Wednesday, 18 September 2013

Homeopaths Without Borders: exploitation or humanitarian?

Today on bmj.com a senior researcher from the Institute for Biomedical Ethics criticises the campaigning group that wants to help the world’s most vulnerable people with homeopathy.

David Shaw says that although the movement Homeopaths without Borders has received a “great deal of criticism in recent years for unethical practices”, it has gone “entirely unmentioned” in medical literature. He says this is surprising given that the campaign is “engaged in activity even more dubious than that of most homeopaths”.

Research and modern medicine

It has often been said that medicine is an art as much as it is a science. It is certainly a craft that requires understanding of the needs and circumstances of the patients it treats. Modern medicine is 'evidence based', which means that it progresses through research and new treatments are soundly tested in randomised controlled trials (RCTs). The two approaches, medicine as a craft and evidence based medicine are complementary; ideally they work together. Whilst modern medicine isn't simply the application of science, it isn't hocus pocus either.

When modern medicine offers humanitarian assistance throughout the world, as it does through organisations like Medicin sans Frontieres,  it brings this evidence based knowledge, skill  and understanding to help those in need. Those being helped assume that what is being done is tried and tested and approved. They trust the skill of those who are treating them. Homeopathy offers little or none of this.

Homeopathy not evidence-based

Homeopathy is a 200-year old system of medicine that seeks to treat patients with highly diluted substances that are administered orally. Homeopathy is based on two principles: "like-cures-like" whereby a substance that causes a symptom is used in diluted form to treat the same symptom in illness and "ultra-dilution" whereby the more dilute a substance the more potent it is (this is aided by a specific method of shaking the solutions, termed "succussion"). It is claimed that homeopathy works by stimulating the body's self-healing mechanisms. There is a paucity of evidence that it works.

Homeopathy is not part of mainstream medicine because it is not evidence based.  The Royal Pharmaceutical Society of Great Britain has concluded that homeopathy is based on a false premise and that "no plausible scientific reason has yet been proposed as to why it should work". Put bluntly, the overwhelming body of evidence is that it doesn't work, and if it doesn't work it is unethical to suggest that it does.

As the UK House of Commons Select Committee on Science and Technology concluded from its long consideration of the evidence "there has been enough testing of homeopathy and plenty of evidence showing that it is not efficacious".

In response to this criticism, advocates of homeopathy argue that much of modern mainstream medicine isn't strictly based on evidence. That may be so; there is more to medicine than the appliance of science. But modern medical practice evolves in the light of ongoing audit of what does and does not work and it seeks to understand why through research. None of this underpins homeopathy.

For the most part through physiological and pharmacological research we can say how drugs work in the body. We may not always be correct but science is an ongoing process of challenging established ideas. None of this is part of homeopathy the basis of which is 'not understood' after 200 years of history.

Homeopaths without Borders

Homeopaths without Borders seeks to promote itself in countries where it does not already have a foothold. Shaw says the Kenyan example, which implies that homeopathy can save lives, is “shocking” and something which no mainstream organisation has claimed for several years.

The Homeopaths without Borders North American group sent several homeopaths to help the people affected by the Haiti earthquake but according to Shaw, “people affected by massive earthquakes cannot benefit from homeopathy any more than people living safely in London”. He adds that it might even harm patients by making them believe that they do not need to seek usual treatment for injuries or disease.

Shaw says that following the earthquake, more Haitians will believe in a “discredited system of ‘medicine’ making long term harm more likely than if the campaign had not got involved in the first place”.

He believes that Homeopaths without Borders North America “exploit developing countries” and is happy to suggest that homeopathic therapies can also help in pregnancy care and delivery.

Homeopaths without Borders also ask for monetary donations, which Shaw believes seems “somewhat pointless” given that there is no evidence for its efficacy and as such it may be diverting money away from “genuinely humanitarian organisations”.

Dr Shaw concludes that “homeopathy is neither helpful nor humanitarian” and is exploiting those “in need of genuine aid”.

In an update on their Haiti mission in 2011 Homeopaths without Borders reported on worsening conditions.

"The team reported that conditions in Haiti remain difficult; piles of rubble still sit in the streets, roads are filled with potholes and rebuilding is extremely slow. Potable water is scarce as is sufficient food, and fear of cholera is evident.

"Haitians continue to demonstrate symptoms of trauma and grief from an earthquake that took place a year and a half ago. Skin problems such as ringworm are prevalent as are gastrointestinal problems including severe diarrhea; some of the latter are related to poor nutrition. Vaginal infections persist. Sadly the group treated several very ill infants who were malnourished, dehydrated, underdeveloped, feverish and covered with rashes from head to toe.

Although a great variety of remedies were used, following were the most frequently administered: Arnica, Aconite, Ignatia, Causticum, Nat mur, Sepia, Phosphorus acid and Sulphur."

Significantly missing from the report was any account of the effectiveness of the 'treatments' given. Nor is it clear how the 'like cures like' principle was at work. Arnica cream has a record of use in treatment in  medicine, but a systematic review of clinical trials shows that homeopathic preparation of Arnica was no more effective than a placebo. Onions can certainly stimulate tears, but it is difficult to see how they can be a cure for the common cold or influenza, yet a homeopathically prepared 'onion solution' might be prescribed by a homeopath.

Homeopath claims

Homeopath organisations claim that research published in medical journals such as the Lancet and the British Medical Journal "have confirmed the effectiveness of homeopathy". This is disingenuous at best. I doubt whether the editors of these prestigious medical journals would agree. On the contrary, the Society of Homeopaths has been censured by the UK Advertising Standards Authority for making unsubstantiated claims that homeopathic remedies can cure depression, bronchitis, osteoarthritis, and vertigo. Most controlled clinical trials show no beneficial effect yet these unsubstantiated claims continue to be made.

Homeopathc preparation of Ignatia continues to be pushed as a remedy for bereavement, heartache and pain.  With little or no evidence it is also suggested as a remedy for headaches, sore throat, nervousness, insomnia, heart palpitations, gas, indigestion, mood swings, menstrual irregularities, irritable bowel syndrome, painful hemorrhoids, or a dry, tickling cough.

I am sure Dr Shaw's hard hitting opinion piece will spark considerable debate.  Many of the arguments have been well rehearsed. Much of the debate will be vituperative; sadly, it usually is. But the central question will be whether there is evidence that homeopathy works and if so why. If there is no such evidence, or the evidence is slim, then it is unethical to suggest otherwise.

There is much that is wrong with the pharmaceutical industry. I believe we need a more holistic approach to understanding disease and treatments.  Homeopathic practitioners have a belief in their approach. This I respect. But it stretches truth and is unethical for them to make claims that cannot be substantiated.

Postscript

The adjudication of the UK Advertising Standards Authority makes interesting reading. The body found the claims of the Society of Homeopaths to be misleading and not substantiated.

"The Society of Homeopaths provided three studies to substantiate the claim that there was sufficient research evidence to support the use of homeopathic treatment for allergies and upper respiratory tract infections. Our expert advised us that the first paper concentrated on effectiveness, safety and cost effectiveness rather than efficacy. The second paper concerned 24 studies, but those with the highest patient numbers showed only non-significant effects in favour of homeopathy or no effectiveness over placebo. The third paper concerned 27 trials and studies and some evidence suggested in some conditions, homeopathy showed some benefit. However, the authors noted that there were general weaknesses in the evidence due to the lack of independent confirmation of reported trials and the presence of conflicting results. Our expert considered that the evidence was not sufficient to support efficacy claims for homeopathy for the treatment of allergies and upper respiratory tract infections. We therefore concluded the claim was misleading and had not been substantiated."

You may also be interested in these articles:

Hilary and Steven Rose lift the lid on modern biomedical science.
Something isn't right in the world of pharmaceuticals. Alarm bells are ringng.

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