tag:theconversation.com,2011:/uk/topics/homeopathy-1144/articlesHomeopathy – The Conversation2021-10-19T07:11:43Ztag:theconversation.com,2011:article/1679812021-10-19T07:11:43Z2021-10-19T07:11:43ZFollow a natural health philosophy? Vaccination may have more in common with it than you think<p>The natural or “alternative” health community is often held up as being vaccine hesitant.</p>
<p>Yet, the relationship between the natural health community and vaccination is complex. </p>
<p>Stories such as the Adelaide naturopath <a href="https://www.abc.net.au/news/2021-08-02/naturopath-banned-over-covid19-vaccine-advice/100342858">recently disciplined</a> for using a newspaper column to spread vaccine misinformation may make headlines.</p>
<p>But other stories like the director of Australia’s <a href="https://www.abc.net.au/news/2021-08-10/covid-anti-vax-naturopath/100365020">largest natural medicine society</a> or even <a href="https://www.nimbingoodtimes.com/archive/pages2021/apr/NGT-0421-16-19.pdf">Nimbin’s herbal medicine columnist</a> publicly advocating for COVID vaccination are more representative. </p>
<p>Although the link between natural health beliefs and vaccine hesitancy gets a lot of <a href="https://www.theguardian.com/australia-news/2021/aug/14/when-covid-came-to-the-anti-vax-capital-of-australia">public attention</a>, there’s actually little evidence on the topic.</p>
<p>I led a <a href="https://pubmed.ncbi.nlm.nih.gov/27475472/">2016 review</a> which found opposition to vaccination was a minority opinion among natural health practitioners and users. Opposition was more likely related to an individual’s personal beliefs than a default philosophical position associated with natural medicine.</p>
<p>Some have suggested natural health practitioners could even help <a href="https://theconversation.com/how-complementary-medicine-practitioners-can-help-get-kids-vaccinated-89854">support vaccination activities</a>. This isn’t as far-fetched as it sounds. There are <a href="https://ndsforvaccines.com/">growing communities</a> of natural medicine practitioners highlighting the alignment between vaccination and natural approaches to health.</p>
<p>One thing people often overlook is the adaptive immune response caused by vaccination <em>is natural</em>. Vaccination prepares the body’s immune system in the <a href="https://www.immune.org.nz/immunisation/immune-system-vaccination">same way</a> “natural” exposure to infection does. It just does it in a safer, controlled way with a much lower dose. </p>
<p>Given there’s no underlying reason why natural health and vaccination cannot coexist, why does this perception exist, and why does it persist?</p>
<h2>Opposition to vaccines wasn’t always a given</h2>
<p>One main reason for historical opposition to vaccination in natural health communities wasn’t due to the vaccine. It was because <a href="https://trove.nla.gov.au/newspaper/article/249993036">they rejected “germ theory” itself</a> – the concept that unseen external pathogens like bacteria and viruses led to disease.</p>
<p>Early naturopathic pioneer <a href="https://www.jstor.org/stable/44449885">Henry Lindlahr rejected vaccination in the early 1900s because</a> “germs, bacteria and parasites are products of disease rather than its cause”. He argued “germs themselves cannot create disease – if they could, humanity would soon be extinct”. Also in the early 1900s, chiropractic founder Daniel Palmer <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743646/">rejected the notion</a> there was any cause of disease beyond misalignment of the spine. </p>
<p>It’s important to view this historic opposition in context, given germ theory had only become mainstream in conventional medicine in the recent decades before these statements. Views of these natural health professions have similarly evolved.</p>
<figure class="align-center ">
<img alt="Person with bandaid after being vaccinated" src="https://images.theconversation.com/files/427121/original/file-20211019-25-f7bd4h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/427121/original/file-20211019-25-f7bd4h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/427121/original/file-20211019-25-f7bd4h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/427121/original/file-20211019-25-f7bd4h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/427121/original/file-20211019-25-f7bd4h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/427121/original/file-20211019-25-f7bd4h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/427121/original/file-20211019-25-f7bd4h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Vaccines support your own immune system to fight COVID.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<p>Natural health communities sometimes raised “toxins” in vaccines as a concern. It’s important to remember, however, that vaccines up until the mid-1900s weren’t like the vaccines of today. First generation smallpox vaccines, for example, were crudely produced from calf lymph in a process <a href="https://theconversation.com/meet-the-vegetarian-anti-vaxxers-who-led-the-smallpox-inoculation-backlash-in-victorian-britain-134173">considered cruel by animal rights groups</a>, which were often closely linked with natural health movements. </p>
<p>Also, the natural health community didn’t reserve judgement for vaccines and pharmaceutical medicines. Natural health adherents saw other “drug systems”, such as herbal medicine and homeopathy, as equally invasive and unnatural. Although few would see these therapies as incompatible with natural health today, their adoption by naturopathic practitioners <a href="https://catalogue.nla.gov.au/Record/330286">caused significant</a> <a href="https://trove.nla.gov.au/work/193421002">tensions</a> in the budding “drugless” profession.</p>
<p>Just as vaccine hesitancy can be a proxy for deeper concerns about <a href="https://www.theguardian.com/commentisfree/2021/aug/15/vaccine-hesitancy-broken-relationship-state-conspiracy-theorists">medicine and the state</a>, conflict between the natural health community and medicine also came to influence vaccine views. </p>
<p>Opposition wasn’t always a given. One of Australia’s <a href="https://encore.slsa.sa.gov.au/iii/encore/record/C__Rb1368739__Sivaline%20harbinger%20of%20health__Orightresult__U__X8?lang=eng">earliest Australian naturopathic journals</a> blamed medicine for stealing vaccination from natural healers without credit.</p>
<p>Towards the second half of the 20th century, anti-vaccination statements increasingly began to target those vaccinating (usually medical doctors) as much as the vaccine. Eventually the oppositional stance of “alternative” health <a href="https://www.taylorfrancis.com/chapters/edit/10.4324/9781003078456-8/medicine-counter-culture-mike-saks">subsumed</a> parts of the natural health community. </p>
<p>Due to their marginalisation by the medical community, parts of the natural health community <a href="https://pubmed.ncbi.nlm.nih.gov/3293229/">started taking on</a> positions that were more about opposing conventional medical practice than about aligning with natural health philosophies.</p>
<p>These <a href="https://www.washingtonpost.com/outlook/2021/09/07/ivermectin-vaccine-skeptics/">underlying factors</a> are similar to why so many people opposing COVID vaccines as unnatural put their faith in equally unnatural alternatives such as ivermectin today.</p>
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<h2>What are the natural alternatives to vaccination?</h2>
<p>To put it bluntly, there aren’t any. </p>
<p>Homeopathic remedies are marketed by some practitioners as <a href="https://www.cbc.ca/news/canada/british-columbia/homeoprophylaxis-vaccination-health-canada-bc-homeopaths-1.5036538">alternatives for childhood vaccinations</a>. The most <a href="https://www2.health.vic.gov.au/public-health/immunisation/vaccination-children/no-jab-no-play/immunisation-enrolment-toolkit/scenarios-and-responses/homeopathic-immunisation">commonly promoted</a> are those claiming to <a href="https://en.wikipedia.org/wiki/Homeoprophylaxis">protect against infectious diseases</a> such as malaria and even COVID. A 2011 survey found nearly one-quarter of Australians thought these “homeopathic vaccines” were an <a href="https://www.ausdoc.com.au/news/vaccine-myths-rife-among-australians">effective replacement</a> for conventional vaccinations. Some have even unknowingly <a href="https://www.abc.net.au/news/2013-08-03/queensland-health-raises-alarm-over-homeopath27s-alleged-immun/4863170">received homeopathic vaccinations</a> thinking they’re conventional vaccinations.</p>
<p>Linking homeopathy and vaccination isn’t surprising. Both <a href="https://collection.sciencemuseumgroup.org.uk/people/cp95080/samuel-hahnemann">emerged during the same period</a> in the 1790s and both focused on infectious diseases (vaccination for prevention of smallpox, homeopathy to address symptoms of malaria). </p>
<p>Homeopathy’s founder Samuel Hahnemann viewed vaccination not only as effective and powerful, but also as an <a href="https://archive.org/details/homopathicmedic00devrgoog/page/n108/mode/2up">extension of and validation</a> of his own theories.</p>
<p>It might not surprise you homeopathic vaccination alternatives aren’t supported by the scientific community. But it may surprise you to know they’re <a href="https://www.thieme-connect.com/products/ejournals/abstract/10.1016/S0007-0785%2805%2980451-X">not supported</a> by the homeopathic community, either. </p>
<p>According to homeopaths, this is because the mechanism of action of “homeopathic vaccination” is <a href="https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0036-1582469">wholly incompatible</a> with <a href="https://highdilution.org/index.php/ijhdr/article/view/360">homeopathic theory</a>. </p>
<p>Homeopathic vaccines are neither homeopathic nor are they vaccines. </p>
<h2>What about just increasing immunity ‘naturally’?</h2>
<p>Some natural health practitioners <a href="https://chiromt.biomedcentral.com/articles/10.1186/s12998-020-00353-2">have claimed</a> their therapies can offer similar immunity as vaccines. However, these views are usually fringe and roundly rejected by their natural health <a href="https://chiromt.biomedcentral.com/articles/10.1186/s12998-020-00353-2">practice</a> and <a href="https://chiromt.biomedcentral.com/articles/10.1186/s12998-020-00312-x">research</a> peers. </p>
<p>What’s more, boosting for a bigger immune response isn’t necessarily better. Boost the wrong parts in favour of others, and a hyperactive immune system can make things worse in the short term, as well as the long term. Autoimmune disease (where an overactive immune system starts attacking the body) is thought to be one of the <a href="https://onlinelibrary.wiley.com/doi/10.1111/cei.13623">causes of “long COVID”</a>.</p>
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<p>In natural health we talk about the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7217399/">therapeutic hierarchy</a>. This recommends using low level interventions which encourage self-healing processes to avoid more intrusive and invasive therapies where possible.</p>
<p>Vaccines – once properly tested and assessed for safety and efficacy – clearly fit this bill. They’re a minimal dose, preventive intervention that support and develop the body’s own healing resources to fight disease. </p>
<p>And they offer the opportunity to avoid the alternative of <a href="https://theconversation.com/when-covid-patients-are-intubated-in-icu-the-trauma-can-stay-with-them-long-after-this-breathing-emergency-167361">aggressive treatment and management</a> of infection and associated symptoms later on.</p>
<p>Ultimately vaccination, like the use of natural therapies, is a matter of personal choice. But as someone passionate about both natural health and public health, it’s one I would highly recommend people take up.</p>
<p>If you’re hesitating to get vaccinated because you’re concerned it may not align with your preferences for a natural approach to health, there’s no need to be. Vaccines may have more in common with natural health approaches than differences.</p><img src="https://counter.theconversation.com/content/167981/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jon Wardle received funding from the National Health and Medical Research Council for part of this work. He is Maurice Blackmore Chair of Naturopathic Medicine and Foundation Director of the National Centre for Naturopathic Medicine, which was established with a gift from the Blackmore Foundation. He is also co-convenor of the complementary medicine special interest group of the Public Health Association of Australia. </span></em></p>Vaccination prepares the body’s immune system in the same way “natural” exposure to infection does. It just does it in a safer, controlled way with a much lower dose.Jon Wardle, Professor of Public Health, Southern Cross UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/961142018-05-08T06:16:00Z2018-05-08T06:16:00ZGovernment decision not to ban homeopathy sales from pharmacies is a mistake<figure><img src="https://images.theconversation.com/files/218007/original/file-20180508-46356-1fu8iho.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Evidence homeopathy works is pretty clear: it doesn't. </span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>Last year <a href="http://www.health.gov.au/pharmacyreview#InterimReport">a review into pharmacy</a> in Australia recommended homeopathic products be banned from sale in chemist shops across the country. This was a sensible recommendation, given pharmacists are trusted scientists in the community and science tells us homeopathic products <a href="https://consultations.nhmrc.gov.au/public_consultations/homeopathy_health">simply don’t work</a>.</p>
<p>In the <a href="http://www.health.gov.au/internet/main/publishing.nsf/content/7E5846EB2D7BA299CA257F5C007C0E21/$File/Pharmacy-Review-Aus-Gov-Response-3-May-2018.pdf">government’s recent response</a> to this review they “noted” the concerns of the reviewer, and have chosen not to adopt it. Here’s why that is a mistake.</p>
<h2>What is homeopathy?</h2>
<p>Homeopathy involves extreme dilution of a compound that is claimed to be therapeutically effective, and uses the concept of “like cures like”. <a href="https://theconversation.com/no-evidence-homeopathy-is-effective-nhmrc-review-25368">For example</a> a fever might be treated with a compound used to induce fevers, in the belief the diluted active ingredient will have the opposite effect and cure the fever.</p>
<p>Products tend to contain the equivalent active ingredient to a single molecule within an Olympic-size swimming pool. Practitioners of fact-based medicine have understandably indicated that any effect of the product could only be attributable to the <a href="https://www.sciencedirect.com/science/article/pii/S0140673605671772">placebo</a> effect (it works because you believe it works) or because the product contains alcohol or a similar <a href="https://publications.parliament.uk/pa/cm200910/cmselect/cmsctech/45/45.pdf">base</a>.</p>
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Read more:
<a href="https://theconversation.com/no-evidence-homeopathy-is-effective-nhmrc-review-25368">No evidence homeopathy is effective: NHMRC review</a>
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<p>Most pharmacists probably abhor such treatments lacking evidence, given they go through years of rigorous university training, are heavily regulated and have a strong professional ethic. But it makes the cash registers clang.</p>
<p>These days pharmacies also sell jelly beans, lipstick, energy bars, vitamins, teddy bears and sunglasses – as well as prescription medications. This, unfortunately, is business practice. </p>
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<strong>
Read more:
<a href="https://theconversation.com/discount-chemists-are-cheapening-the-quality-of-pharmacy-along-with-the-price-68744">Discount chemists are cheapening the quality of pharmacy along with the price</a>
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<a href="https://images.theconversation.com/files/218009/original/file-20180508-46332-102fyyd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/218009/original/file-20180508-46332-102fyyd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/218009/original/file-20180508-46332-102fyyd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/218009/original/file-20180508-46332-102fyyd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/218009/original/file-20180508-46332-102fyyd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/218009/original/file-20180508-46332-102fyyd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/218009/original/file-20180508-46332-102fyyd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/218009/original/file-20180508-46332-102fyyd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Pharmacists are trusted scientists.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
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<h2>Business v health care</h2>
<p>Pharmacies have a special status as businesses, along with many actors in the health system. Successive governments have <a href="http://www.pc.gov.au/research/supporting/pharmacy-review">grappled</a> with tensions around service delivery, standards and <a href="https://www.pc.gov.au/inquiries/completed/productivity-review/report/productivity-review.pdf">competition</a>.</p>
<p>They’ve also had to grapple with a very strong industry body, the <a href="https://www.guild.org.au/">Pharmacy Guild</a> (stronger than the Pharmaceutical <a href="https://www.psa.org.au/">Society</a>). Much of the review reflects agreement between them. In responding to the review the government has flicked the homeopathic hot potato to pharmacy owners:</p>
<blockquote>
<p>Professional standards have been designed for use by individual pharmacists to assess their own professional practice. They are intended to serve as guidance for desired standards of practice. However, it is the sole responsibility of the individual pharmacist to determine, in all circumstances, whether a higher standard is required. It is equally their responsibility to meet that standard and ensure that consumers are provided with the best available information about the current evidence for, or lack-of efficacy in, offered treatments and therapies.</p>
</blockquote>
<p>So given the government has not banned homeopathic products from pharmacies, we could hope for restriction under Australian Consumer Law. They can, for example, <a href="https://www.accc.gov.au/publications/advertising-selling/advertising-and-selling-guide/avoid-misleading-or-deceptive-claims-or-conduct/misleading-or-deceptive-conduct">prohibit</a> sale of products that lack the purported constituents or qualities. But this has yet to happen with homeopathy, as it’s considered misleading but harmless.</p>
<p>The government is putting the onus on consumers to ask the pharmacist “does this work?”, and only the exceptional customer will ask. </p>
<p>If consumers wish to purchase therapies without a proven effect, they should be able to do so from venues that sell incense sticks and similar “wellness” paraphernalia. </p>
<p>They should not be available for sale in an industry necessarily regulated by government and trusted by the community. </p>
<p>It’s time for the Guild and Society to take a stand and reject sale by their members of products that by definition do not work. If pharmacies want status, they have to skip the junk products dollar. The government should help.</p>
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<strong>
Read more:
<a href="https://theconversation.com/pharmacists-are-trusted-medical-professionals-so-they-shouldnt-sell-remedies-that-lack-evidence-65148">Pharmacists are trusted medical professionals, so they shouldn't sell remedies that lack evidence</a>
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<img src="https://counter.theconversation.com/content/96114/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bruce Baer Arnold does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A review into pharmacy practices last year recommended pharmacies stop selling ineffective remedies such as homeopathy. The government didn’t support the recommendation.Bruce Baer Arnold, Assistant Professor, School of Law, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/651482017-06-26T20:09:08Z2017-06-26T20:09:08ZPharmacists are trusted medical professionals, so they shouldn’t sell remedies that lack evidence<figure><img src="https://images.theconversation.com/files/175548/original/file-20170626-326-1vucnvw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pharmacies are trusted medical professionals, so people trust their products. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>A <a href="http://www.health.gov.au/pharmacyreview#InterimReport">government review</a> has recommended pharmacists explain to consumers the limited evidence for effectiveness of complementary medicines, and keep them in a separate area to regulated medications with proven effectiveness. The review also recommended any pharmacy that receives Commonwealth government approval to dispense PBS medicines should not be able to sell homeopathic medicines.</p>
<p>This review was commissioned by the Commonwealth government to examine the efficiency and value for money of pharmacy services and also the regulations under which pharmacies work.</p>
<p>Complementary and alternative medicines are products such as herbal medicines, dietary supplements and multivitamins, and they’re big business. A <a href="http://www.cmaustralia.org.au/resources/Documents/Reports/CMA%20Industry%20Audit%202014.pdf">2014 survey</a> found the revenue from complementary medicines in Australia exceeded A$3.5 billion and was projected to reach $4.6 billion in 2017-18. Pharmacies are a major player in sales of these products, but the exact percentage of total sales in pharmacies, compared to supermarkets and health food stores, is unclear.</p>
<p>The Pharmaceutical Society of Australia (PSA) issued a <a href="http://www.psa.org.au/downloads/ent/uploads/filebase/policies/position-statement-complementary-medicines.pdf">position statement</a> on complementary medicines in 2015. It highlighted the variable evidence and encourages pharmacists to assist consumers’ decision making by discussing the relevant evidence.</p>
<p>The PSA position statement says they do not support the sale of homeopathic products, but stops short of recommending pharmacists do not sell them. Homeopathic products are different from regular medicines. Homeopathy follows a principal of extreme dilution: a substance is chosen to cure an ill, and then the substance is diluted. The vessel containing the substance is then physically hit against a book or other object. There is no reputable evidence for effect from <a href="http://www.nhmrc.gov.au/guidelines-publications/cam02">these products</a>.</p>
<p>The Royal Australian College of General Practitioners (RACGP) was stronger in their <a href="http://www.racgp.org.au/download/Documents/Policies/Health%20systems/PPI-PositionStatement-Homeopathy-v1.pdf">2015 position statement</a> to their members, which said medical practitioners should not recommend these products and pharmacists should not sell them.</p>
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<a href="https://images.theconversation.com/files/175549/original/file-20170626-32738-14gypyt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/175549/original/file-20170626-32738-14gypyt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/175549/original/file-20170626-32738-14gypyt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/175549/original/file-20170626-32738-14gypyt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/175549/original/file-20170626-32738-14gypyt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/175549/original/file-20170626-32738-14gypyt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/175549/original/file-20170626-32738-14gypyt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/175549/original/file-20170626-32738-14gypyt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The review has recommended alternative medicines be kept separate to regulated medicines so consumers know there’s a difference.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
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<h2>What these mean for consumers</h2>
<p>The review’s recommendations should increase the information available to consumers to assist them in making an informed purchase. The changes should also educate consumers about the process by which complementary medicine products are assessed by the Therapeutics Goods Administration (TGA) before they can be sold on the Australian market.</p>
<p>Just like any other medicine, consumers should ask at the point of purchase about the evidence for the claims made and any potential side effects and interactions. If these questions cannot be answered (or there is no one to ask), go to another store where they are willing to provide answers and even written information to support those answers.</p>
<p>A ban on homeopathic products would be a positive change for the pharmacy profession. For too long pharmacists have claimed “health professional” status while functioning more like shopkeepers, primarily chasing profits. Some people claim homeopathic products are an expensive placebo and do no harm. But if the person taking the homeopathic remedy delays treatment, they can be causing harm and increasing medical costs if the condition progresses while being “treated”.</p>
<p>The PSA has not been strong enough on homeopathic products, perhaps because it is are a member-based organisation and some of its members would sell these. </p>
<p>If a product is sold by a health professional it means consumers have faith it will work. These products don’t deserve this trust, and health professionals who endorse them are putting profit before reputation. Pharmacists should only stock products with a strong evidence base.</p>
<p>Other review recommendations include:</p>
<ul>
<li><p>removing the $1 allowable discount on the PBS patient co-payment, increasing equity in PBS prices for consumers no matter where they live</p></li>
<li><p>changing the current paper Safety Net scheme (where patients have to collect a sticker for every script) into an automatic electronic recording and alert system.</p></li>
</ul>
<p>It’s important to note the review is not yet finalised – this release is an interim report and is <a href="http://www.health.gov.au/pharmacyreview#InterimReport">available for public comment</a> until 23 July 2017. There are almost 50 “options” on which comments are sought.</p><img src="https://counter.theconversation.com/content/65148/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A review has recommended separating pharmacists from complementary and homeopathic products.Greg Kyle, Professor of Pharmacy, Queensland University of TechnologyKatherine Browne, Associate Lecturer, Queensland University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/594122016-05-13T13:30:44Z2016-05-13T13:30:44ZDear Prince Charles: an open letter about homeopathy from a chemist<figure><img src="https://images.theconversation.com/files/122497/original/image-20160513-10679-l1n422.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Is there any science in that?</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/dl2_lim.mhtml?src=aWYhOeuZf36skVcqvttUBA-1-21&clicksrc=download_btn_inline&id=319887491&size=medium_jpg&submit_jpg=">Shutterstock</a></span></figcaption></figure><p>Your Royal Highness,</p>
<p>Your recent speech in which you proposed using <a href="http://www.independent.co.uk/news/people/prince-charles-uses-homeopathy-to-treat-animals-on-his-organic-farm-to-fight-antibiotic-resistance-a7027216.html">homeopathy to treat livestock</a> as a solution to the overuse of antibiotics was most interesting. Given that you delivered this to a gathering of international scientists and government officials, you clearly see yourself as qualified to explain the virtues of homeopathy. </p>
<p>Therefore would you please oblige me by answering some questions that I have regarding this most controversial of alternative therapies. </p>
<p>First, let’s make sure I understand things correctly. Homeopathy is based on the idea that <a href="http://www.homeopathyschool.com/why-study-with-us/what-is-homeopathy/like-cures-like/">“like cures like”</a>. So, you might suggest that caffeine plays a part in treating insomnia. But a blast of espresso is sure to keep you awake, so instead you get around this by <a href="http://www.britishhomeopathic.org/what-is-homeopathy/">diluting</a> the coffee. This way, you claim, the beneficial effects are retained while the unpleasant side effects are removed. </p>
<p>I understand that this dilution process is very important when making homeopathic remedies. You might start with a solution of caffeine that’s about the same concentration as coffee. Then you perform a one in 100 dilution. The solution is shaken, often by hitting it against a leather bound surface – a process known as <a href="http://homeopathycommunity.com/TriturationandSuccussion.asp">succussion</a>. The result is known as a 1C solution. You perform another dilution, shake and so on, resulting in a 2C solution. This process continues, often 30 or more times. The net result is a solution that will not contain a single molecule of the original. In fact, it might be the equivalent of diluting the cup of coffee in a sphere of water the size of the solar system.</p>
<h2>But now for the science bit…</h2>
<p>So far, I hope we can agree. But it seems rather unlikely, to me, that this process might result in an effective remedy. <a href="http://www.britishhomeopathic.org/how-does-homeopathy-work/">Homeopaths argue that</a> “water is capable of storing information relating to substances with which it has previously been in contact”. Or to put it another way, the water can remember what was diluted in it.</p>
<p>But there is no sound scientific evidence <a href="https://theconversation.com/what-if-water-had-memory-18071">that water has any such memory storage capacity</a>. Homeopaths often tell scientists that we should be more open minded and not to be so wedded to the dogma that we have been taught. So here I am, putting my education and experience in chemistry to one side for a moment.</p>
<p>Nevertheless, even without everything that chemistry might tell me, there still seem to be some logical holes in the thinking behind this therapy. Hence the following questions for you: </p>
<p><strong>How come the water remembers the starting substance (for example, the caffeine) but not other impurities?</strong></p>
<p>The gold standard for water purity (used by analytical chemists, but not homeopaths) is just ten parts impurity to one billion parts water. The concentration of these impurities is equivalent to a 4C solution. So in dilutions made beyond this point the impurities will outnumber the original substance. How then can the homeopathic solution know which molecules it is supposed to store information about?</p>
<p><strong>Why was homeopathy so ineffectual at combating bacterial infections before the advent of antibiotics?</strong></p>
<p>Homeopathy was around long before antibiotics were commonplace, so why did it so comprehensively fail to treat infections in the pre-antibiotic era?</p>
<p><strong>How can you reconcile the success of modern chemistry and homeopathy?</strong></p>
<p>Modern chemistry, <a href="https://theconversation.com/five-chemistry-inventions-that-enabled-the-modern-world-42452">on which our modern world is built</a>, is dependent on the ability to reproduce the conditions for a chemical reaction anywhere and anytime. A chemist can develop a new antibiotic in a lab in Hull and someone else can repeat the procedure on the other side of the world. If, however, water retains a memory of what was previously in it, then the water will act like it is chock full of impurities. The results of any reaction carried out in the water would be completely unpredictable. </p>
<p><strong>How is the power of a remedy transferred from water to a dry pill?</strong></p>
<p>Homeopaths make pills by dropping a water remedy onto a sugar tablet and then drying it. How is the stored information (supposedly in the water) retained in the pill after the water has evaporated?</p>
<p><strong>And finally … why do you insist on supporting homeopathy despite all the evidence that it doesn’t work?</strong></p>
<p><a href="https://theconversation.com/no-evidence-homeopathy-is-effective-nhmrc-review-25368">Time</a> and <a href="https://theconversation.com/health-experts-find-no-evidence-homeopathy-works-again-38651">time</a> again, large scale, robust studies have found <a href="http://www.independent.co.uk/life-style/health-and-families/health-news/homeopathy-therapeutic-dead-end-systematic-review-no-evidence-it-works-a6884356.html">no evidence</a> that homeopathy is effective. Given the weight of evidence and the fact that homeopathy is incompatible with the science that brought us modern medicines, materials, agriculture and much more, why do you continue to support it?</p>
<p>I really am interested in the answers that you or other homeopaths might be able to provide.</p>
<p>Yours sincerely,</p>
<p><a href="https://twitter.com/sci_ents?lang=en-gb">Professor Mark Lorch</a></p>
<p><em>This open letter is based on one that first appeared on <a href="http://www.chemistry-blog.com/2015/04/14/a-letter-from-a-chemist-to-homeopaths/">Chemistry-Blog</a></em></p><img src="https://counter.theconversation.com/content/59412/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mark Lorch is a member of the Royal Society of Chemistry. </span></em></p>Just a few awkward questions.Mark Lorch, Professor of Science Communication and Chemistry, University of HullLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/526682016-01-21T04:57:42Z2016-01-21T04:57:42ZWhy an ineffective flu remedy is still being advertised in South Africa<figure><img src="https://images.theconversation.com/files/108706/original/image-20160120-26096-fmg20u.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An international study has dismissed the effectiveness of a homeopathic flu remedy but it is still being advertised in South Africa as a viable solution. </span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p>A homeopathic flu product is being advertised in South Africa despite the fact that an internationally based review, and an update to it, have found the product to be ineffective. </p>
<p>The <a href="http://www.asasa.org.za/">South African Advertising Standards Authority</a> received complaints four years ago about the advertising of <a href="http://www.oscillo.com">oscillococcinum</a>, a homeopathic remedy which claims to relieve flu and flu-like symptoms. A year later it ruled that advertising of the remedy could be continued. The decision, however, was based on earlier out-of-date studies. </p>
<p>Its ruling, in July 2012, came just months before a Cochrane systematic review concluded there was insufficient evidence to show any benefit from taking the drug. A <a href="http://www.cochrane.org/CD001957/ARI_homeopathic-oscillococcinumr-for-preventing-and-treating-influenza-and-influenza-like-illness">2015 update</a> to the review confirmed this finding.</p>
<p>But this conclusion has not yet been considered by the authority, and the remedy’s advertising has continued unabated. </p>
<h2>Misinterpreting the evidence</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/107051/original/image-20151231-11914-6ah8el.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/107051/original/image-20151231-11914-6ah8el.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/107051/original/image-20151231-11914-6ah8el.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=300&fit=crop&dpr=1 600w, https://images.theconversation.com/files/107051/original/image-20151231-11914-6ah8el.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=300&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/107051/original/image-20151231-11914-6ah8el.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=300&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/107051/original/image-20151231-11914-6ah8el.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=377&fit=crop&dpr=1 754w, https://images.theconversation.com/files/107051/original/image-20151231-11914-6ah8el.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=377&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/107051/original/image-20151231-11914-6ah8el.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=377&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Oscillococcinum flu remedy.</span>
</figcaption>
</figure>
<p>The authority evaluates advertisements by using its advertising code of practice, but only when complaints have been made. All advertisements should be legal, decent, honest and <a href="http://www.asasa.org.za/codes/advertising-code-of-practice/section-i-introduction">truthful</a>. A complaint is initially ruled on by a committee. Its decision can be appealed through an appeals committee and ultimately a final appeal committee. </p>
<p>The complaint was eventually <a href="http://www.camcheck.co.za/absurdity-of-oscillococcinum/">dismissed</a> after going through all three committees.</p>
<p>The dismissal was based on a report from a general practitioner who is also qualified as a homeopath. The doctor used a Cochrane systematic review to provide evidence for the product. The review’s authors’ conclusion was that the evidence and data were not strong enough to make a general recommendation to use Oscillococcinum for routine or first-line treatment of flu and flu-like syndromes. Note that advertising is in effect a “general recommendation”.</p>
<p>Systematic reviews are done on many medicines. These use predefined criteria to evaluate relevant studies of a particular medicine. Combining specified findings (data) from smaller studies can result in a larger sample size from which new or more accurate conclusions can be drawn. </p>
<p>The <a href="http://www.cochrane.org/about-us">Cochrane Collaboration</a> is the best-known, most-respected and credible organisation involved with systematic reviews in medicine. </p>
<p>The conclusions from the 2006 Cochrane review, which are now no longer accessible, were based mainly on combined data from two old studies. These studies used a sample size of less than 800 participants. It calculated that oscillococcinum reduced the time that someone was ill with flu by an average of 0.28 days – six to seven hours. This is clinically insignificant in the context of what is usually a seven day illness.</p>
<p>The other <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1379831/pdf/brjclinpharm00089-0054.pdf">study</a> the GP-Homeopath used showed that only an unpredictable seven out of every 100 people benefited from using oscillococcinum. Therefore, for 93% of people purchasing oscillococcinum, there is no benefit. </p>
<p>An explicit finding in the 2006 review was that:</p>
<blockquote>
<p>… 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. </p>
</blockquote>
<p>The authority’s final appeal committee gave more credence to, and placed more weight on, the GP-Homeopath’s anecdotal “expert” evidence of treating patients with the product than the scientific data. </p>
<h2>Updated findings</h2>
<p>The January 2015 Cochrane <a href="http://www.cochrane.org/CD001957/ARI_homeopathic-oscillococcinumr-for-preventing-and-treating-influenza-and-influenza-like-illness">review</a> update re-confirmed that there was insufficient evidence that oscillococcinum prevents or treats flu or flu-like illnesses. It further stated:</p>
<blockquote>
<p>Our findings do not rule out the possibility that oscillococcinum could have a clinically useful treatment effect but, given the low quality of the eligible studies, the evidence is not compelling. </p>
</blockquote>
<p>The authors have strong connections to homeopathy. I consider their qualifier that the “possibility” remains that oscillococcinum could have a clinically useful treatment effect, despite the evidence not being compelling, not credible. </p>
<p>They themselves calculated that a sample of 1600 participants would be needed to provide an accurate finding. This is double the size of the sample in the combined studies used for the 2015 meta-analysis. The authors state that such a large trial would “require substantial financial and organisational resources”.</p>
<h2>A quasi-landmark ruling</h2>
<p>The advertising authority’s final ruling was considered by the complementary medicines industry to be a landmark ruling. Complementary medicines have not been adequately regulated in South Africa for decades, and more than <a href="https://pmg.org.za/question_reply/228/">155,000</a> untested products were on the market at that time.</p>
<p>The Health Products Association of South Africa said: </p>
<blockquote>
<p>We believe a necessary precedent has been set and like to think it contributes importantly to the debate on appropriate and relevant control of complementary and alternate medicines, for which the association has long been campaigning. Hopefully it will also help encourage sensible reflection on the free-for-all that has developed in place of this control. </p>
</blockquote>
<p>Although this announcement was subsequently removed from the association’s website, unless the advertising standards authority receives a new complaint about the advertising and packaging of oscillococcinum and rules against it, the product will continue to be misleadingly promoted.</p><img src="https://counter.theconversation.com/content/52668/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Roy Jobson is associated with Advocacy for Responsible Health Information and Advertising International and South Africa (ARHIA). He is an Associate Professor of Clinical Pharmacology at the Sefako Makgatho Health Sciences University; and a Council member of the Allied Health Professions Council of South Africa (AHPCSA).
He writes in his personal capacity and his views do not necessarily represent those of the institutions with which he is associated.</span></em></p>Internationally, the effects of a homeopathic flu remedy has been dismissed – but, in South Africa, it is still being advertised as effective.Roy Jobson, Associate Professor of Clinical Pharmacology, Sefako Makgatho Health Sciences UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/476592015-09-18T10:46:21Z2015-09-18T10:46:21ZWhy homeopathy must not gain a foothold in the UK<figure><img src="https://images.theconversation.com/files/95065/original/image-20150916-6295-1s9hhla.jpg?ixlib=rb-1.1.0&rect=0%2C15%2C3462%2C2381&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">'Traditional' homeopathic medicine bottles.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/widnr/6549284621/">Flickr/Wisconsin Department of Natural Resources</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>Despite <a href="http://www.nhs.uk/Conditions/homeopathy/Pages/Introduction.aspx">the NHS stating</a> that “homeopathy performs no better than placebos”, support for the practice still prevails. The reason why may be that two small, but important, subgroups in the UK support it: the Royal family and some members of the political establishment. </p>
<p>Not only is homeopathy unsafe <a href="http://www.ncbi.nlm.nih.gov/pubmed/12492603">and ineffective</a>, but with the support of the Royals such as the Queen and <a href="http://www.theguardian.com/uk-news/2015/jun/04/black-spider-memos-prince-charles-lobbied-homeopathy-funding-nhs">the secret lobbying of Prince Charles</a> in favour of funding it on the NHS, it also has the potential to cause a ridiculous constitutional crisis. And by gaining more influence within political circles, the chances of it being included on the NHS are higher than ever.</p>
<p>The Queen has had a homeopath by royal appointment for quite some time. Her royal dispenser, Peter Fisher of the <a href="https://www.uclh.nhs.uk/OurServices/OurHospitals/RLHIM/Pages/Home.aspx">Royal London Hospital for Integrated Medicine</a>, hasn’t exactly shied away <a href="http://www.telegraph.co.uk/news/health/news/11739270/Queens-physician-calls-for-more-homeopathy-on-NHS.html">from lobbying</a> the government to provide homeopathy on the NHS – despite much of his own profession being opposed to the idea and calling for it <a href="http://www.theguardian.com/society/2010/jun/29/ban-homeopathy-from-nhs-doctors">to be banned</a>.</p>
<p>When it comes to Prince Charles’ <a href="https://theconversation.com/quacktitioner-royal-is-a-menace-to-the-constitution-and-public-health-16448">support for homeopathy</a>, the apple doesn’t fall far from the tree. His lobbying became ever more apparent in the wake of the <a href="http://www.theguardian.com/uk-news/2015/jun/04/black-spider-memos-prince-charles-lobbied-homeopathy-funding-nhs">black spider letters</a>. </p>
<p>His attempts may have also extended as far as causing Edzard Ernst, the UK’s preeminent scholar of evidence-based approaches to alternative medicine, to <a href="http://www.dailymail.co.uk/news/article-2918600/Top-scientist-claims-lost-job-Prince-Charles-wanted-silence-criticising-report-alternative-medicine-commissioned-royal.html">lose his job</a>. </p>
<p>The second group that seems to favour homeopathy, more than the general public, is a subset of our own elected government. David Tredinnick, a Conservative MP for Bosworth and a member of the Commons health select committee, <a href="http://www.telegraph.co.uk/news/health/news/10991455/Tory-MP-says-astrology-is-good-for-the-health.html">was known affectionately</a> in the House as “the honourable member for Holland & Barret”, due to his support for alternative medicines. </p>
<p>The current health secretary, Jeremy Hunt, is also quite fond of homeopathy. <a href="http://www.theguardian.com/politics/2014/may/08/jeremy-hunt-homeopathy-studies-chief-medical-officer">In 2014</a> he asked the chief medical officer (CMO) to commission expert reviews of three homeopathic remedies. Clearly he hadn’t noticed that the CMO’s publicly expressed belief was that homeopathy <a href="http://www.theguardian.com/politics/2014/may/08/jeremy-hunt-homeopathy-studies-chief-medical-officer">is “rubbish”</a>.</p>
<p>Even when we cross the floor of the House, the outlook doesn’t improve. <a href="https://theconversation.com/uk/topics/jeremy-corbyn">Jeremy Corbyn</a>, the new Labour leader, has stated his support for homeopathy on Twitter. He says he believes they work because both drugs and “homeo-meds” come from organic matter. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"10038631361"}"></div></p>
<p>Corbyn has also signed various parliamentary motions in favour of homeopathy, such as <a href="http://www.parliament.uk/edm/2006-07/1240">advocating NHS homeopathy hospitals</a>.</p>
<p>Heidi Alexander, <a href="http://www.pulsetoday.co.uk/news/political-news/heidi-alexander-appointed-shadow-health-secretary/20020089.article#.VflhUxFViko">the newly appointed shadow health minister</a> has been coy about homeopathy, stating she is “<a href="http://www.buzzfeed.com/jimwaterson/labours-new-shadow-health-minister-considers-backing-homeopa#.pk8BP2yrO">open</a>” to arguments for why it should be provided on the NHS. </p>
<h2>A lack of scientific grounding</h2>
<p>It should not be a shock to learn that homeopathy has no basis in scientific fact – should anyone doubt this I invite them to peruse Edzard Ernst’s <a href="http://www.ncbi.nlm.nih.gov/pubmed/12492603">systematic review</a> of the practice. </p>
<p>Homeopaths have gone to incredible lengths to avoid having their air guitar of medicine tested in any rigorous fashion. Instead, they have created their own self-justifying means of establishing that it works. They call this “<a href="http://homeopathyplus.com.au/tutorial-6-provings">homeopathic proving</a>”.</p>
<p>A “proving” typically involves a dozen people, who will take a homeopathic remedy and record their thoughts, feelings and even dreams. These diaries are then used to “discover” what the remedy can supposedly cure. </p>
<h2>Homeopathy gone wrong</h2>
<p>Proponents of homeopathy will often try to market their remedies with the dual claim that they are both effective and safe. There are many who will shrug their shoulders at those who condemn the practice - “it doesn’t do any harm”, they say, “so why bother?”</p>
<p>Sadly, there are many cases where homeopathy, or at least people’s belief in its supposed healing powers, has caused very real and serious harm. Websites such as <a href="http://whatstheharm.net">Whats the harm?</a> list all kinds of cases where homeopaths have misdiagnosed, mistreated and in some cases even poisoned their patients.</p>
<p>The tragic case of <a href="http://metro.co.uk/2008/11/17/healer-dies-after-letting-cut-foot-rot-150526">Russell Jenkins</a> is a prime example of homeopathy gone wrong. Shunning conventional medical advice in favour of homeopathy, Jenkins died from gangrene caused by a minor injury sustained after standing on a plug. </p>
<p>There are also a depressing number of cases involving the completely unnecessary harm, and even death, of children. <a href="http://www.theguardian.com/society/2003/dec/16/health.medicineandhealth">Isabella Denley</a>, an epileptic toddler from Australia, died after her parents ditched the anti-convulsant medication she had been prescribed in favour of homeopathic remedies. Her parents believed they were doing the best for their child.</p>
<p>Also in Australia, <a href="http://www.smh.com.au/national/parents-guilty-of-manslaughter-over-daughters-eczema-death-20090605-bxvx.html">a Sydney couple</a> were found guilty of manslaughter after their nine-month-old baby died from ill health caused by eczema, after they used homeopathy rather than traditional remedies. </p>
<p>In Rome an Italian couple <a href="http://www.telegraph.co.uk/news/health/alternative-medicine/8844461/Parents-face-inquiry-for-treating-son-with-alternative-medicine.html">were investigated</a> for the manslaughter of their sick three-year-old son, who died after being treated at home with exclusively homeopathic medicine. </p>
<h2>What next?</h2>
<p>Aside from the bogus treatments offered, the frequent undermining of genuine medical advice that some homeopaths engage in is dangerous, particularly when it comes to vaccination.</p>
<p>In the past, the <a href="http://www.rpharms.com/home/about-us.asp">Royal Pharmaceutical Society</a> has <a href="http://news.bbc.co.uk/1/hi/programmes/newsnight/9341713.stm">criticised</a> homeopaths for offering (what they erroneously claim) are “safe alternatives” to vaccinations for diseases such as typhoid, polio and malaria. </p>
<p>Ernst and fellow researcher Katja Schmidt conducted <a href="http://www.1023.org.uk/whats-the-harm-in-homeopathy.php">a covert study</a> to expose the scale of this problem. They found that out of 77 homeopathic practitioners who responded, only two had advised a child should be immunised. The others were content to adopt an anti-vaccination stance and advise parents to choose homeopathic remedies instead. Such advice has had <a href="http://www.bbc.co.uk/news/health-22085678">severe implications</a> for public health in the past.</p>
<p>In short, the idea that homeopathy is “safe” is as tenuous a claim as the delusion that it is effective. Far from being harmless, a belief in the magical powers of <a href="http://www.scilogs.com/in_scientio_veritas/water-memory-myth-that-wouldnt-die/">water’s memory</a> can seriously damage your health.</p><img src="https://counter.theconversation.com/content/47659/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Keir Liddle has received funding from the Chief Scientists Office. He has a member of the SNP. </span></em></p>Support for homeopathy within royal and political circles is a danger for public health.Keir Liddle, PhD Candidate, University of StirlingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/411772015-05-05T04:50:10Z2015-05-05T04:50:10Z‘Holistic’ dentistry: more poppycock than panacea?<figure><img src="https://images.theconversation.com/files/80254/original/image-20150504-2070-1nt4ws1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">All dentists should be practising evidence-based dentistry for the sake of their patients.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/gobikey/4568757099">John Dill/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Many Australian dentists’ websites proudly advertise that they practise holistic dentistry, a philosophy that promotes health and wellness rather than simply treating disease, and considers the whole body and mind, not just teeth. </p>
<p>It sounds exciting. The implication is that this practice is very different – and superior – to the type of dentistry being practised by mainstream dental professionals. But different doesn’t actually mean superior.</p>
<p>Most holistic dental surgeries embrace and encourage alternative therapies. A quick internet search finds Australian dentists practising or endorsing <a href="http://www.lotusdental.com.au/homeopathy-dentistry/">homeopathy</a>, <a href="http://www.thepaddingtondentalsurgery.com.au/about/naturopath-sydney-nsw/">naturopathy</a>, <a href="http://www.davidhoward.com.au/services/wd_homeopathic.html">Bach flower essences</a>, <a href="http://www.myhillsdentist.com/service/acupuncture/">acupuncture</a>, <a href="http://www.naturaltherapypages.com.au/connect/liminac/service/37299">traditional Chinese medicine</a>, <a href="http://www.dentalpartners.com.au/practice-locations/new-south-wales/windsor-chiropractic-dentistry/">chiropractic</a>, <a href="http://www.shdc.com.au/tag/ayurvedic/">ayurvedic medicine</a>, <a href="http://www.brunswickdental.com">osteopathy</a>, <a href="http://www.oakdale.net.au">kinesiology</a>, <a href="http://www.brunswickdental.net/dentistry.php">crystals, aromatherapy, reiki</a>, <a href="http://www.veranese.com/#!dr-jon-dental/c2414">vibrational healing</a>, <a href="http://www.holisticdentist.com.au/vital-breathing-method.html">Buteyko</a> and <a href="http://www.evolvedental.com.au/about">esoteric chakra-puncture</a>.</p>
<p>Since all dentists are registered by the <a href="http://www.ahpra.gov.au/Notifications/Hearing-Decisions/Before-the-national-scheme/Dental.aspx">Australian Health Practitioner Regulation Agency</a>, the public tends to assume they must be reputable and their treatments, even if out of the ordinary, must be effective. And, surely, we have to respect the centuries of ancient wisdom from whence many of these therapies came, right? Well, yes and no.</p>
<h2>Not quite right</h2>
<p>Many ancient remedies have given us modern medical treatments. Hippocrates recognised that <a href="http://en.wikipedia.org/wiki/Willow#Medicine">powdered willow bark</a> (containing aspirin) alleviated headaches. South Americans used <a href="http://en.wikipedia.org/wiki/Jesuit%27s_bark#Medicinal_uses">cinchona bark</a> (containing quinine) to treat malaria. Traditional Chinese medicine gave us <a href="http://en.wikipedia.org/wiki/Ephedrine#Agricultural_sources">ephedrine</a>, a commonly used stimulant and decongestant, and the anti-malarial drug <a href="http://en.wikipedia.org/wiki/Artemisinin">artemisinin</a>. Both are now effective pharmaceuticals.</p>
<p>But doing something for centuries doesn’t automatically make it right. From the time of the ancient Greeks and Mesopotamians up to the late 19th century, <a href="http://www.history.com/news/a-brief-history-of-bloodletting">misguided medicos bled patients</a>, sometimes to death, in vain attempts to treat a multitude of ills. Bloodletting is still <a href="http://www.ibtimes.co.uk/bloodletting-razor-blade-india-leech-therapy-488462">a core belief</a> in some traditional health systems. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/80255/original/image-20150504-2070-1wcv0q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/80255/original/image-20150504-2070-1wcv0q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=659&fit=crop&dpr=1 600w, https://images.theconversation.com/files/80255/original/image-20150504-2070-1wcv0q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=659&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/80255/original/image-20150504-2070-1wcv0q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=659&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/80255/original/image-20150504-2070-1wcv0q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=829&fit=crop&dpr=1 754w, https://images.theconversation.com/files/80255/original/image-20150504-2070-1wcv0q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=829&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/80255/original/image-20150504-2070-1wcv0q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=829&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Doing something for centuries doesn’t automatically make it right.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/marceldouwedekker/7206160814">Marcel Douwe Dekker/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>And traditional Chinese medicine also uses rhino horns, tiger penises, shark fins and bear bile. Even ignoring the appallingly cruel way these “medicines” are obtained, none has any proven health benefits. Rhino horns are <a href="http://www.businessinsider.com.au/rhinos-horns-worth-more-than-gold-2012-5">more expensive by weight than gold</a>. As they consist largely of the protein keratin, purchasers could have saved a fortune by chewing their toenails.</p>
<p>Former Victorian dentist and self-styled “professor” Noel Campbell was practising (very) alternative dentistry in the late 1990s when charged with <a href="http://www.news.com.au/ozone-gas-healer-preyed-on-the-dying/story-fna7dq6e-1111117329113">administering ozone to a patient’s rectum to relieve her facial pain</a>. Not surprisingly, it didn’t work. </p>
<p>Campbell avoided disciplinary action by allowing his dental registration to lapse but continues to provide unproven alternative therapies to patients with cancer and other conditions through his website. And he’s not alone.</p>
<p>The recent cases of Wellness Warrior <a href="http://www.news.com.au/lifestyle/real-life/wellness-warrior-jess-ainscough-dies-from-cancer/story-fnq2o7dd-1227242521955">Jessica Ainscough</a> and The Whole Pantry’s <a href="http://www.mamamia.com.au/news/belle-gibson-cancer-claims/">Belle Gibson</a> show the importance of safe and effective health-care recommendations being based on more than a pretty smile and social media presence. </p>
<h2>Importance of evidence</h2>
<p>But aren’t some alternative therapies safe and effective? And how can we tell the difference? Thankfully, we have very good ways of determining if health treatments are effective. </p>
<p>The concept of <a href="http://www.community.cochrane.org/about-us/evidence-based-health-care">evidence-based health care</a> has arisen over the past few decades and is now almost universally accepted as the required standard for professional health practice. </p>
<p>Evidence-based dentistry accepts patients’ needs and preferences, while insisting treatments be based on the highest-quality scientific evidence and regular systematic reviews of published research.</p>
<p>Currently, most alternative therapies have a very limited <a href="http://www.ama.com.au/position-statement/complementary-medicine-2012">evidence base</a> to support their practice, and research methodologies are often poor. If a beneficial effect is shown, it’s often no greater than that <a href="http://www.nhs.uk/Livewell/complementary-alternative-medicine/Pages/placebo-effect.aspx">achieved by placebo treatment</a>, and <a href="http://www.quackwatch.com/01QuackeryRelatedTopics/altwary.html">less than that achieved by mainstream health care</a>.</p>
<p>Most “natural” medications have never been placed on the <a href="http://www.tga.gov.au/australian-register-therapeutic-goods">Australian Register of Therapeutic Goods</a> simply because they’ve never shown effectiveness. And alternative therapies found to be safe and effective become part of the mainstream health-care arsenal.</p>
<p>Does that really matter though, as long as patients receive the treatment they want and feel better as a result? Yes, it does matter. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/80256/original/image-20150504-2052-shjzjm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/80256/original/image-20150504-2052-shjzjm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=428&fit=crop&dpr=1 600w, https://images.theconversation.com/files/80256/original/image-20150504-2052-shjzjm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=428&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/80256/original/image-20150504-2052-shjzjm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=428&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/80256/original/image-20150504-2052-shjzjm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=538&fit=crop&dpr=1 754w, https://images.theconversation.com/files/80256/original/image-20150504-2052-shjzjm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=538&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/80256/original/image-20150504-2052-shjzjm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=538&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A patient-dentist relationship must be based on trust and professionalism.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/trypode/6347677054">The Guy With The Yellow Bike/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
</figcaption>
</figure>
<p>Most holistic dental practices will provide a wonderfully caring and nurturing environment for patients, but a patient-dentist relationship must also be based on trust and professionalism. A dentist who provides or endorses treatment options based on centuries of “eye of newt and toe of frog” without finding out if any beneficial effect is real or merely a placebo is not acting in the patient’s best interests, even if their belief is genuine. </p>
<p>Not only is any placebo effect unlikely to be maintained in the long term, patients may have wasted considerable amounts of money and been deprived of legitimate treatments that could have provided much greater benefits.</p>
<h2>Still the same</h2>
<p>More than 2,000 years ago, Hippocrates wrote:</p>
<blockquote>
<p>There are in fact two things, science and opinion; the former begets knowledge, the latter ignorance. </p>
</blockquote>
<p>The public expects all health professionals to practise competently, ethically and professionally. Would you prefer a dentist who provides treatment and advice based on evidence from the most recent and highest-quality research studies, or based on clouds of dubious and scientifically unsupported mysticism?</p>
<p>In 1948, the <a href="http://www.who.int/about/definition/en/print.html">preamble to the constitution of the World Health Organisation</a> defined health as “a complete state of physical, mental and social well-being, and not merely the absence of disease or infirmity”. This description still holds up today, and sits very well with the concept of holistic dentistry. So holistic dentistry is really nothing new. </p>
<p>All dentists should be practising holistic dentistry. And they should all be practising evidence-based dentistry, too.</p><img src="https://counter.theconversation.com/content/41177/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Foley does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Holistic dentistry claims to promote overall wellness rather than simply treating disease. But the lack of evidence for the alternative therapies underpinning it are cause for concern.Michael Foley, Senior Lecturer, Public health dentistry, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/256452014-04-17T04:51:40Z2014-04-17T04:51:40ZDoes the weight of evidence signal the end of homeopathy?<figure><img src="https://images.theconversation.com/files/46613/original/w9vnq3t4-1397705957.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Homeopathic medicines are not drugs and homeopathy involves much more than the use of a particular therapy. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/40853856@N03/3940580365">Oonagh Taeger/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>The National Health and Medical Research Council (NHMRC) recently completed <a href="http://consultations.nhmrc.gov.au/public_consultations/homeopathy_health">a review of the evidence</a> for homeopathy’s effectiveness and, after analysing systematic reviews of clinical trials, concluded there was “no reliable evidence for homeopathy and that it cannot demonstrate efficacy.”</p>
<p>To judge the efficacy, and hence the value, of homeopathy on the basis of randomised controlled trials misses the point. Such trials are the gold standard for conventional drugs because they test a medication’s effect across a population, eliminating placebo effects and other forms of perception bias. </p>
<p>But – and here’s the crux – homeopathic medicines are not drugs and homeopathy involves much more than the use of a particular therapy. People don’t visit a homeopath wanting a drug, in fact they often quite deliberately don’t want one; they want individualised treatment. </p>
<p>A randomised controlled trial will tell you exactly nothing about an individual’s experience of a drug. Whereas homeopathy (in which medicines often play a relatively minor role in a complex regimen of care that may include lifestyle modification, diet, exercise and critical self-reflection) is aimed explicitly at how illness is unique to a particular body, experience, and history.</p>
<p>Randomised controlled trial evidence in support of homeopathy is clearly weak. But there are other valid forms of evidence, largely excluded from the NHMRC report, including case studies, patient reports of satisfaction and <a href="http://www.ncbi.nlm.nih.gov/pubmed/22852580">quality of life</a>, and <a href="http://www.ncbi.nlm.nih.gov/pubmed/16296912">observational studies</a>. Here, homeopathy does much better. </p>
<p>And while it’s true these studies cannot eliminate the placebo effect and other forms of perception bias, that may also be in homeopathy’s favour. To understand this, we need to consider why people consult homeopaths.</p>
<h2>More than placebo</h2>
<p>Condemnations of homeopathy suggest homeopaths and the people who consult them are either foolish, deluded or corrupt. But this is patronising and inaccurate. </p>
<p>Most homeopaths, like most doctors, practice in good faith and according to broadly shared ethical principles and virtues. And the people who consult them consistently report benefit from homeopathy. How can this be the case if homeopathy has no effect?</p>
<p>Homeopaths often spend an hour or two in a single consultation to create a caring, therapeutic relationship with their patients. This alone can be powerful – <a href="http://www.ncbi.nlm.nih.gov/pubmed/21395431">physician empathy</a> is a valid clinical tool that not only contributes to patient satisfaction, but has been demonstrated to improve <a href="http://www.ncbi.nlm.nih.gov/pubmed/21248604">treatment outcomes</a>. </p>
<p>Is this just placebo? What’s <a href="http://chp.sagepub.com/content/9/2/81.abstract">wrong with it</a> if that is so? Even though some studies suggest <a href="http://www.ncbi.nlm.nih.gov/pubmed/9310601">greater than placebo</a> benefits in homeopathy, the real question is how we define what constitutes the placebo effect and what we regard as legitimate effects of health professional-patient interactions. </p>
<p>Homeopathy may generate positive lifestyle changes for patients, or a range of other powerful outcomes that we’re only just starting to understand as part of what are now referred to as <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3767074/">“context” effects</a> – or both. </p>
<p>Indeed, homeopathy may work a lot of the time for reasons that conventional scientific medicine has thus far lacked the conceptual tools to explain. And it may have nothing to do with homeopathy’s theoretical explanations or the effects of highly dilute substances.</p>
<h2>Efficacy and harms</h2>
<p>People seek out homeopathy for many reasons, including dissatisfaction with conventional medicine (or a lack of benefit from it) or wanting an alternative form of care that’s tailored to them. Many benefit, reporting <a href="http://www.biomedcentral.com/1472-6882/8/52/abstract">greater satisfaction</a> and well-being with homeopathy than with conventional medicine alone and fewer adverse effects, and feel they’re respected and cared for. </p>
<p>In terms of harms, concerns include money being spent on inefficacious medicines and harms from inappropriately ignoring established and effective conventional treatments.</p>
<p>In an open market, people have the right to make the choices they see fit. We don’t stop people studying or paying to seek solace from all sorts of non-scientific spiritual practices as they choose, not to mention buying all kinds of widely advertised and sold products that we might judge as being, at best, unhelpful to their health. So why object to the consumption of homeopathic treatments? </p>
<p>For possible harms stemming from not seeking or delaying appropriate conventional medicine, <a href="http://homeopathyoz.org/downloads/codeofconduct.pdf">the ethical</a> and educational requirements for practicing homeopaths <a href="http://aroh.com.au/Resources/Documents/Code%20of%20Professional%20Conduct%20v1.6%2024%20February%202013.pdf">must include referral for disease</a> such as infectious illnesses, cancer and cases where symptoms worsen significantly despite treatment.</p>
<p>Most homeopaths behave ethically and with integrity in these cases. Indeed, homeopaths often find themselves wrestling with complex ethical dilemmas in instances where patients resist conventional treatment. </p>
<p>It would help if conventional doctors were more tolerant of homeopathy in these situations, allowing support for patient preferences and sustaining access to both forms of care. This would help support homeopaths’ professional development as well, and they’re likely to be more responsive if they don’t need to be defensive.</p>
<p>Assessing homeopathy with evidence that doesn’t distinguish the unique quality or complexity of individual patient experience is to do it an injustice. And to pretend evidence is not varying and complex, and that only certain kinds of evidence count, is the wrong way to defend science. </p>
<p>It also sets up unrealisable expectations that scientific medicine will always be “correct”. Since medicine is an uncertain business, that’s a recipe for disillusionment when things go wrong, and for propelling people into the arms of alternative practices.</p><img src="https://counter.theconversation.com/content/25645/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David C Levy is a professional member of the Australian Homeopathic Association.</span></em></p><p class="fine-print"><em><span>As well as being a medical philosopher, Ian Kerridge is a practicing haematologist/bone marrow transplant physician. He prescribes high dose chemotherapy – not homeopathic therapies.</span></em></p>The National Health and Medical Research Council (NHMRC) recently completed a review of the evidence for homeopathy’s effectiveness and, after analysing systematic reviews of clinical trials, concluded…David C Levy, Professional Homeopath and PhD Candidate, University of SydneyIan Kerridge, Associate Professor in Bioethics & Director, Centre for Values and Ethics and the Law in Medicine, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/221842014-01-31T01:28:46Z2014-01-31T01:28:46ZWhere is the proof in pseudoscience?<figure><img src="https://images.theconversation.com/files/39820/original/72tgbqx4-1390530630.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Science or pseudoscience?</span> <span class="attribution"><span class="source">Flickr/Aff (formerly Odd Bod)</span></span></figcaption></figure><p>The word “pseudoscience” is used to describe something that is portrayed as scientific but fails to meet scientific criteria.</p>
<p>This misrepresentation occurs because actual science has creditability (which is to say it works), and pseudoscience attempts to ride on the back of this credibility without subjecting itself to the hard intellectual scrutiny that real science demands.</p>
<p>A good example of pseudoscience is homoeopathy, which presents the <a href="http://www.sciencedirect.com/science/journal/14754916">façade</a> of a science-based medical practice but <a href="http://edzardernst.com/2012/11/the-ultimate-proof-of-homeopathys-effectiveness/">fails to adhere</a> to scientific methodology.</p>
<p>Other things <a href="http://www.skeptics.com.au/about/us/things-we-are-sceptical-of/">typically branded pseudoscience</a> include astrology, young-Earth creationism, iridology, neuro-linguistic programming and water divining, to name but a few.</p>
<h2>What’s the difference?</h2>
<p>Key distinctions between science and pseudoscience are often lost in discussion, and sometimes this makes the public acceptance of scientific findings harder than it should be.</p>
<p>For example, those who think the <a href="http://www.crikey.com.au/2010/08/06/come-in-spinner-the-plural-of-anecdote-isis-not-data/">plural of anecdote is data</a> may not appreciate why this is not scientific (indeed, it can have a proper role to play as a <a href="http://www.abc.net.au/news/2014-01-15/scientists-to-test-anecdotal-evidence-of-a-derwent-dolphin-revi/5202094">signpost for research</a>).</p>
<p>Other misconceptions about science include what the <a href="https://theconversation.com/listen-and-learn-the-language-of-science-and-scepticism-6633">definition of a theory</a> is, what it means to prove something, how statistics should be used and the nature of evidence and falsification.</p>
<p>Because of these misconceptions, and the confusion they cause, it is sometimes useful to discuss science and pseudoscience in a way that focuses less on operational details and more on the broader functions of science. </p>
<h2>What is knowledge?</h2>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/39846/original/m6xjwk23-1390539182.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/39846/original/m6xjwk23-1390539182.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/39846/original/m6xjwk23-1390539182.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/39846/original/m6xjwk23-1390539182.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/39846/original/m6xjwk23-1390539182.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/39846/original/m6xjwk23-1390539182.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/39846/original/m6xjwk23-1390539182.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Testing the knowledge.</span>
<span class="attribution"><span class="source">Flickr/biologycorner</span></span>
</figcaption>
</figure>
<p>The first and highest level at which science can be distinguished from pseudoscience involves how an area of study grows in knowledge and utility.</p>
<p>The philosopher <a href="http://www.britannica.com/EBchecked/topic/160445/John-Dewey">John Dewey</a> in his Theory of Inquiry said that we understand knowledge as that which is “so settled that it is available as a resource in further inquiry”.</p>
<p>This is an excellent description of how we come to “know” something in science. It shows how existing knowledge can be used to form new hypotheses, develop new theories and hence create new knowledge.</p>
<p>It is characteristic of science that our knowledge, so expressed, has grown enormously over the last few centuries, guided by the reality check of experimentation.</p>
<p>In short, the new knowledge works and is useful in finding more knowledge that also works.</p>
<h2>No progress made</h2>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/39841/original/3nxzss9w-1390537220.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/39841/original/3nxzss9w-1390537220.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/39841/original/3nxzss9w-1390537220.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/39841/original/3nxzss9w-1390537220.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/39841/original/3nxzss9w-1390537220.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/39841/original/3nxzss9w-1390537220.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/39841/original/3nxzss9w-1390537220.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">It’s all in the stars.</span>
<span class="attribution"><span class="source">Flickr/ dragonoak</span></span>
</figcaption>
</figure>
<p>Contrast this with homeopathy, a field that has generated no discernible growth in knowledge or practice. While the use of modern scientific language may make it <a href="http://www.sciencedirect.com/science/article/pii/S1475491699905143">sound more impressive</a>, there is no corresponding increase in knowledge linked to effectiveness. The field has flat-lined.</p>
<p>At this level of understanding, science produces growth, pseudoscience does not.</p>
<p>To understand this lack of growth we move to a lower, more detailed level, in which we are concerned with one of the primary goals of science: to provide causal explanations of phenomena.</p>
<h2>Causal explanations</h2>
<p>Causal explanations are those in which we understand the connection between two or more events, where we can outline a theoretical pathway whereby one could influence the others.</p>
<p>This theoretical pathway can then be tested via the predictions it makes about the world, and stands or falls on the results. Classic examples of successful causal explanations in science include our <a href="http://www.ted.com/talks/david_deutsch_a_new_way_to_explain_explanation.html">explanation of the seasons</a>, and of the <a href="http://www.nature.com/scitable/topic/genes-and-disease-17">genetic basis</a> of some diseases.</p>
<p>While it’s true that homoeopathy supporters <a href="http://www.britishhomeopathic.org/how-does-homeopathy-work/">try very hard</a> to provide causal explanations, such explanations are not linked to more effective practice, do not provide new knowledge or utility, and so <a href="https://www.mja.com.au/journal/2010/192/8/homeopathy-what-does-best-evidence-tell-us">do not lead to growth</a>.</p>
<p>In the same way, supporters of <a href="http://www.neurolinguisticprogramming.com/">neuro-linguistic programing</a> claim a causal connection between certain neurological processes and learned behaviour, but <a href="http://www.degruyter.com/view/j/ppb.2010.41.issue-2/v10059-010-0008-0/v10059-010-0008-0.xml">fail to deliver</a>, and astrologists offer <a href="http://www.astrologer.com/tests/basisofastrology.htm">no coherent attempt</a> to provide an explanation for their purported predictive powers.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/Q03YJVpm2J8?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">What is neuro-linguistic programing?</span></figcaption>
</figure>
<p>The lack of testable causal explanations (or models, if you will) that characterises pseudoscience gives us a second level of discrimination: science provides casual explanations that lead to growth but pseudoscience does not. </p>
<h2>Operational aspects of science</h2>
<p>The third level of discrimination is where most of the action between science and pseudoscience actually takes place, over what I earlier called the operational details of science. Getting these details right helps deliver useful causal explanations.</p>
<p>This is where battles are fought over what constitutes <a href="https://theconversation.com/scientific-evidence-what-is-it-and-how-can-we-trust-it-14716">evidence</a>, how to properly use statistics, instances of <a href="http://www.sciencedaily.com/articles/l/list_of_cognitive_biases.htm">cognitive biases</a>, the use of proper methodologies and so on.</p>
<p>It is where homeopathy <a href="http://www.indiana.edu/%7Eensiweb/lessons/conf.bias.article.pdf">relies on confirmation bias</a>, where the anti-vaccine lobby is energised by <a href="http://nocompulsoryvaccination.com/2012/11/21/2142/">anecdotes</a>, and where deniers of climate science selectively <a href="http://www.abc.net.au/radionational/programs/scienceshow/an-analysis-of-climate-change-denial/2950084">highlight agreeable data</a>.</p>
<p>This level is also where the waters are muddiest in terms of understanding science for much of the population, as seen in comments on <a href="http://hockeyschtick.blogspot.com.au/2014/01/nyt-journalist-revkin-disappears.html">social media posts</a>, letters to the editor, <a href="http://scienceblogs.com/deltoid/2011/03/22/media-watch-on-the-unbalanced/">talkback</a>, television, <a href="http://www.dailytelegraph.com.au/news/opinion/climate-damage-doomsdayers-have-led-to-a-surge-in-hocus-pocus-ideas/story-e6frezz0-1226619889625">media articles</a> and <a href="http://www.scientificamerican.com/article/antiscience-beliefs-jeopardize-us-democracy/">political posturing</a>.</p>
<h2>The knowledge is out there</h2>
<p>It is important to address these basic operational understandings, but we must also highlight, in both science education and science communication, the causal explanations science provides about the world and the link between these explanations and growth in knowledge and utility. </p>
<p>This understanding gives us better tools to recognise pseudoscience in general, and also helps combat anti-science movements (such as young-earth creationism) that often masquerade as science in their attempt to play in the same rational arena. </p>
<p>A vigorous, articulate and targeted offence against pseudoscience is essential to the project of human progress through science, which, as <a href="http://www.aip.org/history/einstein/philos1.htm">Einstein reminds us</a>, is “the most precious thing we have”.</p><img src="https://counter.theconversation.com/content/22184/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Ellerton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The word “pseudoscience” is used to describe something that is portrayed as scientific but fails to meet scientific criteria. This misrepresentation occurs because actual science has creditability (which…Peter Ellerton, Lecturer in Critical Thinking, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/218272014-01-13T06:12:19Z2014-01-13T06:12:19ZWhat does the public really think about homeopathy?<figure><img src="https://images.theconversation.com/files/38761/original/xt82dmfy-1389291905.jpg?ixlib=rb-1.1.0&rect=1%2C4%2C1022%2C676&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Just add water.</span> <span class="attribution"><span class="source">Richard Craig</span></span></figcaption></figure><p>There is nothing more likely to raise the hackles of any self-respecting rationalist than to be confronted with the latest celebrity story about the miraculous healing power of homeopathy or some other “alternative” or “complementary” quackery. Or, embarrassingly, to discover that some of your best friends are also devotees. </p>
<p>This isn’t a new bugbear in response to some kind of New Age, middle-class hippiedom. Charles Darwin wrote <a href="http://www.darwinproject.ac.uk/letter/entry-1352">in a letter</a> to a cousin: </p>
<blockquote>
<p>You speak about Homeopathy; which is a subject which makes me more wrath, even than does Clair-voyance: clairvoyance so transcends belief, that one’s ordinary faculties are put out of question, but in Homeopathy common sense and common observation come into play, & both these must go to the Dogs, if the infinetesimal doses have any effect whatever</p>
</blockquote>
<p>There is no serious scientific debate about the efficacy of homeopathy. It performs no better than placebo and is based on principles wholly at odds with established scientific understanding. Nevertheless, it whips up what might seem like a disproportionate amount of political controversy. </p>
<p>Health Secretary Jeremy Hunt (yes, the man in charge of UK national health policy) is <a href="http://blogs.telegraph.co.uk/news/tomchiversscience/100179258/jeremy-hunt-health-secretary-thinks-homeopathy-works/">a known sympathiser</a> and got into hot water for allowing <a href="http://www.independent.co.uk/life-style/health-and-families/health-news/hes-at-it-again-prince-charles-accused-of-lobbying-health-secretary-over-homeopathy-8723145.html">Prince Charles to lobby him</a> about prescribing it on the NHS. </p>
<p>A newly appointed public health shadow minister, Luciana Berger, was “forced to renounce” <a href="http://www.independent.co.uk/life-style/health-and-families/health-news/labour-tells-new-health-spokeswoman-to-drop-her-support-for-homeopathy-8876469.html">previously positive</a> views. </p>
<p>And earlier in 2013, Chief Scientist Mark Walport called homeopathy “nonsense”, while his predecessor, John Beddington, said that NHS spending on homeopathy was the only issue where ministers had “fundamentally ignored” his scientific advice. Sally Davis, England’s Chief Medical Officer, said that <a href="http://money.uk.msn.com/socialvoices/why-spend-4m-of-our-taxes-on-homeopathy">the taxpayers’ £4m</a> would be better spent on proven treatments as hospitals suffer painful cutbacks. </p>
<h2>Our survey says</h2>
<p>Yet while binary opposition between support for homeopathy (and other complementary and alternative (CAM) treatments) is how public debate is framed, it is far from clear that the public thinks and does the same.</p>
<p><a href="http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0053174#abstract0">In research</a> we carried out <a href="http://www.wellcome.ac.uk/About-us/Publications/Reports/Public-engagement/WTX058859.htm">using the</a> Wellcome Monitor Survey, we interviewed a random sample of 1179 UK adults aged over 18 about homeopathy and other CAM. We also wanted to know why some people chose or not to use these treatments. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/38695/original/z2x5zm39-1389198272.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/38695/original/z2x5zm39-1389198272.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=349&fit=crop&dpr=1 600w, https://images.theconversation.com/files/38695/original/z2x5zm39-1389198272.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=349&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/38695/original/z2x5zm39-1389198272.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=349&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/38695/original/z2x5zm39-1389198272.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=439&fit=crop&dpr=1 754w, https://images.theconversation.com/files/38695/original/z2x5zm39-1389198272.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=439&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/38695/original/z2x5zm39-1389198272.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=439&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Hands up if you’ve tried it.</span>
<span class="attribution"><span class="source">Wellcome Monitor, 2009</span></span>
</figcaption>
</figure>
<p>A slim majority of the group reported that they had never used CAM. The most popular treatments with the remaining half were herbal medicines, homeopathy and acupuncture.</p>
<p>A quarter of the respondents who reported that they had never used homeopathy said this was because they hadn’t heard of it; a third because they had never been advised to take the treatment and/or that they’d never had an illness that required it; and 3% said it was because homeopathic remedies were too expensive. </p>
<p>Less than a quarter of non-users said that they had avoided homeopathy because they didn’t believe that it worked, or that conventional medicine worked better. </p>
<p>Of course, this may be in part a result of asking a question in a survey of this kind: it is quite hard for people to single out reasons for not doing things.</p>
<p>The most telling statistics emerged when we asked people that said they had used homeopathy why they had: 49% said they were “willing to try anything and didn’t think it could do any harm”. Only 16% said it was because they believed they worked better than conventional medicine. This means that only around 3% of the population have used homeopathy from a belief that it works where conventional medicine doesn’t. The rest either have not used it, or used it for other reasons.</p>
<h2>Disaffected, conventional and dissonant</h2>
<p>To explore this further, we used a statistical modelling technique called <a href="http://www.methods.manchester.ac.uk/methods/latentclass/">latent class analysis</a>, which helps identify groups of persons that are similar to each other in their profile of survey responses. We selected questions for analysis based on the key dimensions of public debate: the importance of science education, belief in the effectiveness of homeopathy, use of CAM, trust in medical doctors and optimism about medical advances in general.</p>
<p>We found that we could split the public <a href="http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0053174#pone-0053174-t001">into three groups</a>. The first, who we called the “disaffected”, comprise just under 30%. They are generally pessimistic about medicine, don’t see the value of science education and don’t believe in the efficacy of homeopathy either. </p>
<p>A second “conventional” group, accounting for just over 30% of citizens, are likely to be supportive and trusting of conventional medicine, reject CAM and value science education. </p>
<p>The third and largest group (just over 40% of the population) is the most interesting. This group is likely to have used CAM and to think that homeopathy is effective. Yet they are overwhelmingly trusting of medical doctors, value science education and are optimistic about medical advances. We call this group the “dissonants” (although they are unlikely to call themselves that). </p>
<p>So what makes it likely that someone will be a dissonant rather than a conventional? Women are <a href="http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0053174#pone-0053174-t002">more likely</a> to be found in the dissonant group. Interestingly, people who are better educated are also more likely to be found in this group, (although from a set of questions we posed in the survey, those with a science qualification and who did better in a scientific quiz are less likely to be included), along with those that think that there’s too little regulation of medical research.</p>
<h2>At odds in the public mind?</h2>
<p>Our research suggests that nearly half of the public don’t believe and act as if CAM and conventional medicine are at odds. Coupled with the significant global industry that has grown up around CAM, it is easy to see why politicians have been unwilling to respond to the clear evidence that homeopathy and CAM are ineffective. In the US, <a href="http://www.richarddawkins.net/news_articles/2013/6/19/alternative-medicine-is-a-34-billion-industry-but-only-one-third-of-the-treatments-have-been-tested">it’s a $34bn industry</a> where half of people report using them.</p>
<p>The competition between proponents and opponents of CAM in all likelihood is set to continue. But there’s some evidence that better science education can help people to distinguish between scientific and pseudo-scientific claims, and it appears that at least some of the openness to CAM might stem from concerns about how medical research is regulated. And it is these that might hold the key to who ultimately comes out of the ring in better shape.</p>
<p><em>The research on which this article is based was carried out with Paul Stoneman, Patrick Sturgis and Elissa Sibley.</em></p><img src="https://counter.theconversation.com/content/21827/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nick Allum and team were partially funded by the Wellcome Trust</span></em></p>There is nothing more likely to raise the hackles of any self-respecting rationalist than to be confronted with the latest celebrity story about the miraculous healing power of homeopathy or some other…Nick Allum, Professor of Sociology, University of EssexLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/180712013-10-02T13:38:50Z2013-10-02T13:38:50ZWhat if water had memory?<figure><img src="https://images.theconversation.com/files/31935/original/jrnvxcqk-1380112596.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> <span class="attribution"><span class="source">Martin Parker</span></span></figcaption></figure><p>Homeopaths believe water has memory. That is how they explain the “medicinal properties” of their concoctions. Apparently people are treated even though the pill or potion may not contain a single molecule of the medicinal agent. But does water really have memory?</p>
<p>That depends on how you define memory. If for water it is defined as the property to have a stable state for sometime, then it has memory, just not a very good one - 50 femtoseconds is its <a href="http://www.nature.com/nature/journal/v434/n7030/full/nature03383.html">retention time</a>. That’s about 60 million million times shorter than the <a href="http://www.telegraph.co.uk/news/newstopics/howaboutthat/5276916/Goldfish-do-not-have-three-second-memories-in-list-of-animal-myths-exposed.html">mythical goldfish’s</a> three-second memory. </p>
<p>But with that “memory”, water could not retain any useful information. The memory is just its ability to form an ordered group of water molecules that can last for 50 femtoseconds. It is a bit like a crowd of people all milling around in train station - there are pockets of order where people are standing around looking at departure boards or getting a coffee. But these groups will disperse after a while. And so it is with water - there are pockets of order where the water molecules are interacting with each other and with things that are dissolved in it, but these are lost pretty quickly.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/31938/original/kss2y2df-1380117884.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/31938/original/kss2y2df-1380117884.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1747&fit=crop&dpr=1 600w, https://images.theconversation.com/files/31938/original/kss2y2df-1380117884.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1747&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/31938/original/kss2y2df-1380117884.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1747&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/31938/original/kss2y2df-1380117884.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=2196&fit=crop&dpr=1 754w, https://images.theconversation.com/files/31938/original/kss2y2df-1380117884.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=2196&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/31938/original/kss2y2df-1380117884.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=2196&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Martin Parker</span></span>
</figcaption>
</figure>
<p>Let’s try another question. What if water had an <a href="http://www.scientificamerican.com/article.cfm?id=elephants-never-forget">elephant’s memory</a> and never forgot?</p>
<p>In that case all the ordered pockets would hang around forever. But it wouldn’t look much like liquid water anymore. Instead it would be quite different; in fact, you would probably call it ice.</p>
<p>How about we try something a bit more bizarre? What if water could remember the molecules that had been dissolved in it long after the original molecules had been diluted away? And then what if that water could still act like them?</p>
<p>That may sound pretty outlandish, but a paper published, in the journal <a href="http://www.nature.com/nature/journal/v333/n6176/pdf/333816a0.pdf">Nature</a> (no less), suggested just that more than 25 years ago. Not surprisingly it proved rather <a href="http://en.wikipedia.org/wiki/Water_memory#The_Nature_controversy">controversial</a>. Pretty soon after publication the paper was discredited, leaving no sound evidence for water being able to remember what has been in it (for any significant length of time). </p>
<p>But let’s ignore the evidence for a moment: what if water could retain a fond memory of long-departed solutes? In that case we’re in trouble, because, as one of my teachers used to say, “chemistry is the study of the soluble”. She meant that chemistry, mostly, involves dissolving compounds in solvents and then reacting them together to get new and interesting compounds. Water is a favourite solvent because more things dissolve in it than <a href="http://chemistry.about.com/od/waterchemistry/f/Why-Is-Water-The-Universal-Solvent.htm">anything else</a>. </p>
<p>However, if water can remember what had been in it then even in its purest form it would behave like it was chock full of impurities, with unpredictable results. No chemical reaction performed in water, from DNA fingerprinting to synthesis of a new drug, would ever work consistently.</p>
<p>But water memory isn’t just bad news for chemists - it would also affect the behaviour of your everyday tap water. One day your glass of water might have a flashback of <a href="http://www.floridachemical.com/whatisd-limonene.htm">limonene</a> adding a pleasant hint of citrus fruit, the next it might recall <a href="http://en.wikipedia.org/wiki/Capsaicin">capsaicin</a> giving your water a spicy kick.</p>
<p>No need to worry, things wouldn’t get that far. After all you’re 70% water, life evolved in water and almost all reactions in all living things happen in water. If the primordial soup could have been influenced by non-existent chemicals then there would have been no stable environment for the life to have formed. Thus no life, no evolution and no human beings to dream up homeopathy.</p>
<hr>
<p><em>Illustrations are by <a href="http://www.college.ampleforth.org.uk/pastoral/boys-houses/st-hughs/house-team">Martin Parker</a>, chemistry teacher at Ampleforth College.</em></p><img src="https://counter.theconversation.com/content/18071/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mark Lorch does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Homeopaths believe water has memory. That is how they explain the “medicinal properties” of their concoctions. Apparently people are treated even though the pill or potion may not contain a single molecule…Mark Lorch, Senior Lecturer in Biological Chemistry, University of HullLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/164482013-07-30T05:17:20Z2013-07-30T05:17:20ZQuacktitioner Royal is a menace to the constitution and public health<figure><img src="https://images.theconversation.com/files/28265/original/4rb8xssb-1375097210.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2200%2C1501&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Prince or medical expert: which hat shall I wear today?</span> <span class="attribution"><span class="source">PA/Eddie Mulholland</span></span></figcaption></figure><p>A constitutional monarch is purely ceremonial and plays no part in politics. But in the UK it isn’t quite as simple as that. The first problem is that we have no constitution. </p>
<p>Things haven’t changed much since the 19th century when Walter Bagehot, author of The English Constitution, wrote that “the sovereign has, under a constitutional monarchy … three rights - the right to be consulted, the right to encourage, the right to warn.”</p>
<p>These are not inconsiderable powers in a country which is meant to be run by elected representatives. But nobody knows how these powers are used: almost all of it is done in secret. </p>
<p>Charles, Prince of Wales, is unusually public in expressing his views. But he also does so in private. He is <a href="http://www.guardian.co.uk/uk-news/2013/jul/25/prince-charles-letters-judges-allow-appeal">currently the subject of an appeal</a> to force the publication of letters written to government officials - the so-called “black spider memos”.</p>
<p>In 2010, <a href="http://www.telegraph.co.uk/news/uknews/theroyalfamily/7147870/Prince-of-Wales-I-was-accused-of-being-enemy-of-the-Enlightenment.html">he told a conference</a> he was proud of being called “the enemy of the Enlightenment” - a remarkable point of view for someone who, as King, would become the patron of the Royal Society, that product of the age of enlightenment.</p>
<p>I’ve no doubt that Prince Charles means well. But his views on medicine date from a few centuries ago, and he has lost no opportunity to exploit his privileged position to proclaim them.</p>
<h2>Euphemisms for quackery</h2>
<p>The “integration” in the Foundation for Integrated Health (PFIH), which was set up to promote the prince’s views, is just the latest euphemism for “alternative” or “quack”. When the Foundation collapsed because of a financial scandal in 2010, it was replaced by the “College of Medicine”. The name changed, <a href="http://www.dcscience.net/?p=3632">but not the people</a> behind it. </p>
<p>Initially this phoenix was to be named the “<a href="http://www.dcscience.net/?p=3263">College of Integrated Health</a>”, but by this time the Prince’s views on medicine had become sufficiently discredited that the word “integrated” was quickly dropped. This might be thought less than frank, but it is just the classic <a href="http://www.sciencebasedmedicine.org/the-bait-and-switch-of-unscientific-medicine/">bait and switch</a> technique, beloved by used car salesmen.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/28264/original/n27hmw3r-1375097012.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/28264/original/n27hmw3r-1375097012.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/28264/original/n27hmw3r-1375097012.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/28264/original/n27hmw3r-1375097012.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/28264/original/n27hmw3r-1375097012.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/28264/original/n27hmw3r-1375097012.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/28264/original/n27hmw3r-1375097012.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">They promise you the world …</span>
<span class="attribution"><span class="source">Loozrboy</span></span>
</figcaption>
</figure>
<p>The prince’s views were also well publicised in Complementary Healthcare: a Guide for Patients, which omitted or misrepresented the evidence about whether treatments worked or not. I wrote a more accurate version: the <a href="http://www.dcscience.net/?page_id=733">Patients’ Guide to Magic Medicine</a>.</p>
<h2>A letter from the prince</h2>
<p>This guide was arguably a danger to public health. When it was rightly criticised by Edzard Ernst, an academic expert in complementary medicine, a letter sent from an aide at Clarence House <a href="http://www.guardian.co.uk/uk/2007/mar/11/health.monarchy">to Ernst’s vice-chancellor</a>, Steve Smith, resulted in <a href="http://www.dcscience.net/?p=89">disciplinary proceedings</a> against Ernst that lasted for a year, and ended with a pompous reprimand.</p>
<p>None of this criticism has dimmed the prince’s enthusiasm for barmy medical ideas.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/28266/original/zw9w83ht-1375098236.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/28266/original/zw9w83ht-1375098236.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=823&fit=crop&dpr=1 600w, https://images.theconversation.com/files/28266/original/zw9w83ht-1375098236.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=823&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/28266/original/zw9w83ht-1375098236.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=823&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/28266/original/zw9w83ht-1375098236.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1035&fit=crop&dpr=1 754w, https://images.theconversation.com/files/28266/original/zw9w83ht-1375098236.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1035&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/28266/original/zw9w83ht-1375098236.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1035&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">On the hunt for answers: we might never know why Jeremy visited the prince.</span>
<span class="attribution"><span class="source">PA/Dominic Lipinski</span></span>
</figcaption>
</figure>
<p>In July, Minister of Health Jeremy Hunt visited the prince at Clarence House. The visit was <a href="http://www.independent.co.uk/life-style/health-and-families/health-news/hes-at-it-again-prince-charles-accused-of-lobbying-health-secretary-over-homeopathy-8723145.html">reportedly to persuade the minister</a> to defend homeopathy, though it was more likely to have been to press the case to confer a government stamp of <a href="http://www.dcscience.net/?p=5562">approval on herbalists</a> and traditional Chinese Medicine practitioners through statutory regulation.</p>
<p>Charles’s greatest ally, <a href="http://www.dcscience.net/?p=6007">the Conservative MP David Tredinnick</a>, who got into trouble for charging to expenses astrology software that purported to <a href="http://www.guardian.co.uk/politics/2010/dec/09/tory-mp-david-tredinnick-astrology">diagnose medical conditions</a>, recently raised this again <a href="http://www.publications.parliament.uk/pa/cm201314/cmhansrd/cm130709/halltext/130709h0001.htm#130709h0001.htm_spnew0">in parliament</a>. </p>
<p>We might never know what was discussed in Hunt’s meeting. And <a href="https://www.gov.uk/government/publications/written-ministerial-statement-freedom-of-information-act-veto-of-release-of-prince-charles-letters">the Attorney General</a> has blocked the release of private letters sent to seven government departments as “disclosure of the correspondence could damage The Prince of Wales’ ability to perform his duties when he becomes King.” This is precisely why they should be made public.</p>
<h2>The prince’s influence</h2>
<p>The prince’s influence is big in the Department of Health (DH). He was given £37,000 of taxpayers’ money to produce his guide, and an astonishing £900,000 to prepare the ground for the hapless self regulator “Ofquack”, or the <a href="http://www.dcscience.net/?p=3311">Complementary and Natural Healthcare Council</a>. </p>
<p>When NHS Choices (set up by the DH to assess evidence) was rewriting its web page about the most discredited of all forms of quackery, homeopathy, officials <a href="http://www.dcscience.net/?p=5778">referred the new advice to Michael Dixon</a>, the Prince’s Foundation medical director. Were it not for the Freedom of Information act, inaccurate information would have been included.</p>
<p>The Prince of Wales’ business, Duchy Originals, <a href="http://www.dailymail.co.uk/health/article-440103/Duchy-original-sins--Charles-range-spotlight.html">has been condemned</a> by the Daily Mail, for selling unhealthy foods. And when it started selling quack “detox” and herbal nonsense he found himself censured by the medicines regulator, <a href="http://www.quackometer.net/blog/2009/03/duchy-originals-pork-pies.html">the MHRA</a> and <a href="http://www.asa.org.uk/Rulings/Adjudications/2009/5/Duchy-Originals-Ltd/TF_ADJ_46199.aspx">the Advertising Standards Authority</a> (ASA) for unjustifiable medical claims.</p>
<p>Ainsworth’s homeopathic pharmacy has two royal warrants, from both Prince Charles and the Queen. They sold “homeopathic vaccines” for meningitis, measles, rubella and whooping cough. </p>
<p>Ainsworth’s had already been <a href="http://bit.ly/16tAm8j">censured by the ASA</a> in 2011 for selling similar products. The MHRA failed to step in until Sam Smith, a young BBC reporter, made a <a href="http://www.youtube.com/watch?v=TZf9mUzI4RI&feature=c4-overview&list=UUei35H3nu7bduw-6DBJFGrQ">programme about it</a>. It still sells Polonium metal 30C and Swine Meningitis 36C, and a booklet recommending homeopathic “vaccination”. Ainsworth’s sales are no doubt helped by the royal warrants. </p>
<h2>Runs in the family</h2>
<p>Charles is not the only member of the royal family to be obsessed with bizarre forms of medicine. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/28262/original/vyytgbzm-1375095788.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/28262/original/vyytgbzm-1375095788.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=944&fit=crop&dpr=1 600w, https://images.theconversation.com/files/28262/original/vyytgbzm-1375095788.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=944&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/28262/original/vyytgbzm-1375095788.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=944&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/28262/original/vyytgbzm-1375095788.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1186&fit=crop&dpr=1 754w, https://images.theconversation.com/files/28262/original/vyytgbzm-1375095788.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1186&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/28262/original/vyytgbzm-1375095788.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1186&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Frederick Quin, England’s first homeopathic doctor in Vanity Fair 1872.</span>
<span class="attribution"><span class="source">Wikimedia Commons/Adriano Cecioni</span></span>
</figcaption>
</figure>
<p>The first homeopath to the British royal family, Frederick Quin, was a son of the Duchess of Devonshire (1765-1824). Queen Mary (1865-1953) headed the fundraising efforts to move and expand the London Homeopathic Hospital. King George VI was so enthusiastic that in 1948 he conferred the royal title on it. </p>
<p>The present Queen’s homeopathic physician is Peter Fisher, who is medical director of a hospital, now rebranded, as the Royal London Hospital for Integrated Medicine (RLHIM).</p>
<p>The RLHIM is a <a href="http://www.dcscience.net/?p=4213">great embarrassment</a> to the otherwise excellent UCL Hospital Trust. It has been repeatedly <a href="http://bit.ly/11UK3Ze">condemned by the ASA</a> and has been forced to withdraw all of its patient information. It’s hard to imagine that this anachronistic institution would still exist without the patronage of the Queen.</p>
<p>To justify the secrecy of Charles’s letter, the attorney general said: </p>
<blockquote>
<p>It is a matter of the highest importance within our constitutional framework that the Monarch is a politically neutral figure. </p>
</blockquote>
<p>Questions about health policy are undoubtedly political, and the highly partisan interventions of the prince in the political process make his behaviour unconstitutional. They endanger the monarchy itself. Whether that matters depends on how much you value tradition and how much you value the tourist business generated by the Gilbert & Sullivan flummery at which royals excel.</p>
<p>The least that one can ask of the royal family is that they should not endanger the health of the nation. If I wanted to know the winner of the 2.30 at Ascot, I’d ask a royal. For any question concerning science or medicine I’d ask someone with more education.</p><img src="https://counter.theconversation.com/content/16448/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Colquhoun does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A constitutional monarch is purely ceremonial and plays no part in politics. But in the UK it isn’t quite as simple as that. The first problem is that we have no constitution. Things haven’t changed much…David Colquhoun, Professor of Pharmacology, UCL, UCLLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/99892012-10-30T01:34:52Z2012-10-30T01:34:52ZKids Smart’s dumb ads: consumers complain of misleading claims<figure><img src="https://images.theconversation.com/files/17038/original/j9ttmb7h-1351561073.jpg?ixlib=rb-1.1.0&rect=34%2C0%2C762%2C560&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Recent consultations found continued inaction on regulatory matters means the community has lost trust in the TGA.</span> <span class="attribution"><span class="source">Pharmacare Laboratories' website</span></span></figcaption></figure><p>Pharmacare Laboratories is facing a new complaint about its <a href="http://www.kidssmart.com.au/kids-smart-products/natural-medicine/">Kids Smart</a> homeopathic medicines amid concerns parents who use the products may delay seeking medical treatment. </p>
<p>The complaint – lodged by a group of oranisations including CHOICE to the Australian Competition and Consumer Commission (ACCC) – alleges promotion of the Kids Smart products implies they are effective in ways that have not been established. </p>
<p>Complainants also claim that the promotion of homeopathic “Kids Smart Calm” for “restlessness, anxiety, irritability and agitation” is inappropriate and dangerous as these symptoms can signify potentially serious childhood infectious diseases such as bacterial meningitis that require medical attention.</p>
<p>Promoting homeopathic “Kids Cold and Flu” and “Kid Pain & Fever” remedies as “effective” against “fever, sore throat and body aches and pain” is also likely to deny children genuinely effective medication such as paracetamol, which can relieve these symptoms. The same holds for the homeopathic “Hayfever” remedy. </p>
<p>Over the past three years, Pharmacare Laboratories have had a least 16 complaints upheld by the Therapeutic Good Administration’s Complaints Resolution Panel (CRP), including a number of recommendations to the delegate of the secretary for non-compliance with CRP requests. Indeed, this company appears to treat the regulatory system with contempt.</p>
<p>In addition to CHOICE, the complaint is endorsed by the <a href="https://www.chf.org.au/">Consumers Health Forum</a>, <a href="http://www.scienceinmedicine.org.au/">Friends of Science in Medicine</a>, the <a href="http://www.drs.org.au/">Doctors Reform Society</a>, the <a href="http://www.skeptics.com.au/">Australian Skeptics</a> and <a href="http://www.healthyskepticism.org/global/">Healthy Skepticism</a>.</p>
<p>The complaint notes that in determination <a href="http://tinyurl.com/9w4n7cm">2011/10/027</a>, the CRP requested Pharmacare Laboratories to publish a retraction and withdraw representations made about claims for its Kids Smart range of homeopathic medicines because it breached a number of provisions of the Therapeutic Goods Advertising Code.</p>
<p>Other upheld complaints about the Kids Smart product range include 2011/10/011, 2011/10/011, 2011/09/043 and 2011/09/044. Pharmacare Laboratories has declined to comply with any of these determinations. And it continues to make the same claims on its website promoting these products.</p>
<p>Pharmacare Laboratories’ behaviour shows the impotence of the CRP (which has no power to enforce their determinations) and also the TGA (which has never taken a company to court for non-compliance with its <a href="http://www.tga.gov.au/industry/advertising-reg9.htm">Regulation 9 advertising orders</a>).</p>
<p>It also highlights the importance of the TGA addressing <a href="http://www.tga.gov.au/about/tga-reforms-blueprint-implementation-04-attachmenta.htm#advertising">recommendation 2c</a> of the recent advertising consultation, “Develop a more effective approach to sanctions and penalties (including use of the infringement notice provisions)”, which currently appears to have no timeline.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/17011/original/b3566rdw-1351490227.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/17011/original/b3566rdw-1351490227.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/17011/original/b3566rdw-1351490227.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/17011/original/b3566rdw-1351490227.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/17011/original/b3566rdw-1351490227.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/17011/original/b3566rdw-1351490227.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/17011/original/b3566rdw-1351490227.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Oonagh Taeger</span></span>
</figcaption>
</figure>
<p>The case illustrates long-standing and fundamental flaws in the <a href="http://www.tga.gov.au/industry/cm-homoeopathic-preparations.htm">regulation of homeopathic medicines</a> in Australia. Homeopathic preparations more dilute than a one thousandfold dilution of a mother tincture are currently exempt from the Australian Register of Therapeutic Goods (ARTG).</p>
<p>This means that the TGA has no power to de-list or otherwise remove the above products from the market despite their gross advertising violations.</p>
<p>In April 2003, the <a href="http://www.tga.gov.au/archive/committees-eccmhs.htm">Australian Expert Committee on Complementary Medicines in the Health System</a> recommended that, “Homeopathic medicines and related medicines making therapeutic claims be regulated to ensure they meet appropriate standards of safety, quality and efficacy.”</p>
<p>In 2008, the TGA conducted a consultation on the “<a href="http://www.tga.gov.au/archive/consult-cm-homoeopathic-080901.htm">Regulation of homeopathic and anthroposophic medicines in Australia</a>”. It was proposed that, “all homoeopathic and anthroposophic medicines must be included in the ARTG, regardless of the final concentration of the ingredients (subject to separate exemptions which will apply to homeopathic and anthroposophic preparations supplied directly to a practitioner for extemporaneous dispensing or compounding)”.</p>
<p>But the issue appears to have dropped off the TGA’s agenda. Despite the concern expressed by many submissions to the TGA transparency and advertising reviews, there’s no mention of homeopathic or anthroposophic medicines in the <a href="http://www.tga.gov.au/pdf/tga-reforms-blueprint.pdf">2011 TGA Reform document</a>. </p>
<p>The listing of these medicines needs to be pursued because the TGA’s failure to act on these matters has resulted in increasing proliferation of homeopathic products being promoted to the public with claims of efficacy that aren’t substantiated by scientific research.</p>
<p>And the claims go far beyond the <a href="http://www.tga.gov.au/pdf/cm-evidence-claims.pdf">allowable statement</a> that “This homoeopathic medicine has been traditionally used for (indication)”. Bauer’s <a href="http://www.brauer.com.au/mums-and-bubs-zone/http://example.com/">homeopathic product line</a> provides many more examples.</p>
<p>This problem isn’t limited to Australia – see “<a href="http://www.skepticnorth.com/2012/06/homeopathic-insect-repellent-is-there-anything-the-natural-health-products-directorate-wont-approve/">Homeopathic Insect Repellent: Is there anything the Canadian Natural Health Products Directorate won’t approve</a>?”</p>
<p>Submissions by many consumers and health professionals to recent TGA consultations noted that the continued inaction on such matters meant the community has lost trust in the TGA. The TGA was asked to address these important regulatory matters without further delay.</p>
<p>Given the ongoing impotence of the CRP and TGA, the ACCC has now been asked to take action against Pharmacare Laboratories on the grounds that the ongoing promotion of their Kids Smart range of homeopathic medicines involves misleading and deceptive conduct and is in breach of Australian Consumer Law (Competition and Consumer Act, 2010). </p>
<p>And CHOICE has today awarded a “<a href="http://www.choice.com.au/reviews-and-tests/awards/shonky-awards/shonkys/the-2012-shonky-awards/page/natures-way-kid-smart-range.aspx">Shonky</a>” to Pharmacare Laboratories for their “<a href="http://www.kidssmart.com.au/kids-smart-products/natural-medicine/">Kids Smart range of homeopathic medicines</a>”.</p><img src="https://counter.theconversation.com/content/9989/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Harvey has accepted travel expenses only to talk about problems of complementary medicine regulation to pharmaceutical companies and industry associations. He has been paid travel expenses and sitting fees for his involvement with government inquiries and working groups concerning pharmaceutical promotion and the regulation of complementary medicines. He has represented CHOICE (the Australian Consumers Assocation) on a number of the regulatory reviews mentioned. Dr Harvey is regarded by industry as a serial complainant. </span></em></p>Pharmacare Laboratories is facing a new complaint about its Kids Smart homeopathic medicines amid concerns parents who use the products may delay seeking medical treatment. The complaint – lodged by a…Ken Harvey, Adjunct Associate Professor of Public Health, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/65572012-05-22T04:30:17Z2012-05-22T04:30:17ZThe legal challenge that could stop homeopathy in its tracks<figure><img src="https://images.theconversation.com/files/10904/original/pn9bv5bc-1337650065.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Could a Canadian-style class action dent the credibility of homeopathy in Australia?</span> <span class="attribution"><span class="source">Flickr/kh1234567890</span></span></figcaption></figure><p>One hundred years of rigorous scientific research hasn’t dented the faith of adherents of homeopathy. The complementary therapy is still centred on the notion that water has a therapeutic “memory” and that undetectable compounds have a physiological, rather than psychological, effect. </p>
<p>Attempts to regulate or restrict the claims of homeopaths are currently underway. But it might take a legal challenge to ultimately stop homeopaths from promoting cures and treatments that simply don’t work. </p>
<p>Before I explain how, I’ll fill you in on some of the recent background. </p>
<p>After a succession of reports showed homeopathy to be a pseudo-science, <a href="http://www.smh.com.au/opinion/political-news/alternative-medicine-crackdown-20120313-1uyiw.html">it’s likely</a> Australia’s National Health and Medical Research Council will <a href="http://www.australiandoctor.com.au/news/latest-news/nhmrc-declares--homeopathy---8216;not-efficacious-">advise</a> that it’s “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”. </p>
<p>This follows a 2010 <a href="http://www.publications.parliament.uk/pa/cm200910/cmselect/cmsctech/45/45.pdf">report</a> by the United Kingdom’s House of Commons Science & Technology Committee, which similarly commented that “beyond ethical issues and the integrity of the doctor-patient relationship, prescribing pure placebos is bad medicine”. The committee said further clinical trials of homeopathy were unjustifiable, but in the meantime, the National Health Service should stop subsidisng the treatment. </p>
<p>Earlier this month, Australian Chief Medical Officer Chris Baggoley began a 12-month investigation to determine which, if any, natural therapies are clinically effective. After that period, the government’s private health insurance rebate will cease to cover homoepathy, reiki and other therapies that aren’t evidence based.</p>
<p>But the removal of the rebate is largely symbolic. It won’t dent the faith of many adherents. And, given the public’s appetite for funky miracle cures, it won’t drive charlatans out of the market.</p>
<h2>Complementary profits</h2>
<p>Homeopathy, along with other forms of complementary medicine such as “magic touch”, is big business. The Commonwealth <a href="http://www.anao.gov.au/%7E/media/Uploads/Audit%20Reports/2011%2012/201112%20Audit%20Report%20No%203.pdf">estimates</a> the complementary medicines industry is worth at $1.2 billion a year, with an annual growth of up to 12%. </p>
<p>But the key regulator, the Therapeutic Goods Administration (TGA), is struggling to get a hold of the <a href="http://www.anao.gov.au/%7E/media/Uploads/Audit%20Reports/2011%2012/201112%20Audit%20Report%20No%203.pdf">industry</a> and has been accused of institutional <a href="http://theconversation.com/flogging-a-dodgy-cancer-cure-say-what-you-like-the-tga-wont-stop-you-3143">incapacity</a>. Most recently, the watchdog has been embroiled in problems with its <a href="http://www.tga.gov.au/newsroom/review-tga-transparency-1101.htm">lack of transparency</a>, and its oversight of faulty hip and breast <a href="http://theconversation.com/medical-watchdog-turns-its-back-on-implant-safety-complaints-5744">implants</a> and <a href="http://theconversation.com/new-weight-loss-claims-show-tga-reforms-arent-working-5526">weight loss</a> products. </p>
<h2>Legal solution?</h2>
<p>There is one light on the horizon. It comes from Canada, where a leading law firm has <a href="http://www.reolaw.ca/casesBoiron.html">launched</a> a C$30m class action – bringing together a large number of complainants – against a multinational company that is marketing <em>Oscillococcinum</em>, a homeopathic anti-flu product. </p>
<p>The litigants are seeking compensation under Canadian consumer protection law. In essence, they argue the sale of the product is fraudulent: the supposedly therapeutic product is “overpriced sugar… the extreme dilutions used to make it ensure there is not a single molecule left of its supposed medicinal ingredient”.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/10913/original/h738bhss-1337655725.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/10913/original/h738bhss-1337655725.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=336&fit=crop&dpr=1 600w, https://images.theconversation.com/files/10913/original/h738bhss-1337655725.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=336&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/10913/original/h738bhss-1337655725.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=336&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/10913/original/h738bhss-1337655725.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=422&fit=crop&dpr=1 754w, https://images.theconversation.com/files/10913/original/h738bhss-1337655725.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=422&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/10913/original/h738bhss-1337655725.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=422&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Vectorportal.com</span></span>
</figcaption>
</figure>
<p>The class action has not yet been tested in court and the manufacturer will presumably defend its product. But as an indication of the likely outcome, a related litigation in the United States <a href="http://www.gilardi.com/boironsettlement/pdf/BRGL_SettlementAgreement.pdf">reportedly concluded</a> with a US$12m settlement. The litigants claimed that the manufacturer violated state “unfair competition and false advertising” laws, given there were no detectable active ingredients. </p>
<p>The manufacturer was forced to add a disclaimer to the products, indicating its claims haven’t been evaluated by the US Food & Drug Administration. The labels must also provide an explanation of how the active ingredients have been diluted. The repackaging is estimated to cost US$7m. </p>
<h2>Potential Australian litigation</h2>
<p>We haven’t yet seen such a class action against providers of homeopathic products. But it’s not precluded by Australian laws, such as the national <a href="http://www.comlaw.gov.au/Details/C2011C00003">Competition & Consumer Act 2010</a>. And given the emergence of a class action industry, law suits against vendors of over-the-counter homeopathic pills and potions are probably in the pipeline.</p>
<p>Litigation alone could be enough to prompt manufacturers wind back claims about the efficacy of their concoctions, and lead us towards greater truth in advertising. An informed public might be appropriately reluctant to hand over the cash when <a href="http://www.naturaltherapypages.com.au/natural_medicine/Homoeopathy">reminded</a> that a central tenet of homeopathy is the “law of the infinitesimal dose” - the more dilute the remedy, the greater its potency.</p>
<p>If homeopathic products <em>are</em> acknowledged as having no pharmacologically active ingredients, they can presumably be sold as lolly water. These harmless substances don’t need to be regulated as medications or “supplements” but cannot claim medicinal properties. </p>
<p>If, on the other hand, they are promoted as having active ingredients – rather than a “memory” of having once come into contact with something active – those claims can and should be put to the test. </p>
<p>If the magic ingredient is undetectable, an Australian court might reasonably infer that the ingredient is not present in the “remedy” and that any therapeutic benefit is entirely attributable to the consumer’s faith. In other words, it’s entertainment or a quasi-religious belief rather than medicine.</p>
<p>Such a finding would act as a wake-up call for Australian academia – in particular <a href="http://theconversation.com/pseudosciences-are-destroying-the-reputation-of-australias-universities-5685">institutions</a> that rely on the revenue from alternative therapy courses. </p>
<p>It might also encourage policymakers to reconsider the regulatory responsibilities of the TGA and the Australian Competition & Consumer Commission (ACCC). In practice, the ACCC acts as the regulator of complementary medicines through restrictions on misleading advertising. It has, for example, <a href="http://www.accc.gov.au/content/index.phtml/itemId/964074">warned</a> that suppliers “must ensure that they are not claiming supposed benefits when there is no supportive scientific evidence”.</p>
<p>Most importantly, a court ruling would encourage the Australian community to adopt a more fact-based view of complementary medicine – in particular, to differentiate between what is merely entertainment and what has a tinge of credibility.</p><img src="https://counter.theconversation.com/content/6557/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bruce Baer Arnold does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>One hundred years of rigorous scientific research hasn’t dented the faith of adherents of homeopathy. The complementary therapy is still centred on the notion that water has a therapeutic “memory” and…Bruce Baer Arnold, Assistant Professor, School of Law, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/69562012-05-11T04:21:25Z2012-05-11T04:21:25ZBudget good news: no taxpayer dollars for a ‘bunch of hooey’<figure><img src="https://images.theconversation.com/files/10552/original/hvfkpdrs-1336704930.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Treasurer Wayne Swan delivering the Budget on Tuesday.</span> <span class="attribution"><span class="source">AAP</span></span></figcaption></figure><p>It’s good news indeed that the Federal Budget is providing the chief medical officer with a million dollars to review what works and what doesn’t in the world of “natural” medicine. Professor Chris Baggoley will have one year to report his conclusions. </p>
<p>At the end of that time, <a href="http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr12-tp-tp042.htm">says Health Minister Tanya Plibersek</a>, “The Private Health Insurance Rebate will be paid for insurance products that cover natural therapy services only where the Chief Medical Officer finds there is clear evidence they are clinically effective.” </p>
<p>Truth be told, this could be the easiest million dollars the CMO will ever earn for the government. He could have a report ready next month, as there are very few “natural” therapies that have any chance of meeting a requirement of evidence. The government predicts it will save $30 million a year after the review.</p>
<p>So what therapies does the government have in mind? <a href="http://www.smh.com.au/opinion/political-news/razor-gang-targets-natural-therapies-subsidy-20120504-1y47n.html">This recent article</a> tells readers that the government is referring to modalities such as “homeopathy, Reiki, aromatherapy, iridology, ear candling, crystal therapy, flower essences, kinesiology and Rolfing.” </p>
<p>Never heard of Rolfing? Well, according to <a href="http://en.wikipedia.org/wiki/Rolfing">Wikipedia</a> it’s “ a therapy created by The Rolf Institute of Structural Integration (also referred to as ‘RISI’) whereby the alleged manipulation of the fasciae by specific methods is believed to yield therapeutic benefit! Rolfing lacks a solid scientific evidence base.” </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/10553/original/q8dgthhq-1336705756.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/10553/original/q8dgthhq-1336705756.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/10553/original/q8dgthhq-1336705756.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/10553/original/q8dgthhq-1336705756.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/10553/original/q8dgthhq-1336705756.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/10553/original/q8dgthhq-1336705756.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/10553/original/q8dgthhq-1336705756.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Ear candling may no longer be coverd by a private health insurance rebate.</span>
<span class="attribution"><span class="source">Bjørn Bulthuis</span></span>
</figcaption>
</figure>
<p>As the founder of the Skeptics, <a href="http://en.wikipedia.org/wiki/Michael_Shermer">Michael Shermer</a>, noted, Rolfing represents “a bunch of hooey”. Those looking for quality evidence on for natural medicines will find the <a href="http://www.thecochranelibrary.com/view/0/index.html">Cochrane Library</a> invaluable.</p>
<p>The article suggests <a href="http://summaries.cochrane.org/search/site/%22spinal%20manipulation%22%20AND%20pain">chiropractic</a> and <a href="http://summaries.cochrane.org/search/site/acupuncture">acupuncture</a> will continue to be funded, as they are “mainstream” practices. But these modalities are used in ways for which there is certainly no clear evidence of clinical effectiveness. </p>
<p>While there’s weak evidence for conservative chiropractic being effective for helping patients with minor musculoskeletal problems, there’s none to support the more extreme use of chiropractic spinal “adjustments” to treat <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.2042-7166.2010.01053.x/full">a wide range of diseases</a> in adults and children. </p>
<p>Using <a href="http://summaries.cochrane.org/search/site/acupuncture">acupuncture to control pain</a> for a very limited number of musculoskeletal problems has been established in clinical trials. But despite many studies, there are no data suggesting it can treat any disease process and the breadth of conditions it’s used for today will not meet the government’s requirement for support.</p>
<p>The initiative announced with the budget papers may well represent the beginning of a more critical assessment of government-funded health programs, with an emphasis on proven effectiveness. This approach would provide a much larger dividend than the anticipated $30 million dollars to be saved after the proposed review. </p>
<p>Australians are, at last, being told by their government that a large number of diagnostic and therapeutic claims made for many so-called <a href="http://www.skepdic.com/tialtmed.html">“complementary and alternative medicines”</a> are without merit and often lead to a delay in correct diagnosis and the start of beneficial treatment.</p>
<p>The process of debunking health services and health-related education involving pseudoscience has surged in recent months in multiple guises. A growing number of articles addressing this issue have appeared in the national press and the matter has been prominent in radio interviews. The t<a href="https://theconversation.com/what-cam-courses-at-universities-should-look-like-5339">eaching of pseudosciences in university</a> health courses has also been questioned. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/10555/original/2zty853b-1336706228.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/10555/original/2zty853b-1336706228.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/10555/original/2zty853b-1336706228.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/10555/original/2zty853b-1336706228.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/10555/original/2zty853b-1336706228.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/10555/original/2zty853b-1336706228.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/10555/original/2zty853b-1336706228.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The evidence base for acupuncture will not be reviewed by the chief medical officer.</span>
<span class="attribution"><span class="source">NYCTCM/Flickr</span></span>
</figcaption>
</figure>
<p>The <a href="https://theconversation.com/does-traditional-chinese-medicine-have-a-place-in-the-health-system-6166">disadvantages of national registration</a> of traditional medical practices has been debated, as has the therapeutic benefits from <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/currentissue-P11000021">homeopathic preparations</a> and other “alternative” therapies. </p>
<p>All this coincides with active <a href="http://www.scienceinmedicine.org.au/">campaigning for the primacy of science-based medicine</a> by a group of scientists, clinicians, lawyers and consumer advocates, (of which we are founding members) now numbering more than 700.</p>
<p>It’s no longer tenable to accuse those concerned with the growing influence of “sciences” not supported by credible evidence of effectiveness to be on a “witch hunt”. Irrefutable worldwide research on homeopathy and many other “natural” therapies shows that they have no more effect than a placebo. </p>
<p>The Government’s commitment to science-based medicine raises a number of interesting questions. Will the private health industry wait for the results of the review before it stops paying for ineffective modalities or at least makes coverage for such treatments an optional extra? If it did, customers could have broad coverage without having to pay for modern pseudosciences. </p>
<p>With international agreement that homeopathy and many other natural therapies are no better than placebo, will Australian pharmacists rid their shelves of homeopathic and other useless preparations? And will the few universities that still prepare people for a career based around these nonsensical therapies stop and recommit to teaching good science? Let’s hope so.</p><img src="https://counter.theconversation.com/content/6956/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors are committed to scientific principles in his academic and clinical careers and are founding member of the Friends of Science in Medicine.
As a member of the Australian Academy of Science, Professor Costa is committed to uphold the highest standard of science in Australian tertiary education and has no other vested interests.</span></em></p><p class="fine-print"><em><span>John Dwyer does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It’s good news indeed that the Federal Budget is providing the chief medical officer with a million dollars to review what works and what doesn’t in the world of “natural” medicine. Professor Chris Baggoley…Marcello Costa, Professor of Neurophysiology, Department of Physiology, Flinders UniversityJohn Dwyer, Founder of the Australian Health Care Reform Alliance & Emeritus Professor, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/59452012-03-25T19:15:43Z2012-03-25T19:15:43ZHealth + Medicine: reflections on our first year<figure><img src="https://images.theconversation.com/files/8919/original/mgnwqs66-1332464421.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The Conversation's health coverage: policy, chiropractic, obesity and medicine.</span> <span class="attribution"><span class="source">AAP, Planetc1.com, Puuiki Beach, LJA Kliche</span></span></figcaption></figure><p>In The Conversation’s first editorial meeting editor Andrew Jaspan explained what he wanted to achieve with the site: a more informed level of debate, based on evidence, research and expert opinion.</p>
<p>It was frustrating, he said, that scientists and other experts were often pitted against non-experts in news stories. And because they were given the same amount of space and were quoted alongside each other, readers might consider the two voices equally informed on a topic. </p>
<p>And so, The Conversation was born. From March 2011, experts had another platform from which to share evidence-based research, information and opinion with a general but curious audience. Perhaps most importantly, readers could join the discussion, share their insights and even interrogate the evidence.</p>
<p>It’s probably no surprise, then, that one of the biggest ongoing debates we’ve hosted on the health and medicine page is the role of alternative therapies in the marketplace and in Australian universities. Or, as some see it, the fight for evidence-based medicine and health care. </p>
<p>Some of our authors felt alternative therapies and medicines were misleading consumers by claiming their unproven therapies worked. At best, patients were being ripped off. At worst, they were steered away from potentially life-saving treatments. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/6163/original/bff737d3c350e6b6-1323131194.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/6163/original/bff737d3c350e6b6-1323131194.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/6163/original/bff737d3c350e6b6-1323131194.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/6163/original/bff737d3c350e6b6-1323131194.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/6163/original/bff737d3c350e6b6-1323131194.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/6163/original/bff737d3c350e6b6-1323131194.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/6163/original/bff737d3c350e6b6-1323131194.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Debates about whether chiropractic should be taught at universities are ongoing.</span>
<span class="attribution"><span class="source">Aidan Jones</span></span>
</figcaption>
</figure>
<p>Marcello Costa kicked off the debate back in March last year – our first week of publishing – with a <a href="https://theconversation.com/a-neuroscientists-view-spare-children-the-manipulations-of-chiropractic-quackery-427">neuroscientist’s view on chiropractic</a>. He said children should be spared from this quackery, particularly given the discipline wasn’t based on credible scientific evidence. </p>
<p>But not all chiropractors are the same, <a href="https://theconversation.com/modern-chiropractic-therapy-is-based-on-evidence-and-here-it-is-1884">explained</a> chiropractic lecturer Peter Tuchin. Spinal manipulation therapy, which forms the base of modern chiropractic, <em>is</em> based on evidence as it’s as effective as standard medicine at alleviating back pain. The outdated practice of “vertical subluxation”, however, shouldn’t be promoted. </p>
<p>More recently, John Dwyer and his colleagues founded a group called Friends of Science in Medicine. <a href="https://theconversation.com/theres-no-place-for-pseudo-scientific-chiropractic-in-australian-universities-4576">There’s no place for pseudo-scientific chiropractic in Australian universities</a>, Dwyer wrote. Judging by your comments, many of you agreed; some didn’t. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/3243/original/Mickey_Liew.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/3243/original/Mickey_Liew.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/3243/original/Mickey_Liew.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/3243/original/Mickey_Liew.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/3243/original/Mickey_Liew.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/3243/original/Mickey_Liew.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/3243/original/Mickey_Liew.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Mickey Liew</span></span>
</figcaption>
</figure>
<p>But the complementary therapies debate also went beyond chiropracitic, into <a href="https://theconversation.com/lay-out-the-welcome-mat-naturopathy-has-come-in-from-the-cold-982">naturopathy</a>, <a href="https://theconversation.com/search?q=homeopathy">homeopathy</a> and alternative therapy regulation. We all thought it might crescendo with the medicines watchdog, the TGA, cracking down on the claims of shonky <a href="https://theconversation.com/consumers-need-the-facts-about-complementary-medicines-3318">complementary medicine</a> manufacturers. Five reports have been released but we’re still <a href="https://theconversation.com/new-weight-loss-claims-show-tga-reforms-arent-working-5526">watching this space</a>. </p>
<p>Another of the founding ideals of The Conversation was to not only publish articles on the problems we face as a society, but to get the best minds in the country to canvass solutions. And we’ve certainly heard some innovative solutions to one of the concerning public health issues: obesity. </p>
<p>Last month David Dunstan told us how he’d <a href="https://theconversation.com/office-workers-its-time-to-beat-the-bulge-and-quit-the-sit-5557">quit sitting at work</a>, and if we did the same (or at least got up out of our chair regularly) we could decrease our risk of heart attack and stroke. Other solutions included <a href="https://theconversation.com/is-a-fat-tax-the-answer-to-australias-obesity-crisis-3712">taxing unhealthy foods</a>, <a href="https://theconversation.com/stemming-the-obesity-epidemic-requires-courageous-population-level-action-3412">subsidising fruits and vegetables</a>, improving <a href="https://theconversation.com/food-industry-digs-in-heels-over-traffic-light-labels-311">food labelling</a>, rethinking our <a href="https://theconversation.com/death-by-suburban-sprawl-better-urban-planning-will-combat-sedentary-lifestyles-3395">city planning</a>, and encouraging kids to <a href="https://theconversation.com/five-ways-to-prevent-early-childhood-obesity-639">get active from an earlier age</a>. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/7406/original/tmxpqqg4-1328504578.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/7406/original/tmxpqqg4-1328504578.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/7406/original/tmxpqqg4-1328504578.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/7406/original/tmxpqqg4-1328504578.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/7406/original/tmxpqqg4-1328504578.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/7406/original/tmxpqqg4-1328504578.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/7406/original/tmxpqqg4-1328504578.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Positive image: Zoe prepares for work.</span>
<span class="attribution"><span class="source">Isaac Brown</span></span>
</figcaption>
</figure>
<p>Still on obesity, one of the most divisive debates we’ve hosted on the site was spurred by an article from Lauren Gurrieri and Isaac Brown, both from Griffith University, on a <a href="https://theconversation.com/showing-it-like-it-is-a-library-to-fight-fatist-images-in-the-media-4252">new image library that presents obese people</a> in positive, natural poses. The image library creators were sick of journalists only having access to stereotypical lazy, undisciplined, and slovenly representations of heavy people.</p>
<p>With 243 comments, it’s one of our most talked about pieces and the follow-up articles keep coming. Jessica Browne and Jane Speight told the “fatists” to back off – blaming people for obesity doesn’t help anyone. Fat studies researcher Cat Pause asked <a href="https://theconversation.com/big-belly-laughs-why-is-it-okay-to-laugh-at-fat-people-5329">why we think it’s okay to laugh at fat people</a>. And Lesley Campbell explained, counter-intuitively, that some overweight and obese people can be <a href="https://theconversation.com/appearance-vs-reality-the-perfectly-healthy-obese-1904">perfectly healthy</a>. </p>
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<img alt="" src="https://images.theconversation.com/files/2468/original/Foshydog.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/2468/original/Foshydog.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/2468/original/Foshydog.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/2468/original/Foshydog.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/2468/original/Foshydog.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/2468/original/Foshydog.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/2468/original/Foshydog.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p>Another thing we did in our first year was interrogate some of the unexamined ideas and assumptions that seem to so readily take up residence in our brains. It turns out we shouldn’t be so quick to believe our parents, friends and trashy lifestyle websites about all things health. Our <a href="https://theconversation.com/topics/medical-myths">Monday’s medical myths</a> series has slowly been subjecting this health mythology to scientific scrutiny and giving us the evidence to say, with some certainty, that <a href="https://theconversation.com/mondays-medical-myth-mixing-drinks-causes-hangovers-5055">mixing drinks won’t leave us with a worse hangover</a>, <a href="https://theconversation.com/mondays-medical-myth-reading-in-dim-light-ruins-your-eyesight-3149">reading in dim light won’t ruin our eyesight</a>, and no, you <a href="https://theconversation.com/mondays-medical-myth-you-can-catch-a-cold-by-getting-cold-2488">can’t catch a cold by getting cold</a>. </p>
<p>I originally envisaged it as a short series, debunking some of the most common myths like “<a href="https://theconversation.com/mondays-medical-myth-drink-eight-glasses-of-water-a-day-905">drink eight glasses of water a day</a>”, “<a href="https://theconversation.com/mondays-medical-myth-sugar-makes-kids-hyperactive-1009">sugar makes kids hyperactive</a>” and “<a href="https://theconversation.com/mondays-medical-myth-we-only-use-10-of-our-brain-1613">we only use 10% of our brains</a>” but, ten months later, we’re still not short of ideas. Thanks to regulars <a href="https://theconversation.com/profiles/tim-crowe-1254">Tim Crowe</a>, <a href="https://theconversation.com/profiles/merlin-thomas-143">Merlin Thomas</a>, <a href="https://theconversation.com/profiles/michael-vagg-1771">Michael Vagg</a> and newcomer <a href="https://theconversation.com/profiles/michael-tam-6616">Michael Tam</a> for making the series a success. </p>
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<img alt="" src="https://images.theconversation.com/files/6046/original/dsc00192-jpg-1322694923.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/6046/original/dsc00192-jpg-1322694923.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/6046/original/dsc00192-jpg-1322694923.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/6046/original/dsc00192-jpg-1322694923.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/6046/original/dsc00192-jpg-1322694923.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/6046/original/dsc00192-jpg-1322694923.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/6046/original/dsc00192-jpg-1322694923.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Geoff Drummond (seated) with Rodney Syme, chairman of Dying with Dignity Victoria.</span>
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<p>Other series we’ve run on the health and medicine page have looked at the world’s biggest public health challenge: <a href="https://theconversation.com/topics/non-communicable-diseases">Non-communicable diseases</a>. And we started a conversation that many of us shy away from – about <a href="https://theconversation.com/topics/talking-about-death-and-dying">death and dying</a>, which included a moving final instalment by Geoffrey Drummond, with his <a href="https://theconversation.com/a-personal-account-of-life-with-terminal-cancer-4475">personal account of life with terminal cancer</a>. </p>
<p>We also separated the myths about dieting from the realities of exercise and nutrition in <a href="https://theconversation.com/topics/the-science-behind-weight-loss">The science behind weight loss</a> – which include many of our most read articles. And our mammoth series on transparency in medicine starts today. </p>
<p>To mark our first anniversary we’ll be introducing a new feature this week – author blogs. <a href="https://theconversation.com/profiles/michael-vagg-1771">Michael Vagg</a>, senior lecturer at Deakin University’s School of Medicine and pain specialist at Barwon Health will bring you Medicandus – a second opinion on health care and medical science. And <a href="https://theconversation.com/profiles/ian-musgrave-1808">Ian Musgrave</a>, senior pharmacology lecturer at the University of Adelaide, will blog about all matters toxic, all around us in Paracelsus’ Poison. </p>
<p>So stay tuned. </p>
<hr>
<h2>Health and medicine’s most popular stories:</h2>
<ol>
<li><a href="https://theconversation.com/ditching-bike-helmets-laws-better-for-health-42">Ditching bike helmets laws better for health</a></li>
<li><a href="https://theconversation.com/helmet-cam-captures-bike-accidents-and-could-make-cycling-safer-3540">Helmet-cam captures bike accidents (and could make cycling safer)</a></li>
<li><a href="https://theconversation.com/food-v-exercise-what-makes-the-biggest-difference-in-weight-loss-3639">Food v exercise: What makes the biggest difference in weight loss?</a></li>
<li><a href="https://theconversation.com/ignore-the-hype-real-women-dont-bounce-back-to-their-pre-pregnant-shape-3456">Ignore the hype, real women don’t ‘bounce back’ to their pre-pregnant shape</a></li>
<li><a href="https://theconversation.com/theres-no-place-for-pseudo-scientific-chiropractic-in-australian-universities-4576">There’s no place for pseudo-scientific chiropractic in Australian universities</a> </li>
<li><a href="https://theconversation.com/a-small-bill-in-the-us-a-giant-impact-for-research-worldwide-4996">A small bill in the US, a giant impact for research worldwide</a></li>
<li><a href="https://theconversation.com/showing-it-like-it-is-a-library-to-fight-fatist-images-in-the-media-4252">Showing it like it is: a library to fight fatist images in the media</a></li>
<li><a href="https://theconversation.com/office-workers-its-time-to-beat-the-bulge-and-quit-the-sit-5557">Office workers – it’s time to beat the bulge and quit the sit</a></li>
<li><a href="https://theconversation.com/determined-to-be-different-what-we-do-changes-the-wiring-of-our-genes-1726">Determined to be different: what we do changes the wiring of our genes</a></li>
<li><a href="https://theconversation.com/profiles/rosemary-stanton-3105/dashboard">Diets and weight loss: separating facts from fiction</a></li>
</ol><img src="https://counter.theconversation.com/content/5945/count.gif" alt="The Conversation" width="1" height="1" />
In The Conversation’s first editorial meeting editor Andrew Jaspan explained what he wanted to achieve with the site: a more informed level of debate, based on evidence, research and expert opinion. It…Fron Jackson-Webb, Deputy Editor and Senior Health EditorLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/58492012-03-15T04:11:03Z2012-03-15T04:11:03ZNo need for an alternative medicine crackdown<figure><img src="https://images.theconversation.com/files/8639/original/ts6y65b8-1331783920.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Treatments should be based on how well they make people feel rather than how scientific or traditional the medicine is.</span> <span class="attribution"><span class="source">By Wikidudeman</span></span></figcaption></figure><p>Homeopathy is a combination of tradition, art and a science that has been used for centuries. Does it really matter if its effect is placebo if it makes people feel better and regain good health? </p>
<p>And why do we have to prove something that’s been working for over a hundred years? Homeopathy is not the same as medicine, and it shouldn’t be measured by the same yardstick. Medicine is not 100% evidence-based itself but it still does wonderful things for people.</p>
<p>Homeopathy uses plant, mineral or animal substances to stimulate the body’s ability to heal itself. The choice of the remedy to use in a particular case is based on the “Law of Similars”: a substance capable of producing a certain set of symptoms in a healthy individual can remove these same symptoms if given to an unwell individual. In other words, what a substance can cause, it can cure (Similia Similibus Currentur). </p>
<p>This is a natural law observed as far back as 400 BC by Hippocrates. This law was developed into a system of therapeutics 200 years ago by the German physician <a href="http://books.google.com.au/books?hl=en&lr=&id=EGphHjIE2U4C&oi=fnd&pg=PR6&dq=samuel+Hahnemann&ots=zU87Gt5r4D&sig=WSdLXXg1g_MW4pUDvTb-6uhnppA#v=onepage&q=samuel%20Hahnemann&f=false">Samuel Hahnemann</a> who is considered the father of homeopathy.</p>
<p>In 2005, the World Health Organisation (WHO) <a href="http://apps.who.int/bookorders/anglais/detart1.jsp?codlan=1&codcol=15&codcch=614">estimated that homoeopathy was used</a> by around 500 million people worldwide, and constituted the largest complementary and alternative medicine regime. And there are <a href="http://www.ncbi.nlm.nih.gov/pubmed/20674839">studies</a> showing the effectiveness of homoeopathy at a large scale.</p>
<h2>Case study: Cuba</h2>
<p>In Cuba, outbreaks of the tropical disease Leptospirosis is recorded by an efficient national surveillance programme. Its incidence correlates closely with heavy rainfall and subsequent flooding. </p>
<p>In response to a developing epidemic in late 2007, and with only enough vaccines to treat 15,000 high-risk people, the government decided to treat the entire population of the region over the age of one with homeopathic medicine. </p>
<p>The medicine was prepared from the inactivated causative organism provided by the Cuban National Vaccine Institute. It was a highly diluted preparation called homeoprophylaxis.</p>
<p>This medicine was given to the 2.3 million people living in the provinces usually worst affected. Within a few weeks the number of infections had fallen from 38 to 4 cases per 100,000 per week. This was significantly fewer than the 38 forecast based on historical figures for those weeks of the year. And the 8.8 million people from other provinces who did not receive homeopathic treatment suffered the forecast infection rate.</p>
<p>The <a href="http://www.sciencedirect.com/science/article/pii/S1475491610000585">effect appeared to be sustained</a> – there was an 84% reduction in infection in the treated region the following year (2008) when, for the first time, incidence did not correlate with rainfall. In the same period, incidence in the untreated region increased by 22%.</p>
<h2>Local scene</h2>
<p>Yesterday’s <a href="http://www.theage.com.au/opinion/political-news/alternative-medicine-crackdown-20120313-1uyiw.html#ixzz1p9IL3W6Q">article</a> in the Fairfax papers – Alternative medicine crackdown – suggested the National Health and Medical Research Council (NHMRC) might declare homeopathy baseless and unethical. This statement would be based on a 2010 evaluation of homeopathy by the British House of Commons science and technology committee which declared homeopathy was no more efficacious than a placebo.</p>
<p>In contrast to the UK government’s stance, the Swiss government’s <a href="http://www.huffingtonpost.com/dana-ullman/homeopathic-medicine-_b_1258607.html">2011 report on homeopathic medicine</a> represents the most comprehensive evaluation of homeopathic medicine ever produced by a government and has just been published in English.</p>
<p>The report says homeopathic treatment is both efficacious and cost-effective and recommends homeopathic treatment be reimbursed by Switzerland’s national health insurance program. </p>
<p>Insurance companies are very particular about which practitioners they cover and rightly so. A homeopath, for instance, needs to belong to a particular association that has a high minimun standard of education to be able to have clients receive private insurance rebates. </p>
<p>All health practitioners can cause harm. Medicine can cause serious harm and even death; there are <a href="http://health.vic.gov.au/ruralhealth/downloads/dla-phillips-fox.pdf">many medical mishaps</a> and deaths every year. According to the former Australian Council for Safety and Quality in Health Care, the rate of adverse events in Australian hospitals is around 10%.</p>
<p>But there have very few deaths from homoeopathy. </p>
<p>All deaths are sad but as a <a href="http://health.vic.gov.au/ruralhealth/downloads/dla-phillips-fox.pdf">Victorian report</a> says: “It is important to recognise that human error is inevitable for even the best trained and best-qualified healthcare providers.”</p>
<p>People have a right to choose the treatments they want and decide how to manage their health issues. All health professionals including homeopaths should be qualified so the public has appropriate treatment. Treatments should be based on how well they make people feel rather than how scientific or traditional the medicine is.</p><img src="https://counter.theconversation.com/content/5849/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sandra Lucas does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Homeopathy is a combination of tradition, art and a science that has been used for centuries. Does it really matter if its effect is placebo if it makes people feel better and regain good health? And why…Sandra Lucas, Lecturer in Nursing, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/58592012-03-15T03:43:09Z2012-03-15T03:43:09ZHomeopathy isn’t unethical, it’s just controversial<figure><img src="https://images.theconversation.com/files/8632/original/3nkzcbvp-1331778498.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The NHMRC's draft statement on homeopathy is too narrow.</span> <span class="attribution"><span class="source">Flirkc/kh1234567890</span></span></figcaption></figure><p>The ethics of homeopathy was once again thrust into the spotlight yesterday after a <a href="http://www.smh.com.au/opinion/political-news/alternative-medicine-crackdown-20120313-1uyiw.html">leaked draft</a> of the <a href="http://www.nhmrc.gov.au/">National Health and Medical Research Council’s</a> statement on homeopathy revealed the agency was considering condemning the practice of this alternative therapy. </p>
<p>The <a href="http://images.theage.com.au/file/2012/03/14/3125800/Homeopathy%2520statement.pdf?rand=1331694590279">NHMRC’s draft statement</a> argues that it’s “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”.</p>
<p>It’s certainly appropriate for the NHMRC to make a statement on homeopathy. But it’s wrong to suggest that homeopathy itself is unethical. </p>
<h2>Limited scope</h2>
<p>The NHMRC claims its statement is based on a recent <a href="http://www.publications.parliament.uk/pa/cm200910/cmselect/cmsctech/45/45.pdf">report on homeopathy</a> by the United Kingdom’s <a href="http://www.parliament.uk/business/committees/committees-archive/science-technology/">Science and Technology Committee</a>, which is similar to Senate committees in Australia. </p>
<p>So, rather than bringing scientists together to assess the evidence, the five-member committee (all MPs) heard from a number of experts before formulating their recommendations. </p>
<p>The UK government’s <a href="http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_117811.pdf">response</a> noted the findings were controversial and there was significant disagreement within the scientific community. The government actively disagreed with some points, including the committee’s argument that the government should refrain from funding any further research involving homoeopathy. </p>
<p>It’s unclear why the NHMRC has based its draft statement on this report and ignored others from the World Health Organization, and Swiss and Canadian governments. </p>
<h2>Informed consent</h2>
<p>The key to the ethical practice of any therapy is <a href="http://en.wikipedia.org/wiki/Informed_consent">informed consent</a> – practitioners need to make patients aware of the evidence for and against their therapies. </p>
<p>Both manufactures and practitioners also need to make consumers aware that highly diluted homeopathic remedies do not contain pharmacological doses of medicine. </p>
<p>But then it’s up to the consumer to make a choice. As Steve Hambleton, president of the Australian Medical Association, <a href="http://www.medicalobserver.com.au/news/unethical-nhmrc-to-reveal-stance-on-homeopathy">stated in response to the NHMRC yesterday</a>, if consumers are fully informed that there is no evidence a treatment is any more effective than placebo and still wish to use it, that should be the end of the matter. </p>
<p>And, of course, efficacy isn’t just an issue for homoeopathy. As medical writer Ray Moynihan noted recently in the <a href="http://www.bmj.com/content/344/bmj.e1075">British Medical Journal</a>, most modern medicine lacks a strong evidence base, including most of the 5,000 treatments Medicare rebates are provided for.</p>
<p>Would the NHMRC be similarly willing to label these therapies unethical? </p>
<p>Critics may concede this point but say homeopathy is different – as science tells us that there is no possible way it <em>can</em> work. But population studies suggest homeopathy can affect patient outcomes. </p>
<h2>It’s about practitioners, not potions</h2>
<p>For therapies such as homeopathy, the problems don’t come from the remedies themselves; they come from unethical practitioners who put patients at risk. </p>
<p>The deaths of 45-year-old cancer-sufferer <a href="http://www.abc.net.au/austory/content/2011/s3260776.htm">Penelope Dingle</a> and nine-month-old <a href="http://www.smh.com.au/national/parents-guilty-of-manslaughter-over-daughters-eczema-death-20090605-bxvx.html">Gloria Thomas</a> weren’t caused by taking homeopathic remedies. Both died because they delayed more effective therapies, on the advice of their homoeopath (or in Gloria’s case, her parents delayed treatment for her eczema and eye infection). </p>
<p>Similarly, the public is placed at risk from <a href="http://ncirs.edu.au/immunisation/fact-sheets/homeopathy-vaccination-fact-sheet.pdf">homeopathic vaccinations</a> – not because of what they contain, but because of the opportunity costs when they’re used as an alternative to real vaccination. </p>
<p>Problems occur when practitioners make claims for which there is no evidence, financially exploit their patients, refuse to refer when necessary and delay effective treatments for serious conditions. </p>
<p>Most homeopaths do not support such acts – the Australian Register of Homoeopaths <a href="http://ncirs.edu.au/immunisation/fact-sheets/homeopathy-vaccination-fact-sheet.pdf">supports full vaccination</a> rather than homeopathic vaccination. But being an unregulated profession, there are always rogue operators who need to be held accountable. </p>
<p>In evaluating the ethics of homeopathy, the NHMRC should highlight the importance of the practitioner and the implications of Australia’s failure to regulate this industry. This has been the approach in the many countries and regions that regulate homeopaths. Ontario, Canada, for instance, is currently <a href="http://www.collegeofhomeopaths.on.ca/">developing a regulatory body</a> for homeopaths to ensure minimum standards of practice and accountability. </p>
<h2>Does homeopathy have an effect?</h2>
<p>The answer is no… and yes – by <a href="http://www.ncbi.nlm.nih.gov/pubmed/18834714">tweaking existing analyses</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/19371564">trials</a>, you could probably make a case either way.</p>
<p>German insurance companies have been using population health and observational studies to investigate whether homoeopathy is an effective allocation of their resources. Studies have demonstrated <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=witt%20c%20homeopathic%20observational">good patient outcomes</a> – as good as or better than conventional care for some conditions, even <a href="http://www.ncbi.nlm.nih.gov/pubmed/19192019">after eight years of follow-up</a> – though results on cost-effectiveness and health service utilisation have been mixed.</p>
<p>The Swiss government also initiated <a href="http://rd.springer.com/chapter/10.1007/978-3-642-20638-2_14#">a report</a> that went beyond looking at clinical trials and included population heath and observational data. It concluded that homoeopathy could be both clinically and cost effective. </p>
<p>As I’ve written previously on The Conversation, homeopathic consultations themselves <a href="https://theconversation.com/question-homeopathys-remedies-but-not-its-approach-1833">may also have some benefit</a>, even if the medicine doesn’t.</p>
<p>If homoeopaths can get patients to improve without an effective medicine, we need more research to understand how this occurs. </p>
<h2>Homeopathy as unethical</h2>
<p>So, what would a statement that homeopathy is unethical mean?</p>
<p>Well, we don’t really know. It would probably mean the end of any research involving homeopathy in Australia, given that it would be hard for any research ethics committee to allow a researcher to explore a therapy deemed unethical by Australia’s major health body.</p>
<p>It would certainly place pressure on private health insurers to stop including homeopathy in their extras packages. But Australian private health insurers don’t pay for complementary medicine only because of their efficacy – they also offer it because it draws patients to their health plans. </p>
<p>In the end, branding homeopathy as unethical is unlikely to affect patient use. Most complementary medicines are patient-driven phenomena, and consumers already make the choice to use them despite mainstream medical opposition.</p>
<p>It may, however, stop them discussing this use with health professionals, increasing potential risks.</p>
<p>The NHMRC says it plans to release its final statement on homeopathy sometime this year. In the meantime, the agency should consider conducting its own investigations, and base these on a variety of international benchmarks. Simply labelling homeopathy unethical based on a single parliamentary review in the United Kingdom – and not even a scientific one – just doesn’t cut it.</p><img src="https://counter.theconversation.com/content/5859/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jon Wardle receives funding from the ARC, the NHMRC, universities (Queensland, Washington and University of Technology Sydney) and the Indian government.
Jon is a founding member of the Network of Researchers in the Public Health of Complementary and Alternative Medicine.
</span></em></p>The ethics of homeopathy was once again thrust into the spotlight yesterday after a leaked draft of the National Health and Medical Research Council’s statement on homeopathy revealed the agency was considering…Jon Wardle, NHMRC Research Scholar, School of Population Health , The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/13932011-08-05T05:09:44Z2011-08-05T05:09:44ZDoctors’ orders: debunking homeopathy once and for all<figure><img src="https://images.theconversation.com/files/2676/original/vitasamb2001.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The placebo effect may be making people feel better but it should never be substituted for real medicine.</span> <span class="attribution"><span class="source">vitasamb2001/FreeDigitalPhotos.net</span></span></figcaption></figure><p>Homeopathy’s got a bit of a run in the media in recent months and the stories are by no means positive.</p>
<p>It all started in April when the medical press highlighted the <a href="http://www.nhmrc.gov.au/">National Health and Research Council’s (NHMRC)</a> impending statement on the practice. </p>
<p>The ABC’s Australian Story then broadcast “<a href="http://www.abc.net.au/austory/specials/desperateremedies/default.htm">Desperate Remedies</a>” bringing the non-medical base of <a href="http://www.sciencebasedmedicine.org/index.php/homeopathy-and-evidence-based-medicine-back-to-the-future-part-i/">homeopathy</a> into the spotlight and last week, the commercial stations jumped on the bandwagon with Channel 7’s Today Tonight running a <a href="http://au.news.yahoo.com/today-tonight/health/article/-/9925741/homeopathy-put-to-the-test/">story</a> about it.</p>
<p>The NHMRC is still finalising its statement, which, it <a href="http://www.nhmrc.gov.au/media/newsletters/research-tracker/2011/nhmrc-research-tracker-21-april-2011-edition">says</a> is based on one by the UK House of Commons Science and Technology Committee.</p>
<p>It has also said it will likely recommend insurers to not pay for homoepathy because studies have found it to be ineffective.</p>
<h2>The genesis of homeopathy</h2>
<p>Homeopathy is a system of health care based on the idea that “like cures like” – substances that cause the same symptoms as an illness can cure that illness. </p>
<p>And the idea that <em>extremely</em> small dilutions, so small that there’s almost no chance of the original substance being present, are more effective than more concentrated solutions.</p>
<p>If the former sounds a bit like alchemy, that’s because it is. “Like cures like” is a fundamental principle of medical alchemy, endorsed by no less than the father of pharmacology <a href="http://en.wikipedia.org/wiki/Paracelsus">Paracelsus</a>. </p>
<p>Homeopathy reflects this idea because when its founder Samuel Hahnemann first formulated his approach in 1796, alchemy was on the wane but still influential. </p>
<p>Medicine looked nothing like it does today at the time, with extreme treatments like bleeding, purgatives and heroic concentrations of opiates in common usage. </p>
<p>Using fruit juice to combat scurvy would only be widely implemented in five years’ time; vaccination lay six years in the future; and the germ theory of disease and the <a href="http://demonstrations.wolfram.com/TheLawOfMassAction/">Law of Mass Action</a> over 50 years in the future. </p>
<p>So it’s not surprising that homeopathy became popular: in an era where conventional treatment was just as likely to kill you as cure you, the gentler ultra-dilute tonics of homeopathy would at the very least not harm you. </p>
<p>Medicine evolved as we came to better understand the body and developed effective medicines. </p>
<p>But homeopathy didn’t. It remained mired in the same 18th century alchemical thinking. </p>
<p>The homeopathic hospitals of the 19th century either closed or were converted (the former Prince Henry’s Hospital in Melbourne where I used to work started life as a homeopathic hospital).</p>
<h2>A little drop won’t do it</h2>
<p>Homeopathy has a symptom-based approach to medicine – it ignores the actual mechanisms of disease. Take insomnia, for instance, the treatment for it is (among other things) “Coffea 30C”.</p>
<p>Coffea is caffeine, the substance in coffee that keeps you awake and the 30C describes how much the caffeine is diluted.</p>
<p>Now, most people would instinctively feel that giving caffeine to someone with insomnia is not the best idea, but the magic is apparently in the dilution.</p>
<p>The C in 30C means the solution has been diluted to one part in a hundred and 30C means the solution has been diluted one in a hundred <strong>30 times</strong>. </p>
<p>If you take a drop of your morning coffee and drip it into the nearest dam, the concentration of caffeine in the dam would be higher than 30C dilution of caffeine. </p>
<p>In fact, a 30C dilution is highly unlikely to contain a single molecule of caffeine.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/2675/original/Erhart_n_karl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/2675/original/Erhart_n_karl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=631&fit=crop&dpr=1 600w, https://images.theconversation.com/files/2675/original/Erhart_n_karl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=631&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/2675/original/Erhart_n_karl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=631&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/2675/original/Erhart_n_karl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=793&fit=crop&dpr=1 754w, https://images.theconversation.com/files/2675/original/Erhart_n_karl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=793&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/2675/original/Erhart_n_karl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=793&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Homeopaths claim the mirror image of a substance’s effect gets stronger with dilution. Erhart_n_karl.</span>
<span class="attribution"><span class="source">Wikimedia Commons</span></span>
</figcaption>
</figure>
<p>Our every day experience is that when you dilute something, it gets weaker. Homeopaths claim that, contrary to our experience and the laws of physics, substances get stronger as they become more diluted. </p>
<p>Or, rather than getting stronger, the mirror image of their effect gets stronger. So, caffeine, a stimulant, somehow becomes an effective sleep aid. </p>
<p>Homeopaths have a number of different, mutually contradictory explanations for this. One of the most popular is that <a href="http://www.badscience.net/2007/08/490/">water retains a “memory” of the substances in it</a>. </p>
<p>Now if this were true, water would retain the memory of all the substances that have ever been in it, and the effects would be rather obvious to all. </p>
<p>We can see why the dilution can’t work by considering caffeine again. We know that caffeine make us more alert by <a href="http://pharmrev.aspetjournals.org/content/51/1/83.long">stopping the action of a brain hormone</a>. </p>
<p>Diluting caffeine out won’t make the brain hormone work harder, nor will a “memory” of caffeine. </p>
<p>Homeopaths explanations are incoherent and require everything we know about how the body works to be wrong.</p>
<p>Any apparent effect of homoeopathy is purely due to the <a href="http://www.cancer.org/Treatment/TreatmentsandSideEffects/TreatmentTypes/placebo-effect">placebo effect</a>, where people feel subjectively better just because we are paying attention to them. But the <a href="http://www.sciencebasedmedicine.org/index.php/spin-city-placebos-and-asthma/">underlying disease doesn’t get any better</a>, and we should never substitute real medicine for placebos. </p>
<h2>But does it actually work?</h2>
<p>We can talk about theory all day, but what if there were evidence that homeopathy actually worked? That would trump any discussion of theory. Clinical trials have been done on homeopathy, and the results aren’t good. </p>
<p>Now, not all clinical trials are equal but good quality clinical trials show homeopathic remedies have no effect. Whether for <a href="http://www2.cochrane.org/reviews/en/ab000353.html">asthma</a>, <a href="http://www2.cochrane.org/reviews/en/ab005648.html">attention deficit disorder</a> or <a href="http://www2.cochrane.org/reviews/en/ab004845.html">side effects of cancer medication</a> (podcast <a href="http://www.cochrane.org/podcasts/issue-2-april-2009/homeopathic-medicines-adverse-effects-cancer-treatments">here</a>). For some diseases such as dementia, there are simply <a href="http://www2.cochrane.org/reviews/en/ab003803.html">no good clinical trials to evaluate</a>. </p>
<p>The most recent evaluation of the evidence for homeopathy was the UK government’s <a href="http://www.parliament.uk/business/committees/committees-a-z/commons-select/science-and-technology-committee/inquiries/former-inquiries/homeopathy-/">Evidence Check 2: Homeopathy</a>. After reviewing the best scientific evidence and submissions from stakeholders, the review concluded that homeopathy showed no evidence of efficacy.</p>
<h2>What’s the NHMRC got to do with it?</h2>
<p>The NHMRC is Australia peak body for <a href="http://www.nhmrc.gov.au/about/organisation-overview/nhmrcs-role">evaluating and promoting best health practice</a>, so it’s entirely appropriate for it to rule on the effectiveness of homeopathy. </p>
<p>It’s rulings have several implications – doctors will be reluctant to prescribe remedies that have no proven efficacy, for instance, and insurance companies will be reluctant to pay out on them.</p>
<p>Australian adults have the right to choose treatments for their aliments (or choose not to be treated). But they need access to the best-available evidence so their choices can well informed. </p>
<p>The tragic story of <a href="http://www.abc.net.au/austory/specials/desperateremedies/default.htm">Penelope Dingle</a> shows what happens when people don’t have such access.</p><img src="https://counter.theconversation.com/content/1393/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Musgrave receives funding from the ARC and NH&MRC.</span></em></p>Homeopathy’s got a bit of a run in the media in recent months and the stories are by no means positive. It all started in April when the medical press highlighted the National Health and Research Council’s…Ian Musgrave, Senior lecturer in Pharmacology, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.