Select Committee on Science and Technology Minutes of Evidence

Examination of Witnesses (Questions 502-519


21 FEBRUARY 2007

  Q502 Chairman: Can I start by thanking you very much for coming today to give evidence to our Committee? I am Lady Finlay. I chair this select committee of science and technology sub-committee inquiring into allergy. Can I also welcome those who have come to listen in to the session, who are seated in the public gallery? There was an information note produced and that has the declaration of interests of all members of the Committee so we will not be restating those as we go through with our questions. We have a lot of questions and I would therefore ask you if you could please be precise and concise with your answers to enable other people to make a comment and to make sure that we get through the questions. Can I ask each of you to introduce yourselves?

  Professor Ernst: My name is Professor Ernst. I am professor of complementary medicine at the Peninsula Medical School Universities of Exeter and Plymouth.

  Professor Corrigan: I am Professor Chris Corrigan, a professor of asthma, allergy and respiratory science at King's College, London School of Medicine, Guy's and St Thomas's Hospitals.

  Ms Chatfield: I am Kate Chatfield. I am here to represent the Society of Homeopaths and I am a senior lecturer in homeopathy at the University of Central Lancashire.

  Professor Brostoff: I am Jonathan Brostoff, professor of allergy and environmental health at King's College, London.

  Q503  Chairman: Ms Chatfield, could I just clarify your professional background? Is that in nursing?

  Ms Chatfield: No. I am trained as a homeopath.

  Q504  Chairman: Specifically?

  Ms Chatfield: Yes.

  Q505  Chairman: I wonder if I can start by asking all of you which techniques allied to complementary and alternative medicine are currently used in the UK for the diagnosis and the treatment of allergic diseases?

  Professor Ernst: It is a difficult question because we are dealing with a flavour of the month type of therapy and they come and go quite frequently. A little while ago, we tried to assess this systematically by looking at seven leading lay books in complementary medicine and for allergies we found 57 different treatment modalities. It is big.

  Q506  Chairman: Would you be able to provide us with a list of those after the session?

  Professor Ernst: Not offhand but if you give me a little time, yes.

  Professor Corrigan: The four commonest ones used for the treatment of asthma and allergy are acupuncture, herbalism or phytotherapy, homeopathy and various physical techniques, spinal manipulation and the like. Some of these techniques claim to diagnose as well as treat allergy. For example, homeopaths and herbalists diagnose. Others take the diagnosis as read and work from there. There are lots of tests available on the Internet, by post and in shops that are claimed to diagnose allergy including leukocytotoxic testing, electrodermal testing or Vega testing, kinesiology, pulse testing and various other miscellaneous ones including iridology.

  Ms Chatfield: In homeopathy we have a very different definition of diagnosis. It is not diagnosing a specific allergy according to a specific allergen. A homeopathic diagnosis for us literally means finding the right remedy for the person, so it is not a conventional diagnosis in that sense.

  Professor Brostoff: Some of the so-called scientific tests for diagnosing allergy and in particular food allergy that are marketed have dubious clinical validity, even when put to double blind studies. That is one aspect, even if the techniques used in the laboratory are robust but the interpretation, I am afraid, is fallacious. In terms of the allergy patients that I see, many have used herbal treatments and I think we did the first double blind placebo controlled trial of Chinese herbs in eczema in the early nineties which showed it to be remarkably successful, but we were careful to exclude toxic elements in the herbs. As the Chinese have been doing it for about 1,500 years, I think we might have a lot to learn from them!

  Q507  Chairman: That is an example as to my second question which is whether there are certain types of complementary medicine that are more suited to particular allergic diseases than others. You have cited one, Professor Brostoff. I wonder if others would like to comment?

  Professor Corrigan: There is a vast body of literature that suggests that there is no net clinical benefit from many of these procedures, including acupuncture, homeopathy and various physical techniques. Some physical techniques have been shown to improve the quality of life for some patients—for example, asthmatics—probably by teaching them how to breathe properly but there is no evidence that they improve the disease. With herbalism you have to be careful. We must not forget that many of the drugs we use today have been derived from plants. It is likely that there are still a few more to be discovered. The problem with herbalism as it is applied currently is that the preparations are not standardised. The active ingredients are not known. The prescription of these substances is rather ad hoc and, because the whole process is unregulated, there is the problem of poisoning. There are well documented cases of toxins such as organophosphorous pesticides in herbal remedies and other toxic agents. Whilst there is scope for looking at allergy treatments derived from plants, this research should be organised more systematically and the active ingredients should be isolated and their properties characterised. With the one exception of herbalism, I do not believe there is any good evidence that any other form of alternative medicine produces a tangible benefit in asthma. There are many studies and summaries of studies to back this statement up.

  Ms Chatfield: In homeopathy, as far as I am aware, we do not have any significant evidence from randomised controlled trials for the treatment of asthma but we do for allergic rhinitis and hay fever and a lot of clinical of evidence suggests that homeopathy could be of great benefit in eczema, particularly with the kinds of patients that we get. We have a very high percentage of children coming with eczema and related allergies. [1]

Results of a six-year study at Bristol Homeopathic Hospital, published 2005, show that over 70 per cent of patients with chronic diseases reported positive health changes after homeopathic treatment. The most marked improvements were seen in children. 89 per cent of under 16 year olds with asthma reported improvement and 75 per cent felt "better" or "much better", as did 68 per cent of eczema patients under 16.

  Professor Ernst: There are virtually dozens of complementary therapies that have been submitted to clinical trials. We have summarised them in a book which I have here and which I am happy to donate to the Committee. This material is systematically and transparently summarised. I agree with my colleague. For no treatment modality is there good evidence that it is clinically effective in asthma, atopic eczema or hayfever. These are the three conditions that we have included in our systematic review.

  Q508  Chairman: I just wonder whether you might be able to comment on the term "holistic allergy therapy". Professor Corrigan, I also wondered what you feel the evidence is for the role of physiotherapy in breathing techniques in patients with asthma.

  Ms Chatfield: I have no idea what holistic allergy therapy is. I have never heard of it.

  Professor Corrigan: There are various breathing techniques which can strengthen the respiratory muscles and these are of proven benefit in some patients with asthma and indeed chronic obstructive airways disease. Anxiety plays a natural role in many of the symptoms of asthma and teaching patients to calm and control breathing, techniques allied to physiotherapy, have been shown to improve asthmatics' quality of life, presumably because they help them to calm down and breathe more naturally. There is no evidence these techniques improve the severity or the natural history of the disease.

  Professor Brostoff: Because allergy services in the UK are minimal for the number of people who complain of allergy, patients will be forced to go and see people who might use Vega machines or apply kinesiology. Anecdotally, many of these patients improve. Whether that is placebo or due specifically to the technique, or it is a subgroup of patients who respond, it would take very little to produce a clinical study of sufficient power to show that the Vega or applied kinesiology in controlled conditions was effective, either globally in groups of patients or in a subgroup. I think it is very sad that effort is not put into this but it is quite understandable. Private practitioners are not going to pay for clinical studies.

  Q509  Lord Colwyn: May we assume that none of you has a problem with the efficacy of the placebo effect?

  Professor Brostoff: I wish I could treat every patient with the placebo effect. It would be much less contentious and have far fewer side effects.

  Professor Ernst: I have absolutely no problem with placebo effects. In fact, as a clinician, I used to try to maximise them but I would like to point out that you do not need a placebo in order to generate a placebo effect.

  Q510  Lord Taverne: Professor Ernst said that his clinical testing of alternative remedies and treatments did not show any effect. Could he comment on what Professor Brostoff has said about the use of Chinese herbs?

  Professor Ernst: This is very complex because Chinese herbs are a whole world in themselves. There are very few people who understand them and I am probably not one of them. They are usually given as individualised treatments so if you all have asthma and I am a Chinese herbalist I would take your pulse, look at your tongue and your constitution and so forth and give you all different herbal mixtures, often containing a dozen or more herbal ingredients and plants. The potential for interaction, for instance, is huge there. This approach has not been submitted to a clinical test. It can be tested, this individualised approach, but it has not been. What my colleague spoke of was a standardised formula of certain herbs targeted for eczema in this case and there were indeed some positive results. Later on there were some negatives as well with that particular formula. That is a different way of dealing with herbalism. There is the standardised herbalism where you buy a pill in Boots, or whatever, and there is the individualised herbalism. The individualised herbalism is the one that has been practised in this country by all herbalists and it has not been submitted to clinical tests in relation to allergy. For some other conditions it has and the results have been negative.

  Professor Corrigan: There are herbs that have been shown to be efficacious in isolated studies because they contain known, active, pharmacological medicines. For example, butterbur is a herb which impairs the immune system and may treat asthma very much along the same lines as conventional steroids. Coleus is another herb which contains forskolin which is a bronchodilator. There are many drugs in some herbs which may be effective but what I deplore is the ad hoc use of these unpurified medicines which may not be safe in an unsystematised and untried fashion.

  Q511  Lord Rea: Could we go back to Vega testing and kinesiology which have been mentioned briefly? Could you remind the Committee exactly what these techniques consist of and how are they used to diagnose allergic disease?

  Professor Corrigan: A Vega test or an electrodermal test is based on a couple of wires being connected to a small galvanometer or battery which generates a small voltage. The machines look very impressive. They have lots of knobs, switches and dials. They impress the customers. There are various variations but the basic technique is that the subject holds one wire in one hand; the other wire is placed in various areas of the skin or other parts of the body which are deemed to be of diagnostic importance. Sometimes there is a plate in the circuit containing a vial of allergen which looks very impressive to the customer. The only galvanometer readings that are generated by this process are caused by flow of electrical current across the skin and depend on how sweaty the patient is or where exactly you put the electrodes. From these measurements, typically a list of substances is produced and given to the subject and they are told that they are allergic to these substances. These lists are entirely ad hoc and random. There is no evidence that this technique can diagnose allergy. Applied kinesiology is the science where practitioners claim to be able to diagnose allergy from the tension in the muscles of the outstretched arm. They will ask a patient to outstretch an arm and apparently, with years of training and experience, when the patient holds a vial typically of allergen in the other hand they can detect changes in the weakness of the muscle of the opposite arm and thereby diagnose whether or not the patient is or is not allergic to the vial of allergen that is being held in the opposite hand. This can be practised with surrogates. In other words, if you have an uncooperative child, the kinesiologist can hold the adult's hand and hold the adult's hand again when they are holding the child's hand. Again, they claim to be able to diagnose what that child is allergic to. This is all completely bizarre and, I am afraid, utter nonsense. There is no scientific evidence or mechanistic base to suggest that these tests could be remotely effective.

  Q512  Lord Rea: Is the diagnostic part of these techniques the same as treatment—as the therapeutic effect—or once the diagnosis has been made is a different treatment applied?

  Professor Corrigan: These diagnostic tests do not necessarily proceed to treatment. Often, the patient is just presented with a list of substances to which they are putatively allergic and then they are just allowed to walk away with it. They are not the basis for specific therapeutic regimens.

  Ms Chatfield: They are then told to avoid those substances.

  Professor Corrigan: Yes, typically they are and typically they do to their detriment.

  Q513  Lord Broers: Presumably this leads to a positive placebo effect anyway, does it? The very fact that people have been treated with an elaborate machine must—

  Professor Corrigan: Of course. It is the fact that they have been treated with an elaborate machine and that they have often paid a large sum to do so which gives them the firm impression that the diagnosis must be right, which is appalling.

  Q514  Lord Rea: Have we any evidence at all about the efficacy of these techniques and could you give us an idea about how much a typical treatment would cost?

  Professor Ernst: Both these techniques have been submitted to proper scientific tests. Some of these tests have been of high methodological quality. When they have, they have resulted in negative findings. In other words, there is no validity to either of these two tests. I cannot comment on the costs. I believe it is around £50 per go.

  Q515  Lord Rea: Would it be possible to suggest that the efficacy is related to the skills and experience of the practitioner rather than the complicated techniques and equipment that they use?

  Professor Ernst: In these tests, obviously the practitioners were experienced and, yes, there was no reproducibility, specificity et cetera, which you require from a diagnostic test to be valuable.

  Professor Corrigan: It is difficult to define what an experienced practitioner is in these cases. One can define an experienced practitioner of physiotherapy because there is a set training course but, with these procedures, there is no standard training manual written down. There are sets of instructions with the individual kits but it is difficult to know how somebody does become professional in these techniques.

  Q516  Lord Rea: I was thinking, rather than skill or training, of the personality of the practitioner.

  Professor Corrigan: I suspect that has a very great deal to do with it, yes, somebody who looks knowledgeable, authoritative and presents you with a piece of paper in a solemn tone which you take as gospel.

  Q517  Lord Taverne: My question is really addressed to Ms Chatfield. What is the difference between homeopathy and isopathy and how do these therapies, do you argue, compare with more conventional treatments in efficacy and cost?

  Ms Chatfield: As Professor Ernst was pointing out, with herbal practitioners there are different ways of applying and prescribing herbal medicines, but it is the same with homeopathy. A homeopathic prescription is based on the symptom picture that the patient presents with. The remedy is prescribed according to the symptoms that the patient presents with. With isopathy, the remedy is not individualised according to the symptoms but according to the specific or primary allergen that has been identified. For example, in the case of a birch allergy, it would be betula that was used as the remedy to treat that if it was an isopathic prescription. The remedies would still be highly diluted as they are with homeopathic remedies. That is the difference between isopathy and homeopathy. Generally speaking, I think homeopaths would consider homeopathy more effective than isopathy but I do not think we have any evidence to show that.

  Q518  Lord Taverne: I was asking about the comparison with conventional treatment.

  Ms Chatfield: If you look at the outcome studies we have, obviously they do not involve the placebo question but we have various high levels of improvement in large scale outcome studies all over the world with this kind of treatment. In terms of cost effectiveness, we do not have enough information on that either. What I would specifically like to see would be research trials which compare the conventional treatment directly with homeopathic treatment in terms of efficacy and cost.

  Q519  Lord Taverne: In a recent debate in the House of Lords, the president of the Royal Society said that if medicines can really work even if only a single molecule is left this would entail some fundamentally new scientific principle with amazingly broad ramifications and fundamental implications for experiment over the whole of science. Could you explain how the mechanism is supposed to work that achieves these astonishing results?

  Ms Chatfield: I think you know very well that I will not be able to because we have not discovered that yet. I am of the opinion—and I think a lot of homeopaths are who were initially sceptical when they came in and, for a number of reasons, are convinced by the evidence—that science is not a static thing. It changes all the time and just because we do not have an explanation currently we do have a lot of people proposing different theories about how it may work. Just because we cannot explain it now does not mean it does not work. Yes, it will mean that science is revolutionised and I do not see that as a bad thing.

  Professor Ernst: There is a fundamental difference in saying we have not discovered the mechanism yet. 50 years ago, we did not know exactly how Aspirin worked but we always knew that there would be a mechanism there because it is pharmacology. With homeopathy, this is fundamentally different. Science tells us that there is no mechanism by which it can work and that is an important difference. If we find the mechanism then we have to rewrite our textbooks of physics, pharmacology and chemistry.

  Professor Brostoff: I do not think there is a problem with rewriting any textbook if new facts arise. The critical data is: has homeopathy in a sense been shown in model systems in the laboratory. The answer is very likely to be yes, both in the haematological system recently and also a long series of experiments in Paris. I know there was controversy over those. The fact that the clinical trials in the homeopathic hospital in Scotland, David O'Reilley's studies, in three separate studies showed that these were statistically significant in terms of active versus placebo suggests that whatever the mechanism is it does bear thinking about.

1   Out of a total of 11 randomised controlled trials investigating the efficacy of homeopathy in the treatment of seasonal allergic rhinitis, eight demonstrate a significant positive effect. Back

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