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There has been lots of talk recently in the Australian media about CAM in universities. A new lobby group known as Friend of Science in Medicine was recently established to get the discussion going about whether this is a good thing. (Full disclosure, I recently added my name to the 400-long list of doctors, scientists and concerned citizens who are worried about pseudoscience creeping into universities).

The discussion has ruffled some feathers and I think this is a good thing. As I said in a comment on The Conversation, what is wrong with us looking at these courses and determining if what they are teaching is evidence-based? If we find there is nothing wrong, then we can carry on our merry way.

Yet, some CAM peeps don’t seem to see it this way. Some have been behaving as if they are being persecuted. Some are claiming that taking CAM out of unis puts the public at risk as practitioners are more likely exposed to shonky teaching (I haven’t seen any evidence for this, but as usual I’m willing to look at it if it’s true).

But this misses the point that it doesn’t matter where you teach it, if it’s nonsense outside of a university it remains nonsense when taught in one. Teaching homoeopathy or tactile therapy in a university environment won’t make it work. To see how homeopathy works, go here.

The argument got rather heated on Twitter recently with Prof Kerryn Phelps jumping in the mix. I had quite a long conversation with her, which remained mostly civil (if not a little strained) until I suggested we weed out the stuff we know doesn’t work or exist, such as subluxations in chiropractic and homeopathy.

The response I got was odd to say the least and I’m still unsure exactly what she was getting at. See the screen shot below (read from bottom up).

Some people suggested this was an example of the No True Scotsman fallacy, which I kinda agree with. More simply, it appears to say “don’t mention homoeopathy, even we’re embarrassed by that”. If you have another idea, please leave a comment.

Someone else called “SkepNurse” also posed the question to Prof Phelps regarding which CAM she would unequivocally say was not worth pursuing any more, either because it can never work or has been proven not to. She posted these tweets on Jan 26th and is still awaiting a direct answer.

Anyway, I’d been poking around for information on whether homeopathy was taught in universities as a stand alone course, and I hadn’t found any evidence. CAM practitioners had confirmed this as well, pointing out that it was a requirement to enter Bachelor of Health Science (Complementary Medicine) at Charles Sturt University but was not taught as a separate subject.

Well, they were wrong.

Homeopathy is taught as a stand alone course subject at a publicly funded university in NSW as part of Southern Cross University’s Bachelor of Clinical Sciences. They offer introductory homeopathy and clinical homeopathy. It is also offered as a service in the health clinic

There is even a prize offered at SCU.

The Warren Brauer Memorial Prize – Homoeopath Dispensary to the value of $500

Awarded to the Naturopathy award graduate who has exhibited a high level of proficiency in the understanding and application of homeopathy.
Donated by Brauer Natural Medicine Pty Ltd

SCU is a publicly funded university who received $32 million of federal funding in 2011. Thus, public funding is going towards the teaching of nonsense in Australian Universities.

When I’ve previously written about public funding for homeopathy in Australia the most I could do was speculate about how much it might cost the tax payer. It’s complicated because our public health system does not directly fund homeopathy as health care, but it does supplement private health funds (which do cover homoeopathy) and also some doctors/gps will prescribe recommend it.

This is the first evidence I have found that tax payers funds directly fund this nonsense. And what a waste of money it is.

I’ve written to SCU to ask for their course outlines for both classes. Let’s hope I get them so I can get a better idea of exactly what they teach.

With continued pressure from FSM, this conversation will likely continue for some time. I would like to see the first casualty be these courses at SCU.

This comment on The Conversation has really summed up this debate for me so far. It’s from Didier Nave, an ex-herbalist of 25 years and the following excerpt speaks volumes;

Time to face the facts. The data is coming in and its not looking good. It’s clearly showing that what we do is not much better than placebo. So the question is do we have the humility to accept the evidence and dump these theories. I doubt it….Have i seen the industry contest or reject its own stupidities like live blood analysis or “detoxing” when it can’t name one toxin that its methods supposedly detox? No, it embraces them instead.”

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To see how The Dean of the School of Health, Professor Iain Graham, defends woo in his uni, see Mick Vagg’s post here.

There’s more info on woo in public and non-public facilities here.

Thanks to Loretta Marron for assisting with research.

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More interesting reading on the current debate (and for healthy discussion in comments) see two recent articles from The Conversation;

Alternative Medicine Can Be Sientific Say Besieged Academics

Pointing The Bone At Chiropractic Quackery Lessons From the UK

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To see the investigation of woo in universities from The Skeptic magazine (and written by Tim Mendham with research from Jo Benhamu) go here (pdf).

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From the ever dangerous and delusional Homeopathy Plus! who would be funny if they were a Poe (they’re not). For the complete crazy go here.

BTW, the reason I’ve had a busy week was because of a post on Mamamia which went well a little bit mental. I been kept busy responding to comments. So far I’ve been called a liar at least three times, usually by people hiding behind anonymous handles. Brave eh? Thanks so much to everyone else who has jumped in to help me.

Mind you Mia Freedman came out today and slapped the anti-vaxers down with this comment.

Anti-vaxers using dirty tactics? Who’d have thunk it…

I did a pre-record for next week’s Mamamia TV with her today.

Also on the panel was Sam de Brito, Sarah McDonald, the head of GetUp! and the editor of Cosmospolitan Magazine (sorry, I fail to remember their names). You can watch it on Foxtel next Friday at 21:15 or on the Mamamia website after it’s aired.

Enjoy your weekend!

If you follow the process, no doubt you’ll know who trolls the internet leaving this statement anywhere someone criticises homeopathy;

“Real is scientific homeopathy like Conventional Allopathic Medicine (CAM). Evidence-based modern homeopathy is a nano-medicine bringing big results”

Firstly, wha??

Only one person can dish up quality woo like this. It’s Not-a-Doctor Nancy Malik of course. And what exactly is “scientific homeopathy”? Best you ask Dr Malik about that.

So given that it was WHAW, many science-based bloggers and tweeters took it upon themselves to make people “aware” that homeopathy is nothing more than an expensive placebo. In most cases, the liquid or sugar pills you buy from your pharmacist in fact contain nothing at all. Thus, the catch phrase of Ten23; “Homeopathy, there’s nothing in it”.

My best mate Richard Saunders did his bit, in the form of an epic slap-down story on Adelaide’s Today Tonight where Brauer “Natural Medicine” came in for a bollocking. As Phil Plait so eloquently put it, this story was unique for the token homeopath not the token sceptic, the latter being the usual way things work on commercial television. If you haven’t seen this video, take the 10 minutes to watch it – it’s great. Richard delivers some succinct and pointed sound bites which really bring the message home (and I’m not too coy to say I was sitting off camera coaching him for this part!).

But, like many sacred cows, homeopathy is an unsinkable rubber duck and despite 200 years and 200 clinical trials, there is still no evidence that homeopathy works (see how homeopathy works here). This leaves homeopaths mumbling excuses like “RCTs don’t work for homeopathy” or “one day quantum physics will solve it”.

Do not pass go, do not collect $200.

So it was with great delight that I opened my Australian Doctor email today to find an article by Paul Smith (whom I highly respect) with the headline; “National Health and Medical Research Council (NHMRC) declares: homeopathy ‘not efficacious’”. It’s a subscription based article so I can’t copy paste it here, but I can provide a summary.

“The NHMRC’s position is…it is unethical for health practitioners to treat patients using homeopathy, for the reason that homeopathy – as a medicine or procedure – has been shown not to be efficacious.”

This is currently a draft statement, apparently drawing on several issues; claims that “homeopathic vaccinations” are an effective substitute for vaccines, recent deaths (see here and here) in Australia where homeopathy was implicated and the findings by the UK Science and Technology Committee in 2010 which concluded that the UK National Health Service should cease funding homeopathy.

This is the first time the NHMRC has spoken out against homeopathy and the implications are significant. As Paul says;

“If the public statement is formally adopted by the council, the major health insurers – Medibank Private, HCF, NIB and MBF – will have to justify why it is using taxpayers’ money to fund “unethical” homeopathic treatments.”

Three billion dollars of taxpayers money is provided every year to fund private health insurance rebates by the government and this includes homeopathy. Should the NHMRC declare it “unethical”, health funds will be under pressure to pull funding for quack remedies like homeopathy.

It’s too early to tell at this stage if this will happen, since the statement is still a draft, but it is tantalising to think that science and rationalism could win this one.

I encourage the NHMRC to formalise this statement and declare homeopathy unethical and devoid of efficacy. Of course people will still be able to buy it, but at their own expense instead of that of the tax payer.

And maybe, just maybe, this will see the end of doctors prescribing it and pharmacists selling it. And wouldn’t that be a huge win for science and scepticism.

The full article (subscription required) can be found here

In Australia, the east coast experienced the worst floods since 1974, quickly followed by Cyclone Yasi ravaging as far inland as Mount Isa. Then there was the terrible earthquake in Christchurch where many died across the pond. And then on Friday a massive 9.0 earthquake exploded under the North Pacific Ocean, sending a huge tsunami smashing into the north-east coat of Japan.

The Japanese are suffering terribly, not just because tens of thousands are missing feared dead, but they also face bitter cold as snow is dumped on the devastation. And even worse, 4 nuclear reactors which took the brunt of the tsunami and earthquake are now at risk of meltdown. Although the reactors are built to withstand earthquakes, the combination of such a huge event coupled with a massive tsunami wiped out back-up systems required to keep the fuel rods cool. As water levels dropped the rods heated up, some producing enough hydrogen gas to cause explosions and subsequently the release of radioactive gas into the air.

Authorities are madly dumping sea water from helicopters onto the rapidly heating fuel rods, and as a precaution have set-up an exclusion zone in a 30 km radius around the plant. However, if the meltdown cannot be prevented, there is a risk of the release of radioactive gas clouds which could drift into populated areas.

Enter the vultures.

Several days ago Australian Skeptics Vice President Richard Saunders circulated an email from Homeopathy Plus! describing homeopathic remedies for radiation sickness and poisoning. It described how homeopathy offered “key remedies that have been used either in research or historically to prevent or treat radiation poisoning..”.

Two emails sent on March 13th and the 16th described;

“If at risk of radiation exposure, any one of the above remedies may be taken as an emergency response, three times a day in a 30C potency.”

The remedies referred to are cadmium iodide, cadmium-sulph, phosphorus, strontium-carbonicum and X-ray.

That’s right, homeopathic preparations of X-rays.

But before you get worried that more X-rays might not be just the best thing to treat radiation burns, let’s take a look at precisely what 30C means. This is a common homeopathic dilution – one you might find on your local pharmacy shelf and means the original substance has been diluted 10 to the power of 60 times (in simple terms, 1 with 60 zeros after it). At a dilution this great, in order for you to come into contact with even one molecule of the original X-rays, you would have to give two billion doses per second to six billion people for 4 billion years. Or to put it another way, a 30C dilution is the equivalent of placing 1 mL of liquid into a cube of water measuring a million million million metres per side.

Impossible and also preposterous. But there’s more.

“If radiation sickness has developed, your homeopath is the best person to advise on treatment dosages and potencies as these will depend on the symptoms you are experiencing and their severity.”

But not just any homeopath. Apparently some people are confused by the number of remedies being offered by different homeopaths. (Apparently they can’t agree amongst themselves).

But never fear! Homeopathy Plus! will only recommend you;

“remedies whose effects are also supported by research and/or confirmed with clinical successes as reported by doctors and physicians dealing with radiation exposure during the Great World Wars.”

But what if you can’t get your hands on a super dilute one to the bajillion dilution of X-rays? No worries, you can take a more concentrated dose of X-rays but you just need to take it more frequently.

Yes, you read that correctly, if the preparation is more concentrated you just need to take it more often.
According to the helpful HP! Newsletter, this means

“…taking a more frequent dose for lower potencies (4-6 times a day) and a less frequent dose (1-2 times a day) for higher potencies.”

This is because homeopaths believe that the more dilute the preparation, the stronger it is. You couldn’t make this stuff up. Well, actually you could but no-one would believe you.

So as you might expect HP! have copped a bit of flack for this irresponsible nonsense. The story was reported in The Australian newspaper, on The Punch website, by Phil Plait in his Bad Astronomy blog, by Brian Dunning on Skepticblog and by Ben Radford on the Discovery website. Adam Cresswell from The Australian asked some experts about the claims that homeopathy can treat radiation burns and got a predictable response –

Victorian GP Bill Williams, who is also a nuclear safety expert, said there was “absolutely no evidence” for any of the remedies being promoted by HP! being useful in treating radiation sickness.

“It’s not really very helpful for people to be promoting treatments in a dire situation like this, which could give people false comfort,” Dr Williams said.

Nuclear radiologist Peter Karamoskos said the claims that were made by Homeopathy Plus were “rubbish”.

“Such claims are dangerous in that it might compromise proper treatment and give false security.”

Sadly this is not the first time HP have spouted rubbish on the unsuspecting public. The Homeopathy Plus newsletter and clinic are both run by homeopath Fran Sheffield who is also good mates with the AVN (birds of a feather and all that.)

In 2010, the TGA instructed Ms Sheffield to remove claims that homeopathy was an effective substitute for vaccination from her website and publish a retraction. She refused to do so on the grounds that she didn’t agree with the decision. And, as with approximately 30% of those served with a TGA retraction order, nothing was done to enforce the finding. In fact the TGA told ABCs Lateline programme that no legal action has ever been taken over non-compliance. Which makes the complaints system look like a complete farce.

Indeed following the Lateline report Fran Sheffield jumped a flotilla of sharks and published a piece on her website called “Lateline: can homeopathy safely protect against epidemic and infectious diseases? Can homeopathy treat serious diseases such AIDS and cancer?”. It was a veritable Gish Gallop of references purporting to show that indeed, it can. So, not only did she refuse to remove false and misleading information from her website, when challenged she simply added more.

A few months prior she sent out an email alert entitled “homeopathy as good as chemotherapy for breast cancer and non-toxic”, based on a paper published in The International Journal of Oncology. Firstly the paper had not made such a claim – it was only a cell study – and secondly it was a terrible piece of bad science chock full of dodgy data. So much so that one of the authors left a comment on my blog where I had taken the paper to pieces, dissociating herself from the work saying “…I asked to not be included (on the paper) because I did not think it was a sound study..”

Still, Ms Sheffield continues to claim that magic vibrating water can cure everything. In a flyer sent out for a workshop last year she stated “homeopathy works for autism, infections, anxiety, allergies, insomnia, coughs and colds, depression, irritable bowel syndrome and much much more..”

Sorry Fran, but there is no evidence that homeopathy works for anything, except maybe for hangovers. I love a nice cold drink of water when I’m hungover. But claims that homeopathy can be used for the treatment of radiation burns or illness are complete rubbish and prey on the vulnerable and desperate.

The full emails can be found here and here.

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I didn’t know this until out of curiosity I went to a website which has been heavily advertised over the last week on Australian television – the NPS website. I knew of this Australian government organisation since I follow them on Twitter but only after visiting the website did I discover they provide information on medicines for consumers and health professionals alike. Plus they are behind MedicineWise Week from January 30th – February 6th, 2011.

In light of the worldwide Ten23 campaign conducted all over the world this weekend – in fact every continent including Antarctica was represented – I thought I would pose as a consumer and search for information about homeopathy.

Like homeopathy itself, what I turned up was minimal and not very useful. I’ll explain more about this a bit later but first, as I was surfing around the NPS site, I found a press release about a survey of Australians’ knowledge of medicines.

Fifteen hundred consumers were surveyed and the results reported that 65% had used a prescription medicine in the last three months, 60% had used an over-the-counter medicine and 45% had used an alternative or herbal medicine.

When it came to alternative medicines and supplements, of those surveyed, less than half considered certain vitamins and herbs to be medicines: multivitamins (23%), echinacea (24%), fish oil (32%). Awareness of Chinese herbal remedies as medicines was slightly higher at 41%.

NPS clinical adviser Dr Danielle Stowasser said, “The first step to being medicinewise is knowing what is a medicine. Medicines include tablets, vitamins, herbs, eye drops, creams and gels. Medicines don’t just come on prescriptions but include things bought in a pharmacy, supermarket and other stores, and from naturopaths and herbalists.”

But thinking back to homeopathy, here’s where I began to get concerned:

Encouragingly, when asked where they would go to find accurate information about medicines, most respondents said a pharmacist (64%) and/or a doctor (60%). However, when asked if they did ask questions of their doctor or pharmacist the last time they received or purchased a medicine, 60% said no and 48% said they did not tell their doctor or pharmacist about other medicines they were taking.

Sixty four percent said they could get accurate information about their medicines from a pharmacist? I’m sure this is true for most conventional medicines – but I have repeatedly asked pharmacists about homeopathy and only once was I given an accurate description of what it is and what it does. ONCE. And in a certain pharmacy in Newtown, I have been (not so politely) shuffled to the door when asking too many questions of the shop assistants about homeopathy.

So, sadly in my experience, consumers cannot rely on pharmacists to accurately advise them on homeopathy.
So, I expected that a quick trip to the heavily promoted NPS website would do the trick. A search for “homeopathy” turns up one link to a generic page on complementary medicines where homeopathy is cited but not explained. A search for “homeopathic” turns up a link to a video which likewise doesn’t address homeopathy directly and in fact could even be construed as misleading. An excerpt from the transcript appears below:

“Manufacturers of non-prescription medicines sold in Australia must ensure that their products meet certain quality and safety standards, however when it comes to providing evidence of their effectiveness, they’re not tested as thoroughly as prescription and pharmacy medicines. The less thorough testing does not mean that these medicines don’t work, rather it means that the manufacturers don’t have to provide as much scientific evidence as they do for prescription and pharmacy medicines.

When you are choosing a traditional or herbal medicine obtain as much information about it and it’s use as you can.”

I doubt there would be any confusion that homeopathic “remedies” are not prescription medicines, but they could certainly be considered pharmacy medicines. After all, they are sold in pharmacies alongside the science-based remedies. So this video implies that since homeopathy – for all intents and purposes – is a pharmacy medicine, then it is tested just like prescription medicines.

Of course this is simply not true. In fact, some homeopathic remedies are exempt from the Australian Register of Therapeutic Goods (ARTG) which is a list of approved medicines and devices, because – in many cases – they are so dilute that they no longer contain active ingredients. Thus, there is nothing to regulate if there is nothing in the “medicine”.

The TGA website states homoeopathic preparations are exempt from the ARTG if :

“(they are) more dilute than a one thousand fold dilution of a mother tincture and which are not required to be sterile; and which do not include an ingredient of: a) human origin; or b) animal origin, if the ingredient consists of, or is derived from, any of the following parts of cattle, sheep, goats or mule deer.”

So unless you started with a mother tincture derived from animal or human sources, the government is not particularly interested in your product. And if it’s more dilute than 1000 times then they’re also not bothered. Makes sense I guess, since sugar pills and water with a dash of alcohol won’t do you any direct harm. (But, this does not mean they don’t do you harm.)

Even more bizarre is that when homeopathy is not sold through pharmacies, it is exempt from the TGA’s own advertising standards.

“A homeopathic product can carry claims which do not comply with the Therapeutic Goods Advertising Code and may still be listed in the ARTG. However, the label on the container and on the primary pack must include a statement to indicate that the indications have not been “approved” by the TGA.”

The description of homeopathy on the TGA website is also not very helpful to uninformed consumers.

“Homoeopathic preparation” is defined by the Therapeutic Goods Regulations as a preparation:

1. formulated for use on the principle that it is capable of producing in a healthy person symptoms similar to those which it is administered to alleviate; and
2. prepared according to the practices of homoeopathic pharmacy using the methods of:
   1. serial dilution and succussion of a mother tincture in water, ethanol, aqueous ethanol or glycerol; or
   2. serial trituration in lactose.

Wouldn’t it be much simpler to say “there’s nothing in it” (which they allude to further down the page anyway) and “there is no evidence that it works?“. Do they really think consumers are going to know what “sucussion” and “serial trituration” means? Like pretty much all of homeopathy, it’s goobledigook.

But, the facts remain that homeopathy is indeed listed on the ARTG, meaning it is assigned an official looking government number, which lends it legitimacy. For example, Brauer Natural Medicine Children’s Cold Flu Relief is listed as AUST L-132568. The fact sheet for this product states that all the ingredients exist at a 1000 fold dilution (1 µL in 1 mL)*.

Finally, a use for homeopathy. Photo courtesy of David Barwick

I found 37 listings for Brauer homeopathic “medicines” including childrens’ cough relief, hangover relief oral spray, and natural medicine burn cream. Interestingly, sleep and insomnia relief – (see left) the sleeping tablets popular amongst Ten23 overdose participants – are not listed on the ARTG since the active ingredients are diluted much more than 1000 times.

So whilst homeopathy is sold in pharmacies, many pharmacists don’t know what it is. They, like many consumers, think it is herbal (whilst it may have started out herbal, it’s certainly not by the time it gets to the shelf of your local chemist).

So what have I learnt in MedicineWise week? Firstly, the Australian government seems confused about homeopathy. I was unable to find a clear and concise explanation of what it is on their official websites, they appear to be bundling it in with pharmacy medicines, thereby implying that it works and further, they are lending it legitimacy by designating it official looking numbers on the official register of government approved Australian medicines.

No wonder the public remains confused. And no wonder it is left to the #ten23 campaign to increase awareness that, Homeopathy There’s Nothing In It.

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*The onus is on the user to verify the current accuracy of the information on the document subsequent to the date shown”. The sheet is dated accurate as at November 2006.

It gives a good visual overview of the places where vaccination uptake levels are low and hence the likelihood of diseases spreading once they get into the population is high. The term given to protection from disease outbreak when a large percentage of the population is vaccinated is “herd immunity”. In simple terms, it means those who are not vaccinated because they are either too young or may have allergies or be immunocompromised, are protected by other people.

The concept of “herd immunity” as a mechanism for protecting others is often rejected by anti-vaxers, perhaps because they won’t acknowledge they are putting other people’s kids at risk by choosing not to vaccinate.

For an easy to understand explanation of how herd immunity works check out the video on the website Chain Of Protection.

It’s a stark reminder in light of another death from pertussis this week, this time of a 5 week old baby boy in Adelaide – the first since 2001. South Australia has been experiencing a pertussis epidemic for over 12 months now. According to statistics from the SA Department of Health, during the period of 1 January 2010 to 15 June 2010, a total of 2,277 cases were reported, compared to 1,493 cases reported for the same period last year. Being so young, the boy was too young to be vaccinated and may have caught the bacteria from an adult carrying the disease.

Many adults and parents are not aware that their whooping cough vaccine does not last forever and as such, they may need to get a booster shot – especially if they are caring for young children. Some governments offer free booster shots, but the SA government is still considering had lagged behind in this respect.

A story from Adelaide Now reports that SA Health chief medical officer Professor Paddy Phillips said the department was waiting for the release of a report into whooping cough vaccinations.

“There’s a Federal Government working party looking into the issue of subsidy for a whooping cough vaccine for adults … when that party reports, we will take up their recommendations,” he said. The party has been working for a long time it would seem. The McCafferys met with both federal and state governments over a year ago, following the death of their daughter from pertussis, to ask them to instigate an education campaign. Let’s not beat around the bush, while departments pass the buck & blame, kids are dying.

For the Adelaide boy’s parents, vaccination was not an option, but some parents are choosing not to vaccinate. Part of the reason for this trend is the amount of misinformation on the internet – and many people rely on “Google University” to get information these days.

The two lowest areas for vaccine coverage in Australia are the Northern Rivers Region (covering the Byron Bay area and the AVN) and the Eastern Suburbs of Sydney, demographically two very different areas. One is characterised by alternative lifestyle families (one could say hippies) and the other well educated, affluent white collar workers. Whilst the reason the former choose to not vaccinate is probably clear, the other is not. Whatever the reason, vaccination has been a victim of it’s own success in many ways, as people become complacent about the threat of communicable disease. We don’t see kids in calipers or iron lungs these days, so out of mind out of sight.

Yet, there is plenty of accurate information on the internet for concerned parents if you look in the right places. I wrote this article for the launch of the new Australian Skeptics website over 12 months ago but it still serves as a good resource for links to government websites and other accurate information.

HUG ME! I'm vaccinated pendant from SurlyRamics

One example of bad advice, is that offered by homeopaths who are allegedly recommending “unproven” herbal remedies, including belladonna and phosphorus, for whooping cough.

According to an article on Adelaide Today, homeopaths say their treatments can prevent and cure whooping cough, while doctors say that is “complete rubbish”. The newspaper contacted the Australian Homeopaths Association for comment but did not receive a response. For the uninitiated, homeopathy is water which contains no active ingredients at all, so of course it can’t cure or treat any disease. Well, apart from dehydration of that is.

Not that pesky scientific evidence has got in the way of claims by homeopaths before. Our favourite Aussie fruit-loops over at Homeopathy Plus! issued an e-newsletter this week claiming that criticism of homeopathic vaccines (also known as homeoprophylaxis) was “..an orchestrated campaign in which those hostile to homeopathy are trying to stop patients accessing it through the NHS…” and “Homeopathy has been repeatedly used for protection or treatment during world epidemics and outbreaks. It is inexpensive, quickly distributed, easily administered and safe. Remedies exist for all diseases.”

Yes well, citation needed. Actually none of that is accurate.

Meanwhile, the ninth infant has died from pertussis in California in an epidemic about to break records. And the education campaign about the dangers of pertussis promised by the Australian government has not materialised. This is a preventable tragedy and one that needs action now.

A few weeks back on the Think Tank we heard the story of David Tredinnick, the UK Conservative MP who spent 700 quid of taxpayers money on astrology software. It turns out he believes in all kinds of woo, including  such tosh as, depending on the phase of the moon, “surgeons will not operate because blood clotting is not effective and the police have to put more people on the street”. He is also a big fan of homeopathy, and in response to the recent Committee on Science and Technology evidence checks findings about homeopathy, he submitted four early day motions (EDMs) to the House of Commons for consideration.

For those non UK readers, EDMs are motions tabled by Members of Parliament for debate “on an early day” (namely an unspecific date in the future). EDMs cover all manner of subjects that the MP thinks parliament should be made aware of and possibly debate. They can address serious matters such as climate change, or trivial events such as the Pidgeon Bombs EDM which was tabled in the 2003–04 session of the UK Parliament. This EDM concerned itself with a disclosure by MI5 that it had proposed using pigeons as flying bombs World War II. According to Wikipedia, the motion condemned the proposal, describing humans as “obscene, perverted, cruel, uncivilised and lethal”, and proposed that the House “looks forward to the day when the inevitable asteroid slams into the Earth and wipes them out thus giving nature the opportunity to start again”. (I realise this is Wikipedia but I sincerely hope this is true).

EDMs remain open for signature for the duration of the parliamentary session but are rarely ever signed by all 400 MPs and few make it to the floor for debate.

Despite the recent evidence check and the damning findings that the National Health Service should cease funding homeopathy, no further clinical trials of homeopathy should be conducted, evidence shows homeopathy doesn’t work, explanations for why homeopathy works are “scientifically implausible”, David Tedinnick was just busting to share some “new information” about homeopathy! So he tabled four EDMs, one citing “new research” concerning homeopathy as a effective treatment for breast cancer (which came out prior to the evidence check BTW) (EDM285), for depression (EDM286) and also insomnia (EDM287). Tredinnick also objected to the British medical association’s recent public statements that homeopathy is witch craft and calling for no further commissioning of, nor funding for, homeopathic remedies in the NHS (EDM284).

He cited published peer reviewed studies as evidence for his claims. One of them I happen to know very well, since I spent the better part of a Saturday back in February debunking the entire paper. The reason I did this was because Richard Saunders had received an e-alert from Homeopathy Plus! With a headline screaming “Homeopathy as good as chemotherapy for breast cancer and non-toxic!”. Which is a pretty extraordinary claim for some magic water. And also likely to be complete bollocks (I won’t keep you in suspense – it is).

EDM285 is reproduced below.

That this House welcomes the study published in the International Journal of Oncology, 2010 Feb; 36(2): 395-403 which revealed that homeopathic remedies have a beneficial effect on breast cancer cells; notes that researchers at the University of Texas conducted an in vitro study to determine whether products prescribed by a clinic in India have any effect on breast cancer cell lines; further notes that the researchers studied four ultra-diluted remedies, carcinosin, phytolacca, conium and thuja against two human breast adenocarcinoma cell lines, MCF-7 and MDA-MB-231 and a cell line derived from immortalized normal human mammary epithelial cells, HMLE; observes that the remedies exerted preferential cytotoxic effects against the two breast cancer cell lines, causing cell cycle delay/arrest and apoptosis; believes that the findings demonstrate biological activity of these natural products when presented at ultra-diluted doses; and calls for further research in this important area.

Yeah, I guess Tredinnick, like Homeopathy Plus either didn’t read the entire paper or doesn’t understand how to interpret the scientific literature cause this aint what I gleaned from the paper.

So the Twitterverse was mobilised to gather rebuttals to these 3 papers. Once Dr Evan Harris had my blog and Orac’s from Science Blogs in his sticky fingers, Dr Julian Huppert got straight onto composing a rebuttal. And it is a joy to read.

So let’s see what became of EDM 285 once it Harris and Huppert had gone to town on it.

EDM285A1 now reads like this:

Line 2, leave out from `403′ to end and insert `as an example of the failure of adequate scientific peer review because the paper provides no statistical analysis to support any conclusion, indicates that the experimental control, 87 per cent. alcohol solution, was itself toxic to the cell cultures, does not illustrate or explain the different chromatographic profiles of the solvent and the test substances, and does not provide sufficient data to allow proper evaluation of the study; notes that the lead author has retired and runs a homeopathy website which falsely claims that homeopathy is as effective as a conventional chemotherapy agent, Taxol, in treating breast cancer; further notes that one of the authors, Alison Pawlus, has publicly disowned the paper; regrets that isolated poor-quality studies are cited by proponents of homeopathy to endorse dangerous and exploitative cancer-curing claims in the face of overwhelming weight of scientific evidence against them; and agrees with the conclusions of the Science and Technology Select Committee’s Fourth Report of Session 2009-10, Evidence Check 2: Homeopathy HC45 that putting patients through pointless further clinical trials, and the spending of scarce public sector funds on research into homeopathy cannot be justified.’.

The comment about Alison Pawlus, listed as an author on the study publicly disowning the paper is derived from a comment she left on my blog where she stated;

“As an unintentioned co-author on this study, I feel obligated to respond….”

Alison went onto say “…I asked to not be included because I did not think it was a sound study…”

And

“I believe this study demonstrated changes in alcohol percentages on cells rather than the efficacy of homeopathic medicine.”

The amendments to the EDMs constitute a marvellous result and are testament to the dedication of Dr Evan Harris and Dr Julian Huppert. The fact that this message got out so quickly is also a credit to the power of the blogosphere and twitterverse. In fact, this was how I originally got my hands on the full text of this article, by tweeting for someone to source it for me. Thanks @xtaldave!

But David Tedinnick is not the only one who has jumped to conclusions about the findings of this paper. I already mentioned Homeopathy Plus! making a giant leap in logic from “cells treated in culture” to “homeopathy is better than chemo for cancer.” Many others have picked up this meme and run with it, despite the fact that not even the paper itself makes this claim.

The only reference to a common cancer drug appears buried in the discussion and states, “Interestingly, the cytotoxic effect of two of the remedies investigated in this study, Carcinosinand Phytolacca, appeared similar to the activity of 0.12 ?M paclitaxel (Taxol), the most commonly used chemotherapeutic drug for breast cancer, when it was tested in the two adenocarcinoma cell lines investigated in this study in parallel experiments (data not shown)”.

I repeat, DATA NOT SHOWN. Interesting that homeopathy sympathisers can go from this, to homeopathy can cure cancer. But then facts, evidence and science never really did interest them much. As for David Tredinnick, well it seems he is not much interetsed either, as revealed in a debate between him and Dr Simon Singh BBC Radio 4. You can listen to the audio here.

You can also read two great stories about the loonie beliefs of David Tredinnick from The Guardian by Nature’s @AdamRutherford here and The Lay Scientist’s @mjrobbins here.

The entire exercise was summed up by tweeter @paulNUK2010 who relected; “How to get your scientific papers peer reviewed by experts in the field – get David Tredinnick to cite them in an EDM #homeopathyEDMs”.

So very true.

As I said in my original blog post, the journal that published this tosh has an impact factor of 2.234 but a fail factor of 10^23.

Sadly, these amendments do not mean the loonie EDMs have been thrown out. We still need MPs to show their support by signing the amended versions.

If you live in the UK, please write to your MP here. You will find a form letter to use for a guide here.

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.

Hundreds of members at the British Medical Association’s (BMA) annual conference of junior doctors have passed a motion attacking the alternative medicine and other remedies they claim have no scientific basis to support them.

Dr Tom Dolphin, deputy chairman of the BMA’s junior doctors committee in England, told the conference:

“Homeopathy is witchcraft. It is a disgrace that nestling between the National Hospital for Neurology and Great Ormond Street [in London] there is a homeopathic hospital paid for by the National Health Service (NHS)”.

The NHS is the equivalent of Medicare in Australia.

The announcement supports recommendations from the The House of Commons Science and Technology Committee after a parliamentary enquiry called an “evidence check”. In a 273 page report, summarising the evidence for the efficacy of homeopathy, the committee concluded that

* The NHS should cease funding homeopathy
* Recommend no further clinical trials of homeopathy.
* Evidence shows homeopathy doesn’t work.
* Explanations for why homeopathy works are “scientifically implausible.”
* Committee views homeopathy as placebo.

The report was tabled with evidence from hundreds of submissions from scientists.

From the report, the Committee wrote;

“In our view, the systematic reviews and meta-analyses conclusively demonstrate that homeopathic products perform no better than placebos.”

The Committee concluded;

“Given that the existing scientific literature showed no good evidence of efficacy that further clinical trials of homeopathy could not be justified.”

“We do not doubt that homeopathy makes some patients feel better. However, patient satisfaction can occur through a placebo effect..When doctors prescribe placebos, they risk damaging the trust that exists between them and their patients.”

Gordon Lehany, chairman of the BMA’s junior doctors committee in Scotland, said it was wrong that some junior doctors were spending part of their training rotations in homeopathic hospitals, learning principles that had no place in science.

He told the conference in London:

“At a time, when the NHS is struggling for cash, we should be focusing on treatments that have proven benefit. If people wish to pay for homeopathy that’s their choice, but it shouldn’t be paid for on the NHS until there is evidence that it works.”

The UK currently had four NHS funded homeopathic hospitals, in Liverpool, Bristol, Glasgow and London. A fifth hospital in Kent closed in 2009 when NHS funding was withdrawn. Latest figures show 54,000 patients are treated each year at four NHS homeopathic hospitals at an estimated cost of £4 million.

Homeopathy was invented 200 years ago by the German physician, Dr. Samuel Hahnemann, and is based on a ‘like-treats-like’ concept: that the symptoms of an illness can be treated by minute quantities of the same substance that caused it. But remedies are diluted to such a degree, there is virtually no chance of the active ingredient existing in the final product.

The concept of “Homeopathy, there’s nothing in it” made headlines around the world last year when mass homeopathic overdoses were conducted outside of pharmacies across the globe. The campaign was organised in protest at the highly respected Boots chain of pharmacies in the UK selling their own range of homeopathic “remedies”.

During the parliamentary evidence check, the professional standards director for the Boots high street pharmacy chain, Paul Bennett admitted to selling homeopathic remedies because they are popular, not because they work. In a statement, which has since been referred to as a huge foot-in-mouth, he said;

“There is certainly a consumer demand for these products,” but “I have no evidence to suggest they are efficacious”.

Homeopathy also publicly funded in Australia

In Australia, homeopathic consultations are not directly covered by Medicare, but GPs can bill for any consultation deemed “by the majority of professional peers as clinically relevant”, a Medicare spokesperson said.

Dr Ken Harvey, of the school of public health at La Trobe University, objects to the use of public money on placebo;

“I don’t believe there’s an evidence base to homeopathy, and I don’t think it should be financed by public money,”

“If a doctor wants to offer homeopathic consultations then it should be done separately…at the patient’s own expense.”

Dr Harvey referred to a New South Wales GP who offers homeopathy consultations as being fully reimbursed by Medicare. The GP, Dr Michael Cleary was adamant;

“The people who are using [homeopathy] are [also] taxpayers,” he said.

“If I was a person who wasn’t allowed to get a Medicare rebate from seeing my [homeopathic] doctor, I’d be wondering why I’m paying the levy.

Professor Mike Daube, president of the Public Health Association of Australia, also called on the TGA and Department of Health to conduct a review of homeopathy.

“There’s a long history to homeopathic practice, but we need to know whether it’s appropriate in the light of 21st-century science,” he said.

Embargoed until April 18th, 12 noon.

Current evidence showing that homeopathic medicines are ineffective treatments is not
biased against homeopathy, as some homeopaths have argued, according to a review
published in the Medical Journal of Australia.

Prof Edzard Ernst, Director of Complementary Medicine at the University of Exeter, UK,
writes that about 150 controlled clinical trials have been published on homeopathy – a
therapeutic method that often uses highly diluted preparations of substances that, when
administered to healthy people, create the same effects as the disorder in the unwell patient.

Prof Ernst said in situations where the results of these trials were neither all negative nor all
positive, some commentators resorted to “cherry picking” those findings that fit their own
preconceptions.

“The problem of selective citation is most effectively overcome by evaluating all reliable
evidence, an aim best met by systematic reviews,” Prof Ernst said.

He searched the Cochrane Database of Systematic Reviews – generally considered to be the
most reliable source of evidence – in January this year for reviews that had the term
“homeopathy” in their title, abstract or keywords. Of the six articles that met the inclusion
criteria, none provided compelling evidence for the effectiveness of homeopathic remedies.

“Homeopaths have argued that systematic reviews that fail to generate positive conclusions
about homeopathy are biased,” Prof Ernst said.
.

“However, as most of the reviews I appraised were authored by homeopaths, it seems
unlikely that they were biased against homeopathy. In fact, one might argue that they were
biased in favour of homeopathy.
.

“For instance, one reviewer [not a Cochrane author] deliberately set out to select only the
positive evidence and omit all negative evidence.”

Prof Ernst said some homeopaths argued that the controlled clinical trial was not suited for
the study of homeopathy and that observational data, which appeared to suggest that
homeopathy was effective, demonstrated the true value of the method.

“A more rational explanation would be that the positive outcomes of observational studies are
caused by the non-specific aspects of homeopathic treatments, while the controlled trials
demonstrate that homeopathic remedies are placebos,” Prof Ernst said.

The Medical Journal of Australia is a publication of the Australian Medical Association.

Get the full pdf here.