Prof Ernst has covered the details of the Judicial Review brought by homeopathy user Honor Watt against NHS Lothian after their decision to withdraw funding for homeopathy referrals to the Glasgow Homeopathic Hospital: Homeopathy: another day in court + another defeat.
The judgement, published yesterday, names the three products she was prescribed and calls them ‘homeopathic medicines’: Agaricus and Rockrose for anxiety and Bovista for arthritis.
Ignoring the fact that many homeopaths would baulk at the notion of prescribing a homeopathic potion for a particular medical condition rather than treating her ‘holistically’, it’s interesting to look at these in a bit more detail.
Agaricus and Bovista (puffball) are both genuses of mushroom and Freemans list four different Agaricus products: Agaricus Bulb, Agaricus Emet, Agaricus Muscarius and Agaricus Stercorarius, and one Bovista product: Bovista (Lycoperdon Gigan). It could well be these that Watt was prescribed.
RockRose isn’t listed as a homeopathic product, but Rock Rose is one of the 38 Bach Flower products and Freemans do sell these — genuine Bach Centre products, apparently — so it could be this she was prescribed for her anxiety.
Homeopath Dr Edward Bach described Rock Rose thus:
The rescue remedy. The remedy of emergency for cases where there even appears no hope. In accident or sudden illness, or when the patient is very frightened or terrified or if the condition is serious enough to cause great fear to those around. If the patient is not conscious the lips may be moistened with the remedy.
Bach Flower products are not homeopathic, of course: they are very dilute herbal products, usually diluted to around 1 part in 100,000 using brandy and grape alcohol. And there is not a jot of good evidence to support any notion that it can do what Bach supposed it could.
But then, Bach Flower Remedies are foods, not medicines and have been that way since the medicines regulator, the MHRA, cancelled the Product Licences of Right (which they had held for the past 40-odd years) in January 2014. Because of this, they are now classified as foods and have to abide by the rules laid down by the EU Register of authorised health and nutrition claims. In the UK, advertising claims for food supplements fall within the remit of the Advertising Standards Authority. The rules do allow some health claims to be made, but only ones authorised as shown in the register. However, because Bach products are mostly alcohol, the rules rightly prohibit any health claims.
The Bach Centre sells Rock Rose in the usual 10 ml bottle for £5.99 to the general public. I wonder how much NHS Lothian were paying?
Only by the label
Of course, the two mushroom products are unlicensed medicines and as such, should not be advertised, sold or supplied to the general public, but we know that Freemans have sold other unlicensed medicines to the public, including homeopathic owl.
We also know that, once in their bottles, it’s a bit difficult to tell which is which. Giving evidence to the House of Lords Science and Technology Committee in 2007, Kate Chatfield. representing the Society of Homeopaths and a senior lecturer in homeopathy at the University of Central Lancashire was asked:
Lord Broers: I have a simple, technical question about homeopathy and drugs. Is it possible to distinguish between homeopathic drugs after they have been diluted? Is there any means of distinguishing one from the other?
Ms Chatfield: Only by the label.
Prof Ernst was also present, but Hansard doesn’t record whether he chuckled at that admission.
Too many Cooks?
John Cook of North West Friends of Homeopathy and director of the British Homeopathic Association (BHA) gets a mention in the judgement as having been specially invited by Lothian Health Board during their consultation and the judgement mentions that the Board’s submission says:
The real force behind the petition [to the Court of Session] was a charity, not the petitioner. [Honor Watt]
The Judge says no more about this — presumably because it was irrelevant to the case as presented — but the BHA is mentioned in relation to its position on the evidence for homeopathy.
We know the BHA — and John Cook in particular — are staunch defenders of homeopathy and they are one of only of several homeopathy charities, but it does seem a fair assumption that it was the BHA that was behind this — they are a charity, after all. Perhaps they were funding it as well. It could have been another homeopathy charity, Homeopathy: Medicine for the 21st Century [sic]. Who knows? If you do, please let me know.
I was checking the documents of the BHA that are filed at Companies House and noticed that two documents were filed on 20 August:
Termination of appointment of John Kenneth Halesworth Cook as a director on 15 April 2015
Termination of appointment of Francis Samuel Treuherz as a director on 3 August 2015
The BHA’s website still shows Treuherz (who also runs the website Homeopathy Helpline [sic]) as a trustee, but not Cook. Cook is shown as a Trustee in archive.org’s cache of that page on 16 March 2015.
Mr John K H Cook (retired 15 April 2015)
Interestingly, their area of operation as noted on the Charities Commission website is ‘Throughout England and Wales’. If it really was them behind the JR in Scotland, might the Charities Commission be interested (although given recent events it seems unlikely)?
It could be Cook was due to stand down (he was 68 in April) anyway… but is it a coincidence these documents were filed just seven days before the judgement was handed down?
Whatever has been going on, the fact remains that homeopathy on the NHS is becoming increasingly marginalised, adding to the other recent signs that homeopathy is in its death throes on the NHS:
And what better excuse is needed to again highlight this, showing the decline in the number of NHS homeopathy prescriptions fulfilled in community pharmacies in England: a drop of 94% in the past 17 years.
Last month, the following exchange took place in the House of Commons during Health Questions, supposedly about the Government’s revised adult Autism strategy:
David Tredinnick (Bosworth) (Con): Is my right hon. Friend aware that there is clear evidence that homeopathy is effective in treating autism, especially when doctors have not found a solution? Now that the Society of Homeopaths is regulated by the Professional Standards Authority, will he make more use of homeopathy in the health service generally, and in this particular instance?
Mr Speaker: The hon. Gentleman’s question is quite a long way from the statutory guidance, but it can be given a brief reply.
Norman Lamb: I have to say that I was not aware of the information provided by the hon. Gentleman. I should be happy for him to send me more information, but I make the general point that it is always important for us to base our decisions and expenditure on evidence.
We know Tredinnick is a True Believer in homeopathy and all thing quackish, but here is a definitive claim that “there is clear evidence that homeopathy is effective in treating autism”.
There is, of course, no good evidence homeopathy can effectively treat any condition whatsoever other than HWS (Heavy Wallet Syndrome), but it would certainly be interesting to see what evidence Tredinnick thought substantiated such a bold claim.
Since Normal Lamb (Minister of State for Care and Support at the Department of Health) asked Tredinnick to send him that information, I submitted a Freedom of Information Act request to the DoH to get hold of that ‘clear evidence’.
The information provided consisted of a letter from Tredinnick, an article from the magazine Homeopathy in practice from 2010 titled Saving a lost generation: Autism and homeopathy and a screenshot of the home page of the website CEASE Therapy, originally created by the late homeopath and MD Tinus Smits:
See also Lee Turnpenny’s take on this FOIA response: ‘MINISTER FOR QUACKERY’: TREDINNICK’S CONTINUING FOLLY
Tredinnick told Lamb:
As you will be aware, in the past 20 years there has been a dramatic rise in neurological and developmental disorders in children, particularly Autism Spectrum Disorder (ASD). Conventional medicine considers ASD incurable, and offers powerful pharmaceutical medication to deal with the most difficult behaviour, often with serious side effects.
However, there is ongoing work in this area by homeopaths in various places around the world including the Netherlands, United States and Australia, which suggests that homeopathy could be effective in tackling the possible underlying causes behind autism. I attach an article and information on this for your information.
Whilst the evidence on autism could be described as anecdotal, there were, up to the end of 2013, a total of 188 RCT papers in homeopathy (on 100 different medical conditions) which have been published in good quality scientific journals. 44% of the RCTs have a balance of positive evidence and only 5% are negative. The remainder were inconclusive which does not mean they are negative.
In light of the large number of conditions that conventional medicine finds difficult to treat, including autism, this is an area which does warrant further research.
Where to start with this…
Tredinnick regurgitates the same old zombie arguments and fallacious nonsense homeopaths and their supporters are wont to do.
But remember Tredinnick proclaimed in the House that “there is clear evidence that homeopathy is effective in treating autism”, so it’s surprising that he didn’t bother to provide any…
But at least he now says:
Whilst the evidence on autism could be described as anecdotal…
Is this his ‘clear evidence’? Is he now saying that anecdotal evidence is ‘clear evidence’ or has he realised that anecdotes are not ‘clear evidence’ and shifted his position? I doubt he has any clue.
The BHA’s current page has slightly different numbers, but let’s take Tredinnick’s outdated numbers to show how he misrepresents the balance of evidence.
He states that only 5% are negative and that 44% are positive. But what of the remaining 51%? Tredinnick tells us these are ‘inconclusive’ and implies that these should just be ignored.
But that’s not how it works.
Prof Edzard Ernst deals with this very problem in his blog post: The alchemists of alternative medicine – part 3: the ‘NON-CONCLUSIVE’ method:
A clinical trial is a research tool for testing hypotheses; strictly speaking, it tests the ‘null-hypothesis’: “the experimental treatment generates the same outcomes as the treatment of the control group”. If the trial shows no difference between the outcomes of the two groups, the null-hypothesis is confirmed. In this case, we commonly speak of a negative result. If the experimental treatment was better than the control treatment, the null-hypothesis is rejected, and we commonly speak of a positive result. In other words, clinical trials can only generate positive or negative results, because the null-hypothesis must either be confirmed or rejected – there are no grey tones between the black of a negative and the white of a positive study.
Homeopaths don’t like the way this turns out: it would mean that there were more negative trials than positive and that wouldn’t look too good in their advertising. It’s bad for business.
So, how could they spin this to make it look good for homeopathy?
Prof Ernst nails it:
One fairly obvious way of achieving this aim is to simply re-categorise the results. What, if we invented a new category? What, if we called some of the negative studies by a different name? What about NON-CONCLUSIVE?
How exactly do we do this? We continue to call positive studies POSITIVE; we then call studies where the experimental treatment generated worst results than the control treatment (usually a placebo) NEGATIVE; and finally we call those studies where the experimental treatment created outcomes which were not different from placebo NON-CONCLUSIVE.
Genius! (And it’s not often that can be said about homeopaths!)
The trick that Tredinnick uses makes it look as if the balance of evidence for homeopathy is overwhelmingly in its favour (44% to 5%), but the correct way to state his numbers is: 44% are positive and 56% are negative. Remember Tredinnick said “The remainder were inconclusive which does not mean they are negative”, but oh yes, it does mean they are negative — they do not refute the null hypotheses: they are therefore negative.
But even then it’s still not that simple.
All trials are equal, but some are more equal than others
There is no doubt that some of these 44% trials will be of a higher quality than others and what’s important is which of them are the better ones and what do the results of those show. Creating a trial that gives positive results for homeopathy is easy, but we should not be swayed by any trial without looking closely at how robust it is. If it is a trial that was not robust methodologically, we should view it with suspicion and treat its results with extreme caution. What we need to do — assuming what we’re trying to achieve is not to confirm preconceived beliefs but to genuinely look to see what the best, most robust, most independent, least biased evidence tell us — is to tentatively acknowledge those better results until such time as even better evidence comes along.
This isn’t the place to go through all the trials making up the 44%, but it’s useful to remind ourselves of the time when the Society of Homeopaths were investigated by the Advertising Standards Authority over claims they made. Their evidence was demolished by the ASA as not being up to the standard required to substantiate the claims they made. Although the ASA don’t identify the evidence the SoH provided, Cool Hard Logic on YouTube has had a very good go at identifying most of the papers. His demolition of them is a joy to watch.
But as Linde et al. noted after examining 89 placebo-controlled trials of homeopathy:
We conclude that in the study set investigated, there was clear evidence that studies with better methodological quality tended to yield less positive results.
Of course, looking at all the best evidence leads to just one conclusion:
It is concluded that the best clinical evidence for homeopathy available to date does not warrant positive recommendations for its use in clinical practice.
That’ll be a negative, then.
Why does Tredinnick believe otherwise?
The magazine article
Next up is the magazine article Tredinnick sent to Lamb. Perhaps it has that elusive evidence?
It’s not really worth demolishing all the tropes spewed out in it by homeopath Carol Boyce MCH CCH RSHom(NA), but the flavour of it can be got from just a couple of quotes:
Under the guise of ‘protecting’ children from the ‘scourge’ of childhood diseases, known to kill or maim just a handful of (already sick) children every year in the West, the push for enforced mass vaccination may be trading our children’s entire futures and with them the very future of society itself. (For more information on this see: http://www.ageofautism.com.)
The link to the notorious anti-vax site Age of Autism is very telling.
But, of course, homeopathy comes to the rescue:
Treating a case of ASD [Autism Spectrum Disorder] should be no different for the homeopath than any other case, although the options for success seem to be increased when the homeopath is familiar with the specific symptomatology of ASD, in order to identify the strange, rare, peculiar and characteristic symptoms of the case and not confuse them with those that belong to the diagnosis.
We can initially take the pressure off the system by removing the maintaining causes — gluten and casein — from the diet and supplementation to address the nutritional deficiencies that impact the ability to synthesise, catabolise and excrete.
Ultimately, though, the body must be able to complete these processes independently in order to sustain health in the absence of supplementation. Once these metabolic processes are reset and working efficiently, it stands to reason that external supplementation is no longer required and has the potential to overload the system, especially a system that has already had problems with excretion and subsequent toxicity.
There you have it in all it’s sciencey-sounding jargon finery, the simple solution to treating ASD.
If only someone would tell the doctors.
At least the article doesn’t fall into the usual referenciness trope and lists just:
Baron-Cohen S et al (2009) ‘Prevalence of autism-spectrum conditions: UK school-based population study.’ The British Journal of Psychiatry 194, 500-509 http://www.cdc.gov/vaccinesafety/Activities/vsd/priority_studies.html#3
Knapp M, Romeo R, Beecham J (2007) Economic Consequences of Autism in the UK. Foundation for People with Learning Disabilities
Boyce C (2007) ‘Magnus Pharma and the Golden Goose — The case of allopathy and the implications for homeopathy.’ Similia Vol 19 No 1 June 2007
Klein L (2010) http://www.narayana-verlag.com/spectrum-homeopathy/louis-klein-the-orchid-project?fromOverview=spectrum-homeopathy-012010
Scholren J (2009) http://www.interhomeopathy.org/lanthanides_in_pdd_nos
Shang A (2005) http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)67177-2/abstract
None of those, however, provide Tredinnick’s ‘clear evidence that homeopathy is effective in treating autism’.
Just stop it
And finally, CEASE Therapy.
Standing for Complete Elimination of Autistic Spectrum Expression, this has also been well covered elsewhere: here by Orac:
Apparently Tinus Smits was no different. I’ll give him credit, though. If you’re a homeopath and believe that autism is caused by vaccines, toxic medicine, other toxic substances and “some diseases,” what would you treat autistic children with? If you know the Law of Similars, you know the answer. The Law of Similars states that the way to treat a symptom is to use a diluted substance that causes the symptoms. So, if you’re a homeopath, it’s rather obvious. If you believe, against all science, against all reason, against all medicine that vaccines, “toxic medicine” and other “toxic substances” cause autism, then there’s only one thing to do, isn’t there. Yes, that’s right:
The treatment of autistic children and even adults has matured through 300 cases over the last three years and is called CEASE Therapy, which stands for Complete Elimination of Autistic Spectrum Expression. Step by step all causative factors (vaccines, regular medication, environmental toxic exposures, effects of illness, etc.) are detoxified with the homeopathically prepared, that is diluted and potentized substances that caused the autism. Currently we use the 30C, 200C, 1M and 10M potencies to clear out the energetic field of the patient from the imprint of toxic substances or diseases.
Yep. Unadulterated pseudo scientific nonsense.
CEASE Therapy is frequently advertised on the websites of homeopaths and the notion that vaccines are the cause of just about everything is well ingrained in the homeopathic psyche.
But still no ‘clear evidence’. Perhaps there isn’t any after all.
Coincidentally, Tredinnick is hosting an event at Westminster this evening that promises to be, erm, interesting. As announced on the website of the Confederation of Healing Organisations:
An email sent out by a PR company (whose website doesn’t even appear to work) gave more details:
The evening, co-hosted by David Tredinnick and the Parliamentary Group for Integrated Healthcare, will begin with Professor Chris A. Roe (University of Northampton) presenting the positive results arising from the most comprehensive meta-analysis to date into the scientific evidence for the efficacy of healing as a complementary therapy. Immediately following this there will be a unique opportunity to question several of the lead researchers about the research and also the results. There will then be a wider discussion with the researches [sic] and a variety of representatives within the healing community about the implications of these results and what this means for healing as a complementary therapy within and alongside the NHS.
Forget homeopathy. Move aside chiropractic. Ignore acupuncture. We appear to have good positive evidence for Healing!
The history of Healing stretches back for thousands of years. Nowadays most Healers view their work as a natural and purposeful energy based process which, from mostly anecdotal evidence, is believed to help relieve everyday stress, provide a sense of physical and emotional revitalisation and on some occasions bring about a deep sense of peace.
If you’re none the wiser, you’re not alone.
To conduct an analytical review of the published empirical studies on healing to date to determine whether it is tenable to claim that directed intention can have a measurable effect on another living system and to identify best practice to maximise effect sizes in future research (Confederation of Healing Organisations)
…so it looks like he’s presenting the results of this research.
It’ll be interesting to see what this meta-analysis is and how it stands up to scrutiny. Will it be ‘clear evidence’ as Tredinnick might think, or just ‘homeopathic’ levels of evidence?
If I get any information on it, I’ll let you know.
Oh my God — it’s full of stars!
Tredinnick certainly seems to believe in it. In the House of Commons in 2009, he declared:
In 2001 I raised in the House the influence of the moon, on the basis of the evidence then that at certain phases of the moon there are more accidents. Surgeons will not operate because blood clotting is not effective and the police have to put more people on the street.
It would be easy, you would have thought, to provide evidence for clear claims such as those.
Evidence, for David Tredinnick, is nebulous, variable and malleable to suit whatever hobby-horse he is currently promoting.
Professor Edzard Ernst recently announced his retirement as Director of the Complementary Medicine Research Group. What does this mean for him and for the future of critical research into the evidence for alternative therapies?
I interviewed Prof Ernst to find out.
Professor Edzard Ernst is critical of many sorts of complementary therapies. But his views of what works — and what doesn’t — are informed by critical examination of the evidence.
Many of his detractors would have us believe otherwise and see any critical examination of their pet therapy as a biased attack. Nothing could be further from the truth as anyone who understands the scientific process would understand.