Issue 5 / 14 February 2011

WANT to earn a million dollars for a little bit of research? All you have to do is prove homoeopathy works.

Magician, escape artist and outspoken North American sceptic James Randi may be offering the incentive in the confidence he’s never going to have to pay up, but the supporters of homoeopathy are probably optimistic of grabbing the cash.

You’d have to expect some of them to give it a go.

When it comes to alternative remedies, there are plenty of products that have not passed the rigours of a randomised controlled trial, relying on anecdotal evidence of benefit in some people and at least the whiff of a plausible mechanism.

And then there’s homoeopathy.

We’re talking about so-called medicines where the active ingredient is not only not active, it may not even be present.

Homoeopathic solutions are so dilute there may not even be a single molecule of the ingredient in a product — which makes the claim of “no side effects” probably the most truthful part of the marketing spiel.

As one Twitter wit recently put it, when lamenting the existence of an international organisation called Homoeopaths Without Borders, their French name could be “Medecins sans Medicines”.

(However, claiming no side effects doesn’t mean no harm, as demonstrated in the tragic case in Sydney of Gloria Thomas who died at 9 months of age of septicaemia after her parents treated her severe eczema with homoeopathic remedies after abandoning prescribed conventional medications.)

As a magician, Randi is an expert in the creation of illusions so perhaps it’s no surprise that he is a high-profile supporter of the international 10:23 campaign against homoeopathy.

The campaign recently saw a group of protesters in Melbourne stage a public “overdose” (below) of a homoeopathic sleep remedy.

The group managed to keep their eyes open after taking 10–20 times the recommended dose of the product. In fact, it didn’t even seem to raise a yawn.

But it did raise some serious questions about why these remedies with no backing in evidence (eg, this MJA review last year) and no plausible mechanism continue to receive implicit backing from people who should know better.

The Victorian Government’s Better Health website, for example, seems to be trying a little too hard to provide a “balanced” view.

While it certainly includes cautions about efficacy and advises homoeopathy is not a substitute for medical treatment of serious conditions, the site also offers advice on finding a registered homoeopath and promotes events such as World Homoeopathy Awareness Week.

Of even greater concern are the pharmacists who lend their professional authority to such quack remedies by selling them to people who have not had the advantage of university training in pharmacology.

When it comes to evidence-based pharmacy, James Randi the magician could teach them a trick or two.

Jane McCredie is a Sydney-based science and medicine writer, and author of Making girls and boys: inside the science of sex, published by UNSW Press.


Posted 14 February 2011

Please note that this video is not hosted on the MJA InSight website but is hosted externally on YouTube. AMPCo has no control over the content or any of the videos hosted on the YouTube website.

16 thoughts on “Jane McCredie: Overdosing on anecdotes

  1. Anonymous says:

    Hey “Richard”: Just an FYI – “Zenon Gruba” who commented on here that homeopathy works on his patients, is in fact a qualified MD based in Australia who uses scientific testing as well as homeopathy, nutrition etc to treat his patients and has a track record of successfully curing hundreds of patients of their chronic illnesses. I have friends who have gone to him and had everything from chronic endometriosis to prostate cancer cured with Dr Gruba’s methods. It can take up to 4 months to get in for an appointment with Dr Gruba because he is renowned for healing his patients. He’s probably too busy researching the cure behind another chronic illness to reply to your comments with proof of his “anecdote”.

  2. Anon says:

    The belief that there is no evidence for the action of homeopathic medicines, is based on a misunderstanding and misreporting of the significance of meta-analyses and reviews to date as it has been filtered down through the media. The best evidence in a broad sense may be in the Cochrane database, however, to suggest that the best evidence for homeopathy is in this database is a slippery misrepresentation. Similarly, to say that the Cochrane reviews of homeopathy report that there is no evidence for the action of homeopathy is a verbal slight of hand.
    Recognizing the heterogeneity of the material they are dealing with, the reviewers’ conclusions in reviews to date like in the Cochrane database are much more equivocal than the brazen statement ‘there is no evidence for homeopathy’. This is notwithstanding the headline that is plastered at the top of the Cochrane dementia review for example, and which could let the casual observer believe that there is evidence that homeopathy does not work in dementia; all the reviewers concluded was that they could not find any studies to analyse.
    Meta-analyses are at the top of the pecking order of clinical evidence. They provide very good evidence. However, meta-analysis only achieves its elevated status when certain criteria are fulfilled. Systematic reviews may be done with or without meta-analysis. Systematic reviews are done without meta-analysis, when the investigator does not have adequate information to do a formal analysis. Something is not rigorous evidence just because it is called a meta-analysis or systematic review.
    The ideal meta-analysis is one that is designed even before the prospective studies on which it is based are performed. This is often not possible, so for practical reasons meta-analysis may be performed retrospectively, ie, after the clinical studies are performed. In this case the meta-analysis needs to be based on identical studies, or at the very least on very similar studies with similar designs and end points. What has been done in most reviews of homeopathy to date is as if the published performance data of a Humvee in the desert is clumped together with the published data on Nissan Patrols, Toyota Corollas, Go Karts and other vehicles. The more disparate the studies are then the more assumptions must be made about how to do the analysis; the more speculative the results of the analysis or review becomes. A poor quality meta-analysis can come to diametrically opposite conclusions with minor changes in assumptions. This has been discussed in Rutten’s paper in the Journal of Clinical Epidemiology in 2008. There is no doubt about the importance of prospectivity in the design of any clinical study or meta-analysis and that the designs of studies incorporated in the review should be similar.
    There are numerous practices encompassed by the term homeopathy, and Ian Watson lists a number of these in the book “A Guide to the Methodologies of Homeopathy”. The studies collected in reviews to date comprise a hotchpotch of different methods and experimental designs.
    The best evidence available at the moment is in the positive statistical association demonstrated by various double-blind randomized controlled trials or blinded randomized controlled laboratory studies. There is no data which demonstrates that homeopathic medicines are inactive. On the contrary. The studies which have been clumped together retrospectively in meta-analyses or reviews to date lack the homogeneity to be used for negation of positive randomized controlled trials clinical or laboratory studies, and are inferior evidence.
    If one of these methods is tested by RCT and achieves statistical significance, the resulting p-value provides a measure of the extent to which the null hypothesis, in this case the hypothesis that the particular homeopathic preparation does not work, can be rejected. It is a mathematical statement and not a matter of opinion. If one bases ones conclusions on reviews that use heterogeneous studies, it is like trying to draw conclusions about the Humvee using the car analogy above.

  3. Dr Ken Harvey says:

    Furthermore, patients have died from relying on homepathy and other “alternatives” to evidence-based medicine. The coroner’s report on the appalling suffering and death of Penelope Dingle who refused surgery for rectal cancer and opted to be treated by a homeopath instead should be compulsory reading for all homeopaths and students of “alternative medicine”. See:

  4. joel says:

    This is much ado about nothing.
    No patient of mine – or anyone I know for that matter – has been cured of a serious illness using homeopathics.
    It’s about time these so-called experts stopped bamboozling the gullible.

  5. Richard says:

    anon: Your amusing attempt to describe scientific method and the interpretation of “evidence” is laudable but you have still not provided any evidence for the efficacy of homeopathy!! How can a metanalysis be anything other than retrospective? Goodness, gracious me.
    Zenon Gruba: You have made the author’s point, whether tongue-in-cheek or unintended. Thanks for the anecdote! Now show us the evidence……..
    The point is not necessarily in understanding the molecular mechanism of medicines (although this is useful for all sorts of reasons), but in reproducibly demonstrating efficacy, with or without attendant side effects. The nature of evidence is complex. For example, the mechanism(s) of action of anaesthetic agents is only now being revealed, despite a multitude of theories and absolutely no question about their efficacy (and their adverse effects) for over 150 years! And no randomised controlled trials were required to demonstrate something that was obvious to everyone present at the first public demonstration. Some things are more subtle and placebo effect is real. But, subtle or not, there is still no evidence for any benefit of homeopathy, whether RCT, meta-analysis or otherwise. Until then it should not be supported by public institutions.

  6. Sue Ieraci says:

    Anon writes very eloquently, but unfortunately not very scientifically. He or she employs many logical fallacies of the pseudo-scientists – putting up a straw man, misquoting the literature, claiming that orthodox scientists are parrots, citing so-called “errors” of the early scientists.
    Most human endeavour – including science – advances incrementally over time. Many old theories have been found to be erroneous as new evidence and new endeavour clarifies things. In the face of evidence, scientific knowledge and practice undergoes continuous improvement. And so, obstetricians DO now wash their hands, and many other advances have made child and maternal mortality vanishing small in our wealthy communities.
    But does homeopathy work that way? I think not. Like most beliefs, homeopathy sticks to its original tenets despite evidence to the contrary – it does not improve with ongoing knowledge because its followers BELIEVE it to be true.
    Anon mistakes progress for “fashionable opinion”. Does he or she bear similar views about – say – aviation? Did the Wright Bros have it right afterall? There is no reason for MJA to be embarrassed, but perhaps Anon should be…

  7. Zenon Gruba says:

    I only have one thing to say about homoeopathy. It works incredibly well for my patients.

  8. anon says:

    Correction: “The Right Man Syndrome: skepticism and alternative medicine” by Larry Dossey.

  9. Chris Richardson says:

    “The problem with homeopathic studies is not lack of evidence, rather it is a lack of independent reproducible evidence” … Hilarious. Couldn’t have put it better!

  10. Trevor Lowe says:

    Clinical trials are meant to be designed to avoid confounding factors. Hence they have exclusion criteria to attempt to ensure that only one variable is being measured. If “anon” believes that homeopathic trials had confounders which precluded meaningful results, it essentially also means that the trials provided NO evidence for efficacy. Confounding factors are exactly that and impossible to predict accurately their impact.
    Meta analysis may well be done retrospectively, however they use data from prospectively designed trials. If the homeopathic trials had positive, but non statistically valid, results, then meta-analysis is the best shot at providing statistical significance through increasing the total numbers studied.
    Quoting learned and remarkable men does not prove an argument. Each of these men quoted provided evidence to substantiate the move from one paradigm to another. Homeopathy has yet to provide evidence beyond placebo effect.

  11. Ken McLeod says:

    If anyone feels the slightest bit tempted to give homeopathy the benefit of the doubt, they should read the Coroner’s Report on the death of Penelope Dingle first.
    And to think that homeopathy is supported by the Victorian Government through links on its Better Health website, and the Federal Govt through health insurance rebates, and pharmacists through sales to a gullible public. Shame on them.

  12. anon says:

    The title of the article refers to anecdotes, and yet the article itself provides nothing other than anecdote in the best tradition of the ‘right man’.
    The skeptics mass overdose is a publicity stunt. It has about as much in common with science as the German Democratic Republic had to do with democracy.There are lots of studies in Medline supporting action of homeopathy.The problem with homeopathic studies is not lack of evidence, rather it is a lack of independent reproducible evidence, and this is not the same thing. If experiments are difficult to replicate it can be due to a number of reasons and not just that the subject being investigated is not efficacious or is a placebo.There may be various confounders. Such things can only be properly investigated by focussed research programs, and not just by sifting over others’ research retrospectively.
    Individuals who parrot ‘there is no evidence of effect of homeopathy’ are basing it mostly on prejudice and at best on meta-analyses, which amount to little more than political spin. The meta-anlayses purport to represent rigorous science. In fact they all neglect one of the main criteria of rigor which is prospectivity. Accordingly it is possible to make retrospective assumptions and come to any conclusion one likes – be it positive or negative. In this regard one could study the 2 papers on trials published on Medline by AL Rutten and colleagues in 2008.
    If one thinks that homeopathy is contrary to commonsense, remember Einstein is reported to have said: Commonsense is the sum of prejudices one has by the age of 18.
    Also don’t forget it took medical practitioners a number of decades before they agreed with Semmelweis and they widely accepted it was a good idea to wash one’s hands before dealing with patients in labour ward or surgery. Evidently it made no sense to them either at the time. Meanwhile, rampant obstetric mortality continued in Europe while they came to grips with their commonsense.
    Also, a scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die and a new generation grows up that is familiar with it.
    ~Max Planck
    An unflinching determination to take the whole evidence into account is the only method of preservation against the fluctuating extremes of fashionable opinion”
    ~Alfred North Whitehead
    It seems too many commentators here are caught up in the extremes of what they perceive as fashionable opinion, which may have more in common with the spirit of the Spanish Inquisition than with science. Aren’t such stances an embarrassment to the MJA?

  13. Anonymous says:

    I once consulted a naturopath in desperation when suffering chronic insomnia. She prescribed a homeopathic. It seemed to make my condition even worse. I mentioned this to her and she said that’s what happens with homeopathics. Initially they make the condition worse, that’s how you know they are working. Then you start seeing an improvement. I didn’t persevere with it. Maybe that’s what happened to the Sceptics?

  14. Michaelw nixon says:

    Homeopathy does work – it’s in the psychosomatic area of the brain. Remember the days when doctors asked the patient ” would u like the green or the red pill? ” mike in Darwin

  15. Anon says:

    Homeopathy was invented in the late 18th century by Hahnemann. Perhaps it became popular because, as the remedies contained nothing, at least it did not make the patient sicker, unlike other more conventional treatments of the day.

  16. Dr Ken Harvey says:

    The Melbourne Skeptics overdosed on Brauer Sleep and Insomnia Relief pills.
    A spokesman for Brauer said: “These people were saying that the product didn’t work. But the product is indicated for insomnia. If any of these people were suffering from insomnia then it would have worked. But they were using it for an overdose. It’s not indicated for that.”
    In response, Melbourne Skeptics said, “If Brauer Sleep and Insomnia Relief preparations are as effective as they claim, have no side-effects and are safe in over-dose then Brauer is morally and ethically obliged to make an application for them to be registered with the Therapeutic Goods Administration (TGA) and included on the Pharmaceutical Benefits Scheme (PBS) so all Australians can enjoy their benefits at a subsidised price. This only requires Brauer to submit the same evidence of efficacy that sponsors of prescription sleeping pills needed to do”.

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