What do three positives in a row mean?
Here is an interesting paper documenting Dr. Reilly’s research on homeopathy. He performed a study three times because he thought each previous result to be tarnished in some way. Turns out that with this approach the authors concluded: “Either homeopathy works or controlled clinical trials do not.” Read the details about the study, sorry, the three studies, below.
David Reilly, M.D of Glasgow Medical University was elected to the Royal College of Physicians and surgeons, one of Britain’s highest medical honors.
He became interested in hypnosis and inner mind work, but had to put it aside until he describes reaching a crisis point. He says his first water in the desert was through the British Society of medical and dental hypnosis where he took some postgraduate courses. He was thrilled to bring together in a systematic way, some of the ideas that he had previously studied and spontaneously applied with his patients.
He sees an ad for a position of registrar at the Glasgow homeopathic hospital and applies for it knowing very little about homeopathy. He says he has no confidence in the dilutions, but he was very interested in the system of care.
He liked the feeling of the hospital. There was an open-minded feeling about the hospital. The doctors seemed more “flexible” there.
He believed that to shift a culture’s medical views he would have to publish research in the most prestigious journal.
He chose to study the treatment of hay fever and pollen, because most people understood that you can give pollen shots to combat pollen allergies. The only new concept was the one of the dilution. He designed the study with the input of his most skeptical colleagues, because he thought it important to consult your enemies rather than your best friends and try to understand where they’re coming from.
When the pilot study worked, he confesses he was shocked. He had believed all along that the dilutions were merely placebo. When it came out positive, his gut feeling was, “this has got to be a mistake”. They submitted the pilot study to the Lancet (it was rejected) so they took on criticisms from every forum they could gather, incorporated some changes and re-ran the study, but made it 5 times bigger. They took drastic measures to protect the study from fraud, hired a neutral statistician. The results again were positive. They re-submitted it and it was published in The Lancet.
Criticism started to roll in “Who cares about hay fever”? “It had nothing to do with hay fever.” (The criticism was about the research being about homeopathy!) He had now tainted his reputation as a homeopathic researcher.
Reilly then approached the head of respiratory medicine at Glasgow University and asked him if he would like to be the man who disproves homeopathy. I have the grant!
This time they studied asthma and its allergen trigger house dust-mites. This time they studied conventional patients with conventional researcher, included lab tests and histamine provocation. The remedies were made in France sent straight to the pharmacists, double blinded, who recorded them and administered them to patients.
Within 7 days of receiving the remedy, the patients showed a clinically and statistically documented drop in symptoms.
A cultural debate ensued as to wheatears the clinical trial evidence was proving sufficient to validate an unconventional therapy. A review was published after 100 trials of homeopathy, with 77% showing results in favor of the therapy. Reilly began to ask “would 200 trials be evidence would 300 trials be evidence?
What do three positives in a row mean? Either we have shown that homeopathy works and that it works more than placebo, or we’ve determined that the clinical trial doesn’t work!
Details of Reilly’s asthma study:
He was able to get around the subjective problems that arise in case taking by designing a study that used conventional allergy testing to determine what substances the subjects were most allergic to. The subjects then chosen for treatment were given the 30c potency of the substance they were sensitive to. They were then evaluated by both homeopathic doctors and conventional doctors. The study showed that 82% of the patients given a homeopathic medicine improved. Only 38 % of Placebo receivers experienced a similar degree of relief. When asked if they felt the patient received the hom. Remedy or the placebo, both the patients and the doctors tended to guess correctly.
The experiment was relatively small- 24 patients. The smaller the sample size, the larger the difference must be between those treated with medicine and those given placebo.
One interesting aspect of Reilly’s studies was the meta-analysis , reviewing the data from all three studies on allergic conditions, which totaled 202 subjects. The researchers found a similar pattern in all three studies. Improvement began in the first week and continued through the end of the trial four weeks later. The results of this meta-analysis were so substantial, (P=0.0004) that the authors concluded that either homeopathy works or controlled clinical trials do not.
The amount of scrutiny and critism that surfaces when there is a positive study about homeopathy is absurd. After the Lancet published Reilly’s third study, there was still no acknowledgement that homeopathy works, and there was even a statement that conventional medicine works better. A strange statement considering that the experiment did not test homeopathy against conventional medicine. Dana Ullman said about it, “If we proved a person could fly, they would respond: Well a jet plane can still fly higher and faster.”
Mosby’s (2004) Mosby’s Complementary & Alternative Medicine: A Research-Based Approach St. Louis pg. 384-385.
Ullman D. (1991) Discovering Homeopathy: Medicine for the 21st Century Berkeley: North Atlantic Books. pg. 55-56