Tauranga homeopath Clive Stuart has had part of his complaint against an article on homeopathy (Homeopathy – Trick or Treatment?) published in the July 2012 edition of North & South, upheld by the Press Complaints Commission (PCC)*. While the PCC did not agree with his complaint that balance needed to be numerically equivalent (there were quotes from two people critical of homeopathy and one defending) or that his letter to the editor should not have been accompanied by a response from a critic of homeopathy (Dr Shaun Holt), they did uphold his complaint that the article was wrong to say that “homeopathic remedies have failed every randomised, evidence-based scientific study seeking to verify their claims of healing powers”.

The article title is a reference to the excellent book ‘Trick or Treatment? Alternative Medicine on Trial’ by Dr Simon Singh and Prof Edzard Ernst. Prof Ernst is a doctor and former homeopath who was the world’s first professor of complementary medicine, at the University of Exeter. This is what they conclude about homeopathy:

“Hundreds of trials have failed to deliver significant or convincing evidence to support the use of homeopathy for the treatment of any particular ailment. On the contrary, it would be fair to say that there is a mountain of evidence to suggest that homeopathic remedies simply do not work. This should not be such a surprising conclusion when we recall that they typically do not contain a single molecule of any active ingredient.”

But lets not take their word for it. In 2009-2010 the UK House of Commons Science and Technology Committee performed an ‘evidence check‘ on homeopathy, calling defenders and critics alike to present the evidence for and against homeopathy. Their conclusion:

“…the evidence base shows that homeopathy is not efficacious (that is, it does not work beyond the placebo effect) and that explanations for why homeopathy would work are scientifically implausible.”

It would seem from these that the scientific evidence points to homeopathy having no effect beyond placebo, when evaluated using methodologically sound protocols by people without a vested interest in homeopathy. However, the PCC:

“found the article inaccurate in so far as the state of scientific research into homeopathy is not
as conclusive as North & South had suggested.”

If only the article had included the words ‘well-designed’ in that sentence. What a difference a couple of little words would have made. There is certainly an important lesson for journalists in this debacle.

It is interesting to read in the judgement* how the PCC came to their conclusion. They seem to have been swayed by a 7 page letter from a Dr David St George. We’ll get to who he is in a moment. This is what the PCC say:

Dr St George believed the statement in North & South’s article arose from a misunderstanding of the Lancet study, which had compared 110 published placebo-controlled trials of homeopathy with the same number of published placebo-controlled trials of conventional medical drug treatments. He said most of the 110 homeopathy trials in that study were “randomised, evidence-based scientific studies” which demonstrated an effect beyond a placebo effect.

Actually the Lancet study Dr St George is quoting concluded “Biases are present in placebo-controlled trials of both homoeopathy and conventional medicine. When account was taken for these biases in the analysis, there was weak evidence for a specific effect of homoeopathic remedies, but strong evidence for specific effects of conventional interventions. This finding is compatible with the notion that the clinical effects of homoeopathy are placebo effects.”

Two disturbing things come to light from this case. The first is that the PCC breached its own rules by accepting Dr St George’s letter which was the third submission in this case (two submissions are allowed by both sides) so it will be interesting to see why this was allowed. The second is finding out who Dr David St George is and what he does for a living. Dr St George has a medical degree from the University of Auckland and a degree in epidemiology from McGill University in Montreal, Canada. He worked as a consultant clinical epidemiologist at the Royal Free Hospital in London and then as Director of Research and Clinical Effectiveness at Southampton University Hospital. He was also the first Director of Research at the Foundation for Integrated Health, a controversial charity founded in 1993 by the Prince of Wales to promote alternative and complementary medicine, lobbying for its inclusion in the UK’s National Health Service. The charity closed in 2010 after it’s finance director, accountant George Gray, was convicted of theft and sentenced to three years in prison. It is unclear what research, if any, the Foundation undertook.

Dr St George’s other ‘achievements’ include helping Middlesex University set up an undergraduate degree in traditional Chinese medicine**, being research committee chairman of the (now defunct) Scottish School of Herbal Medicine and a former member of the British Acupuncture Accreditation Board***. But now he is back in New Zealand and working for the NZ Ministry of Health as ‘Chief Advisor – Integrative Care’. I wonder if this swayed the PCC at all into accepting his unorthodox, rather lengthy and over technical submission. This is what it says on the Ministry’s website about Dr St George’s role:

Dr David St George’s role is to provide professional leadership, direction and advice on complementary and alternative medicine (CAM), and on the integration of CAM with conventional health care, particularly in the area of primary care and chronic care conditions.

Oh dear. I think we need to find out exactly what ‘direction and advice’ Dr St George has been giving to the Ministry for Health. Because by his submission to the PCC I’m not entirely confident it will be based on unbiased methodologically sound scientific evidence. Dr Prue Williams, General Manager of Science Investments for the Ministry of Business, Innovation and Employment, announced at the recent NZ Association of Scientists annual meeting in Wellington that there are plans for all ministries to have scientific advisors in place. I suggest whoever is appointed for the Ministry of Health starts by looking into Dr David St George.

*It’s case 2320, the judgement for which isn’t up on the PCC website yet.

[Update: 14:20 on 16/04/2013 - judgement now available online here]

***On the subject of Traditional Chinese Medicine (TCM) Singh and Ernst conclude: “Some elements may be effective for some conditions, while others (e.g. cupping) are unlikely to offer any benefit above placebo. Many aspects of TCM are potentially harmful. Some individual herbs used in TCM (e.g. liquorice, giner, ginko) undoubtedly have pharmacological effects.. On the other hand, some.. are toxic … may also contain non-herbal ingredients (e.g. endangered animals), contaminants (e.g. heavy metals) or adulterants (e.g. steroids).”

***On the subject of acupuncture Singh and Ernst conclude: “..there is no evidence at all to demonstrate the existence of Ch’i or meridians [the basis for acupuncture points]. There are some high-quality trials that support the use of acupuncture for some types of pain and nausea, but there are also high-quality trials that contradict this conclusion. In short, the evidence is neither consistent nor convincing – it is borderline.”

Shang A, Huwiler-Müntener K, Nartey L, Jüni P, Dörig S, Sterne JA, Pewsner D, Egger M (2005). Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet 366(9487):726-32.