This post needs a bit of a background. A few weeks ago we noted that the Dean of Pharmacy at the University of Toronto was organizing a trial on using homeopathic preparations for the treatment of ADHD. A letter to the Dean asking how a Faculty of Pharmacy would get involved in studying something that is dismissed by the vast majority of the scientific community seemed appropriate. Eventually this letter was signed by more than ninety scientists and physicians and was sent off. There was no reply. In our view, not only is this a waste of funds, it adds an aura of respectability to a scientifically bankrupt notion. This is especially disturbing now in face of the measles outbreak since the private clinic where the study is to be carried out is a supporter of “nosodes,” the homeopathic “alternative” to vaccination. The original letter sent to Dr. Boon is reproduced below the following opinion piece that appeared in the Montreal Gazette.
Academic Freedom Comes With Academic Responsibility
Academic freedom is sacrosanct in universities. Researchers must be free to pursue their ideas, be they conventional or peculiar. But academic freedom also includes the freedom of others to question those ideas, and scholastic consideration dictates that those questions be addressed, especially when they are posed in a courteous letter signed by ninety scientists and physicians from around the world, including two Nobel Laureates.
The letter in question was sent to Dr. Heather Boon, Dean of the Leslie Dan Faculty of Pharmacy at the University of Toronto and focused on a study she was organizing to investigate the use of homeopathic preparations in the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in children. Those of us who signed the letter, along with the vast majority of the scientific community, believe that numerous studies have concluded that the effects of homeopathy do not extend beyond a placebo response. The letter sought Dr. Boon’s views on why a Faculty of Pharmacy was organizing a trial that legitimizes homeopathy, a practice that has no scientific plausibility.
Homeopathy is not an umbrella term for alternative modalities. It is a very specific practice that originated before the dawn of the scientific era when little was known about disease or chemistry. Samuel Hahnemann, a well-meaning German physician, concluded that a substance that causes symptoms in a healthy person cures those symptoms in a sick person if it is sufficiently diluted. His process involved thumping the solution into a leather pillow between dilutions, and finally using a drop to impregnate a sugar tablet that would then serve as a “homeopathic medicine,” the term deriving from the Latin for “similar” and “disease.”
Hahnemann could not have realized at the time that the final solution did not contain a single molecule of the original substance. Today, homeopaths have to contend with chemical knowledge and have proposed that the curative effects are to be explained by the sequential dilutions leaving an imprint on the solution, although they appear to be at a loss to explain how such an image is transferred to a sugar pill or how a molecular ghost can have healing properties.
Stymied by the implausibility of nonexistent molecules having therapeutic potential, homeopaths point to papers in the scientific literature demonstrating a larger than placebo effect, as well as to the millions around the world who use homeopathy with satisfaction. Neither of these is surprising. Toss a hundred coins into the air and count heads and tails. Maybe 45 heads, 55 tails. Maybe 48 tails 52 heads. But do this a hundred times, and one event may come out 30 heads and 70 tails. If this is the only one reported, the impression would be that the coins were not fairly weighted. So it is with studies of homeopathy. Just by chance alone, some results will indicate efficacy. That’s why we look at all the studies and come to the conclusion that we are looking at a placebo response, which of course is valuable and should not be dismissed. Indeed, couple the placebo response with the fact that homeopathic treatments are administered by caring people who spend a lot more time with patients than physicians can, and that they mostly target self-limiting conditions or diseases that have their ups and downs, and you have a formula for satisfaction.
ADHD is a serious condition that merits serious research. Apparently the University of Toronto researchers carried out a pilot study involving homeopathy that seemed to indicate benefit. That study, however, was unblinded, devoid of randomization, had no control group and relied on a subjective outcome, making any data derived from it essentially meaningless. Even if we were to attach some importance to the claimed reduction of symptoms, the effect was about half of that seen with conventional medication, making the homeopathic treatment clearly inferior. Furthermore the proposed study would use individualized treatments for each subject as determined by a homeopathic consultation, so at best the results would be ambiguous in terms of making any recommendation.
The study is actually to be carried out at the Riverdale Homeopathic Clinic, a private institution that also offers ear candling, cranial sacral therapy and “nosodes,” which are homeopathic versions of vaccines. No public funding is involved; support comes from a foundation dedicated to alternative medicine. Nevertheless, one wonders why with various nutritional and biofeedback treatments with significant potential for helping with ADHD needing exploration, a scientifically insolvent notion is being pursued. One also wonders why a Dean of Pharmacy at a major Canadian Institution did not take the time to respond directly to repeated requests for her comments on a contrary opinion expressed by a large number of notable scientists and physicians.
Dear Dr. Boon
The following originates from the McGill University Office for Science and Society and has been signed by scientists and physicians from the international community. We are all devoted advocates of academic freedom and support the right of researchers to pursue any field of study they feel has merit. But we also feel that it is fair to ask colleagues questions about how a particular study they are engaged in may contribute to the bank of scientific knowledge. It should be emphatically stated that those who have added their name to this letter, including two Nobel Laureates, in no way wish to interfere with your research. Everyone is just interested in your response to the concerns expressed here.
Those concerns deal with the trial we understand you are organizing to investigate a homeopathic approach to the treatment of ADHD. First, let us point out that the McGill Office for Science and Society accepts no funds from any vested interest; our only allegiance is to the scientific method and to evidence-based science. It makes no difference to us whether any substance, including homeopathic products, is regulated or not, as long as the decision is arrived at through proper scientific evaluation rather than emotion, “they say” or pressure from vested interests.
Along with the majority of scientists, we find the notion of nonexistent molecules having a physiological effect through leaving some ghostly impression in water that is then transferable to a sugar pill simply untenable. Even if some sort of “memory” effect prevailed, there is no reasonable explanation for how it could affect biology. Furthermore, after all the sequential dilutions and succussions, the original impurities in the solvent would be more extensively present in the final solution than any component from the original homeopathic source. After evaluating the scientific literature, including a comparison of 110 homeopathic studies with 110 conventional studies for a number of disorders and outcomes, the most likely conclusion is that any benefit attributed to homeopathy can be ascribed to a placebo response.
Generally, scientists look askance at homeopathy, but don’t bother much with it because they consider it to be harmless folly. Unfortunately, this is not the case when homeopaths recommend “nosodes” as alternatives to vaccination, or attack the use of antibiotics for infections, or offer unproven treatments for ADHD.
The reason for this extensive email is to solicit your rationale, given your training as a pharmacist, for the study you are carrying out. Is the motivation a concern that parents are wasting money and possibly sacrificing effective treatment by resorting to homeopathy for ADHD, and that the study may clarify the situation? Or is there a belief that there may be some factor other than a placebo response involved? In that case, what mechanism may be operative?
You allude to the results of a pilot study that warranted this further research. That study, however, was unblinded, devoid of randomization, had no control group and relied on a subjective outcome, making any data derived from it highly questionable. You also note that the reduction of symptoms found in the pilot study was about half of that seen with conventional medication, making the homeopathic treatment clearly inferior.
Basically, as you have gathered, we are curious about why, given the need to investigate natural therapies that may actually have a potential for benefit, and faced with a scarcity in funding, a Department of Pharmacy is interested in investigating a subject that has been addressed extensively in the literature and has been found wanting both in evidence and plausibility. There is also a concern that just the mounting of such a study by a highly reputable researcher at a top notch university will be used by homeopaths to justify diverse aspects of their practice, including steering patients away from evidence-based treatments.
Looking forward to your comments,