Lancet article on Homeopathy

Myksyk

Anyone see the Times article on the recent article in The Lancet which concluded that Homeopathy is no better than placebo? I know Paul O'Donoghue was on Newstalk 106 this am discussing it but didn't hear that either.

Myksyk

Blast ... I heard that Edward (?) Ernst was on debating another person from the College of Homeopathy on Today FM yesterday ... missed that too!

ISAW

Myksyk wrote:

Blast ... I heard that Edward (?) Ernst was on debating another person from the College of Homeopathy on Today FM yesterday ... missed that too!

I note the ISS chair was also debating the Lancet artical with a homeopath lady (based in the UK I think) on Newstalk106 yesterday as well.

I called them to complain about her use of the term "95 percent confidence interval" It gave the impression that homeopathy works 95 per cent of the time. I pointed out that it really meant that one case in twenty could show positive results just by accident and that medical trials are much much more stringent. I believe they go usually about 1 in 10,000 which is 99.99 percent confidence. Is that correct?

I also complained they she was claiming that medicine has to somehow prove homeopathy works. It doesnt! It is the other way round. If she made the claim than she should provide the evidence it works. I havent seen any yet.

Zaph0d

Myksyk wrote:

Anyone see the Times article on the recent article in The Lancet which concluded that Homeopathy is no better than placebo?

What's wrong with placebo? The medical establishment acknowledges its existence by using double blind tests to eliminate its effects.

Placebo supplied by a complementary medical practitioner will often work better than an unsympathetic GP. Maybe doctors should learn to administer effective placebo rather than knocking their competitors with this comparison. Good therapists, whether conventional or alternative, treat the patient rather than the disease.

Nobody likes competition and no doctor likes to see his status lowered by finding he's less effective than a therapist dishing out water and kind words.

It's important to draw a line between the effectiveness of a medical treatment and the credibility of the hokey theories that back it up.

Myksyk

Zaph0d wrote:

What's wrong with placebo?

Nothing ... did someone say there was something wrong with it?

Zaph0d wrote:

The medical establishment acknowledges its existence by using double blind tests to eliminate its effects.

You are correct.

Zaph0d wrote:

Placebo supplied by a complementary medical practitioner will often work better than an unsympathetic GP.

Very interesting point and may indeed be true.

Zaph0d wrote:

Maybe doctors should learn to administer effective placebo rather than knocking their competitors with this comparison.

I agree in part tho some feel there are ethical considerations in the deliberate use of placebo as a treatment.

Zaph0d wrote:

It's important to draw a line between the effectiveness of a medical treatment and the credibility of the hokey theories that back it up.

Precisely. Good point. A treatment may 'work' insofar as it offers the effects of placebo and other genral factors but there is a danger that the ideas and theories which are put forward to explain the effects are also accepted.

It is also important to note that placebo effects are very limited, apply to some categories of illness and not others and reliance on it for significant outcomes in serious conditions is dangerous and unwarranted. It also leads to stagnation and lack of progress. At least, as you say, it is acknowledged in medicine ... it is piggybacked on in alternative medicine and its effects claimed as evidence of the validity of various CAM practices and their strange theories about the world, people and their health.

Zaph0d

Myksyk wrote:

Nothing ... did someone say there was something wrong with it?

My mistake; I thought when you quoted the Lancet saying that "Homeopathy is no better than placebo" that you meant to imply that placebo is worthless.

I agree in part tho some feel there are ethical considerations in the deliberate use of placebo as a treatment.

Yes, it would be wrong to deliberately deceive patients. I see a bigger ethical problem with the many doctors I know who make use of alternative therapists for their own ailments yet would never refer a patient to an alternative therapist.

there is a danger that the ideas and theories which are put forward to explain the effects are also accepted

Maybe it's more dangerous if people abandon effective medical treatments discovered over the centuries, merely because western doctors don't know why these treatments work. Many third world medical treatments are suited to the particular local ailments and are affordable because they grow in the region and don't require expensive equipment to administer. It's awful to live in a 3rd world country and see the western educated government attempt to dismiss local medicine as embarrassing witch doctery and replace it with impossibly expensive conventional treatments designed to cure people who've eaten too many hamburgers. The local doctors trained up in Western medicine leave for the US at the first opportunity. Meanwhile companies like Merck send researchers to look for drug ideas in the local remedies.

An alternative medical treatment may be effective beyond the placebo effect without us having any decent theory for why it works. This has no impact on the validity of the treatment. If it works, it works. We may never know why.

Because I'm a skeptic, I would doubt any theory I heard on what makes a treatment effective, whether part of the western medical canon or not.

pH

It's awful to live in a 3rd world country and see the western educated government attempt to dismiss local medicine as embarrassing witch doctery and replace it with impossibly expensive conventional treatments designed to cure people who've eaten too many hamburgers.

Have you any evidence that any doctors are trying to treat people in 3rd world countries with drugs like Xenical?

Have you any idea how much difference some simple innoculations can make to the infant mortatilty rate?

There are no 'Alternative' cures for the real killers like TB, malaria, dysentry, measles and now sadly HIV/AIDS or are you saying there are?

davros

Zaph0d wrote:

Maybe it's more dangerous if people abandon effective medical treatments discovered over the centuries, merely because western doctors don't know why these treatments work.

I've heard this accusation leveled at modern medicine before: "you can't explain how it works, therefore you dismiss it."

It's quite unfair. What modern medicine cares most about is that it works. The how-it-works can come later, if at all.

Drug discovery methods have been remarkably reliant on trial-and-error until very recently. Tens of thousands of compounds are screened in parallel to determine which is most effective against a particular disease. The most promising prospects are the basis for the next round of molecular variations and so on. Eventually there will be animal testing, human testing and clinical trials. At all points, the emphasis is on safety and efficacy. Sure, it's helpful to know how the drug produces its effect but this is not required for approval.

Drug companies love nothing better than to get hints from folk medicine as to where to begin their search for molecules. If it works, it'll be used. If it doesn't, it'll be discarded.

Most of alternative medicine is properly dismissed because it does not work, not because its mechanism is unknown.

Zaph0d

pH wrote:

Have you any evidence that any doctors are trying to treat people in 3rd world countries with drugs like Xenical?

I was thinking of the Philippines opening heart disease and lung cancer hospitals in Manila. A reasonable thing to do in the west but not cost effective in the third world. Western medicine and drug therapy has evolved to meet the needs of the most common ailments associated with obesity, old age and our sedentary lifestyles. These treatments and the diagnostic techniques used to recommend them are often not affordable to the average third world peasant.

By contrast, third world health problems are commonly related to malnutrition, poor education and poor sanitation. A third world health infrastructure is often ill-equipped to safely manage the administration of western medicines.

Have you any idea how much difference some simple innoculations can make to the infant mortatilty rate?

I think the implication of this question is that you understood me to be recommending CAM over western mediciine in all cases in the third world. In fact, I said that I would not recommend western medicine over CAM in all cases in the third world. I'm sure your misunderstanding was not intentional

There are no 'Alternative' cures for the real killers like TB, malaria, dysentry, measles and now sadly HIV/AIDS or are you saying there are?

This question again assumes that I recommend CAM over western medicine in all cases in the third world.

davros wrote:

Most of alternative medicine is properly dismissed because it does not work, not because its mechanism is unknown.

I don't believe this. I think most conventional doctors would reject most alternative medical treatments in public without any knowledge of efficacy. Supporting any type of alternative medicine would entail risking his reputation amongst his peers who may be displeased to see their income stream threatened.

Let's see what we do agree on (Correct me if you disagree with anything):

• The placebo effect can be beneficial to a patient's health in certain circumstances.
• Whether CAM or conventional, a medical treatment can be effective without our knowledge of how it works.
• it is likely that there are traditional herbal cures that are effective that western medicine is not yet aware of.

My GP told me that he had no cure for three quarters of patients at his clinic. They had illnesses that should clear up on their own, given some rest and healthy living. To me this looks like a huge and legitimate market for CAM.

davros

Zaph0d wrote:

I think most conventional doctors would reject most alternative medical treatments in public without any knowledge of efficacy.

Well, as the beginning of this thread shows, doctors do come across evaluations of CAM in their medical journals. The overwhelming lack of evidence published in authoritative sources must surely contribute to their opinions on the efficacy of CAM.

Supporting any type of alternative medicine would entail risking his reputation amongst his peers who may be displeased to see their income stream threatened.

Is that really the case though? It hasn't stopped some doctors augmenting their income streams by embracing CAM. It hasn't prevented pharmacists flogging iridology exams and homeopathic preparations. The market speaks louder than professional reputation, perhaps.

Let's see what we do agree on (Correct me if you disagree with anything)

I don't disagree but I wouldn't like to draw a conclusion about, say, herbal medicine and apply to it CAM in general.

My GP told me that he had no cure for three quarters of patients at his clinic. They had illnesses that should clear up on their own, given some rest and healthy living. To me this looks like a huge and legitimate market for CAM.

If CAM here means a "lifestyle coach" that will guide improvements in nutrition, exercise and sleep patterns, say, then sure. If CAM means an iridologist taking money from patients on the basis of false claims then, no, I don't believe that's legitimate.

pH

Let's see what we do agree on (Correct me if you disagree with anything):
<SNIP>
* it is likely that there are traditional herbal cures that are effective that western medicine is not yet aware of.

This is not likely. Most traditional herbal cures have long since been looked at, and where useful (Willow bark, ephedra etc) they have been tested and continue to be used (mainly artificially created versions).

Much of what's left is the 'Like cures Like' reasoning, and it is unlikely that powdered rhino horn really has any effect on impotence, or just because a plant's leaves are shaped like a liver that it actually is a liver tonic.

When it was reasonable to believe in a God created earth, it was also reasonable to believe that God had left 'markers' on plants to indicate their medicinal uses. Evolution however is very unlikely to leave these markers.

That is not to say that some plants out there have yet undiscovered properties that may be beneficial from a medical standpoint.

Zaph0d

pH wrote:

This is not likely. Most traditional herbal cures have long since been looked at, and where useful (Willow bark, ephedra etc) they have been tested and continue to be used (mainly artificially created versions).

Are you saying that most of the herbal cures including, for example, the thousands used by traditional Chinese medicine alone, have been clinically tested and proven to be ineffective?

Much of what's left is the 'Like cures Like' reasoning, and it is unlikely that powdered rhino horn really has any effect on impotence, or just because a plant's leaves are shaped like a liver that it actually is a liver tonic.

When it was reasonable to believe in a God created earth, it was also reasonable to believe that God had left 'markers' on plants to indicate their medicinal uses. Evolution however is very unlikely to leave these markers.

This is a criticism of the theories behind these medicines rather than their effectiveness.

That is not to say that some plants out there have yet undiscovered properties that may be beneficial from a medical standpoint.

Given that there are 400,000 plus species of flowering plants and many compounds in each, I would expect that there are many treatments left to discover.

pH

Zaph0d wrote:

Are you saying that most of the herbal cures including, for example, the thousands used by traditional Chinese medicine alone, have been clinically tested and proven to be ineffective?

No I'm not. The question here is of likelihood which you yourself asked. If any 'cures' were having real effects then the results can be seen at a statistical level and the components examined. As I said this has happened with a number of effective natural treatments.

This is a criticism of the theories behind these medicines rather than their effectiveness.

No, again it's an assessment of how likely they are to have any effect above the placebo. If throughout history people discovered that a certain root cures X, then at least it is likely that it is worth testing. If the link between the plant and organ affected is based on it looking similar, then in my opinion it is less likely that if subjected to a clinical trial that it will be successful.

Zaph0d

pH wrote:

If any 'cures' were having real effects

How would you judge that the 'cures' were having real effects? Presumably the practitioners and patients over thousands of years believe they are effective.

then the results can be seen at a statistical level and the components examined.

Do you mean by this a double-blind or similar test?

If throughout history people discovered that a certain root cures X, then at least it is likely that it is worth testing.

I agree with this.

If the link between the plant and organ affected is based on it looking similar, then in my opinion it is less likely that if subjected to a clinical trial that it will be successful.

Maybe so. Of course the 'magical' explanantion may have been thought up after its use had become common. Having a story helps to sell an idea.

pH

How would you judge that the 'cures' were having real effects? Presumably the practitioners and patients over thousands of years believe they are effective.

Your position seems to be that unless the 'cure' had been through a full clinical trial then it cannot be discounted. May I remind you once again, your original question was about likelihood or probability that 'known' herbal or natural medicines, not recognised by western medicine were actually having a genuine curative effect on patients.

For example, let's imagine that a certain people have a natural cure for AIDS, say drinking bat's blood. And let's assume the 'cure' use is widespread throughout the culture. If you can look at AIDS survival at a statistical level across the population versus known untreated survival rates and there is no statistically significant difference, then in all probability the cure is not effective.

It is common in western medicine to double-blind test new treatments, but this is not necessary where the practice is already in the field so to speak; you can just gather data looking for anomolies. Once you find data that is statistically significant, then you need to discount placebo and observer bias in a properly controlled study. However if the data is not significant in the first place (including placebo and observer bias effects) then there is no need to conduct a clinical trial.

Given current knowledge of the general health of the chinese population, it is unlikely that any of the widespread TCM 'cures' are having a genuine curative effect.

robindch

> Given current knowledge of the general health of the chinese
> population, it is unlikely that any of the widespread TCM 'cures'
> are having a genuine curative effect.

There's an interesting and worthwhile report from the good guys over in CSICOP on the beliefs of chinese doctors concerning the efficacy of traditional chinese medicine (first part here, second part here) which rings true, having seen a few weeks back what was on offer in the Beijing Union Medical College Hospital, one of the better western-style hospitals in the city. In addition to some efficiently-operated modern kit, and competent doctors who spoke excellent English, we were recommended to take several TCM potions and lotions about which the doctors wouldn't say much more than 'they're good for you' with a lot of busy hand-waving. Didn't take them and all was fine, thankfully.

Another interesting, and more general, article on the psychology of CAM lives at:

http://www.theness.com/articles.asp?id=8

Zaph0d

I'll have a read through robindch's references and reply to pH when I get a chance.

robindch

Looks like Charles isn't going to take the Lancet report lying down. An "independent" report, which he commissioned, is apparently going to say that "patients with conditions such as back pain and stress can benefit from some of the therapies" and that "osteopathy, chiropracty and acupuncture could have a larger role in NHS care". While the report itself has yet to appear, the BBC summary lives at:

http://news.bbc.co.uk/1/hi/health/4312780.stm

Oh yes, and the report was written by an economist, not a doctor.

Zaph0d

pH wrote:

Your position seems to be that unless the 'cure' had been through a full clinical trial then it cannot be discounted.

This is not my 'position'. I am trying to learn something here rather than defend a conviction.

pH wrote:

If any 'cures' were having real effects then the results can be seen at a statistical level

I don't know much about medical testing so I was asking what statistical tests there are other than double blind etc. Double blinds are expensive and I guess that most TCM herbs have not been tested in this manner.

For example, let's imagine that a certain people have a natural cure for AIDS, say drinking bat's blood. And let's assume the 'cure' use is widespread throughout the culture. If you can look at AIDS survival at a statistical level across the population versus known untreated survival rates and there is no statistically significant difference, then in all probability the cure is not effective.

OK. In this example, you have a terminal illness, so a statistical analysis is possible based on mortality rates. But what about the range of non-fatal illnesses; how would you statistically analyse that a certain population group was suffering less pain or recovering more quickly from certain diseases? You'd need medical data from countries where peoples' births and deaths aren't always deemed worthy of being recorded.

Now what you've said is that it is unlikely that there are any traditional herbal cures that are effective that western medicine is not yet aware of. In the absence of the testing of these cures I don't understand how you have come to this conclusion.

robindch wrote:

Oh yes, and the report was written by an economist, not a doctor.

What is the objective of a health system? Is it to provide the best healthcare for the population given a certain budget? This is triage restated: do the most with what you've got. Getting an economist involved looks like a good idea to me.

We only understand a little of how humans and other natural life forms function, so I can't see how one can have strong convictions on the mechanism of interactions of hundreds of thousands of plants with human health. A person isn't as simple as a PC or a bicycle.

The article in the Lancet (has anyone read this or got a copy?) summarises past reserach on homeopathy and concludes that it is no more effective than placebo. Now this paper is a meta-study of other published papers, some in favour and some against the efficacy of homeopathy. These papers were published in journals like the BMJ and The Lancet itself. So we have a bunch of contradictory studies, all deemed worthy of publication after peer review in these reputable journals. Now we have a metastudy where the pro-homeopathy articles are denounced to be bad science. Maybe they should call them counter-revolutionary.

I think homeopathy is probably BS but I don't see any conclusive proof yet. One of my favourite arguments is that at least it has no side effects (har har).

I do not believe that western medicine is more cost effective in all cases than complementary/alternative medicine. Do you?

SkepticOne

Zaph0d wrote:

I think homeopathy is probably BS but I don't see any conclusive proof yet. One of my favourite arguments is that at least it has no side effects (har har).

But you earlier said that you don't know much about medical testing. Such proof might well take the form of test results which you may not be in a position to evaluate.

Perhaps it would be an idea to read up on how medical testing is done.

Zaph0d

SkepticOne wrote:

But you earlier said that you don't know much about medical testing. Such proof might well take the form of test results which you may not be in a position to evaluate.

true

Perhaps it would be an idea to read up on how medical testing is done.

I agree.

pH

Zaph0d wrote:

The article in the Lancet (has anyone read this or got a copy?)

The LANCET (Volume 366, Issue 9487) wrote:

EDITIORIAL - THE END OF HOMEOPATHY
That homoeopathy fares poorly when compared with allopathy in Aijing Shang and colleagues' systematic evaluation is unsurprising. Of greater interest is the fact that this debate continues, despite 150 years of unfavourable findings. The more dilute the evidence for homoeopathy becomes, the greater seems its popularity.

For too long, a politically correct laissez-faire attitude has existed towards homoeopathy, but there are now signs of enlightenment from unlikely sources. The UK Parliamentary Select Committee on Science and Technology issued a report about complementary and alternative medicine in 2000. It recommended “any therapy that makes specific claims for being able to treat specific conditions should have evidence of being able to do this above and beyond the placebo effect”. Going one step further, the Swiss Government, after a 5-year trial, has now withdrawn insurance coverage for homoeopathy and four other complementary treatments because they did not meet efficacy and cost-effectiveness criteria.

In a Comment, Jan Vandenbroucke gives a philosophical interpretation of Shang's study. One other philosopher he might have included is Kant, who reminds us that we see things not as they are, but as we are. This observation is also true of health-care consumers, who may see homoeopathy as a holistic alternative to a disease-focused, technology-driven medical model. It is the attitudes of patients and providers that engender alternative-therapy seeking behaviours which create a greater threat to conventional care—and patients' welfare—than do spurious arguments of putative benefits from absurd dilutions.

Surely the time has passed for selective analyses, biased reports, or further investment in research to perpetuate the homoeopathy versus allopathy debate. Now doctors need to be bold and honest with their patients about homoeopathy's lack of benefit, and with themselves about the failings of modern medicine to address patients' needs for personalised care.

Homeopathy related articles in this issue:

Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy
Pages 726-732
Aijing Shang, Karin Huwiler-Müntener, Linda Nartey, Peter Jüni, Stephan Dörig, Jonathan AC Sterne, Daniel Pewsner and Matthias Egger

Homoeopathy and “the growth of truth” • DISCUSSION
Pages 691-692
Jan P Vandenbroucke

Critics slam draft WHO report on homoeopathy • NEWS
Pages 705-706
Michael McCarthy

If a mod says it's ok to post the articles here I will, otherwise PM me for a PDF of the article you're interested in.

davros

pH wrote:

If a mod says it's ok to post the articles here I will...

Best not to. I see these articles are being sold individually online for $30 here.

I'm impressed by the Swiss. Here, Bupa and Vivas both cover homeopathy. VHI does not, as far as I can tell, though it does cover other alternative practices.

The medical card does not seem to cover homeopathy. I wonder is that by accident or design.

pH

I'm pulling up this old chestnut because it's the latest thread on Homeopathy.

http://education.guardian.co.uk/higher/news/story/0,9830,1670033,00.html

Highlights :

• Britain's first professor of complementary medicine, Edzard Ernst of Exeter University, has denounced homeopathy as ineffective.
• He's losing his funding (and his job)
• Britain has five homeopathic hospitals, which are funded by the NHS.

davros

Oh, that is sweet

Peanut

"Ernst's department was created in 1993 when Exeter was given £1.5 million by construction magnate Maurice Laing. When accepting these funds, Ernst said the university promised to raise the same amount again. 'They never did,' he added."

His department runs out of funding that was originally from a private organisation, dear oh dear, so he has to reference suspect trials to support his moaning, presumably in a desperate strike at the unfairness of it all :rolleyes: