A canna’ change the laws of physics

Scotty, The Naked Time, stardate 1704.3, Episode 7

Homeopath says what ….

Posted by apgaylard on August 28, 2009

bigstockphoto_Feverfew_126686A while ago* I came across the British Homeopathic Dental Association (BHDA).  Their website makes some amazing claims.  I decided to see what they would offer to substantiate just one of them: the claim that, “Homeopathy will give you […] Remedies that will cure ulcers cold sores etc” 

I asked, 

“You claim that homeopathy provides, “Remedies that will cure ulcers cold sores etc”.  Do you actually have any proper evidence to support this claim?  To be quite frank I don’t [believe] that you do, but I’m always happy to be surprised.”

I quickly received two replies from their Secretary:

“Dear Doubting Thomas,  sorry Adrian

The best evidence you will ever find is from the patients treated with homeopathic remedies.  Next time you have a patient, or better, yourself, with a mouth ulcer, you know they usually last 3 days. Buy some Feverfew and chew a harmless useless tablet and repeat two hourly. There will be your evidence.

Some unfortunate patients get bouts of mouth ulcers at regular intervals. Do as I say and the intervals between bouts gets longer until they no longer have any.

Be brave and try. You can do no harm and you might even surprise yourself. Do chew or suck as they do not work if just swallowed

Cheers

[…] ( Do keep in touch. You might even want to join BHDA)”

So, no evidence from any trials at all, let alone good ones.  All this offers is an appeal to anonymous testimonies.  Hardly the rational, scientific and dare I say professional reply that I would expect from an officer of a serious medical association.  There are all sorts of strangeness in this reply, but my favourite bit is: 

“[…] chew a harmless useless tablet […]“

Now that’s an accurate description of homeopathy.  I got a follow-up reply a little while later.  Clearly the BHDA didn’t think that their first reply was very persuasive: 

The only evidence that we have is experience, in my case 48 years of patients telling me that it works, and, of course my own experience of remedies working for me.  Mouth ulcers. Next time you have one chew Feverfew and the ulcer will go in a few hours, when normally it takes 3 days. People whe hace [sic] regular crops of ulcers, the bouts will get further apart taking Feverfew until they cease altogether.

How open is your mind to experience? 

Which covers the same ground: I should trust the alleged experience of this homeopath dentist and his patients.  It seems that he cares little about the potential for being mislead by recall bias and confirmation bias; let alone the natural history of the condition. 

Speaking of which, the UK NHS Choices website points out that minor ulcers normally heal within ten to fourteen days, whilst major ulcers, “heal more slowly, over a period of several weeks.”** It goes on to say that most ulcers do not require specific treatment and usually heal naturally.  So the ulcers that this homeopathic dentist is talking about seem to be at the (very) minor end of the spectrum if he expects them to be gone in three days anyway. The natural history of these ulcers clearly has the potential to fool this homeopath.

Finally, as both stress and anxiety may be responsible for at least some ulcers, the placebo effect cannot be ignored either.

Given the potential influence of these factors, personal experience in the presence of belief, or the absence of proper experimental controls, is not a reliable guide. 

It’s fun to point out careless phrasing.  It’s no fun at all to see a qualified dentist with no grasp of what constitutes medical evidence and no appreciation of the limitations of his observations.   This attitude harks back to the pre-scientific practise of medicine. 

So, is there any evidence listed by reputable sources?  Searching PubMed for “feverfew AND ulcer” along with “feverfew AND mouth” returned a single reference.  Abebe (2003) provided “an overview of the utilization of herbal supplements with particular emphasis on possible interactions with oral health drugs and oral manifestations.”  It mentions feverfew in the context of the herbal treatment of gingival bleeding and swelling; so no evidence here.  Using the same searches in the Cochrane Library revealed no evidence. 

Searching the NHS Evidence website turned up nothing relevant.  There is some discussion of the use of the herb for treating arthritis, fibromyalgia and migraines.  To put this in context, a Cochrane review by Pittler and Ernst (2004) concluded that: 

“Five trials were identified that assessed the efficacy of feverfew (taken as an oral preparation) compared with placebo. Results from these trials were mixed and did not convincingly establish that feverfew is more effective than placebo for preventing migraine.”

Also, Pattrick, Heptinstall and Doherty (1989) reported a small trial (n=41) that found, “no apparent benefit from oral feverfew in rheumatoid arthritis.”  A review by Soeken, Miller and Ernst (2003) found no other trials. 

The evidence for the use of feverfew as a herbal remedy is summed up by NCCAM

  • Some research suggests that feverfew may be helpful in preventing migraine headaches; however, results have been mixed and more evidence is needed from well-designed studies.
  • One study found that feverfew did not reduce rheumatoid arthritis symptoms in women whose symptoms did not respond to conventional medicines. It has been suggested that feverfew could help those with milder symptoms.
  • There is not enough evidence available to assess whether feverfew is beneficial for other uses. 

Perhaps a bit more generous on migraine prophylaxis that Pittler and Ernst (2004), but the message is clear: feverfew is of no proven use as a herbal treatment.  

So it matters not a jot whether the BHDA had in mind the sort of homeopathy that uses actual rather than imaginary doses of alleged therapeutic agents.  Even if its present in the pill there is no reason to think that it will do any good, particularly for mouth ulcers.  In fact, NCCAM cite “canker sores” (mouth ulcers) as a possible side effect from using this herb.  

Maybe this is where the BHDA got their ideas of using it as a remedy for mouth ulcers from, though it doesn’t seem that other homeopaths share their views.*** 

For instance, the BHDA link to abcHomeopathy as a source of additional information.  This site has an on-line remedy finder and a homeopathic store.  The only mention of feverfew on the site is a comment on their forum.  This is an experience of one person taking a homeopathic preparation of feverfew for tinnitus. 

‘Googling’ “homeopathic feverfew” also reveals a short article by one Dana Ullman.  This recommends treating Headache with feverfew; though Ullman appears to be advocating herbal rather than homeopathic treatment (“Make an herbal tea of it, or simply take a feverfew capsules.”) 

It seems that feverfew as a treatment for mouth ulcers isn’t something that’s much recommended in the homeopathic world.  Anyway, I thought that, as the BHDA say, “homeopathy treats the person, rather than the disease.”  So what are they doing making a blanket recommendation for me? 

Also, here is the BHDA’s secretary – a practising homeopathic dentist – making grand claims for a treatment of a disease, not person, with no evidence.  This is a treatment that has nothing to back it up, even if the feverfew in the pills hasn’t been diluted out of existence.  This treatment doesn’t even seem to make sense in the weird world of homeopathy

What do I take from this brief correspondence? I’ll never trust my teeth to a homeopathic dentist and their harmless, useless tablets. 

Disclaimer

I am not a doctor (or a dentist for that matter!) This does not constitute medical advice.  If you need that consult a properly qualified and registered medical practitioner.

I try to make sure that what I write is both accurate and fair.  If you think that I have got anything wrong please let me know.  If you are right I will happily change what I have written.

Notes

*This correspondence took place between the 17th and 26th November 2008.

** Not well phrased.  Fourteen days is, of course, a couple of weeks.

***I know, even if other homeopaths used feverfew to treat mouth ulcers, this still would not make sense in the real world.

References

Abebe W. An overview of herbal supplement utilization with particular emphasis on possible interactions with dental drugs and oral manifestations. Journal of Dental Hygiene : JDH / American Dental Hygienists’ Association. 2003;77(1):37–46. Available from: http://view.ncbi.nlm.nih.gov/pubmed/12704968.

Pattrick M, Heptinstall S, Doherty M. Feverfew in rheumatoid arthritis: a double blind, placebo controlled study. Annals of the Rheumatic Diseases. 1989 July;48(7):547–549. Available from: http://view.ncbi.nlm.nih.gov/pubmed/2673080.

Pittler MH, Ernst E. Feverfew for preventing migraine. Cochrane Database of Systematic Reviews. 2004;(1). Available from: http://dx.doi.org/10.1002/14651858.CD002286.pub2.

Soeken KL, Miller SA, Ernst E. Herbal medicines for the treatment of rheumatoid arthritis: a systematic review. Rheumatology. 2003 May;42(5):652–659. Available from: http://dx.doi.org/10.1093/rheumatology/keg183.

Acknowledgements

Thanks to Robert Carnegie over at the Bad Science Forum for pointing out the apparent lack of support for the use of feverfew for mouth ulcers within the homeopathic world.  Without the prompt of this thread I would have left this correspondence languishing in my inbox.

Edits

None yet!

[BPSDB]

 

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17 Responses to “Homeopath says what ….”

  1. Zeno said

    There you go again, demolishing AltMed claims with your all-powerful science.

    Keep it up!

  2. draust said

    Hmm. A plug for the herb from Homeopathic Parallel Reality booster and legendary online quack filibuster-er Dana Ullman, aka “DUllman”. Now that really is a recommendation to cherish.

  3. Andrew said

    It’s no fun at all to see a qualified dentist with no grasp of what constitutes medical evidence and no appreciation of the limitations of his observations.

    I am also not a dentist but I have been to a couple of dental conferences, and read more than my share of dental journals. I seem to recall an editorial once describing dentistry as “becoming” rather than being evidence-based. I have seen research dentists argue over a presentation because they had differing opinions on some unproven aspect of treatment. Certainly the School of Dentistry I’m at runs a ‘Research Methods’ course for dentists starting PhD courses which assumes no prior knowledge of science. It’s more-or-less Ben Goldacre’s book with a stats primer bolted on. I mention this not to malign dentists, but because I infer from it that it’s not that important that a dentist understands why what he does is correctt. I can quite easily believe that a practising dentist might be taken in by alternative medicine, much more easily than, say, a GP, and I don’t think it’s cause for alarm in and of itself.

    What’s cause for alarm is that it’s possible to set up an entire dental practice without anyone pointing this stuff out.

  4. [...] This post was Twitted by Blue_Wode [...]

  5. alcari said

    Actually, from reading all this, it sounds more like she’s talking about herbal medication is all cases. Now, I couldn’t find much on the effect of feverfew on ulcers, maybe even just as analgesic, but it’s marginally more plausible than homeopathy.

    I’ve used rhubarb extract on painfull uclers myself. It doesn’t cure a thing, but it does dull the pain after it burns like hell for a second or two. I can imagine people saying that “it helps”.

    • alcari said

      and by that I mean actual rhubarb, not water that once ran in the vicinity of it :p

      • apgaylard said

        Yes, I think you are right, the BHDA stuff does read more like herbalism. No wonder people often confuse the two!

        From what I’ve found feverfew seems initially to have offered some promise in preventing migraine, but this seems marginal at best.

        Rhubarb extract is something I am not familiar with. It seems that there is a body of literature (PubMed). Maybe I’ll have a look at it some time.

        Thanks for the comment.

  6. rmgw said

    My dentist here in Barcelona is a (very expensive – but aren’t they all?) German chap, all the high tech stuff up to the minute – imagine my horror when an assistant told me that they recommended extracting wisdom teeh systematically because they’re “sinks for toxins”…and that they recommend homeopathy for various sorts of oral problems. Could this be the dentist’s own view? – I asked him. Oh, yes, he’s been most impressed with the results of homeopathy. The only problem he has is overcoming the PATIENTS’ scepticism!
    So here is a case of the professional persuading supposely less-knowledgeable patients to go for homeopathy. Dental training (the same has been found on Skeptvetfor veterinarians) is rather practical than scientific – as Andrew’s post indicates. Judging by the number of mainstream doctors I’ve heard of who either recommend or tolerate CAM treatments here, this seems to be too widespread to cause comment now. How it can be remedied is another matter.

    • apgaylard said

      Interesting account. I wonder how prevalent CAM beliefs are amongst dentists compared to doctors generally? The practical vs. scientific traning observation is certainly thought-provoking. From what I’ve seen nurses are particularly vulnerable as well.

  7. brunton said

    The stuff about the “harmless useless tablet” reminded me of Reggie Perrin:

    “David:
    …But why should anyone buy a pill that doesn’t do anything?”

    “Reggie:
    Because it comforts them, David. It has no effects whatsoever, therefore it has no side-effects, you don’t need to keep it out of the reach of children, and Catholics can take it. Alright?”

  8. rmgw said

    There we have it! the final proof! If homeopaths can produce an effective contraceptive sugar pill, they’re home and dry. I knew Reggie Perrin would save the universe.

  9. draust said

    Cracking Reggie Perrin quote. Has anyone tracked it down on Youtube?

    I thought the homeos had already cracked contraception. Follow the logic:

    – pregnancy makes you feel sick
    – treat homeopatically with something that evokes same symptom: thus alcohol
    – dilute alcohol vastly to “potentize” = water.

    Therefore: drink water to prevent yourself falling pregnant.

    If you resolutely substitute this “homeopathic alcohol” for the twelve snakebites, fifteen alcopops and dozen vodka and tonics favoured by our British young folk on a typical weekend night out, I would wager the chances of pregnancy will decrease substantially.

  10. kenedwards1 said

    why on earth do people still continue to insist on using the verb ‘fall’ with pregnant – it connotes a moral lapse, or submission to an illness at best. this continued use does nothing for women. Is not pregnancy actually revered and generally regarded as an exalted position.

    i hate this. it smacks of victorian moral disapprobation. let’s stop it.

  11. rmgw said

    “Is not pregnancy actually revered and generally regarded as an exalted position.”

    errrrrr…… no?

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