Sadly, this is not the first time I have reported on deaths associated with the use of homeopathy. Recently there was the case of the untreated eczema death of toddler Gloria Sam, for which her parents were convicted of manslaughter.

Penelope Dingle died in 2005 from untreated bowel cancer aged 45 after being diagnosed in 2003. She first presented with bleeding from the bowel in 2001. Following a colonoscopy, she was advised by doctors to have surgery to remove the cancer. She declined conventional cancer treatment, instead deciding on following a regimen of alternative treatments including special diets, vitamins and homeopathy.

Her husband is Dr Peter Dingle, a prominent Professor of Environmental Toxicology at Murdoch University in Perth and a media personality and author. Modelling himself as a kind of Aussie Joseph Mercola, he has a flashy website and has written such titles as “Is your home making you sick?”, “Improve your memory, your thinking and your life” and “The six week healthy eating planner”, the latter co-written with a naturopath (read: not a doctor).

The inquest was conducted at the request of the family following Mrs Dingle’s death in 2005. According to evidence given at the inquest from friends of Mrs Dingle and from her diaries, she and her husband made a pact with homeopath Francine Scrayen to not take any conventional treatment including pain relief. Dr Dingle also planned to write a book about how to cure cancer with homeopathy and alternative treatments once his wife was cured. A friend of the couple testified they were “enthralled and entrapped” in the spell of Ms Scrayen.

A report from the West Australian newspaper described;
“….Pen had so much faith in Francine. She was totally in her control”.

The friend described how Mrs Dingle has called the homeopath “at least a dozen times a day” and would only consume homeopathic medicines prescribed by her.

She came to visit Mrs Dingle in 2003, and was shocked to see how emaciated she was, since she had been assured by the couple that Mrs Dingle was responding well to the treatment. When the friend spoke to the homeopath, who consulted exclusively by phone, her concerns were dismissed, with the homeopath saying Mrs Dingle’s pain “was in her head” and she merely had constipation. She would not allow Mrs Dingle to take any other forms of medicine.

The friend also described how Mrs Dingle moaned in pain every night she was there, and even a visiting nurse who rated her pain nine on scale of ten was unable to convince her to take pain relief. Eventually she did succumb, receiving morphine in hospital and emergency surgery. This was only after she was advised by doctors that she would vomit feacal matter and die an excrutiatingly painful death within 24 hrs if she did not. Her bowel was completely obstructed by the tumour at this stage and she had not had a movement for 12 days.

It was too late for Mrs Dingle by this stage as the cancer has metastasized after such a long period of neglect and she died in 2005.

The question now is will the homeopath be held accountable for contributing to the death? I am not familiar with the legislation in WA, but in NSW it is illegal to claim to be able to cure incurable diseases, in accordance with the Code of Conduct for Unregistered Practitioners, legislated by the HCCC. But technically, homeopaths are actually not unregistered practitioners since they do have a regulatory body, the Australian Homeopathic Association which has a code of conduct of their own.

It seems you don’t need to dig very deep to see where Mrs Scrayen has breached the code (mind you on looking through it, it is not particularly specific about harm or seeking conventional medical advice when necessary).

Section 1, part 1 under general principles of professional conduct, states that:
“the welfare of patients…..shall take precedence over a member’s self interest and the interests of employees and colleagues.”

Section 2, part 2 also states:
“Members shall not …cause undue harm to patients.”

The only other section that is relevant in this case is Section 2.4:

“Patients whose state of health is deteriorating shall not be attended indefinitely without the member in charge suggesting or insisting upon a consultation with at least one other practitioner to confirm the assessment and treatment.”

But by stating “at least one other practitioner” does suggest another homeopath, not like a proper doctor or anything, you know the ones who are qualified to treat cancer for example.

The HCCC Code of Conduct is not so ambiguous. Section 5 states:

“Health practitioners not claim to make claims to cure certain serious illnesses. (1) a health practitioner must not hold him or herself out as qualified, able or willing to cure cancer and other terminal illnesses.”

Now I don’t know if the homeopath claimed she could cure Mrs Dingle’s cancer – this information has not been revealed as far as I know. It might be the case that the couple made the decision to only use homeopathy and not conventional medicine. But even of this is true, the homeopath did apparently forbid Mrs Dingle from using conventional pain relief and surely this breaches either code of conduct for responsible behaviour.

We will wait and see. In the meantime, this is yet another sad case to add to the hundreds on the What’s the Harm website. It makes you wonder what exactly motivates people to shun science based medicine, and especially in this case, where the alternative was just water and the desire to pursue this line of treatment even after it became obvious the magic vibrating water was not helping.

Add to this, the fact that Dr Dingle has a PhD? None of it makes sense.

Whatever that means.

The week will also reflect on the memory of the 255th anniversary of the Birth of Dr. Samuel Hahnemann, the creator of homeopathy.

Homeopaths and homeopathy supporters from around the globe will join forces in April during World Homeopathy Awareness Week (WHAW). The website lists many suggested activities and events, such as handing out fliers, promoting homeopathy through television and radio, organising musical concerts/stage concerts/skits/plays, etc with a homeopathic theme. Which all seem pretty harmless and twee, until you get to this one.

“Contact other homeopaths in your area and organize free clinics for the poor.”

Why? Are the poor thirsty? Or need a bath? Why else would they be wanting expensive water?

I also plan to get the word out about homeopathy during WHAW.

And the word is bollocks.

But seriously, as sceptics we should make an effort to publicise homeopathy during this time to let people know it does nothing and it contains nothing. It’s water, or whatever else was used to dissolve the active ingredient, which has long disappeared by the time it appears on the shelf.

I plan to dig up some of the position statements from organisations concerned with the harm that homeopathy can do.

Many of us are familiar with the one released by the WHO in response to an open letter from Sense About Science imploring them to take a position on homeopathy. Their response was;

The WHO DOES NOT recommend the use of homeopathy for treating HIV, TB, malaria, influenza and infant diarrhoea

Dr Mario Raviglione, Director, Stop TB Department, WHO: “Our evidence-based WHO TB treatment/management guidelines, as well as the International Standards of Tuberculosis Care (ISTC) do not recommend use of homeopathy.”
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Dr Mukund Uplekar, TB Strategy and Health Systems, WHO: “WHO’s evidence-based guidelines on treatment of tuberculosis…have no place for homeopathic medicines.”
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Dr Teguest Guerma, Director Ad Interim, HIV/AIDS Department, WHO: “The WHO Dept. of HIV/AIDS invests considerable human and financial resources [...] to ensure access to evidence-based medical information and to clinically proven, efficacious, and safe treatment for HIV… Let me end by congratulating the young clinicians and researchers of Sense About Science for their efforts to ensure evidence-based approaches to treating and caring for people living with HIV.”
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Dr Sergio Spinaci, Associate Director, Global Malaria Programme, WHO: “Thanks for the amazing documentation and for whistle blowing on this issue… The Global Malaria programme recommends that malaria is treated following the WHO Guidelines for the Treatment of Malaria.”
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Joe Martines, on behalf of Dr Elizabeth Mason, Director, Department of Child and Adolescent Health and Development, WHO: “We have found no evidence to date that homeopathy would bring any benefit to the treatment of diarrhoea in children…Homeopathy does not focus on the treatment and prevention of dehydration – in total contradiction with the scientific basis and our recommendations for the management of diarrhoea.”

Of course it might also be time to remind people about the recent findings by The House of Commons Science and Technology Committee in the UK on homeopathy. In a 273 page report, they concluded

* The UK National Health Service should cease funding homeopathy
* No further clinical trials of homeopathy should occur.
* Evidence shows homeopathy doesn’t work.
* Explanations for why homeopathy works are “scientifically implausible.”
* Committee viewed homeopathy as placebo.

The UK Health Protection Agency also published a statement saying they do not recommend homeopathy for malaria prevention.

“There is no scientific proof that homeopathic remedies are effective in either preventing or treating malaria. In addition, the Faculty of Homeopathy does not promote the use of homeopathic remedies for disease prevention and note that their use in malaria prevention is unlikely to be acceptable to insurance providers.”

But in an undercover investigation by Simon Singh and Sense About Science, a researcher pretending to be travelling to malarial affected areas was advised that homeopathy was effective, by homeopaths and pharmacy assistants. At Nelsons Pharmacy in London, which claims to be Britain’s biggest manufacturer of homeopathic remedies she was advised of the remedies;

“They make it so your energy doesn’t have a malaria-shaped hole in it so the malarial mosquitos won’t come along and fill that in.”

Are you serious? You have to be making that up.

Of course, if homeopathy is just water then it won’t hurt you right? Well no, as long as you are also receiving evidence based, effective treatments. Otherwise, it can be lethal.

I plan to make as many people as possible aware of WHAW.

Aware that it’s complete bollocks.

Dr Ken Harvey, a lecturer at Latrobe University School of Public Health, who authored the complaint (read the full complaint as a pdf here), objected to claims on the website that “homeopathic immunisation is effective against poliomyelitis, chicken pox, meningococcal disease, hepatitis (all types), Japanese encephalitis, Hib, influenza, measles, pneumococcal disease, smallpox, typhoid, cholera, typhus, whooping cough, rubella, mumps, diptheria, malaria, tetanus, yellow fever, dysentery and many other epidemic diseases”.

The websites, classified as advertisements for the purposes of the complaint, also claimed that “recent research conducted at Swinburne University by Australian homeopath, Dr Isaac Golden confirmed that homeoprophylaxis provides the same degree, or better protection, than vaccines with none of their side effects or complications.”

About influenza, the websites state that the homeopathic preparation, “Anas Barbariae relieves the intensity and shortens the duration of flu symptoms better than anti-virals…..without the side effects” and “symptoms are sometimes removed in a few hours”.

In reference to the claims about the positive results of Isaac Golden, Dr Harvey noted these claims are directly contradicted by the thesis from where they are sourced. Golden’s thesis contains the statement; “the effectiveness of the homeopathic immunisation programme could not be established with statistical certainty given the small sample size..”. In spite of this, and in lieu of providing further evidence,  the complainant stated (in part) that the thesis had “indeed reached a positive conclusion with a high degree of confidence”.

The findings from The Complaints Resolution Panel stated that although the complainant cited references for homeoprophylaxis, they “did not provide complete copies of the papers cited.” Further, the material on the websites was deemed “misleading”, “unverified” and “abused the trust or exploited the lack of knowledge of consumers” (my emphasis).

The Panel found that none of the material supplied by the advertiser supported claims made on the websites, and therefore the information was misleading and “likely to arouse unwarranted expectations” from consumers. The Panel ruled for Homeopathy Plus! and www.d-n-h.org to remove the misleading material and issue a retraction on their websites which is to remain for 90 days. The advertiser has 14 days to comply with the ruling.

Claims about efficacy of homeopathic immunisation are in direct contravention to statements from the National Council for Homeopathy London which “strongly supports the conventional vaccination programme..”. In Australia, The Executive Director of the Australian Natural Therapies Association said “no properly qualified natural therapist would recommend homeopathic immunisation as an alternative to conventional immunisation”.

This comes at a time when NSW Health authorities have issued a warning about meningococcal disease following the death of a woman in Sydney, and a spike in cases in NSW, with eight reported in December 2009, in Sydney.

For more information about homeopathy, see the 10:23 campaign. To participate in a mass homeopathy suicide attempt in Australia, see the events page on Facebook.

It was entitled “OUR RELATIONS WITH HOMEOPATHY”

and was in response to speeches previously published regarding “..prevailing professional laxity and charlatanry, in connection with the homeopathic quackery”.

Dr McCormack had some pretty scathing things to say about homeopathy and its use by “…shallow men and women…able to lure lucre by every imaginable wile from the sick and the silly”.

He went on to say;

“When patients are once secured, they are, ….retained by the combination of every current medical novelty which may at the time be most in favour with the moneyed throng of quack-fanciers“.

“..homoeopathy…is truly a combination of any and every available charlatanic trick,…..and therefore all that remains for us, as men of science and men of integrity, is to give notice, that we exclude from all professional intercourse practitioners who are in any way engaged in using or upholding a system which we think bears upon its very face fraud as well as absurdity“.

Wow, pretty serious stuff. One might imagine you could now get sued for saying things like this, ala, the BCA and Simon Singh.

But McCormack went further than this by listing a series of guidelines desscribing how clinicians who used or practiced homeopathy should be received by their medical colleagues;

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“1. That it is the opinion of this (Provincial) Association, that homoeopathy as propounded by Hahnemann, and practised by his followers, is so utterly opposed to science and common sense, as well as so completely at variance with the experience of the Medical Profession, that it ought to be in no way or degree practised or countenanced by any regularly educated medical practitioner.

2. That homoeopathic practitioners, through the press, the platform, and the pulpit, have endeavoured to heap contempt upon the practice of Medicine and Surgery as followed by members of this Association, and by the profession at large.

3. That for these reasons it is derogatory to the honour of members of this Association to hold any kind of professional intercourse with homoeopathic practitioners.

4. That there are three classes of practitioners who ought not to be members of this Association, viz.-lst, real homeopathic practitioners; 2nd, those who practise homoeopathy in combination with other systems of treatment; and 3rd, those who under various pretences meet in consultation, or hold professional intercourse with those who practise homoeopathy”.

—-

Finally;

“To adopt resolutions setting forth that the homeopathic dogma and the doctrine of infinitesimal doses have no truthful basis, and are, in fact, mere nonsensical delusions…The worst part of homeopathy, is in my opinion, the DISHONESTY of the majority of those who live by it”.

So there you go, homoeopathy, declared bullshit as early as 1851.

You can find the full reference here.

Tip o’the hat to Jo Benhamu.

Unfortunately, it has become all too common commonplace that SCAMs (Supplementary, Complementary and Alternative Medicine) make unsubstantiated claims about their products and services.

It has also become commonplace that they get away with making such claims, seemingly without consequence.

As was the case when I was told at the Mind Body Wallet festival that my friend’s cancer could be cured with an AUD12,000 course of fruit juice diets, detox and herbs/supplements. Claims such as these are illegal in New South Wales under section 5 of the Code of Conduct for Unregistered Practitioners which states that;

“Health practitioners not to make claims to cure certain serious illnesses. (1) A health practitioner must not hold him or herself out as qualified, able or willing to cure cancer and other serious illnesses”.

So it was a surprise to see this happen today.

This is the work of a sceptical colleague, Michael, who issued a lengthy complaint to the Complaints Resolution Panel of the Therapeutic Goods Administration some time ago. Recently he received a 9 page facsimile advising that his complaints about Arnica Montana, a purveyor of homeopathy, regarding breaches of section 4(1)(b), 4(2)(a), 4(2)(b), 4(2)(c), 4(2)(d), 4(2)h, 4(2)(i), 4(7) and 5(2) of the advertising code were deemed valid.

Arnica Montana  Enterprises Pty Ltd were instructed to comply with the following sanctions: Withdrawal of Advertisement, Withdrawal of Representation and Publication of Retraction. This involved publishing a  retraction on the website which appears below.

Regular listeners to the Skeptic Zone and readers of the Zoners blog may recall I called these people out back in February for issuing a statement on their website about the use of homeopathy for severe burns and recommending its use for the victims of the Victorian Bush fires, known as “Black Saturday”, the worst natural disaster in Australia’s history. The website stated; “In the light of recent events in Bali and the bush fires in the Eastern States of Australia information about the use of Homeopathy by the ordinary person is knowledge that should be shared.”

The advertiser was given an opportunity to respond to the criticisms, and rejected the allegation that there was “anything deceptive or misleading” in the advertisement/website. The advertiser claimed that the website was “intended to be an information website to educate the public about the use of homeopathic remedies” but not to the exclusion of any other system of medicine.

But The Panel found that the advertisement breached sections of the code which prohibit advertisements for products that “abuse the trust or exploit the knowledge of consumers” and was “likely to arouse unwarranted and unrealistic expectations of product effectiveness”.

This was based on the finding that “the advertisement included claims of benefits in relation to burns, scalds, pain, traumatic shock, severe burns….no persuasive evidence was provided that the advertised products could have benefits in relation to the wide range of conditions referred to”.

Evidence? Why do you need evidence? The advertiser stated “controlled trials cannot be used for homeopathy but [that] there is a mass of unpublished evidence” and stated that they “would be grateful to know which section of the Code requires published scientific evidence as a precondition to advertising”. Besides they have testimonials all over their website…but wait, they were called into question too.

The Panel stated that the advertiser did not provide evidence that any of the testimonials in the advertisement were genuine.

According to the code; Section 4(7) requires that testimonials “must be documented, genuine, not misleading and illustrate typical cases only”.  The panel found that the advertiser did not provide any evidence that the testimonials were genuine, and cited this as an example;

“the calendula cream I make is specific to cancer skin keratoses and I have successfully treated many of these and established melanonas by using the sage cream at night and the calendula during the day”.

Interesting that it unlawful to publish testimonials that are not genuine or “atypical”. This could apply to many a woo website.

But then this;

The Panel noted that the advertisement breached section 4(5) of the code;

“..by implying that other therapeutic goods (namely vaccines and sunscreens) could be harmful….”

If you search the website for vaccination, you will get hits for the Australian Vaccination Network (AVN), Meryl Dorey and other misinformation that we have come to expect from the anti-vaxers. (Who would have thought, a homeopath condemning vaccination). I wonder where does the AVN website sit with respect to this? Would their website be deemed an advertisement? After all, they do sell literature and DVDS, but I suspect these products do not come under the auspices of “therapeutic goods”.

An advertisement is defined by The Code “…to include any statement, pictorial representation or design, however made, that is intended, whether directly or indirectly, to promote the use or supply of the goods”.

This is why the entire arnica montana website was deemed an advertisement; the Panel noted that it was clear that the website offered a range of products for sale, and was satisfied that the website as a whole constituted an advertisement for therapeutic goods.

Interestingly, the complaint summary cites the subject matter of the complaint as “website advertisement” and the sanctions as “withdrawal of advertisement”, thus implying the entire website is to be withdrawn. If you go to the website, you will see the published retraction, but the remainder of the website still functions as normal.

And if you think there’s no harm in homeopathy, then see this story.

This story appeared on SMH online today. It details plans to establish a register for quacks, apparently in an attempt to separate the wheat from the chaff. Sounds a little bit like the register set up in the UK recently and blogged about here.

I read this article with trepidation, firstly because I think putting quacks on a register lends legitimacy to their profession and this is undeserved in my opinion.

“The industry’s reputation was dealt a blow this month after the NSW Supreme Court convicted a homeopath of the manslaughter of his nine-month-old daughter, who died of septicemia caused by chronic eczema.”

Yes, the industry was dealt a blow, but this was not because of a shonky homeopath, this was because homeopathy does not work in the treatment of eczema. Or any other illness in fact. A meta-analysis published in the Lancet in 2005 compared 110 conventional and homeopathy trials and the effect of homeopathy was deemed no greater than placebo (Shang et al., Lancet 2005; 366: 726–32).

An editorial which appeared in the same issue of the Lancet stated; “despite 150 years of unfavourable findings…the more dilute the evidence for homeopathy becomes, the greater seems its popularity.” Why we keep wasting money and good science on testing it, to continually get the same answer is beyond me.

The article continues;
University of Queensland researcher Jon Wardle, who heads a steering committee to set-up a register said; “We are making sure that when the public sees a naturopath they have training, act ethically and if something goes wrong, there is a complaints procedure,” he said. Mr Wardle said the lack of formal accreditation meant people with as little as one week’s training could call themselves naturopaths and it is these people who dispense a large quantity homeopathic remedies.

This is where I get annoyed. Firstly, there is a complaints procedure in NSW. It was established with the new Code of Conduct for Unregistered Practitioners which was introduced in August 2008. Section 17 of the code states that practitioners must display the Code and information about the way in which clients may make a complaint to the HCCC if necessary.

Funny that, I went to Mind Body Wallet a few weeks back armed with my code and saw it displayed nowhere, neither at stalls doing invasive procedures such as live blood analysis, or massage or anywhere.

I have to say, I am not convinced that the relevant regulatory bodies/associations or members of them are particularly concerned about following the rules when it comes to legislation. In NSW at least, they seem to have dutifully ignored conforming to this recent legislation. I am suspicious that the establishment of a nationwide register is really just a sneaky way to add undeserved legitimacy to profession where there is scant evidence for efficacy.

But this is not the worst part about this article. The article was penned by 2 journalists, Rachel Browne and Melissa Singer, neither of whom seem to understand much about what constitutes conventional medicine or doctors. They refer to a British podiatrist and homeopath Tariq Khan, as Dr Khan. This is misleading and infers that Khan is a clinical doctor, naturopaths use the title ND, (and referred to by some as not a doctor). They tell us that Dr Khan recommends homeopathy be used in conjunction with conventional treatment. And of course a homeopath is going to endorse the use of homeopathy.

The man apparently had talks with the head of dermatology at St George Hospital, Dedee Murrell, to discuss using homeopathic remedies for an incurable disease, the rare genetic condition epidermolysis bullosa. Let me state that again. Homeopathy as treatment for an incurable disease. This following the beginning of the article where the journalists discuss the parents of Gloria Thomas being charged with manslaughter for shunning conventional medicine and treating their daughter’s eczema with homeopathy. She subsequently died.

This is very poor journalism. To begin an article with charges of manslaughter for a homeopathy-related death and then discuss using it for incurable diseases is just credulous on the part of Rachel and Melissa.

But then this; “The Royal Australian College of General Practitioners and the Australasian Integrative Medicine Association have given qualified support to the use of complementary medicine where there is research about its outcomes.”

Precisely Rachel and Melissa. There is research. To show it does nought. Take a look at the Lancet article. Visit PubMed for goodness sake. Do some research, please.