The King’s New Medicine: on the soporific effect of homeopathy

This is the story of the King’s new clothes.

Now there was once a king who was absolutely insane about

new clothes and one day, two swindlers came to sell him what

they said was a magic suit of clothes. Now, they held up this

particular garment and they said, “Your Majesty, this is a magic suit.”

Well, the truth of the matter is, there was no suit there at all.

But the swindlers were very smart, and they said,

“Your Majesty, to a wise man this is a beautiful raiment

but to a fool it is absolutely invisible.”

THE KING’S NEW CLOTHES, From the film “Hans Christian Andersen” (1952)

 It’s Homeopathy Awareness Week (HAW) again in the UK from the 14^th to 21^st June.  This is an annual publicity campaign run by homeopathy organizations and a potion maker.  It’s an attempt to convince potential customers that homeopathy is useful for something significant.  The two main problems are: there is no real evidence that homeopathy can help with any specific health issue, and they are peddling magic pills that typically contain no medicine.

This event always gives me a strong sense of déjà vu: after failing to produce any proper evidence for being able to help with women’s health (2010) and hay fever (2009), this year it’s sleeplessness (insomnia).

The campaign’s website, ‘heal through homeopathy’, highlights the undoubted importance of the topic by claiming that, “… sleeplessness … affects an estimated 77% of people in GB.”  However, according to a National Health Service (NHS) publication, “Sleeplessness – A Self Help Guide” the figure is around 30%.  Perhaps the homeopaths are overstating the problem?

A summary of a recent YouGov poll^* put it this way:

“The majority of the British public need between six and nine hours’ sleep a night to feel fully rested, according to a recent survey. 43% claim they need 6-7 hours and another 33% of the population stated they require 8-9 hours to feel fresh the following day. This appears to be consistent with the hours of sleep the public normally get with a huge 79% claiming they get between 6-9 hours each night. However, almost one in five respondents (18%) state that they get a just a maximum of five hours of sleep a night and just seven percent claim that they feel fully rested with this amount.”

This seems to suggest that a smaller percentage of the population feel they are not getting enough sleep than the homeopaths are suggesting.

Measles, vaccination and homeopaths

Measles is in the news again.  Just to provide a little context, the graph above shows the number of confirmed measles cases in England and Wales since 1996^*. The impact of insufficient vaccine coverage is easy to see. This year is looking like being a good year for measles; not so good for vulnerable members of the community. According to the BBC, “The Health Protection Agency [HPA] reported 334 cases compared with 33 in the similar period last year.”  In fact, this is rapidly approaching the total of 374 cases reported for the whole of 2010.  It seems that this is related to “an epidemic in France, where 7,000 cases have been reported since January – more than in the whole of 2010.”

The HPA are advising “Whether you stay here in the UK or travel abroad, it is crucial that individuals who may be at risk are fully immunised.” Although the coverage with the MMR vaccine is improving in the UK, it is “still far from the 95% uptake rate needed to stop the spread of the disease in the community.”^** One reason for this is the damage done by the media^*** uncritically promoting the views of the disgraced Andrew Wakefield^† and other vaccine scaremongers.

Measles and MMR: the risks

It’s easy to forget just how dangerous measles is.  Those of us who grew up in times where it was more common may tend to look back on measles as an inconvenient rite of passage.  Generally, this is because we may not have had direct personal experience of the serious consequences that can arise from a measles infection.  In the years since, vaccination brought diseases like measles under control and people have, thankfully, become even less familiar with the dangers.

Editing reality

I really hope that this is the last post I write about the homeoprophylaxis campaign against Leptospirosis in Cuba during 2007 – 2008 (Bracho et al, 2010).  Deep down I know that this uncontrolled, un-randomised poorly-reported trial published in a terrible pseudojournal, dealing with a highly variable disease which is amenable to personal protective measures, a real vaccine and antibiotic treatment is going to get thrown at me again and again.

Homeopathic propagandists will not worry that real medicines were also used in the treatment region, a media campaign raised awareness of the disease and the homeopaths intervened at the peak of a multi-year problem.  Neither will it bother them that the net outcome was a return to the same infection rate as the rest of Cuba or the Intervention Region in 2004, or that the paper was rejected by proper journals.

However, before I move on I think that the accompanying guest editorial by Roniger and Jacobs (2010) deserves some additional scrutiny. It’s entitled, “Prophylaxis against Leptospirosis using a nosode: Can this large cohort study serve as a model for future replications?”

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:

Much ado about nothing

So, the much-trailed^* paper on the homeopathic intervention in an outbreak of Leptospirosis in Cuba during 2007 has finally been published (Bracho et al, 2010) along with a very useful companion editorial (Roniger and Jacobs, 2010).

The editorial claims that, “the size of the population treated and the dramatic decrease in disease incidence compared to previous years make it difficult to dismiss these results as spurious or occurring by chance.”

Before finding it quite easy to dismiss these results, some background information on Leptospirosis is in order.

Keen on neem?

Neem [Azadirachta indica A. Juss] is a tree of the mahogany family.  Various claims have been made for its health-giving properties.  As the Abha Light organisation seems keen on neem as an anti-malarial, I decided to do a brief review of the literature.  What follows is a commentary based on searching PubMed for ‘neem and malaria’, and doing some additional searches.

I don’t claim that this is exhaustive and I have not been able to locate any information on some of the papers cited^*.  For articles behind paywalls, I have only been able to consult the abstract.

A Review

One of the first things that I look for, when I’m researching a new topic, is a review article.  A recent publication by Anyaehie (2009) seemed to provide a good starting point.

Deluded and Dangerous

I recently stumbled across a paper describing the work of the Abha Light organisation – a group of particularly dangerous homeopaths treating malaria in Kenya with homeopathy, and disparaging proper medicine for good measure.

It should go without saying that malaria is a serious, potentially fatal, disease that should not be treated with untested remedies – especially the sugar pills and magic water of homeopathy.  So committed are the homeopaths of Abha Light that they believe that their magic works and that it is superior to proven medicines.

These themes shine through the paper presented by Didi Ananda Ruchira at the Cuban Nosodes 2008 International Conference, entitled, “The Use of Homeopathic Prophylaxis and Treatment For Malaria in Endemic Areas Of Kenya: Part 2“.  It provides some alarming insights into the surreal world of Abha Light.

A homeopathic refutation – part three

In the third part of my series examining an attempted refutation of the critics of homeopathy (Milgrom, 2009) I look at the claim that homeopathy has a serious scientific foundation.

Dilute Science

This part of the essay starts by outlining a common criticism levelled at the most common form of homeopathy practised in the US and UK.  This calls homeopathy unscientific because:

“[…] in many homeopathic remedies, the original substance has been diluted out of molecular existence, detractors claim belief in homeopathy has no basis in science as ‘nothing cannot do something’.”

So, can apologists for homeopathy point to serious scientific work which shows that nothing can do something? 

A homeopathic refutation – part two

This post is the second in a series examining the claims made in a recent essay that seeks, in part, to refute common criticisms of homeopathy (Milgrom, 2009).  I have already examined the empty assertions about evidence for clinically useful specific effects.  Now, I would like to move on to examine an attempted refutation of claims that, “Homeopathy is deadly”. 

How deadly is homeopathy?

Milgrom starts with a bit of distraction: “The claim that homeopathy is deadly has never been substantiated, primarily because it cannot be proved anyone has died as a direct result of taking a homeopathic remedy.” 

This is entirely irrelevant; no critical discourse that I have come across has made the claim that the remedies themselves are toxic^*.  As I pointed out in my last post: the problem is not in the pills, but in their uselessness; and the attitudes of some homeopaths.  He then moves to the actual concerns of sensible critics: 

“The claim arises over concerns that those taking homeopathic remedies might forgo ‘life-saving’ drugs. This is a false perception: many who come to homeopathy do so only after conventional treatments have failed.”

A homeopathic refutation – part one

Lionel Milgrom recently had an essay published defending homeopathy (Milgrom, 2009).  It’s available on the Homeopathy World Community website.  In it, he notes the current parlous state of homeopathy as a mainstream medical intervention in the UK and seeks to do two things: (1) refute what he identifies as the main criticisms of homeopathy and (2) explore the context for what he views as unjustified attacks. 

In this post I shall examine Milgrom’s opening and his comments on the evidence for homeopathy.  I will be examining his arguments around: the scientific nature of homeopathy, its risks, the role of the profit motive and the influence of philosophy, in subsequent posts. 

Sitting comfortably? 

The summary starts with a familiar defence: “homeopathy has been in successful and continuous use for well over 200 years”.  This makes the usual mistake of conflating two different arguments: efficacy and popularity.  It is a common mistake to assume that the two go hand in hand.  History tells a different story.