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Prof. Robert Hahn: My Scientific Article on Homeopathy
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Published: 15 September 2015
Picture: Professor Robert Hahn
For Dr. Helmut B. Retzek's very succinct version of Professor Hahn's article, (translated from German), with opening commentary by the bloggers, please click here!
http://fighting-for-homeopathy.blogspot.com/2015/09/did-professor-ernst-sell-his-soul-to.html
http://safe-medicine.blogspot.co.uk/2015/09/the-contribution-of-professor-edzard.html
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This translation is provided for information purposes only. The Swedish text
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My Scientific Article on Homeopathy
By Professor Robert Hahn
Professor Robert Hahn is a leading medical scientist, physician, andProfessor of Anaesthesia and Intensive Careat the University of Linköping, Sweden. http://www.roberthahn.se/RobertHahn.htm
Original Article in Swedish here:
http://roberthahn.nu/2014/01/05/min-vetenskapliga-artikel-om-homeopati/
(Translated from the Swedish)
Robert Hahn has summed up the meta-analyses comparing homeopathy with placebo in a scientific article published in tidksriften Forschende Komplementärmedizin in October 2013. Robert discusses the background in his article, which essentially builds on three previous blogs.
Almost 3 years ago the association Science and Adult education (VoF) ran a summer campaign against homeopathy. During the political week in Almedalen, there was a bunch of guys in their late teens wearing T-shirts with the text "I am a skeptic" sent by VoF. They ended up on the TV along with astronaut Christer Fuglesang, who one evening was free to argue against homeopathy. It was described as a sham and a racket. The guys said one after the other, that there is not a single scientific study that shows that homeopathy works.
I wondered how these young guys could know this and have the ability and knowledge sufficient to read and evaluate the literature? Absolutely not, was my conclusion. To read and evaluate this literature is actually complicated and requires that you yourself are working professionally within medical science. The boys of course, had been told by older members of VoF to say that. They served as an advertisement for something they neither understood nor were able to evaluate its power. They trusted the people who claimed to serve and represent public education and science in order to, with their own name, publicly represent the approach that they obtained to accept as self-evident in science.
Is there evidence for homeopathy?
This depressing fact led me to blog about existing evidence behind homeopathy. My three blogs on the subject in the late summer of 2011 attracted enormous attention. The goal was to go through the scientific articles that ask whether homeopathy is a statistically more effective treatment than placebo (sugar pill, etc.) for medical illnesses.
The attention surrounding these blogs had the effect that I was invited to summarise them and publish in an international medical journal.It was published in October 2013 under the title of
Homeopathy: Meta-Analyses of Pooled Clinical Data in the journal
Forschende Komplementärmedizin (2013; 20: 376-381). If you want an overview of my other more than 300 scientific articles you can turn on
this link. This is my single text on homeopathy and alternative medicine, but I think it fills a role.
Unfortunately, I cannot publish my whole article on homeopathy on the Internet, as science journals are commercial companies that have copyright on their products. You can read the abstract in
PubMed. I add links to my previous blogs, where the essence is clear
Blogg 1,
Blogg 2,
Blogg 3)
(
Blog 1,
Blog 2,
Blog 3) but I also summarise my views below.
Systematic reviews and meta-analyses
The starting point of the article is the change in the approach to the evaluation of medical treatments that took place in the mid-1990s. It had previously been academic. In other words, one should understand the mechanism behind why a treatment works to accept it. The criterion created problems. Lots of treatments are used in hospitals of which the mechanism is still unknown. Nitrous oxide, commonly used during childbirth, is one such example.
Medicine turned now to the practical concept of being evidence-based, which meant that it collates all the literature that range from systematic reviews or meta-analyses. The question asked was: Does the treatment work or not? A meta-analysis is typically used to summarise all scientific studies in which patients have been randomly assigned to receive a study drug (in this case, homeopathy) or placebo (control). Statistical calculations are then used to examine whether intake of the the study drug is associated with statistically better or faster healing of the disease compared to placebo. How much better is indicated by an odds ratio, where "better than placebo," is indicated by a figure greater than 1.0. The improvement is statistically significant (the risk is less than 5% of the improvement that can be explained by chance) if the reported confidence interval (CI) does not include 1.0.
The reader should be cautioned that the mechanism for a curative effect is no longer in focus. It is enough that the treatment works.
Linde articles
Klaus Linde's meta-analysis from 1997 (Reference 1) is the first and most honestly written. Linde found an odds ratio of 2.45 and a CI of 2.05-2.93. Thus a very clear effect in favour of homeopathy versus placebo based on 89 eligible studies. Here you can follow the selection of articles and there is a reasonable balance between the number of included studies and the opportunity to demonstrate effects of statistics. Interestingly, Linde attached a map of how effective homeopathy is in various disease states. To me it seemed clear that homeopathy exerts its effect mainly in milder diseases of the immune system (allergies, hay fever, etc.).
Linde's study was followed by a counter-current of articles that apparently sought to invalidate the results. The first criticism concerned the study quality, which can be grouped as a Jadad score.When it did so with Linde's 89 studies, there was a trend of studies with lower Jadad score which showed stronger effect. Linde showed that the positive effect again increased at the highest Jadad score (Reference 2).
Edzard Ernst
That argument was not approved by the anti-alternative medicine activist Edzard Ernst who drew a line between all Jadad scores, excluding the highest and calculated the effect of the best studies theoretically (Reference 3). In my view, this is crazy, because it will replace the real data with virtual (theoretical) data.
Ernst wrote in 2002 about an alleged meta-analysis of homeopathy, but it is actually a systematic overview (Reference 4). I confided in my article several peculiarities in this overview. Ernst, for example, disallowed articles that demonstrated specific effects of disease, while in other cases blaming homeopathy for not showing specific effects. I have never encountered any science writer who is so clearly biased (partial) as Edzard Ernst.
Cucherat's "Type II error"
Cucherat (Reference 5) is a fundamentally honest writer who strove greatly to finally reject homeopathy as a treatment method. Conventional meta-analytical statistics were not used, but he chose instead the 5 methods most unfavorable to homeopathy. Cucherat used a technology that Edzard Ernst in many studies utilised to the fullest, namely to remove all the material with reference to a quality factor. For homeopathy it is not sufficient to remove 90% of all the documentation, as the treatment is still superior to placebo.
However, statistical superiority cannot be demonstrated if one removes 95-98% of all performed studies. Therefore, that is what Cucherat did. One can say that the author deliberately create a "Type II error". I am critical of several reasons Cucherat rejected studies. Marginal details should not render exclusion.
Cucherat first removed 101 of the total of 118 studies in the material. Still, homeopathy is highly effective, with a risk of less than 3.6 at 100 000 for the difference to placebo to be explained by chance. When he strips away even more, and 9 of the best studies remain, has homeopathy still a statistically significant effect?
By removal of another 4 studies, Cucherat has created a situation where the risk is 8.2 out of 100, so that the difference between homeopathy and placebo could be explained by chance. The conclusion? Cucherat argues that homeopathy has no effect.
I think Cucherat is a coward. At the risk of disturbing his career and being at loggerheads with organisations like VoF, he simply did not dare publish what his material actually showed. He deliberately created a Type II error by ignoring more than 96% of the studies he initially identified as good enough at meta-analysis.
Shang selection was equally crazy
The next meta-analysis is authored by Shang et al.and published in 2005 (Reference 6). Here you have, just like Cucherat, 96% of all studies removed, but, unfortunately, without clearly explained reasons. The odds ratio had been turned upside down, so that despite all the exclusions, it shows that homeopathy is 13% better than placebo, but one could believe that it is 13% worse. Shang had also used a so-called "funnel plot", which is inappropriate and non-scientific when mixing different diseases. The reason is that studies with high expectation of efficacy (here, for example, hay fever) often include fewer patients than those with low expectations of the impact. This is a widely accepted ethical standard. I must also interpose that writers around Shang several years previously published a very negative article on homeopathy, which makes me doubt the group's starting point was objective.
Thus ends my review. Above mentioned are the 6 key articles, but my overview of
Forschende Komplementärmedizin contains a total of 22 references. There is more to say, but everything will not fit here. Those who want to read the entire article must unfortunately buy it online (which costs maybe £5).
Evidence and faith
I believe nothing. It is not my task, nor of practical interest, as I do not myself work within homeopathy. What interests me is to tell you about tendentious and biased scientists, not objective in the way that you (and everyone else) think, when they wave their professor titles to give legitimacy to personal beliefs. There are those who entice unsuspecting young people to join their ideological causes. So I do not like this, and it is opposed to my mission.
However, I must admit that I am critical of the base used in these quoted studies that evaluate the question of homeopathy as a better treatment than placebo. The answer will be confused by the effectiveness in diseases where homeopathy is superior to placebo, with the lack of effectiveness in diseases where homeopathy is not superior.To bring the issue forward one should instead be focused on specific diseases. Linde already pointed out that issue in his 1997 article.
Instead of increasing the knowledge of the effects of homeopathy for various diseases, there has been an ideological battle surrounding the principle of whether homeopathy works at all in any disease. My review has shown clearly that the academics who tried to disprove that homeopathy works, really tried to succeed.
Scientists strongly influenced by ideology
Who can you trust? We can begin to weed out Edzard Ernst. I have read some other studies that he published, and they are not serious. In my opinion his works should be abandoned. Both Cucherat and Shang have deliberately created the Type II error by ignoring almost all published studies that actually exist. The reason? Well, if they had included only a few more studies in their analyses, and excluded only 90% of the published studies, homeopathy would have emerged to be more effective than placebo.
I assume that the authors played around a lot with their exclusions to get the result from the start and decided their findings, namely that homeopathy has no effect. The mathematical game does not appear serious b
ut through it they have saved their academic careers and are still welcomed. They do not get ridiculed and persecuted by organisations such as VoF and get the dunce's cap on their heads. I have been fascinated that the academic world is so greatly influenced by ideology. In the case of homeopathy, it is obvious that one should stick to what evidence the evaluation gives. And it says that homeopathy has no effect, but only if you remove 95-98% of the studies that should be evaluated and use completely unsuitable models, such as funnel plots for a mixture of different diseases.
Academics' reactionsI will give three examples of academically trained people's reactions to homeopathy in general and my work after this evidence evaluation.
A colleague commented to me on Facebook. He said he was surprised that I was interested in homeopathy when I was otherwise so scientific. Taboo subject! Evidence-valuation in this area must not work, if you want to be a good and serious scientist. This type of fear should not play any part in science. But now the fear is there, and it's very real.
Another example is the use of derogatory expressions to suppress all sensible exchange of opinions on the issue. Karolinska Institute's Professor of complementary medicine supported VoF's summer campaign against homeopathy in 2011 by the media and explained that homeopaths are charlatans who engage in deception.
A third example is that one simply begins to lie. In my article in
Forschende Komplementärmedizin I mention Dan Larhammar's article (with several participants) in the Swedish newspaper
Svenska Dagbladet during the summer campaign in 2011 (though without mentioning him by name). Larhammar said that homeopathy is a scientific absurdity (which is correct). But he also wrote that science held that homeopathy has no effect and referred to only two articles that summarise the research situation. The two articles are, according Larhammar, those written by Shang and Ernst. There are of course many more. If we read all 6 articles, it becomes clear that these two papers are unequivocally the most negative towards homeopathy. They both have unfortunately used questionable methods to arrive at that conclusion. Larhammar has thus given a selection of literature in order to fit his message.
As an honest scientist, I have made an appraisal of all the articles I have described here. The picture then became clear that it is not unequivocally established that homeopathy is a "fake medicine". An evidence score shows precisely the opposite. It is abusing their position, for professors to let ideology control the scientific message.
Dan Larhammar is a specialist in everything
It is mainly Dan Larhammar, VoF's former president, who created the campaign against homeopathy. He has done this many times. I am personally convinced that Larhammar is the main brain behind the VoF summer campaign in 2011.
Within VoF's sphere you need neither training nor experience to be a specialist in all areas. In the Daily News (5/1/2014) it emerges Dan Larhammar is an expert in basic education. He, along with others from the Academy of Sciences have analysed and understood what had gone wrong in school. A few years ago, he appeared in the Daily News as an expert on autism spectrum disorders. In the book Science or Error (Leopard Publishers 2005), he appears as an expert on neurokognition. In fact, Dan Larthammar is a pharmacist and conducts basic research on fish. He lacks expertise in most areas in which he appears as
a specialist.
.">It reminds me of Ludwig Von Drake, a figure as a child I read about in
Disney´s Comic Magazine. He was also an expert on everything.Omnipotence is a heavy burden to bear.
References1. Linde K, Clausius N, Ramirez G, Melchart D, Eitel F, Hedges LV, Jonas WB.
Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet 1997; 350: 834-43.
2. Linde K, Scholz M, Ramirez G, Clausius N, Melcart D, Jonas WB.
Impact of study quality on outcome in placebo-controlled trials of homeopathy.J Clin Epidemiol 1999; 52: 631-6.
3. Ernst E, Pittler MH.
Re-analysis of previous meta-analysis of clinical trials of homeopathy.J Clin Epidemiol 2000; 53: 1188th.
4. Ernst E.
A systematic review of systematic reviews of homeopathy. Br J Clin Pharmacol 2002; 54: 577-82.
5. Cucherat M, Haugh MV, Gooch M, Boissel J-P.
Evidence for clinical efficacy of homeopathy. A meta-analysis of clinical trials. Eur J Clin Pharmacol 2000; 56: 27-33.
6. Shang A, Huwiler-Münterer K, Nartey L, June P Dörig S, Sterne JA, Egger M.
Are the clinical effects of homeopathy placebo effects? Comparative study of placebo-controlled trials of homeopathy and allopathy Lancet 2005; 366: 726-32.
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http://roberthahn.nu/2014/01/05/min-vetenskapliga-artikel-om-homeopati/
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