Another excellent programme from radio 4: The Infinite Monkey Cage on conspiracy theories. Prepare to be enlightened and depressed at the same time!
(Image courtesy of tayebMEZAHDIA, Pixabay)
Finally the homeopathic lobby has got what it has been asking for for some time, the publication of an unfinished, 2012 draft report on an overview of reviews of the effectiveness of homeopathy (a.k.a. the 2012 draft report ). This was originally commissioned by Australia’s principal funding body for medical research, the National Health and Medical Research Council (NHMRC), as a part of its investigation into the usefulness of homeopathy which eventually led to the publication, in 2015, of its report and position statement largely condemning homeopathy . The NHMRC chose not to include the 2012 draft in their final report.
For years homeopaths, unhappy with the conclusions of the 2015 report and determined to discredit it, have been making far-fetched claims about the so-called 2012 draft report, including accusations that the NHMRC actually produced two reports, one of which (the draft in question) was suppressed as it was favourable to homeopathy. As always with such people everything is a conspiracy, anything to compensate for a lack of evidence.
In truth the facts about the draft are much more straightforward, and not at all the story of cloak and dagger intrigue which homeopathic bodies would prefer us to believe. The NHMRC didn’t produce two reports – as Chief Executive Officer Professor Anne Kelso says in a statement accompanying the published draft , ‘It must be emphasised that [the 2012 draft report] is an incomplete piece of work that is not a NHMRC-endorsed report, therefore its content must be read in this context. NHMRC’s usual practices of quality assurance were not applied to this document. These practices (which include methodological review, expert review, public consultation and approval from the expert committee and NHMRC’s Council) can often result in significant changes to initial drafts.’
In other words the 2012 draft was exactly what it says on the tin, a first draft report which hadn’t been subject to normal quality assurance by the commissioning body. It is simply part of the usual scientific process of investigation, not some anti-homeopathy cover-up. This is just another example of homeopaths cherry-picking the information they prefer to hear, regardless of quality, rather than the larger truth.
(Image courtesy of Pixabay)
This cherry picking is so blatant too, for instance a press release by the self appointed ‘Homeopathic Research Institute’ (HRI) about the 2012 draft reports  ‘We… welcome the valuable clarification provided by NHMRC CEO Prof Anne Kelso, that NHMRC’s second Homeopathy Review published in 2015 “did not conclude that homeopathy was ineffective”’ yet completely omits the actual conclusion, mentioned in the same statement by Prof. Kelso only a couple of lines later, ‘there are no health conditions for which there is reliable evidence that homeopathy is effective‘! It seems the HRI is more concerned with the semantics of the report than it’s actual findings.
The 2012 draft makes for interesting reading however. The published version contains annotations to the original text from the NHMRC expert homeopathy working committee which give an insight into the authors’ thought process. The annotations point out a number of serious flaws including that some of the conclusions within the draft were the opinions of the draft’s authors rather than a reflection of the evidence. There was also a failure to note that a majority of the homeopathic trials considered had a medium, high or undetermined risk of bias; subjective, undefined and subjective terms were used, such as evidence being described as ‘encouraging’ for the effectiveness of homeopathy and, at a later stage, trials described as ‘unfocussed’ rather than what they really were – poor quality. There was confusion about what different evidence grades mean (one Grade C trial is described as ‘encouraging’ while on the same page another Grade C trial is described as providing ‘no convincing evidence’).
The annotations cast light on growing disagreements between the expert committee and the authors of the draft. This eventually led to the contract between the NHMRC and the producers of the report being ‘… terminated in August 2012 with the mutual agreement of NHMRC and the contractor’. The inescapable conclusion is that, for reasons given in the annotations themselves, the 2012 draft was not fit for purpose and as a result was rejected by the committee.
So, no conspiracy, no ‘cover up’, just a poorly performed review which was properly rejected by the body that commissioned it. Homeopathy is still ineffective, nothing about the 2012 draft review changes that or anything else. Nor, unfortunately, should anyone expect it to change the tired old conspiracy rhetoric either, which will be rolled out yet again by Hahnemann’s ‘true believers’ – it takes more than good science and solid evidence to counter a faith-based system.
4] [HRI press release]
Frei, H., Everts, R., von Ammon, K., et al. (2005) ‘Homeopathic treatment of children with attention deficit hyperactivity disorder: a randomized, double blind, placebo controlled crossover trial’, European Journal of Pediatrics, vol. 164, pp. 758–767.
Adler, M. (1999) ‘Efficacy and safety of a fixed-combination homeopathic therapy for sinusitis’, Advanced Therapeutics, vol. 16, no. 2, pp.103–111.
RVM says: An open label, practice based survey, no blinding, no placebo control, yet bizarrely referred to as “evidence” by homeopaths… Just another customer satisfaction survey masquerading as science.
Links: [abstract, pub med]
Aabel, S,. Laerum, E., Dølvik, S. and Djupesland, P. (2000) ‘Is homeopathic ‘immunotherapy’ effective? A double-blind, placebo-controlled trial with the isopathic remedy Betula 30c for patients with birch pollen allergy’, British Homeopathic Journal, vol. 89, pp. 161–168.
RVM says: Apart from a couple of days there was no statistically significant difference between trial groups although for 10 days out of the 4 week test period the authors felt there was a “clinically interesting” (whatever that means) difference. No mention of randomisation in the abstract or of how blinding was achieved. The staggering conclusion: “treatment with Betula 30c during the pollen season deserves further attention“. Well, it might if you’re desperate to sell homeopathy to people who trust you and you’re happy to turn a blind eye to the fact it simply doesn’t work.
van Bree, F.O.J, Bokken, G.C.A.M., Mineur, R., Franssen, F., Opsteegh, M., van der Giessen, J.W.B., Lipman, L.J.A. and Paul A M Overgaauw, P.A.M. (2017) ‘Zoonotic bacteria and parasites found in raw meat-based diets for cats and dogs’, Veterinary Record, vol. 182, p. 50, (DOI: 10.1136/vr.104535).
[full reference and links]
Yet another paper has just been published confirming the less than startling fact that raw diets for dogs contain what we professionals call ‘germs and bugs‘. A team of Dutch researchers looked at thirty five samples from eight commercially available brands of raw meat based diets (RMBD) and discovered bacteria such as E. coli, Listeria, and Salmonella, as well as parasites including Sarcocysts and Toxoplasma gondii in them. A staggering 80 per cent of the samples contained antibiotic resistant E. coli bacteria. This seething collection of flora and fauna can cause illness in humans ranging from gastro-enteritis through haemorrhagic colitis and kidney-failure, to death in new-born babies and abortion in pregnant women. The organisms can transfer from dog to dog as well as to owners either directly from the raw-fed dog or indirectly by the contamination of the surfaces and utensils used to prepare the raw-food; they will multiply at room temperatures in food bowls. In many cases dogs can carry these micro-organisms, all the time shedding them into the environment, without showing any signs of ill health themselves. Furthermore such diets have been reported to cause problems in the dogs who eat them such as damaged teeth, perforated guts, hyperthyroidism and nutritional imbalance.
The study concludes, in that typically dispassionate way that published papers do, that owners should be made aware of the risks of feeding raw food to pets. RationalVetMed would venture a step further – just don’t! There is no good reason to feed raw food to your pets and there are serious risks to you, your family and your pets if you do. If, despite the risks, you insist on feeding raw then that is up to you but don’t kid yourself it has anything to do with supposed health benefits, because there are none, your decision is purely and simply a lifestyle choice.
See RationalVetMed.org for the full reference and links.
‘Well‘, said the homeopath, drawing breath during a particularly bruising facebook debate, ‘science doesn’t know everything. Those conventional medicines, they always do more harm than good and hardly any have been tested by your so-called Gold Standard, the double blind placebo controlled trial (DBPCT). Just the other day I heard that Cartrophen took down a bunch of Labradors!‘
Apart from this typically egregious example of the kind of emotive, vague and unsubstantiated ‘evidence’ homeopaths favour, the point is science doesn’t begin and end with the DBPCT. Science is a system, a method which at its most basic is just a way of asking questions and investigating claims. Science actually comes down to one particular question: ‘Prove it!’. So in the unlikely event that Carprophen [a useful, safe and popular painkiller for dogs] did ‘take down a bunch of Labradors‘ that should, and would have been investigated through the official suspected adverse reaction surveillance scheme (SARSS) and steps taken, as actually happened in cases like Thalidomide in human medicine or the use of avermectins in certain collie dogs or any one of a number of other cases. It’s easy to do, you can report drug reactions online at the click of a button from a whole load of different official government websites or you can phone the drug company direct and they’ll do it for you or, if you’re old fashioned like me, you can fill out a garish yellow Veterinary Medicines Directorate SARSS forms using your favourite fountain pen and pop it in the post – I’ve got a pile of them on my desk and use them or their online equivalents regularly.
This is science in progress – a self-correcting system working to put itself (and medicine) in order. When did you last hear of anyone using vitamin E to treat heart disease? Yet this was a very popular treatment in the middle of the last century, used by intelligent, highly trained veterinary surgeons who, like homeopaths, swore it gave good results ‘in their cases’. It’s the same with the treatments of heroic medicine – no one practices purging, firing or bleeding now, the thought of doing so would horrify any contemporary veterinary surgeon. Yet they were the go-to treatments of their day and anyone who didn’t believe in them at the time would have been regarded as being thicker than a whale omlette.
The reason these long-discredited treatments are no longer mainstream as they once were is that science-based (rational) practitioners were, unlike homeopaths, able to recognise and accept a treatment practitioners had been using for generations was doing more harm than good and were willing to change based on scientific evidence rather than just personal experience. The problem with homeopaths is they don’t change, their methods of treatment are based entirely on personal experience. When presented with actual science – evidence homeopathy is ineffective – all we hear are increasingly implausible excuses about why it really does work, despite all appearences, and how critics are always wrong. Homeopaths’ starting point is first and foremost that homeopathy works, after that any evidence which comes their way is cherry-picked, filtered or dismissed to support that core belief, not to test it as should be the case. And that ain’t science, and it ain’t right!
And the daft thing is, after all that, even if proper drugs were utter rubbish, even if they did all the dreadful things homeopaths pretend they do, it STILL wouldn’t mean that homeopathy works!
Parmen, V. (2014) ‘Electroacupuncture Analgesia in a Rabbit Ovariohysterectomy’, Journal of Acupuncture and Meridian Studies, vol. 7, no. 1, pp. 15-24.
To be frank, this is one of the most cruel papers on any subject I have come across. I was so utterly shocked by it I couldn’t believe what I was reading and hoped I had misunderstood what the experimenters had done here in the name of acupuncture research. So I asked Martin Whitehead, of the Campaign for Rational Veterinary Medicine to take a look for me. It turns out I hadn’t misunderstood, the authors of this paper had actually operated on rabbits, surgically opening their abdomens and removing their uterus and ovaries while they were fully conscious and tied down to a metal frame, without the benefit of any form of anaesthetic or pain relief, while at the same time administering electric shocks to them and claiming this was “acupuncture anaesthesia” (a discredited technique which is illegal in many countries). As a colleague said when I mentioned this paper to her, “how is that not torture?”
Comment from Dr Martin Whitehead:
This paper makes me feel queasy. That it had ethical approval from the university make me feel even more queasy.
It is clear that the acupuncture group rabbits were given no anaesthesia or analgesia (other than any resulting from the acupuncture and unknown-intensity electric currents passing through the rabbit).
The neuroleptanalgesia group were given ketamine (no analgesic action) and xylazine (which does have some analgesic action) but no other analgesia.
From Table 1 it appears that the rabbits were tied down in the metal device shown in Fig. 1 and receiving the electroacupuncture for at least 42-55 mins. Even if there was no surgery, not a nice thing to do to a rabbit – assuming they are conscious throughout, which certainly seems to have been the case.
In section 2.3. it says “the intensity of the electric current stimulation was slowly increased from zero until the animals showed signs of discomfort and twitching. After that, the intensity was slowly increased to 4, 6, and finally to 8 V for the abdominal site; for dorsal stimulation, the intensity was slowly increased to 2.2 V and then to 2.7 V.” That sounds grim.
Only voltages are stated, with no idea what current was being used (e.g., for comparison with a TENS machine), so it is not possible to tell what sort of effect this current would have on nerves or muscles.
From Fig. 3, the heart rate was lower in the electroacupuncture group, except at the time of actual surgery when it was much higher, which is not a promising sign. The respiratory rate was far higher in the electroacupuncture group before and during surgery, also not a promising sign. Those findings could be interpreted as indicating that the electroacupuncture rabbits were feeling more pain than the neuroleptanalgesia rabbits.
The one scrap of comfort I get is the very last sentence of the Results section – there was no “screaming related to stress or pain”. I hope that means there was no screaming at all.
So, the next time someone says, with regard to Complementary and Alternative Veterinary Medicine, “where’s the harm”, you might like to point them to this paper. How delusional and a priori convinced of the merits of acupuncture, must the authors be to think this was, in any way, a humane procedure?
Links: [full text (OA)]
Campaign for Rational Veterinary Medicine’s Danny Chambers has just given a very strong interview on the John Darvil show, on BBC Radio Bristol on Wednesday 16th August, 2017.
The subject was the availability of homeopathy on the NHS and Danny gave a succinct explanation why its continuing endorsement by the NHS is wrong on every level. It’s a waste of money, undermines real medicine and, bottom line, puts lives at risk. For instance, this recent paper demonstrates that cancer patients who opt to use CAM treatments such as homeopathy are up to 5 times more likely to die within 5 years of diagnosis as a result of their cancer.
The link to Danny’s interview is here: www.bbc.co.uk/programmes/p05b5096 (the relevant section starts about 7 minutes 30 seconds in) and it’s well worth a listen as a robust and measured counter to the arguments of the homeopathic lobby. It’s going to be available until around the 16th September.