates the second law of thermodynamics. In the nine years since, this has not become anything like mainstream.
  • Homeopathy, 2007; 96: 175–182 is “The defining role of structure (including epitaxy) in the plausibility of homeopathy” by ML Rao, Rustum RoyW, Iris Bell and Claudia Witt (again). BadSciencers fisked this one too, noting that “different” spectra turned out to be the same graph and so on. A letter to the journal, reproduced in a JREF discussion, notes fatal flaws with the data as presented.
  • Physica A, 2003; 323: 67-64 is “Thermoluminescence of ultra-high dilutions of lithium chloride and sodium chloride” by Louise Rey. The Bad Sciencers didn’t have a lot to say about this other than that it’s speculative: it seeks to project condensed matter effects onto liquids. Definitive or conclusive it ain’t.
  • Biochim Biophys Acta, 2003, 1621: 253-60 is “Effects of ultrahigh dilutions of 3,5-dichlorophenol on the luminescence of the bacterium Vibrio fischeri“, by Brack et. al. I can’t find any significant discussion of this other than drive-by citations in laundry lists of references on homeopathy apologist websites.

So TatMaggot sets out her stall with a series of papers that include weak, irreproducible or uninterpretable results, and which advance in some cases contradictory hypothetical explanations for how homeopathy might work in some classes of substance.

None of these shows any link between “remedy” and symptom or disease, none of them shows any evidence of a clinically useful effect, none of them shows any evidence of a general or universal effect that is unambiguous and specific. This is, in other words, a re-warming of the Homeopathy “memory of water” issue.

Molehill Montagnieering

No paean to the refuted “memory of water” thesis would be complete without reference to Jacques Benveniste and Luc Montagnier.

TatMaggot of course believes Benveniste, it goes without saying, all avid homeopathy believers do. The special pleading is all reproduced: the pejorative characterisation of Randi, the claims that they “changed” the protocol and so on. It really doesn’t mater how sincerely you want to believe in it, the Benveniste experiment is a busted flush. Attempted replications have failed.

Montagnier has a self-published series of experiments that purport to back Benveniste, but these have not been independently validated either and when interviewed by CBC’s Marketplace he acknowledged that his work “cannot be extrapolated to the products used in homeopathy” – and indeed the same is true of Benveniste’s work, had it not been refuted.

Lastly, there is the knotty problem of shelf life. The effects Montagnier claims to have observed, last a few tens of femtoseconds – a fraction of a picosecond. This is entirely incompatible with the claims of an effect that increases over time, or is stable.

Jumping on the Banerji wagon

As with the previous issue of WDDTY claiming homeopathy is “much more than placebo”, the intellectual heart of this thread lies in the Banerji foundation and their extraordinary claim to reverse cancer using homeopathy alone.

Papers cited include the uninterpretable rubbish that is “Cytotoxic effects of ultra-diluted remedies on breast cancer cells” (Int J Oncol. 2010 Feb;36(2):395-403) and the followup “Ruta 6 selectively induces cell death in brain cancer cells but proliferation in normal peripheral blood lymphocytes: A novel treatment for human brain cancer” (Int J Oncol. 2003 Oct;23(4):975-82). The balance of the sources are: a WashPo editorial, the Banerjis’ publication in the best cases series (which explicitly does not establish the validity of the treatment), a Yahoo group, the Banerji website, the “journal of acupuncture and meridian studies“, the only genuinely new source since the last go-round as far as I can tell, (spoiler alert: meridians don’t exist and acupuncture is an elaborate placebo), and the BBC News website. Oh, and the Daily Mail, often cited in the top-tier medical journals for its groundbreaking basic research on the influence of immigration on the British pint or some such.