Clothing naked quackery and legitimising pseudoscience
BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d5960 (Published 21 September 2011) Cite this as: BMJ 2011;343:d5960All rapid responses
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In answer to George T Lewith's question, anyone conducting clinical
trials of (ultradilute) homeopathic 'remedies' is practising pseudoscience
(more precisely: futile cargo cult science). I'd hope and expect that a
"rigorous scientist", aware of the enormous weight of evidence against
such bizarre and perverse hypotheses, would understand intuitively why
that is so even if he or she were unaware of the full explanation (1).
Competing interests: No competing interests
Sir,
I am deeply grateful to Ms MacLachlan for her comments and somewhat
surprised she has not been more scathing.
I congratulate her on not complaining that homeopaths offer benefit
to patients with asthma, eczema, arthritis, depression, allergies,
irritable bowel syndrome and many other illnessse, but kept to a rather
limited list and hope she will not be as vocal about banning the unproven
and widely advertised over the counter remedy 'paracetamol' sold for
profit to children as 'calpol', despite having greater liver toxicity than
the herbal remedy Kava Kava which was banned....for liver toxicity, as my
headaches would be much more difficult to deal with.
I understand barely 200 complaints were lodged with the Advertising
Standards Authority.
My usually reliable sources must have been having an off day, much
like the sources she has sought advice from who have given her and her
collaborators inaccurate information regarding: the existence of research
proving the effect above placebo of Homeopathic medicinal drugs; patients
finding Homeopathy palatable and free of side-effects; useful alongside
conventional treatments; growing in popularity; a useful adjunct for a
Doctor to employ in helping sick people heal; extremely widespread in
Europe and particularly in India; cheap and cost-effective; a person's
right to seek out; able to almost eliminate the incidence of Leptospirosis
in the homeopathicly treated regions of Cuba and the fact real patients'
illness experience pathways have seen extremely significant benefits from
Homeopathy after failed interventions from secondary care medical
colleagues. She should check her sources.
I warmly congratulate her on not finding fault with any of the rest
of my letter, ergo agreeing with me on the finer points therein.
Yours sincerely
Andrew Sikorski
Competing interests: please see below
Sir,
Professor Lewith has dealt with the misconception about the evidence
base for homeopathy, in the letter from Bewley et al . Their response is
awaited.
There is another aspect of Bewley et al's letter which needs to be
addressed. It concerns the language they use, and it's implications.
Regular readers of Rapid Responses and the BMJ printed edition will
have noted in recent years that whenever an electronic response, printed
letter or article contains abuse, insults, sneers or dismissive comments
about medical colleagues, the targets are almost invariably homeopaths.
So repetitive are our critics' insults that they may have to search
for innovative, printable variations.
Bewley et al's choice of "naked quackery" is a splendid oxymoron.
The Oxford English Dictionary(OED) defines quackery as the "
characteristic practices or methods of a quack: charlatanry."
A quack, says the OED, is " an ignorant pretender to medical skill... an
empiric or impostor in medicine... to puff or palm off with fraudulent and
boastful intentions.. "
Can anyone imagine a convincing performance of such vices, by a naked
man or woman ?
Oxymoron or not, the contradictory phrase is surely intended to be as
rude as bad taste will allow.
This is another example of the use by our critics of a "vocabulary of
denigration". (1) (2)
Children in school debating societies are warned that to use abusive
or insulting terms only demonstrates the weakness of their argument, and
suggests a lack of personal responsibility and self control.
This lesson is soon forgotten by some politicians, by a small minority of
football supporters, and by a tiny minority of our colleagues.
That tiny minority of our colleagues has to recognise that they have
professional, as well as personal responsibilities.
The General Medical Council's advice is that if a doctor suspects
that a colleague poses a danger to patients, he or she must report that
colleague,either locally, or to the GMC.
The OED definition of quackery is clear. If Bewley et al accept that
definition, they are obliged to report all the medical homeopaths that
they can identify, to the relevant local authority or employer, or to the
GMC.
To fail to do so is to neglect their professional duty.
Perhaps they will tell us how they intend to proceed ?
And you, dear members of the BMJ editorial team, who have given
Bewley et al's letter credibility by printing it in the BMJ, you may wish
to consider whether you have served the best interests of our profession,
and your reputation, by having done so so.
1 R D Laing, The Divided Self, Tavistock Publications (1959 )
2 College of Medicine, quackery, a vocabulary of denigration ?
BMJ 2011;342:doi:10.1136/bmj.d3712 (Published 15 June 2011)
Competing interests: NHS GP. Occasional homeopath, unpaid.
Please allow me to correct Dr Sikorski, who is evidently labouring
under a misapprehension about the Nightingale Collaboration, which could
have been avoided if he'd read our website before commenting about us.
Far from acting to remove anybody's constitutional right to do
anything, the Nightingale Collaboration challenges false and misleading
claims made about unproven healthcare treatments in their promotion
directly to the general public, by those who stand to profit from such
deception.
Our first campaign, which focussed on homeopathy, resulted in
hundreds of complaints to the Advertising Standards Authority about UK
homeopaths who were claiming to be able to treat or help a range of
serious conditions. I personally complained about homeopaths who claimed
or implied they could treat autism, Crohn's disease, HIV, fertility
problems, swine flu and who promoted homeopathic alternatives to
vaccination. We are not acting to stop anybody purchasing any of these
"treatments" if they want to; we are simply demanding that those who
promote them are held to the same standards of proof demanded of
advertisers of other products and services, so that we consumers can make
an informed choice. I'm surprised that any health care professional would
disagree with this objective.
Dr Sikorski's assertion that we have "published the CAP guidelines
relating to homeopathic advertising drawn up by CAP on Friday, before
these guidelines are even published by the CAP on their own website," is
nonsense. The new guidelines appeared on the ASA website on Thursday 22nd
September. We tweeted a link to them the same day. We have not "published"
them and only publicised them on our website for the first time today,
28th September. As Dr sikorski's comment appeared yesterday, I'm at a loss
as to where he got this misinformation from and why he is promoting it
and, again, why he didn't check our website before doing so.
Competing interests: No competing interests
I note that Bewley et al have not provided any further argument, new
data or evidence to counter my suggestions and justify their statement
that; 'Homoeopathy has definitively and repeatedly been proved to work no
better than placebo or nocebo". Do they have further data that will allow
us to consider this statement as anything more than their personal
opinion? If they are unable to provide this would they like to consider
modifying their statement based on the limited and conflicting data
currently in the public domain, as would be appropriate in normal
scientific debate, to a more moderate and evidence based position?
Professor George Lewith
University of Southampton
Competing interests: No competing interests
SIr,
Dr Ray Noble suggests that those who regard homeopathic remedies as
innocuous, are making " a dangerous assumption if patients are persuaded
to give up standard treatments."
This is the BMJ website so we must presume that Dr Noble is writing
about medical homeopaths.
Would Dr Noble kindly tell us what evidence he has, that medical
homeopaths in the UK do persuade patients to give up standard treatments
?
Thank you.
Competing interests: NHS GP. Occasional homeopath, unpaid.
Whilst the "aims of the BMJ are to publish rigorous accessible
information that will help doctors improve their practice" one hopes an
additional reason would be to help relieve patients' symptoms?
Realising the BMJ is keen for its members to write in
(BMJ2003;326:985 ) to express their opinions I am doing so in response to
a letter by Obstetric consultant Susan Bewley which you published,
ironically, on the page following your extensive editorial on 'Placebo by
Proxy'. The letter gives voice to non GMC/ non BMA 'armchair clinicians'
who are not involved in clinical care and who have a bigoted opinion on
Homeopathy.
Did you know that patients like and respond to cost
effective Homeopathy- especially those who have had failedinterventions
from secondary care colleagues?
http://www.facultyofhomeopathy.org/research/clinical_outcomes_studies.html
Did you know there is RCT scientific evidence Homeopathy
works?http://www.facultyofhomeopathy.org/research/
Did you know there are some 400 GMC registered colleagues belonging
to the Faculty of Homeopathy, some of whom are even BMA members, who
incorporate Homeopathy in their daily clinical practice?
http://www.facultyofhomeopathy.org/about_us/
Did you know clinical doctors who were initially most
sceptical of Homeopathy (their number includes myself)
having looked into Homeopathy become some of Homeopathy's strongest
advocates?
Did you know Homeopathy is utterly different from a
molecule in a drop in the oceans?
Did you know Digoxin and Ritalin act on Homeopathic
principles?
Did you know there is an undemocratic minority lobby group whose
members comprise the groups Sense about Science and Nightingale
Collabortion who act to remove a person's constitutional right to choose
which form of therapy they seek to help their symptoms with?
The Nightingale Collaboration has published the CAP
guidelines relating to homeopathic advertising drawn up by CAP on Friday,
before these guidelines are even published by the CAP on their own
website!
Did you know there is no single proven effective medical treatment
for any condition with the term 'syndrome' in the diagnosis?
In my practice it is particularly those people with long term
chronic conditions and the 'heartsinks' who appear to have found benefit
from Homeopathy, making my GP working day sweeter.
Patients deserve to continue to be able to access
Homeopathy, which has been available alongside standard
treatment as a complementary therapy on the NHS, since
the inception of the NHS, particularly when your own BMJclinical evidence
data
(http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp)
indicate how inadequate our current knowledge is and
especially at this time of financial difficulty.
Meanwhile research should continue to further advance our
understanding of the effects of Homeopathy which
continues to have real effects in patients' lives.
Yours sincerely
Andrew Sikorski
MBBS MRCGP MFHom.
Competing interests: Dr Sikorski is a conventional NHS GP partner practicing integrated medicine including homeopathy alongside usual care.
I applaud the letter from Bewley et al regarding homeopathy. Times
are hard, and in many medical subspecialties we find ourselves having to
fight our corner on behalf of our patients. In ophthalmology, it has been
a struggle to obtain the anti-VEGF drugs Ranibizumab and Bevacizumab for
our patients, even though there is a wealth of evidence supporting their
efficacy in treating age-related macular degeneration, and the
complications of diabetic eye disease; the former being the most common
cause of blind registration in the developed world, and the latter the
most common cause of blind registration in those of working age.
Against this backdrop, it is infuriating to see NHS resources being
allocated to "treatments" for which the evidence of efficacy is poor to
non-existent. There is no such thing as "alternative" medicine. If a
properly-constructed prospective randomized controlled trial shows that a
treatment works, then it's medicine. If it doesn't, then it's not medicine
and it's not an alternative.
Competing interests: No competing interests
My first reaction to this new body was to welcome any attempt to
bring alternative treatments under the same regulatory and ethical
framework as conventional medicine. This would require application of the
same rigorous criteria of evidence based judgment and critical ethical
review. Establishing a separate regulatory body appears to accept the
argument that there is something unique about these treatments such that
they cannot be expected to conform to these criteria. It implies there is
some other scientific methodology by which they can be tested.
Patients cannot give appropriate informed consent if they cannot be
informed about the likely success compared to conventional treatment.
There is a mistaken assumption that somehow because these treatments
cannot have an active ingredient in the same way as conventional drugs
that they are therefore innocuous and cannot do any real harm. This is a
dangerous assumption if patients are persuaded to give up standard
treatments. There should at least be expected equipoise between
treatments, yet there is little to base such an assumption.
Herbal and Homeopathic treatments need to be brought under the same
regulatory control and ethical review as mainstream medicine. This must
mean getting rid of the mumbo jumbo and finding agreement on appropriate
ways to test them.
Competing interests: No competing interests
Re:The Emperor wears no clothes!?
Dr Sikorski somehow managed to miss the fourth paragraph of my
previous response to him. Here it is again:
"Far from acting to remove anybody's constitutional right to do
anything, the Nightingale Collaboration challenges false and misleading
claims made about unproven healthcare treatments in their promotion
directly to the general public, by those who stand to profit from such
deception."
I understand why he would feel more comfortable with the idea that we
are "acting to remove people's constitutional rights" and that we are
being "vocal about banning" things but, much like his faith in homeopathy
itself, this is a delusion and I note that he makes no attempt to
substantiate it.
We don't need to check our sources. It is not we who decides whether
or not a claim is false or misleading - it is the regulatory bodies. Once
again, I would encourage him to actually read our website, where all this
is explained clearly and at length.
I'm not sure what his point is about Calpol but if there is anything
in its marketing to the public that is misleading, then I suggest he
complains about it using the information we helpfully provide on our
website. Together we can conquer false claims in healthcare advertising!
The figure of 200 complaints was probably accurate back in March.
There have been a few more since then. In fact, it would seem the ASA have
been somewhat overwhelmed by them. Again, Dr Sikorski might find it
helpful to read the ASA's own website, instead of relying on his usual
sources, especially if these are the same sources he relies on for
information about us.
I don't know why he assumes that my complaints about homeopaths were
confined to the limited list of conditions I mentioned previously.
Actually, the homeopaths I complained about did claim to treat all the
conditions he names and dozens more besides.
I dare say readers will be surprised at his interpreting the fact
that I only focussed on one paragraph that misrepresents the Nightingale
Collaboration as meaning that I agree the rest of it.
I do hope that if Dr Sikorski wants to continue this correspondence,
he can manage to do so without repeating any more falsehoods about the
Nightingale Collaboration and what we are doing.
Competing interests: No competing interests