Respectful Insolence

Homeopathy deconstructed in the FASEB Journal

Well, this is encouraging to see: A scientific journal publishing an article debunking pseudoscience, in this case the pseudoscience of homeopathy. (Grrrlscientist might object to the use of Hogwarts in the title, in essence comparing homeopathy to the wizardry of Harry Potter’s world. So would I, actually. Such a comparison is an insult to Hogwarts.) In any case, I thought it’d be a nice little tidbit, a warmup for tomorrow’s Your Friday Dose of Woo, if you will, to discuss it briefly.

It starts out with a quote from Oliver Wendell Holmes:

Do you think I don’t understand the hydrostatic paradox of controversy? If you had a bent tube, one arm of which was the size of a pipe-stem and the other big enough to hold the ocean, water would stand at the same height in one as in the other. Thus discussion equalizes fools and wise men in the same way, and the fools know it.

Genius.

This analogy applies to so many things, not just homeopathy. Heck, Deepak Chopra is living proof of the truth of this statement. So are “intelligent design” creationists. (I’m going to have to remember this quote and use it in the future–liberally.) But advocates of homeopathy prove it perhaps better than any other purveyors of woo, as FASEB Editor-in-Chief Gerald Weissmann understands:

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THE HYDROSTATIC PARADOX has never been so well illustrated as by current discussions of alternative medicine and its poster child, homeopathy. Hahnemann’s system, a therapeutic regimen unchanged since the Age of Mesmer, is making a comeback in the Age of Oprah. In 1810, Hahnemann (1755-1843) rebuked Enlightenment medicine in an over-ideational treatise called The Organon of the Rational Art of Healing…Not content to play the spiritual card, Hahnemann took swipes at the science of his day. Anatomy, physiology, and pathology, he argued, presented only “dim pictures of the imagination.” Since disease was not caused by any discrete physical agent, but to man’s lack of harmony with the “vital force” of nature, he asked “Has any one ever succeeded in displaying to view the matter of gout or the poison of scrofula?” More than a century after crystals of monosodium urate were shown to be the matter of gout by Garrod, and the poison of scrofula was found to be M. tuberculosis by Koch, homeopaths still believe that Organon’s vital force of nature is at the root of gout and TB.

You’d think that something as patently scientifically ridiculous as homeopathy, the concept that a substance can be diluted to the point where not a single molecule of that substance remains and still be able to have activity in disease, a concept that violates the laws of chemistry and physics as we understand them, would have faded into justly deserved obscurity by now. You’d think that a concept that ridiculous even by “common sense” (the idea that a homeopathic remedy can become stronger the more you dilute it) would have become nothing more than a historical oddity by now. You’d be wrong. These days, modern homeopathists have come up with new and more bizarre forms of woo to justify the unjustifiable, even invoking quantum mechanics in outrageous (albeit admittedly sometimes entertaining) ways to explain how homeopathy could “work” and how water could somehow retain a “memory” of substances with which it had come in contact.

Unfortunately, as the article points out, famous and powerful people fall for this nonsense. For example, Prince Charles happens to be a big booster of alternative medicine, including homeopathy, even going to far as to say in a speech before the World Health Organization:

In May 2006, Prince Charles addressed the World Health Assembly in Geneva to argue for homeopathy and its kindred therapies. He urged a return to remedies “rooted in ancient traditions that intuitively understood the need to maintain balance and harmony with our minds, bodies and the natural world.” He complained about modern biomedicine: “It seems to be that in our ceaseless rush to modernize, many tried and tested methods which have shown themselves be effective have been cast aside as old-fashioned or irrelevant to today’s needs.” . . . In 1985, he caused a stir by warning the British Medical Association that “the whole imposing edifice of modern medicine, for all its breathtaking successes is, like the celebrated Tower of Pisa, slightly off balance.” Last year, he funded a commission headed by a bank executive as lacking in scientific credentials as the Prince himself, to “look at the effectiveness, especially from a financial point of view, of integrated healthcare.”

British scientists struck back, with an open letter criticizing the use of non-evidence-based medicine by the National Health Service, but, like many true believers, Prince Charles blithely ignored it:

Prince Charles was unfazed–on the day the Open Letter was published, he stopped at St Tydfil’s Hospital in South Wales to watch alterative medicine at work. He accepted a “spiritual” crystal, as if he were Albus Dumbledore, headmaster of Hogwarts School, accepting the Philosopher’s Stone. Unlike Dumbledore, however, who only professed witchcraft and wizardry, Prince Charles called up every form of “integrative therapy” against Alzheimer’s disease (9) . One notes that when Prince Charles and other fans of unproven or disproved medical practices use terms such as “integrated therapy” or “alternative medicine,” they’re following the lead of creationists who hide under the term “intelligent design”–these are all convenient slogans that permit the credulous to con the gullible.

Personally, I find the comparison of Prince Charles to Albus Dumbledore to be rather offensive. Dumbledore was a much more intelligent and admirable–and, yes even scientific, at least in terms of the fantasy world in which he exists–character than Charles will ever be. I’ll forgive Weissmann that, though, because it’s truly heartening to hear a major scientific journal recognize that “integrated therapy” is more a marketing ploy than anything else. As Professor Michael Baum pointed out:

As for the Prince’s “financial point of view,” Professor Michael Baum, another of the signatories, noted that Britain had spent 20 million pounds refurbishing the Royal Homeopathic Hospital. Had that sum of money been spent on making available herceptin and aromatase inhibitors, it could saved 600 lives a year in one health district alone.

That’s the price of dabbling with quackery like homeopathy, particularly in a national health system in which diversion of resources to quackery results in diversion of resources away from effective, evidence-based therapies. But patients like it, regardless if it’s effective or not; so it’s politically popular.

We in the States aren’t spared the attack of this particular form pseudoscience, of course, and the article points that out. Special scorn is reserved for the National Center for Complementary and Alternative Medicine, which, despite the overwhelming scientific implausibility of homeopathy and the lack of evidence for any efficacy for it greater than placebo, maintains only a tepid “skepticism” towards it that borders on acceptance, apparently based on the concept that, if so many people believe in it there must be something to it (either that, or not wanting to tick off the credulous):

The NIH seems happy with research on homeopathy and kindred therapies. Its website replies “yes” to the question “Is NCCAM funding research on homeopathy?” while admitting that “Homeopathy is an area of complementary and alternative medicine (CAM) that has seen high levels of controversy and debate, largely because a number of its key concepts do not follow the laws of science (particularly chemistry and physics).”

No kidding. But NCCAM seems content enough not to let a little thing like conflict with well-established laws of chemistry and physics stop it from “studying” homeopathy, as Weissmann points out:

However, when it comes to homeopathy, NCCAM is careful to issue a disclaimer: “It has been questioned whether a remedy with a very tiny amount (perhaps not even one molecule) of active ingredient could have a biological effect, beneficial or otherwise.” Nevertheless, NCCAM has contributed $250,000 towards a clinical trial of “verum LM” (a homeopathic medicine diluted 1:50,000) for fibromyalgia at Dr. Andrew Weil’s Program in Integrative Medicine at the University of Arizona. Weil is the guru who in a 1986 book, Health and Healing announced that “Sickness is the manifestation of evil in the body.” Hahnemann redux, one might say.

Personally, in this time when the NIH budget is declining and it’s getting harder and harder for even worthy scientific studies to be funded, I resent the waste of giving our taxpayer dollars to Andrew Weil to “study” hokum like homeopathy. Other forms of alternative medicine, such as herbal medicine, fine. Many of our medicines have come from plants, and I’d bet there are lots of potential remedies out there yet to be discovered. But to waste taxpayer money funding something as patently ridiculous as homeopathy! I view it as yet another manifestation of the triumph of faith over reason that seems to be the order of the day and a symptom of the same malady that results in huge swaths of the population not accepting evolution as valid science.

Leave it to Oliver Wendell Holmes, though, to see through the sham that is homeopathy 150 years before NCCAM sprung up to “study” it anew, as Weissmann describes in a section amusingly called Dilutions of Grandeur:

But Boston in 1834 had permitted curious forms of the healing art to flower and Holmes was appalled. By 1842, he had had enough and wrote the definitive critique of the practice: “Homeopathy and its Kindred Delusions.” He found that homeopathy was “lucrative, and so long as it continues to be will surely survive, –as surely as astrology, palmistry and other methods of getting a living out of the weakness and credulity of mankind and womankind.”

Holmes nailed it exactly. Homeopathy remains extremely lucrative today, and so persists, even though the claims for some homeopathic products are so patently ridiculous that it’s hard to believe that anyone would take them seriously. Even now, there are few better demolitions of homeopathy than what Holmes wrote 164 years ago, and it’s instructive to note that even science as it existed in the mid-19th century was more than up to the task of conclusively demonstrating what a sham homeopathy is. The transcript of Holmes’ speech is well worth reading in its entirety, not the least reason because of its carefully modulated sarcasm. As quoted in the article, Holmes also wrote at another time:

Some of you will probably be more or less troubled by that parody of medieval theology which finds its dogma in the doctrine of homeopathy, its miracle of transubstantiation in the mystery of its dilutions, its church in the people who have mistaken their century, and its priests in those who have mistaken their calling.

Bingo. Homeopathy shares far more with religion than with any science- or evidence-based medicine.

Scientific and medical journals dedicated to sound science and evidence-based medicine would do well to emulate Oliver Wendell Holmes and not be shy about speaking out against quackery such as homeopathy. For whatever reason, 19th century medicine seems to be making a comeback in this nation, with powerful patrons and now a government bureaucracy in the very heart of American biomedical science (the NIH) protecting and promoting it. If this persists, I’m just afraid that we’ll soon see 19th century mortality rates returning with these 19th century medical concepts, as well. I’m glad to see that the FASEB Journal spoke out (although I fear that it will be in for a deluge of angry letters from the credulous). I only wish more scientific and medical journals would follow the FASEB Journal‘s lead.

Comments

  1. #1 Mustafa Mond, FCD
    October 19, 2006
  2. #2 Nomen Nescio
    October 19, 2006

    here’s another throwaway line: if homeopathy had any point to it, the surest cure for a migraine would be to throw an aspirin in the ocean, and then start drinking from the other shore.

    it’s almost too easy to beat up on the homeopaths, though. as it should be, after over a century of that art being practiced…

  3. #3 coracle
    October 19, 2006

    Thanks for bringing that to my attention. PC’s enthusiasm is a shame on the nation and yet, somehow, he retains a reputation for intelligence.

  4. #4 Subjective Rationalist
    October 19, 2006

    Good times. While I am a fan of certian forms of so-called alternative medicine, homeopathy is ridiculous and deserves to be set aside. It is shameful that some people lumped it in with other therapies and treatments that actually have merit.

  5. #5 Big Al
    October 19, 2006

    he’s wrong of course, capillary effects would make the water in the small tube, a little higher.

  6. #6 Paul
    October 19, 2006

    Subjective Rationalist,

    Which Alternative therapies and treatments do you contend actually have merit?

  7. #7 Blake Stacey
    October 19, 2006

    @Mustapha Mond, FCD:

    Who, oh who will be the next great spoon molester?

  8. #8 David Harmon
    October 19, 2006

    An older quote to the same effect: “Never argue with a fool — people might not know the difference”.

    Oh, and Hogwarts exists in a (fictional) universe where “magic” is both testable and reproducible.

  9. #9 KeithB
    October 19, 2006

    Did they give a date on the Holmes quote?

    I found a while back that someone attributed the quote to OWH the lawyer, rather than his dad OWH, a doctor.

  10. #10 Orac
    October 19, 2006

    That last quote is cited as coming from this work:

    Holmes, O. W. (1892) Medical Essays, vol. X of The Standard Edition of The Works of Oliver Wendell Holmes, xiii Houghton Mifflin Boston.

  11. #11 David Harmon
    October 19, 2006

    An older quote to the same effect: “Never argue with a fool — people might not know the difference”.

    Oh, and Hogwarts exists in a (fictional) universe where “magic” is both testable and reproducible.

  12. #12 sparc
    October 19, 2006

    The comments section in FASEB J has really improved since Gerals Weissmann became editor.
    E.g., in his article “Swift-boating Darwin” (FASEB J 20(3):405-407) Weissmann makes a clear statement for science based medicine and against hokus pokus even if the later is gowernmetally funded:

    The notion that there are alternative or complementary
    systems of medicine other than those based on the laws
    of physics and chemistry has swept not only daytime
    television, but captured the hearts and minds of our
    legislatures and our elite universities, and has found a
    home on the campus of the NIH (8, 9). The National
    Center for Complementary and Alternative Medicine
    (NCCAM) explains why it is funding work based on
    Ayurvedic notions of animal magnetism:
    This vital energy or life force is known under different
    names in different cultures, such as qi in traditional
    Chinese medicine, ki in the Japanese Kampo system, doshas
    in Ayurvedic medicine, and elsewhere as prana, etheric
    energy, fohat, orgone, odic force, mana, and homeopathic
    resonance. (10)

    I’m afraid that our current tolerance of homeopathic,
    chiropractic, Ayurvedic, holistic, crystal-based,
    or aroma-driven modes of healing has helped to clear
    the way for the alternative or complementary science of
    intelligent design. Once advocates of folk-based remedies
    persuaded the public that there are alternative or
    complementary explanations of what ails us, why not
    accept faith-based alternative or complementary explanations
    for how we came about? If the laws of chemistry
    and physics (e.g., PV nRT) need not apply to medicine,
    why should we rely on the laws of evolution such
    as natural selection or the Hardy Weinberg equation of
    population genetics […]?

    In the same issue you will find the FASEB statement against teaching intelligent design, creationism and non-scientific beliefs in science classes.

    In addition I recommend his article “NIH funding: not a prayer” about “The Study of Therapeutic Effects of Intercessory Prayer (STEP)” (FASEB J 20(9): 1278-1280).

  13. #13 KeithB
    October 19, 2006

    Well, OWH, jr, the supreme court justice’s *Dad* was OWH, who was a famous doctor that died around 1895. It seems that he is more likely to be the one who wrote a book of “Medical Essays”

    http://en.wikipedia.org/wiki/Oliver_Wendell_Holmes%2C_Sr.

    Not a big deal, but I am sure that most folks think of junior when they see OWH.

  14. #14 Mustafa Mond, FCD
    October 19, 2006

    I can see Chris Mooney’s next book now: The Royal family’s War on Science

  15. #15 Mustafa Mond, FCD
    October 19, 2006
  16. #16 Theo Bromine
    October 19, 2006

    here’s another throwaway line: if homeopathy had any point to it, the surest cure for a migraine would be to throw an aspirin in the ocean, and then start drinking from the other shore.

    Actually, according to my understanding of the (pseudo)science of homeopathy, “like cures like”, so you need to throw a migraine causing agent in the ocean (perhaps some red wine and/or chocolate) and before you proceed to the other shore.

    My favourite is the one about the homeopath who nearly died of a massive underdose.

  17. #17 tim gueguen
    October 19, 2006

    You’d think people would be more cautious about making appeals to ancient traditions. After all in many cultures it was an ancient tradition that slavery was acceptable, to name just one example of a practice most people in the industrialised world have rejected.

  18. #18 jre
    October 19, 2006

    A while back, I exchanged e-mails[1] with Brigitte Mars, the host of Boulder’s local radio program Naturally. I had suggested that users of the homeopathic remedy Oscillococcinum should consider rubbing a goose’s belly, but avoid waving the medicine bottle in the direction of France, to avoid danger of overdose.

    Later, prompted by a comment from Skeptico, I made an attempt to codify the scale of dosage.

    [1] Ms. Mars’ reply was, in its entirety, “Many Blessings, Jim!” Still don’t know quite what to make of that.

  19. #19 Coin
    October 19, 2006

    From the Holmes piece:

    Such was the state of opinion when Hahnemann came forward with the proposition that all the cases of successful treatment found in the works of all preceding medical writers were to be ascribed solely to the operation of the Homeopathic principle, which had effected the cure, although without the physician’s knowledge that this was the real secret. And strange as it may seem he was enabled to give such a degree of plausibility to this assertion, that any Person not acquainted somewhat with medical literature, not quite familiar, I should rather say, with the relative value of medical evidence, according to the Sources whence it is derived, would be almost frightened into the belief, at seeing the pages upon pages of Latin names he has summoned as his witnesses.

    It is stated by Dr. Leo-Wolf, that Professor Joerg, of Leipsic, has proved many of Hahnemann’s quotations from old authors to be adulterate and false. What particular instances he has pointed out I have no means of learning. And it is probably wholly impossible on this side of the Atlantic, and even in most of the public libraries of Europe, to find anything more than a small fraction of the innumerable obscure publications which the neglect of grocers and trunk-makers has spared to be ransacked by the all-devouring genius of Homeopathy. I have endeavored to verify such passages as my own library afforded me the means of doing. For some I have looked in vain, for want, as I am willing to believe, of more exact references. But this I am able to affirm, that, out of the very small number which I have been able to trace back to their original authors, I have found two to be wrongly quoted, one of them being a gross misrepresentation.

    Even if every word he had pretended to take from his old authorities were to be found in them, even if the authority of every one of these authors were beyond question, the looseness with which they are used to prove whatever Hahnemann chooses is beyond the bounds of credibility.

    Holy crap, it’s a circa 1842 description of how quote mining works.

  20. #20 Steve Watson
    October 19, 2006

    I’m a (Canadian) monarchist-by-default, by which I mean I’m not stuck on the tradition, and couldn’t give a rodent’s rectum about the Royal Family, but simply observe that as a political institution it seems to be working adequately, and there are lots of worse ways to choose a Head of State (like the one our neighbours to the south use, judging by the results).

    However, in view of the Heir Apparent’s penchant for nonsense like this, I may have to reconsider even my lukewarm endorsement. I would prefer my future King to be (to steal a phrase from Douglas Adams) “mostly harmless”, and prominent woo-boosters are not.

  21. #21 Justin Moretti
    October 19, 2006

    >>>Oh, and Hogwarts exists in a (fictional) universe where “magic” is both testable and reproducible.<<<

    And in which improvements in technique are discovered, documented and verified on testing by an impartial observer.

    “Any sufficiently advanced science is indistinguishable from magic.” Arthur C. Clarke

  22. #22 sparc
    October 20, 2006

    Unfortunately, comparable rubbish is also found in cosmetics adverts (e.g. anti aging products of Beiersdorf and Lancome) which claim that such products directly interfere with DNA repair. If they did, they could not be sold as cosmetic products but had to be treated as pharmaceuticals (at least in Europe). Indeed, manufacturere have to make sure that the ingredients do not cross the cornified layers of the skin.

  23. #23 Peter Barber
    October 20, 2006

    Gerald Weissmann writes:

    A therapeutic regimen unchanged since the Age of Mesmer, is making a comeback in the Age of Oprah.

    And is being championed by an institution from the age of William the Conqueror. Prince Charles advocates sensible things like sustainable agriculture and town planning for cohesive and happy communities – and then he ruins his credibility by talking about homoeopathy, coffee enemas and the like. I feel more and more strongly that the Royal Family is an anachronism.

  24. #24 TheProbe
    October 20, 2006

    As you probably recall, I have always strongly admired Justice OWH, Jr., and have been an afficianado of the poetry of OWH, Sr.

    Now I am in love.

  25. #25 Old Ari
    October 21, 2006

    I have heard that Queen Vic was a homeopsycopathic, and that Prince Albert would not have died when he did if he had had proper medical treatment

  26. #26 James
    October 21, 2006

    His Highness’s fondness for town planning, sustainable agriculture and homeopathy all come rom the same place – a love of the archaic. He wants people to live in 19th century villages and practice 19th century agriculture and 19th century medicine.

    As a New Zealander Charles will be my King too one day (and the Queen / King of England is New Zealand’s head of state as well), and while I am a fan of the monarchy as it exists (I think having an apolitical head of state is a good idea), but I don’t think Charles will be as good in the role as his mother is.

  27. #27 trissss@gmail.com
    August 9, 2007

    I’m quite a cartesian person, and while I don’t ‘believe’ in homeopathy, a remedy I took by mistake solved my allergy problem in one week, where conventional medicine had failed for 15 years. Now I don’t care about how it works, it couldn’t make it work better in my case.

  28. #28 stephen
    August 9, 2007

    I realize that most of you are very much against homeopathy and I certainly understand the skepticism. I am also skeptical of this practice but try and keep my mind open. I do think that this work (http://www.biomedcentral.com/1472-6882/5/12) may shed some light on the apparent lack of scientific studies showing the merits of this type of alternative medicine. My personal feeling is that it has always been difficult to gain acceptance for hypotheses that do not fit well with the general state of understanding. So therefore I believe we scientists should try and stay as objective as possible and withhold judgment on these topics for as long as possible in the event that this is just one more example of a slow change in understanding of the medical establishment.

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