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Papers, listed by lead author: B

B

Baker, S. et. al. (2005) ‘Homeopathic veterinary medicine’, (letter),Veterinary Record, vol. 157, pp. 390–391.

Links: [full text with links to references - vet rec, html]
Responses: (This is a reply to Hektoen 2005)

Ball, C., Dawson, S. and Williams, N. (2014) 'Leptospira cases and vaccination habits within UK vet-visiting dogs', Veterinary Record, vol 174, no. 11, p. 278, (http://dx.doi.org/10.1136/vr.102085). [permalink]

''This study investigated the number of suspected and confirmed canine leptospirosis cases within UK vet-visiting dogs. Practices reported cases that they either believed or confirmed to be canine leptospirosis over a 12-month period… Thirteen (14.61 per cent) reported suspected or laboratory-confirmed cases… of which five were laboratory confirmed…

'Twelve of the thirteen cases reported within the last 12 months had no current vaccination, emphasising the need for regular, annual Leptospira canine vaccinations. The majority of reported cases resulted in a high mortality rate (n=8/13; 61.54 per cent).

'We demonstrate that canine Leptospira infections are present in the UK despite vaccine availability, and that dogs are dying as a result of such infections... As all but one case was witnessed within non-vaccinated canines, it highlights the importance for dogs in the UK to maintain a current vaccination.'

This paper convincingly demonstrates the need for UK dogs to have annual vaccination boosters. The authors looked at UK cases of canine leptospirosis in the previous 12 months and found that all but one of the 13 cases identified occurred in non-vaccinated dogs and over 60% of those cases died. They emphasise the need for annual booster vaccination to maintain protection against leptospirosis wherever in the UK a dog lives as they also found little correlation between cases and the traditional ‘at-risk’ areas such as rural locations or close to water courses. Leptospirosis is endemic in the UK and it can cause disease in humans as well as dogs. The vaccine used to protect dogs is an inactivated one with a duration of immunity of one year at most. Thus annual booster vaccinations are required to maintain immunity and any dog whose boosters have lapsed for more than a few months requires a fresh, primary course of two injections, a few weeks apart, in order to re-establish protection.

Anyone who claims otherwise is at best ignorant of the facts and, at worst, out and out lying and, if you look more closely, in all probability selling ‘nosodes’ which they pretend will do the job of vaccination. The bottom line is dogs are dying of preventible diseases as a result of anti-vaccination dogma.

Links: [full text, html (£)]:[full text, pdf (£)]

Balzarini, A., Felisi, E., Martini, A. and De Conno, F. (2000) ‘Efficacy of homeopathic treatment of skin reactions during radiotherapy for breast cancer: a randomized, double-blind clinical trial’, British Homeopathic Journal, vol. 89, pp.8–12.

Weak and vague findings - Ernst (2007) says of this paper, "Patients treated with homeopathy noted less hyperpigmentation and a decrease in skin temperature, but these differences were no longer significant by the end of the 10-week follow-up. Total severity scores favoured homeopathy, but statistical significance for the difference was noticed only during recovery". The authors themselves report "The limited number of patients observed and the posology employed could have interfered with the significance of the results".

There are always people trying to exploit worried and vulnerable patients, but when it comes to cancer sufferers it is particularly disgusting.

Links: [abstract, pub med]:[abstract, science direct]
Responses: [Ernst 2007]

Barnes, J., Resch, K.L. and Ernst, E. (1997) ‘Homeopathy for postoperative ileus? A meta-analysis’, Journal of Clinical Gastroenterology, vol. 25, pp. 628–633.

A paper which looked at the time to first flatus during recovery in patients having undergone abdominal surgery. The authors mention that "several caveats preclude a definitive judgment".

Links: [abstract, pub med]:[CRD database]:[Bandolier]

Barrett, S. 2009 Homeopathy: The Ultimate Fake, Quackwatch.

A brilliant summary of all that is wrong with homeopathy with Stephen Barrett at his quiet, rational, informative best, methodically debunking the nonsense put out by those who profit from the sale of bogus remedies to desperate, worried victims. If there was any doubt about the self interested motives of CAM proponents just read some of the comments at the end of the article -- nothing like a well researched, rational argument to reveal the truth behind the smoke and mirrors.

Links: [original article html]

Bauer, Matthew (2004) An Interview with Dr Paul Unschuld Acupuncture Today: Part One Vol 5, no 7; Part Two Acupuncture today Vol 5, no 8 [permalink]

Dr. Unschuld has degrees in Chinese studies, pharmacology, public health, and political sciences and is one of the world’s leading authorities on the history of Chinese medicine. He has a level of sympathy with acupuncture and feels it has benefits to offer, but like many serious scholars in this area is occasionally frustrated at the rather flagrant re-writing of Chinese history by modern practitioner-advocates more interested in promoting their own agenda than actually getting at the truth.

"It is a fact that more than 95 percent of all literature published in Western languages on Chinese medicine reflect Western expectations rather than Chinese historical reality. Bestsellers are usually written by those who know no Chinese, have no access to Chinese medical history, and have never - or at best for short periods - been to China... while they reflect Western yearnings, they fail to reflect the historical truth of Chinese medicine"

"... few people are aware that TCM is a misnomer for an artificial system of health care ideas and practices generated between 1950 and 1975 by committees in the People’s Republic of China, with the aim of restructuring the vast and heterogenous heritage of Chinese traditional medicine in such a way that it fitted the principles [of] Marxist-Maoist type democracy and modern science and technology..."

"... before serious historical research on the origins and conceptual basis of Chinese medicine had been conducted, much of Western secondary and tertiary literature claimed a Daoist underpinning for TCM. This is incorrect for two reasons. First, TCM is a product... of Communist China... Second, even if we were to apply the term TCM to pre-revolutionary Chinese medicine, the Daoist impact should be considered minimal..."

"Acupuncture, it appears, at no time played a dominant role in Chinese health care..."

"... All of that is to draw attention to the complexity of ancient Chinese medical history. This complexity is in stark contrast to the simplistic and often naive historical accounts found in modern Western secondary literature on acupuncture and Oriental medicine"

Links: [Part 1 full text, Acupuncture Today]:[ [Part 2 full text, Acupuncture Today]

Bell, I.R., Lewis, D.A., Brooks, A.J., Schwartz, G.E., Lewis, S.E., Walsh, B.T. and Baldwin, C.M. (2004) ‘Improved clinical status in fibromyalgia patients treated with individualized homeopathic remedies versus placebo’, Rheumatology, vol. 43, pp. 577–582.

"This pilot or feasability study replicates and extends a previous 1-month placebo-controlled crossover study in fibromyalgia that pre-screened for only one homeopathic remedy. Using a broad selection of remedies and the flexible LM dose (1/50 000 dilution factor) series, the present study demonstrated that individualized homeopathy is significantly better than placebo in lessening tender point pain and improving the quality of life and global health of persons with fibromyalgia."

Although the placebo was claimed to be indistinguishable from the remedy no check was done of participants at the end of the trial to determine if they knew what group they were in. Somewhat unorthodox outcome variables were chosen - tender point pain on palpation for instance rather than conventional pain score assessments such as McGill Affective Pain scores or McGill Sensory Pain ratings both of which showed no difference between groups at 3 months. There are no objective tests available for fibromyalgia, accordingly all outcome measures are indirect. Problems noted by science based medicine and Perry et al (below) - patient numbers are low, flaws in the randomisation process, statistical differences in end-points only seen after statistical 'adjustment' of the results (in table 2).

Links: [abstract, pub med]:[abstract, Rheumatology]:[full text, pdf, Oxford journals]
Responses: [Scienced based medicine on homeopathy and fibromyalgia]:[Perry et al 2010]

Bell, I.R. (2005) ‘All evidence is equal, but some evidence is more equal than others: Can logic prevail over emotion in the homeopathy debate’, Journal of Alternative and Complementary Medicine, vol. 11, no. 5, pp. 763–769.

A guest editorial, this opinion piece is a homeopathic howl of anguish about a well conducted study (Shang et al 2005) which has found that homeopathy is ineffective.

It starts off reasonably well as Shang’s study is criticised for not disclosing which trials fulfilled the selection criteria for inclusion in their meta-analysis (this error was recognised by the authors and rectified within a short time of publication). After that though it very quickly degenerates into a litany of the usual lame excuses trotted out by homeopaths about papers whose conclusions they don’t agree with.

Some of the 110 homeopathic trials involved in the selection were “unhomeopathic” we are told; Bell complains that some are "isopathy" - although this of course is never a criticism when results go more in homeopathy’s favour (Reilly et al 1994). Doctor Bell also complains that the Shang paper isn't the "final word" in homeopathic trials. Well the authors never claimed it was, this is simply a straw man argument. An editorial in the same edition of the Lancet did proclaim “The End of Homeopathy” but then quite clearly stated this was because of “150 years of unfavourable findings”, not because of any one paper.

The howl intensifies as the author continues according to the familiar mantra: political bias, including a "heterogenous" set of cases treated with different types of homeopathy, the “forgetting” of the alleged "better overall well-being", and "greater energy" experienced by homeopathic patients during treatments (nicely vague end points, those, and ones which were never intended to be included in the study), the claim that homeopathy is supposedly cheaper (not if it doesn’t work it isn’t!) are all dragged in to cloud the issue and of course the tired old ‘usual suspects’ (Cucherat et al. 2000; Linde 1997; Reilly et al. 1994) are brought into play, with the claim that they are "largely favourable" to homeopathy when in fact they are not (not to anyone who has actually looked at them anyway).

There is the usual complaint of the lack of funding for homeopathic trials (even though the profits of homeopathic pharmacies run into the billions every year) which is completely irrelevant as of course the Shang paper was actually an extremely good study of homeopathy. The problem here for the homeopaths is not lack of funding, it's lack of results.

Nice try, but no coconut I’m afraid.

Links: [abstract, Liebertonline]:[Full text, pdf, OA, JPHMA]

Bell, I.R., Lewis, D.A., Brooks, A.J., Lewis, S.E. and Schwartz, G.E. (2003) ‘Gas discharge visualisation evaluation of ultramolecular doses of homeopathic medicines under blinded, controlled conditions’, Journal of Alternative and Complementary Medicine, vol.9, pp.25–38.

"The procedure generated measurable images at the two highest voltage levels. At 17 kV, the remedies exhibited overall lower image parameter values compared with solvents (significant for Pulsatilla and Lachesis), as well as differences from solvents in fluctuations over repeated images (exposures to the same voltage). At 24 kV, other patterns emerged, with individual remedies showing higher or lower image parameters compared with other remedies and the solvent controls... the present findings also highlight the need for additional research to evaluate factors that may affect reproducibility of results"

Links: [abstract pub med]:[abstract liebertonline]

More weak and unconvincing stuff, many weaselly words in the abstract, slithering around the issue of statistical significance.

Bellavite, P., Ortolani, R., Pontarollo, F. et al. (2006) ‘Immunology and homeopathy 4. Clinical studies – Part 2’, Evidence-based Complementary and Alternative Medicine, vol.3, pp. 397–409.

An uncritical, non-selective and completely credulous trawl through dozens of papers concerning homeopathy, this literature review appears to have no criteria for inclusion at all other than that a paper must have come to a result favourable to homeopathy. The authors even acknowledge the weakness or the material they are studying throughout: “A general weakness of evidence derives from lack of independent confirmation of reported trials and from presence [sic] of conflicting results”, “... the open and uncontrolled nature of the trial makes it impossible to draw definite conclusions.” “... randomization was not specified” and “The two groups were not randomized but …” are but a few examples of how weak the evidence under scrutiny is. Nevertheless for reasons known only to themselves it is still maintained that such flawed material is proof positive for homeopathy.

Things start to get desperate when, at one point, the authors even include a trial that someone heard a mention of at a conference but where the complete paper appears to be unavailable to report on. Things get worse as they stop off at one point to briefly argue that hoary old chestnut that proper trials are unsuitable for testing homeopathy since homeopathy “depends on in-depth anamnesis and atmosphere of trust, which is disrupted by randomization” (this is of course complete nonsense - either homeopathy works or it doesn't, lowering the bar for success is just cheating!) then, still careering around for credibility they strike a glancing blow at quantum physics by inserting the word 'entanglement' suggestively a few times before grinding to a halt mired in the no-hope saloon of the homeopathic researcher - observational studies.

In the final conclusion the authors claim there is an “efficacy/effectiveness paradox” where homeopathy is rubbish in proper trials but the people who use it and make money from it think it's great. Or, as we at RationalVetMed would prefer to say, “it doesn't work” (stop me if I’m getting too technical).

Links: [abstract pub med]:[full text pub med central]:[full text pub med pdf]

Belon, P., Cumps, J., Ennis, M., Mannaioni, P.F., Roberfroid, M., Sainte-Laudy, J. and Wiegant, F.A.C. (2004) ‘Histamine dilutions modulate basophil activation’, Inflammation Research, vol. 53, pp. 181–188.

Links: [full text BVVS pdf]:[abstract - ingenta connect]:[Citation only, pub med]
Responses: [JREF forum]:[the great DBH rant]

Benre, V.V. and Dharmadhikari, S.D. (1980) ‘Arnica and Hypericum in dental practice’, Hahnemannian Gleanings, vol 47, no. 2, pp. 70–72.

Nothing available on line.

Benveniste, J. et. al. (1988) ‘Human basophil degranulation triggered by very dilute antiserum against IgE’, Nature, vol. 333, no. 30, pp. 816–818.

This is the notorious ‘memory of water’ experiment by Jacques Benveniste’s team, a source of much agonising on both sides of the debate. Although it is normally referred to as Benveniste’s paper (because it was - hence the listing in the ‘B’ section) his name modestly appears at the end of the list of authors. The lead author is Dayenas, E., so you will find the paper dealt with in the appropriate section, under ‘D’.

Berrebi, A., Parant, O., Ferval, F. et. al. (2001) ‘Treatment of pain due to unwanted lactation with a homeopathic preparation given in the immediate post-partum period’, Journal de gynécologie, obstétrique et biologie de la reproduction, vol. 30, pp. 353–357.

The main article is in French - quelle damage!

Links: [abstract, pubmed]:[full text, ElsevierMasson]

Berezin, A.A. (1990) ‘Isotopical positional correlations as a possible model for Benveniste experiments’, Medical Hypotheses, vol. 31, no. 1, pp. 43–45.

Links: [abstract, pub med]

Beyerstein, B.L., (1997) ‘Why bogus therapies seem to work’, Skeptical Enquirer, vol. 21, no. 5.

“At least ten kinds of errors and biases can convince intelligent, honest people that cures have been achieved when they have not.”

Links: [full text - CSI]

Bignamini, M., Saruggia, M. and Sansonetti, G. (1991) ‘Homoeopathic treatment of anal fissures using Nitricum acidum’, Berlin Journal on Research in Homeopathy, vol 1, pp. 286–287.

As examples of just how lame your average homeopath is about evidence have a look at the description of this paper (for which there is no offical, serious reference on line, just a load of pro-homeopathic speculation) as given on a couple of pro-homeopathic websites.

The Homeopathic Research Institute describes what it calls the abstract, "The authors used randomized clinical experimentation that was controlled by a double-blind versus placebo challenge to evaluate the therapeutic activity of Nitricum acidum 9 CH on anal fissures. In general, the active treatment appeared to be satisfactory, but was statistically significant only in two of the 6 parameters considered: burning sensation and the subjective opinion of the patient regarding the efficacy of the treatment.". The H'pathy web site states "Patients using Nitricum acidum 9C once daily in a double blind placebo controlled trial found subjective relief with the medicine over the placebo"

It is difficult to believe that the first quote is an abstract from an actual scientific paper, even one published in a pro-homeopathic journal. It looks as if it has been written by a five year old and it appears whoever wrote it doesn't understand any of they technical terms they are using. "The authors used randomised clinical experimentation... controlled by a double blind versus placebo challenge" is vague and imprecise and sounds more like something from a star trek script. Maybe it’s a translation issue but it is not the usual form of words found in scientific papers and one has to wonder why that particular phrasing was used and whether something is being hidden as a result.

"Satisfactory" is a weasel word which (particularly when preceeded by its partner in crime "appeared") strongly suggests that the authors are desparately trying to squeeze more from the data than is justified from their actual findings, so although there was no statistical significance to the figures they never the less felt justified describing the treatment using a subjective and completely meaningless term which tells us more about the prejudices of whoever wrote this than about the effects of homeopathy.

We aren't told in the selected quotes available what the other parameters considered were but of the two where "statistical significance" is claimed (and we aren't given the figures behind the claim) both are extremely vague and subjective even according to the author of this "abstract". Remember, this is homeopathy versus a sugar tablet, a blank, in other words versus nothing at all, and the absolute best they can claim is an unspecified change in "burning sensation" and the patient's own, subjective opinion of the treatment, something which, however meaningful to the individual patient, has no place in a scientific study. We have no idea what other parameters were looked at, how significant those parameters might have been or how far short of the mark homeopathy fell. This is an excercise in cherry picking data.

The verdict here has to be "could do better"!

Links: [nothing available online]

Bodey, A.L., Almond, C.J. and Holmes, M.A. (2017) 'Double-blinded randomised placebo-controlled clinical trial of individualised homeopathic treatment of hyperthyroid cats', Veterinary Record, vol 180, p. 377 (doi:10.1136/vr.104007). [Permalink]

‘Abstract... There were no statistically significant differences in the changes seen between the two treatment arms following placebo or homeopathic treatment... or between the means of each parameter for either treatment arm before and after placebo or homeopathic treatment...  The results of this study failed to provide any evidence of the efficacy of homeopathic treatment of feline hyperthyroidism.’

Hyperthyroidism (an over-active thyroid gland) in cats is a nasty, insidious disease which, in a nutshell, turns the metabolism of affected cats up to eleven. Their heart starts to beat so fast it eventually fails, their energy consumption rockets so they develop a ravenous appetite, eating more food than ever before, yet they still lose weight. And they also get quite grumpy as a rule. But despite all this they can live, untreated, for quite a while, although with serious quality of life issues.

Some homeopaths claim you can treat an overactive thyroid by using homeopathy or, more precisely, isopathy with nosodes prepared from ground up thyroid glands (which, by the way, is an example of ‘sympathetic magic’, along the lines of the medicine man spitting on the ground to bring rain or a voodoo priest sticking pins in an effigy of someone who is ill). These homeopaths are most charitably described as ‘mistaken’.

What happens when truly hyperthyroid cats are treated homeopathically (i.e. with nothing) is that they stuggle on for months and months with heart failure and weight loss, becoming increasingly uncomfortable and breathless yet all the time, like most cats, just appearing to sit around quietly rather than making a fuss, right up until the point they go into acute heart failure and die, often in some considerable distress. And while this is happening the attending homeopath is either claiming success on the good days or claiming an ‘aggravation’ during the bad ones - ‘ever had your cat vaccinated, ever fed it commercially prepared cat food, ever given it any medicine, or flea or worm treatment? There you are then, it’s all your fault, it’s the toxins’, they’ll tell you as they trouser your hard-earned cash.

And it’s all nonsense - you cannot successfully treat an overactive thyroid with homeopathy or isopathy as this well conducted trial by statistical supremo Mark Holmes and crew shows.

Of course, the homeopaths are wingeing about it, as they always do when trials, no matter how well conducted, don’t give results they like, even when in this case homeopathic head honcho John Saxton personally gave his go ahead for the trial design.

The homeopathic practitioner, Chris Almond, who participated in the trial says he is expecting a hard time from his homeopathic colleagues - ‘I don’t think I am going to be very popular’ he complains in an article in the BSAVA Companion magazine. And then, in typical homeopathic fashion, the excuses start - having been a willing part of the trial for the whole six years it took to perform, cooperating at every stage and interpreting the answers from owners in response to an agreed questionnaire, once the results are published he suddenly changes his tune, ‘the quality of responses from clients in the questionnaire was often “pretty poor” and made it difficult for him to determine the best individualized treatment for each animal’. Furthermore, he has now decided ‘he was also uncomfortable with the three-week duration of therapy set in the trial protocol’ and, anyway (one can almost hear the stamping of tiny feet and the sound of toys being thrown out of prams by this stage), ‘the experience of participating in the study has shown him that the randomized controlled trial format is simply not suitable as a test of homeopathic methods’.

Well why didn’t he say something sooner, one might well ask? Could it be he was waiting just in case the results were favourable to homeopathy first, in which case the triumphalist cries from the vet homs would have been deafening? But that didn’t happen, the results were entirely in line with expectations and it looks like Mr Almond is currently being hung out to dry by his erstwhile colleagues for consorting with the devil and participating in a well run, methodologically robust trial along with two other veterinary surgeons who were completely independent of any vested interest. Really, what was he thinking!.

I can do no better than to quote Andrew Bodey, the (conventional) veterinary practitioner whose idea it was to perform the trial in the first place, 'If the purpose of your efforts is to justify your own opinions rather than to answer a legitimate question, then that is not going to work…'

There’s no getting away from it, homeopaths are simply poor losers.

Links: [Abstract pubmed]:[Abstract vet rec]:[Full text, html, vet rec (£)]:[Full text, pdf (£)]

Comment: [Edzard Ernst]:[Companion Magazine - Bonner 2017 Homeopathy, Informing the debate (£)]

Boissel, J.P., Cucherat, M., Haugh, M. and Gauthier, E. (1996) ‘Critical literature review on the effectiveness of homoeopathy: overview of data from homoeopathic medicine trials’, In: Homoeopathy Medicine Research Group: report to the European Commission Directorate General XII: science, research and development. Brussels 1996: pp. 195–210.

This report is apparently unavailable online but, from the similarity of the authors and title, it seems to have given rise to the paper by Cucherat et al, (2000), published in the European Journal of Clinical Pharmacology. Since they are effectively the same a critique of both works can be found following the Cucherat citation on this site. It doesn’t stop homeopaths reporting both pieces as if they were two different works of course to increase their “evidence base” - something which speaks volumes for the attitude of homeopaths to research!

Bordes, L.R. and Dorfman, P. (1986) ‘Evaluation of the antitussive effect of Drosetux syrup: double-blind study versus placebo’, Cahiers d'oto-rhino-laryngologie, vol. 21, pp. 731–734.

an antique paper, in French, apparently not available in English or on line, how convenient for anyone touting this as evidence in favour of homeopathy!

Bornhöft, G., Wolf, U., Ammon, K., Righetti, M., Maxion-Bergemann, S., Baumgartner, S., Thurneysen, A.E. and Matthiessen, P.F. (2006) ‘Effectiveness, safety and cost-effectiveness of homeopathy in general practice–summarized health technology assessment’, Forsch Komplementärmed, vol. 13, no. 2, pp.19–29.

“Taking internal and external validity criteria into account, effectiveness of homeopathy can be supported by clinical evidence and professional and adequate application be regarded as safe”
Oh, wait, no it can’t... Just another uncritical and wildly optimistic trawl through what passes for research in the smoke and mirror world of homeopathy. Dozens of papers looked at, no mention of exclusion criteria, methods, numbers, power, significance or anything else. Only the abstract is available on line though.

Also, ”Forsch Komplementärmed” translates as “Research in Complementary Medicine” - publication bias did anyone say?

Links: [abstract pubmed]:[summary, Karger]

Bracho, G., Varela, E., Fernandez, R., Ordaz, B., Marzoa, N., Menendez, J., Garcia, L., Gilling, E., Leyva, R., Rufin, R., de la Torre, R., Solis, R.L., Batista, N., Borrero R. and Campa, C. (2010) ‘Large-scale application of highly-diluted bacteria for Leptospirosis epidemic control’, Homeopathy, vol. 99, pp. 156–166.

This paper describes a trial conducted (one might say inflicted) on Cuban citizens including children, in some cases as young as one year of age, who were at risk of dying from leptospirosis due to "environmental, socio-economic and climatic changes" which caused a rise in incidence in the regions studied.

According to homeopaths Roniger and Jacobs (2010), this paper was initially rejected by mainstream journals by virtue of its complete lack of randomisation and inadequate controls (the authors rather grandly claim the entire of Cuba's remaining population as their control arm - imagine all those consent forms). It finally found refuge in that trade journal of homeopaths, the less-than-imaginatively entitled Homeopathy. Hardly the place to look for an unbiased view one might imagine, and one would be correct!

When studied carefully, all this paper demonstrates is the incidence of leptospirosis in the areas under test, which had been badly affected by flooding for a number of years, merely returned to the same background levels (three to four cases per 100,000 of the population per week) as the unaffected, and untreated, surrounding areas, once the flooding had subsided. No need to invoke the magic of homeopathy here.

Which is just as well, since the trial didn't even use homeopathy. The technique employed, although disingenuously referred to by many homeopaths as "homeopathic" was so-called "homeoprophylaxis", using nosodes, or "homeopathic vaccination". Such an error would certainly have resulted in howls of derision from furious homeopaths, had the final results not appeared so favourable to homeopathy.

Apgaylard, Andy Lewis and Peter Lipson all have something to say about it in their various excellent blog entries, and Martin Whitehead’s critique is an object lesson in critical appraisal. Follow the links below for well-reasoned analysis of this ridiculous and vastly over-hyped study.

Links: [abstract, science direct]:[full text - sphq]:[press report - medical news today]
Responses: [apgaylard 2010 - here is the news]:[apgaylard 2010 - much ado about nothing]:[apgaylard 2010 - editing reality]:[Lewis, A., 2009 - quackometer - Hasta el Absurdo Siempre!]:[Lipson, P., 2010 - science based medicine]:[critique by Dr Martin Whitehead, veterinary surgeon]:[Edzard Ernst]
Keywords: leptospira, nosode, Cuba

Brien, S., Lewith, G. and Bryant, T. (2003) ‘Ultramolecular homeopathy has no observable clinical effects. A randomized, double-blind, placebo-controlled proving trial of Belladonna 30C’, British Journal of Clinical Pharmacology, vol. 56, no. 5, pp. 562–568.

Conclusion: "Ultramolecular homeopathy had no observable clinical effects".

The clue is in the title ;-)

Links: [abstract - pub med]:[full text - html]

Brien, S., Prescott, P., Owen, D. and Lewith, G. (2004) ‘How do homeopaths make decisions? An exploratory study of inter-rater reliability and intuition in the decision making process’, Homeopathy, vol. 93, no. 3, pp. 125–131.

"The validity of clinical decision making in homeopathy is largely unexplored and little is understood about the process or its reliability. This exploratory study investigated... the extent to which decisions are based on clinical facts or intuition and how reliable decisions are. Three experienced, independent homeopathic clinicians/proving researchers rated the symptom diaries of the 206 subjects taking part... The level of agreement between raters was generally poor ... All raters used both facts and intuition. The rater's reliance on the facts was significantly associated with classifying those subjects who had no proving response. Raters used significantly higher intuition scores when classifying a prover..."

So, homeopaths use either "facts" - such as whether patients have a fear of clams, the tendency to wink after dinner or a feeling of weakness nine days after taking the remedy (all these are genuine examples by the way) - or they just make it up as they go along (and none of them agree with one another anyway). Six of one, half a dozen of the other really.

Links: [abstract, pubmed]

Brien, S., Lachance, L., Prescott, P., McDermott, C. and Lewith, G. (2011) ‘Homeopathy has clinical benefits in rheumatoid arthritis patients that are attributable to the consultation process but not the homeopathic remedy, a randomized controlled clinical trial’ Rheumatology’ vol. 50, no. 6, pp. 1070–1082.

“Homeopathic consultations but not homeopathic remedies are associated with clinically relevant benefits for patients with active but relatively stable rheumatoid arthritis”.

In other words it’s the long chat which makes the difference, not the homeopathic pills. There is nothing unique or special about homeopathy, it’s all in the bedside manner; the only difference between a homeopathic practitioner with a good bedside manner and a real doctor with a good bedside manner is that the real doctor doesn’t do that little thing at the end with the sugar tablet.

Links: [abstract, rheumatology]:[full text, html, rheumatology]:[full text, pdf, rheumatology]
Responses: [Ernst, 2011]

Brigo, B. and Serpelloni, G. (1991) ‘Homoeopathic treatment of migraines: a randomized double-blind study of sixty cases (homoeopathic remedy versus placebo)’, Berlin Journal on Research in Homeopathy, vol. 1, pp.98–106.

A non-English language paper with no reference or abstract available on line therefore unable to verify any claims made on its behalf - how convenient.

Brinkhaus, B., Wilkens, J.M., Lüdtke, R. et al. (2006) ‘Homeopathic arnica therapy in patients receiving knee surgery: results of three randomised double-blind trials’, Complementary Therapies in Medicine, vol. 14, pp. 237–246.

“CONCLUSIONS: In all three trials, patients receiving homeopathic arnica showed a trend towards less postoperative swelling compared to patients receiving placebo”
Well, that sounds fantastic, surely this is proof that homeopathy works (well, at least a “trend towards” it, that’s got to mean something hasn’t it?). Absolutely it is, oh, apart from the next bit “However, a significant difference in favour of homeopathic arnica was only found in the Cruciate Ligament Repair (CLR) group”, well, but surely... err, hang on the CLR trial only has 57 of the 319 patients looked at in total. But surely, significance is significance isn’t it? Well, is it?  In this paper the authors admit that the difference in absolute terms between knee circumferences (designated merely as a secondary outcome) was nowhere near statistically significant in any of the trials, being only a few millimetres between the two groups (placebo and verum) out of a total of around 390 mm - not that striking at all really when you think about it. It’s only when the percentages are looked at, using an unusual “triangle” test, that statistical significance appears, like a rabbit out of a hat.

This paper also is a classic example of looking at indirect outcomes of an intervention. The authors have chosen to look at post-operative change in knee circumference; all very interesting I’m sure but you don’t see many patients in orthopaedic wards with tape measures measuring their operation sites and shouting with joy when they find the circumference of their knee is 6mm less than their neighbour’s. What you do see is people moaning about how much it bloomin’ well hurts - that is the outcome that is relevant to the patient. Yet in this trial, pain is relegated to a mere secondary outcome. And guess what, there is no significant difference in pain scores in any of the groups. The authors also go on to freely admit, in a throw away line, that conventional pain- killers out-perform the homeopathic remedy in every case. They also complain that they haven’t been able to study the effects of arnica in patients who are not using conventional pain killers - no great surprise they didn’t get ethical approval for that one.

So this is yet another homeopathic lemon I’m afraid. In all the ways that are meaningful to the patient homeopathy is useless and, even in the parameters which present homeopathy in its best light, the minute differences in knee circumference are only different when looked at as a percentage, not absolute measurements and then in only 57 out of 319 patients. And remember, the RationalVetMed elephant-in-the-room as always with these so called favourable trials is that homeopathy is being compared WITH A SUGAR TABLET! Compared with real drugs even the authors admit homeopathy falls completely flat (they just don’t use those words, and they bury that bit in the last paragraph of the discussion) so, at the end of the day one has to ask “why bother”.

Finally, the authors also claim that they found 40 trials of homeopathic arnica (presented conveniently in a non-English language journal) which, they say, found that, by and large, it was great stuff. I wonder if all those trials were as rigorous as this one?

There are other trials of Arnica, which the authors are strangely quiet about, which come to the conclusion that arnica as a treatment for bruising and swelling is a complete waste of time, for example Stevinson (2003), Ernst and Pittler (1998) and Ernst (2003). One even appears in the Homeopathy journal - now that makes a refreshing change.

Links: [abstract, pubmed]
Responses: [skepticnorth]:[Ernst 2012, Skeptical Enquirer]

Brydak, L.B. and Denys, A. (1999) ‘The evaluation of humoral response and the clinical evaluation of a risk-group patients’ state of health after administration of the homeopathic preparation Gripp-Heel during the influenza epidemic season 1993/94’, International Review of Allergology and Clinical Immunology, vol. 5, pp. 223–227.

Despite this paper’s optimistic claim (“the clinical data we obtained indicate seroprotection against influenza after the administration of Gripp-Heel when compared with the control group”) and its impressive graph at figure 1 this study really does not deliver the goods.

For a start there is selection bias as all participants were volunteers, so we have no way of telling whether or not patients were influenced by their own state of health, whether or not they believed in homeopathy or other factors when volunteering for the trial, in fact no selection criteria are given at all. The authors have conducted their trial in a population representative of the real world at-risk group which is good but it does mean that all participants were suffering chronic illnesses which inevitably will have an effect on their immune status and antibody levels (which is what the authors were investigating). We are told that the participants were “randomly divided into two groups” but are given no details of the randomisation process. This is important as it would be possible for those carrying out the randomisation to unconsciously influence which type of patient was entered into either the control or the verum group, introducing another form of bias. There may have been a tendency to put patients it was felt were less likely to contract flu or perhaps those who simply looked more ill or frail in one group rather than another.

The participants were living in nursing homes (how many isn’t specified but it is more than one) but we are not told whether patients were selected randomly across the whole group of them or whether all patients from one nursing home were put in one group. Obviously different conditions in one home compared with another would have a marked effect on the outcome so it is surprising that this isn’t even discussed. There is also no mention of whether or how the two populations were matched in order to make sure that the control group was comparable with the treatment group, an essential prerequisite to a study of this sort.

No blinding is mentioned and again this is crucial and throws real doubt on the paper’s methodology. Certainly there would have been no need to blind the participants, who would have presumably been unaware of their circulating antibody levels, but what about the people doing the analysis? It is not unheard of for a technician who gets an unexpected result to re-run the analysis “just to check”. It would be easy to unwittingly introduce bias at this point if someone tended to re-run tests which produced results that didn’t correlate with the outcome they were expecting yet didn’t re-run truly unexpected results which, however unlikely, did fit in with their expectations. The figures used in the paper include only mean antibody levels, we have no idea what individual patients’ levels were so the calculations can’t be checked and there is no way of telling whether there may have been bias at this stage or whether one or two extreme results had undue influence on the overall averages; results which might otherwise have been excluded from the calculations as ‘outliers’ or possibly spurious.

It cannot be said with any certainty whether any of these types of bias were present of course but from the way the paper is laid out and from the limited data we are given there is no way to be sure, and when you are testing a claim that remedies which contain no active ingredients are effective in protecting vulnerable individuals against a life threatening disease, the onus is on the authors to make sure that such loose ends are well and truly tidied up before making such bold claims. Making clinical recommendations from these results is irresponsible and this paper is by no means evidence that homeopathy has any discernible effect.

Links: [full text, pdf, biopathica]

Buell, P.D., May, T. and Ramey, D. (2010) ‘Greek and Chinese horse medicine: deja vu all over again’, Sudhoffs Archiv, vol. 94, no. 1, pp. 31–56. [permalink]

Sinologist Paul Buel treats us to an enlightening and scholarly article about Ancient Chinese Veterinary Acupuncture and reveals it is actually far from ancient. Oh, and it’s not particularly Chinese either… and it’s not really what we’d call acupuncture.

"... while Chinese horse medicine developed in characteristically Chinese ways, it did so with major and fundamental borrowings from many other traditions. most probably Greek, including Greek medicine as mediated by Arabic translations, of which there are a great number."

“... the first surviving work in Chinese specifically devoted to veterinary medicine only dates from 1384. This is the Simu anji ji (SMAJJ) ‘Collections for Pacifying Stallions when Administering Flocks’...

"Conspicuously absent from the SMAJJ, and for that matter, from all pre-modern Chinese horse veterinary texts is any reference whatever to what even remotely be considered acupuncture... The term zhen, "needling", (better "incision", "penetration"), incorrectly translated "acupuncture" as a matter of course is used to describe insertions for purposes of cauterisation and bleeding, and, later, minor surgeries..."

Links: [abstract pubmed]:[full text, pdf, DoctorRamey.com]

Burger, J., Kirchner, M., Bramanti, B., Haak, W. and Thomas, M.G. (2007) ‘Absence of the lactase-persistence-associated allele in early Neolithic Europeans’, Proceedings of the National Academy of Sciences of the United States of America, vol. 104, no. 10.

From the press release: “This study challenges the theory that certain groups of Europeans were lactose tolerant and that this inborn ability led the community to pursue dairy farming. Instead, they actually evolved their tolerance of milk within the last 8000 years due to exposure to milk.”

From the paper: “Although our data are consistent with strong selection for [lactase persistence] beginning with the introduction of cattle to Europe ~8800 B.P., it is unlikely that fresh milk consumption was widespread in Europe before frequencies of [the lactase gene] had risen appreciably during the millennia after the onset of farming”

What has this paper, on the evolution of stone-age Man, got to do with anything veterinary you may ask? Well, one of the supposed lynch-pin arguments of the Raw Food evangelicals is that because the dog has only recently evolved from the wolf there cannot possibly have been time for it to have changed in any significant way, in particular in relation to its digestion and dietary habits. There are a few papers which suggest this made-up claim is complete nonsense, and this is one of them. If humans evolved in a mere seven to eight thousand years from being unable to tolerate milk as adults to a situation where milk was a useful, even essential, food then obviously wolves could have made all sorts of similar adaptations in the far greater time they’ve been living in “the human niche”.

Links: [full text, PNAS, pdf]
Responses: [press release, UCL]
Key words: raw, food, meaty, bones, barf, rmb

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