Blinded by pseudo-science?

This article was posted on twitter under the #ten23 hashtag today by a homeopath (who shall remain nameless), who perhaps thought that this was good evidence to cite for homeopathy being superior or at least preferable to conventional treatment of bacterial infection by antibiotics.

The article contains one line which caught my eye:

Research shows that homeopathy can serve as an effective alternative to antibiotics in a range of infectious conditions for which they have been commonly used5-13.


WOW! – look at that – “5-13” – that’s 9 references to back up 1 point – must be an important one!

Let’s take a closer look at these articles that show that “homeopathy can serve as an effective alternative to antibiotics“:

5. Adler M. Efficacy, safety of a fixed-combination homeopathic therapy for sinusitis. Adv Ther 1999; 16: 103-111.

Abstract says: (Note I was unable to obtain the full paper as I hit a 404-wall for this journal.)

The average treatment duration was 2 weeks. At the end of treatment, 81.5% of patients described themselves as symptom free or significantly improved. Adverse drug effects were not reported.

Hmm, NHS says:

Sinusitis often clears up by itself, and about two thirds of those who get the condition do not need to see their GP.

On average, sinusitis takes about two-and-a-half weeks to clear.

Over-the-counter painkillers and decongestants can be used to relieve facial pain and a blocked nose. Antibiotics are unlikely to help unless the sinusitis becomes chronic (persistent).

So, the NHS say that on average, sinusitis will sort itself up after 2 and a half weeks, and the majority of sufferers do not need to see a medical practicioner.

In the homeopathic study – 100% of sufferers saw a homeopathic practioner, and 81.5% of them were better than significantly improved after treatment.

So no improvement on no treatment at all. Hmm.

NEXT!

6. De Lange de Klerk E, et al. Effects of homoeopathic medicines on daily burden of symptoms in children with recurrent upper respiratory tract infections. BMJ 1994; 309: 1329-1332.

Ooh! BMJ. A real journal. And it looks promising! ” Design : Randomised double blind placebo controlled study.

Paper Concludes:

CONCLUSION–Individually prescribed homoeopathic medicines seem to add little to careful counselling of children with recurrent upper respiratory tract infection in reducing the daily burden of symptoms, use of antibiotics, and need for adenoidectomy and tonsillectomy.

and elsewhere

Homoeopathic medicines produce no clinically relevant improvement in recurrent upper respiratory tract infections.

Hang on a minute – the homeopaths are actually citing a paper which concludes “homoeopathic medicines seem to add little…” to try and bolster the case for homeopathy as an effective therapeutic strategy? Either someone didn’t read this paper, or someone didn’t think that someone else would read this paper.

I believe “FAIL” is suitable internet vernacular for an occurance such as this.

7. Frei H, Thurneysen A. Homeopathy in acute otitis media in children: treatment effect or spontaneous resolution? Br Homeopath J 2001, 90: 180-182.

Another disease where sponaneous resolution is a factor. Treatment of the disease is not relevant in this case, as the study looks a pain management. A notorious placebo mine field. However – I can’t find the full text of the paper to comment on how the study was conducted. If you have a .pdf of this – leave a comment and I’ll get in touch.

EDIT: Tom Johnston kindly provided me with a copy of this paper.

The conclusion is the usual homeopathy arm-wavey – “fewer treatment failures in the group receiving homeopathy…. positive treatment effect of homeopathy when compared with placebo in uncomplicated AOM cannot be excluded.”

Basically – “Because of the preliminary nature of this study and its small sample size, definitive results were not found.”

8. Friese K-H, Kruse S, Ludtke R, Moeller H. Homeopathic treatment of otitis media in children: comparisons with conventional therapy. Int J Clim Pharmacol Ther 1997; 35: 296-301.

I finally tracked down the .pdf of this paper (I can send it to anyone who wants a copy – add a comment below) – and it is a curious paper.

“there were no statistical differences between the 2 group in any of the outcome measures”

those 2 groups being homeopathic treatment and antibiotic treatment.

They also note that 5 children involved in the study took antibiotics after homeopathic treatment – but apparently, any comment on that would be “beyond the scope of this article” O RLY?

However given that they state:

it was found that 95% of patients with acute otitis could be treated without antibiotics

a trial that compares treatment with antibiotics versus treatment with homeopathic remedies seems utterly pointless.

A placebo controlled study is clearly required.

9. Jacobs J, Springer DA, Crothers D. Homeopathic treatment of acute otitis media in children: a preliminary randomized placebo-controlled trial. Pediatr Infect Dis J 2001; 20: 177-183.

Oh look! A randomized placebo-controlled trial!

CONCLUSIONS: These results suggest that a positive treatment effect of homeopathy when compared with placebo in acute otitis media cannot be excluded and that a larger study is justified.

D’oh! So close, and yet so far.

10. Riley D, Fischer M, Singh B, Haidvogl M, Heger M. Homeopathy and conventional medicine: an outcojmes study comparing effectiveness in a primary care setting. J Altern Complement Med 2001; 7: 149-159.

Hmmm – one thing we can all take home from this is that Google Scholar is much better at finding papers in obscure alternative med journals than PUBMED – can’t think why. The full text of this paper lives here.

The conclusion to this paper is that:

the information from this study will improve clinical trial design in the real world medical setting and offer a better understanding of how homeopathy and other alternative medical therapies are and can be integrated into the practice of medicine.

So it looks like it was more of a methods paper. However, the study seems poorly designed – there were  large descrepancies in age ranges of participants in the “homeopathic” (lots of under 12s) and “conventional” groups (mostly adults) and this paper looked at a broad range of pathologies:

(1) upper respiratory tract complaints including allergies; (2) lower respiratory tract com- plaints including allergies; or (3) ear complaints.

No mention is made in the paper of what conventional therapies (antibiotics?) were used, what the actual diseases were (i.e. were they diseases that spontaneously resolve anyway) – so it is impossible to draw any sort of conclusion about this paper. No placebo control was used (unethical in primary care setting, I guess).

11. Steinsbekk A, Fønnebø V, Lewith G, Bentzen N. Homeopathic care for the prevention of upper respiratory tract infections in children: A pragmatic, randomised, controlled trial comparing individualised homeopathic care and waiting-list controls. Complementary Therapies in Medicine 2005, 13, 231-238.

This paper lives here (you need to pay or have access) – has a small sample size (169) and, again, does not look at specific diseases and therapies. There is no placebo control.

The authors note:

But, as this was a pragmatic study, it provides no evidence to sustain an argument that homeopathic medicines have specific efficacy.

<facepalm>

12. Weber U, Luedtke R, Friese KH, Fischer I, Moeller H. A non-randomised pilot study to compare complementary and conventional tretaments of acute sinusitis. Forsch Komplementarmed Klass Naturheilkd 2002; 9: 99-104.

What? Acute sinusitis again? We’ve already seen that:

Sinusitis often clears up by itself, and about two thirds of those who get the condition do not need to see their GP.

On average, sinusitis takes about two-and-a-half weeks to clear.

Over-the-counter painkillers and decongestants can be used to relieve facial pain and a blocked nose. Antibiotics are unlikely to help unless the sinusitis becomes chronic (persistent).

However, the conclusions of the paper offer no succour to homeopaths in search of peer reviewed support:

Conclusions: Both treatments appear to be equally effective (or ineffective). Results might be biased because both treatment groups differed substantially. Randomised trials including at least 400 patients are needed to produce valid results.

(Also – the “homeopathic” remedy used was at 3X dilution – so not at sub-avagadros concentrations.)

13. Wiesenauer M, Gaus W, Bohnacker U, Haussler S. (Efficiency of homeopathic preparation combinations in sinusitis. Results of a randomized double blind study with general practitioners.) Arzneimittelforschung 1989; 39: 620-625.

The abstract can be found here. The full text of this paper is not available online.

Sinusitis (again).

The paper concludes:

there was no remarkable difference in the therapeutic success among the investigated homeopathic drug combinations nor between the active drugs and placebo.

Once again, the “homeopathic” rememdies were not at sub-avagadro’s concentrations.

So – in conclusion.

Despite the disparity between homeopathy and science, it would appear that homeopaths are all too willing to try and blind unwary readers with science. Here I have taken a closer look at 9 references provided by homeopaths to provide evidence for the efficacy of their treatments. Of those 9 references:

  • 4 say that there is no evidence for the efficacy of homeopathy,
  • 5 are poorly designed / need bigger sample groups,
  • 2 use “homeopathic remdies” at dilutions not greater than 12C (so we might expect to find some active ingredient),
  • 1 paper is openly dismissive of the clinical relevance of homeopathy.
  • 4 of them admit that they are looking at diseases which normally resolve without medical intervention anyway *.

So when someone shows you something with a list of references to support their claim – make sure you look at the references!

Because people WILL use references that say the exact opposite of what they are saying in the hope that you won’t bother reading them!

*Yes – I know this doesn’t add up to 9 – some papers fall into more than one catagory 🙂

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4 Responses to Blinded by pseudo-science?

  1. Anonymous says:

    I have access to article no. 7 if you want a copy. It’s available as ASCII for WIndows, Mac and Linux and also as HTML. Email – tj6218 at bris.ac.ukNice post.

  2. Dr_Aust_PhD says:

    The J of Alternative and Complementary Medicine (JACM) – see yr ref 10 – is a “house organ” for Unreality, Dave. To understand why you can take a look at their list of Editors. Many of the most frequent “serial publishers” in JACM are also the folk on the editorial board. While this is not unknown in conventional science, it rings alarm bells in CAM because it speaks to the circularity of their “peer review” process – by CAM advocates, reviewing by CAM advocates, for CAM advocates. This does not exactly promote rigorous critique Other AltMed journals have the same problem -see http://bit.ly/4qgMtOOne of the most egregious examples is JACM’s publishing of multiple instalments of the “Quantum Entanglement Theory of Homeopathy” by the indefatigable Lionel Milgrom (who is on the JACM Editorial Board). There are about two other people in the world who believe his wibblings, and publish similar stuff – and both are also on the JACM Board. They do not include any physicists with knowledge of quantum mechanics – funny that. Real physicists who look at the stuff have been thoroughly unimpressed – see e.g. http://shpalman.livejournal.com/

  3. zeno001 says:

    Excellent fisking!

  4. Evidence Matters says:

    Nicely done. For other close scrutiny of the claims of homeopathy and the over-hyped publications and certain reviews, I strongly recommend Gaylard’s 40+ posts on homeopathy (particularly the sequence on memory of water in which both he and shpalman scrutinised the claims and found them wanting.) Paul Wilson’s work also merits some attention, albeit, again, it addresses the lamentable ‘science’ of homeopathy and the intention experiments.

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