Wednesday, 6 January 2010

Homeopathy: There's Nothing In It

I have no deep interest in complementary and alternative medicine (CAM).

If it was not for the propensity of some of its misguided practitioners to sue (or threaten to sue) critics for libel, I suspect CAM would not often feature on this Blog at all.

What concerns me about some chiropractors and homeopaths is that their natural impulse is to get a lawyer involved and send a nasty letter, rather than actually producing evidence.

Of all the matters which have arisen out of the misconceived libel case brought by the BCA against Simon Singh, perhaps the most damning is the contrast between the speed of the libel claim and the tardiness in then producing the "plethora" of evidence.

I have never had any doubt that the BCA could have brought a libel claim; but I have always maintained that they should not have done so.

And events continue to prove this view correct.

Like chiropractors, homeopaths are sometime quick to threaten libel: the Society of Homeopaths tried to sue Quackometer and its webhosts for defamation, whilst the dangerously misguided and unethical Jeremy Sherr also bandied libel threats.

I remember when I first read about homeopathy.

I sort of could see what the like treats like principle was all about, though it seemed hopelessly irrational; but I was flabbergasted when I read about extreme dilution.

Did these people really believe in this?

I cannot express my bewilderment any better than to refer you to my friend Crispian Jago's practical demonstration.

I have no objection to anyone making an informed choice to drink water with lets pretend but non-existent ingredients.

However, it must be wrong for homeopathy to be sold as if it is an effective and efficacious treatment.

I thereby support an excellent new campaign to raise awareness about homeopathy generally and to challenge its availability at Boots the Chemist in particular.

Please go and have a look at the Ten23 site and, if you agree, do sign their open letter.


David said...

"What concerns me about some chiropractors and homeopaths is that there natural impulse is to get a lawyer involved and send a nasty letter rather than actually producing evidence."

I'm not going to bash on about this forever, but it's nonsense to say that chiropractors have a natural impulse to get lawyers involved. As far as I am aware. the BCA v Singh case is the first time that a critic has been called to account in this way and it has not been for making negative comments about chiropractic. It has been for making an assertion that a professional body has been acting dishonestly.

That's a different thing and, whatever the backlash has been, it's perfectly proper that Singh should be corrected.

Jack of Kent said...

Er, David:
Chiropractors resort to legal intimidation

David said...

@ Jack the UK.

RobC said...

Surely if they (the BCS) where acting honestly they would not have decided to remove references to curing conditions such as asthma and colic from their literature after things stopped going their way regarding the court action.

Whether the BCS are deluded or deliberately dishonest if no credible evidence for the named conditions exists then the treatment is essentially bogus.

Personal testiment, anicidotal or belief counts as credible evidence (before you include those in your next posting David)

Steve said...

Homeopathists makes Chiropracters look respectable.

I think thats called damning with faint praise..

Botogol said...

Boots the chemist? Worse - they deal homeopathy at my GP surgery

john b said...

While I accept that homeopathy sounds deeply implausible, I don't think the argument from incomprehension is the best approach.

I went to a talk by a leading Oxford professor of neurology last year where he explained that scientists have absolutely no idea how SSRIs (Prozac and its imitators) cure depression. But we know that they do, because there's a massive quantity of clinical trial data showing that they do.

If there were any clinical trials at all showing that homeopathy worked better than placebo, then the fact that we don't understand how the mechanism could possibly work would be irrelevant - medical science would accept that it was a valid treatment, and that would be enough.

Saying "you're a daft bunch of woo merchants with something that could never work" plays into their 'conspiracy of mainstream' hands. Saying "prove it works and I'll march down Oxford Street waving banners promoting it" is what science is all about...

(Tim Minchin's quote is relevant here. "You know what they call alternative medicine that's been proved to work? Medicine!")

Les Rose said...

John B: Extraordinary claims require extraordinary evidence. SSRIs are called SSRIs because they have been shown to inhibit serotonin reuptake selectively. Whereas I agree that the acid test is of efficacy, putative mechanisms are still relevant.

john b said...

Yes, but there's no understanding among leading neuroscientists of the mechanism by which inhibiting serotonin reuptake selectively works to reduce depression (the obvious layman's view, that a) there's simply more serotonin around, b) serotonin makes you happy, QED, has been demonstrated *not* to be the reason - it's something far more complex that hasn't yet been fathomed).

Peter in Dundee said...

Yet there are good reasons to still think that serotonin is a good target. Firstly agents that deplete serotonin, such as MDMA (ecstasy) result in depressive effects after heavy use and cessation. Also it was shown that people with a particular allele of the serotonin receptor are more likely to get bad depression after major life traumas (death of a close person, divorce etc).

SSRI's may be a blunt instrument and there is wrinkle that they also increase the birth of new neurons on a timescale coincident with improvement, but they do work and so a more complex serotonin hypothesis is still more likely than not to be operating. Part of the problem is that serotonin is unlikely to be a problem everywhere in the brain, yet we dose everywhere in the body. Hence side effects like dry mouth.

We are working on better, more targeted delivery methods but they are aimed more at things like cancer than the brain at the moment, but they will come.

Watch for eg for versions in molecular cages that are uncaged using focussed ultrasound or radio waves in a scanner etc to identify where in the brain needs to be targeted.

Dr Aust said...

Re John B's comment :

The point about homeopathy is that the two approaches mesh - the "prior plausibility" approach (aka incomprehensibility) and the "lack of real evidence" detailed-forensic-scientific-analysis-of-the-trials approach.

To scientists, homeopathy serves as a kind of sine qua non demonstration of the way implausible / mystical / belief-based therapies are both clung to (all evidence notwithstanding) and promoted.

As a sub-set of this, homeopathy also shows what happens if you take a completely placebo therapy and feed it into the arena of medical trials, where biases of various kinds are undoubtedly present, and indeed are well-described.

The first point is that most of the studies will be done by enthusiasts / advocates for homeopathy. So you get enough random false positives, people fooling themselves through the psychological need to believe or through lack of technical know-how, finagling of results, over-promotion of wholly inadequately-controlled "positive" studies, "file drawer" burying of the results of negative studies, etc etc. that the homeopaths can always find SOME positive results in the literature.

And all the detailed meta-analysis of the trials which shows that the positives are illusory (essentially, as the study design and size, and hence reliability, improves, the "positive effect" of homeopathy beyond placebo tends inexorably to zero) cannot "unconvince" them.

Coming back to the point made by "john B", we basically default to incomprehensibility because the scientific argument is won, to the satisfaction of all but the homeopaths, who are utterly beyond all convincing (cf the anti-vaccination nuts and MMR).

And... the incomprehensibility argument is quicker, pithier, and easier for a layman to grasp.

Steve Page said...

Irving Kirsch's "The Emperor's New Drugs" is a very good book about the SSRI industry; whilst he accepts that SSRIs are effective for treating severe chronic depression, he makes a strong argument against their efficacy within moderately depressed individuals, as the improvement is often not significantly different from those who are prescribed active placebos. Furthermore, non-significant trials have been suppressed by the SSRI manufacturers; any scientific team that only releases results that they want you to see has to have their ethics called into question.

Back on topic, homeopathy is bogus. There, I said it. Since we're quoting Tim Minchin: "Show me that it works and how it works, and when I've recovered from the shock, I will take a compass and carve "Fancy that!" on the side of my cock." :)

Anonymous said...

There is most certainly at least one more instance where chirorpactors made legal threats. I know as I was one of those on the receiving end. It was very nicely done too - I received my letter from the lawyers at around 4:30pm on a Friday, thus ensuring a weekend with little sleep.

In addition, NZ's best known Doctor, Shaun Holt, also had complaints laid against him for daring to suggest on television that the evidence for chiropractic isn't that good.

The NZ chiropractors also wrote to the vice chancellor of the university where I work, stating that I was bringing it into disrepute for, wait for it, complaining to the advertising standards authority about various chiropractic claims being advertised. Funnily enough, the complaints I made were very similar indeed to those made by the esteemed Zeno but they weren't upheld in NZ.

Andrew Gilbey, Massey University, NZ

Dr Aust said...

David Colquhoun blogged about Shaun Holt's case here, and you can also read about it on Shuan Holt's own blog here and here.

Puja said...

Real (homeopathic) medicine cures even when Conventional Allopathic Medicine (CAM) fails

mddawson said...

I would have thought that if a product was claimed to contain certain ingredients but didn't could be regarded as false advertising.

By bringing legal action in regards to these false claims against homeopathy manufacturers could force them to actually quote exact quantities of ingredients.

It could also force them to include measurable quantities of active ingredients. Then secondary legal action could take place in regards to the safety of homeopathic mixtures that include toxic ingredients such as arsenic and scopolamine.

Steve said...

Use of the word "Cures" is going to get a homeopath into a lot of actual legal trouble, and besides, when your spleen explodes are you gonna call for the 100C Ironium (or whatever) or 999 and see a real doctor?

RichieRich said...

Some time ago I read the chapter on homeopathy in Simon Singh's book which suggested there is very little evidence for its efficacy beyond placebo from controlled trials.

However...a couple of people have pointed out to me that there are cases of people being treated by a homeopath and the first, second..and nth remedy not working but the n+1th remedy bringing about a cure. How would sceptics explain this? If n remedies haven't worked, surely it's likely that one will be more sceptical about homeopathy than at the beginning of one's treatment ("it still hasn't worked") and so suggesting that the n+1th remedy is having a placebo effect that the previous n remedies didn't have doesn't seem a watertight explanation.

I'm sure there are people on here who've looked into this much more than me so I'd be interested to hear what people think.

Dr Aust said...


The simple answer is that things get better on their own, and not in predictable ways or at predictable times.

The "philosophy" of homeopathy allows them to claim this as a victory (for their "craft" and whatever remedy the person is then taking), no matter how many remedies have done nothing.

Just one more example of how their self-delusion is reality-proof.

Dr. Nancy Malik said...

Evidence-based modern homeopathy is the scientific revolution (fastest growing medicine in the world) in the 21st century

RichieRich said...

Dr Aust

Many thanks for your reply.

I guess one response would be for homeopaths to say..."Ah, but you can't prove that the person got better spontaneously". But this seems a pretty weak response. It seems to me the burden of proof is on homeopaths to show that their treatment is effective and that it truly was the n+1th treatment that made the difference.

Is the road to proof double-blind controlled studies? At this point it seems open to the homeopath to object that this is not an effective means of testing homeopathy.

Let's say 20 people all experience symptom/illness X. The homeopath would, I think, say that although all 20 experience X, the cause of X will, from a homeopathic perspective, be different and so must the treatments. So each of the 20 people may require a different set of homeopathic pills etc. And thus it doesn't make sense to do a double-blind study using just one homeopathic pill.

I'd be interested to know what the standard sceptic response to this line of argument is.

Dr Aust said...

Hi Richie.

Trials have been done this way (e.g. see example here) - it is usually referred to as "individualized" homeopathy. It can still be double-blinded perfectly easily provided it is the "homeopathic pharmacy" (i.e. not the practitioner) who gives out the remedy tablets. Ben Goldacre explains all this in a well-known and accessibly written article here.

Some of the big meta-analyses of trials of homeopathy show "subgroup analysis" (dividing trials into different types) including individualised homeopathy. The result still don't provide any evidence for homeopathy working. All that the "subgroup" analysis tends to show is that the larger, and better blinded, and more bias-free the trial, the less any apparent effect of homeopathy - tending inexorably to "no effect" as the trial design improves.

Most scientists see this, combined with homeopathy's intrinsic implausibilty, as being the end of the argument. Hence the opposition to having it on the NHS, or spending more money researching it.

RichieRich said...

Dr A

Many thanks for your reply.

David Colquhoun said...

An interesting matter of real pharmacology arises here. There have been references above the lack of understanding of how SSRI antidepressants work. It is now pretty clear that SSRIs are no better than placebo in mild or moderate depression. As well as being something of an embarrassment to the Pharms companies that promoted them very strongly, this is also an embarrassment to herbalists whose proudest boast is that St John's Wort is as good as SSRIs. Fail all round.

stripey7 said...

@mddawson, I agree it makes sense to force manufacturers to disclose actual quantities of (purportedly) active ingredient. But surely we don't want to do it in a way that causes them to increase those quantites to nonzero, when they're frequently toxic. That would be risking people's lives simply to make a point.

A "high ground" approach would be to challenge them to describe the product in a way that makes their doctrine explicit, so that consumers can decide for themselves how plausible it is. Something like "Water previously exposed to belladonna. Probable number of molecules from belladonna: 0."