Dangerous delusions

[BPSDB] Professor Ernst’s recent exploration of the dubious ethics apparently demonstrated by some homeopaths, pharmacists and their professional bodies in, “peddling so-called ‘vaccines’ without any evidence that they are effective” set me thinking about the recent “Scientific Research in Homeopathy” conference.

What views, if any, did the speakers express on the issue of immunization?  Three of the speakers addressed this subject.  We shall see that one homeopath doesn’t think that vaccines are needed; another thinks that homeopathy can both treat people with malaria and offer effective prophylaxis; and the conference organiser is hiding behind a fig leaf.

Dr Lionel Milgrom, to my surprise, made a series of wild comments, I’ve discussed them before; but his views are illuminating.

• He is evidently unhappy with Simon Singh’s ‘Newsnight’ expose of homeopaths peddling Homeopathic malaria prophylaxis; along with Sir David King’s evidence to the Select Committee on Innovation, Universities, and Skills.
• He notes that Malaria is the second biggest killer in the world with around one-million new cases/year; and that a child dies every 30 seconds.
• ‘Big Pharma’s’ response comes in for some criticism, “New anti-malarial drugs are not profitable so tend not to get involved in researching them – leaves it to charity”
• Current anti-malaria drugs can cause schizophrenia.
• Mathew Parris doesn’t like them.
• Quoting Andrew Weil‘s seminal work ‘Health and Healing’ he seems to cast doubt on the usefulness of vaccination, “In fact, cholera, typhoid, tetanus, diphtheria and whooping cough, etc, were in decline before vaccines for them became available – the result of better methods of sanitation, sewage disposal, and distribution of food and water.”

It’s a classic Alt.Reality diatribe.  It cherry-picks mercilessly: ignoring evidence that doesn’t suit.  Non sequiturs litter the piece: just because malaria is a big problem doesn’t mean homeopathy has anything to offer; just because the pharmaceutical industry put profit before people doesn’t make homeopathy anything more than a delusion; just because drugs have risks doesn’t mean that this outweighs their benefits; just because big inroads were made into disease by improved hygiene and nourishment doesn’t mean that some more progress isn’t needed; and so on.

He is also keen on appeals to misleading authority.  After citing apparently scientifically illiterate MP’s Andrew George and Frank Field: Times journalist and ex-MP (is there a trend here I wonder?) Mathew Parris is presented as an authority.  I could go on, but I’d like to cover some new ground. 

Jayney Goddard, the president of the club who organised this quack-in, talked about, “Homeopathy in Epidemics and Pandemics“.  This went down the well-worn route of relating largely anecdotal information on how homeopathy fared, against conventional therapies, in the treatment of epidemics – at a time when conventional therapies were likely to be either ineffective or harmful.

To this end there was a roll-call of epidemics including: Typhus Fever (1813), Cholera (1831- 1892), Yellow Fever (1878), Smallpox (1870 – 1873), Diphtheria (1862-1864) and Spanish Flu (1918).  She then moved to talk about Homeopathic Prophylaxis.  A common thread emerges – she says homeopathic prophylaxis has proved to be highly effective. 

Of course Goddard’s points are all largely irrelevant: smallpox has been wiped out without the ‘help’ of homeopathy.  Diphtheria is now very effectively controlled in countries that vaccinate, as is Yellow Fever. Typhus is unheard of in developed countries, largely thanks to an effective vaccine.  As for Cholera, “safe, effective, and inexpensive interventions for both preventing infection and treating clinical illness have been developed”.  Her fox is not so much shot, as fossilised.

When discussing Scarlet Fever (now very readily treated with antibiotics), she points to a report credited to a homeopath called Dudgeon who, it is claimed, reported that, ten allopaths this time who used prophylactic Belladonna on 1646 children and only 123 cases developed. These were excellent results when the attack rates were ranging as high as 90%”.  No reference or details as to how these data were collected is provided.

Smallpox gets a similar treatment.  Goddard states that, “In 1902 during a smallpox epidemic in Iowa, Dr. Eaton reported that 2806 patients were treated prophylactically with Variolinum. Of the 547 patients who were definitely exposed, only 14 developed the disease. Overall protection rate was 97%.” (Jayney – it’s all gone now anyway!)

Goddard, Slide 25

Similarly impressive results are quoted for Meningitis prophylaxis.  In this case there also seems to be a reference to a respectable journal (British Medical Journal, 1987:294‐6).  However, this reference appears to be a typographic error.  According to such luminaries as Dana Ullman and Randall Neustaedter this study should be cited as:

Castro, D. & Nogueira, G. G. (1975). Use of the nosode Meningococcinum as a preventative against meningitis. Journal of the American Institute of Homeopathy, 1975 Dec 68 (4), 211-219. 

This is not good scholarship from Goddard.  I’ve e-mailed her to see if she’ll correct herself.

As the Ullman and Neustaedter quotes (above) make plain this was a ‘study’ reported in the homeopathic vanity press, not a credible peer-reviewed medical journal.  Neustaedter points out that the control group was not randomized. I guess that he means assignment to either treatment or control was not randomised, or that the control group was arbitrary – not selected from the same population as the treatment group: a fatal flaw in either case. He also notes that this was not a rigorous trial. (In classic Ullman tradition this poor quality study is styled as, “impressive”.)

Polio prophylaxis is also claimed to be highly effective (See Slide 26, below).  Claims of 100% efficacy are as impressive as they are implausible; no references are provided and no indication is given about how the data were collected.  

Goddard, Slide26

The final speaker in this triumvirate of prophylaxis peddlers was Karin Mont, chair of the Alliance of Registered Homeopaths (ARH).  Her contribution was entitled, “Homeopathy: Healthy Medicine or Heresy?”  She included a very good summary of the problems with homeopathy early in her presentation.

Mont, Slide 3

Absolutely.  If only she had left it there, but no, the NHS has problems so homeopathy must work: the classic Alt.Reality non-sequitur.  Apparently the NHS doesn’t deal with the causes of illness either.  She then had quite a bit to say about malaria.

Mont, slide 8

Yes, malaria is bad and drugs do have side effects (and pharmacological effects too for that matter) but that doesn’t mean that homeopathy is anything other than a placebo therapy.

Mont, slide 9

The first comment on Slide 9 is quite true, but doesn’t mean that homeopathy is the answer: ensuring that people can afford medicines that work (among other things) is.  The other points are entirely false and provide a eloquent substantiation of the dangerous nature of homeopathy (well, some of its practitioners actually) that Mont mentioned.  What evidence does she produce to support these wild claims?

Mont, slide 10

Slide 10 provides the supporting evidence: a travel guide and an article in the ARH’s in-house magazine.  The magazine article is available on the ARH’s website.  The report, such as it is, of a trial in Kenya is reported in so little detail that it is amazing that anyone would take this seriously.  Even though little real information is provided, there is enough to see that this is not worthy of even being called a bad trial.

“This began in July 2003 and was conducted over a period of 18 months on a group of 33 willing volunteers. All are workers in the Mtwapa area. Their family members were included if requested.
  See page 18 for a synopsis of age and incidence of malaria. The information was given to me by the workers and cannot be verified.
  However, the employers of these workers could verify that many days work had been lost over the 18 months prior to the trial, due to suspected malaria.”

Partington, T (2006), Silent and Deadly, prophylaxis and treatment of malaria, Homeopathy in Practice, Spring 2006, Alliance of Registered Homeopaths.

So no control group, no randomisation; in fact, a self-selected group who self-reported their health status.  It’s also clear that the ‘trial’ baseline (infections prior to the ‘study’ period) was established by third-party anecdotes. So, what was the outcome of the ‘trial’?

“Throughout the duration of the trial, only one person thought that he had contracted malaria but this was not verified by a blood test and the worker recovered very quickly.”

And the author expects people to take her word for it.  The point with a proper piece of scientific reporting is that sufficient information is provided so you don’t have to take it entirely on trust from people with a point to prove: Nullius in verba.  Of course, even well conducted work reported to high standards in reputable journals may be wrong.  When the reporting of something so unlikely is so bad you can practically guarantee it. (Also, see the redoubtable quackometer on this topic.)

 

The assertions that, “homeopathy has proved highly effective .. homeopathy can act as a prophylaxis .. homeopathy can treat people with malaria” are wrong and as a consequence dangerous.

Next comes a quite remarkable attack on Simon Singh’s ‘Newsnight’ expose of homeopaths peddling Homeopathic malaria prophylaxis.

Mont, slide 11

This issue has been comprehensively covered elsewhere.  I cannot help wondering what is wrong with an ‘undercover’ investigation – aside that it caught out some unethical homeopaths doing what they shouldn’t have.  Similarly, asking a specific question is hardly unfair: they didn’t have to answer!

 

Her main defence seems to be, “no exploration of facts relating to prophylaxis and treatment of malaria in indigenous population”.  This appears to be code for ‘homeopathy works’!  This stance would appear to confirm the criticisms made by the investigation.

 

She then wraps up with the obligatory homoeomythology about Shang et al (that they didn’t disclose the identities of the final eight studies) and some false criticisms of, “Controlled Clinical Trials”.  She may just as well have put, “they don’t give me the results I want” on the list.

So, what common threads can we tease out of this mess?  I would say that these speakers sought to promote homeopathic prophylaxis using three main strategies.

1. Dishonestly cast doubt on conventional immunization (cost, side effects and usefulness).
2. Highlight homeopathic success relative to pre-scientific medicine.
3. Cite worthless ‘trials’ as long as they favour homeopathy

 Contrast this with the public position of the respectable face of homeopathy in the UK, Peter Fisher:

“Malaria is a serious and life-threatening disease and there is no published evidence to support the use of homeopathy in the prevention of malaria,” comments Dr Peter Fisher, a member of the Faculty of Homeopathy and Clinical Director of the Royal London Homeopathic Hospital.

Given that, “Malaria is a serious and life-threatening disease” and, “there is no published evidence to support the use of homeopathy in the prevention of malaria” to pretend otherwise must be dangerous.

Now I am not saying that researchers shouldn’t get together and discuss wild ideas; or that they shouldn’t have the freedom to be wrong.  However, particularly in the field of medicine, they should act with a degree of responsibility absent from these authors. 

Neither are these authors just researchers:  Milgrom and Mont are practising homeopaths.  If Mont really believes that, “homeopathy can act as a prophylaxis … homeopathy can treat people with malaria” I do wonder what she tells her clients.

Also, it’s disingenuous for Jayney Goddard’s CMA to provide the presentations of these authors on their website, at the same time as it carries their fig leaf of a “Position Statement on Malaria and Complementary Medicine”, which says, in part:

“There is no research evidence that complementary medicine in any form can prevent people from contracting Malaria …

Many of our readers will remember that an organisation called Sense About Science did some secret filming of homeopathic practitioners – the journalist deliberately misled the practitioners and told them that he was a patient who was supposedly going to a malaria zone. The CMA was not involved in this film and neither were any of our Members.

If a patient comes to a CMA Member we suggest that the following should be considered:

1) Don’t go to malaria infested locations – inform your client that they are at extremely high risk of infection if they travel to a malaria zone.

2) If your client has has [sic] no choice and has to travel – tell them to make sure that they don’t get bitten.

3) There is no medicine that is proven in trials to be 100% reliable – neither conventional nor homeopathic. There have been some unfortunate side effects of conventional medications – so patients should liaise with their GP to make sure that they have all the relevant information about possible drug reactions and interractions [sic] where appropriate so that they can make an informed decision.”

This directly contradicts Mont’s assertions.  Quite why the investigative journalist’s subterfuge undermined the evidence gathered escapes me.  Recommendations 1) and 2) seem pretty sensible though.  However, item 3) indulges in the fallacy of false equivalence – conventional medicine may not be 100% reliable but all the (real) evidence shows that this is massively superior to the homeopathic ‘alternative’.  It also contradicts Mont – according to her ‘evidence’ homeopathy is 100% effective for malaria prophylaxis!

All in all revealing nonsense that seeks to undermine effective immunization and promote a delusion; and a dangerous one at that.

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