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E

EASAC (European Academies’ Science Advisory Council) statement (2017) Homeopathic products and practices; assessing the evidence and ensuring consistency in regulating medical claims in the EU [Online]:[permalink].

"Veterinary practice — we conclude... that there is no rigorous evidence to substantiate the use of homeopathy in veterinary medicine and it is particularly worrying when such products are used in preference to evidence-based medicinal products to treat livestock infections.

"There should be consistent regulatory requirements to demonstrate efficacy, safety and quality of all products for human and veterinary medicine, to be based on verifiable and objective evidence, commensurate with the nature of the claims being made. In the absence of this evidence, a product should be neither approvable nor registrable by national regulatory agencies for the designation medicinal product.

"3.4 Veterinary applications - The use of homeopathic products in veterinary medicine is also controversial, and the recent implementation of EU rules risks undermining science-based farming practices…"

“… if the homeopathic remedy is found ineffective, this risks delay with potential harm for livestock and spread of the infection to other animals.

“A recent comprehensive systematic review of the scientific literature on homeopathy in farming (Doehring and Sundrum, 2016) evaluated whether such remedies could replace the use of antibiotics for infectious disease or growth promotion... The results from those studies supporting homeopathy lacked reproducibility and the systematic review concluded, ‘Within the studies considered, the use of the same remedy administered to the same species with a comparable medical condition was never repeated’ and ‘Replacing or reducing antibiotics with homeopathy currently cannot be recommended unless evidence of efficacy is reproduced by randomised clinical trials and proven in various farm practice conditions’.

“Thus, while EASAC recognises the strategic importance of attempts to reduce antibiotic use in animals.., the use of non-scientific alternatives is not advisable. The proliferation of unfounded homeopathic practices should not be encouraged in either veterinary or human medicine” [emphasis added]

This statement is a response to European Commission Regulation EC No 889-2008 of 5 September 2008, a piece of legislation advocating withholding real, science-based medicines from organically reared livestock in favour of medical practices such as homeopathy which are based more in superstition than fact. EASAC are not impressed, particularly by the undermining of science-based farming practices by EU politicians more interested in votes than science. The phrase ‘There should be consistent regulatory requirements to demonstrate efficacy, safety and quality… to be based on verifiable and objective evidence, commensurate with the nature of the claims being made.’ is enough to send a shiver down the spine of any practicing homeopath!

Links: [full text (pdf)]

Responses: [Edzard Ernst]:[Independent newspaper]

Ebert, F., Staufenbiel, R., Simons, J. and Pieper, L. (2017) 'Randomized, blinded, controlled clinical trial shows no benefit of homeopathic mastitis treatment in dairy cows', Journal of Dairy Science, Mar 22. pii: S0022-0302(17)30249-7. (doi: 10.3168/jds.2016-11805). [permalink]

‘We observed no significant differences in time to recovery, somatic cell count, risk of clinical cure within 14 d after disease occurrence, mastitis recurrence risk, or culling risk. The results indicated no additional effect of homeopathic treatment compared with placebo.’

A well conducted, triple-blind clinical trial performed by independent researchers in the prestigious Journal of Dairy Science, conducted over a 12 month period, looked at 162 cows suffering from the painful and economically important condition, mastitis. The conclusion: yet again homeopathy has no effect beyond placebo.

As Prof Ernst says, ‘How much more evidence is needed before homeopaths abandon their bogus claims?’

Links: [Abstract, pubmed]::[Full Text]

Comments: [Edzard Ernst]

Edwards, D.S., Henley, W.E., Ely, E.R. and Wood, J.L.N. (2004) ‘Vaccination and ill-health in dogs: a lack of temporal association and evidence of equivalence’, Vaccine, vol. 22, nos. 25–26, pp. 3270–3273 [permalink].

This is the strangely named POOCH survey (it stands for Practice Overview Of Canine Health) 9055 pre-tested and validated postal questionnaires, carefully designed so participants wouldn’t know the specific purpose of the questions in order to avoid bias were sent out and 4040 were returned completed by owners of dogs who had recently been vaccinated. This is a massive sample size, so we can be assured about the reliability of this study. After analysis of the results the authors reported “No temporal association was found between vaccination and ill-health in dogs… Results demonstrated that recent vaccination (<3 months) does not increase signs of ill-health by more than 0.5% and may actually decrease it by as much as 5%.”

Links: [Abstract, science direct]

Egan, J. (1995) ‘Evaluation of a homoeopathic treatment for subclinical mastitis’, Veterinary Record, vol.137, p. 48.

“... there was no evidence of any benefit being obtained either in eliminating bacteria or reducing milk somatic cell count (SCC ) from using this [homeopathic] preparation.”

Links: [abstract, vet record]

Egan, J. (1998) ‘Homeopathic mastitis control: a study on the uptake and efficacy of products in the Republic of Ireland’, Proceedings of the British Mastitis Conference, Axient/Institute for Animal Health, Milk Development Council/Novartis Animal Health pp. 22-28.

“In a joint study between the research centres at Abbotstown and Moorepark the efficacy of a homoeopathic nosode was evaluated in three herds... A total of 188 lactating cows were assigned at random, in a double blind trial, into two groups and treated with either a nosode or placebo for a period of 12 months. The homoeopathic preparation used in this experiment was formulated at 30c potency... A placebo was also used.

“A total of 148 cases of clinical mastitis cases developed in 70 of the cows on experiment... There were no significant differences between the two treatments in the number of new cases of clinical mastitis either within herds or in all herds collectively. There was also no significant difference in the frequency of isolation of individual pathogens from animals on each treatment.

“In a separate study Meaney evaluated the efficacy of a nosode... One group of 13 animals was treated with the nosode and a further group of 13 cows acted as an untreated control. The nosode was administered using a vulva spray technique and the experiment was conducted over an eight-month period. It was concluded that the nosode had no effect in reducing the mastitis incidence or milk somatic cell count.”

Links: [full text, British Mastitis Conference.org - pdf]

Elliott, M. (2001) ‘Cushing's disease: a new approach to therapy in equine and canine patients’, British Homeopathic Journal, vol. 90, no. 1, pp. 33-36. [permalink]

“Forty-one cases of Cushing's Disease affecting both equine and canine patients were treated with an identical mixture of two homeopathically prepared remedies and the clinical improvements seen in the cases assessed... The overall success rate for the therapy was 80% and results were broadly similar between the two species, indicating that homeopathy lends itself to the treatment of Cushing's Disease.”

This certainly is a ‘new’ approach, even for something as bizarre as homeopathy. This trial makes no attempt at “individualising” patients for the treatment of this potentially life threatening disorder of the adrenal glands. Individualisation is normally considered crucially important to the homeopathic treatment of disease as most homeopaths will tell you, and even more so during studies which have produced negative results when lack of individualisation provides an excellent excuse for dismissing conclusons which don’t concur with homeopathic preconceptions. This study however claims positive findings so lack of individualisation no longer matters; as far as homeopaths are concerned it’s results that count after all.

Another extremely important foundation of homeopathic treatment is the lengthy consultation with each patient, or in the case of veterinary patients, with the owner. This is necessary to obtain the vast list of “symptoms” which the homeopath needs to obtain the “simillimum”, i.e. the remedy which best suits the patient. How else is the homeopath supposed to find out important information like whether the patient has a “fear of clams” or a headache on one side of the head which is worse in the early hours (these are genuine examples)? In this case however the author has skipped past all that tedious and time consuming nonsense and has obtained the correct remedy by using “radiesthetic principles”, which is to say dowsing. Rather flying in the face of traditional homeopathy you may think, and you’d be right. But the beauty about a bogus treatment like homeopathy is that you really can just make it up as you go along - who is going to be able to prove you wrong after all?

“Surely though”, (comes the inevitable cry), “surely that’s all irrelevant, you’re just nit-picking - ‘The overall success rate for the therapy was 80%’ - Put that in your allopathic pipe and smoke it”.

Well, not quite... Only 12 of the 18 dogs in this study were diagnosed using even the most basic blood test, one which is readily available to the practitioner. None of them had their adrenal glands examined by ultrasound, something which is less common in practice but which a researcher ought to have considered, or at least discussed. The rest were diagnosed by clinical signs alone, which is a highly unreliable (some would say impossible) way of making a definitive diagnosis, despite the author’s claim that they were showing “classic symptoms” - there are no “classic symptoms” for Cushing’s Disease. During the follow up no blood tests were carried out in any of the participants. All “improvements” (in this condition noted for its waxing and waning characteristics) were assessed, unblinded, by the author purely on the basis of clinical examination and history. In the case of the 23 horses, 13 were diagnosed on clinical examination alone, “many” (the actual number seems to be 8) were diagnosed on clinical examination and blood glucose test, one was tested using a protocol normally used for thyroid disorders and only one had the reasonably reliable dexamethasone supression test. Again, follow up assessments were carried out by the author, purely on the basis of clinical examination. Given the absence of objective parameters used to assess response to treatment and the lack of blinding and a control group, bias (unintentional or otherwise) cannot be ruled out in this paper.

So, there we have it. Animals in this trial were denied the well researched and effective medications commonly available at the time to treat Cushing’s syndrome in order to test sugar tablets and dowsing on them and even that testing was inadequate as no follow up blood tests were carried out. In my opinion this trial was highly unethical by any standards; others hold even stronger views. Not a great day for the veterinary profession I’m afraid.

A year or so after Mr Elliot’s paper was published it was referenced in a proper paper on equine Cushing’s disease by Dr Harold Schott of Michigan State University, published in a proper journal (Schott 2002). In it he mentions all sorts of tests that can be done to diagnose and monitor equine Cushing’s syndrome (every one of which Mr Elliott appears to be unaware of) yet strangely fails to mention dowsing - how remiss of him!

Links: [abstract - pub med]:[full text - homeopathicvet]:[full text, thepenzancehorse.com]:[full text, semanticscholar pdf]
Responses: [critique - BVVS]:[Schott 2002]

Ennis, M. (2010) ‘Basophil models of homeopathy: a sceptical view’ Homeopathy, vol. 99, pp. 51-56.

“After over 20 years research trying to find out if high dilutions of histamine have a negative feedback effect on the activation of basophils by anti-IgE, what do we know? The methods are poorly standardized between laboratories... Certainly there appears to be some evidence for an effect – albeit small in some cases... How much of the effect is due to artifacts remains to be investigated.”

Links: [abstract, science direct]:[full text, similima, pdf]:[JREF forum]:[full text researchgate]

Ernst, E., Saradeth, T. and Resch, K.L. (1990) ‘Complementary therapy of varicose veins - a randomized, placebo controlled, double-blind trial’, Phlebology, vol. 5, pp.157-163 [permalink].

Abstract:

The aim of this study was to test the effectiveness of a combined homeopathic medication in primary varicosity. A well-defined population of 61 patients was randomized into active medication (Poikiven®) or placebo. Both were given for 24 d. At the start of the trial, after 12 d medication and at the end of the study, objective and subjective parameters were recorded: venous filling time, leg volume, calf circumference, haemorheological measurements and patients' symptoms such as cramps, itching, leg heaviness, pain during standing and the need to elevate the legs. The results show that venous filling time is changed by 44% towards normal in the actively-treated group. The average leg volume fell significantly more in this group, but calf circumferences did not change significantly and blood rheology was not altered in any relevant way. None of the patients reported side-effects. Subjective complaints were relieved significantly more by Poikiven than by placebo. These results suggest that the oral treatment of primary varicosity using Poikiven is feasable.

The journal Phlebology’s online archive doesn’t go back as far as the publication of this paper and their pub-med archive only started in 2007 so the full paper is unavailable. The abstract however, is now available on the Sage Journals website (link below).

This study was conducted by Edzard Ernst (now the bête noir of the homeopathic industry), during his time at the Department of Physical Medicine and Rehabilitation in Vienna. An obscure work, it hasn’t escaped the attention of eagle eyed homeopathic bloggers though, who have gleefully siezed upon it as conclusive proof of the Proff’s perfidiousness, suggesting this one, ancient paper which allegedly finds that homeopathy works, fatally undermines all his later research which proves it doesn’t.

This claim is ridiculous of course although it is very revealing about the attitudes of homeopaths who regard research as something to be used in a point-scoring exercise rather than in a genuine spirit of inquiry. Professor Ernst himself discusses this in his blog (link below) and reveals a number of interesting snippets about the paper not contained in the abstract.

One of the most damning of his disclosures is that the substance under test, Poikiven®, isn’t actually a homeopathic remedy atall, it’s a herbal one. Oh sure, it’s got ‘homeopathy’ written on the label, but according to the ingredients list it’s got, well... ingredients. And that’s something no homeopathic remedy should have. One of the central tenets of homeopathy is that less is more (the so-called Law of Infinitessimals), so much so that, to make them stronger, remedies are diluted literally billions of times over until, in a true homeopathic remedy, not one shred of the original ingredient remains. Poikiven on the other hand has stuff in it, mainly plant ingredients in considerable concentrations, one of which (“Aesculus or horse chestnut” according to Ernst) very conveniently, is a proven treatment for... you guessed it, varicose veins!

Neither is the paper itself terribly convincing about the ability of Poikiven® to successfully treat varicose veins – for a start the sample size was tiny, at only sixty-one participants. Then, according to the abstract, there were nine parameters studied: venous filling time; leg volume; calf circumference; haemorheological measurements; cramps; itching; leg heaviness; pain during standing and the need to elevate the legs. Out of all of those only venous filling time and average leg volume improved while calf circumferences and blood rheology [that’s stickiness to you and me] didn’t change in any significant way. No mention is made of the others, presumably if they had improved or even remained the same (like calf circumferences and blood rheology) they would have been mentioned in the abstract so we are left to speculate whether they may have got worse after treament with the substance under test.

So, any claims made by homeopaths that this paper is proof homeoathy works are completely wrong, unless the definition of homeopathy is so elastic as to be meaningless. This is just more homeopathic hype from people who don’t understand how science works.

Links: [abstract]
Responses: [ISF thread]:[Ernst (July 2015)]

Ernst, E. and Pittler, M.H. (1998) ‘Efficacy of homeopathic arnica: a systematic review of placebo-controlled clinical trials’, Arch. Surg., vol 133, no. 11, pp. 187-190.

"... The claim that homeopathic arnica is efficacious beyond a placebo effect is not supported by rigorous clinical trials."

Links: [abstract - pub med]:[full text - archives of surgery html]:[fulltext - arch surg pdf]

Ernst, E. (1999) ‘Evidence-based complementary medicine: A contradiction in terms?’, Ann Rheum Dis, vol. 58, pp. 69-70.

Links: [full text, pub med, pdf]

Ernst, E. and Pittler, M.H. (2000) ‘Re-analysis of previous meta-analysis of clinical trials of homeopathy’, Journal of Clinical Epidemiology, vol. 53, p. 1188 (a re-interpretation of Linde, 1997).

“Viewed in this way, the re-analysis of Linde et al. can be seen as the ultimate epidemiological proof that homeopathic remedies are, in fact, placebos.”

Links: [abstract, pub med]:[full text, JCE]

Ernst, E. (2001) ‘A primer of complementary and alternative medicine commonly used by cancer patients’, Medical Journal of Australia, vol. 174, pp. 88-92.

"Our knowledge regarding the potential benefit and harm of CAM is insufficient."

Links: [full text - MJA, html (£)]:[abstract, PubMed]

Ernst, E. (2002) ‘A systematic review of systematic reviews of homeopathy’, British Journal of Clinical Pharmacology, vol. 54, pp. 577–582.

“... there was no condition which responds convincingly better to homeopathic treatment than to placebo or other control interventions. Similarly, there was no homeopathic remedy that was demonstrated to yield clinical effects that are convincingly different from placebo. It is concluded that the best clinical evidence for homeopathy available to date does not warrant positive recommendations for its use in clinical practice.”

Links: [abstract, pubmed]:[abstract, Wiley]:[full text, pubmed central]:[fulltext, Wiley html]:[full text, Wiley, pdf]

Ernst, E. (2003) ‘The benefits of Arnica: 16 case reports’, Homeopathy, vol. 92, no.4, pp. 217-219.

"Following the publication of a randomised controlled trial of Arnica in hand surgery, a number of reports of apparently beneficial effects of Arnica came to the author's attention. Many of these apparent responses could have been due to other factors including the use of herbal (non-diluted) Arnica, placebo response and natural course of disease."

Links: [abstract, pubmed]

Ernst, E. (2004) ‘How much of general practice is based on evidence - The Back Pages’, in British Journal of General Practice, vol. 54, p. 316.

Well, between 55% and 97% according to Professor Ernst - much much more than is claimed by CAVM supporters trying to denigrate real medicine.

Links: [references, pubmed central]:[full text, pubmed central, pdf]
Responses: [Novella How Much Modern Medicine is Evidence-Based? - Neurologia blog]

Ernst, E. (2005) ‘Is homeopathy a clinically valuable approach?’, Trends in Pharmacological Sciences, vol.26, no.11, pp. 547-548.

“Contrary to many claims by homeopaths,there is no conclusive evidence that highly dilute homeopathic remedies are different from placebos... Contrary to widespread belief, homeopathy is not entirely devoid of risk. Thus, the proven benefits of highly dilute homeopathic remedies, beyond the beneficial effects of placebos, do not outweigh the potential for harm that this approach can cause.”

We’ll take that as a ‘no’ then!

Links: [abstract, pubmed]:[abstracts, trends in pharm sci]:[full text pdf dcscience]:[full text, pdf, findthatfile.com]

Ernst, E. (2007) ‘Homeopathy for cancer?’, Current Oncology, vol.14, no.4, pp.128-130.

“INTRODUCTION: Homeopathy is ‘a therapeutic method of using preparations of substances whose effects when administered to healthy subjects correspond to the manifestation of the disorder in the individual patient’. The discipline was developed by Samuel Hahnemann (1755–1843) about 200 years ago. Hahnemann postulated that

“• if a remedy causes a symptom in a healthy volunteer, then it can be used to treat that symptom in a patient (the “like cures like” principle).
• if a remedy is potentized (that is, diluted and sucussed), it becomes more rather than less effective (the “memory of water” theory).
• all diseases originate from the “itch” (psora), gonorrhea (sycosis), or syphilis (lues).

“The third of these assumptions is now all but forgotten (I suspect that homeopaths feel embarrassed by its overt incorrectness), but despite the fact that the two other axioms also fly in the face of science, they still form the basis of homeopathy today.

“Initially Hahnemann was remarkably successful, and homeopathy conquered much of the world. With hindsight, this early popularity probably accrued because, unlike many other therapies of the time, homeopathy was not outright harmful. With the eventual emergence of conventional treatments that generated more good than harm, homeopathy’s popularity faded.

“Considering the biologic implausibility of high potency homeopathy, my conclusions have to be conservative. There is no evidence at all that homeopathic remedies can change the natural history of any cancer. The few RCTs of homeopathy are in the realm of cancer palliation and supportive care and have not generated convincing evidence of a beneficial effect.

“For indications other than cancer, the evidence from rigorous RCTs is also not convincing. As a result, there is no reason to believe that homeopathic medicines have anything to offer to patients suffering from cancer or other conditions apart from non-specific effects. However, to generate the placebo effect, we do not necessarily need placebos."

Links: [full text, pdf, current oncology]:[full text, pubmed central]:[full text, pdf, pubmed]

Ernst, E. (2010) ‘Homeopathy: what does the “best” evidence tell us? A Systematic Review’, Medical Journal of Australia, vol. 192, no. 8, pp. 458-460.

“The findings of currently available Cochrane reviews of studies of homeopathy do not show that homeopathic medicines have effects beyond placebo”

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

Ernst, E. (2011) ‘Homeopathy, non-specific effects and good medicine’, Rheumatology, vol. 50, no. 6, pp. 1007-1008.

This is a response to Brien (2011).

Links: [full text, html, rheumatology]

Ernst, E. (2011) ‘How Much of CAM Is Based on Research Evidence?’ Evidence-Based Complementary and Alternative Medicine, vol. 2011, epub only, article ID: 676490.

Only 7.4% of CAM is based on decent evidence, and even that may be a gross over estimate.

Links: [abstract pubmed]:[full text, html, pubmed central]:[full text, html, hindawi publishing corp]

Ernst, E, Lee, M.S. and Choi, T.Y. (2011) ‘Acupuncture: Does it alleviate pain and are there serious risks? A review of reviews’, Pain, vol 152, pp. 755–764.

“This review was aimed at critically evaluating systematic reviews of acupuncture as a treatment of pain and at summarizing reports of serious adverse effects published since 2000... Numerous contradictions and caveats emerged. Unanimously positive conclusions from more than one high-quality systematic review existed only for neck pain. Ninety-five cases of severe adverse effects including 5 fatalities were included. Pneumothorax and infections were the most frequently reported adverse effects. In conclusion, numerous systematic reviews have generated little truly convincing evidence that acupuncture is effective in reducing pain...Serious adverse events, including deaths, continue to be reported.”

So, acupuncture doesn’t really work and it can kill you. Methinks RationalVetMed will be sticking to good old paracetamol!  

Links: [abstract, pubmed]:[full text pdf DC Science]

European Union (2008) COMMISSION REGULATION (EC) No 889/2008 of 5 September 2008 laying down detailed rules for the implementation of Council Regulation (EC) No 834/2007 on organic production and labelling of organic products with regard to organic production, labelling and control [Online] [permalink]

This is the piece of legislation which ensures that organically farmed animals are denied the benefit of safe, effective, tried and tested medicines when they are ill or suffering, and given drops of water or sugar tablets instead. The fact something like this is even in existence is a sign of how badly infiltrated the EU bureaucracy is by those promoting the pseudoscientific dogma of complementary and alternative medicine and just how political this sort of document is, favouring public opinion over science. If any organic farmers are reading who care more about their animals than homeopathic fairytales there is a handy get out clause though. It does say homeopathy shall be used ‘provided that their therapeutic effect is effective for the species of animal, and the condition for which the treatment is intended.’ So there you are; there is absolutely no homeopathic remedy which is effective in any species or for any condition, so that lets you off the hook. Just as long as you are prepared to abide by the draconian meat, milk and egg witholding times laid down again, in contradiction to the proper science.

One thing, when searching in this document the EU has used some archaic spelling, so search on homoeopathy, not homeopathy.

“Article 24

“Veterinary treatment

“1.   Where despite preventive measures to ensure animal health as laid down in Article 14(1)(e)(i) of Regulation (EC) No 834/2007 animals become sick or injured they shall be treated immediately, if necessary in isolation and in suitable housing.

“2.   Phytotherapeutic, homoepathic products, trace elements and products listed in Annex V, part 3 and in Annex VI, part 1.1. shall be used in preference to chemically-synthesized allopathic veterinary treatment or antibiotics, provided that their therapeutic effect is effective for the species of animal, and the condition for which the treatment is intended.

“3.   If the use of measures referred to in paragraph 1 and 2 is not effective in combating illness or injury, and if treatment is essential to avoid suffering or distress of the animal, chemically-synthesised allopathic veterinary medicinal products or antibiotics may be used under the responsibility of a veterinarian.

“4.   With the exception of vaccinations, treatments for parasites and compulsory eradication schemes where an animal or group of animals receive more than three courses of treatments with chemically-synthesised allopathic veterinary medicinal products or antibiotics within 12 months, or more than one course of treatment if their productive lifecycle is less than one year, the livestock concerned, or produce derived from them, may not be sold as organic products, and the livestock shall undergo the conversion periods laid down in Article 38(1).

“Records of documented evidence of the occurrence of such circumstances shall be kept for the control body or control authority.

“5.   The withdrawal period between the last administration of an allopathic veterinary medicinal product to an animal under normal conditions of use, and the production of organically produced foodstuffs from such animals, is to be twice the legal withdrawal period as referred to in Article 11 of Directive 2001/82/EC or, in a case in which this period is not specified, 48 hours.”

Links: [full text (English)]:[full text (pdf English)]

Responses: [EASAC statement]

F

Ferley, J.P., Zmirou, D., D’Adhemar, D. and Balducci, F. (1989) ‘A controlled evaluation of a homoeopathic preparation in the treatment of influenza like syndromes’, British Journal of Clinical Pharmacology, vol. 27, pp. 329-335.

This rather old, practice-based trial tested the effectiveness of the commercial homeopathic remedy Oscillococcinum on 478 patients suffering from "influenza-like" symptoms although the authors themselves state that it is by no means certain all the participants were suffering from the influenza virus. Contrary to normal homeopathic practice no attempt was made to individualise patients before prescribing the remedy (or placebo); this is a criticism used widely by homeopaths when looking at trials which have failed to demonstrate an effect for homeopathy, yet criticism among homeopaths of this paper is strangely lacking. I’m sure it can’t be anything to do with the fact that it gives results they like

Interestingly the authors describe Oscillococcinum rather grandly as being "made of a highly diluted autolysate of animal organs" - that's putrid duck liver and heart to you and me!

Patients recorded their own rectal temperatures as well as five cardinal signs (headache, stiffness, lumbar and articular pain and shivers) in a study diary at home, although not every part of the diary was completed by all patients. During the trial many participants used antibiotics as well as other conventional drugs to treat pain, fever and cough (which pretty much covers the five cardinal signs) in addition to the test substances.

The authors mention "the treatment allocation of active drug or placebo was made on a randomized double-blind basis" but don't explain what this means and details of the randomisation and blinding process are vague throughout.

The findings are far from spectacular and the authors state "The effect was modest (the increase in proportion of recoveries within 48 h was less than 7%)" and "it would be unwise to claim that the study has demonstrated a cause and effect relationship between the drug and the recoveries".

I wonder if the duck they got the Oscillococcinum from was lame? That would certainly explain the results.

Links: [abstract, pubmed]:[Full text, pubmed central]:[Full text, pdf, pubmed central]
Responses: [cochrane review]

Fisher, P., Berman, B., Davidson, J., Reilly, D. and Thompson, T. (2005) ‘Are the clinical effects of homoeopathy placebo effects?’, Lancet, vol. 366, no. 9503, pp. 2082 - 2083 (this article is a response to Shang et al, 2005).

Links: [full text, Lancet]

Fisher, P. and Dantas, F. (2004) ‘Homeopathy: do not condemn what we do not understand (letter)’, Rev. Hosp. Clin., vol.59, no.3 [response to Almeida (2003)].

Links: [full text - scielo, html]
Responses: [Almeida (2004)]

Fisher, P. and Scott, D.L. (2001) ‘A randomised controlled trial of homeopathy in rheumatoid arthritis’, Rheumatology, vol. 40, pp. 1052-1055.

“We found no evidence that active homeopathy improves the symptoms of RA”
Peter Fisher, head of the London homeopathic hospital (or whatever name it is trading under at the time of reading) not only concludes in this study that homeopathy makes no difference in patients suffering rheumatoid arthritis but also seems to concede the general point that is is useless to try to tell the difference between homeopathy and placebo: “It seems more important to define if homeopathists can genuinely control patients’ symptoms and less relevant to have concerns about whether this is due to a ‘genuine’ effect or to influencing the placebo response.” says Doctor F. - so, it seems it doesn’t matter to homeopaths whether their pills work or not. One wonders if they’ve told the patients of this fact.

Links: [abstract, pubmed]:[full text, html, rheumatology]:[full text, pdf, rheumatology]:[full text, pdf, DCScience]
Responses: [DCScience]

Francoz, D., Wellemans, V., Dupré, J.P., Roy, J.P., Labelle, F., Lacasse, P. and Dufour, S. (2017) 'A systematic review and qualitative analysis of treatments other than conventional antimicrobials for clinical mastitis in dairy cows', Journal of Dairy Science, vol. 100, pp. 7751–7770 (doi.org/10.3168/jds.2016-12512). [permalink]

"The objective of this systematic review was to identify treatments other than conventional antimicrobials for the treatment of clinical mastitis in lactating dairy cows. A systematic review was performed with studies written in English or French selected from CAB Abstracts, PubMed, and Web of Science from January 1970 to June 2014. Controlled clinical trials, observational studies, and experimental challenges were retained. Lactating dairy cows with clinical mastitis were the participant of interest. All treatments other than conventional antimicrobials for clinical mastitis during lactation were retained. Only studies comparing the treatment under investigation to a negative or positive control, or both, were included... Assessment of risk of bias was evaluated using the Cochrane Collaboration tool for systematic review of interventions. A total of 2,451 manuscripts were first identified and 39 manuscripts corresponding to 41 studies were included. Among these, 22 were clinical trials, 18 were experimental studies, and 1 was an observational study. The treatments evaluated were conventional anti-inflammatory drugs.., oxytocin.., biologics.., homeopathy.., botanicals.., probiotics.., and other alternative products... All trials had at least one unclear or high risk of bias... No evidence-based recommendations could be given for the use of an alternative or non-antimicrobial conventional treatment for clinical mastitis. We concluded that homeopathic treatments are not efficient for management of clinical mastitis."

Links: [abstract, pubmed]:[full text (OA) J DAIRY SCI]:[full text (OA) science direct]:[pdf (OA) science direct]:[pdf (OA) J DAIRY SCI]

Responses: [Edzard Ernst]

Frass, M., Dielacher, C., Linkesch, M., Endler, C., Muchitsch, I., Schuster, E. and Kaye, A. (2005) ‘Influence of potassium dichromate on tracheal secretions in critically ill patients’, Chest, vol. 127, pp. 936-941.

There is quite a lot for the sceptic to be suspicious about with this paper. For starters the authors have seen fit to ignore one of homeopathy's basic tenets - individualisation - something that is considered a serious omission in trials where the results don't go the way that believers like. This is particularly baffling in light of the fact that the lead author is himself an eminent homeopath. There are ethical concerns as well, even though the trial was "approved by the local Institutional Review Board" and consent was fully informed, the participating patients were nevertheless taken off a well established conventional treatment for the duration of the trial, in other words a real medicine was replaced by a sugar pill - some commentators (below) have questioned just how much the review board understood about the implications of homeopathic “treatement”. The authors state in the introduction that COPD is a common condition so the question has to be asked why they didn't choose to include a third arm in the trial to compare conventional medication with homeopathy and placebo.

The sample sizes are small for such a common problem (only 25 in each group), some of the end points are vague ('stringiness' of mucus for example) and, most importantly, the two groups are unbalanced; the placebo arm having more patients at an advanced stage of COPD than the verum. In particular, at the start of the trial, there were a greater number of patients on home oxygen in the placebo group than the verum. This suggests these patients had worse pre-existing lung pathology which would have extended both time to extubation and length of stay in intensive care (two of the chosen end points) disproportionately between the groups. With such small group sizes this would give the false impression that the homeopathic remedy was more effective that it really was. Individual COPD scores are not given for each participant so it is impossible to determine the full statistical significance this imbalance has had, but it would certainly cast doubt on the authors’ conclusions.

The most serious criticism though of papers such as this, extend to the wider picture, away from nit-picking about details in individual trials. Homeopathy is so incredibly unlikely (its mechanisms of action are effectively impossible) that it will take more than one or two trials, no matter how robust, to prove it effective when the greater body of evidence finds no benefit. This isn’t just some new antibiotic where the broad principle of action (chemical interraction between drug and target bacteria) is understood, even if the precise mechanism is in question. This is a methodology which claims that a remedy made of pure sugar, distantly derived from an extremely toxic base, with unknown ‘information’ being passed on by an unknown carrier in the diluent can, even in the absence of the actual starting ingredient, somehow enter the body and affect it in such a way as to improve health and well being in specific and measurable ways. In other words, to coin a well worn phrase “extraordinary claims require extraordinary evidence” - for more on this see Sehon et al (2010).

At this point this paper is a one off. It is always possible, no matter how convincing the probability value, that one or two papers, even if perfectly conducted, will show positive results for an ineffective treatment purely by chance and the greater the number of trials carried out the more likely it is that such chance results will arise. At the moment, given the body of evidence against homeopathy, it looks like this paper may be one of those, a so-called outlier, a fluke. But it is a start and, if I were a homeopath, I would be very interested in this paper. What is needed now is for this trial to be replicated by other researchers, preferably non-homeopaths, in other centres and with larger sample sizes, homeopathy also needs to be tested against the best available conventional medicines too, not just placebo.

At the time of writing the original paper is 10 years old and research projects take time to set up so there may be more to come about this. It will be interesting to see whether homeopaths decide to continue down the research line and build on what this paper seems to hint at or will content themselves with repeated citing of a solitary paper as if a mere 50 patients could prove homeopathy was even slightly more effective than a blank sugar tablet.

Links: [abstract, pubmed]:[full text, Chest]:[full text, pdf, chest]
Responses: [Gorski, D., 2010 - science based medicine]:[respectful insolence (an earlier version of the SBM post)]:[Colquhoun, 2007 Chest]:[Colquhoun - Improbable Science]:[JREF forum]:[Edzard Ernst (blog)]

Frei, H., Everts, R., von Ammon, K., et al. (2005) ‘Homeopathic treatment of children with attention deficit hyperactivity disorder: a randomized, double blind, placebo controlled crossover trial’, European Journal of Pediatrics, vol. 164, pp. 758–767.

Links: [abstract, pubmed]:[abstract, springerlink]:[full text, pdf, www.heinefrei]
Responses: [Adler, 2005]

Frenkel, M., Mishra, B.M., Sen, S., Yang, P., Pawlus, A., Vence, L., Leblanc, A., Cohen, L., Banerji, P. and Banerji P. (2010) ‘Cytotoxic effects of ultra-diluted remedies on breast cancer cells’, International Journal of Oncology, vol. 36, no. 2, pp. 395-483.

This trial, conducted on cells in test tubes, not actual patients, by a team affilliated with the Integrative Medicine (i.e. CAM) Program-Unit of the University of Texas claims impressive results when cancer cell cultures were exposed to homeopathic remedies. The paper was then taken up by various homeopathic groups who screamed the lie that now homeopathy was as effective as chemotherapy.

Unfortunately for the team the paper has been critiqued by someone called Maggie who is a cell biologist and really knows what she is talking about (see ‘responses’ below) and it seems that in fact the paper is so full of holes you could use it as a colander. Even one of the authors thought it was not a sound study, calling into question the quality of the controls and suggesting that any differences seen between the remedies and ‘controls’ was due to variations in alcohol content (alcohol is toxic when applied directly to cells as was done here). Why it should have appeared in a reputable peer reviewed journal is a mystery. Maggie, our sceptical reviewer, suspects the reviewers may have been dozing - RationalVetMed couldn’t possibly comment!

A special place should be reserved in hell for people who claim homeopathy can treat cancer - have a look at the three responses linked below; this paper really is complete claptrap.

Links: [abstract, pubmed]:[abstract, Int J Oncol]:[full text, pdf, Int J Oncol]
Responses: [’Maggie’, the sceptics’ book of pooh pooh]:[anomalous distraction]:[Orac - respectful insolence]

Friese, K.H. and Zabalotnyi, D.I. (2007) ‘Homeopathy in acute rhinosinusitis: A double-blind, placebo controlled study shows the effectiveness and tolerability of a homeopathic combination remedy’, HNO, vol 55, pp. 271-277.

A german language paper unavailable online without a hefty subscription - how convenient! Yet, according to homeopaths it’s still powerful evidence for their dubious and dangerous practice.

Links: [abstract, pubmed]:[abstract, springerlink]

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