Homeopathy For Cancer, Endorsed by ASCO?? Not Really

When searching for a non-toxic cancer treatment without any side effects, for many people homeopathy seems an attractive option. And sure enough, there are people out there who try to convince cancer patients that homeopathy is a real option. A strong sales argument would be that conventional science proves it to be effective – and precisely this claim has been made for a homeopathic remedy called Psorinum.

What is homeopathy?

Homeopathy, originated by Samuel Hahnemann in the 18th century, is a system of medical treatment based on the use of minute quantities of remedies that in larger doses produce effects in healthy people similar to those of the disease being treated (“the law of similars”). Homeopaths believe that very small doses of a medication (“the law of infinitesmals”) will have very powerful healing effects because their potency can be increased by vigorous and methodical shaking (homeopaths call this process “dynamization” or “potentization” of the remedies by means of “succussion”).

Homeopathy’s main principles  have  remained unchanged, while  our understanding of physiology (how the body works) and physics has evolved and increased tremendously. From present day understanding of physiology we know that homeopathy has no biological basis, but this was not self evident 200 years ago.

Homeopaths like to call homeopathy a “holistic” system, but this is a misnomer. A homeopath prescribes remedies based on symptoms only. It is a symptom based system in the extreme, not a holistic system, and since it occupies itself only with symptoms, it does not address the cause of the disease at all.

As said, one core principle is that the effect of a remedy gets stronger the more the remedy is diluted (and shaken vigorously: “succussed”). From present-day knowledge, we know that nothing else in nature gets stronger when diluted – or succussed, and most homeopathic remedies are so diluted that not even a single molecule of the original substance can be found.  Sometimes homeopaths use a lesser degree of dilution, which means that the remedy may contain minute amounts of the original substance.

Nowadays many homeopathic remedies are administered as pills. At some point in the manufacturing process, a drop of water (the diluted and succussed remedy) is dripped onto the pill, which is then left to dry. Today we understand that when the pill is dry, the water has evaporated.

But the absurdities don’t stop there. Through a process called grafting, the acquired capabilities of the dried sugar pills can be transferred to other dry sugar pills; all that is needed is physical contact between a dried sugar pill, and the sugar pills that are to acquire the same capabilities.

Could homeopathy still work?

Many “absurd” ideas have been accepted in the past after passing fair tests. Could this happen to homeopathy too? Actually, homeopathy failed many fair tests. It has been tested so extensively that it is fair to conclude that there is evidence of absence, not just absence of evidence.

Is the homeopathic remedy Psorinum an effective cancer treatment?

No, it’s not.

Let’s take a closer look at Psorinum – and the evidence that is supposedly accepted by ASCO. What we will look into is this published paper  and the presentation given at the ASCO conference in 2009.

The 186 patients in the study had been diagnosed with inoperable cancers of the stomach, gall bladder, pancreas or liver. The patients also had various types of supportive treatments, both conventional and in the form of various homeopathic remedies. Ten  of them dropped out of the study and opted for conventional treatment instead.

We are told that psorinum is an alcoholic extract of scabies: pus cells. Such an extract may indeed still contain some minute biological active substances. This is explained in a blog post here.

We are also told that the remedy used was a “6x-dilution”. This means that the psorinum was in a 1 to 1ooo.ooo dilution. So this remedy may actually have contained some biologically active substances. The patients ingested the remedy, but it is not clear if they drank it, or took pills. Again – a dried pill is a pill where the water has evaporated.

Tumour response was evaluated using CT-scans, and the patients were followed up via personal meetings, phone calls, and emails. One of the things they were asked was whether they had been taking any other conventional or investigational cancer treatments. If they answered yes, they would no longer be offered the homeopathic treatment.

A significant number of the patients experienced shrinkage of their tumours, and 5-year survival rates were approximately 40%. Such figures are indeed impressive. But was it really the Psorinum therapy that was working?

Well – we do know that there are long-term survivors of these types of cancer through conventional medicine. And the only way we know that these patients did not receive any conventional or other experimental treatment is, that they told the researchers so.

There is an interesting graph that is not in the printed article, but only in the oral conference presentation:

This is a way to illustrate survival statistics. The higher the graph, the more survivors. Allopathy is the term homeopaths use for conventional treatment. So the yellow curve represents those who had psorinum and conventional as well as homeopathic treatment. The green curve represents those who had psorinum and conventional supportive treatment, and the magenta represents those who had Psorinum and homeopathic supportive treatment.

The yellow and the green curves are really not all that different. We really can’t tell if the small difference is statistically significant. But the magenta curve is definitely different from the others. It appears that conventional treatment is necessary for homeopathy to work.

There is one important question that can’t be answered from the data: How would these patients have fared on conventional treatment (or allopathy if you will) alone? This is because the researchers never bothered to include a group that had conventional treatment only.

The hypothesis that homeopathy shortened the lifespan of this group of patients is just as valid as the hypothesis that it prolonged it.

If we take the absurdities of homeopathy and the qualified research into account, odds are however, that it didn’t do a damn thing.

What else could be wrong with the study?

As we said, these survival statistics look impressive. So it is reasonable to ask ourselves if there could be anything in the study, that would make it more impressive than it really is.

We can’t know for sure, because the whole dataset isn’t available. But there are some other possibilities that aren’t all that far fetched.

1) Perhaps some of the patients didn’t really have cancer.

The only thing we are told about age distribution is that the patients were between 18 and 86 years old. With the exception of liver cancer, these cancers are rare in people younger than 40. Elderly people without cancer will most likely live longer than people with cancer, but it is not all that implausible, that they would die of old age within the observation period.

The diagnoses were based on either biopsies or fine needle aspirations. According to the study design, none of them were operated, so what we need to take into account here is the possibility of false positive biopsies/fine needle aspirations. Fortunately false positive biopsies are rare, but they do occur. See for instance this study.

2) Another thing we can ask is how reliable the stagings were. The stage is a way to describe how advanced the cancer is. The higher the stage, the more advanced. The most advanced stage is stage 4, where the cancer has spread to other locations. The lower stage, the longer expected lifespan. Cancers do not progress at the same speed. Some cancers grow slow while others grow faster.

We are told that some of the cancers were stage 2 and 3 cancers. Stages are defined differently for different cancers. Since none of them was operated, we only have the radiologic examinations. So what we have to take into account is the possibility of radiologic overstaging. This is a review of radiologic staging of stomach cancer. The researchers went through all publications they could find were radiologic staging was compared to the pathoanatomical stage found in the subsequently surgically removed tissue. In all of these studies, overstaging by CT-scans was found in up to 28,4 % of the cases. So overstaging is a distinct possibility in a study like this one.

3) Was the tested treatment the only one used? The homepoathic treatments used are described in details. The so called “Allopathic supportive treatments” less so. Also the information that they did not receive any other treatments was not based on chart reviews. It was based on information given by the patients during interviews. What would you answer, if you really wanted to try psorinum alongside conventional/experimental treatment of a cancer with a poor prognosis?

So what about all the fuss?

The thing is that there is a big difference between presenting data in a peer reviewed research paper and at a conference. In a peer reviewed paper, the submitted paper has been read by a group of “experts” chosen by the editor. The job of these reviewers is to check if the paper is relevant for the journal and if the study design and results warrant the conclusion that the authors draw from it. Based on their assessment, they may recommend that the paper is published or that changes will have to be made.

An abstract for a conference presentation is also reviewed, but only to check if the study is relevant for the conference. No attempts are made to check if the conclusions are consistent with the study design/results. Here is the abstract from which ASCO accepted the presentation. Not easy to spot that this is about homeopathy. And it is not easy to spot why (based on the data) the conclusion that

Psorinum therapy is effective in treating stomach, gallbladder, pancreas, and liver cancers….

is just as valid as our suggestion  that:

Psorinum therapy reduces the efficacy of conventional supportive treatment of  stomach, gallbladder, pancreas, and liver cancers….

Or the more likely conclusion

Psorinum therapy has no effect on stomach, gallbladder, pancreas, and liver cancers….

So a presentation at an ASCO conference does not mean an endorsement by ASCO.

UPDATE March 13 – 2018: The published article has been retracted. More details here.