The Quackometer

Bafflegab - the multiloquence characterized by consummate interfusion of circumlocution or periphrasis, inscrutability, and other familiar manifestations of abstruse expatiation - is word that ought to be familiar to Lionel Milgrom.

Milgrom is a champion apologist for homeopathic 'science'. As a former director of the Society of Homeopaths, he delights the homeopathic community with his musings on quantum theory, entanglement and its hypothesised role in 'patient-practitioner interactions'. Since quantum theory is highly specialised and requires advanced mathematical understanding to appreciate, one can be pretty sure there is not a member of the Society of Homeopaths who has the slightest clue what he is on about, or the knowledge to judge if he is speaking sense. But that does not matter. They wallow in his his quantum words like a medieval peasant listening to a Latin sermon. Or if I was being particularly cruel, like a dog, head cocked, listening to its owner describe her day at work. It is comforting, beguiling, but meaningless. But more on quantum homeopathy later.

Milgrom is now accusing critics of homeopathy as being the 'New Fundamentalists'. Somehow, the likes of Edzard Ernst, Richard Dawkins, David Colquhoun and Ben Goldacre and stuck in some naive philosophical view of science that cannot comprehend the 'new paradigm' of homeopathy. I want to show how his arguments are a distraction and just plain wrong; rhetorical devices designed to deflect from the substantive criticisms being made. They are at essence a classic ad hominem attack using the old devices of straw men and misrepresentation. For homeopaths, his arguments are just impenetrable but comforting words that allow them to ignore the serious concerns being expressed about the activities and beliefs of homeopaths.

Milgrom's accusations that critics of homeopathy are the 'New Fundamentalists' have appeared in a number of places. Most prominently, a series of seminars were held recently by Jayney Goddard. The accusations made it (shamefully) onto the pages of the Times Higher Education Supplement. The presentation that Milgrom gave is available from the vitamin pill industry lobby group, the Alliance for Natural Health. But importantly, Milgrom has set forth his ideas in a paper published in the Journal of Alternative and Complementary Medicine, entitled Homeopathy and the New Fundamentalism: A Critique of the Critics.

So what are the accusations that Milgrom makes against Homeopathy's critics and why are we 'fundamentalist' in our outlook? His arguments can be summarised as:

1. We are 'economical with the truth' and we 'propagate porkies'. Straight up, we are liars.
2. Modern medicine is 'deadly' and we are ignoring this fact.
3. We lie when we say there is no good evidence for homeopathy. We cling to 'discredited' meta-analyses, such as Shang at al.
4. We ignore 'developments' in material science that shows water has a memory.
5. We are philosophically naive in our demands of 'proof' for homeopathy and that we are challenged by 'Popperian and Kuhnian' views of science. Hence, we are 'unscientific'.

In Milgrom's own words,

New Fundamentalism’s hallmarks include the denial of evidence for the efficacy of any therapeutic modality that cannot be consistently “proven” using double-blind, randomized controlled trials. It excludes explanations of homeopathy’s efficacy; ignores, excoriates, or considers current research data supporting those explanations incomprehensible, particularly from outside biomedicine: it is also not averse to using experimental bias, hearsay, and innuendo in order to discredit homeopathy. Thus, New Fundamentalism is itself unscientific.

Let's examine these charges.

Liars?

It is not clear what untruths Milgrom is accusing the critics of uttering. He uses the example of Nick Cohen's article in the Observer where he said that "To its fans, homeopathy is the ultimate cure-all. In fact, its effects can be positively deadly". Milgrom does not make clear what is a lie here. Cohen's article argues that if homeopaths pretend they can cure AIDS and other dangerous diseases with magic water then there beliefs are undoubtedly deadly. As with all homeopaths, Milgrom is ignoring the charge and instead labeling those that point out the obvious as just liars. Homeopaths like to pretend that this criticism is a lie. It is easier than policing their own trade.

It is an odd accusation to make since we are now accustomed to high profile homeopaths being 'economical with the truth'. We have seen Neal's Yard Remedies misrepresent themselves after being caught out selling illegal homeopathic products and the Society of Homeopaths have never been straightforward over their role in pushing sugar pills for malaria.

Modern medicine is 'deadly'

This is a common homeopathic trick: to point out how many people are harmed by medical treatments, often using highly suspect figures. The argument is meaningless because homeopaths never put any of their charges in context - that medicine is often about taking risks and that the benefits need to be weighed against the risks.

The emptiness of this argument was recently demonstrated by Harriet Hall in a article called 'Death by Medicine' where she takes this common homeopathic whine and substitutes 'medicine' for 'food'. It is worth quoting her at length:

Overweight is known to cause hypertension, heart disease and early death, as well as a huge number of other health problems. It is a major factor contributing to diabetes. Attempting to control weight (treating the symptoms instead of the cause) has led to a proliferation of dangerous diets and drugs such as the recent Fen/Phen scandal and the ephedra catastrophe. Unnecessary surgical procedures (again, treating the symptoms instead of the cause) mutilate the gastrointestinal tract of these unfortunate victims of food. Concerns about food lead to anorexia nervosa and bulimia. More money is spent on food than on any other class of products; just think how much more good that money could have done if it were spent instead on valuable research into things like homeopathy, acupuncture, and therapeutic touch! Frequent automobile trips to grocery stores and restaurants cause accidents, depletion of fossil fuels, and contamination of the atmosphere. Thousands suffer from indigestion, constipation, and diarrhea. Certain foods are deadly for those with allergies. Wheat is poison for those with celiac disease. Phenylalanine in foods causes mental retardation in children with undiagnosed PKU. Food may not contain all the vitamins and minerals and trace nutrients required for good health; people who depend on diet and refuse to take supplements can be seriously harmed. If you add up all the years of life lost due to overeating, obesity, allergic reactions, contaminants and toxic chemicals in food, deficiency syndromes, botulism, food-transmitted diseases like hepatitis, salmonella and E. coli, etc. etc. you will quickly come to the conclusion that food is the leading cause of death and injury in the United States. In fact, it is the ONLY cause: no illness has ever developed without previous food ingestion.

Of course, the ultimate parody of this form of thinking was achieved at DHMO.org, the campaign body that has shown that water is a deadly chemical that needs to be banned NOW! Yes, water, food and medicine all carry risks: intrinsic, political, technical and commercial. By only examining risks without balancing benefits, you can condemn any activity in life. And in all cases, delusional alternatives are never the answer.

We lie when we say there is no good evidence for homeopathy.

Over the past two decades there has been a steady increase in the number of trials of homeopathy. In turn, various authors have looked at the accumulation of evidence and performed 'meta-analyses' where all the evidence is drawn together to try to come to an overall conclusion. The early meta-analyses tended to show a small but positive effect for homeopathy but acknowledged the poor quality of evidence available. Later and better analyses have shown smaller effects until the latest and most definitive, Shang et al, was able to conclude that homeopathy is just a placebo therapy.

Homeopaths have a number of strategies to cope with this hammer blow:

1. Only cite the earlier, cruder and more positive studies.
2. Attack the Shang study as discredited and unscientific.
3. Make up ad hoc meta-analyses and hope no-one notices what you are doing.

The third trick is interesting and common. You will find homeopaths saying things like, "81% (insert high number here) of clinical trials into homeopathy show a positive effect. Critics ignore these trials.' Homeopaths are performing their own on-the-hoof metaanalysis - assessing lots of disperate data to come to an overall conclusion.

Now, this is not true that these positive trials are ignored. Science is not a democracy where the majority result wins. What researchers like Shang do is look at all the trials and then weight them by quality. Poor quality trials are either discounted or given low weight. When this is done it is seen that high quality trials show little or no effect. This is truly taking into account all the evidence, including the evidence of quality. What homeopaths are doing is pre-selecting trials on their result (positive) and then drawing conclusions from only those trials regardless of the quality of those trials - cherry picking. It is at best poor meta-analytical technique; at worst, entirely dishonest.

Milgrom chooses to use technique 2 - discredit Shang et al. Now, as with all scientific papers, Shang has flaws. It is publicly published so that other researchers can pick over those flaws and hence give the original researchers and others chances to address the flaws or do more work. If after this criticism, sufficient corrections can be made without the whole work collapsing then we can be sure that the work is solid. Homeopaths pick out the original flaws in the Shang paper, but then completely ignore how those flaws have been dealt with. They then call the paper 'discredited'. AP Gaylard discusses this in an article - Shang’s secret - the hydra of homoeomythology. In short, the weaknesses of the Shang paper do not invalidate or distract from its conclusion - homeopathy is an inert therapy.

We ignore 'developments' in material science that shows water has a memory.

Milgrom believes that critics are unduly dismissive of research in material science that shows water has a 'memory' and hence there are plausible mechanism for homeopathy. Milgrom highlights several papers that claim such a thing. However, as of yet, there are no repeatable experiments that have been done that can show a consistent difference between two ultramolecular homeopathic remedies. Rao et al, published in Homeopathy (July 2007), is the study that come closest and is often brought up by homeopaths such as Milgrom.

This paper is excoriatingly bad. In the next issue of the journal, a response was published that tore it apart. The major concerns are:

1. Despite being used as good evidence for the memory of water, all experiments were done on ethanol.
2. There were no controls to ensure that different samples came from the same stock bottle of ethanol. Hence, different contamination levels could account fo differences seen.
3. There were no data to show that the differences were consistent.
4. Graphs presented in the paper were clearly not what they said they were.

They concluded,

It is clear that the data presented are wholly inadequate to support the authors’ assertion that UV spectroscopy can differentiate between the two remedies, and between different potencies of the remedies. If the authors wish to test their assertion so that it can be substantiated it will be necessary to repeat the work from the beginning, ensuring that all samples used in the study are sourced from the same bottle of stock solvent, that all duplicate preparations for precision assessment are separately prepared de novo from the mother tinctures, and that sufficient data are generated to allow robust and valid statistical analysis of the results.

That Milgrom and others have completely ignored this devastating critique speaks for itself. It is noteworthy that it is critics of homeopathy who published this analysis in Homeopathy. Rather than critics ignoring the work in material science, they have fully engaged with it and show how it is lacking. It is the homeopaths who then fail to engage and ignore these arguments. Homeopaths have not published critical appraisals of Rao - instead it used as a tool of propoganda.

The 'memory of water' is a holy grail for homeopaths that will be forever out of their grasp. Water does cluster in memory-like ways, but only over picoseconds. Not a good shelf-life. And, has been pointed out numerous times, even if water did have a memory, it is only one of the difficulties amongst many that make homeopathy so implausible.

Milgrom also likes his own work on the 'quantum theory of homeopathy' to show that critics are 'stuck in an old paradigm of science'. Now it is true that Milgrom's work has almost entirely been ignored by other quantum physicists and that is because it is utter meaningless bafflegab. If Milgrom had wanted to be taken seriously then he would have published in a physics journal. Instead he chooses to play to the gallery and publish in Homeopathy again. It is a thoroughly confused paper that cannot decide whether his ideas are real or just a metaphor. It is just a metaphor then it fails on two levels: firstly, it is not clear what it is a metaphor for; secondly, metaphors are supposed to enable insight into difficult ideas by comparing them with familiar ideas. Does he believe that quantum mechanics is a familiar idea for homeopaths? Pure bafflegab.

It is true that such musing are largely ignored by physicist because they are obvious nonsense. At least one has taken time out to show us why.

We are philosophically naive in our demands of 'proof' for homeopathy

Here Milgrom descends into more bafflegab, this time of a philosophical nature. His intention is to show that critics of homeopaths are simplistic in their views of science (people like Richard Dawkins no less) and that our demands for 'proof' are naive.

I will not fully deconstruct Milgrom's views on paradigms and the philosophy of science: the work is done much better by AP Gaylard here.) What I will say is that Milgrom is essentially setting up a straw-man.

To illustrate this, we can see how he treats the recent challenge by Ernst and Singh to homeopaths to show some good evidence for homeopathy. Milgrom uses his sophistry to suggest that Ernst, Singh and indeed Randi will never pay out their prize money because they know full well that science can never provide 'proof' of anything. What Milgrom fails to tell his audience is that Ernst and Singh do not use the word 'proof' in their challenge. Has Milgrom even read their challenge? It does not look like it. What they ask for is evidence. And they state exactly what sort of evidence they require. I do the same in my own simple challenge. I do not ask for proof. What I am looking for is strong evidence that would be clear and unambiguous to anyone. No sophisticated philosophy required. Ernst and Singh are not naive in their views of science - what they ask for is simple - good evidence, that we can all debate and assess.

Milgrom says that there is evidence, but that it is rejected because people like Ernst are somehow stuck in an 'old paradigm' of science and that such evidence does not fit in with their 'currently held theory'. This is nonsense.

Image that your partner rushes into the room and says there is a tiger in the garden. Do you believe them? Probably not - despite them being normally truthful. If your partner had said nothing, the chances of there being a tiger in the garden are near zero. What does this new information add to the probability of their being a large carnivorous cat there? The chances are still near zero as it is far more likely that your partner is mistaken, playing a joke or had one too many margaritas. If however, you partner rushed in with pictures on the digital camera and half the street were running down the road screaming, you may wish to re-assess you beliefs about garden-feline interactions. There is a mathematical formulation for assessing the importance of new evidence like this - Bayesean analysis of prior probabilities. It can be summed up as 'extraordinary claims require extraordinary evidence'.

Such is the same for homeopathy. Weak evidence will not change the 'scientific paradigm' when the new theory is so highly implausible. There is nothing 'unscientific' about this and nothing 'subjective' in the rejection of such evidence that does exist for homeopathy.

Will the real fundamentalists please stand up

So, has Milgrom convinced anyone apart from the cock-headed homeopaths that critics are the 'new fundamentalists'? No. What Milgrom is doing is best summed up by Steven Poole in his book, Unspeak. Poole tells us that 'words are weapons'. The idea is to stop thought and make dissent impossible - to shut down debate before it happens. Anti-abortionists are 'pro-life'. How can you be against them? Are you 'against life'? Friends of the Earth - how can you criticize them? Are you an enemy of the Earth? Bush has been a master of using upspeak. The War on Terror - are you with us or not? His administration describes the beating to death of Iraqi prisoners as ' the repeated administration of legitimate force'. Bafflegab. Milgrom is using upspeak to allow homeopaths to ignore the serious criticisms being made of them by allowing them to dismiss their critics as just simple minded fundamentalists who are not open to new ideas.

Milgrom has failed to prove his point, not least because he fails to consider what a fundamentalist is. Usually, fundamentalism is used in a religious context and means,

a deep and totalistic commitment to a belief in the infallibility and inerrancy of holy scriptures, absolute religious authority, and strict adherence to a set of basic principles (fundamentals), away from doctrinal compromises with modern social and political life.

And of course, you only have to look to homeopathy for similar views. Another prominent homeopath George Vithoulkas confronts a similar question to Milgrom in the journal Homeopathy again, and comes to a thoroughly fundamentalist conclusion.

Vithoulkas asks "British media attacks on homeopathy: Are they justified?". His response is to blame 'progressive' homeopaths from straying from the teachings of Hahnemmann in his 'bible' the Organon. He condemns new homeopaths for having new 'dangerous ideas' on vaccination and provings.

He attacks the heretical homeopaths and blames them for the critical onslaught. He says,

With all these irrational and arbitrary ‘‘new ideas’’ the ‘‘modern teachers’’ are defaming homeopathy and demolishing the corner stones that constitute its scientific edifice. So it is not without reason that scientists reacted badly, that the media launched a war against homeopathy and the opponents of homeopathy are at this moment celebrating.

His call is for homeopaths to fall back to the 'rational' teachings of Hahnemann. He concludes,

There are today enough sane homeopaths who can turn the [homeopathic] craziness, disorder and confusion into order and sanity, but they must speak out. This journal should be part of such a proactive movement defending the essence and substance of the theories and principles bequeathed to us by Samuel Hahnemann.

The parallels with religious fundamentalists are obvious. Substitute Jesus or Mohammad for Hahnemann and you see a call to a strict interpretation of the scriptures and a rejection of progressive thought. The reasons for Homeopathic fundamentalism and religious fundamentalism may be similar: the feeling of being under attack from a powerful degenerate hegemony and a strong belief in holding the keys to the truth of the universe.

So, Lionel Milgrom. Who are the new fundamentalists? Those that seek evidence and insight? Or those that want to hide in their beliefs and sacred texts and are too afraid to allow them to be subject to criticism and enquiry?

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An analysis of another presentation made at Jayney Goddard's fun day by Dr Alex Tournier has now been taken to bits by gimpy.

Labels: BPSDB, homeopathy, Lionel Milgrom