Trick or Treatment (21 page)

Shang’s view of homeopathy is backed up by the Cochrane Collaboration, the highly respected, independent evaluator of medicines introduced in the previous chapter. There are Cochrane reviews on homeopathy for the induction of labour and the treatment of dementia, chronic asthma and flu. Cochrane’s conclusions are based on sixteen trials involving over 5,000 patients. Over and over again, the evidence is either non-existent or shaky, leading to conclusions such as ‘there is not enough evidence to reliably assess the possible role of homeopathy in asthma’ ‘current evidence does not support a preventative effect’ and ‘there is insufficient evidence to recommend the use of homeopathy as a method of induction’.

It is interesting to contrast the tenor of these comments on homeopathy with Cochrane’s conclusion on a conventional medicine such as aspirin: ‘Aspirin is an effective analgesic for acute pain of moderate to severe intensity with a clear dose-response.’ Moreover, Cochrane confirms how the efficacy of real medicine is so robust that it can be tested in different ways: ‘Type of pain model, pain measurement, sample size, quality of study design, and study duration had no significant impact on the results.’ This is the sort of confident conclusion that emerges when a genuinely effective medicine is tested. Sadly, research into homeopathy has failed to deliver any kind of positive conclusion.

Conclusions

It has taken several thousand words to review the history of homeopathy and to survey the various attempts to test its efficacy, but the conclusion is simple: hundreds of trials have failed to deliver significant or convincing evidence to support the use of homeopathy for the treatment of any particular ailment. On the contrary, it would be fair to say that there is a mountain of evidence to suggest that homeopathic remedies simply do not work. This should not be such a surprising conclusion when we recall that they typically do not contain a single molecule of any active ingredient.

This raises an interesting question: with no evidence that it works and with no reason why it ought to work, why is it that homeopathy has grown so rapidly over the last decade into a multi-billion-dollar global industry? Why do so many people think that homeopathy works, when the evidence, frankly, shows that it does not?

One problem is that the public are unaware of the vast body of research that undermines homeopathy. While Linde’s original overly optimistic paper from 1997 is hyped on many pro-homeopathy websites, there are far fewer mentions of his more equivocal 1999 re-analysis of exactly the same data. Similarly, the even more important and more negative 2005 paper by Shang is often omitted from homeopathy websites.

Worse still, the public can be misled by news stories that show homeopathy in an unjustifiably sympathetic light. One of the most high-profile homeopathy news stories in recent years concerned a study by the Bristol Homoeopathic Hospital published in 2005. The hospital tracked 6,500 patients during a six-year study and observed that 70 per cent of those suffering with chronic diseases reported positive health changes after homeopathic treatment. As far as the public was concerned, this appeared to be an extraordinarily positive result. However, the study had no control group, so it was impossible to determine whether these patients would have improved without any homeopathic treatment. The 70 per cent improvement rate could have been due to any number of factors, including natural healing processes, or patients being reluctant to disappoint whoever was interviewing them, or the placebo effect, or any other treatments that these patients may have been using. Science writer Timandra Harkness was one of many critics who tried to point out why the Bristol study was largely meaningless: ‘It’s as if you had a theory that feeding children nothing but cheese made them grow taller, so you fed all your children cheese, measured them after a year and said
There – all of them have grown taller – proof that cheese works!
’

We suggest that you ignore the occasional media hype and instead rely on our conclusion, because it is based on examining all the reliable evidence – and the evidence suggests that homeopathy acts as nothing more than a placebo. For this reason, we strongly advise you to avoid homeopathic remedies if you are looking for a medicine that is more than just make-believe.

Before ending this chapter, it is important to reiterate that we have come to our conclusions about homeopathy based on a fair, thorough, scientific assessment of the evidence. We have no axe to grind and have remained steadfastly open-minded in our examination of homeopathy. Moreover, one of us has had a considerable amount of experience in homeopathy and has even spent time practising as a homeopath. After graduating from a conventional medical school, Professor Ernst then trained as a homeopath. He even practised at the homeopathic hospital in Munich, treating inpatients for a whole range of conditions. He recalls that the patients seemed to benefit, but at the time it was hard to determine whether this was due to homeopathy, the placebo effect, the dietary advice given by doctors, the body’s natural healing ability, or something else.

Ernst continued to practise (and indeed receive) homeopathy for many years, remaining open to its potential. If homeopathy could be shown to be effective, then he and his colleagues would have been overjoyed, as it would offer fresh hope for patients and present new avenues of research in medicine, biology, chemistry and even physics. Unfortunately, as Ernst took a step back and began to look at the research into this form of medicine, he became increasingly disillusioned.

One key piece of research that helped to change Ernst’s view was conducted in 1991 by the German pharmacologist Professor W. H. Hopff, who repeated Hahnemann’s original experiment with Cinchona – according to Hahnemann, if a medicine that cured malaria was given to a healthy volunteer, then it would actually generate the symptoms of malaria. Using his own students as guinea pigs, the professor compared Cinchona with a placebo and discovered no difference. Neither positive nor negative. In short, Hahnemann’s results, which provided the foundation for homeopathy, were simply wrong. Such trials made it clear to Ernst that homeopathic medicines are nothing more than elaborate placebos.

Nevertheless, some readers might still feel that elaborate placebos are perfectly acceptable. You might feel that placebos help patients, and that this alone justifies the use of homeopathy. Some mainstream doctors sympathize with this view, while many others strongly disagree and feel that there are reasons why the placebo effect alone is not enough to justify the use of homeopathy in healthcare. For example, placebo treatments are not inevitably beneficial, and they can even endanger the health of patients. Even homeopathic remedies, containing no active ingredients, can carry risks. We will discuss the issue of safety in homeopathy and in relation to other alternative therapies at the end of the next chapter.

In the meantime, we will end this chapter by briefly considering another negative aspect of using placebo-based treatments such as homeopathy, namely the cost. This issue has been highlighted by Professor David Colquhoun, a pharmacologist who in 2006 criticized the sale of a homeopathic first-aid kit:

If a person is going to spend £38.95 on a first-aid kit, then surely it is better to spend the money on real medicines that are genuinely effective, as opposed to wasting it on fake medicines, such as homeopathy, which offer only a placebo benefit. Perhaps the most extreme example of a homeopathic rip-off is a remedy called
Oscillococcinum
. The following paragraph, which is from an article published in the magazine
U.S. News and World Report
in 1996, underlines the utter absurdity and profiteering that underpins the homeopathic industry:

In fact, the packaging boldly states that each gram of medication contains 0.85 grams of sucrose and 0.15 grams of lactose, which are both forms of sugar. In other words, Oscillococcinum is a self-declared 100 per cent sugar pill.

Remedies free of active ingredients worth $20 million derived from a single duck? This has to be the ultimate form of medical quackery.

C
HIROPRACTORS
,
WHO USUALLY DEAL WITH BACK OR NECK PROBLEMS BY
manipulating the spine, are becoming such an established part of the healthcare system that many readers will be surprised to see chiropractic therapy included in a book about alternative medicine. After all, many conventional doctors refer their patients to chiropractors, and many insurance plans are willing to cover such treatments. This is particularly true in America, where chiropractors are most widespread, and where roughly $3 billion is spent annually on chiropractic treatment. As well as being an established part of the American healthcare system, chiropractors are becoming increasingly popular – between 1970 and 1990 their numbers tripled, and in 2002 there were 60,000 chiropractors practising in North America. It is expected that this figure will almost double by 2010, whereas the number of medical physicians will have increased by only 16 per cent.

Perhaps the most significant indication that chiropractors have become part of the medical mainstream is that they are licensed in all fifty US states, and they also have legal recognition in many other countries. For example, chiropractors in the United Kingdom are regulated by statute, which means that they have a similar standing to that of doctors and nurses. So, bearing all this in mind, why do chiropractors deserve to be labelled as alternative therapists?

The chiropractic approach to medicine emerged towards the end of the nineteenth century with a radically new view on health. The founders of chiropractic therapy argued that poor health was due to
subluxations
, by which they meant slight misalignments of the vertebrae in the spine. In turn, they believed that subluxations interfered with the flow of so-called
innate intelligence
(akin to a life force or vital energy), which then led to health problems of all sorts. But there is no evidence for the existence of innate intelligence or its role in health. The concepts of innate intelligence and subluxations are as mystical and as baffling as the concepts of Ch’i in acupuncture or extreme dilution in homeopathy, which means it makes no sense at all from a modern scientific point of view. That is why chiropractic treatment is still considered by many as an alternative medicine – despite its current popularity.

But, if we temporarily suspend disbelief and leave the underlying philosophy to one side, the key question is straightforward: does chiropractic therapy help patients? Fortunately, this is a question that has been addressed thanks to evidence-based medicine and the use of clinical trials.

So far, evidence-based medicine has generated a pessimistic view of alternative medicine. Acupuncturists and homeopaths have spent centuries developing treatments to help patients, and yet scientists have examined the evidence, mainly from clinical trials, and concluded that these therapies are over-hyped. Acupuncture appears to be nothing more than a placebo for everything except some types of pain and nausea, and the jury is out even for these conditions. Worse still, homeopathic remedies have failed to be more effective than placebos in the treatment of every known condition.

Some readers may start to suspect that evidence-based medicine is somehow biased against alternative medicine. Perhaps acupuncture and homeopathy are actually valid therapies, and instead maybe it is in fact the clinical trial that is at fault? Perhaps the clinical trial is part of an establishment conspiracy cooked up by doctors and scientists to protect themselves from the interference of meddling outsiders? Just in case you are harbouring any such suspicions, let us take another look at the clinical trial and evidence-based medicine in general before examining the evidence for and against chiropractic therapy.