Homeopathy: Can we believe what we hear?

The BBC Radio Four Today programme interviewed one Dr Peter Fisher (Clinical Director and Director of Research at the Royal London Hospital for Integrated Medicine and a Fellow of the of the Faculty of Homeopathy) this morning (2015-11-13 beginning at 01:33:39).

When pressed on the scientific evidence for homeopathy (the subject of the interview) Dr Fisher had this to say:

"The most recent analysis of all clinical trials of homeopathy conducted by the Robertson Centre for Biostatistics at the University of Glasgow came to a clearly positive result that was published last December."

I thought I might take a look at this paper, so I tweeted Dr Fisher:

.@PeterAGFisher Please could you provide a link to (or ref for) the (+ve for homeopathy) meta-analysis you mentioned on the wireless?

— Dr Mike Ward (@Schroedinger99) November 13, 2015

Dr Fisher kindly got straight back to me:

@Schroedinger99 @PeterAGFisher Sure will dig out and send later. Peter Fisher

— Dr Peter Fisher (@PeterAGFisher) November 13, 2015

I think if I were going on the wireless to cite a scientific paper I should have grabbed hold of a copy beforehand - just to be on the safe side. But perhaps Dr Fisher has a better memory than me. Let us see.

I am still waiting for Dr Fisher to dig out his copy of the paper and send me a link or a reference so I thought I might try and track it down myself.

First port of call The Robertson Centre for Biostatistics at the University of Glasgow. No publications there at all concerning homeopathy - in 2014. So I checked 2015 and 2013 just to be on the safe side. No joy.

I tried another tack and googled "Robertson Centre for Biostatistics" Homeopathy. This led me to this page of the British Homeopathic Association which cites a "Systematic review and meta-analysis of randomised controlled trials (RCTs) in homeopathy". This page and my google search both pointed to the paper below - all roads lead to Rome it seems.

Randomised placebo-controlled trials of individualised homeopathic treatment: systematic review and meta-analysis Robert T Mathie1*, Suzanne M Lloyd2, Lynn A Legg3, Jürgen Clausen4, Sian Moss5, Jonathan RT Davidson6 and Ian Ford2

* Corresponding author: Robert T Mathie rmathie@britishhomeopathic.org

Author Affiliations

1 British Homeopathic Association, Luton, UK

2 Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK

3 Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK

4 Karl und Veronica Carstens-Stiftung, Essen, Germany

5 Homeopathy Research Institute, London, UK

6 Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA

This paper is dated 2014 December and refers to the Robertson Centre for Biostatistics, University of Glasgow and is a meta-analysis of homeopathy studies. I'm sticking my neck out and assuming this is the paper which Dr Fisher referred to ..... but just to be on the safe side I tried to double-check:

@PeterAGFisher perhaps you are referring to this paper: https://t.co/7C2WGJ8vy6 - that isn't from Robertson Centre, but one of 6 authors is

— Dr Mike Ward (@Schroedinger99) November 13, 2015

So far I have not been vouchsafed a reply. If I do hear from Dr Fisher I shall be more than happy to revisit what I say below - should this prove to be the wrong paper.

Assuming it is the right paper, let us list the claims made for it (each in turn):

1. This paper analyses "all clinical trials of homeopathy".
2. The analysis was "conducted by the Robertson Centre for Biostatistics at the University of Glasgow".
3. This paper "came to a clearly positive result".

Does this paper analyse all clinical trials of homeopathy?

No. It analyses some clinical trials of individualized homeopathy. In other words, it does not analyse clinical trials of the homeopathic remedies that the vast majority of people who avail themselves of this type of product consume. It analyses a small subset of trials which involve homeopathic prescriptions individually specified by dedicated homeopaths. We might note here that it is intrinsically more difficult to conduct large scale blinded randomized trials on groups of patients receiving individualized treatments than it is when all patients are receiving exactly the same treatment - especially when that treatment is in the form of tablets. But let's defer judgement on the trial itself. (please see note [1] below)

Was the analysis conducted by the Robertson Centre for Biostatistics at the University of Glasgow?

No. The paper is not listed by the Robertson Centre for Biostatistics as one of its publications. The paper has six authors, one of whom - Suzanne M Lloyd (a statistician) - works at the Centre. The copyright for the paper is actually held by Robert T Mathie of the British Homeopathic Association. Mathie is also the corresponding author.

Oh well, perhaps Dr Fisher just got his words a bit muddled. I probably would if I had to appear on the wireless first thing in the morning. Let us ask the most important question:

Did the paper come to a clearly positive result?

You be the judge:

Conclusions

• There was a small, statistically significant, treatment effect of individualised homeopathic treatment that was robust to sensitivity analysis based on ‘reliable evidence’.
• Findings are consistent with sub-group data [klaxon alert!] available in a previous ‘global’ systematic review of homeopathy RCTs.
• The overall quality of the evidence was low or unclear, preventing decisive conclusions.[my emphasis]
• New RCT research of high quality on individualised homeopathy is required to enhance the totality of reliable evidence and thus enable clearer interpretation and a more informed scientific debate.

A "clearly positive result"? (Even before we analyse whether the evidence presented really supports even these highly tentative conclusions - something I'd like to do later if I get time.[1]) I think the man on the Clapham omnibus would probably conclude that this question deserves a resounding "no" too.

Over to you Dr Fisher!

PS If you listen to the clip you'll hear Dr Simon Singh (@SLSingh) putting the case for science (on behalf of The Good Thinking Society @GoodThinkingSoc) and I should urge anyone not familiar with the arguments surrounding so called "alternative medicine" to read the excellent "Trick or Treatment?: Alternative Medicine on Trial" by him and Prof Edzard Ernst (@EdzardErnst).

[1] Alan (please see comment below) has drawn my attention to this discussion of the paper cited by Dr Fisher which is well worth a read and saves me having to fillet this particular fish myself. And this discussion is followed up with a more definitive analysis of flaws in the paper by Prof Edzard Ernst here: HOMEOPATHY: proof of concept or proof of misconduct?.