Bad Science: Homeopaths still misrepresenting the evidence

Following the World Health Organization’s (WHO) condemnation of homeopathy as a cure for all sorts of dangerous ailments, prominent homeopaths complained that the WHO did not take into consideration the “growing evidence-base” of their favorite pet “therapy”! Now, we are all well aware that the evidence base ranges from inconclusive meta-analyses, to damning systematic reviews, so how this is a “growing evidence-base” FOR homeopathy is beyond me…

Becoming more specific now, the Society of Homeopaths (SoH) has issued a press-release to defend homeopathy as an ailment for childhood diarrhoea, even thought they themselves raise cautionary flags over the promotion of their woo for such serious diseases as cancer, AIDS, and malaria. Here is what they had to say:

However, both the BBC and WHO have failed to acknowledge the evidence base for the use of homeopathy in the treatment of childhood diarrhoea in which, using randomised, double-blinded trials, the results were significant versus placebo(1).

And let’s please all remember once again the spot-on comment by Paula Ross, the SoH’s Chief Executive (yeah!):

this is just another poorly wrapped attempt to discredit homeopathy by Sense About Science. The irony is that in their efforts to promote evidence in medicine, they have failed to do their own homework. There is a strong and growing evidence base for homeopathy and most notably, this also includes childhood diarrhoea

To the science then! The SoH have produced three references, all of them from Jacobs et al, on the effectiveness of homeopathic remedies for the treatment of diarrhoea:

Treatment of acute childhood diarrhoea in Nicaragua

This trial involved 81 children aged from 6 months to 5 years in a randomised, double-blind trial of intravenous fluids plus placebo versus intravenous fluids plus homeopathic remedy individualised to the patient. The treatment group had a statistically significant decrease in duration of diarrhoea.

Jacobs J. Treatment of acute childhood diarrhoea with homeopathic medicine: a randomized clinical trial in Nicaragua. Pediatrics 1994; 93: 719-725.

Treatment of acute childhood diarrhoea, repeated in Nepal

In a replication of a trial carried out in Nicaragua in 1994, 116 Nepalese children aged 6 months to 5 years suffering from diarrhoea were given an individualised homoeopathic medicine or placebo. Treatment by homoeopathy showed a significant improvement in the condition in comparison to placebo.

Jacobs J., Jimenez M., Malthouse S., Chapman E., Crothers D., Masuk M., Jonas W.B., Acute Childhood Diarrhoea- A Replication., Journal of Alternative and Complementary Medicine, 6, 2000, 131-139.

A meta-analysis of childhood diarrhoea trials

This meta-analysis of 242 children showed a highly significant result in the duration of childhood diarrhoea (P=0.008). It should be noted that the World Health Organisation consider childhood diarrhoea to be the number one public health problem today because of the millions of children who die every year from dehydration from diarrhoea.

J. Jacobs, WB Jonas, M Jimenez-Perez, D Crothers, Homeopathy for Childhood Diarrhea: Combined Results and Meta-analysis from Three Randomized, Controlled Clinical Trials

Oh heavens! Homeopathy does work after all! At least for diarrhoea that is… Unless… hmmm. Could it be, perhaps, just maybe, that homeopaths have once again used their favorite practises? Namely, cherry picking and misrepresentation of evidence?

The quack-buster this time is long-time expert on quack dissections: Andy Lewis. Andy has shred to pieces the society’s claims, and so with kind permission (which I haven’t got but I assume that he would be kind enough so as to grant me that permission) I reproduce the juice of his revealing post here:

Let’s be a little bit more comprehensive. The Society have cherry picked their studies and failed to acknowledge the sticking points.

Here are all the trials published on childhood diarrhoea and homeopathy, including the ones the Society failed to mention.

1. Jacobs J, Jimenez LM, Gloyd SS, et al. Treatment of acute childhood diarrhea with homeopathic medicine: a randomized clinical trial in Nicaragua. Pediatrics. 1994;93:719–725.

2. Jacobs J, Jimenez LM, Malthouse S, et al. Homeopathic treatment of acute childhood diarrhea: results from a clinical trial in Nepal. J Altern Complement Med. 2000;6:131–139.

3. Jacobs J, Jimenez LM, Gloyd SS, et al. Homeopathic treatment of acute childhood diarrhea: a randomized clinical trial in Nicaragua. Br Homeopath J. 1993;82:83–86.

4. Jacobs J, Guthrie BL, Montes GA et al. Homeopathic combination remedy in the treatment of acute childhood diarrhea in honduras. J Altern Complement Med. 2006;12:723-32.

The obvious thing is that they have all been done by the same author. So, an alarm bell should ring that these studies have not been independently replicated.

The first of these studies was perhaps the most important, being published in a real journal, and not a CAM comic, and showing a ‘significant’ effect. The next issue of the journal contained a rather damning critique, [in which] they concluded,

“In summary: 1) The study used an unreliable and unproved diagnostic and therapeutic scheme; 2)There was no control for product adulteration; 3)Treatment selection was arbitrary; 4) The data were placed into odd groupings without explanation, and contained errors and unexplained inconsistencies; 5) The results were not clinically significant and were probably not statistically significant; 6) There was no public health significance; 7) Selection of references was incomplete and biased to support the claims of the article, and references were quoted inaccurately; and 8 ) Editorializations were inappropriate.”

When Jacobs did her own metaanalysis of the first three trials she acknowledged the lack of statistical power in these studies and recommended larger trials. She did the fourth larger trial (which was also of better quality) and surprise surprise,

The homeopathic combination therapy tested in this study did not significantly reduce the duration or severity of acute diarrhea in Honduran children.

The result of this careful study was that the homeopathic treatment was no better than a placebo.

That explains a lot. Same old practises: cherry picking the trials which confirm (borderline) their pet therapy; ignoring the major flaws and expert deconstructions; even ignoring the same authors’ subsequent research of better methodology because it is damning!

One thing is for sure and became evident once more here: homeopaths cannot and should not be trusted.