Saturday 19 December 2009

Goldacre et al, Projection and a Meta-analysis in the Lancet showing the effectiveness of homeopathy beyond placebo.

I would like to draw your attention to a meta-analysis that was published in the Lancet (yes the very journal that proclaimed the "END" of homeopathy) in 1997. It clearly shows that homeopathy does work beyond the placebo effect. But first I would like to consider why the critics of homeopathy so fiercely claim that there is no evidence for homeopathy.

So where exactly do Ben Goldacre et al get their nonsensical data from? There is a mountain of evidence supporting homeopathy working beyond the placebo effect yet they still preach the same message - "there is no evidence to show homeopathy to work beyond placebo." I have faith however that the British public can make their own rational decision on whether they believe homeopathy to work if they are given the correct information.

Those with an agenda will bend and twist homeopathy into what they want, but ultimately the truth prevails. We have to wonder why some people would want to do this? I honestly can't answer that question for the likes of Ernst, Goldacre et al. Why would someone feel so threatened that they would feel the need to lie and manipulate the public into believing their own belief structures, hence why I used the word "preach" earlier. They are preaching a belief structure that does not hold up to scientific questioning.

Ironically this is what homeopaths are accused of time and again by their critics. However there is a principle in psychology called Projection which is simply defined as something you project unconsciously of yourself onto another individual, believing that they have the same attributes as yourself. Often however this is as a result of denial of yourself, and the fact that it is actually yourself that holds those attributes.

For example, critics of homeopathy claim it to be unscientific, mumbo-jumbo that is based upon belief and not actual substance. Now this could be true if it weren't for the fact that there is a lot of scientific evidence supporting homeopathy, so now we have to ask the question of why they so strongly believe themselves to be right? This is where the role of psychological projection comes in, because they deny that they themselves are unscientific and biased in their approach.

So homeopathy must take the brunt of their own denial of themselves. Which is obvious for all to see as their writings are so clearly based upon bias and nonsense. There is evidence that homeopathy works, yes scientific evidence not just anecdotal, and yes published in "prestigious" journals like the Lancet as I will show below. So what are they going on about? Hence the conclusion of projection, maybe they should acquaint themselves with the writings of Freud and Jung.

Here is the abstract of the meta-analysis promised

"Meta-analysis of 89 trials on homeopathic medicine versus placebo. Result: significantly in favour of homeopathy (OR 2.45 (95% CI 2.05-2.93)). This meta-analysis included 186 placebo-controlled studies of homeopathy published until mid-1996, of which data for analysis could be extracted from 89. The overall ratio was 2.45 (95% confidence intervals 2.05-2.93) in favour of homeopathy, which means that the chances that homeopathy would benefit the patient were 2.45 times greater than placebo. When considering just those trials of high quality published in MEDLINE listed journals, and with predefined primary outcome measures, the pooled odds ratio was 1.97 and significant. Even after correction for publication bias the results remained significant. The main conclusion was that the results "were not compatible with the hypothesis that the effects of homeopathy are completely due to placebo." If the results of new trials were to show no difference between homeopathy and placebo, we would have to add 923 trials with no effect with 18 patients in each order to balance the two."

Linde K, Clausius N, Ramirez G, et al. Are the clinical effect of homeopathy placebo effect? A meta-analysis of placebo-controlled trials. Lancet 1997; 350:834-43.

10 comments:

  1. Good stuff, glad that the Lancet will publish positive stuff about homeopathy, even after their serious error in 1997.

    Would you know, have the Lancet ever apologised for this?

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  2. There was a retraction, but as always they never gain the same publicity as the original wrongful article - stashed away at the bottom of page 22 no doubt.

    This paper by the way was from 1997, the oft-cited and much discredited Shang paper was in 2005, so this was before all of the "hype" surrounding that paper.

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  3. Hi Alex,

    I think it is bit premature to start using start using bar room philosophy to explain critics reaction to the Linde paper. Instead you should actually read what they have written.

    Have you read Goldacre's or Ernst and Singh's book's that discuss this paper?

    If not, I would suggest that it is a bit rich to call them liars.

    The Linde 1997 paper is, of course, one of a series of meta-analyses of homeopathic studies over the years. As time has progressed, better trial data has emerged and more sophisticated analyses has been applied. Homeopaths cite Linde 1997 because it gives them the most favourable result.

    However, as with all scientific papers, it was subject to criticism and a number of weaknesses were highlighted. Critics pointed out that too many trials had been included with what is called a low Jadad scores (a measure of trial quality). If you restrict the analysis to only high Jadad trials, the result for homeopathy looks a lot worse.

    Linde agreed and redid the analysis and published a new paper (Linde 1999). This paper concluded that the 1997 had overestimated the effect of homeopathy.

    Homeopaths who discuss 1997 without discussion 1999 are either ignorant of the literature or cherry picking the result they want. Neither is good. Were you aware on 1999?

    Obviously, since then more trails have been done and better meta-analyses conducted. Each time, the result for homeopathy has looked worse and worse.

    It is rich to therefore conclude that critics of homeopathy are using "nonsensical data" and being unscientific. They are simply looking at all the available data and not selecting only the data that appears to support preconceived ideas.

    Indeed, by discussing Linde 1997 as if it were definitive, one might be able to accuse you of being manipulative and misleading. Have you read their books?

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  4. Yes, it is tedious to see the same few individuals homeopathy bashing & chasing their tails on the same points, trotting out their serial denials of facts where they have been pointed to the evidence. In the end one has to leave them and hope that they will evolve one day to a more reasonable position without confusing too many others in the meantime.

    Why are they given a platform by some of the dailies and websites that should know better? One can only conclude here that vested interests are at work. There is a lot of money riding on maintaining the status quo in conventional medicine and control of the money that the taxpayer is annually forced to contribute to it.

    Tim

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  5. Le canard noir - "they are simply looking at all the available data and not selecting only the data that appears to support preconceived ideas." If only that was true! Come on who are trying to kid?

    I wasn't stating that this is the definitive answer to whether homeopathy is evidence based, I am merely pointing out that there is evidence published in a prestigious journal showing homeopathy to work better than placebo, that there can be no doubt, non?

    Tell me, have you read Ben Goldacre's "piece" in the Lancet Nov 2007? He says "Five large meta-analyses of homeopathy trials have been done. All have had the same result: after excluding methodologically inadequate trails and accounting for publication bias, homeopathy produced no statistically significant benefit over placebo."

    This is simply not true.

    Anyway le canard I am not really interested in an intellectual argument with you, its not something I am interested in. I don't believe you are ever going to change your belief structures, and you don't have to, we live in a country where freedom of speech may be practised and we may both have our own views. Likewise patients should be able to choose their own healthcare.

    Merry Christmas to you too.

    Alex

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  6. Hello Alex,

    Yes, I am aware of Goldacre's Lancet article where he states that 5 reviews have been done. If you check, he gives the references for those 5 papers. He does not include Linde 1997, no doubt for the reasons I gave above. Linde agreed that there had been serious weaknesses in the analysis and its conclusions were unsound. Good reason to discount it from a meta-meta-analysis. I trust you read these papers you discuss?

    I am also sure you are aware that even in Linde 1997, the papers was unable to find any statistically signifant evidence that homeopathy was effective for any named condition. That fact alone would make it hard to take the results of this paper and turn them into clinical recommendations - even without the fatal flaws.

    As I have pointed out before, it is not valid to choose a review and paper that appears to support homeopathy and then proclaim you have positive evidence. Things are a little more involved than that. What you do is called 'cherry picking' and it leads to misleading conclusions all too easily.

    So, Alex. Were you aware of Linde 1999? If so, why did you choose to ignore it? And if not, are you really up to date with the research? And, have you read Goldacres, Ernst and Singh's books?

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  7. Like I have said I am not getting into a debate over the fine details of research papers.

    So tell me Andy, what do you want homeopaths/homeopathy to do? What is your aim? What is your motivation? and Why? This is the one thing that baffles me.

    Alex

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  8. Hi Alex, I think you should address LCN's points about the Linde (1997) paper. To myself, to LCN, to Goldacre, Singh, Ernst and even Linde the conclusions of that paper have been superceded by more recent analysis and have been found wanting. There needs to be a real debate amongst homeopaths over the claims they can make for homeopathy given the evidence and the implications this has for its practice. Given that official regulation, and thus some veneer of respectability, looks increasingly unlikely because of the SoH's intransigence and them and other organisations refusing to use the CNHC model it is looking like the only people prepared to defend homeopathy are the homeopaths themselves. Unfortunately if they persist in overstating the evidence, behaving unethically and resorting to base insults then they will find opposition against them hardening and increasing in number. Beware hubris, it will be the end of you.

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  9. Wow im popular all of a sudden!

    As I have said to Andy I will not get into a worthless futile debate with you.

    I will ask you he same questions I asked Andy. What do you want homeopaths/homeopathy to do? What is your aim? What is your motivation? and Why? This is the one thing that baffles me.

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  10. Alex, I'd like homeopaths to accept the totality of the scientific literature on homeopathy. I would like them to cease making claims not borne out by the totality of this literature. I would like them to stop denigrating evidence based medicine. I would like to see an end to unethical experiments, particularly in the developing world, conducted by homeopaths. I would like to see an end to the false accusations and smears you subject your opponents to. And I would like to see effective regulation capable of enforcing this and punishing those who trangress it.

    My aim is to achieve this, my motivation irrelevant.

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