Respectful Insolence

I tell ya, I go away for a few days, let the blogging slow down, decrease the usual logorrhea. Heck, I even go for the lazy blogger trick of an open thread. In the meantime, while I was busy learning about real science at the 2010 AACR Meeting, the forces of pseudoscience have not been quiet. No, they’ve been active; indeed, there is so much that requires Orac’s not-so-Respectful Insolence and so little time for me to apply it. That means that, almost certainly, “deserving” candidates will be missed. That is a shame, but even Orac needs his rest from time to time.

None of this means that I can resist (at least not easily), when everyone’s “favorite” font of burning stupid, homeopathic apologist, derailer of comment threads, and someone who has no idea when he’s not just whipped but whipped, pureed, and stomped, pops up and deposits a turd of pseudoscience on that repository of pseudoscience, quackery, and woo, The Huffington Post. And I don’t intend to, given that Dana has supplied me with–shall we say?–an exceedingly “target-rich” environment. In particular, his article could provide rich fodder for a game of “Name That Logical Fallacy,” but that alone doesn’t make it “worthy” of the loving application of a heapin’ helpin’ of not-so-Respectful Insolence. This time around, Dana, filled with the arrogance of ignorance and clearly deeply resenting the justified criticisms of his favorite form of quackery (homeopathy, for those of you not familiar with him) and his hilariously inept attempts to defend it, has apparently decided it’s time to strike back. Since he has failed miserably to provide one iota of evidence that homeopathy is anything other than magic-based medicine (to steal Jamy Ian Swiss’ line) or, as I like to put it, Dr. Strange’s medicine, Ullman has apparently decided to go on the attack against science-based medicine. The result, as usual, is hilarious, as Ullman has produced a post entitled How Scientific Is Modern Medicine Really?

I have to say this: Even if every accusation laid on science-based medicine by Dana Ulman weren’t a huge bunch of distortions and cherrypicking, modern medicine would be orders of magnitude more scientific than Dana’s preferred modality, homeopathy. But let’s move on to Dana’s woo-ful whine. The first thing I noticed is that it appears to be a rehash of a very similar article that Ullman published two and a half years ago (and which I had some fun with when he posted it), except that he appears to have found a little more recent material to throw in, some more recent anti-SBM attacks to cherry pick. Consequently, rather than taking on the whole article, I refer the reader to my old deconstruction and will concentrate mainly on what is different in the 2010 edition of Ullman’s rant about how “medical science was wrong before” and, “Oh, by the way, doctors are poopyheads.” Ullman starts out very similarly to his old article:

Doctors today commonly assert that they practice “scientific medicine,” and patients think that the medical treatments they receive are “scientifically proven.” However, this ideal is a dream, not reality, and a clever and profitable marketing ruse, not fact.

The British Medical Journal’s “Clinical Evidence” analyzed common medical treatments to evaluate which are supported by sufficient reliable evidence (BMJ, 2007). They reviewed approximately 2,500 treatments and found:

  • 13 percent were found to be beneficial
  • 23 percent were likely to be beneficial
  • Eight percent were as likely to be harmful as beneficial
  • Six percent were unlikely to be beneficial
  • Four percent were likely to be harmful or ineffective.
  • 46 percent were unknown whether they were efficacious or harmful

The “study” to which Ullman refers is the introduction to BMJ’s ClinicalEvidence. It sounds pretty damning, doesn’t it? Except, as many attacks on SBM are, this is an exceedingly deceptive way of presenting information. For one thing, there is no discussion of how frequent the treatments are or for what conditions. Every “treatment” is treated as a single treatment, regardless of how uncommon the disease or treatment may be. It’s quite possible, for instance, that the 13% of treatments that were found to be beneficial were beneficial for far more than 13% of patients or 13% of conditions. No mention is made of what the 46% of treatments whose efficacy is supposedly unknown are, either. They could well be treatments for uncommon conditions or experimental treatments or holdovers.

Another thing that’s rather interesting about BMJ ClinicalEvidence is that it apparently doesn’t just cover conventional medicine. It covers alternative medicine as well. For example, look at this review of therapies for tension headache. Well, actually you can’t, and neither can I, because I don’t have a subscription to BMJ ClinicalEvidence, and neither does my institution. However, it’s possible to find summaries of the reviews in the lay press sometimes, and this is one case where the evidence was summarized by the BMJ team for The Guardian. It lists treatments that work (amitriptyline, mirtazapine) and treatments that are likely to work (cognitive behavioral therapy, for instance), but what’s interesting is what BMJ lists as treatments of unknown efficacy. These include “alternative” modalities, such as acupuncture, which really should have been listed not as “needing more study but under “does not work,” based on multiple studies–which tells me right there that the reviewers for BMJ are giving too much leeway to some alternative medicine modalities. Also included was Indian head massage and biofeedback. You get the idea.

But here’s something more interesting. Look at what therapies are listed as harmful. It is argued that taking over the counter painkillers is potentially harmful, but this is probably only true if headaches are frequent. If a person is not getting a headache every other day, if a person is, for instance, getting a headache only once or twice a month, it is unlikely to be harmful to take Tylenol or ibuprofen. Although pointing out that taking such drugs for headaches that occur 15 times a month may be harmful is probably true, when a bunch of such reviews are lumped together, a lot of therapies get thrown into the “harmful” or “unknown” categories. More importantly, it appears that the BMJ doesn’t just confine itself to “conventional” or “science-based medicine.” It appears to include all sorts of alternative therapies in its list. So Ullman is–surprise! surprise!–being either clueless (if he didn’t bother to look at a few reviews) or intellectually dishonest (if he did) by implying that the overall summary by BMJ represents the percentage of conventional therapies that don’t work. In fact, it looks at conventional medicine and various “alternative” modalities, like herbal remedies, acupuncture, etc.

In fact, lumping together all these therapies as a huge list is, in essence, meaningless other than a couple of things. First, I’m heartened at the low percentage of treatments that are likely to be harmful. Second, given that BMJ apparently includes a whole bunch of “alternative” therapies in its reviews, it’s actually not so bad that only 46% of treatments are of unknown effectiveness. In any case, as a commenter pointed out, for individual conditions, SBM does quite well–asthma, for instance, where 67% of treatments are beneficial or likely beneficial;
24% of treatments are of unknown effectiveness; 9% of treatments are unlikely to be beneficial. And, depending on the disease or condition, even conventional medicine’s efficacy can vary wildly.

Of course, homeopathy’s efficacy remains very constant, no matter what the condition. Homeopathy doesn’t work and would thus fall into “unlikely to be beneficial,” but only if you can say wildly, extravagantly, ridiculously unlikely to be beneficial. After all, it’s just water.

Another new bit that Ullman grafted onto his 2007 article is this:

Today in America, every man, woman, and child is prescribed around 13 prescription drugs per year (and this doesn’t count the many over-the-counter drugs that doctors prescribe and that patients take on their own) (Kaiser, 2006). Just 12 years earlier, Americans were on average prescribed less than eight drugs per person, a 62 percent increase! The fact of the matter is that drugs are not tested for approval in conjunction with other drugs, and the safety and efficacy of the use of multiple drugs together remains totally unknown.

This practice of “polypharmacy” is increasing substantially, and Big Pharma is pushing it hard and benefiting from it in a big big way.

According to a 2008 nationwide survey, 29 percent of Americans used at least five prescription medications concurrently (Qato, Alexander, Conti, 2008), while just three years previously, 17 percent took three or more prescription drugs (Medscape, 2005). Even conservative publications such as Scientific American can no longer deny the increasing serious problems from pharmaceuticals. A recent article highlighted the fact that there has been a 65 percent increase in drug overdoses leading to hospitalization or death just in the past seven years (Harmon, 2010).

One notes that, while it’s clear that polypharmacy is a problem, one can’t help but note that the very same source that Ullman cites also points out that the percent of the population with a prescription drug expense in 2003 was 61% (for those under age 65) and 91% (for those 65 and older), which has changed little since 1996, when they were 62% and 88%, respectively. One possible implication is that people who are on a prescription drug are now more likely to be on more prescription drugs than they were in the past. One thing that bugs me about these number, though, is that it is not clear whether these prescriptions represent new prescriptions or refills or both. My guess is that it’s both. In any case, Ullman clearly chose the number that sounds the worst, given the rate of increase in prescription drug spending is decreasing, from 4.5% in 2007 to 3.2% in 2008, although projections are that this spending will increase by 6% every year for the next decade, which is not suprising or out of the ordinary given that the Baby Boomer generation is heading into retirement and that senior citizens tend to use far more prescription drugs than do younger people. It just sounds scarier to make it sound as though every American is on at least 13 prescription drugs. Again, I’m not saying that polypharmacy and arguably too much spending on prescription drugs are not problems. However, practitioners of science-based medicine are aware of these problems and are trying to do something about them. In marked contrast, Ullman remains blissfully unaware or unwilling to admit that homeopathy is nothing more than water.

Similar comparisons can be made to the observation that there has been an increase in prescription drug overdoses over the last seven years. What Ullman neglects to mention is that the vast majority of this increase is due to prescription opoids and tranquilizers:

The biggest percent increase in hospitalizations for poisoning for a specific drug was a quintupling for methadone, according to the team’s report published in the American Journal of Preventive Medicine. This may be due to the more than 10-fold increase in overall retail sales of this drug from 1997 to 2006, they state.

Poisoning by benzodiazepines such as Xanax and Ativan — drugs that possess sedative, hypnotic, anti-anxiety, anticonvulsant and muscle relaxant activities — rose 39 percent over the study period.

Poisoning by barbiturates, which also have sedative, hypnotic and anti-anxiety actions, actually fell 41 percent, as did hospitalizations for poisoning by antidepressants (a decrease of 13 percent).

One also notes that there is a thriving black market for illegally selling many of these prescription drugs, as well as overprescription and wider availability of much drugs of a potency that could until recently only be obtained through intravenous injection. In any case, Ullman, not surprising, disingenuously makes it sound as though it’s all prescription drugs, not primarily drugs from one category, that are responsible for this increase in hospitalization. Once again, no one is arguing that unintentional overdoses of opiods and tranquilizers are not a problem. Once again, it is the medical profession, not homeopaths, who are sounding the alarm. Ullman is just cribbing reports done not by homeopaths or “alternative medicine” practitioners but by practitioners of science-based medicine and scientists. Once again, it is useful to point out that an overdose of any homeopathic remedy–true homeopathic remedy, that is, not homeopathic remedies that contain actual drugs or herbs in pharmacologically active concentrations–is nearly impossible to achieve, aside from drowning or water intoxication.

Ullman also can’t resist adding a different take to his attacks on big pharma, other than the pharma shill gambit and conspiracy mongering:

An even stronger case can be made for the epidemic of “elder medical abuse” due to the much larger number of drugs prescribed to and for our senior citizens. It is no wonder that so many of them have become mental zombies, while Big Pharma profits big time and insurance companies simply raise their rates.

If we were living a lot longer and the quality of our lives was improved by medical care, one could make a case for why today’s medical care is providing more benefits than problems, but this is simply not true.

Although we are commonly told that we are living longer than ever now, this is simply a clever, even tricky, use of statistics. The fact of the matter is that there has been a considerable reduction in deaths during the first five years of life … and this reduction in deaths has resulted primarily from a medicinal agent called “soap,” not from the use of any specific conventional pharmaceutical agent.

Ultimately, an American who was 40 years old in 1900 and an American who was 40 years old in 2000 has a similar chance of living to 80 years old today.

Ullman is just plain wrong here. As these life tables from the Department of Health and Human Services, National Center for Health Statistics; National Vital Statistics Reports, vol 54., no. 19, June 28, 2006. show, in 1900, life expectancy at age 40 was 27.74 years for white males and 29.17 years for white females. In 2000, the same numbers were 37.1 years and and 41.3 years, respectively, impressive increases. For age 60 over the same period life expectancy in men has increased from 14.35 years to 20 years; women from 15.23 years to 23.2 years. Ullman’s either mistaken or lying, take your pick. Or perhaps Ullman considers a 33% increase in life expectancy in men and a 42% increase for women from age 40 over the last century to be “similar.”

The bottom line is that we are living longer than ever and staying active longer than ever, and it sure isn’t homeopathy that is making that possible. In light of the flowing swaths of burning stupid that Dana laid down in his article, I can’t help but point out that Dana promises a part 2. I also can’t wait, as I’m sure it will be as entertaining as this rehash of his 2007 article, which, by the way, I did deconstruct back in 2007, which is the main reason I didn’t rehash the not-so-Respectful Insolence that I laid down on the parts of Ullman’s latest HuffPo travesty that are more or less identical (or at least very similar) to his 2007 piece.

Finally, I will close by citing what is perhaps the most disingenuous bit that Ullman included in his post:

NOTE: This article focuses on the issue of the amount of “science” in medical care today. I predict that many commenters below will choose to attack me or the subject of homeopathy, even though THIS is not the subject of this article. I sincerely hope that commenters will stick to the subject at hand. For those of you who wish to comment on homeopathic medicine research, I urge you to do so at articles on that subject.

Unfortunately for Dana, the one part he did keep from the older article is his rant against the AMA for having tried to suppress homeopathy back in the 1800s. In essence, Ullman is doing what apologists for homeopathy and various forms of alt-med have done for decades, if not centuries. Because they can’t present any convincing positive evidence for the efficacy of their favorite woo, they point out–and exaggerate, if necessary–the problems of science-based medicine. Unfortunately, these problems do not invalidate science-based medicine, nor do they validate homeopathy. Ullman means to imply that they do, because he really can’t do anything else. That’s why I did two things: I addressed the distortions in Ullman’s distortion-packed article, and I contrasted science-based medicine with homeopathy. In the end, even if everything Ullman said were utterly true and completely unexaggerated or cherry picked, science-based medicine would still be effective, and homeopathy would still be water.

Comments

  1. #1 Mu
    April 21, 2010

    Lets hope someone asks him how many of the “unlikely to work” treatments in the study he cites are homeopathic .

  2. #2 Patrick
    April 21, 2010

    I really like that note at the end because when I looked for the comments on his article, I saw this :

    “Featured Comments
    ChristyRed
    I’ve used homeopathy for the past dozen years and give thanks every day for the wonderful homeopath who introduced this magnificent system of medicine to the people in this area. It’s been so..”

    his supporters should really read that note and not comment about wateropathy on an article about “science”

  3. #3 Dangerous Bacon
    April 21, 2010

    What Ullman, like so many other alties who do tu quoque attacks on mainstream medicine seems oblivious to is that his source material for deficiencies in mainstream medicine is a mainstream medical journal. This is another example of how medicine is self-criticizing and self-correcting. Contrast that with the frequency with which alt med journals and homeopathy proponents review homepathy’s failures and urge that it be drastically overhauled or discarded – approximately never.

    And even if we accepted Ullman’s fulminations about lack of efficacy and greed in mainstream medicine at face value, why should we then turn to magic water instead?

  4. #4 Jojo
    April 21, 2010

    I plugged Dana’s note into Google translator (translating from Homeopath to Rational) and this is what I got:

    Note: I’ve written this article to take pot shots at my opponents. However, because I didn’t mention what it is I’m trying to defend, I’m really hoping that you will fall for my distraction and join me in bashing people people who are more credible than I. I really hope that by scolding you before you comment that you will be shamed into not criticizing me. If you cannot refrain from pointing out that I am a complete loon, please do it elsewhere so I can ignore you. Na Na Na boo boo.

  5. #5 DT
    April 21, 2010

    Another point about the BMJ Clinical Evidence’s assessment of treatments is that they use a very rigid yardstick to evalute treatments.

    Among the nearly half of all treatments for which there is “unknown effectiveness” are many for which the current available evidence does not meet with the standards of evidence being measured (ie no clear cut RCT or similarly strong evidence). For many of the treatments used which fall into this category there is some evidence, it is just not robust enoughto be categorised.

    The irony is that at the same time Dana regards any minimal/anecdotal froth as conclusive “proof” that homeopathy works, and wouldn’t know what robust evidence was if it bit him in his sorry ass.

  6. #6 Lycanthrope
    April 21, 2010

    I thought one of the worst parts was:

    The fact of the matter is that drugs are not tested for approval in conjunction with other drugs, and the safety and efficacy of the use of multiple drugs together remains totally unknown.

    Yet again, you’re either utterly, staggeringly ignorant or you’re lying, Ullman. There are many, many well-documented cases of adverse drug interactions, both with other prescription drugs and with other substances in general. Part of a pharmacist’s job is to know about these interactions.

  7. #7 Jilian Gastronicus
    April 21, 2010

    Methinks you’d benefit from some anger management. Or male member enlargement.

  8. #8 Jilian Gastronicus
    April 21, 2010

    Methinks you’d benefit from some anger management. Or male member enlargement.

  9. #9 madder
    April 21, 2010

    @DT:

    Absolutely spot-on. One is reminded of the fact that there are no RCTs supporting the use of parachutes to prevent deceleration fatigue, and that this intervention would therefore fall under the category of “unknown effectiveness.”

  10. #10 Pablo
    April 21, 2010

    You kind of touch on one of the questions I have about the BMJ article when you discuss how the treatments for asthma are generally supported (and I would still love to see the “non-effective” treatments for asthma – let me guess? Acupuncture? Chiropractor?)

    What are the ailments for the 46% of non-effective treatments? Common cold? Fatigue? Insomnia?

    A patient goes to the doc for a common cold, and the doctor recommends bedrest and chicken soup. Well, yeah, but it really hasn’t been shown to cure the cold. A patient with insomnia, and the doctor says drink a glass of warm milk. These recommendations are of dubious use, and the doctor knows it, but they appease the patient in a case where no real treatment is indicated.

    I recently went to the doctor for a heart arythmia, and what did I get? Nothing. Whoa, is that an effective treatment? Not at all, but given the presentation, medical treatment wasn’t indicated. If I were the type to worry about it, he could have recommended a non-efficacious treatment, if nothing else to get me out of the office. And it would have been perfectly acceptable.

    I am not at all surprised at the amount of non-effective treatment given. A very large amount of the time, the best approach is to do nothing. However, I think you will find that as the specificity of the diagnosis gets better, and the severity of the ailment increases, the reliance on scientifically viable techniques increases.

  11. #11 OleanderTea
    April 21, 2010

    Methinks you’d benefit from some anger management. Or male member enlargement. — Posted by: Jilian Gastronicus

    …Created by a homeopathic “doctor”, no doubt.

  12. #12 Calli Arcale
    April 21, 2010

    Orac:

    One thing that bugs me about these number, though, is that it is not clear whether these prescriptions represent new prescriptions or refills or both. My guess is that it’s both.

    If I’m not mistaken, it’s worse than that — it also doesn’t indicate whether these 13 prescriptions are being taken concurrently. Polypharmacy is when a person is taking several drugs together; how many people are really taking 13 drugs together all year long?

    Now, Ullman shocking does touch on a real point: polypharmacy is a growing practice, as we discover more treatments for more conditions, and it deserves continued study. But he seems to step from that to validating homeopathy, which is often intentionally polypharmaceutical — homeopaths will tailor treatments to the individual, mixing up a whole bunch of remedies to address the specific person’s imbalances. But why does his criticism of mainstream polypharmacy not apply to homeopathic polypharmacy? Perhaps because different homeopathic drugs generally cannot interfere with one another — they’re all solvent, so mixing them will just increase the dose of solvent. But that would involve admitting that homeopathy is bunk. Hmm….. Curious.

  13. #13 daijiyobu
    April 21, 2010

    Dullman recommends naturopathy. Case closed.

    -r.c.

  14. #14 Ian
    April 21, 2010

    *Le sigh* Comments section on HuffPo filled with whale.to citations.

    I was having a conversation with a guy last night who was lamenting the fact that he is no longer in university. He said that the people he thought were stupid in school are actually GENIUSES compared to the stupid he now faces in the real world.

  15. #15 Pablo
    April 21, 2010

    I was having a conversation with a guy last night who was lamenting the fact that he is no longer in university. He said that the people he thought were stupid in school are actually GENIUSES compared to the stupid he now faces in the real world.

    That explains Sarah Palin, for example.

    (seriously, listening to Palin totally reminds me of the answers I see on essay problems by college undergraduates. e.g. Step 1: restate the premise of the question as your answer)

  16. #16 Denice Walter
    April 21, 2010

    Orac sez,”Ullman’s either mistaken or lying,take your pick.” I don’t know, but this seems to be a common “Back to Eden” urban legend in Woo-topia, with a few variants:1.our ancestors lived in a “purer” world,free of toxins,Big Pharma,stress,etc.(Hah!)2.people who live “simply” today(e.g. “back to nature” types,indigenous people in say, oh, Ecuador and their neighbors, like Adams)actually live *longer* than we do.Gary Null has a nearly endless spiel about how rural Italians have these long, relaxed vegan meals, how everyone works hard in the fields,drinks pure water, etc.and similar nonsense about the lives of Americans 200+ years ago(e.g. “the ‘Founding Fathers’ lived to be over 80″.A few did,but it was hardly average).I doubt that these ideas are based on data, more like movies and novels.(BTW,I actually studied psych of aging)

  17. #17 Scott
    April 21, 2010

    If I’m not mistaken, it’s worse than that — it also doesn’t indicate whether these 13 prescriptions are being taken concurrently. Polypharmacy is when a person is taking several drugs together; how many people are really taking 13 drugs together all year long?

    In particular, consider things like SSRIs or triptans, where different people have different responses to different members of the same class of drug. In such cases it’s pretty routine to try several different drugs in succession to find out which works best for the patient in question.

  18. #18 SRDavid
    April 21, 2010

    Homeopathy is clearly bogus, but criticism of the psycho-pharmacology is on target. Psychiatrists are prone to automatically write a script rather than practice psychotherapy. Many of the mind-altering drugs carry stiff penalties in side-effects and are of less than stellar efficacy.

    I should modify the previous sentence. They are of tremendous efficacy in reducing the costs of treatment that the insurance industry must pay. They are also efficacious for the bottom line of the big pharma.

    Then there is iridology, emdr, naturopathy, reiki, and so many more–how about crystal energy. You have so much grist for your mill.

  19. #19 Todd W.
    April 21, 2010

    Regarding polypharmacy, FDA actually is thinking about this. They have, for example, this guidance document discussing design of drug-drug interaction studies. There is also this page discussing the issue of drug interactions, with lots of other links to follow.

    In short, FDA is strongly encouraging companies to test their new products in combination with other products that are likely to be used concurrently. Wow. Science-based medicine actually working to figure these issues out?

  20. #20 Poogles
    April 21, 2010

    “Psychiatrists are prone to automatically write a script rather than practice psychotherapy. ”

    This sounds so much like the “all OB’s just schedule inductions/c-sections so they can go golfing!” tripe, that I would like to see some evidence that this is the case, more often than not (of course, you will always find examples of professionals behaving badly – which says nothing of the overall profession).

  21. #21 Dangerous Bacon
    April 21, 2010

    “Homeopathy is clearly bogus, but criticism of the psycho-pharmacology is on target. Psychiatrists are prone to automatically write a script rather than practice psychotherapy. Many of the mind-altering drugs carry stiff penalties in side-effects and are of less than stellar efficacy…They are of tremendous efficacy in reducing the costs of treatment that the insurance industry must pay. They are also efficacious for the bottom line of the big pharma.”

    They’re also pretty damn efficacious for treating, say, depression in many people, who no longer have to endure extended psychotherapy sessions of higly dubious value, wasting time having their ids and superegos probed instead of getting on with life (with the aid of “the big pharma”).

  22. #22 Poogles
    April 21, 2010

    I would also add that there are many situations where the drug is needed before the therapy will even do any good – depression for example: if a person is so depressed and hopeless that they can barely crawl out of bed each morning, how are they going to get through long, often painful sessions exploring the deep recesses of their minds/personalities/life experiences?

    This is not always the case of course.

    Then there are those who refuse therapy, for whatever reason. Are they to have NO relief, simply because they didn’t choose the non-medication option?

    Sorry, I tend to get a little ruffled when people start claiming that doctors are just writing pills for people with mental illness, instead of giving them therapy. It’s not really a black and white issue.

  23. #23 Pablo
    April 21, 2010

    They’re also pretty damn efficacious for treating, say, depression in many people, who no longer have to endure extended psychotherapy sessions of higly dubious value,

    …speaking of non-effective treatments…

    “We should abandon those darn pharmacological treatments that are found to work is a large number of cases in favor of … psychotherapy, which doesn’t fix the problem.”

    It’s just the same crap that denies that mental illness is actually an illness, and thinks it is just a “state of mind.” Using psychotherapy for mental illness is like teaching someone with a broken leg to walk on crutches. It might help them get around, but it doesn’t address the cause of their problem.

  24. #24 J. J. Ramsey
    April 21, 2010

    I object to the claim that homeopathy is just water. Sometimes it’s wax, too. :P

  25. #25 Vicki
    April 21, 2010

    Pablo–

    In some cases, psychotherapy may be like teaching someone to walk on crutches. But we don’t always have a better option, at least not yet. It seems (I am not a professional) as though it depends to some extent on the nature and causes of the symptoms. That mental illness is an illness doesn’t mean that drugs are always the best way to treat it.

    In other cases, I think talking therapy may be somewhat like physical therapy. They don’t just teach you to walk with crutches, or not to lift heavy weights, they strengthen the body. Even with physical ills, neither surgery nor pharmacological interventions are always the best choice, or the best place to start. (When I had rotator cuff problems, the surgeon’s plan of action was PT; if that didn’t work, cortisone; and if that didn’t work, surgery. He sent me off with a recommendation for PT and the hope that he would never see me again. He hasn’t.)

  26. #26 Pablo
    April 21, 2010

    In some cases, psychotherapy may be like teaching someone to walk on crutches. But we don’t always have a better option, at least not yet.

    Which is why paraplegics are confined to wheelchairs.

    Absolutely there are times when we can’t fix the problem and need to provide other means of assistance. The same applies to treatment of mental illness. We can try things to fix the underlying cause, but until we do that, we provide a means to help the person cope.

    People with broken legs DO use crutches, while we use other means to fix the leg – i.e. there is role for therapy with drugs. But just because there are crutches available doesn’t mean we shouldn’t fix the leg.

  27. #27 DLC
    April 21, 2010

    Sorry, Ullman, but when you state your belief in Homeopathy, you also state your complete and utter lack of qualification to make any scientific claims. I’d just as soon hear the wizard of Oz discourse on particle physics.

  28. #28 Joseph
    April 21, 2010

    If you look at randomized trials of cognitive behavioral therapy (CBT) vs. anti-depressants or anxiolytics, both forms of treatment typically perform similarly well. CBT obviously has the advantage of lacking physiological side-effects, and it shouldn’t have any major withdrawal issues after you decide to stop taking the drug. CBT gains are apparently maintained at long-term follow-up.

    Combining drugs and CBT seems to work even better than either one alone.

  29. #29 BLUEMaxx
    April 21, 2010

    so..if I, as a member of the BIGPHARMA conspiracy develop a new drug.. we have two choices, right?

    submit all the research and information that proves efficacy and safety for the drug/chemical/potion, and ask for formal review by educated scientists, with goal of hopefully gaining approval from the FDA for prescriptive use.

    OR

    Call it HOMEOPATHIC… dilute it beyond recognition, and sell it with a disclaimer posted on the label.

    and remember folks …

    go over to the PEPSI site… and cast your 10 votes for something above or below GENERATION RESCUE… help prevent a $250,000 grant from being tragically wasted.

  30. #30 Don Cox
    April 21, 2010

    “CBT obviously has the advantage of lacking physiological side-effects, ”

    Are you certain of that?

    If it has the physiological effect of reducing the depression, it could have other physiological effects.

  31. #31 Matthew Cline
    April 21, 2010

    This is another example of how medicine is self-criticizing and self-correcting. Contrast that with the frequency with which alt med journals and homeopathy proponents review homepathy’s failures and urge that it be drastically overhauled or discarded – approximately never.

    I think the point of view of Ullman (and others who make similar criticisms) is that if the philosophy behind conventional medicine were sound, then the self corrections would all have taken place soon after conventional medicine had been founded, with it rapidly converging on perfection, at which point it would remain unchanged for the rest of eternity. Thus, to him, the fact that self corrections are still happening indicates that conventional medicine is bogus.

  32. #32 Todd W.
    April 21, 2010

    @Matthew Cline

    In other words, the Nirvana fallacy?

  33. #33 Calli Arcale
    April 21, 2010

    CBT is not without risks. Though it isn’t likely to have significant physiological effects, as it isn’t a physiological intervention, it can go badly wrong. Much like surgery, the practitioner can screw up, and if you embark upon CBT, you are taking the risks that your practitioner is not going to be able to help you and may even make you worse.

    This could be as simple as the patient struggling with ineffective CBT for weeks, deciding this proves they’re beyond hope, and killing themselves. Or it could be much more dramatic, and clearly into the realm of malpractice. There was a woman here in Minnesota not too long ago who I believe had her license revoked for seriously bad CBT — she basically pandered to her patients’ delusions, even to the point of arranging a meeting between two of them and taking them to her home to help keep them safe from the government mind-control agents which they were convinced lurked outside. The investigation found that she was not acting maliciously — just very, very misguidedly. You’re not supposed to actually contradict your patient, I suspect, and she took that to its logical extreme….

    Obviously, that wouldn’t often be a risk. But if you’re working to change a person’s behavior, you could inadvertently change it for the worse.

  34. #34 Calli Arcale
    April 21, 2010

    J. J. Ramsey @ 23:

    I object to the claim that homeopathy is just water. Sometimes it’s wax, too. :P

    Or sugar, or ethanol! I like those better. More fun. ;-)

  35. #35 Joseph
    April 21, 2010

    You’re not supposed to actually contradict your patient, I suspect, and she took that to its logical extreme….

    I’m pretty sure that’s not even “bad” CBT, but basically “not CBT.” A major part of CBT (ant is predecessor, REBT) involves challenging irrational, unrealistic and fantastic beliefs and worldviews.

  36. #36 Calli Arcale
    April 21, 2010

    I admit I am a software engineer, not a therapist, and do not know what CBT actually entails, nor the distinctions between various different types of “talk therapy”. I underwent therapy once, but I don’t really know what the correct term for it would be. In any case, isn’t the objective supposed to be to guide the *patient* to challenging those beliefs and worldviews? If the therapist just says “you know, that’s all bullshit”, there probably won’t be a second appointment.

  37. #37 Ian
    April 21, 2010

    @Poogles

    This sounds so much like the “all OB’s just schedule inductions/c-sections so they can go golfing!”

    Interestingly enough I was at a journal club on Monday where we were discussing the factors that influence OB decisions to schedule C-sections. A group in the USA tried to create a mathematical regression model to test whether it was due to a local (same hospital) or regional (same health authority) effect. Most of the variance in the model went unexplained, meaning that those hypotheses were not supported by the data (1600 physicians in NY and FL).

    One of the members of the group said she was part of a similar effort to discern why C-section rates were so high in one of the health authorities here in my province – the provincial health service keeps excellent records. They specifically tested the assumption that rates could be explained as a time-of-day or day-of-week phenomenon and found no association.

    Here is a picture of an otter.

  38. #38 Anonymous
    April 21, 2010

    Since this post appeared, Ullman’s article has been moved off the top banner position to significantly lower on the page. (Correlation does not imply causation, of course.)

  39. #39 Phil H
    April 21, 2010

    “It’s just the same crap that denies that mental illness is actually an illness, and thinks it is just a “state of mind.” Using psychotherapy for mental illness is like teaching someone with a broken leg to walk on crutches.”

    You are making a very strong claim there about the ultimate ’cause’ of psychological illness – especially something as complex as depression, which probably has multiple genetic, developmental and sociological factors involved in its genesis and maintenence.

    In fact, I’ve heard the inverse of that argument – SSRIs are a crutch, and therapy is needed to help you fully recover. This is is a good metaphor for how the combination of CBT and SSRIs is presumed to work on a neurobiological level (SSRIs ‘boost’ the signal from the more emotional parts of the brain to the more rational parts, and CBT boosts the signal from the more rational parts to the more emotional parts).

    If you have to choose just one, CBT is actually preferable to drug treatment alone as it has a lower rate of relapse. Don’t buy into the drug company hype about depression being ‘chemical imbalance’ – it’s neurologically meaningless, and it denies the brain the ability to do what it excels at – rewiring itself.

  40. #40 Science & Honor
    April 21, 2010

    A major part of CBT (ant is predecessor, REBT) involves challenging irrational, unrealistic and fantastic beliefs and worldviews.

    @Joseph,
    If that’s the case, all these homeopathy quacks could use a good dose of it!

  41. #41 Science & Honor
    April 21, 2010

    A major part of CBT (ant is predecessor, REBT) involves challenging irrational, unrealistic and fantastic beliefs and worldviews.

    @Joseph,
    If that’s the case, all these homeopathy quacks could use a good dose of it!

  42. #42 Science & Honor
    April 21, 2010

    A major part of CBT (ant is predecessor, REBT) involves challenging irrational, unrealistic and fantastic beliefs and worldviews.

    @Joseph,
    If that’s the case, all these homeopathy quacks could use a good dose of it!

  43. #43 Science & Honor
    April 21, 2010

    A major part of CBT (ant is predecessor, REBT) involves challenging irrational, unrealistic and fantastic beliefs and worldviews.

    @Joseph,
    If that’s the case, all these homeopathy quacks could use a good dose of it!

  44. #44 Science & Honor
    April 21, 2010

    A major part of CBT (ant is predecessor, REBT) involves challenging irrational, unrealistic and fantastic beliefs and worldviews.

    @Joseph,
    If that’s the case, all these homeopathy quacks could use a good dose of it!

  45. #45 Science & Honor
    April 21, 2010

    A major part of CBT (ant is predecessor, REBT) involves challenging irrational, unrealistic and fantastic beliefs and worldviews.

    @Joseph,
    If that’s the case, all these homeopathy quacks could use a good dose of it!

  46. #46 Science & Honor
    April 21, 2010

    A major part of CBT (ant is predecessor, REBT) involves challenging irrational, unrealistic and fantastic beliefs and worldviews.

    @Joseph,
    If that’s the case, all these homeopathy quacks could use a good dose of it!

  47. #47 Science & Honor
    April 21, 2010

    A major part of CBT (ant is predecessor, REBT) involves challenging irrational, unrealistic and fantastic beliefs and worldviews.

    @Joseph,
    If that’s the case, all these homeopathy quacks could use a good dose of it!

  48. #48 Science & Honor
    April 21, 2010

    A major part of CBT (ant is predecessor, REBT) involves challenging irrational, unrealistic and fantastic beliefs and worldviews.

    @Joseph,
    If that’s the case, all these homeopathy quacks could use a good dose of it!

  49. #49 Science & Honor
    April 21, 2010

    A major part of CBT (ant is predecessor, REBT) involves challenging irrational, unrealistic and fantastic beliefs and worldviews.

    @Joseph,
    If that’s the case, all these homeopathy quacks could use a good dose of it!

  50. #50 Science & Honor
    April 21, 2010

    A major part of CBT (ant is predecessor, REBT) involves challenging irrational, unrealistic and fantastic beliefs and worldviews.

    @Joseph,
    If that’s the case, all these homeopathy quacks could use a good dose of it!

  51. #51 Anthro
    April 21, 2010

    It is just as bad as Ullman for all you armchair psychiatrists to be offering your views (mostly anecdotal or completely undocumented) on mental health and its various treatment approaches.

    Having raised a child with a serious chemical imbalance, I can tell you that talk is great, and a part of treatment, but without the drugs, my child (and many others according to actual research) would be dead or in jail at best. I take my advice on mental health from medical doctors, including the specialty of psychiatry, not from lay people who hold highly personal and ideological views on mental health. I don’t have a TV and see very few drug ads, and I tire of people commenting that I have “just put my kid on drugs because of TV ads” and other such ignorant quips.

    ——

    Hey Orac–my suggestion for threads was Ullman–glad you agreed. You should check out his last couple of posts–supposedly offering “documentation” and “studies” that prove homeopathy. Most of his sources were his own books!

  52. #52 Chris
    April 21, 2010

    Anthro, been there, done that with a relative, who unfortunately died last month.

  53. #53 Chris
    April 21, 2010

    Oh, Anthro, I should add the healthiest time she had was right after leaving the psych ward. Then she went to a naturapath and was prescribed homeopathy. She found out very quickly that homeopathy does not work, which she shared with our extended family in a long letter. She went back to the real meds (though unfortunately she failed to follow up with the other recommendations from the doctors, like talk therapy, getting outside for walks, etc).

  54. #54 stuv.myopenid.com
    April 21, 2010

    Oh, I strongly disagree. CBT can be EXTREMELY painful!

    Wait. Wrong CBT? Never mind.

  55. #55 Denice Walter
    April 21, 2010

    Not wanting to wade into the morass,(i.e. the relationship between meds /psychotherapy,psychosocial education,vocational,etc.,which of course, varies with the particular MI being addressed):for a *start*,google up NIMH,then “Mental Health Topics”,then by condition.Tons of other related material via NAMI.

  56. #56 Old Rockin' Dave
    April 21, 2010

    Not only is homeopathy venerable woo, but woo-busting goes back nearly as far. The link is to a surprisingly well-designed trial of homeopathy that was done in 1835!

  57. #57 Old Rockin' Dave
    April 21, 2010

    http://www.sciencebasedmedicine.org/?p=4750
    The link appears to have been stripped off in my posting.

  58. #59 Travis
    April 21, 2010

    stuv, my initial thoughts were the same. That is one term to bring out the weirdos;-)

  59. #60 daijiyobu
    April 21, 2010

    Ullman plugs naturopathy, enough said!

    His argument overall, to borrow an analogy from Kim Atwood, is like saying that because jets are dangerous, flying carpets are the better choice.

    They’re safe. Certainly safer.

    -r.c.

  60. #61 Toxicosis
    April 22, 2010

    Would Phase 4 clinical trials be considered a hallmark of the scientific method in conventional therapy? If so how and why? If physicians are encouraged by pharmaceutical companies to prescribe any drug for a separate condition not indicated by the drug company initially, nor passed by the FDA for such use would this qualify as an application of the scientific method? Is prolific experimentation permissable devoid of scientific studies with toxicologic drug products justifiable, as long as only physicians do this? If drug companies hire private consultants or other scientists to ghostwrite papers on their behalf, or to allow scientists to place their names to articles endorsing new drugs that they have not written, would this also be considered a necessary practice supporting objective science and the scientific method?

    http://thestar.blogs.com/ethics/2010/02/only-onequarter-of-us-medical-centres-ban-ghostwriting.html

    And finally if a drug can stand firmly on it’s own merits than why would it be necessary to rig the game or game the system? Is this what science is all about?

    http://www.thefreelibrary.com/Uncover+bias+in+clinical+trials:+drug+research+should+be+objective,…-a0168737338

  61. #62 trrll
    April 22, 2010

    Would Phase 4 clinical trials be considered a hallmark of the scientific method in conventional therapy? If so how and why? If physicians are encouraged by pharmaceutical companies to prescribe any drug for a separate condition not indicated by the drug company initially, nor passed by the FDA for such use would this qualify as an application of the scientific method?

    This is kind of foolish. The only difference between a phase 4 trial and a phase 3 trial is that a phase 4 trial is conducted after a drug has been initially marketed. Do you imagine that somehow, once a drug has been marketed for a particular condition, there is nothing more to be discovered about it? Even a pharmaceutical company does not have the resources to carry out studies of every plausible use of a drug. So they initially focus on the most likely, and most profitable, applications. Subsequent studies may examine other possible applications.

  62. #63 Tracy W
    April 22, 2010

    SRDavid – you appear to think that psycho-pharmacology being cheaper than psychiatry is an argument against using them. In fact it’s an argument *for* using them. Of course, there may be other arguments against using a cheaper treatment system that outweigh the benefits of saving money, but that doesn’t mean that it’s always a bad thing to reduce the costs of treatment. Resources are limited, skilled psychotherapists are expensive. Something has to give somewhere.

    And please don’t take this as a comment about the state of the US medical system in particular. I personally am a NZer and thus used to a government-paid health care system, where costs come home to the taxpayer, but in a private system where insurance companies cover costs, insurers in their turn recover their costs from their customers so the point is the same. And I note that the USA and NZ have both seen rapid increases in health care spending from 1990-2007 – so in that at least both systems are similar.

  63. #64 Todd W.
    April 22, 2010

    OT, but here’s another project to vote for on the Pepsi Refresh Everything contest. The applicant is a doctor at Massachusetts General Hospital and is researching the possible causes of Alzheimer’s disease. Currently, he’s ranked 67th, but if we can get enough votes, we can probably put him at least above GR/AoA.

  64. #65 Toxicosis
    April 22, 2010

    @trll
    Since the majority of Phase 4 studies will never be submitted to the FDA, they may be totally unregulated. Few of them are published. In fact, like all industry sponsored trials, they are not likely to be published at all unless they show something favorable to the sponsor’s drug. If they are published, it is often in marginal journals, because the quality of the research is so poor. Whereas companies generally prefer phase 1 through phase 3 studies to be done by experienced research investigators, phase 4 programs offer sponsors the opportunity to initiate and develop strategic relationships especially with high volume prescribers. In other words, it isn’t really research, so don’t worry about it’s scientific validity.
    And devoid of a mechanism of action of the drug towards a specific symptom set or syndrome, why does guesswork replace rigorous scientific assessment?

  65. #66 OleanderTea
    April 22, 2010

    Tracy W: “SRDavid – you appear to think that psycho-pharmacology being cheaper than psychiatry is an argument against using them. In fact it’s an argument *for* using them. “

    On the subject of psycho-pharmacology vs. psychiatry…there are other reasons, at least in the US’s corporate culture, that Americans love their pills. We don’t want to wait to get better, and even if we do, our employers REALLY don’t want to wait for us to get better.

    This was my experience when I was on disability leave from my job, because of major depression and panic disorder (which developed after the chronic pain condition started). And the disability benefit administrators thought that after six weeks on an antidepressant, one should be back to work full-time! All better! When we know that isn’t how depression always works.

    A lot of people have had similar experiences when trying to use their “employee benefits” for psychiatric reasons. The idiot companies that administer corporate short-term disability benefits understand, “Patient is on a trial of 60 mg fluoxetine; Dr. Bob will evaluate progress in two weeks” far better than, “Patient is undergoing talk therapy, behavior modification, and exercise, and will be re-evaluated in four weeks.”

    Our Corporate Feudal Overlords don’t really want us to have time to heal and recover from anything. Rest and care isn’t seen as being “proactive”, but taking a pill is.

    I have nothing against pills – Effoxor gave me “myself” back, and medications for asthma and pain ensure that my quality of life is pretty darn good – but I don’t like that as a society we ONLY value pills.

    Of course, that doesn’t mean that I think homeopathy or crystal therapy aren’t quackalicious.

  66. #67 Calli Arcale
    April 22, 2010

    Toxicosis: part of what you’re alluding to is “publication bias”. Positive studies are far more likely to see the light of day than negative ones, and that’s actually not restricted to studies sponsored by drug companies. (Not all trials are run by drug companies; universities do a lot of studies as well, and though one might hope their motivations to be more pure, academics suffer from the “publish or die” phenomenon, and may feel that positive studies look better when applying for tenure.)

    Oleander Tea:

    Our Corporate Feudal Overlords don’t really want us to have time to heal and recover from anything. Rest and care isn’t seen as being “proactive”, but taking a pill is.

    I have nothing against pills – Effoxor gave me “myself” back, and medications for asthma and pain ensure that my quality of life is pretty darn good – but I don’t like that as a society we ONLY value pills.

    Of course, that doesn’t mean that I think homeopathy or crystal therapy aren’t quackalicious.

    I think our Corporate Feudal Overlords aren’t really to blame for that — our culture is. As you say, we as a society would rather take a pill than do something that involves a significant time commitment — or admit to actually being physical unfit in some way. Truthfully, I think our bias towards pills actually makes us more receptive to quackery, not less; to the average Joe, the appeal of homeopathy is exactly the same as the appeal of aspirin. “Take two and call me in the morning.” If our doctor could wave a magic wand and make us better, we’d be all over that, and not entirely unreasonably; of course that sounds more appealing than interrupting our schedules.

    The biggest reason we resist improving leave policies is not evil bosses. It’s the Puritan work ethic. We see time off as “slacker time” and while we like to joke about how much we’d like to slack off for a while, we joke to set ourselves at ease that we’re not really slackers. We’re dedicated hard workers. We’d rather slack, but because we’re good, upstanding people, we don’t. That’s not entirely bad, but not entirely good either, and we end up feeling very conflicted about a lot of things.

  67. #68 gaiainc
    April 22, 2010

    The adage I remember from med school and residency is that it’s generally not a good idea to challenge a paranoid schizophrenic’s delusion that the black helicopters are out to get him or her. Really. Not a good idea. However, it’s OK to challenged a depressed person’s feeling of helplessness or worldview that only bad things happen to him or her when good things do happen. The distinction may seem subtle, but it’s there.

    Challenges to getting mental health care includes: lack of coverage (which includes insurances only covering X number of visits where X is clearly an insufficient number of visits), lack of access to services, not finding a therapist that you like that your insurance covers, not finding a psychiatrist that you like that your insurance covers, time, willingness to work with therapy (which can be challenging).

    In an ideal world (or my ideal world) people would do counseling/therapy as well as meds. In my reality, my patients have easier access to me to do do meds than they do counseling. Completely effed-up.

    More on topic, the more I read Ullman, the more I have to shake my head. Oy. So much stupid in so little space. It hurts us, my precious. It hurts us.

  68. #69 trrll
    April 22, 2010

    Since the majority of Phase 4 studies will never be submitted to the FDA, they may be totally unregulated. Few of them are published. In fact, like all industry sponsored trials, they are not likely to be published at all unless they show something favorable to the sponsor’s drug. If they are published, it is often in marginal journals, because the quality of the research is so poor. Whereas companies generally prefer phase 1 through phase 3 studies to be done by experienced research investigators, phase 4 programs offer sponsors the opportunity to initiate and develop strategic relationships especially with high volume prescribers. In other words, it isn’t really research, so don’t worry about it’s scientific validity.

    Clinical trials in progress are required to be listed on clinicaltrials.gov, so if the results are never published, people are likely to assume that the results were negative. While there have certainly been instances of Phase 4 studies being misused as marketing devices, this seems to be the exception. There are many examples of the indications for drug use being expanded based on Phase 4 studies, which can be highly profitable for the manufacturer. To achieve this, the research has to be of high caliber. Such studies also may reveal risks that were not apparent in smaller studies prior to approval. For example, it was Merck’s Phase 4 studies of Vioxx published by Merck that revealed that Vioxx carries cardiovascular hazards, which ultimately led to the withdrawal of Vioxx from the market. Subsequent studies revealed that these cardiovascular hazards are shared by almost all NSAIDs, something that might well not have been discovered if not for Merck’s published phase 4 studies.

    In fact considering the widespread belief (particularly among advocates of “alternative” therapies that lack any reliable clinical studies showing benefit) that drug companies cover up negative results or even fabricate favorable results, isn’t it remarkable that the business news is full of reports of major studies of drugs in which pharmaceutical companies have invested hundreds of millions of dollars coming out negative. For small companies, a negative outcome can often be the end of the company, yet this happens all the time.

    And devoid of a mechanism of action of the drug towards a specific symptom set or syndrome, why does guesswork replace rigorous scientific assessment?

    In most cases, by the time that a drug is released, its mechanism is fairly well understood, so additional applications are inferences, not guesswork. But physiology and pharmacology are complicated, so reasonable inferences can still turn out to be wrong. Which is why the FDA requires phase 4 studies to expand the indications for a drug, even when the proposed new use seems obvious based upon the drug’s mechanism.

  69. #70 Pablo
    April 22, 2010

    In most cases, by the time that a drug is released, its mechanism is fairly well understood, so additional applications are inferences, not guesswork.

    Wasn’t Rogaine a high-blood pressure medication? Or was that Viagra? I think Viagra was something else.

  70. #71 Todd W.
    April 22, 2010

    Just to tie into trrll’s comment about clinicaltrials.gov, there is, IIRC, legislation either in the works or already passed with an implementation timeline that all trials, in addition to the registration requirement, are (or will be) required to post results. That would include phase 4.

  71. #72 trrll
    April 23, 2010

    Wasn’t Rogaine a high-blood pressure medication? Or was that Viagra? I think Viagra was something else

    It is not uncommon for a molecule to be initially synthesized with one action in mind, but for it eventually to be discovered to have another effect. In general, it is not possible to predict what function a molecule will have on the body without testing, other than by similarity to known molecules (and even that is often misleading). Big pharmaceutical companies have huge compound libraries, which they will screen for action against new biological drug targets.

    Both minoxidil (Rogaine) and sildenifil (Viagra) were somewhat fortuitous discoveries. Nobody decided out of the blue to test minoxidil (Rogaine) for treatment of hair loss or sildenifil (Viagra) for erectile disfunction. Rather these were side effects noted during clinical testing for another indication. Both were initially developed as vasodilators for treatment of hypertension, which makes a certain amount of mechanistic sense. It is speculated that minoxidil may increase blood supply to hair follicles, whereas sildenafil turns out to be particularly good in inducing vasodilation in a specific body part.

  72. #73 squirrelelite
    April 23, 2010

    On the subject of homeopathy, Roger Ebert made this interesting comment in his review of a bad movie today:

    http://rogerebert.suntimes.com/apps/pbcs.dll/article?AID=/20100421/REVIEWS/100429995/-1/email_headlines

    “The movie deals with artificial insemination, romance, sex and organic goat cheese, which are promising areas for investigation, but it’s so watered-down, it approaches homeopathy.”

  73. #74 jonmc
    April 24, 2010

    On the Huffington Post Ullman is described as a Homeopathy expert in his bio. So does that mean he only knows 1 ten millionth or less of what he is talking about?

  74. #75 squirrelelite
    April 24, 2010

    @jonmc,

    That’s probably right.

    But, at least he can support it with a “proving”.

  75. #76 Mongrel
    April 25, 2010

    Yet again, you’re either utterly, staggeringly ignorant or you’re lying, Ullman. There are many, many well-documented cases of adverse drug interactions, both with other prescription drugs and with other substances in general. Part of a pharmacist’s job is to know about these interactions.

    In the UK, and most countries have similar regulations, a quick look at either the Specification of Product Characteristics (SPC) or the enclosed Patient Information Leaflet (PIL) will show numerous warnings about Contraindications (See here for examples – http://www.medicines.org.uk/emc/)

    As for the thought that drugs pass Phase III clinical trials and that’s it, they’re let loose on an unsuspecting public – balderdash. Most countries have something similar to the UK’s [url=http://www.mhra.gov.uk/Safetyinformation/Reportingsafetyproblems/Reportingsuspectedadversedrugreactions/Healthcareprofessionalreporting/BlackTriangleScheme/index.htm]Black Triangle Scheme[/url], which means the drug is monitored closely by the whole range of healthcare professionals

  76. #78 Sauceress
    April 25, 2010

    I’m sure this has been asked (possibly answered)somewhere on this site before, but if water has memory then where/how do homeopaths obtain “pure water” for use in their dilutions?

  77. #79 Calli Arcale
    April 26, 2010

    trll:

    It is speculated that minoxidil may increase blood supply to hair follicles, whereas sildenafil turns out to be particularly good in inducing vasodilation in a specific body part.

    Just to elaborate, because I think it’s very cool, sildenafil is used in a number of non-ED applications. For instance, there are women who take it, and it’s not for sexual problems. (Viagra has been rather disappointing in female sexual dysfunction.) Cooler still is its use in neonatal intensive care units. It has saved the lives of a number of “blue babies”, increasing blood flow in their bodies to compensate for their inefficient hearts until surgery could correct the underlying problem.

  78. #80 madder
    April 26, 2010

    @Sauceress:

    Water has a memory, but it is a particularly ill-motivated pupil:

    It forgets rather easily: distillation makes it forget, obviously, but the water containing a homeopathic solution will also forget its lessons if it is dumped into a body of water such as a lake or river. This is fortunate, because otherwise we’d all be at the mercy of hundreds or thousands of competing preparations– homeopathic goofballs, if you will.

    It learns only with difficulty: lessons must be literally beaten into it by a willful instructor. The preparation must be “succussed” after each dilution, and this includes bashing the container against the wall. Preferably wooden, as I recall.

    It is left as exercises for the reader to show how, say, a waterfall with fallen trees in it fails to generate homeopathic solutions, and how any homeopathic solution dumped into said waterfall is destroyed.

  79. #81 madder
    April 26, 2010

    @Sauceress:

    Sorry, I forgot to add that one can conclude from the foregoing that any old water the homeopath finds will suffice.

  80. #82 Gwen
    April 29, 2010

    AFAIK they use double distilled water (that still has impurities in it, many if not all of them in higher concentration than the “active ingredient” will be in the final product – and those are succussed, too, so one has to wonder how intelligent water has to be to understand it’s not supposed to remember those impurities and make them “remedies”). Of course even if water had a memory (the way homeopaths think it has), it still wouldn’t explain
    a) why other solvents (e.g. ethanol) can be used
    b) how the memory can be transferred to sugar pillules
    c) how this memory is kept once the “remedy” enters the body

    Of course none of this matters as long as homeopaths can’t even show that their remedies work at all – with studies that are both clinically significant positive AND replicable.
    So I guess madder is right, they may use double distilled water, but as water seems to be incredibly intelligent it doesn’t really matter what kind they use.

  81. #83 Abhi
    April 30, 2010

    Homeopathy is great since based on totality of symptoms of the whole person, not just disease he\she is suffering. I suffered from allergy and had lost all hope.. somebody suggested homeopathy.. i doubted if it will work fast enough or will it work at all… it did… and i got well. Since then i keep on trying more ab’t homeopathy.. homeopathic remedy is not just magic water… if u think so.. then try it… and u will amazed at the results!!

  82. #84 Antaeus Feldspar
    April 30, 2010

    homeopathic remedy is not just magic water… if u think so.. then try it… and u will amazed at the results!!

    Really? And how do you know that the “results” I get from homeopathy are any different from the results I’d get from simply waiting for the condition to subside on its own, as many conditions do?

    The answer is that you don’t see what happens to any one person, you study it scientifically by looking at an experimental group and a control group. When this has been done the results indicate that those getting the homeopathic remedies don’t actually improve any faster or more thoroughly than those getting placebo.

  83. #85 pv
    May 1, 2010

    @66, Dullman is staggeringly ignorant and a compulsive liar.
    I’m waiting for him to produce one (only one) fully documented, incontrovertible example of homeopathy having cured a non-self-limiting condition. I’ve posted this request several times over the last 3 or 4 years to any homeopath who care to stump up the goodies. But no case has been forthcoming. 200+ years of patient care and meticulous record keeping, and there should be case examples crawling out of the woodwork. But in fact after 200 years the total number of case examples is zero… fuck all.
    Homeopaths are medical frauds and I’d say most of them know it. They take money under false pretences to “cure” self-limiting or invented illnesses, which by definition need no medical intervention. If it were the financial industry they would quite rightly be in prison.

  84. #86 zoogal
    November 5, 2010

    “Thinking themselves wise they became fools” Rom 1:22

    “John Ioannidis is one of the world’s most important experts on the credibility of medical research.”…

    The Atlantic reports:

    “His work has been widely accepted by the medical community … Yet for all his influence, he worries that the field of medical research is so pervasively flawed, and so riddled with conflicts of interest, that it might be chronically resistant to change — or even to publicly admitting that there’s a problem.”

    meaning that Dana could very well be speaking the truth, don’t be so quick to judge. Also, concerning Homeopathic treatment, my husband suffered from severe Asthma, all I would hear is him gasping for air and puffing on the inhalers. I finally got fed up and dragged his butt into a Homeopathic clinic and he is now inhaler and asthma free! It also cured my colicy baby and I am sure my baby doesn’t lie. Oh and it cures my dogs ailments like punctures, infections, etc in half the time of traditional vet drugs and I am pretty sure my dogs don’t lie or have “fake” diseases either. Oh and if you want to talk about “control” groups why not look into Cuba and Brazil that now use Homeopathic immunizations instead of vaccinations and have done studies involving over 2 million people and have proved they work. Cuba now has used them for over 9 million people! It is even supported by the Finlay Institute! http://www.medicalnewstoday.com/articles/197128.php

  85. #87 Scott
    November 5, 2010

    @ 76:

    Citations needed.

  86. #88 Chris
    November 5, 2010

    All hail, zoogal, our new Necromancer. Providing not only “proof by anecdote” (which is worthless), but making us aware of a silly article that was covered here by a friend of Orac.

  87. #89 Susan Vaughan
    November 13, 2010

    Despite the one commenter’s remarks,
    Drugs are NOT tested for their interactions with multiple drugs. And the tests results the FDA gets from manufacturers are not always (if ever) on the up and up.

    During the course of their use, doctors become aware of drugs’ interactions with other drugs as well as their adverse effects on the general population, and of course as we learn more about P450 clearing, we can expect some drugs to cause problem interactions when they share the same clearance pathways.
    Drugs are only supposed to be allowed on the market if they are shown through premarket trials, to be safe and effective. If they have a narrow margin of safety and yet fill no special unmet need, then they are not supposed to be approved. But that is not what is happening now, as the story of Halcion, for one, illustrates.

    One only needs to study the well-documented history of Halcion to understand how our current health care system is based, at least partly, on fraud. Halcion got on the market through Upjohn’s fraud, it stayed on the market through Upjohn’s use of distortion and legitimation and wielding the power of its huge monetary worth (using SLAPPS and SLAURS etc) — and now, despite volumes of serious adverse effects reports and an unprecedented number of violent acts associated with its use, this notorious sleeping pill is being re-packaged and sexed up as the ideal dental sedative, and being promoted by the same kinds of lies that got it on the market, in the first place, and kept it on the market after it was banned in a number of countries including the UK. It was documented conflicts of interest that kept the drug on the US market after it was banned elsewhere.

    Halcion’s well-documented example should make everyone skeptical of our health care system and eagerly seeking alternatives to its drug-based mode of “healing.”

    Anyone critical of homeopathy or other non-drug treatments has apparently not yet been destroyed or had a loved one destroyed by one of our “wonder-working” FDA-approved medications.

    And, as a grad student in Public Health, I learned that all the talk about us living longer lives applies to the generation born BEFORE WWII – before technology from chemical warfare got transformed into our modern pharmaceutical industry and chemical industries — before food lost its nutritional value because of the way farming has changed — before synthetic perfumes and pesticides (made by the pharmaceutical industry also) began taking over our lungs and our brains and affecting school children. and before our air was polluted and our school and work environments became closed off from fresh air and polluted as well.

    Just wait and see how long the next generation lives – the one that grew up on McDonalds and Gatorade and so forth.

    Give Food Inc a glance.

    Chemicals, pharmaceuticals, pesticides and perfumes, Medicare, and the government are all in business together and the they’re all feeding off of one another, all at the public’s expense.

    I give Ullman great credit for getting a word in edgewise.

  88. #90 Chris
    November 13, 2010

    Oh, look! Now we have the “moving the goal posts” Necromancer!

    Gee, Susan, did it take you seven months to come up with that comment? With that much time, you would think a cite or two would have been warranted? So do tell us how homeopathy is related to actual food. How exactly does diluting a substance to one part to 1060 (that is “30C” by the way) parts of a solvent work? We wait with baited breath.

  89. #91 Chris
    November 13, 2010

    Oh, look! Now we have the “moving the goal posts” Necromancer!

    Gee, Susan, did it take you seven months to come up with that comment? With that much time, you would think a cite or two would have been warranted? So do tell us how homeopathy is related to actual food. How exactly does diluting a substance to one part to 1060 (that is “30C” by the way) parts of a solvent work? Often times the liquid remedy is sprinkled, or just waved by, a jar of lactose sugar pills. Obviously that is not real food. We wait with baited breath for your well documented answer.

  90. #92 Chris
    November 13, 2010

    Oh, rats! How did that double post happen? It must have posted when I hit “preview.” Considering the second has the edit I did in “preview.”

  91. #93 Todd W.
    November 13, 2010

    Drugs are NOT tested for their interactions with multiple drugs. And the tests results the FDA gets from manufacturers are not always (if ever) on the up and up.

    I’m sure you have evidence of this? FDA strongly recommends that manufacturers include in their clinical trials testing with other drugs that are likely to be given at or around the same time as the investigational drug. Why, the FDA even has guidance documents (and quite a few of them at that) on drug development and drug interactions. There is even a procedure manual for assessing drug-drug interactions with questions like, “Is there an in vitro basis to suspect in vivo drug-drug interactions?”

    The guidance “Drug Interaction Studies – Study Design, Data Analysis, and Implications for Dosing and Labeling” states:

    The guidance reflects the Agency’s current view that the metabolism of an investigational new drug should be defined during drug development and that its interactions with other drugs should be explored as part of an adequate assessment of its safety and effectiveness.

    So, you were saying?

  92. #94 madder
    November 13, 2010

    @Susan Vaughan:

    So, if I follow your evidence and reasoning correctly, it goes something like this: “Conventional medicine is imperfect. Therefore homeopathy is effective.” This is a truly revolutionary finding. I encourage you to submit your novel logic to philosophy journals, for clearly they’ve been doing everything wrong. I would also encourage you to submit this evidence for the effectiveness of homeopathy to all the major journals in physics, chemistry, biology, pharmacology, and medicine, because every single “fact” they contain is overturned by the truth of homeopathy. Actually, why don’t you just start with Science or Nature? Your pick.

    I see that you claim to be a graduate student in a Master’s of Public Health program. I hope that your advisors see this post, because you will instantly rocket to the top of your class. We need more people like you dispensing public-health advice*.

    * You are trying to undo all the advances in several hundred years of medicine, right? So that all the pharma companies will grow obscenely wealthy on the resulting epidemics and complications?

  93. #95 Dave
    November 15, 2010

    As for Roger Ebert, look whan allopathic treatment did to him!

  94. #96 Chris
    November 15, 2010

    Dave, it is now up to you to prove that homeopathy is effective for cancer. Please remember that we require a high level of evidence and argument by assertion is worthless.

  95. #97 Vicki
    November 15, 2010

    I’m fairly sure that Ebert’s answer to that would be some variant on “I’m still alive.” Difficult as it is for some people to accept, Ebert does not seem to believe that the surgery ruined his life, or made it not worth living.

  96. #98 Lisa Davidson
    February 21, 2011

    There’s one thing that everyone is leaving out here. Let’s stop theorizing and start experimenting. I’m not talking about curing cancer or doing anything fancy at the moment. I just want to demonstrate that homeopathic remedies have great power. I’m not describing how to use them to cure anything, although it’s quite possible to do so if you use them correctly. I will just give you one simple and repeatable experiment, which anyone can make. To assure yourself of the accuracy of your results, you can make this experiment over and over. This is the experiment. Get some Ignatia in 30C potency. You can get this at any health food store that has a Boiron section. Dispense five or six pellets of this into a small glass of water, swish them around until they dissolve (this will take a while), and drink it. Repeat this every morning until you feel results, in case you have not felt anything yet, although most likely you will have. Do not mix remedies together. Use only one kind at a time. Let this demonstration only be of Ignatia. Do not use combination remedies with labels such as Fear or Sadness. They are simply silly. Believe me, if you do this for a week you will notice profound effects, and, in fact, you will have conducted what they call a “proving.” This is the scientific way of investigating whether a remedy has any particular powers or not. Then, once you know whether a remedy is a worthwhile weapon to add to your arsenal of “disease-fighting” agents, you will be well on your way to being a real scientist. It is of no use to be swept into arguments of logic and theory and egomania: you need to just experiment with the stuff and see if it does anything or not. And it’s fun, actually.

  97. #99 Lisa Davidson
    February 21, 2011

    I mean that all we can do is divide the issue up into very small pieces, and check each piece for validity. One thing we can do is decide on a remedy and take it for a week and write down what happens. It seems to be something one can actually do, a simple task that takes the place of speculation. Actually, the doctors and practical men among you might enjoy taking Sulphur instead of Ignatia. I thought of Ignatia first, but you can get Sulphur at the Boiron counter too. Incidentally, don’t take either of those remedies at bedtime, because they will both keep you awake. But, just as in the case of Ignatia or anything else, it may take a few days to display its full effects, which are very much worth seeing. I might note that in case you find the effects highly disagreeable, you can take the same remedy in a 6C potency, which Boiron also makes, to reduce this. (Thanks for reading this second post also.)

  98. #100 Forbidden Snowflake
    February 21, 2011

    This is the experiment. Get some Ignatia in 30C potency. You can get this at any health food store that has a Boiron section.

    Did Boiron pay you to write that comment?

    Repeat this every morning until you feel results, in case you have not felt anything yet, although most likely you will have.

    Let me get this straight: you’re supposed to drink that stuff for an indefinite amount of time, and when at some point in the future you feel better than you did the day before, attribute the change to the sugar pills, rather to the million other factors in your life.

    This is the scientific way of investigating whether a remedy has any particular powers or not.

    No, it most certainly is not. The scientific way of investigating would involve several methods of verifying that the results aren’t happenstance and that the improvement isn’t imaginary. Your method is basically a recipe for deceiving oneself.

    It may surprise you to know that you’re not the first to whom the idea of testing homeopathy occured. It has been tested and failed. Can we let it go yet?

  99. #101 squirrelelite
    February 21, 2011

    @Lisa Davidson,

    Actually, I do agree with a couple of things you said.

    For instance, you said that:

    I mean that all we can do is divide the issue up into very small pieces, and check each piece for validity.

    Good idea, although it sounds a bit Western reductionist and all that.

    But give it a try.

    1. Demonstrate that you can reliably distinguish between one of those pellets from Boiron and a similar pellet that didn’t have the 30C ignatia added to it.

    2. Demonstrate that the ignatia pellet is more effective for some diagnosable medical condition than the non-ignatia pellet.

    Oops, forget that. We never accomplished step 1. But, don’t give up. There is a $1 million prize if you ever complete step 1. I’m still waiting to hear from Dana when he wins that prize.

    I also agree with your suggestion to use it in the 30C potency. Well, actually you can probably get away with stopping at 24C since there’s probably not a single molecule of strychnine left. But I won’t complain if you want to reduce that chance to one in a million. I like having a less than one in a million chance of dying of strychnine poisoning in the next year, (if that were achievable). Fortunately strychnine is only about as poisonous as LSD and a lot less poisonous than that Australian snake venom mentioned in an NCIS episode I re-watched this weekend so I’ll probably survive.

    But, I did look up a couple of references.

    Hit number two on Google was this:

    http://www.realmagick.com/6913/ignatia/

    Huh! I thought this stuff was scientific?

    Let’s see what it’s supposed to be good for.

    Ignatia is a medicine for grief and anguish. It relieves and heals acute emotional pain and physical complaints resulting from it. Situations that might ask for Ignatia are for instance: sudden loss of a loved one, death of a human being or an animal, rape, assault, robbery, accident and scary, frightful situations, in fact anything that can cause you an emotional shock. Furthermore Ignatia is a beautiful medicine in cases of (silent) grief for several reasons, for instance feeling of being denied, disapproval, jealousy, homesickness.

    Oh, I thought you said don’t use it if it’s labeled for Fear or Sadness?

    I also went to another reference.

    http://www.rxlist.com/script/main/art.asp?articlekey=96174&page=2#Dosing

    How does Ignatius Bean work?
    Ignatius bean contains the poisons strychnine and brucine which affect the transmission of nerve impulses to muscle.

    Are there safety concerns?

    Ignatius bean is UNSAFE. It is poisonous. Side effects and toxicities include restlessness, feelings of anxiety, heightened sense perception, enhanced reflexes, dizziness, painful neck and back stiffness, twitching, jaw and neck spasms, painful convulsions of the entire body, increased muscle tension, difficulty in breathing, seizures, renal failure, and death.

    Long-term use of Ignatius bean can cause liver damage and be fatal. If you already have liver damage, you are especially at risk for toxicity.

    Since Ignatius bean is poisonous, be especially careful not to take it if:

    •You are pregnant or breast-feeding. It can harm you and the baby.

    So, yes, definitely dilute it. The less concentrated, the better.

  100. #102 Antaeus Feldspar
    February 21, 2011

    Lisa, what you propose is not in fact very scientific at all. Science is about devising studies so that they rule out as many sources of error as possible; your proposed experiment is designed in such a way as to make such error all but inevitable.

    Let’s start with the fact that you are asking each person to perform this experiment personally and then come to a conclusion based solely on what happened to them. This is called “sample size of 1″ and it’s a classic error. The source of error that we invite in with a sample size of 1 is plain old coincidence. Me, for example, I’m still recovering from a pretty nasty stomach bug for which I had to stay home from work. That was a few days ago, and naturally as one would expect I’ve been feeling better every day as my body fights off the remaining illness. Suppose my illness had been a little less severe, so that I didn’t know I had caught a bug? If I did your suggested experiment under those conditions, I might in all good faith attribute my improved energy and appetite to the homeopathic remedy, when in truth the remedy had no part in it! I would just as confidently declare “the remedy made me feel so much better” if I had unwittingly been taking pure sugar pills instead.

    And that brings us to our second source of error: your “experiment” makes absolutely no attempt to rule out the placebo effect. Again, I happen to be suffering from the lingering effects of a nasty stomach bug. You can well understand that I want to feel better. You can well understand that every morning as I’ve woken up with this thing, I’ve tried to tell myself I’m feeling better. Don’t you think that that factor will taint any such “experiment”? Don’t you think that even if I’m actually feeling just about the same, I’ll tell myself “… better. Really. I’m feeling better.” And if I’m “testing” a “remedy” at that time, won’t I falsely give the credit for my wishful sense of improvement to the remedy? Again, if I was taking a pure sugar pill under the impression that it was a “remedy” I would be confidently attributing great benefits to a sugar pill that had done nothing.

    Finally — and this is not the last source of error in your proposed experiment, I’m sure, only the last one I’ll point out — your instructions for conducting this “experiment” practically guarantee false results through what we might call the “Clever Hans effect.” Clever Hans was a horse who could supposedly answer math problems by tapping the answer out with his hooves. Presumably you can already guess that the horse was not truly doing math; do you know what was really happening? The horse was in fact incapable of math but very good at watching the reactions of humans. When it was asked a question like “what is 3 + 2?” it knew that it should start tapping its hooves. When it had tapped five times, onlookers would show anticipation, wondering “is Hans going to get the correct answer by stopping now?” and the horse recognized that anticipation as the cue to stop.

    Your “experiment” invites that same source of error to waltz in when you instruct “Repeat [taking the remedy] every morning until you feel results”. Not “repeat for a given amount of time and then evaluate whether any results were detected.” Repeat until you feel results. That’s exactly what Clever Hans did; it repeated the action of clopping its hooves until it detected results. Suppose a group of us did your “experiment”: one of us stopped the “experiment” when he felt better on the next day, one stopped when she felt better on the third day, and one stopped when he felt better twenty days later. Did the experiment prove anything about the remedy? No more than Clever Hans stopping when he reached five proved that he was understanding and solving math problems.

    You have gone about this more politely than many of those who come here intent on proving homeopathy to us do. I thank you for that politeness. But you also told us “It is of no use to be swept into arguments of logic and theory and egomania”. I will suggest to you that the true “egomania” here is to think that one can devise experiments that give meaningful results without consideration of “logic and theory”. Science is in fact a kind of super-humility, of recognizing how very many sources of error there are in the world and how very easily they can in fact fool us, if we do not take great precautions.

  101. #103 Militant Agnostic
    February 21, 2011

    Ignatia is now my favourite homeopathic remedy. Unfortunately it does not appear to cure ignorance.

  102. #104 T. Bruce McNeely
    February 21, 2011

    How does Ignatius Bean work?

    So we’ve finally found out his first name? You learn something new every day.

  103. #105 Denice Walter
    February 21, 2011

    @ T. Bruce : HAHAHAHAHAHAHA! What’s *not* to like about you?
    ( Plus, your name brings “T.Rex” to mind!)

  104. #106 LW
    February 21, 2011

    I thought about how Lisa Davidson could prove the effectiveness of homeopathic water. For instance, she could take an unlabeled vial of it, consume the appropriate quantity (whatever that is) and report the effects. If homeopathic water actually had any effects besides quenching thirst, the effects she reported should match those from the original “proving”.

    But then, I thought, any homeopath will refuse that test on the grounds that it won’t work because the body only takes in that part of a homeopathic remedy that it actually needs, this being the excuse for why skeptics who overdose on homeopathic sleeping pills suffer no Ill effects.

    But doesn’t that argument then invalidate *all* provings, and thus the entire basis of homeopathic “medicine”? How do homeopaths get around that?

  105. #107 Lisa Davidson
    February 21, 2011

    OK. Whew, lots of comments to answer. First of all: I’m not trying to use it to cure anything. I can see that no one has done the experiment, because you’re all still thinking and reasoning about it. I feel kind of like Galileo when he said look through the telescope, you can see the moons of Jupiter. It’s not really something to reason about; it’s something to actually observe. I’m not talking about curing illness with it, either. My only point is to demonstrate that these things have effects. Provings are supposed to be done on people in relatively good health. don’t do it if you’re sick. I’m not trying to cure you or make you sick, either, as if I could from this distance. All I have suggested is a way by which one can find if these substances have an effect or not. The only way you can find out is by trying it. Also, don’t use combination remedies. You need to do this with one single remedy. Fine, I mean, go ahead and think and reason all you like, but it doesn’t speak to my point. If you actually try it, then you will have tried it. By the way, I only said Boiron because it’s convenient and all over the place. It makes no difference what brand you use. I’ve probably missed some points here but i’ll look again later. thanks for talking about it!

  106. #108 Gray Falcon
    February 22, 2011

    I feel kind of like Galileo when he said look through the telescope, you can see the moons of Jupiter.

    The difference between you and Galileo is that he could show that the moons of Jupiter were not specks of dust on his lens, but you can’t prove anything.

    The only way you can find out is by trying it.

    I have never been to Japan. Therefore, Japan does not exist. No, I’m afraid that logic doesn’t work.

  107. #109 Gray Falcon
    February 22, 2011

    Let me rephrase the last part. By your logic, I have read several Japanese comics, and know enough of the Japanese language to know how hard it is to translate to English, but since I have never seen Japan, I cannot be certain it exists or not.

  108. #110 Matthew Cline
    February 22, 2011

    @Lisa Davidson:

    I feel kind of like Galileo when he said look through the telescope, you can see the moons of Jupiter. It’s not really something to reason about; it’s something to actually observe.

    If you’d said that it would take effect within, say, an hour of taking the remedy, then your analogy might be valid (assuming the effect would be so profound that it couldn’t be a placebo). But you basically said “keep taking it until you notice an effect”. For a single person doing this experiment, how is that person supposed to know if the change is due to the remedy or due to something else? If you had a large group of people doing this, and half were given placebos in a randomized and blinded manner, then you’d be able to tell in spite of the non-specific delay, but for just a single person there’s no way to tell.

  109. #111 Lisa Davidson
    February 22, 2011

    OK, yes. Do not do this experiment if you are pregnant. I should have definitely said this, sorry. And “”Repeat [taking the remedy] every morning until you feel results”. Not “repeat for a given amount of time and then evaluate whether any results were detected.” Repeat until you feel results.” What’s the difference? My experiment, if I am allowed to call it “mine” since it’s a very old one, is really just to see what happens. It is not result-oriented in the sense that one might wish to feel better. It might make one feel worse. That’s why I suggest to have the remedy ready in 6C potency to slow down the unpleasant effects of it, if any. And certain people are a thousand times more sensitive than certain other people. These hyposensitive ones are the ones who might need six pellets, but the more sensitive ones may need only a sip or two. Also, they’re just called remedies because, for some reason, this is agreed upon as their common name so that people will know what we’re talking about. I am not suggesting that at this point we are using them to remediate anything. We are just testing them as to see what on earth they do at all. And also, I said to put five or six pellets of 30C in a small glass of water and drink it all. That is actually much too much. I only suggested that quantity because I thought I only had one chance at showing this. But the saner way to test these things, again, is to have some every morning, say one pellet of 30C dissolved in a glass of water. I don’t have a particular axe to grind here, but I just want the discussion to be based on experiment and observation. The best way is to have no preconceptions at all. And we are all an audience of one, are we not? I have seen enough paradoxical reactions to allopathic drugs to know that people are very different. My agenda, if I have one at all (of course I do, but I hope it’s a benevolent one) is to separate speculation from observable fact.

    And it has to be said that modern homeopathy has become completely insane. The science of the original classical thinkers of it has been completely subverted, and a lot of homeopaths now try to put their own spin on it to be original or to show off, and I can very well understand why people think it’s a lot of nonsense. It mostly turns me off, to tell you the truth. I always thought there might be something in it, but most of the teachers are idiots. But the real classical homeopathy is where it’s at, if you’ll pardon the expression. And it’s all observation-based. It was all started by M.D.’s. Now it’s been taken over by intuitive star-gazing Tarot-card reading who knows who’s, and I’m basically totally embarrassed by them. But facts are facts, and fact will out. I probably shouldn’t even be saying this, but I feel this need to tell the truth, because I think it’s more important than if somebody will like me at some seminar or not. I mean, that’s life.

    Antaeus Feldspar, you are completely correct in what you say. But how can we investigate these things? The way the old masters did it was by taking these drugs, giving it to their friends and family members to take, and scrupulously writing down everything that happened to them that was a deviation from their usual baseline condition. Then they collected the results. They found, for instance, that in a proving of one particular remedy, very few provers reported a certain specific symptom. But the great majority of provers reported another specific symptom. It helps, obviously, to have a large number of people proving one remedy, and there are exact ways of making a proving so that it is done carefully and correctly. They include placebos, and all that.

    And the psychological effects of these drugs, although quite noticeable, are not the only things that these drugs cause. They have plenty of physical effects, too. Just to give one example, Sulphur tends to give provers a sudden diarrhea that drives them out of bed at five in the morning. (Please forgive me, doctors and men of practical ability.) Now this does not happen to all of the provers. This is why you need to have a large sample. But it ends up being pretty objective, because you can see, hmm, that’s interesting, half of the people reported this strange numbness or this boring pain in the head as though a nail were being driven through it, or this feeling that their consciousness did not belong to them, or an incredible constipation, or a corrosive leucorrhea that ran all the way down to the ankles. If 80% of the provers say that they had this leucorrhea and they never had it before, it makes you think that it was the experimental drug that gave it to them. This is doubly true if they stop taking the drug and the leucorrhea goes away. Then if they take the drug again and they get the leucorrhea again, this symptom is on its way to being verified. It takes a lot to verify a symptom. I mean, they were not casual about it.

    In fact, this is how Hahnemann proved the first remedy. He was translating an English Materia Medica by Dr. Cullen, into German. This book said that the bark of the Peruvian tree, the cinchona bark, was used to cure the fever and chills of malaria. Then for some unknown reason, Hahnemann, in a state of health, decided to take some cinchona bark and see what happened to him. Now this is the interesting part that gave him the idea. The cinchona bark gave him fever and chills. He stopped taking it, and the fever and chills went away. He took it again, and the fever and chills came back. He stopped taking it again, and the fever and chills went away again. So he thought, how could something that causes fever and chills, cure someone that already had fever and chills, who had not taken that something, but just had the illness anyway? That, in essence, is where the idea of “like cures like” comes from. He did it backwards, in a way. He started with the disease and then he took the remedy for that disease without having the disease, and he got the symptoms of the disease. Pretty interesting thinking, to me.

    In my understanding, which may be all wrong, the homeopathic sleep-in was done by taking combination remedies, which are pretty useless. Also, the ingredients that compose these remedies were never proved together but only separately, so we really have no idea what they would do together, if anything. And actually these people in the sleep-in have shown that mixing them together pretty well nullifies the action of any of them, so we must thank them, really, for advancing the cause of classical homeopathy, one of whose cardinal principles is the use of only one remedy at a time, whether that was the intention or these demonstrators or not. Actually, they were trying (and succeeding) to discredit mixed-remedy nonsense, although they thought they were discrediting homeopathy, and they did a fine job of it. I love provings. Literally, they demonstrate things. Anyone who is convinced by the work of these people at the sleep-in that mixed remedies don’t work, is using their head in the way it was designed. But it is wrong to generalize from that demonstration that single remedies do nothing. They must be proved in their turn, and they have been proved over thousands of clinic-hours and personal observation.

    The sad fact is that a man named Morris Fishbein, believe it or not, led the AMA in a huge smear campaign against homeopathy in the U.S., I believe in the 1920’s or some time around then. I don’t know the details of it, but we can certainly see the results of it. We have mistaken indoctrination for truth, to an extent. All I want to do is to experiment objectively. I try not to let myself be brainwashed by homeopaths, and it’s often fairly easy, because they say some pretty silly things. But at least their remedies don’t cost much, and possibly that is the reason for the smear campaign, although I don’t really know. And, incidentally, it is not true that homeopathic remedies don’t have side effects and are perfectly safe. They are not. They can have plenty of side effects, which are called “accessory symptoms.” You’re not supposed to have them. It takes a lot of thought to prescribe the correct remedy, and you can actually ruin someone’s health with the wrong one, or even the right one in the wrong potency and the wrong size of dose.

    So I’m warning you against the experiment, I mean, try it if you’re in good health and curious enough, but we do need to distinguish fact from opinion, and that’s the whole point of the experiment to me. I hope I haven’t bored everyone to tears by now, but thank you anyway. And as far as being able to recognize a remedy by its feel, there are a few thousand of them, so I’m not sure if I could do that. I might be able to recognize Lachesis because I’ve taken so much of it. (One of its symptoms is loquacity, actually . . . .) but it does have a very recognizable and wonderful (to me) feeling to it.

    And of course you can test if sugar pills affect you differently than remedies do. Just take sugar pills for a week, then take the other kind for a week. These pills are available from homeopathic pharmacies on-line, so you can use them and taste the very slight sweetness, if any (I’ve never been able to taste it at that dilution). Have a friend put them in bottles labeled with a code, so you won’t know which ones they are. One caveat: if you start with the medicated pills it might take a week for them to wear off, so you should probably try them with a month in between, so you can normalize yourself. Believe me, some of these things have amazing symptoms, like brown urine and you name it. I mean, they’re pretty hard to miss.

  110. #112 Lisa Davidson
    February 22, 2011

    Now there is one so far unsurmountable problem, and I do not know how to cope with this problem. It is central to our translation from homeopathic to allopathic terms. The big problem is that homeopaths don’t treat diseases, but patients. They treat a type of patient. So, from the beginning, we have to say that someone has “a kind of pneumonia,” or “a kind of arthritis,” or “a kind of dementia.” So already we cannot speak in the same terms, and this is very unfortunate. I know there must be a way to transcend this difficulty, the difficulty that makes people call all our evidence anecdotal. I am going to think about this, and the next class I am scheduled to take is actually called Research Methodology, so maybe I will find the great key in it somehow. I certainly hope so. There is a terrible division between us in our “opposing” schools, and we are all scientists, and we are all trying to better the human condition, and I would like to bridge this gap. Perhaps I will understand how to do it, in time. There must be a way to do it, because we are not opposed, really at all, in our aims. The great homeopaths of the past all had regular medical educations. This division has come about perhaps in the same spirit that has divided so many groups today who really have common interests.

  111. #113 Lisa Davidson
    February 22, 2011

    Matthew Cline says
    If you’d said that it would take effect within, say, an hour of taking the remedy, then your analogy might be valid (assuming the effect would be so profound that it couldn’t be a placebo). But you basically said “keep taking it until you notice an effect”. For a single person doing this experiment, how is that person supposed to know if the change is due to the remedy or due to something else? If you had a large group of people doing this, and half were given placebos in a randomized and blinded manner, then you’d be able to tell in spite of the non-specific delay, but for just a single person there’s no way to tell.
    Posted by: Matthew Cline | February 22, 2011 12:37 AM

    This is exactly how a real proving is done, just as you say. The repetition that I suggested was only for the theoretical hyposensitive prover who might try this. I have taken plenty of remedies that instantly had an effect, and in fact, much too much of an effect, a horrible effect. This is because of my particular constitution, that certain remedies “resonate” with me more than other remedies might. And that’s why you need a lot of people in the proving, exactly as you say. I just said to keep taking it because I was trying to make this general silly point, but of course you’re right. Every remedy affects every person quite differently. And also there are very slow-working remedies, for instance Baryta-carbonica, which might take a month to have any effect at all.

  112. #114 Chemmomo
    February 22, 2011

    Lisa, Lisa, Lisa.
    Where do we begin? Let me assure you that Galileo’s problems with the authorities of the time did not stem from showing people the moons of Jupiter through his telescope (I highly recommend taking a look if you can; they’re pretty cool, even if you can’t do the math to predict their movements!)

    I do want to commend you for (1) suggesting we all take the same remedy in your experiment and (2) excluding pregnant women and anyone else who might otherwise be vulnerable. However, if you want to propose experiments like this one, you really need to learn a lot about experimental design, basic science, and medical history.

    As far as I can tell from reading your last really long post, you’re stuck following Samuel Hahnemann’s original tenets of homeopathy because even you can see that (in your words) “modern homeopathy has become completely insane.” I’ve got no argument there–the problem is that Samuel Hahnemann earned his medical degree even before John Dalton came up with Atomic Theory. (Not including links to avoid spam filter: Hahneman, History of Homeopathy site, http://altmed.creighton.edu/Homeopathy/history.htm, degree in 1779; Dalton published in 1803 http://en.wikipedia.org/wiki/John_Dalton – yeah, it’s Wikipedia but it’s the same date as all my texbooks). Do you think maybe science has advanced a little since then?

    Please, please, please, Lisa: if you to wish to engage in scientific experiments, please learn some science. Try to get some basic grasp of chemistry and physics, as understood in the this century and the last one – beyond what was known back in the 18th century when Hahnemann was coming up with his ideas.

    And please try to figure out what would be an appropriate control for your experiment. Right now you don’t have one (Here’s a hint: what if half your participants didn’t add the remedy, but just stirred the water for the same amount of time that it took for the remedy to dissolve. Then what?). This doesn’t actually require understanding scientific principles – you’re just trying to avoid random variables. Think about it.

  113. #115 Matthew Cline
    February 22, 2011

    Every remedy affects every person quite differently.

    Then how can homeopathy be used as an effective form of treatment?

  114. #116 Chemmomo
    February 22, 2011

    Links went in anyway, but didn’t trip filter. Cool. Must learn more html.

  115. #117 Chemmomo
    February 22, 2011

    Lisa, a proposition for you, if you’re willing: report back to us what’s taught in that Research Methodology course you’re going to take. I’d really like to know.

  116. #118 David N. Andrews M. Ed., C. P. S. E.
    February 22, 2011

    Joseph: “I’m pretty sure that’s not even ‘bad’ CBT, but basically ‘not CBT’. A major part of CBT (ant is predecessor*, REBT) involves challenging irrational, unrealistic and fantastic beliefs and worldviews.”

    * To be honest, Joseph, RET/REBT isn’t really a predecessor to CBT. Along with Beck’s cognitive therapy, RET/REBT was a parallel development.

  117. #119 LW
    February 22, 2011

    Lisa @103: “I have taken plenty of remedies that instantly had an effect, and in fact, much too much of an effect, a horrible effect.”

    Lisa, do you realize that you can make a million dollars with that ability? The Amazing Randi would be happy to set up a trial with one vial of one of those “remedies” that acts instantly on you and a number of vials of plain water. All you would need to do is pick out the “remedy” — which would be easy based on its instant effect — and you would have proven homeopathy and made a million dollars in an afternoon.

    Go for it!

  118. #120 DrDuran
    February 22, 2011

    Lisa, saying “we are all scientists” insults every real scientist.

  119. #121 Lisa Davidson
    February 23, 2011

    Lisa, saying “we are all scientists” insults every real scientist.
    Posted by: DrDuran | February 22, 2011 6:49 AM

    I was referring to the people on this forum that I’m trying to have a rational conversation with, not every human being in the universe, and not every homeopath either. I am assuming, for the sake of this conversation, that the forum members have at least some scientific inclinations (observe, hypothesize, test the hypothesis, repeat, bla bla etc, we know the drill, I presume). At least I intend to give them the benefit of the doubt, OK?

    Every remedy affects every person quite differently.
    Then how can homeopathy be used as an effective form of treatment?
    Posted by: Matthew Cline | February 22, 2011 2:00 AM

    The homeopath looks at the entire clinical picture. This involves looking up every relevant, meaningful symptom that the patient has, in the repertory, which is a kind of dictionary which lists symptoms and every proven remedy which has created this symptom, ranked in a hierarchy by the symptom’s strength or prevalence in that remedy. In other words, if 80% of the provers of a remedy reported that symptom, then the remedy name is printed in boldface type. Italics are used to mean that maybe 40 or 50% of the provers had that symptom. Plain Roman type means that only a few of the provers had it. This does not mean, incidentally, that in these few provers the strength of the symptom was mild. It could have been quite intense. The typeface only means how many provers had it, not if it was powerful or not.

    Now it needs to be clarified, something I just touched on earlier, about the different kinds, say, of pneumonia. I know this makes no sense unless I explain this more thoroughly. The homeopath takes into account the person’s temperament and constitution, personality, food and sleep preferences, and many other things. For example, if you look in the repertory under nausea, you will find, among other remedies, Nux-vomica and Pulsatilla. But you need to take into account the kind of patient who has the nausea. Nux-vomica suits fiery, zealous, highly ambitious, chilly individuals, while Pulsatilla suits yielding, timid individuals who are always warm and always want the window open, and generally feel better outdoors, at least when it’s cool outside.

    And there is another difference to take into account, which is the difference between acute and chronic treatment. Acute basically means that a situation has existed for less than six months. It includes the usual things, sprains, fractures, all of that. And you don’t need to distinguish so much about the patient’s temperament when prescribing for an acute condition. I mean, a bruise is a bruise and would benefit from a dose of Arnica, no matter what kind of personality the patient has. But chronic situations need closer investigation.

    When I said every remedy affects everyone differently, I was talking about provings. This is how we can test, say, one thousand participants in a proving of, say, Sulphur. Some of them will not be affected, or will only demonstrate a few little symptoms. And others will be hugely affected. Then you have to classify all these data, and you come up with a picture of Sulphur which will say how strongly each of these symptoms is represented in the remedy. Then, after this, if you try Sulphur on patients who have these symptoms, and you see that Sulphur has cured these symptoms, and if you do this repeatedly on many patients with these particular symptoms, then you have clinically verified that this remedy, Sulphur, has cured these symptoms. If you are analyzing someone’s case and see the situation clearly, then you know which nausea remedy, for example, to use, among the large number of nausea remedies listed in the repertory. You need to narrow down the field by looking at concomitant symptoms, temperament, all those things. Then you have a lot better of an idea. That’s why you need to look at all the other symptoms the person has, in addition to the presenting complaint, the nausea, or whatever it happens to be.

    From Chemmomo: And please try to figure out what would be an appropriate control for your experiment. Right now you don’t have one (Here’s a hint: what if half your participants didn’t add the remedy, but just stirred the water for the same amount of time that it took for the remedy to dissolve. Then what?). This doesn’t actually require understanding scientific principles – you’re just trying to avoid random variables. Think about it.

    You are right that this problem is not addressed in my “experiment.” However, this problem is addressed by the appropriate design of a proving, which I think I spoke of in my answer to Antaeus Feldspar the night before last, or sorry, maybe it was Matthew. And don’t forget that my so-called and probably unfortunately called “experiment” is not designed to cure anyone. If someone is the fiery, zealous type and takes some Pulsatilla, nothing will probably happen. That’s exactly why they do a proving with lots of people, and the more people are in it, the more exact will be the picture which will arise from it. My “experiment” is sloppy but simple. I mean, there’s a terrible remedy which will give cluster headaches, and I didn’t tell you that one for obvious reasons. I’ll tell you if you like, but I mentioned Sulphur and Ignatia because they have very noticeable effects but will not create unbelievable physical pain. And frankly, I shouldn’t even call it an experiment in the rigorous way. It’s more of a little demonstration. I mean, if you want to demonstrate the law of gravity, just drop something. And where’s the control group? You have to start somewhere. Maybe you won’t call it gravity, but it still makes the thing you drop fall downward. This is the kind of thing that can be demonstrated. Theory doesn’t even come into it. There it is, it will fall on your foot, whether you can explain it or not.

    I understand that intellectual hackles are being raised here, and this is not a very rigorous or very methodological or very peer-reviewed or very anything demonstration that I suggest, but if you try it, you might learn something. Take something until something happens to you. Stop taking it. Try it again. Stop taking it again. And try it again. That ought to demonstrate something to you. It’s like, you’ve done this a thousand times in your life. Eat a pound of chocolate and see if you feel different. You know. I might suggest Sulphur or Lycopodium or Nux-vomica to the highly intellectually driven. Some people are more receptive to some remedies than to other remedies. I just get the feeling that people are saying, it’s illogical, therefore it couldn’t work. Well, whatever, I don’t know what to say. Possibly they think it’s illogical because they don’t know enough about it.

    There’s actually a very good book on the subject, written by an M.D. who is also a classical homeopath, if anyone wants to take a look at it. It’s called Hahnemann Revisited, by Luc De Schepper, and I think you can probably get it on Amazon dot com.

    I’d be more than happy to tell you what the Research Methodology class says. It might help a lot with this conversation.

  120. #122 Lisa Davidson
    February 23, 2011

    In this kind of experiment, which I really do think deserves to have the name of experiment, the person has to be his own control. I know that every moment is different, you can never go back to that moment when you take the remedy and divide yourself into two different people, one who takes it and one who doesn’t, and the only possible control we have is to alternately take it and not take it. I mean, you’re really not that different from one month to another unless there is an impinging circumstance. But you can be your own control in the reasonable and expectable course of life. I know that certain things disagree with me, and whenever I try them, they continue to disagree with me. I can’t eat certain foods. I also know that certain remedies make me feel certain ways, and I have verified this over and over again. I’ve done this with “the right remedy” for my condition, and also “the wrong remedy,” and they both had tremendous effects. The experiment is to discover whether homeopathic remedies have any effect. Well, you may have to try various ones, but you’ll find it eventually. This constraint exists because I have no idea who you are, what type you are, or what remedy would affect you at all. It would be easier if I did, but I don’t. Also, use a well-known remedy, not one of those “small remedies” they’re coming up with these days. And don’t use a combination remedy.

  121. #123 AnthonyK
    February 23, 2011

    “The homeopath looks at the entire clinical picture. This involves looking up every relevant, meaningful symptom that the patient has”
    Uh, no. The homeopath has a biased, untested world view, based on belief in a mythical system, founded in ignorance (and I don’t nessecarily mean stupidity there) and continued in wishful thinking.
    Nothing you do is actually “tested”, far less “proved” – the clinical picture you have is, we now know, batshit crazy. None of your remedies is properly tested – you know, double-blinded, randomised, reproducible, it’s just what the homeopath “feels”, based on a book of bullshit.
    Hey – where’s your cure for malaria…….sorry, but “my persistent headaches seem a little less severe than before” may be temporarily relieving, but will reveal nothing about the brain tumour which may kill you.
    And let’s not forget that homeopathists accept neither that bacteria/viruses cause diseases, nor that vaccines can prevent them.
    Fail, fail, fail.
    You’re still gonna die, right?
    And for your own sake, I really hope that should you have a serious, treatable illness that you seek proper medical help, because otherwise you’ll just be another homeopathy fan dying because you have no understanding of how medicine really works.
    And even with proper medicine, you’ll still die.
    It’s just that, on average, you’ll live a little longer.
    And be considerably less stupid.

  122. #124 Gray Falcon
    February 23, 2011

    Lisa Davidson, you still have yet to address why the “try it yourself” argument is different from questioning whether Japan exists because one has never physically set foot there.

  123. #125 Lisa Davidson
    February 25, 2011

    All I can say is, it works if it’s done properly. I’ve seen it happen. I mean, however misinformed and batshit crazy you think I am, I’ve still seen it. Later. (probably a lot later.) Gray Falcon — what? you lost me there.

  124. #126 Lisa Davidson
    February 25, 2011

    Only one more thing, and I’m out of here.
    Yes, there is a cure for malaria. It is called Malaria Officinalis. It both prevents and cures.
    I want to say “deal with it,” because I cannot withstand the stream of hostility.
    But it’s true nonetheless.

  125. #127 Narad
    February 25, 2011

    Yes, there is a cure for malaria. It is called Malaria Officinalis.

    Prepared from “marsh miasm”?

  126. #128 Chris
    February 25, 2011

    Lisa Davidson:

    I want to say “deal with it,” because I cannot withstand the stream of hostility.
    But it’s true nonetheless.

    Possibly because you make blanket claims and do not support them with real evidence. Especially with the last declaration about “Malaria Officinalis.” Especially with results like these (several are for malaria):
    http://whatstheharm.net/homeopathy.html

  127. #129 Gray Falcon
    February 25, 2011

    We already have studies showing the homeopathy doesn’t work. Insisting that we need to try it ourselves to know that it doesn’t work is not unlike suggesting that we can’t tell if a country exists until we’ve actually been there.

  128. #130 Chris
    February 25, 2011

    Plus, insisting one try it themselves for something as dangerous as malaria is just pure lunacy.

  129. #131 Arac Kiralama
    March 27, 2011

    Nowadays, I read many thing about this issue. I am a bit confused. Everyone is saying something else.

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