University of Toronto is criticised for study of homeopathy in ADHDBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1234 (Published 05 March 2015) Cite this as: BMJ 2015;350:h1234
All rapid responses
Owen Dyer quotes the concern of critics of the Toronto researchers looking at homeopathic treatment of children and adolescents with a diagnosis of ADHD, that they may be “ ..steering patients away from evidence -based treatments.“
What evidence-based treatments do they refer to ?
What evidence do they have that any such treatments, whether they refer to talking therapies, educational initiatives, or psychoactive drugs, are used as guidelines suggest ?
The critics in Canada , and the BMJ in London, might have turned first to the distinguished editor, now retired, of the New England Journal of Medicine, Marcia Angell.
Angell has written at length (1,2 ) of the extraordinary use and abuse of psychoactive drugs in North America, with particular attention to the over treatment of children with supposed ADHD and bipolar disorder.
She writes that “what should be of greatest concern for Americans is the astonishing rise in the diagnosis and treatment of mental illness in children, sometimes as young as two years old.”
Angell’s reply (3) to those, including the President of the American Psychiatric Association, who were perturbed by her comments, questions whether the benefits of many psychoactive drugs in widespread use, outweigh their harm.
She concludes “ I have spent most of my professional life evaluating the quality of clinical research, and I believe it is especially poor in psychiatry. “
Is the situation in the UK any better ?
McClure recently pointed out that “ ADHD is such a confused and over simplistic and, consequently over diagnosed disorder, that it cannot deliver the certainty that health managers understandably expect on behalf of tax payers. “ He added that ADHD is worth $9billion to drug industry in the USA. (4)
McClure has also quoted (5) a member of the ADHD guideline’s development group, on increasing evidence that methylphenidate “precipitates self harming behaviour in children“ and that “there was no evidence that the drug reduces the long term problems associated with ADHD “.
Timini recently wrote “ As a member of the expert working group and then the lead reviewer for the NICE ADHD guideline, it became clear to me that evidence counted little compared to opinions of the guideline group members .” (6)
Methlyphenidate causes growth retardation. It is given, often for years, while crucial neuronal development occurs, and synapses are being established, in the prefrontal and frontal cortex.
Hard pressed conscientious doctors and staff in underfunded CAMHS clinics have long waiting lists and short consulting times. GPs may be unaware of other options when they are advised to prescribe psychoactive drugs to children and young people .
Little wonder that homeopaths are often sought out by distressed families and teachers, who have reservations about conventional long term medication for problematic children.
If people were more aware of the good results we regularly see, the steady trickle might become difficult to manage.
1 The Epidemic of Mental Illness : Why ? New York Review of Books, June 23, 2011
2 The Illusions of Psychiatry, New York Review of Books, July 14, 2011
3 ‘The Illusions of Psychiatry’ : An Exchange, New York Review of Books, August 18, 2011
4 Why are we failing young patients with ADHD ? BMJ 2014;349:g6082
5 Prescribing methylphenidate for moderate ADHD BMJ 2013;347:f6216
6 Prescribing methylphenidate for moderate ADHD BMJ 2013;347:f6216
Competing interests: Unpaid advisor to homeopathic projects. No private practice.
Bravo for a well written article. Too many of these skeptics post wild accusations that have no merit, hoping repetition will encourage belief. Thank you Christopher Johnson!
Competing interests: No competing interests
No one should be fooled by the supposed "controversy” about the ADHD study in preliminary stages at the University of Toronto. The letter, written by Joe Schwarcz at McGill University and signed by 90 scientists, protesting this trial is just the latest in a centuries-long line of actions undertaken by foes of homeopathy to damage its name and social standing. Of course these would-be vigilantes always claim their efforts are meant to “protect the public” and “support sound science,” but history teaches otherwise.
The very first prospective clinical trial of homeopathy (Stapf, 1821), which took place at Charité Hospital in Berlin, was halted prematurely by medical authorities after it became clear the patients were benefitting from the treatment. (1) The second homeopathic trial (Wislicenius, 1821), also conducted in Berlin, at the Garrison Hospital was allowed to run to completion but the recorded (positive) data were subsequently seized by hospital authorities without explanation and were never published. (1) And so on. Of the twelve clinical trials conducted between 1821–1835 eight were subject to blatant interference from allopathic medical authorities, two were performed by allopathic doctors who had no clue how to practice homeopathy and two suffered no meddling. Nearly all of these trials showed positive results for homeopathy (even those subject to brazen attempts at sabotage). (1)
This sort of research mischief has occurred unmitigated since that time with malfeasance in the modern era taking on somewhat subtler dimensions—e.g. the Shang trial (2005) in which the methodology was adjusted post-hoc, statistical procedures were inappropriately applied and numerous meta-analytic research standards egregiously violated in order to arrive at a result allegedly demonstrating homeopathy’s inefficacy. (2) In all of these cases great effort has been taken by homeopathic critics to alert the public about these “conclusive” results demonstrating that homeopathy does not work.
In considering this historical record we should remember that allopathic medicine of the 19th century was not only utterly ineffective but was in most cases actively harmful to patients – often resulting in gross morbidity and/or death. On what grounds then, did medical authorities criticize and attack homeopathy? These critics were either ill-intentioned or in the most benign reading, ill-informed. When we understand this, we can begin to contextualize recent events.
Although allopathic medicine of the present era is unquestionably improved over the 19th century, homeopathy remains as effective as ever and has not been bested in any direct comparative trials with allopathy. In fact, the opposite is more often the case. (3) In recent years, as the quantity and quality of homeopathic research has increased, so too has action from a small number of vocal critics to curtail this progress (just as in numerous eras in the past). Given that the basic science research now shows clearly that homeopathic remedies have biological effects (4,5) and given that the body of clinical research provides increasing evidence of homeopathy’s effectiveness and efficacy, foes of homeopathy are left one last firewall—to simply stop further performance of homeopathic trials. They have been attempting to accomplish this by voicing “ethical” concerns, which they hope will pressure institutions to avoid conducting studies. (6) Of course these “ethical” concerns are based on a false premise—that homeopathy has been shown to be inefficacious.
In the case of homeopathic treatment of ADHD, many high quality trials have been conducted and nearly all are positive – including three randomized, controlled trials (7,8,9) and a ten-year follow up study in which the homeopathic group had greater sustained improvement than the stimulant medication group. (10) The idea that it is unethical to further study this very promising treatment is of course, absurd. And given what we know from history, we should view with extreme skepticism Dr. Schwarcz and friends’ supposed concerns.
1. Dean ME. History of Homeopathic Trials – Origins, Structure and Development. Essen, Germany: Karl and Veronica Carstens Publishing House, 2004:101-112.
2. Shang A, Huwiler K, Nartey L, et al. Are the clinical effects of homeopathy placebo effects? Comparative study of placebo-controlled trials of homeopathy and allopathy. Lancet 2005;366:726-732.
3. Sinha MN, Siddiqui VA, Nayak C, et al. Randomized controlled pilot study to compare Homeopathy and Conventional therapy in Acute Otitis Media. Homeopathy 2012;101(1):5-12.
4. Sainte-Laudy J, Belon P. Inhibition of basophil activation by histamine: a sensitive and reproducible model for the study of the biological activity of high dilutions. Homeopathy 2009;98(4):186-97.
5. Witt CM, Bluth M, Albrecht H, Weisshuhn TE, Baumgartner S, Willich SN. The in vitro evidence for an effect of high homeopathic potencies--a systematic review of the literature. Complement Ther Med 2007;15(2):128-38.
6. Shaw DM. Homeopathy is where the harm is: five unethical effects of funding unscientific ‘remedies’. J Med Ethics 2010;36(3):130-1.
7. Frei H, Everts R, von Ammon K, et al. Homeopathic treatment of children with attention deficit hyperactivity disorder: a randomised, double blind, placebo controlled crossover trial. Eur J Pediatr 2005;164(12):758-67.
8. Praveen Oberai, S Gopinadhan, Roja Varanasi, et al. Homoeopathic management of attention deficit hyperactivity disorder: A randomised placebo-controlled pilot trial. Indian J Homeopathic Med 2013;7(4):158-167.
9. Lamont J. Homeopathic treatment of attention deficit disorder. Br Homeopath J 1997 Oct;86:196-200.
10. Von Ammon K, Sauter U, Kretschmar S, et al. Long term effects of homeopathic treatment in children suffering from attention deficit disorder with and without hyperactivity. Int J High Dilution Res 2013;12(44):119-120.
Competing interests: No competing interests