Rational Veterinary Medicine:
Papers, listed by lead author: I-
Homeopaths and other anti-
Imrie, R.H., Ramey, D.W., Buell, P.D., Ernst, E., and Basser, S.P. (2001) ‘Veterinary Acupuncture and Historical Scholarship: Claims for the Antiquity of Acupuncture’, The Scientific Review of Alternative Medicine, vol. 5, no. 3. [permalink]
“Abstract: Claims for the antiquity of acupuncture are ubiquitous in both the human and veterinary acupuncture and popular literature. These claims are not supported by the historical record. Evidence for therapeutic “needling” (zhen) of any kind dates back at most just over 2100 years, and even this evidence is ambiguous. The earliest clear-
Links: [full text SRAM, pdf]
Jacobs, J., Jimenez, L.M., Gloyds, S.S., Gale, J.L. and Crothers, D. (1994) ‘Treatment of acute childhood diarrhea with homeopathic medicine; a randomized clinical trial in Nicaragua’ Pediatrics, vol. 93, no. 5, pp. 719-
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) -
Jacobs, J., Jonas, W.B., Jimenez-
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.
When considered as they are (a series of similar trials) there are multiple accounts of these papers' 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 -
According to Wallace Sampson (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 -
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 -
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 -
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 -
As Wallace Sampson (2009), “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 -
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 -
Responses: [Gorski, D., 2008 in SBM -
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-
“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.. and Crothers, D. (2001) ‘Homeopathic treatment of acute otitis media in children: a preliminary randomized placebo-
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” . Significantly, there is no mention of the rest of the hours -
Yet again though this nonsense is consistently trotted out as evidence in favour of homeopathy!
Jaeger, G.T., Larsen, S., and Moe, L. (2005) ‘Stratification, blinding and placebo effect in a randomized, double blind placebo-
“The purpose of this study was to investigate the... effects of blinding and placebo in a clinical experiment. Eighty dogs with canine hip dysplasia (CHD) were included in a randomized, placebo-
Conclusion and Clinical Relevance: The age of the dogs influenced the outcome of the CHD treatment, and is recommended as a stratification factor. A significant placebo effect has to be expected and an optimal blinding procedure is necessary in similar clinical studies.”
Introduction: The term "allopathy" was invented by German physician Samuel Hahnemann (1755-
Links: [full text -
Johnson, S.B., Park, H.S., Gross, C.P. and Yu, J.B. (2018) 'Use of Alternative Medicine for Cancer and Its Impact on Survival', Journal of the National Cancer Institute, vol. 110, no. 1, (https://doi.org/10.1093/jnci/djx145). (First published online August 10, 2017). [permalink]
“… alternative medicine (AM) use was independently associated with greater risk of death compared with conventional cancer treatment (CCT) overall and in subgroups with breast, and colorectal cancer. Although rare, AM utilization for curable cancer without any CCT is associated with greater risk of death.
“… AM was associated with worse five-
When apologists are challenged over the dubious ethics and motives which underly homeopathy and other forms of CAM they tend to drift off into the realms of abstruse philosophy, cultural relativism and the sins of ‘scientism’, collegiality, fair-
Then a paper like this comes along and brings the whole debate back down to earth, with a great thump.
To quote from the news report at VetSurgeon.org (link below):
“Overall, cancer patients who used alternative medicine were 2.5 times more likely to die within a 5 year period than those who chose conventional cancer therapy. However, people with breast cancer were 5.7 times more likely to die in the same period if they used alternative medicine rather than conventional medicine. This evidence flies in the face of the British Association of Veterinary Homeopathic Veterinary Surgeons' claim that homeopathy cures cancer.”
But some homeopaths don’t even want to read that simplified version of events, so perhaps just the title of the report will give a pithy enough summary: “Choose Alternative Medicine and Die Early”
Yes, I think that covers it nicely.
Johnston, B.C., Shamseer, L., da Costa, B.R., Tsuyuki, R.T. and Vohra, S. (2010) ‘Measurement issues in trials of pediatric acute diarrheal diseases: a systematic review’ Pediatrics, vol. 126, no.1, e. 222-
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 since 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.
Only the abstract of this paper is available online and that is basically a great diatribe about how wonderful homeopathy is, who invented it, what its “tenets” are and why the only reason people think it doesn’t work is because they can’t get their heads past Avogadro’s law (it isn’t).
There are no indications of what the actual paper is -
It’s always significant (and very unusual) when no indications of how a paper of this sort was written or what the inclusion criteria were, and not a hint of final conclusions are given in an abstract. Since the abstract is the only publicly visible part of the paper it’s almost as if they had something to hide!
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 Complementary and Alternative Medicine, 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”
“... There is a lack of conclusive evidence on the effectiveness of homeopathy for most conditions. Homeopathy deserves an open-
A comprehensive, open access review (albiet suffering a pro-
Jonas, W.B., Bellanti, D.M., Paat, C.F., Boyd, C,C., Duncan, A., Price, A., Zhang, W., French, M. and Chae, H. (2016) 'A Randomized Exploratory Study to Evaluate Two Acupuncture Methods for the Treatment of Headaches Associated with Traumatic Brain Injury', Medical Acupuncture, vol. 28, no. 3, pp. 113-
Responses: [Edzard Ernst]