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Homeopathy 2010; 99(02): 149-150
DOI: 10.1016/j.homp.2010.02.009
Letter to the Editor
Copyright © The Faculty of Homeopathy 2010

Response to Leslie Rose and John Garrow: Clinical trials, clinical evidence, and selective citation

Misunderstanding RCTs is all ‘tu quoque’
Lionel R. Milgrom
Subject Editor:
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Publication Date:
16 December 2017 (online)

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Both Mr Rose and Prof Garrow were signatories of the now-infamous letter to The Times advising Primary Care Trusts against the use of ‘unproven alternative therapies’, and which described homeopathy as ‘an implausible treatment’.[ 1 ] This letter made unauthorised use of the NHS logo a fact which received no media attention. Consequently, by suggesting my understanding of Randomised Controlled Trials (RCTs) is misleading, Rose and Garrow are being just a tad hypocritical.

If they had read my article properly,[ 2 ] they would have noticed that I stated quite clearly Sir Michael Rawlins is ‘no great friend of homeopathy’. Regardless of Rose and Garrow's personal communication with him[ 3 ] therefore, Rawlins' critique of those with absolute faith in the role of RCTs to determine clinical decision making, stands, “I am aware that those who develop and use hierarchies of evidence are attempting to replace judgements with what, in their eyes, is a more reliable and robust approach to assessing evidence. All my experience tells me they are wrong”.[ 4 ]

Of course, we could trade Rawlins' quotes all day, but that would merely detract from the reality which is that Rose and Garrow have cherry-picked, choosing to ignore other substantive points in my article. They have said nothing for example, about the shocking systemic abuse of science exposed recently in medical and pharmacological research.[ 5–7 ] The fraudulent use of statistics to make false claims about drug efficacy is surely a topic of far graver concern than pointless ‘tu quoque’ theoretical perorations on BMJ pie charts,[ 8 ] or my putative ignorance of the role of the RCT. Nor have they considered RCT evidence which demonstrates Prozac, one of the world's biggest selling drugs, is actually no better than placebo.[ 9 ] Would Rose and Garrow now be as damning of Prozac's widespread use as they are of homeopathy?[ 1 ] I hardly think so. Or, like Nelson putting his telescope to his blind eye, do they prefer to remain as visually challenged to the obvious signals[ 10,11 ] of an encroaching scientific evidence ‘monoculture’ staring them in the face? Rose and Garrow might make better use of their undoubted statistical talents by helping to clean up the mess in their own biomedical backyards.

Finally, Rose and Garrow have really got it all ‘tu quoque’ when they say, “It may be tempting for chiropractors and homeopaths to rely on uncontrolled observational data when RCTs fail to give them the answers they want, but would that be good science?” Besides ignorance of the positive research literature on homeopathy, what this clearly demonstrates is the underlying Evidence-Based Medicine (EBM) mantra that all therapeutic procedures must somehow be scientifically proven and understood before they can be allowed to be of any benefit to patients.

Bearing in mind that patient welfare is at the very least as important as scientific proof, and that medicine is as much an art as it is a science, one doesn't need to be a homeopathy/CAM practitioner to see the fallacy in Rose and Garrow's EBM line of reasoning. Smith and Pell[ 12 ] effectively demolished this argument seven years ago with their paper on the use of parachutes “to prevent death and major trauma related to gravitational challenge” (i.e., falling). It concludes, “As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of EBM have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of EBM organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute”. In the name of science and, of course for charity, perhaps Rose and Garrow might consider training for such a jump, sorry, trial….