There is a new college degree in quackery

Radio Canada Internation reports the reactions being made by many in response to a new course that offers to train you in quackery.  They are not alone, other have deployed similar criticism. The course on offer is Homeopathy …

Starting this fall, Georgian College in Barrie, Ontario, will offer a diploma in homeopathy, a practice the critics says is mere quackery.

The critics say the college course is legitimising a pseudo-science. In a 1998 editorial in the Journal of the American Medical Association,   Drs Fontanarosa and Lundberg wrote in part; “There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data, or unproven medicine, for which scientific evidence is lacking”.

There have always been courses in such quackery, so to be clear the key point is not just that Homeopathy is stuff that does not do what it claims, but that this is an abuse of public funds …

The critics are also upset that public money is helping fund the three-year course as the community college is publicly funded institution and students can request loans and grants from the publicly supported Ontario Student Assistance Programme.

What exactly is Homeopathy?

You might perhaps consider it to be some form of herbal medicine, hence it has a chance of actually doing something.

Sorry, but that is not what Homeopathy is, so let’s explore what it really is.

The idea, dreamed up by Samuel Hahnemann in 1796 on the basis of no evidence at all, is that “like cures like”. If for example you have sleeping problems, then the proposal is to give you a remedy that contains caffeine.

I’m really not kidding, if you drink too much coffee, then the “cure” they offer you is a remedy made from coffee… 

Coffea Cruda (Coff) Coffee is well known for producing sleeplessness but because of homeopathy’s ‘like treats like’ effect, it will relieve insomnia when given in crude, or especially homeopathic form. The type of symptoms it relieves are those produced by coffee.

If you think that’s crazy then wait for what comes next.

Beyond this “like-for-like” belief, the next discovery is that a homeopathy remedy is diluted to the extreme. A typical remedy can be as “potent” as 30C or might even be 100C, so you might quite naturally wonder what exactly does 30C or 100C mean?

Let’s explain that.

Take 1 part of the ingredient, add 100 parts of water, and then vigorously shake – 10 hard strikes against an elastic body. This is called “succession”. This is 1C. Now take 1 part of the 1C and add 100 parts of water, do the same and you have 2C.  Keep repeating until you get to 30C.

The claim is that a solution that is more dilute is described as having a higher potency, and so these more dilute substances are considered by homeopaths to be stronger and deeper-acting remedies.

To help you wrap your head around this, a 12C solution is equivalent to a “pinch of salt in both the North and South Atlantic Oceans”.  13C is one drop of that diluted by all the water on the planet.

By the time you get to 30C what you are given contains no active molecules from the original substance at all. What is of course bizarre is that this remedy is supposed to be magically infused with the property of the ingredient that you started with and to have somehow “forgotten” all about anything and everything else that it ever came into contact with. (Hint: the secret of earning an income from plumbing is the knowledge that it’s not all water).

If you are now beginning to think, “But that’s absurd” then you are beginning to get it, because this is indeed pseudoscientific nonsense and all you actually have is a placebo. This is not about some herbal remedy that just might do something, instead it is more or less a belief in magic.

What is the evidence?

You always have to consider the possibility that something that we just don’t understand might be going on, so with that thought in mind let’s ask ourselves if there is any evidence that anything happens when you run a proper clinical trial. Is there?

No.

That is not simply my personal opinion, that is the prevailing objective evidence-based consensus. Since I live in the UK, then here is the view from here …

• The UK’s British Medical Association has described homeopathy as ‘witchcraft’
• The UK government’s chief scientific adviser, Sir Mark Walport, has dismissed it as ‘nonsense’
• The UK’s Chief Medical Officer Dame Sally Davies has labelled it ‘rubbish.’
• The National Health Service recently banned homeopathic treatments from being funded.

Some might perhaps label that as Big Pharma bias and claim that it really does actually work and that there is evidence for that. So with that thought in mind we can briefly review the very best possible evidence. The gold standard for clinical studies, Cochrane Studies, reveals that there is no evidence that it works

Currently there are seven Cochrane reviews that investigate the deployment of Homeopathy for the treatment of specific conditions, and here, via Professor Edzard Ernst, is a brief summary of all seven with links to each that can be checked …

1 Does homeopathy work for asthma?
Six trials with a total of 556 people were included. The authors concluded that ‘there is not enough evidence to reliably assess the possible role of homeopathy in asthma.’

2 Does homeopathy work for dementia?
There were no studies that could be included and the authors concluded that ‘in view of the absence of evidence it is not possible to comment on the use of homeopathy in treating dementia’.

3 Does homeopathy work for the induction of labour?
Two trials, involving 133 women, were included. The authors concluded that ‘there is insufficient evidence to recommend the use of homoeopathy as a method of induction’.

4 Does homeopathy work for ADHD?
Four studies with a total of 168 patients were eligible for inclusion. The authors concluded that ‘there is currently little evidence for the efficacy of homeopathy for the treatment of ADHD’.

5 Does homeopathy alleviate the adverse effects of cancer treatments? 
Eight controlled trials with a total of 664 participants met the inclusion criteria. The authors concluded that ‘this review found preliminary data in support of the efficacy of topical calendula for prophylaxis of acute dermatitis during radiotherapy and Traumeel S mouthwash in the treatment of chemotherapy-induced stomatitis. These trials need replicating. There is no convincing evidence for the efficacy of homeopathic medicines for other adverse effects of cancer treatments.’

6 Does homeopathy work for irritable bowel syndrome? 
Three RCTs with a total of 213 participants were included. The authors concluded that ‘a pooled analysis of two small studies suggests a possible benefit for clinical homeopathy, using the remedy asafoetida, over placebo for people with constipation-predominant IBS. These results should be interpreted with caution due to the low quality of reporting in these trials, high or unknown risk of bias, short-term follow-up, and sparse data. One small study found no statistically significant difference between individualised homeopathy and usual care (defined as high doses of dicyclomine hydrochloride, faecal bulking agents and diet sheets advising a high fibre diet). No conclusions can be drawn from this study due to the low number of participants and the high risk of bias in this trial. In addition, it is likely that usual care has changed since this trial was conducted.’

7 Does homeopathic Oscillococcinum work for influenza?
The authors included six studies: two prophylaxis trials (327 young to middle-aged adults in Russia) and four treatment trials (1,196 teenagers and adults in France and Germany). They concluded that ‘there is insufficient good evidence to enable robust conclusions to be made about Oscillococcinum in the prevention or treatment of influenza and influenza-like illness’.

Bottom line: Homeopathy does not work.

Oh but wait, what was that observations from Number 5 above that reads “this review found preliminary data in support of the efficacy of topical calendula for prophylaxis of acute dermatitis during radiotherapy and Traumeel S mouthwash in the treatment of chemotherapy-induced stomatitis”. There they looked at a total of eight trials …

• 2 of the 8 appear to show some benefit … but, here is the catch … the homeopathy remedies deployed were not the usual highly diluted remedies, they did actually contain some active molecules that might do something. Strictly speaking those were not clinical trails of an actual homeopathic remedy.

So yes, it still does not work, there is no wiggle room here.

The real danger

You might perhaps be tempted to consider the idea that since it does nothing at all it is harmless then it should not really be a huge concern.

It is however all highly problematic. Ask yourself these questions …

• As a student: How would you feel about investing three years of your life into studying and learning something that is essentially worthless?
• As a patient: If you had a serious illness, how do you feel about being giving a treatment that has been shown to do absolutely nothing instead of a treatment that has been demonstrated to work?

It persists because once you invest a considerable degree of time and finance into it, it becomes almost impossible to come to terms with it being quackery. Those with such investments don’t deliberately deceive, but instead rationalise doubt and conflicting evidence away so that the emotional investment can be retained. When you are in that position you will perceive yourself as the hero David with the truth pushing back against the big-pharma Goliath.

OK, one last quote.

In response to the availability of this new course, Joe Schwarcz, director of McGill University’s Office for Science and Society had this to say …

“The real danger in homeopathy is not toxicology — there’s nothing in there. The real danger is toxicity to the mind because it can convince people to go down this ridiculous route when there actually might be treatments that can work for whatever condition they have.”