Spot The Difference?

November 21st, 2005 by Ben Goldacre in bad science, bbc, homeopathy, media | 108 Comments »

Here’s an interesting exercise. For once, the actual academic paper behind a news story is available for free online…

www.liebertonline.com/doi/pdf/10.1089/acm.2005.11.793

Which means you can see for yourself whether the media are representing it fairly, in realt time, as it grows…

news.bbc.co.uk/1/hi/england/bristol/4454856.stm

www.bbc.co.uk/radio4/today/listenagain/ram/today5_homeopathic_20051121.ram

The study basically asks people how happy they are after having some homeopathy. The first thing that strikes you about their methods is that there is no control group to compare with, so it’s quite possible that everyone is just getting better naturally, at the same speed that they would have anyway.

This is particularly likely in view of the fact that they have chosen some rather self limiting or cyclical conditions: the symptoms of the menopause, for example, for most people, will get better over time by themselves. It’s a bit like congatulating yourself for showing that bruises heal, or night follows day.

What’s also interesting here is how some knowledge of stats has bled through into the mainstream, but only certain ideas. So, for example, people have latched onto the notion that bigger studies sometimes have greater power to detect a difference between two groups, but also now seem to think that this is the be-all-and-end-all of critical appraisal, and the most important feature of any study. Hence the size of the study is emphasised in the press release for this paper.

Anyway, lots of nerdy stuff to chew on, I’m looking forward to seeing what the rest of the press makes of this study.


++++++++++++++++++++++++++++++++++++++++++
If you like what I do, and you want me to do more, you can: buy my books Bad Science and Bad Pharma, give them to your friends, put them on your reading list, employ me to do a talk, or tweet this article to your friends. Thanks! ++++++++++++++++++++++++++++++++++++++++++

108 Responses



  1. Ben Goldacre said,

    November 21, 2005 at 12:46 pm

    Here’s the press release by the way, in the name of transparency…

    PRESS RELEASE
    EMBARGOED UNTIL: 09.00 Monday 21 November

    Largest ever NHS homeopathic hospital study shows significant
    improvements in 70% of patients treated with homeopathy

    The results of a six-year study at Bristol Homeopathic Hospital (part of
    United Bristol Healthcare NHS Trust) show that over 70% of patients with chronic
    diseases reported positive health changes after homeopathic treatment.

    Over 6,500 consecutive patients took part in the study, published in the
    latest issue of the international, peer-reviewed Journal of Alternative and
    Complementary Medicine. A wide range of chronic diseases were treated
    including eczema, asthma, migraine, irritable bowel syndrome, menopause,
    arthritis, depression and chronic fatigue syndrome. The most marked
    improvements were seen in children – 89% of under 16s with asthma reported
    improvement and 75% felt ‘better’ or ‘much better’, as did 68% of eczema
    patients under 16.

    Dr David Spence, Clinical Director and Consultant Physician at Bristol
    Homeopathic Hospital and Chairman of the British Homeopathic Association, a
    co-author of the study, says: “These results clearly demonstrate the value
    of homeopathy in the NHS. This is a very large number of patients with conditions
    that are difficult to treat successfully with conventional medicine.

    “One of the criticisms levelled at homeopathy is that it only works because
    of the length of the consultation. But in fact the appointment times at
    Bristol Homeopathic Hospital are very similar to those for other specialties
    at United Bristol Healthcare NHS Trust such as rheumatology, neurology and
    respiratory medicine and are substantially less than for psychiatry.”

    All the patients were referred by their GP or hospital specialist and many
    had tried conventional treatment first without success. Commenting on the
    study, the Editor-in-Chief of the Journal of Alternative and Complementary
    Medicine, Dr Kim Jobst said: “These are response rates with which any
    orthodox NHS medical health provider or pharmaceutical company would be
    justly pleased.”

    The study, which is the largest consecutive homeopathic clinical series ever
    reported, echoes findings from Tunbridge Wells Homeopathic Hospital in 2000,
    where 74% of 1372 patients reported a positive result from homeopathic
    treatment, and similarly at Liverpool Department of Homeopathic Medicine in
    2001, where 76% of 1100 patients reported an improvement of their
    condition.

    Sally Penrose, Chief Executive of the British Homeopathic Association and
    Faculty of Homeopathy said: “This study gives a powerful and convincing
    picture of homeopathy in the real world, which is what matters to patients,
    and is an important addition to the debate about the rightful place of
    homeopathy in the NHS. Homeopathy has been part of the NHS since
    1948 and we want to see more patients being given the opportunity to
    benefit from homeopathy when appropriate.”

    Notes to editors

    The Bristol paper: Homeopathic Treatment for Chronic Disease: A 6-Year,
    University-Hospital Outpatient Observational Study: Dr D S Spence, Dr E A Thompson
    and S J Barron. J. Altern. Complement. Med. 2005; 11#5: 793-398 and
    www.liebertpub.com/acm

    Tunbridge Wells and Liverpool studies both published in British Homeopathic Journal

    Homeopathy on the NHS
    Homeopathy has been practised by doctors in the UK since the early 1840s and
    is the only complementary therapy to have been included in the NHS since its
    inception over 50 years ago. Bristol Homeopathic Hospital, like the other
    NHS homeopathic hospitals in London, Tunbridge Wells, Liverpool and Glasgow,
    is staffed by doctors who have trained and qualified in homeopathy.

    The Faculty of Homeopathy
    The Faculty of Homeopathy was incorporated by Act of Parliament in 1950 to
    provide education and training in homeopathy for statutorily regulated
    healthcare professionals. The Faculty’s membership includes doctors, vets,
    dentists, nurses, pharmacists, podiatrists and a number of other healthcare
    professionals who integrate homeopathy into their practice.

    The British Homeopathic Association
    The British Homeopathic Association (BHA) is a registered charity, which
    aims to ensure high-quality homeopathy is an integral part of general and
    specialist health care. The BHA works towards this goal by providing
    information to the public, promoting access to treatment and supporting the
    homeopathic education of health care professionals and research. A list of
    health care professionals qualified in homeopathy can be obtained by calling
    ############## www.trusthomeopathy.org

    Journal of Alternative and Complementary Medicine
    In addition to the observational study at Bristol Homeopathic Hospital, this
    issue of the Journal of Alternative and Complementary Medicine includes new
    clinical and basic science research papers as well as hypothesis and
    editorial material in a special issue dedicated to homeopathy. All articles
    are available free online from: www.liebertpub.com/acm

    - ends -

    For further information, case studies of patients treated at Bristol Homeopathic Hospital or to interview the report’s authors Dr David Spence orDr Elizabeth Thompson, please contact:

    Elinor Adams, United Bristol Healthcare NHS Trust (which runs Bristol Homeopathic Hospital) on ##############

    Sarah Buckingham, BHA and Faculty of Homeopathy, on ##############or (out of hours)
    ##############or email: ##############

    To interview Dr Kim Jobst, Editor of the Journal of Complementary and
    Alternative Medicine please contact: ##############

  2. Mathew said,

    November 21, 2005 at 12:54 pm

    I love it! The website is trust homeopathy. i.e. in the absence of strictly controlled studies or any clear scientific mechanism by which we could see how homeopathy can possibly work, what are we left with? Trust. Please trust us, we’re nice people. Homeopathy does work. Honestly.

  3. Ben Goldacre said,

    November 21, 2005 at 12:56 pm

    Oh, and lastly, er, “class”, the great Trisha Greenhalgh and her seminal series “How To Read A Paper” remain the best resource for learning how to pull apart published research, available in book form on amazon, “How to Read a Paper: The Basics of Evidence-Based Medicine“or free PDF download here:

    bmj.bmjjournals.com/collections/read.shtml

  4. Paul said,

    November 21, 2005 at 1:42 pm

    Interesting that the BMJ teaches us how to read and pull apart research.
    If you go here:

    bmj.bmjjournals.com/cgi/content/full/330/7501/0-g

    you’ll see comments by one of the editors on a long and rather misguided article about why we shouldn’t subject studies of acupuncture to the rigours of properly controlled trials. The editor comments that
    “…Acupuncture is interwoven with so called non-specific factors, such as talking and listening, which are in fact part of the therapeutic relationship. The process of diagnosis is also hard to separate from the therapy, emerging as it does throughout treatment rather than being an isolated preceding event. The fact that these non-specific but probably therapeutic elements are usually in both arms of trials explains (to my satisfaction at least) the otherwise puzzling fact that, despite its long history and widespread use, acupuncture has never found convincing support from RCTs. ”

    She goes on to state that, with such rich and complex therapies, randomised controlled trials are too simplistic. This is the BMJ remember, a bastion of medical science.

    So we have some journals happy to publish non-controlled studies, and others, which should know better, counselling that RCTs are too simplistic to capture the full beauty of the complementary approach.

    Despair ye

  5. amoebic vodka said,

    November 21, 2005 at 1:48 pm

    nooo… we tried, we really did (and if we’d been 20 minutes later we might have given up). At least we now know where the paper is so we can read it. Oh, and we don’t need the hats. Yay.

    We though the idea of a control in an experiment was part of the curriculum for year 7 science?

  6. Tessa K said,

    November 21, 2005 at 1:48 pm

    Excema, asthma, migraine, IBS, menopause, arthritis, depression and chronic fatigue syndrome. So homeopathy isn’t claiming to be a cure, just a temporary relief? Was there any follow-up on the patients to find out how long the effect lasted?

    Someone might like to explain to the patients that there is a difference between feeling better and being better. You could cheer up a cancer patient with a nice massage but it isn’t going to help them long-term. A bar of chocolate, glass of wine or episode of a good sitcom would do the same. Can I get Bilko or The Larry Sanders Show on prescription? After all, laughter is the best medicine.

  7. Ben Goldacre said,

    November 21, 2005 at 2:07 pm

    I disagree, think it would be a useful finding that people felt better. But not if they were going to feel better anyway. We need experiments that can tell us if homeopathy makes people feel betterer, not better.

  8. ChrisH said,

    November 21, 2005 at 2:29 pm

    my favourite bit is the way the authors have stuck every letter after their name they could think of…

    yours in Science
    Dr Chris Harrod, PhD, BSc, MIFM etc etc

  9. Nick A said,

    November 21, 2005 at 2:47 pm

    I liked that fact that there is no comparison of a recorded baseline measure with the follow-up. So it is left to the patient to recall how bad they felt to start with and do the sums themselves, so to speak.

    And how were people selected into the study? Presumably most subjects already had some degree of belief in the possible efficacy of homeopathy, which would probably predispose them to giving a favourable reply to the follow up questions.

    Scandalous.

  10. RS said,

    November 21, 2005 at 2:47 pm

    Funny that despite being “12 different physicians, all medically qualified for at least 15 years” they had no concept of separating out the outcome scoring from the treatment. Essentially the ‘doctors’ at the hospital were asked to rate whether their patients got better, funnily enough they thought that they did. Science in action.

  11. RS said,

    November 21, 2005 at 2:54 pm

    Hey, three quarters of patients with cancer got better, and only 10% got worse!

  12. Alex B said,

    November 21, 2005 at 2:55 pm

    “The study basically asks people how happy they are after having some homeopathy”

    this basically reminds me of a-level psychology. for experiments where you are asking people how they feel, what they think, stuff like that you often find that the experimenter oftens gets the answers they want and the person being interviewed gives the answers they think the experimenter wants.

    how can a serious scientist have performed this study? the main problem with homeopathy is that the therapy acts as a placebo, so they then just give evidence that the therapy results in people feeling slightly better…. where is the science there? where is the comparison to people getting no help, to people being given a placebo like therapy, to people getting genuine medical help?

    its just irritable, the need for people to believe in something ridiculous rather than use their powers of reason to see that disease is best dealt with using medicine (obviously talk based therapies are useful when it comes to illness possibly related to mental health)

  13. RS said,

    November 21, 2005 at 3:23 pm

    “Some recent studies11,12 of homeopathic treatment in specific conditions have suggested a lack of efficacy, but the design of these studies has been flawed13,14 and therefore the results cannot be regarded as reliable.

    13. Richardson J, Hughes-Games J, Lewith G, et al. Homeopathic
    Arnica [letter to the editor]. J R Soc Med 2003; 96:204–207.”

    I just had a look at these references to have a see what the flaws were, and came across this:

    “The paper by Stevinson and co-workers (February 2003 JRSM1) suggests that people undergoing carpal tunnel surgery are not helped by homeopathic arnica. The authors themselves describe the study as preliminary, and it has several important methodological flaws. To begin with, they failed to carry out a power calculation before conducting the research. They suggest that there were no reliable data on which to base a formal sample size calculation. However, they could have used the data from this pilot study to calculate a post-hoc power analysis in order to establish the robustness of their conclusions and determine the appropriate sample size for a full study.”

    This is an example of bad science that is a bit more sophisticated than the usual so I thought it’d be instructive to consider it. Lots of scientists fall into this trap, but post-hoc power analyses are not only meaningless but misleading. This is because if you test for the power of a negative study, using the actual effect size, the study will seem underpowered – and of course it will – the study was not significant. Once you’ve done the study you can look at the confidence intervals to see how strongly negative your study is (I don’t think they presented them in this study because it used non-parametric tests). A power analysis is only done a priori, and is used to estimate how many subjects you’ll need to obtain a significant result for the effect size you predict, or regard as the minimum meaningful or interesting effect size. I suppose you could do a post hoc power analysis if you had to, but you certainly wouldn’t use the actual effect size, you’d make a number needed to treat or similar estimate. Otherwise, by this reasoning, no study could ever be considered to be negative, because it would always be underpowered.

  14. Aidan said,

    November 21, 2005 at 3:37 pm

    The BBC article says that one finding contradicted another.
    - One found 70% of patients said they felt better.
    - The other found that homeopathy was indistinguishable from a placebo.

    Surely those aren’t contradictory. Placebos (as far as I know), have been found to be quite effective, particularly in making the patient feel better about their illness.

    This recent study doesn’t test homeopathy against a control group who used a placebo (and wouldn’t that be easy to test with homeopathy – unlike for example, a heart bypass), so it neither contradicts nor confirms it.

  15. Stephen said,

    November 21, 2005 at 3:54 pm

    I’m sorry but this paper just shouldn’t have been published without a control. Its meaningless.

    I know that you often have a pop at humanities graduates– personally though I hate fucking doctors. They shouldn’t be allowed near scientific journals. Most of them are arse/elbow ambiguous.

  16. GWO said,

    November 21, 2005 at 4:20 pm

    I’m sorry but this paper just shouldn’t have been published without a control. Its meaningless.

    Consider the source. Do you really think the Journal Of Complementary and Alternative Medicine is likely to insist on strictly controlled trials? I’d imagine it’d be a pretty thin publication if it did.

  17. Edward Bozzard said,

    November 21, 2005 at 4:24 pm

    Just found this on the BBC website, in the talkback section, in a story relating to Spontaneous Human Combustion – Clearly Bad Science is indemic..

    news.bbc.co.uk/1/hi/magazine/4456428.stm

    “When this topic pops up in the public domain, I often wonder if cell division in the human body might be responsible as a source of ignition. My theory runs like this if heat is created when cells divide, is it not possible that a freak occurrence of cells dividing simultaneously might create enough to burn ? Probably complete hokum but food for thought. “

  18. Stephen said,

    November 21, 2005 at 4:39 pm

    Consider the source. Do you really think the Journal Of Complementary and Alternative Medicine is likely to insist on strictly controlled trials? I’d imagine it’d be a pretty thin publication if it did.

    Well unfortunately it is listed on Pubmed. What sort of referee would pass this?

  19. RS said,

    November 21, 2005 at 5:52 pm

    “Methodologic issues for improving the quality of clinical trials to evaluate homeopathy in the treatment of chronic diseases include the need for more observational data from real-world homeopathic practice. Selection of outcome
    measures must also reflect the real-world circumstances.
    Outcomes of importance to patients must be the primary concern of clinicians, and both specific and nonspecific outcome measures with lengthy follow-up are needed to encompass this adequately”

    Right-on-sister. Who says patients want their cancers to respond to treatment? We reject your so called objective measures of morbidity and mortality. We all know that in today’s touchy-feely health service all we need to do is make them feel better while they slowly die.

  20. Alex B said,

    November 21, 2005 at 6:19 pm

    well i dare say the referee(‘s) who reviewed it is a homeopathy nutjob as well

  21. RS said,

    November 21, 2005 at 6:30 pm

    And as those of us with experience in science know, if you are producing the result or message your reviewers want they’ll be much less critical.

  22. John A said,

    November 21, 2005 at 8:02 pm

    Arrrrrg! This study certainly does not show us the usefulness of homeopathic medicine in ordinary everyday clinical practice. However it does illustrate the problem. If you are a GP and have a difficult group of patients (Spence) send them to a homeopathic hospital. It might just stop them coming back and you don’t have to lie to them. Secondly if even a Dr (Spence) can misattribute the health gain patients obviously will to. How do you engage in a campaign to stop the NHS funding of homeopathy without putting extra strain on GPs? And how do you sugar-coat the message that the homeopathic-treatment-using public is poorly informed and (therefore understandably) mistaken? I don’t think that’s a message of which they are particularly receptive.

  23. John A said,

    November 21, 2005 at 8:03 pm

    Sorry the >q< tag isn’t working. “the usefulness of homeopathic medicine in ordinary everyday clinical practice” and “difficult group of patients” should have been in quotes (both from Spence).

  24. Morag said,

    November 21, 2005 at 9:53 pm

    I’m sorry, but the thing that bugs me about this is the sheer dishonesty. I’m quite sure Dr. Spence knows just as well as the rest of us why this “study” isn’t worth the paper it’s written on. He knows perfectly well what trials need to be run to determine whether the magic sugar pills actually have any physiological effect or not. The problem is that this isn’t what he wants to achieve.

    The clear purpose of this and similar exercises from Tunbridge Wells and Liverpool and Glasgow is not to examine whether the diluting and succussing does anything magic to the water, it’s to get the headlines that they’ve evidently succeeded in getting. According to the BBC, this “contradicts” the Lancet study from August. Does’t matter whether it does or not, every homoeopath who has an axe to grind now has a sound-bite to smack down any mark who might have heard of the latter episode. The dishonesty of the whole exercise simply sickens me.

    Peer reviewed? Of course it was. Reviewed by equals. That is, by other committed homoeopaths. Wow.

    And as for “trusthomeopathy.org” – have you been through their “research” pages? On “comprehensive meta-analyses of clinical trials in homeopathy”, only the 1997 Linde et al paper is mentioned – not a word of the ten or so papers that have re-analysed the same data and come to the opposite conclusion (two of these actually by the original authors!), or any of the four reviews published since 2000, all of which come to a resounding negative, or the fact that virtually every review has found that the better the design of a study, the more likely it is to show no effect.

    And the next page? “Clinical research in homeopathy with positive findings.” Well, at least they’re upfront about their bias! But gosh, they only have five papers to cite! And when you look at these, they’re frankly pathetic – small, low-power preliminary trials, or questionable controls (a homoeopathic back rub is just as effective as a non-homoeopathic back rub for example), and the last of the five is actually a negative result that seems to have snuck in by accident.

    And this is “trusthomeopathy”, published by the medical doctors who make up the Faculty of Homoeopathy. The desperation to cobble together a case that looks good is palpable, unfortunately, there will no doubt be people who will “trust” this lot implicitly.

    Sorry, I digress. Bristol.

    Prof. Egger had it right of course. “Patients were simply asked by their homeopathic doctor whether they felt better, and it is well known that in this situation many patients will come up with the answer the doctor wants to hear.”

    That’s how you get a headline showing that 89% of your childhood asthma patients have improved. (Oops, but only about 67% actually felt “better, or much better”.) As opposed to the actual blinded and controlled trial of what (as far as I can tell) was exactly the same exercise on an identical group of patients.
    thorax.bmjjournals.com/cgi/content/abstract/58/4/317
    “The main outcome measure was the active quality of living subscale of the Childhood Asthma Questionnaire administered at baseline and follow up at 12 months. Other outcome measures included other subscales of the same questionnaire, peak flow rates, use of medication, symptom scores, days off school, asthma events, global assessment of change, and adverse reactions.”

    And, dearie me, the conclusion of this trial, which actually measured things that could be objectively measured, and compared the magic-sugar-pill-taking group to a group who got the same therapeutic consultation and non-magic-sugar-pills?
    “This study provides no evidence that adjunctive homeopathic remedies, as prescribed by experienced homeopathic practitioners, are superior to placebo in improving the quality of life of children with mild to moderate asthma in addition to conventional treatment in primary care.”

    But are any of the news outlets actually going to mention that one? And if they do, will they then decide that the new study “contradicts” it?

    Sorry, I’m blathering. But the hypocrisy and (sorry to say it again) blatant dishonesty that is coming out of the medical community in an attempt to shore up this house of cards simply make me see a nasty shade of fluorescent scarlet.

  25. Kadin said,

    November 21, 2005 at 10:17 pm

    Ben, I wonder if you have heard of this. It’s worse than bad science being done by reporters. It’s bad science being done by politicians.

  26. Caradog said,

    November 22, 2005 at 9:34 am

    Kadin,

    I’m not a scientist by any interpretation of the term so I’m open to be criticised, but I can’t see how the link is evidence of Bad science. You may not like the fact that politicians want to abolish animal testing, but they do have the democratic right to abolish it if they want to. The position may be anti-science (which is arguable), but I wouldn’t call it bad science. Politicians aren’t saying ‘by waving hands over a rabbit and feeling their life-energy, we can determine how effective these drugs are, much better than any ‘evidence’ that Western Science can produce’. They’re just saying that the practice of animal testing is unethical.

    If you’re going to argue that anything which limits science is bad science then medical ethics goes out of the window. Scientists here can correct me if I’m wrong, but I think I can safely say that most scientists don’t consider Josef Mengele as their poster-boy.

  27. stevemosby said,

    November 22, 2005 at 9:51 am

    Caradog –

    I agree with you to an extent, but there are also comparisons in some ways. Although the anti-vivisection movement does rely heavily on ethical arguments, it also presents a number of scientific arguments that sound convincing on the surface but generally aren’t very sensible or informed when you delve deeper. So there is that similarity – of science being twisted and used as a voice of authority to lend credence and support. But that whole subject is a great big can of worms. :-)

  28. Ian said,

    November 22, 2005 at 10:22 am

    I know it’s not relevant to this part of the discussion, but as far as alternative/complementary treatments are concerned… chiropractic as a preventative treatment for children – can anyone point me in the direction of anything useful? Most of what I’ve found has been overwhelmingly positive (from chiropractors) or overwhelmingly negative (mostly US-based groups).

    Would appreciate any pointers – am trying to get to grips with PubMed for the first time!

  29. Morag said,

    November 22, 2005 at 11:16 am

    Couldn’t you take these questions to a general forum? I was rather enjoying the discussion of the Bristol survey, and it seems to be getting horribly derailed.

  30. Kumar said,

    November 22, 2005 at 11:26 am

    Hello,

    I think few aspects were not thought in considering & commenting on studies on homeopathy…may also be on other alt. systems.

    1.The Adjunctive study’s Effect. Studies are usually done as Adjunctive studies i.e. both conventional treatments/medicines were given along with homeopathic remedies. The problem in studying in this manner may be a compulsion , may be due to current belief & legal status. Who will/can take the chance? As a result, stronger & faster effects of conventional medicine can overpower or supress comparatively lighter and slower effects by homeopathic remedies. However, whatever if left with this effect, may be indicative, but can be variables. The story can be bit different on exclusive treatment by homeopathic remedies at their home, where some emotional/belief effects may also add something more. Prople treating may have some fear/other thoughts under modern environment at Con. system’s home.

    2. Repoting Bias: These may or may not play some role. Few liked systems as per convention, can be seen & reported at the minimum level, wheras other unliked, non-conventional can be seen & repoted by looking at higher/highest levels of tests.

    3. Effect tyes: Homeopathic effects are said/thought/claimed by homeopaths as gentle, softer, slow but deep & long term. So these can’t be compared with conventional medicine’s real effects+side/adverse effects which can be stroger & faster.

    4. Conventional vs. Alternative: Other systems as homeopathy, are treated as alternative somewhat alike back bencher. How can compare these similar to conventional system in everything as most means, attention, popularity & work power might have alloted to conventional system….as convention by the authorities. Look at Germany for…., they looked to have given some more attention to homeopathy.

    I submit these comments in good & unbiased sense, as non-technical thoughts–so may not be taken as final/firm. To be justified or not , may be in one’s hand, naturally may not be socially. Best Wishes. Kumar

  31. Morag said,

    November 22, 2005 at 11:40 am

    Sorry, what was that you were saying about animal experimentation and chiropractic?

  32. Bob said,

    November 22, 2005 at 11:59 am

    There were other problems with this:
    a) Lack of a control group (already spotted).
    b) No follow up of dropouts (i.e. the respondents self-selected).
    c) No randomisation or blinding (already spotted)
    d) The outcome measure was not calibrated or universally recognised.
    e) No control of whether patients were receiving other (i.e. conventional) treatment.
    These flaws mean that the study itself would fail at the first hurdle in a critical review.
    Without going into too much detail, the outcome measure is a very important aspect of trial design. The measure they used had not been validated for the type of trial they have done. Check out www.sf-36.org for something that would carry some weight.

  33. John Jackson said,

    November 22, 2005 at 12:42 pm

    I agree with Morag’s analysis here.

    When looking at studies like the Bristol one, it’s easy to tear into it and criticise its lack of scientific rigour. I do think though, that we really need to understand the true purpose of the study.

    Its true purpose is not to provide scientific evidence that homeopathy works; it is to provide publicity, and get the message across to a largely scientifically illiterate public that “homeopathy works”.

    The real problem, as I see it, is the credulous reporting of studies such as this one. The story has been reported as if it is highly significant, and then a few criticisms are allowed in later. How does such a blatantly flawed study get past a science editor in the first place?

    The end result will be that the message “homeopathy works” is all that will get through to most readers; and this will continue as long as organisations like the BBC allow themselves to be dupes.

  34. Michael P said,

    November 22, 2005 at 1:51 pm

    “How does such a blatantly flawed study get past a science editor in the first place?”

    I’m beginning to doubt that the BBC has a science editor.

  35. Elmer Phudd, Phrenologist to The Elephant Man said,

    November 22, 2005 at 2:54 pm

    Great comments Ben.

    stevemosby said: “science being twisted and used as a voice of authority to lend credence and support.”

    Ha! Yeah, intelligent design anyone?

    If we show that the placebo effect of alt. therapies are betterer than just sitting in bed watching daytime TV, and we assume that the sociological connotations of having a fully-garbed witch doctor drip goat semen on your head makes it a twice-more effective remedy than Trisha, then is it therefore better for the health of the population if the NHS/Government/The Man supports this Santa Claus? I suppose the problem lies in increasing numbers of patients refusing to take proper meds because of those few accounts where the proper meds didn’t work any better than the placebo.

    Rather than wait for the offshots of the haplotype mapping project to lead to better individual-specific drugs, I reckon proper GP’s and the like should start wearing monkey bone jewelry and hide their drugs in a scrotum. So long as the proponents of these therapies continue to rape and pervert the reality of their surroundings with twisted science, the only way is to muscle in on their market, surely!

  36. BSM said,

    November 22, 2005 at 2:55 pm

    I’d like to echo what Morag said and emphasise just how despicable I find it that the homs resort to PR exercises like this and pretend they are science. The worst of it is that I am sure they are doing this knowingly- this survey has so carfeully skirted round any acceptable methods of applying proper controls it cannot have occurred by accident or ignorance.

    To put an optimistic gloss on this, it is basically an admission of defeat. They know they can’t prove they offer anything more than a placebo so they must dress up that effect as much as possible.

    As vets, one of the reasons some of us are trying so hard to remove the tacit acceptance of this nonsense by our profession is that there is no way that you can dress up the placebo effect and portray it as a benefit to an animal.

  37. Ron Zeno said,

    November 22, 2005 at 4:38 pm

    The entire journal is available free: www.liebertonline.com/toc/acm/11/5 There are related editorials, papers on “The Homeopathy Debate”, and research papers, of which this study is one. I’ve only read the abstracts of the research papers so far, but I’m unimpressed with the journal.

  38. Ron Zeno said,

    November 22, 2005 at 8:34 pm

    I’ve now read through as much of the journal as I care to, at least until I have further reason to do. While there are some interesting perspectives, and possibly even some good research, most appears to be desperately biased.

  39. Ben Goldacre said,

    November 22, 2005 at 11:42 pm

    Am I right in thinking everybody sensibly ignored this story except the BBC?

  40. Kadin said,

    November 23, 2005 at 5:05 am

    Caradog,

    The Wikipedia article ‘Junk science’ (redirected from ‘Bad science’) defines it as “a pejorative term used to derogate purportedly scientific data, research, analyses or claims which are driven by perceived political, financial or other questionable motives.” Promising to eliminate animal testing makes the implicit (scientific) claim that there are no benefits to animal research, or that any benefits are outweighed by ethical issues. While there have been regrettable instances of testing in the past (and possibly today), either claim is untrue (unless one has, in my opinion, a grossly distorted set of ethics, or a gross misunderstanding of animal testing procedure and requirement). This has been done purely for political reasons. From this, I would conclude that the promise counts as ‘bad science’.

  41. Michael P said,

    November 23, 2005 at 8:58 am

    I think so Ben. I’ve just had to re-read the BBC bit to remind me. After they more or less said that this disproved the Lancet study, they at least bothered to get a comment from Matthias Egger. But the article definetely leans to homeopathy with the title “New study is boost to homeopathy”, and the first paragraph more or less says that it was a good treatment for these chronic conditions – “A six-year study at Bristol Homeopathic Hospital shows over 70% of patients with chronic diseases reported positive health changes after treatment.” But of course, there was no treatment.

    Whoever wrote the piece clearly didn’t read the paper.

  42. Caradog said,

    November 23, 2005 at 9:52 am

    Kadin,

    Thanks for the reply. I think the wikipedia definition is a bad one. On that basis, all research done by pharma companies is junk (or bad) science due to it’s financial motives, and that the nuclear bomb was also bad science because it was done for political reasons.

    You may dislike the political economy of science (which regards impotence as more important than malaria for example) and you may be opposed to nuclear weapons – both on ethical or political grounds, but it’s not bad science to be either for or against. I’d define Bad Science as assertions (I hestiate to use the word ‘work’ in this context) which are based on deeply flawed research methodology. The fact that others, particularly the media, are happy to lap this up and promote it is a crucial part of this phenomenon. The article you mentioned merely showed politicians stating their ethical poistions. They were not claiming that their scientific knowledge was superior or equal to scientists.

    You believe that the ethical benefits gained from animal testing outweigh the ethical downsides. Fair enough, but that is a ethical/political judgement (which politicians have a right – perhaps a duty – to hold), not a scientific one (which scientifically unqualified politicians do not have a right to hold, or at least do not have a right to have it considered valid).

    Then I’m again, I’m just a flaky humanities graduate, so what do I know. Perhaps Ben can settle the arguement one way or the other. Is Bad science all about work based rubbish methodology which claims to be scientifically valid, and the media promoting rubbish methodology as valid when it patently isn’t, or does it also include those who believe it that in a few cases scientific research should be limited on ethical grounds

  43. Ben Goldacre said,

    November 23, 2005 at 11:00 am

    I’d define Bad Science as assertions (I hestiate to use the word ‘work’ in this context) which are based on deeply flawed research methodology.

    I’d also include, perhaps higher on the shit list: assertions that are based on deeply flawed interpretations of perfectly good research.

    For example: Michael van Straten says there is evidence that X is clinically effective for Y, but the only published research is speculative lab experiments, and no clinical data. Those lab data papers are still perfectly good studies for what they are, but they do not show what the alternative therapist claims they show.

    Likewise, when The Times says “One of Britain’s most widely prescribed antidepressants has been linked to a seven-fold increase in suicide attempts” but the academic paper to which they refer simply does not show that, the research methodology of the paper to which they refer is still, obviously, perfectly good, but their interpretation of it is (shamefully, ridiculously, loopily) wrong.

  44. Paul said,

    November 23, 2005 at 1:03 pm

    I agree with Ben’s suggestion that the essence of Bad Science lies in unjustified assertions. No single observation that we make can be bad science, whether it is part of a randomised placebo-controlled trial or not. It is in the conclusions and assertions that bad science really rears its head.

    With this in mind, and thinking particularly of dear Melanie, I think that Bertrand Russlell had two things to say that get close to the core of the problem

    “A stupid man’s report of what a clever man says can never be accurate, because he unconciously translates what he hears into something he can understand.”
    and
    “If a man is offered a fact which goes against his instincts, he will scrutinize it closely, and unless the evidence is overwhelming, he will refuse to believe it. If, on the other hand, he is offered something which affords a reason for acting in accordance to his instincts, he will accept it even on the slightest evidence. The origin of myths is explained in this way.”

    Perhaps the origin of bad science is also explained in this way

  45. Teek said,

    November 23, 2005 at 2:34 pm

    Paul, as ever Bertrand Russell puts things that we’re all thinking into words more eloquent than we could ever muster…!!

    the key to Bad Science is indeed a “stupid man” reporting ” a “clever man’s” findings, which fit Ben’s definition of “assertions that are based on deeply flawed interpretations of perfectly good research.”
    but sometimes it can be more than that. the supposedly “clever man” can oversimplify, overstate, exxagerate or downplay his own work too, making his assertions into Bad Science. take our favourite gastroenterologist and every tabloid newspaper’s friend, Andrew Wakefield. He made assertions, in public and in very graphic tones, that simply don’t fit with his own findings. that isn’t just Bad Science, it’s Bollocks Science.

    people are always spinning, mis-interpreting and sensationalising scientific findings – not just the media, which would be akin to the first Russell quote that Paul cited, but scientists and clinicians themselves, closer to the second quote.

    unless both sides put an end to this, the scientific community could easily lose credibility.

  46. Deetee said,

    November 23, 2005 at 2:52 pm

    Ben Goldacre asked: “Am I right in thinking everybody sensibly ignored this story except the BBC? ”

    Well the Daily Mail (who else?) featured it.

    I actually think the paper shows that homeopathy does NOT work very well. After all, if you conduct an uncontrolled, unblinded observational study with very subjective outcome measures and undefined length of follow up, if you study 10 medical conditions of which 6 typically spontaneously improve naturally over time, ignore cases that didn’t bother to return for follow up after the first appointment (huge inherent selection bias here..) and at the end of it all can only claim that 50% of patients rated their overall health “better or much better”, then I would personally rate the intervention (homeopathy) as a failure.

  47. BSM said,

    November 23, 2005 at 3:02 pm

    Deetee is right. I think this leads us to a good working definition of a placebo being any random intervention nicely packaged that leads to roughly half of patients saying they are much better.

    In speaking to a fellow vet who acted as consultant to one of the drug firms trialling non-steroidal anti-inflammatory drugs he said they were routinely up against 60% placebo responses when using owners reports of benefits to animals, so real drugs have to get close to 100% improvements in many trials to prove a clear benefit (vet drug trials are often quite small).

    Parenthetically and salutarily, apparently those same studies usually show the owner to be less error-prone than the vet in assessing their own animal. Which means that I try to listen to animal owners more than I look at their animals and remember to tell them we both might be wrong!

  48. Ray said,

    November 23, 2005 at 4:45 pm

    a “stupid man” reporting ” a “clever man’s” findings

    It’s more complex than that. It’s all about cognitive bias, which we all share, clever or stupid – the difference is that the scientific method attempts to analyse phenomena without that bias. The trouble is that this kind of thing isn’t generally known, and people are (understandably, I suppose) insulted by any suggestion that their perception or conclusions may be wildly mistaken. In health issues, the post hoc ergo propter hoc (after this, therefore because of this) fallacy repeatedly turns up.

  49. John A said,

    November 23, 2005 at 6:48 pm

    Hey all,

    A little off topic but I have just read a fascinating review on the placebo effect. Apologies to those of you without insitutional subscriptions – you’ll only be able to get the abstract.

    What I found interesting in particular is that there are certain painkillers with effects stronger than placebo (apparently – not sure if this was done double blind) that when administered secretly have no effect. Also apparently open injection of placebo in full view of the patient (with the patient believing it to be painkiller) causes as much post-operative pain reduction as 6-8mg of morphine administered without the patients knowledge.

    I find myself thinking again about Ben’s point about the apparent gap in the market for being lied to…

  50. John A said,

    November 23, 2005 at 6:57 pm

    Caradog and Kadin,
    The animal rights lobby produce plenty of bad science all the time (see the myths section on the RDS website for example). However I agree that the link posted was not an example of bad science as nowhere did the politician make a scientific claim – he merely stated his opinion.

  51. Morag said,

    November 23, 2005 at 9:51 pm

    BSM and I are both vets, and our concern is the extension of the market for this sort of treatment to include animals. I’ve said this before and I’ll say it again. The apparently eye-popping extent of the placebo effect you can get in an animal when using subjective assessments of improvement demonstrates very clearly that this isn’t some wonderful “triggering of a self-healing response”, it is pure imagination. It works entirely on the person who is doing the subjective reporting. What’s more, if that person is not the actual patient, it seems that you can get an even more marked effect! It seems that, if you ask the actual patient how they feel, you may get a closer-to-truthful response than if you ask an owner to report how they think their pet is.

    The point is that while getting a real belief from a patient that they feel better might arguably be of benefit to them, getting a real belief into the owner that their pet appears better does not help the pet.

    We have far to much tolerance of null-intervention alternative medicine in the veterinary profession, including homoeopathy. This is often justified by pointing to the officially sanctioned position of the discipline in human medicine and the NHS. If there are five NHS homoeopathic hospitals and it’s possible to draw a consultant’s salary while practising homoeopathy, then that puts it beyond criticism. And vets go on treating sick animals with sugar pills. I really do with the medical profession would get its own house in order, for the sake of animal welfare.

  52. Elmer Phudd, Phrenologist to The Elephant Man said,

    November 23, 2005 at 10:29 pm

    Deetee said, “I actually think the paper shows that homeopathy does NOT work very well”

    No disrespect to the majority of the population, but I’m willing to bet that most folks out there forgot the importance of using controls in experiments the day they dropped out of school… or started their BA in Classics. The problem with the BBC or Mail quoting this article is that they feed the lay-majority with what is evidently, to the scientifically aware at least, baseless inference. And I’m sure they have absolutely no idea of what fibs they’re telling.

    Anyway….

    I’m completely suspicious of this ‘Journal of Alternative and Complementary Medicine’. If I wasn’t so busy I’d investigate this further, but considering how cocked-up the experimental design is, and how unfoundered their conclusions are, I’d never pass it in peer-review. But then again I don’t dowse for goat semen so I’m no peer. And that. I believe, is one major problem that this publication highlights.

    The home page for the journal states,

    “Indexed in:

    MEDLINE, Current Contents/Clinical Medicine, Science Citation Index, Science Citation Index-Expanded, EMBASE/Excerpta Medica, CISCOM-Centralised Information System for Complementary and Alternative Medicine, International Pharmaceutical Abstracts, AMED, Cumulative Index to Nursing and Allied Health Literature (CINAHL).”

    The article is indeed on medline. Sure enough there’s no denying that you can find some far-out wacky abstracts there if you look with the right keywords.

    Here’s a significant morsel from what the US-based Medline/Pubmed runners, the National Library of Medicine has to say about “Journal Selection for MEDLINE”:

    “Quality of editorial work:

    The journal should demonstrate features that contribute to the objectivity, credibility, and quality of its contents. These features may include information about the methods of selecting articles……..

    (wait for it)

    …..especially on the explicit process of external peer review…..”

    Which, according to our oppinions of the ‘Journal of Alternative..Blah’, can have detrimental effect on the scientific merit of experimental design when considering the mischief of a bunch of corroborating homeopaths, which in turn contradicts this criteria:

    “Quality of content:

    Scientific merit of a journal’s content is the primary consideration in selecting journals for indexing. The validity, importance, originality, and contribution to the coverage of the field of the overall contents of each title are the key factors considered in recommending a title for indexing, whatever the intended purpose and audience.”

    Again, I’m not denying you can find the odd messed up perspective on reality within the Medline archives, and I’m not trying to slam there effort….pfff, I remember having to rifle through index cards for journal article keywords before uni invested in an Ovid CD rom. Maybe this particular article isn’t representative of the journal as a whole, but then again it IS a journal dedicated to promoting alt. therapies – and anyone with a scientific awareness would doubt it’s ability to survive given the subject’s demonstrable lack of credibility.

    I suppose my point is that loop holes in the indexing of ‘research’ can result in the continued perpetuation of bad science based on ‘authoritative’ articles with false merit such as this one.

    Marc.

  53. Elmer Phudd, Phrenologist to The Elephant Man said,

    November 23, 2005 at 11:08 pm

    There’s an article on the front page of The Scientist website from someone representing an organisation called, ‘Sense About Science’:

    ‘Making Sense of Science – Peer review is the missing link for the public’

    www.the-scientist.com/2005/11/21/10/1

    I’ve only just discovered this organisation, and one of their main aims seems to be to promote the importance of peer review when evaluating science news.

    www.senseaboutscience.org.uk/

    They have produced a small guide on peer-review, for public education purposes…

    “Our new leaflet, written with input from patients, pharmacists and medical practitioners, among others, lets the public in on the arbiter of scientific quality: the peer review process.”

    www.senseaboutscience.org.uk/PDF/ShortPeerReviewGuide.pdf

    Considering most of the public are unlikely to read anything containing the word “science” unless it’s a review for a Hollywood film, I would recommend that they change that to “let’s the MEDIA in on the arbiter of scientific quality”

    …but again, it seems that even the peer-review process can have it’s faults.

    Marc.

  54. Kadin said,

    November 24, 2005 at 2:45 am

    I stand corrected, and retract my statement of ‘bad science being done by politicians’. However, I maintain that it is an example of bad science affecting politics. Based upon the article, I would bet money that one or several of the politicians directly involved in this believe one or many of the myths/examples of bad science in the page provided by John A. I also maintain that it contains the implicit claim that animal testing is not necessary for scientific research. I agree that the Wikipedia introduction should say something closer to, “purportedly scientific data, research, analyses or claims which are *biased* by perceived political, financial or other questionable motives” or something similar.

  55. Kumar said,

    November 24, 2005 at 11:25 am

    Let us look at it, bit deeply. Suppose, people think that it is a biased/fabricated report than, how can one trust in studies/reports/everything made and presented by just few people in other fields. For example, some astronaughts have seen “earth as round”, people believed on their saying/photos. But if , anyone want to take it alike skin removing from hair, can say I or majority of people have no yet practically seen it as round, alike ball in fingers, and for all our practical purpose, it is flat, so sorry, I don’t agree and don’t want feel imbalanced ,alike standing on football.. So, we have to trust senier people in the field and in the sayings of sufficient people.

    About obsevational vs. DBPC, as I said, homeopathic remedies have gentle…….effects in comparisan to conventional medicines which are having stronger effects with immediate noticale side effects, so can overpower/supress the noticable gentle gross effects of homeopathic remedies in short term resulting into and many variations. It is not clear, whether conventional medicines(to all) were also given and continued during whole study or not? But in view of “x” group representing candidates with outer influences including CMs was sepretely surveyed, it looks that conventional treatment to all candidates were not given.

    Anyhow, in any type, Survey report shows quite positive results (somewhat exactly, as homeopaths & its patients observe at home). But why DBPC studies not? Mostly, it can be due that when studying with CMs, variations(both relevant & non-relevants) can be there in reporting whereas may not be if homeopathic remedies are given, exclusively. At home or during routine treatments, it may become possible with some added benefits of independancy, emotions ,belief etc..

    I think this report , is in favour of homeopathic effects with or without conventional medicines. As some people object that it is not DBPC report, but Why then doctors sent patients to homeopathic hospital? Why doctors, homeopaths, patients & their relatives not discontinuued, if they noted no positivities during a long period of six years? Can anyone expect and disbelieve, such a big baised report is possible in UK’s such a reputed hospital and in view of above remarks?

    Bit a piece of my thoughts. Regards.

  56. Michael P said,

    November 24, 2005 at 11:38 am

    Kumar – don’t mix up ‘feeling a bit better” with ‘treatment for a disease.”

    These patients might have felt a bit better at the end of the trial, but the ones that went along with cancer are still more than likely dead.

    Don’t forget that.

    If you’re going to insist on homeopathy as a treatment for feeling a bit peaky, then fair enough, but remember that when it comes to serious diseases you’re playing with people’s lives.

  57. Ian said,

    November 24, 2005 at 1:18 pm

    …and of course, there are the cases where homeopaths recommend preventative treatment. It often seems very unclear what you are preventing – except bankruptcy on the behalf of the homeopath. So many alternative therapists seem to diagnose ‘potential’ or ‘future’ problems, and naturally the best way to avoid them is to have treatment with that same therapist.

    I seem to recall a claim, probably nonsensical, that in some cultures you onluy pay your doctor while you are well – if you get ill they have clearly stopped doing their job properly. Perhaps we should try this with CAM practicioners! (sp?)

  58. tom p said,

    November 24, 2005 at 1:26 pm

    Elmer – it’s interesting the stuff you found from Medline about their criteria for indexing journals. I seem to recall that when I worked in scientific publishing (for a small company publishing ludicrously expensive journals that were available on subscription only) their main criterion was the availability of the articles or issues to be purchased individually by people who found the articles via MedLine.

    Then again, we did publish proper peer-reviewed journals that could genuinely be described as ‘scientific’, so maybe our excessive control was their only problem with us.

  59. Caradog said,

    November 24, 2005 at 1:28 pm

    Kadin,

    I have no real knowledge about how necessary animal testing is, so I make no judgement as to the rightness of animal testing. My guess would be that it is far more necessary than animal rights activists would like to say, and it is justifiable in medicial research (considerably less so in the case of cosmetic research). I’d also entirely agree with you that politicians should be very careful before treading onto science related issues. The problem is that scientists are scientists not politicians, so politicans are rarely qualifed to make direct decisions on science issues. This in itself isn’t inherently bad, provided they respect scientific methodologies and scientists in general. Trouble is, this respect (sorry for sounding a bit Blair here) is diminshing, partly because scientists have let the quacks get away scott-free for far too long, thereby allowing people, in true post-modern fashion, to believe that all opinions are equally valid within the public ‘narrative’. Hopefully this will change, but I’m not particularly optimistic.

  60. tom p said,

    November 24, 2005 at 1:56 pm

    Kumar – we don’t “have to trust senier (sic) people in the field and in the sayings of sufficient people”. Just because someone apparently senior or otherwise respected says something that doesn’t necessarily make it true. That’s why there’s peer-review and why methods are published along with conclusions, so that informed criticism is possible. People have been saying that the Earth was round based on observational data for a long time before any astronauts ever left the earth.

    You also fail to say why there would be variations with conventional medicines but not homeopathic remedies, what type of variations you’re talking about and why, if there are none of these apparent variations of which you talk nonsensically in homeopathy, double-blind placebo controlled trials would therefore fail to prove that homepoathy is effective. If homeopathy works, then proper studies that reduce the possibility of accidental or intentional bias would prove it.

    Your pathetic flannel and mystical mumbo jumbo just won’t wash here, sonny jim

  61. Deetee said,

    November 24, 2005 at 2:16 pm

    Kumar, if I understand your comments you are asking why the patients were referred to a homeopathic hospital in the first place. This is a good point – and one which raises the first example of significant selection bias in this study which would work in favour of homeopathy having a positive effect, namely that GPs/doctors are likely to refer only patients who they think might gain some benefit from homeopathy in the first place.

    Then you ask why patients did not discontinue treatment if they noted no effect. Well we don’t know this- the study simply tells us that they only included for analysis patients who continued to attend for followup after the initial appointment. They (conveniently for them) do not put a figure to how many dropped out. Now, who do you think is more likely to return for followup – patients who felt they may benefit from homeopathy, or those who thought “this is a load of bollocks, I’m not going to carry on with this charade”? Well, obviously the former. This is another potentially huge selection bias operating in favour of a positive outcome favouring homeopathy, but the study authors do not even bother commenting on it.

    I am tearing my hair out at how such a weakly constructed and conducted study even passed peer review, never mind how supposedly intelligent individuals thought it could reveal anything useful in the first place.

    Kumar, you finally question how anyone could disbelieve such a “big” report from a “reputed” hospital. Well, quite easily, once one studies the data. Being impressed by large numbers, and a misplaced belief in authority (Argumentum ad verecundiam) are well described logical fallacies you would do well to be aware of.

  62. MRC_Hans said,

    November 24, 2005 at 2:22 pm

    To those of you who are not familiar with Kumar:

    Kumar believes that if something has been believed by a lot of people, for a long time, then it is extremely strong evidence that it is true. so strong that only an “absolute” disproval from science can make it false. And an absolute disproval, in Kumar’s vocabulary, means one that is totally clear, flawless and unequivocal. Finally, since Kumar’s understanding ig scinece and physics is approximatly on fifth grade primary school level, nothing will ever seem absolute in science to him, because he will not understand it.

    Sorry to be so harsh on a(nother) new arrival here, but our friend Kumar has quite a track record, elsewhere.

    Oh, and Kumar’s spelling and language is unusually correct and clear in his posts here. Usually, he doesn’t try very hard to be comprehensible.

    Cheers, Hans

  63. Andrew T said,

    November 24, 2005 at 2:37 pm

    Hello,
    My mum has osteoperosis. It makes her bones hurt. She went to her GP. Yes her GP – who is ‘interested’ in homeopathy. GP couldn’t prescribe anything as she couldn’t decide if my mum was a ‘sea’ or a ‘sand’ person. My mum is a ‘this is all nonsense’ person so didn’t even get the nice little placebo effect. Personally I think the referral of people to homeoapths by their GPs is shocking, attempting to practice it themselves even more so. Especially in light of the Lancet report.

    The problem with homeopathy is that we pay for it, and that medical practitioners, who one assumes once upon a time studied pharmacology, phsyiology, biochemistry etc support it. If gullible idiots wish to flush their money down the drawn, despite repeated warnings from others, then let them. But not my money please, which i would personally prefer be spent, on say for example, helping develop a cure / symptom reliever / preventative therapy for osteoperosis. Or anything else for that matter.

    As Nicky Campbell said on Watchdog 5th October, 2004:
    If something has been clinically tested and doesn’t work, it’s snake oil.”
    www.randi.org/jr/082605charles.html

  64. Kumar said,

    November 24, 2005 at 4:36 pm

    Thanks for many ggod posts in reply to my post. Many people don’t like my dynalik ideas–so may nail me. So pls take your own decisions. I shall try to reply one by one.

    Hello Michel,

    I feel , “feeling much better” for a period of six years or so can also be important. What happened afterwords or happening now, I think, I atleast don’t know. So we can’t just ignore this much also unless you consider it as an “absolute fraud/illitracy”.

    There ought to be some limit of any therapy. As per obsevations & indirect views of people in field, Homeopathy may be-where no much problem or where no solution is there, mean at stage where one in quite comfortable and can take some risk & chances to avoid strong medicines or when no other choice/hope left.

    Moreover, I don’t know about CMs, whether taken by all during whole of time during this survey or not. Some say yes taken as heard on Radio, but it is not there in report.

    Best.
    Hi tom,

    Yes, quite fair. But observations & experiances in homeopathy is also quite old, much older than this report. If you say and can find that all those involved in homeopathy since long and those involved in this study were/are frauds then I can’t challange or contradict your assessment. If you say no, this much can’t be fraud, then we have to go on some beliefs, survey , observations etc. and have to find out, why it is observed positive in surveys, observations etc. but mostly fails in many DBPC studies? Some reasons can be thought as Iindicated here previously.

    You couldn’t understand about possible variations. I meant variations in getting and observing the effects of homeopathic remedies due to influence of strong modern medicines, if both homeopathic & conventional treatments are taken at a time. You know that taste of lesser sweat substance can be owerpowered, superceeded or supressed by more seat substance…for example.

    As I feel, any adjunctive study i.e. CMs+Homeopathis remedies, can interfere in getting and observing gentle effects of homeopathic remedies as I indicated “The Adjunctive study’s Effect” in my first post. If I am not wrong most DBPC studies could be done as adjunctive studies considering modern atmosphere and risk factor. If so, any such study can show variations in indicated/possible effects of remedies,can confuse both homeopaths and patients, or may show no homeopathic effects at all. How then those adjunctive studies can be condidered to give credit or discredit to homeopathy.

    Best.

  65. Kumar said,

    November 24, 2005 at 5:56 pm

    Hello Deetee,

    Yes, GPs/doctors referred their patients to homeopathic hospital is a positive point in favor of homeopathy as it indicates that GPs/doctors were knowing and experienced about possibilities of benefits from homeopathic treatments & about hospital’s reputation in that area.

    Secondly, I think it is indicated in report, how much candidates participated in survey initially and how much dropped (sorry, I am not able to read again so just remember). Since, it was six year study; all may have not completely participated. Moreover it was not a DBPC study, so some leniencies can be thought. We should look it as a long term observational study/survey involving mass candidates, not controlled study. So, still we can’t deny everything in one shot on such a hard work done by senior & reputed doctors and reputed hospital (also reputed for GPs/doctors, so referred). Yes, if this study would have made clearer, it would have been in further interest of homeopathy.

    As I said, we should consider it as a “long term observational study/survey involving mass candidates, not controlled study but still should not shoot it in one shot, rather can respect for the hard work done.

    Sorry, I believe in senior & reputed people in any field as a believer, so I believe–earth is round in real–may be flat for common people or for all or most practical purposes AND in studies/surveys done by other system’s senior people. But it can be just my personal thoughts so can’t advocate for others.

    Best.

    Mr. Hans,

    In spite of that, I think you are still with me since many years. Why?

  66. amoebic vodka said,

    November 24, 2005 at 7:04 pm

    It doesn’t even compare people who had no kind of treatment with people who did. Making it totally worthless. As a piece of observation, all it says is that 70% of people studied felt better 6 years later. It says nothing about homeopathy at all (except being evidence supporting the hypothesis “homeopaths can’t design experiments” ).

    As for giving it marks for effort…er…no. Getting a mark for writing your name on the paper is an urban myth.

  67. Elmer Phudd, Phrenologist to The Elephant Man said,

    November 24, 2005 at 7:53 pm

    Again, this ‘got past peer-review’ because the peers involved all worship the same wood spirit.

  68. Morag said,

    November 24, 2005 at 9:09 pm

    Andrew T, look at this page.
    news.bbc.co.uk/1/hi/england/2666411.stm
    If your mother’s GP has really treated her so badly, there is a good chance that a complaint might be taken seriously. Unlike the spineless veterinary regulators, the GMC does not look kindly on doctors who let their faith in alternative medicine cloud their medical judgement.

  69. Dean Morrison said,

    November 25, 2005 at 3:08 am

    There was an episode of ‘Doc Martin’ on channel 4 tonight where the (fictional) Doc Martin (played by Martin Clunes) exposes a herbalist as a fraud and even goes as far to call her a ‘rip-ff charlatan’ .
    Perhaps some hope somewhere – if they could only bring this critical thinking to the reporting of actual science.
    I wonder if this poor reporting and seeming drop in standards is not unconnected with the increasing use of independant production companies by the BBC?

  70. Dean Morrison said,

    November 25, 2005 at 3:15 am

    .. seems that MP David Tredinnick – the MP who spoke up for the ‘Dowsing Doctor’ in Morag’s link, seems to use the few parliamentary questions he has asked to pursue a herbal medicine agenda:
    www.theyworkforyou.com/mp/david_tredinnick/bosworth#performance

  71. Elmer Phudd, Phrenologist to The Elephant Man said,

    November 25, 2005 at 10:59 am

    Dean, nice find.

    On the one hand it sounds to me like Tredinnick is defending the actions of someone that would have gotten them burned at the stake a few hundred years ago, but on the other he’s asking for tighter methods of analysis for regulating herbal products.

    Personally I believe that there’s a significant difference in the use of certain herbal products (some of which do have an observable phramacological effect) and the essence of techniques such as homeopathy and crystal dowsing, which offer nothing more than a placebo crutch and a vice upon which irrationalists claim the laws of physics are wrong.

  72. Marge said,

    November 25, 2005 at 11:24 am

    Elmer Phudd – thanks so much for that link to the leaflet on peer reviews. Very useful for work (information for parents of children with special needs, in case you’re interested), and myself.

  73. Dean Morrison said,

    November 25, 2005 at 12:32 pm

    Elmer – I don’t think that Tredinnick is calling for tighter regulation at all – quite the opposite (read further into his questions – like this one on obesity-
    “David Tredinnick (Bosworth, Con) Link to this | Hansard source

    In the light of the huge costs to the NHS associated with obesity and unhealthy living, why did the Government allow the implementation of the food supplements directive, which by removing many safe and effective products from the shelves, will prevent thousands of people from maintaining their own health?. He obviously thinks his constituents have elected him as the member for Holland and Barratt.”

  74. Dean Morrison said,

    November 25, 2005 at 12:34 pm

    whoops! – put the quotation mark in the wrong place in the last post – should have been after [health?] – the last sentance was my observation of course…

  75. Ben Goldacre said,

    November 25, 2005 at 1:18 pm

    Blimey. Has anyone seen the Telegraph article on this today?

  76. Andrew T said,

    November 25, 2005 at 1:30 pm

    Cheers ben. Thanks for that
    www.telegraph.co.uk/health/main.jhtml?xml=/health/2005/11/25/hhomeo25.xml
    for those without a paper copy to hand.
    Nice to see it is uncritical. I am becoming increasingly convinced that people are ashamed of the placebo effect. It works for them. Lucky them. They seem unwilling to accept that it could just be the placebo, as if its a character slight on them for being duped or something.
    ” The placebo effect, he argues, accounts for most clinical improvement.
    Try telling this to Angela Evans or Deborah Williams, whose homoeopathic relief from their worsening illnesses has been so real, and so lasting, as to be life-changing. ”

    Congratulations. But if the pills really worked then homeopaths would be able to claim James Randi’s $1 million prize for provable magic, for which i believe they are eligible.

  77. amoebic vodka said,

    November 25, 2005 at 1:47 pm

    If you don’t buy the Torygraph, try here.

    We like:

    ‘Egger [...] accusing Spence and his colleagues of failing to use a “control group” for comparison and Spence retorting that his huge observational study – the largest of its kind ever published – involving 23,000 consultations with no exclusions and no bias, is a pure measure of achievement. “It’s what I call ‘real world’ analysis,” he told me. “It’s what happens.” ‘

    No bias? Hahahahahahaha.

    ‘Egger rather insultingly suggests that homoeopathic patients, asked by their friendly practitioner if they feel better, “will come up with the answer the doctor wants to hear”. ‘

    Stop insulting us with facts, we just can’t take it… Next you will be telling us that thunder isn’t really the sound of clouds banging together and there’s no way amoebas can write blogs because they’re too small to use a keyboard.

    ‘The placebo effect, he argues, accounts for most clinical improvement.

    Try telling this to Angela Evans or Deborah Williams, whose homoeopathic relief from their worsening illnesses has been so real, and so lasting, as to be life-changing.’

    When will they get that the placebo effect is real. If we had heads, we’d be banging them against the wall.

  78. Caradog said,

    November 25, 2005 at 1:50 pm

    Ben,

    Can you take this apart for non-scientists such as me? How can he say that there are ‘no exclusions’, and there are no bias? Surely you can always include more people, and surely there’s always going to be some danger, however small, of some bias creeping through. Is Spence saying that he didn’t use a control group – if so, how can he be certain that there’s no bias?

    Also (again, please correct me if I’m wrong here) if the patient says ‘It flares up if I get upset or stressed, but I just come back for a new powder [which] gives me hope’ isn’t this the placebe effect writ large?

    The article also says ‘A homoeopath assesses the whole person – a patient’s medical history, symptoms and even personality traits’. Er, correct me if i’m wrong, but isn’t this what all GPs do?

    Where’s the research published by the way?

    Oh and by the way, are you a ‘Silvery-haired gentleman with a soft, listening manner and eyes as bright as quartz’? I’m only asking as accoring to the Telegraph, this is an important piece of information as to how reliable your scientific assessments are

  79. Cococo de Channel said,

    November 25, 2005 at 1:52 pm

    Keep taking the arsenic
    Daily Telegraph
    25/11/2005

    Results of a six-year study have proved a boost for homoeopathic remedies. Elizabeth Grice reports

    As benign-looking as any poisoner in a crime thriller, Dr David Spence is administering arsenic to two unsuspecting females.

    Dr David Spence
    More than 70 per cent of Dr Spence’s patients reported an improvement in their health

    He is a silvery-haired gentleman with a soft, listening manner and eyes as bright as quartz. They love his attentiveness, and, though they don’t have any idea what is in the little packets of white powder that he prescribes for them every few months, they love his medicine even more.

    Angela Evans and Deborah Williams both suffer from complaints that years of conventional medicine failed to ameliorate or cure. As a last resort, they were referred by their frustrated GPs to the twinkling Dr Spence, a homoeopath working within the NHS.

    “We get everyone else’s failures,” he says mischievously. “I deal with patients who have been thrown on the medical scrap heap. You could say that’s not a very promising case load.”

    Evans, 54, had been prostrated by severe migraines two or three times a week since the age of 16. For hours, she would have to lie in a darkened room. Her social life drained away because it was impossible to know with any certainty whether she would be able to go out.

    “My life was on hold,” she says. “I’d reached the point of desperation.” Williams, 35, had endured such an extreme form of pre-menstrual tension (PMT) that for two weeks of every month, she was so irrational, so depressed and so full of rage that it was becoming a strain on her marriage.

    As it happens, the homoeopathic remedy for both was varying doses of the well-known poison, arsenicum album, or white arsenic.

    “It is a big medicine,” says Spence, with satisfaction. “It has a very well-documented toxicology. It affects most systems of the body.” Homoeopathic physicians have been prescribing it for more than two centuries in Europe and America – for a whole raft of problems, from asthma to anxiety – apparently without a single case of poisoning.

    Neither Evans nor Williams knew what was in their remedy, and they were so grateful to be better that they didn’t bother to ask.

    In the search for a cure for her migraines, Evans had had a brain scan and taken every form of conventional medicine. Many had unpleasant side-effects; none, the desired effect. “You reach the point, to be honest, where you’ll have a go at anything because you are so desperate,” she says.

    Since taking homoeopathic remedies, she has resumed a normal life – having only one migraine attack in the last six months. “And I am a calmer person generally for whatever it is I’ve been taking.”

    Williams, too, is a changed person. Her rages and depressions have vanished, she can do her job as a flight attendant without biting the heads off colleagues and her long-suffering husband, Dean, who tended to get the brunt of her irrational outbursts, says: “It is like the sunshine after the storm. A really dark cloud has lifted.”

    Both women were part of a six-year study at Bristol Homeopathic Hospital, where Spence – once as sceptical about the value of homoeopathy as many mainstream doctors – is clinical director and consultant physician.

    The results have been a colossal boost, not just to homoeopathy as a therapeutic system, but to Spence personally, because he is nearing retirement. They show that more than 70 per cent of his 6,500 patients with chronic diseases reported an improvement in their health after treatment.

    With children, the results were even better – 89 per cent of under 16s with asthma improved, as did 68 per cent of young eczema patients. “As you would expect, children have much cleaner and more responsive systems,” he explains. “They are capable of quicker recovery and repair.”

    The other reason the survey is causing him such delight is that it contradicts a scathing report published in The Lancet recently by Professor Matthias Egger, among others. The Anglo-Swiss review of 110 trials dismissed homoeopathy as no better than taking dummy drugs and concluded that “specific effects of homoeopathic remedies seem implausible”.

    A homeopathic dispenser with a patient
    Sales of over-the-counter homoeopathic remedies reached £32 million last year

    This has led to a medical ding-dong in the long-running debate about the value of homoeopathy, with Egger (known in the profession as Eggy) accusing Spence and his colleagues of failing to use a “control group” for comparison and Spence retorting that his huge observational study – the largest of its kind ever published – involving 23,000 consultations with no exclusions and no bias, is a pure measure of achievement. “It’s what I call ‘real world’ analysis,” he told me. “It’s what happens.”

    Spence berates Egger and his colleagues for “rehashing old statistics” and producing a data-deficient report, while Egger rather insultingly suggests that homoeopathic patients, asked by their friendly practitioner if they feel better, “will come up with the answer the doctor wants to hear”. The placebo effect, he argues, accounts for most clinical improvement.

    Try telling this to Angela Evans or Deborah Williams, whose homoeopathic relief from their worsening illnesses has been so real, and so lasting, as to be life-changing.

    Joan Dainton, 76, another of Spence’s grateful patients, has had her chronic psoriasis eased by his prescription for potassium salts after all conventional medication failed.

    “There isn’t a cure,” she says, “but it is wonderful to be so much better. It flares up if I get upset or stressed, but I just come back for a new powder. It gives you hope when you come to a place like this after not getting anywhere for so long.”

    In homoeopathy, illnesses are treated using highly diluted forms of herbs and minerals, known as microdoses, that in higher quantities could provoke the very symptoms that are being addressed.

    The therapy is based on the principle of “like cures like”, an idea first expounded by Hippocrates, the so-called father of medicine in 450 BC, but not rationalised into a clinical system until the late 18th century, by the German physician, Samuel Hahnemann.

    A homoeopath assesses the whole person – a patient’s medical history, symptoms and even personality traits – and then creates custom-made tinctures, pills or powders from hundreds of wondrously-named plants such as bryony, calendula, feverfew, flaxseed, gentian root and ginkgo biloba.

    Last year, there were 44,887 new or follow-up appointments at Britain’s five homoeopathic hospitals, in Bristol, London, Glasgow, Tunbridge Wells and Liverpool.

    And sales of over-the-counter homoeopathic remedies reached a record £32 million last year.

    Though he feels his discipline is vindicated by his new report, Spence makes no extravagant claims. Homoeopathy is neither a panacea for all conditions, he says, nor appropriate for all illnesses – 30 per cent of his patients get no benefit at all. It has an excellent track record for eczema, asthma, bowel problems, hormone imbalance, arthritis, depression and in cancer therapy, for instance, but is no good for thyroid disorders or diabetes, and hypertension is best treated conventionally.

    “My patients don’t always like it when I refer them to a GP,” he says. ” They say, ‘You, of all people.’ But there are things that must be treated by ordinary medicine.

    “I am only a simple physician. I am here to help patients get better. There is still a body of resistance within the medical profession to homoeopathy because the exact mechanism of action of homoeopathic medicines is not yet fully understood. But people can make of it what they like. At the end of the day, if the patient is better that is all that counts.”

  80. Elmer Phudd, Phrenologist to The Elephant Man said,

    November 25, 2005 at 2:15 pm

    Dean, Ok I agree he does seem to be on a mission. I don’t know how I feel about this European legislation on health supplements. Sure, people should eat healthier diets, but I think that even for people without chronic illness, certain additives can improve their wellbeing (I mean stuff like iron, B-complex vits or even St. John’s Wart, not nicotine, caffeine and alcohol). So long as they don’t harm us, then we should have a choice. Obviously it’s up to the likes of us to weed out the crystal dowsing rip offs.

    Andrew T said, “I am becoming increasingly convinced that people are ashamed of the placebo effect.”

    Yeah well that’s the problem with the placebo effect, as far as I know, it only works ‘significantly’ if you don’t know about it. You blow its cover, and its effects will be lost. I’m sure the proponents of alt. therapies know this, which is why they defend it so rabidly in the face of indisputable evidence against.

    Is there any way of commenting to the editor/author of these articles, to explain to them why the research is a pile of crap, and that their interpretation of it makes them out to be ignorant fools?…at least in a more eloquent (and preferrably sarctastic) way.

    My PhD supervisor once wrote an email to the Metro (pfff), explaining that some organism they talked about was not in fact a bacteria, but a virus. He actually got his comment printed. I suggested he should try to submit the article to Medline, but he made do with attaching the clipping to the departmental publication ‘hall of fame’ display, woo!

    P.s…

    George Best has just died. The day after late-night opening hours for Britains pubs become reality. May he rest in peace.

  81. Morag said,

    November 25, 2005 at 2:41 pm

    If you really want to be pedantic, it should be “a bacterium”. “Bacteria” is the plural form.

  82. Elmer Phudd, Phrenologist to The Elephant Man said,

    November 25, 2005 at 3:02 pm

    Morag, yes you’re correct. I guess a lack of a humanitific education has it’s failings! No wait, actually I meant to say “strep A bacteria”, honest guvna!

  83. Andrew T said,

    November 25, 2005 at 3:25 pm

    Caradog – I’ve spent the morning teaching statistics to so i may have addled my brain. Unfortunatly there is more than 1 type of bias, so time for a long post. But not too Kumar-esque i hope:

    “How can he say that there are ‘no exclusions’, and there are no bias? Surely you can always include more people, and surely there’s always going to be some danger, however small, of some bias creeping through. Is Spence saying that he didn’t use a control group – if so, how can he be certain that there’s no bias?”

    The study ran as follows. People who attended the homeopathy hospital were followed through time. There was no decision to exclude patients from the results based on criteria. This can bias results. For instance, given they ‘know’ it doesn’t work for diabetes, they could have decided to exclude diabetic patients, which ‘may’ make homeopathy appear better than it is. This is selection (or exclusion, depending which way you look at it) bias, where people are selected into a study are systematically different from the population from which they are drawn.
    The size of the study is in fact irrelevant to whether it is biased or not – what is required are clear well written protocols from before the trial was started, describing how people are enrolled. You can have biased and unbiased studies of any size.

    The obvious point here is that the ‘population’ of people all wanted to attend the homeopathic hospital – they have a degree of credulity about the effect of homeopathy, or are unaware of its snake oil status. They may not reflect the general public at large.
    In fact they probably don’t. This type of bias is not relelvant to whether there is a control / intervention group.

    Assignment bias can occur when people are assigned to either the treatment or the control group not at random. This is why we blind the experimenter in a double blind trial. If a doctor thinks the experiemntal drug may really work and a very sick patient needs to be treated, it is overly tempting to give them the experimental drug rather than the placebo, in the hope it might work. There is a different charcteristic (sickness) between placebo and treatment which affects outcome (wellness) and the 2 are linked. The general result is that drugs/treatments appear to work less well than they actually do. Clearly as there is no control group, no bias is present – that doesn’t make it any better.

    Ascertainment or information bias
    Outcome of the trial (‘wellness’, say) is biased. This is due to extracting information in such a way that it may not represent the true picture. Given that the method chosen to ascertain ‘wellness’ – the doctor asks, is one of the most biased methods of doing so, it is hardly surprising they received such a ‘good’ rating.
    If the trial had had a control group, and the controls were asked how they were feeling by the doctor, this again would have been biased and they would have cancelled each other out in the analysis. But that would have shown no effect of homeopathy. No points and no prizes for the homeopaths.

    And theres more biases out there as well. eg publication, english language and citation biases. but this is enough to get you started on. You can never be certain you have no bias but you can put systems in place that minimize the effect of it. They have ‘probably’ done that, but it still doesn’t mean its worth the paper its written on.

  84. Teek said,

    November 25, 2005 at 3:44 pm

    Guys, am I the only one to have sensed a little Wakefield-esque reporting here?

    “As benign-looking as any poisoner in a crime thriller”

    “the twinkling Dr Spence”

    and my personal favourite,

    “He is a silvery-haired gentleman with a soft, listening manner and eyes as bright as quartz”

    so f***ing what if he’s handsome and has eyes like quartz…?!! this appalling reportage belongs in the gutter press, not in the best-selling broadsheet in the UK (i’m a sandal-wearing Guardianista, but the Torygraph is way too serious a paper to get away with this).

    the article’s tone reminds me way too much of the romanticised versions of Andrew Wakefield that were published following his Lancet paper – painting a vision of an heroic rebel, a kind man that’s “just trying to do his job” in the face of a medical establishment (in this case personified by Egger) that ‘just won’t believe.’

    so the guy’s a charming chap – so go on a date with him, don’t write some gloryfying piece that uncritically reports biased, unscientific work as fact!!!

    i’ve really had enough with this terrible standard of “journalism,” which turns out to be no better in the Torygraph (supposedly respectable paper, read by intelligent folks) than in the Mail.

    anyone fancy writing an open letter to the Minister that’s responsible for the press…?

    grrrrr…..!!!!

  85. Cococo de Channel said,

    November 25, 2005 at 3:48 pm

    “EGGY??!!!”

  86. Ian said,

    November 25, 2005 at 3:48 pm

    Apologies for the delay…

    thanks also to Elmer – that link and leaflet will be passed on to my students as soon as I can get some copies!

  87. Elmer Phudd, Phrenologist to The Elephant Man said,

    November 25, 2005 at 3:58 pm

    Teek, ha! yeah, the Telegraph is written by rejects of Readers Digest.

    Ian, no problem. Thanks should go to the Sense About Science organisation. I just thieved it from their site after all!

  88. Caradog said,

    November 25, 2005 at 4:05 pm

    Andrew,

    Thanks for taking the time to explain it for me, I understand it quite a bit better now. Still can’t understand on what basis he can claim ‘no bias’ though. Saying no selection bias is fair enough (just), but claiming no bias at all like the twinkling doctor does is a bit dodgy isn’t it?

  89. Andrew T said,

    November 25, 2005 at 4:14 pm

    was just a cut and paste job changing words here and there.
    and no, you can never claim there is no bias. peer-review helps look at that but it has been suggested on this thread that CAM peer review may not be all its cracked up to be.
    i really couldn’t comment….
    As for trust based on looks: let me on bad science TV thats what i say. i’ll show you proper twinkling eyes (diamond, not quartz thank you) and devilishly handsome good looks. the torygraph wont know whats hit them.

  90. Caradog said,

    November 25, 2005 at 4:56 pm

    Without disrupting the debates relavent to this article, Ben’s favourite nutritionist Dr Gillian McKeith (yes, she’s still calling herself a doctor) is in ‘Closer’ this week. Her advice? Don’t eat any cooked food. Ever.

    Where would we be without her?

  91. Elmer Phudd, Phrenologist to The Elephant Man said,

    November 25, 2005 at 7:08 pm

    Caradog,

    I’m (thankfully?) out of touch with what’s hip in the UK, but I assume you mean ‘Closer’ the magazine? Their website has a little votey-thing, asking the question, “Do you think the Atkins Diet is bad for you?” but unfortunately they don’t have a button for ‘Oh my, erm, can you repeat the question please?’

    www.closermag.co.uk/

    Apparently this weeks issue has an article on losing a stone with (world renowned dietician) Carol Vorderman, and ‘real life’ article detailing a mothers plight as her daughter slowly turns to stone, no less.

    “Seven-year-old LW faces a terrifying future trapped in her own body.”

    Sometimes I forget what a privilige it is to travel the astral planes at will by means of an out-of-body experience.

    Oh wait, no, her daughter has something serious called ‘Fibrodysplasia Ossificans Progressiva’.

    Made me click though didn’t it! B******s!

    I wouldn’t worry too much Caradog, if Doc McKeith is facing a terrifying future trapped inside the likes of ‘Closer’.

  92. CaptainSensible said,

    November 25, 2005 at 8:19 pm

    I’m a Telegraph reader, but I’m hardly a Tory (floating libertarian voter or something); I just the like the layout and the quality of the writing. However, I’m tempted to send them a truckload of hatemail for printing this nonsense.

  93. Kumar said,

    November 26, 2005 at 2:55 am

    “if their conditionshad been affected by obvious external factors (e.g.,
    other treatments}, this was scored as an “x.””

    The above from report indicates that candidates who have taken other treatment(should be inclusive of conventional treatment) are seprately groupped in “x” group.

    The out come of “x” group : TABLE 4. OVERALL OUTCOME FOR 6544 PATIENTS; “x” showing just o.3% & n20

    Biased or not biased is a seprate issue which can be checked by surveying again– hostital, homeopaths, GPs of patients, patients participated and their parents, by those who feel/find it otherwise. Whether they or science shouldn’t be interested for their purposes, to check its truth? If not, can it be not taken as a bias for self interests?

    The essence of any study on homeopahy is, whether study was “adjunctive study” or not and whether some relaxations are given to homeopathy or not in view of, how it is taken by the authorities, kept as back-bencher, not researched equally etc.

  94. Mojo said,

    November 26, 2005 at 11:26 am

    No, Kumar. The statement you quoted does not indicate that candidates who had taken other treatments were assigned an “x”. It says that patients whose conditions were “affected by obvious external factors” were assigned an “x”. It just uses “other treatments” as an example. It certainly doesn’t say that all those who were also receiving conventional treatment were excluded.

    I suspect that what they’re talking about here are negative effects that could be pinned down to an external cause. After all, if a patient said that they felt better after their homoeopathic treatment, I very much doubt that the homoeopaths will have gone looking for reasons other than the homoeopathy, seeing as the whole study relies on the post hoc ergo propter hoc fallacy.

    There was no control on the study, therefore it is impossible to say whether any claimed improvements were the result of the homoeopathic treatment, or whether they would have just happened anyway.

    And it really is pointless to argue about whether or not the patients were receiving conventional treatment. One of the authors of the study (Spence) actually admitted, in an interview on Radio 4 on 21st November, that the patients in the study had also been receiving conventional treatment.

  95. BSM said,

    November 26, 2005 at 4:08 pm

    “Can you take this apart for non-scientists such as me? How can he say that there are ‘no exclusions’, and there are no bias? Surely you can always include more people, and surely there’s always going to be some danger, however small, of some bias creeping through. Is Spence saying that he didn’t use a control group – if so, how can he be certain that there’s no bias?”

    I don’t think you’ve quite been given the correct answer to your question. There are only two possibilities. He either knows he is talking nonsense but says it anyway, or he doesn’t even understand the issue. There is no third option, neither is flattering and both are typical of the woo-woo medicine community.

    (Please folks, try to resist the urge to respond to Kumar. It may sound unfair, but he has limitless time and desire to divert discussions of pseduomedicine to his cracked agenda of homeopathy, Tissue Salt Remedies (use Google and be prepared to weep) by employing his complete collection of logical fallacies.

    Sorry, Ben, a badscience link got posted at JREF and Kumar followed it)

  96. Kumar said,

    November 26, 2005 at 4:20 pm

    Mojo, it is already clear that it was a long term observation of many patients, not a DBPC study. It is therefore pointless to impress on it again & again. Homeopathy is a different type of system than conventional system, based on symptoms, gentle and deep effects, difficult to check in path. Tests, so its justifications can be in observations, survey or sometimes in DBPC study without adjunctive stronger medicines/healing agents than homeopathic remedies. You know sound , stronger than any dull sound (may be ultrasonic) can suppress/overpower that dull sound unless you are very far from stronger sound or very near to dull sound. Probably, all stronger stimuli/sensations can suppress/overpower or dim the comparatively weaker ones. It can also be thought for my other points–stronger influences of conventional system, currently.

    It is not there in report that adjunctive modern medicines were used in all cases but just “x” group is indicated which clearly indicate that CMs was used in “x” group. I can’t say about radio report as we are going with survey report. How he said, what he said, was it just for medicines given to x group or to some few patients, if given all the times OR he has spoken in view of prevailing modern atmosphere (PMA). If you still don’t believe in any one, you can check it with GPs, doctors, homeopaths, parents & patients again.

  97. Michael Harman said,

    November 26, 2005 at 7:45 pm

    Andrew T wrote: “This is why we blind the experimenter in a double blind trial. If a doctor thinks the experimental drug may really work and a very sick patient needs to be treated, it is overly tempting to give them the experimental drug rather than the placebo, in the hope it might work.”

    I think it’s trickier than that. Even with an honest experimenter who doesn’t swap the drug and the placebo, if the experimenter knows which is which he may give subtle clues to the patient, so the patient may get some idea of whether he/she is expected to do well or not. If the experimenter is blinded, all patients are given identical impressions about what the treatment is, how it is expected to work, and so on.

  98. ADH said,

    November 27, 2005 at 12:14 am

    Michael Harman wrote: “I think it’s trickier than that. Even with an honest experimenter who doesn’t swap the drug and the placebo, if the experimenter knows which is which he may give subtle clues to the patient, so the patient may get some idea of whether he/she is expected to do well or not. If the experimenter is blinded, all patients are given identical impressions about what the treatment is, how it is expected to work, and so on.”

    Unlike drug trials there are many interventions for which it is impossible to blind the person who is providing the intervention, e.g. surgery. It may therefore be impossible to eliminate bias entirely but we can take steps to minimise its scope. Outcomes can be assessed or administered by independent observers who are blinded to the treatment the patient has received. Careful design of the control arm (e.g. sham acupuncture) may make it possible to blind the patient to the treatment they have received.

    That said, the Spence paper is appalling. If we asked the authors to look at the number of deaths in their patients I doubt they would be so keen to perform an uncontrolled analysis that attributes the outcomes entirely to homeopathy.

    For those with an interest in peer review I recommend the website of the Fifth International Congress on Peer Review and Biomedical Publication (with links to previous meetings) at www.ama-assn.org/public/peer/peerhome.htm

  99. BSM said,

    November 27, 2005 at 9:04 am

    “That said, the Spence paper is appalling. If we asked the authors to look at the number of deaths in their patients I doubt they would be so keen to perform an uncontrolled analysis that attributes the outcomes entirely to homeopathy. ”

    As I have said in another thread (www.badscience.net/?p=189) Spence has previously been very keen to show how powerful homeopathy is by citing its alleged adverse effects.

    I think it would be reasonable for him to be challenged to explain how many of his 6,500 reported advers effects, and, you are right, how many died during their follow-up period.

  100. rudeboy said,

    November 28, 2005 at 12:24 pm

    “Greater improvements were noted in children”

    No kidding: they were the most suggestible group within a highly suggestible cohort.

  101. Michael Harman said,

    November 28, 2005 at 2:09 pm

    Re ADH’s comment, point taken. But I think we’re talking mainly about homeopathy here, not surgery. Is there difficulty in double-blinding giving out prescriptions of homeopathic concoctions?

  102. BSM said,

    November 28, 2005 at 2:20 pm

    “No kidding: they were the most suggestible group within a highly suggestible cohort.”

    If you define homeopathy as the effect of doing exactly nothing then everything about it makes a lot more sense. It’s only if you have to keep coming up with cover stories for all its problems and difficulties that problems arise.

    Intermittently I feel sorry for homeopaths as well as angry with them. They can spend entire careers and their whole intellectual life defined by a giant lie. On a human level and outside the rough and tumble of debate I think that is terribly sad.

  103. BSM said,

    November 28, 2005 at 3:25 pm

    ” Is there difficulty in double-blinding giving out prescriptions of homeopathic concoctions?”

    The only problem is getting homeopaths to co-operate with well-controlled studies, which prove homeopathy to be a crock, hence their need for PR stunts like Spence’s.

  104. kabeach2001 said,

    November 28, 2005 at 3:41 pm

    Is it right that he law is going to be changed to allow practising homeopaths to marry? DISGUSTING!!

  105. A medical Customer!! said,

    December 3, 2005 at 12:30 am

    Hay I love it……. all the times I have ever been to a Doctor…….especially for a prolongued issue…….. I dont recall ever having any follow up…… Infact I have a skin problem which I developed in London 3 years ago…now I live outside the UK… I finally got it resolved after visiting a Doctor here…. with a follow up “request” from the Doctor, six months later……………. well well well….never had any follow up from a Brit Doc (I believe thats how the media refers to the medical profession these days)

    My view of the UK medical….er…..profession….is noth much higher than….Doctor’s views of sharlatans…..

    I even got offered Antibiotics for a cold by a UK Doctor….. now I know you all slave endlessly under the NHS…until you get a lucrative jobe elsewhere…….providing antibiotics to a reasonably healthy person with a cold….probably means me paying for the perscription and me paying more tax for a service which has a highly educated but often ineffective service…….

    But then you had to pay more for the letters behind your names and could be earning as much as someone who splashed out 65 bucks for an AANC dip with a Channel 4 contract!

    I write this just to remind you all that as a patient…no not a purveyor of Penta water…or cocaine filled condoms…but a simple lowly patient.

    I respect your imperic knowledge, but cringe at your superiority….

    BUT I LOVE THE DEBUNKING OF “OTHER” QUACKS :-

  106. Jack said,

    March 7, 2006 at 1:22 pm

    My asthma and eczema both got better, with time, without any homeopathy, before I was 16. Can I put myself forward as a volunteer for the control group? It shouldn’t be that hard, I live in Bristol (where the study took place) after all?

  107. wayscj said,

    November 21, 2009 at 8:19 am

    ed hardy ed hardy
    ed hardy clothing ed hardy clothing
    ed hardy shop ed hardy shop
    christian audigier christian audigier
    ed hardy cheap ed hardy cheap
    ed hardy outlet ed hardy outlet
    ed hardy sale ed hardy sale
    ed hardy store ed hardy store
    ed hardy mens ed hardy mens
    ed hardy womens ed hardy womens
    ed hardy kids ed hardy kids ed hardy kids

  108. iphone revolution said,

    December 30, 2009 at 8:37 am

    iphone wireless

    iphone

    Apple iphone

You must be logged in to post a comment.