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?.

BBC Apologizes (a bit) for Promoting Quackery

Sorry, no time to write this up properly, but here's the complaint I submitted to the BBC about an item in a programme called "Melvyn in the Morning" transmitted by BBC Radio Lincolnshire on 24 January 2013:

Complaint Summary:

unchallenged promotion of bogus cancer treatments

Full Complaint:

The section of the programme between ~11:05 and ~11:35 contained a series of interviews with people who sell homeopathy and other quack treatments and people who claimed to have benefited from such treatments. One of the claims made was that such treatments are preferable to conventional medical treatment for cancer. If someone selling homeopathy made such claims on a website or advertisement, he or she would actually be breaking the law. None of the claims were discussed on the programme by anyone with scientific or medical knowledge. In short, the behaviour of this radio station was deeply unethical and irresponsible. When it comes to potentially fatal medical conditions, quackery promotion kills. Claims like this should never be broadcast without being challenged by someone who knows what they are talking about.

And the reply which I received

Dear Dr* Ward

Thanks for contacting us and apologies for the delay in getting back to you.

We raised your concerns with the Managing Editor of Radio Lincolnshire, Charlie Partridge, who has responded as follows:

“Dear Doctor Ward,

As Managing Editor of BBC Radio Lincolnshire I have reviewed the part of Melvyn Prior’s programme, broadcast on 24th January 2013, to which you refer. The context is that the Chief Medical Officer had been critical of homeopathic medicine which led the programme team to wonder what listeners’ experience of homeopathic and alternative medicines had been. Melvyn invited callers to tell him.

The segment to which you refer started with a call to a local registered homeopath, known to the programme, during which Melvyn discussed what homeopathy is and what it could be used for. The Chief Medical Officer’s views were explained to listeners clearly and consistently, giving a context to the contrary opinions being expressed. The other callers were all listeners to the programme with their own honestly held views. One caller said that her chest problems had been cured after using homeopathic remedies, another caller, herself a registered homeopath, discussed her view that homeopathy could help prevent things like hay fever. She was also quite specific that people should always consult their GP and that homeopathy should never replace conventional medicine. One caller referred to her daughter in law in the USA who’d had surgery for breast cancer and who had decided not to take the prescribed post- operative medicine for fear of side effects, and who had, instead, sourced some “ anti-cancer” pills from the internet. The caller said that her daughter in law was now well.

Later in the programme Melvyn read out an email critical of homeopathy. [I did not hear this]

Having listened in detail, I believe that the programme segment could not be construed as an endorsement of homeopathy, and was clearly intended as a platform for discussion of the Chief Medical Officer’s widely-reported comments. However I do think that at times, the presenter was insufficiently challenging, particularly to the assertions of the “breast cancer” caller. Melvyn could have been more assertive in the light of the lack of scientific evidence for homeopathy. [my emphasis]

I have discussed this with the programme team and have asked them to bear this in mind in future programmes. We will seek to put the balance right in a future programme. I would also add that had you called the programme we would have been delighted to put you on air to put your side of the debate.

Thank you for taking the time to share your views with us. We welcome this type of feedback, and do use it to inform future decisions about our programmes.”

We hope this goes some way in addressing your concerns, thanks again for taking the time to contact us.

Kind Regards

BBC Complaints

There are a number of points here that I should take issue with, but I was pleased to read the words I have highlighted.

NB The caller who referred to her daughter in law in the USA reported that her daughter was advised to take Tamoxifen and had eschewed this in favour of homeopathic "remedies" (ie sugar). I don't have any real objection to the BBC broadcasting such anecdotes, but given the very real danger that other cancer sufferers might follow the example set by the caller's daughter and suffer an untimely death as a result, it was incumbent on the BBC to counter this anecdote with some science-based advice.


*non clinical

Woo in the Telegraph

Someone may die after reading this tosh!

Article about treating ovarian cysts with magic water

Sir
It is grossly irresponsible of the Telegraph to publish an article like this without any accompanying opinion from a genuine health professional.
If people choose to “treat” their hay-fever using “homeopathic medicines” (i.e. “medicines” with no ingredients) that’s fine by me. If people choose to treat their ovarian cysts using “homeopathic medicines”, they could die.
Yours faithfully
Dr Schroedinger99

Footnote to anyone reading this who might be inclined to believe that there is something in homoeopathy:

Let’s take one of the remedies mentioned: Nux Vomica. This is an extract from the Strychnos Nux Vomica tree which contains a number of highly poisonous alkaloids – none of which, to my knowledge, have any useful role in the treatment of hangovers. Fortunately for Annabel Croft, homoeopaths do not supply this extract in its pure form. They dilute it first. They really really dilute it:

As you will find if you follow the http://www.healthroughhomeopathy.com/ link for this article: “Over the counter remedies tend to come in 6c and 30c potencies. A solution labelled as '6c' has been diluted six times at a ratio of one part substance to 99 parts alcohol and water, whereas a solution labelled as '30c' has been diluted 30 times at a ratio of one part substance to 99 parts alcohol and water. 6c potency is typically used for long standing conditions, such as rheumatic pain. 30c potency is typically used for first aid or acute situations, such as the onset of a cold or bruising after a knock or fall.”

What this means is that homeopathic Nux Vomica with a potency of 6c has one part Nux Vomica to 100 to the power 6 parts alcohol and water – eg 1 ml Nux Vomica in 1000000000000 ml of alcohol and water; homeopathic Nux Vomica with a potency of 30c has one part Nux Vomica to 100 to the power 30 parts alcohol and water – eg 1 ml Nux Vomica in 1000000000000000000000000000000000000000000000000000000000000 ml of alcohol and water (which won’t even display on my calculator).

(I hope I've got these figures right, but, hey, I could be out by several million and still make the same point)

This alcohol and water is sprinkled onto pillules (typically containing lactose) and these are then dried – ie the alcohol and water is allowed to evaporate. The pillules can then “be dissolved in warm water” (I am not making this up) which the patient can (presumably) either drink or dilute 1000000000000000000000000000000000000000000000000000000000000 times and begin the whole process again.

Anyone who believes that these remedies could possibly have any effect is, IMHO, in serious need of clinical help.

I suppose, to be fair, I should at least consider the possibility of "water memory":

It has been suggested that one way to explain the alleged efficacy of homoeopathic remedies may be that water somehow "remembers" what used to be in it. There is, in should be noted, no scientific evidence for such a mechanism or for the efficacy of homoeopathic remedies, but I think it is also worth pointing out that the notion of "water memory" is inherently implausible.

For example:

* The tap waster we all drink has had all sorts of things removed from it and would be extremely hazardous if it "remembered" those constituents in the sense suggested by homoeopathy.

* There are (I suppose) chemicals that "remember" other chemicals (in a certain sense) like antibodies; but injecting someone with rabies antibodies will not produce a similar effect to injecting someone with rabies antigens.

* Even if we allowed water to "remember" what had been in it, how are we to explain the transfer of that memory to pills (which may be made of lactose or calcium carbonate or almost anything and which have lost all the water put on them to evaporation) and from the pills back to water?