Homeopath says what ….

A 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 17^th and 26^th 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]