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.
‘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!