Two recent and related papers, published in the Journal of Clinical Epidemiology and Homeopathy (the journal of the Faculty of Homeopathy, the UK’s professional organisation of medically qualified homeopaths), have reconstructed the analysis carried out by the authors of The Lancet’s much vaunted 2005 meta-analysis, on the back of which the journal triumphantly editorialised “the end of homeopathy”, and have placed on record the fact that the study was hugely flawed and in some instances just plain incorrect.

These papers emphatically underline the position this blog has taken from the outset — that the underlying data does not support the assertion that homeopathy is no more than placebo. The jury is still out, and those that claim otherwise are misrepresenting their personal opinion as proven scientific fact when it’s nothing of the kind.

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I learned something from running this blog. And that’s that it takes up a phenomenal amount of time and energy.

It got to the stage a few months ago when the extent to which it was impinging on the rest of life was unacceptable: disputing differences in perspective, for all the need for better public debate on the subject of homeopathy, isn’t quite up there with First Life. (Not to mention that the blog seemed to be doing perfectly well without me.) So having gone socks away for a bit, this business of the time and the energy brought me very conveniently round to the subject of this post.

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Ben Goldacre’s March 1st Bad Science piece for the Guardian, Don’t laugh, sugar pills are the future, in which he comments on the latest research to show that SSRIs are not much more effective than placebo in treating depression is, as usual, a bit thin on the ground with the actual science itself, even if his title might turn out to be remarkably prescient. And, wonder of wonders, I even agree wholeheartedly with a substantial amount of his earlier piece on February 27th, based on the same study, A quick fix would stop drug firms bending the truth. But far more interesting is the piece by Clive Cookson in the FT, Is there an ethical way to fine-tune the placebo effect?

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Evidence-based medicine is a worthy objective. According to the Oxford-based Centre for Evidence Based Medicine, “Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.”

The present campaign against homeopathy and other complementary therapies makes extensive use of these aims to justify calls for these therapies’ exclusion from the NHS on the grounds that there is “no evidence” for their efficacy. I’ve gone into the evidence question in relation to homeopathy in other posts. This one looks at the evidence base for biomedical treatment. After all, if biomedical treatment is to be so clearly preferred over the complementary therapies which presently lack the robust evidence base being demanded, then one would assume that biomedical treatments have a clear advantage here.

One would assume wrongly.

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I didn’t write this article. It’s from the website Suppressed Science. I’m posting it here in the interests of raising public awareness of this increasingly common and rather unpleasant condition. We’re already aware of its non-self-limiting nature — sufferers have clearly demonstrated their incapacity to limit its effects to themselves — and so far there’s no evidence of it being curable.

It should not be confused with scepticaemia, the condition of having doubt in the blood. Scepticaemia is essentially healthy. DD Scientismic fascistitis.

Contributions from other homeopaths on candidates for genus epidemicus remedies are welcome.

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A lot of hot air has been expended on homeopathy’s apparent inability to “prove” itself in clinical trials. Many people, many of whom call themselves scientists, seem only to need this fact, plus the therapy’s apparent implausibility, to jump to the conclusion the whole thing is nonsense on stilts, and work themselves up into lathers of righteous indignation about the fact that it continues to be practiced. I’ve gone into this a couple of times in the comments to posts on this blog, but this question really does deserve detailed examination, because the issue is not at all as simple as it might seem.

The presupposition of clinical trials is that there is a stable, locally active cause that is only active in the treatment group, irrespective of blinding and the circumstances of the trial or any changed clinical context as a result of the trial. In plain English, this means that the whole basis of clinical trials is predicated on the assumption that the bulk of the treatment effect resides in the physical substance that’s being trialed. It’s a localist hypothesis, proceeding — in homeopathy’s case — from the following logic:

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While musing on the nature of evidence, and what is or is not considered ‘evidence’ in all the various contexts evidence is used, I came across this excellent rapid response in the BMJ back in 2004 by Clifford Miller, “a practising English lawyer, graduate in physics and a sometime examining lecturer on law, standards and ethics (particularly, the law of evidence) to Masters student technologists at the Imperial College of Science Technology and Medicine”.

He writes, in the context of the imputed association between MMR vaccination and the onset of autistic states, on “The Unreliability of Scientific Papers as Evidence”:

“Reliable evidence is that which is authentic, accurate and complete. In short, scientific evidence is incomplete if used for purposes outside the strict confines of science because it fails to take account of evidence of lay witnesses of the facts and is hence only applicable to the narrow and specific confines of scientific enquiry and not the broader ones found in other fields of human endeavour.

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I’ve been taking a closer look at what Ben Goldacre regards as ‘good science’, given that he makes such grandiose and sweeping claims about the respective quality of research into both homeopathy and pharmaceutical interventions in both his recent Guardian article, What’s wrong with homeopathy? and the accompanying comment piece in The Lancet, Benefits and Risks of Homeopathy.

In the Guardian, he claims:

I look about 12, and I’m only a few years out of medical school. This is all good fun, but my adamant stance, that I absolutely lack any authority, is key: because this is not about one man’s opinion, and there is nothing even slightly technical or complicated about the evidence on homeopathy, or indeed anything, when it is clearly explained.

He then goes on at great length, much of it speculative, to give his reasons for why just about all homeopathic research is meaningless nonsense full of nothing but bias and conventional medical research is robust.

But thanks to a rapid response on the BMJ’s website, we learn the following from John Stone:

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So now we have another prominent ‘scientist’ joining the chorus. Sir David King, the government’s chief scientific advisor, speaking to MPs on the innovation, universities and skills select committee about his role, laid into sections of the media (for their “campaigns” against GM foods and the MMR vaccine) and the Department of Health over its decision to allow homeopathic remedies to be licensed by the Medicines and Healthcare Products Regulatory Agency, the public body that licenses drugs.

“How can you have homeopathic medicines labelled by a department which is driven by science?” said King. “There is not one jot of evidence supporting the notion that homeopathic medicines are of any assistance whatsoever.”

(Reports in the Guardian, the Daily Telegraph, the Daily Mail)

Make no mistake, this “not one jot of evidence” is nothing more than a mantra which those continually repeating it seem to hope will eventually become accepted as some sort of “truth” merely through repetition. In no sense does it bear any relation to the actual state of the evidence base for homeopathy. It is, quite simply, a lie.

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This is the second paragraph from Ben Goldacre’s recent comment piece Benefits and risks of homeopathy in The Lancet’s November 17 edition.

During the cholera epidemic in the 19th century, death rates at the London Homoeopathic Hospital were three times lower than those at the Middlesex Hospital. (6) The reason for homoeopathy’s success in this epidemic is even more interesting than the placebo effect. At the time, nobody could treat cholera, and while medical treatments such as blood-letting were actively harmful, the homoeopaths’ treatments were at least inert.

(6) Hempel S. The medical detective. London, UK: Granta Books, 2006

Notice how Goldacre doesn’t give us the actual figures. (And this is The Lancet, not the Guardian.) Neither does he clarify that his reasoning is speculation, not established fact. The actual mortality percentages would allow readers to make some kind of sensible judgement about his conjecture that medical treatments exacerbated mortality while homeopathic treatment equated to no treatment at all.

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