Respectful Insolence

Homeopathic remedies as a “catalyst”

I sometimes feel a bit guilty beating up on homeopathy. It just seems like beating up on a blind man. The feeling passes quickly, of course, but it’s at least somewhat understandable. Homeopathy is so patently ridiculous from a scientific standpoint that watching homeopaths try to justify and defend a therapy that consists of substances that are usually so diluted that there is not a single molecule remaining by invoking the “memory” of water or even quantum theory is, in a perverse way, entertaining to a skeptic like me. I’m always waiting to see what sort of strange analogy or explanation that they’ll come up with next, given the extreme biological and physical implausibility of the concepts behind homeopathy and the utter lack of basic scientific evidence that homeopathy can work and clinical evidence that it does work more than a placebo.

Sometimes, however, I wonder what it is that homeopaths think they are doing. Clearly, many of them are motivated by the same sorts of things that motivate “conventional” physicians (like me): To help people, to cure disease. The difference is that, in most cases, scientific and clinical evidence supports the therapies we use. In most cases of homeopathy and other so-called complementary and alternative medicine modalities, anecdotes are all that can be marshaled to support them. Sometimes, I come across the writings of homeopaths trying to explain what it is that they do, in this case the Basics of the Homeopathic Prescription. First, you must understand the concept of potency:

Potency basically refers to the strength and depth of effect of a homeopathic remedy. Potency is expressed in terms of the number of times the remedy has undergone the process of dilution and succussion (as described in The How and What of Homeopathic Remedies), and the factor of each dilution (1:10, 1:100, or 1:50,000).

Higher potencies stronger-acting than lower ones, even though they are apparently more diluted (remember that the effect of the homeopathic remedy is not chemical, so the concentration of the original substance is unimportant to the potency). This counterintuitive fact is proven as valid in everyday clinical practice.

Uh, no. It isn’t. I’m sorry, but it’s just not true. There’s no scientific evidence to suggest that diluting a remedy will make it stronger, with or without succussion. There is, however, evidence that not a single molecule of a homeopathic remedy remains in many solutions, such as the 20C or 30C dilution, two of the most commonly used homeopathic dilutions. What I found more interesting was the claim that the homeopathic remedy is “not chemical.” If that’s the case, then what is it? Humans (and, indeed, all life) is driven by chemical reactions. The actions of pharmaceuticals all depend on chemistry, as drugs interact with receptors or other molecular targets and cause chemical reactions that influence cellular and organ function. Even herbal remedies used by CAM practitioners work through lowly chemical interactions and reactions. Yet homeopathy seems to claim that it doesn’t need this basic mechanism of life. So the question remains: If homeopathy doesn’t work through chemistry, how does it work? I remind homeopaths that even arguments about the “memory” of water are arguments of chemistry. True, they’re arguments of woo chemistry, but they are based in chemistry that claims that somehow water retains structural “memory” of substances that have come in contact with it and then can somehow transmit that “memory” to cells.

Our intrepid homeopath has an answer:

The action of the homeopathic remedy is thus like that of a catalyst. Catalysts are used in chemistry to stimulate reactions to progress at a much faster rate than otherwise. Many chemical reactions that take place within seconds with the help of a catalyst would take many thousands of years to occur naturally. Similarly, the homeopathic remedy accelerates the body’s self-healing capacities . This is why a single dose of a remedy could, under the right circumstances, produce a long-lasting reaction from the organism. This reaction often persists for several weeks to several months before before further dosing is required.

No, no, no. A catalyst is actually present in detectable amounts in a chemical reaction. Homepathic remedies are not present in any such detectable quantity. Indeed, no homeopath has ever been able to differentiate water from a homeopathic remedy diluted much beyond Avagaddro’s number. These remedies are nothing more than water. I realize that this is an analogy, but it’s a poor one. After all, one characteristic of a catalyst is that it decreases the activation energy of a reaction, allowing it to proceed faster, while not being consumed in the reaction itself. If a homepathic remedy is truly a catalyst, it wouldn’t be consumed. Would it accumulate in the body? Who knows? If it had any activity at all,that would be a concern.

Given the lack of science behind homeopathy, I really have to wonder at some of the statements here:

In the case of acute illnesses, homeopathic remedies are in a frequency proportional to the severity of the condition. For example, a stroke victim will receive a remedy once every minute or two to begin, then once every few minutes, and several times daily in the few days which follow. On the other hand, treating the common cold might require one to three doses per day.

And we know this through…what evidence? None, as far as I can tell. Here’s another bold claim:

The homeopathic remedy can be dispensed either in liquid form or in tablet form. The liquid form is based on a water-and-alcohol mixture, whereas the tablet form is made of sucrose or lactose suffused with the homeopathic remedy.

The choice of format is based sometimes on personal patient considerations, and sometimes on therapeutic considerations. For example, those averse even to the small amount of alcohol found in a daily homeopathic dose can opt for tablets; children can be give the sweet tablets to encourage intake, or conversely the liquid form to avoid sugar intake; those who are lactose intolerant can opt for sucrose tablets or the liquid form; and so on. In addition, there are subtle differences between the effect of these two formats of the homeopathic remedy that might also dictate the choice between the two.

What are these “subtle” differences? What is the experimental evidence? Remember, anecdotes are very problematic and can easily lead to the impression that a remedy that is no more than a placebo appears to work. That’s all homepathy is, an elaborate placebo.

It’s rather depressing to see articles like this. They are, no doubt intentionally, written in an authoritative tone, as though there is a great deal of evidence to support the recommendations and practices described. It’s all a charade. if you ask a homeopath what the evidence supporting the claims that certain dosages or dosing frequencies are most effective, most likely you’ll get a response that “clinical experience” supports it. That may have been enough 25 years ago, even for “conventional” medicine, but no more. “Conventional” medicine has steadily been actively trying to become more and more science- and evidence-based. If the use of anecdotes is no longer enough for “conventional” medicine, it’s not enough for homeopathy or any other so-called CAM either.

And that’s why my guilt over beating up on homeopathy as a concept rapidly passes.

Comments

  1. #1 Interrobang
    February 6, 2008

    Years ago, I used to know a homeopathist through another friend of mine who seems to be a total Woo Magnet — I’ve heard of forms of woo you haven’t touched yet on FDOW, simply because of knowing this person. Eek!

    Anyway, I hung around the homeopathist enough to have figured out some of what made her tick, if not how she got there originally. To be a homeopathist, you have to be a dualist, a vitalist, and know about enough chemistry to make you dangerous. You also have to have approximately zero idea of how the scientific method actually works — I remember having a long discussion with this personage about the “science” behind the 17th C. guy who initially developed homeopathy, and she was dead-bang convinced that record-keeping = doing science. (In that case, I’m a computer scientist, since I write software documentation.) It doesn’t hurt if you’re a bit of a hippy-dippy syncrete, either.

    You also have to be the type I refer to as a “fixer,” which is generally someone who’s suffused with the desire to help people (at all costs) and not enough brains, skills, or basic competence to do it very well. These types tend to become social workers, counsellors, and/or things like homeopathists, aromatherapists, or other woo-meisters. Key to pulling this one off is to be convincing (mostly because you believe it yourself) and have a pleasant demeanour (at least at first).

    I still remember how she told me my kidneys were weak (I’ve never had a spot of trouble with them) and never said Thing One about my gallbladder, which was even then starting to bother me. (I wound up having a lap chole about four years later.) Heh.

  2. #2 dr
    February 6, 2008

    i love how there is a tablet form of homeopathic medicine. its funny, a synonym for placebo is often a “sugar pill,” which is exactly what their tablet form is! unbelievable that they can tell you “we are giving you a sugar pill as medicine” and yet people still believe. i often wonder the motivations of these homeopaths. while i think some do actually believe in this, i imagine there are a fair amount of those who are in it for the money and exploiting the gullible, and alleviate their own guilt by knowing that no harm is being done.

  3. #3 Emily
    February 6, 2008

    I was a little sad to discover that a favorite author of mine took up homeopathy. She at least acknowledges that it doesn’t make any kind of sense, but she seems willing to say that it’s magic and leave it at that. In her case it seems she had a bout of chronic fatigue and after 18 months of trying everything else finally tried homeopathy and started getting better. Now, from what little I know about chronic fatigue, it seems that many cases mysteriously start improving after a year or two, so I see no reason to attribute her recover to hydration.

    My guess is that after trying homeopathy and starting to recover she was inclined to attribute that to the woo. It seems she’d rather believe in magic than coincidence.

  4. #4 Nelson Muntz
    February 6, 2008

    “Why, sometimes,” she said, “I’ve believed as many as six impossible things before breakfast.” — The White Queen, in Alice in Wonderland.

    Homeopathy seems to be based on a simplistic idea along with its refutation. Start with the idea that like cures like, find out that fails, but never give up on your first impulse, figure it must be the dosage that matters, and in time you will get to the contradictory premise that like doesn’t treat like, which leaves you at the bizarre notion that infinite dilution is the perfection of cure. Homeopathy is the right arena for people who can’t learn from mistakes.

    I’ve thought about marketing Homeopathic Deadly Nightshade, with the fine print saying, “Contains no Deadly Nightshade. Active ingredients: none. Inactive ingredients: tap water, dissolved carbon dioxide.”

  5. #5 Calli Arcale
    February 6, 2008

    I think that very very few (if any) are outright liars, in it purely for the money. Though the money is probably a draw, I think the vast majority sincerely believe that they are helping. Thing is, they’re picking homeopathy instead of regular medicine not to “harmlessly” exploit the gullible but because it’s easier than regular medicine. Critical thinking takes effort, and the proper application of science is arduous. I think the real appeal for homeopaths is that the appeal of easy answers. Why spend eight+ years of expensive post-secondary education, plus residency, etc, just to do what these homeopaths can do merely by consulting a set of tables? You and I know the answer — because really understanding disease takes a lot of serious work. But they don’t know that. They think it should be easy. Indeed, some may think that if it takes work, you should smell a rat.

    This is why people are drawn to the promise of panaceas. This is why they like “The Secret”. This is why people think that it’s possible to achieve zero defects in any process (a philosophy with disastrous effects when applied to real-world things like air traffic control; this philosophy has been deemed a large part of the why reason runway incursions occur — FAA procedures depend unreasonably on flawless execution). This is why homeopaths get so much business. The common theme is that you should be able to get what you want for minimal effort.

    At least, that’s my theory. If I wanted to be mean, I’d say this means homeopaths are intellectually lazy. I’d prefer to say that they’re intellectually sloppy. Trouble is, though many think their practice is essentially harmless, their critical thinking skills are so lacking that they probably wouldn’t even be able to tell if they were harming people. This may be why so many quacks who kill patients keep on going. It’s not because they’re money-grubbing villains (though some are) but because they honestly don’t think they’re responsible for the death.

  6. #6 Matt Penfold
    February 6, 2008

    “I think that very very few (if any) are outright liars, in it purely for the money. Though the money is probably a draw, I think the vast majority sincerely believe that they are helping.”

    I know what you are trying to say here but for me it seems to let the practitioners of the hook to much. Many very probably do sincerely believe that what they doing is backed by evidence, and that they do indeed want to help others. The only problem is that they have no basis for holding that view. The only way they could have arrived at such a view is by a willful disregarding of how science, and medicine, works, and as such honesty is not something they can make much claim to. It is much like the situation with creationists. Creationism is not an honest position, and no one (with the exception I think of the mentally ill or mentally retarded) can hold a creationist position and make claim to be honest. There is a duty on people taking a position to understand the position they are taking. In the case of both homeopaths, and creationists, they cannot do so without ignoring masses of evidence.

  7. #7 Dangerous Bacon
    February 6, 2008

    “And that’s why my guilt over beating up on homeopathy as a concept rapidly passes.”

    If you want to get rid of that guilt altogether, there a homeopathic remedy – mercury salts!

    An impressive case study:

    http://www.hpathy.com/materiamedica/dsouza-mercury-salts.asp

  8. #8 Jen
    February 6, 2008
  9. #9 jayh
    February 6, 2008

    Someone should tell the auto makers about this. Catalytic converters can cost thousands to replace because of the platinum and other catalyists, but apparently all they really need to do is expose the system to catalysts and it will remember.

    The bean counters will be thrilled.

  10. #10 Chris Noble
    February 6, 2008

    I’ve thought about marketing Homeopathic Deadly Nightshade, with the fine print saying, “Contains no Deadly Nightshade. Active ingredients: none. Inactive ingredients: tap water, dissolved carbon dioxide.

    Sounds like Fair Deal Homeopathy.

    Finally an honest homeopath!

    If I lived in the UK I’d order some fair deal homeopathic pills!

  11. #11 royniles
    February 6, 2008

    Homeopaths not outright liars? If not outright, they are liars nonetheless – outright deceivers in any case.

    They defend themselves with the usual “pseudo-scientist” argument: If you can’t prove something is impossible, then it’s theoretically possible, and therefor if we posit that it’s true, you can’t say by your own logic that we’re wrong.

    That’s all many who want to believe something need to give themselves permission to believe it. So the problem or question to tackle first would seem to be, why do their adherents want to believe the barely believable and how much do they want it?

    And the countermeasures should involve less of a discussion of the logic of homeopathic suppositions than of the deceit involved in whatever efforts were applied that caused adherents to hope for an ultimately ridiculous prospect to begin with.

    It is our nature to expect to be deceived, but we want to feel complicit in the deception – it must be of the type that reinforces our expectations. We didn’t agree in advance to deception that only bolsters the deceiver’s expectations.

  12. #12 andrea
    February 6, 2008

    “It just seems like beating up on a blind man.”

    Orac, I’m expecting some blind person with a martial arts belt to come and beat you up (figuratively, in a blog comment) for your disablist remark there. It is not only dismissive of blind people, but it is also insensitive in light of the fact that a variety of disabled children and adults meet their deaths from various forms of abuse.

    I appreciate the rest of the post, but please, find a suitable metaphor!

  13. #13 Susan
    February 7, 2008

    I’m interested in the comment made in a previous post about “fixers” I’ve encountered many such people in my life and I’m wondering if this could be used as an overall psychological term (If it weren’t for the fact that many people who study therapy and psychology are “fixers” themselves) The thing I’ve noticed about people like this is they have a weird moral superiority complex that comes from the fact that they’re “helping” everybody. They’ll try and help you too, whether you need it or not.

  14. #14 royniles
    February 7, 2008

    Every social group has niches for the designated “fixer.” It puts you high (or higher) on the pecking order if one can qualify. Problems then occur when one fakes their abilities to gain that spot and the trust of other group members in the bargain. And so was born the designated con artist.

  15. #15 Alan Kellogg
    February 8, 2008

    Emily,

    Would that famous author be Robin McKinley?

    Whereto homeopathy and chemistry. Homeopathy relies on two principles, similarity and contagion. That is; like affects like, and things once in contact stay in contact. How this works is not what matters, what matters is that one day an authority said it works. You’re dealing with pre-scientific method methodology here.

    At the same time the fact homeopaths try to dress up the woo in pseudo scientific verbiage is testimony to science’s explanatory power. Properly applied the scientific method works, and woo masters want to take advantage of that.

  16. #16 North of 49
    February 10, 2008

    Interrobang’s comment about her homeopath friend (top of the thread) had a couple of great points that I’ve seen in a lot of other belief systems, not just CAM woo:

    1) You also have to have approximately zero idea of how the scientific method actually works…

    2) …she was dead-bang convinced that record-keeping = doing science.

    Great example: A couple of years ago I saw a piece on the Daily Planet science show, on Discovery Channel Canada, where they interviewed one of England’s premier crop circle “researchers”. By the end of the interview it was clear this earnest lady was convinced she was “doing science”, but was in fact only practicing a Cargo Cult version of the real thing.

    It was as if science was only about following the proper forms, not about basic factual knowledge, analysis, process, comprehension and understanding. She had elaborate charts and diagrams, notebooks full of observations, results of “experiments” (detecting the ‘energy vortex’ that created the crop circle by burying a vial of Penta water [another great woo product] in it and then some time later, after dowsing to find it, examining it for “changes” — too bad she sealed the vial with porous cloth tape), all done with finicky care and attention to detail, but in no way based on anything approaching reality.

    At the beginning, when she talked about this mysterious circle-carving energy vortex being created in the upper atmosphere out of a combination of “electrons and…” [pause while she searches for a word, then says a trifle hesitantly, as if the term isn't quite right] “positive ions”, I had to laugh. But by the end it was just painful to watch, she so clearly had no clue.

    Further down the thread, Calli Arcale added: I think the real appeal for homeopaths is that the appeal of easy answers.. This applies to the crop circle researcher perfectly, with the caveat that the actual easy answer — it’s the hoaxers, stupid — is disregarded because it’s not supernatural. In a lot of woo, and in what for lack of a better term I’ll lump together as New Age Lunacy, there seems to be a tropism away from any “natural”, i.e. real-world, explanation and towards a supernatural one — and any one will do.

    Finally, rovniles mentioned the pseudo-scientist argument, which for me boils down to “science can’t explain this, so my crackpot idea must be right”. This is often used in reverse, for example, if one expresses dubiousness about the supernatural nature of crop circles, the believer’s response will be “well how do you explain X”, and it does no good to tell them that’s not how it works; I don’t have to explain anything, it’s the people who make the claims who have to explain it, with, you know, hard evidence. They won’t buy that, because “evidence” is just one of those built-in biases of the Vast Scientific Establishment Conspiracy.

    Well, that was refreshing. Thanks, all.

  17. #17 David / Homeopathy Zone
    February 12, 2008

    As the “intrepid homeopath” who authored the article quoted above, I will point out several things:

    1) As per previous correspondence between us, Orac refuses to accept that there is some high-quality research evidence in favor of the claim that sub-molecular dilutions produce a clinical effect. He simply ignores it. That this evidence is not conclusive (and it certainly is far from it) is as much an indication for further research as it is for no more research — the choice between the two is ideological rather than scientific. Regardless, Orac’s claim that there is no convincing evidence is an obfuscation and deliberate simplification of the current state of research.

    2) Orac claims that medicine has moved beyond clinical experience into controlled research is only partly correct. Many treatments including virutally all surgeries remain clinically based interventions.

    3) Yes, homeopaths’ claims are based on clinical observation. That there is a logical possibility of all such successes being due to placebo is indisputable, but it is a viable explanation only for the ignorant who engage in armchair skepticism and haven’t witnessed the work of a competent homeopath over a sufficient time period, which I dare say includes all skeptics I have encountered.

    4) The action of homeopathy is not chemical in the sense that it doesn’t rely on the presence of specific molecules. Nothing new here. Homeopaths claim that there is another level of activity in living organisms that has to do presumably with the arrangement of the original solvent molecules, for which the term “chemical” is not quite appropriate.

    5) My reference to a catalyst was a conceptual rather than physical allusion: as I mentioned in the article the “effect” of the remedy persists after it has been “exhausted”, which would be impossible in the case of catalysis. This is due (unlike in non-living machines) to the healing response of the body, which is what the remedy “catalyses”.

    I have researched evidence-based medicine in depth, contrary to various presumptions of my and other homeopaths’ level of knowledge of scientific methodology. Whoever believes that the methods of EBM are the ultimate in evidence is simply ignorant of the complexities brought up by virtually any attempt at a clearcut demonstration of efficacy. Clearcut results are readily obtainable only when the effects of medicines are crude: immediate, aggressive, and direct. Medicines that work indirectly (by activating a healing response), gently, and gradually are disadvantaged under such a research enterprise, even before individualization of treatment and other complexities are factored in.

    Where I will agree with Orac and other skeptics is when the criticize the educational background of the average homeopath: the barrier to entry is very low and therefore there are countless poorly educated homeopaths who are ignorant of scientific principles and not even very knowledgeable in homeopathy, either. But this is a (proper) criticism of the state of the profession rather than of the system per se. But to claim that homeopathy is simpler than conventional medicine reeks of ignorance: medical doctors who turn to studying homeopathy regularly report that mastering the subject-matter is as or more difficult than most medical specialties.

    I hereby entitle this blog “Respectful Ingorance”.

  18. #18 HCN
    February 12, 2008

    Okay, David, perhaps you can answer my questions (no other homeopathy fan has attempted other than some silly hand waving, and not the number I really want):

    1) How many sodium and chlorine ions are in one cubic centimeter of Nat Mur 30C? Now the answer is a number that can be calculated using basic high school chemistry and algebra.

    2) Andre Saine claims that homeopathy works better for rabies than modern medicine. Is that true? And if it is can you tell us where this is adequately documented?

  19. #19 Lilly de Lure
    February 12, 2008

    Andre Saine claims that homeopathy works better for rabies than modern medicine. Is that true? And if it is can you tell us where this is adequately documented?

    More pertinently, would Andre Saine be prepared to be personally bitten by a rabid animal in front of an audience and then try to cure himself to prove his point?

  20. #20 royniles
    February 12, 2008

    This is from David’s site (somehow omitted from his post just above):

    “How does homeopathy work?
    Homeopathy can be likened to surgery for the soul, because healing takes place through the precise action of homeopathic remedies on the spiritual core of the person.
    Repairing this wound in the soul, which is always the cause of the physical and psychological ailments that we experience, restores the balance of body and mind, freeing both to serve the higher purpose of our existence.
    Once the spiritual cause of disease is addressed, the vast majority of conditions commonly considered incurable become curable.”

    What can I say except that this is unmitigated crap! It’s ignorance in its most deliberate form.

  21. #21 HCN
    February 12, 2008

    Roy, that is so true.

    What is even more idiotic is the claim that those of who think it is unmitigated crap are told by the “sweet loving” homeopaths that it is our lack of belief (or love) goes counter to healing.

    Which kind of falls apart when it was a baby girl who was killed by sepsis when her homeopath father failed to get her decent medical care (missed two appointments, but flew to India):
    http://scienceblogs.com/insolence/2007/11/a_real_death_by_homeopathy.php

  22. #22 David / Homeopathy Zone
    February 14, 2008

    HCN,

    I will not indulge you in your attempt to test my chemistry IQ and steer the argument in a pointless direction (we both agree that the amount of chemical is infinitesimal on average and in most specific cases nil).

    Andre Saine has spent years dredging homeopathic libraries so he bases his claims on case records; perhaps he has personal cases as well. I’d suggest contacting him directly if you are truly interested in investigating this further. But your demand for proof of maximal claims is disingenuous when you reject homeopathy’s minimal claims and the preliminary evidence of the sort that you approve of currently available.

    Royniles,

    Your claim that my surgery metaphor, which describes a phenomenon that you have no way of understanding without first having witnessed the action of homeopathy in a sufficient number of cases, is itself unmitigated crap — in a science blog I’d expect those making claims to back them with evidence of some sort, even of the “weak” or “insufficient” sort of clinical evidence I can offer. But evidently skeptical statements gain their truth-value strictly from their self-evident nature.

    If you reject the limited notion of soul that I am assuming in my statement then you are rejecting, in naive ‘scientistic’ fashion, a chief aspect of human experience as merely illusional. This is why there are so many illusional people who are not helped by conventional medicine yet I am able somehow to help. You see, it is rational for me to use my alleged-by-you placebo medications and obtain clearly remarkable clinical results on a reasonably consistent basis rather than adopt your dispassionate reason and turn to those approaches that have proven unhelpful in those very patients whom I treat.

    I have yet to see a counter-argument to this, other than fear-based, ominous pronouncements about the demise of science if more of this were allowed to happen.

  23. #23 HCN
    February 14, 2008

    So, in short, you cannot answer the questions honestly.

  24. #24 HCN
    February 15, 2008

    Repeating some stuff I wrote on http://www.sciencebasedmedicine.org/?p=35#comment-1233 :

    He blasters and blathers on how modern medicine (which is a term that includes ALL treatments, not just drugs, but things like surgeries, physical therapy and changes in behaviors,) has caused death. There is no denial that real medicine can cause harm, but he forgets that it has created better health.

    The big thing is that modern medicine works the majority of the time. Whereas homeopathy does not work.

    In good studies, homeopathy only works as well as placebo. In other words: it does nothing.

    In my own family where there is a genetic form of high blood pressure, members of that side of the family would typically die before they turned 50 years old. With the advent of diuretics to control blood pressure over 50 years ago, the average age of death is over 70 years old (there were 7 siblings born between 1901 and 1925, the first child died during the Spanish Flu Pandemic, another one died of hypertension when he was 40, but the oldest lived well into his 90s, and the youngest died last year at 81 — and it turned out for her she had had lung cancer due to her several decades of cigarette smoking).

    I’m pretty sure my oldest son would not have lived had his neonatal seizures had not been controlled by anticonvulsants. He could have ended up the same as this child:
    http://www.theage.com.au/articles/2003/11/25/1069522605256.html

    Also taking a look at an old family bible sent to me by a cousin I learned that my grandmother had two brothers, both of whom died before the age of 7. Not quite sure of what, but children dying of diphtheria, pertussis, measles and strep infections at the turn of the 20th century was very common (so was homeopathy). Now it is not so very common (and neither is homeopathy). It seems that the record for vaccines is much better than homeopathy.

    If a homeopath disagrees that vaccines are better than homeopathy, then he or she is welcome to show the real data. I would especially be interested to see the real data which makes Andre Saine claim homeopathy works better for rabies than modern medicine (century old anecdotes are not sufficient).

    (and no, I am not going to write Andre Saine, nor will I buy his forthcoming book… the man is a lunatic. I wanted YOU (or Dana Uhlman) to answer my question… with real evidence.

    The evidence I want to see must be less than a decade old, not from the 19th century, and include control groups. Is no one willing to infect cute fluffy little bunny rabbits with rabies and then see how well they do with homeopathic remedies?)

  25. #25 royniles
    February 15, 2008

    The N.D. con-artist commented above that “If you reject the limited notion of soul that I am assuming in my statement then you are rejecting, in naive ‘scientistic’ fashion, a chief aspect of human experience as merely illusional.”
    He wants us to think that attack against his deliberate idiocy is an attack against the “soul” concept, when in fact his own remarks in effect are using that concept to help him do exactly what believers in that soul abhor. He’s corrupting everything they stand for – violating their and others trust, doing harm in the name of good, and yes, calling on their God to support him in gulling his children.
    “Repairing this wound in the soul” is what he actually claims his remedies do, as if somehow they have more power than the God that he himself has rejected just by making this sort of asinine claim.
    If we have a soul, it is best shown in the nature of each man’s conscience. I say this man has no conscience and no soul and crap is putting it as mildly as possible when describing his duplicitous appeal to God as a justification for his otherwise outrageous claims. He is essentially saying that the most likely crop of suckers he can pick are those raised and bred in a faith that he secretly thinks attract the clueless and gullible.
    Demise of science? People like him who use religion as a mask for chicanery will more likely suck their religious hosts dry before science loses a beat.

  26. #26 David / Homeopathy Zone
    February 15, 2008

    HCN,

    The problem with your requests for evidence is that despite some high-quality evidence you persists in your claim that “[i]n good studies, homeopathy only works as well as placebo.” This is presumably based on the much-hyped Shang et al. study. I have addressed this issue at length over here. Why should the homeopathic community or researchers spend time on such experiments? So that you claim that the results don’t apply to people and are therefore “clinically irrelevant”? There are fundamental philosophical reasons that prevent you from accepting homeopathy regardless of the evidence in favor of it (see my reply to Royniles below).

    I agree with you about the dangers of homeopathic recommendation against vaccination when travelling to countries in which the risk-benefit ratio is completely different from what it might be in a Western country, and that there are many irresponsible, uneducated homeopaths. These issues are professional rather than fundamental ones: I have lost count of the number of totally irresponsible medical behaviours, mis- or missed diagnoses, unnecessary medicating (by medical rather than my standards), and so on that I have come across in my practice through my patients.

    Royniles,

    I must congratulate you on your innovative attack on homeopathy from the theistic perspective: a pincer-like counterpoint to the scientific attack, whether it is rhetorical or stems from your own concurrent belief in science and in God (presumably through some Cartesian division into the spiritual and the material realm). At the same time I will ignore your presumptuous assessment of the state of my soul.

    The “limited” notion of soul that homeopathy supposes is no anti-religious. It is simply a sufficient notion for purpose of homeopathy (which doesn’t deal with theological questions) and, just like in science, there can be atheistic and God-fearing homeopaths who share the same beliefs about homeopathy.

    So long as “soul” and the like are seen as outside the purview of science (and, if at all, strictly within the purview of theology), which deals strictly with “extended matter” (an inheritance from Descartes that is responsible both for the power and the limitations of contemporary science), any doctrine that claims to deal with the soul will be attacked both by scientists as unscientific and by some religious people as sacrilege.

    Yes, I stand by my claim that homeopathy is capable of “repairing the wound in the soul” — evidence for that is found in numerous case reports and in how people describe their own experience of healing (this is why I always invite skeptics to spend time in clinical observation rather than rant, or else refrain from comment, but to no avail). It is not denied that healing might require God’s succour (but then this should equally in the case of a successful surgery), nor is it denied that it involves relevant shifts body in brain chemistry, etc. The claim is strictly empirical and refers to the soul insofar as we can perceive it in individuals by observing and conversing with them.

    Therefore the only religious people that should rightly be offended by this are those who believe that manipulating the soul in any way is evidence of the workings of the devil but manipulating the body is not (because the former is sacred yet the latter is not — a reflection of the medieval bias which later infused Descartes’ metaphysics).

    The above philosophical issue is the reason that research on homeopathy, as well as far more robust reserach on certain mind-over-matter phenomena (which similarly disobey the Cartesian division of mind and matter), remains forever ostracized by those who are blinded by Cartesian dogmatism. (Yes, Cartesianism is brilliant and is the reason for the success of science and its transformative effects on our life. But it is a model whose emerging limitations should by now cause discomfort to all rational minds when confronted, e.g. with suffering patients who present with an impeccable scientifically sanctioned bill of health, and are told “It is all in your head[=mind, i.e. Descartes non-extended realm]“.)

  27. #27 Orac
    February 15, 2008

    David, you might want to read these two posts to see why we are not particularly impressed by the “positive” studies of homeopathy that you like to cite:

    1. Prior Probability: The Dirty Little Secret of “Evidence-Based Alternative Medicine”
    2. Essential reading: Why prior probability is important in considering the results of clinical trials of so-called “complementary and alternative medicine”

    While you’re at it, you might want to check out Kimball Atwood’s series:

    “Homeopathy and Evidence-Based Medicine: Back to the Future”:

    Part 1
    Part 2
    Part 3
    Part 4
    Part 5

  28. #28 royniles
    February 15, 2008

    David resorts to the philosophical gobbledygook that is both the first and the last resort of the charlatan.

    Referring to his fundamental explanation of homeopathic efficacy, he now says: “The claim is strictly empirical and refers to the soul insofar as we can perceive it in individuals by observing and conversing with them.”

    The acceptable way to use big words commonly involves adhering to their definition in the culture at hand. In the West, we tend to agree that “empirical” claims are verified through the accumulation of appropriate and sufficient evidence in the world of experience. I doubt if many would agree it’s either sufficient or appropriate to base an allegedly scientific doctrine on observations and conversations with individuals about where they think their problems may be coming from. Especially if those individuals appear to subscribe to the “cartesian dogma” that you also pretend to excoriate.

    Methinks all you understand about Descartes is that, as a horse’s ass, you have a place somewhere in his vicinity.

  29. #29 David / Homeopathy Zone
    February 15, 2008

    Orac,

    You’re agreeing with the point that I’ve been arguing for: my point about the philosophical disagreement being fundamental can be expressed in Bayesian terms. Those who dogmatically uphold the Cartesian division I described bring to their assessment of evidence about homeopathy a prior probability of 0, because homeopathy disobeys this Cartesian division (and there are other reasons, such as the allegedly self-evident implausibility of water having some sort of information-carrying capacity, for these people to assign this probability).

    Since, to quote from the article you refer to in you post:

    The simplest result, albeit one that many find discomfiting, is found if P(A) approaches zero: no amount of “confirming data”–especially of the error-prone sort generated by a clinical trial–should convince us to accept the hypothesis

    it follows that no amount of positive evidence would change your mind. Thus requesting extraordinary evidence while welcoming that which is provided with the uttermost hostility is insincere.

    I’ve been arguing all along (also in other threads) that prior probability inevitably creeps into the allegedly disinterested evaluation of EBM evidence. When such bias devolves into outright prevarication, in the form of misrepresentation of positive evidence as negative, then you no longer engage in honest discourse, let alone Bayesian-informed EBM.

    Besides, glorifying Bayesian prior probability in the context of EBM is like having one’s cake and eating it too! Set up a supposedly objective set of criteria, but when these don’t work (don’t fulfill pre-existing beliefs) you simply move the target.

    Until there is an objective way of assigning prior probability, and there isn’t one, because it is a quantification of belief in a system in which belief is not objective by definition, you are only shooting yourself in the foot through such argument.

    Royniles,

    Please comment on “Disrespectful Insolence” instead.

  30. #30 royniles
    February 15, 2008

    Apologies to Decartes for not being more specific. I was merely referring to the French saying that “L’endroit approprié pour de cart est derrière de horse.”

  31. #31 David / Homeopathy Zone
    February 21, 2008

    Orac,

    Your invocation of Bayesian statistics supports rather than refutes what I’ve argued for here and in past threads:

    My claim is that no amount of positive evidence for a phenomenon that is deemed improbably on a priori grounds will satisfy, and so is yours.

    I find it rather amusing that you present Bayesian statistics as a refinement of EBM, without providing a convincing method for ascertaining prior probability, which by definition is a subjective notion. It’s rather like eating one’s cake and having it too!

    Aggregating past research data is not sufficient to determine this probability, because a research enterprise investigating a new topic goes through a learning curve, and research methods that fit the subject matter need to be developed (the RCT didn’t arise ex nihilo but took over 100 years of evolution within the context of conventional medicine to obtain its modern form). Indeed, if your criticism of EBM is to be taken seriously the RCT it is still evolving in response to the needs of conventional medicine. Yet when homeopaths state that the RCT needs to evolve to serve the homeopathic clinical method their concerns are disregarded.

    The very fact that EBM has to adjust its methods in response to supposedly false-positive results (obviously there are individual such results, but I am objecting to the interpretation that such results are commonplace — if they are then either some methods are indeed real, however improbable, or EBM cannot be trusted) in studies that use the same methods as conventional ones is reveals the critical insufficiency of EBM as the ‘gold-standard’ it is purported to be. Now the emperor has lost his clothes and EBM is exposed as a useful tool in a context which includes other considerations of likelihood plus clinical experience, rather than being a major breakthrough.

    So we are left with deciding on what we believe based on prior probability, which is built on cultural factors, philosophical beliefs, and clinical experience — just as I’ve been saying all along.

  32. #32 Orac
    February 21, 2008

    No, taking prior probability into account is only another way of saying that extraordinary claims require extraordinary evidence to support them. The claims that water has memory, that serial dilution with succussion make a remedy stronger, and that “like cures like,” the main tenets of homeopathy, are all extraordinary claims particularly the first two. Show me the extraordinary evidence supporting homeopathy, and I would be willing to reconsider hundreds of years of physics and chemistry, coupled with 150 years of biology and pharmacology, that say that homeopathy can’t work.

    In other words, if you’re going to convince me of a claim that, if true, would overthrow science that is so strongly supported with evidence from many decades, then you have to show me evidence that is at least as compelling as and preferably more compelling than the evidence from established science that shows that your claim can’t be true. So show me that incredibly compelling evidence that rivals our long-standing understanding that shows homeopathy can’t work.

    I’ll wait.

  33. #33 David / Homeopathy Zone
    February 21, 2008

    The compelling evidence is the clinical one. The results obtained with homeopathy are too extraordinary too often to be explained away as placebo – it is a logical and possible explanation, but it ceases to be the best one in light of clinical experience. Unfortunately skeptics are consistently dismissive of such experience before considering the evidence first-hand, and maintain their armchair skepticism despite invitations to engage with the evidence as mentioned. The intellectually honest approach would be express personal skepticism but to refrain from being publicly dismissive.

    Designing a study that will capture clinical experience is difficult and very costly as it often takes many months to several years to obtain cures from chronic conditions. These cures are accompanied by improvement not only in objective signs (although these often take a while to manifest) but by many so-called subjective factors that in fact indicate the true healing that has taken place. Dismissing the latter is a matter of philosophical conviction (Cartesian dualism) rather than scientific reason. So there are further issues of design such as how to include these quality-of-life measures. All of this is possible in principle (homeopathic research has evolved over the last few decades) but not if every positive study is sprayed with bullets from a machine gun and angry calls for an end to homeopathic research ensue.

    There is nothing beyond an incipient research enterprise that I can offer to those who are dismissive-in-principle of homeopathy’s clinical experience, just as you as a surgeon have nothing to offer but your clinical results, and are able rarely or never to back them with true PCRCTs (although physical plausibility will be on your side, you’ll argue).

    Homeopathy does challenge the scientific status quo, but it is challened by so much collective evidence from so many fields that they all cry out for an explanation within a new scientific framework. All of this doesn’t cancel current scientific knowledge, but rather refines it, and exposes many claims of implausibility as dogmatic rather than evidence-based. Chemistry will not collapse if liquids are shown to have information-carrying capacity, as it is far more robust than suggested. There is no evidence that water doesn’t have information-carrying capacity; it is assumed within a wider theoretical framework in which water is a substance with multiple anomalous, often unique properties, so there would be nothing to overthrow as you suggest.

    The history of science shows that at many points in time things were assumed to be implausible but turned out to be true. The challenge nowadays is that the frontier is not in physics (where experiments are relatively simple and the components under investigation – electrons and relatively simple physical systems – are highly uniform), but in biology and consciousness, where subjects are open systems, unique, and incredibly complex living organisms. The nature of evidence therefore changes accordingly and must evolve along with science.

    Conventional medicine is crude precisely because it treats complex systems as though they were simple. This is a powerful approach, but its limits are becoming more and more apparent with the passage of time, and I deal with the ‘rejects’ of this approach all the time.

    Skepticism that first adopts and then essentially rejects EBM as needed is not the solution to the problems we currently face societally. Accordingly we are seeing conventional medicine collapsing under its own weight, through skyrocketing costs that are no longer accompanied with sky-rocketing health gains. In this context rejecting clinically successful approaches (observational studies clearly support homeopathy’s clinical efficacy) because they supposedly degrade science by working through placebo (even when this is so) is an over-reaction.

    Offer a better solution to concrete health problems than I can offer and I will take my hat off, just as I do whenever someone requires the services of a surgeon (as I myself required once).