Spying on Shang
Posted by apgaylard on August 10, 2008
It seems like I’m becoming a collector of misconceptions about the Lancet paper published by Shang et al (2005). This week I’ve been having a small disagreement with a homeopath named Clive Stuart on Margaret McCartney’s blog at Ft.com.
One of his criticisms of Shang et al was new to me. He said, “When the 8 studies were finally revealed, it turned out that most of them were for the prophylaxis of flu.”
I pointed out that there were only two studies in the final eight that were concerned with ‘flu-like symptoms: Rottey (80) and Papp (71) [note: the references are to the webappendix and additional material]. I thought that this would be the end of it, but no, he countered, “You say that “only two related to flu-like symptoms”. This is incorrect. Actually 5 of the 8 studies related to influenza. Three dealt with prophylaxis of influenza and two with actual treatment of influenza. One study dealt with prophylaxis of conjunctivitis, one with treating acute respiratory inflammations and one with muscle soreness in runners.”
Again, the same error; but made with such confidence and additional detail. I wondered whether he might have been misled by an apparently authoritative source. A little ‘googling’ reveals a commentary on “Egger/Shang’s meta-analysis” published by The European Committee for Homeopathy (ECH) in September 2005.
“Our Swiss colleagues who know people who were involved in Matthias Egger’s meta-analysis (Shang et al), have disclosed that the following 8 trials were used for the conclusion of the meta-analysis …
… Three studies deal with the prevention of flu, two with the treatment of flu, one with the prevention of conjunctivitis, one with the treatment of acute respiratory inflammations with a complex remedy and one with the treatment of muscle soreness in long-distance runners.”
Spies in the camp! Very James Bond. Now, the content is so similar that if this is not Stuart’s source, both must share a common source. This document is also claiming to disclose original information, increasing the likelihood of it being Stuart’s primary source.
The date of the document also falls in to the period between late August and December 2005; the interregnum between the publication of Shang et al and the author’s disclosure of the identity of the final eight studies of homeopathy (and the six of conventional medicine).
During this time it’s clear that the homeopathic community was, rightly, concerned to discover the identity of the studies. It seems that their enthusiasm spilled over into desperation and they relied on hearsay. It’s also typically disappointing that a homeopath has failed to keep up-to-date with a topic which seems to be so important to them (it was Stuart who first raised the topic of Shang et al in the thread.)
Are there any general lessons here? First, it illustrates the importance of going back to primary sources, where possible. A corollary of this is that hear-say is not to be trusted.
If Stuart had actually read the Author’s reply he would have found the eight trials that he is interested in identified by a reference number, “larger trials of higher methodological quality (references 46, 55, 71, 80, 84, 94, 96, 97 in webappendix 1)”
Looking at either webappendix 1, or the extra material provided on-line, enables anyone to match the numbers to the trials. And you get this list:
46. Jacobs J, Jiménez LM, Malthouse S, et al. Homeopathic treatment of acute childhood diarrhea: results from a clinical trial in Nepal. J Altern Complement Med 2000; 6: 131-39.
55. Labrecque M, Audet D, Latulippe LG, Drouin J. Homeopathic treatment of plantar warts. Can Med Assoc J 1992; 146:1749-53.
71. Papp R, Schuback G, Beck E, et al. OSCILLOCOCCINUM® in patients with influenza-like syndromes: a placebo-controlled double-blind evaluation. Br Homeopath J 1998; 87: 69-76.
80. Rottey EED, Verleye GB, Liagre RLP. Het effect van een homeopathische bereiding van micro-organismen bij de preventie van riepsymptomen: een gerandomiseerd dubbel-blind onderzoek in de huisartspraktijk. Tijdschr Int Geneeskunde 1995; 11: 54-58.
84. Schmidt JM, Ostermayr B. Does a homeopathic ultramolecular dilution of Thyroidinum 30cH affect the rate of body weight reduction in fasting patients? A randomised placebo-controlled double-blind clinical trial. Homeopathy 2002; 91: 197-206.
94. Vickers AJ, Fisher P, Smith C, Wyllie SE, Rees R. Homeopathic Arnica 30x is ineffective for muscle soreness after long-distance running: a randomized, double-blind, placebo-controlled trial. Clin J Pain 1998; 14: 227-31.
96. Walach H, Haeusler W, Lowes T, Mussbach D, Schamell U, Springer W et al. Classical homeopathic treatment of chronic headaches. Cephalalgia 1997; 17: 119-26.
97. Weiser M, Clasen BPE. Randomisierte plazebokontrollierte Doppelblindstudie zur Untersuchung der klinischen Wirksamkeit der homöopathischen Euphorbium compositum- asentropfen S bei chronischer Sinusitis. Forsch Komplementärmed 1994; 1: 251-59.
It is clear that the conditions covered by these trials are: (46) acute childhood diarrhea (sic), (55) plantar warts, (71) influenza-like syndromes, (80) influenza like disease, (84) body weight reduction in fasting patients, (94) muscle soreness after long-distance running, (96) chronic headaches and (97) sinusitis. For anyone keeping count that’s two trials involving influenza like disease/syndromes (note, the articles don’t claim to be about ‘flu per se as it was not confirmed in the patients.)
Another general lesson that could be drawn is the importance of keeping up-to-date. It seems that Stuart was aware that the author’s had identified the trials, “many months later” (four, actually). However, this had not prompted him to check whether the ‘friends of friends’ of the ECH were correct.
(I should also point out that the ECH appear to be aware of the correct composition of this group of studies, judging from their discussion of Shang et al. However, they don’t seem to have explicitly corrected their earlier ‘intelligence’.)
Stuart’s statements also highlight some of the schisms between the various homeopathic communities, “When the 8 studies were finally revealed, it turned out that most of them were for the prophylaxis of flu !?! This has absolutely nothing to do with standard individualized homeopathic practice.”
Contrast this with the position of other homeopaths on Oscillococcinum, a homeopathic lack of duck heart/liver sold for both the prevention and treatment of ‘flu. According to the Complementary and Alternative Medicine Website of the New Zealand Guidelines Group, “”Homoeopathic preparations, such as oscillococcinum or similar products, are often prescribed by homoeopaths for the prevention and treatment of the flu.” (google “oscillococcinum +prevention +flu” for more examples.)
When variants of homeopathy appear to come out well in trials they are embraced; when there is an apparent problem they are an impure aberration and condemned:
“La vittoria trova cento padri, e nessuno vuole riconoscere l’insuccesso.” [Victory has a hundred fathers, and no one acknowledges a failure.]
The Oxford Dictionary of Proverbs. Oxford University Press, 1982, 1992, 1998, 2003, 2004. Answers.com 10 Aug. 2008.
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