Good medicine: homeopathy
BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e6184 (Published 14 September 2012) Cite this as: BMJ 2012;345:e6184
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Michael H Stone writes: "As someone whose degrees are in chemistry, the idea that pure water 'has some sort of memory'is something that would completely upturn the physical sciences if it were correct: the 'history of tapwater' would also be a terrifying unknown!"
Personally I don't feel that 'upturning the physical sciences' is a negative thing or 'a terrifying unknown.'
I wonder what Mr Stone has to say about recent news that scientists from Harvard and MIT have managed to create molecules formed from photons bound together. The discovery goes against what scientists have previously believed to be the signature quality of photons: that they are massless particles that do not interact with each other. The capacity to create molecules out of photons has been described by the physicists involved as “pushing the frontiers of science”.
Surely this is what science ought to be about is it not? Surely science is NOT about maintaining the status quo and fearing the terrifying unknown. It seems evident from Mr Stone's comment that he falls into the category of maintaining the status quo and being uninterested in new discoveries and possibilities and sadly he is not alone in his attitude. Perhaps if he were to open his mind to new discoveries he might learn something instead of living in fear of scientific advancement.
http://www.sciencedaily.com/releases/2013/09/130925132323.htm
http://www.newscientist.com/article/dn3817-icy-claim-that-water-has-memo...
Competing interests: No competing interests
I think L Sam Lewis, GP, was probably right, but all of these discussions about homeopathy, need to be clear about the question being asked.
As someone whose degrees are in chemistry, the idea that pure water 'has some sort of memory'is something that would completely upturn the physical sciences if it were correct: the 'history of tapwater' would also be a terrifying unknown !
But 'does the process of homeopathy' generate patient improvement, is a different question from 'does pure water which was specially prepared have a clinical effect'.
And that distinction, has to be kept in mind - although, my personal postion is generally 'negative' towards homeopathy compared to 'conventional' treatments being paid for by the NHS.
Competing interests: No competing interests
JK Anand said:
""Nightingale" I presume refers to Miss Florence Nightingale of Crimea? She cleaned up the mess made by doctors, if I recall history correctly."
Florence Nightingale is - rightly - well known for her many nursing endeavours. She is perhaps less well known publicly for her contribution to the field of statistics: she was the first elected female member of the Royal Statistical Society [1] and an honorary member of the American Statistical Association. [2] She invented a version of chart called the Nightingale rose diagram (also called a polar area diagram) that she used to illustrate some of the results she produced in her many reports (and Royal Commission) on sanitation and health.
However, interesting as she is (and I can highly recommend a visit to the Florence Nightingale Museum next to St Thomas's Hospital in London [3]), this is a distraction from the topic at hand: the lack of good evidence for homeopathy.
1 “The Royal Statistical Society.” 2013. Accessed July 9. http://www.rss.org.uk/site/cms/contentCategoryView.asp?category=42.
2 “The First 160 Years.” 2013. Accessed July 9. http://www.amstat.org/about/first160years.cfm.
3 “The Florence Nightingale Museum - Home.” 2013. Accessed July 9. http://www.florence-nightingale.co.uk/.
Competing interests: Director of the Nightingale Collaboration, which challenges misleading healthcare claims.
Thank you.
Now I will be in a mood to read your original letter.
"Nightingale" I presume refers to Miss Florence Nightingale of Crimea? She cleaned up the mess made by doctors, if I recall history correctly.
Some years later, a "mere chemist" by the name of Louis Pasteur invented the first antirabies vaccine. Then the medical fraternity gave him a medical licence - without examining him in anatomy, physiology or pharmacology etc.
JK Anand
Competing interests: No competing interests
JK Anand said:
"I wonder if in the discussions on this site we could dispense with words such as "infamous"?"
Indeed, and my apologies for that. I used the word as an indication of the level of abuse this report has achieved in terms of its citation as overwhelming support for homeopathy by the 'neutral' Swiss Government, when it is clearly no such thing. I give several examples of this on my blog. [1] As I stated, an official from the Swiss Government publicly corrected some of these misunderstandings. [2]
1 “That ‘neutral’ Swiss Homeopathy Report | Zeno’s Blog.” 2013. Accessed January 29. http://www.zenosblog.com/2012/05/that-neutral-swiss-homeopathy-report/.
2 Gurtner, F. 2012. “The Report ‘Homeopathy in Healthcare: Effectiveness, Appropriateness, Safety, Costs’ Is Not a ‘Swiss Report’.” Swiss Medical Weekly (December 17). doi:10.4414/smw.2012.13723. http://www.smw.ch/content/smw-2012-13723/.
Competing interests: Director of the Nightingale Collaboration, which challenges misleading healthcare claims.
I wonder if in the discussions on this site we could dispense with words such as "infamous"?
Notorious, discredited, disgraced, infamous, distinguished, award-winning - leave me unimpressed.
Competing interests: No competing interests
Zetetic150 said:
"The most comprehensive systematic review is the German report, commissioned the Instute KIKOM showing that homeopathy works beyond the placebo. Ernst and D. Sahw tried to attack the study, however the authors of the report refuted each of their claims."
This would appear to be a reference to the infamous Swiss - not German - Government homeopathy HTA (as it is commonly referred to by homeopaths), which was neither published by the Swiss Government nor was an HTA.
Neither was it a systematic review, but a limited literature review in which the authors (mainly homeopaths, two of whom were associated with KIKOM, the Institute for Complementary Medicine) chose to 're-interpret' the conclusions of previous meta-analyses, in the direction of being more positive of homeopathy. This re-assessment was criticised by the PEK (Programm Evaluation Komplementärmedizin) set up by the Swiss Government to assess the evidence for homeopathy in terms of appropriateness, comparative effectiveness, risk-benefit-ratio and cost-effectiveness. The Shang et al. matched trials and meta-analysis was another part of the PEK's overall investigation into homeopathy and other alternative therapies.
However, the homeopathy report, eventually published in English in 2011 [1], wasn't even the same report that was submitted to the PEK, but one that was added to by its editors. Felix Gurtner of the Federal Office of Public Health FOPH, Health and Accident Insurance Directorate, Bern, Switzerland stated it was:
"a broad analysis of the literature incorporating publications and unpublished reports on studies of various methodologies (randomised and non-randomised trials, case series, experimental studies). This review was declared to be an HTA by the authors (the final PEK report does not classify the literature reviews as HTA reports) and published later as a book under their responsibility without any consent of the Swiss government or administration. The book by Bonhöft and Matthiessen was later translated into English and published in 2012." (Reference numbers removed to avoid confusion.) [2]
The PEK disagreed with the somewhat rosy tint that the report's authors put on homeopathy and, as a result, the Swiss Government removed homeopathy from its state reimbursement scheme. It wasn't until after much campaigning and a referendum that the Government agreed to allow reimbursement, but only for a temporary period with the condition that unless scientific evidence for homeopathy was provided by 2015, reimbursement would finally end in 2017.
So, even though Ernst criticised the report, [3] it was the Swiss Government PEK that first and most damningly criticised it, saying:
"For all five assessments, it is very obvious that all or some of the authors have a positive attitude towards the treatments in question or are convinced about their efficacy. Unquestionably, strict proponents of the usual hierarchy of evidence will regard the presented evaluations as scientifically untenable and unreasonably positive (except for some specific aspects of phytotherapy). Even less skeptical academic doctors will regard many interpretations as very optimistic and not scientifically convincing."
and
"The positive interpretation of the current evidence seems understandable, as long as one does not require especially high evidence standards, given the low plausibility of homeopathy in the light of established scientific knowledge. Very skeptical people will regard the reviewed evidence as not very convincing." [4]
In response to the report's authors' comments that Zetetic150 mentions, Ernst said:
"I am grateful to the authors of this response. A careful assessment of their arguments will convince any critical evaluator that the HTA is, in fact, a thinly disguised attempt to generate a positive overall impression for homeopathy in the absence of convincing evidence for its therapeutic value." [5]
Zetetic150's 'comprehensive systematic review...showing that homeopathy works beyond the placebo' is nothing of the sort and I wait with bated breath to see what scientific evidence is presented to the Swiss Government in 2015.
1 Bornhöft, Gudrun, Peter F Matthiessen, and SpringerLink (Online service). 2011. Homeopathy in Healthcare -- Effectiveness, Appropriateness, Safety, Costs an HTA Report on Homeopathy as Part of the Swiss Complementary Medicine Evaluation Programme. Berlin: Springer. http://dx.doi.org/10.1007/978-3-642-20638-2.
2 Gurtner, F. 2012. “The Report ‘Homeopathy in Healthcare: Effectiveness, Appropriateness, Safety, Costs’ Is Not a ‘Swiss Report’.” Swiss Medical Weekly (December 17). doi:10.4414/smw.2012.13723. http://www.smw.ch/content/smw-2012-13723/.
3 Edzard Ernst. 2012. “A Critique of the Swiss Report Homeopathy in Healthcare - Ernst - 2012 - Focus on Alternative and Complementary Therapies - Wiley Online Library.” Accessed June 2. http://onlinelibrary.wiley.com/doi/10.1111/j.2042-7166.2012.01160.x/full.
4 “That ‘neutral’ Swiss Homeopathy Report | Zeno’s Blog.” 2013. Accessed January 29. http://www.zenosblog.com/2012/05/that-neutral-swiss-homeopathy-report/. Swiss German translations by Sven Rudloff.
5 Ernst, Edzard. 2013. “Response from Edzard Ernst.” Focus on Alternative and Complementary Therapies 18 (2): 110–110. doi:10.1111/fct.12025_2.
Competing interests: Director of the Nightingale Collaboration, which challenges misleading healthcare claims.
Angela Kennedy, like so many 'postmodernists' puts 'science' in parenthesis, and raises the irrelevant matter of beliefs.
In a fight between believers in Santa and believers in Easter Bunnies, a knockout is still a knockout. A blinded RCT with pre-specified scoring points will decide the winner.
Whether or not homoeopathy is superior to placebo seems to me to depend on whether we compare bottle H versus bottle P as the only difference, or is the homoeopathic history-taking and other influences to be included. I reckon I could improve my GP consulting outcomes just by taking an extra 10 minutes of active listening.. probably more effectively than many of my prescriptions ! I would be very happy to give placebos wherever an RCT had shown equivalence, but wonder if I could keep a straight face whilst offering 10c Arnica.
Competing interests: No competing interests
Many meta analysis in homoeopathy so far have shown that homeopathy does more than placebo. The meta analysis of Shang et.al. demonstrates the placebo response, except in URTI affections. Latter, Rutten, Stolper and others publish two re-analysis demonstrating that Shang results are 1) Less conclusive of the originals, and 2) Demonstrating, the falsification of the null hypothesis.
Other systematic reviews, in example, Ernst in BJP concludes:
"In conclusion, the hypothesis that any given homeopathic remedy leads to clinical effects that are relevantly different from placebo or superior to other control interventions for any medical condition, is not supported by evidence from systematic reviews. Until more compelling results are available, homeopathy cannot be viewed as an evidence-based form of therapy."
But, the conclusion of this study is based in few and poor analysis about studies in Linde (1997). Ernst forced the findings of his study by the omission of the double-blind studies about of oscilloccinum, in example Ferley and Papp. Ernst also fails to say that no plausible mechanisms of homeopathy, despite the existence of studies, by Prof. Igor Jerman, in 1997 to support the findings of Benveniste, Spira, Lavallé, DelGuidice, Wiegant, VanWijk, Lobyshev, etc..
The most comprehensive systematic review is the German report, commissioned the Instute KIKOM showing that homeopathy works beyond the placebo. Ernst and D. Sahw tried to attack the study, however the authors of the report refuted each of their claims.
In 2007 a meta-analysis published by the U. of Colombia exchange facts, showed that homeopathy works beyond the placebo. Unfortunately the study accepted for publication seem "uninteresting".
Competing interests: No competing interests
Re: Good medicine: homeopathy
Sarah Martin misunderstands the nature of the science that conflicts with homeopathy.
The ability to create molecules from photons is an interesting effect predicted in advance and then proven by experiment using very high energies. It does indeed push the frontiers, but it does not overturn science.
Homeopathy, by contrast, posits effects that genuinely would overturn very large parts of science which underpin such everyday items as GPS and lasers.
There is no need to worry, though, because science already has a complete and coherent explanation for all the observed effects which is both internally and externally consistent. Homeopaths refuse to accept this explanation but have nothing to offer in its stead other than appeals to unverified or refuted concepts.
Homeopathy offers no new discoveries to which the mind might reasonably be opened. It is homeopaths, not scientists, who refuse to open their minds to new facts (such as the refutation of the "laws" of infinitesimals and similia towards the end of the 19th Century) and instead push the "status quo" in the form of outdated doctrines which are increasingly obviously founded on belief not empirical reality.
Homeopathy has exactly the same scientific status as do the origin of life by special creation and geocentric cosmology. It is a field based on fervent belief but divorced from reality.
Competing interests: No competing interests