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Papers, listed by lead author: C


Camerlink, I., Ellinger, L., Bakker, E.J. and Lantinga, E.A. (2010) ‘Homeopathy as replacement to antibiotics in the case of Escherichia coli diarrhoea in neonatal piglets’, Homeopathy, vol. 99, no. 1, pp. 57–62.

This must be one of the few papers ever published to study a condition in animals which doesn’t take the trouble to discover whether the animals concerned actually have the condition in the first place! That’s right, not one of the pigs under study had a confirmed enteropathogenic E. coli infection. The limited number of cultures which were carried out revealed no sign whatsoever of the enteropathic E. coli under study. Instead the authors preferred to make this judgement by virtue of the colour of the diarrhoea, a laughable way of making a diagnosis, particularly one intended to support the far-fetched claim that homeopathy works.

This fact plus the journal of publication is a trade journal for homeopaths positively bursting at the seams with vested interests and given the study mentions only “observer” blinding (so we can’t be sure whether the stockmen, or the people presenting the pigs for examination by the observers, or the people administering the remedy, or the people doing the statistics were not aware which group had received which treatment) means this study has questionable methodology and protocols, to say the least.

That of course hasn’t stopped homeopaths the world over making the claim that this is proof positive of the effectiveness of homeopathy.

Links: [abstract, sciencedirect]:[abstract pubmed]:[full text, pdf, centaurea]
Responses: [moteprime]:[Pepijn van Erp]:[skepdic]:[]
Keywords: veterinary

Caspi, O., Millen, C. and Sechrest, L. (2000) ‘Integrity and research: introducing the concept of dual blindness; how blind are double-blind clinical trials in alternative medicine?’ Journal of Alternative and Complementary Medicine, vol. 6, no. 6, pp. 493–498.

The authors claim that double blinded trials aren't appropriate for some types of CAM so they propose "... a new term in research methodology, dual-blind, to describe a methodological alternative in which the caregiver is not blind but the patient and an external evaluator/investigator are". Almost as if they're trying to hide something. I propose a new term for "Dual Blind": "not blinded at all, in any way shape or form". Because that's what it means. This is a typical tactic of the promoters of CAVM - if the science doesn’t support your position then keep changing the methodology until it does.

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

Caulfield, T. and DeBow, S. (2005) ‘A systematic review of how homeopathy is represented in conventional and CAM peer reviewed journals’ BMC Complementary and Alternative Medicine, vol. 5, no. 12.

“While a small study with clear limitations, there was a stark difference between the numbers of studies that were negative in the conventional journals (69%) as compared to the CAM journals (30%)”

And the authors have the nerve to suggest it’s science-based journals that are prejudiced, not that homeopathic journals which are wildly optimistic and uncritical when it comes to selecting papers for publication.

Links: [full text BMC]
Responses: [Gimpy’s blog: Publication bias in CAM? Nope, it’s orthodox research that is flawed. Err maybe not]

Cavalcanti, A.M., Rocha, L.M., Carillo, R., Lima, L.U. and Lugon, J.R. (2003) ‘Effects of homeopathic treatment on pruritus of haemodialysis patients: a randomized placebo-controlled double-blind trial’, Homeopathy, vol. 92, pp. 177–181.

Links: [abstract pubmed]:[abstract, science direct]

Chang, Y.E., Glissmeyer, M., Tonnes, S., Hudson, T. and Johnson, N. (2006) 'Outcomes of breast cancer in patients who use alternative therapies as primary treatment', American Journal of Surgery, vol. 192, pp. 471-473. [permalink]

Alternative therapies used as primary treatment for breast cancer are associated with increased recurrence and death. Homeopathy instead of surgery resulted in disease progression in most patients.

So there you have it, it couldn't be more simple - patients who use bogus therapies, including homeopathy, to treat cancer are more likely to die than those using real medicine. Anyone selling homeopathy who tries to tell you otherwise is lying, possibly with lethal results. But why should they care - you (or your pet) is the one with cancer, whereas they're the ones making the profit.

Links: [abstract, pubmed]

Chapman, E.H., Weintraub, R.J., Milburn, M.A., et al. (1999) ‘Homeopathic treatment of mild traumatic brain injury: a randomized, double-blind, placebo-controlled clinical trial’, Journal of Head Trauma Rehabilitation, vol. 14, pp. 521–542.

The abstract of this questionable study is packed with weasel words, which doesn’t bode well for the rest of it: “This study suggests that homeopathy may have a role in treating persistent MTBI.”

Criticalist, a poster at the James Randi Educational forum (link below), reports a problem with the statistics in this one and also comments on the limitations of not using a validated questionnaire:

‘Their outcome measure is the results of a questionnaire, which they administered to both groups, before and after the treatment. The authors admit that this tool had not been validated in previous trials, which in itself is a major problem - they simply have no idea if the primary outcome measure of the trial measures what they think it does.

‘The questionnaire comprises 3 sections with a total of 65 questions about various activities, to which the the subjects reply by scoring a 1 -5; (1 = never, 2 = rarely, 3 = sometimes etc...). These are rank ordered ordinal variables which means that while they progress in order, they don't provide quantitative information. So for example, someone who has a weight of 60kg is always exactly twice as heavy as someone whose weight is 30kg. However someone who replies "most of the time' (a score of 4) to the question "How often do you feel frustrated" is not always frustrated exactly twice as much as someone who had responded "rarely" (a score of 2). Ordinal variables like these have to be analysed statistically in a different manner to ratio scales like weight, but the authors do not do this.

‘Instead they add up all the numbers they get in each part of their questionnaire before and after the treatment and present it an arithmetic mean. They then perform a t test for each of seven sections of the questionnaire. Doing this they found no real differences in the majority of the data ("Our data revealed the limitations of our standardized tests to detect changes from treatment") Out of the seven analyses they performed one is significant (p=0.009) the rest are not. They then perform a whole raft of multivariate analyses, with again one or two results they claim are significant.

‘Overall, I am reminded of a quote from one of my statistics lecturers; "If you torture the data long enough, eventually it will confess"’

Links: [abstract, pubmed]:[abstract, journal head trau rehab]:[full text]
Responses: [JREF forum]

Chikramane, P.S., Suresh, A.K, Bellare, J.R., Kane, S.G., (2010) ‘Extreme homeopathic dilutions retain starting materials: A nanoparticulate perspective’, Homeopathy, vol. 99, pp. 231-242. [permalink]

It has become fashonable for homeopaths these days to talk about 'nanotechnology' as being the latest answer to how homeopathy supposedly exerts its effects. Poor old quantum physics is 'so last year' when it comes to explaining homeopathy now, the cutting edge homeopath has moved on to pastures new. Of course both quantum physics and nano-technology are both only the latest in a long and eclectic list of 'mechanisms' for homeopathy which have, in the past, included magnetism, 'spallation', an increase in the number of electrons in the oxygen content of remedies, manipulation of the life force, water vortices, nano-bubbles, micro-clusters of water molecules, electro-magnetic impulses and so on ad infinitum. Most of these mechanisms are mutually incompatable, all of them are pure speculation and none of them are correct.

This paper and others like it are what is responsible for this latest "fashion towards the tiny" as they claim that homeopathic medicines retain their base ingredients at extreme dilutions, in the form of silicate coated nanoparticles. They also serve as a perfect illustration of homeopathic pseudoscientific research at its finest and the desperation of the homeopathic mindset, prepared to believe any old guff that is put in front of them so long as it confirms their preconception that homeopathy works.

The authors purchased homeopathic remedies from a local Indian street market which they took to their laboratory, dried and then analysed using Electron Microscopy and Atomic Emission Spectroscopy. This supposedly revealed that quantities of the original ingredients from which the remedies had been manufactured – namely gold, silver, platinum, copper, tin; and up to 4000pg/ml of zinc – were still present, and at similar concentrations regardless of the level of dilution. They also reported another similar study which had previously found iron and mercury residues at even higher concentrations in other remedies.

Instead of doing what most of us would have done at that point and contacting trading standards to report a manufacturing fault, contamination, or possible adulteration, the authors appeared delighted, describing the fragments they had found as nano-particles and publishing their results as a positive finding and a possible mechanism for homeopathy.

The obvious question to ask is, if these findings are true of metal-based remedies, what about those made from say lymph from smallpox sores (variolinum) or other, smaller viruses, or prions, which are in common use – should the relevant authorities be informed there is a likelihood of viral particles being present in homeopathic and isopathic preparations?

Homeopaths are fond of pointing out that those who haven't received sufficient indoctrination cannot be expected to fully comprehend homeopathy so we will have to take it on trust that consumption of quantities of toxic heavy metals and possibly a variety of infectious agents are of benefit to the vital-force, that elusive spiritual entity which is the stock in trade for homeopaths. Those less enlightened know full well they are thoroughly bad in the ‘corporeal’ entity.

But the enormous elephant in the room is how, as homeopaths claim, the potency of homeopathic remedies increase with successive dilutions if they rely on the presence of physical ingredients for their effect? Do these nano-particles increase in numbers in circumstances where the concentration of every other substance in the known universe would fall (in which case could this be a commercially viable means of producing gold?) or do they instead manage to remain in the remedy despite the best efforts of the homeopathic pharmacy to dilute them out of existence, somehow becoming stronger in the process – how does a nano-particle become stronger anyway?

In the meantime, we can look forward to hearing how nano-particles manage to form from some of the other, more ethereal, ingredients employed in homeopathic remedies which are readily available from online suppliers – storms (Tempesta) and shipwrecks (Naufragium Helvetia) for instance, or light from the planet Venus (Venus Stella Errans). And what about anti-matter (Positronium), would that have to be encased in anti-silicone in order to exert its effect while avoiding a cataclysmic release of explosive energy in a Star Trek style warp-core breach type scenario? And finally, how on Earth do nano-particle sized portions of dead bees (Apis mel) manage to relieve the symptoms of itching anyway?

Over the years in the veterinary media we have seen much claimed in the name of homeopathy. Hundreds of papers have been presented allegedly supporting the idea homeopathy works, none of which has done anything of the sort; there have been claims homeopathy can cure cancer while the concurrent involvement of pharmaceuticals noted for their anti-cancer properties is concealed; now we have a supposed mechanism for homeopathy which seems to hinge on mundane contaminants even the authors of the study admit in all likelihood arose during the manufacturing process.

In light of all this perhaps homeopathic practitioners should concede that the struggle to prove homeopathy in the material world is lost and, rather than rejecting magic as an explanation, might consider embracing it as homeopathic researcher Professor Harald Walach did some time ago when he made the quite categorical statement, “homeopathy is effective in a non-local way: it acts by magically activating connectedness...” (Walach, 2000). This seems to us here at RationalVetMed to have a certain refreshing honesty at least!

Links: [abstract, pubmed]:[abstract, homeopathy journal]:[full text, homeoint, pdf]:[full text, researchgate, pdf]

Comments: [IRCC, pdf]:[ (elecronmicrographs)]:[]

Clover, A. (2000) ‘Patient benefit survey: Tunbridge Wells Homoeopathic Hospital’, British Homeopathic Journal, vol. 89, pp. 68–72.

Yet another patient questionnaire–open, non-randomised, no controls; designed to feed homeopathic web-sites with bogus, feel-good propaganda. Just imagine, if you’d been treated with care and attention by a nice homeopath, all for free (this is the NHS mind you) by someone who then gave you a list of questions to answer. You’d have to be pretty mean, well certainly impolite and churlish to say “it was rubbish”, no matter how you felt really. I mean this is Britain after all and most people are just polite by nature, particularly when asked directly in a questionnaire which they had to fill in while still at the clinic and in front of clinic staff.

But even with all this pressure for an answer in the affirmative in this self selected population of patients who presumably had favourable inclinations towards homeopathy in the first place (otherwise they wouldn’t have been there) an incredible 26% actually said they had either got worse or felt no benefit whatsoever following homeopathic treatment, with a further 19% saying they felt only “slightly better” following treatment. When you take into account the number of questionnaires which were handed out but not completed the situation looks even worse with only 40% of surveys returning a positive report. What with all this and despite the author’s admission that this study is “not a definitive research paper” and runs contrary to homeopathic principles it’s no wonder the only journal they could find which would publish this paper was the British Homeopathic Journal, one of the major trade magazines for homeopathic profiteers. Even still, you will find this report touted in countless web sites as evidence favourable for homeopathy.

Links: [abstract science direct]

Colquhoun, D. (2007) ‘Treating Critically Ill Patients With Sugar Pills’, Chest, vol. 131, no. 2, pp. 635–636

This is a response to Frass (2005) and is followed by a response from the authors of the original paper.

Links: [full text, html, Chest]:[full text, pdf, Chest]

Colquhoun, D. (2009) ‘Secret remedies: 100 years on’, British Medical Journal, BMJ 2009;339:b5432

‘Clark’s claim in 1927 that: “some travesty of physical science appears to be the most popular form of incantation” is even truer today. Homoeopaths regularly talk nonsense about quantum theory, and “nutritional therapists” claim to cure AIDS with vitamin pills. Some of their writing is plain delusional, but much is a parody of scientific writing, in a style that Ben Goldacre calls “sciencey.” It reads quite plausibly until you check the references.’

This is Professor Colquhoun at his finest, giving an elegant, straight to the point summary of the state of quackery in the UK. He is especially annoyed at Prince Charles - the BMJ missed that bit out for some reason so he published the original article on DCScience anyway!

Links: [abstract, pubmed]:[fulltext html BMJ]:[original, unedited text DCScience]
Responses: [rapid responses BMJ]

Colquhoun, D. and Novella, S.P. (2013) ‘Acupuncture Is Theatrical Placebo’, Anesthesia and Analgesia, vol. 116, no. 6, pp. 1360-1363. [permalink]

Although it is commonly claimed that acupuncture has been around for thousands of years, it has not always been popular, even in China. For almost 1000 years, it was in decline, and in 1822, Emperor Dao Guang issued an imperial edict stating that acupuncture and moxibustion should be banned forever from the Imperial Medical Academy.

‘Acupuncture continued as a minor fringe activity in the 1950s. After the Chinese Civil War, the Chinese Communist Party ridiculed Traditional Chinese Medicine, including acupuncture, as superstitious. Chairman Mao Zedong later revived Traditional Chinese Medicine as part of the Great Proletarian Cultural Revolution of 1966.2 The revival was a convenient response to the dearth of medically trained people in postwar China and a useful way to increase Chinese nationalism. It is said that Chairman Mao himself preferred Western medicine. His personal physician quotes him as saying “Even though I believe we should promote Chinese medicine, I personally do not believe in it. I do not take Chinese medicine.”’

A neat summary of the state of acupuncture research and the disconnect between the actual results of much of this research and the spin placed upon it by acupuncturist, occasionally even the researchers themselves, often so keen for a 'positive' result they are happy to ignore the fact that placebo acupuncture also gave the same 'positive' result. And if placebo acupuncture works aswell as 'proper' acupuncture, then what's the point? It's not acupuncture any more, it's just sticking pins in animals and people.

As the authors of this piece say '... such an accumulation of negative results would result in the withdrawal of any conventional treatment'.

Links: [Improbable science, pdf]
Responses: [Improbable science]

Conforti, A., Bellavite, P., Bertani, S., Chiarotti, F., Menniti-Ippolito, F. and Raschetti, R. (2007) ‘Rat models of acute inflammation: a randomized controlled study on the effects of homeopathic remedies’, BioMed Central Complementary and Alternative Medicine, vol. 7, no. 1.

“The present study was designed to explore the possibility [of testing] in a controlled way the effects of homeopathic remedies on two known experimental models of acute inflammation in the rat. To this aim, the study considered six different remedies indicated by homeopathic practice for this type of symptom in two experimental edema models... using two treatment administration routes...

“In a first phase, the different remedies were tested in the four experimental conditions, following a single-blind... procedure. In a second phase, some of the remedies... were tested by oral administration in the carrageenan-induced edema, under double-blind... and fully randomized conditions...

Results: In the first phase of experiments, some statistically significant effects of homeopathic remedies were observed... In the second phase of experiments, the effects of homeopathic remedies were not confirmed. [By contrast], the unblinded standard allopathic drug indomethacin exhibited its anti-inflammatory effect in both experimental phases.

Conclusion: The discrepancies between single-blind and double-blind methods in animal pharmacological research are noteworthy and should be better investigated, also in non-homeopathic research.”

Well, there one has it, if you want even vaguely credible results from research into homeopathy (or indeed, anything else for that matter), it needs to be double blinded. Singe blinded may sound impressive but unless the paper specifically mentions double blinding then you may as well stop reading, put the article down and go and find something more interesing to do. Watching some paint dry always helps pass the time I feel, or try banging your head against a brick wall perhaps.

Links: [abstract, pubmed]:[full text, HTML, BMC]:[full text, HTML, PMC]:[full text, pdf]

Conzemius, M. and Evans, R. (2012) ‘Caregiver placebo effect for dogs with lameness from osteoarthritis’, Journal of the American Veterinary Medical Association, vol. 241, no. 10, pp 1314-1319. [permalink]

The authors reveal something which many veterinary surgeons have suspected for decades, that there is a form of “placebo effect” where animals are concerned. Obviously animals don’t have a placebo effect as such but it is perfectly possible for both owners and veterinary surgeons to convince themselves there has been an improvement in an animal they are treating when more objective assessments report no change, or even a deterioration, in health.

This finding is of fundamental importance when trying to understand the use of alternative medicine in animals. Very many sceptics have claimed that so called “improvements” are nothing more than an unconscious conspiracy between owner and therapist, greatly to the detriment of the animal under treatment. Now, if proof were ever needed, here it is.

Links: [fulltext JAVMA - subscription required]:[abstract - JAVMA]:[abstract - bioinfobank]

Cracknell, N.R. and Mills, D.S. (2008) ‘A double-blind placebo-controlled study into the efficacy of a homeopathic remedy for fear of firework noises in the dog (Canis familiaris)’, The Veterinary Journal, vol. 177, pp. 80-88.

“Seventy-five dogs that showed a fear response to fireworks participated in a double-blinded, placebo-controlled clinical trial to assess the efficacy of a homeopathic remedy for the alleviation of their behavioural signs... There were significant improvements in the owners’ rating of 14/15 behavioural signs of fear in the placebo treatment group and all 15 behavioural signs in the homeopathic treatment group. Both treatment groups also showed significant improvement in the owners’ rating of the global severity of their dog’s responses. However, there was no significant difference in the response seen between the two treatment groups.

A post hoc analysis was carried out... to investigate the likelihood that an effect could be detected with the sample size used... we believe the clear lack of a value approaching significance, means we can be confident that there was a real lack of it in this study and the lack of significance is not a type II statistical error.”
A study which shows, once again, that homeopathic remedies are indistinguishable from sugar tablets - how many times does this need repeating!

The investigation of canine behaviour using this type of technique is fraught with difficulties and pit-falls. Such matters are dealt with most exquisitely by Overall and Dunham (2008) (see link below).

Links: [abstract, pubmed]:[full text, pdf, omoepatia]
Responses: [Overall and Dunham, 2008]

Cucherat, M., Haugh, M. C., Gooch, M. and Boissel, J.P. (2000) ‘Evidence of clinical efficacy of homeopathy. A meta-analysis of clinical trials. HMRAG (Homeopathic Medicines Research Advisory Group)’, European Journal of Clinical Pharmacology, vol. 56, no. 1, pp. 27-33.

“OBJECTIVE: To establish, using a systematic review and meta-analysis, whether there is any evidence from randomised controlled clinical trials of the efficacy of homeopathic treatment in patients with any disease...  The combined P value for the 17 comparisons was highly significant P = 0.000036. However, sensitivity analysis showed that the P value tended towards a non-significant value (P = 0.08) as trials were excluded in a stepwise manner based on their level of quality...

CONCLUSIONS: There is some evidence that homeopathic treatments are more effective than placebo; however, the strength of this evidence is low because of the low methodological quality of the trials. Studies of high methodological quality were more likely to be negative than the lower quality studies...”

This paper derives from a report commissioned by the EU by Boissel et al (1996) and is one of the "Usual Suspects". Both versions of the report are dealt with together here as one of the pieces of evidence homeopaths believe best supports their views.

What the homeopaths say: The European Network of Homeopathy Researchers (ENHR) mention a report which seems similar to Boissel et al (1996) although it is listed as “short version” about which they state -HMRG report with overview of clinical research in homeopathy, identified 184 controlled clinical trials. They selected the highest quality randomized control trials, which included a total of 2617 patients for a meta-analysis. This meta-analysis resulted in a p-value of 0.000036 (which means that results are highly significant) indicating that homeopathy is more effective than placebo. The researchers concluded that the "hypothesis that homeopathy has no effect can be rejected with certainty".

This rather optimistic conclusion does not concur with the conclusion of the resulting paper (Cucherat et al, 2000) cited above despite the fact that the authors are mostly the same.  It is significant that the origin of this quote by ENHR is not available on line - we have no primary source for it as we do for the much more cautious European Journal of Clinical Pharmacology version (see link to abstract below).  It is also of interest that the "short version" of the report (or at least the quote taken from it) doesn't contain the highly significant qualifier which appeared in the later paper following the 'P=0.000036 likelyhood that homeopathy works' claim, namely "However, sensitivity analysis showed that the P value tended towards a non-significant value (P = 0.08) as trials were excluded in a stepwise manner based on their level of quality".  In other words, the better the quality of the trial the worse the result for homeopathy.

Contrast the ENHR comment with this one, from Stephen Barret of homeowatch:   

In 1996, a lengthy report was published by the Homoeopathic Medicine Research Group (HMRG), an expert panel convened by the Commission of the European Communities... After examining 184 reports, the panelists concluded: (a) only 17 were designed and reported well enough to be worth considering; (b) in some of these trials, homeopathic approaches may have exerted a greater effect than a placebo or no treatment; and (c) the number of participants in these 17 trials was too small to draw any conclusions about the effectiveness of homeopathic treatment for any specific conditions.

Another comment from Wayne Spencer in the Skeptical Intelligencer, August 1997, Volume 2 Number 2 states:

... 184 placebo-controlled trials were examined. Most studies were of poor quality and only 20 trials were found that (a) were randomised; (b) had a clearly described primary outcome; and (c) had a curative intention. After further eliminations because data was unavailable or insufficient for the purpose at hand, results from 15 trials (17 comparisons) were pooled and employed .

“The diversity of diseases and outcomes studied in the trials precluded a classical meta-analysis. Instead, Boissel et al (1996) applied a statistical test to the 17 eligible comparisons with a view to testing the hypothesis that "the treatment effect is not present in any of [the] trials pooled"... The result indicated that the probability that the results could be attributed to mere chance was less than 1 in a 1000 (p<0.001). The authors explained:

"’This means that, in at least one trial, the null hypothesis of the absence of effect can be rejected, namely that, in at least one trial, the experimental patients (i.e. those who were treated with homeopathic medicine) had some beneficial effects compared with the trial patients (i.e. those who received nothing, or a matching placebo), assuming that none of the pooled trials were biased in any way’ ...

Spencer points out that the authors stated they were unable to rule out such bias and that evidence for homeopathy became weaker as the quality of trials increased, a sure indication that bias was, in fact present.  His final comment on this paper is "as factors identified within the report itself qualify its support for the claims of homoeopathy virtually out of existence, little additional comment would seem to be necessary."

Of the original report, Edzard Ernst states in the House of Commons Science and Technology Committee on homeopathy (see link) "Boissel et al merely combined p-values of the included studies. This article is now... outdated. Furthermore it is not unambiguously positive." and of the published paper, "Cucherat et al is the publication of the Boissel document which was a EU sponsored report. [The authors themselves noted that “there is some evidence that homeopathic treatments are more effective than placebo; however, the strength of this evidence is low because of the low methodological quality of the trials.”]"

So, the final verdict (and remember, this is some of the absolute best evidence that homeopaths can produce): only 16 out of 184 trials were of adequate quality; analysis using an unorthodox statistical method suggested that one or a few seemed possibly to show homeopathy might have some benficial effect compared with plain sugar tablets but even this result could be due to bias which, for the purposes of the analysis, the authors had to assume wasn’t present. Furthermore, better quality trials gave less favourable results for homeopathy.

Not too convincing really, for a system of medicine which claims to be as powerful as homeopathy, to barely scrape past a sugar tablet in the "beneficial effects" stakes, and then only if everyone involved could be trusted to have had no vested interest in the results.

Next please...

Links: [abstract - pub med]:[abstract, springerlink]
Responses: [CRD - DARE database]:[Edzard Ernst blog]