Thursday, 5 April 2018

Homeopathic Treatment of Autism - Evidence #2

Although the previous post stated this would look individual homeopaths offering CEASE therapy, on reflection, it seemed better to look at a different book first. Partly because it covers different ideas from Smits' and partly it contains mention of CEASE therapy that provides a little additional insight.

Homeopathy and Autism Spectrum Disorder
This 2014 book is written by Mike Andrews who is a UK lay homeopath and a member of the Society of Homeopaths (SoH). Andrews has been a lay homeopath since 1990. He has taught at various homeopathic colleges. Andrews describes himself as an "Autism Specialist". As previously discussed, no lay homeopath has the competence to treat autism. The claim puts in breach of consumer protection legislation, advertising regulation and SoH's own Code of Ethics and Practice

The book is subtitled "A Guide for Practitioners and Families". In reality, it is a series of jumbled musings and overstated claims. It is interesting in that it collects musings and claims from different homeopaths from a number of different countries.

At first appearances, Andrews seems much less arrogant in his assertions than Smits but still shares many of his delusions, if expressed in less aggressive terms. The same can be said of most of the contributors but some have the same unwavering certainty as Smits. 

Non-Homeopathic Treatments
Andrews starts by asking whether more can be done to "treat" autism but what he really is doing is pointing out as what he sees wrong with other approaches and then says that homeopathy is the answer!

Behaviour modification? Andrews lumps together all sorts of psychological and educational therapies into this category. What he is really referring to is Applied Behaviour Analysis (ABA) which is extremely controversial as a treatment for autism but part of the concern is the "potential to suppress or repress aspects of the whole homeostatic system" and goes on to say that this could cause physical or psychological problems. Homeostasis doesn't mean what Andrews seems to imply - unless homeopaths have a different meaning for the word. One of the concerns regarding ABA is that it can be psychologically damaging to some austistic children. Another concern is that can involve physical punishment. But it is unlikely that Andrews means injury.

In his very brief analysis of "conventional medicine" much is made of the use of antipsychotics as a "liquid cosh" - content largely taken from this paper. The paper is far more cogent and nuanced than Andrews. He makes much of side-effects of medicines targeting at certain symptoms, claiming that homeopathy can deliver the same results with side-effects. Homeopathy can treat epilepsy? It would be beyond the competence of any UK lay homeopath to do so and so on.

Andrews makes more of diets and dietary supplements and is generally supportive but states they deal with symptoms not causes. He also repeats the nonsense that Smits claimed about plastics and microwaves. Organic food too.

He quotes at length from prominent Australian anti-vaxxer and homeopath Fran Sheffield on "biomedicine". It is curious that a distinction is made as conventional medicine - which is what Sheffield means - was discussed earlier in the chapter. Yet again, much is made of side effects of medicine but also suppression and how homeopathy is superior because it does neither and is more effective.

Then Andrews confuses matters by talking about "biomedical interventions" - bogus treatments such as chelation and candida overgrowth treatments. No responsible medical practitioner would offer these treatments as a treatment for autism.

What is ASD?
In the next chapter, Andrews, like Smits, seems to accept medical definitions of autism and the diagnostic criteria used. Unlike Smits, he appears less certain as to the causative factors. To his credit he does say that it does not help for parents to blame themselves for a child's condition. He says it is not his "job to campaign or to speculate as to the possible causes of the child's ASD diagnosis". But other contributors to the book do think it theirs.

But Andrews does speculate. He swallows whole the line that rates of autism have risen rapidly and thus genetic factors can not explain autism alone. At one point he directly says that there is an increased prevalence of autism in a discussion about prevalence in different countries/communities. Oh dear. He talks about "toxins" and immunisations and mentions that they contain "toxins". He says "However, as with most research into the causes of autism, there is research is for and against most factors". That Andrews even entertains the notion that immunisation causes autism suggests he does not understand the research.

Andrews later explains what is going on "homeopathically". It is difficult to follow. It seems to involve "the body's energy system". If Andrews is to be read literally, he believes that autism is a disease.
In a healthy state the body is able to respond to negative influences, but when we enter a permanent state of ill health or disease the body becomes stuck in its reaction. The idea of homeopathic treatment is that by treating like with like we give the body the information it needs to respond to the problem and swing it back to health.
It gets worse.
There may also be what homeopaths refer to as maintaining causes; that is, continuing exposure to aggravating factors which overload the body's ability to respond. In the case of ASD these might be specifically poor gut health or heavy metal toxicity; although a well-chosen remedy can at times address this on its own without the need for other changes.
And worse.
In some respects it could be postulated  that the genetic viability or vitality of the human race is declining and certainly within homeopathic thinking the family medical history and heredity has always been taken into account in prescribing for children. This area of homeopathic treatment is known as 'miasmatic treatment'.
The idea that the "vitality" of the human race is declining is often associated with the Greek homeopath George Vithoulkas - who suggests it is due to "allopathic drugging" and that antibiotics will turn in the human race into degenerate, chronically ill beings. Vithoulkas is notorious for the claim that antibiotics can not cure syphilis - they "suppress" it and cause it to turn into the tertiary form. Homeopathy can not treat or cure syphilis. Miasms are invisible undetectable forces that are supposed to cause "dis-ease" in homeopathy.

Other Homeopaths and their Ideas
The reader is on taken a whistle-stop tour of homeopathic treatment around the world. Or rather, Andrews lists some homeopaths by country, writes a few uncritical and uninformative sentences. This post will concern UK homeopaths and/or advocates of CEASE therapy and ignore the rest, however bizarre.

Andrews makes brief mention of some UK homeopaths - the ideas of some are explained in more depth later in the book - and will discussed later in this post. Some will be explored in another post. Anton van Rhijn was a consultant at the Royal London Hospital for Integrated Medicine (RHLIM) but appears to have been in Norway since 2010. Van Rhijn seems to be in the business of selling dubious medical tests and now seems more interested in functional medicine than homeopathy. Ursula Kraus-Harper is also mentioned and worrying that by 2014 she had treated over 100 children with CEASE therapy. Andrews says that there at that point there were a large number of homeopaths trained in CEASE therapy but with little practical experience.

Andrews seems to have emailed a set of questions to various homeopaths. They would appear to be, with some variation -
  • What do you see as the limitations of nutritional therapy and behaviour modification?
  • What do you see as the potential of homeopathy to reverse autism?
  • In your overview of what is happening in the homeopathic community worldwide, what do you see people achieving with homeopathy?
  • In your experience what seem to be the most effective strategies that homeopaths use?
  • Do you think that there are specific groups of remedies with affinities for these children?
  • Can you expand on this?
  • What is the most severe case of autism that you have seen helped by homeopathy?
  • What do homeopaths need to know when treating autism?
  • What do you see as the causative factors for autism and how does this relate to homeopathic treatment protocols?
  • What do you as the main issues that preventing the recognition of homeopathy's role in treating ASD?
  • What kind of research would you like to see to show the effectiveness of treating these children with homeopathy?
Carol Boyce
Carol Boyce is a lay homeopath. She was born in the UK. It's not clear where she is now based but appears to currently be a member of the North American Society of Homeopaths. Her biography makes for chilling reading. Her hubris is extraordinary. Those in warzones and in poverty do not need homeopathy. They need real medicines. 

It would appear that Boyce does not "specialise" in treating autism. It is not even clear if she practices as a homeopath any more. What she says can be regarded as unsubstantiated second or even third-hand anecdote. Boyce is likely credulous and prone to exaggeration. For example -
The cases I have seen are compelling, albeit they are anecdotes - children as old as nine and ten with intractable and severe symptoms of ASD, resolving within days or weeks and moving into mainstream education, without the need for classroom support staff.
Boyce has not "seen" cases. She has read/heard anecdotes. Above looks like conflation. That Andrews finds her "great overview of what of what homeopaths are achieving worldwide in the field of ASD, without having a clinic herself, specialising in this area" credible is difficult to credit.

Boyce seems to think that the Defeat Autism Now! works up to a point. Perhaps Boyce was not aware DAN! and DAN! practitioners were deep problem by then. Clients were starting to sue practitioners. UK DAN! practitioners in the naturopathy and "nutritional therapy" sectors are finding themselves suddenly put under pressure to offering the treatment. It could have to do with the Professional Standards Authority wanting the Society of Homeopathy to act on CEASE therapy. There is uncritical mention of ABA. But these approaches are limited, unlike homeopathy.
I see homeopathy as having huge, currently untapped potential and I sat based on speaking to homeopaths about their working and filming interviews with parents of recovered children.
Boyce has seen homeopath cure/treat many conditions considered impossible by allopathy. Boyce has spoken to parents who wasted large amounts of money only for homeopathy to "get back their child", the child before the onset of regressive autism. There's a problem with that statement. The very rare Childhood disintegrative disorder is certainly can involve dramatic regression but more generally, autism seems to follow one of two paths - a slow noticing of more and more signs from an early or seemingly normal development and  sudden loss skills around the 2-3 year mark (although signs of autism prior to this may not have noticed). There isn't a great deal of evidence for these differences in initial presentation resulting in different outcomes. She feels that there is an urgent need to get the information out about the hundreds of cases of successful treatment.

Understanding that these parents (most often the mother) have been on a mission for years, desperately searching for ways to recover their child - they are are the experts on ASD.

She says such parents often know more than the medical professionals treating their child. This is problematic in so many ways.

In terms of causation, Boyce states that she deliberately steers clear of discussion in many places but here takes the standard homeopathic line that is multi-factorial but very clearly implicates vaccination as a cause - and trots out the line that many, many parents have seen their child "regress" within hours of vaccination. Again, the "epidemic" of autism is invoked. And research suggesting that genetics plays a key role in prevalence of autism is down played and worse. Boyce discusses why "science" ignores homeopathy and won't even "give it a go".
The current scientific dogma, dominated by materialism, which suggests we already know everything there is know about how the world works, also contributes to the reluctance. I can't help but think that this negative pressure and the fear of peer group criticism, prevents individual doctors from being open to the possibility. It makes no sense that families suffer, relationships break down, children loose a childhood, suffer untold pain, anguish and loneliness because a medical culture is too afraid and closed to even explore a potential solution - even less sense when the solution is safe, gentle, effective and affordable.
It is impossible to know where to even begin with this. To clear, she is not being quoted selectively or out to context. This is what she thinks. It may be partly an emotional reaction to rejection. Boyce wanted to conduct a study into autism. It did not get passed the ethics board.

Boyce made a short documentary film Saving a Lost Generation- Reversing Autism - although the intention was make something longer with the same title. It can be found on her Something to Say Publications website along with some other footage but can be viewed here which also clearly shows the crowdfunding attempt. None of these video clips show "cure" or "reversal". The website also has a copy of an article that appeared in the Alliance of Registered Homeopaths magazine in which Boyce. Boyce wanted to conduct a clinical trial of homeopathic treatment of autism. She was trying to crowdfund money for it and a documentary film at the same time. The exact nature of the proposed trial is unclear but the article above states -
The footage of two cases treated by Dr Anton van Rhijn forms the basis of a larger ongoing project, including a pilot study looking at the potential of homeopathy to reverse autism. We have a school for ASD children involved, researchers from a university department and a medical doctor willing to do the base line testing are in place. We are currently raising money to run the study.
Van Rhijn's "research protocol" is referenced here. It is basically an exclusion diet with use of supplements and homeopathic remedies. It involved blood and other tests - some of dubious validity. It is not atypical of the biomedical approach mentioned earlier. It would appear that recruitment was supposed to be via private and NHS referrals to the RLHIM. The trial was supposedly ready to go - there was "involvement of a respected university department" and a "very experienced lead investigator" had signed onto the project. There's no indication of the identity of the university or the investigator. But the evil Internal Review Board ethics committee rejected the proposal. Boyce is unreliable but states that the rejected it on the basis of the lack of evidence for the efficacy of homeopathy. But the protocol involved more than just homeopathy but this is not mentioned. It is all about homeopathy.

Philippa Fibert
Fibert is a UK lay homeopath registered with the Society of Homeopaths but also has a history of Special Educational Needs teaching. A great deal is made of her research but that research is into Attention Deficit Hyperactivity Disorder (ADHD) not autism. ADHD is more prevalent that ASD and it has its own set of controversies. Like ASD, ADHD is a diagnosis based on interviews, observation and scoring against certain criteria. In theory, a child can meet both criteria but a dual diagnosis tends not to be given, hence it is difficult to gauge the prevalence of ADHD type symptoms in the ASD population. As the research does not relate to ASD, it is not worth discussing.

One of Fibert's case is discussed - a teenager with dual ADHD/Aspergers diagnosis. He obviously made progress and his behaviour improved. The mother attributes this to homeopathy but there is evidence of "cure" or "autism reversal". Later on in a discussion of treatment of ADHD with homeopathy and the "significant improvement" -
Even so, Fibert is wary of presenting homeopathy as a miracle cure. 'It can take time to find the right remedy,' she warns. 'This study is very much a process of experimentation and I'm still finding out what works. But after a career trying to help vulnerable children as a teacher and parent educator, I've found this to be the most effective intervention by far.'
Fibert does not have a lot to say about nutritional therapy or behaviour modification. She thinks that homeopathy has huge potential to reverse autism but hedges her bets by saying some cases are more amenable to homeopathic treatment that others.

Fibert seem to believe that CEASE therapy is effective once a child's bowels are moving. Fibert doesn't mention vaccination as a cause but talks of environmental toxicity, in particular organophosphate poisoning. There are studies that suggest a mother's exposure to organophosphate pesticides during pregnancy has an association with increased likelihood of a child being diagnosed with ASD or ADHD.

Fibert specialises in ADHD and has never seen severe cases of autism.

Autism and Autisming
Simon Taffler also get his own chapter. He is a UK lay homeopath and member of the Society of Homeopaths. Indeed, they gave him a Fellowship - although its value is questionable given some of the other members it has been awarded to. Taffler does not confide himself to homeopathy. He also claims to have "education" in naturopathy and craniosacral therapy. Like many homeopaths he mentions nutrition but he is neither a nutritionist registered with the Health Care Practitioner Council or a Dietician. It is unclear if Taffler merely offers vague "advice" about diet or whether he advocates the use of dietary supplements.Taffler is also involved with the Homeopathy Action Trust - a small charity that is notorious for funding Western homeopaths activities in Africa. But it also seems to have given money to Carol Boyce.
Autism is not a standard problem; homeopathy is not a standard product and there are no definitive treatments. Homeopathy may not always produce a miraculous improvement but it can make a significant difference. Indeed in over 25 years of treating patients on the autistic spectrum, I have witnessed many positive outcomes.
Taffler makes a fuss about "autisming" - the idea that autism is a process not a condition. It's actually a diagnosis using certain criteria. He was very impressed by John Melnychuk's treatment of Amy Lansky's son. Lansky is important in that she wrote Impossible Cure: the Promise of Homeopathy a book which is often cited by supporters of homeopathy as evidence of the potential for cure. Some who have read her writings in depth suggest her son was never formally diagnosed and had a speech delay that was unrelated to autism.

Taffler makes a number of bizarre statements about "allopathic practitioners" and them viewing autistic children simply in terms of "disease" or "deficit". Of course, autism awareness is not as good as it could be amongst doctors but efforts are being made but Taffler makes no mention that many autistic children and their families will have support of other professionals. Unfortunately in the UK, funding of such support is not as good as it should be. Taffler prattles on about "holism" and that "allopaths" treating different symptoms as different conditions whereas homeopathy treats everything as one disease. Co-morbidities do not necessarily have the same cause - this is patently obvious - and ignores the importance of symptomatic relief.

There is something very strange about Taffler viewing autism as something to be battled against, to be cured. That is not a life long condition but, in essence, a disease that can be temporary in nature. Many autistic people would find this attitude offensive.

So what is "autisming"? Taffler, like so many other homeopaths, is unclear in his explanations but it would appear to be "an extreme process caused by the innate self-healing mechanism trying to recover and realign itself".

Taffler says "multiple factors are probably at work" in autism. He states he has seen very few patients with proven vaccine-induced autism - although how he knows this is not explained. He mentions exposure to agricultural chemicals, "probable" heavy metal poisoning but does seem to think that immunity is implicated in some way and that autism is "triggered". Taffler confuses incidence with prevalence. He also talks about "maintaining causes" - chemicals and the use of antibiotics and steroids.

The description of his "method", if it were not in the context of determining which homeopathic remedy to prescribe, seems quite sensible. It would not be out of place in a talking therapy context but, of course, there are talking therapies that have actual evidence of efficacy.

Asking Questions and Managing Expectations
Andrews advises parents to ask certain questions of a homeopath including how to contact them in an emergency. What Andrews thinks a homeopath can do in an emergency is not stated. One question that is not mentioned is whether the homeopath can actually provide any evidence that their treatments actually work.

He explains what to parents the need for a homeopath to build a rapport. He explains the case-taking process and mentions that homeopaths often ask strange, seemingly irrelevant questions. This is because it is part of a homeopaths task "to look at how the child's innate potential has gone off course."

Andrews talks about the homeopath's expectation of parents but this is uninteresting. He later talks about other homeopaths attempting to treat non-verbal patients although he doesn't seem to have himself.

Working with Others
This chapter mainly talks about parents but there is brief mention of health care professionals etc and attempting to work alongside them but the reality is that the majority of professionals will not engage with lay homeopaths. The attitude of some very vocal homeopaths to the medical profession may play a role in this but the fact that there is no evidence for the efficacy of homeopathy is likely more important. Andrews at no point mentions that lay homeopaths should defer to professionals.

Most professionals are unlikely to be aware of what some homeopaths get up to. They likely regard homeopathy as a harmless irrelevance. As discussed in the previous post, there are safeguarding concerns associated with lay homeopaths attempting to treat autistic children but professionals are unlikely to be aware of them.

Most Common Homeopathic Treatments
Again, a lot of this is uninteresting but it contains discussion of the classical homeopathy approach and CEASE therapy.

The classical approach often focuses on finding the similimum, the magic remedy that will cure the disease completely. Oh, some remedies that aren't the similimum will have some effect but, with perseverance, Andrews seems to think the similimum can be found for a patient and there will be "far more remarkable results." Andrews use a classical approach.

Andrews is quite critical of CEASE therapy. He says that inexperienced practitioners might make assertive claims for its efficacy without any evidence of their own but then states that there are some experienced homeopaths using it and cites Philippa Fibert and Ursula Kraus-Harper as examples. He criticises the rigidity of approach. He mentions that the "detoxes" be extreme but says this is OK rather than a cause for concern.

End note
Andrews states -
My intention in this book has been to show that homeopathy has a role to play in the management of autism spectrum disorder (ASD).
Most would think Andrews has failed in this.


No comments:

Post a Comment