Steven R. Olsen - my Pseudo-Doctor!

` I have quite a long and amusing story to tell you, so why don't I start with the beginning of the first draft, which had been written back on June 9th:

` Lou Ryan has been taking a vial of more or less plain vodka (known as a 'homeopathic remedy') for his muscular problems - which are rather serious, especially because he has a great deal of muscle mass.
` As for me, when I was an abused and vulnerable teenager, I though that homeopathy was a viable treatment until experience with alternative medicine left me suspicious. That was when I began finding evidence that maybe it doesn't work so well. In fact, I had met someone who said he had been replacing his wife's asthma remedy with plain tap water for six months and she still hadn't noticed - nor had an asthma attack!
` So, since I am now living with Lou and thus have access to his remedy, I was brazen enough to replace it with... plain vodka! I even went to the liquor store in Marysville (to ensure that nobody would recognize me) to buy it! Then at home, in front of my SpyCam, I put the remedy into a Special Purple Jar, rinsed out Lou's jar with water and coffee (he'd said that caffiene nullifies homeopathic remedies, though it turns out that's only when you drink it) and put the vodka in.
` I would have used an entirely different jar, but I didn't have one. Nevertheless, he told me that refilling the vial does not equal new remedy.
` Then, I went to the back alley and left the bottle out for a homeless person - within a few minutes it was gone. Apparently, someone took it!
` The vodka's effect looks to me as if it is as effective as the remedy. [Which resulted in this cryptic post.] He's not waking up in the middle of the night and is better able to move while teaching me karate.
` In fact, he's told me a few times; "I've barely been in any pain since I took that remedy! Like I've said, you're going to have to try homeopathy for your bodily numbness! I'm tellin' ya, they can fix anything!"

` Yes, vodka has many uses.

` Sigh....

` I just called my mom and told her what I'd done. She laughed her ass off and told me never to tell him what I'd done because people have a right to believe in whatever they want as long as it makes them feel better.
` Frankly, I think that Lou's belief is an insult to his super-skeptical ways, and so it would be something he'd notlike to believe in if only he knew.


` June 20th:

` ...I was going to post this entry in hopes that someone could give me some advice on how to tell him, but a measley week later I wound up telling him when he had said (during a debate over its effectiveness); "I don't think I'd believe you unless you'd replaced my remedy with vodka and it had the same effect."

*Blink.*

` I was so surprised I just had to tell him, and he didn't even believe me until I showed him the video! After a while, he said; "I knew something wasn't right... only one symptom has improved.... I thought it tasted funny.... Well, I don't feel any different now that you've told me, so what do you have to say for yourself?"
` Not much. I'm not good with confrontations.
` Still unable to convince me, he went on the internet and started reading all this stuff to me about how the reason why homeopathy works, even though there's virtually nothing in it, is because of the 'spirit-like energy', etc, etc.

` Goodness!

` So, later on, I found a bunch of scientific papers about homeopathy, published online for all to see. Here is a good representation of what I've found....
` A recent article in The Lancet was the first one that had been pointed out to me. Here is the abstract:

Background
Homoeopathy is widely used, but specific effects of homoeopathic remedies seem implausible. Bias in the conduct and reporting of trials is a possible explanation for positive findings of trials of both homoeopathy and conventional medicine. We analysed trials of homoeopathy and conventional medicine and estimated treatment effects in trials least likely to be affected by bias. [The PDF illustrates exactly what is meant by ‘bias’ and I see no trickery here!]

Methods
Placebo-controlled trials of homoeopathy were identified by a comprehensive literature search, which covered 19 electronic databases, reference lists of relevant papers, and contacts with experts. Trials in conventional medicine matched to homoeopathy trials for disorder and type of outcome were randomly selected from the Cochrane Controlled Trials Register (issue 1, 2003). Data were extracted in duplicate and outcomes coded so that odds ratios below 1 indicated benefit. Trials described as double-blind, with adequate randomisation, were assumed to be of higher methodological quality. Bias effects were examined in funnel plots and meta-regression models.

Findings
110 homoeopathy trials and 110 matched conventional-medicine trials were analysed. The median study size was 65 participants (range ten to 1573). 21 homoeopathy trials (19%) and nine (8%) conventional-medicine trials were of higher quality. In both groups, smaller trials and those of lower quality showed more beneficial treatment effects than larger and higher-quality trials. When the analysis was restricted to large trials of higher quality, the odds ratio was 0•88 (95% CI 0•65–1•19) for homoeopathy (eight trials) and 0•58 (0•39–0•85) for conventional medicine (six trials).

Interpretation
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.

` On my own, I've found an article at Veterinary Sciences Tomorrow if you'd like to read it. The conclusion:

The test of science is hard and merciless. Many conditions must be satisfied in order to demonstrate therapeutic effectiveness. The golden standard is the prospective randomized double-blind clinical trial. For medicine this is a formidable enough challenge; for homeopathy it appears to be insurmountable. After seven years of investigation costing more than $100 million per year [7. National Council for Alternative and Complementary Medicine (USA). ], there is still no evidence whatever that extremely diluted solutions of homeopathic substances have any effect. The actual existence of drug pictures has not been confirmed and the application of homeopathic therapy has no more effect than a placebo. With regard to the title of this article, there is but one possible conclusion: homeopathy has not withstood the test of science.

` I also found an article about such analyses worldwide in The American Council on Science and Health (January 1, 2000) called Scientific Evidence on Homeopathy by David W. Ramey:

The scientific investigations of homeopathy [see PfH, Vol. 11, No. 4, Homeopathy and Its Founder: Views of a British Researcher] that have been completed and published are sufficient for drawing reliable conclusions about this counterscientific approach to medicine. These studies have generated widely assorted positive, negative, and neutral conclusions. Therefore, it is not difficult, especially if one does not consider the quality of the evidence, to find published conclusions compatible with, or pervertible to, a particular bias. But parading pieces of evidence thus culled does the public little or no good.
Homeopathy has been the subject of at least 12 scientific reviews, including meta-analytic studies, published since the mid-1980s.
A sensible short-cut to taking on the question of whether homeopathy is effective is to examine all relevant published reports of meta-analytic studies (statistical studies of studies) and of other scientific reviews. This approach is not without drawbacks, however. In a meta-analytic study, for example, an explicit and straightforward conclusion may be based on the findings of weak (e.g., poorly designed) studies.
Homeopathy has been the subject of at least 12 scientific reviews, including meta-analytic studies, published since the mid-1980s. From reading the literature that proponents of homeopathy disseminate, one might well get the impression that the findings of these studies are somewhat open to interpretation, and that the basic question regarding the evidence amounts to: "Is the glass half empty, or half full?" But the findings are remarkably consistent:

* In a 1990 French review of 40 published randomized clinical trials of homeopathy, researchers found that most of the studies had had major methodological flaws and concluded: ". . . the results do not provide acceptable evidence that homeopathic treatments are effective."

* In a meta-analytic study of homeopathy in human medicine published in The British Medical Journal in 1991, investigators concluded: "At the moment the evidence of clinical trials is positive but not sufficient to draw definitive conclusions because most trials are of low methodological quality and because of the unknown role of publication bias. This indicates that there is a legitimate case for further evaluation of homeopathy, but only by means of well-performed trials."

* In a 1992 German review of homeopathy in human medicine, researchers concluded: ". . . The review of studies carried out according to current scientific criteria re-vealed—at best—a placebo effect of homeopathy. Until now there is no proven mechanism for the mode of action of homeopathy. Some-times so-called alternative medicine prevents effective curative measures. . . ."

* In a 1993 German review of homeopathy in veterinary medicine, researchers came to several conclusions: (a) "Doctor and veterinarian are similarly obligated to apply the therapeutic measure that prevailing opinions deem most effective. Where there is for particular definite illnesses a particularly effective and generally recognized treatment, in such cases the supporters of homeopathy may not disregard the better successes from their own differing direction." (b) "It is undisputed that homeopathy in the area of stronger potency can achieve effects pharmacologically and toxicologically; the superiority of homeopathy as a therapeutic measure in comparison with conventional therapy methods is at this point not verified. Moreover, the harmlessness of homeopathy in stronger potency is for the most part not verified." (c) "The effectiveness of homeopathy in middle and high potencies is up to now not verified. It is undisputed that with the help of homeopathy, not insignificant placebo effects can be achieved. In veterinary medicine, giving an animal an 'active' placebo and another a 'passive' can play a significant role and influence the owner."

* Every standard homeopathic preparation is a serial agitated dilution (SAD)—that is, a result of the successive ad-mixture and agitation of a substance. In a 1994 review and meta-analytic study of SADs in experimental toxicology, investigators stated: "As with clinical studies, the overall quality of toxicology research using SAD preparations is low. The majority of studies either could not be reevaluated by the reviewers or were of such low quality that their likelihood of validity is doubtful. The number of methodologically sound, independently reproduced studies is too small to make any definitive conclusions regarding the effect of SAD preparations in toxicology."

* In a 1996 French review of homeopathy, researchers made the following statements. (a) "No one should ignore the role of nonspecific factors in therapeutic efficacy, such as the natural history of a given disease and the placebo effect. Indeed, these factors can be used to therapeutic advantage." (b) "As homeopathic treatments are generally used in conditions with variable outcome or showing spontaneous recovery (hence their placebo responsiveness), these treatments are widely considered to have an effect in some patients." (c) "How-ever, despite the large number of comparative trials carried out to date there is no evidence that homeopathy is any more effective than placebo therapy given in identical conditions." (d) "We believe that homeopathic preparations should not be used to treat serious diseases when other drugs are known to be both effective and safe." (e) "Pending further evidence, homeopathy remains a form of placebo therapy."

* Of their study published in The Lancet in 1997, investigators said: "The results of our meta-analysis are not compatible with the hypothesis that the clinical effects of homeopathy are completely due to placebo. However, we found insufficient evidence from these studies that homeopathy is clearly efficacious for any single clinical condition." They further stated: "Our study has no major implications for clinical practice because we found little evidence of effectiveness of any single homeopathic approach on any single clinical condition." In conclusion the researchers stated that more research on homeopathy was in order "providing it is rigorous and systematic."
(In a later issue, a critic of the study noted that the best of the trials in question had been distinctly less likely to generate a positive finding than had the trials as a whole, and another critic indicated that preferential nonpublication of relevant studies that had generated negative findings may have skewed the findings of the meta-analytic study.)

* In another meta-analytic study conducted in 1997, researchers examined the use of homeopathy for postoperative ileus, a condition characterized principally by surgical lack of peristalsis and measured by the delay between the close of a surgical procedure and the first post-op expulsion of flatus. The investigators concluded: "[Our analyses] do not provide evidence for the use of a particular homeopathic remedy or for a combination of remedies for postoperative ileus. Several drawbacks inherent in the original studies and in the methodology of meta-analysis preclude a firm conclusion." They also noted that the effect of homeopathic preparations of not more than 12c—i.e., preparations that might contain some of the basic substance—was significant, whereas that of homeopathic preparations of more than 12c was not.

* In a review of homeopathic treatment of animals published in 1998, S. G. Wynn recommended approaching homeopathy with an "open mind." As evidence of efficacy, she cited three studies in which some improvement had been directly observed, seven studies whose data were ambiguous, and six studies in which the animals' condition had worsened or had not changed. In several of these 16 studies, the subjects had been healthy to start with. Wynn even described a study in which the condition of sick animals had worsened as possible evidence of effectiveness through induction of a "healing crisis."

* In a 1998 review of the effects of homeopathic preparations based on the herb arnica, which are typically used to treat conditions due to physical trauma, researchers concluded: "The claim that homeopathic arnica is efficacious beyond a placebo effect is not supported by rigorous clinical trials."

* In a review published in November 1999 of the use of homeopathic "remedies" to prevent headaches, E. Ernst concluded that available trial data do not suggest that homeopathy is more effective than a placebo in the prevention of migraines or other headaches.

* In a meta-analytic study published in January 2000, it was found that a homeopathic preparation for preventing colds and the flu was ineffective.

Several rigorous trials of homeopathy in human medicine have been performed in recent years. According to these randomized, placebo-controlled, double-blind trials, homeopathic "remedies" are not effective:

* in the treatment of adenoid vegetations (abnormal glandular growths) in children,
* for controlling pain and infection after a total abdominal hysterectomy, and
* for preventing migraines.

Furthermore, none of the studies that have generated positive findings has been replicated with such findings, the methodological quality of these studies has been questionable, and the better studies of homeopathy have tended not to generate positive findings.
David W. Ramey, D.V.M., has been practicing equine medicine and surgery since 1983. He is the author of nine books on equine health, including A Consumer's Guide to Alternative Therapies in the Horse (Howell Bookhouse, 1999).

` Even a lot of the optimists are not convinced, as I've seen in articles such as this one in the Annals of Internal Medicine:

Homeopathy is an alternative therapeutic system based on the "Principle of Similars" and the use of "minimum" doses. Homeopathy was a prominent component of 19th-century health care and recently has undergone a revival in the United States and around the world. Despite skepticism about the plausibility of homeopathy, some randomized, placebo-controlled trials and laboratory research report unexpected effects of homeopathic medicines. However, the evidence on the effectiveness of homeopathy for specific clinical conditions is scant, is of uneven quality, and is generally poorer quality than research done in allopathic medicine (61). More and better research is needed, unobstructed by belief or disbelief in the system (62). Until homeopathy is better understood, it is important that physicians be open-minded about homeopathy's possible value and maintain communication with patients who use it. As in all of medicine, physicians must know how to prevent patients from abandoning effective therapy for serious diseases and when to permit safe therapies even if only for their nonspecific value.

` Well, Lou said he'd read that collection, and none of that affected him one iota. He said that the reason you can't find very many articles in 'Western' medical journals that support homeopathy is because 'Western' doctors are paid to suppress 'the facts'.
` There are, he says, thousands of studies in favor of homeopathy, even though there aren't that many that are good. And the fact that I can't find them is further proof of this.
` Also, he says that the last one definitely shows some promise for homeopathy in general cases, but not specific ones. (I don't know... both tables seem almost equally dubious to me!) Therefore, that should count as some kind of evidence.
` Not really....
` But we did agree upon something; if I didn't see his homeopath, then I could not be 100% confident that it would not have an effect on me. So, he struck a deal with me; if his screwed-up leg untwisted, I would go to see his homeopath, Steven R. Olsen, ND.


` August 18th:

` Well, that is what I did, because Lou's leg did straighten out... and then promptly went crooked again. This is because the 'remedy' I gave him had been working at the same strength as it had worked the first time, causing the usual intense flush of the system, increase in symptoms, then reversal of almost all of his symptoms, including his nausea from not eating all the time, his sensitivity to temperatures, adult ADD, etc.
` After about a week, it completely wore off and he had to get a new remedy. However, none of this makes any sense because I simply gave him a different purple jar of another brand of vodka rather than his remedy: It shouldn't have had as much effect, or for that matter, any effect at all!
` However, I don't want to tell him that because, just after I gave it to him, I promised I wouldn't do it again - I don't want it to appear that I've broken my promise! Besides, the effects I've observed from this definite placebo have been quite striking and, um, too interesting to interfere with.

` So, I went to see Steve Olsen this afternoon. As expected, he was very nice, though quiet. Basically, I unloaded my entire life story on him and he used his computer database to find several different treatment options. He barely said anything, much less did tell me what to expect from the remedy he'd given me.

` Well, I'll tell you if I feel any different. And I'll tell him, too, next week. (For another $50....) Oy vey is mir!