Sometimes politicians actually get it right.
I know, I know, it makes me choke on my words to admit it, but sometimes politicians can actually get science right. I’m referring to something that happened in the U.K., yesterday, when the Science and Technology Select Committee delivered its verdict on homeopathy. Indeed, the Committee has gone so far as to call for the complete withdrawal of NHS funding and official licensing for homeopathy. The report is called Evidence Check 2: Homeopathy, and I’ll cut to the chase. This is what the report concluded:
By providing homeopathy on the NHS and allowing MHRA licensing of products which subsequently appear on pharmacy shelves, the Government runs the risk of endorsing homeopathy as an efficacious system of medicine. To maintain patient trust, choice and safety, the Government should not endorse the use of placebo treatments, including homeopathy. Homeopathy should not be funded on the NHS and the MHRA should stop licensing homeopathic products.
It’s about time.
I realize that homeopathy is a frequent topic of supporters of science-based medicine, but that’s just because it’s about as pure a form of quackery as there is. After all, homeopathy is, more than almost any other “complementary and alternative” medicine modality, pure placebo given that homeopathic remedies above 12C (1024-fold dilution) are unlikely to have a single molecule of the original remedy left over. By the time homeopaths reach a 30C dilution (1060-fold), it’s incredibly unlikely that even a single molecule of active compound is left in the mixure, given that Avagadro’s number is on the order of 6.02 x 1023, 1037-fold lower than the dilution factor. These remedies are either left as water or packed into sugar pills and sold. It is the very fact that real homeopathy (not herbal remedies labeled as “homeopathic” when they are not) uses nothing more than water or alcohol diluents that makes it a perfect example to study how an inert “cure” can seem so compelling to so many people.
Moreover, the very principles of homeopathy are so ridiculous a their core from a scientific standpoint that it makes an excellent test case to examine how quackery can flourish. Stripped to its core, homeopathy is nothing more than a tarted up version of sympathetic magic, in which Frazier’s Law of Similarity (“like cures like”) is combined with the Law of Contagion (a.k.a. the “memory of water,” in which water somehow magically remembers only the good “homeopathic” bits that it’s been in contact with and somehow never remembers all the pollution, poison, and poo). Add to that the magical ritual in which it is supposedly the “succussion” between each dilution step that imbues the homeopathic remedy with its magical powers, and belief in homeopathy is nothing more than a belief in pure magic. Make no mistake, many are the times I’ve had homeopaths like Dana Ullman and others piously and condescendingly inform me that homeopathic remedies are more than just diluted substances but that it is the succussion that imbues them with their potency.
Unfortunately, the report can’t describe homeopathy in these terms, but there are certainly some excellent and very insightful observations, first, for example, about the plausibility of “like cures like”:
- We conclude that the principle of like-cures-like is theoretically weak. It fails to provide a credible physiological mode of action for homeopathic products. We note that this is the settled view of medical science. (Paragraph 54)
- We consider the notion that ultra-dilutions can maintain an imprint of substances previously dissolved in them to be scientifically implausible. (Paragraph 61)
That’s nothing more than a polite way of saying that “like cures like” is complete bollocks. (This is a British report, after all; so I think I should use the lingo.) Ditto the conclusion that water has “memory” that can maintain an imprint of substances previously dissolved on them. Of course, I would have put it another way, but then I don’t write reports for political bodies. I would also have been a lot less polite and a lot more–shall we say?–insolent than Martin Robbins was about this quote from Dr Peter Fisher, Director of the Royal London Homeopathic Hospital:
Dr Fisher stated that the process of “shaking is important” but was unable to say how much shaking was required. He said “that has not been fully investigated” but did tell us that “You have to shake it vigorously [...] if you just stir it gently, it does not work”
I’ve always wondered about this. As many may recall, Samuel Hahnemann, the founder of homeopathy, recommended smacking the vial containing the remedy being diluted against a leather-bound Bible as a way of shaking it. Martin may find it rather curious that homeopaths have never figured out how much shaking is needed between dilutions or how shaking supposedly “potentizes” the homeopathic remedy. Unfortunately, our National Center for Complementary and Alternative Medicine appears to have stepped in to fund a study of just that question, as I pointed out two years ago. Yes, that’s right. NCCAM has paid for what can only be described as pseudoscience. Would that our own government would have the clarity of vision to conclude, as Science and Technology Select Committee did, that homeopathy is not only not worth studying anymore but that doing so in clinical trials is unethical:
- There has been enough testing of homeopathy and plenty of evidence showing that it is not efficacious. Competition for research funding is fierce and we cannot see how further research on the efficacy of homeopathy is justified in the face of competing priorities.
- It is also unethical to enter patients into trials to answer questions that have been settled already. Given the different position on this important question between the Minister and his Chief Scientist, we recommend that the Government Chief Scientific Adviser, Professor John Beddington, investigate whether ministers are receiving effective advice and publish his own advice on this question.
Finally, I’ve discussed the ethics of trials of homeopathy, particularly in Third World countries. To understand the reason why clinical trials of homeopathy are unethical comes down to a question of informed consent. One of the overarching principles of clinical trials is that subjects must enter into them only after truly informed consent. That means that the patient must understand what the therapy being tested is, what its odds of helping are (as best as can be estimated by what is known about it at the time of the trial), and what the potential side effects are. Does anyone think that homoepaths actually describe what homeopathic remedies are to potential research subjects or patients. If they did, they’d have to explain that homeopathic remedies are water, that they have been diluted to the point where not a single of active molecule is likel to remain in them, and that science says that this is impossible. Indeed, to be truthful, a homeopath would have to explain that, for homeopathy to work, huge swaths of what we know about multiple areas of science, including physics, chemistry, and biochemistry would have to be not just wrong but totally, completely, and spectacularly wrong. I’m not talking about cutting edge science needing to be wrong, either. Cutting edge science is often later found to be incorrect or not supported by subsequent data. No, I’m talking about well-established science, such as the law of mass action or the chemistry and physics that say that the “memory of water” is so improbable form a scientific standpoint that it is, for all practical purposes, indistinguishable from impossible.
Of course, no homeopath would ever tell a patient or potential research subject anything like that. It would be the truth, but homeopaths believe in their woo, as do, unfortunately, many of the physicians suckered in to doing studies on these “remedies.” Even physicians not entirely sold on homeopathy tend to be so open-minded that their brains fall out when it comes to the possibility of the “memory of water.”
Even so, the MPs actually got it:
For patient choice to be real choice, patients must be adequately informed to understand the implications of treatments. For homeopathy this would certainly require an explanation that homeopathy is a placebo. When this is not done, patient choice is meaningless. When it is done, the effectiveness of the placebo–that is, homeopathy–may be diminished. We argue that the provision of homeopathy on the NHS, in effect, diminishes, not increases, informed patient choice.
This single brief paragraph is shockingly insightful, so much so that I find it hard to believe that it was written by a panel made up of politicians.
Perhaps the single most important conclusion of this report is the acknowledgment that when the government funds a treatment, it puts it imprimatur on that treatment. For all intents and purposes, by funding homeopathy, the British government is endorsing it as being evidence-based and effective, and this report recognized this fact. Indeed, it is because of this that the report explicitly recommends that the NHS stop funding homeopathy and other woo not based in science and evidence. This recommendation is also, in essence, a recommendation that the most famous bastion of homeopathic quackery in the world, the Royal London Homeopathic Hospital (visited three years ago by yours truly), be defunded and closed. The MPs also recommended that homeopathic medicines be delicensed:
It is unacceptable for the MHRA to license placebo products–in this case sugar pills–conferring upon them some of the status of medicines. Even if medical claims on labels are prohibited, the MHRA’s licensing itself lends direct credibility to a product. Licensing paves the way for retail in pharmacies and consequently the patient’s view of the credibility of homeopathy may be further enhanced. We conclude that it is time to break this chain and, as the licensing regimes operated by the MHRA fail the Evidence Check, the MHRA should withdraw its discrete licensing schemes for homeopathic products.
The MHRA is the Medicines and Health Care products Regulatory Agency. Basically, it appears to be the U.K. equivalent to our very own Food and Drug Administration. Being an American, I had not previously been aware that the MHRA licensed homeopathic remedies. And I thought the DSHEA of 1994 was bad! At least the FDA doesn’t license homeopathic remedies! In any case, it’s good to see the MPs tell it like it is and point out that it is not appropriate for a government body charged with regulating drugs and medical products to license placebos and confer upon them the status of real medicine.
Is this report likely to lead to action? Who knows? I’m not British and am therefore not familiar with British politics; perhaps some of my British readers could comment on the likelihood that these recommendations will become law and policy. Even as a Yank, though, I do know that Prince Charles is a huge booster of homeopathy and other varieties of quackery, and I can’t help but wonder what sort of influence he will bring to bear on the threat to his beloved homeopathic hospitals and remedies. On the other hand, this is a pretty resounding, damning report. Moreover, health care money is tight in the U.K., just as it is pretty much everywhere else in the wake of the global recession. Add this report to the budgetary pressures that will demand more efficiency and more evidence that what the NHS spends its limited resources on, and one can’t help but hope that this hard, cold reality, coupled with the political cover of this report, will lead to decreasing support and funding for homeopathy in the U.K.
A guy can dream, can’t he?