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?
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?