Why I am Standing Against David Tredinnick

This is a guest blog post from Dr Michael Brooks who is prospective parliamentary candidate for the Science Party in the Leicestershire constituency of Bosworth. Michael Brooks holds a PhD in quantum physics, is an author, journalist and broadcaster. He is a consultant at New Scientist and the author of the acclaimed non-fiction title 13 Things That Don’t Make Sense.

Yesterday I bumped into a friend who declared himself disappointed in me for standing against David Tredinnick over homeopathy. “I thought you were the one rational, sane science writer who had an open mind about homeopathy,” he said. I told him I do have an open mind: I am sure homeopathy is a placebo (when it does anything) but I’m willing to admit that I don’t think we’ve quite proved that yet.

I came home from that encounter to a tweet from @blindasabat suggesting I clarify my position over the NHS issue. In a Guardian blog post last year I said homeopathy should be available on the NHS – because it’s the best placebo we have. So, with my mouthing off about Tredinnick, did I or didn’t I think homeopathy should be available on the NHS?

Good question.

Doctors like and use placebos. And they are, many say, clinically useful. There’s just not a good ethical way to use them as yet (though this placebo-boosted Ritalin trial is pretty interesting).

It seemed reasonable to me last year that doctors who believe that homeopathy is effective (let’s not get started on that one), and prescribe it for patients who want it and might derive (placebo) benefit from it. So, I argued, where’s the harm? There’s no deception and a positive health effect.

The harm is, of course, if the cost is higher than the benefit. And it seems it is. When I wrote the Guardian piece, I wasn’t aware of the Kent study highlighted in the House of Commons Science and Technology Select Committee report. It showed that homeopathy did not provide value for money, even as a placebo. For me, that’s case closed. I’m more than happy to accept their conclusions and change my view.

That’s more than can be said for my Bosworth opponent David Tredinnick. He has decided that he knows better, and is leading a campaign to get the report ignored. Herein lies the dangerous – not to say irresponsible – problem with MPs’ scientific ignorance. If you’re going to take scientific conclusions and throw them out because you don’t like them, why support funding for scientific research at all. If it only produces inconvenient results, surely it’s best to cut those pesky scientists off without a penny?

And it’s not just Tredinnick. 70 MPs have followed his pied piping and signed the Early Day Motion. You want to know who shouldn’t be an MP, in my humble opinion? Here’s the list.

The conclusion of my book’s chapter on homeopathy, for all those who have furrowed their brows at it without actually reading it, is that homeopathy resists scientific disproof in the same way that the existence of God and orbiting teapots do. The claims shift, the medicines put up for testing are of infinite variety (therefore when one goes down another takes its place) and the establishment is incredibly wriggly when it comes to being pinned down about what a “cure” is. It’s worth reading this piece on Pathological Science and drawing comparisons, I’d say.

But there’s another few points I want to make – and here’s where I might cause some skeptics to go rabid.

I think you have to be careful about trumpeting the almighty nature of the evidence-based approach – especially if you are going to invoke placebo.

The shimmering mirage of homoeopathy’s occasional survival even of meta-analysis (the 1997 Lancet study and the contesting of the validity of Shang’s 2005 study) ought to be seen in the context of meta-analyses of the placebo effect itself.

When you do meta-analysis of placebo, it appears not to be real. Here’s something extracted from one of my New Scientist articles (I think it’s subscription only):

In 2001 Asbjorn Hróbjartsson of the Nordic Cochrane Institute in Stockholm, Sweden, did a meta-analysis of 130 clinical trials that compared the placebo group with a no-treatment group, to reveal the “true” placebo effect. The studies involved around 7500 patients suffering from about 40 different conditions ranging from alcohol dependence to Parkinson’s disease. The meta-analysis concluded that, overall, placebos have no significant effects. Two years later the team published a follow-up study with data from 11,737 patients, and Hróbjartsson will publish another in the next few months.

That study is now out. The results are, broadly speaking, the same. This guy is not some crank: he’s invited to help the American Medical Association form their policy on placebos. His view is that it’s largely bunk, and the result of patients telling doctors what they think the doctor wants to hear. Placebos are overrated and largely ineffective, Hróbjartsson reckons.

The thing is, when you talk to placebo researchers like Fabrizio Benedetti, who sees the placebo effect at work biochemically – in other words, sees that it is real – he dismisses the meta-analyses as hiding the truth: the real effects get washed out because there are so many different effects under test.

So it’s dangerous to say that a meta-analysis proving that something is no better than placebo is a conclusive scientific proof. If you want to, you can use the same argument to say that the placebo effect is not real. That way madness lies.

The point is, as I put it in the subtitle of my chapter, the idea behind homeopathy is patently absurd. And, beyond anecdotes and a few positive trials (all of which have flaws), there’s no evidence it works. So the question is, why won’t it go away?

First, because anecdotes are very powerful. If someone’s had a positive experience of homeopathy, even if they are a skeptic they will still feel well-disposed towards it. That won’t change.

Second, it’s really hard to prove to everyone’s satisfaction that something so evasive and slippery is not really there at all.

Having said that, it seems to me that all of the good research is gradually eroding the case that homeopathy works. But it’s going to take time, money and a lot of courage to pursue that. Is it worth it? Probably not.

I say that after seeing Vilma Bharatan’s experience. Bharatan works as a botanist at the Natural History Museum. In 13 Things I look at some of her preliminary work: she is a homeopath but also a good scientist, and she’s trying to get to the bottom of things.

For her trouble, she has been hounded by sceptics who write angry letters to the NHM’s managers asking why a homeopath is allowed to work there. And, as her work continues, she will start to be hounded by the homeopaths too.

Why? Because her evidence is leading her towards the idea that the whole dilution thing is bunkum.

100 years ago one of the leading lights of homeopathy, a guy called Richard Hughes, started coming to the same conclusion. He also started to question the supportive “evidence” that other homeopaths were coming up with. Guess what happened to him? He was ostracised by the homeopathic community. No one talks about him today.

(By the way, the Quackometer has accused me of being too uncritical in my analysis of Bharatan’s work. That may be fair, but perhaps I’m biased by her sheer courage in even trying to go down this road.)

So I just think this is one of those cases where everyone, on every side “knows” they are right. You can add more evidence, but it will only be put to work if it can back up those preconceptions.

My last point is this: we waste a hell of a lot of energy on this when, as far as I can tell, it doesn’t matter that much. Most people are sensible, including my friends who swear that homeopathy works. They don’t use it when they think they might have something serious. And I don’t know of any GP who would recommend homeopathy for anything that had even the remote possibility of being a serious illness/condition. There might be a few people who risk their own lives using homeopathic anti-malarials, but that’s not an NHS concern, and people risk their lives with drugs and alcohol all the time. Humans are not rational beings, on the whole.

My pet theory is that homeopathy is a form of middle class rebellion (OK, the Queen uses it, so it’s not exclusively middle class. But I’d love to know how many truly working class homeopathic adherents there are). That Kent study found that less than 1 per cent of the PCT population use homeopathy services, and the majority of those people were in Royal Tunbridge Wells (which has one of the country’s biggest homeopathic pharmacies. I’ve been there. It’s extraordinary). So I suspect it’s the affluent’s way of kicking against the boring, predictable, rational and entirely explicable world that they live in. It makes them feel a little bit edgy and dangerous. They don’t smoke cannabis any more, and they don’t have the courage to take up their friend’s offer to join the local coven. Homeopathy is just crazy enough for them to feel they’ve still got that punkish attitude they had in their teens.

But that’s not really the point of this post. Pet theories aside, I’m hoping this post will go some way to letting people know where I stand. I understand the confusion. The review of my book in Physics World was the only place that noted my dilemma over homeopathy: “about half of the people criticizing his book thought he’d been horribly unkind to homeopathy, while the other half savaged him for not being unkind enough.” You can’t please everyone. Sometimes you please no one. I get it. Do I think homeopathy should be available on the NHS? No, I don’t. Not any more. OK?

On this theme…

7 Comments on Why I am Standing Against David Tredinnick

  1. That was fascinating, thanks Michael. And good luck with the campaign.

    I liked the discussion on the placebo effect. You mentioned the ethical problem without going very deeply into it. It is something that I’ve had churning in the back of my mind ever since I became a reader of Bad Science blogs. Perhaps because I’m older than the current generation of medics I don’t have any great objection to doctors prescribing what are effectively placebos for a range of conditions for which there aren’t any good evidence-based treatments. With my scientific hat on it angers me to read the nonsense that alternative medicine produces. With other hats on I agree with you that for the most part there is no great problem if the middle classes want to feel edgy. That section was wonderful btw – how interesting it would be to see research on how social class and CAM interact.

    But enough on homeopathy. David Tredinnick believes in many and varied pieces of woo and (a greater failing) that public policy should not be guided by science where it conflicts with that woo. Go get him.

  2. “how interesting it would be to see research on how social class and CAM interact.”

    Cf. “GROLIES”

    http://news.bbc.co.uk/1/hi/3159813.stm

    On a more sober note, could you give us citations/links to those placebo meta-analyses? 

    Other readers may know I’m a vet and even in my profession I meet a lot of, “Yes, well, maybe the placebo effect is useful, so why be rude to homeopaths.”

    I think that citing the placebo effect has become the easy get-out for the mild sceptic of CAM who doesn’t want to think through the logical consequences of the use of unmedicine in animals and people.

    I know Ben Goldacre has played up the significance of the placebo effect, but I do wonder whether that is a matter of perspective. Most of the examples of a ‘real’ placebo effect seem to derive from work on conditions with a huge and obvious psychosomatic component or conditions that are completely.  psychological/psychiatric. Do those meta-analyses preclude the existence of a clinically meaningful placebo effect even in those psychosomatic conditions?

    Research into the placebo effect is confounded by a tricky problem- with psychosomatic/psychological conditions, a willingness to lie to your therapist/doctor about how you feel is very hard to dissect from an actual internal experience of feeling better. It’s easier when the subjective report can be tested against an objective measure. An interesting and important example from my field is the analysis of outcomes of cruciate ligament surgery. There are several competing techniques and the literature suggests they all result in a sound patient 6mths post-op in 60-80% of cases as assessed by owners and vets. It turns out that if the gait is analysed objectively (weight transmitted to a pressure plate in the floor when the dog walks over it) only 15% of patients return to normal function. In other words 50-70% of the reported benefit of the surgery is at best over-estimated and at worst, just plain wrong. With human psychosomatic/psychological conditions, what we lack are good objective measures that would reveal the degree to which patients and therapists are over-estimating their own improvement.

    And good luck against Tredinnick. But at least Tredinnick is an explicitly obvious loon. I think more worrying are the large fraction of those 70 MPs who are clearly incapable of accepting objective scientific fact but actually wield a larger aggregate amount of leverage in favour of CAM behind the political scenes.

    We should develop a metric for this similar to the Canard. Let’s call it a Tredinnick. The MP for Bosworth stands as the reference, 1 Tredinnick. If that list contains 5 outright loons, that is 5T. But the other 65 may be on average 0.2T so their effective lobbying weight is 13T and they, en masse, are the more dangerous. 

    By the way, 1,000T, or 1 kiloTredinnick can also be called 1 Ullman.  

      

  3. “There is no justification in all of science for this idea — and yet there remains some slim evidence that homeopathy works.

    The key word here is slim. But even the slimmest of evidence makes this scientifically tantalising.” [from the book’s website]

    This is where you go horribly, horribly wrong IMHO, Dr Brooks. The idea that a few anomalous laboratory results – which admittedly could appear to a poor scientist to provide support for (part of) the homeopaths’ absurd fantasy – constitute something “scientifically tantalising” is breathtakingly eccentric.

    “she is a homeopath but also a good scientist … her evidence is leading her towards the idea that the whole dilution thing is bunkum.”

    Righhht… In the same way that someone involved in one of the computerised searches for prime numbers saying that their evidence was leading them towards the idea that there is no largest prime would be a “good mathematician” perhaps?

    “My last point is this: we waste a hell of a lot of energy on this when, as far as I can tell, it doesn’t matter that much.”

    Well I think you’ve unconvincingly downplayed the harms done by high street homeopathy etc. and entirely missed some of the other homeopathy related issues we waste our energy on. For example, I wonder if your mind would be “open” enough to accommodate the prospect of a son or daughter changing their mind about following in your footsteps and going off to UoW to study for a BSc in homeopathy instead? ]:->

  4. I liked that posting – it’s good to see someone not getting drawn into the polarising which inevitably takes place on these issues. The class business points up that how people behave, feel and, yes, believe about homeopathy and so on has a lot to do with how they want to be seen and what sort of person they think themselves to be. People get very het up in discussions about woo, for instance – why is it so particularly maddening to think another person has a head full of nonsense? There are lots of areas where one disagrees on the best of grounds with someone else, but feelings don’t rise so high. Of course, we all look for practical (financing homeopathy, children not receiving the care they should) or scientific reasons why we’re right, but I don’t think this accounts for the intense agitation contrary opinions arouse – I’m speaking from my own experience of anti-woo debates on various forums. I’d be prepared to bet that there’s something more personal at stake, namely one’s own self-image. Dr. Brooks’ posting is accordingly not going to wave the anti-woo group flag vigorously enough for some. I hope he wins his seat and shines his light on the Commons.

  5. Michael,

    Overall, I find a lot to agree with you on and good luck in the campaign.
    But…

    “I am sure homeopathy is a placebo (when it does anything) but I’m willing to admit that I don’t think we’ve quite proved that yet.”

    Why are you sure when you don’t think it’s been proved yet. In other words, what is the basis of your certainty. That doesn’t sound like a scientific approach to the evidence.

    “The harm is, of course, if the cost is higher than the benefit.”

    That is the minor harm. In Africa homoeopaths are killing people with homoeopathic alternatives to vaccines.

    “homeopathy resists scientific disproof in the same way that the existence of God and orbiting teapots do”

    The theistic god is a false hypothesis and the deistic god an unnecessary hypothesis. The orbiting teapot is a just an unnecessary hypothesis and no one actually takes it seriously. So, homoeopathy is more like the deistic god hypothesis than the orbiting teapot hypothesis.

    “it’s dangerous to say that a meta-analysis proving that something is no better than placebo is a conclusive scientific proof.”

    I agree. Like BSM said. The there is a subset of the placebo effect where it does work. That is in the treatment of psychosomatic illness, depression, and pain.

    “Richard Hughes; Vilma Bharatan”

    And Edzard Ernst as the best example. A professor of alternative medicine and practicing homoeopath who set out to provide evidence for altmed and found that there was none.

    “we waste a hell of a lot of energy on this when, as far as I can tell, it doesn’t matter that much. Most people are sensible…”

    But some aren’t and some are exploited. Some die. And I guess Africans don’t count in a UK election.

  6. As far as I can see, everything to do with homeopathy is in the words. The fatuous “homeopathy works as well as a placebo”. Or “…no better than a placebo”.
    “Sugar pills and water (subject to ritual shaking, bashing or whatever) work as well as, or no better than, sugar pills and water”. And when phrased like that one can see homeopathy for the obvious con it is. Its all in the verbal equivalent of sleight of hand.

    Apart from the very real dangers in diverting people from possibly effective medicine, the obscenity is in the dishonest claims and profiteering. Nelson and Boiron are basically conducting a legalised scam. They produce sugar pills and water and sell them as if they are something else containing medicinal properties. Prison sentences have been handed down for less.

    If one insists that doctors have the option of dishing out a placebo when they wish, there is nothing to stop them. There are forms of words to do it without calling it homeopathy or anything at all for that matter, and whereby the patient isn’t being fleeced. The effect is in the ritual not in the sugar or water. And the cost of sugar pills and water should reflect the cost of sugar pills and water, not some arbitrary value of recovery from which the likes of Nelson and Boiron, and a bunch of dispensing charlatans, can profit.

  7. Homeopathy is a fraud exacted on (and by) the credulous and uneducated, and therefore a potential** crime.
    Anyone educated person who supports this fraud should be prosecuted to the extent of the law.
    No homeopath in current society can possibly claim to be unaware that the modality comprises solely of wishful thinking.
    ________________
    ** Insanity is a mitigating factor, unfortunately.

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