Homeopathic Treatment of Autism - Evidence #1

It may seem unlikely to some that there is much more to be said on this subject. That there is no real need for any more detail on what homeopaths get up to, especially in the light of some action starting to be taken. It could be argued that previous posts (especially this one) have made a strong enough case to convince the average reader of the inherent risks of letting homeopaths anywhere near autistic children.

Regulators, authorities, etc need more evidence to act on than a few quotes from websites. It is easy to make complaints about advertising based on online marketing but demonstrating competence issues and raising safeguarding concerns requires more than just stating a homeopath has written something that does not comply with legislation and regulation. Thus research continues.

Whilst no startling revelations about what homeopaths get up to has emerged, what further research has revealed is how deeply delusional homeopaths who claim to treat autism are. More jaded readers will say this is nothing new.

There is quite a lot of this, so it is delivered in parts.

Autism Beyond Despair
This book by Tinus Smits is about CEASE Therapy, which he invented. CEASE stands for Complete Elimination of Autistic Spectrum Expression - a bold claim. It is aimed at parents of autistic children and to a lesser degree homeopaths who are interested in becoming CEASE therapists. It is not a training or instruction manual. Interestingly no training in English is being offered at the moment - unclear what the situation in the Netherlands is. However, there is nothing to prevent anyone attempting CEASE therapy without the special "training" but you don't get a certificate that is unrecognised by an authority, nor do you get a listing on the CEASE Therapy website. 

Before even discussing the contents of the book, note that it has a foreword by J.B.Handley, co-founder of Generation Rescue, an organisation that is fervently anti-vaccination and promotes ineffective and dangerous treatment. Handley is infamous for stating "To our community, Andrew Wakefield is Nelson Mandela and Jesus Christ rolled up into one. He’s a symbol of how all of us feel."

In another foreword, Smits is described by a Dutch homeopath -

Tinus has high expectations of himself, but also of his colleagues. He has a strong Hahnemanian attitude, saying: make it like I do, but do it exactly like me, otherwise you will not the same results. Perhaps this is exactly the quality you to achieve what he has done, the ability to open up new horizons.

Smits died in 2010 from cancer.

Bizarre Concepts
Oh, Smits did not invent CEASE therapy. Apparently, it was created through him by the Universal Intelligence. The exact meaning of "Universal Intelligence" is never made clear by Smits but it is a phrase that crops up in writings about osteopathy, chiropractic and homeopathy as well as in esoteric writings. In short, it would appear to be some sort supreme being, possibly even God as most would understand the concept.

A quotation on William Garner Sutherland from an Indian publication - 

Another pioneer in the field of complementary medicine was Dr. Garner SUTHERLAND who was a student of Dr. STILL was dedicated to the service of the truth, and to his patients. “All Life is manifested in energy on motion. Without motion, in some degree, there can only be death. Motion must be essential to function, but that motion must be intelligent and purposeful from the living organism to successfully compete with its environment. Hence that motion must be guided and directed by a Supreme Being. There must be a channeling of the Universal Intelligence down to the individual cell or organism. Otherwise all would be chaos.” SUTHERLAND also believed that the cerebrospinal fluid receives and is endowed with “the Breath of Life”. It would thus seem that the early cranial osteopaths recognized the interchangeability of energy and matter as it relates to biology. This ‘liquid light’ which is the cerebrospinal fluid behaves with the purpose and intentionality of all particles and waves, as discovered by HEISENBERG and EINSTEIN and summarized in the quantum mechanical formula: E= MC2 .  

Attempts to use scientific terms to justify homeopathy et al are nothing new. And of course, there has always mean a tendency in some to regard homeopathy in an esoteric light - eg J T Kent. This has always resulted in dispute and confusion within homeopathy and thus the creation of many types of homeopathy and groups. It still goes on now. 

Smits had own brand Inspiring Homeopathy. It different from some "brands" in that it claims that no-one, including Hahnemann understood miasms. Instead it focuses on Universal Layers. Doubtless the Universal Intelligence was working through him when he came to realise this.

In this regard a distinction has to be made between the individual layer with eventually sub-layers, caused by vaccination, allopathic drugging or important emotional afflictions, and the universal layers, treating lack of self-confidence, affective problems, incarnation problems, lack of boundaries, old traumas (victim problems), guilt (bully side) and duality, the last obstacle to our unification with our higher self our soul. In totality there are seven universal layers. At the individual layer everybody needs his individual remedy, but once arrived in the universal layers only a few remedies can be used. These remedies are: Carcinosinum, Carcinosinum cum Cuprum, Cuprum metallicum; Saccharum officinale; Lac maternum; Vernix caseosa; Rhus toxicodendron; Anacardium orientale; Hydrogenium. This aspect of universal layers, where the individuality of the patient seems to be lost, can be for the classical homeopath a big obstacle. But once the patient enters these universal layers practice proved to me that these remedies were the best ones to resolve their problems and to help them to evolve to deeper awareness and more stability in both physical and emotional, mental and spiritual health.

This on some levels resembles Hering's Direction of Cure but it posits a structure of individual levels underlied by the seven Universal Levels. Smits also makes mention of "energetic fields" which can be read as the homeopathic concept of Vital Force although their relation to the Universal Layers is unclear. Smits certainly believed in Vitalism.

What Smits thought Autism is etc
Smits does not posit any different diagnostic model and seems to accept diagnoses by medical professionals whatever their preferred criteria. As might be expected, Smits places great importance on certain signs and symptoms.

Some of Smits ideas about the causes of autism were mentioned in this post. The book explains his ideas at greater length but they are very muddled and difficult to follow. Smits often repeats a particular idea many times, sometimes in a contradictory fashion. 

What is clear is that he largely dismisses a genetic cause, his main argument being that there has been a tremendous increase in reported case (100%-150%) in "the past few years" and then that a genetic disease can only increase 3%-4% in a 30 year period. Smits cites no sources for his claims, produces none of those charts that are so popular with anti-vaccinationists. An increase in reported cases does not mean an increase in prevalence. Smits says -

And how do we explain the many healings all over the world if genetics is the main reason? No, the genetic theory as the main causative factor cannot hold. Genetics can give a certain predisposition, but not more than that.

Homeopaths, as a group, seem to have different meanings from most people for words that describe quantity.

Smits seems to have believed that autism is rarely due to physical changes/differences in brain structure. He believed that in except of the case of brain damage, autism can be completely cured. Autism is due to the overload of stresses on the neocortex that block its correct functioning.

Smits definitely believed that vaccination was behind autism in the majority of cases he saw, despite the overwhelming evidence to the contrary, but not necessarily just vaccination - he suggested that there could be multiple causes and that vaccines other than MMR could be causal. Smit's antagonism to vaccination can not be overstated. He also stated that conventional medicines are very toxic, antibiotics are of great concern but even something as trivial as a nasal decongestant spray be a reason. Smits mentions medicines taken during pregnancy as well as exposure to toxic substances/medicines in parents prior to pregnancy. There are toxins that are teratogenic, there are also toxins that can cause mutation in egg/sperm cells that result in birth defects. As that article explains, pathogens and ionising radiation can cause birth defects. Smits rarely mentions pathogens. Smits encountered at least one autistic child who had never been vaccinated. In this case, Smits put it down to Xylometazoline nasal spray and smoking as well as indirectly implying other historical factors too.

Whilst it is impossible to be certain, Smits seems to imply that it is not physical damage that these toxins cause (unless brain damage is involved) but rather they act on the "energetic field" which as mentioned before is essentially the same as the homeopathic concept of the Vital Force, thus blocking the correct functioning of the neocortex and possibly that of other organs. Smits talks about weakened immune systems resulting in for example - "chronic runny noses, ear infections, bronchitis, digestive problems, etc." These toxins do not have to be still present to disrupt the "energetic field". They can leave an "imprint". Apparently, "imprints" in the "energetic field" of either/both parents can be passed on.

Smits states that approximately 85% of autistic children have digestive problems. He cites no source. There is no robust evidence of variation/prevalence of GI problems between autistic and other children but 85% seems high for all but the most rabid anti-vaccinationists - but figures can inflate with retelling. Wakefield's putative autistic enterocolitis was completely refuted. It is true that management of GI problems in autistic children can pose great difficulties - constipation especially. It is worth remembering that some GI problems may be auto-immune conditions but again, the evidence is not 100%. Combined with the idea that "toxins" may be still in the body, it is unsurprising that Smits is keen on dietary supplements but they are used in a more supportive role. What is curious is that Smits talks about GI problems and supplements using scientific terms, admittedly bogus science, yet autism mostly talked about in terms of vitalism.

Smits seems to find the whole modern world toxic. He talks about his healthy childhood on a farm with no running water, electricity or heating. His family did not have a car. But he was connected to the Earth in his natural fibre clothing. And doubtless had lower free radicals than modern children. Smits was born after the Second World War.

Smits attitude to autistic children themselves can be summed up by -

I am not a scientist but just a homeopathic doctor who wants to heal these little creatures who suddenly become wrecks instead of a joy for their parents.

Smits also claims to have cured cancer with homeopathy.


Treatments
The "treatments" that are part of CEASE therapy were discussed in some detail here. In reality, most of them are not harmful in the short term but some could be problematic over a longer period.

Where Smits differs from many other homeopaths is in his use of isopathy. Indeed, his emphasis on isopathy is very unusual. The idea that homeopathic medicines can "detoxify" is ridiculous in many ways (see below for more detail). It does crop elsewhere in homeopathy, in connection with aggravation (see "elimination symptoms" on the second page of the article) but not with such a strong emphasis. It's worth pointing that most homeopaths would attempt to treat the symptoms of the aggravation if they persist and if they still persisted, either they or the parents would hopefully eventually seek medical attention. If Smits is to be believed, he would not have treated symptoms he believed to be signs of "detoxification". The nature of the "detoxification" is discussed later.

It may be unreasonable to expect any form of logic from homeopaths, but it impossible to reconcile the concept of "detoxification" with Smits' vitalistic view of the causes of autism. How can these "energetic imprints" be expelled from the body by, for example, diarrhoea? Are the imprints somehow transferred to the liquid excrement? Why can they not be eliminated in a less unpleasant way? Why can they not simply dissolve into nothing that they actually are? Is some kind of bizarre transmutation going on?

The use of supplements seems fairly innocuous - the suggested doses are on the high side - but it is worrying that Smits advocated raising vitamin C intake to the level of causing diarrhoea and then reducing it to a "tolerance" dose. A child could well be subject to more frequent diarrhoea if their intake of vitamin C varied or for some reason their tolerance decreased. Given that Smits saw diarrhoea as a positive sign, this is problematic. Smits does cite megadoses of vitamin C and sees no problem with it and seems to believe the dubious claims made for it. Similarly, Smits is keen on zinc supplement - to boost Metallothionein - but again is accepting dubious claims this time made by the likes of the Pfeiffer Medical Center which is typical of places that offer bogus "biomedical" treatment of autism (a longer, much more in depth treatment can be found here). Smits does not seem to have gone in for lots of pointless tests and a huge array of supplements as per the "biomedical" crowd.

Smits expressed frustration that CEASE therapy took too long to deliver "results" - three years is mentioned. It is difficulty to determine how often Smits saw patients during their treatment or exactly how involved with them he was - in the sense of whether he was acting the primary care provider or more on a consultative, special basis. Put another way, did he attend to all of a patient's medical needs or just their autism? In discussion of cases, Smits refers to previous treatment by other practitioners but never concurrent treatment except to disparage parents.

In terms of how treatment was conducted, it seems to vary but in terms of the "detoxification" Smits would prescribe remedy to treat what he thought was the "toxin" most responsible for autism. If it caused "detoxification", it was deemed a success, even if there were no obvious improvements. Smits at times seems to have regarded meltdowns as a sign of "detoxification". How long Smits would persist with a particular remedy until trying a different potency or a different remedy is unclear but he would eventually. If that failed to provoke (or rather, be close in time to) a "detoxification", then there there was another toxin at work.

And of course, even if a "detoxification" did occur, if there were no improvement in a child, this must be due to another toxin that Smits would then go on to deal with. Once he exhausted all of these "detoxification" treatments, any resulting issues were to be dealth with by classical homeopathy as opposed to isopathy.

In some cases, it is clear that Smits continued to treat children even after supposed cure - "to prevent regression".

What fees Smits charged is unknown.


The Results of Detoxification? Poo and Pus
The idea that toxins are eliminated by the intestines is an almost complete misunderstanding of basic physiology. Faeces mostly contain undigested food and bacteria. Most toxins are secreted by the kidneys. Faeces may contain toxins but that is because either the toxins did not cross the gut wall or that bacteria in the intestine excreted the toxins (some of which could have crossed the gut wall into the bloodstream). Faecal impaction and diverticular disease can be associated with intestinal infection. Intestinal parasites can also produce toxins that, again, can cross the gut wall but this does not mean that the intestines excrete toxins.

As seen in a previous post, Smits believed that diarrhoea is "detoxifying". Smits advocated not treating diarrhoea. Whilst in the West, deaths due to diarrhoea are very rare, this is not the case in much of the world - it is second leading worldwide cause of death in those under five. Diarrhoea has many potential causes, some of not so serious, others potentially very serious even in the West. NHS guidance on childhood diarrhoea is very clear. It says to consult a GP when a child has -

• had 6 or more bouts of diarrhoea in the past 24 hours
• vomited more than 3 times in the past 24 hours
• have watery or bloody poo
• show signs of dehydration (for example, fewer wet nappies)
• have severe stomach ache or one that doesn't stop
• still have diarrhoea after 5 to 7 days

The guidance also stressed the need for watch for signs of dehydration - see NHS guidance. Even if diarrhoea does not require medical treatment, it is not a pleasant experience. It is also the case that vaccination has reduced the incidence of certain viral diseases that cause diarrhoea.

Smits also said that unusual urine should be ignored. The colour of urine is generally a good indicator of hydration levels. The darker the urine, the greater the dehydration. It can also be associated with various conditions such as haematuria - which can be a sign of cancer as well as infection. Cloudy urine urine can be a sign of urinary tract infection. It is not something to be ignored. The smell of urine is less important as a diagnostic indicator (often influenced by foods) but again can be a sign of bacterial infection. 

Middle ear infections (otitis media) are relatively common in children. Most cases resolve in a few days but even so, it can be intensely painful, hence painkillers are often prescribed. Those cases that do not resolve may well require treatment with antibiotics. Untreated, they can result in secondary infections, temporary or permanent hearing loss and so on. Hearing loss is a serious matter but secondary infections can be fatal. Antibiotics have reduced deaths enormously and are very rare in Western countries but they do happen. It is also the case that certain vaccinations have reduced the incidence of infections.

Middle ear infections generally result in some discharge but large amounts of pus should raise concerns, but not for Smits apparently.

Expectoration is nothing to worry about either. The colour of phelgm can be an indication of bacterial infection and serious conditions such as bronchiectasis or if reddish in colour tuberculosis. 

Smits also stated fever was to be ignored. This is difficult to take at face value. Surely Smits was not advocating ignoring all fevers? No explanation is needed of why this is a bad idea.

Even some homeopaths find Smits ideas a bridge too far. Fran Sheffield is notorious anti-vaccine propagandist who was fined by the Australian courts stated on her website -

The next concern, again because other therapists and parents unskilled in homœopathy will reference this book, is that it displays little or no awareness of the best-practice principles of using potentized substances. Rather than being avoided, aggravations are commonplace and even encouraged throughout case examples. The patient’s response to the remedy is not taken into account nor are subsequent doses adjusted to suit their sensitivity. In one notable example, the author advises that an aggravation of a high fever, bloody diarrhoea and very dark cloudy urine should be celebrated as an ‘enormous reactivation of vital energy and a fantastic process of detoxification and healing.’ This instruction is far removed from the ‘rapid, gentle, and permanent’ ideal of cure to which we are taught to aspire. That homœopaths and others are encouraged to rejoice at such severe aggravations in dependent children who may not be able to express their distress, and without any investigation to rule out underlying pathology, is concerning and potentially harmful.

Sheffield also offers to treat autism with her own brand of homeopathy as well as offering ineffective "homeopathic vaccination" (AKA homeoprophylaxis - which is contentious even for homeopaths) but even that she identifies harm is extraordinary given that most reviews and discussion of the book by homeopaths is fawning and uncritical.

Success! Or not
In the book Smits claims to have treated over 300 autistic children. Yet the cases he discusses do not seem to bear out claims of "cure". Smits presents anecdotes. There is no quantification of improvement and crucially no mention of any child no longer meeting the diagnostic criteria for ASD. Nor is there any mention of failures or drop out rates. Smits said -

I realise that there is still no scientific proof for the effectiveness of this therapy, but fortunately parents do not have to wait for proof to try it for their child. However, to make this therapy well established as a powerful tool for healing autism, this research is necessary and has already been undertaken by the CEASE organization.

The book was published in 2010. No research has been published. Mention is made in the book of a pilot study of 50 children but that is all. The design of the study is not described. Perhaps the study was abandoned when Smits died? Perhaps it was completed but the results negative and it was not published. Who knows?

In a chapter titled "Complete and Almost Complete Cures" he discusses a handful of cases he considers of special significance. There are some testimonials from parents. The cases make for strange reading - Smits see significance in trivial signs (liking pickles and vinegar) and minor childhood maladies that could be associated with any individual child. Smits make no mention of any other therapy or support that the children make have been given. No mention is made of changes to family or school circumstances, etc. All improvement is entirely attributed to his treatments.

None of the cases relate to Childhood Disintegrative Disorder (CDD). It is important to remember that autism is very broad term and that the diagnostic criteria focus on communication and social skills - certain behaviours are also considered important, especially repetitive ones but are not unique to autism - see Obsessive-Compulsive Disorder for example. A diagnosis of Autism in itself tells you very little about a child - and conversely, if diagnosis determines that a child is not autistic, it does not mean that they no communication/social skills problems or do not exhibit certain behaviours, merely that they don't tick enough boxes. No mention is made of learning disability or other co-morbidities such as sensory deficit disorders. This important as higher intelligence and early development of language tends to be associated with better outcomes. Anxiety is another key co-morbidity which will be discussed.

That the children in these cases are described as doing well at school suggests no learning disability per se.

Except, perhaps, in the case of CDD, autism is not a static thing. Children at not frozen at a particular stages of their development. They do grow physically, they learn things - yes, the rate and direction of progress may be different from non-autistic children but no two children develop in exactly the same way as it is. There are some studies (discussed here) that suggest that some autistic people can develop in a way that means that no longer meet the diagnostic criteria. There are also autistic people who still meet the criteria but in terms of outward behaviour would be perceived as most as non-autistic. The prevalence of this is unknown - figures of between 3% - 25% are quoted and it is known that some of these people have not given any kind of specialised therapy. Some higher claims made by Applied Behaviour Analysis (ABA) clinics have seen, but is considered by many to be coercive training is not displaying autistic behaviours. Indeed, many autism advocates would like to see the practice stopped.

Given the above, of course Smits was going to see improvements in the vast majority of his patients (and if he saw none, would likely have ascribed it to "brain damage"). And, over time, some of his patients may well have reached the point where they no longer met the diagnostic criteria for autism. Note that Smits never states that this happened. Either he or parents or both state "cure" is "complete" or "nearly complete". The question is how can the claim that his treatment had "cured" be justified? Or that his treatment is superior to any other treatment or just unspecific supportive care? And that the benefits of his "treatment" outweighed the risks of not treating potentially serious conditions?

Looking more broadly at the cases Smits discusses, there is a lot of talk about behaviours, especially aggression. Many non-autistic children have problems with aggression. The psychological causes are numerous as are theories about aggression. However, again, he makes recourse to "toxins" and "energetic imprints" and "restoring function of the neocortex" claims to have "cured" aggression using isopathy and classic homeopathy. It is almost as if Smits believed that all negative behaviours stem from "toxins" - that emotions are subject to the influence of "energetic fields" and imprints. Anxiety can manifest itself in many ways one of which is aggression. Anxiety is often linked to issues regarding emotional self-regulation, problems with which are linked to a heightened fight-or-flight response. Smits describes a scenario in which a child is brought to his office, lashes out and has to be restrained by four adults. Of course, this is due to "energetic imprints" and nothing to with the child being frightened. And even if it were due to the child being frightened, that would because "energetic imprints" caused him to be scared of new situations/tall Dutchmen with bizarre beliefs.

Smits also talks about seeing improved social interaction but social skills, to whatever degree they are innate, can be learned and even if innate, developed further. Deficits in social skills are not confined to autistic people. Anxiety and depression can lead to lead to impair. Many adults diagnosed late in life talk about thinking that their problems were related to lack of social skills, lack of confidence, shyness and so on. Many therapies and even self help guides can be useful in enhancing social skills. For some, improved social skills and the enhanced and more rewarding social interaction that results is highly beneficial in reducing overall anxiety. Children are not born with a complete set of social skills. They develop over time. But forever reason improvement occurs, to Smits, again is down to homeopathy.

Evil Doctors
Smits reserves special bile for Paul Offit. Offit is the co-inventor of a rotavirus vaccine and to quote from that article -

A 2009 review estimated that vaccination against rotavirus would prevent about 45% of deaths due to rotavirus gastroenteritis, or about 228,000 deaths annually worldwide.

Yes, the vaccine is one of four available ones but even so, the rest of the article does demonstrate what a massive positive impact rotavirus vaccines have had. Offit is very regarded and is staunch advocate of vaccination. Offit is not afraid to challenge the claims of anti-vaccinationists, especially those who claim vaccines cause autism, as well as alternative medicine in general. Offit, unsurprisingly, is a figure of hate among the anti-vaccinationists. He and his family have been threatened with violence, even death.

Offit wrote a book Autism's False Prophets. Smits devotes a whole chapter of the book to it and Offit. So twisted is Smits' thinking that believes that parts of the book confirm his beliefs. 

First I want to thank Paul A. Offit for his book, which purports to prove scientifically that autism is not linked to vaccines, because it actually confirms that I am on the right track.

Either Smits was highly selective in reading, believed that certain words mean something very different from population understand (depressingly common amongst homeopaths) or was reading a complete different book. Smits fails to that the book is not a "proof" - that is found elsewhere - it is an articulation of the general scientific consensus aimed at the lay reader.

Smits believes that Offit stating that there is no demonstrable link between thimerosal or aluminium hydroxide in vaccines and autism proves his contention that there multiple causes which include thiomersal. Then Smits dismisses what he intreprets as claim that all cases of autism have a genetic cause with the same assertation described earlier that the massive increase in reported cases can not be due to genetic disease. Smits goes onto state -

Offit presents himself as a skeptic who only accepts what is scientifically proven. But reality is not limited to what science has proven. Science is not reality, it is just a perception of reality. The earth was round even when while scientists believed it to be flat.

Science is a number of things. One of them is an attempt to describe reality. Smits said himself he is not a scientist. The idea that the Earth is spherical dates back to 6th Century BCE and proofs arrived in the 3rd Century BCE and no, these ideas were not lost to Science. Smits then cites Lynn McTaggart and  as vindication of his point of view.

Paul Offit also disbelieves in alternative medicine, but he seems confused about what it is. He lumps together every therapy not applied in conventional medicine. Alternative medicine is non-toxic and stimulates the vital energy to engage in a healing process. This is in contrast to conventional medicine, which suppresses with mostly toxic products. It is not fair to focus on the dangers of alternative medicine, when more than 100,000 Americans die each year because of conventional medicine. This is official number reported but only the tip of the iceberg.

Earlier in the book, Smits exhorts "brave doctors" to challenge the orthodoxy that vaccines are a good thing. He suggests that the World Health Organisation et al should stop their vaccination programmes or at least delay vaccination until children's immune systems have developed and also reduce the number of vaccinations. Smits cites Isaac Golden and his homeoprophylaxis as a potential solution.

More?
There is more in the book that makes just as bizarre reading. Interviews with Smits can be found on the internet as well as videos made and articles written by him. He wrote a number of others books and there used to be DVD but it seems impossible to get hold of now. Smits also was engaging in activities in Nepal.

This is probably sufficient to describe Smits's notions and what CEASE therapy is.

Prevalence in the UK 
The total number of practitioners of CEASE therapy worldwide is unknown but is known that there are approximately 120 claiming to be trained in the UK (although there could be others). Some may no longer be practicing. Some may never have attracted any patients for CEASE therapy. One had reportedly treated over 100 children by 2014 (but over what time period is unknown). How many UK children are currently being treated with CEASE therapy is a complete unknown. It could be tens, it could be hundreds being put at risk.

CEASE therapy as described by Smits carries risks. The degree to which UK practitioners rigidly conform to Smits' vision is unknown. Kim Kalina apparently conducts training in English. It may be slightly different in tone and emphasis. It may be less aggressive in terms of ignoring symptoms. It might be that training of UK homeopaths mitigates some of the risks, but there is evidence that some pose as much, if not more, risk as Smits did. This will discussed in the next post. Yes, some of them are members of the Society of Homeopaths.

Deaths in the Western world that can attributed to homeopathy are very fortunately rare. It is not the homeopathic remedies that kill but the delay in seeking medical attention. The numbers of children who have been left with permanent harm as the result of such neglect is unknown. Likewise, there are no numbers for children how have recovered completely yet experienced unnecessary suffering.

Anti-vaccination sentiment is responsible for a rise in measles cases seen in the West.