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Homeopaths Without Borders practice exploitation not humanitarianism

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f5448 (Published 17 September 2013) Cite this as: BMJ 2013;347:f5448

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Re: Homeopaths Without Borders practice exploitation not humanitarianism

Unfortunately, Christine Jahnig appears not to have fully understood the points to which she is replying. I crave your indulgence in clarifying these

The "findings of the Swiss HTA" are not "findings of a Swiss HTA". This claim is specifically refuted by Dr. Gurtner of the Swiss Federal Office of Public Health (http://www.smw.ch/content/smw-2012-13723/). The process of review of complementary and alternative medicine (PEK) resulted in the withdrawal of funding for homeopathy: this would not have happened if the report were as Ms. Jahnig characterises it.

It is not unreliable because it was written by homeopaths, it is unreliable because it reverses the hierarchy of evidence in order to reach a predefined conclusion, and because the authors have a material and undeclared conflict of interest (http://www.smw.ch/content/smw-2012-13594/), and of course because it is not the document homeopathists claim it to be (http://www.zenosblog.com/2012/05/that-neutral-swiss-homeopathy-report/).

To say that Bornhöft et. al analysed all of the homeopathy literature is to miss the point: Linde et. al (http://www.ncbi.nlm.nih.gov/pubmed/10391656) eloquently describe the relationship between poor study methodology and positive outcome in homeopathy trials. Bornhöft et. al. fail to make this connection. Many of the studies they consider to be good, lack blinding, controls or some other fundamental component of sound science, and they themselves make clear that their self-appointed task is to find a way of justifying homeopathy despite the lack of plausible mechanism, rather than to critically evaluate whether it is efficacious. The authors posit "cognition based medicine" as an alternative to evidence-based medicine, in order to allow subjective (including placebo) effects to be counted as evidence of efficacy. This is, to put it mildly, controversial.

In fact, evidence-based medicine already gives homeopathy an easier ride than it should. Ioannidis (http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0020124) describes why an inert treatment will always end up with a body of evidence showing a weak positive effect. It is telling that the US National Center for Complementary and Alternative Medicine (NCCAM) is no longer funding trials of homeopathy (http://scienceblogs.com/insolence/2012/11/19/the-success-of-nccam-grants...) and concludes that there is "little evidence to support homeopathy as an effective treatment for any specific condition" (http://nccam.nih.gov/health/homeopathy).

NCCAM has spent at least a billion dollars evaluating alternative treatments, including homeopathy, and has yet to validate a single one.

Ms. Jahnig seems to think that criticism stems from a "bias against homeopathy" This is an easy mistake to make, but a mistake nonetheless. Criticisms of homeopathy stem not from a bias against it, but from the application of normal standards of scientific rigour. This is "biased against homeopathy" in the same way that evolutionary biology is biased against young-Earth creationism. Beliefs that are claimed to be scientific, but fail the basic tests of scientific inquiry, are apt to be rejected by a large majority of the scientifically literate.

There is only one standard. That is why the All Trials initiative (http://www.alltrials.net/) exists. Simon Singh and Ben Goldacre, both of whom have written well known debunkings of homeopathy, are among the driving forces behind that initiative.

A homeopathy study will typically start by stating that homeopathy is popular, has been around for 200 years, and is based on the idea that like cures like and dilution increases potency. A scientific review will begin by noting that despite its popularity and age, there is no evidence that like cures like or that dilution increases potency. Bornhöft et. al. started from the premise that homeopathy works and set about assembling a hierarchy of evidence to support that belief, scientific reviews such as Linde and Shang et al. (http://www.ncbi.nlm.nih.gov/pubmed/16125589) explore what the data actually says and find that the evidence for homeopathy is weak, consistent with the null hypothesis.

If you remove the starting assumption that homeopathy is valid and ask not "how can I show this to be true?" but "is this true?" you get an answer the homeopaths don't like. This is their problem, not that of science.

It does not matter how often homeopaths claim that this is a Swiss HTA report and convincingly demonstrates that homeopathy is safe and effective, the responsible official specifically states that it isn't, and doesn't.

One final point: Homeopathists do not get to decide who may and may not comment on their beliefs, as Ms Jahnig appears to wish. Poisoning of the well aside, Gurtner's criticisms of the Bornhöft report are, if anything, more damning than Shaw's. The Chief Medical Officer and the Chief Scientific Advisor are also on record as rejecting the claims of homeopathy in robust terms.

There is no conspiracy, homeopathy is simply wrong, like pretty much every other medical belief of its time. We no longer use purging or blistering or bloodletting to balance the humours, so there is no longer a valid place for doing nothing as an alternative to these practices.

Competing interests: No competing interests

14 October 2013
Guy Chapman
Engineer
None
Reading, UK