Here Is the News

These days scientific papers are often accompanied by a press release.  It gives the journal or institution at which the work was done a chance to highlight what they think the main message from the work is.  Some might even see it as applying some PR spin.  The recent paper on a trial of homeopathy on a Leptospirosis outbreak in Cuba (Bracho et al, 2010) has its own accompanying press release.  It’s from the Faculty of Homeopathy, the representative body for the UK’s medically qualified homeopaths, whose stated aim is to promote, “… the academic and scientific development of homeopathy. It ensures the highest standards in the education, training and practice of homeopathy”.

It’s instructive to see what message the UK medical homeopath’s representative body is trying to get into the minds of press and public.

First it’s no surprise that they welcome this apparently successful trial with open arms.  Homeopathy, is the journal of The Faculty of Homeopathy.  The paper appears to confirm the view of The Faculty and provide some justification for its work.  So what message do they want people to take away from this publication?  Is it an accurate reflection of the work?  Let’s have a look and see:

Side step

“It provides fascinating evidence that a highly dilute substance, prepared according to homeopathic principles, may contribute to the prevention of Leptospirosis” [emphasis mine throughout]

This is misleading, and given the expert nature of the source of this press release I wonder whether this is deliberate or not.  The trial did not use “a highly dilute substance” it used a liquid that had been shaken in a container that had once contained the substance; but that was either 199 or 9,999 cycles of shaking and emptying ago.  The most concentrated form of the medicine diluted the initial preparation to one part in 10⁴⁰⁰.  Simply put, there’s no substance left in this homeopathic medicine; it’s all been washed away.

So why talk as though there is something left?  Is it perhaps a ruse to make the claims seem more believable to a general audience?  Maybe they are trying to by-pass the most obvious and oft made criticism of homeopathy: that there’s nothing in it.  There was a time when I thought that homeopaths used highly-dilute substances.  Just maybe the press release is aimed at this blind-spot in the collective consciousness.

A red herring

Moving on to the press release’s interpretation of the paper, it makes this claim about Leptospirosis.

“Its incidence correlates closely with heavy rainfall and subsequent flooding”

It’s probably a reasonable general observation.  But it’s not a good piece of context for this work.  First, the paper only presents rainfall data for five years – a pretty short length of time over which to establish a correlation.  Second, my analysis of the data shows that while there appeared to be reasonable correlation in the area the homeopathic treatment was applied, in the rest of Cuba the correlation appears to be poor.  This indicates that conventional approaches can combat the risks posed by rain.

Unflattering comparison

“Within a few weeks the number of cases had fallen from 38 to 4 cases per 100,000 per week, significantly fewer than the historically-based forecast for those weeks of the year.”

This clearly aims to make an impressive point, and it’s straight from the paper, so reflects it fairly.  However, the press release like Bracho et al (2010) fail to mention that this just returned the region to its 2004 level of Leptospirosis – when it didn’t use homeopathy – a level typical of the rest of the country.  This is quite a nice propaganda technique – presenting something that is true, but removing it from a context that would help someone draw ‘off message’ conclusions.

“The 8.8 million population of the other provinces did not receive homeopathic treatment and the incidence was as forecast.”

This tries to imply that something bad happened in the rest of the country, it did not.  The incidence rate for Leptospirosis for the whole of 2007 was 16.7 cases/week per 100,000 inhabitants for the Intervention Region (IR) and 3.5 in the rest of Cuba.  In 2008 these weekly rates ran at 2.7 and 4.3 respectively.

The un-spun truth is that in both treated and untreated regions, the Leptospirosis rate was in the same “3 – 4 cases/week per 100,000” range over the course of 2008 (Roniger and Jacobs, 2010).  The untreated region did just as well as the treated one.  Not a message that the Faculty of Homeopathy wants anyone to spot.

Correlation or causation?

“The effect appeared to be sustained: there was an 84% reduction in infection in the treated region in the following year (2008) when, for the first time, incidence did not correlate with rainfall.”

This is another nice bit of spin.  By mentioning “The effect” they are inviting the reader to see homeopathy as the cause.  All the paper presents is a temporal correlation in an un-controlled, un-randomized trial.  Correlation is, of course, not causation.  Also, the use of percentages will turn out to dramatise the relative changes.

Playing the percentages

“In the same period, incidence in the untreated region increased by 22%.”

Yes, in the untreated region weekly cases shot up from 3.5 cases/week per 100,000 to 4.3.  Still around 3 – 4 cases/week per 100,000.  This bit of the press release is basically spinning natural variation in the rate as some sort of indictment of not having homeoprophylaxis.  The percentages help sell the story.  This trick is popular with mainstream authors and journalists hoping to make an effect look more sizable.

Personable propaganda

Next, some expert homeopaths are deployed to sell the results.  It’s more persuasive to be told something by a named person.

“Infectious diseases are still the bane of humanity, particularly in the developing world”, states Dr Sara Eames, President of the Faculty of Homeopathy. “Anything which appears to reduce infection rates in a potentially fatal infection, particularly when it can be prepared and delivered quickly, safely and cost effectively, has to be taken seriously and studied further.”

There is nothing wrong with the first half of the statement.  It’s motherhood and apple pie.  The second half is another story.  The “Anything” which “appears” to work is not likely to include the homeopathy.  As I argued in my earlier piece on this paper, the most likely culprits are improved uptake of conventional controls, antibiotic and vaccine intervention in high-risk groups and outbreaks, or just regression to the mean.

Certainly looking at how to maximize the impact of conventional controls is a very important topic and should be, “taken seriously and studied further.”  However, with finite healthcare resources, magic water formulation and dispensation should not the taken seriously.  Further study would just be wasteful.

Cuba already has an effective vaccine.  Antibiotic treatment using Doxicycline, as the paper inadvertently shows, is highly effective for outbreak control.  Given that the authors attributed the rise in Leptospirosis in the IR from 2005 – 2007 to, “the implementation of policies promoting agriculture and animal breeding that caused rapid and continuous changes in the size and composition of risk groups, making identification difficult” attention should be given to better identification of those at risk.  Magic water is just a distraction.

This is a smoke-and-mirrors plea for indulgence.  It’s initially hard to argue with doing “anything” to help with “a potentially fatal infection”.  However, it is really arguing for the diversion of resources on a wild goose chase – that is not justifiable in dealing with an infection for which effective control strategies, prophylaxis and treatments already exist.

“Dr Peter Fisher, Editor of Homeopathy, notes “This is a very large study and its results, if confirmed, have huge potential impact.  We need more research into the effectiveness of homeopathic preparations in preventing infectious diseases, complications, and the economic viability of a homeopathic approach.””

Some caution is evident in the tone struck by the usually relatively sensible Dr Peter Fisher.  It implies the need for confirmation; however it’s essentially the same pitch for a diversion of resources from the effective to the delusional.  It also contains an element of the agenda explicitly developed in the accompanying editorial (Roniger and Jacobs, 2010): the expansion of homeoprophylaxis and treatment to other dangerous diseases.  Again, it’s slick media technique: use what you are promoting to advance your broader agenda.

All press releases accentuate the positive.  The techniques used here are all too common.  I find it interesting that this bunch of homeopaths seem keen to side-step the issue of what’s actually in their potions.

It’s worrying to see them use an uncontrolled, un-randomised trial badly reported in a pseudojournal to promote the idea that specially shaken water needs to be taken seriously for preventing infectious diseases.  Now that’s a positively dangerous message.

Disclaimer

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.

This is not medical advice.  If you need that see a properly qualified and registered doctor.

Related Posts

Much ado about nothing – my review of Bracho et al (2010).

Homeoprophylaxis: An idea whose time has come—and gone – Peter Lipson’s more elegant dismissal of Bracho et al (2010) on Science Based Medicine.

Dilutions of Grandeur – my review of an even worse paper on homeopathic prophylaxis and treatment of dengue in Brazil.

Dengue: magic water and the great social mobilization – How  homeopathy can be used as a cover for improving conventional interventions.

Dengue: betting on homeopathy? – Another homeopathic press release.

References

Bracho G, Varela E, Fernández R, Ordaz B, Marzoa N, Menéndez J, et al. Large-scale application of highly-diluted bacteria for Leptospirosis epidemic control. Homeopathy. 2010 July;99(3). Available from: http://dx.doi.org/10.1016/j.homp.2010.05.009

Roniger H, Jacobs J. Prophylaxis against Leptospirosis using a nosode: Can this large cohort study serve as a model for future replications?  Homeopathy. 2010 July;99(3):153–155. Available from: http://dx.doi.org/10.1016/j.homp.2010.06.004.

Edits

13/08/2010 – Typo corrected and the status of The Faculty of Homeopathy better described. Thanks to David Waldock for spotting these.

[BPSDB]

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