You are Taking Part in a Randomised Controlled Trial Right Now

Double Blind Randomised Controlled Trials (DBRCTs) are not the preserve of medical science. Increasingly, corporations are using them to enter into a new world of Evidence Based Marketing where massive, continuous and automated trials are being run on us in order find out how to sell more stuff and become more profitable. What does this mean for medicine and our lives?

Our beliefs are our internal models of the outside world that help us inform decisions. When faced with a need for action we must have beliefs about what our goals are, how valuable those goals are, the chances of succeeding in moving towards those goals when taking a particular action and what are the consequences of failure. Our brain is calculating what our ‘next best action’ is so that we maximise our pay back from the action. As such, having beliefs that correspond to reality helps us make good decisions. But we are not like computers where we assign numeric probabilities to our chances of success, or correctly value our goals, or estimate the consequences of failure. We most often have intuitive feels for our next best actions that may be hard to express to another person. If we become experts in a certain field though, those intuitions may be more commonly replaced with learned knowledge and we may make more conscious and explicit calculations. But completely ignoring our intuition is hard.

Doctors are faced with a constant stream of choices. At each stage of their interactions with a patient there are dozens of decisions and options that need to be analysed, prioritised and then made. Typically, only one thing can be done at a time. What is the best thing to do next with this patient given what they have told me, what diagnostic information I have available, their history and my experience? Should I wait to see how things progress and get more information? Is surgery the right option or is medication right? Which medication? Should I refer to a more specialist colleague? What risks are there in the various courses of action? What is the patient’s attitude to these risks? What impact would a poor outcome have on the patient? This is complex stuff and the training required to get to the state where you can start making such decisions on your own is likely to be over a decade – maybe two. Getting it wrong can have severe repercussions.

The big change over the last few decades in medicine is that, increasingly, historical statistical evidence is being used to help inform such decisions about ‘next best actions’. Before the advent of the Evidence Based Medicine movement, such decisions were largely made on experience, training and intuition. The problems of this approach were that any particular doctor can only ever achieve a certain stock of experience and training. In a career, the number of times any doctor might have seen a certain rare condition could be counted on the fingers of one hand, if at all. Even for common conditions, a doctor’s experience of various modes of treatment may well be limited. What is worse is that personal intuition and experience are subject to horrible biases, cognitive errors and delusions that make judgements very suspect. Evidence Based Medicine has added new sources of information into the decision making process in the form of pooled data from thousands of patients. We can now assign numerical probabilities to our chances of success given data on what has happened in the past. Doctors have slowly subjugated their personal intuition and experience to the collective authority of the evidence from thousands of carefully collated cases, often in the form of clinical trials.

When faced with the question ‘What is the next best action with this patient?’ a doctor can draw on the statistical evidence of thousands of cases somewhat like the one in front of her. Double-blind randomised controlled trials (DBRCTs) are now the benchmark method for providing the statistical evidence to help inform good choices. So now, an understanding of interpreting statistical data is as much a requirement of doctors as a detailed knowledge of anatomy. This change has not been smooth and is still ongoing as this development has sometimes been seen as a threat to the authority and power of the individual consultant.

Also, the medical problem of collecting the data to allow accurate predictions of outcomes can be very difficult. It is expensive, requires lots of ethical considerations and consent from many participants. There is then the difficult problem of ensuring the results can be turned into effective actions by ensuring that medical staff are made aware of the results and that they have access to these results at their point of need.

For the patients and the public, statistical evidence can be treated with suspicion. The adage that there are ‘lies, damn lies, and statistics’ has come to be interpreted as that ‘all statistics lie’, rather than ‘statistics can be misused to deceive’. But, what is pretty much unknown is how deep statistical evidence is being used to affect our lives. It is not just medicine that has noticed the power of obtaining data from controlled trials in order to make better decisions. Where this sort of thinking is increasingly making the biggest impact is not in hospitals but in a marketing department near you. And they are using these techniques to the most devastating effect. There have been no big breakthroughs in mathematics that is making this happen. Rather, software is becoming cheap and easily deployable and usable by people without PhDs in statistics. Web technology allows the intelligence discovered through statistical analysis to be easily delivered and used by the companies employees and on automated web sites. Marketing departments are using sophisticated software without being aware of its underlying complexity.

Let’s look at a mobile phone company. On the face of it, a simple business. They sell you a mobile phone and a tariff and collect some money off you monthly, or through some sort of voucher scheme. However, it is now a hugely competitive business where anyone who is ever likely to own a phone probably now does (or maybe more than one). The fight is for the customer loyalty of the most profitable customers and to sell more services to them. How does a mobile phone company do this?

Imagine that you bought a mobile phone a year ago. You are now at the end of your contract and the flashy phone you acquired last year now resembles a house brick and is as trendy as acne. You are free to stop paying your line rental and jump to a new company or get an upgrade with your existing company. What should the mobile phone company do? They could email you and offer you a new, smart, sexy phone and good deal on a tariff. But, this might alert you to the fact that you are free to jump ship and get that iPhone you know you need from a competitor. Alternatively, your company could just keep quiet and hope you keep paying your bills each month at no cost to them. Upgrading your phone is expensive for the company (in the UK, handsets are heavily subsidised). Your company does not want to do this if they do not have to. But, if they do nothing, you might quietly slip away without them ever knowing. Should they contact you or not?

The answer is statistical analysis of what other customers like you have done in the past – predictive analytics. Given your age, your address, your monthly spend, the number of texts you send, your overseas calls, the amount of time you chat on the phone, your payment history, your payment method, the complaints you have made, the ring tones you download and your eye-colour, your mobile phone company can make a good guess at your likelihood to ‘churn’ – that is, up sticks and go to the competition. Moreover, it can predict how much you might spend next year and so work out how much it can afford to spend trying to keep you as a customer (or if it should quietly ‘let you go’.) Some customers get offered low tariffs, flashy gold plated handsets, text bundles and free insurance. Others get offered a free ringtone. Statistical analysis is deciding what you get.

But it gets more sophisticated than this. If you do happen to ring up your mobile phone call centre, the complete experience, second by second, will be decided by propensity analyses to decide the ‘Next Best Action’ at every stage of the call. Do you get directed to a real agent or put in the queue for the dreaded speaking machine? Which agent will speak to you? How old will the agent be? Will they support the same football team or like the same soaps? What will that agent say to you? Every sentence the agent says will have a computer suggesting the next best thing to say. Do they offer you a phone upgrade? Ask you to pay by Direct Debit? Offer you a deal on home broadband? Agents may not have to ask you these things, but they will quickly learn their bonuses improve if they do. Computers are whirring away in the background constantly re-evaluating what is the next best thing to do. If you happen to owe your mobile phone company money on a bill, you can bet you will have been sent to one of their specialist ‘collections’ agents who will be following strategies suggested by the computer to get you to promise to pay.

Frequently, sufficient historical data is not available to make accurate predictions about how you will behave. In comes real-time adaptive controlled trials. When the companies next best actions are being enacted, your responses are being collected and recorded. In the background, software is running an experiment to work out what to do in the future. The software creates experiments, assigns strategies, and randomly splits the customer base into experimental groups and control groups without any human being aware who is in what group. The software is counting response types in real time and adjusts its next predictions in response to what is happening right now. A competitor might bring out a new special offer. The software recognises that certain customer ‘treatments’ are no longer quite so effective and so quietly drops certain offers, or reserves them for the most ‘price insensitive’ customers. All this could happen within hours and without a real marketeer lifting a finger. The management are no longer deciding how to market what to which customers. They are simply defining corporate strategies, such as their profitability goals or the extent of their customer base, and the statistical analysis software is quietly getting on with the job of deciding who to offer which products and when to do it. Call centre agents are none the wiser that the strategies they are using on their callers are slowly and continuously changing as the evidence base for their effectiveness is evolving.

And it is not just the call centre – the adverts that appear on your tailored personal banking web site, the leaflets that go in your statement and the promotional text messages you receive are all part of a unified and optimised strategy that is unique to you based on the vast amount of data that the company has on you, and, moreover, it is based on the evidence of effectiveness of hundreds of thousands of previous interactions with similar customers. Most often, a company will decide that their next best action is to do nothing; they know that bombarding you with silly sales messages just annoys you. The ‘Old Company’ sends you a hundred leaflets knowing that less than 1% will hit a receptive target and that the rest are actually doing the company harm. But without predictive capability, it has no choice. The trick is to know when that sales message will hit a chord. The beliefs that inform companies when is the best time to sell to you are no longer held in the intuitive minds of the marketing department but in the coefficients of predictive models in a computer.

Is this happening right now? It is getting very close. Scenarios like these are happening in the majority of large consumer companies. They are learning how to use the various strands of these technologies and deploying more and more. John Wanamaker, the department store owner famously said, “Half the money I spend on advertising is wasted; the trouble is I don’t know which half.” If he was only wasting half, then he was doing well. We are now witnessing the emergence of Evidence Based Marketing where Wanamaker’s maxim will be laid to rest. Companies are talking about Enterprise Decision Management where the technologies required to do this are brought together into a central decision hub that is used to ensure the myriad of tiny and large decisions that are being made day-to-day are manageable, understandable, controllable and based on evolving evidence.

The most aggressive mobile phone companies are starting to behave just like this example, and others are following suit. It is not just phone companies, but your cable TV company, your bank and your electricity supplier. Any large company not doing this in five to ten years time will not be a company. Already, some of the largest banks are making billions of next best action decisions per year using this sort of strategy. It is not just the big decisions, such as whether to lend you money, but thousands of tiny decisions such as to ask you whether the company has your correct home phone number or your cable company to remind you that a blockbuster film you might enjoy is on tonight. Your total commercial experience will be determined by the results of thousands of double-blind randomised controlled trials, and you will be taking part in a dozen more trials, right now, without you even knowing. We are all now consumer lab rats.

For the consumer, the experience may not always be positive. Some may feel that their company appears to ‘know what they want’. Others may feel locked out of good deals. We are allowing this technology into our lives without us really thinking about it. Amazon tells you what is the next best book to buy and what music you will like. Google displays adverts that have trial-based evidence behind them to suggest you might click on them. Your Internet dating site is telling you who your next best lover is. The songs you listen to, the books you buy and the news you read is all personally decided on a ‘demographic of one’ and may well be unique to your own tastes, buying habits, politics and preferences, and all decided by statistical analyses of huge numbers of people. Sophisticated customers know this and play this to their advantage. If you are not threatening to leave your mobile phone company next time your contract is up you will not be passed to their ‘retention team’ and so will be denied the best deals. Complain too much though, and your mobile phone company (or, actually the underlying software) will decide you are not worth the bother. It’s going to be a battle. Expect consumers to retaliate, or at least, expect other start-up companies that use even more statistical evidence to help you retaliate and get the best deals. When should you buy that easyJet ticket or book that holiday? Do you know when it will be the cheapest without risking that it will sell out? Expect someone to help you soon. The First Consumer Statistics War is beginning.

Our reaction to this technology might be horror. It is impersonal and diabolical. Its advocates claim that it is just making large companies more like your local butcher who knows your name, knows you like smokey rindless bacon and you are good for credit. The reality is that it is a bit of both: a dehumanisation that makes the experience somewhat more personal. It really is just a massive extension of what your butcher does: he is nice to you and knows you well, so that he get the most out of you without you feeling cheated or exploited and start shopping elsewhere. Both you and your butcher feel happy with this arrangement.

How will this affect the relationship you have with your doctor? Well, I doubt it will be quite so brutal or extensive – just yet. The main difference is that it is not solely the doctor deciding what the desired outcomes are. The key word is ‘best’ in Next Best Action. Who says what is best? In corporations, they set their own goals depending on corporate strategy: number of customers, profit per customer, quarterly sales targets, etc. You have no say. With the doctor, their emerging role is to help you decide where you want to end up given the various risks and benefits of various courses of treatment. Would surgery risk curtailing your mobility, hobbies and family life? Would it be better to look at other therapies right now? Part of the doctor’s job is to help patients understand the statistical nature of what might happen. As the homeopaths are so fond of telling us, treatments must be individualised, but it is evidence based medicine that can really help individually tailor those paths of action using a good understanding of the risks and benefits of each path and your personal goals.

As I said earlier, one of the difficult problems of evidence based medicine is turning the currently available evidence into actions. It is a real problem to get the data to the doctors at the right time and the right place and in a form that can be used to help make informed decisions. Maybe doctors may learn something from their ruthless commercial colleagues. It may never happen they we see doctors simply following scripts from a computer (with the possible exception of hugely complex and time-pressured emergency and intensive care), but computers will be at hand to provide the most up to date evidence base for various courses of action. Unlike commercial data, the collation of vast amounts of health data to help in this process may not be easy. Even collecting anonymised data to help produce rolling ‘real time experiments’ is fraught with ethical and technological difficulties. The rewards are real. Statistical technology has the potential to offer us better and faster diagnosis, clearer understanding of treatment options and higher chances of favourable outcomes.

Medicine is undoubtedly moving in this direction and our reaction to it will be interesting. Already, dissatisfaction with a doctor is one of the key reasons why people turn to alternative medicine. Will the perception of increased impersonality made by the presence of computer aided consultations push people further into the arms of quacks? Will the irony of improved diagnosis and treatment plans risk people seeking unproven and dangerous alternatives?

Whatever happens, I think the emerging and defining difference between conventional health care and quackery will be the role of statistical data in helping to determine the next best actions for patients. Nowhere is this starker than how homeopaths deal with evidence in their practice. Homeopathy, if it survives, will become a living museum of what medicine used to be like before statistical data was used to help determine actions. Paternal and ineffective, but personable. Homeopaths use their ‘experience’, their ‘training’, their intuition, and their bible – the Organon. No homeopath ever uses the statistical data from a trial to determine which remedy to prescribe. What homeopaths end up using is their delusions and wishful thinking. In fact, the resistance to evidence in homeopathy is overwhelming and defining. For someone wishing to maintain their health, their next best action might be to ignore those not using statistics to decide their next best action.

On this theme…

30 Comments on You are Taking Part in a Randomised Controlled Trial Right Now

  1. There are serious errors in the description here of how homeopaths usually select a remedy for the patient. In the 21st century this is commonly done on a computer and the database used is called a repertory. This database lists and grades the likelihood of a remedy helping a given symptom. These collections of clinical material were first compiled in the time of Hahnemann and have been corrected and added to ever since.Some have over a million entries eg Dr Schroyen’s Repertorium Syntheticum. Homeopaths routinely share new information as it is simple in this digital age. It is not a question of a homeopath dreaming up a remedy choice out of thin air. There are some wannabe homeopaths who do this just as there are children who push toy planes and think they are pilots.
    Descriptions of homeopathic practice on this site are in my opinion frequently libellous.
    I believe that what we are seeing at present is a new form of intolerant fundamentalism – Scientific Fundamentalism – There seems to be a phenomenom of groups of scientists that cannot abide other people with belief structures that are perceived as being at serious variance with theirs. Homeopaths are reported as pouring into Africa to ‘cure’ AIDS. The only person foolish enough to announce this is an ex-homeopath called Peter Chappell (much lampooned here)
    Websites that are not approved of can be attacked ferociously. I don’t consider Peter Chappell to be a homeopath and wouldn’t dream of following his methods but I wouldn’t bring down his website using no expense spared cyber-weaponry. This happened four days ago. This is a criminal act.
    Quakometer is apparently run by a doctor and obviously takes considerable time. Why isn’t Andy Lewis practising medicine? The state paid for his training but instead he plots war against homeopaths. It is most odd and conspiracy theorists will have a field day.
    Science can’t explain consciousness. There are many things it cannot explain. It is not is a rightful position to tell people what they can and can’t believe. Perhaps some scientists would like to start giving people pills if they persist in going to church or believing in the human soul. Scientific Fundamentalism could be a worse threat than the Islamic version IMHO

    • “Scientific Fundamentalism”

      You mean the kind of fundamentalism that wants to force (proper and self-proclaimed) medical practitioners to stick to the facts?

      The dictatorship of unbiased evidence?

      I feel your pain. What a cruel world.

      😉
      Daniel

  2. Great article, LCN.

    slmcowan- Ah, yes. Peter Chappell is neither a true homeopath nor a Scotsman. That would explain why he was one of the speakers at the SOH AIDS conference.

    As for homeopathic repertories, it was my impression that the information contained within was collected from the anecdotal impressions of individual homeopaths rather than properly controlled trials. If that is the case, then LCN’s statement that “No homeopath ever uses the statistical data from a trial to determine which remedy to prescribe” is perfectly accurate.

  3. I’m afraid Mr Joseph Hewitt has got a number of things wrong here. Firstly the Society of Homeopaths Conference takes place at the University of Leicester this April. The event he refers to was just a fringe event called a symposium at Roots and Shoots (apparently a small special needs gardening club off Kennington Road).

    Secondly it does not follow that a speaker at an event is necessarily a homeopath. Germaine Greer spoke at an Alliance of Registered Homeopaths and she certainly is not a homeopath. People get invited if they are perceived as having something to say that will provoke a debate. Peter Chappell has courted some notorious publicity with his pronouncements and for some reason he was invited. Despite his views and methods being at variance with just about everybody homeopathic he is well known for his earlier more orthodox work. eg he designed the first homeopathic software.
    As far as I know the attendance at this event was little more than a man and a dog. It has been blown out of proportion by spin doctors of the fundamental scientist world.
    If some homeopaths such as Hilary Fairclough have sacrificed their time and money to try and allieviate suffering in Botswana that should be commended. She is not attempting to replace orthodox treatment. Suffering does not end the moment ARVs are commenced. Patients usually start to look better and also live longer but will still go through very rough patches. Another problem never discussed is that patients on ARVs will frequently infect lots of other people in their extra years. Women in Africa are highly vulnerable to predatory infected men. Unemployment can be 70-80% in some parts of Africa and people may feel as if they just have their bodies to live on. This is completely ignored by naive politically correct Westerners

    Thirdly I did not anywhere state that homeopathic repertories were collated from random controlled trials. I was simply correcting the usual defaming description of how homeopaths are supposed to select one remedy from another. It like talking to the proverbial brick wall.

  4. One of your best articles yet, and a refreshing widening of your usual themes. But the arguments could, I think, be taken a little further. The evolution of decision making enabled by the fascinating new nexus of statistical methodology and increasingly affordable computational power (Moore’s ‘Law’, Butter’s ‘Law’ etc), can be documented not only in medical decision making and mobile phone marketing, but in every other arena of complex human behaviour. This takes in activities as diverse as piloting the new ‘chaotic’ fighter planes, management of large parts of the food chain, the financial system, and – I am reliably informed – increasing elements of military decision making.

    This progression appears to be inevitable, reflecting as it does the desire of individuals on all sides to use the new tools to maximise their own gains; but as the current financial downturn / recession illustrates, the progressive shift of decision making into an extremely abstract realm, evidenced by the role of 2nd and 3rd generation financial instruments in creating the conditions necessary for this recession, has left us vulnerable, on a very large scale, to simpler and more basic realities. This is what happens when inaccurate data or incorrect assumptions are integrated in, and disappear within, higher level models.
    Recent developments on the statin front provide an example closer to home.

    There is a closely related aspect to this which is equally interesting, and that is the impact of this shift in decision making on our own cognitive abilities, and indeed on our sense of what it is to be human as we move closer to the so-called AI singularity. Forget Vinge’s initial terminology; Kurzweil’s later definition of the singularity as a gradual process is more productive, and your article is one more yelp of alarm (there are many others, coming from skilled and literate practitioners in many other disciplines) that we are already in the foothills of this process.

    But let’s return to medicine, as this is the discipline you represent. When we arrive at that point where doctors are effectively locked out of diagnostic and therapeutic decision making, and reduced to conduit roles, will it still be necessary or even justifiable to put the next generation of bright young things through the prolonged and expensive training that we use today? And what happens when we take this further and start to down-grade analytical and decision-making skills, and prioritise the older human (and medical) skills of listening, empathy and sympathy?

    Just speculating. Paul C

  5. I am getting more and more confused by the contradictory arguments put forward by various homeopathy supporters. On the one hand we have SLMCOWAN here saying that homeopaths do follow a statistical evidence-based approach, while over on Gimpy’s Organon blog we see homeopaths arguing that a statistical approach is bound to fail as it is based on a ‘false’ assumption that the average response of a population has any significance to an individual.

    There are clearly disagreements between homeopaths on matters such as this but I’m yet to find any discussion of them in the homeopathic literature. These differences in opinion only seem to be evident in arguments with critics. Could it be that each homeopath just chooses the argument best suited to the current discussion.

  6. “If some homeopaths such as Hilary Fairclough have sacrificed their time and money to try and allieviate suffering in Botswana that should be commended.

    Another problem never discussed is that patients on ARVs will frequently infect lots of other people in their extra years.”

    So, if homeopaths try to help that’s commendable, even if their “help” consists of nothing more than charging (relatively) lots of money for a questionable placebo? On the other hand, if EBM provides real help, that’s a bad thing because it’ll only give extra time for those nasty Africans to go on infecting each other? You’re a strange scary one, slmcowan.

    As for Peter Chappell not being a homeopath, well, if only there were a way for laypersons like myself to tell which homeopaths are the true homeopaths and which ones are not. If only there were some observable or otherwise significant difference… oh well, it’s not relevant to the point at hand. I’ll concede the point to your professed knowledge.

    “Thirdly I did not anywhere state that homeopathic repertories were collated from random controlled trials. I was simply correcting the usual defaming description of how homeopaths are supposed to select one remedy from another.”

    So, you agree that homeopaths don’t base their treatment on the result of trials… exactly what is it in LCN’s article do you disagree with then?

  7. I’m quite happy with the computerised butcher, because I’m smug enough to think that I can use it to my advantage. Applied well, it should lead to lower incremental costs.
    Most people like personal service, feeling that they can see inside the butcher’s head, satisfying themselves as to his motives. This is probably not the case with statistical software, hence the unease that many may feel.

    I have often wondered how Homeopaths make their diagnosis from the limited information of external symptoms and patients’ reports.
    There are thousands of remedies, many with hundreds, if not thousands of indicators.
    This is a serious pattern matching condition for our humble brains.
    There are many uncontrolled background variables, and according to Hahnemann, a patient’s sensitivity to a remedy may vary a thousand to one. Computerised experts systems may help, but of course, they are a recent addition.
    Does anybody know how many conditions a GP can diagnose without the aid of patient records or further tests?

    Slmcowan,
    The brick wall is listening, but receives no coherent answers. Asking for tolerance is no substitute for evidence; Homeopathy is a science and not a religion.
    I have no reason to dislike Homeopathy any more than I do surgery – and that cuts people open.
    Questioning Homeopaths about the details is a reaction to their lack of adequate response to more penetrating, but reasonable questions.
    If skeptics seem ignorant of the details, then it is because we get several answers. Homeopathy is not hard to understand.

  8. In answer to points raised by Joseph Hewitt,
    Firstly, the small number of homeopaths visiting Africa are not doing this for money, but for charity. It should be obvious that there will be no money to be made dispensing homeopathic remedies to sick people in Botswana etc. To repeat, these people are flying out and giving their time because they have seen results from their practices that enthuse them enough to attempt to do something for their fellow human beings. It is a misrepresentation to claim that homeopaths are attempting to replace orthodox treatment.

    Secondly, I resent the twisting of my words to insinuate that I prefer Africans with HIV to be ignored by orthodox medicine. I was simply pointing out that the current MANNER in which they are being dispensed is certainly RAPIDLY accelerating the spread of AIDS. People given free ARVs need to be threatened with prison if they deliberately and knowingly infect others. Their partners and families should be told of their condition. If these people appear irresponsible they should be given a choice, a discreet as possible marker on their body or a lack of treatment.
    Rwanda for example has seen a horrific spread of AIDS since the arrival of ARVs. I was married in Rwanda 4 years ago and numerous people in our wedding photos are now sick or dead. If things continue as they are, Africa may be almost empty in a hundred years apart from couples who are both virtuously monogamous.

    Thirdly, Peter Chappell is not to be found in the current registers of the Society of Homeopaths or the Alliance of Registered Homeopaths. You simply need to consult these. We have Common Law in the UK and it is true that anybody can decide that they are a homeopath. This is not ideal but I would argue that it is better than a situation where the likes of Prof Ernst start deciding who is and isn’t a homeopath. It would be like pilot licences being awarded by a bus driver.

    Lastly as I explained I objected to the distorted and ridiculous description of how remedies are selected by a homeopath. It does not rely upon intuition and hocus-pocus. I don’t have the patience to give you a free tutorial but the ARCHIBEL website would give you a better idea.

  9. “Firstly, the small number of homeopaths visiting Africa are not doing this for money, but for charity.

    To repeat, these people are flying out and giving their time because they have seen results from their practices that enthuse them enough to attempt to do something for their fellow human beings.”

    If they were paying for this entirely out of their own pockets and not interfering with the real medicine, I might agree with you. As it is they are taking limited resources that could be better spent on improving the ARV program. As you admit yourself, there are many problems that need to be addressed. I fail to see how administering placebos will solve any of them.

    If you want to help people, I think it’s important to actually, you know, help people.

    “Secondly, I resent the twisting of my words to insinuate that I prefer Africans with HIV to be ignored by orthodox medicine.”

    I know, you weren’t trying to say that Africans should die, you were merely trying to show that EBM doesn’t have all the answers and therefore we should believe in magic pixies. It’s an old gambit. Unfortunately, this isn’t a particularly convincing argument, and it leads people to say stupid things like “Homeopathy good! Saving lives bad!”.

    “Lastly as I explained I objected to the distorted and ridiculous description of how remedies are selected by a homeopath. It does not rely upon intuition and hocus-pocus.”

    Without controlled testing, I’m afraid it does rely upon intuition and hocus-pocus, at least according to some definition of those words. It may be the combined intuition and hocus-pocus of hundreds of practitioners compiled into book form, but without controls all of this information is basically useless.

    Even well-intentioned researchers are subject to biases and can make mistakes. That’s why the scientific method is so important.

    Your reaction, I expect, will either be “How dare you accuse homeopaths of fraud!” or “Homeopaths have ways of dealing with bias, but I can’t explain them to you”.

  10. In answer to Joseph Hewitt:
    I would have to admit that if you were my doctor I would be happier if you were using information from random controlled trials instead of your own ideas. This is because you are very inclined to make rash assumptions about the other person and what is stated.
    It is not very objective to keep dwelling on the tiny number of homeopathic volunteers but you have assumed that they are being paid. They are not being paid in pounds, dollars or even peanuts.
    If resources are being reallocated it is their loss and not the taxpayer.
    It is your assumption also that homeopathic remedies are utterly ineffective but if this is so this would mean that the likes of George Vithoulkas must have superhuman healing powers. It is clear that you haven’t even bothered to witness anything yourself. If you are a sceptic or a believer it is all too easy to reinforce your prejudices on the internet.
    I don’t object to random controlled trials but they can be flawed if assumptions are made that all humans are identical. An anaesthetist is aware that all humans are different and that is why they are used to closely observe a patient. Different procedures and drugs will affect patients differently in different situation. There are countless variables.

  11. “I would have to admit that if you were my doctor…”

    If I were your doctor, I’d advise you to find a new one too. I’ve never been to medical school and strongly believe that all diseases can be cured with sufficient amounts of peanut butter. Any patient entrusted to me would clearly be in mortal danger.

    “It is your assumption also that homeopathic remedies are utterly ineffective but if this is so this would mean that the likes of George Vithoulkas must have superhuman healing powers.”

    I didn’t say that homeopathic remedies are utterly ineffective; I said they were no more effective than placebo. That’s what trials have pretty consistently shown.

    As for this George Vithoulkas character, I’d have to read about trials based on his work before I’d be willing to attribute anything to his methods at all.

    “It is clear that you haven’t even bothered to witness anything yourself.”

    You realize that this is a sales pitch and not an argument, right? Whether or not I’ve witnessed anything has nothing to do with whether or not homeopathy has been empirically vindicated. I’m no more immune to bias than anyone else.

    “I don’t object to random controlled trials but they can be flawed if assumptions are made that all humans are identical.”

    Agreed. That’s why it’s a good thing that most trials use a sample size of more than one person. That’s also why it’s a good thing that studies are criticized and replicated by other researchers.

  12. “In the 21st century this is commonly done on a computer and the database used is called a repertory. This database lists and grades the likelihood of a remedy helping a given symptom.”

    GIGO. Using a computer may sound “sciency”, but it adds nothing to the validity of the “proving” data involved, and says nothing about the validity of “like cures like”.

  13. simcowan said:

    “This is not ideal but I would argue that it is better than a situation where the likes of Prof Ernst start deciding who is and isn’t a homeopath. It would be like pilot licences being awarded by a bus driver.”

    Why is Prof Ernst unsutiable int his role? If you look at his C.V. (below) I’d say that he was almost ideal for it.

    Edzard Ernst MD, PhD, FRCP, FRCPEd

    Laing Chair in Complementary Medicine

    Professor Ernst qualified as a physician in Germany in 1978 where he also completed his MD and PhD theses. He has received training in acupuncture, autogenic training, herbalism, homoeopathy, massage therapy and spinal manipulation. He was Professor in Physical Medicine and Rehabilitation (PMR) at Hannover Medical School and Head of the PMR Department at the University of Vienna. In 1993 he established the Chair in Complementary Medicine at the University of Exeter. He is founder/Editor-in-Chief of two medical journals (Perfusion and FACT). He has published more than 30 books and in excess of 700 articles in the peer-reviewed medical literature. His work has been awarded with eight scientific prizes. In 1999 he took British nationality.

  14. Poor Prof Ernst doesn’t believe that homeopathy works. He is often referred to as a ‘qualified homeopath’ but it has never been explained to me how or where. I have never once heard a fellow homeopath sing his praises.
    I have never seen a single write-up of a successfully cured case by this would-be homeopath – Please find one for me.
    Wouild you employ and award a would-be pilot who believes flight is impossible? Would you put him in charge of the proper pilots?
    I have never bumped into him at a homeopathic seminar in 25 years.
    His trials seem to be a farce and a set-up. Why use Arnica for patients having carpal-tunnel wrist surgery? The appropriate remedy would have been Hypericum. Of course the Arnica trial failed -Anybody with the slightest knowledge of homeopathy would have expected failure. Prof Ernst clearly has been too busy collecting prizes to learn the basics of his professed subject.

  15. simcowan wrote:
    “Women in Africa are highly vulnerable to predatory infected men…..This is completely ignored by naive politically correct Westerners”

    Westerners are not responsible for African male sexual practices.
    That you know of them is a result of Western research, and the drive behind the condom program. In your version, men are predators.

    “If some homeopaths such as Hilary Fairclough have sacrificed their time and money to try and allieviate suffering in Botswana that should be commended”

    The question of payment is not particularly relevant. Those dispensing Homeopathy in Botswana are promoting a recondite system of medicine that is denied by the science of the society it is seen to represent. To mislead desperate and unsophisticated people in this way is shameful. Good deeds and zealotry are so often uneasy bedfellows.

    “Science can’t explain consciousness.”
    This is folk lore. Science has a very good model of consciousness, though many hope the subject to be so inscrutable they have not bothered to investigate it. There is a small library of books that you may care to read before making such an assertion.

    I did look at the ARCHIBEL site, but could find only instruction on the use of the software.

  16. Humber sais ‘Westerners are not responsible for African male sexual practices.
    That you know of them is a result of Western research, and the drive behind the condom program. In your version, men are predators’

    Of course Westerners aren’t responsible for miscreant diseased individuals but if they dispense ARVs they ideally should do it in a responsible manner. ‘Doing good’ with a lack of wisdom is often a disaster. Westerners forget that the majority of African women are vulnerable. No social security, no council housing, and usually no job unless you flirt with the boss. It should be elementary that men carrying HIV should be instructed / threatened to take care.
    Condoms, by the way, are not used by the vast majority of African men no matter how much they might be promoted by Westerners.

    Obviously it is the African governments also who neglect to take this seriously. I do not wish to blame just Westerners. Perhaps my previous words gave that impression.

    Regarding Westerners visiting Africa who seek to help AIDS sufferers I simply must repeat that there is no attempt to replace orthodox treatments. Quite why everybody on this site assumes this shows their prejudice. They get their ARVs and they get a homeopath to talk to at length. What is the harm in that even if it is assumed to be placebo ? treatment?

    I’d be genuinely interested if you could give a good book explaining consciousness. Thanks

  17. slmcowan

    You are clearly very impressed by homeopaths’ discovery of electronic devices.

    Do you like these?

    http://www.bio-resonance.com/elybra.htm

    http://www.remedydevices.com/

    Do they have more or less evidence to support their use than the pattern-matching computer programmes of which you are so proud.

    Where did the people marketing these machines get their validating data from?

    As Mojo has just said: GIGO. Of course pattern-matching homeopathic programmes produce an output. But, you have exactly zero valid data to show that the output has any meaning.

    You may be pleased and impressed that the output matches your personal reading of the repertory. The whole thing may give the impression of internal consistency. But, even if homeopathy were fully internally consistent, that would not make it true. It means no more than that the person programming the software has a similar view of the repertory as you. It tells you nothing about whether that repertorised remedy does what it claims to do.

    Of course, homeopathy is actually wildly internally inconsistent, but that’s a story for another day.

  18. Hello badly shaved monkey,
    Yet another unwarranted and wild assumption I’m afraid. Bio-resonance machines appear to be little more than random number machines if you take them apart. I have played with them and had a few freakishly good results but that is all it was – A freak. These ‘machines’ are a con and can lead the naive totslly astray.

    Repertories however definitely have not nonsense as the more carefully they are used the greater the probability of success.
    An experienced homeopath won’t prescribe on a single symptom but on as many as possible. In this way the partial inaccuracy of the repertory is overcome. There is a far greater probability of success when ten or more symptoms are found to match a particular remedy. Ideally you want more than that. This need for information explains why good homeopaths have huge libraries and databases.

  19. Simcowan,
    A lot of these posts seem to involve telling each other what we don’t mean.

    I don’t know how you can say that the vulnerability of African women is not appreciated by the West. The fact that a minority of women, and a lot of men, are acting as HIV sinks and then cross-infecting their wives, is a well understood problem.
    This is why condoms were so promoted, but it does not help to label the men as predators. Calling them ‘irresponsible’ is to apply Western values in the same manner that you decry. I don’t see how it would be possible to control any forced behaviour. There would be little governmental support or resources. A possible, but impracticable approach.

    Homeopathy may not be replacing AVR’s, but it generally at odds with scientific ideas of disease control and treatment.

    If the remedies have only a feel good effect, it does matter that they are being dispensed, because they will be confused with active medication. If AVR’s have any unpleasant side effects, they will be dropped in preference.
    I think that it is unrealistic to expect these patients to appreciate the differences in ideology.

    Getting men to use condoms is an International problem, but good intentions could be better satisfied with at least trying condom promotion, rather than placebo’s.

    I will post this evening regarding the books.

  20. Humber said
    This is why condoms were so promoted, but it does not help to label the men as predators. Calling them ‘irresponsible’ is to apply Western values in the same manner that you decry.

    Perhaps I should not have brought up this angle on the HIV problem as it is not very PC and will always get pounced on with glee. Maybe it is not relevant to this thread either! However I do know of numerous cases where low-life people merrily spread their diseases and when this happens to even friends of friends of friends you can get very angry.
    Of course not all African men are predators but if you are a well-off African man in Africa it can be very easy to indulge yourself to your heart’s content. The social and work environments can be very different.
    Thinking about it, I agree that it would not be possible for African Governments to police sexual behaviour of sick people. Many African prisons are standing room only.The resources don’t exist.
    As marking people is unacceptable, even if supported by vulnerable Africans there is really no solution apart from throwing lots of condoms around and putting up posters etc

    I really would expect homeopaths to do their best not to confuse patients about the role of ARVs.
    Peter Chappell is the most controversial homeopath in connection with AIDS and he was telling me personally just a couple of days ago that there is no question of attempting to get people to neglect their ARVs.
    I think negative assumptions are being made.

    I will be very grateful if you could list a book that attempts to explain consciousness from a strictly scientific and materialist viewpoint. I can’t promise to be converted but am genuinely interested. Thanks

  21. slmcowan, that was an interesting reply:

    I have made no unwarranted or wild assumptions. Please show one that I have made

    When asked about the validity of those machine you said;

    ” These ‘machines’ are a con and can lead the naive totslly astray.”

    Perhaps you should look at this page;

    http://www.remedydevices.com/testim.htm

    Here you will find enthusiastic testimonials from happy users. Are they just idiots? Why is their opinion less valid than yours? I note in passing that this difference of opinions is just one of the many internal consistencies from which homeopathy suffers, so thank you for proving one of my points.

    Which leads us to;

    “Repertories however definitely have not nonsense as the more carefully they are used the greater the probability of success”

    I’m afraid that your retreat to argument by bald assertion counts for very little. You are welcome now to produce some verifiable evidence that this is true. You know, comparative data with proper analysis.

    I take it from the tone of your posts that you actually practice homeopathy. I’m sorry to say that the quality of thought you have displayed so far is exactly why many of us think you should be regulated out of existence. Given that you cannot reflect competently upon your activities someone else should do it for you.

  22. slmcowan said;

    “Homeopaths are reported as pouring into Africa to ‘cure’ AIDS. The only person foolish enough to announce this is an ex-homeopath called Peter Chappell (much lampooned here)”

    slmcowan also said;

    “Peter Chappell is the most controversial homeopath in connection with AIDS and he was telling me personally just a couple of days ago that there is no question of attempting to get people to neglect their ARVs.”

    Just thought that merited highlighting.

  23. Three false assumptions of Badly Shaved Monkey as requested:

    1. I am clearly very impressed by homeopaths’ discovery of electronic devices.

    2. That I may be pleased and impressed that the output (of Bio-resonance) matches my personal reading of the repertory.

    (There is absolutely no comparison between a random number machine and a homeopathic repertory – Either this is complete ignorance or a wind-up)

    3. I take it from the tone of your posts that you actually practice homeopathy.

    No I don’t. I’m otherwise occupied at present.

    That’s quite a few assumptions in a few lines.

    Lastly, you mentioned Peter Chappell. It is not for me to defend Peter Chappell’s work as it is a departure from Homeopathy – I don’t understand it personally. I would rather leave it to him.

  24. Simowcan,
    Certainly the best proponent of the entirely materialist viewpoint of the mind is Daniel C Dennett, and a good start if you are interested. Of course, the philosophical library is large, and even today, the inimitable David Hume is still discussed.

    Dennnet’s major book is “Consciousness Explained’. This book was published in 1991 and he has since revised his ‘multiple drafts’ model, but the basic arguments are the same. This book is dense with ideas and a fascinating read, even if you do not agree with the conclusion.

    His model has been confirmed by a battery of behavioural tests. In the last decade alone, ‘nMRI’ scanners have undergone a revolution that rivals that of the computer, allowing detailed confirmation of the materialist model. One thing I appreciate about Dennett, and why I recommend him, is that he tackles his opponents head on. Dennett’s books will also provide their arguments and supporting bibliography.

    A more recent and less technical book is ‘Sweet Dreams’, in which Dennett tackles the philosophical objections to the study of consciousness, that cause many to concede defeat and declare the topic beyond our understanding. (This is how they want) it to be, I think)

    Like Dennett, most current researchers and philosophers are monoists, that is, they do not separate mind and body, and so turn their backs on the tradition of Descartes. Probably the best writer from this more subjectivist, but material camp, is Thomas Nagel. His infamous paper “What is it like to be a bat?” is a reasonable encapsulation of his objections to the materialist view.
    Even further removed is Jerry Fodor, but he seems to have lost the plot and now argues rather like a creationist, but I suppose it is necessary to read all sides.

  25. Many thanks Humber,

    I very much appreciate the time and trouble that you have taken here. I’m going to start with the bat paper as I’ve found it easily plus it isn’t too long:

    http://members.aol.com/NeoNoetics/Nagel_Bat

    It should be a gentle way into a complex subject as I’ve often wondered about these creatures as they sometimes swoop just over my head in the garden early in the evening.
    I’ve heard about Dennett and he is going to be heavier but I will be having a go. Thanks for telling me about Jerry Fodor.
    Regards to you

  26. I love statistics, but I think they are going to run themselves over with these models. The words “Bayesian” filter keeps coming to my head.

    Bayes ideas are great for spam filters, but really quite bad for predicting weather and seismic events.

    Considering how badly statistics are being used these days to gather health data, I don’t predict much better for the health industry. Whether it is the Tamoxifen study stoppage (the canceled the study because they thought there were signs the treatment worked, but you wouldn’t be able to tell if the treatment worked until the end of the study), Cell phones non-studies (how many times do you have to get negative results on a ubiquitous product to know their is nothing there), or pthalates in babies, the quality of the data is so abused as to make any future analysis nonsensical.

    The software will constantly adapt for marketing purposes, but there is a feedback mechanism that will eat itself in the end.

    This does beg a product though. Tie your statistics to a consumer database, tie your phone into it while you talk to the customer service of any of these companies and the “product” provides you with next best step information. We can make computers talk to each other with you and the call tech as mouthpieces.

    Add to this the fact that the execs of company don’t know anything about statistics either and what you really have is a bunch of Silver Bullet, Quacks, etc bamboozling each other as to the pertinence of their Next Best Action system.

    Good story though.

  27. I stumbled acrros your blog. I find very amusing your attack on hmoeopaths and homoeopathy.
    I have onlu one thing to say. I have tried orthodox medicine many times on myself, my children and my dog and all I got was worsening effects and side effects. I say that I have studied pharmacology and because I am a retired dental surgeon.
    I have only one thing to ask: How do you measure placebo effect on a baby, a toddler and a dog after taking a homoepahtic remedy and the amelioration fo the three subjets is staring at your face?
    How can you say it is placebo effect???

  28. because the placebo effect, in its broadest sense, is also about yourexpectations of the significance of the pill on the baby, toddler and dog. I am surprised that if you have been medically trained you do not understand such things as the placebo effect, regression to the mean, and so on.

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