Zeno's Blog

The random thoughts of a sceptical activist

Falling trust in homeopathy

There’s an un-written rule — or at least there should be — that anything said in support of homeopathy cited by a homeopath or supporter should be taken with a large pinch of natrium muriaticum.

That’s not to say homeopaths will always be wrong or there won’t be some grain of truth in what they say, of course, but it will always bear a bit of investigation. There will frequently be more to it than meets the eye.

Take for example, a homeopath citing the meta-analysis Clinical trials of homoeopathy by Kleijnen et al. (1991). Nancy Malik summarises this paper thus:

Clinical Trials of Homeopathy (1991) FULL TEXT // 81 (77%) out of 105 RCT (1943-1990) shows statistically significant result for homeopathy and 15 out of 22 best quality studies are also statistically significant.

Out of 81, 5 out of 5 of the clinical trials for hay fever showed a positive result and 8 out of 10 trials looking at mental or emotional problems showed a beneficial effect, while 6 out of 7 trials for infection showed that homeopathy could effectively relieve the problem.

“Based on this evidence we would be ready to accept that homoeopathy can be efficacious, if only the mechanism of action were more plausible” and “the evidence presented in this review would probably be sufficient for establishing homoeopathy as a regular treatment for certain indications……..a conventional method would have been acknowledged with this amount of evidence”, the results are mostly favourable for homeopathy regarding the quality of trials.”

Glowing praise for homeopathy it would seem, but what she fails to mention is the conclusion the authors reached, quoted here in full:

Conclusions At the moment the evidence of clinical trials is positive but not sufficient to draw definitive conclusions because most trials are of low methodological quality and because of the unknown role of publication bias. This indicates that there is a legitimate case for further evaluation of homoeopathy, but only by means of well performed trials.

Homeopathy pelletsSpot the difference. Malik does try to link to the paper (but not to an accessible copy of it), but how many will click on her link to check the veracity of what she says? Some other examples of conclusions homeopaths would rather you didn’t read can be found on the Discover Homeopathy website.

Anyway, the point is made: always check original sources to make sure claims made by homeopaths for homeopathy are complete and accurate.

Trustworthy

How much do people trust homeopathy? That’s difficult to know unless a survey is done asking that specific question. We could perhaps use the sales of homeopathic products as a proxy, but market surveys are complex things to do and tend to cost a lot on money. Mintel, for example, will sell you their market survey on homeopathic and herbal products in the US for a mere £2,466.89 (Excl.Tax), or their report Complementary Medicines – UK – December 2009 for just £1,750. Well beyond the reach of many, including me.

But the teaser for that last report does tell us:

Growth in the UK’s £213 million complementary medicines market [note: not specifically homeopathy] has gathered pace in the last two years. It is estimated to have grown in value by some 18% between 2007 and 2009 when Mintel last reviewed the industry.

We also know that the market for homeopathic and anthroposophic medicinal products in the EU exceeded €1 billion for third year in a row in 2011. It doesn’t tell us anything about the sales in the UK, but it’s still an interesting figure. Whither the cries of homeopaths that they have no money for decent trials? And we know there is plenty of scope to raise the money for trials if they really, really wanted to.

But homeopaths frequently like to use increasing sales figures in the mistaken belief that this somehow correlates with efficacy. Equally, sales figures are not a measure of trust: they tell only about the success of marketing and PR that they do about whether homeopathy works or whether people trust it.

But fortunately, there are some limited data available that answers that question about trust.

Twittering

In a recent Tweet, a dedicated homeopathy supporter claimed:

60% growth h’pathy mkt in Europe 1995-2005 Mintel est sales in UK to reach 46M pds 2012

When asked for a source of those figures, she replied:

Mintel, Global Global TGI Barometer — look them up

I did.

As I said, Mintel reports cost a lot of money, but I thought it would be interesting to see if I could find the Global TGI Barometer source.

A search shows that the one Global TGI (Target Group Index) Barometer that pops up regularly on homeopaths’ websites is the Global TGI Barometer, January 2008, Issue 33: The lure of alternative medicine. It’s this article that is cited frequently in support of homeopathy, eg:

British Homeopathic Association: The growing demand for homeopathy

A survey conducted by Global TGI in 2008 found 15% of the population of Britain trusted homeopathy.

Homeopathy manufacturer, Nelsons: 150 Facts About Homeopathy

57.  In India, alternative treatments, including homeopathy, are well established and integrated into the healthcare system, with 94 per cent of people saying that they have faith in alternative remedies.[8]

[8]  Global TGI Barometer, January 2008; Issue 33.

Dr Brian Kaplan: Homeopathy in perspective:

Homeopathy has never been so popular; currently 15% of the population of Britain trust it.1 Homeopathy is the fastest-growing form of complementary medicine and has experienced a growth of 44% since 2004.1 1. Global TGI Barometer, January 2008; Issue 33.

Homeopath, Paula Yates:

It is estimated that between 6 and 9 million people in the UK choose to use homeopathy (Source: Global TGI Barometer, issue 33 – Jan 2008).

Homeopath, Gill Marshall:

It is used by 15% of people in the UK, 27% of Germans and 40% of French people. (2)

(2) Global TGI Barometer January 2008 Issue 33: The lure of alternative medicine.

There are a couple of websites that seem to give most of the text of the article (eg here and here, but the links to the original source are broken), but none looked like the full article, so I asked the publishers, Kantar Media. Although the document is some six years old, they were kind enough to send me the full, original article: The lure of alternative medicine.

This was about a survey of 13 countries, finding out what proportion of people agree with the statement ‘I trust homeopathic medicine’: I trust homeopathic medicine This puts a rather dramatic perspective on the 15% figure for Great Britain.

Additionally, it’s clear that many of the statements made by homeopaths about this article are not supported by what the article actually says! I have to wonder if any of them actually read the article — it is only three-and-a-half pages long — or whether they were just parroting what others had said.

The article also says:

In many countries, particularly in Europe, consumers are less convinced. At 15% agreement, Britons are the least trusting of homeopathy, and only 1 in 10 say that they prefer alternative medicine. Even in Germany, the birth place of homeopathy, just 27% of people trust this kind of treatment. France is the European market in which people are most trusting of homeopathy.

Unfortunately, we can only speculate about the historical, cultural and political reasons for these marked differences, but maybe the reason for the figure for France is more obvious?

But now we know that one of the sources the homeopathy supporter cited did not substantiate the claims she made for the growth in homeopathy. No surprise there. Copying and pasting without engaging brain is an all too familiar gambit of homeopathy supporters — perhaps through ignorance or in the desperate hope that no one will bother to check… More likely, though, it can be attributed to a complete lack of curiosity on their part.

In decline

We already know that homeopathy in the NHS has been in steep decline for the last few decades: The decline of homeopathy on the NHS This could well indicate that homeopathy isn’t as unthinkingly accepted as it once was.

But the Global TGI Barometer data was from some six years ago — what about trust in homeopathy now? Although Kantar Media haven’t publicly published such a comprehensive survey since 2008, in 2013 they published a Factiod, a single page document Headache Remedies: East vs. West. In it, they were able to say:

TGI data shows that 43% of people in China agree with the statement ‘I trust homeopathic medicine’ compared to just 20% in the USA and 12% in GB.

It would have been good to see up-to-date figures for the other countries, but this does show that trust in homeopathy products in Great Britain has dropped by a fifth,  from 15% in 2008 to just 12% in 2013.

As more people find out what homeopathy is and how homeopathy works, we should not be surprised to see this figure drop even more.

Paying the price of homeopathic research

Do homeopaths’ claims that trials are too expensive and that they can’t afford them hold water?

Science is simply a systematic way for carefully and thoroughly observing nature and using consistent logic to evaluate results. Which part of that exactly do you disagree with?

— Dr Steven Novella

Homeopaths have an ambivalent attitude to research: they are quick to jump on any results they think support their pseudo scientific beliefs, yet any paper that shows homeopathy to be no better than placebo is denounced, usually with cries that the ‘homeopathic system of personalised, holistic medicine’ is just not suited to being tested using flawed ‘conventional’ double-blind randomised controlled trials (DBRCT). And sometimes Big Pharma tell lies.

But homeopaths have a problem: all advertising in the UK has to comply with the Advertising Standards Authority’s CAP Code and this rightly demands a high standard of evidence for any claim, regardless of whether it’s about how clean a soap powder makes your whites, how efficient double-glazed windows are or how much a skin cream reduces the appearance of wrinkles. So it is with homeopathy: high quality evidence is required. Continue reading

WDDTY: Waging war on “doctor-induced disease”

What does the two-decade-old ‘endorsement’ by The Times really say?

Any reader not aware of the current fuss and bother over the What Doctors Don’t Tell You magazine can find a comprehensive list of blog posts, etc curated by Josephine Jones: WDDTY: My Master List.

In a recent spat — after The Times published an article by Tom Whipple (Call to ban magazine for scaremongering) — WDDTY posted a scan of part of a 1989 Times article that appeared to praise their original (online subscription) publication of the same name, saying it was “A voice in the silence”.

WDDTY use this same endorsement 24 years later on their main website, the WDDTY subscription website for their latest glossy, supermarket edition (although they get the quote mixed up with others) and in the glossy magazine itself.

Despite calls for them to publish the complete article, its editor, Lynne McTaggart, has not obliged, so I will. Continue reading

Beware the spinal spin

Finding a document on the website of the British Chiropractic Association titled  “CONFIDENTIAL FOR BCA MEMBERS ONLY” is an open invitation…

Perusing the BCA’s website usually finds extremely useful advice on schoolbagsgardeningbrasshopping, Bank Holidays, bakinggadgets, sitting and, of course, Christmas.

This time, however, I was bravely looking for what they said about the differences between chiropractic and osteopathy after a comment by a chiro on Prof Edzard Ernst’s blog:

Chiropractic and osteopathy have different origins. They are separate forms of spinal manip. Typically osteopaths use long level techniques, chiros use short lever. Both aim to achieve the same thing – spinal health.

This highlights a frequent question asked by skeptics: Are chiropractic and osteopathy substantially or even significantly different forms of healthcare?

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Stop this unscientific meddling

The exposé  by Prof David Colquhoun of the interference by the Department of Health — at the behest of homeopathy promoters — in the publication of impartial, scientifically-based information about homeopathy on the NHS Choices website has been covered by the Guardian and the Daily Mail this past week.

Damned by their own words, the DoH said in response to the draft submitted by the editors of NHS Choices that mentioned the House of Commons Science and Technology Committee’s comprehensive Evidence Check report on homeopathy:

Can we remove this statement? This report is really quite contentious and we may well be subject to quite a lot of challenge from the Homeopathic community if published.

The statement was removed. What NHS Choices were eventually told to publish was a biased sop to homeopathy, including a list of the main homeopathy trade bodies and a list of medical conditions homeopathy could, apparently, treat.

Andy Lewis, on his excellent website, The Quackometer, asked that we contact our MP over this to demand NHS Choices be allowed to replace this biased page with one that properly reflects the scientific consensus on homeopathy so that the public can make properly informed choices in their health care.

Below is our email to our MP. We urge all those concerned about the public being given unbiased information to write to your own MP — please feel free to use whatever you feel useful.

We are concerned to read that the Department of Health has been interfering with the content of the NHS Choices website to the detriment of the public’s ability to make informed choices about health care.

It was reported in the Guardian on 13 February (Prince’s charity lobbied government to water down homeopathy criticism) and in the Daily Mail on 15 February (Homeopathy charity run by Charles ‘cowed civil servants’ into supporting the therapy) that the NHS Choices website editor had been prevented from stating the lack of scientific evidence for homeopathy for fear of lobbying from the ‘homeopathy community’. This debacle came to light after a Freedom of Information request by Professor David Colquhoun.

As a result of this interference, the page on homeopathy as it stands now is in danger of misleading the public into thinking that homeopathy may be able to treat potentially serious medical conditions such as asthma, ear infections, high blood pressure and depression when there is no scientific evidence to suggest this is the case.

In his response to the House of Commons Science and Technology Committee’s Evidence Check report on homeopathy (which recommended removal of all NHS funding for homeopathy because of the complete lack of scientific evidence), the Secretary of State for Health stated:

10. In order for the public to make informed choices, it is therefore vitally important that the scientific evidence base for homeopathy is clearly explained and available. He will therefore engage further with the Department of Health to ensure communication to the public is addressed. His position remains that the evidence of efficacy and the scientific basis of homeopathy is highly questionable.

He also stated:

14. The Government agrees that, when looking at the evidence base for efficacy, it is important to focus on the most scientifically robust studies and evidence.

It is therefore incomprehensible and deplorable that the Department of Health believes it now acceptable to tell the public that homeopathy can be used to treat the following:

  • asthma
  • depression
  • ear infections
  • hay fever
  • other mental health conditions, such as stress and anxiety
  • allergies, such as food allergies
  • dermatitis (an allergic skin condition)
  • arthritis
  • high blood pressure

For such a highly respected, informative and authoritative source of sound medical information such as NHS Choices to have been forced by the DoH into publishing such erroneous information on homeopathy is disgraceful and unacceptable.

This can only lead to the public being mislead and potentially making ill-advised and dangerous health care decisions.

As we are sure you are aware, the Chief Medical Officer, Professor Dame Sally Davies, has recently made clear that homeopathy is ‘rubbish’. The DoH needs to heed this advice and allow NHS Choices to completely re-write the page on sound scientific and evidence-based principles.

We also note that Anna Soubry recently stated to the House:

The Department [of Health] does not maintain a position on any particular complementary or alternative medicine treatments including homeopathy.

We therefore ask you to request that the Secretary of State for Health explain these actions and that he allow NHS Choices the freedom to ensure that the public can make the informed choice that are entitled to make based on sound scientific evidence and principles and not to have that distorted by vested interests.

We look forward to receiving your reply.

Thanks and best regards.

I’ll let you know what response we get.

The Scottish Chiropractic Association: Attempting to ‘manipulate’ the entire Scottish population?

Guest post by Blue Wode. Originally published on The Twenty First Floor on 14 March 2012.

Introduction

In recent times, the two main UK chiropractic associations, the British Chiropractic Association (BCA) and the McTimoney Chiropractic Association (MCA), have come under intense scrutiny. The BCA was brought to its knees by the misconceived libel case it brought against the science writer and broadcaster, Simon Singh, and, as a direct result of it, the MCA suffered the humiliation of having a confidential email to its members leaked online which revealed that it had urged all of them to take down their websites as they were a real threat to both them and their practices. By comparison, the Scottish Chiropractic Association (SCA) has enjoyed a relatively uncontroversial existence. Until now.

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A right Royal chiro cock-up

Jubilation in the chiropractic world! But, as usual, all is not what it might first seem…

Chiropractors granted Royal Charter:

The College of Chiropractors will soon be given the honour of being named the Royal College of Chiropractors. In doing so, Chiropractors become the first complementary health specialty to be awarded a Royal Charter. It is great news for Chiropractors and the development of the chiropractic profession in general.

Royal Charters have traditionally been awarded to specialty areas of Medicine such as the Royal College of Surgeons or Royal College of Dentists. It recognises the value of the College of Chiropractors unique position as a leader in the profession. (Source)

College of Chiropractors receives Royal Charter. Feels great to now be part of The Royal College of Chiropractors (Source)

The College of Chiropractors have been granted Royal Charter. Congratulations to the Royal College of Chiropractors! (Source)

The College of Chiropractors will soon be given the honour of being named the Royal College of Chiropractors. (Source)

One chiro was quick to update their website (or maybe he always thought it was a Royal College?) with this new imprimatur:

 I am registered with the General Chiropractic Council…and a member of the British Chiropractic Association (BCA) and the Royal College of Chiropractors. (Source)

The British Chiropractic Association (BCA) published a press release (cached) that probably started this all off:

College of Chiropractors granted Royal Charter

Dated: 12 November 2012

At a meeting of the Privy Council on Wednesday, the Queen approved the grant of a Royal Charter to the College of Chiropractors, the first Royal Charter to be granted to a complementary medicine organisation in the UK.

The College is an academic, professional membership body, established along the lines of the Medical Royal Colleges, which over the past 13 years has sought to ensure quality, safety and excellence are at the forefront of chiropractic practice in the public interest.

Chiropractic is regulated by statute and although chiropractors provide their services largely within the private sector, NHS funding for chiropractic treatment is now emerging region by region under the Department of Health’s new commissioning arrangements. Chiropractors specialise in the diagnosis and treatment of problems affecting the joints, muscles and nerves and are probably best known for treating low back pain, a condition which costs the equivalent of between 1% and 2% of the UK GDP and has a significant impact on people’s lives.

Rarely granted, a Royal Charter signals permanence and stability and, in the College of Chiropractors’ case, a clear indication to others of the leadership value and innovative approach the College brings to the development of the chiropractic profession. The Royal Charter essentially formalises the College’s position as a unique, apolitical, consultative body, recognising its role in promoting high practice standards and certifying quality and thus securing public confidence.

Tim Jay, President of the College, said, “The College of Chiropractors’ Royal Charter emphasises to the public and other health bodies that chiropractic is a healthcare profession with parity in the field of musculoskeletal health, providing a viable and recognised option for patients.”

All the usual spin, of course.

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Fog on the Tyne

The Freedom of Information Act 2000 (FOIA) is an important tool for everyone, not just skeptics. It gives the right to anyone to ask for any information held by public authorities who are obliged to supply that information unless it is covered by a limited number of exemptions.

The House of Commons Justice Committee said earlier this year:

The Freedom of Information Act has been a significant enhancement of our democracy.

Indeed it is, but it is under threat and a campaign was started earlier this year to protect it. The threats to it are concisely summarised in an e-petition to the Government (unfortunately now closed):

Leave FOI Alone (#saveFOI)

Responsible department: Ministry of Justice

The Freedom of Information Act 2000 (FOI) has exposed the scandal of MPs’ expenses, and many examples of waste and improper behaviour by public authorities, politicians and public officials. We call on the government not to allow it to be watered down, nor for there to be a charge for making requests for information.

The public authorities covered by the FOIA are listed in Schedule 1 to the Act and include the bodies you would expect and maybe a few you’ve never heard of.

But Trading Standards (TS) is one such public authority covered by the FOIA.

Each Local Authority in the country has a Trading Standards service and they are the guardians of an impressive list [Link disabled because of possible malware on that website] of regulations, orders and rules including the Consumer Protection from Unfair Trading Regulations 2008 and, of course, the Cancer Act 1939.

I have never requested any information under the FOIA about Trading Standards, but it’s easy to see that some information could be very useful in finding out, say, information on complaints and understanding how they work and deal with complaints.

A very useful tool for all Local Authority residents and others.

But maybe not in North Tyneside.

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The bitter sugar pill

In his Guardian article, Homeopaths offer to rebrand products as ‘confectionery’, Martin Robbins tells the story that, faced with being unable to sell their products as homeopathic medicines because they were unlicensed, a manufacturer offered to re-brand them as sweets. The irony of that won’t be lost on many, but what else has been going on?

…sceptics [are] posing as genuine members of the public…

Thanks to his FOIA request, we now know that the medicines regulator, the MHRA, told homeopathy manufacturers Helios and Ainsworths to discontinue the sale and supply of a number of their kits of homeopathic products because they contained homeopathic products that were not registered (under the HR scheme) or authorised (under the NR scheme) and because the names of the kits were not as had been registered with the MHRA.

McCarthy-style reporting, encouraged by the self-appointed detractors of homoeopathy…has protracted this decline [in the homeopathy industry]

These two issues are important: under the Medicines Regulations, individual homeopathic products have to be registered or authorised by the MHRA, and so do kits of these products, with the name of the kits agreed with the MHRA.

Helios and Ainsworths fell foul of the Medicines Regulations on both counts.

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That ‘neutral’ Swiss homeopathy report

What does the Swiss Government really think about homeopathy?

By Sven Rudloff and Zeno

Jump to Postscript

A lot has been made by homeopaths about the ‘neutral’ Swiss Government’s report and its unequivocal support of homeopathy. It’s been lauded by the luminaries of the homeopathic world as further proof — as if any was needed, of course — that homeopathic ‘medicines’ are superior in every way to those dangerous and expensive pharmaceutical drugs.

Arch proponent of homeopathy, Dana Ullman, proclaimed:

The Swiss government’s exceedingly positive report on homeopathic medicine

The Swiss government has a long and widely-respected history of neutrality, and therefore, reports from this government on controversial subjects need to be taken more seriously than other reports from countries that are more strongly influenced by present economic and political constituencies.

In late 2011, the Swiss government’s report on homeopathic medicine represents the most comprehensive evaluation of homeopathic medicine ever written by a government and was just published in book form in English (Bornhoft and Matthiessen, 2011). This breakthrough report affirmed that homeopathic treatment is both effective and cost-effective and that homeopathic treatment should be reimbursed by Switzerland’s national health insurance program.

The provisional reimbursement for these alternative treatments ended in 2005, but as a result of this new study, the Swiss government’s health insurance program once again began to reimburse for homeopathy and select alternative treatments. (Source, cached)

Ullman again:

this report from the Swiss government has confirmed the efficacy and cost-effectiveness of homeopathic treatment. (Source, cached)

The Society of Homeopaths:

Swiss scientists endorse homeopathy evidence

Report says homeopathic medicine is clinically effective

A comprehensive and authoritative research study by Swiss scientists has offered an unambiguous endorsement of the evidence base for homeopathy as a clinically effective system of medicine.

Their report, part of a Swiss government evaluation of complementary and alternative medicines, gives a massive boost to the growing body of research underpinning the therapeutic effects of homeopathic medicine. (Source, cached)

The Faculty of Homeopathy and the British Homeopathic Association:

Evidence for homeopathy builds

Long-awaited English translation of Swiss study endorses evidence for homeopathy

This important report addresses the evidence for the effectiveness of homeopathic therapy in everyday use (i.e. the real world), its safety and its cost-effectiveness.

The authors, Doctor Gudrun Bornhöft and Professor Peter Matthiessen, state: “There is sufficient evidence for the preclinical effectiveness and the clinical efficacy of homeopathy and for its safety and economy compared with conventional treatment.”

Following on from the initial publication of this report, a public referendum in Switzerland in 2009 supported the inclusion of homeopathy and other complementary and alternative medicines in the Swiss national health insurance, with 67% of the people voting in favour. Earlier this month, the Swiss government passed legislation to enact the referendum’s conclusion. (Source, cached and source, cached)

GP and homeopath Dr Andrew Sikorski:

In 2009 a Swiss national referendum voted in favour of complementary medicine being part of the public health service which is now covered by the obligatory public health insurance system. This decision was partly informed by the findings of the 2006 Health Technology Assessment report commissioned by the Swiss Government on the effectiveness, safety and cost-effectiveness of homeopathy in general practice. (Sourcecached)

Many other websites have echoed these sentiments, with many taking their lead from Ullman’s article and possibly placing far too much reliance on what he had to say, eg Swiss Government finds homeopathy effective and cost efficient (cached).

You’d think from all this that the ‘neutral’ Swiss Government had taken to homeopathy like the proverbial quacking duck to water.

Of course, to state in this context that the Swiss Government has a ‘widely-respected history of neutrality’ is to conflate political neutrality with scientific objectivity.

As usual, research of truly homeopathic proportions, misrepresentation and cherry picking are the order of the day.

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