Friday, July 23, 2010

The Old Dichromate Homeopathy Quackery

Debunked Again

I've noted here and elsewhere the continued espousal of homeopathy by the Academic Health Center at the University of Minnesota, e.g. the Strib blog post:
The Director of the Center for Spirituality and Healing has written in glowing terms about a journal article concerning the use of homeopathic dilutions of dichromate in the ICU. See for example:

This absurd paper, published because incompetent reviewers did not read it carefully, has been debunked yet again. Despite the many debunkings, the homeopathy crowd including our self described nurse scientist head of CSH continues to tout it.

From Science Based Medicine:

Regular readers of this blog are probably familiar with a certain homeopath named Dana Ullman.

One study ... is a favorite of Ullman’s, one he likes to trot out time and time again. Specifically, it’s a study of homeopathy in the ICU that was published, in all places, in Chest ...

Although I do feel a bit guilty not providing you with more original peerless prose pontificating on medical pseudoscience that you know and (hopefully) love, this article is constantly trotted out by homeopaths, even five years later ...

From the abstract:
Conclusion: These data suggest that potentized (diluted and vigorously shaken) potassium dichromate may help to decrease the amount of stringy tracheal secretions in COPD patients.
Holy homeopathy, Batman! Does this study mean that homeopathy actually works for critically ill patients in the ICU?

First off, the title is interesting. Note how the word “homeopathy” or “homeopathic” does not appear. In fact, no derivative of the word “homeopathy” appears anywhere in the abstract. It’s almost as though the writers were trying to get this in under the radar. After all, most doctors don’t know much about homeopathy, which means that they don’t know much about what a “30C” dilution is or that such a dilution dilutes a substance to the point where there almost certainly isn’t a single molecule left.

This all makes me wonder how this study ever got past the Institutional Review Board (IRB). After all, if there’s active ingredient left over, then the study would be proposing to give a toxic substance to patients on ventilators in an ICU. If the investigators made it very clear to the IRB that the dilution would be such that there would be no potassium dichromate left, then the IRB should have asked about the ethics of giving both experimental groups what is, in essence, a placebo.

[You'll have to read the rest for technical details deemed not of general interest, especially since they have been repeated earlier many times and never refuted by the homeopathy crowd.]

The bottom line is that, contrary to Dana Ullman’s representation of this study as slam-dunk evidence of the efficacy of homeopathy, it’s nothing more than a very questionable study in which it is unclear whether the treatment and control groups were truly comparable. The homeopaths’ conclusion would be hilarious were it not so sad that such woo has found its way into otherwise reputable journals.

[Sadly, the author concludes:]

As much fun as I have deconstructing such studies, hoping in vain for a good study but inevitably being disappointed, it is still disconcerting to see this sort of study published in Chest.

More disturbing still is that an IRB allowed such a study of a useless medication on intubated ICU patients with COPD. It just goes to show that peer review is not perfect. It may remain the best bulwark against pseudoscience, but it’s only as good as the reviewers, and it’s not a foolproof guarantee against pseudoscience.

What I fear is that, as more and more pseudoscience and non-evidence-based woo invades medical school, the dividing line between evidence-based medicine and woo will blur even more, and, as the older generations of physicians retire, the newer generation, who has been exposed to woo in medical school, will be less willing or able to call a duck a duck when they see it. Quack quack.


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