Irresponsibility to the nth power: Homeopaths treating HIV in Africa

Anyone who reads this blog knows my opinion of homeopathy. Just type "homeopathy" in the little search box on the left side of this blog, and you'll be greeted with many, many posts dating back to the very beginnings of Orac's presence on ScienceBlogs. Of course, science is with me on this one, as it does not support the primary claims of homeopathy, including:

• Like cures like
• Dilution with succussion makes a remedy stronger
• Water has "memory" of remedies that it has come in contact with, which is how homeopathic remedies can "work," even though they've been diluted to the point where, even homeopaths admit, there is unlikely to be even a single molecule of active substance left.

Dr. Kimball Atwood has also discussed the utter implausibility and lack of scientific support for homeopathy in a five part series: "Homeopathy and Evidence-Based Medicine: Back to the Future" (Part I, II, III, IV, V), as well as why homeopaths can cite clinical trials that appear "positive" despite this extreme scientific implausibility in "Prior probability: The dirty little secret of 'evidence-based' medicine" (parts I and II). So what am I to think of this story about homeopaths treating HIV patients in Africa?

The story begins:

MAUN, 21 February 2008 (PlusNews) - The nondescript town of Maun in northern Botswana is often no more than a way-station on the road to the luxury safari camps of the Okavango Delta, a haven for wildlife and one of Africa's most popular tourist destinations.

For Hilary Fairclough, a former nurse from England, a visit to Maun while accompanying her partner on a work trip in 2000, planted the seed of an idea that has brought her back twice a year since then.

She was stunned by the toll HIV/AIDS was taking on the Batswana, at a time when antiretroviral (ARV) drugs had yet to become available in the public health sector, and in 2002 she returned to find out if there was a demand among people living with HIV for her services as a trained homeopath.

Very few homeopaths practice in Botswana, and not many people in Maun had heard of this alternative form of medicine before her arrival, but the Maun Homeopathy Project, as it later became known, has since treated 1,500 HIV-positive people in the area.

The service, which is free thanks to donations from the project's supporters in the UK, is provided by two volunteer homeopaths she recruits from the UK to spend three months at a time in Maun.

Many of the project's patients are now taking ARV medication, but report that the homeopathic remedies help them deal with the sometimes unpleasant side effects as well as opportunistic infections and depression, and improve general wellness.

This is even more irresponsible than the time, exposed by Le Canard Noir, homeopaths made claims that they could treat malaria, resulting in the Society of Homeopaths trying to silence his blog with vacuous legal threats. Of course, homeopaths are spouting the usual excuses for why their remedies fail, for instance, the typical appeal to other ways of knowing:

Despite being around for over 200 years, the efficacy of homeopathy is still being debated. Supporters of conventional medicines tend to view it as a placebo at best and quackery at worst. In an opinion published this week in The Star, a South African daily newspaper, Mark Colvin, a doctor and epidemiologist, described homeopathy as based on "an absurd premise" that has never been scientifically substantiated.

Homeopathy's supporters respond that homeopathic medicine operates so differently from conventional medicine - treating the whole person rather than just their illness - that the conventional means of measuring effectiveness are inadequate.

What a load of fetid dingo's kidneys! (Apologies to Douglas Adams.) This is nothing more than claiming that their woo is too "wholistic" or "mystical" to be measured by science; in other words, it's magical thinking typical of homeopaths and advocates of homeopathy. The homeopaths also play the martyr card, something they're very good at:

Fairclough, who practices homeopathy in the UK when she is not doing fund-raising and administration for the project in Maun, is dismayed to have been drawn into the controversy after the project was mentioned in several opinion pieces in the UK press during December 2007.

The media debate was sparked by a London symposium on the homeopathic response to HIV and AIDS, but the question of whether or not public health services such as the UK's National Health Service (NHS) should fund homeopathic treatment was also raised. NHS funding for two homeopathic hospitals has since been cut.

"I think it's a very small number of people who are anti-homeopathy in the UK, who have a powerful voice," Fairclough said. "Here [in Botswana], people feel there's room for different approaches."

She believes part of the appeal of homeopathy in Botswana is because it has elements of both traditional and western medicine. "It comes in a pill, but the approach - taking into account mind, body and spirit - is more Batswana. People are very comfortable with it," she said.

Of course she should be dismayed. She should be ashamed, actually! Of course, it's nothing more than a few really nasty, nasty skeptics who, against all magical thinking, insist upon science- and evidence-based medicine, who are responsible for this horrific persecution of homeopath to the point of--gasp!--trying to stop the NHS from wasting funds that could otherwise be spent on effective medicine or improving services on antiscientific woo.

There is, however, clearly a reason why homeopaths have managed to make inroads. As usual, it is because modern scientific medicine is overburdened and has a hard time dealing with the emotional needs of its patients in its quest to get effective medicine to the people:

To understand why patients queue up outside the Lutheran Church, sometimes travelling from villages several hundred kilometres away, one has only to look to Botswana's overstretched public health service.

Like the homeopathic remedies, ARVs are free in Botswana, but with a national HIV infection rate of 24 percent, second only to Swaziland, the need is overwhelming. Just as the government has sought to expand access to ARV treatment, doctors and nurses have been leaving the country to take better-paying jobs in South Africa and other neighbouring countries, or even in Australia and the UK.

"At the moment, we have five doctors and we're supposed to have 13," said the chief medical officer at Maun Hospital, Dr Richard Kambinda. The hospital's HIV/AIDS clinic is supposed to be staffed by three doctors, but Kambinda said it was lucky if it had one at any given time. The machine used to establish the CD4 count, which determines when a patient should start taking ARVs, or how well they are doing on treatment, has been broken for several months.

"In the hospital they don't ask so many questions, they do everything quickly," Kelegobile commented. "They only give you painkillers, always painkillers."

Botswana's ARV treatment programme has often been cited as a model for other countries in the region, but some people, including the hospital's former chief medical officer, Dr Eric Beltz, believe it has sacrificed quality for quantity.

Beltz, who moved to Australia three years ago but was visiting Botswana when IRIN/PlusNews spoke to him, worries that the rapid scale-up of the HIV/AIDS treatment programme, combined with the shortage of staff to monitor drug adherence and treatment failure, will create significant problems with drug resistance in the not too distant future.

His concerns are shared by Israel Tjiharuka, who runs a counselling centre for people living with HIV in the village of Sehitwa, about 100km from Maun, where the homeopathy project runs an outreach clinic once a month.

"In our hospitals the doctors are busy - they'll just refill [ARV prescriptions], they won't ask any questions," he told IRIN/PlusNews. "People aren't educated about what side effects they might experience on certain drugs, so they don't complain."

I will give Fairclough credit for one thing, though. At least she doesn't claim homeopathy can treat HIV alone. In doing so, however, she can't resist making an unsupportable claim:

Although Fairclough regularly treats patients for side effects from ARVs, she is careful to describe homeopathy as "complementary" to ARV treatment. "I've had a couple of patients say they just want the homeopathy, but I say 'no, it's not enough, you need the ARVs'. It might be that homeopathy could keep people from needing ARVs for longer, but we can't afford to conduct that kind of research."

"Homeopathy could keep people from needing ARVs longer"?

The mind boggles.

If this story shows anything, it shows one thing that is crystal clear wherever homeopaths get a foothold: What is needed is not woo like homeopathy but more resources in the medical system that can fund an adequate number of physicians and nurses, adequate equipment and medication, and allow for enough time so that the clinics don't make patients "feel like a number." Those failings of conventional medicine, particularly in impoverished areas like Botswana, are a magnet for woo. Unfortunately, the answer is, as usual, very difficult, given that it will take lots of money to achieve.