... and other stories.
Papers, listed by lead author: I-J
I
Imrie, R.H., and Ramey, D.W., (2000) The evidence for evidence based medicine Complementary Therapies in Medicine Vol. 8 pp.123–126
Homeopaths and other anti-
Links: [abstract, pubmed]:[full text, SRAM]
Irwin, Z., and Tashkin, D.P., (2000) Alternative medicine for allergy and asthma J Allergy Clin Immunol Vol.106 pp 603-614
Links: [abstract - science direct ]
Jacobs, J., Jimenez, L.M., Gloyd, S.S., et al. (1993) Homeopathic treatment of acute childhood diarrhea: a randomized clinical trial in Nicaragua British Homeopathic Journal Vol. 82 pp. 83-86
Jacobs, J., Jimenez, L.M., Gloyds, S.S., Gale, J.L., Crothers, D., (1994) Treatment of acute childhood diarrhea with homeopathic medicine; a randomized clinical trial in Nicaragua Pediatrics Vol. 93 no. 5 pp. 719-725
Links: [abstract, pubmed]:[abstract, pediatrics]:[full text, pediatrics, pdf]
For commentary see below
For commentary see below
Jacobs, J., Jimenez, L.M., Malthouse, S., et al. (2000) Homeopathic treatment of acute childhood diarrhoea: results from a clinical trial in Nepal. [alternate title (ENHR) - Acute Childhood Diarrhoea - A Replication] Journal of Alternative and Complementary Medicine Vol. 6 pp. 131-139
Jacobs, J., Jonas, W.B., Jimenez-Perez, M., Crothers, D., (2003) Homeopathy for childhood diarrhea: combined results and metaanalysis from three randomized, controlled clinical trials Pediatric Infectious Disease Journal Vol. 22 no. pp. 229-34
Links: [abstract, pubmed]:[full text, otcpharma, pdf]
Dr Jennifer Jacobs is, at the time of writing, assistant professor of epidemiology at the University of Washington. Among her interests she lists alternative medicine, she can be contacted via an organisation called 'Harmony Research and Consulting' and every one of the selected publications on her University biography page is concerned with homeopathy.
Between 1993 and 2006 she published four papers which are listed immediately above this commentary (a fifth paper, published in 2006 is cited below). Two were published in peer reviewed journals, two in alternative medicine publications. The fourth paper (Jacobs 2003) was a metanalysis of the first three (Jacobs 1993, 1994 and 2000). These papers are closely related and will be addressed as a group.
As a series of similar trials these papers there are multiple accounts of their various flaws and deficiencies to be found throughout the web, from sceptic commentaries to critiques in professional journals, including Paediatrics, the journal in which the 1994 study was published (Samson and London 1995). Yet they are still, despite this, being touted even today by homeopathic profiteers and apologists as evidence that homeopathy works.
To summarise the main criticisms is hard - sometimes one can have too much choice! But Rational Vet Med will bravely attempt to do so on your behalf. For full details have a look at the links below.
According to Wallace Simpson (2009) of Science Based Medicine, in the first two papers (Jacobs, 1993 and 1994) the statistical analysis chosen by the authors was inappropriate for the types of data which were obtained - the fact that chosen end points were vague and a variety of different remedies were used were among the factors which rendered the chosen analysis inadequate. Although it was claimed that participants were randomised into 2 groups there were considerable and statistically significant differences between the 2 groups, with the homeopathic group being both older and heavier, which would have meant it was likely that members of this group would show a quicker recovery from diarrhoea anyway, regardless of the type of treatment.
By way of explanation the authors claimed, not unreasonably, that this (statistically significant) discrepancy was as a result of chance variation (and they later applied a statistical trick to work around the problem). In contrast, at the end of the trials, when the alleged benefits of homeopathy were announced in the conclusion, this claim was justified, even though the actual differences between groups were slight, on the basis that the results of the trial also were statistically significant. No mention that the results themselves were just as likely to have been as a result of chance as the initial disparity between groups.
Another difference between the groups in one of Jacob's trials was that there was significantly fewer bacterial isolates from the stools of the participants in the homeopathic group than there were in the placebo group - one reviewer has speculated this could have been as a result of treatment with antibiotics which apparently is common practice in some areas and which the researchers may or may not have been aware of. Obviously it is not impossible this could have affected the outcomes.
The authors suggest that this series of papers is confirmation that homeopathy could be of use in the fight against the scourge of diarrhoea in the third world. In fact it is nothing of the sort - all the really severe cases presented were treated properly - in hospital with conventional fluid therapy and medication.
The trials conducted by Jacobs et al dealt only with mild cases which are often self limiting anyway. It is noteworthy that the authors use the correct clinical term for such cases by describing them as “acute” -
Dr Jacobs herself acknowledges the lack of statistical power in her first three trials when embarking on the metanalysis (2003). There are also a number of discrepancies carried over from the three trials in the metanalysis which appear magnified when the figures are combined. Again, an inappropriate statistical analysis is used, there are imbalances between the homeopathic and the placebo groups and the end point for which such great significance is claimed is a minute difference between homeopathic and placebo groups such as could be accounted for by pure statistical noise - variations in times of sampling for example. The difficulty of making accurate measurements in diarrhoea trials is highlighted in a paper by Johnson et al (2010).
As Wallace Simpson (2009) of Science based Medicine says, “what actually occurred, even at maximum difference between homeopathy and controls, was a difference between having 3 (or slightly more) stools per day and no more than 2 stools per day for 1 day or so at only one of four measured periods of the study. The calculated difference in terms of days to the end point was slightly more than a half a day. Most patients and most family members would hardly be aware of such a small difference.”
Yet, on the back of this measley finding when tested, not against real, proven medicines but against a plain sugar tablet the authors are suggesting that homeopathy has a major part to play in controlling third world epidemics - if that wasn't so murderously irresponsible it would be laughable.
The morals of performing such trials on vulnerable individuals in developing countries using medicines which have been thoroughly proven as ineffective by other, less partisan authors is a whole topic of its own and is dealt with by David Gorski (2008) in Science Based Medicine (link below).
The final nail in the coffin of this woeful series of studies was picked up by Andy Lewis (2009), writing on his 'Quackometer' blog in response to one of Dana Ullman's data dumps. At the end of the series of original papers Dr Jacobs acknowledged the low statistical power of the three studies which went to make up the metanalysis (2003) and called for other, larger trials to be carried out in the future. Three years later she carried just out such a trial herself (Jacobs, 2006 - see below) and, guess what - there was no difference between placebo and verum groups! This final trial in the set is, of course the one that all homeopaths have amnesia about and which never appears on the vast lists of references trotted out by the homeopathic intelligencia (if that isn't a contradiction in terms!), nor has it ever featured in a revised version of the 2003 metanalysis - too much to hope for really. The 2006 trial was however considered by Altunc et al in their 2007 systematic review of trials investigating the use of homeopathy in childhood ailments - the authors weren't impressed, and neither is Rational Vet Med.
Responses: [Gorski, D., 2008 in SBM - On the ethics of clinical trials of homeopathy in Third World countries ]:[Simpson, W., 2009 in Science based Medicine (SBM) - Homeocracy ]:[Simpson, W., 2009 in SBM - Homeocracy 2 ]:[Simpson, W., 2009 in SBM - Homeocracy 3 ]:[Simpson, W., 2009 in SBM - Homeocracy 4 ]:[Lewis, A., 2009 in Quackometer - The Society of Homeopaths are a Shambles and a Bad Joke ]:[Barnett, D.R., 2001 Clinical Research in Homeopathy: A Limited Skeptical Review and Analysis (Part I) in The North Texas Skeptic]
Jacobs, J., Guthrie, B.L., Montes, G.A., et al. 2006 Homeopathic combination remedy in the treatment of acute childhood diarrhea in Honduras Journal of Alternative and Complementary Medicine Vol. 12 pp. 723-732
“There was no significant difference in the likelihood of resolution of diarrheal symptoms between the treatment and placebo groups... The homeopathic combination... did not significantly reduce the duration or severity of acute diarrhea in Honduran children...”
Jacobs, J., Springer, D.A., Crothers, D., 2001 Homeopathic treatment of acute otitis media in children: a preliminary randomized placebo-controlled trial Pediatric Infectious Disease Journal Vol. 20 pp 177–183
A magnificent excercise in homeopathic straw-
And it’s not surprising when you’re comparing one placebo with another that some days one will appear to do better than another, that’s what is known as statistical noise and is simply due to random variation, although, typicaly it doesn’t stop the homeopaths mentioning it as if it was some great positive finding at “24h and 64h” - what about the rest of the hours, eh? Conveniently the number of converse instants when placebo “outperformed” homeopathy isn’t mentioned in the abstract - strange that.
Yet again though this nonsense is consistently trotted out as evidence in favour of homeopathy!
Links: [abstract, pubmed]:[Cochrane review]:[NHS review of OM treatments]:[NICE report on antibiotic use in OM]
Introduction: The term "allopathy" was invented by German physician Samuel Hahnemann (1755-1843). He conjoined allos "opposite" and pathos "suffering" as a referent to harsh medical practices of his era which included bleeding, purging, vomiting and the administration of highly toxic drugs. These practices were based on the ancient Greek humoral theory which attributed disease to an imbalance of four humors (i.e., blood, phlegm, and black and yellow bile) and four bodily conditions (i.e, hot, cold, wet and dry) that corresponded to four elements (earth, air, fire, and water)...
Links: [full text - NCAHF ]
Johnston, B.C., Shamseer, L., da Costa, B.R., Tsuyuki, R.T., Vohra, S., 2010 Measurement issues in trials of pediatric acute diarrheal diseases: a systematic review Pediatrics Vol. 126 no.1 e. 222-231
This paper reports that because of the difficulty of defining the parameters under scrutiny, the results of pretty much any trial of diarrhoea has to be taken with a pinch of salt. That is true of any conventional treatment, no matter how plausible it appears and it is especially true of homeopathy as it has no possible mode of action and is completely implausible. Sugar tablets don’t cure anything, least of all life threatening conditions affecting vulnerable children. Any suggestion to the contrary is simply murderous.
Links: [abstract, pubmed]:[full text, html, pediatrics]
Jonas, W.B., Linde, K., Ramirez, G., 2000 Homeopathy and rheumatic disease Rheumatic Disease Clinics of North America Vol. 26 no.1 pp. 117-123
Jonas, W B., Anderson, R.L., Crawford, C.C. and Lyons, J.S. (2001) A systematic review of the quality of homeopathic clinical trials BMC Complement. Altern Med Vol. 1 no. 1 p. 12
“Conclusions: Clinical homeopathic research is clearly in its infancy with most studies using poor sampling and measurement techniques, few subjects, single sites and no replication”
Links: [abstract - BMC ]:[full text - BMC, html ]:[full text - BMC, pdf ]
Jonas, W.B.; Kaptchuk, T.J., and Linde, K., (2003) A Critical Overview of Homeopathy Ann Intern Med. Vol. 138 pp. 393-399
“... There is a lack of conclusive evidence on the effectiveness of homeopathy for most conditions. Homeopathy deserves an open-
Links: [abstract - pub med ]:[full text - Ann Int Med, pdf ]:[full text - Ann Int Med, html ]:[full text - homeovet, pdf ]
A comprehensive, open access review (albiet suffering a pro-
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