Tag Archives: misuse of evidence

The “Top Secret” 2012 draft

secret-3037639_640(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 [1]). 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 [2]. 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 [3], ‘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.

homeopathy-1604071_1280(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 [4] ‘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.

Links:

1] [Annotated draft 2012 report]

2] [NHMRC report and position statement]

3] [NHMRC CEO statement accompanying the 2012 draft]

4] [HRI press release]

Comments:

[Edzard Ernst blog] :: [Australian sceptics]

A Cure for Cancer?

The website of the British Association of Homeopathic Veterinary Surgeons (BAHVS) features a case report in its ‘successful cases’ section, concerning a dog named Bedford (BAHVS, 2012). Bedford was diagnosed with a particularly nasty manifestation of a type of cancer, the squamous cell carcinoma, which appeared as a sizeable mass on top of his head, causing considerable pain and facial deformity.

The story continues, explaining Bedford’s owner, feeling conventional medicine had gone far enough, went on to seek homeopathic help, which was duly given, and to which he reportedly responded, eventually returning to his old self and able to enjoy life again, with no more problems.

From the photographs, it is clear the mass was initially large and painful, yet, after treatment, although the second photograph provided is from a slightly different angle, Bedford appears almost back to normal – the distortion of his brow and eyes seems to have gone and there is a keen look in his eyes.

Taken at face value (although the word ‘cure’, while present in the web address, is conspicuously absent from the account) this ‘successful case’ appears to support the position homeopathy can have profound, positive effects on cancer.

And what could be simpler? Dog gets cancer, dog is given homeopathy, dog recovers. Surely this must be convincing proof of the power of homeopathy?

I was curious to say the least when I first read Bedford’s story. My first thought, given what is known about homeopathy, was this story, as it stood, was unlikely to be true. Cancer Research UK, for instance, reports ‘there is no scientific or medical evidence [homeopathy] can prevent cancer or work as a cancer treatment’ (Cancer Research UK, 2015). Rather than dismiss it out of hand however, I wrote to the BAHVS and they were kind enough to send me Bedford’s clinical history.

On reading the notes, I discovered there was a significant gap in the account. It transpires, at the same time Bedford was receiving homeopathic treatment he was also being treated with robenacoxib, a drug of the non-steroidal anti-inflammatory (NSAID) group.

This class of drugs is well researched and is widely known to have anti-cancer properties, particularly in cases of squamous cell carcinoma (Hilovska et al, 2015). Yet, for whatever reason, the BAHVS had not seen fit to point out such a drug was being given. Other science-based medications – ‘strong opiates’ for instance – are referred to, yet the very one that might have had a real bearing on the case was not even mentioned (although I notice, on the current manifestation of the page, the acronym ‘NSAID’ has indeed appeared, albeit with no explanation as to its significance).

Assuming this might have been an inadvertent omission, I wrote back to BAHVS to explain the situation and suggest, in the interests of full disclosure, they might like to add a paragraph or two to the account describing the potential role of robenacoxib in this case. That way, readers would be able to make a properly balanced judgement about the case, since anyone reading it as it stood could be forgiven for incorrectly assuming the changes in Bedford’s cancer were solely the result of homeopathic treatment.

To my great disappointment, however, the BAHVS declined to make any change to the account, informing me in its reply ‘it is what it is’.

It is clear that ‘what it is’ is simply another example of the tendency of homeopaths to cherry-pick evidence to suit their preconceptions, even, as in this case, when it has been pointed out that by doing so they are misleading the public.

It has to be asked, if homeopathic practitioners are so confident about their chosen modality – despite the wealth of scientific literature which finds it is no more effective than placebo – what is it they have to fear about presenting a full and honest account of this case rather than the one that currently still stands?

References:

British Association of Homeopathic Veterinary Surgeons (BAHVS) (2012) Resolved Cancer Case 2 [Online]. Available at http://www.bahvs.com/cured-cancer-case-2/ (Accessed 24 May 2017).

Cancer Research UK (2015) Homeopathy [Online]. Available at http://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/complementary-alternative-therapies/individual-therapies/homeopathy (Accessed 24 May 2017).

Hilovska, L., Jendzelovsky, R. and Fedorocko P. (2015) ‘Potency of non-steroidal anti-inflammatory drugs in chemotherapy’, Molecular and Clinical Oncology, vol. 3, no. 1, pp. 3–12, [Online]. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4251142 (Accessed 24 May 2017).