NHS funding of homeopathy

[Zep]

What people, and politicians particularly, like to see these days are the "30-second sound bite" on TV. Remember also that most politicians are not your actual university-graduates, but jumped-up working-class spivs or failed shopkeepers in good suits.

So perhaps it's time to move from the "learned paper" approach (which seems to go right past them, intellectually), and making the points in a prime-time TV-based simpletons' sound-grab approach. Intellectually painful to many of us, I know, but you need to consider your audience too...

 

[Rolfe]

Mojo - Most of the available veterinary trials of homoeopathy have been on farm animals. This situation lends itself very easily to such trials, as the group can be split into verum and placebo with little trouble. This should attract no criticism, as in reality homoeopathic vets appear to treat a herd as a single individual, and prescribe one remedy for the lot for a single condition - often through the water supply. Nevertheless, even these trials, when negative, are declared useless as they "lack individualisation". (Of course, when they are positive, they are gilt-edged proof, you understand!) This led to the amazing spectacle of one bunch of researchers actually doing a trial of individualised homoeopathy on a dairy herd, relaying individual characteristics of the cows to a group of homoeopaths who solemnly decided which remedy each should have. This was patently ridiculous, because no homoeopathic vet actually seems to practise like this. (Of course the study was negative, and some other excuse why it "wasn't proper homoeopathy" promptly got trotted out.)

Zep. You're right. Any suggestions, or do I have to offer a small cash prize?

Rolfe.

 

[Davidlpf]

According to the rules of homeopathy wouldn't fewer homeopathic hospitals be more effective.

 

[Zep]

Zep. You're right. Any suggestions, or do I have to offer a small cash prize?

Rolfe.

I think you should be able to provide proper evidence of homeopathy in tonight's round in order to come back tomorrow night and play for a large government research grant!

 

[Mojo]

Rolfe: what I was thinking about was more to do with the extent to which homoeopaths treating humans really individualise treatments. We know that they have treatments that they recommend in "first aid" situations (e.g. arnica for bruising) and we've seen claims that these work in a high proportion of cases (indeed, they are claimed to work so well, and so quickly, that their action is self evident). It is certainly claimed that these work without individualisation.

But what about remedies administered after a consultation? How many patients with, for example, asthma are given the same remedy, and what proportion of these are claimed to have been helped by the first remedy they receive? If both of these are any significant proportion of patients, then there can be no real objection to RDBPC trials of a single remedy - for example if remedy X is administered to 50% of patients with asthma at their first consultation, and is claimed to help 50% of asthma patients to whom it is administered, then this should be testable without individualisation. I just wondered if we had any reliable information about what homoeopaths actually prescribe. Of course, it might be neccessary for the homoeopaths to be unaware that data was being collected as it might influence their prescribing patterns.

 

[Rolfe]

There was some discussion about this in another thread. BSM challenged a homoeopath to say how many different remedies she actually used over the course of a week or a month. He commented that while they go on and on about individualisation, in practice they seem to stick to a relativly small range of things they themselves are familiar with, and within that range to prescribe pretty much one remedy for one presenting sign.

Rolfe.

 

[Mojo]

What, even if the patient likes sausages?

But seriously, this should pretty much knock the objection to trials of non-individualised homoeopathy on the head: if homoeopaths consistently prescribe the same remedy after the initial consultation for a particular condition, and claim that at least some proportion of patients improve immediately, then a trial of that remedy for that condition would be an appropriate test.

And think of the anecdotes. Have you ever seen someone claiming that after real medicine failed to help them they went to a homoeopath and got better 6 months later? Relief is always immediate in the anecdotes - see Winterson's recent article, for example.

 

[flimflam_machine]

We know that they have treatments that they recommend in "first aid" situations (e.g. arnica for bruising) and we've seen claims that these work in a high proportion of cases (indeed, they are claimed to work so well, and so quickly, that their action is self evident).

Just to pick up on a comment in another thread. Why arnica for bruising? As far as I'm aware, arnica does actually act to reduce swelling in real measurable doses, and can be bought in cream and massage oil form for this purpose. Doesn't homeopathic use of arnica in order to reduce swelling, therefore, completely violate the like-cures-like principle? Surely you would want to use something that actually causes swelling in real doses in healthy patients. In the absence of a homeopath to ask, does anyone here have an answer for this?

 

[Ivor the Engineer]

Just to pick up on a comment in another thread. Why arnica for bruising? As far as I'm aware, arnica does actually act to reduce swelling in real measurable doses, and can be bought in cream and massage oil form for this purpose. Doesn't homeopathic use of arnica in order to reduce swelling, therefore, completely violate the like-cures-like principle? Surely you would want to use something that actually causes swelling in real doses in healthy patients. In the absence of a homeopath to ask, does anyone here have an answer for this?

They are making it up as they go along.

 

[Rolfe]

Just to pick up on a comment in another thread. Why arnica for bruising? As far as I'm aware, arnica does actually act to reduce swelling in real measurable doses, and can be bought in cream and massage oil form for this purpose. Doesn't homeopathic use of arnica in order to reduce swelling, therefore, completely violate the like-cures-like principle? Surely you would want to use something that actually causes swelling in real doses in healthy patients. In the absence of a homeopath to ask, does anyone here have an answer for this?

I recall asking about this in another thread. I don't remember getting a definite reply. Are these arnica creams and so on actual measurable quantities of mountain daisy or not? If they are, do they work?

I don't know the answer to the first point, as for the second, I've found no evidence that a herbal preparation of mountain daisy does in fact have any beneficial effects against swelling or bruising.

But you're right, if herbal mountain daisy is (or even, I suppose, is said to be) effective in this situation, then the use of homoeopathic mountain daisy in exactly the same situation is completely irrational.

Rolfe.

 

[Rolfe]

They are making it up as they go along.

Yeah, that too.

Rolfe.

 

[Deetee]

I recall asking about this in another thread. I don't remember getting a definite reply. Are these arnica creams and so on actual measurable quantities of mountain daisy or not? If they are, do they work?

I don't know the answer to the first point, as for the second, I've found no evidence that a herbal preparation of mountain daisy does in fact have any beneficial effects against swelling or bruising.

But you're right, if herbal mountain daisy is (or even, I suppose, is said to be) effective in this situation, then the use of homoeopathic mountain daisy in exactly the same situation is completely irrational.

Rolfe.

I too asked this in another thread.
Presumably during the proving of arnica patients developed extensive haemorrhagic complications. Its use in this situation homeopathically would be otherwise quite inappropriate. (But then the use of any homeopathic preparation in any situation is inappropriate).
Do MRCHans or his Hpathy contacts have info on this?

 

[Rolfe]

I'm sure this one would bear closer examination. I just don't know where the original connection between mountain daisy and bruising arose in the first place.

Rolfe.

 

[Ocelot]

If someone is uneccessarily on a drug or suffering side effects from it, there is no need to resort to nonsensical strategies like substituting a homeopathic remedy for them - the simple answer is to stop the drug. The vast majority of people do not need to be patronised in the way you suggest.

Yet again, you make statements without any evidence;- or can you show us some studies where homeopathy has shown its value in this regard?

Dr Ben Goldacre, as even handed as ever, indicated in his recent article an example where exactly this effect has been inferred.

http://www.accampbell.uklinux.net/homeopathy/homeopathy-html/chapter06.html

In 1854 London was struck by an outbreak of cholera. This gave homeopaths a chance to show what they could do. Among the patients admitted to the orthodox hospitals the death rate was 52 per cent, while at the homeopathic hospital, where 61 patients were admitted, only 10 died (16 per cent) - and of these, one died at the door of the hospital as he was being taken from the cab and another was treated only after he had been given up by an orthodox physician. The Board of Health and the Medical Council omitted the figures for the homeopathic hospital in the Blue Book published in 1855 to report on the outbreak, but Lord Grosvenor raised the matter in the House of Lords and a report including the homeopathic results was subsequently published. At this distance in time it is impossible to know why the cholera patients treated homeopathically did better. (Similar results were reported at this time for Italy.) Today we know that the essential treatment for cholera is fluid replacement, and if this is done the death rate is low; however, neither homeopaths nor conventional doctors would have been aware of this in the nineteenth century. Perhaps the better results achieved by the homeopaths were due to their patients not receiving toxic doses of conventional medicine.

 

[fls]

And think of the anecdotes. Have you ever seen someone claiming that after real medicine failed to help them they went to a homoeopath and got better 6 months later? Relief is always immediate in the anecdotes - see Winterson's recent article, for example.

I think that just reflects the choice of acute illness to illustrate the effects of homeopathy. I have heard stories from patients and seen case reports from homeopaths where relief occurs after months.

The time to relief corresponds to the usual course of disease. Normally, that would be a clue.

Linda

 

[Deetee]

Dr Ben Goldacre, as even handed as ever, indicated in his recent article an example where exactly this effect has been inferred.
http://www.accampbell.uklinux.net/homeopathy/homeopathy-html/chapter06.html

The specific claim by physiotherapist was:"Homoeopathy may be very usefull in weaning off people from unneccessary and dangerous drugs that cause iatrogenic diseases and iatrogenic neuroses."

I asked for evidence to back up this specific claim.

A report on the deaths from cholera in 1854, when conventional treatments for the condition at the time (Leeches? Cupping? Arsenicals?) were undoubtedly unneccessary and unsafe by modern standards does not in my opinion provide evidence for Physiotherapist's claim. If he was talking about drugs and orthodox medicine in the mid 19th Century he should have said so.

I note Physiotherapist did not even attempt to respond to my question.
I now invite him again to post any current evidence for his claim, and specifically where homeopathy was used to wean people off unneccessary/toxic conventional drugs causing iatrogenic diseases.

 

[Rolfe]

Attended an excellent lecture yesterday about diarrhoea in calves. Very very similar to cholera, especially as regards treatment. One of the major correlations with recovery was reported as good nursing, encouragement to eat, and tender loving care. Also, strict cleanliness of bedding, and keeping bedding dry.

One possible reason for the homoeopaths' better outcome with cholera might lie in the relatively small number of patients allowing time to be devoted to better nursing and cleanliness. I've also seen it suggested that the class of patients being attracted by the homoeopaths was middle and upper class, people with a better survival rate than the lumpen proletariat in the first place.

Which of course has nothing to do with your main point. I've never heard of anyone refusing to stop taking a medicine they'd been told was doing them no good (or possibly doing them harm) unless they were supplied with a placebo substitute garnished with a pack of lies. Of course, the pack of lies may be being used to conceal the fact that the prescription was wrong in the first place, but that's not how I would treat my clients, I must say.

Rolfe.

 

[fls]

The specific claim by physiotherapist was:"Homoeopathy may be very usefull in weaning off people from unneccessary and dangerous drugs that cause iatrogenic diseases and iatrogenic neuroses."

I asked for evidence to back up this specific claim.

A report on the deaths from cholera in 1854, when conventional treatments for the condition at the time (Leeches? Cupping? Arsenicals?) were undoubtedly unneccessary and unsafe by modern standards does not in my opinion provide evidence for Physiotherapist's claim. If he was talking about drugs and orthodox medicine in the mid 19th Century he should have said so.

I note Physiotherapist did not even attempt to respond to my question.
I now invite him again to post any current evidence for his claim, and specifically where homeopathy was used to wean people off unneccessary/toxic conventional drugs causing iatrogenic diseases.

It was Phytotherapist, rather than Physiotherapist, who made the claim.

Linda

 

[Ocelot]

The specific claim by physiotherapist was:"Homoeopathy may be very usefull in weaning off people from unneccessary and dangerous drugs that cause iatrogenic diseases and iatrogenic neuroses."

I asked for evidence to back up this specific claim.

A report on the deaths from cholera in 1854, when conventional treatments for the condition at the time (Leeches? Cupping? Arsenicals?) were undoubtedly unneccessary and unsafe by modern standards does not in my opinion provide evidence for Physiotherapist's claim. If he was talking about drugs and orthodox medicine in the mid 19th Century he should have said so.

I note Physiotherapist did not even attempt to respond to my question.
I now invite him again to post any current evidence for his claim, and specifically where homeopathy was used to wean people off unneccessary/toxic conventional drugs causing iatrogenic diseases.

Good for you, you tenacious little fellow. Now please explain why the fact that this episode comes from the mid 19th Century matters.

Surely it demonstrates a likelihood that

"Homoeopathy HAS BEEN very useful in weaning off people from unnecessary and dangerous treatments that caused iatrogenic diseases and iatrogenic neuroses."

This is more than enough to support an assertion framed as a suggestion of a possibility.

Homoeopathy MAY BE very useful in weaning off people from unnecessary and dangerous drugs that cause iatrogenic diseases and iatrogenic neuroses.

Iatrogenic diseases are most obvious many years afterwards when medical science has moved on. It should come as little surprise that the most obvious examples hail from a day when conventional medicine was grounded in the four humours.

Taking it for granted that homeopathy's direct effects are purely as a placebo then for it to no longer be possible that homeopathy is useful in this regard then we must assert that evidence based medicine has advanced to a stage where iatrogenic diseases and neuroses either no longer exist or are confined to an arena where homeopathic remedies are never used as a substitute.

To provide more up to date examples of iatrogenic condition where this may be relevant take painkiller addiction.

Would you accept that painkiller addiction is a iatrogenic disease as described above? If so here is one testimonial to the use of a homeopathic remedy.

http://www.drugs.com/forum/111089-post570.html

No it’s not a study that proves that this is generally the case. However you’ll not that the claim made was not that

Homoeopathy IS GENERALLY very useful in weaning off people from unnecessary and dangerous drugs that cause iatrogenic diseases and iatrogenic neuroses

Or

Homoeopathy may be very useful in weaning off people from drugs WHICH ARE GENERALLY unnecessary and dangerous in causing iatrogenic diseases and iatrogenic neuroses.

Phytotherapist, in framing his assertion as a possibility ensures that the converse is that his assertion is impossible. Only one exception is required to disprove this impossibility. Only one instance where this is possible is required to show that it is not impossible. As such the power of a single anecdote is unusually applicable. Both by my previous example via Dr Goldacre and this evidence are sufficient to defend this as a possibility but what the hey here’s another example of homeopathy being used as part of a treatment of pain killer addiction. http://www.treatmentforaddiction.com/article.cfm/id/180675

Yes it’s a load of old tosh and the effects are purely psychological but then again addictions are at least partly a psychological affliction so it’s reasonable to consider the possibility that homeopathy MAY help.

Now I advise you to retreat from this losing battle and concede that homeopathy (or any placebo) MAY occasionally be better than certain other treatments that were once or even still consider conventional.

Instead the relevant question is whether in general this is the case. Whether the increasingly rare circumstances where evidence based medicine is so deficient as to make a placebo preferable, are outweighed by the instances of people choosing unproven “alternative treatments” when it is certain that conventional medicine would substantially decrease mortality and morbidity.

 

[malbui]

[derail]

Attended an excellent lecture yesterday about diarrhoea in calves.

That's not a sentence you read every day. Not in my circles, anyway.

[/derail]