An unexpected confluence between ScienceBlogs advertising and HuffPo quackery

Apparently something’s going on here on ScienceBlogs. It’s something that I don’t like at all. You, my readers, have been informing me of it. Oddly enough, it also jibes with potential blogging material that appeared on that wretched hive of scum and quackery, The Huffington Post. You’ll see what I’m talking about in a moment. Suffice it to say that it is not a confluence that makes me happy. It’s not even a confluence that amuses me. Rather, it’s a confluence that should never, ever happen. But happen it has.

It began with advertisements that have been popping up. Unfortunately, after a long period of time having been banished successfully to whatever Internet netherworld they come from, the dubious ads are back on ScienceBlogs. The first one showed up a week or two ago; it’s an ad that’s been everywhere featuring a creepy 72 year old face on a ripped body and touting an “anti-aging” medical practice known as Cenegenics. All you need to know about Cenegenics is that it appears to be nothing more than human growth hormone quackery. And it’s here on ScienceBlogs. In all fairness, I will point out that I did complain about it to advertising. I received no response from the advertising person, although our intrepid intern assured me that if I pointed the ads out they should disappear. Indeed, I thought they had disappeared. Unfortunately, yesterday my wife informed me that they haven’t.

But that’s not the worst of it. This is:

i-e945cf983b7e8cd6a5cdfc9f756532de-Synaptol.jpg

It’s an ad for Synaptol, which bills itself as being able to do the following things:

  • Safely and quickly relieves ADD / ADHD symptoms including hyperactivity, inattentiveness, poor concentration, and difficulty reading and writing
  • Balances energy levels and provides therapeutic support for optimal overall health and vitality
  • Provides fast, effective, natural ADD / ADHD symptom relief in children and adults with no negative side effects*

And here’s the reason why Synaptol can claim to have no side effects:

Synaptol is an OTC formulated proprietary natural medicine, featuring FDA approved active homeopathic ingredients + an oligotherapeutic water base for superior, natural ADD / ADHD symptom relief. Synaptol’s approved ingredient blend quickly starts working with your body for natural relief, and promotes overall health. Imagine your family’s fast return to a better quality of life – symptom free!

Our unique approach utilizes a multi-directional process to safely relieve ADD / ADHD symptoms and to naturally promote a healthy lifestyle marked by energy, vibrancy, and a fresh approach to life.

That’s right, Synaptol is homeopathy using these ingredients:

Aconitum Ferox, Adrenalinum, Apis Mellifica, Argentum Nitricum, Avena Sativa, Baptisia Tinctoria, Cochlearia Armoracia, Medorrhinum, Phosphorus, Scutellaria Laterifolia, Sumbulus Moschatus, Viola Odorata

Other: Aesculus Hippocastanum, Litsea Cubeba, Madia Elegans, Mentha Piperita, Myosotis Sylvatica, Ranunculus Occidentalis, Scleranthus Annuus.
Each of the active homeopathic ingredients in Synaptol is included at a potent 10X, 30X, and 100X dilution, and stabilized in our oligotherapeutic water base for maximum absorption and balancing response. Synaptol also contains a proprietary Oligotherapeutic Neurotransmitter Health Complex to promote optimal synaptic health.

One can’t help but notice that we’re looking at some very minimal homeopathic dilutions. In fact, there are probably real homeopathic substances actually present in the remedy. Be that as it may, ScienceBlogs is now advertising pure quackery.

Here’s where the uncomfortable confluence comes in.

Just yesterday, everyone’s favorite apologist for homeopathy whose arguments are, well, homeopathic in their logic, reason, and science, with the exception that in his case diluting his argument does not make it stronger, Dana Ullman, dropped another turd of undiluted nonsense entitled Homeopathic Alternatives for Children with ADHD.

As usual, Dana Ullman begins by attacking conventional medicine, pointing out that the drugs we use for ADHD (attention deficit hyperactivity disorder) or attention deficit disorder (ADD) have come into question. Hilariously, he tries to appropriate the concept from homeopathy of “like cures like” to claim that Ritalin is based on homeopathic concepts:

It is initially surprising and confusing to learn that Ritalin is an amphetamine-like drug. One would think that this type of drug would make hyperactive children even more hyperactive. However, when Ritalin is prescribed to children who are already hyperactive, it tends to slow them down. Ironically, the use of a drug that causes symptoms similar to those of the patient is actually the basic principle of homeopathic medicine (treating “likes with like”).

This is typical Ullman. He appropriates legitimate medical therapies and then tries to convince his readers that they are in fact based on homeopathic principles. He’s done it with vaccines, digitalis, nitroglycerin, colchicine, and allergy shots. This argument is utter nonsense, of course. All of these medical treatments are based on pharmacology, physiology, and biochemistry. Their effectiveness has nothing to do with homeopathic concepts, although Ullman has in the past tried mightily to appropriate them for his favorite pseudoscience. Even Ullman appears to seem aware of this, as he later admists that these are not “true” homeopathic medicines because they have actual medicine in them and because they are not “individualized” according to homeopathic principles.

As is typical with Ullman, he then cherry picks a bunch of low quality studies, the first of which is Frei and Thurneyson. This study was an open-label study, which means it was not blinded. This makes it useless, so much so that one wonders why the investigators even bothered. Also, it was not even placebo-controlled. Basically, all the children in the study received homeopathic treatments, and those who didn’t improve were then switched over to standard medical therapies. Not surprisingly, this study was published in the British Homeopathic Journal.

The next trial cherry picked by Ullman was actually published in a real journal. I’m not sure why, but it was, even though it’s only marginally better than the first study cited by Ullman. The study is Frei et al. Note that it’s the same author as the first trial and that Thurneyson is the corresponding author, meaning it’s the same research team. Unfortunately, my university doesn’t have subscribe to this journal, at least not online; so I only had access to the abstract, but the abstract is quite telling. According to the abstract, prior to the start of the randomized trial, 83 children aged 6-16 years with ADHD diagnosed using DSM-IV criteria (what, no homeopathic diagnoses?) were treated with “individually prescribed homeopathic medications.” Out of these children, 62 who achieved an improvement of at least 50% on the Conners’ Global Index (CGI), a measurement of ADHD, were then enrolled in a randomized, placebo-controlled trial. Of course, whenever I hear “placebo-controlled” with respect to any trial of homeopathy, I can’t help but wonder how on earth one tells which is placebo and which is homeopathic remedy, given that homeopathy is water. Be that as it may, the investigators then did a crossover design, in which children were randomized to placebo or homeopathy at the beginning, and then at the 6 week mark each subject crossed over to the other group. The results were as follows:

At the beginning of the trial and after each crossover period, parents reported the CGI and patients underwent neuropsychological testing. The CGI rating was evaluated again at the end of each crossover period and twice in long-term follow-up. At entry to the crossover trial, cognitive performance such as visual global perception, impulsivity and divided attention, had improved significantly under open label treatment (P<0.0001). During the crossover trial, CGI parent-ratings were significantly lower under verum (average 1.67 points) than under placebo (P =0.0479). Long-term CGI improvement reached 12 points (63%, P <0.0001).

Wow. That’s a mighty…interesting p value. It’s barely statistically “significant.” Does this mean that the results are invalid? Not necessarily, but I’d want to take a close look at what statistical tests were used. As for the long-term clinical improvement, that is a meaningless number, given that all of the children received homeopathy and all of theme crossed over.

The third study that Ullman cited actually surprised me. No, it didn’t surprise me that the study was completely negative. It was, after all, a study of homeopathy, which is no different from water. Basically every subject in the study underwent a homeopathic consultation and then received either an individualized homeopathic remedy or a placebo. In any case, what surprised me is that Ullman actually cited this paper. I suppose he cited it because he bought into the handwaving by the authors, who tried to make the proverbial silk purse out of a sow’s ear by concluding, “A therapeutic effect of the homeopathic encounter is suggested and warrants further evaluation. I’m not sure how they managed to conclude that. I looked at the paper and the “money figure,” which plots the Conners’ Global Index scores of both control and treatment groups over time. A more perfect overlap is rare to find in a clinical trial. There really was no detectable difference between the curves. But the corresponding author of this study was our old friend David Katz, he of advocating that physicians accept a “more fluid” form of evidence than that nasty evidence- and science-based medicine. He’s good at trying to salvage some positive claim for himself when the evidence is stacked against him.

Next up on the list is another study from the British Homeopathic Journal that is unusual in that it comes from a single author, John Lamont, PhD. Also interestingly, Ullman didn’t include a link to this reference, for reasons that are unclear. In any case, this was a small study of 43 children, and for some reason it, too, was a crossover design study. This made me wonder: What is it with homeopaths and crossover studies? And why can’t they do them right by including a washout period between the two interventions, placebo and homeopathy. Crossover studies can be appropriate when examining a series of two treatments, but given that this was a straightforward comparison of homeopathy to placebo, the crossover design seems redundant and more likely to confuse results more than anything else. For such a small pilot study, a simple design of control versus treatment design would be more straightforward. Another curious thing about this study is that all improvement is parent- or caregiver-assessed. Investigators did not use the standardized Conners’ Global Index. Finally, the study was not truly randomized; rather it was quasi-randomized using alternation. Worse, the allocation was done by the clinician, who was also the researcher who did the study, which meant that assignments were easily predictable.

I remain unimpressed. I do, however, marvel at how homeopaths can dilute their remedies to 200C, as they did for this study, and still think that they are anything other than water. Apparently their ability to do clinical research is just as diluted as their 200C remedies, and this is another case where dilution does not result in stronger remedies.

Finally, Ullman notes that there is a Cochrane Collaborative review of the use of homeopathy in ADHD. This review concludes:

The forms of homeopathy evaluated to date do not suggest significant treatment effects for the global symptoms, core symptoms of inattention, hyperactivity or impulsivity, or related outcomes such as anxiety in Attention Deficit/Hyperactivity Disorder.

And:

There is currently little evidence for the efficacy of homeopathy for the treatment of ADHD. Development of optimal treatment protocols is recommended prior to further randomised controlled trials being undertaken.

This is what I hate about Cochrane. No matter how fantastical the therapy, no matter how resoundingly negative the evidence, Cochrane reviews almost always conclude that “more research” is needed or provide some weaselly comment like the one above. Amusingly, Ullman complains that this Cochrane review didn’t include his favored studies. Similarly, he engages in some serious contortions to try to argue against the Cochrane Collaboration:

The Cochrane Collaboration is an internationally respected group of researchers who evaluate research. In their review of homeopathic treatment of children with ADD/ADHD, they concluded, “There is currently little evidence for the efficacy of homeopathy for the treatment of ADHD” (Coulter and Dean, 2007). It is important to note that they stated that there was “little evidence,” not “no evidence,” that homeopathic medicines have been shown to be effective in the treatment of children with ADD/ADHD.

Further, it should be noted that the Cochrane Collaboration maintains a very high standard for their definition of “efficacy,” and they commonly note that there is “little” or “no” evidence for various commonly used conventional medical treatments, despite the billions and billions of dollars spent on them by individuals, insurance companies and governments.

Talk about excuses! Basically, Ullman doesn’t like the fact that the Cochrane Collaboration found no benefit to children with ADHD that could be ascribed to his brand of sympathetic magic; so he tries to wave off the negative results. He also whines that studies looking at homeopathy are different from each other. Here’s a hint, Dana: That’s true of virtually every single topic that the Cochrane Collaborative performs its systematic reviews on! Not surprisingly, Ullman also invokes the tired old canard that, because homeopathy isn’t sold by big pharma, there isn’t much money in it and there are fewer studies.

Ullman finishes his article with a curious detour. After having discussed treating ADHD with homeopathy, suddenly he starts pointing to studies suggesting that pesticide exposure might be correlated with ADHD. So little relationship to the text before does this section have, that I seriously questioned whether Ullman had pulled a cut-and-paste error, in which he inadvertently pasted a six paragraph segment from another article he was writing into this one.

Basically, what it all boils down to is that Ullman is spinning, spinning, spinning. Given the quack ads that have been appearing on ScienceBlogs lately, including the Cenegenics ad, ads for Synaptol, and–gasp!–ads for Cancer Treatment Centers of America, I hope that whoever’s in charge of advertising these days doesn’t get the bright idea to hire Dana Ullman as a copy writer.