Respectful Insolence

I’ve complained about it time and time again because it’s annoyed me time and time again. Specifically, I’m talking about how various news outlets report scientific studies involving so-called “complementary and alternative medicine” (CAM), sometimes called “integrative medicine” (IM), the latter of which I like to refer to adding a bit of woo to make the scientific medicine go down. In general, because the press likes stories that buck the establishment, it tends to favor studies that seem to show that CAM modalities work. Even worse, it tends to misinterpret negative studies in the most favorable light possible, even if what is reported about a study and what is reported in the media about that study, all too often, related only by coincidence.

A particularly egregious example was recently forwarded to me by a few of my readers. It’s an article that appeared in the BBC entitled Homeopathy ‘eases cancer therapy’. Suffice it to say that the study being discussed concludes nothing of the sort, but that doesn’t stop the BBC from writing:

Some homeopathic medicines may ease the side-effects of cancer treatments without interfering in how they work, a scientific review has concluded.

The Cochrane Collaboration said, while there were few studies, it did appear that some effects of radiotherapy and chemotherapy could be alleviated.

No, it’s not. Let’s see what the Cochrane Collaboration actually wrote, specifically Homeopathic medicines for adverse effects of cancer treatments. Ironically enough, it was authored by practitioners at the Royal London Homoeopathic Hospital (which, you may recall, I visited in the summer of 2007), one of whom is a member of the British Medical Acupuncture Society. What one can assume this to mean is that we don’t have an Orac-like scourge of CAM writing this review. Far from it! These are likely to be true believers. (Otherwise they wouldn’t be working for the Royal London Homoeopathic Hospital, would they?)

The search strategy was pretty straightforward, as far as Cochrane Reviews go. A fairly standard list of databases, including MEDLINE, was searched for studies involving homeopathy and cancer patients in which the hypothesis being studied was that the homeopathic remedy could somehow relieve side effects of cancer treatment. Of course, there are numerous side effects from cancer treatment, particularly due to radiation and chemotherapy, and it has long been an area of research to find ways to minimize those side effects and/or to design therapies that produce fewer side effects.

Over the last ten years, medical scientists have even made considerable progress on that front. Unfortunately, of late the CAM movement has insinuated itself into these efforts, making the claim that CAM treatments somehow represent a “natural” or “gentler” method of decreasing canceer therapy side effects. In the case of homeopathy, there is no doubt that homeopathic remedies are “gentler.” They are, after all, nothing more than water. Whether or not they are more “natural” is hard to say. Certainly water is “natural,” but I’m not so sure about magical thinking behind the “principle of similars” that underpins homeopathy, along with the even more magical thinking that claims that diluting a compound far beyond the point that not a single molecule is likely to remain somehow makes a homeopathic remedy “stronger,” coupled with the even more magical thinking that states that this “potentization” of homeopathic remedies can’t occur without vigorous shaking “succussing” at each serial dilution step. That sure sounds more supernatural than natural to me.

Here are the studies that the Cochrane Review considered:

Eight controlled trials (seven placebo controlled and one trial against an active treatment) with a total of 664 participants met the inclusion criteria. Three studied adverse effects of radiotherapy, three studied adverse effects of chemotherapy and two studied menopausal symptoms associated with breast cancer treatment.

In essence, this is a hodge-podge with very small numbers. it’s only eight studies against three conditions, of which only three of the studies were deemed to be of high quality. The results were:

Two studies with low risk of bias demonstrated benefit: one with 254 participants demonstrated superiority of topical calendula over trolamine (a topical agent not containing corticosteroids) for prevention of radiotherapy-induced dermatitis, and another with 32 participants demonstrated superiority of Traumeel S (a proprietary complex homeopathic medicine) over placebo as a mouthwash for chemotherapy-induced stomatitis. Two other studies reported positive results, although the risk of bias was unclear, and four further studies reported negative results.

This is underwhelming at best. It’s also an example of the old “bait and switch.” Calendula is not a homeopathic remedy at all! Remember, homeopathic remedies must be diluted. True, not all homeopathic remedies are diluted to the point where not a single molecule remains. (Indeed, up to around 12C, homeopathic dilutions might include the odd molecule or few of the active substance.) However, they do need to follow the principle of similars and they do need to be diluted and succussed. Calendula ointment is an ointment made with an extract of Calendula that is not diluted at all. No one–and I mean, no one–argues that undiluted natural products can’t have a pharmacological effect. It is quite possible that Calendula ointment was useful for dermatitis due to radiation therapy. But Calendula in the form of the ointment used is not a homeopathic remedy. It is simply a natural product mixed into an ointment. In that, it is, in essence, very much like aloe vera, which is mixed into hundreds, if not thousands of different ointments, gels, and various other creams designed to be rubbed on the skin for a variety of complaints.

What about Traumeel S?

This appears to be the study that found that Traumeel S can prevent stomatitis (inflammation of the mucus membranes in the mouth). One thing that bothers me about Traumeel S is that it’s a proprietary mixture of “thirteen homeopathic remedies.” What’s in it is not revealed. Moreover, although it’s described as “highly diluted,” there is no indication of just how diluted it is. Are we talking real, honest-to-goodness homeopathic dilutions, or are we talking just dilutions that leave a measurable amount of potentially active natural product extract in the remedy? No one knows except the HEEL Company of Germany, and it ain’t telling. If there is, then Traumeel S is probably not a homeopathic remedy. Moreover, I could find no replication of these results on a larger scale than this small pilot study. It’s not as though there hasn’t been time; this study was published in 2001. When I see a small study nearly eight years old that has never been followed up with a larger, more rigorously designed study, I always wonder if such a study was undertaken but, thanks to publication bias and the file drawer effect, was never published.

Now I know what you’re thinking. You’re thinking that I’m being too harsh on the BBC. After all, it did cite Edzard Ernst:

Edzard Ernst, professor of complementary medicine at the Peninsula Medical School, said there were “several problems with the body of evidence examined by this review.
“First, independent replications are lacking completely but would be necessary before we can accept any of these treatments in routine healthcare.

“Second, nobody doubts that undiluted remedies can have effects; and interestingly, the positive studies here seem to be on such medicines rather than on the highly diluted treatments which are a hallmark of homeopathy.

“In fact, the calendula cream found to be effective in one study is not diluted at all and thus it cannot, to all intents and purposes, be considered to be a typical homeopathic remedy.

“Finally, this review found hardly any high quality studies in the first place. So overall, this new piece of evidence simply confirms plenty of previous research demonstrating the unproven nature of homeopathy.”

Speak it, Brother Edzard!

Despite this extensive quote from a real skeptic and scientist, the BBC article still strikes me as bending over backwards to point out that homeopathic remedies had no side effects (how could they? they’re water) and could thus “co-exist” with conventional therapies. Again, what a surprise, given that homeopathic remedies are water. Do we ask chemotherapy and radiation therapy patients to avoid water? The stories I’ve seen also invariably emphasize time and time again that “more studies are needed.” No they’re not. Homeopathy is so incredibly improbable from a basic science standpoint that for it to be true would require that much of what we understand about chemistry, physics, and biochemistry be invalidated. Sure, it’s possible for such a paradigm shift to occur, but for that to happen would, as I emphasize time and time again, evidence that homeopathy works that is at least compelling as the mountains of scientific evidence that leads scientists to conclude that it can’t work. Certainly the thin gruel that is this Cochrane Review doesn’t even come close to meeting that standard. In fact, it doesn’t even suggest that homeopathy works. At best, it suggests that certain herbal remedies might work. Might.

The bottom line is that homeopathy is quackery. It’s quackery because it doesn’t work any better than a placebo (which, in fact, it is–nothing more than an elaborate placebo). It also goes against the laws of physics and chemistry so outrageously that there is really no need for “further study” unless someone can produce evidence far, far more compelling than anything in this Cochrane Review that homeopathy is anything other than water and does anything greater than a placebo. Until at least one of those two things happens, preferably both, further tests of homeopathy are a humongous waste of resources and nothing more than a sham designed to promote quackery.

Comments

  1. #1 Andy Lewis
    April 17, 2009

    I think Cochrane have compromised their reputation by publishing this review, essentially from a vested interest group. The London Royal Homeopathic Hospital is in danger of closing. It now exists in part of one floor of its once grand building and is desperate to stay alive.

    This review picked on an easy target “Do homeopathic cancer treatments cause side effects?” No one in their right mind would doubt that standard homeopathic products cause side effects – as they don’t cause effects either. Why Cochrane has to pander to such junk science is beyond me.

    But the hospital have got their good headlines, mostly thanks to stupid science reporting at the BBC. I suggest more readers send a complaint into them about this thoroughly misleading headline.

    I predicted this would happen a few days ago…

    http://www.quackometer.net/blog/2009/04/homeopathy-does-not-cause-side-effects.html

  2. #2 Andy Lewis
    April 17, 2009

    The BBC have now changed their headline. A little bit better…

    Homeopathy ‘no cancer care harm’

  3. #3 sff
    April 17, 2009

    I think this is the crucial thing. When homeopathy was invented [before the germ theory was widely accepted] you were probably better off with homeopathic remedies, because at least they wouldn’t kill you faster. For most conditions, a placebo was probably as useful as any of the ‘real’ treatments.

    The problem is that modern medicine has left homeopathy in the dust, when it became actually able to cure things, and the homeopaths don’t realize it. They’re still stuck in 19th century medical thinking.

  4. #4 migg
    April 17, 2009

    regarding Traumeel S contents:
    The article in question mentions that it contains 13 active substances in dilutions ranging from 10-1 to 10-6. I googled it and found formulation for a gel and oral and injection formulation. Not sure if it’s the same they used, though.

  5. #5 Marcus Ranum
    April 17, 2009

    the BBC article still strikes me as bending over backwards to point out that homeopathic remedies had no side effects (how could they? they’re water) and could thus “co-exist” with conventional therapies.

    I think a lot of britons might get upset if they discovered how horribly they’ve been fleeced by homeopathy. They probably expect that their government regulators are protecting them from con-men. Learning you’ve misplaced trust can really sting.

  6. #6 Sam C
    April 17, 2009

    Orac:

    [homeopathic remedies] are, after all, nothing more than water.

    This is an outrageous misrepresentation!

    Homeopaths also prescribe sugar pills. Mainly for water-intolerant patients, I guess.

  7. #7 Sam C
    April 17, 2009

    Andy Lewis:

    [The Royal London Homeopathic Hospital] is in danger of closing. It now exists in part of one floor of its once grand building and is desperate to stay alive.

    The RLHH is on a corner of Queen Square. On one side of Queen Square is the National Hospital for Neurology and Neurosurgery (NHNN); the RLHH and NHNN are both in the University College of London Hospitals group. And around Queen Square are some leading edge neuroscience research units. So we have in one location, the extremes of super-science medicine in the NHNN and super-woo in the RLHH.

    UCLH management meetings must be fun when the RLHH is competing for funding against real medicine and real medics!

  8. #8 Adam Cuerden
    April 17, 2009

    The BBC’s complaints page is here:

    http://www.bbc.co.uk/complaints/complaints_stage1.shtml

    I’d suggest that everyone make a complaint: The BBC has statutory regulators, and well-backed complaints are not allowed to be taken lightly.

  9. #9 Lorne
    April 17, 2009

    There must be something to homeopathic drugs. After all Tyler Hamilton just got busted for his second doping infraction after taking a “Homeopathic” substance. http://www.velonews.com/article/90740/tyler-hamilton-retires-following-second-positive-doping-test. This has got be a first for the homeopathic community, enough of what ever is in the water or sugar pills was left behind in his drug blood stream to find traces of Dehydroepiandrosterone (DHEA). Or was that the herbal compound. Anyhow further proof in my books that just because it’s natural doesn’t mean it’s safe.

    Keep up the good work Orac.

  10. #10 Michael Simpson
    April 17, 2009

    Lorne, I think there was some bad writing in the Tyler Hamilton article. A lot of people have broadened the definition of homeopathy to include a lot of woo potions. Homeopathic potions are diluted to the point where they contain nothing. If it’s not, then it’s not homeopathic.

    Going off topic a bit, cycling is just plain dirty. I remember watching Lance win all of those TdF races, actually flying out to Paris to watch one of them a few years ago. I was pretty devoted to the sport, and proud of the Discovery Channel Team (or, prior to that, the USPS team). Not so much now.

  11. #11 Andrew Wade
    April 17, 2009

    Despite this extensive quote from a real skeptic and scientist, the BBC article still strikes me as bending over backwards to point out that homeopathic remedies had no side effects (how could they? they’re water) and could thus “co-exist” with conventional therapies.

    I thought placebos do sometimes have side effects. Besides which I wouldn’t trust homeopathic remedies not to have been adulterated with active ingredients.

  12. #12 Danimal
    April 18, 2009

    Orac, you continue to amaze me. I have have difficulty coming up with one well crafted paragraph a day in my job. Yet you come up with one voluminous post after another. I wish I had your talent for writing. What pisses me off though is that you always seem to appeal to authority by citing David Gorski. He does not have half the brains you do.

  13. #13 Mojo
    April 18, 2009

    The inclusion of the Calendula study is interesting in the light of the finding of the recent paper by Ludtke and Rutten that “the conclusions on the effectiveness of homeopathy highly depend on the set of analyzed trials”.

  14. #14 Marilyn Mann
    April 18, 2009

    This “more study is needed” gambit was used by the tobacco companies for decades.

  15. #15 dt
    April 18, 2009

    The BBC have now changed their headline. A little bit better…

    Homeopathy ‘no cancer care harm’

    but still very misleading.
    Since many gullible patients feel that homeopathy is effective, they may forgo conventional therapy in order to indulge their wooist delusions. In these circumstances, homeopathy has definite potential for harm.

  16. #16 Joe
    April 19, 2009

    As far as considering the traumeel and calendula products, which are not diluted to oblivion, I suggest that one dilution-succussion (1X, i.e., 10%) could be legitimately considered homeopathic. I ran that past a veterinarian/biochemistry professor who is an expert on homeopathy. She responded “How long is a piece of string?” I remain confused about what constitutes homeopathy, and I am measuring many pieces of string, to little avail.

  17. #17 Neuroskeptic
    April 20, 2009

    I wrote to the authors of the review and asked them why they included the study of the calendula ointment. They replied (post here)

    “We contacted the manufacturer of the calendula ointment and they confirmed that it had been prepared in accordance with the German Homeopathic Pharmacopoeia, therefore the trial met our inclusion criteria”.

    No comment…

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