drpaulmorgan

A homeopath doesn’t like being called out for promoting misinformation

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Long-time “friend” (they’re certainly well-acquainted with him) of the Advertising Standards Authority (ASA), Steve Scrutton, a Homeopath from Corby, is a regular poster on Twitter and his own blog (ironically titled “Safe Medicine”) about his chosen means of earning a living and also about various other subjects such as anti-vaccination and other forms of quackery. It’s fair to say that he exhibits features that fall under the term of crank magnetism. His brushes with the ASA were based around him making claims of benefits for products he was selling via a website he ran. I don’t know the details, but he was ordered to remove the claims. Having failed to do so, he was then listed by the ASA as a “non-compliant advertiser”. I don’t know whether he did comply by changing that website or simply closed it down, but it seems he’s no longer on that list. Just as well, as repeated non-compliance can lead to prosecution by Trading Standards!

Since I joined Twitter a few years ago now, he’s been someone whose tweets have found their way into my timeline and/or mentions columns. I don’t follow him, nor do I stalk him in the way that some obsessive homeopathy fans stalk people who counteract their stupidity with actual science, rational thought and critical appraisal. Yes, I particularly refer to a woman called Sandra Courtney aka @BrownBagPantry on Twitter – her modus operandi is to block people but then keep a Twitter feed open looking at the tweets of people she’s blocked before posting screen captures of their tweets and/or creating childish images.
Anyway, back to Steve.

Every so often, I have the misfortune to see a tweet from Mr. Scrutton that promotes homeopathy as being a treatment of benefit in a wide variety of health conditions. Some of these conditions are very real, others – it may be said – have less basis in reality. Not that such things necessarily worry homeopaths.
To be absolutely clear about what homeopathy is and what it isn’t, let’s take a quick look. In essence, a German physician called Samuel Hahnemann in 1796 was disillusioned with the conventional medicine of the day. To be fair to him, most of what was available was pretty awful – a variety of toxic potions and blood-letting was the mainstay. Rather than going into detail, I’ll post this link about the history of homeopathy. A detailed description of homeopathy can be found here.  There have been many studies of the effectiveness of homeopathy, many claiming positive results. There have also been many showing negative results too. The selective quotation of positive results is termed cherry-picking. Homeopaths and their fans are every bit as bad about this as any other advertiser and, sadly, many scientists. To overcome the issues of such selection bias, it’s necessary to first understand how to critically appraise a scientific publication. In medicine, this is a core skill in the development of the practice of evidence-based medicine (EBM, for short). A useful website that explains how EBM works and how to do it is this one – http://www.cebm.net/
As you might gather, a major problem for homeopathy is the complete lack of prior plausibility – there’s no rational reason, given our understanding of basic chemistry, physics and biology – why homeopathy should have any effect beyond placebo. Homeopaths seems to struggle with the concept that their various sugar pills and nostrums are just placebos and that claims of benefit, usually based on anecdotes or small studies can be explained either by the placebo effect or the phenomenon of regression towards the mean. When people rely on homeopathy to treat real diseases, the consequences can be disastrous. See here for a list of examples and here for the particularly tragic and awful story of Penelope Dingle.

I’m pretty sure that at some point in the past, I’d responded to some of Scrutton’s tweets by asking for credible evidence and/or pointing out the flaws in claims he’d made. I think I’d posted some comments in response to posts on his blog – Steve didn’t take kindly to this, not allowing my comments to pass (his) moderation. Ah well – it’s his blog! Recently, a new flurry of his tweets came into my view, repeating a number of repeatedly disproved and debunked claims. This is commonly referred to as a PRATT – a Point Refuted A Thousand Times. A standard practice of repeating a claim multiple times in the mistaken belief that it will somehow make their claim true or maybe they’re simply hoping that a more gullible, less skeptical audience will see their claims and take them at face value. It seems that Steve didn’t take too kindly to having his claims questioned and so he decided to write a blog post all about me. Steve – I’m flattered! Yes, I’m angry – angry that homeopaths keep making claims that aren’t supported by robust scientific evidence and that people are duped into buying their wares when the evidence is clear. Homeopathy has been conclusively shown to be of no benefit beyond placebo when subjected to appropriate critical appraisal. When trying to summate evidence from a variety of clinical trials, the best method to make an assessment of the evidence is to conduct a meta-analysis. This can be quite challenging and time-consuming, as it’s necessary to assess the quality of each trial. Nevertheless, there have been meta-analyses of homeopathy, most notably in The Lancet by Shang et al and, more recently, by the Australian Government’s National Health and Medical Research Council just a few months ago. These meta-analyses are bad news for homeopaths as – unsurprisingly – they show that homeopathy is just placebo. But why let the hard facts get in the way of your business model? The amount of bleating and pleading for special treatment by the homeopaths is enormous! Not to mention trying to create conspiracy theories about “Big Pharma” buying off the authors of the reports or that the meta-analyses are somehow intrinsically biased or deliberately misleading. Let’s see how they try to deny reality – http://www.britishhomeopathic.org/bha-blog/australian-report-misrepresents-clinical-research-evidence-in-homeopathy/

https://www.hri-research.org/resources/homeopathy-the-debate/the-australian-report-on-homeopathy/australian-nhmrc-report-in-detail/

Very sad and pathetic.

So, let’s have a look at the specific whinges, sorry “allegations” made by Scrutton about me.

Firstly, he complains that my response to him posting a link to his blog post about tetanus as being “per abuse” – I think he means “pure abuse” but I can forgive the odd typographical or spelling error. Tetanus is a really horrible, nasty disease with a high mortality rate. Read more about it here.

I said that his claim of benefit for homeopathic remedies in treating tetanus was ““Stupid, idiotic, downright dangerous. You should be ashamed for promoting such dangerous, bad advice”. Which it was. Let’s see what the scientific evidence for homeopathy in the treatment of tetanus might be. First, a PubMed search for “homeopathy tetanus” (“homoeopathy tetanus” gives identical results) gives the following exhaustive list of published papers of scientific evidence:-

 

So – just two papers, one of which refers to athletic injuries and the other is about attitudes of homeopaths towards vaccination! Oh dear – this isn’t looking good for Steve. Maybe my search was too specific? I tried several similar searches – same results. Maybe Google will yield more? Of course it does! Shame that on the first page almost all results are from homeopathy websites – one is from the truly crazy whale.to (made famous by being the basis of Scopie’s Law). The only other article on that first page is this one. OOPS! Maybe Steve meant homeopathic vaccination – truly an oxymoron – for tetanus. Oh dear again! PubMed gives just that first reference from that first search. For an excellent summary of so-called “homeopathic vaccines” you could do worse than read this. Just deluded nonsense.

Oh Steve! You made claims without any supporting scientific evidence. My comment was therefore totally justified.

On to Scrutton’s next moan, about how I called him out for promoting homeopathy “remedies” for psoriasis, an unpleasant skin disease than can be painful and disfiguring. I said, apparently (probably!) that his claims of benefit for the remedies “…..are all equally useless identical sugar pill placebos”. A PubMed search yields a pretty poor – but still better than for tetanus – 16 results. None are randomised controlled trials. Not a good start. Some of the list are about a variety of  chronic skin conditions, including psoriasis, but with very small numbers – certainly nowhere near enough to ascribe any benefit to any homeopathic “remedy”. The only paper with a half-decent is “Homeopathic treatment of patients with psoriasis–a prospective observational study with 2 years follow-up”. The abstract is available via PubMed. Just 82 patients in an observational trial treated by 45 different “physicians”. Does this constitute evidence of benefit? Err, no. It’s a small observational study where much of the claimed improvement could easily be due to regression to the mean. A letter published in the October edition was not exactly complimentary – sadly, I can’t link to it as it’s a pay-to-view journal, but if you have access you can find it from http://www.ncbi.nlm.nih.gov/pubmed/19682178    A Google search yields just links to various homeopathy-promoting websites.

Oh dear again, Steve! Again, there is no published scientific evidence to support the claims you made. My comment was therefore totally justified.

Next up, Steve objects to me commenting that his claims of benefit for using homeopathy to treat mustard gas exposure are “Utterly deluded nonsense”. Scrutton would appear to be referring to experiments conducted by the British Homeopathic Society for the Ministry of Home Security in 1941-42. Mustard gas was – and still is – an agent used as a chemical weapon in World War 1. It is highly toxic. In the past few weeks, it has been reported in the media that it is being used in the Syrian conflict. Technically, its use for war was banned under the terms of the 1925 Geneva Protocol. After WW1, chemists were able to investigate the biological effects on mustard gas and by manipulating its structure, they synthesised the very first cancer chemotherapy agent. It’s transformation from an agent designed to kill and maim to one of therapy is documented here by Cancer Research UK. That’s not to say that these drugs aren’t still toxic, but great progress has been made in cancer care ever since.

Fearing a repeat of the horrible effects of mustard gas chemical attack, British Government scientists were keen to develop antidotes as World War 2 began. One group they asked to see if they could help was the British Homeopathic Society. They initially said that there was no evidence of benefit from “homeopathic mustard gas potencies” but that a few homeopaths were calling for such preparations to be made for use in the event of mustard gas attack. They proposed that trials were undertaken. Trials were undertaken in Glasgow, but were inconclusive. A second set of trials in London was initially reported as showing some benefit for the homeopathic preparation. However, the results were rejected by the Ministry. This appears to be despite a reasonable study design.The results of both sets of trials were reanalysed in 1982, but the results were not published in any meaningful format. The authors of the reanalysis concluded that the Glasgow results were more likely to have shown benefit for the homeopathic preparation, but that the London trials were not analysed using appropriate statistical tests. The trials are documented here by the James Lind Library and re-published in the Journal of the Royal Society of Medicine. What we have here, then, is a mixed bag. A Google search only produces a list of websites, blogs and comments by homeopaths linking to the same set of studies. Is there any further evidence one way or the other? A PubMed search yields just two results. Unsurprisingly, they are the same as before – theJournal of the Royal Society of Medicine article and an article in “Homeopathy” about the same experiments. Despite this total lack of any further evidence, homeopaths commonly recommend homeopathic mustard gas as a remedy. I wonder where they obtain the mother tincture from?

So, the evidence of benefit for homeopathic mustard gas? Basically, none. All we have is a couple of trials from the early 1940s which were inconclusive and nothing since. Oh dear, Steve! In calling your claims of benefit for homeopathy in treating mustard gas exposure “utterly deluded nonsense”, it would seem from the evidence that I’m right.

Not going too well, is it Steve?

Next up, and finally, Scrutton goes off the deep end about my support for vaccination and my view that getting vaccinated is a civic duty to bolster herd (community) immunity. It does seem that most homeopaths are part of the anti-vaccine crowd of fools and that Steve is deep into the delusion that vaccines are dangerous and don’t work. It is true, of course, that vaccines are not 100% effective or reliable, but generally they improve the odds of not catching a fatal disease by several orders of magnitude. This also emphasises the need for herd immunity so that those who cannot safely be vaccinated or those in whom a vaccine may not be effective are still protected by the disease being kept at extremely low prevalences or even totally eradicated (smallpox). Last year, the influenza vaccine was, quite frankly, not great, being only about 34% effective. Influenza viruses are tricky, devious little so and so’s. Work is ongoing to developing a universal influenza vaccine, but it’s not yet approaching clinical use. Last year’s vaccine was rendered less effective than desired due to viral genetic drift. Vaccines can have adverse reactions, but these are mostly mild and transient. Severe, long-lasting reactions are extremely rare. Most are due to anaphylaxis to vaccine components. In the USA, a database of adverse reaction reports is collated in the Vaccine Adverse Event Reporting System (VAERS). The existence of this database is frequently pounced upon by anti-vaxxers as evidence of harm from vaccines. However, this is simply not the case. While it has helped identify a number of serious adverse reactions to vaccines, the overwhelming majority of reports are either of the mild variety described earlier or are not related causally to the administration of a particular vaccine.

The biggest scandal in the field of vaccination was, of course, the work of no-longer-a-doctor Andrew Wakefield who claimed that his research showed a link between the administration of the MMR vaccine and the development of autism. This work has been subsequently discredited and the Lancet paper retracted. Subsequently it was shown by an investigation conducted by Brian Deer that Wakefield’s work was fraudulent. As a result of this, Wakefield was struck off the General Medical Council register in 2010. Despite saying he would appeal against this ruling, he never did. He also made several unsuccessful attempts to sue Deer and others.

Scrutton claims that the diseases prevented by vaccines are not preventable by vaccines. Oh really? The evidence conclusively shows that Scrutton is wrong. Next he claims that the diseases vaccinated against are not dangerous and are not life-threatening. Oh really, again? Where do I start with this depth of ignorance? Vaccination has eradicated smallpox. Smallpox used to kill and maim. So, not that dangerous at all – if you ignore the 30% death rate. Measles can kill and maim. This year saw the first recorded measles death in the USA since 2000.  A particularly nasty complication is subacute sclerosing panencephalitis (SSPE). I could go on and on, but even just with these two vaccine-preventable diseases, it can be conclusively shown that Scrutton is utterly clueless and factually wrong. Finally Scrutton claims that there’s no such thing as herd immunity because vaccinated people have gone on to contract the disease which they were vaccinated against. Steve’s ignorance is manifold. As already stated, vaccines are not 100% effective and many are not long-lasting in benefit. An excellent summary is provided here from New Zealand. Scrutton states that herd immunity is only good for the profits of pharmaceutical companies so they can sell more vaccines. Laughable! Let’s look at what “herd immunity” is. Rather than me try to explain it, let’s look at what real scientists (i.e. not a homeopath) say what herd immunity is and how it works. From the Oxford Vaccine Group Vaccine Knowledge Project. From the World Health Organisation.  From Dr. Rachel Dunlop, Post-doctoral fellow in cell biology at the University of Technology, Sydney, Australia (linking to this other article here) – notice how she debunks other myths about vaccines typically spread by anti-vaxxers. Here’s another description by the National Institute of Allergy and Infectious Diseases, part of the USA’s National Institutes of Health.

 

Once again, it seems that the evidence is conclusively showing Scrutton’s assertions to be wrong. Of course, there are people who should not be vaccinated at a particular time of their life or indeed ever. It is these people who benefit most from herd immunity! So, when I said that vaccination gives freedom against preventable, dangerous, life-threatening diseases, the evidence shows that this statement is backed up by overwhelming scientific evidence. As for herd immunity being a civic duty, then yes, I believe that it is a civic duty to be vaccinated if possible, in the same way that you have a civic duty not to drive when under the influence of alcohol or other drugs that affect your ability to drive competently and safely.

Scrutton ends this rant by claiming that I am abusing people who choose not to use “conventional” (as in real, proven, effective) medicines, opting instead for various forms of quackery. Wrong again, Steve. I point out factual inaccuracies in the claims made by people who promote those various forms of quackery. I provide links to the scientific evidence. I ask people making such claims to provide the evidence that supports their claims. When they provide what they think is evidence of benefit to support their claims, I debunk it.

I really don’t care if you think that this is abuse. Asking you to back up the claims you make is not abuse. The Advertising Standards Authority and the Committees of Advertising Practice work on the principles that advertisements must be legal, decent, honest and truthful – but I’m sure you know all about this, don’t you? And there’s more here. In fact, the CAP use you as an example of how not to advertise.

Ranting against those calling you out for promoting misinformation does appear to be a nasty habit of yours. Particularly, it seems, you dislike the ASA. The ASA dislikes people making claims that can’t be backed by evidence – like you, for example.

 

 

 

https://twitter.com/stevescrutton/status/639391429018714112

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