Respectful Insolence

Homeopathy in the–cringe–ICU

Blogging on Peer-Reviewed ResearchAbout a month ago, I did a facetious throwaway piece about “homeopathic enchantments” being used by one of my favorite comic characters (who, alas, no longer has his own comic series), namely Doctor Strange, the Sorcerer Supreme. Given that it was not intended as anything other than a lark, I was rather surprised when it generated a long discussion thread fueled by a homeopath named Dana Ullman, who showed up in the comments and argued with me and several of my best regular commenters. He kept the discussion thread going far longer than the average thread on this blog, provoking annoyance on my part. Then, as quickly and mysteriously as he had appeared, he disappeared.

However, before he did, he referred to a study of homeopathy in the ICU that was published, in all places, in Chest, a respectable journal that, as you might expect, is dedicated to research on diseases of the chest, such as chronic obstructive pulmonary disease (COPD), cardiac disease, and basically any disease that manifests its pathology in the chest, although it primarily deals with critical care. I had been planning on taking a more detailed look at that study ever since then, but other topics came up. Also, I didn’t really want to put up with a return of Dana Ullman, at least not then. Then Dr. R. W. happened to see the article about 10 days ago, commenting quite correctly that the article impressed him with just how far into the medical mainstream woo has penetrated, while retired doc also expressed his dismay. His comments reminded me to put this article in the queue again.

Now it’s time. Given that the article originally appeared in 2005, I don’t feel too bad about not getting around to it right away, other than that I totally missed Homeopathy Awareness Week, when I could have had a lot of fun doing several homeopathy posts. Here’s the abstract:

Influence of Potassium Dichromate on Tracheal Secretions in Critically Ill Patients.

Michael Frass, MD; Christoph Dielacher, RN; Manfred Linkesch, MD; Christian Endler, PhD; Ilse Muchitsch, PhD; Ernst Schuster, PhD and Alan Kaye, MD. Chest. 2005;127:936-941.

* From the Ludwig Boltzmann Institute for Homeopathy (Drs. Frass, Endler, and Muchitsch), Vienna, Austria; II Department of Internal Medicine (Mr. Dielacher and Dr. Linkesch); Department of Medical Computer Sciences (Dr. Schuster), University of Vienna, Vienna, Austria; and Department of Anesthesiology (Dr. Kaye), Texas Tech University Lubbock, TX.

Background: Stringy, tenacious tracheal secretions may prevent extubation in patients weaned from the respirator. This prospective, randomized, double-blind, placebo-controlled study with parallel assignment was performed to assess the influence of sublingually administered potassium dichromate C30 on the amount of tenacious, stringy tracheal secretions in critically ill patients with a history of tobacco use and COPD.

Methods: In this study, 50 patients breathing spontaneously with continuous positive airway pressure were receiving either potassium dichromate C30 globules (group 1) [Deutsche Homöopathie-Union, Pharmaceutical Company; Karlsruhe, Germany] or placebo (group 2). Five globules were administered twice daily at intervals of 12 h. The amount of tracheal secretions on day 2 after the start of the study as well as the time for successful extubation and length of stay in the ICU were recorded.

Results: The amount of tracheal secretions was reduced significantly in group 1 (p < 0.0001). Extubation could be performed significantly earlier in group 1 (p < 0.0001). Similarly, length of stay was significantly shorter in group 1 (4.20 ± 1.61 days vs 7.68 ± 3.60 days, p < 0.0001 [mean ± SD]).

Conclusion: These data suggest that potentized (diluted and vigorously shaken) potassium dichromate may help to decrease the amount of stringy tracheal secretions in COPD patients.

Holy homeopathy, Batman! Does this study mean that homeopathy actually works for critically ill patients in the ICU? Not so fast there, Robin. Let’s take a look.

First off, the title is interesting. Note how the word “homeopathy” or “homeopathic” does not appear. In fact, no derivative of the word “homeopathy” appears anywhere in the abstract. True, the Ludwig Boltzmann Institute for Homeopathy is mentioned in the institutional affiliations, but that would be easily missed by someone perusing the abstract. It’s almost as though the writers were trying to get this in under the radar. After all, most doctors don’t know much about homeopathy, which means that they don’t know much about what a “30C” dilution is or that such a dilution dilutes a substance to the point where there almost certainly isn’t a single molecule left.

First a word about the methods: Apparently in homeopathy lore, potassium dichromate is useful for treating thick respiratory secretions. On what basis, I don’t know From where I come from, potassium dichromate is a nasty chemical; it’s a powerful oxidizing agent. Indeed, it’s sometimes used to clean laboratory glassware, although I never used it for that. It’s also used in photography and screen printing. It’s pretty toxic stuff and can cause a nasty dermatitis. Given all that, it’s a good thing that this stuff was diluted to nonexistence before being administered to patients sublingually (under the tongue)! If it weren’t, it could have caused some damage.

This all makes me wonder how this study ever got past the Institutional Review Board (IRB). After all, if there’s active ingredient left over, then the study would be proposing to give a toxic substance to patients on ventilators in an ICU. If the investigators made it very clear to the IRB that the dilution would be such that there would be no potassium dichromate left, then the IRB should have asked about the ethics of giving both experimental groups what is, in essence, a placebo. More disturbing is that the investigators stopped the administration of β-agonist bronchodilators to these patients before they were started on placebo or treatment, in order “to avoid any potential influence and/or interaction.” Again, if there is potassium dichromate in the homeopathic remedy, then why did the IRB allow the investigators to administer it in the first place with no supporting evidence, either in clinical or animal models, that it might have an effect? If there is no potassium dichromate in the homeopathic remedy, then stopping effective medications in both study groups strikes me as unethical. In fact, the investigators essentially admit that it is diluted to nothing:

In homeopathic concentrations, potassium dichromate acts primarily by its mucolytic properties. In this study, we used a preparation of C30, which is equivalent to a potentiation of 30 dilutions, in which each of the 30 dilution steps is followed by subsequent vigorous succussions. Therefore, the above-described toxic effects were eliminated. In addition, the original orange-red color disappeared during the preparation. Onset of action may vary from patient to patient but is generally observed within 24 to 48 h.

What “above described toxic effects,” you ask? None, really. The investigators didn’t describe any potential toxic effects from potassium dichromate until the discussion section. Apparently, the reviewers didn’t read this study too carefully (which is, of course, one possible explanation for such woo making it into a journal with an impact factor of 4.008). Be that as it may, let’s look at the patient characteristics, shall we?

First, there were only 25 patients in each group, which is a pretty small number for anything other than a pilot study. You have to remember that, when studies are small, spurious results are more likely to occur. At first glance, the patient characteristics in this table appear pretty well balanced. At first glance. Actually, this is a good example of when statistical nonsignificance doesn’t necessarily mean clinically nonsignificant. For one thing, the stage of COPD in the control group was higher than that of the treatment group (1.20 ± 0.5 versus 1.08 ± 0.4, p=0.178). This seems very odd, because both groups are listed as having mild COPD by this criteria, given that the COPD stages run from 0 to 3, with 0 being normal lung function and 1 being the least severe. If the average COPD stage for each group was close to 1, then why did the patients have such difficulty coming off the ventilator? Something’s odd there, since the mean FEV1 (forced expiratory volume in 1 second) was 54.0 ± 5.3% in the potassium dichromate group and 52.4 ± 5.5% in the control group, both of which are very close to the range of stage 2 COPD (FEV1 between 35% and 49%). In other words, it would seem that most of the patients were bad stage 1 patients.

A more interesting difference, however, and potentially more likely to influence the results of the study comes when you look at the number of patients who were on home oxygen before being hospitalized and developing respiratory failure. In the control group, 9/25 patients were on chronic home oxygen, whereas in the potassium dichromate group, only 5/25 were on home oxygen. Leaving aside that both numbers seem very high for two groups whose COPD scores are 1.2 or below given that it’s usually patients with stage 3 COPD who require home oxygen, it is clear that the control group had nearly twice the number of patients who were on home oxygen before admission. This seems inconsistent with a small difference in in the COPD score, and the low COPD scores seem inconsistent with such severe exacerbations. After all, the definition of stage 1 COPD is:

Often minimal shortness of breath with or without cough and/or sputum. Usually goes unrecognized that lung function is abnormal.

Essentially no patients with stage 1 COPD need home oxygen. Ditto stage 2 COPD, which is defined:

Often moderate or severe shortness of breath on exertion, with or without cough, sputum or dyspnea. Often the first stage at which medical attention is sought due to chronic respiratory symptoms or an exacerbation

By the measurements listed, the average patient in both groups had at worst slightly worse than stage 1 COPD, which makes it odd indeed that 36% and 20% of the control and potassium dichromate groups, respectively, were on home oxygen. Let’s just put it this way. Needing home oxygen is a good marker for one of two things: either more severe COPD or other concurrent lung conditions. Those four extra patients on home oxygen could potentially account for the longer time to extubation and longer length of stay in the hospital in the control group. We can’t tell if they do or not because the data isn’t presented in such a way to allow us to do so. It’s possible that the differences in patients on oxygen before admission made a difference. It’s also possible that this is just a spurious result from a relatively small study. Or, it’s possible that it might be correct and there might really be an effect, but this latter scenario is unlikely given the flaws in the study and the fact that no homeopath has yet explained a mechanism by which something like homeopathic potassium dichromate might do a single thing to eliminate secretions–or anything else, for that matter.

The bottom line is that, contrary to Dana Ullman’s representation of this study as slam-dunk evidence of the efficacy of homeopathy, it’s nothing more than a very questionable study in which it is unclear whether the treatment and control groups were truly comparable. The homeopaths’ conclusion would be hilarious were it not so sad that such woo has found its way into otherwise reputable journals:

The present study suggests that potassium dichromate C30 may be able to minimize the amount of tracheal secretions and therefore to allow earlier extubation when compared to placebo. Since the potentiation (dilution and vigorously shaking) of the study drug beyond the Avogadro number imposes no interaction with the patient’s metabolism, and due to the low cost of the drug, its use in the ICU may be beneficial, minimizing morbidity and mortality. Studies give some insight into the potential way of action of homeopathically prepared drugs. Cluster-cluster aggregation phenomena in aqueous solutions of fullerene-cyclodextrin conjugates, β-cyclodextrin, sodium chloride, sodium guanosine monophosphate, and a DNA oligonucleotide revealed that there are larger aggregates existent in dilute aqueous solutions than in more concentrated solutions.20 In another study, ultra-high dilutions of lithium chloride and sodium chloride (10-30 g cm-3) have been irradiated by x-rays and gamma-rays at 77 K, then progressively rewarmed to room temperature. During that phase, their thermoluminescence has been studied and it was found that, despite their dilution beyond the Avogadro number, the emitted light was specific of the original salts dissolved initially.

This is the first scientific study of the effect of potassium dichromate on tracheal secretions. While the mechanism of potentized (diluted and vigorously shaken) drugs still remains subject to research, several articles describe its clinical usefulness. The effect may be best explained by cybernetics, which means that the information of the homeopathic drug acts consensually on the regulator. Thereby, the body regains its original property to regulate physical parameters.

First off, it’s nice to see that the investigators essentially admit that diluting above Avagadro’s number eliminates any trace of the compound. It is, however, unclear why they brought up ultrahigh dilution solutions irradiated at 77 Kelvin (or -196° C) and then rewarmed. First off, 10 to 30 molecules per cc is an incredibly concentrated solution in homeopathic terms. Second, homeopaths don’t cool their solutions down to the temperature of liquid nitrogen, irradiate them, and then slowly rewarm them, making me doubt very much the relevance of the experiment to anything that homeopaths do. But the part about cybernetics cracks me up. That one was clearly pulled out of someone’s hat (or perhaps out of their nether regions); yet it got by the reviewer.

As much fun as I have deconstructing such studies, hoping in vain for a good study but inevitably being disappointed, it is still disconcerting to see this sort of study published in chest. More disturbing still is that an IRB allowed such a study of a useless medication on intubated ICU patients with COPD. It just goes to show that peer review is not perfect. It may remain the best bulwark against pseudoscience, but it’s only as good as the reviewers, and it’s not a foolproof guarantee against pseudoscience. As you can see from this study, it’s making its way into even the ICU, which is one place where evidence-based medicine should rule supreme and in which there should be no place for woo. What I fear is that, as more and more pseudoscience and non-evidence-based woo invades medical school, the dividing line between evidence-based medicine and woo will blur even more, and, as the older generations of physicians retire, the newer generation, who has been exposed to woo in medical school, will be less willing or able to call a duck a duck when they see it. Quack quack.

Comments

  1. #1 Blake Stacey, OM
    July 2, 2007

    I have a theory that the normal institutions of peer review are good at detecting “bad but honest” science; the flipside of the same coin is that they’re vulnerable to pseudoscientific gamesmanship. (The Bogdanov Affair taught this to physicists.) It’s like optimizing for detecting Type I errors and thereby increasing the chance of Type II errors: take the batteries out of the smoke detector, and your toaster won’t set it off, but neither will burning upholstery.

    If the Chest article appeared in 2005, is it too late to write a response and send it to the journal?

  2. #2 Justin Moretti
    July 2, 2007

    Arthur C. Clarke said in 2001: A Space Odyssey (novel), “We can design a system that’s proof against error – we can’t design one that’s proof against deliberate malice.”

  3. #3 Gork
    July 2, 2007

    Good catch!

    The tricksters now and then sneak one past the guardians of truth. Several years ago a prominent journal (Nature? Science?) let one slip through disguised as something else but was secretly meant to ‘prove’ that water molecules remembered solutes they’d encountered.

    I remember reading a decade or so ago that an Indian journal got scammed by a ‘gasoline pill’ report, one of those just-add-water deals.

    It happens.

    Although, yes, it shouldn’t.

    Peers are better at catching honest mistakes than sneaky dirty filthy tricks.

  4. #4 qetzal
    July 2, 2007

    For one thing, the stage of COPD in the control group was higher than that of the treatment group (1.20 ± 0.5 versus 1.08 ± 0.4, p=0.178). This seems very odd, because both groups are listed as having mild COPD by this criteria, given that the COPD stages run from 0 to 3, with 0 being normal lung function and 1 being the least severe.

    Interestingly, these numbers, along with the group size, allow us to deduce the actual distribution of COPD stage in each group. (I assume COPD stage is always a whole number, right?)

    For the treatment group, the only way to get 1.08 +/- 0.4 is if 24 patients had stage 1, and one had stage 3.

    For the control group, the only way to get 1.2 +/- 0.5 is if 21 patients were stage 1, three were stage 2, and one was stage 3.

    In other words, the placebo group included 4 patients with moderate or severe COPD. The homeopathy group included only one.

    The bottom line is that, contrary to Dana Ullman’s representation of this study as slam-dunk evidence of the efficacy of homeopathy, it’s nothing more than a very questionable study in which it is unclear whether the treatment and control groups were truly comparable.

    I think we can safely conclude they were not comparable.

  5. #5 daedalus2u
    July 2, 2007

    Peers and peer review are only good for evaluating what Thomas Kuhn called “normal science”. That is science done within the existing paradigms. Science outside the existing paradigms can’t be easily evaluated by peers using “normal science”.

    Peer review can’t deal at all with fraud.

  6. #6 Joe
    July 2, 2007

    Concerning Orac’s questions about the Institutional Review Board. It may be that Austria does not require them. On the other hand, if there was an IRB, it may have consisted of homeoquacks.

    Thanks for this post!

  7. #7 HCN
    July 2, 2007

    One of the things I learned from this and another paper that Ullman was touting was (it was also done by the Homeopathic Institute in Graz):

    Do not get sick enough to require hospitalization in either Graz or Vienna (stick to Salzburg, it is a much nicer town anyway!).

    By the way, Ullman showed up on the JREF forum as “JamesGully”, insisting people critique the Chest study:
    http://forums.randi.org/showthread.php?p=2666311&highlight=chest#post2666311

  8. #8 HCN
    July 2, 2007

    Also, Ullman/Gully mentioned he was going to out of town for a coupld of weeks, so he may find this a bit later:
    http://forums.randi.org/showthread.php?p=2702627#post2702627

  9. #9 Bryan Spondre
    July 2, 2007

    Thanks Orac for a critique that even I as a lay person could understand.

  10. #10 S.H.A.M. Scam Sam
    July 2, 2007

    “It’s almost as though the writers were trying to get this in under the radar.”

    Sigh.

    “Almost”? I keep telling you doctors, and scientists, these cults have targeted you:

    http://jef.raskincenter.org/published/NursingTheoryForSite.html

    And do I have to remind you of how Deepak Chopra made his name – with a bogus study that got past JAMA (AKA the Maharishi Caper):

    http://www.aaskolnick.com/naswmav.htm

    If you would spend more time focusing on this obvious threat – instead of denying it (and, especially, mocking it) but, still, wondering where it’s coming from – you might be able to put a stop it from undermining your authority.

    Like Tony Blair’s wife, Cherie Blair, claiming she can’t be nutjob because she’s a lawyer:

    http://www.dailymail.co.uk/pages/live/articles/news/news.html?in_article_id=465527&in_page_id=1770

    You guys have to get over yourselves – and stop joking around – and deal with the cancer within your profession.

  11. #11 David Colquhoun
    July 2, 2007

    That is a lovely analysis of the Frass paper. The editor of Chest seemed remarkably unperturbed by the fact that this paper had got through his reviewing process. But at least he did publish a response from me (see http://www.dcscience.net/improbable.html#chest , alongside a totally unrepentant response from the authors.

    The extent to which such nonsense seems to have become tolerated by the medical establishment is truly scary.

  12. #12 trrll
    July 2, 2007

    For one thing, the stage of COPD in the control group was higher than that of the treatment group (1.20 ± 0.5 versus 1.08 ± 0.4, p=0.178).

    Why on earth would anybody quote a p-value for the characteristics of randomized treatment groups?

    After all, the p-value is essentially the likelihood that the populations from which the samples are drawn are actually the same, and that the difference in the sample means is due to chance. But in this case, the treatment groups are known to be randomly drawn from the same population (since these measurements are prior to treatment), so the value of p is necessarily 1.0. I suppose one might apply a p-test if one wanted to test the hypothesis that the investigators engaged in outright fraud in patient selection, but otherwise it is pretty meaningless.

    The use of p-values in this context argues that the investigators don’t understand the distinction between statistical significance and clinical significance. This is a fairly basic statistical error, and one that does not inspire confidence in the validity of their other statistical conclusions. In particular, there are a lot of ways that even a well-meaning investigator who does not understand statistics can accidentally introduce bias.

    I suppose that they could be trying to argue that the low p-values obtained in post-treatment measures are not due to fortuitous differences in the small test populations, but this is not appropriate as the relationship between pre-treatment patient characteristics and outcome is not necessarily linear.

  13. #13 spudbeach
    July 2, 2007

    Just to echo and amplify trrll a bit:

    It makes no sense to take the average of a non-numeric, categorical, variable. If they had labeled the stages of COPD as A, B, C, and D, would you the paper have reported the average stage as A.2 ?

    Much better is qetzal’s method of saying how many were in each category. That allows diligent researchers to quickly see the difference between the groups, rather than being deceived by the assumption that there really is a real number that it makes sense to average there.

    I’ll be looking more closely at the paper, but I just had to get that glaring misuse of mathematics off of my chest. Math is the servant of the sciences: it shouldn’t be turned into the evil henchman.

  14. #14 Johnny Vector
    July 2, 2007

    If they had labeled the stages of COPD as A, B, C, and D, would you the paper have reported the average stage as A.2 ?

    Well, sure! If you learned math from that grade school textbook that Feynman reviewed:

    John and his father go out to look at the stars. John sees two blue stars and a red star. His father sees a green star, a red star, and two yellow stars. What is the total temperature of the stars seen by John and his father?”

    (Feel free to explode in horror here.)

    Sigh. I miss Feynman.

  15. #15 andrea
    July 2, 2007

    Just as a totally silly aside, the first researcher’s name, “Frass” is also the technical term for insect feces. Really, a person can’t help their name, and there are plenty of people whose surnames are humorously tied to their professions. But every time I hear or see the word frass, I think of…

  16. #16 Skeptyk
    July 2, 2007

    Good heavens, David Colquhoun, the response to your good letter in Chest wasn’t simply “totally unrepentent”, it was astonishing. Some choice quotes:

    “Homeopathy is a science based on applied toxicology…We are happy that toxicology as well as homeopathic proof have been shown to be reliable and consistent for centuries.”

    How on earth anyone can cling to this delusion memeplex in the face of plain evidence used to fascinate me, but this just appalls me. Homeopaths underfoot in the ICU, tax dollars paying for pretend medicine, journals publishing earnest nonsense.

    “Since Dr. Colquhoun assumes that high potencies exhibit no effect at all, then we cannot understand why it should be dangerous to treat critically ill patients additively if there is ‘nothing’ in it.”

    See that right there drives me up a wall. Not just the snarky tone, but the false naivete. Why is it dangerous? Well, let me see. How about wasting time and money delivering a complex schedule of placebos and then lying to people about the fact that they ARE placebos? How about legitimizing the use of pretend medicine, lending homeopathy the authority of scientific medicine by allowing, nay, encouraging, the ritual of counting out glamour globules of milk sugar and putting them inder tongues like a eucharist? Yes, those are dangers. Continuing this farce, in the face of implausibility and (homeo)pathetic notions of evidence, is bolstering other quackery, too.

    But this was the last straw:
    “We also are concerned that Dr. Colquhoun questions the value of randomized controlled trials. This opinion appears to be inconsistent with the current position of conventional science.”

    Not only is there nothing in your letter that could possibly be stretched to mean this, but dollars to donuts these guys know exactly who you are. Trying to paint you, of all people, as dissing scientific trials is contemptible. At best they make themselves look foolish, but perhaps this tactic gives them crediblity among the credulous; maybe they fancy themselves as beleaguered brave homeopaths up against that mean old Colquhoun.

    Ironically, Frass was also one of the authors of a letter (2005) in the very dubious Journal of Alternative and Complementary Medicine, with the title: “Bias in the trial and reporting of trials of homeopathy: a fundamental breakdown in peer review and standards?”

    Ya think?…

  17. #17 S.H.A.M. Scam Sam
    July 3, 2007

    One more try and I’ll stop – I promise:

    Guys, you’re not going to get a reasonable answer out of them – THEY’RE CULTISTS – to keep expecting logic from people who have given their minds over to nonsense just makes you into fools.

    Rule #1 of cults is “The guru is always right” – not the friggin logical-assed scientists. Look for yourselves:

    http://www.orange-papers.org/orange-cult_q0.html

    See?

    I betcha, if you (seriously) looked at The Cult Test, and compared the info to the way fans of homeopathy behave, you’d see what I’m trying to tell you. Keep that link handy. Study it. Refer to it often. Especially when you encounter more of these idiots. It’ll save you a lot of sleep – and stress.

    Some people are already there:

    http://www.angelfire.com/mb2/quinine/cult.html

    http://www.angelfire.com/mb2/quinine/allergy.html

    Don’t diss those pages because they’re not well done: not everyone’s as good at html as you types who can be so damn smart in some areas yet dumb as a brick in others – like noticing the cultists right in front of your faces – y’know?

    Who loves ya, Baby?

  18. #18 S.H.A.M. Scam Sam
    July 3, 2007

    BTW – here’s the straight dope on homeopathy:

    http://www.angelfire.com/mb2/quinine/index.html

    Now, if it’s wrong, then I’ll gladly accept that I am.

    If not,…

  19. #19 DrFrank
    July 3, 2007

    The effect may be best explained by cybernetics, which means that the information of the homeopathic drug acts consensually on the regulator. Thereby, the body regains its original property to regulate physical parameters.
    Actually, in Cybernetics we tend to only study real systems.

  20. #20 MartinM
    July 3, 2007

    “Since Dr. Colquhoun assumes that high potencies exhibit no effect at all, then we cannot understand why it should be dangerous to treat critically ill patients additively if there is ‘nothing’ in it.”

    Of course, that’s not what they actually did.

    More disturbing is that the investigators stopped the administration of β-agonist bronchodilators to these patients before they were started on placebo or treatment, in order “to avoid any potential influence and/or interaction.”

  21. #21 S.H.A.M. Scam Sam
    July 3, 2007

    Homeopathy has a founder and traditional leader who is now acknowledged and revered also by the present generation of homeopaths: Hahnemann.

    Homeopathy has a popular axiom: Similia Similibus Curentur.

    There a mystery – an unreasonable belief – in homeopathy, revealed to the initiated after further study: The theory of potentization.

    There is a financial involvement of subscribers to homeopathy: Institutions and colleges of homeopathic learning. To get a diploma or a degree in homeopathy, students must attend one of them.

    Homeopathy played a prominent role in at least one cult: The Order of the Solar Temple. Fifty-three members of this cult committed mass suicide or were murdered in Switzerland and Canada in October 1994. There was an Australian connection where the cult leaders and some members lived on the Gold Coast in Queensland. The leader of the cult claimed to be a Doctor of Homeopathy. His name was Luc Jouret. Mr.Jouret was born in Kitwit in the Belgian Congo, now Zaire, in 1938. He was once active in left-wing fringe politics as a member of the Walloon Communist Youth between 1965 and 1975. Mr. Jouret flirted with communism, but also joined the New Order of the Temple, a cult founded in 1968 by a French right-wing extremist. Jouret traveled and gave public lectures on homeopathy, in which he talked on ‘self realization’ and recruited members for the cult. Some were enrolled from amongst his patients.
    Jouret was a charismatic and persuasive speaker and those who knew him said the homeopathic doctor was a clever man who could easily influence people. When a patient in Switzerland went to him for homeopathic treatment, Jouret told him he was dying of cancer. Month later Jouret claimed to have miraculously cured him. The man and his wife fell for the story and made a donation of $1 million to the cult.

    In the final count homeopaths have to believe, put their faith into the existence of a Vital Force and a Healing Power of a dynamized medicine. Neither of these two has ever been demonstrated to the scientific world. Both remain in the sphere of philosophy and mysticism.

    But – hey – keep arguing with them if you want,…

  22. #22 HCN
    July 3, 2007

    Who are you to tell us what and HOW we should deal with pseudo-medicine? Expecially with all that disconnected blathering.

    Did you not notice that this blog posting was about pseudo-medicine sneaking into a decent medical journal like “Chest”… and that it was a poorly designed study in the first place, and the writers were not exactly up front with their purpose?

  23. #23 HCN
    July 3, 2007

    Also, there is very real problems with homeopaths getting away with their nonsense unchallenged. Such as in the case of UK (where the royals still endorse this particular kind of pseudo-medicine):
    http://www.senseaboutscience.org.uk/index.php/site/project/71/

    There have been cases in the Uk of people not getting the real malaria precautions from the NHS, but consulting homeopaths for their stuff. Then while travelling, they actually get malaria.

    More here: http://www.badscience.net/?cat=35

  24. #24 HCN
    July 3, 2007

    What is even more frightening is that Dana Ullman himself has suggest that homeopathy “shows promise” in the treatment of HIV:
    http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=12676041

    Exposing his lapses in medical and statistical expertise with his “Masters of Public Health” is really better for “public health” than letting him go unchallenged.

  25. #25 S.H.A.M. Scam Sam
    July 3, 2007

    I’m one of the only rational human beings left who’s, obviously, smarter – and braver – than you: that’s who I am: Someone who’s gonna challenge you.

    Disconnected blathering? I outlined the definition of a cult – and homeopathy fits perfectly – but you big brains go on acting like it’s an intelligence test (which only serves to make your dumb asses feel smart) while people die and money goes to the criminals out there:

    1. Arguing with cultists makes you fools.

    2. Mocking cultists proves you’re ineffectual.

    3. The authority of science, and medicine, is withering away while you blather on about the obvious: the cultists are wrong.

    4. What are you gonna do about cults in your profession? They’re in Chest, they’re bombing London, they’re ripping off the NHS – what are you gonna do, Big Brains?

    You talk like it’s someone else’s responsibility to identify these assholes and remove them – it’s not – it’s yours. I (and others like me) can only hope to spur YOU to action.

    Now, I want to know: what are you idiots gonna do?

  26. #26 HCN
    July 3, 2007

    Cults in my profession? Since when were aerospace engineers bombing London?

  27. #27 S.H.A.M. Scam Sam
    July 3, 2007

    See? Jokes.

    You’re pathetic.

  28. #28 HCN
    July 3, 2007

    It is not a joke. You said “What are you gonna do about cults in your profession? They’re in Chest, they’re bombing London, “… I assume you were addressing me.

    Since I am an aerospace engineer, I sincerely asked since when did we bomb London (except, of course, since World War II and the German rockets).

    But really, you are ranting and raving, and you have no clue who your audience is.

    This blog is not only visited by thouse in the medical profession, but many others. Like myself, who has had family members sucked into scams pseudo medical practitioners, or had other family members health endangered by the anti-vax loons.

    Again, I ask: Who are you to judge?

  29. #29 S.H.A.M. Scam Sam
    July 4, 2007

    “The classic definition of insanity is doing the same thing over and over again and expecting a different result.”

    - Albert Einstein

    Put another way: How’s arguing with cultists been working out for you?

    And who am I to judge?

    Just think of me as science and medicine’s “discriminating shopper”,…

  30. #30 Joe
    July 4, 2007

    If this is a double post, I hope Orac deletes it.

    Blog/foums such as this are valuable for our education, so that we can educate others (not disabuse homeopaths from their notions). When homeopaths do crop up, we also learn what they think, and how to counter it. In this particular case, I could not evaluate the “Chest” paper for myself, and Orac (and others) give me talking points.

    The next time someone points to that article I can point to its deconstruction.

    I rarely encounter people who value homeopathy. However, my brother’s friend recently told me he was going to a chiropractor for a sore neck. When I explained the connection between chiro neck snaps and stroke- he canceled his appointment and went to a real doctor. That type of success is my reason for reading, and, sometimes, participating in these discussions.

  31. #31 S.H.A.M. Scam Sam
    July 4, 2007

    Your brother ain’t no cultist. What about this repeated litany from scientists and doctors – on these blogs – saying, “Why don’t these people get it?” when the cultists are faced with logic? Do you really think arguing with them is helping anyone, while we know – KNOW – people are dying, driven insane, marriages are being destroyed, friendships wrecked, etc., as these smarty-pants refuse to do more of substance than mock the whole movement?

    It’s sickening, if not as sickening, as the cult movement itself. Hell, you might as well count these idiots as part of it, for their approach to it:

    They’re enabalers.

    I respect the people who speak out – and take action. The rest of ‘em are losers, wondering why “nobody listens to us”, when they do nothing of substance against the very-real threat that ordinary people, like me, have had to face. I’ve gone from admiring doctors and scientists to thinking they’re lame-assed assholes, more concerned with appearances than reality:

    Which, I guess, makes them just a different kind of cult.

    Screw you guys.

  32. #32 Orac
    July 4, 2007

    The same back at ya, dude.

    I sat back ignoring you as long as I could, but now I’m getting a bit tired of your holier-than-thou “why don’t you do something?” trolling. You don’t like what Orac is layin’ down and what his commenters are saying? Fine. Frankly, I don’t give a rodent’s posterior what you think of me or my blog, nor do I need or want you to be telling me what I should and should not be doing.

  33. #33 gingerbaker
    July 4, 2007

    Here I am, innocently drinking my tea,when I realized with great panic that I am poisoning myself.

    It’s not the tea – it’s the water!

    All that water, flowing over rock and ground, picking up millions of toxins, and then diluting them to ever higher toxicities.

    Retaining all that potency as memory – no doubt survivable through multiple distillations. All those memories, collected over millennia.

    How does the water know which memory is to be useful for a particular patient or research subject??

    Homeopathy should be denigrated not because it is ineffectual, but because it is enormously dangerous if we are to believe the claims of its proponents. :D

  34. #34 Clark Bartram
    July 4, 2007

    Orac said:

    “Apparently in homeopathy lore, potassium dichromate is useful for treating thick respiratory secretions. On what basis, I don’t know From where I come from, potassium dichromate is a nasty chemical; it’s a powerful oxidizing agent.”

    I figure you actually do know the answer to this but just in case other readers don’t, in order to be “proved” homeopathically a person must have taken pure 100% potassium dichromate and then kept a log of what symptoms he or she felt. That person must have noted thickened respiratory secretions. Using homeopathic principles, a diluted and potentized solution of a substance which causes a certain symptom will treat that symptom.

  35. #35 Orac
    July 4, 2007

    Point taken. I should have dug into the literature and looked up what the symptoms of potassium dichromate toxicity are. ;-)

  36. #36 HCN
    July 4, 2007

    S.H.A.M Scam Sam,

    I do feel your frustration. Some of us have been dealing with the anti-vax loons for a long time. It doesn’t help when they buy authors like David Kirby to write books for them, or have part of the Kennedy clan be one of their supporters (claiming he is an environmental lawyer, when the only reason he started with “Riverkeepers” was because he was ordered to by a judge as community service after a heroin conviction).

    Dangerous idiots like Dana Ullman are pure entertainment compared to the Mercury Militia.

    But your posting style was making it like you were SUPPORTING homeopaths. It is almost as if you were drinking and posting. Don’t do that.

    It is a hot summer day (okay it is for this part of the country!)… and I am literally waiting for paint to dry (it is purple, and on the trim of a new basement bathroom). So I took some time between paint and barbecue duties and did some googling:

    http://blogs.nature.com/news/blog/2007/03/degrees_in_homeopathy_slated_a.html#comment-86524

    https://letters.salon.com/baec20cc775e570606ebd3a42a9d9bc0/author/index1.html

    What happened to your “Macho Response” blog?

  37. #37 S.H.A.M. Scam Sam
    July 4, 2007

    Orac,

    You not giving “a rodent’s posterior” is EXACTLY the problem: you don’t care – about me or anybody else. Rather than asking who I am to be telling you anything, you should be asking yourself why you (a supposedly-smart guy who understands most of this shit scientifically) isn’t COMPELLED to do more.

    You’re more than happy to light one under my ass – and it takes a Big Man to do that – but what do you do when it comes to the really big players? They’re giving people malaria and shit and the best you can muster is to mock them. I laugh at your sense of compassion and worth – you’re worse than worthless because you KNOW.

    It’s the Fourth of July and what are you celebrating? Attacking me for being anguished over unwarranted deaths and people with no voice WHO NEED YOUR HELP.

    You don’t like my style? But you do like Mark, at denialism blog, who is no nicer, right? He compares people to Holocaust deniers but he’s your pal? Fuck you. I may be “holier than thou” but you got no moral standing what-so-ever.

    And I’m not “trolling” – I’m WORKING. I’m making sure you assholes know there’s at least one “average guy” who knows your all bonkers – the cultists for doing what they do and you guys for doing what you do – which is NOTHING.

    Scientists and doctors should be beating down Oprah’s door – IN MASS – to set the record straight and expose the harm she’s done. They should be threatening not to do more research until they are heard. They should be marching. They should be kicking the “alternative medicine” out of hospitals and exposing the “need for more research” for the scam that it is in newspapers world-wide. You could seriously organize. Hell, I’ve talked to doctors who care more than you do but they feel helpless because YOU can’t be bothered to do anything real people can relate to – why is it I can get to them but you can’t? You’ve got all the respect and credibility in the world, but for what? There’s shit you could do, if you did give “a rodent’s posterior”, but you don’t. You’d rather hit me up – for rudeness – when you, and many others by now, KNOW I’ve dealt with nthe worst of this shit: one dead body from contact with a quack who also bothered to fuck my ex wife, who joined his cult, and they stole all my money before I(surprise) got divorced after 20 fucking years of marriage. Wanna hear more? Go to the SHAMbook blog. Steve’s been documenting more of these kinds of stories.

    Go on, Big Guy, fuck with me – you can’t say shit to hurt me. You’re nobody doing nothing but blah, blah, blah. What good is analyzing another cultists paper going to do? What good is any cultists paper? Why don’t you work to kick them to the curb so they can’t sneak another paper in, in the first place? Or is that just too below you? Wimp.

    You argue with cultists, like that’s gonna save one fucking life. “Big Whoop” to The Great and Mighty Orac. He’s soooo fucking “smart”. But for what? To argue with idiots. Do I bother you? I want to bother you. I WANT to keep you up at night, wondering why you’re such a fucking lamer. WHERE THE FUCK IS YOUR PASSION, FOOL? (Oh, I forgot: you’re saving it for little ol’ me.) Did you do some experiment that shrank your nuts? I shit on you, Orac. You’re a fucking waste, just like the people you mock. Hell, The Daily Mail does more than you. They EXPOSE THESE PEOPLE TO THE PUBLIC FOR WHAT THEY ARE.

    HCN,

    I don’t buy it – nobody criticizes denilism blog for rudeness – and they got no reason for it: I do – and a good one. A classic case of the very-real harm this shit can do to the unsuspecting. But all I get from science, medicine, the law – everyone – is how fucking helpless they are. That is, after they work up a head of steam to tell me what a fucking asshole I am. THAT they have all the energy in the world for. Such BRAVERY.

    Moving on, I’m re-thinking the blog. (Thanks for asking.) I’m considering a new flow-chart kinda deal: See, every article on some loony, like this one on Cherie Blair:

    http://www.dailymail.co.uk/pages/live/femail/article.html?in_article_id=465798&in_page_id=1879&in_page_id=1879

    They always mention other assholes that they’re involved with – like Hillary Clinton, Carole and Sylvia Caplin, Cameron Diaz, Cher and Belinda Carlisle, etc. – so I wanna connect-the-dots. I might even call the blog that: “Connect The Dots”.

    I might even open it with Orac’s picture – with a dot in the middle of his fucking head.

    That ought to “make a connection” with a better class of people.

  38. #38 HCN
    July 5, 2007

    Scam Sam said “And I’m not “trolling” – I’m WORKING. I’m making sure you assholes know there’s at least one “average guy” who knows your all bonkers – the cultists for doing what they do and you guys for doing what you do – which is NOTHING.”

    So how well does that pay? How is a cancer surgeon on the East Coast with a blog supposed to help YOU? And why should he?

    Who are these people: ” Carole and Sylvia Caplin, Cameron Diaz, Cher and Belinda Carlisle, “… and what do they have to do with anything? Did Oprah get elected to public office? Because as far as I know she is just a talk show host who only goes for ratings… I was not aware she set any kind of public health policy.

    So what did you do when a homeopath killed your mother-in-law? Did you file a lawsuit? Did you inform your local public health department? Have you contacted your local legislators about the scam?

    What exactly have you done other than write snarky comments on other people’s blogs? Like here:
    http://scienceblogs.com/denialism/2007/06/hurricanes_and_global_warming.php

    By the way, I also enjoyed the book _Natural Causes_.

    You have lots of good ideas, but you need to focus on who exactly has the resources to do what you want. Stop watching day-time talk shows, and start finding more contructive ways to deal with your anger. Start with your own state’s health licensing process. Find out how and why a homeopath like Dana Ullman (who is in California) is allowed to practice medicine without a clue. Then do something about it.

    Also, as someone else suggested in Mark’s Denialism blog… you are becoming a scientist in your own way. Try formalizing that and even though you are pushing the half century mark and take some classes at one of the many colleges in your area.

  39. #39 S.H.A.M. Scam Sam
    July 5, 2007

    HCN,

    No – stop it – you don’t know what you’re talking about:

    When people run off with all your money – every dime – you’re not in much of a position to fight back. I’m doing what I can, while also trying to stay alive at the most basic level. Like food and shelter. When cultists decide to eliminate somebody – knowing there’s no one to stop them – they don’t screw around. Those of us that get blind-sided by this have our lives turned up-side down, and our pockets are emptied, while we’re still in shock. Kids are taken. And, because so many are willing to deny that cults exist – until a Heaven’s Gate or something happens – anyone that mentions them is treated like they’re in one. (That’s a HUGE problem.) Your emphasis on what I’m doing, instead of what a cancer specialist – a fucking cancer specialist!!! – is galling. A cancer specialist has money. A cancer specialist has connections. A cancer specialist has influence. A black guy, alone, has nothing but his rage – and an internet connection to reach you fools with.

    It’s like you WANT to wear blinders. Then – whoops – there’s David Koresh! Where’d he come from? Madonna’s into Kaballah? No big deal, right? As she leads others into the fold – who commit more crimes. Hillary’s handing out bio-electric shields? Let’s not mention her occult beliefs as a serious topic while she tries to become President of the United States. You’re fucking idiots. Who do you think you’re dealing with here? That one stupid woman – like Oprah – is opening up a world of trouble – tearing society apart, right before your eyes – and you guys act like nothing’s happening at all. It all means nothing to you. How can society hold once everyone’s “following their own truth”? How can reason – or science – hold sway as Oprah’s allowed to preach this crap at 3PM everyday? And be admired for it? It’s madness.

    Stop watching television? That’s where they are! John Travolta, Tom Cruise, Kirstie Alley, that woman from Dharma & Gregg – all members of “The World’s Most Dangerous Cult” – which has killed people, and ruined the lives of others, and nobody says anything as they prance across our TV and movie screens because THEY’RE SUCH GOOD ACTORS. What a fucking trade-off: Innocent people die and have their lives destroyed by their cult so you assholes can say what a great movie “Pulp Fiction” is. I don’t know about you but, to me, that’s damning. Only Germany – which knows the danger, first hand – acts like something important is going on. You fools are SLEEPING.

    Go on, belittle me. Think you can tell me how to deal with my case – in France. But whatever you do, keep avoiding to do what I’m telling YOU to do:

    Get on the fucking stick – and ACT – stop “cringing” as they creep on your turf.

    Fuck all the talk. You don’t have to do it all at once. Just focus on exposing one thing for now: Homeopathy. Not because it was the source of my problems, but because:

    1. It’s fucking water. People can understand the kookiness of believing in it.

    2. It’s in health food stores and the like – the con of it can be exploited to alert people to how they’re being taken in “for their health”.

    3. It relies on a “vital force”. This introduces the idea that people (especially Christians) are swinging into mysticism and The Occult. Most people – especially black people (who, in many ways, act as the conscience of this country) – will NOT like that. Smacks of The Devil. Religious belief can have it’s uses, for atheists, you know?

    4. It’s influence is world-wide. France, Germany, Australia, The U.K., India – they all are dealing with it. Really expose it – and kill it – in the U.S. and the rest (with the influence of each nation’s activist scientists and doctors) will fall as well.

    5. It’s been promoted by Oprah. She must be stopped. She is a fucking oracle to these people. Telling them to “take risks” and “find your own truth” as she pushes one bogus treatment or belief after another. Really. Exposing – and destroying – Oprah Winfrey is a key. (And, no, my ex was no Oprah fan.)

    You guys – and especially the gals – have to stop thinking like PC fucking scientists and start understanding these people, their tactics, and their goals. You can’t reason with them. I explained homeopathy to my wife, and she just said, “You’re just saying that because you don’t believe.” (Scary moment, Kids.) It’s the rest of the population you’ve – we’ve – got to reach. Go to Rush Limbaugh (who has homeopaths for advertisers but talks about the danger of new agers, and Oprah, already) Bill O’Reilly – all the major mouthpieces. They are reachable. But you’ve got to stop seeing them as the enemy and start using them for what they do: they reason with the American public.

    Get organized.

  40. #40 S.H.A.M. Scam Sam
    July 5, 2007

    One more thing:

    Think of the O.J. Trial. Overwhelming DNA evidence meant NOTHING because Johnnie Cochcran understood PEOPLE. You guys know the science, inside and out, but you’ve got to start thinking like Johnnie.

    You guys hashing out that another cult paper is wrong by analysis (surprise – again) isn’t going to advance the cause of The Enlightenment one inch. You’ve got to be men to reach men. Start acting like it. Not scientists. You’re that already.

  41. #41 Lucas McCarty
    July 5, 2007

    Well, I’ll give it a go.

    Ladies and gentlemen of this *supposed* jury, this is Chewbacca: http://en.wikipedia.org/wiki/Chewbacca. Now Chewbacca is a Wookie and he lives on Endor with the Ewoks, but Wookies are from Kashyyk. Now ladies and gentlemen, this does not make sense, why am I talking about Chewbacca who is from Kashyyk? What does this have to do with the rise of woo? Exactly. Like Chewbacca living on Endor with two-feet tall Ewoks, all of this makes no sense. So while you’re considering your decision and conjugating the Emancipation Proclaimation just ask yourself “Does any of this make sense?” Which is why if Wookies are from Kashyyk, you must reject woo.

  42. #42 Orac
    July 5, 2007

    Lucas nailed it.

    Really, Sam, you don’t bother me. Mildly annoy me to the point where against my usual better judgment I fired off a snarky little repost yesterday, sure. But really bother me? No. I’ve had far worse than you take a run at me many times in the past.

    To me you sound like the flip side of antivaccination cranks. You even use the same capitalization and profanity. If a quack’s influence in your life has brought you to this, I’m sincerely sorry for you and hope you manage to lose enough of the bitterness to regain some coherence in your writing and thought. Really. But, from where I’m sitting, ranting does less good than what you view my contribution as. Besides, you have no idea what I do and do not do regarding alternative medicine and pseudoscience outside of the blog.

    And, really? Refusing to do more research until…what? Until we are “heard”? What the hell does that mean? We are “heard.” The problem is, the woo-meisters are heard more, and you are seriously deluded if you think that they’ll listen any better to your tactics, except to view those using them as seriously unhinged, because that’s the way you sound. No insult; it’s just the the way you sound.

    Regardless of the contempt you heap on one of my preferred blogging activities, analyzing papers like this does serve a purpose, even if you think it’s a waste of time. I’m sorry if it’s not angry enough or “active” enough (or “organized”) for your liking. I don’t exist to seek your approval any more than you do to seek mine. As for your other comments, analyzing papers like this is showing these people for what they are–by showing how bad their “science” is. It’s giving those who are reachable the tools to critically examine dubious claims, so that when someone like Dana Ullman points to a paper like this, there is my analysis to point to to show why that paper doesn’t show what Dana claims it shows. Ditto the Generation Rescue “survey.” I also tend to concentrate my efforts on the next generation, medical students and residents, to teach them to value evidence-based medicine and to recognize quackery when they see it. I’m guessing that’s probably far more than you do or could accomplish

    Don’t like me or my chosen activity? Fine, keep hurling profanity, taunts, and childish insults. Troll all you like until someday your trolling reaches a point that my regular readers and I finally get fed up with you and I’m forced to ban you. I’m patient with trolls, by the way–John Best, anyone?–but even my patience has limits.

    If you think you’re going to get more people on your side with that attitude of yours and trolling on Mark and my blogs, all I can say is, good luck with that. You’ll need it.

  43. #43 James Cole
    July 5, 2007

    Found you via DC’s improbable science page. An excellent blog post and some v interesting comments. Nice one.

  44. #44 SmellyTerror
    July 5, 2007

    Couldn’t nice, woo-ishly certain homeopathy give a good dose of placebo effect? Might make a nice change to the usual: “well, this could go wrong. It probably won’t, but we can’t promise anything”. Talk about killing the mood!

    My problem is that the woo would just make me chuckle, which wouldn’t help my chest wound.

    …but placebos have an effect, right? Screw it – just lie to me. Tell me the sugar pill is Concentrated Awesome, tell me it’ll fix me right up. Might only give me a teeny tiny percentage more of a chance, but I’ll take what I can get.

    I’m serious. Most of this patient consent stuff, in my experience, is pure shite. I don’t know what the hell the best course of care is – that’s why I’m in the damn hospital in the first place. That’s why you guys are getting the big bucks. So the only choice I can make is a bad one.

    “Mr Terror, we’d like to chop this bit off, and squirt this stuff into blood. It’ll hurt. The alternative is something… uh, else, but we really think the chopping and squirting is the way to go. What would you like to do?”

    Well duh. I trust ya. Do what you gotta do.

    So why not go the whole hog? Why not just lie if that gets the maximum placebo effect? As a potential patient, I just want the best chance I can get.

    Is there a “lie to me” box I can tick?

  45. #45 S.H.A.M. Scam Sam
    July 5, 2007

    “Let fury rule the hour – anger can be power – if you know how to use it.” – The Clash

    Like I said, you cherry pick: Mark can be insulting as hell but he’s your buddy. His response to me? It went something like this:

    “What do you want us to do? We’re a bunch of twits.”

    Just throwing his hands up. Helpless. I want you to stop being relativists and, I don’t know, watch “300″ a few times to remember what men are. Seriously, what good is discovering another cult paper is wrong? They just move on as you guys high-five each other. Meanwhile, Tony Robbins has cultivated Bill Clinton to speak before thousands at time. Great job, guys.

    As far as this not making sense – cultists don’t make sense – and, in order to understand them, I’ve had to visit every manner of silly web site (cultists, christian, scientific, therapeutic, etc.) to try and wrap my own mind around what the fuck they’re thinking. (I no longer argue with them. It’s useless. Why scientists haven’t noticed that eludes me,….) I make enough sense to reach those that do give “a rat’s posterior”.

    And I love this:

    “I’m guessing that’s probably far more than you do or could accomplish,…If you think you’re going to get more people on your side with that attitude of yours and trolling on Mark and my blogs, all I can say is, good luck with that. You’ll need it.”

    You don’t know me (or what I’ve accomplished in the past) but, along with my current fight for survival, I’m doing my own “outside work” and you’d better hope I’m not successful because I will be nailing the scientific community for it’s inaction in this area. (Not having credentials can have it’s own power, y’know.) I know Frank Zappa’s dictum that “In a battle between man and the world, bet on the world” but he didn’t know me either: I KNOW I can change minds – that’s why I had to be attacked by the cults: I’m a guy, despite their best efforts, they couldn’t influence – even through my wife. I’ll happily take you all on. I’ve already got allies – in medicine, science, and government – I don’t need you. I want you, but I don’t need you. (I get enough positive feedback to keep me going.) I don’t need anyone who can see they’re outnumbered but, still, doesn’t care to really fight. Al Qaeda – another cult – is in the hospitals? Possibly 50 doctors?

    http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/07/05/nterror405.xml

    And you’re cringing? Who’s gonna be the “loser” when I get done with you?

    You don’t have to ban me, I’m done here. This exchange is up, for all time, to be referenced later. People will see how you focused on my “attitude”, rather than my arguments and passion, and you will be damned – the same way appeasers were when they found the jews, piled up like cord wood, in WWII. Somebody’s got to play today’s Churchill, and I got nothing but “blood, sweat, and tears.” That’ll be enough:

    It was the last time.

  46. #46 Dr Aust
    July 5, 2007

    Well Smelly, that is how it used to be. Doctors used all the tricks, including a good dose of theatrics, dollops of paternalism (“as an expert doctor I know best”) and judiciously applied white-ish lies (brandishing bottle of probably useless medicine, e.g. cough syrup for couguing kid) “This is often quite effective”.

    BUT…

    Ethicists, politicians, patient advocates AND PATIENTS (in surveys) told doctors this kind of stuff was unacceptable.

    It remains one of the greater ironies of a lot of Woo that it succeeds in making people THINK they’re being helped) by adopting all the practises that mainstream doctors have been made to renounce.

  47. #47 Orac
    July 5, 2007

    And you’re cringing? Who’s gonna be the “loser” when I get done with you?

    I’ll take my chances. And, dude, the “cringe” was because reading about anyone using homeopathy in the ICU is cringe-worthy. It’s a cringe of psychic pain, not a cringe of cowardice.

    This exchange is up, for all time, to be referenced later. People will see how you focused on my “attitude”, rather than my arguments and passion, and you will be damned – the same way appeasers were when they found the jews, piled up like cord wood, in WWII. Somebody’s got to play today’s Churchill, and I got nothing but “blood, sweat, and tears.” That’ll be enough

    Oh, please. Invoking the Nazis and Nazi appeasers? The above rant is almost worthy of a visit from the Hitler Zombie.

    Now I know you’re full of shit.

    In any case, reference away. But, please, do reference everything, not just chosen bits that you think will make me look bad (even though they won’t). I’m willing to bet that any sane person who looks at the exchange will see what you call “passion” as nigh incoherent ranting and likely marvel at my patience in dealing with you or wonder why I didn’t just ignore you. In retrospect, perhaps I should have.

    Unfotunately, I’ve always had a weak spot for feeding trolls.

  48. #48 Dr Aust
    July 5, 2007

    Well Smelly, that is how it used to be. Doctors used all the tricks, including a good dose of theatrics, dollops of paternalism (“as an expert doctor I know best”) and judiciously applied white-ish lies (brandishing bottle of probably useless medicine, e.g. cough syrup for couguing kid) “This is often quite effective”.

    BUT…

    Ethicists, politicians, patient advocates AND PATIENTS (in surveys) told doctors this kind of stuff was unacceptable.

    It remains one of the greater ironies of a lot of Woo that it succeeds in making people THINK they’re being helped) by adopting all the practises that mainstream doctors have been made to renounce.

  49. #49 Dr Aust
    July 5, 2007

    Well Smelly, that is how it used to be. Doctors used all the tricks, including a good dose of theatrics, dollops of paternalism (“as an expert doctor I know best”) and judiciously applied white-ish lies (brandishing bottle of probably useless medicine, e.g. cough syrup for couguing kid) “This is often quite effective”.

    BUT…

    Ethicists, politicians, patient advocates AND PATIENTS (in surveys) told doctors this kind of stuff was unacceptable.

    It remains one of the greater ironies of a lot of Woo that it succeeds in making people THINK they’re being helped) by adopting all the practises that mainstream doctors have been made to renounce.

  50. #50 Dr Aust
    July 5, 2007

    Well Smelly, that is how it used to be. Doctors used all the tricks, including a good dose of theatrics, dollops of paternalism (“as an expert doctor I know best”) and judiciously applied white-ish lies (brandishing bottle of probably useless medicine, e.g. cough syrup for couguing kid) “This is often quite effective”.

    BUT…

    Ethicists, politicians, patient advocates AND PATIENTS (in surveys) told doctors this kind of stuff was unacceptable.

    It remains one of the greater ironies of a lot of Woo that it succeeds in making people THINK they’re being helped) by adopting all the practises that mainstream doctors have been made to renounce.

  51. #51 Dr Aust
    July 5, 2007

    Well Smelly, that is how it used to be. Doctors used all the tricks, including a good dose of theatrics, dollops of paternalism (“as an expert doctor I know best”) and judiciously applied white-ish lies (brandishing bottle of probably useless medicine, e.g. cough syrup for couguing kid) “This is often quite effective”.

    BUT…

    Ethicists, politicians, patient advocates AND PATIENTS (in surveys) told doctors this kind of stuff was unacceptable.

    It remains one of the greater ironies of a lot of Woo that it succeeds in making people THINK they’re being helped) by adopting all the practises that mainstream doctors have been made to renounce.

  52. #52 Dr Aust
    July 5, 2007

    Well Smelly, that is how it used to be. Doctors used all the tricks, including a good dose of theatrics, dollops of paternalism (“as an expert doctor I know best”) and judiciously applied white-ish lies (brandishing bottle of probably useless medicine, e.g. cough syrup for couguing kid) “This is often quite effective”.

    BUT…

    Ethicists, politicians, patient advocates AND PATIENTS (in surveys) told doctors this kind of stuff was unacceptable.

    It remains one of the greater ironies of a lot of Woo that it succeeds in making people THINK they’re being helped) by adopting all the practises that mainstream doctors have been made to renounce.

  53. #53 Dr Aust
    July 5, 2007

    Well Smelly, that is how it used to be. Doctors used all the tricks, including a good dose of theatrics, dollops of paternalism (“as an expert doctor I know best”) and judiciously applied white-ish lies (brandishing bottle of probably useless medicine, e.g. cough syrup for couguing kid) “This is often quite effective”.

    BUT…

    Ethicists, politicians, patient advocates AND PATIENTS (in surveys) told doctors this kind of stuff was unacceptable.

    It remains one of the greater ironies of a lot of Woo that it succeeds in making people THINK they’re being helped) by adopting all the practises that mainstream doctors have been made to renounce.

  54. #54 Dr Aust
    July 5, 2007

    Well Smelly, that is how it used to be. Doctors used all the tricks, including a good dose of theatrics, dollops of paternalism (“as an expert doctor I know best”) and judiciously applied white-ish lies (brandishing bottle of probably useless medicine, e.g. cough syrup for couguing kid) “This is often quite effective”.

    BUT…

    Ethicists, politicians, patient advocates AND PATIENTS (in surveys) told doctors this kind of stuff was unacceptable.

    It remains one of the greater ironies of a lot of Woo that it succeeds in making people THINK they’re being helped) by adopting all the practises that mainstream doctors have been made to renounce.

  55. #55 Dr Aust
    July 5, 2007

    Well Smelly, that is how it used to be. Doctors used all the tricks, including a good dose of theatrics, dollops of paternalism (“as an expert doctor I know best”) and judiciously applied white-ish lies (brandishing bottle of probably useless medicine, e.g. cough syrup for couguing kid) “This is often quite effective”.

    BUT…

    Ethicists, politicians, patient advocates AND PATIENTS (in surveys) told doctors this kind of stuff was unacceptable.

    It remains one of the greater ironies of a lot of Woo that it succeeds in making people THINK they’re being helped) by adopting all the practises that mainstream doctors have been made to renounce.

  56. #56 Dr Aust
    July 5, 2007

    Well Smelly, that is how it used to be. Doctors used all the tricks, including a good dose of theatrics, dollops of paternalism (“as an expert doctor I know best”) and judiciously applied white-ish lies (brandishing bottle of probably useless medicine, e.g. cough syrup for couguing kid) “This is often quite effective”.

    BUT…

    Ethicists, politicians, patient advocates AND PATIENTS (in surveys) told doctors this kind of stuff was unacceptable.

    It remains one of the greater ironies of a lot of Woo that it succeeds in making people THINK they’re being helped) by adopting all the practises that mainstream doctors have been made to renounce.

  57. #57 Dr Aust
    July 5, 2007

    Well Smelly, that is how it used to be. Doctors used all the tricks, including a good dose of theatrics, dollops of paternalism (“as an expert doctor I know best”) and judiciously applied white-ish lies (brandishing bottle of probably useless medicine, e.g. cough syrup for couguing kid) “This is often quite effective”.

    BUT…

    Ethicists, politicians, patient advocates AND PATIENTS (in surveys) told doctors this kind of stuff was unacceptable.

    It remains one of the greater ironies of a lot of Woo that it succeeds in making people THINK they’re being helped) by adopting all the practises that mainstream doctors have been made to renounce.

  58. #58 Dr Aust
    July 5, 2007

    Well Smelly, that is how it used to be. Doctors used all the tricks, including a good dose of theatrics, dollops of paternalism (“as an expert doctor I know best”) and judiciously applied white-ish lies (brandishing bottle of probably useless medicine, e.g. cough syrup for couguing kid) “This is often quite effective”.

    BUT…

    Ethicists, politicians, patient advocates AND PATIENTS (in surveys) told doctors this kind of stuff was unacceptable.

    It remains one of the greater ironies of a lot of Woo that it succeeds in making people THINK they’re being helped) by adopting all the practises that mainstream doctors have been made to renounce.

  59. #59 Dr Aust
    July 5, 2007

    Well Smelly, that is how it used to be. Doctors used all the tricks, including a good dose of theatrics, dollops of paternalism (“as an expert doctor I know best”) and judiciously applied white-ish lies (brandishing bottle of probably useless medicine, e.g. cough syrup for couguing kid) “This is often quite effective”.

    BUT…

    Ethicists, politicians, patient advocates AND PATIENTS (in surveys) told doctors this kind of stuff was unacceptable.

    It remains one of the greater ironies of a lot of Woo that it succeeds in making people THINK they’re being helped) by adopting all the practises that mainstream doctors have been made to renounce.

  60. #60 Dr Aust
    July 5, 2007

    Well Smelly, that is how it used to be. Doctors used all the tricks, including a good dose of theatrics, dollops of paternalism (“as an expert doctor I know best”) and judiciously applied white-ish lies (brandishing bottle of probably useless medicine, e.g. cough syrup for couguing kid) “This is often quite effective”.

    BUT…

    Ethicists, politicians, patient advocates AND PATIENTS (in surveys) told doctors this kind of stuff was unacceptable.

    It remains one of the greater ironies of a lot of Woo that it succeeds in making people THINK they’re being helped) by adopting all the practises that mainstream doctors have been made to renounce.

  61. #61 Dr Aust
    July 5, 2007

    Well Smelly, that is how it used to be. Doctors used all the tricks, including a good dose of theatrics, dollops of paternalism (“as an expert doctor I know best”) and judiciously applied white-ish lies (brandishing bottle of probably useless medicine, e.g. cough syrup for couguing kid) “This is often quite effective”.

    BUT…

    Ethicists, politicians, patient advocates AND PATIENTS (in surveys) told doctors this kind of stuff was unacceptable.

    It remains one of the greater ironies of a lot of Woo that it succeeds in making people THINK they’re being helped) by adopting all the practises that mainstream doctors have been made to renounce.

  62. #62 Dr Aust
    July 5, 2007

    Well Smelly, that is how it used to be. Doctors used all the tricks, including a good dose of theatrics, dollops of paternalism (“as an expert doctor I know best”) and judiciously applied white-ish lies (brandishing bottle of probably useless medicine, e.g. cough syrup for couguing kid) “This is often quite effective”.

    BUT…

    Ethicists, politicians, patient advocates AND PATIENTS (in surveys) told doctors this kind of stuff was unacceptable.

    It remains one of the greater ironies of a lot of Woo that it succeeds in making people THINK they’re being helped) by adopting all the practises that mainstream doctors have been made to renounce.

  63. #63 Dr Aust
    July 5, 2007

    Well Smelly, that is how it used to be. Doctors used all the tricks, including a good dose of theatrics, dollops of paternalism (“as an expert doctor I know best”) and judiciously applied white-ish lies (brandishing bottle of probably useless medicine, e.g. cough syrup for couguing kid) “This is often quite effective”.

    BUT…

    Ethicists, politicians, patient advocates AND PATIENTS (in surveys) told doctors this kind of stuff was unacceptable.

    It remains one of the greater ironies of a lot of Woo that it succeeds in making people THINK they’re being helped) by adopting all the practises that mainstream doctors have been made to renounce.

  64. #64 Peter Moran
    July 6, 2007

    Let’s be very wary about sending the message that such studies would be satisfactory proof of homeopathic activity if we were unable to find fault with them.

    Peter Moran

  65. #65 S.H.A.M. Scam Sam
    July 6, 2007

    All this makes me feel like Batman in the Dark Knight series. Or that FBI guy that died in the World Trade Center – the one that knew Al Qaeda was coming but no one would listen to him – because they didn’t like his attitude – which just made their own attitudes stupid as hell when the shit went down.

    Going off-topic for a second – look at the posts that follow your Doctors and terror topic:

    http://scienceblogs.com/insolence/2007/07/doctors_and_terror.php#c489030

    Only one person (ParanoidMarvin) understands the Sunni and Shia stand-off – the beliefs – of the people in the Middle East. The Sunni have been giving hell to the Shia for thousands of years – and we stopped it – but people are, somehow, convinced to be against that. They understand nothing about it – just as you know nothing about new age thinking. They think it’s just fundamentalists – not the very beliefs of the people. And definitely not like the beliefs of new agers, etc., are causing people to act here. True, new agers aren’t blowing themselves up, but – just like Al Qaeda – they are executing their plans with precision, and the longer you deny it, the more successful they’ll be.

    Look at this: http://www.nytimes.com/2007/07/05/opinion/05kinsley.html

    It’s an article from the NYT about Scooter Libby. It never once mentions Richard Armitage – the guy who’s already admitted he was the one to reveal Valerie Plame’s name to the press.

    http://www.opinionjournal.com/editorial/feature.html?id=110008872

    No, Libby did it, right? Who’s a conspiracy theorist? Somebody’s lying and it’s not me – or “Scooter”.

    Here’s another article from the San Francisco Chronicle on the same topic:

    http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2007/07/04/EDGS8QQJPL1.DTL

    No Richard Armitage there either (remember: Armitage has already openly admitted it was him) Just Scooter Libby lied (about what exactly?) and Bush and Cheney are bad guys.

    Oh, but Bill Clinton is a sweetheart who puts cigars up a girl’s vagina and then practically drives her crazy – and Hillary, the new age feminist, should be President. To do what exactly? Introduce more pseudo-science, maybe? Bill did start NCCAM, and we all know what a wonderful addition it’s been to the welfare of the public – and our discourse on modern medicine – or “men’s science”, as it’s called, right?

    But you fools buy it. You don’t know up from down. You are pawns to believers who want you to hate whoever is doing and saying the right thing. Anything that is right, you’re convinced is wrong.

    Now, what did another of Orac’s posters say – one other smart one – amongst all that nonsensical, simple-minded, psycho-babble that only reveals how little they know about beliefs? Oh yea:

    “Just because someone has had an education, it doesn’t make them automatically good, rational and humane.”

    Makes me think of your “I don’t give a rat’s posterior” comment. A person reveals a lot when they say, openly, that they don’t care about something. All hell can be breaking loose – and it is – but you don’t care because of my attitude: you’re educated. I wonder why there’s all those nursing cults that are grouped around hating doctors? Doctors are too big to care, they say. We’ll make another truth, they say. One that does care. And they’ll do anything to get it. Listen to yourself:

    “It’s almost as though the writers were trying to get this in under the radar.”

    Well, “duh”, brainiac. It’s no wonder you’re in “psychic pain” – you’re missing the big picture. You studied homeopathy. And you’ve studied TT. But you haven’t studied the people doing it – what they believe – what they’ll act on. People act on their beliefs, Orac.

    It’s late. I’ve been working and have to get some sleep, but I’ll leave you with this:

    New age is set up like Al Qaeda: a bunch of different groups, acting independently, for a common goal: to take you – and anyone that thinks like you – down. You don’t like me? Fine.

    To them, that’s a twofer.

  66. #66 Orac
    July 6, 2007

    I knew you were full of crap when you said that you wouldn’t be posting any more.

  67. #67 S.H.A.M. Scam Sam
    July 6, 2007

    Whatever, man:

    You’re the doctor.

    I’ll see you in the public sphere.

  68. #68 Orac
    July 7, 2007

    I can hardly wait.

    [yawn]

  69. #69 HCN
    July 7, 2007

    A couple things of interest, this book:
    http://www.amazon.com/Fads-Fallacies-Name-Science-Popular/dp/0486203948 … take note when it was published (hint, it’s older than Orac!).

    Plus a video talked about here:
    http://depletedcranium.com/?p=46

    Unfortunately the video neglects that the agencies talked about were then and still are overworked and underfunded.

  70. #70 Mojo
    July 11, 2007

    Ullman (in his “JamesGully” persona) is now claiming that Orac’s critique of the paper has been published in Chest and that the authors of the article reponded “and blew his weak critique out of the water”. True to form he doesn’t provide any references:

    http://forums.randi.org/showthread.php?postid=2754983#post2754983

  71. #71 Orac
    July 11, 2007

    Hilarious.

    I wonder why he hasn’t shown up here to tell me where I’m wrong in my analysis…

  72. #72 Laura Peterson
    July 11, 2007

    The ‘scientific method’ does not apply well to homeopathy, at least in the current form. Poke fun at homeopathic organizations doing research but is it any different from drug companies doing the research for the effectiveness of their own drugs? The proof is in the using. I am not a practitioner but am a devoted user of anything that works well and I use homeopathy.

  73. #73 Mojo
    July 11, 2007

    “The ‘scientific method’ does not apply well to homeopathy, at least in the current form.”

    What do you think the ‘scientific method’ is? In what way does it “not apply well” to homoeopathy?

    How would the ‘scientific method’ need to change in order for it to apply to homoeopathy?

  74. #74 MartinM
    July 11, 2007

    The ‘scientific method’ does not apply well to homeopathy, at least in the current form.

    The ‘current form’ involves a highly sophisticated, technical concept known as counting. Take two well-matched groups of patients, give one the real treatment and one a fake, and count the good outcomes in each group. Significantly better outcomes in the treatment group -> working treatment. So in exactly what way does counting not apply well to homeopathy?

    Of course, if the ‘current form’ of the ‘scientific method’ came out in favour of homeopathy, you can bet your ass we’d hear a different story.

  75. #75 Linda
    July 12, 2007

    Why on earth would anybody quote a p-value for the characteristics of randomized treatment groups?

    After all, the p-value is essentially the likelihood that the populations from which the samples are drawn are actually the same, and that the difference in the sample means is due to chance. But in this case, the treatment groups are known to be randomly drawn from the same population (since these measurements are prior to treatment), so the value of p is necessarily 1.0. I suppose one might apply a p-test if one wanted to test the hypothesis that the investigators engaged in outright fraud in patient selection, but otherwise it is pretty meaningless.

    The use of p-values in this context argues that the investigators don’t understand the distinction between statistical significance and clinical significance. This is a fairly basic statistical error, and one that does not inspire confidence in the validity of their other statistical conclusions. In particular, there are a lot of ways that even a well-meaning investigator who does not understand statistics can accidentally introduce bias.

    I suppose that they could be trying to argue that the low p-values obtained in post-treatment measures are not due to fortuitous differences in the small test populations, but this is not appropriate as the relationship between pre-treatment patient characteristics and outcome is not necessarily linear.

    I just wanted to comment that is not unusual to check that the randomization led to roughly equivalent groups by testing whether or not there are significant differences between the two groups on the measured characteristics before the treatment is given. If the two groups are different to begin with, it would hardly be surprising to find that they are different at the end. But it makes the conclusion that the difference is due to the treatment suspect. It is also a crude test, so clinically relevant differences could be missed.

    Linda

  76. #76 Thom
    July 18, 2007

    It is correct that “is not unusual to check that the randomization led to roughly equivalent groups by testing whether or not there are significant differences between the two groups on the measured characteristics before the treatment is given”. However, it is problematic because NS does not mean that the true difference is zero. (This is compounded if the preminary test lack statistical power – as in this case: the COPD measure is an ordinal categorical measure of a continuous severity of symptoms. Categorizing a contiunuous variable creates a very unreliable measure that decreases the power of the test.)

    An alternative is to give descriptive statistics and confidence intervals (CIs) for the differences in severity bewtween groups. These CIs would include zero but also indicate that the groups could quite easily differ greatly in severity (because N is small). This would be much more informative.

    It is also possible to include pre-test severity as a covariate in ANCOVA (rather than I guess the t test they used). Using ANCOVA in this way is a much more powerful technique for a 2 group randomized design. One drawback is that if the pre-test severity (e.g., via COPD) is measured more unreliably than the DV the contribution of the covarate will be underestimated.

  77. #77 wilsontown
    October 5, 2007

    Hm, Dana Ullman showed up on my blog claiming that this critique of the COPD study was ‘embarrassing’. Naturally, he failed to explain why.

    Keep up the good work, I say.

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