Forum on NCCAM's Direction: Was the Integrator Irresponsible in Printing the Clay Article on Jack Killen, MD?

Summary: Guest writer Beth Clay's mention of homeopathy and her challenging of the credentials of a top NIH NCCAM deputy, Jack Killen, MD, provoked strong responses. I corresponded multiple times with an anonymous scientist who was livid with the Integrator and Clay yet did not want his comments published, even anonymously. I capture some of the exchange, as I believe there may be many others who agree. Entrepreneur Taylor Walsh wonders if the challenges to Killen are merited. Consultant David Matteson, MPH credits the Integrator (and Clay) for the discussion. Finally, author and homeopath Dana Ullman, MPH, details a rebuttal to Killen's view, as quoted in Newsweek, that there is "no condition for which homeopathy has been proven to be an effective treatment."

Taylor Walsh, entrepreneur

2.    Taylor Walsh:  "Focus on Killen's tenure at DAID and homeopathy comments is displaced"

Taylor Walsh has commented frequently in the Integrator, most frequently providing an excellent report on the NIH NCCAM meeting in which the new director, Josephine Briggs, MD, introduced herself to her new community. He wrote to Clay, copying me.

"I was intrigued by the piece that John just published, but in a run over to the sites you mentioned -- British Med Journal, NCCAM's homeopathy page -- I couldn't find any information that would offset Killian's quotes in the Newsweek article.   I can't find anything that states that homeopathy has been found to be useful for any condition.   Most of the content refers to the difficulty in defining anything measurable for the treatment. (My 'survey' was limited only to those links in the article. Are there other sources?)

"The issues of NCCAM non-compliance for director, staff and council membership, and staffing intrigue, are one thing -- a serious thing, but without an obvious repository of positive research on homeopathic treatments, the focus on Killen's DAID tenure seems misplaced.   His comments to Newsweek do not appear to misstate the current state of the research, at least from what I can see, although that is the suggestion."

Taylor Walsh
Publisher, LifePageshttp://www.lifepages.net
Washington, DC

David Matteson

3.    David Matteson: "So good to be calling a spade a spade ..."

"I so appreciate someone calling a spade a spade -- or at least giving direct voice to what we're all thinking but are too polite and PC to ask.  Just because it causes an uncomfortable moment, does not mean it is 'wrong.'  On the contrary, if we avoid being uncomfortable and practice working through it until we find a common place ... well, you get the point.  

"So, thank you, for opening and holding a space.  Strikes me that the Integrator is a perfect media for hosting a heads up discussion."

David Matteson, MPM, MURP, MPS
Early Edge Directions

Dana Ullman

4.   Dana Ulman, MPH: Defending "the Rodney Dangerfield of alternative medicine"

Dana Ullman, MPH, has been a leader in the field of homeopathy for 30 years. He most recently published The Homeopathic Revolution which offers extensive information on the use of homeopathy by leading historic, political, sports and entertainment figures.

"I think of homeopathy as a 'Rodney Dangerfield of alternative and complementary medicine' because it doesn't get the respect that it deserves.  However, even worse than the lack of respect is the ignorance and misinformation that exists on this subject.  When leading representatives of the NCCAM are ill- and under-informed about homeopathy, this is but a symptom of a greater disease, though this dis-ease can be 'cured' relatively easily with good and accurate information.

"The fact of the matter is that the Lancet published a 'review' of clinical research in homeopathy in 2005 that compared 110 homeopathic studies with a 'matching' 110 conventional medical studies (Shang, et al, 2005).  They found 21 homeopathic studies that were 'high quality' research and only 9 (!) conventional studies that fit this higher standard.  Few media have reported on this provocative fact that more than twice as many studies on homeopathy were a high quality clinical trial.  Strangely, however, the researchers didn't compare these high quality studies. Instead, they selected only 8 homeopathic trials and 6 conventional trials that used larger numbers of patients (and they mysteriously left out several good and large homeopathic studies). These studies were no longer 'matching' in any way, and 7 of 8 homeopathic trials tested only one medicine without any of the typical individualization of treatment that is commonly used in homeopathy (for readers to get a sense of how skewed the studies this group select was, one of the homeopathic studies selected was testing its ability in weight-loss).

	"The ill-informed media and selected ill-informed representatives of the CAM community (including Dr. Jack Killen, in this case) have echoed the 'junk science' reports and turned this information into 'junk journalism.'" - Dana Ullman, MPH

"This review of research has been sounded and harshly criticized, and yet, the ill-informed media and selected ill-informed representatives of the CAM community (including Dr. Jack Killen, in this case) have echoed the 'junk science' reports and turned this information into 'junk journalism.'

"For the record, there are numerous meta-analyses reviewing the broad field of homeopathy have found that the placebo response is an inadequate explanation for the positive responses observed in controlled trials (Kleijnen J, et al, 1991; Linde, et al 1997).  Further, several meta-analyses evaluating the homeopathic treatment of specific diseases has also found positive results, including in the treatment of allergic disorders (Taylor, et al, 2004), post-surgical care (Barnes, et al, 1998), childhood diarrhea (Jacobs, et al, 2003), and influenza (Vickers, Smith, 2006).

"And for those under-informed individuals who say that homeopathy may be helpful but only for self-limiting conditions, I encourage them to do some simple homework.  Read about two studies conducted at the University of Vienna Hospital.  A randomized, double-blind, placebo-controlled study was performed to assess the influence of the homeopathic medicine Kali bichromicum (potassium dichromate) 30C on the amount of tenacious, stringy secretions from the throat in critically ill patients with a history of tobacco use and Chronic Obstructive Pulmonary Disease (Frass, et al., 2005). COPD is the #4 reason that

"I wholeheartedly agree with Beth Clay in asking Dr. Jack Killen to make a formal apology to Newsweek and to the CAM community for his ill-informed statement about homeopathy." -Ullman

people in America die.  In this study, fifty patients received either Kali bichromicum 30C globules (group 1) or placebo (group 2). The amount of tracheal secretions was reduced very significantly in patients given the homeopathic medicine (P = <0.0001). Also, extubation could be performed significantly earlier in patients given homeopathy (P = <0.0001), and their length of stay in the hospital was significantly shorter (4.2 days for homeopathic patients and 7.4 days for patients given a placebo).

"This group of researchers also conducted on trial on patients with severe sepsis, a hospital-borne condition in which 50% (!) of patients typically die.  However, in a double-blind placebo controlled trial those patients who were given individually chosen homeopathic medicines had a 50 percent greater chance of survival than those given a placebo (Frass, et al, 2005b).

"This short review of research is just that, and there are many other studies that I could review, and there are an even greater number of basic science studies and reviews of research that I could also cite.

"I wholeheartedly agree with Beth Clay in asking Dr. Jack Killen to make a formal apology to Newsweek and to the CAM community for his ill-informed statement about homeopathy.  I also ask Dr. Josephine Briggs seriously consider showing some 'good faith' actions and what might be considered an 'affirmation action' program towards homeopathy and homeopathic research.  Clearly, the NCCAM needs to make up for the many years in which it has not funded research evaluating homeopathic medicine. Further, Dr. Briggs should consider providing some in-service educational programs for its staff so that it

	"As the NCCAM considers funding research evaluating homeopathic medicines, such research must not only be good sound scientific investigations, but it must also be respectful of the unique systems methodology that homeopathic medicine embodies." - Ullman

can become adequately informed about homeopathy and homeopathic research and so that its website can more accurately portray of body of evidence that exists for homeopathy.  Finally, as the NCCAM considers funding research evaluating homeopathic medicines, such research must not only be good sound scientific investigations, but it must also be respectful of the unique systems methodology that homeopathic medicine embodies.

"Only when the NCCAM takes a more holistic approach in dealing with its internal problems and with its present under-educated and under-experienced staff will it be able to externalize its wisdom for the benefits of the taxpayers who are funding their existence."

Dana Ullman, MPH
Homeopathic Educational Services, Berkeley, CA. 
 
References: 
 
Barnes J, Resch K-L, Ernst E (1997). Homeopathy for postoperative ileus? A meta-analysis. Journal of Clinical Gastroenterology, 25:628–633.
 
Frass, M., Dielacher, C., Linkesch, M., Endler, C., Muchitsch, I., Schuster, E., and Kaye, A. Influence of Potassium Dichromate on Tracheal Secretions in Critically Ill Patients, Chest, March 2005;127:936-941.
 
Frass, M., Linkesch, M., Banjya, S., et al. Adjunctive Homeopathic Treatment in Patients with Severe Sepsis: A Randomized, Double-Blind, Placebo-Controlled Trial in an Intensive Care Unit, Homeopathy, 2005b, vol. 94, pp. 75–80.
 
Jacobs J, Jonas WB, Jimenez-Perez M, Crothers D (2003). Homeopathy for childhood diarrhea: combined results and metaanalysis from three randomized, controlled clinical trials. Pediatric Infectious Disease Journal, 22:229–234.
 
Kleijnen J, Knipschild P, ter Riet G (1991). Clinical trials of homeopathy British Medical Journal, 302:316–323. This review of research assessed 105 trials, 81 of them positive. The authors concluded: “Based on this evidence we would be ready to accept that homoeopathy can be efficacious, if only the mechanism of action were more plausible”, “the evidence presented in this review would probably be sufficient for establishing homeopathy as a regular treatment for certain indications”, and "the evidence of clinical trials is positive but not sufficient to draw definite conclusions".
 
Linde K, Clausius N, Ramirez G, et al (1997). "Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials". Lancet 350 (9081): 834–43. Linde and colleagues analysed 89 trials and found a mean odds ratio of 2.45 (95% confidence interval, 2.05–2.93), in favor of homeopathy. When considering just those trials of “high quality” and after correcting for publication bias, the findings actually remained statistically significant. The main conclusion was that the results “were not compatible with the hypothesis that the effects of homoeopathy are completely due to placebo.” 
 
Shang, A. Huwiler-Muntener, K., Nartey, L., et al. Are the Clinical Effects of Homoeopathy Placebo Effects? Comparative Study of Placebo-Controlled Trials of Homoeopathy and Allopathy, Lancet, 2005, 366:726–732.
 
Taylor MA, Reilly D, Llewellyn-Jones RH, McSharry C, Aitchison TC (2000). Randomised controlled trials of homoeopathy versus placebo in perennial allergic rhinitis with overview of four trial series. British Medical Journal, 321:471–476.
 
Vickers A, Smith C (2006). Homoeopathic Oscillococcinum for preventing and treating influenza and influenza-like syndromes (Cochrane Review). In: The Cochrane Library. Chichester, UK: John Wiley & Sons, Ltd. CD001957.

Integrator Report on My March 14, 2008 Meeting with Incoming NIH NCCAM Director Josephine Briggs, MD