Respectful Insolence

Our project has several objectives; 1) To treat as many AIDS patients as possible, so as to relieve suffering 2) To develop a homoeopathic understanding of the disease. This understanding should enable us to list the homeopathic remedies which are most successful in treating AIDS. 3) To make our project sustainable by spreading this knowledge and the related remedies throughout Tanzania and Africa, so that local health practitioners will be able to prescribe these remedies to large masses of people. 4) To produce formal research on the treatment of AIDS with homoeopathy so as to show the world what it is able to achieve.

Together with Sigsbert Rwegasira, a Tanzanian homoeopath, and other international homoeopaths, Jeremy will initially create a clinical and teaching infrastructure in Tanzania. Once this is established, more homeopaths will come to Tanzania to participate in the project. When this mechanism is fully operational, we aim to open homoeopathic schools in Tanzania and throughout the whole of Africa, training doctors, homeopathic professionals, nurses and local practitioners.

We have the support of several eminent homeopathic researchers, as well as the Muhumbili University of Health Sciences in Dar Es Salaam, Tanzania and the Department of Integrative Medicine at the University of Maryland, USA.

I'm particularly interested in Sherr's desire to discover a "homeopathic" understanding of the disease. Let's see. I'm not a homeopath, but I understand the ridiculous principles of the Law of Similars. HIV causes profound immunosuppression that generally takes several years to develop after the initial infection. What else causes profound immunosuppression? Well, high dose chemotherapy in preparation for bone marrow transplant with stem cell rescue will do it. It's also a permanent destruction of the immune system such that it can only be reconstituted with a bone marrow or stem cell transplant. Consequently, by the Law of Similars, all Sherr would have to do would be to get some of those nasty chemotherapy drugs used for ablation of the immune system in preparation for bone marrow transplant, dilute them by 30C (remember, each dilution in the series of 30 is 1:100, making this a 1 x 10^-60 dilution), and use that to treat HIV/AIDS. Don't worry, it's perfectly safe. Avagaddro's number is around 6 X 10²³; so a 30C dilution is at least 36 orders of magnitude greater than that, meaning that the odds against the presence of a single molecule in the remaining dilution is astronomical. There you go: Instant homeopathic treatment for AIDS.

Of course, I'm being facetious. Homeopaths will solemnly and condescendingly tell you it's much, much more complicated than that and that each treatment must be "individualized" (which, to a homeopath, basically means "make it up as I go along"), but it isn't really, at least not when you boil it down. On the other hand, since homeopathy was devised over 200 years ago, the concept of "immune system destruction" had not yet been elucidated; so one could argue that we would need to find something that causes similar symptoms as the ones that AIDS patients suffer and dilute and succuss that to make a homeopathic remedy for AIDS. So let's give Sherr a chance to explain for himself:

In many ways homoeopathy is the perfect medicine for persons suffering from AIDS, and particularly in Africa. AIDS means Acquired Immune Deficiency Syndrome. Homoeopathy works by stimulating and enhancing the immune system and therefore it is precisely in this disease that homoeopathy can be most effective.

Homoeopathy is a system of medicine with an outstanding record of cures, both in individual and epidemic diseases. Homoeopathy was extremely effective in the great flu pandemic of 1918, and the cholera epidemics of the 19th century. Homeopathy has proved effective in yellow fever, whooping cough, polio, typhus, and malaria. Today, homoeopaths all over the world are having very promising results with AIDS patients, substantially improving their well being and restoring health.

While conventional medicine aims to fight the virus, and is able to buy time for the patient, there is no radical change in the underlying health. In effect, conventional medicine only supplies a temporary relief, often at a great cost financially, and with many severe side effects.

Funny, but I don't recall Samuel Hahnneman saying anything about homeopathy "stimulating" the immune system. As has been explained many times before, "boosting the immune system" is a virtually meaningless claim, particularly when made in such a manner. The immune system is a tightly balanced system. Too little immunity, and disease or cancer can develop. Too much activity of the immune system, and devastating autoimmune disease can develop. There are also more than one type of immunity. Boosting the "wrong" type of immunity for an infection would do no good at all and could well do harm. I may not be an immunologist, but I can see Sherr's nonsense for what it is--nonsense.

Even worse are Sherr's claims that homeopathy was effective against the influenza pandemic of 1918. Really? What evidence does he base that claim on? Even worse, are claims that homeopathy can treat all those infectious diseases, particularly malaria. Indeed, about a year ago the Society of Homeopaths in the U.K. was criticized for not stopping its members from making claims that homeopathy could prevent or cure malaria. Its response? To abuse the U.K.'s plaintiff-friendly libel laws to threaten to sue the blogger who busted them. I suppose I should be grateful that Sherr left out leptospirosis as a "success story" for homeopathy. In any case, as is almost always the case with homeopaths, Sherr offers no evidence to support his claims of efficacy against all those diseases.

Another thing that the Society of Homeopaths fiasco demonstrated, as did Celia Farber's attempt to alter her postings after her ill-advised writing about Christine Maggiore, is that the "memory hole" no longer exists. Shortly after the Society of Homeopaths forced the removal of the articles critical of its members, the article reappeared on dozens, if not hundreds, of blogs. This is very similar to what happened when über-quack Joseph Chikelue Obi tried to do the same thing, forcing a blogger through legal threats to remove posts critical of his promotion of quackery.

The bottom line is that the memory hole just doesn't work on the Internet, whether it's the person who wrote the information and is now trying to retrieve it or it's information being forced off of a website or blog because of vacuous legal threats. It is a lesson that our intrepid homeopath Jeremy Sherr is now learning, as he tries to "realign" the contents of his blog to be not so incriminating when it comes to his advocacy of a completely unethical clinical trial of homeopathy in HIV patients in Tanzania. He announced his intention over a year ago:

It would involve treating three to five hundred AIDS patients over a couple of years. The aim is twofold; one, to treat individually and show the efficacy of homoeopathy for these patients and two, to look for a genus epidemicus for AIDS, providing it is an epidemic. Epidemics have certain characteristics and AIDS is one foot in and one foot out. I do not want to hear what this or that homoeopath gave an AIDS patient; I just want to collect the symptoms for myself, as Hahnemann said we should do with epidemics, and see.

Doing research in Third World countries is very dicey from an ethical standpoint, because it is increasingly being viewed as unethical to provide anything less than the scientifically validated standard of care as the minimum floor of therapy to patients in the control group, even if such therapy is normally not available to the people living in such areas. Indeed, the Helsinki Declaration codifies this principle:

32. The benefits, risks, burdens and effectiveness of a new intervention must be tested against those of the best current proven intervention, except in the following circumstances:

• The use of placebo, or no treatment, is acceptable in studies where no current proven intervention exists; or
• Where for compelling and scientifically sound methodological reasons the use of placebo is necessary to determine the efficacy or safety of an intervention and the patients who receive placebo or no treatment will not be subject to any risk of serious or irreversible harm. Extreme care must be taken to avoid abuse of this option.

Neither of these conditions apply to any therapy of HIV. There is an effective treatment in existence, and using a placebo would harm HIV patients. Now compare this to what Sherr ended up actually proposing:

When I was in South Africa 5 years ago, we had designed a very complex trial together with the Nelson Mandela hospital in Durban. This trial had three arms; patients with homoeopathy and without ARV treatment, patients with homoeopathy and ARV treatment, and patients with ARVs alone (Placebo treatment is considered unethical in AIDS). It was a very comprehensive and well designed trial and it covered all the bases. And once the dean of the hospital resigned to go into the private sector, it was also a very dead trial. So I am happy to go for a simple trial initially, with one arm of AIDS patients with homoeopathy and no ARV. There are plenty of statistics on ARV treatment and patients with no treatment at all that we can compare to. If we can prove that homoeopathy has any positive effect at all, we can move on to bigger and better things.

The best available therapy for HIV/AIDS is HAART. Period. Or, at least, until better therapies are developed. Consequently, even if homeopathy weren't utterly implausible and no more than a water placebo, it would have been completely unethical to include a homeopathy alone arm to this study. Because homeopathy is nothing more than water with no reasonable likelihood to be expected for therapeutic benefit, the trial design that Sherr originally intended was utterly unethical. Indeed, it was even more unethical than an appallingly unethical study of homeopathic remedies in infectious diarrheal diseases in Honduras. Sherr was informed of this in the comments of his blog by numerous people. He then did what Celia Farber tried to do. He tried to throw his original comments down the "memory hole" and produce a newer, shinier, happier version without the ethical--shall we say?--lapses:

When I was in South Africa 5 years ago, we had designed a very complex trial together with the Nelson Mandela hospital in Durban. This trial had three arms; Homoeopathy for HIV patients who are not yet eligable for ARVs, patients with homoeopathy and ARV treatment, and patients with ARVs alone (Placebo treatment is considered unethical in AIDS). It was a very comprehensive and well designed trial and it covered all the bases. And once the dean of the hospital resigned to go into the private sector, it was also a very dead trial. So I am happy to go for a simple trial initially, treating AIDS patients who are not taking ARVs. There is no shortage of patinets who, although they have been offered ARVs, have chosen not to take them, usually because of the serious and debilitating side effects. There are plenty of statistics on ARV treatment and patients with no treatment at all that we can compare to. These are only preliminary thoughts, and any trial we undertake will be rigorously planned and ethically reviewed. If we can prove that homoeopathy has any positive effect at all, we can move on to bigger and better research.

I can't help but ask Sherr what lawyers always ask witnesses who change their story: Are you lying now or were you lying then? Sadly, what Sherr apparently doesn't realize is that, even though this new version of the trial he supposedly proposed is not as bad as the original from an ethical standpoint, it is still of highly dubious ethics. Remember the Helsinki Declaration. It requires that clinical trials test new therapies against the best current standard of care. Any exception is frowned upon, and there has to be an incredibly compelling reason justified by the researcher sufficiently to convince an ethics panel before such research can even be considered. This is to prevent "slumming" in poor countries by physicians in rich countries; in other words, it's a way of protecting vulnerable poor populations from exploitation. As an investigator you can't go to Third World countries looking for patients who aren't getting the standard of care and propose to test something that is below the standard of care. This would be true even if homeopathy had therapeutic potential. Given that homeopathy is nothing more than a placebo, Sherr's "reinvention" of his proposal is a long run for a short slide. It may be marginally less unethical than his original proposal, but it's still pretty damned unethical. Sherr's utter cluelessness about even the very basic ethical principles of clinical research is showing.

Fortunately, others have taken action to archive much of what Jeremy Sherr has written and said about his plans to "research" homeopathy for AIDS:

Yes, there are Jeremy and Camilla Sherr, advocating the use of homeopathy to treat epidemics and, after noting that "killing all the bacteria and viruses" only makes them come back stronger, claiming that it can "make the person stronger" to fight off viruses. Never mind that that, even if that worked, it would be a selective pressure just like antibiotics, and the bacteria would evolve resistance. Indeed, if this post by Camilla Sherr is any indication, the Sherrs are even more clueless than I thought:

In particular case 101, the first case I saw when I arrived. She feels that the ARVs are poisoning her, and claims that she feels worse in many ways since taking them; she had been vomiting continuously for months, which began soon after the drugs. Her relatives are very worried about this. There was a long list of symptoms: Chest pain, fullness in the stomach, dark brown urine. She is very weak, and has heaviness in the legs. She suffers from bad dreams, has a sense of failure and is constantly angry. She sleeps poorly. Before the ARVs she had a CD4 of 137. We don't have a CD4 now (the lab was not yet set up when we took this case).

Three weeks after the remedy she is feeling better then she has for a long time. Her energy is vastly improved, and she can walk long distances. Legs are better, sleeping well, glands down, stomach better, urine clear, dreams gone, no vomiting. She is feeling much happier in herself. But here is the real surprise: her CD4 count this week has gone up to a massive 1430! That is beyond healthy. What a shame we didn't have the initial count, so I am NOT claiming the the amazing CD4 count is a result of homoeoapthy, but the general improvement certainly is.

So, research ethics or no research ethics, the Sherrs are forging ahead treating Tanzanians with quackery. Worse, they use the same sort of ploy that cancer quacks do. When a patient is treated with both conventional therapy and quackery, attribute any improvement to the quackery (wink-wink, nudge-nudge, tha'ts not what I'm sayin', you know, but I'm sayin'), not to the proven medication. Worse, as is described by Gimpy, Jeremy Sherr isn't just a lone wolf. He appears to have the backing, or at least the tacit approval, of much of the homeopathy establishment in the U.K.

The Sherrs appear to be sincere, but it is that very sincerity, combined with utter cluelessness about how scientific and clinical research is conducted, that makes them dangerous, especially to impoverished HIV-positive people in Africa. What they propose is the use of the ancient superstition of sympathetic magic dating perhaps as far back as Paracelsus instead of medicine, wishful thinking instead of science. It is not for nothing that it's said that the road to hell is paved with good intentions, and it's clear that he and his wife really, really believe, as demonstrated by this quote:

I have decided that the main aim is to get out there and cure as many people as possible. I know, as all homeopaths do, that you can just about cure AIDS in many cases. But shhhh... I'm not allowed to say that, so you didn't hear it. With the little funding that I have I will start working in Sigsbert's existing clinics seeing as many AIDS patients as I can. Together with Margot Diskin from Ireland we will check out the northern areas of Tanzania and see if there are more opportunities to treat the sick. That is the first, high and only mission.

[...]

And that is the third mission, teaching homeopathy, spreading what we learn, using Sigsbert's School and any other means possible. We need to get homeopathy known through Africa, because millions are dying of AIDS and malaria and TB, and the pharmaceutical companies are making fools of them with their expensive, non curing, mal inducing drugs. Homeopathy IS the solution for Africa- curative, gentle, natural, and affordable. No side effects- just effective!

Of course, even the Sherrs' good intentions don't stop them from--shall we say?--"revising" history when their cluelessness leads them to proposing astoundingly unethical clinical trials. Particularly amusing is Jeremy Sherr's rant about the justified criticism of his proposed research:

How predictable; the Pharmaceutical Inquisition have discovered my site and they are squawking away in a hysterical frenzy. I take this as a compliment and thank them for the publicity.

Alas, the pharma-inquisition has a nasty little habit of nit picking other peoples blogs as if they were a scientific document, misstating issues, taking them out of context and amplifying them into a malevolent distortion of truth. For their benefit I will STATE THE FACTS CLEARLY:

Ah, yes, the usual conspiracy mongering about big pharma. Not very original, I'm afraid. Neither is his lying about what he clearly said previously about having designed an a clinical trial five years ago that involved a no-antiretroviral arm nor his having altered the text of what he had written. As jaycueaitch asks, how does Mr. Sherr reconcile his claims now that he is not advocating using homeopathy instead of anti-retroviral drugs with his previous claims that homeopathy can cure AIDS? Also, if he was so honest and had no intention of ever doing research that would include a group of HIV-positive patients receiving only homeopathy and no HAART, why did he feel the need to go back and revise what he wrote only after bloggers noticed it and called him out for it? Even more importantly, why does he make no mention that he had revised his text?

Worst of all, though, Jeremy Sherr has made it very clear that he doesn't care about ethics--not really--through his statement in the past (archived here and, for the moment at least, still on Sherr's website):

I personally am too impatient for academics, research and statistics but I feel that it has got to be done. Therefore I have been working to set up a proper research study of homoeopathy treating HIV and AIDS patients. And because I have contacts and a bit of a name, maybe I can get it off the ground, with a little luck and help from my friends. But it has been very frustrating, because the academic wheels grind far too slowly for me. You have to find willing partners and get a protocol through an ethics committee, and you need to talk their language. I hope it will work but if not, I will just go and do it on a small scale myself - I am determined to do that.

Translation: I know I'm right and don't need no steeekin' science. I'll grudgingly try to dabble in science and "play the game" because I have to, but if the ethics board stops me I'll just go ahead and treat AIDS patients with homeopathy alone anyway.

Unfortunately for the Sherrs, as was the case with the Society of Homeopaths, Joseph Chikelue Obi, and Celia Farber, when it comes to the quackery of the Sherrs the memory hole no longer works in the Age of the Internet. In their case, that's definitely a good thing. Dangerous quacks like these homeopaths shouldn't be allowed to experiment on impoverished Africans just because they are deluded enough to think that it will help and because they think they can get away with it.