Respectful Insolence

Apparently, while I’ve been at this meeting, Mayo Clinics Proceedings has published this systematic review of the scientific literature on the “efficacy” of homeopathy. Its conclusion:

The evidence from rigorous clinical trials of any type of therapeutic or preventive intervention testing homeopathy for childhood and adolescence ailments is not convincing enough for recommendations in any condition.

Actually, it would have been more accurate to say “not convincing at all.” It’s inevitably smaller, more poorly designed or non-randomized studies that purport to show treatment effects, which inevitably are shown to be no better than placebo in larger, well-designed randomized studies. And then when those studies come out homeopaths inevitably claim that randomized, double-blind studies are not an “appropriate” manner in which to study homeopathy. (It’s too “complex” and “individualized,” you know.) Meanwhile, the American Medical Student Association uncritically promotes homeopathy, among other forms of the woo-iest woo, and all this woo infiltrates American medical schools.

I tend to be with Dr. RW on this one. My reaction is a big yawn, because we knew this already. I do like the way Dr. RW describes homeopathy “research”:

Some mainstream woo-pushers, not wanting to seem totally shameless, try to give woo the trappings of evidence based medicine. Here’s the recipe: test an implausible claim and throw in a little chance variation. Combine that with a massive dose of publication bias and voilĂ !–evidence based woo!

“Evidence-based woo”? I may have to–ahem–appropriate the term for my own nefarious use.

The plain fact is that medical science knew enough to debunk homeopathy over nearly 200 years ago. Oliver Wendell Holmes, for example, used pretty much the same scientific rationale to show it for the woo it was. The only reason homeopathy seemed better than traditional medicine 200 years ago was because traditional medicine was so bad. As Arthur Allen reminded me in his book Vaccine, medicine in the late 1700′s and early 1800′s consisted of bleedings, epic sessions using purgatives, cadmium- and arsenic-laced tonics, and a variety of other demonstrably harmful “treatments.” The reason homeopathy seemed better was because it was, in essence, doing nothing; i.e., a placebo. Given how harmful some medical treatments were back then, doing nothing was often better than what doctors did, and that’s exactly what homeopathy did. The mystery is why the irrationality that is homeopathy stubbornly persists now that there are effective treatments for so many diseases.

Comments

  1. #1 Kristjan Wager
    February 9, 2007

    Orac, I think you miss one obvious point – since placebo is usually water or some other liquid, then every time placebo has been shown as effective as medicine, it has been shown that homeopathy is as effective as that medicine.

    Hmmmm…. of course, that doesn’t explain why such medicine is discarded, but it’s probably due to the fact that there is no need for two types of cures that has the same effect. Yeah, that’s it.

  2. #2 Skeptico
    February 9, 2007

    (Ducks and awaits the inevitable hordes of woo comments supporting homeopathy.)

  3. #3 anonimouse
    February 9, 2007

    The mystery is why the irrationality that is homeopathy stubbornly persists now that there are effective treatments for so many diseases.

    Because many of the treatments for those diseases come with side effects. Some of them are rather unpleasant. Since homeopathy does nothing to your body, it has no side effects other than lightening your wallet a bit and preventing one (in some cases) from pursuing a more effective treatment protocol.

    At some level, use of homeopathy is actually MORE understandable than use of, say, herbal remedies that often have pretty nasty unintended side effects and can actually interfere with beneficial drug treatments.

  4. #4 anonimouse
    February 9, 2007

    snakeflake – I was wondering where to get my stash of illegal somas, thanks.

  5. #5 Kristjan Wager
    February 9, 2007

    At some level, use of homeopathy is actually MORE understandable than use of, say, herbal remedies that often have pretty nasty unintended side effects and can actually interfere with beneficial drug treatments.

    Correct me if I am wrong, but isn’t homeopathy deluted with alcohol? Could interfere with drug treatments

  6. #6 Saint Gasoline
    February 9, 2007

    I could be wrong, but a placebo isn’t effective if the patient knows they are taking a placebo pill, right? Don’t they have to think it will work?

    If so, then have people performed any tests where patients are given homeopathic treatments that they are told are placebos? If they no longer worked, I think that’d be pretty strong evidence that homeopathy is pretty much just a placebo. Is this the sort of test they have performed? Or am I wrong in my assumption that placebos don’t work if the patient is aware that he is taking a placebo?

  7. #7 Alexandra
    February 9, 2007

    “Correct me if I am wrong, but isn’t homeopathy deluted with alcohol?”

    Is that a misspelled “diluted” or “deluded”? (Or is it just an apt homeopathy neologism?)

  8. #8 Joseph
    February 9, 2007

    Re: “not convincing enough”

    They were trying to be nice no doubt. Woo peddlers are overly sensitive. They’ll call you closed-minded. They complain about all criticism and call it “negativity”.

  9. #9 Eric Wallace
    February 10, 2007

    The mystery is why the irrationality that is homeopathy stubbornly persists now that there are effective treatments for so many diseases.

    I don’t think it’s that much of a mystery. I don’t have any real data here, but from the few people I know who take homeopathic remedies, they are not doing so for diseases with effective mainstream treatments.

    Rather, they are seeking treatment for seasonal colds, allergies, chronic (low grade) pains, fatigue, general malaise. Problems that mainstream medicine is often not good at resolving. I suspect that those kind of issues (rather than, say, chelation for autism, or what-not) are the driving force behind the vast majority of the alternative healthcare/herbal supplement industry.

    None of this proves it’s working, of course, just that many people don’t feel like they’re being well served by mainstream medicine.

  10. #10 HCN
    February 10, 2007

    Alexandra said “Is that a misspelled “diluted” or “deluded”? (Or is it just an apt homeopathy neologism?)”

    This made me smile (even though I know Kristjan is Danish, and English is a second language… and that it was a common typing error even for us native English speakers).

    Also a note to Mr. Eric Wallace: I recently spoke to someone who was believer in homeopathy. This person had been in a auto accident and was taking homeopathy treatments for an auto accident related pain. She was not too pleased when I related my account about my experience… I broke a couple of ribs in a head-on auto accident (a common result of lap seat belts without shoulder belts). It took at least three years for the pain to finally go away. But it did, without homeopathy. My thought to her was, if you still have pain after two years, why are you still going to the homoepath?

  11. #11 Maronan
    February 10, 2007

    While I disagree with the “less is more” doctrine of homeopathy, I often find that I can cure most of my early-morning woes by diluting the ground-up seeds of the coffea arabica plant in hot water. It just requires a little less dilution than homeopathy usually calls for.

    Incidentally, the domain names “oracknows.com” and “www.oracknows.com” have been registered by an anti-vaccination woo-pusher and set to redirect to his own site. (I’m supposing you already knew this.) Is this an annoyance or a compliment?

  12. #12 Kristjan Wager
    February 10, 2007

    Alexandra said “Is that a misspelled “diluted” or “deluded”? (Or is it just an apt homeopathy neologism?)”

    This made me smile (even though I know Kristjan is Danish, and English is a second language… and that it was a common typing error even for us native English speakers).

    I apparently have a knack for turning up new, rather apt, words by misspelling others. Well, in this case I ment “diluted”.

  13. #13 HCN
    February 10, 2007

    Maronan, you can read all about the cybersquatter here:
    http://oracknows.blogspot.com/2005/11/internet-squatter-j-b-handley.html

  14. #14 Prometheus
    February 10, 2007

    Am I the only person who finds placebo-controlled studies of homeopathy incredibly amusing? After all, how are you to know that the placebo isn’t an extremely diluted solution of something? And since the core delusion of homeopathy is that greater dilutions have greater power, the placebo might be having an effect to improve (or worsen) the disorder under study.

    Or, homeopathy could be a bunch of baloney.

    The main problem with “testing” homeopathy is that the standard for statistical significance is p less than or equal to 0.05, which means that the chance of finding a difference when there is none is 5% (or less).

    So, if you do enough homeopathy studies (and especially if you test multiple outcomes and “forget” to apply the Bonferroni correction), you will eventually find one that shows a difference with p less than 0.05. Anyone who finds this hard to believe should read the study by Leonard Leibovici on retroactive intercessory prayer (see: http://www.bmj.com/cgi/content/full/323/7327/1450 ).

    Prometheus

  15. #15 Bob Calder
    February 10, 2007

    Weren’t the trials done in England in the 80′s? I believe one of Gould’s books contains a story of the process and a description of the way it had to be repeated because of objections. The dilution porcess was unbelievably tedious and elaborate.

  16. #16 Maronan
    February 10, 2007

    HCN– Thanks. I got deja vu reading that; I think I’d seen it before. I don’t come here very often. Usually I just read Pharyngula and Pandagon, but I came over to Insolence for the Skeptic’s Circle.

  17. #17 Lucas McCarty
    February 11, 2007

    Genius! I don’t know why I never thought of it before…

    Homeopathic gasoline!!!

    You just dilute petrol a million times and homeopathic theory should mean that it will in fact burn much more efficiently inside a car engine. I’ve just solved the problem of depleted fossil fuels and possibly global warming, and I don’t even need to worry about that thing with an oil-based compound not diluting in water because that’s the science of the past and doesn’t apply anymore. Homeopathy is the science of the future!

  18. #18 Davis
    February 11, 2007

    Anyone who finds this hard to believe should read the study by Leonard Leibovici on retroactive intercessory prayer

    Thanks for my laugh of the day — this is an incredible study. I love this part:

    What this study adds
    Remote intercessory prayer said for a group of patients is associated with a shorter hospital stay and shorter duration of fever in patients with a bloodstream infection, even when the intervention is performed 4-10 years after the infection

    (Emphasis added)