Respectful Insolence

Homeopathy deconstructed in the FASEB Journal

i-e7a12c3d2598161273c9ed31d61fe694-ClassicInsolence.jpgAs I mentioned on Friday, over the last few days I was in Chicago attending the American College of Surgeons annual meeting. At least, that’s where I was until last evening. Unfortunately, I got back home too late and was thus too tired to lay down some fresh Insolence, Respectful or otherwise, for your edification today. Fear not, though. I’ll get to it. In the meantime, here’s another blast from the past from the past. This post first reared its ugly head almost exactly three years ago; so if you haven’t been reading at least three years, it’s new to you.

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

It starts out with a quote from Oliver Wendell Holmes:

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

Genius.

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

i-277885a9d56a3a21acf6a68fcdc22a07-z380090659930001.gif

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Comments

  1. #1 Kismet
    October 15, 2009

    How’s the outlook for defunding the NCCAM or diverting ressources to the study of more useful and plausible “alternative” approaches? Worse than ever? As bad as ever?

    How come it took that long for pilot and bigger studies of vitamin D/MK-7 or phylloquinone to materialise? Shouldn’t the NCCAM fund those, or who funded the vitamin studies like SELECT? (not that the execution of those studies was always flawless)

  2. #2 Rob W
    October 15, 2009

    My view towards homeopathy is quite mixed — that is, one major shortcoming in modern western medicine is a broad failure to take advantage of the placebo effect. There are many, many conditions and symptoms that would ideally be treated with nothing at all beyond a sympathetic professional ear, encouragement, and a pill that “many people with this condition find quite helpful”. And there are no side-effects whatsoever!

    Homeopathy can really “work” — this is how — and if a patient goes into the doctor with a bad cold demanding medicine… it’s far better for them to come out a homeopathic placebo than a course of antibiotics. OR one of the other “alternative” medical treatments that is WORSE than placebo because it’s actively dangerous. Homeopathic remedies are inert.

    There’s the possibly-fatal flaw of placebos, of course — they *require* some level of misleading the patient, which is dangerous. I don’t know if there’s any real way to find a functional way to use them without abuse, and without people thinking they’ll cure their cancer… but it’s definitely worth exploration.

    I currently live in France, where homeopathy is friggin’ everywhere, but the pharmacists will tell you (and apparently the doctors who might suggest it also explain.. my doctor doesn’t) that for serious illnesses and certain conditions, it won’t be sufficient and/or won’t help. I have a neighbor who’s a big advocate of homeopathy, but this is her point of view — it doesn’t at all replace other medical treatments. That point of view is not proving to be dangerous for her.

  3. #3 Rob W
    October 15, 2009

    Just in case it doesn’t go without saying — yes, it’s a shameful waste of limited resources and *lives* to continue these studies attempting to find anything more than placebo effects in homeopathy.

  4. #4 Todd W.
    October 15, 2009

    I wonder if petitioning the Office of Management and Budget to take a scrutinizing look at NCCAM would have any effect. With all the money they’ve spent, they have little to show for finding anything positive in SCAM (Supplement, Complementary and Alternative Medicine) treatments.

    The questions to pose to the OMB would be, does their performance justify the expenditures they have made? Would the money and other resources be better utilized by transferring some or all to other areas of NIH?

  5. #5 Epinephrine
    October 15, 2009

    Always glad to see homeopathy treated with the scorn it deserves, but I’m not that impressed with the Holmes quote in the beginning. The comparison brings to mind [i]ad populum[/i] arguments, essentially implying that it’s wrong to treat the two sides as equally potentially valid, because one side has many more supporters.

    While I agree that homeopathy and intelligent design are both crocks of shit, it isn’t due to the number of people that adopt the positions (nor the number of scientists that adopt those positions) – it’s because the evidence doesn’t support the claims, that homeopathy makes no testable predictions, and that homeopathic “theory” is magic and handwaving rather than an explanatory framework.

  6. #6 Joe
    October 15, 2009

    Orac,

    I can’t really hold it against NCCAM. Its congressionally mandated that they fund research on woo. At best, they could shift their funds to other woo. That they tell us these don’t follow the laws of physics is probably as far as they can rebel without Harkin reforming them to be even more wooful.

    Congress would have to change this, but the chair of the relevant Senate committee is . . . Tom Harkin.

  7. #7 Todd W.
    October 15, 2009

    @Joe

    Congress would have to change this, but the chair of the relevant Senate committee is . . . Tom Harkin.

    Exactly why I suggested going for the purse strings via OMB.

  8. #8 Joe
    October 15, 2009

    Epinephrine,

    I don’t think OWH Sr.’s metaphor was about the number of people supporting the arguments. It was about the amount of evidence supporting the claims.

  9. #9 Joe
    October 15, 2009

    @Todd W.,

    I’m not sure OMB could do anything about it, other than try to ensure that the President’s budget doesn’t fund it.

  10. #10 Kismet
    October 15, 2009

    @Rob W
    I would disparage and preferably sue any doctor who blatantly lies and misleads me like that. Maybe some people enjoy being lied to, but I don’t want to suffer because of them. I prefer to be scientifically literate and, yes, I do consider even small lies like that to be dangerous to my health. A false sense of efficacy and safety is dangerous IAC.
    The problem with your medical accomodationalism – and it seems to be exactly that – is that it necessarily paves the way for more dangerous abuse. People will surmise, heck, if homeopathy “works”, why not let it “work” for the treatment of serious diseases, why not study it or why not sell it or an “improved placebo”? They’ll simply confuse “working” and working and the line between truth and lie will blurr even more for the general public. Not a good thing. Many people already have a hard time grasping scientific concepts.

    Maybe there are ways to benefit from the placebo effect, but promoting dishonesty of health professionals is not one of them. An example comes to mind: If you’ve got a cold get yourself some chicken soup and enjoy its classical anti-cold benefits – that way you’ll benefit from the placebo effect without promoting dangerous and deadly quackery.
    That may be a safe way to use the placebo effect.

  11. #11 Todd W.
    October 15, 2009

    @Joe

    NIH is part of the Department of Health and Human Services, which is funded by OMB. So, they control the purse strings, which is a pretty good motivator for “suggesting” change.

    @Kismet

    To add to what you mentioned, accommodating the use of placebos as treatment could potentially open the door for marketing of drugs (made by Big PharmaTM) that operate no better than placebo. That just stands to dilute (no pun intended) the medical standards of treatment.

  12. #12 Epinephrine
    October 15, 2009

    Joe wrote:

    I don’t think OWH Sr.’s metaphor was about the number of people supporting the arguments. It was about the amount of evidence supporting the claims.

    If I misconstrued it, I apologise. The unit of measure seemed to be “wise men” and “fools”, so it sounded like an ad populum comparison, many fools versus a few wise men. As an analogy regarding evidence it would be a much better quote :)

  13. #13 wfjag
    October 15, 2009

    Completely off topic, but, thought you’d enjoy reading about a Georgia federal judge fining Orly $20,000 “for her litigation tactics in a suit questioning whether Barack Obama is a U.S. citizen.” See Lawyer Fined $20K for ‘Wild Accusations’ in Suit Over Obama Citizenship, Oct 13, 2009, by Debra Cassens Weiss, American Bar Association Journal, http://www.abajournal.com/news/lawyer_fined_20k_for_wild_accusations_in_suit_questioning_obamas_citizenshi/

    As The Band would play: “Life is a Carnival.”

  14. #14 Sastra
    October 15, 2009

    I’ll add to Kismet and Todd W.’s list of ‘problems with advocating placebos’ by piling on the additional concern that it fosters a general disrespect for the methods and discoveries of science. Not only does promoting homeopathy lead to a misunderstanding of how the world works, but it encourages people to consider science to be a sort of conspiracy of dunces. Most people have either already encountered, or are likely to encounter, the fact that the consensus of scientists is that the principles of homeopathy contradict modern physics and chemistry. Now, however, they have to weigh this against the fact that doctors — at least, their doctor — thinks this doesn’t matter. Hey, so what? That’s what “the experts” say. “We” know different. The laws of nature are flexible, for they bend differently for different people.

    That sort of attitude is a very bad habit to get into.

  15. #15 Rob W
    October 15, 2009

    Kismet, others — I agree totally with the potential problems of advocating placebo use.

    My gut feeling is that there’s a way to curb the abuses, and a very limited approach could be feasibly used by regular non-woo doctors with only mild misdirection (“you could try this — it’s not a standard medical treatment, but 35% of the people who did reported that their pain was relieved, and there are no side effects”; then confirming it is a placebo if asked). I’d love to see some data on what doctors are already doing this — there have been, forever! — and get something more solid than my gut feeling (and yours, that it will lead to loss of respect for medicine/science, slippery slope to greater abuse, etc.).

    My observation has also been that the biggest reason many of the people I meet distrust science ALREADY is because they have “evidence” of the effectiveness of alternative treatments that science says are bunk. The placebo effect is NOT the same thing as no effect; is there no way for science to put sham treatments “in their place”, so to speak, so that people don’t continue to have reason to believe that science is out-of-touch, wrong, or some kind of conspiracy?

    I certainly don’t have any grand vision of how everything could work — I’m writing this as I think it — and I don’t want doctors lying to me either… but mostly I think it’s a damned shame that the really quite useful placebo effect is untapped, when it could be helping so many people. Apparently the placebo response is also getting significantly stronger, perhaps due to the advent of pervasive drug advertising; here’s an article on the subject I ran across a few months ago:
    http://www.wired.com/medtech/drugs/magazine/17-09/ff_placebo_effect?currentPage=all

    Is there any possible way to exploit that without playing witch doctor?

  16. #16 Rob W
    October 15, 2009

    Huh, that’s convenient. See here for another reminder that we shouldn’t be dismissing the placebo response:
    http://scienceblogs.com/notrocketscience/2009/10/the_placebo_effect_affects_pain_signalling_in_the_spine.php

    It’s not just people fooling themselves into thinking they feel less pain; they ACTUALLY feel less pain.

    This is why there’s also some risk involved in dismissing placebo effect treatments as useless shams; it’s not strictly true, and people know it; so they’re led to believe there might be some reason to the explanations given by the proponents (and THAT’s where the real sham comes into play…).

  17. #17 Sastra
    October 15, 2009

    Rob W.

    Is there any possible way to exploit that (the placebo effect) without playing witch doctor?

    Yes. The placebo effect works across the board, for legitimate medicine as well as the woo. That’s why they do testing, to make sure that the aspirin or whatever isn’t just seeming to work. If the medicine or therapy works out, you don’t lose the placebo effect. You have placebo effect +.

    I think then that the way to exploit the placebo effect in mainstream medicine is for doctors to use the same sort of reassurances and personal attention as alt med practitioners do — only they’re not lying. Exaggerating, perhaps, but not lying.

  18. #18 Rob W
    October 15, 2009

    Ah; good point. It does still leave a hole for cases where just a simple placebo would be better (for conditions that do respond to placebo where there *is* no real medical treatment yet, or where the active medications have some dangerous and unpredictable side effects that should be avoided if possible…), but you’re quite right; it’s not as if the effect is being completely wasted in modern medicine, and it could be exploited more without using placebos at all.

  19. #19 Air yeezys
    October 15, 2009

    I currently live in France, where homeopathy is friggin’ everywhere, but the pharmacists will tell you (and apparently the doctors who might suggest it also explain.. my doctor doesn’t) that for serious illnesses and certain conditions, it won’t be sufficient and/or won’t help. I have a neighbor who’s a big advocate of homeopathy, but this is her point of view — it doesn’t at all replace other medical treatments. That point of view is not proving to be dangerous for her.

  20. #20 firemancarl
    October 16, 2009

    First, hi everyone. I’ve been a lurker here and I think this is my first post. I like you hate the woo etcetera etcetera…

    So, funny thing happened on the way to the forum. Facebook actually. A guy I’ve known for a few years unfriended me becuase everytime he posted some alt med woo chiropratic anti vax shit, I would use info from this blog, ERV , and Phil Plait etc. I guess the final straw was yesterday when he posted 2 links. One was a video of some putz extolling the amount of mercury in the flu vac was deadly-28 gagillion times the safety level or some such. The second was about a cheerleader for the Washington Deadskins who got a vax and 10 days later suddenly had all sorts of nervous system issues. So, I ask him questions, like why it took 10 days and what underlying conditions did she have. The whole thingy seemed fishy. So, I must assume( yeah yeah ass whatever) he dropped me cause I dared to question him.

  21. #21 Antiquated Tory
    October 16, 2009

    Nevertheless, NCCAM has contributed $250,000 towards a clinical trial of “verum LM” (a homeopathic medicine diluted 1:50,000) for fibromyalgia at Dr. Andrew Weil’s Program in Integrative Medicine at the University of Arizona.
    Hey, an imaginary cure for an imaginary disease!
    Seriously, though, consider something like fibromyalgia, which certainly has symptoms (however non-specific) that a person suffers. Sure now, it’s almost certainly part psychosomatic and part generalized aches and discomfort that we all feel from time to time (esp those of us over 40). (See the difference in France between ‘j’ai fatigue’ and ‘je suis fatigue.’) But in our culture, you can’t just say “we can’t really find anything wrong with you, it’s probably due to some psychological stress you’re experiencing. Try taking it easy for awhile.” In our culture, that’s insulting the patient, telling them that they aren’t “really” sick, that it’s “all in the mind.” Never mind that suffering is suffering, psychosomatic in origin or otherwise. People want the confirmation and legitimacy that comes with a physical condition! (That’s why the term ‘fibromyalgia’ was coined in the first place.) And they want a physical cure. In other cultures they may have demons or djinn exorcised; in ours they want a doctor to listen to them and then to give them a drug. In this kind of thing I think homeopaths can perform a valuable service. They give the patients what they need, they get the patient out of your waiting room, and they keep themselves off the dole list! Now, if only there were a way to pay homeopaths with imaginary money… (Maybe someone from Goldman Sachs can help.)

  22. #22 imre
    November 20, 2009

The site is undergoing maintenance presently. Commenting has been disabled. Please check back later!