[bpsdb] A lot of the time alternative medicine is something we can chuckle at - rich Chelsea types with more money than sense going into some local quack shop to get their Chakras realigned or whatever. But sometimes a quack comes along so utterly misguided, so horrifically arrogant, that they have the potential to endanger lives. In his live blog from Tanzania, Jeremy Sherr, a homeopath with an interest in AIDS, is gleefully telling the world about his fake treatments for AIDS patients.

Edit: Since I wrote this article and the claims made on Jeremy's blog were brought to wide attention, he has apparently been busy censoring and deleting entries. Rob Hinkley at semiskimmed.net has posted an incomplete archive here.

Jeremy's Tanzania blog surfaced in November 2008, and swiftly came to the attention of skeptical blogger Gimpy. For more details of his background read Gimpy's excellent post, but it suffices to say that Sherr is a sort of homeopathic superstar, with offices around the world; streams of revenue coming from his training, software and various remedies; and famous for his homeopathic "provings". He even has his own Wikipedia page.

Sherr believes that modern medicine is a conspiracy, and that homeopathic remedies can cure Malaria and AIDS. His latest venture in Tanzania involves travelling there to meet a fellow homeopath and set up a clinic, and in the first entry in his blog he bemoans the lack of funding available to do this: "There is plenty of money for AIDS, and there is plenty of money for Africa, but when it comes to homoeopathy- brick wall, a polite 'f off'. If I sound frustrated about this, it is because I am. After 10 years of emailing and conferencing and pleading and applying, I remembered what I have always known. Homoeopathy is the odd one out, the weird freak of medicine. And society and the conventional powers don't want to know."

It's not that homeopathy is the "odd one out", in fact it shares the same thing that all medicines have in common - if they can't be demonstrated to work, they won't get funded. If Jeremy really thinks homeopathy works, he should be conducting clinical trials in the UK, rather than 'f-ing off' to Tanzania where he can make wild claims without anyone around to check his data. Claims like: "I have decided that the main aim is to get out there and cure as many people as possible. I know, as all homeopaths do, that you can just about cure AIDS in many cases. But shhhh… I'm not allowed to say that, so you didn't hear it." You're allowed to say it Mr. Sherr, but unfortunately you do have to back it up with evidence.

Now, maybe you're reading this and you believe homeopathy can work. In that case this next quote, from the same entry, should still shock you: "I have little interest in the many new paths of homoeopathy that have addressed Aids and the epidemic. That does not mean I don't believe they work, I am sure they do to whatever extent, but I choose to follow the classical way as described by Hahnemann. The other systems may seem easier, but to me they are less sound philosophically."

The arrogance is spectacular. He concedes that other homeopaths may have techniques that work, but he doesn't give a shit about these because they clash with his "philosophy". Never mind the evidence, he simply doesn't care. It would be laughable, if it wasn't affecting the treatment of hundreds of AIDS victims.

Concern over Sherr's work escalated after his January 2nd entry, in which he stated ("ARV" = Anti-RetroVirals, the drugs used to treat AIDS): "So I am happy to go for a simple trial initially, with one arm of AIDS patients with homoeopathy and no ARV. There are plenty of statistics on ARV treatment and patients with no treatment at all that we can compare to. If we can prove that homoeopathy has any positive effect at all, we can move on to bigger and better things."

Naturally, this comment provoked outrage, as you can see in the comments. The idea of allowing AIDS patients to remain untreated goes against every principle of medical ethics, and there is no mention of a placebo-controlled group. Without a meaningful control, there will be no useful results. These thoughts don't seem to have occurred to Sherr at all. John from HolfordWatch left perhaps the best comment, and I'll reproduce it here since it sums up my own thoughts so well:

"And a trial of an implausible remedy that lacks good evidence of any benefit over placebo - and which is being given to patients who are not receiving ARV treatment - is ethical? Not to mention that the poor trial design means that you will not generate useful results - so you have the added ethical problem of wasting the time and energy of patients (and of the medics etc. who are working on the trial)."

"If you want to conduct a trial, wouldn't it be more ethical to use e.g. patients who are receiving ARV in a proper RCT? You could provide one arm with 'real' homoeopathic pills, and the second arm with 'placebo' homoeopathic pills."

Sherr hasn't replied to these comments, but clearly he's seen them. We know this because he has edited his blog entry. This is a particularly odious practise - while I'll often reedit my blog entries to clarify points, I made it clear when I have done so, particularly when people have commented on that point. To simply edit out a quote that 16 people have left comments on without any explanation is not on. You can see the old and new versions side-by-side below.

The Google Cached original:
"So I am happy to go for a simple trial initially, with one arm of AIDS patients with homoeopathy and no ARV. There are plenty of statistics on ARV treatment and patients with no treatment at all that we can compare to. If we can prove that homoeopathy has any positive effect at all, we can move on to bigger and better things."

It now reads (with edits in bold):
"So I am happy to go for a simple trial initially, treating AIDS patients who are not taking ARV. There is no shortage of patinets who, although they have been offered ARVs, have chosen not to take them because of the serious and debilitating side effects. There are plenty of statistics on ARV treatment and patients with no treatment at all that we can compare to. These are only preliminary thoughts, and any trial we undertake will be rigorously planned and ethically reviewed. If we can prove that homoeopathy has any positive effect at all, we can move on to bigger and better research."

Not only has Sherr edited his blog, he's also deleted comments. A more recent post describing the response to treatment of a female patient stated: "Before the ARVs she had a CD4 of 137. ... her CD4 count this week has gone up to a massive 1430! ... Thank God for homoeopathy!" In response to this, a commenter named Hinkley asked "why he attributes an increase in CD4 count in a patient taking ARVs to homeopathy". The comment was deleted, and the blog entry was edited to remove the claim. Indeed, the entry now bizarrely states "I am NOT claiming the the amazing CD4 count is a result of homoeoapthy, but the general improvement certainly is."

Now, just think about that statement, the facts being presented, and the logic involved. Sherr reports that the patient was on anti-retroviral drugs, her CD4 count improved, and she got better. Jeremy Sherr has backtracked away from claiming that homeopathy reduced her CD4 count, yet claims that it was homeopathy rather than the ARVs that was responsible for the "general improvement." How can he possibly deduce this from his data? At best the results are insufficient to answer the question, and ultimately most rational doctors would conclude based on existing evidence that the tried-and-tested ARV treatment was being effective.

But leaving specific facts aside, this wholesale editing and reediting of claims, and the censorship of fair comments about those claims, is not consistent with the actions of a man who would be happy to back those claims up with evidence. If Sherr is making thoughtless comments on a blog about his AIDS treatments then that's poor. If he's simply saying whatever he feels he can get away with, that's poorer still. People who have evidence don't retract or alter their claims at the slightest whiff of criticism.

How likely is Sherr to conduct a decent trial? Blogger Gimpy reported on an interview with Sherr in 2007, in which he stated: "You have to find willing partners and get a protocol through an ethics committee, and you need to talk their language. I hope it will work but if not, I will just go and do it on a small scale myself - I am determined to do that."

As Gimpy noted, what is shocking is the arrogance displayed by a man who is apparently prepared to simply ignore ethics committees to go ahead with trials. Given Sherr's views as expressed here, I fear that little is likely to prevent him going ahead with his amateur plans. As as Gimpy also commented, "this raises chilling parallels with Matthias Rath, the vitamin pill salesman whose rogue theories helped contribute to the deaths of hundreds of thousands in South Africa and beyond."

The influence of quacks and AIDS denialists over President Thabo Mbeki led to the adoption of insane policies that led to an estimated 300,000 needless deaths from AIDS in South Africa, a truly shocking, unimaginable figure. This underlines the point that the activities of those like Jeremy Sherr that are liable to undermine the progress of fighting AIDS in Africa are such a deadly serious issue. This isn't Westerners frittering money on daft treatments, this is the adoption of pseudoscience in countries whose populations are being decimated by the HIV virus.

And indeed, the alternative medicine "disease" that corrupted South Africa's health system seems to be making steady progress in Tanzania. Jeremy notes on his blog that: "Sigs explained about the Tanzanian law that support homoeopathy and other traditional medicines; Traditional and Alternative Medicine Act No. 23 of 2002. You can read it on [URL]. Sigs has been the main force behind this law, and he made sure that it was done properly and safeguards homoeopathy and just about every other major alternative medicine."

It is, in effect, a Woo's Charter, but it's not quite as "protective" of homeopathy as Sherr seems to think, for it sets standards for alternative and traditional medical practitioners to meet, and aims (among other thingss) "to Protect the society from abuse of traditional and alternative health Practitioner and research on human beings." Surely this should be applicable to Sherr's research? It appears though that with the support of "Sigs", Sherr has free-reign to do pretty much whatever he wants in the country. It's a disturbing thought. 6.5% of the population in Tanzania have AIDS, and any disruption of the progress being made by ARV treatment would be catastrophic.

This story continues to develop. Myself and a number of concerned individuals, Gimpy in particular, have been contacting a variety of official channels to complain about various aspects of the "research" and the wider project that Sherr is conducting. A number of conversations are ongoing, and I'll be reporting more on these efforts in the future. I also intend to write some more on the wider issue with the Tanzanian government and the activities of other quacks in the country. In the meantime, you can keep track of Jeremy's African adventure on his blog.

Watch this space.