An Example Of Homeopathic Charlatanry And A Quote-Mining 101

Date started: 26/3/13
Date Completed: 8/5/13
Date First Published: 8/5/13


OK - let’s not beat about the bush. I’ve already pointed out, on this blog, that homeopathy is not medicine – it’s medical fraud – it’s pseudo-medical superstition.

Homeopathy regularly gets mentioned by Rationalists as such:

‘The Honest Liar - Homeopathy: Money for Nothing’
http://youtu.be/E-FwdACE2ZY

This article will not be about whether homeopathy ‘works’. It doesn’t.


The reason for this mini-essay is that i have wandered across an example of homeopathic proselytisation; and as far as the depths of superstitionistic deception go, it’s a damn good example.

The propaganda herein is compiled by a ‘Dr.’ Nancy Malik - a homeopath – not a proper doctor (and not a medical doctor). They call themselves ‘doctor’ but a degree in homeopathy is really no more valuable than a degree in ‘Goldlilocks and the Three Bears’... which means, they’re not a doctor. Because i don’t know whether they’re married, i’ll just title them with “Ms”.
http://drnancymalik.wordpress.com/
Incidentally, i found her site when she commented on this article by ThinkWell – an organisation seeking to educate the public so that they can make medical decisions more effectively.
http://www.ithinkwell.org/homeopathy-the-truth/
They’re good people. If you have the time/expertise, they’re worthy of your support.

Their own article seems reticent. This one will not be.


Following through to Ms Malik’s site, this article was top (at the time of writing). As the 'review' is long, i shall comment on it as we read through. All writing from Ms Malik's article will be in grey. My apologies if you're struggling to read it - i wanted good contrast.

‘Meta Analysis and Systematic Reviews Meta Analyses, Cochrane Review, Randomised Controlled Trial’
http://drnancymalik.wordpress.com/article/meta-analysis-and-systematic-reviews/

1. 19 studies does not include studies on benefits of homeopathy for plants and animals
2. 19 studies does not include ‘positive but statistically non-significant’ studies.
3. Out of 19, 1 study is on in-vitro and 2 studies are on combination remedies.
4. 14 journals comprises of 7 integrative, 1 homeopathy and 6 CAM journals

Ahem - “does not include”? Leaving the egregious grammar aside -- why say what they don’t do?? Considering that they have set their web-site up specifically to propagandise in favour of shaken-water superstition, the semantics of points 1 and 2 seem mal-formed! Surely they want to say that they do include studies of benefits through homeopathy!?

This is not a good start!

And 14/19 studies come from quackery-based journals? Puh-lease! That’s Religion-grade integrity – “You must worship this deity, just like this. Why? Because i just wrote down in this book that you should. That’s why! <s>”. Referencing them is as pointless as referencing 'War Of The Worlds' or 'Captain Scarlet', for the existence of life on Mars!


Here are the referred-to studies, one by one:

1. British Medical Journal
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.

Best quality, yes; but if you actually read the paper (and i will nudge you toward the fact that it was published 22 years ago!!) you will find that they consider the general quality to be “of low methodological quality”.
Some whole quotes: (emphasis added for a reason that will come clear, later)

“Most trials seemed to be of very low quality, but there were many exceptions. The results showed a positive trend regardless of the quality of the trial or the variety of homoeopathy used... 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.”
We now know that there is a humongous amount of publication bias in the world of magic shaken water. We've learned a lot since 1991. “Further evaluation of homeopathy” has already been done.

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.

No – they found a slight positive result – that’s not the same as “effectively [relieving] the problem”. By the way, the description says “81 (77%) out of 105 RCT (1943-1990) shows...” but this report says many of the studies brought into the meta-analysis contained no control group, and sometimes the control was just more, but differently magic, homeopathy! Meta-analyses cannot erase the flaws in their component parts - they are just sums of other studies.

“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.”

“Based on this evidence” and “presented in this review” do not refer to the BMJ article linked, which would be a self-reference, and would support the homeopath’s claim that a BMJ article supported homeopathy. These quotes refer to a hypothetical study that had not been done, back in 1991. The authors were suggesting a future study that might, hypothetically, support homeopathy, because the evidence mentioned in this meta-analysis did not support it! Here is the full quote:

“The weight of the presented evidence will probably not be sufficient for most people to decide definitely one way or the other. The question arises, What further evidence would be needed? Investigations in animal or plant models may increase the belief of sceptical people before they have read the evidence from clinical trials, but if no positive results are found homoeopaths may claim that homoeopathy only works in humans. We did not assess the evidence from such investigations; Scofield concluded in 1984 in a comprehensive review article that "despite the great deal of experimental and clinical work there is only little evidence to suggest that homoeopathy is effective. This is because of bad design, execution, reporting or failure to repeat experimental work."'If more (well performed) controlled trials in humans are demanded, cooperation between sceptical investigators and homoeopaths is likely to make the trial results more convincing for many readers. The question is how many of such trials would be needed to draw definitive conclusions? The evidence presented in this review would probably be sufficient for establishing homoeo-pathy as a regular treatment for certain indications. There is no reason to believe that the influence of publication bias, data massage, bad methodology, and so on is much less in conventional medicine, and the financial interests for regular pharmaceutical companies are many times greater. Are the results of randomised double blind trials convincing only if there is a plausible mechanism of action?  Are review articles of the clinical evidence only convincing if there is a plausible mechanism of action? Or is this a special case because the mechanisms are unknown or implaus-ible?
In our opinion, additional evidence must consist of a few well performed controlled trials in humans with large numbers of participants under rigorous double blind conditions. The results of the trials published so far, and the large scale on which homoeopathy is brought into practice, makes such efforts legitimate.”

This is something that i have little patience with. As someone with a strong physical sciences background, i have learned that there are certain avenues of study that are complete wastes of time. Medicinists, however, have an embarrassing record of rejecting good Science (e.g. handwashing in hospitals!) so they have come to consider everything as potentially feasible! Just look at a site like phys.org and its sister-site medicalxpress - there's a whole load more bunk on the latter than there is on the former! Shaken water as medicine, though? I’m tempted to say that the authors should have been wiser, but then, if they had been, they would probably not have bothered to do this meta-analysis at all! Pseudo-science is often not worth researchers’ time.

Quoting, in present meta-analyses, studies of such little worth, from 22 years ago, is bordering on facetious!

Item 1 contradicts the claim of shaken water’s efficacy as a medicine.

2. Lancet
Are clinical effects of homeopathy placebo effects? (1997) FULL TEXT // 74 out of 89 RCT (1966-1995) showed homeopathy statistically significantly superior [2.45 times more effective and positive at 95% confidence interval (CI)] to placebo, 26 out of 89 studies were of high quality for which odds ratio reduces to 1.66, still significant.
The main conclusion was that the results “were not compatible with the hypothesis that the effects of homoeopathy are completely due to placebo.”

Right, so, considering Ms Malik’s tendency for quote-mining (If you skipped all that text, up ^ there, you’ll want to go back and see the naughty stuff for yourself) you’ll be expecting this to be a mis-quote too, right? Actually, it is a complete quote. But the very next line is:

“However, we found insufficient evidence from these studies that homeopathy is clearly efficacious for any single condition.”

Did you just facepalm? I think you should have done.

What this says, is that nothing (homeopathy) beats another nothing (placebo) but not by far enough to have the phrase ‘it works’ applied to it.

How come? Because statistical significance is not the same as study strength. A tiny study can accidentally give statistical significance, purely down to systematic error (researcher biases, patient biases, etc). And the bigger this bias, the more powerful the study that is necessary. Quacks won’t do these... surprise, surprise. Statistical significance is not enough!

{That really doesn’t scan well into Arnold/Black’s Bond theme...  never mind...}

Item 2 also contradicts the claim of shaken water as a medicine.

3. The Journal of Alternative and Complementary Medicine
Randomized controlled trials of individualized homeopathy: a state-of-the-art (1998) // out of 32 RCT, overall odd ratio for high quality 19 trials =1.62 (statistically significant) at 95% CI which reduces to 1.12 for 6 best quality trials at 95% CI.

OK – the title gives it away. If it were a reputable study, it would have been published in a reputable journal – not a grotty little pseudo-science rag! I’m not even bothering to read this one; it's not worth my time...

Item 3 should not be counted in favour or against the claim of shaken water as medicine.

4. European Journal of Clinical Pharmacology
Evidence of clinical efficacy of homeopathy (2000) // 11 (65%) out of 17 comparisons in 16 RCT (1967-1998) shows statistically significant results, p= 0.000036. For 16 double-blind RCT, p=0.000068. For 5 high quality double-blind RCT, p=0.082

Full title of the study: “Evidence of clinical efficacy of homeopathy. A meta-analysis of clinical trials. HMRAG. Homeopathic Medicines Research Advisory Group.”

Ah – yes – remember what i said about systematic error, introduced by researcher bias? I think we can expect the quacks to be slightly biased in favour of their quackery... don’t you?

For a great example of how willing pseudo-scientists are, to distort, corrupt, and outright lie, about their claim’s evidence base, read this article, by Steven Novella, about the ‘Swiss Report on Homeopathy’. Two reports – one by epidemiologists – one by homeopaths – both used the same evidence-base – and they came to completely different conclusions.
http://www.sciencebasedmedicine.org/index.php/the-swiss-report-on-homeopathy/

“Published and unpublished reports of controlled clinical trials....”

Unpublished? You mean unverifiable? Bad practice.

“Trials were selected using an unblinded process by two reviewers.”

Why select the studies in an unblinded way? You can’t corrupt them by reading them. Read as many as you can! This makes no sense, to me.

“The selection criteria were randomised, controlled trials in which the efficacy of homeopathic treatment was assessed relative to placebo in patients using clinical or surrogate endpoints. Prevention trials or those evaluating only biological effects were excluded.”

Again, we’re seeing shaken-water compared to nothing. This is bad practice, even for proper, chemical medicine (you know – the stuff that’s actually got stuff in it). We want to know whether it’s better than a currently available alternative – not nothing at all!

On the matter of deception (which, if we’re honest, is what they’re trying to do, here) it’s much easier to draw false positives from comparisons with nothing, than comparison with something that clearly works well!

Item 4 contradicts the claim of shaken water as a medicine.

5. Homeopathy
The 2005 meta-analysis of homeopathy: the importance of post-publication data (2008) FULL TEXT
This isn’t even a study into whether homeopathy works. What a waste of time.

Item 5 should not be counted in favour or against the claim of shaken water as medicine.


On to the next section:

META ANALYSIS ON SPECIFIC MEDICAL CONDITION
1. Journal of Clinical Gastroenterology
Homeopathy for post-operative ileus: meta analysis (1997) //6 trials, 776 patients, 4 out of 6 trials are of best quality

Where done?

“Department of Complementary Medicine, Postgraduate Medical School, University of Exeter, United Kingdom.”

And what did they do?

“We therefore performed meta-analyses of existing clinical trials to determine whether homeopathic treatment has any greater effect than placebo administration on the restoration of intestinal peristalsis in patients after abdominal or gynecologic surgery.”

Again, they’re comparing shaken water with nothing. And all to maximise their chances of getting a false positive.

“Studies of high methodological quality were more likely to be negative than the lower quality studies.”

Of course they were.

Item 6 contradicts the claim of shaken water as a medicine.

2. Forschende Komplementärmedizin und Klassische Naturheilkunde(German ) meaning Research in Complementary and Classical Natural Medicine
Homeopathic Galphimia glauca for hay fever: meta analysis (1997)

More ‘research’ by quacks. Refer again to the Swiss report. My German isn’t good enough to read the report directly, but i wouldn’t waste my time anyway.

Item 7 should not be counted in favour or against the claim of shaken water as medicine.

3. British Medical Journal
Homeopathy for allergic rhinitis: meta analysis (2000) FULL TEXT // 4 double-blind randomised placebo-controlled (DBRPCT), n=253, p=0.0007

Yet another comparison with nothing! I expect better from the BMJ. Plus, this study was funded by homeopaths, and the researchers clearly started with a pro-homeopathic prejudice:

“we conclude that this study has failed to confirm our original hypothesis that homoeopathy is a placebo”

This is a contorted way of concluding that it failed to support the claim of homeopathy working. But in the blurriness of the data, an unscrupulous person could claim that it shows... lack of not-workingness?? Hmm...

Item 8 contradicts the claim of shaken water as a medicine.

4. Paediatric Infectious Disease Journal
Homeopathy for diarrhea: meta-analysis (2003) ) FULL TEXT //A meta-analysis of three studies showing homeopathy reduced the duration of the disease by a quarter.

Again, a summation of three different studies, all comparing.. yes, you’ve guessed it... shaken water to nothing.

Item 9 should not be counted in favour or against the claim of shaken water as medicine.

5. Arzneimittel-Forschung(German) meaning ‘Medicines Research’
Treatment of vertigo with vertigoheel (2005)
“Two trials were observational studies and the other two were randomised double-blind controlled trials.”

Two down, two standing. What ya got, kid...

“The meta-analysis of all four trials showed equivalent reductions with VH and with control treatment: mean reduction of the number of daily episodes 4.0 for VH and 3.9 for control (standard error 0.11 for both groups); mean reduction of the duration (on a scale 0-4) for VH 1.1 and for the control 1.0 (standard error 0.03 for both groups); mean reduction of the intensity (on a scale 0-4) for VH 1.18 and for the control 1.8 (standard error 0.03 for both groups).”

Right, so the number of episodes drops the same amount for both, neither effect duration, and the control is better at mitigating intensity. But what are the controls? Not nothing! Yay.

One is betahistine – a drug used against vertigo in Ménière's disease – we don’t know whether those in the study had it, so we don’t know whether to expect anything of it.

The next is Gingko biloba extract, which is a quack product, and so obviously won’t work ;-)

The third is dimenhydrinate – a low-potency anti-nausea drug – we shouldn’t expect much of this, against vertigo, which is usually considered a far more extreme condition than simple nausea.

Ulitmately, this study shows little evidential strength, but it’s better than comparing shaken water with nothing. It breaks the monotony, at least.

Item 10 should not be counted in favour or against the claim of shaken water as medicine.

META ANALYSIS ON HIGH DILUTIONS

One thing about interventions that work, is that they show a dose reponse – the higher the dose, the more impact you see. Stub your toe harder, feel more pain. That's how reality works. This should be interesting...

1. Human and Experiment Toxicology
Meta-analysis of serial agitated dilutions in experimental toxicology (1994) // 80% homeopathic medicines shows efficacy

Um... no, it wasn’t. To be honest, i have no idea what this is doing in here. And i barely have any idea of what it’s about. Presumably, Malik didn’t either, and that’s why she’s left it undescribed. It doesn't seem to involve patients in any way.

Item 11 should not be counted in favour or against the claim of shaken water as medicine.

SYSTEMATIC REVIEWS
1.Rheumatic Diseases Clinics of North America
Homeopathy and Rheumatic Diseases (2000)

I can’t get past the paywall, so i have no idea what this one says. Open Access Science, please!

Item 12 should not be counted in favour or against the claim of shaken water as medicine.

2. British Homeopathic Journal
Homeopathic remedies for the treatment of osteoarthritis: a systematic review (2001) // Zeel superior to hyaluronic acid, combination of Rhus Tox, Causticum and Lac Vac superior to paracetamol

Hmm... quacks writing their own propaganda pieces again. Better than hyaluronic acid, you say? You mean it works better than something that doesn’t work either. Sounds familiar... oh, yeah – they’re comparing shaken water to nothing, again.

Item 13 should not be counted in favour or against the claim of shaken water as medicine.

3.Forschende Komplementarmedizin(German) meaning ‘Research in Complimentary Medicine’
Effectiveness, Safety and Cost-Effectiveness of Homeopathy in General Practice (2006) FULL TEXT

[coughs] More quacks writing their own reviews...

Item 14 should not be counted in favour or against the claim of shaken water as medicine.

4. Evidence based Complementary and Alternative Medicine
Immunolgy and Homeopathy-4 PART-1 (2006) FULL TEXT
Immunolgy and Homeopathy-4 PART-2 (2006) FULL TEXT

Contradiction in terms, in the title. Moving on.......

{...maybe wait a while to mock their misspelling of 'immunology'? Alright, we're done...}

Item 15 should not be counted in favour or against the claim of shaken water as medicine.

5. Complementary Therapies in Medicine
The in vitro evidence for an effect of high homeopathic potencies—A systematic review (2007) FULL TEXT // 73% of 67 in-vitro experiments (1/3 of them replicated) published in 75 publications showed specific effects with high dilutions including 68% of high quality experiments (SAPEH score>=6).Nearly 3/4 of them found a high potency effect. Nearly 3/4 of all replications were positive.

“In vitro” means “in a dish”. And what about in people? Pointless studies are pointless. Homeopathy is currently used on people – we are beyond in-vitro studies.

And where was it done? At the...

“Institute for Complementary Medicine (KIKOM), University of Bern, CH-Bern, Germany”

Yet another place, set up specifically for the purpose of producing propaganda. This is beginning to get tiring!

Item 16 should not be counted in favour or against the claim of shaken water as medicine.

6. Homeopathy
Placebo effect size in placebo-controlled clinical trials of individualised homeopathy are same as that of conventional trials(2010) FULL TEXT

Compared to placebo. Aaaaaaaargh!!! They’re comparing it to nothing, again! But wait...
They’ve really shot themselves in the foot, with this one.

SCAM proponents (Spurious, Complementary & Alternative Medicine) frequently claim that their products ‘work’ via the placebo effect. Example here.

If the placebo effect for homeopathy is the same as for real medicine, then what benefit is there from homeopathy? They just demonstrated it to be void. Remember: real medicine comes with a medicinal effect, plus placebo effect, on top.

Item 17 contradicts the claim of shaken water as medicine.


COCHRANE SYSTEMATIC REVIEW
Homeopathic medicines for adverse effects of cancer treatments (2010) FULL TEXT // 8 RCT with n=664
Homeopathic medicines for the prevention or treatment of adverse effects of chemotherapy, radiotherapy, and menopausal symptoms caused by hormonal therapies or oestrogen withdrawal.
Compared with trolamine, calendula reduced the incidence of acute dermatitis of grade two or above in women undergoing radiotherapy for breast cancer in one clinical trial involving 254 participants.

What they don’t tell you, is that trolamine’s side-effects include “blistering/peeling/redness/irritation at the application site, nausea/vomiting, ringing in the ears.” And now read that sentence again:

“Compared with trolamine, calendula reduced the incidence of acute dermatitis...”

Or maybe it just.... didn’t contribute to acute dermatitis??

“Two hundred and fifty four women with a diagnosis of non metastatic breast cancer who had been treated with either a lumpectomy or mastectomy, were randomised to receive either calendula ointment or trolamine (a topical agent which does not contain corticosteroids that had been used routinely for many years in their institution).”

Calendula is a species of flower, which is popularly used in naturopathic bullshit. Species of flowers are popular, per se, in quackery, but calendula's popular amongst them.

But let’s remember, here, that we’re talking about homeopathic calendula, which means there probably isn’t actually any in the ointment – it’s most-likely pure moisturiser – petroleum jelly, or something like that. I wouldn’t be surprised if that seemed to sooth dermatitis; especially when compared to a product that we know inflames skin conditions!

{Please note: some homeopathic preparations, due to sloppy medical standards, do pose a danger with contaminants and crushed glass, both of which can be fatal. This is a hazard faced by the 10-23 campaign in their public overdoses}

"Based on a single trial involving 32 participants, Traumeel S appears to show promise in the treatment of chemotherapy-induced stomatitis."

And what’s the very next sentence to this one, in the report?

“High quality trials to date provide no evidence for the efficacy of homeopathic medicines over placebo in women with breast cancer suffering from menopausal symptoms.
No serious adverse effects that could be attributed to homeopathic medicines or interactions with conventional treatment were reported in the included studies. No cancer treatments were modified or stopped because of the homeopathic interventions.”

Homeopathy, when tested properly, once again, has failed the test. And of course there aren’t any adverse reactions – there’s nothing in it!

Item 18 contradicts the claim of shaken water as medicine.



The wrap-up:


Right, so, what do we have, at the end of this “scientific*modern*evidencebased” meta-analysis of homeopathic ‘medicine’?


We have 11 meta-analyses that are benign, scientifically speaking – they do not help substantiate either way – they neither support the claim that homeopathy works, nor the claim that it doesn’t.

And we have 7 meta-analyses that substantiate in favour of the claim that it does not work, and thereby in contradiction of the claim that it does.


Unfortunately, for the people who believe in magic water/sugar/moisturiser, no-score draws do not score points in the world of Science i.e. the real world.

The evidence, even in her own review, shows that homeopathy does not work!


7 against; 11 neutral; 0 in favour



The efforts of a Rationalist, such as myself, are to consider ideas on their merits alone, and so we get practiced at extricating their veracity from the nature of the specific person that happens to be airing them at the time.

But all of this data, apparently, has been compiled by Ms Malik alone. What must Ms Malik be like, in character, to produce all of this? There’s a lot of work, here. I don’t know or care whether she likes cats, cheese, Queers, Humanists, or which IPL cricket team she favours, but all of this work presents us with evidence in favour of one character facet - she must be delusional.

She’s gone to all this effort, to present data that flatly contradicts her claims - that homeopathy can treat this, that, and the other. If she were malicious (and not just incompetent) surely she would bother to fabricate some data to agree with her. But she has not - she's left it all in disagreement, and lied about it.

My imagination's saying she’s probably the equivalent of that kindly-but-deluded old Anglican figure, who supports the teaching of Science, in the belief that it will encourage 'faith in Christ'.

It’s nice of her to do all this work – but it shows her to be wrong! And lying, in my book, is not a cause for praise.



I'm not being melodramatic when i say that medicine is a case of life or death - it really is.

People are affected by non-products – claims without content. They need stuff that works.

They are affected when research funding is wasted on avenues that cannot produce anything useful. That money could have been spent on researching something real. And with the same logical basis, the money of the patient could be spent on a product that is real, too.

The danger of this non-medical superstition – this pseudo-science – is that there is no real product.

There is a claim that 'this' will do 'this', but there is nothing there that will actually do it.


Homeopathy is one of the biggest fraudulent money-spinners that is treated as contentious by physicians. It should not be. We know that it does not work. Even the meta-analyses that homeopaths present, themselves, show that it does not work.


Selling something that does not work is fraud. There are too many gullible people who ‘set up shop’ before the claims behind their business are validated. This means they become emotionally embedded in that activity, which makes it much more difficult to be rational about its merits (or lack thereof). As an ex-Religious person, i know how hard it is to escape your own beliefs, when they're superstitious – bloody hard!

The only way to stop ourselves from getting into these positions is to wait for evidence – to be skeptical.

It's not just for the patients - the people who are already ill - who should be skeptical about the treatments they're offered. Everyone should be skeptical, including those who offer treatments to others. After all - would you want to live with the guilt of hurting people through your good intentions?



Stay skeptical, people. Stay skeptical.