... and other stories.
Papers, listed by lead author: E-F
E
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]
Elliott, M., (2001) Cushing's disease: a new approach to therapy in equine and canine patients Br Homeopath J. Vol. 90 no. 1 pp. 33-6
“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 mad 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 results which don’t concur with homeopathic preconceptions. This study however claims positive results 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”, ie 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 - yes, you heard, 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 cry of the wounded homeopath), “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”. 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.
Links: [abstract - pub med ]:[full text - BAHVS, pdf ]:[full text - homeopathic vet ]
Responses: [critique - BVVS ]
Responses: [critique -
Links: [abstract, science direct]:[full text, similima, pdf]
Ernst, E., Saradeth, T., Resch, K.L., (1990) Complementary therapy of varicose veins - a randomized, placebo controlled, double-blind trial Phlebology Vol. 5 pp.157-163
"Over a period of 24 days, the effects of a homeopathic complex preparation and placebo on varicose veins were tested in a double-blind trial of 61 people suffering from this condition. The homeopathic complex produced an averaged 44% improvement in the condition while those given the placebo experienced an averaged worsening of the disorder"
Nothing available online apart from optimistic and unenlightening selected excerpts in pro-
Links: [homeopathic.org]:[homeopathy knoll]
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. 187-90
"... The claim that homeopathic arnica is efficacious beyond a placebo effect is not supported by rigorous clinical trials."
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]:[full text, homeopathy.org]
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]
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 ]
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]
"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 -
Links: [references, pubmed central]:[full text, pubmed central, pdf]
Responses: [Novella How Much Modern Medicine is Evidence-Based? - Neurologia blog ]
Responses: [Novella How Much Modern Medicine is Evidence-
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.”
Links: [abstract, pubmed]:[abstracts, trends in pharm sci]:[full text pdf dcscience]:[full text, pdf, findthatfile.com]
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.
• 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.
Links: [full text - ITO ]
"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."
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
Evans, I., Thornton, H., Chalmers, I., Glasziou, P., (2011) Testing Treatments - Better Research for Better Healthcare 2nd edition, London, Pinter and Martin ltd ISBN 978-1-905177-48-6
Ferley, J.P., Zmirou, D., D’Adhemar, D., 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-
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 5 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 5 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]
Responses: [cochrane review]
Fisher, P., Berman, B., Davidson, J., Reilly, D., 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)]
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 honcho of the London homeopathic hospital (or whatever name it is masquerading 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 doesn’t matter to homeopaths whether their pills work or not - well I could have told him that, honestly, some people!
Peter Fisher, head honcho of the London homeopathic hospital (or whatever name it is masquerading 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. -
Links: [abstract, pubmed]:[full text, html, rheumatology]:[full text, pdf, rheumatology]:[full text, pdf, DCScience]
Responses: [DCScience]
Responses: [DCScience]
Frass, M., Dielacher, C., Linkesch, M., et al. (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 -
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.
That said however (and if one can rise above the triumphalist crowing of its supporters) this appears to be one of the better pro-homeopathic trials around despite its obvious limitations.
The most serious criticisms 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; it is by no means positive proof for homeopathy but it is a promising pilot study. 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 6 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 more crowing over a solitary paper as if a mere 50 patients could prove homeopathy 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]:[Huffington Post]
Responses: [Gorski, D., 2010 -
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]
Responses: [Adler, 2005]
Frenkel, M., Mishra, B.M., Sen, S., Yang, P., Pawlus, A., Vence, L., Leblanc, A., Cohen, L., Banerji, P., 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 (that’s CAM to you and me) Program-
Unfortunately for the team the paper has been critiqued by someone called Maggie who is a cell biologist and 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 in to 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 - RVM 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 insolance ]
Responses: [’Maggie’, the sceptics’ book of pooh pooh]:[anomalous distraction]:[Orac -
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
Hmmm, a german language paper unavailable online with out a hefty subscription -
Links: [abstract, pubmed]:[abstract, springerlink]
| History of RVM |
| The Best They Can Do |
| The Usual Suspects |
| How to look at evidence |
| CAM journals and evidence |
| Scepticism about homeopathy |
| Arguments |
| Acupuncture references |