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The British Pharmaceutical Conference (2007) staged a debate on “Homeopathy or Allopathy. Which would you choose”. On one side was Felicity Lee (ex Chair of the Society of Homeopaths). I was on the other side. Ben Goldacre was there and he recorded the whole thing. You can listen to it here (if you have nothing better to do).

Thanks to the high-tech equipment at the conference, I was able to show in place of a slide, a section of an article written by Felicity Lee with the title “What health problems can it help with?“. These include, for example, migraine. But if you look at the National Electronic library of Complementary and Alternative medicine (which is compiled by CAM people) what you find is this.

“There is insufficient evidence to support or refute the use of homeopathy for managing tension type, cervicogenic, or migraine headache. The studies reviewed possessed several flaws in design.”

Goldacre also recorded, after the debate, an interview with Felicity Lee. It is rather more interesting than the debate itself. It’s fascinating because, as in the debate, she refuses again and again to be drawn into discussing the evidence and is quite unable to say why she thinks it is not possible to do proper trials.

She did mention that a suitable condition for a trial might be osteoarthritis, but seemed to be quite unaware that such a trial was done in 2001 by no less a person than Peter Fisher (clinical director of the Royal London homeopathic Hospital and the Queen’s homeopathic physician). The outcome of this paper (download it) was that homeopathy didn’t work any better than placebo.

The paper ended with this memorable statement.

“Over these years we have come to believe that conventional RCTs [randomised controlled trials] are unlikely to capture the possible benefits of homeopathy . . . . It seems more important to define if homeopathists can genuinely control patients’ symptoms and less relevant to have concerns about whether this is due to a ‘genuine’ effect or to influencing the placebo response.”

That is the nearest that Fisher has ever come in public to admitting it is all placebo effect, though at other times, of course, he has denied that strenuously.

## 22 Responses to A debate with Felicity Lee

• Something I have often wondered but have never seen much evidence about is: what proportion of the 90% of annual asthma deaths that Asthma UK claim are preventable occur in people who choose not to use prescribed medications because of fears of side effects? Some CAM practitioners actively reinforce these fears. Homeopathy and other CAM is popular among people suffering from long term chronic conditions such as asthma and its promoters make much of its safety. But if an indirect effect of it is to dissuade people, actively or by implication, from using prescribed medications to control a potentially – though infrequently – fatal condition, can it really be described as harmless?

A slightly related gripe: if I want to retrieve evidence based medical information on allergy from the NLH, I have to consult several of its specialist libraries (Respiratory, Skin, ENT etc) as there is no single NLH specialist library which collects this information in one place. So it is easy to miss important new information. I’m tempted to draw a comparison between this fragmentation and the problems people suffering from mulit-system allergic disease can encounter in trying to obtain a high-quality specialist diagnosis. A bit galling, then, that CAM has its own specialist library!

• I expect you’ve seen this before David, but Anthony Campbell’s web-published book on homeopathy makes interesting reading, particularly in the context of Peter’s Fisher’s remarks in the arthritis study.

http://www.acampbell.ukfsn.org/homeopathy/homeopathy-html/chapter01.html

Most notable is chapter 12, where Campbell, who is a (medically-qualified) former consultant at the Royal Homeopathic Hospital AND a former editor of Homeopathy (current Editor-in-Chief Peter Fisher), basically says he thinks homeopathy is a kind of stealth psychotherapy and thus works via placebo effect:
http://www.acampbell.ukfsn.org/homeopathy/homeopathy-html/chapter12.html

Of course Campbell is retired, so arguably does not have to “keep toeing the homeopaths’ party line” any more.

• I think there may well be quite a pronounced difference between medically trained homeopaths, like Fisher and Campbell, and their ‘lay’ colleagues as represented by the Society of Homeopaths. It is quite possible that many doctors see homeopathy as a useful mechanism for administering a placebo without getting too bogged down in the ethics of doing this explicitly. Of course, it then becomes quite difficult to admit this is what you are doing.

Conversely, the lay homeopaths have no such constraints as they are essentially an unregulated profession, untrained scientifically and attracted to homeopathy explicitly because of its anti-establishment, alternative credentials. These people deeply believe the homeopathic fairy tales associated with treatment and build up a mind set that is hugely resistant to external debate and criticism. Denying the applicability of RCTs to homeopathy is part of the lay homeopaths credo, but they do not understand why this should be so. It is just an article of faith.

• You are quite right. There is certainly a big difference when it comes to things like malaria and vaccination. The two branches of homeopathy are directly opposed to each other in their approach. It reminds one of the internecine warfare between religious sects, though as far as I know there has been no physical violence yet.

• Agreed 100% on both points, Canard. Re. the anti-establishment take of non-medical homeopathy, this is something Ben Goldacre has commented on – if you read the Society of Homeopaths’ Online bumf about “What is Homeopathy?” it is carefully couched to hit every hot button of “you are dissatisfied with conventional medicine, so come to us”.

Every standard gripe about conventional medicine gets a nod, e.g.:

“Patients are treated as individuals, not as a collection of disease labels”

“Homeopathy treats all your symptoms – mental, emotional and physical.”

“Your homeopath understands that establishing good health involves treating both mind and body, so time is taken to listen to your emotional and physical symptoms.”

“Healing… …from within your body, without any danger of damaging side effects.”

“Homeopathic remedies… …are very safe… …There is no danger of addiction or toxicity.”

– and so on.

The homeopathic medics are a very interesting case in the specific context of “can’t admit what it really is”. They do put themselves in a terrible position of DoubleThink. Although some of the more way out “alternative” ones seem to be plain bonkers. I find it hard to imagine even Peter Fisher endorsing the qLink pendant, as one well-known medical homeopath has done:

PS – good grief – serendipitously I find that the qLink also has a ringing endorsement from our old friend …Patrick Holford (last URL)! Blog threads collide… almost makes me believe mysterious cosmic forces are in play.

• As with most woo-woo claims, the proponents of homeopathy fall back on the “there’s no way that this claim can be tested” alibi. This makes homeopathy unique among “sciences,” in that it cannot be examined by “conventional RCTs.” Note that we can find the catch-word “Heisenberg” also dropped in along with “quantum” and “vibrations” from time to time, to provide a veneer of scientific appearance. I challenge the believers in homeopathy to provide just ONE example – outside of their delusion – of a phenomenon that cannot be examined. That loud silence you hear…

• Just listened to both the “debate” and the Lee interview.

It’s really sad to see a person of science (reportedly) make such a hash of answering simple questions. If I were Lee, I’d be ashamed to show my face in public.

M.

• Wow, I have just been able to listen to the Ben interview of Felicity Lee.

Firstly, apologies for my earlier post that was well covered in the debate. Secondly, it is staggering how Felicity, supposedly one of the best advocates of homeopathy, utterly folds under quite reasonable questions. Most lay homeopaths would have not got so far as they would have started calling Ben a Big Pharma shill and murderous iatrogenic baby killer.

• Having looked at the Society of Homeopathsâ€™ website, it strikes me that you cannot complain about a registered homeopath. Can they be struck off?

• Some dangerous advice from a homeopath which could have turned our badly for a young child here: http://news.bbc.co.uk/1/hi/health/2341009.stm

“…Next, the family tried homeopathic medicine.

“That’s when things went really wrong.

“She was horrified about Chris having nasty steroids, and she advised us to stop all that.

“He developed septicaemia because he had been scratching so much and it had become infected…”

Compare with:
“Dr Fisher is an NHS GP and practices both conventional and complementary medicine to suit individual patients.

He said: “If someone had TB I wouldn’t advise homeopathy, but if someone has eczema, I wouldn’t advise steroid creams, but homeopathic ones.”

• *sigh*

The sensible answer would be “If someone has serious itchy weeping eczema, they need steroids properly prescribed by a competent GP to damp down the eczema so that it doesn’t run the risk of getting infected.

If the eczema is mild, you could try controlling it with just things like emulsifying ointment

http://www.netdoctor.co.uk/medicines/100000923.html

…and just keep the steroid creams “in reserve” for flare-ups. It would be sensible to discuss this with your GP.

Homeopathic creams are guaranteed to do bugger all, and unlike emuslfying ointment you will typically have sod all idea what the “ingredients” of the cream are.

While the “partnership with patients” line has some good aspects, and doctors and patients TALKING is always positive, a doctor encouraging parents to believe that homeopathic creams are a splendid thing for eczema strikes me as misguided to say the least. Of course, it is possible that if they were also using a properly-constituted emulsifying ointment, a little bit of “magic cream” in addition would be a GP’s way of keeping the parents onside.

• Oh… THAT “Dr. Fisher”.

Of course, as Peter Fisher is neither a GP nor a paediatrician he wouldn’t be treating kids.

The moral: If you need a doctor, don’t see a homeopath. But if you need a specialist doctor, see a specialist doctor.

• http://www.seattleweekly.com/2005-06-08/news/death-by-natural-causes.php – asthma death of a teenage girl, 2005:

“…Around 11:30 a.m. on July 25, 2001, Su Wilson found her 16-year-old daughter, Megan, lying in bed at their Kenmore home, her chest heaving. “Megan, get up! You have to use your medication,” Su recalls telling her daughter, who suffered from chronic asthma. According to her mother’s recollections, Megan rose from her bed and used a device called a nebulizer, which transmitted a medicinal vapor to her lungs. When that didn’t work, Su called Megan’s primary care physician, a Kirkland naturopath named Lucinda Messer.

One critical fact about that day is in dispute. Messer says that she repeatedly urged Megan and her mother to go to the hospitalâ€”and they refused. It’s noted on the medical chart from that day. But Su Wilson insists Messer never mentioned the hospital.

In any case, these things seem clear: Several hours after Megan woke up, she and her mother arrived at Messer’s office, which at the time was across the street from Evergreen Hospital. Messer was busy with another client, so an acupuncturist who worked out of the office, Dan Brown, performed acupuncture on Megan. Messer then treated Megan with a shot of vitamin B-12 and an herbal remedy called a tincture.

What Messer did not do was perform tests used by conventional medical doctors to determine the severity of an asthmatic attack and whether a patient needs to receive emergency care. There is no consensus on whether such tests should be a part of naturopathic care. But most medical doctors agree that they are essential. “The very basics were not done with this child,” says Robert Baratz, a Massachusetts internist and critic of alternative medicine who reviewed documents related to the case at the request of Seattle Weekly…”

• This tragic story reminds me of the one a year or two back about the Californian HIV-positive mother who wouldn’t have her child tested for HIV and had the kid treated by naturopathically-inclined docs who wouldn’t / didn’t insist on the test either.

The result? Death of the child, probably from a respiratory infection as a result of a depleted immune system.

http://en.wikipedia.org/wiki/Christine_Maggiore

http://www.aidstruth.org/LATIMES-article-9-24-2005.php

When this happens with small children I personally think the parents should be prosecuted. With a 16-year old I suppose they would be argued to be largely “autonomous” for treatment purposes.. but given 16 yrs of presumably parental indoctrination with nutri-bullshit, one wonders how independently “informed” the child could be.

In the HIV case, the courts in some countries have been known to substitute their judgement for the parents’, and take the child into care so that the child can be treated properly… but that takes time.

http://news.bbc.co.uk/1/hi/health/1964470.stm

• This is what happened when a GP made a similar mistake – http://news.bbc.co.uk/1/hi/scotland/glasgow_and_west/6434577.stm . But it seems Lucinda Messer got off more lightly:

“My case was the first case in Washington where natural medicine was triedâ€”and nobody knew what they were doing,” Messer says. Actually, the case never reached trial. It was settled in 2003 for a confidential amount that Messer says was around $250,000 or$300,000. Messer’s insurance company never reported the settlement to the state Department of Health, as required by state law.

Messer herself, however, reported the case to the Naturopathic Physicians Board of Medical Examiners in Arizona, where she is also licensed. The board dismissed the case. Looking through the case file now, its executive director, Craig Runbeck, realizes that the board seemed to have considered only information supplied by Messer…”

• Yes, but what is a “naturopathic physician”? If a “naturopathic physicians” doesn’t have a medical degree, the term is utterly meaningless and the use of the word “physician” is a straighforward con. In the modern world “physician” is widely expected to mean a medical degree (and license).

If they simply have some worthless degree in “herbal medicine” then what they really are is “herbalists”, or at best “licensed medical herbalist”.

Physician my arse, in other words.

A medical doctor who, when seeing a child having a moderate to severe asthma attack, did not get the kid to blow into a Peak Flow Meter (at least), put them on a pulse oximeter (if available) to check their haemoglobin O2 saturation, and did not tell kid and parent to go to the ER / A&E Dept for proper assessment, would be done for gross professional misconduct and would probably lose their licence to practise medicine.

What I find incredible is that these herbal quacks can display such breathtaking incompetence and have nothing happen to their ability to keep doing this to other poor deluded fools. Again, if they did this in Germany (where “Alternative Healthcare Practitioners” have to be licensed by the State), and they did something this stupid, they would be deprived of their license to practise their “trade” and possibly prosecuted.

• Crikey. Obviously I am not sufficiently well versed in the ways of US Alt Med. According to this:

http://nccam.nih.gov/health/naturopathy/

– some of these “Naturopathic Physicians” have seemingly done a 4-yr postgrad “ND” degree (typically run by Natural Health Altie Colleges, I note). These NDs (according the NCCAM website) have to pass a state or national exam and be licenced.

??!.. exam in what? I wonder how much basic science and pathology (as opposed to “systems of health belief”) it contains?

While this 4 yr training might be at the “upper end” of non-medically qualified herbalism (and similar), and a “Licencing Board” is arguably better than “no regulation” (as in the UK), I would have my doubts (putting it mildly) about whether the regulation worked. For instance, if the said NDs can’t recognise life-threatening asthma attacks, then what is their “pseudo medical” training good for?

In addition, the idea that such people (who I suspect don’t have the trauma life support skills conventional doctors do) are allowed to put drips into people and drip in EGTA, and the like, truly boggles the mind.

http://scienceblogs.com/insolence/2007/06/another_clean_kill_by_chelation_1.php#more

• Unfortunately, asthmatics themselves can be volnerable to the utopian promises of CAM, see this recent thread from the Asthma UK forum: http://www.asthma.org.uk/applications/discussion/view.rm?post_id=28751

The poster seems to find her asthma is not really severe, even though she says her boyfriend has witnessed some bad attacks.

*sigh*

• this has just popped up in my inbox, about the difference between patients’ and doctors’ estimation of asthma severity, patients being those with a tendency to underestimation:
http://www.resmedjournal.com/article/PIIS0954611107002132/abstract

• not quack related but utterly, utterly depressing from yesterday’s LA times, regarding preventable deaths in the penal system: http://www.latimes.com/news/science/la-me-prisons20sep20,1,6107801,full.story?ctrack=2&cset=true

“…And an asthma patient died after failing to receive steroid medication for two days following transfer from a county jail…

…Eighteen deaths were found to be preventable, meaning better medical management or a better system of care would have prevented deaths. An additional 48 were found to be “possibly preventable,” meaning better medical management of a system of care might have prevented death.

Of the deaths considered preventable, six were from asthma, which receiver Robert Sillen said he intended to make a priority for reforms.

“The leading cause of [preventable] death being asthma is unconscionable, and it is evidence of systemic problems and problems with individual clinical judgments,” Sillen said in an interview. “Adults in 21st century California should not have asthma as a primary cause of death.”

• Im wandering how many people actually believe homeopathic treatment are surely effective.

Wich would, to them, mean that they can use it as a replacement for “conventional” medecine anytime.

I use to live in British Columbia, Canada, were anything “alternative” goes as better than conventional for many residents.

But i have never met anybody, even working in the alternative medecine fields ( rolfer, homeopath, herbalists etc ) that claimed that there treatments were actually all that effective.

In fact i have seen it mostly advertised as a “try that first” and if it fails go conventional. Of course as asthma, malaria and such are risky bets, but my point is, whats the percentage of people using homeopathy being misled into using homeopathic medecine beeing absolutly oblivious of its chances of failing.

I dont think i have ever met such a person.