Complementary and alternative medicine Medicine Quackery

The “frontier science” of homeopathy?

If there’s one type of so-called “complementary and alternative medicine” that I’ve always been very up front about, it’s that I consider homeopathy to be the ultimate in pseudoscientific twaddle when it comes to CAM. The reasons should be obvious to anyone with a background in basic science. After all, homeopathy is nothing more than the most magical of magical thinking writ so large that it’s a wonder than anyone can believe it.

Think about it. What are the two main principles of homeopathy? The first is “like cures like,” which postulates on the basis of the prescientific observations of an 18th century German named Samuel Christian Hahnemann. In reality, this principle is nothing more than sympathetic magic at its root, resembling strongly Frazer’s Law of Similarity, which is one of the implicit principles of magic. There’s no scientific support for this principle. Even more ridiculous is the law of infinitesimals, which is in essence the claim that the serial dilution of homeopathic remedies with succussion (shaking) somehow makes the remedy more potent. This was a tenuous claim even more than 200 years ago, but when Avagadro’s discovery made it abundantly clear that homeopathy is pseudoscience by permitting a simple calculation that demonstrated that typical homeopathic dilutions of 30C (thirty serial one hundred-fold dilutions) are highly unlikely to have a single molecule of the compound left in them. Of course, that hasn’t stopped homeopaths from going through all sorts of contortions of logic and science to try to claim that homeopathy is anything more than water and that the benefits claimed for homeopathy are anything more than placebo. They’ve claimed that not only does water have memory but that the memory persists long enough and is somehow able to transmit the healing power of the remedy to the human body, biology be damned, sometimes abusing quantum theory most hilariously along the way.

Recently, I’ve come across homeopathy apologists claiming that homeopathy should be considered “frontier science.”

It starts out with a healthy dose of persecution complex:

Much to the dismay of many people cured by homeopathy around the world, a recent wave of strong opinion held by a very few asserts that homeopathy is not scientific, or, at the very least, is “bad science”. Unfortunately those writing blogs claiming that Homeopathy is bad science have a very closed view of what science truly is and what the future of science may look like. Much of their postulating is borne out of fear. Fear of what they do not understand, and fear of a perceived threat to the scientific status quo from which they derive security. Hence, they vehemently attack a form of health care that has profoundly helped thousands of people all over the world.

Gee, I wonder if he’s talking about little ol’ me. Probably not, although whoever he’s talking about sounds like my kind of blogger. Of course, being lectured by a woo-meister about a lack of understanding of “what science truly is” is truly rich. So is the claim that homeopathy is some sort of “threat” to the “scientific status quo.” Sound familiar? It’s the same sort of complaint that “intelligent design” creationists make for their pseudoscience: That, any day now, ID is going to show just how wrong all those evolutionary biologists are. So far it hasn’t, and homeopathy is, if anything, even less convincing on a scientific basis than ID. Of course, trying to play the martyr card is always a good way to make one’s view seem “dangerous” and thus hide its utter implausibility. Indeed, ID creationists have taken this tactic to a ridiculous extreme by recruiting Ben Stein to don a pair of too-tight black schoolboy shorts trying to look like Angus Young from AC/DC and narrating an entire movie (Expelled!) that does nothing but play the martyr card. Whenever you see someone playing the martyr card like that (even to the point of likening critics to the Inquisition), it’s often a good indication that they’re defending woo, and this is no exception.

Another indication that we’re dealing with pseudoscience is when its defender starts dealing with claims in such a way as to exempt itself from the normal methodology of science:

These recent attacks on homeopathy rely heavily on misunderstanding and selective misinformation. The constant cry is that homeopathic remedies are placebo and can therefore do nothing. When homeopaths assert that remedies work on animals and therefore cannot be the placebo effect, they blame the biased observer. Tell that to my sister who was able to cure her entire herd of sheep sick with highly contagious pinkeye with the use of a homeopathic remedy. These critics have even gone so far as to say that the reason homeopathy “seemed” successful in the cholera epidemic of 1854 was because conventional medicine was so harmful:

“So, while hideous medical treatments such as blood-letting were actively harmful, the homeopaths’ treatments at least did nothing either way.” (The Guardian, Ben Goldacre November 16th 2007).

Ben always was a smart one, one of the rare journalists who really gets it when it comes to pseudoscience. He’s quite correct. I also particularly like the part about homeopaths asserting that remedies work on animals. I’m guessing by “assert” he means he has no scientific evidence in the form of randomized trials to back up that assertion; otherwise he would have said so. As for the cholera epidemic, one always has to be very careful about trusting 150 year old anecdotes describing uncontrolled trials like this:

Mr. Goldacre’s statement is at odds with the excellent therapeutic results of homeopathic patients reported at the time of the epidemic:

“In 1854 London was struck by an outbreak of cholera. This gave homeopaths a chance to show what they could do. Among the patients admitted to the orthodox hospitals the death rate was 52 per cent, while at the homeopathic hospital, where 61 patients were admitted, only 10 died (16 per cent).” (English Homeopathy in the 19th Century; Campbell)

Not only is it clear that homeopathic treatment was successful, but the “Bad Science” author admits the harm conventional medicine was doing. In this day and age of prescription drug therapy which is rife with harmful, even leathal side affects, can we really say conventional medicine is any better than it was in 1854? Remember the Hippocratic oath: “first do no harm”.

Of course, this anecdote is entirely consistent with Mr. Goldacre’s observation. Moreover, this was not a randomized trial. We have no idea if the two groups were equivalent, and even if they are it’s entirely possible (even likely) that the results could be explained by a harmful effect of “conventional” medicine that increased the baseline mortality rate from cholera. Remember, surviving cholera is a matter of keeping hydrated more than anything else. Anything that increases the level of dehydration will increase mortality rates, and any form of bleeding or, as was more common in the 1850s inducing purging with toxic metals such as antimony, cadmium, or mercury would certainly have a high likelihood of doing just that. At best, this anecdote tells us nothing.

Next, we’re treated to a bunch of whining about the 2005 meta-analysis of trials of homeopathy that appeared in the Lancet. Naturally, because the study found that homeopathic treatments were equivalent to placebos and that the larger and better designed and controlled the trial, the less likely it was to find an effect of homeopathy, homepaths really hate this article. They much prefer an older and less well-designed meta-analysis from 1997, also published in The Lancet, which is the one that they always cite. Of course, meta-analyses always have to have rigorous inclusion criteria, and what was unique about the 2005 article is that the authors looked at 110 matched placebo-controlled trials of homeopathy and of “conventional” interactions and compared them. They found strong evidence for specific effects by “conventional” remedies and very weak evidence for homeopathic remedies, which, when taken in its totality, was most compatible with the notion that homeopathic effects are placebo effects.

He finishes off with the “science is faith” canard, which has become such a laughable cliche among the defenders of woo, that its use should be prima facie evidence that what is being defended is pseudoscience.

More recently, he’s been arguing that randomized clinical trials are not applicable to testing whether homeopathic remedies work, in a lovely diatribe against “evidence-based medicine,” arguing that anecdotes favored by homeopaths are just as good as those randomized clinical trials that we “dogmatic” and “close-minded” advocates of scientific medicine insist on:

In homeopathy we discuss our science to a great extent with cases. This is in contrast with mainstream medicine, where journals are filled with double blind studies, more recently called “Randomized Clinical Trials”, or abbreviated RCT’s. The double blind studies are seen as the ultimate in science, the holy grail to prove if something works or not. Many homeopaths have the feeling that they are not effective for homeopathy, or even further that they cannot be used in homeopathy. But double blind studies can also be done in homeopathy as for instance; David Riley has done in 2 studies with hay-fever. He proved homeopathy did work, but the point is that homeopaths didn’t learn anything from it.

Case series are considered a valid form of evidence in science- and evidence-based medicine. However, they are considered a generally weak form of evidence because there is no control group and they are prone to all sorts of biases and confounding factors, including selection bias and regression to the mean, something this homeopathy apologist seems not to understand:

If I talk about my experience, skeptics will dismiss that as “anecdotal evidence.” I understand their point of view. It’s where I started out. But look at it from my point of view for a moment. It’s like if I start a new garden. I plant some seeds and later plants come up. How do I know that any single plant is where it is because I planted it there? Maybe an animal moved that seed. Or maybe I’m sharing the garden and my neighbor planted that seed on my side. Perhaps. But when I look at my whole garden I can clearly see that it’s the garden I intended, or not. That’s how it is with homeopathy, both when considering a single improved symptom and a single successfully cured patient. Collective anecdotal evidence can be that obvious and compelling.

Of course, it’s impossible for me to resist pointing out that “collective anecdotal evidence” was “obvious and compelling” for hundreds of years that bloodletting could treat all sorts of diseases and conditions. Indeed, “collective anecdotal evidence” can be very deceiving, thanks to the placebo effect and quirks in human thinking. Indeed, it was the very realization that this is true that led scientists towards more and more controlled trials, culminating with the advent of the double-blind, randomized placebo-controlled clinical trial.

It should also be pointed out that, as has been discussed before, when prior probability is left out of the equation, even randomized clinical trials of therapies with a low estimated probability of working based on scientific considerations (and, boy, does homeopathy fit that description) can produce an unfortunately high percentage of false positive results. Single studies can’t “prove” anything, particularly if they are of low quality. In any case, the claim that homeopaths “didn’t learn anything” from studies that allegedly showed that homeopathy worked should not be surprising, given that they never learn anything from the many more studies that show clearly that homeopathy doesn’t work. Sinking even deeper into crank arguments, we’re also treated to a claim that a randomized clinical trial is a “black box“:

That is indeed the central point, the insight. Double blind studies are a kind of black box idea, one symptom is evaluated when one impulse is given (mostly a medicine), but there is no idea what is going on inside the black box. Sometimes the researcher does not even want to know what is going on. Researching one facet is often done out of reasons of simplification; the living organism is too complex to take everything into account, but that is just the pitfall. Reduction of complex problems into simple ones can be revealing, but especially in living systems it can also lead to distorted conclusions. That is what we can see in practice: promising treatment leads, after a while, to disappointments as the benefits turn out to be not that great and the side-effects are growing. It was more complex than originally thought.

The main problem lies in the black box. It is typical that in the past double blind studies were called “double blind studies”, it expresses that nothing is understood.

The issues of reductionism and homogeneity in patient selection and methodology are legitimate issues when it comes to applying the results of randomized clinical trials more broadly, but clinical trials are anything but a “black box.” Rather, they represent a transparent methodology (at least after the blinding is lifted and the data analyzed) designed to minimize the possible effects of failures in human cognition and normal human biases on the results of the study. Moreover, our intrepid critic of RCTs neglects to mention (or fails to understand) that determining how a drug or treatment works is not the purpose of RCTs; figuring out if it works and how much is, although collecting and analyzing blood, urine, and even tissue samples from trial subjects often does shed light on the mechanism by which the treatment works. Moreover, clinical trials often measure quantitative, objective endpoints (examples: tumor size, death), whereas it’s rare to see a homeopathic “case study” that measures such parameters. Finally, “double blind” does not refer to nothing being understood but merely to the way that investigators and patients are blinded to the treatment group. But RCTs are not the real problem homeopaths have with science. I bet you can tell where this is all going:

What is the black box? It is the energy field, the soul or psyche or whatever one wants to call it, which is denied by mainstream medicine, by the materialism paradigm. That leads to strange and counter intuitive notions; like that intelligence does not exist, but is defined as the results of a test. The test then is not the result of intelligence, but intelligence is a result of the test. What other option does one have when there is no mind or soul? Behaviorism is a very striking example of this direction. [Homeopathic] case studies can show the in depth structure of disease, the origin in the mind and that gives understanding of health and disease. Statistics are then not necessary anymore. One can even say that statistics are only needed when understanding is lacking.

Yes, indeed! It’s that nasty materialistic assumption behind science that really bothers homeopaths, not the science itself. The reason is simple. Homeopathy is magical thinking, and it’s hard to find a better concession that this is true than the paragraph above, which would not be out of place on the Discovery Institute website penned by that dualism maven himself with zero understanding of evolution, Dr. Michael Egnor. If it weren’t magical thinking, then why would it be necessary to invoke nonmaterialistic ideas about the mind and bemoaning the lack of soul in that evil “materialistic” science?

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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