Feb 21^st (twenty days ago): I posted here a critical review of a paper purporting to research the effects of homeopathy on cancer patients, prompted by its citation in QuackRag What Doctors Don’t Tell You. Concurrently, I attempted to post question/comment on the paper – with a link to my blog piece – via facility for the purpose at BMC Cancer.

Feb 28^th (thirteen days ago): I followed-up on the non-appearance of my comment at BMC Cancer.

The paper, my take on it, and BMC Cancer‘s comment-posting tardiness have attracted the attention of my SciLogs colleague, Kausik Datta, who also attempted to express his thoughts on the paper via (what is meant to be) the forum for doing so. Eventually (three days ago), Kausik’s comment appeared on the BMC Cancer site. All I got, the same day, was the following clipped e-mail:

‘Your discussion posting “Without homeopathic remedies, is care   ‘

Which might, as my comment still hasn’t appeared, have been meant to inform me that it has been rejected. Yet, despite my further request for clarification, I am none the wiser as to whether this is the case and, if so, why?

When facility for commenting on a paper in a(n Open Access) journal is available, it is not unreasonable to either expect it to appear, or to be informed that it will not (with or without explanation). That Kausik’s comment, which post-dated mine, is now publicly available suggests a problem with my words, upon which I can only speculate. Is it too easy, then, to assume that my critique of the paper is deemed a biased attack? Perhaps, as I’m not (unlike Kausik) attached to a research institution, my ‘N/A’ affiliation provokes suspicion and wariness. Or maybe it is something to do with the provision of the link to my original (long) post being in contravention of Ts&Cs. Having recently made the mistake of trying to post (the link to) a long (meandering) comment on another paper on a separate topic elsewhere (on which I was rapidly informed of contravention and rejection), I purposely kept this comment brief and to the point, with re-iteration of the questions I’d already asked (without response) of the (non-)corresponding author. The moderators could always remove the link. But I remain unaware of approval or rejection, because no-one will (yet) enlighten me.

A commenter on Kausik’s post fairly pointed out that the Open Access publishing business model is separate from the issue of whether or not a journal provides a forum for discussion on papers published under that model; the real issue being whether or not a journal should provide a comment/discussion facility for its papers if it cannot manage it. We might wonder, as Kausik argues, that ‘Open Access’ ought to mean more than that, if it permits the public to access – and question – the research it funds – a public which includes scientists, and interested ex-researchers such as yours truly. I cannot comment on the difficulty of controlling for spam (though judging by the thousands efficiently squirrelled away in my Comments spam folder, I note that SciLogs/WordPress seems to cope with it just fine). Such problem could be dealt with by closing comments on individual papers (after a time). And so it does occur to me that, as the (‘Highly accessed’) paper in question was published over two years ago, it could be that comments on it were closed due to fading interest and to avoid spam. Except it does not state ‘Comments closed on this article’; what it did state (until Kausik’s comment appeared three days ago) is ‘No comments have yet been made on this article.’ Which I take to mean that it is open to comments. I previously wrote that I could fairly accept low prioritising delay without assuming inefficiency. Accept? Or accepted? I think, with Kausik’s interim comment having made the cut, it’s been long enough.

My exception to this publication was not, I should point out, the first. I came to it two years after the fact, via WDDTY. But it had previously received sceptical treatment elsewhere. Indeed, the study was roundly debunked by ‘Le Canard Noir‘. How did he come across it? Via an article entitled, ‘Homeopathy has a ‘clinically relevant’ effect way beyond placebo’, in June 2011 on the website of… WDDTY! Yes, not only does the QuackRag resort to cheap misappropriation of a piece of questionable ‘research’. It recycles it.

I don’t know whether ‘Le Canard Noir’ attempted to comment on the paper at the BMC Cancer site. I don’t know whether anybody besides Kausik and myself has ever tried. But in response to the plausible argument that, two years after publication, ‘the moment has passed’, I might retort ‘Tell that to the editors/publishers of WDDTY‘. They apparently still consider this paper not too stale for feeding confirmation bias on a spoon to its gullible readership. And, in so doing, practicing the continuance of the disingenuous tactic of keeping this sort of thing fresh in the media… for picking up by careless journalists. As such, it remains important to call out WDDTY‘s authority-appealing nonsense and expose it for the ass-wiping trash that it is. And also to determine whether or not the authors/publishers of the paper are aware of, and concerned by WDDTY misappropriating their work?

If a clinical/medical/scientific journal such as BMC Cancer deems it legitimate to publish this ‘alternative’ kind of thing (and presumably it does – because it does), then it ought to:

i) assign reviewers that will do the job thoroughly, but nevertheless…

ii) expect (indeed welcome) critical discussion, hence the necessity to…

iii) facilitate open comment on its comment facility.

Reviewer 1 writes:

‘There should be a description of what was the homeopathic treatment, is that treatment classical in nature or using complex remedies? Is the treatment goal just to improve symptoms or was it constitutional? Was there any intent to improve the tumour response and progression or just improve QOL?’

I haven’t looked at the originally submitted version of the manuscript (it is also there, if you’ve the time), so don’t know how foggy this all was before review. What interests me here is this reviewer’s, err, leanings which, it seems to me, are of the belief in the efficacy of homeopathic remedies in treating disease – including tumours. I, for one, find this highly alarming.

But then, do not the second and third paragraphs, in effect, expose recognition of the study’s gaping flaw… the impossibility of control? This problem is discussed at length by ‘Le Canard Noir’, Kausik and myself… of the published version, ie that which followed re-submission after the reviews. Why is it that the reviewers were (presumably) satisfied with the revision, whereas others are not?

Reviewer 2 commences with congratulatory compliment on this ‘very successful research’. (Again, that’s before revision.) I still fail to see where this study ‘succeeded.’ Didn’t we already know that more attentive, personalised care makes people feel better? Is a study that cannot fail successful by deduction? What is so revelatory here? This reviewer asks:

‘How did the tumor stage change in both groups after 1 year?’

Again, the suggestion of belief (– not ‘Did the tumor stage change…?’ but ‘How did the tumor stage change…?’ –) in the efficacy of homeopathy on organic disease. But why this concern with (the supposed effects of) remedies, when the study is supposedly not about them?

I have not, though their names are provided, checked out the specialisms of these reviewers. I prefer to base my comments here on the publicly available statements made regarding this particular paper. In my original post I wrote, in my ever-attempts to be fair, that the paper was ‘… presumably peer-reviewed by academic types more suitably qualified than I to assess the corrections for confounding factors, the validity of the scoring, and statistical analyses thereon.’ But I hadn’t then read those reviews. This does all make me wonder how the original version was pitched. But I’m not sure I want to go there. If a scientific clinical/medical journal wants to justify publishing this kind of thing, then it should, for the sake of its readers, assign referees who will provide scientifically valid reviews.

And so what of this reader’s (still ‘under moderation’) comment at BMC Cancer? I maintain I ask genuine questions and make valid points – particularly the inverting of QuackRag WDDTY‘s excuse for citing it; viz. that the paper constitutes evidence that ‘Homeopathy is more than placebo’. Rather, I contest that it demonstrates there is no such thing as homeopathy at all.

Because, in its reaching effort to justify the irrelevance of the randomised controlled trial to homeopathic remedies – because their usage cannot be extricated from the individualised care process prescribing them – this paper is self-contradictory. Evaluation of the effects of the care component of ‘classical’ homeopathy is likewise impossible if those effects rely on the anticipation of remedies which are ‘… likely… only active in an unbroken therapeutic context’ engendering that anticipation. Yet, whilst seemingly arguing the inseparability of remedy and care elements, this is what the authors half-quixotically attempted: ‘It is important to notice that we have not studied the effect of homeopathic remedies, but of homeopathic care.’ But leave out the remedies – thereby eliminating the anticipation of them – and what are you left with? At best… care. No more ‘homeopathic’ than anything else.

All this labour based on the assumption (belief?) that there is homeopathy. But there isn’t. There is no such thing. If this paper in BMC Cancer is successful at all, it is by this subtle affirmation.