Research into Homeopathy is Unethical

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On the 17th of May, David Tredinnick MP will be holding a reception in the House of Commons. In conjunction with the Homeopathy Research Institute, the reception is being held “to promote scientific research in the field of homeopathy.”

The invitation letter states,

There is currently a growing body of scientific evidence suggesting that homeopathy offers an inexpensive, effective treatment option for many chronic conditions, however the only way to know definitively is by conducting further high quality research.

At this unprecedented event, there will be brief thought-provoking presentations by experts such as Professor Kate Thomas – Honorary Professor of Health Services Research, and the chance to exchange views with this diverse group of attendees.

We look forward to seeing you at this event. Once we have received confirmation of your attendance, we will send a printed invitation giving you access to the Members’ Dining Room from 4.00 – 6.00 p.m.

If you would like to bring a guest, please let us know their name and contact details.

I was really looking forward to going, as you might imagine. A journalist friend had received the invite and took advantage of their kind offer, as written in the invite, to ‘bring a guest’. The downside was that I had to provide my name and address for the pass. However, once this was submitted, the following email was sent,

As regards your suggestion to invite Mr Andrew Lewis, we currently are very stretched on numbers and hence will not be able to invite Mr Lewis to this reception. Were a place to become available we will keep him in mind.

Best regards,

Alex

That’s a shame.

Not too surprising though, as I have been very critical of the standard of Alex Tournier’s work at the Homeopathy Research Institute. And I have been most derisory about the host MP, David Tredinnick: the MP who is obsessed with homeopathy and protestors in Parliament Square, and also uses his expenses to buy astrology software and training.

So, by the by. Why is this reception happening and why is it horribly misconceived?

Undoubtedly, it is in response to the House of Commons Science and Technology Select Committee report into the Evidence base for homeopathy.

The report was damning about the evidence base. It concluded,

In our view, the systematic reviews and meta-analyses conclusively demonstrate that
homeopathic products perform no better than placebo.

On the theoretical basis of homeopathy, they reported,

We conclude that the principle of like-cures-like is theoretically weak. It fails to provide a credible physiological mode of action for homeopathic products. We note that this is the settled view of medical science.

We consider the notion that ultra-dilutions can maintain an imprint of substances
previously dissolved in them to be scientifically implausible.

The implications of homeopathy being a placebo based on pseudoscience are very significant for patient trust in the NHS,

When doctors prescribe placebos, they risk damaging the trust that exists between them and their patient

For patient choice to be real choice, patients must be adequately informed to understand the implications  of treatments. For homeopathy this would certainly require an explanation that homeopathy is a placebo. When this is not done, patient choice is meaningless. When it is done,  the effectiveness of the placebo—that is, homeopathy—may be diminished. We argue that the provision of homeopathy on the NHS, in effect, diminishes, not increases, informed patient choice.

On the specific question of government funding for research into homeopathy, the report is also clear,

There has been enough testing of homeopathy and plenty of evidence showing that it is not efficacious. Competition for research funding is fierce and we cannot see how further research on the efficacy of homeopathy is justified in the face of competing priorities.

It is also unethical to enter patients into trials to answer questions that have been settled already.

Now, naturally, homeopaths dispute that it is settled that homeopathy is an inert, placebo treatment. And this reception is a call for government to put research resources into homeopathic treatments. Indeed, the homeopaths state quite clearly in the invitation that “There is currently a growing body of scientific evidence”.

This is a deeply unethical position – and it is unethical for a single very important reason that the House of Commons committee did not highlight.

In order to understand the deep problems with undertaking research into homeopathy, it is worth considering why you would ever carry out medical research of any sort.

The best research is carried out to reduce the uncertainty surrounding the effectiveness of treatments in a way that will help better inform doctors and patients. Research starts with a question that is intended to reduce an area of ignorance, as current claims, experience and knowledge may be uncertain, or even misleading. As Evans, Thornton and Chalmers say in their excellent book, Testing Treatments (free pdf download here.)

Misleading claims about treatments are common, so all of us need to be able to decide whether claims about the effects of treatments are valid. Without this knowledge, we risk concluding that useless treatments are helpful, or that helpful treatments are useless.

The Advisory Group on Health Technology Assessment said in 1992,

From an ethical standpoint, clinical research and clinical practice should be considered congruent. This is so for very new forms of care intended to benefit patients (but whose potential for benefit or harm is unknown), as well as for more established forms of care, with which experience may be greater, but which are of unproven value. For the NHS, the ethical imperative is to encourage the research necessary to know how to use its limited resources to the best advantage of all in its care.

Good research leads to better decisions by doctors. And for patients, informed consent only really becomes meaningful when they are able to assess the benefits and risks associated with any treatment.

But research, no matter how well conducted, can only be meaningful and ethical if the results of that research are used to change behaviours. That is, if the research means that ineffective or harmful treatments are discontinued, and effective ones used appropriately.

And this is why research into homeopathy, and indeed all alternative therapies, is ethically dubious and should not be funded.

You see, for a homeopath, they already have the answers. They ‘know’ their sugar pills are effective. This is what allows them to tell HIV patients in Africa to stop taking ARVs and to trust homeopathy instead – even thought there is not a jot of evidence to think that this is anything other that murderous. No amount of evidence to the contrary would stop homeopaths doing this.

Indeed, a good question to ask a homeopath is ‘what aspect of your practice has ever been influenced by clinical trials?’ There are no claims that have ever been dropped by homeopaths as a result of the overwhelming evidence of the ineffectiveness of what they do. Belief in alternative medicine is more like a religious belief – based on revelation and scripture and immutable in the face of contradictory facts.

Homeopathy is a faith and not a science. It is the denial of evidence, and as such, new evidence will not influence behaviours and beliefs.

So, why do homeopaths call for more research?

Well, the research is not done to change their minds –it is done to try to influence the decisions of others. That is to make patients trust a homeopath. To make politicians invest more in public funding for homeopathic treatments. In other words, homeopathic research is used solely for propaganda – not for making informed treatment decisions. And that is why it is deeply unethical.

But if research is designed to uncover the truth, how can research be used to mislead people into thinking a treatment is effective when it is not?

The answer is that creating fair tests of treatments requires care, thought and, often, expense. It is the easiest thing in the world to design and conduct a trial that will give a misleading result. Make the trial too small, or with inadequate controls, or try to test too many things at once, and a result may emerge that reflects the biases in the trial and not the reality of the treatment.

And so when homeopaths claim there is a “growing body of scientific evidence suggesting that homeopathy offers an inexpensive, effective treatment” it is vitally important to look at the quality of those trials. And what is found is that most of these trials are very small, poorly controlled, or both. Indeed, every systematic review of homeopathy has concluded that the vast majority of studies into homeopathy provide low grade evidence due to trial quality. Worse, the latest systematic reviews have clearly shown that the highest quality trials tend to show no effect for homeopathy, and that if you exclude small and poor studies from your analysis, then there is no good evidence that homeopathy is anything better than a placebo.

And that is what the House of Commons Select Committee found.

However, homeopaths ignore and deny this. They resort to simply saying “look how much evidence we have” or even, as the Society of Homeopaths did in their submission to the House of Commons evidence enquiry, try to subvert the very notions of scientific evidence. When the Society state in the first sentence of their home page that “Homeopathy is an evidence-based medicine” we can be sure that this is a group of people that are, at best, completely ignorant and indifferent to the nature of evidence, or, at worst, deliberately deceptive.

The MPs on the committee were not happy about this. They put the following condemnation in their report,

We regret that advocates  of homeopathy, including in their submissions to our inquiry, choose to rely on, and promulgate, selective approaches to the treatment of the evidence base as this  risks confusing or misleading the public, the media and policy-makers.

For this reason alone, MPs who may attend this meeting should be sufficiently sceptical of any claims being made about the nature of the current evidence base into homeopathy.

Further research into homeopath risks adding to the misleading corpus of research already in existence. It will diminish resources that could be used to answer genuine uncertainty in clinical practice. Government funding also lends legitimacy to a superstitious form of medical belief that puts people at genuine risk. Dangerous homeopathy clinics being set up in the developing world are able to use the fact that NHS funds homeopathy as an endorsement of what they do.

For these reasons, MPs should ignore this desperate call to legitimise what can only really be described as unethical quackery.

60 comments for “Research into Homeopathy is Unethical

  1. May 6, 2011 at 11:09 pm

    “There is currently a growing body of scientific evidence suggesting that homeopathy offers an inexpensive, effective treatment option for many chronic conditions, however the only way to know definitively is by conducting further high quality research.”

    Hmmm. On Wikipedia we have a tag for that: {{dubious}}

    • pvandck
      May 6, 2011 at 11:29 pm

      I have a tag for it: {{dishonest}}
      There simply is not any body of scientific evidence, big or small, growing or declining, suggesting that homeopathy offers an inexpensive, effective treatment option for many chronic conditions.
      Utter garbage from a man who has a family vested interest promoting and profiting from quackery. It’s hard to credit that such wilfully ignorant and scientifically illiterate individuals is allowed a seat in the Country’s Parliament.

      • May 6, 2011 at 11:44 pm

        One must be fair: he may be deluded rather than venal.

      • Richard Rawlins (FRCS)
        May 8, 2011 at 8:30 am

        Please can pvandck explain what these “family vested interest” is.

        Thank you.

    • May 8, 2011 at 9:29 am

      Now, that’s what I call open minded and even handed.

      And this is why research into homeopathy, AND INDEED ALL ALTERNATIVE THERAPIES, is ethically dubious and should not be funded.

      Let’s not confuse the crusade with knowledge or understanding, after all there could never ever possibly be an ‘alternative’ approach with any credence whatsoever?

  2. Adam C.
    May 7, 2011 at 12:04 am

    I wonder if there’s enough evidence to report to an Ethics cCommittee in that disinvite?

  3. May 7, 2011 at 12:37 am

    Terrific post and what spineless gits for not letting you go to the party.

  4. Mojo
    May 7, 2011 at 12:38 am

    Indeed, a good question to ask a homeopath is ‘what aspect of your practice has ever been influenced by clinical trials?’

    There’s a relevant comment on homeopathic research in Linde & Melchart: “Randomized controlled trials of individualized homeopathy: a state-of-the-art review” (J Altern Complement Med. 1998 Winter;4(4):371-88): “The motivation for doing trials seems less to be innovation or self-critical evaluation of performance (which is generally considered to be the motivation for good research) but rather justification in front of a hostile scientific establishment.”

  5. phayes
    May 7, 2011 at 5:15 am

    Great article, as usual, but there’s a problem with homeopathy ‘research’ much deeper than any of that. In fact there’s not really any such thing as “homeopathy research”, never mind “high quality homeopathy research”. Putting what is already known together with some simple reasoning¹ demonstrates that a homeopathy CT simply couldn’t generate evidence in support of the homeopathy hypothesis, no matter how well it was done. Consequently, such ‘research’ isn’t even pathological science – it’s futile cargo cult science.

    I’ve found it very ironic and depressing that nonsense like this (Bem’s recent retrocausality experiments are another notable example) has exposed an intransigent attachment to pseudoscience and illogic festering in the bones of (proper) science. As E.T. Jaynes put it:

    “It is a major scandal that orthodox methods continue to be taught at all to young statisticians, economists, biologists, and medical researchers; this has done irreparable damage in these fields for decades.”

    ¹ http://www-biba.inrialpes.fr/Jaynes/cc05e.pdf

    • Le Canard Noir
      May 7, 2011 at 7:36 am

      I agree that there are also very deep methodological issues with homeopathic research too – as well as ethical ones.

      I have written about the problems of interpreting evidence in light of prior plausibility here:

      Should Cochrane Call for More Research Into Homeopathy?

  6. ophu
    May 7, 2011 at 8:37 am

    Wow, about the only time you see spin like this is when Toto rips back the curtain… “Pay no attention to the man behind the curtain!”

  7. Tzspence
    May 7, 2011 at 10:26 am

    If the research is carried out efficiently will either prove or disprove the homeopathy.

    So what’s the problem? Surely evidence is king?

    • Lecanardnoir
      May 7, 2011 at 11:30 am

      Please read the above article for answers to that question.

  8. phayes
    May 7, 2011 at 11:46 am

    Yes – excellent – I read that article after I saw the link to it in your twitter feed. Jaynes puts the icing on the cake by explaining why positive results from fly-in-the-face-of-established-science experiments are actually evidence of error and not evidence supporting the pseudoscientific/nonsense hypotheses themselves.

    I find it depressing that I often get “blank, incomprehending stares” from apparently intelligent and rational people when I try to explain this seemingly intuitively obvious stuff. I think Jaynes was right about the major scandal bit but on top of that I get the impression that e.g. Bem has no real understanding of just how far from Kansas you have to be before retrocausality can be taken seriously.

  9. Matt
    May 7, 2011 at 1:00 pm

    I am an experimentalist, concomitant with which I find designing and carrying out a good experiment is its own reward. Your ethical and scientific objections to homeopathic research are cogent and well founded, but I think space could be made to do perform some solid, if pointless, experiments here. So if someone wants to waste their time and can fund it without diverting resources from something that matters (perhaps Boiron, Neils Yard and/or Boots would help) this is how I think it could be done.

    Your ethical and scientific objections stem from homeopathies implausibility. I think that used cleverly that very implausibility could enable homeopathic research because it means it can be falsified in studies of people with innocuous conditions, thereby dodging some of the ethical issues. So I suggest healthy young men with colds (or similar). Colds aren’t a sexy thing to cure, but if homeopathy did manage it, then because it stands so separate from the rest of science, it would prove its validity as a system of medicine.

    To deal with the scientific problem, our fresh faced researchers would have to resign themselves to a long, and in my view impossible, trek to the other end of Bayesian posterior probability. They need a research program; they need to develop a set of well characterised experimental protocols; they need to repeat and repeat and repeat positive results to show they aren’t a result of chance or bias; they will need to update their protocols to counter criticisms of their methods; they should also test homeopaths ancillary claims: can they identify remedies by proving the >30C preparations, can they identify patients on verum and placebo arms of a trial from the pattern of aggravations and alleviations etc. This is another good reason for choosing healthy young men with colds as there will be a plentiful and continuous supply for their many experiments and replicates.

    Attempting such a research program would be demoralising, as only an eternity of negative results could be. It will also never be attempted since the real point of all Tredinnick’s shenanigans is to provide cover for the quack industry. BUT we should be saying: “This may be hard but it’s possibly, if you want to demonstrate homeopathy is effective this is what it will take”. If we try to block off parts of science as forbidden, even for good pragmatic reasons, we risk betraying the enlightenment values the sceptic movement has done so much to promote. Worse than that, sceptics risk coming across as hypocritical ideologues with no more foundation for their assertions than the cranks and quacks they criticise.

    • phayes
      May 9, 2011 at 4:47 pm

      No-one’s trying to “block off parts of science”. Homeopathy is pseudoscience, not science. Even so, none of us – AFAIK – have ever suggested forbidding (pseudo-)research into it – by privately funded parties at least.

      “if you want to demonstrate homeopathy is effective this is what it will take”.

      Yes, FAPP Rumpelstiltskin is what it’ll take to demonstrate the efficacy of homeopathy: the somethingness of nothing; the truth of that which is already effectively known to be false. At least that’s being honest with the homeopaths. The enlightenment betrayal and risk of hypocrisy has always lain in the false impression many (probably most) sceptics have given to homeopaths that all they need to do is conduct some ordinary-ish CTs and apply some orthodox but wholly inappropriate inference to the results.

      • Matt
        May 13, 2011 at 12:55 pm

        I really like the phrase:

        “the truth of that which is already effectively known to be false”

        What I want to keep clear is the demarcation between real and pseudo science. The authority of real science comes from the primacy it gives to experimental data, reproducible results and falsifiable hypothesis rather than authority or dogma. If you ever say something shouldn’t be researched you undermine that authority.

  10. ScepticsBane
    May 7, 2011 at 6:55 pm

    The author states, scientistically but most certainly not scientifically that…
    ” When the [Homeopathy] Society state[s] in the first sentence of their home page that “Homeopathy is an evidence-based medicine” we can be sure that this is a group of people that are, at best, completely ignorant and indifferent to the nature of evidence, or, at worst, deliberately deceptive.”

    There is indeed a deception going on, but not by the Homeopaths. It is a self deception on the part of self deluded “quackers” and pseudo skeptics, convinced that the world is being victimized by various systems of alternative medicine and these so called skeptics have, astoundingly and against all principles of rational debate and inquiry, appointed themselves and their opinions as chief arbiters of what is and is not “evidence” and what does and does not qualify as science and as “ethical”. They are, in fact, intellectual orcs, unthinking followers with mostly good intentions who have been duped by some clever intellectual manipulations by a group of Homeopathy and CAM (complementary and alternative medicine) haters who will resort to bullying, insult, charges of deception and the like in order to terminate all discussion, all debate, and, especially, all funding for the supposedly “rogue” medicine systems against which their irrational tirades, compounded by fear, uncertainty and doubt, are focused.

    The full description of the erroneous “scientism” fallacies can be read in chemist and homeopath Lionel Milgrom’s article “Beware Scientism’s Onward March”, easily found on the web or at this link:

    http://www.anh-europe.org/news/anh-feature-beware-scientism%E2%80%99s-onward-march

    Milgrom’s article is suggested reading for real skeptics in which the intellectual diversions, the legerdemain regarding the concept of “evidence”, the careful avoidance of perfectly sound evidence in favor of Homeopathy, the placebo deception and the non-thinking which allows a small group of anti-alternative medicine book writer profiteers and a few cohorts in Parliament to monopolize debate, allow their own opinions to predominate and, reinforced by an army of Orc like journalists of sometimes well meaning ineptitude, spread their misrepresentations, misconceptions and just plain ignorant tirades all over the web until it is misperceived as some sort of scientifically “sound” and “reasonable” position which it is most assuredly not. Read the Milgrom article and decide for yourself.

    • Le Canard Noir
      May 7, 2011 at 9:21 pm

      Hello ScepticsBane

      I see you resort to ad hom when faced with criticism – like so many homeopaths.

      Perhaps you would like to answer the question I posed in the pose?

      ‘What aspect of your practice has ever been influenced by clinical trials?’

      Perhaps, then we can discuss your attitudes to clinical research – the subject of the post.

    • Matt
      May 7, 2011 at 9:53 pm

      On your point about “perfectly good evidence for homeopathy” and Milgrom’s article: A couple of things strike me about the papers he cites as positive studies “considered by many to be of at least equally high quality” as the negative ones.

      1. There are only six papers.
      2. One of them is a review paper.
      3. They are disparate and include an in vitro, observational, cost benifit and cohort study.

      Where is the coherent series of experiments each verifying and building on the one preceding it?

      You point out how much sceptics keep harping on about evidence for claims. This is actually generous. If homeopathy were scientific its precepts would follow from a body of empirical evidence, and its historical development would trace that emergence. What we see are a set of ideas springing fully formed from Hahnemann that must be retrospectively shored up with “evidence”.

    • Badly Shaved Monkey
      May 8, 2011 at 8:17 am

      I followed your link down its rabbit hole to read what Milgrom said. Hilariously wrong as usual, but I’d like you to answer a specific question given that you seem to respect him.

      Read this paragraph;

      “142 RCTs of homeopathy had been published in peer-reviewed journals. In terms of statistically significant results, 74 of these trials were able to draw firm conclusions; 63 were positive (patients given a homeopathic medicine improved significantly more than the comparison group given either an inactive placebo or established conventional treatment), and 11 were negative (no significant difference was seen between the action of the homeopathic medicine and the comparison group).”

      What has Milgrom got completely wrong, which shows he does not even understand the arguments of his own side?

      This is not a trick. The answer is very simple and if you are appropriately familiar with Mathie’s claims about the evidence you will spot it instantly.

      Over to you…

    • May 8, 2011 at 9:53 am

      You have encapsulated the approach of the quackometer and followers quite succinctly.

      I am neither a supporter or opponent of homeopathic treatments and have virtually no knowledge of the approach (something I suspect I share with Andrew Lewis)but, I suppose, if the quackometer weren’t so blindly tribal it might have to concede that there may just be some value in homeopathy despite a lack of ‘conventional’ evidence.

      It’s true that a new model of efficacy and a different concept of evidence is needed to explain the results of alternative approaches as they don’t fit the model designed for pharmaceuticals but it’s hard to see where the funding might come from.

      I personally quite like the scenario of a sick person who has spent years with the conventional establishment without improvement who then tries an alternative approach and is cured.

      Now, that has to be worth investigating.

      • Matt
        May 8, 2011 at 2:03 pm

        “I personally quite like the scenario of a sick person who has spent years with the conventional establishment without improvement who then tries an alternative approach and is cured.”

        It’s a nice thought. The problem with this approach is that lots of random things happen all the time everywhere. In the field of medicine; sometimes people get sick, sometimes they get better.

        The question you want to answer is whether your person gets better BECAUSE of the alt med or just COINCIDENTLY with its application. How would you manage that?

        I don’t think you could manage it just by looking at the set of people you describe. That set of people look like the alt med caused them to get better, but that’s why they were selected! There are three other groups to consider: the people who tried alt med and didn’t get better; the people who didn’t try alt med but did get better and the people would didn’t try alt med and didn’t get better. difficult to look at all these groups with an observational study.

        However if alt med causes people to get better, then if we divided a group of patients into two, gave one alt med and the other conventional treatment or placebo would we not see higher recovery rates in the alt med group.

        But at that point we’re doing a trial. Which you reject as the tribal dogmatic old notion of “evidence”.

        I hope this sketch shows how the need for trials becomes clear from a few simple steps of practical reasoning rather than some dusty old authority.

      • Badly Shaved Monkey
        May 8, 2011 at 2:21 pm

        No we don’t need a “different concept of evidence” to explain the results of SCAM. Almost none of it works at all for anything. This is really not a very difficult idea to grasp. What is it that you think still requires explanation?

    • BillyJoe
      May 8, 2011 at 2:30 pm

      Anyone who has read Lionel Milgrom’s explanation of how quantum physics explains homoeopathy and how that also explains why the RCT cannot work for homoeopathy could not possibly take this person seriously ever again.

    • May 8, 2011 at 7:52 pm

      In response to Matt (as badly shaved monkey seems to have lost the plot) you are absolutely right with the first part of your reply, there are usually many factors involved and individuals can respond quite differently so judgements have to be made on the balance of probabilities and that requires volume. It would require lots of similar people with similar issues receiving similar treatment to begin to determine a degree of effectiveness of that treatment for that condition. It’s not the case that it has to be one against the other. It is about determining whether or not an alternative approach or treatment brings about the desired effect regardless of whether or not a chemical intervention also does. There is a strong belief amongst our society that if you can fix it without taking drugs then that is the better option. In my opinion a well founded one.
      If one person reported seeing a dog driving a car you would naturally dismiss it as a mistake or an hallucination, if ten people reported seeing a dog driving a car you might conclude that it was a scam, perhaps for entertainment purposes but if thousands of people reported dogs driving cars all over the world you may be forced to conclude that some dogs can indeed drive cars.
      It is possible to reach valid conclusions for treatment in ways other than controlled trials. When the numbers are high enough patterns emerge. You also make a good point in that when miraculous recovery occurs (much more often than you might imagine) the response of the establishment is that they probably got the original diagnosis wrong, which might be true, but for those cases where the formerly visible and untreatable tumour is no more it’s often put down to just one of those things. It’s also not really credible to conclude that after much time on the unsuccessful medication it suddenly worked when an alternative remedy had been applied.
      The problem with your final three paragraphs is that trials such as you allude to only work for drugs. It is only drugs where it is possible to hide from everyone who gets the active ingredient and who doesn’t. I’m not defending homeopathy as they do prescribe stuff but suggesting that there are other ways to promote health other than surgery or drugs.
      Take physiotherapy, for example. It’s not possible to do trials in the same way. People either receive treatment or they don’t and when they do they know about it, so you might want to consider what other factors play a part in forming such a ‘mainstream treatment’ without ‘trialling’ as one would with chemical intervention.
      I mentioned earlier about numbers and for reports of cures by alternative methods they do exist. If you are open to receiving such information you will see it everywhere. There are thousands of examples all over the web in anecdotal form which, I admit, has its problems but when such reports occur time and time again, from their number similarities of the individual, the illness and the treatment will repeat. If there are enough people saying they had this condition and they received this treatment and it worked then it is probably something worth investigation. The problem with dogmatic and immovable opinions is that people who display such belief characteristics just won’t see or understand things that oppose them.
      I explain the role of belief in driving unwanted behaviour (and illness) extensively in my book ‘The Sophisticated Alcoholic’ to be published 25th November by O-Books.
      David

      • Badly Shaved Monkey
        May 8, 2011 at 9:29 pm

        Sorry, Mr Allen, what do you mean “lost the plot”?

        Lionel Milgrom has factually incorrectly reproduced the Society of Homeopaths version of the evidence base. I have simply asked you to identify the error. It’s not a trick. It’s very easy. Milgrom should have spotted it and so should you.

        I’m afraid this is another example of us knowing the homeopaths’ arguments better than they know them themselves.

        Have another go.

      • Mojo
        May 9, 2011 at 8:28 am

        When the numbers are high enough patterns emerge.

        “Mass existing in well distributed people since long”?

      • Matt
        May 9, 2011 at 11:43 am

        This bit is particularly wrong for homoeopathy:

        “It is only drugs where it is possible to hide from everyone who gets the active ingredient and who doesn’t.”

        The treatment prescribed always looks like a spherical white pill a couple of mm across. It’s the simplest possible thing to blind.

        In response to this:

        “I mentioned earlier about numbers and for reports of cures by alternative methods they do exist. If you are open to receiving such information you will see it everywhere.”

        There is a good scientific reason for not being open to such information. As I said above, random stuff happens all the time. The job of science is to pick apart cause and effect within that maelstrom of happenings and provide mechanistic explanations.

        Our imagination can conjure an infinity of mechanistic explanations for real world phenomena. To test which of these are most correct requires carefully constructed experiments to test whether our proposed mechanism enables us to make accurate predictions. You can’t do that with the kind of anecdotal reports you describe, no matter how much of it you accrue.

    • May 9, 2011 at 12:33 pm

      On the point of my use of the word drugs you are right, just the wrong word, perhaps external chemical intervention would be better. As I said I’m no defender or critic of Homeopathy as I know nothing about it and if one is administering pills then double blind trials fit the bill. My whole point was that a clumping together of any approach that’s not ‘medical science’ automatically being labelled as ineffective. Daft really when there are many approached you know nothng about.

      There is never any good reason not to be open minded. In fact that is the antitheseis of scientific discovery. The problem with le Canard and followers is that their minds seem to be already made up as if terrified that some new information might destroy a nicely encapsulated view of the world.

      David

      • Badly Shaved Monkey
        May 9, 2011 at 1:42 pm

        I’m not sure what your point is. There is plausible and proven medicine: licensed drugs. There is plausible but hard to prove medicine: quite a lot of surgery, psychotherapy. There is plausible but disproven medicine: acupuncture in many of its forms. There is implausible and disproven medicine: homeopathy, reiki.

        What modalities do you wish to bring in from the cold. Give us an example of such a neglected orphan.

      • phayes
        May 9, 2011 at 4:07 pm

        “There is never any good reason not to be open minded. In fact that is the antitheseis of scientific discovery. The problem with le Canard and followers is that their minds seem to be already made up as if terrified that some new information might destroy a nicely encapsulated view of the world.”

        What a surprise – the deeply ironic “open mind” fallacy¹. The classic resort of the ignorant and irrational in fearful resistance against the established science that has already destroyed their cherished fantasy world view.

        ¹ http://skeptico.blogs.com/skeptico/2005/10/the_appeal_to_b.html

      • Matt
        May 9, 2011 at 4:55 pm

        What they said plus:

        Being open minded means being open to persuasion by cogent rational argument and robust evidence. What you are talking about is simply believing the last thing you were told or the first idea you have. That isn’t open mindenss, its an idiots charter.

      • May 9, 2011 at 9:12 pm

        Naturally, your open mindedness is rational and critical, yet fair, whereas everyone else’s, oops, I mean those that disagree with you, is idiotic, ignorant and irrational.
        Silly of me not to have known that.
        Just an observation here, the continued use of intensifiers such as idiotic, ignorant, rot, rubbish, etc. actually detracts from an argument rather than enhancing it. It’s a bit like shouting on paper. As we all know when you resort to shouting it’s because you have no argument left.

      • May 9, 2011 at 9:30 pm

        I’ve just looked at the skeptico blog link and what is said there can be true and is well explained but, it isn’t always the case yet the blog is written in away that suggests no exceptions. It is very heavy on attitude and light on balance so all in all it’s a bit juvenile. Worthy of a football slogan though.

      • Matt
        May 10, 2011 at 1:44 pm

        The thing is; the blog is a polemical form and comments and forums are adversarial. It is unsophisticated to criticise a piece of work for conforming to the characteristics of its genera. It is equally unsophisticated to dismiss a set of ideas just because they are sometimes, or even always, expressed in polemic.

        Would you dismiss the views of someone passionate about correcting an injustice, purely because they were passionate, committed and possessed of conviction?

        I suggest an experiment for you to test the monomania of sceptics. Go to a sceptics in the pub event and have a chat with some people over a beer. I predict you’ll get an interesting and nuanced conversation.

  11. May 7, 2011 at 9:22 pm

    I could not agree more with you about the flaws of homeopathic “science.”

    But I am more divided in my mind on homeopathic practice. Most practitioners I know are caring and responsible physicians. They do not give harsh medicines with myriad of side-effects as allopaths often do. They usually are not bought by the pharma industry. They listen to patients and give lifestyle advice. They basically, by taking away all pills, let nature heal itself – which Nature will do in about ninety-five percent (my estimate).

    Then again, if homeopaths claim they can heal AIDS or malaria in Africa with little sugar pills, it is getting outright dangerous and criminal.

    I think we can’t do enough studies that show that homeopathy does not work in the ways it claims – it works by omission of more detrimental medicines and suggesting better nutrition and exercise choices. But the funding should come from homeopathic manufacturers and physicians – they should have a desire to prove us. Funding should not come from public resources.

    Thank you for this article!

    Alexa Fleckenstein M.D., physician, author.

    • BillyJoe
      May 8, 2011 at 2:41 pm

      The zero prior probability of homoepathy (ie there is no way it could possibly work) should have been enough to prevent us from wasting time, energy, and resources investigating homoeopathy in the first place. But, now, after so many failed trials*, it is surely time put a stop to any further wasting of time, energy, and resources. We surely have better things to do.

      *In fact, the zero plausibility demands that the evidence should actually be extraordinary.

  12. Richard Rawlins (FRCS)
    May 8, 2011 at 8:39 am

    Dr Alexa,

    When you say they are “responsible physicians”, do you mean they are medically qualified?

    The title “physician” cannot be used by any one not registered with the GMC.

    What you have described these practitioners doing is naturopathy (or ‘good avice’ if you like), not homeopathy.

    Homeopaths (by definition) identify patients with a particular “polycrest” or character and then prescribe remedies which contain no active ingredient.

  13. Badly Shaved Monkey
    May 8, 2011 at 9:53 pm

    “It is possible to reach valid conclusions for treatment in ways other than controlled trials….

    Take physiotherapy, for example. It’s not possible to do trials in the same way. People either receive treatment or they don’t and when they do they know about it, so you might want to consider what other factors play a part in forming such a ‘mainstream treatment’ without ‘trialling’ as one would with chemical intervention.”

    Mr Allen, we file that comment in the drawer labelled  ’no shit, Sherlock’. This does not come as news to people working in surgery and similarly hard to blind modalities. 

    And you are wrong. 

    All of medical trialling and observation comes down to probabilities. We want to maximise the likelihood of intervening in an effective manner. Controlled trials maximise this. Observational and epidemiological data can try to substitute for controls by accounting for confounding variables, but this is not a true replacement for good controls. In other words, this does not allow you to claim that weaker evidence is a fair replacement for controlled data and appeal for these weaker forms to be taken at face value. Real medicine acknowledges these weaknesses. SCAMmers spin the data and pretend there are no weaknesses. You only need to see how Spence’s 2005 survey of homeo patients has been promoted by their lobby groups. 

    Medicine that depends on these hard to control modalities is weighed down by a legacy of useless treatments. Real medicine knows and accepts these limitations. SCAM pretends they don’t exist. 

    Furthermore, homs pretend their therapy is one of these hard to control modalities to excuse their collection of weak types of evidence.  This is another of their lies. 

    • May 9, 2011 at 12:54 pm

      In which case my point is valid but I’m not sure what yours is.

      I’m also not sure what I’m wrong about. I agree that where it is possible to do controlled trials that’s more likely to show a true picture than not doing them or doing something else.
      Also I’m not defending distorted or sham excercises to promote a treatment but I come back to my original point that to prejudge all ‘alternative’ approaches as invalid is contra scientific. Minds made up and all that. Just because some might be suspect doesn’t necessarily mean that they all are.

      I love your use of the term ‘real medicine’. No grey areas in your world it seems.

      Just taking a step back for a moment I can’t really think of an autoimmune disease that can be cured by conventional treatments even though the management of them is improving. By way of example the incidence of Breast cancer has grown by about 70% in the last 50 years yet the mortality rate has declined by only about 5%. Tha means we are losing ground which is not the direction we should be going in.

      Sometimes solutions come from outside the box and to deny that possibility by denouncing everything that isn’t part of the unsuccessful conventional approaches is clearly limiting.

      Some people can see that and some can’t.

      David

      • Badly Shaved Monkey
        May 9, 2011 at 1:35 pm

        Mr Allen,

        The difference between real medicine and SCAM lays in the propensity of their practitioners to follow where the science leads. There is much of a grey zone given the behaviour of SCAMmers.

        On the other hand, your “wrong” statement does remain ““It is possible to reach valid conclusions for treatment in ways other than controlled trials….” Ironically, given what you have just said, it is wrong because it lacks shading. ALL conclusions in medicine are statistical and therefore inherently grey. There are not “different” ways to the truth. There is a spectrum of better and worse ways. SCAMmers would have us believe there are alternative, but equally valid paths. All their alternatives are merely ways of making judgement that are compromised to greater degrees than the best ways. It is true that the best ways are impracticable in some instances, but the need to resort to poorer quality data does not validate that poorer quality approach. Yes, it may be that conclusions that are valid (if we had omniscient access to what is true and could make that judgement) may derive from poorer types of data, but he signal to noise ratio is worse.

        Your mistake, and that of SCAMmers, is to present observational data as being an equal alternative to controlled data. And so their asinine promotion of outcome data enters the public realm.

        I am not failing to address shades of grey, I am merely tying to explain the ways in which we handle those shades and highlight abuses of that process.

      • Badly Shaved Monkey
        May 9, 2011 at 1:36 pm

        P.S. I am not a cancer epidemiologist, but I think your data, if correct, reflect and ageing population.

    • May 9, 2011 at 8:42 pm

      I’m sure we differ philosophically because I would say there are, in fact many ways to the ‘truth’ assuming of course that you know what the ‘truth is’.
      Your response to my couple of stats about breast cancer is really interesting as you automatically assume that couldn’t be the case and I understand why. It’s a breathtaking statistic which challenges the whole conventional approach and as such has to be a mistake. However these figures are freely available so you could answer your assumption yourself. Even more interesting is that the current figures benefit from the introduction of screening in the 70’s which made a positive difference to the 5 year mortality rates.
      For all the good things that modern medicine can achieve there is still no cure for any of the auto-immune illnesses so could all the effort be going in the wrong direction? To deny all alternative approaches to illness in the face of a failed conventional approach could be said to be the very definition of dogma.
      I’m not sure we’ll ever agree but thanks for the discussion.

  14. le canard noir
    May 9, 2011 at 1:22 pm

    Of course this is rot. My position is not one born of fear, but of analysis of the claims.

    I have been writing about homeopathy now for 5 years on this blog. Researching claims, looking at papers. Observing behaviour.

    I speak from a position of a thorough acquaintance with the supposed science of homeopathy – and I would say a more thorough knowledge of homeopaths.

    Homeopathy does not stack up. Its claims do not bera analysis. It is a superstition and a pseudoscience. That is no closed mindedness of me. It is a rejection of empty-mindedness.

    • May 9, 2011 at 8:22 pm

      As I’ve mentioned many times I’m not defending homeopathy only pointing out that it is clearly a nonsense to tar all aalternative approaches with the same brush which you are prone to do repeatedly.

      Many of your observations about homeopathy and chiropractic are well made and you have, indeed, spent a lot of time on these ‘disciplines’ but it doesn’t automatically follow that you know much about them. If one only seeks that which supports already formed judgements than that’s what will be found.

      One could, of course, speak to the clients/recipients of whatever approach you want to explore, but that would take an open mind and be quite risky for the determined crusader. It is rare that something is either all bad or all good. A problem with the never ending dammnation scenario is that by natural definition it has to be wrong.

      I suppose my real point is that the refusal to find anything remotely good in anything you ‘investigate’ does itself detract from the message. A salutory memory might be the almost universal application of leeches for any and all illnesses wholeheartedly supported by the ‘scientific/medical/ establishment. Before you say ah, but we’re much cleverer now think what might be said about today’s efforts in 100 years. Perhaps we all live in the current illusion.

      David

      • Badly Shaved Monkey
        May 9, 2011 at 9:31 pm

        and on what basis do you declare that the widespread use of leeches for many diseases was incorrect?

        You must have a basis for this assertion, yet you seem incapable of making the same statement about currently fashionable medical nonsense. Curious.

      • Mojo
        May 9, 2011 at 10:39 pm

        I’d be interested in knowing the basis for the claim that the use of leeches “for any and all illnesses” was supported by the “scientific/medical/ establishment”, given that after hundreds of years of prescientific use this use became less widespread, and ultimately disappeared, at the same time that scientific methods were being introduced to medicine.

      • Mojo
        May 9, 2011 at 10:50 pm

        “As I’ve mentioned many times I’m not defending homeopathy only pointing out that it is clearly a nonsense to tar all aalternative approaches with the same brush…”

        And yet you are posting your comments on an article that is specifically about homoeopathy (and in your second post claimed that “if the quackometer weren’t so blindly tribal it might have to concede that there may just be some value in homeopathy despite a lack of ‘conventional’ evidence”).

        If you wish to defend “aalternative approaches” other than homoeopathy, why not do so in the comments to articles about these particular therapies rather than in an irrelevant thread about homoeopathy?

  15. Badly Shaved Monkey
    May 9, 2011 at 1:48 pm

    Buggering typos!

    For “There is much of a grey zone given the behaviour of SCAMmers”

    Read “There is NOT much of a grey zone given the behaviour of SCAMmers”

    • Badly Shaved Monkey
      May 9, 2011 at 1:52 pm

      Autocorrect on the iPhone changes “buggering” to “buttering” and then to “buffeting”
      :-)

  16. Will
    May 11, 2011 at 1:44 pm

    Open your mind wide enough and everything falls out…

  17. Badly Shaved Monkey
    May 12, 2011 at 6:20 am

    It’s beginning to look like SkepticsBane and David Allen have left the building. That’s a pity, but it’s a familiar pattern. Challenge flowery woo rhetoric with a couple of specific questions and they reliably vanish like mist in the morning light.

    Oh, well, it’s their loss.

  18. BillyJoe
    May 12, 2011 at 12:16 pm

    “It’s beginning to look like SkepticsBane and David Allen have left the building.”

    I guess they’ve finished JAQing off. :D

  19. Carl
    May 13, 2011 at 11:14 am

    I disagree with your comment about all research into alternative therapy not being funded, most alternative therapists may have blind faith but scientists should always seek proof.. What happens with alternative therapy is that every now and then something might be right. For example herbal remedy’s. We test them find out there’s an active ingredient turn it into medicine.

    But yeah i think enough trails have been done on homoeopathy it doesn’t work its concepts are not even plausible and the trails have come back negative.

  20. le canard noir
    May 13, 2011 at 11:44 am

    I think my point still stands for herbalism.

    Herbalist do not prescribe because they have good evidence that a herb is effective, but because of lore, tradition and other ad hoc methods of prescription. Scientific research will not change that. And if research does show that a plant may have medicinal properties they will use that to justify their lore as a whole rather than to learn how best to make a useful treatment by looking at dosages, effectiveness,safety etc.

    Such work is called pharmacology. Herbalists only practice a very primitive and ineffective form of pharmacology.

  21. Muscleguy
    May 14, 2011 at 6:05 pm

    Not to mention that herbalists persist in claiming they are treating modalities of doubtful, diffuse and even meaningless reality. For eg some herbs are claimed to ‘clean the blood’ (what? like the kidneys do?) or are ‘liver cleansers’ as though the liver doesn’t function very well at ‘cleansing’ the body of unwanted substances. It is what it is for and has been honed to do that job over hundreds of millennia by natural selection. They think that one herb can do something the liver can’t?

  22. MadGav
    May 17, 2011 at 3:12 pm

    Milgrom appears to have forgotten that the null-hypothesis (with respect to homeopathy) is that it provides no benefit beyond that expected from a placebo.

    So if we accept his statistics, 63 of those 142 RCTs were positive, 11 were statistically negative and the remaining 68 provided insufficient evidence to abandon the null hypothesis.

    It seems odd that he’s pimping a 63 to 79 outcome against homeopathy.

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