Respectful Insolence

Remind me to mark April 10 down on my calendar. I never realized it was such an important day, and, in any case, I wouldn’t want to miss it. Nor should the rest of the skeptical blogosphere. Why? It’s World Homeopathy Day, “celebrated” (or, if you’re a fan of evidence-based medicine, as I am, lamented) in “honor” of Samuel Hahnemann, the originator of homeopathy, who was born on April 10, 1755.

Oh, joy. (On the other hand, I’m sure I can think of some sort of blog fun to have next April 10.)

Homeopathy, as you may recall, is the “alternative” medical therapy in which, it is postulated, a therapeutic compound diluted to the point where chemistry would dictate that there is not a single molecule of the substance left, actually becomes more potent. Reasons put forth as an explanation for this alleged effect, which, if real, would contravene the laws of chemistry, physics, and biology, range from the claim that water somehow retains the “memory” of compounds that have been diluted in it to fallacious invocation of quantum effects, the all-purpose explanation woos like to use when their particular brand of woo clearly conflicts with the laws of nature, as homeopathy does. Moreover, according to the homeopathic “law of similars,” the substance chosen to be diluted should, in non-homeopathic doses, produce an effect similar to what the disease is producing.

It’s all bunk, of course, and no good randomized controlled trials show homeopathy to be any better than placebo, yet this woo persists. Naturally, homeopaths realize that science isn’t supporting it. Consequently, they like to make excuses, and here’s a great example. First, the article acknowledges the problems with homeopathy:

Homeopathic remedies are believed to be no better than a placebo, according to several articles in medicals journals and publications. In fact, the Lancet, which in 1997 extolled the virtues of homeopathy, has published a piece to the contrary in an August 2005 issue, although based on a small study.

Critics say that the system based on the principle of Similia Similibus Currentur, meaning `like is cured by like’, does not convincingly explain how the medicines work. Further, there have been no modern scientific testing or double blind studies to prove the efficacy of the drugs; only “provings” since Hahnemann’s time which, the critics say, do not really hold water.

Sceptics also question the rationale of “constitutional remedies” which entail labelling an individual as belonging to a specific constitution type corresponding to a certain drug, as for instance an Ignatia, Pulsatilla, Nux Vomica, etc which, in turn, are related to the temperament of the individual. Non-believers also scoff at the potency of the drugs vis-à-vis the Avogadro’s number. According to this law of chemistry, there is a limit to which a substance can be diluted while retaining its original properties. However, most homeopathic drugs are used in dilutions beyond this limit, making it “substance-less.”

That’s actually a pretty good criticism of why homeopathy is utter bunk. Too bad the writer didn’t stop there. On the other hand, his letting the homeopaths try to justify their woo brings out the magical thinking behind homeopathy:

So, how do homeopathy practitioners respond to such criticism? According to Dr Kumaresan and Dr Kanakaraj of Sugam Homeopathy Clinic in Chennai, any material can be converted into energy form by potentisation or dynamisation — a method unique to homeopathy. This energy remains stable only in alcohol or sugar base and the medicines thus stored in the form of energy do not have an expiry date. The potency of various drugs is obtained by dilution, which involves vigorous shaking if the medicine is in liquid form, through a process called succussion, or by finely grinding or pulverising if the drug is insoluble.

Dr Britto Wilbert Das of Roch Homeo Clinic concurs, saying that it is quality and not quantity that is important in homeopathy where a spark of energy is all that is needed to trigger the body’s immune system to act and effect a cure. The greater the succussion, the better the drug quality — its purity and power being enhanced. And any toxicity it may contain is simultaneously removed.

Of course! How could I have been so blind? It’s so obvious. The homeopathic medicines are converted to “energy” that can only remain stable in the alcohol or or sugar base that homeopaths use to dilute it. And they strengthen the immune system and remove toxins, too. Is there anything they can’t do? Of course, these are claims that should be testable scientifically. Or maybe not, at least not according to the homeopaths:

While conceding that double-blind studies of homeo drugs were under way in some places, Dr Das and Dr B. Anantaraman of Arudhra Homeo Clinic, Chennai, however say that such a study is ideally not possible.

Allopathic cure is based on objective symptoms unlike homeopathy, which uses both objective and subjective symptoms as felt by the patient. While allopathy has a specific drug for a specific disease condition, a single homeo drug may be used for varying conditions and also several drugs may be used for a single condition.

Individualisation is the cornerstone of homeopathy treatment. No two people with the same or similar conditions need be given identical drugs or in identical potency. In fact they may require entirely different sets of drugs based on the totality of symptoms. Hence, a double-blind study may not be possible to prove the efficacy of homeo drugs.

How convenient. How clever of them to try to make a distinction between “subjective” and “objective” symptoms. Symptoms are what the patient tells you he is feeling, what’s bothering him. Pain is a symptom. Coughing is a symptom. Some symptoms can be “objectively measured” (coughing, fast breathing, frequency of urination, etc.), but many are almost entirely subjective, pain being the most common example. Conventional medicine tries to treat both whenever possible, contrary to what the article above says. Indeed, morphine is a perfectly good drug for treating the subjective symptom of pain. So are nonsteroidal antinflammatory drugs (NSAIDs) for lesser degrees of pain–and NSAIDS also objectively decrease inflammation by a molecular mechanism that can be objectively measured. Second, the homeopaths are conveniently building right into the definition of their woo an excuse for when scientific testing fails to demonstrate any objective signs of efficacy. That’s right; if you believe the homeopaths, homeopathy is too complex to subject to double-blind, placebo-controlled trials, you see, because no two patients get exactly the same drugs at exactly the same homeopathic “potency.” Of course, it can be said for many diseases treated with conventional medicine that “a single drug may be used for varying conditions and also several drugs may be used for a single condition.” Cancer is a great example of this, where most cancers present oncologists with a choice of different chemotherapy regimens with different potencies and different side effect profiles. Certain chemotherapeutic drugs can be used for multiple tumors, and nearly all cancers are treated with more than one chemotherapy agent. Yet, we poor “allopaths” somehow manage to test our treatments in randomized studies and show them to be superior to placebo.

I wonder why homeopaths can’t do the same. Naturally, they have another layer of excuses:

More often than not, patients approach homeopathy when all other systems have failed, when their bodies have been treated to a host of drugs, thus masking their true, original condition. This compounds the task for homeopathic doctors, necessitating them to “tear down and rebuild from a state of chaos”. Needless to say, the system is often faulted for being slow or even ineffective!

Or perhaps the system is faulted for being ineffective because it is ineffective.

And what do these homeopaths offer as “evidence” of the efficacy of homeopathy? If you’ve been around this blog for a while, I suspect that you know the answer to this one. Yes, indeed, it’s anecdote time:

Dr Kumaresan and Dr Kanakaraj cite some of their successes in treating difficult conditions. One of their patients, 80-year-old M. Swamy was a diabetic and afflicted with Coronary Artery Disease (CAD).

With over 90 per cent multiple blocks in the blood vessels of his heart he was advised by-pass surgery, which he could not undergo owing to low blood pressure. Doctors gave him a few days of life; that’s when he decided to take the plunge anyway and try homeopathy. Thanks to the treatment, he says, he is much better and living well.

Parvati conceived thrice and had miscarriages each time. The reason for repeated miscarriages was loss of foetal fluid. She also tried artificial insemination, in vain. With four months of homeo treatment, Parvathi conceived and delivered a healthy baby girl in 2005.

And, of course, they claim with no evidence that homeopathy is great for curing or palliating a number of diseases, including AIDS, cancer, and heart disease.

This article does bring up a question that I’ve always wondered about, though. In attempting to conduct a clinical trial of a homeopathic remedy, what, exactly, does an investigator use as a placebo? After all, think of the logistical difficulties involved. What if a molecule of the active ingredient came in contact with the placebo somehow? In the homeopath’s world, the placebo might then be contaminated and have become an active treatment. Placebos and medications might have to be stored at a great distance from each other, to prevent the diffusion of even a molecule of the homeopathic remedy into the placebo. In either case, such a “contamination” could, a homeopath could argue, tend to decrease any treatment “effects” observed. Of course, to homeopaths, it isn’t just the substance, but it’s the preparation, the “succusation”; but, even so, given the ridiculousness of the basic concept behind homeopathy, the task of coming up with a suitable placebo control for clinical trials that will convince the homeopaths is not trivial.

So how about I throw this one open to everyone: What would be a good placebo to use as a control in randomized, double-blind trials of homeopathy that would fit in with the whole system of homeopathy?

This could be fun.

Comments

  1. #1 G. Shelley
    November 28, 2006

    Individualisation is the cornerstone of homeopathy treatment. No two people with the same or similar conditions need be given identical drugs or in identical potency. In fact they may require entirely different sets of drugs based on the totality of symptoms. Hence, a double-blind study may not be possible to prove the efficacy of homeo drugs.

    Even if this were true, I don’t see why it would prevent double blind trials. If each patient in the trial sees the homeopath and is prescribed a set of drugs on an individual basis, it would be which patients actually receive this and which receive the placebo that is blinded.
    I know I am not the first to suggest this

  2. #2 luna_the_cat
    November 28, 2006

    This is not so much a suggestion as it is a thoroughly depressing add-on. You know how you’ve had run-ins in the past with legitimate medical practitioners defending woo?

    Alas, the UK is no better.

    From http://www.abdn.ac.uk/mediareleases/release.php?id=788
    “Sixty per cent of doctors’ surgeries in Scotland prescribe homeopathic or herbal remedies, according to a study of nearly two million patients, published in the December issue of the British Journal of Clinical Pharmacology.

    Five per cent of the practices included in the study prescribed 50 per cent of the remedies and accounted for 46 per cent of the patients receiving them.

    • 4160 patients (2.2 per 1000 registered patients) were prescribed at least one homeopathic remedy during the study period. 73 per cent were female and the average age of patients was 47. …”

    Homeopathic and herbal prescribing in general practice in Scotland. Ross S, Simpson C R and McLay J S. British Journal of Clinical Pharmacology.
    Volume 62.6. Pages 647 to 652. (December 2006).

    Yeeeesh.

  3. #3 Simon
    November 28, 2006

    I’m still wanting to know if I can build a terrible biological weapon using my bathtub and diluting an antibiotic down in it.

  4. #4 Prup aka Jim Benton
    November 28, 2006

    I can’t verify this, but my wife’s psychotherapist, who is Russian and claims to have been a doctor in Russia, also has said that homeopathy is a standard part of the medical training there.
    It’s also worth noting that one of the major hospitals in Philadelphia is named after Hahnemann, though I believe they no longer practice his quackery.

    Prup, M.S.P.B.M
    (Melancholy Spectaror of the Psychic Bellyache of Mankind — and a tip of the hat to whoever recognizes the source)

  5. #5 anonimouse
    November 28, 2006

    That post made my head hurt.

    I hate homeopathy. At least with the mercury loons and the kooky Hoxsey freaks, there’s at least some vague semblance of an attempt to be scientific – no matter how stupid it may be.

    Homeopathy is ridiculous and improbable.

  6. #6 Ginger Yellow
    November 28, 2006

    Luna – it’s probably worse in the UK. Middle England loves its alternative medicine. It’s even funded on the NHS.

    I particularly like the way the “energy” is only “stable” in alcohol or sugar. How exactly is that supposed to work?

  7. #7 outeast
    November 28, 2006

    Luna_the_cat, the conflation of homeopathic and herbal remedies there could be a problem. While homeopathic remedies are pure bunk, herbs are just plants and can (in many cases do) have pharmacological effects.

    If my doctor prescribed some homeopathic remedy, I’d walk out like a shot. Our paediatrician, though, prescribed a medication derived primarily from fennel (ie a herbal remedy) for our son’s colic; while I’m unsure it’s been making any difference, I wouldn’t fault her for prescribing it – there have been a few studies (see PubMed) suggesting it can be effective (ie better than placebo, ie notwoo).

  8. #8 JP
    November 28, 2006

    Since homeopathic treatments are just placebos, shouldn’t the control in a double blind trial of homeopathy be real medicine cleverly disguised as a placebo?

  9. #9 Alex
    November 28, 2006

    Clearly, as the potency increases with the dilution, the ideal placebo would be the pure active ingredient.

    I suspect that for, say, arsenic this would indeed show significantly better results with the homeopathic dilution than with the placebo.

  10. #10 Joshua
    November 28, 2006

    What would be a good placebo to use as a control in randomized, double-blind trials of homeopathy that would fit in with the whole system of homeopathy?

    Obviously, a 100% pure sample of whatever they put into the dilution!

  11. #11 Joshua
    November 28, 2006

    Curses! Alex beat me to the punch. ;)

  12. #12 Alex
    November 28, 2006

    I’ll leave it to you to speculate on how you’d get the arsenic experiment past the ethics committee..

  13. #13 Joe
    November 28, 2006

    I read a book by a homeoquack. He said that, when homeo seems to fail it is because he has not made a correct diagnosis/prescription. He *defined* his quackery as effective.

    A homeopathic placebo? Perhaps, serially diluted and succussed water. Unless, that is a homeopathic remedy, too (for drowning).

  14. #14 KeithB
    November 28, 2006

    “In fact, the Lancet, which in 1997 extolled the virtues of homeopathy,”

    Why do I have trouble believing this? Does anyone know what the Lancet said in 1997?

    I would bet it was, “While there are obviously no side-effects from Homeopathy….”

  15. #15 Narc
    November 28, 2006

    Couldn’t you just pass the homeopathic treatment through a third party? The patient then gets the same individualization as before, but the third party either does or does not replace the homeopathic remedy with plain water.

    Not *tap* water, mind you. With the trace levels of lead and arsenic present in that, it could be instantly fatal.

  16. #16 asdfjkl qwerty
    November 28, 2006

    Where do the homeopaths get the water they use to dilute their active ingredients, and how do they remove all traces of whatever else has been diluted in it over the last million years or so? Or do they produce their own, from H2 and O2?

    I suspect that much of our water supply has passed through the kidneys of various animals at one time or another, so the disciples of Hahnemann may be dosing their patients with whale piss as much as anything else.

  17. #17 Icequeen
    November 28, 2006

    Unfortunately, my family doctor is a homeopath, and I can’t switch with the way the system is set up.

    When my daughter was suffering from eczema, he gave me a perscription for some weak hormone cream, and something noted as “calcium carb.”

    “Calcium carbonate? You’re perscribing my daughter chalk?”

    He got all huffy and mentioned it was calcium carbonicum (google tells me this is.. calcium carbonate)

    The pharmacy didn’t even want to fill in the perscription.

    A couple of days later I returned because the situation had worsened (she was drawing blood from the scratching) and I would like to see an actual dermatologist (silly I know). He initially declined to transfer me because the worsening was an initial effect of the calcium.

    He’s a shit doctor without the woo but this makes it so much harder to get shit done.

  18. #18 Sastra
    November 28, 2006

    So how about I throw this one open to everyone: What would be a good placebo to use as a control in randomized, double-blind trials of homeopathy that would fit in with the whole system of homeopathy?

    Ah, but this request contains the seeds of its own destruction, because you asked for a placebo which “would fit in with the whole system of homeopathy.” And the whole system of homeopathy is based on a kind of magical thinking which sees human intentions and needs as active participants in the process.

    How does the water KNOW which one of many millions of substances it once came into contact with it’s supposed to “remember?” Through the connecting force of spirit which is found in all matter. Our conscious intentions effect physical forms by will alone. The shaking part of ‘potentisation’ is not valuable because it mixes or jostles anything on the physical level: it is a ritual which establishes a correspondence between need and remedy.

    So finding a proper placebo is simple. The actual composition of the control is unimportant. Did a homeopath look at it and WISH that it wasn’t a placebo? Well, then, there you go.

  19. #19 Berlie
    November 28, 2006

    Between whale piss, and a homeopath’s wishes, I’m rolling here. My coworkers are looking at me funny.

  20. #20 s_hohum
    November 28, 2006

    Since homeopathy uses this nonsense called “Similia Similibus Currentur”, the obvious thing to use as a contrast is something that has the opposite effect. For example, for a fever one could use aspirin diluted in exactly the same way as whatever fever inducer a homeopath would use. From any rational perspective, both are placebos, of course.

  21. #21 Badger3k
    November 28, 2006

    I didn’t know that homeopathic remedies worked with alchohol. Now I can say I’m not getting drunk – I’m practicing homeopathy!

  22. #22 Kristjan Wager
    November 28, 2006

    >I didn’t know that homeopathic remedies worked with alchohol. Now I can say I’m not getting drunk – I’m practicing homeopathy!

    Only if it’s diluted alcohol.

  23. #23 Infophile
    November 28, 2006

    Icequeen: Is getting another doctor not possible? With circumstances like that, I’d recommend changing if at all possible. If changing isn’t possible, then just stop going to him (minimal treatment from a homeopath should give maximum effect after all :P).

    Failing all that, sue him for malpractice. (This is assuming he’s an MD who’s gone wacko. If he’s uncertified, there’s not much you can do that skeptics aren’t already trying to do.)

  24. #24 luna_the_cat
    November 28, 2006

    outeast: The study I quoted actually did note the difference quite explicitly between homeopathic and herbal remedies. They pointed out that the problem with herbal remedies was the fact that the doctors are actually dosing people with (in many cases) genuinely bioactive substances with unknown reaction profiles, and that most of the people receiving them are also on conventional medications as well. They are setting their patients up for uncharted drug reactions, in other words. When it comes to things like St. Johns Wort and Evening Primrose, we already *know* that those drug interactions can be serious, too.

    Homeopathy, they explicitly noted, is different, because there, drug interactions are extremely unlikely (no kidding!), but essentially they are just spending NHS money on something with no evidence of efficacy at all.

    The problem was also noted that many of the recipients of “alternate” therapies were children under 16. I believe the criticism is that for kids we should probably be sticking to proven therapy. And the failure in both cases, which I believe can legitimately be conflated, is the failure to stick to evidence-based medicine.

    Speaking for myself, I’m furious that NHS money gets spent on non-evidence-based “medicine”, when the local hospitals are having to cut staff and deny people cancer drugs. It really steams me that they fund woo and run out of money for the real stuff.

    Speaking of which, Ginger Yellow: tell me about it; I live near Aberdeen, and I’m a supporting member of Sense About Science. (Orac, you should swap stories with these people.) I still have family in the US, though, and to be honest, I think it’s equally bad there, if not slightly worse.

  25. #25 Robster
    November 28, 2006

    Kristjan,
    I think I’ll be having a martini tonight. Gin has all kinds of plant flavorings in it (Juniper is the one that gives the main flavor and name). So a bottle of fine gin will not only give me a buzz but treat arthritis and preventative against liver problems! Utter BS.

  26. #26 luna_the_cat
    November 28, 2006

    Robster: make sure you have your martini shaken, not stirred. It bruises the gin, sure, but it increases the antioxidant activity! (Really; and this one has evidence, too: http://www.bmj.com/cgi/content/full/319/7225/1600 )

  27. #27 Koray
    November 28, 2006

    See, you don’t understand. Once you try to analyze it, homeopathy stops working promptly. Your frontal cortex waves act as antimatter to the energy contained in the solution. Here, let me give you another anecdote to make you feel better, you unique as a snowflake, special patient…

  28. #28 Joe
    November 28, 2006

    @Infophile,

    Would you recommend a chiropractor?
    http://infophilia.blogspot.com/2006_09_01_infophilia_archive.html
    “Wait, did I just say “Good” Chiropractors? Yes, I actually did.”

  29. #29 llewelly
    November 28, 2006

    I particularly like the way the “energy” is only “stable” in alcohol or sugar. How exactly is that supposed to work?

    You can feel it! Drink 10 ounces of ethyl alcohol, and in about 45 minutes, you will feel your energies stabilizing.

  30. #30 llewelly
    November 28, 2006

    wait! I take back that 10 ounces – that’s an awful lot of alchohol – about 25 shots of hard liquor.

  31. #31 Old hippy
    November 28, 2006

    Placebos have very significant effects and can be very helpful.
    In the beginning it was I believe chalk pills
    “Calcium carbonate? You’re perscribing my daughter chalk?”
    The problem is although we know placebo has a significant positive effect for many things and in many cases there is no legal or ethical way to prescribe it any more. This may in part result in the popularity of homeopathy medicines, which many practicioners may think of as nothing more than a palcebo they can get away with.

  32. #32 Adam Cuerden
    November 28, 2006

    This is taking it far too seriously, but:

    1. Get a group of homeopaths.
    2. Let them prescribe whatever homeopathic medicines they want to a set of patients.
    3. Double-blinding the medicine cupboards, give some of the patients the sugar pill prescribed, others a… er… sugar pill.
    4. Let them talk their way out of that one!

  33. #33 Bronze Dog
    November 28, 2006

    Something else homeopaths can try, commonly suggested by Randi: See if they can tell the difference between a sugar pill and a sugar pill under double-blind conditions.

  34. #34 Chris Noble
    November 28, 2006

    The greater the succussion, the better the drug quality — its purity and power being enhanced. And any toxicity it may contain is simultaneously removed.

    If this is true why don’t they use succussion directly as a form of detoxification?

    However, I suspect that that having the crap beaten out of you with a large leather bound bible would be that popular.

  35. #35 pkiwi
    November 28, 2006

    I work next to a homeopathic “clinic”. There are lovely, earnest, ex-hippy types running it. They are now into “airnergy” – a form or woo that has you breathing in humid air (ok, according to them it has been “energised” to a singlet oxygen state or something).

    I have been thinking of an appropriate placebo for this similarly untrialled woo. Given the above, maybe it should be tested against providing air without any oxygen? That might show some effect.

  36. #36 James
    November 28, 2006

    Just a thought, but shouldn’t they hold Wold Homeopathy Day on April 1st, not the 10th?

  37. #37 Porlock Junior
    November 29, 2006

    That remark about Lancet endorsing homeopathy in 1997 — that couldn’t be a confusion with the infamous paper in Nature by Benveniste, could it?

    BTW: Joe’s homeopathic remedy for drowning — I am awestruck by this elegantly simple idea.

    This thread is so incisive that it has inspired me to solve one of Hilbert’s problems. It’s not in his standard 1900 list, having taken some more years to work out, but it’s rather famous:
    “If one were to bring ten of the wisest men in the world together and ask them what was the most stupid thing in existence, they would not be able to discover anything so stupid as astrology.”

    I say, Homeopathy.

    Do I get the IgNobel prize now?

  38. #38 Christophe Thill
    November 29, 2006

    So, in making a homeopathic remedy, matter is transformed into energy? Shouldn’t there be some kind of big explosion?

    OK, now it’s quiz time.
    What homeopathic remedy would you recommend:
    – against water retention?
    – as a female contraceptive?
    – against bulimia?
    – for a bruise caused by hitting your head with a hammer?
    – for a hangover?

  39. #39 axon
    November 29, 2006

    “Individualisation is the cornerstone of homeopathy treatment. No two people with the same or similar conditions need be given identical drugs or in identical potency. In fact they may require entirely different sets of drugs based on the totality of symptoms.”
    So how does the homeopath decide which treatments to use if he has no data that takes into account the placebo affect and natural regression back to health for minor ailments?

  40. #40 Greco
    November 29, 2006

    What homeopathic remedy would you recommend:
    – for a hangover?

    Avoid hangovers: keep yourself drunk.

  41. #41 bob koepp
    November 29, 2006

    Placebo? Let homeopaths pick whatever they want as a placebo, so long as they can present evidence (even of the anecdotal variety) that it doesn’t influence the dependent variable of interest. Then let the testing begin.

  42. #42 trrll
    November 29, 2006

    What homeopathic remedy would you recommend: – for a hangover?

    Hair of the dog what bit you!
    0.0000000000000000000000000000000000000001 proof
    (shaken, not stirred)

  43. #43 BrendanH
    November 30, 2006

    Old Hippy may be on to something — there is a place for placebo in medical practice (“take two aspirin and call me back if it doesn’t improve” at the milder end) but the problem with delivery of placebo is that it needs to be double blind — practitioner and patient need to believe in it. Homeopathy is absolutely excellent at this, and could almost be said to have evolved to serve an important function, namely the treatment of minor but treatment-resistent ailments whose biggest downside is the anxiety they cause. Isn’t there some traditional physicians’ mission statement to the effect of “to cure, whenever possible; to comfort, always”?

    The only problem, of course, is how to make sure it never impedes the more conventional “intelligently-designed” treatments.

  44. #44 trrll
    November 30, 2006

    Old Hippy may be on to something — there is a place for placebo in medical practice (“take two aspirin and call me back if it doesn’t improve” at the milder end) but the problem with delivery of placebo is that it needs to be double blind — practitioner and patient need to believe in it.

    This isn’t really true. Double blind protocols control for a variety of sources of error, of which unconscious communication of expectations to the subject is probably fairly minor. They are probably more important in terms of controlling for unconscious bias in data analysis, such as double-checking results that don’t match expectation, but failing to double-check results that do.

    In fact, many of the original experiments that indicated that placebo effects could be large were not done double-blind–the experimenters lied through their teeth. I can’t help wondering if one of the reasons why placebo effects seem less prominent in modern studies is the evolution of ethical standards. Today, it would be considered unethical to enroll a subject in such a study without informing him of the possibility that he might be given a placebo.

    So the modern physician is faced with a dilemma. In some cases, the safest, most effective treatment may indeed be a placebo, but it is no longer considered ethical for a physician to lie to a patient. But a physician can give a patient a prescription for a homeopathic preparation and say in perfect honesty, “You might give this a try. Nobody really understands how it works, but some people find that it helps.” And at least with genuine highly-diluted homeopathic remedies (as opposed to “nutritional supplements”) the physician doesn’t have to worry that the medication will actually harm the patient.

  45. #45 Steve
    December 1, 2006

    As i understand it homeopathy developed from the like cures like hypothesis. The dilution bit came second because actually arsenic etc is poisonous so you have to dilute it. Any success it had was probably due to it being less harmful than the current state of medicine at the time – its hard to harm someone giving them a sip of water.

    Homeopaths have their schizms too, accuse one of not being true to Hahnemanns methods.

    Other interesting points include if patients get worse then its an “aggravation” caused by the homeopathy remedy and a sign that the wrong remedy was used, if they get better its a success. It is all self reinforcing. They keep trying till something “works”.If patient don’t come back, its because he was cured! I personally think the mechanism here is regression to the mean or something similar!
    Don’t get me started on provings……..

  46. #46 Alan
    December 2, 2006

    In honor of World Homeopathy Day you should have a completely empty blog post or, better yet, a completely blank page. By diluting the content, you see, you make the web page even more useful and effective. Homeopathic theory tells us that a completely blank page will be the most informative.

  47. #47 dorkafork
    December 2, 2006

    The abstract for 1997 Lancet study is here.

    INTERPRETATION: The results of our meta-analysis are not compatible with the hypothesis that the clinical effects of homeopathy are completely due to placebo. However, we found insufficient evidence from these studies that homeopathy is clearly efficacious for any single clinical condition. Further research on homeopathy is warranted provided it is rigorous and systematic.

    Looks like the further research was rigorous and systematic, because in 2005 the Lancet apparently published several pieces that threw cold water on homeopathy. (Like this one.)

  48. #48 BrendanH
    December 2, 2006

    I think of there being three levels to a placebo effect, only the last of which really matters in RCT contexts.

    1: Action removes the anxiety related to not doing something about a problem, independently of subjective or objective improvement.

    2: Taking something makes you think you’re better (subtle difference from 1) even though objectively you are not.

    3: Taking something you believe to be effective makes you objectively better via unspecified psychosomatic means.

    For minor untreatable ailments, effects 1 and 2 are tangible benefits. I take trlll’s point that effect 3 is rarely authenticated.

  49. #49 NaturallyCheap
    December 17, 2006

    Next April 10th, you should post the recipe I spent this afternoon coming up with. I did of poking around to discover that one of the more common homeopathic remedies is Nat Mur 30C (also called other variations of natural sea stuff). So here is the detailed recipe (feel free to pass it around):

    1) Take ½ teaspoon of sea salt and dissolve into 1 cup of distilled water in a bottle.

    2) Shake well.

    3) This is a 1C solution (ratio 1/100).

    4) Take ½ teaspoon of the 1C solution and put it a bottle with 1 cup of distilled water, throw out the 1C solution.

    5) Shake well.

    6) This is a 2C solution (ratio 1/10000).

    7) Take ½ teaspoon of the 2C solution and put it a bottle with 1 cup of distilled water, throw out the 2C solution.

    8) Shake well.

    9) This is a 3C solution (1/1000000).

    10) Take ½ teaspoon of the 3C solution and put it a bottle with 1 cup of distilled water, throw out the 3C solution.

    11) Shake well.

    12) This is a 4C solution (1/100000000).

    13) Take ½ teaspoon of the 4C solution and put it a bottle with 1 cup of distilled water, throw out the 4C solution.

    14) Shake well.

    15) This is a 5C solution (1/10000000000).

    16) Take ½ teaspoon of the 5C solution and put it a bottle with 1 cup of distilled water, throw out the 5C solution.

    17) Shake well.

    18) This is a 6C solution (1/1000000000000).

    19) Take ½ teaspoon of the 6C solution and put it a bottle with 1 cup of distilled water, throw out the 6C solution.

    20) Shake well.

    21) This is a 7C solution (1/100000000000000).

    22) Take ½ teaspoon of the 7C solution and put it a bottle with 1 cup of distilled water, throw out the 7C solution.

    23) Shake well.

    24) This is an 8C solution (1/10000000000000000).

    25) Take ½ teaspoon of the 8C solution and put it a bottle with 1 cup of distilled water, throw out the 8C solution.

    26) Shake well.

    27) This is a 9C solution (1/1000000000000000000).

    28) Take ½ teaspoon of the 9C solution and put it a bottle with 1 cup of distilled water, throw out the 9C solution.

    29) Shake well.

    30) This is a 10C solution (1/100000000000000000000).

    31) Take ½ teaspoon of the 10C solution and put it a bottle with 1 cup of distilled water, throw out the 10C solution.

    32) Shake well.

    33) This is a 11C solution (1/10000000000000000000000).

    34) Take ½ teaspoon of the 11C solution and put it a bottle with 1 cup of distilled water, throw out the 11C solution.

    35) Shake well.

    36) This is a 12C solution (ratio 1/1000000000000000000000000).

    37) Take ½ teaspoon of the 12C solution and put it a bottle with 1 cup of distilled water, throw out the 12C solution.

    38) Shake well.

    39) This is a 13C solution (1/100000000000000000000000000).

    40) Take ½ teaspoon of the 13C solution and put it a bottle with 1 cup of distilled water, throw out the 13C solution.

    41) Shake well.

    42) This is a 14C solution (1/10000000000000000000000000000).

    43) Take ½ teaspoon of the 14C solution and put it a bottle with 1 cup of distilled water, throw out the 14C solution.

    44) Shake well.

    45) This is a 15C solution (1/1000000000000000000000000000000).

    46) Take ½ teaspoon of the 15C solution and put it a bottle with 1 cup of distilled water, throw out the 15C solution.

    47) Shake well.

    48) This is a 16C solution (1/100000000000000000000000000000000).

    49) Take ½ teaspoon of the 16C solution and put it a bottle with 1 cup of distilled water, throw out the 16C solution.

    50) Shake well.

    51) This is a 17C solution (1/10000000000000000000000000000000000).

    52) Take ½ teaspoon of the 17C solution and put it a bottle with 1 cup of distilled water, throw out the 17C solution.

    53) Shake well.

    54) This is an 18C solution (1/1000000000000000000000000000000000000).

    55) Take ½ teaspoon of the 18C solution and put it a bottle with 1 cup of distilled water, throw out the 18C solution.

    56) Shake well.

    57) This is a1 9C solution (1/100000000000000000000000000000000000000).

    58) Take ½ teaspoon of the 19C solution and put it a bottle with 1 cup of distilled water, throw out the 19C solution.

    59) Shake well.

    60) This is a 20C solution (1/10000000000000000000000000000000000000000).

    61) Take ½ teaspoon of the 20C solution and put it a bottle with 1 cup of distilled water, throw out the 20C solution.

    62) Shake well.

    63) This is a 21C solution (1/1000000000000000000000000000000000000000000).

    64) Take ½ teaspoon of the 21C solution and put it a bottle with 1 cup of distilled water, throw out the 21C solution.

    65) Shake well.

    66) This is a 22C solution (ratio
    1/100000000000000000000000000000000000000000000).

    67) Take ½ teaspoon of the 22C solution and put it a bottle with 1 cup of distilled water, throw out the 22C solution.

    68) Shake well.

    69) This is a 23C solution
    (1/10000000000000000000000000000000000000000000000).

    70) Take ½ teaspoon of the 23C solution and put it a bottle with 1 cup of distilled water, throw out the 23C solution.

    71) Shake well.

    72) This is a 24C solution
    (1/1000000000000000000000000000000000000000000000000).

    73) Take ½ teaspoon of the 24C solution and put it a bottle with 1 cup of distilled water, throw out the 24C solution.

    74) Shake well.

    75) This is a 25C solution
    (1/100000000000000000000000000000000000000000000000000).

    76) Take ½ teaspoon of the 25C solution and put it a bottle with 1 cup of distilled water, throw out the 25C solution.

    77) Shake well.

    78) This is a 26C solution
    (1/10000000000000000000000000000000000000000000000000000).

    79) Take ½ teaspoon of the 26C solution and put it a bottle with 1 cup of distilled water, throw out the 26C solution.

    80) Shake well.

    81) This is a 27C solution
    (1/1000000000000000000000000000000000000000000000000000000).

    82) Take ½ teaspoon of the 27C solution and put it a bottle with 1 cup of distilled water, throw out the 27C solution.

    83) Shake well.

    84) This is an 28C solution
    (1/100000000000000000000000000000000000000000000000000000000).

    85) Take ½ teaspoon of the 28C solution and put it a bottle with 1 cup of distilled water, throw out the 28C solution.

    86) Shake well.

    87) This is a 29C solution
    (1/10000000000000000000000000000000000000000000000000000000000).

    88) Take ½ teaspoon of the 29C solution and put it a bottle with 1 cup of distilled water, throw out the 29C solution.

    89) Shake well.

    90) This is a 30C solution
    (1/1000000000000000000000000000000000000000000000000000000000000).

    And then you are done! You can make up other remedies by knowing what the mother tincture is. For instance “Nux Vomica” (or Nux Vom) is from vomit, Nux Sulph uses sulpher, and the stuff advertised on the radio for colds, Oscillococcinum is from duck liver.

    If you have any questions about homeopathy, you would be wise to consult the http://www.badhomeopath.com .

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