QUACKERY RISK Practice

LETTERS

ETHICALLY UNACCEPTABLE In order to be persuasive we therefore if the journal, and by connection the need evidence massively more com- BDA, dental academics and clinicians, Sir, I write regarding Homeopathy and pelling than the studies cited, because viewed homeopathy as having some its ethical use in dentistry (BDJ 2011; we’d have to discard everything we clinical validity. 210: 291-292). In addition to the article have learned about physics and physical I remember being told, as a dental stu- there are two quite long letters in sup- chemistry since Avogadro. As it turns dent, that to engage with such quackery port of its use. out, systematic reviews of the research simply allows it to benefit from the illu- Lest your readers begin to think that show that the more positive results are sion of scientific debate. This is what we there may be possible benefits of home- from methodogically weaker studies, risk here. opathy I would draw their attention to while stronger methodology tends inex- On the positive side, however, I am the excellent article by Dr Kevin Smith.1 orably toward the conclusion of placebo always happy to be reminded of the tale In this he looks at all the aspects of plus experimenter bias.2-5 of the homeopath who forgot to take his homeopathy but the critical part of his As the House of Commons Science and medicine and died of an overdose. summary is ‘A utilitarian analysis of Technology Committee concluded, there R. Levy, London the utilities and disutilities leads to the is no robust evidence that homeopathy DOI: 10.1038/sj.bdj.2011.487 conclusion that homeopathy is ethically is effective beyond placebo.6 To pretend unacceptable and ought to be actively otherwise is unethical as it violates the IMPECCABLE ARTICLE rejected by healthcare professionals’. principle of informed consent. In a world Sir, my thanks to the BDJ for allowing K. G. Isaacson where it is seriously being promoted for Britain’s homeopaths a forum to argue By email the treatment of cancer and radiation their case in a recent, impeccable article 1. Smith K. Against homeopathy – a utilitarian perspective. Bioethics 14 February 2011. poisoning, and the prevention of malaria (BDJ 2011; 210: 299-301). DOI: 10.1111/j.1467-8519.2010.01876.x (Epub and typhoid, with provably devastating I found it encouraging to read that ahead of print). results, I am afraid your publication of dental professionals now have a further DOI: 10.1038/sj.bdj.2011.489 this article is cause for serious concern. avenue for research through which they G. Chapman, Reading can add to the evidence base on which RESTORATION FRAGMENTS

1. Brien S, Lachance L, Prescott P, McDermott C, we practise. The potent placebo effect Sir, we present a unique case of a for- Lewith G. Homeopathy has clinical benefits in of homeopathic medication is one we eign body reaction in a 52-year-old male rheumatoid arthritis patients that are attributable to the consultation process but not the homeo- can now look to embrace and should patient presenting with pain in the lower pathic remedy: a randomized controlled clinical indeed ‘maximise it for the benefit of right quadrant and a large destructive trial. Rheumatology 2011; 50: 1070-1082. 2. Kleijnen J, Knipschild P, ter Riet G. Clinical trials of our patients’. area of bone loss in the body of the man- homoeopathy. BMJ 1991; 302: 316-323. The heartening fact that the remedies dible. This was subsequently attributed 3. Linde K, Clausius N, Ramirez G et al. Are the clinical effects of homoeopathy placebo effects? are so biologically inert that through to an intra-osseous foreign body reac- A meta-analysis of placebo-controlled trials. adopting them in our everyday practice tion as a result of amalgam displaced Lancet 1997; 350: 834-843. 4. Linde K, Scholz M, Ramirez G, Clausius N, Melchart we can seek to ‘minimise the amount of into the socket during an extraction D, Jonas W B. Impact of study quality on outcome potentially dangerous medication used’, several months ago. in placebo-controlled trials of homeopathy. J Clin Epidemiol 1999; 52: 631-636. removes one of the few quandaries I had Physical examination revealed slight 5. Cucherat M, Haugh M C, Gooch M, Boissel J P. whilst witnessing their prescription dur- facial swelling present at the right body Evidence of clinical efficacy of homeopathy. A meta-analysis of clinical trials. HMRAG. Homeo- ing previous employment in a busy Brit- of the mandible with no cervical lym- pathic Medicines Research Advisory Group. Eur J ish dental hospital. phadenopathy or trismus. The patient Clin Pharmacol 2000; 56: 27-33. 6. Evidence check: Homeopathy, House of Indeed, the article’s links to the Brit- had no neurological deficits including Commons Science and Technology Committee, ish Homeopathic Association provided intact lip sensation. 20 October 2009. me with the knowledge I was lacking Intraoral examination revealed a firm DOI: 10.1038/sj.bdj.2011.486 regarding the theory of water’s ‘mem- palpable swelling in the buccal sulcus ory’, which underpins homeopathic around the lower right second premolar QUACKERY RISK practice. Thankfully I discovered that region, with no mobility or tenderness to Sir, I am sure I am not the only reader to they use distilled water (which I’m percussion of the adjacent teeth. be exasperated by the editor’s acceptance assuming has had its memory wiped) Panoramic radiograph (Fig. 1) showed a of the opinion piece Homeopathy and its to formulate their medications. My con- diffused irregular radiolucent area in the ethical use in dentistry (BDJ 2011; 210: cerns lay in that if common tap water right side of the body of the mandible with 299-301). I assume an opinion piece slips was used in these potions then they residual amalgam residue present within past the peer review process. This is no may still possess a latent memory of the the affected bone leading to significant reason uncritically to accept arguments infinitesimally small amounts of faeces root resorption of the lower right canine, lacking in analytic rigour. and urine which would have previously first premolar and first molar teeth. The There are numerous unsubstantiated passed through it. Of course, doing that pathological area was explored, debride- and selective claims in the piece. Unfor- would be silly. ment and curettage of the area was per- tunately, its inclusion will permit future N. Stanford, Newcastle-upon-Tyne formed under local anaesthesia with references by homeopaths to the BDJ as DOI: 10.1038/sj.bdj.2011.488 extraction of the L44 and L46.

558 BRITISH DENTAL JOURNAL VOLUME 210 NO. 12 JUN 25 2011