17 June 2009

Oh Christ, not homeopathy again...

Now, back in early May I made the following post on Twitter:

I am livid about this story. 9-month old girl dies because her parents used homeopathy instead of real medicine. http://sn.im/hcs17
A little later, I received the following unbidden message:

@Rablenkov could direct your anger to some horrific figures re seroxat being unleshed on the public... and more re allopathic negligence. Empiricism in medicine is wrong .
Now, what this lady doesn't know is that I have more direct experience of Seroxat than she could imagine. Back in 2000, I was prescribed it for a prolonged period of depression (the worst time of my life, but of no relevance to this post).

Seroxat, a brand-name for Paroxetine, has been claimed to result in suicidal tendencies in some patients. There are other claimed side-effects which you can read about via the Wikipedia article here.

Personally, I found that the drug did help me, but I suffered from nausea and quite bad mood swings. After one particular incident in which I suddenly snapped and threw a fork at my girlfriend of the time (missed her completely, hit the boiler and she laughed herself silly) I suddenly realised that it didn't seem a healthy thing to be taking. I stopped immediately.

Unlike others, I suffered no withdrawal symptoms whatsoever and have been drug-free ever since.

Now, it's certainly true to say that companies like GlaxoSmithKline are there for one reason only - to make money. In the course of their continued quest for cash, it is possible that they may make hasty decisions which later prove to be questionable (I'm being extraordinarily careful here with my comments about a billion-dollar company with excellent legal representation.)

Let's just say, to avoid any litigation, that the drugs industry doesn't always get it right. However, they have, through their various medications, saved millions of lives. I'll say that again - millions of lives. To me, that is justification for their continued existence.

But, to claim that because there are problems with a particular drug (I'm sure the homeopaths have a list of problematic medications) people should turn instead to a treatment that doesn't actually work, is sheer nonsense. It's like saying "Right, that car I bought had a manufacturing defect therefore all cars are bad and, instead, I'm going to travel to work on a skateboard pulled by elves. Mush! Mush!".

Or something.

I sent the following reply:

@jadetaylor38 Yes, I could, but I'd rather rail against the utter disgrace that is homeopathy. Give me evidence over superstition any day.
I received no response and assumed that the homeopathy lady had moved on to other targets. However, 5 weeks later, she decided to come back to Twitter and send me a reply.

@Rablenkov shame yr missing out on a remarkable & dynamic mode of health care. I cn talk from experience only; not secondary speculation.
Oh dear, oh dear. She fails to understand that when you discuss extraordinary claims about medicine and science, personal experience is worthless. Let me give you an example. Imagine that I have a sore throat. I've tried Lockets, Night Nurse, Lemsip, the whole nine yards. Then, out of sheer desperation, I decide to rub a slice of raw liver over my eyebrows. The following day, I wake up and the sore throat is gone. It's a miracle! Behold the healing power of raw liver applied to the eyebrows! I must go and write a book about it!

What we're seeing there is somebody taking one event (the raw liver rubbing) and linking it to another event (the sore throat getting better). That doesn't mean there is any correlation between the two, just that one happened and then, a little while later, the other happened. And, in some cases, that's all the personal experience that people have had with homeopathy. They were unwell, they took it, they got better, therefore homeopathy cured them. It simply isn't true. Add the placebo effect into that mix and the efficacy of homeopathy is called even further into doubt.

I replied:

@jadetaylor38 Clinical trials, meta-analyses and evidence show that I'm missing out on a treatment that fares no better than placebo.
A day later, I received another response:

@Rablenkov interesting i'm in process of exploring ths & currently finding the trials R not individualized & therefore the law of similars is void.
Oh fuck. She's now brought 'the law of similars' into the equation. Let me explain, extraordinarily briefly. The Law of Similars was invented by the father of homeopathy, Samuel Hahnemman. I can't be bothered to explain it, so I'll let Wikipedia do the talking: "Hahnemann observed from his experiments with cinchona bark, used as a treatment for malaria, that the effects he experienced from ingesting the bark were similar to the symptoms of malaria. He therefore reasoned that cure proceeds through similarity, and that treatments must be able to produce symptoms in healthy individuals similar to those of the disease being treated. Through further experiments with other substances, Hahnemann conceived of the "law of similars", otherwise known as "like cures like" (Latin: similia similibus curentur) as a fundamental healing principle. He believed that by inducing a disease through use of drugs, the artificial symptoms empowered the vital force to neutralise and expel the original disease and that this artificial disturbance would naturally subside when the dosing ceased."

To this day, nobody has proven that the law of similars actually works. Let's move on.

I sent two more replies in quick succession:

@jadetaylor38 Look harder. If you research properly you will find that meta-analysis of 'individualized homeopathy' exists.
jadetaylor38 Out of interest, are you aware of any blinded, randomised trials which you accept as evidence of homeopathy's efficacy?
I didn't expect to hear from her again. I was wrong. 3 days later:

@Rablenkov yes 1997 linde st al: meta analysis published in Lancet. UCL published revealing N,sensitivity and many other stats with very positive results. This is dramatically contrasted to (2005) trial where minimal information was published. One trial using homeopathy was on a study to show weight loss over a 48hr period. Of course that trial showed out of favour.
"No, no, no, no, no!", I bleated. "Please don't tell me she's quoting the 1997 study."

The meta-analysis published in 1997 by Linde, Clausius, Ramirez, Melchart, Eitel, Hedges and Jonas (details here) stated in its findings that "The combined odds ratio for the 89 studies entered into the main meta-analysis was 2.45 (95% CI 2.05, 2.93) in favour of homeopathy. The odds ratio for the 26 good-quality studies was 1.66 (1.33, 2.08), and that corrected for publication bias was 1.78 (1.03, 3.10). Four studies on the effects of a single remedy on seasonal allergies had a pooled odds ratio for ocular symptoms at 4 weeks of 2.03 (1.51, 2.74). Five studies on postoperative ileus had a pooled mean effect-size-difference of -0.22 standard deviations (95% CI -0.36, -0.09) for flatus, and -0.18 SDs (-0.33, -0.03) for stool (both p < style="font-style: italic;">
@jadetaylor38 Ah yes, that would be the same 1997 meta-analysis in which the final conclusion was "we found insufficient evidence from these studies that homoeopathy is clearly efficacious for any single clinical condition". In 1999 Linde clarified further in an article for the Journal of Clinical Epidemiology, "The evidence of bias weakens the findings of our original meta-analysis. Since we completed our literature search in 1995, a considerable number of new homeopathy trials have been published. The fact that a number of the new high-quality trials (e.g. [14,15]) have negative results, and a recent update of our review for the most “original” subtype of homeopathy (classical or individualized homeopathy, seem to confirm the finding that more rigorous trials have less-promising results. It seems, therefore, likely that our meta-analysis at least overestimated the effects of homeopathic treatments". Therefore, you cannot use the 1997 Linde meta-analysis as proof of homeopathy's efficacy.

It is a well-known tactic for homeopaths to quote the 1997 meta-analysis without referring to, or recognising, the 1999 clarification. I find this to be a rather unpleasant and dishonest manoeuvre.

So far, I have received no response and, in all honesty, I don't particularly care whether I do or not.

You see, this lady seems to be utterly convinced by homeopathy and will disregard any evidence to the contrary. You can guarantee that the study she quoted above used a very similar method to many others. She will willingly cite that study because it supports her case, then ignore the other, equally valid, meta-analyses because they don't support the fairytale she's invested so heavily in.

She will probably never understand that the greatest difference between science and homeopathy is that science grows, evolves, and adapts to change, while homeopathy will always stay the same, fighting its corner regardless of whatever evidence presents itself.

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