Can Homeopathy Be Both a Useless Placebo and Dangerous at the Same Time? 4/30/13 via ANH

[*GG*]

Let’s look at the science.

Earlier this month we told you about an attack on homeopathic medicines in California courts, one that could threaten the industry.

We also told you about a recent report published in the International Journal of Clinical Practice.
That report claimed to do a systematic review of all adverse event reports (AERs) in connection with homeopathy from 1978 to 2010. On the one hand, the report concluded that homeopathy is ineffective because it has no active ingredients, that it is nothing more than a placebo because it has been diluted so much that “the likelihood of a single molecule approaches zero.” On the other hand, the report also concluded that homeopathic preparations caused many dangerous allergic reactions.

We pointed out that you can’t have it both ways—either homeopathic preparations are powerful enough to cause a physiological reaction, or they can’t do anything at all. This is all too typical of what passes for scientific review of homeopathy. Dismiss it any way you can, regardless of fact or logic. If that doesn’t work, then argue that homeopathy is dangerous because it may keep people from visiting a conventional doctor.

We promised to return to the subject of what real evidence there is behind homeopathy. That is a large subject, but here are some scientific studies from the past ten years showing that homeopathy can indeed be effective—far more effective than placebo. These studies, which range from random controlled trials (RCTs, the supposed “gold standard”) to observational studies to meta-analyses, often look at homeopathy as an adjunct to conventional medicine.

Here is just a sampling:
· Acute otitis media (when the middle ear gets blocked with fluid and infected with bacteria): a 2012 RCT showed that symptomatic improvement was quicker in the homeopathy group than conventional therapy group, with a much lower antibiotic requirement
· Allergies: a 2012 observational study revealed that homeopathy substantially improved allergy symptoms and conventional medicine dosage could be substantially reduced; a 2013 study listed the effectiveness of different homeopathic treatments for allergies based on the type of allergy
· Asthma: In a study of individualized homeopathic treatment for asthma, there was evidence that it decreased the severity of asthma in children
Other studies show effectiveness of homeopathy for conditions ranging from chicken pox,diarrhea, and in a multi-center observational study, chronic sinusitis. Homeopathy could be an effective treatment for low-grade chronic inflammation, which is the root of many diseases, and as a complement to conventional anti-tubercular treatment (a finding that is especially important as patients are becoming resistant to TB drugs).

Much more research is ongoing despite the abysmal lack of funding for it. At the very least there is promising evidence supporting homeopathy.

So if it works, how does it work?

A homeopathic remedy is an extremely pure, natural substance that has been diluted many times. In large quantities these substances would cause the same symptoms the patient is trying to cure. In tiny, diluted doses, it is not only safe and free from side effects, but it will trigger the body to heal itself. For example, when you chop a red onion, it causes watery eyes and a runny nose in most people. Allium cepa is a remedy created from red onion; in very small doses,Allium cepa doesn’t create those symptoms but instead activates the body’s own mechanism for stopping watery eyes and a runny nose.

As noted in “Immunology and Homeopathy,” an article published in the journal Evidence-Based Complementary and Alternative Medicine, “The profound analogies between homeopathic thought and immunology are due to the fact that the whole of homeopathic theory is substantially based on the principle of regulating endogenous systems of healing, the best known of which is certainly the immune system and its neuroendocrine integrations.”

http://www.anh-usa.org/can-homeopathy-be-both-a-useless-placebo-and-dangerous-at-the-same-time/

 

[Esther12]

I think that homeopathy is useful as a way of helping us understand how a treatment without any real value can still gain positive results through certain types of research. I think that anyone with an interest in looking cautiously at the claims made for the value of psychosocial interventions for CFS (or anything else) would benefit from understanding how it is that homeopathy can lead to signs of improvements in health in some studies.

 

[natasa778]

I think that homeopathy is useful as a way of helping us understand how a treatment without any real value can still gain positive results .

Really!? I am amazed by repeated insistence by some that homeopathy does NOT work, when we simply don't have the technological means at the moment to prove one way or the other ... I consider myself a true sceptic in this matter, which is full of religious believers on both sides Fantastic exchange in BMJ recently on this btw, illuminating nicely the forces behind the irrational blind insistence on homeopathy having no value, before being able to check

 

[Esther12]

Really!? I am amazed by repeated insistence by some that homeopathy does NOT work, when we simply don't have the technological means at the moment to prove one way or the other ... I consider myself a true sceptic in this matter, which is full of religious believers on both sides Fantastic exchange in BMJ recently on this btw, illuminating nicely the forces behind the irrational blind insistence on homeopathy having no value, before being able to check

Aren't we getting into respecting the potential of 'fairy-dust' at that point? There are lots of things which we cannot prove are not helpful.

There are people who are ideologically and simplistically anti-homeopathy, and dismissive of those who turn to homeopathy, without realising how tenuous the evidence in favour of more 'mainstream' interventions is (I think that homeopathy can be preferable to mainstream alternatives, just because sugar-pills are less likely to be harmful than certain alternatives). But the history of homeopathy's development, the nature of the treatments, the proposed mechanism of efficacy... all these things point to homeopathy being pure placebo.

The only reason I read research about homeopathy is because I'm interested in how treatments without true medical value can be shown to be effective in certain types of trials, and here I think that the nature of homeopathy does make it a useful control for us. To have a treatment like homeopathy, which some therapist's genuinely believe to be truly effective, seems to me to be a great tool for controlling for certain biases which can afflict research into more respectable treatments.

With CFS, I can see how going to homeopathy could be good, just because it can involve (if the therapist is genuine) spending time with a therapist who is not trying to manipulate, manage or dismiss you, but is treating you as an equal and trying to help. I don't think that there's any realistic chance of there being more to it than that though.

 

[user9876]

The only reason I read research about homeopathy is because I'm interested in how treatments without true medical value can be shown to be effective in certain types of trials, and here I think that the nature of homeopathy does make it a useful control for us. To have a treatment like homeopathy, which some therapist's genuinely believe to be truly effective, seems to me to be a great tool for controlling for certain biases which can afflict research into more respectable treatments.

.

I've not read any homepathic trials but I was wondering when you have read how do they measure outcomes. Do they just use subjective outcomes or do they use any objective measures. I was wondering as well as looking at them as a control do they form a useful way of us understanding the measurement systems used behind a trial and the types of errors we believe are occuring in ME trials.

 

[Esther12]

I've not read any homepathic trials but I was wondering when you have read how do they measure outcomes. Do they just use subjective outcomes or do they use any objective measures. I was wondering as well as looking at them as a control do they form a useful way of us understanding the measurement systems used behind a trial and the types of errors we believe are occuring in ME trials.

I don't want to pretend that I've read more than I have - probably only ten or so studies over three years. The positive ones tend to use subjective measures and not be blinded or have a poor control. I'm sure I've read studies showing objective improvements too, but presumably without a control (or it could just be that 1 in 20 studies ends up with a significant but minor improvement).

I was looking for one on CFS that could be compared to PACE, but didn't find anything directly comparable, or using equivalent outcome measures. There was one CFS study that was actually quite well done - double blind, etc. I think it showed a minor but not statistically significant improvement for homeopathy.

 

[natasa778]

But the history of homeopathy's development, the nature of the
treatments, the proposed mechanism of efficacy... all these things point to homeopathy being pure placebo.

I wouldn't be so sure ... but my understanding of those things is of course my subjective opinion ... and I am of the opinion that we do not have the means to measure or prove or DISprove the proposed mechanisms. Going in circles aren't we


some interesting, and amusing, stuff here, but I guess it all depends on one's subjective opinions on where today's science is in respect of sussing out the'history of homeopathy's development, the nature of the treatments, the proposed mechanism of efficacy'

http://www.bmj.com/content/345/bmj.e6184?tab=responses

The only reason I read research about homeopathy is because I'm interested in how treatments without true medical value can be shown to be effective in certain types of trials

Still amazed ... and amused ....

 

[Esther12]

I wouldn't be so sure ... but my understanding of those things is of course my subjective opinion ... and I am of the opinion that we do not have the means to measure or prove or DISprove the proposed mechanisms. Going in circles aren't we

Possibly. I completely accept that it's impossible to prove... well, almost anything.

One way in which I am 'sympathetic' to homeopathy is that it has attracted research by 'sceptics', in a way that a lot of more 'mainstream' interventions do not. I suspect that the research around the efficacy of homeopathy suffers from less of a positive bias than the research around a lot of other interventions. Personally, I'd like to see a much more sceptical approach taken towards claims about the efficacy of all treatments.

 

[natasa778]

Yes, and even with all that scepticism (and shall we say downright hostility) the research around the efficacy of homeopathy has shown that it is no less effective than most of the 'proper' drugs (see Miligroms posts on bmj thread). Go figure... And that we often haven't a faintest clue about the true mechanisms of many of the 'proper' drugs.

 

[natasa778]

not completely off topic, those unexpected (and higly unwelcome, for many) trial results into efficacy of chelation therapy for heart disease gave me a good chuckle. While I personaly highly doubt that results and mechanisms of action have anything to do with removal of metals, it is always warming to see it proven that things are not always as simple and black-and-white as 'sceptics' and 'doubters' would love them to be

 

[Esther12]

I don't know anything about chelation, but was disappointed to see some people arguing that the positive result was a problem because the treatment was implausible and being misleadingly promoted, rather than recognising that the problems with the chelation trial are shared by many studies used to show the efficacy of treatments conventionally thought to be 'plausible'. My view is that we're not nearly sceptical enough about lots of claims about 'mainstream' medical treatments, and that this harms patients, wastes money, and distorts our understanding of reality.

There can be a one-sidedness to some people's scepticism which I don't like. A lot of people who see themselves as 'sceptics' seem to me to slip in to faith for a certain type of authority.

 

[wdb]

Can Homoeopathy Be Both a Useless Placebo and Dangerous at the Same Time?
Absolutely it can: http://whatstheharm.net/homeopathy.html

 

[natasa778]

Can Homoeopathy Be Both a Useless Placebo and Dangerous at the Same Time?
Absolutely it can: http://whatstheharm.net/homeopathy.html

That website is a bit ridiculous to put it mildly ... it would be like saying that chemotherapy is both useless and dangerous, because many people who undergo it later die of cancer ...

 

[HowToEscape?]

Possibly. I completely accept that it's impossible to prove... well, almost anything.
.

Not buying that. The computer you are reading this on came about due to proof and disproof regarding supposed properties of the physical world. These properties were not proven with mathematical certainty, just a high enough level that it turns out to be reliable. Gravity, electricity and evolution are "just theories", but ask a sweaty creationist to belly-flop onto the 3rd rail and they will for one moment become ardent though unwitting advocates of science.

The human body is complex, medicine more so, and so proving that one or another medicinal procedure works is difficult. In practice we have to settle for a level of proof notably less than 100%, but a long way from zero. If you wind yourself an electric motor you can be pretty sure it's going to turn when you give it power without doing a single test, relying on the "unprovable" theory of electromagnetism.

Medicine is at the opposite end of difficulty and certainty from an electric motor. Some of what's accepted as good medicine today will be discredited years from now. Some of it works but will be updated. Some, like aspirin, will remain for ages. This isn't a dark secret; there's a famous quip said to be spoken to first year med students: "Half of what we're teaching you is wrong. We don't know which half.", illustrating that medicine is incomplete and difficult. You could use that difficulty to make quite a nice business for yourself, if you're ambitious and somewhat cavalier about ethics.

How? If I were in the business of selling something that doesn't work and which I know will never be proven to work, I would look to sow uncertainty on competition that does work, especially if it works moderately well and is improving. My competition might have some level of proof that their treatment works, while I have none. That's a problem for me but hardly insurmountable. Maybe I can flip that around to my advantage? Sure! If I could get you to believe that nothing could ever be proven, then my game is as good as anyone else's medicine. What's a good medicine for me to sell you? Hm, first, it can't cost me too much to make. Second, it shouldn't get me arrested. Third, the buyers probably shouldn't die off soon after taking it; that would be bad for business. What's the ideal thing for me to sell?

Belief. If the customer believes, then for the thousands of ailments that come and go on their own I've got'm. For those that don't I get credit for any improvement and no blame for any harm. Belief is endless and can't be disproved, and it cost me as much effort to sell a million as a thousand. Now to find something clear but mystical to contain that belief. Something that costs me no more than five cents per dose, needs no inspection and clears customs.

Water. Water + belief = $

 

[Esther12]

Not buying that. The computer you are reading this on came about due to proof and disproof regarding supposed properties of the physical world.

How do you know I'm using a computer? Or that you are?

Whoah.... I could be in The Matrix right now!

I don't think that scepticism and caution does anything to justify the use of homeopathy. We can be confident that homeopathy is not an effective medicine, but I think that it's just honest to acknowledge that we cannot be certain it is not an effective medicine. This does not mean that it is sensible to use homeopathy though.

 

[HowToEscape?]

How do you know I'm using a computer? Or that you are?

Whoah.... I could be in The Matrix right now!

I don't think that scepticism and caution does anything to justify the use of homeopathy. We can be confident that homeopathy is not an effective medicine, but I think that it's just honest to acknowledge that we cannot be certain it is not an effective medicine. This does not mean that it is sensible to use homeopathy though.

Impossibility of proof ... we're getting into philosophy, or perhaps religion. M'self, I think we need to settle for "good enough proof", meaning good enough to be confident of making decisions with. We do it every day with things familiar to our own experience. We can also do it with less familiar things based on the experience of others, if we trust that they are adequately competent and honest.

I think we can prove well enough that shaken water is not medicine. You could design a study to show this, with considerable bother and expense. The study alone doesn't provide certainty, but the study combined with what we know about the physical world gets us to, meh, around 99.44%. Or you could just drink un-shaken un-memory water because we are confident enough they are the same.

But since there's very little/sometimes nothing in the medical emporium for us, a harmless distraction that lifts your mood for a while has something to recommend it. If you really believe magic water works and feel less stressed out and hopeless after using it, you get some real benefit. Hormone levels will change, and perhaps inflammation may be in better shape due to one's change of mood. So in this hypothetical case the belief in magic had a physical benefit, we could measure that. Odd, but better than nothing. Real harm would come from confusing this with direct treatment for what's wrong and ignoring effective medicine which alleviates the cause of our issues, should we ever find it.