Respectful Insolence

One of the things that distinguishes evidence-based medicine (EBM) and science-based medicine (SBM) is how the latter takes into account prior probability that a therapy is likely to work when considering clinical trials. My favorite example to demonstrate this difference, because it’s so stark and obvious, is homeopathy. Homeopathy, as regular readers of this blog no doubt know by now, is a mystical, magical system of medicine based on two principles. The first is the law of similars, commonly phrased as “like cures like”; i.e., the way to treat symptoms is to use a smaller amount of something that causes the same symptoms. I know, I know, it’s rather silly, but homeopaths really believe it. Although on some occasions it may be that the drug used to treat a disease might be capable of causing the symptoms of that disease, there’s no scientific basis to support this concept as a generally applicable medical principle. The second principle is the law of infinitesimals, which states that diluting these remedies makes them stronger. This leads to the well-known criticism that homeopathy dilutes its solutions many, many orders of magnitude more than Avagadro’s number, meaning that there is not a single molecule of the original remedy left. Indeed, a typical dilution for a homeopathic remedy is 30C, meaning 30 serial 100-fold dilutions. This is equivalent to diluting the solution 1060. Given that Avagadro’s number is only on the order of 1023, I trust that you can see the problem.

Not that any of this keeps homeopaths from paddling boldly up the river of pseudoscience, usually by proclaiming that water has “memory.” According to homeopathy, water somehow “remembers” the presence of the remedy and transmits its healing power to the recipient of the remedy, while somehow magically forgetting all the poop, urine, dirt, and other contaminants that it’s been in contact with. In other words, homeopathy is water; its prior probability of doing anything other than what a small amount of water can do is essentially nil. Moreover, on the basis of basic science alone, we can conclude this with a very, very high degree of confidence because, for homeopathy to “work,” many well-established laws of physics would have to be not just wrong but spectacularly wrong, as would many principles of chemistry and biology. Given the amount and quality of scientific evidence demonstrating that homeopathy can’t possibly work, to prove otherwise would take at least as much high quality evidence from multiple different sources, evidence of high enough quality to call into doubt these same laws of physics. Equivocal or weakly positive clinical trials whose results could be due to bias, placebo responses, regression to the mean, and other confounding factors don’t cut it.

In real science-based medicine, there will, of course, be gray areas, areas where the prior plausibility is not so clear-cut. However, where it is so clear cut, such as in magic-based therapies such as homeopathy, reiki, and various other “energy healing” methods, prior plausibility considerations put a much higher hurdle for clinical trial data to overcome if efficacy is to be demonstrated. For instance, if a homeopathic remedy unequivocally healed stage IV pancreatic cancer in multiple patients, then, prior plausibility considerations aside, we would have to take it seriously. No such evidence has ever been presented.

It turns out that homeopaths are very sensitive to arguments based on prior plausibility, so much so that they’ve apparently tried to turn them against us nasty, dogmatic, reductionistic “Western” scientists. (Oh, wait, homeopathy is “Western” too, having been invented by a German.) I just came across a hilarious article by someone named Peter Fisher entitled Plausibility Bias and the Controversy Around Homeopathy. It comes from something called the Homeopathy Research Institute which, amusingly, claims to facilitate scientific research into homeopathy. First, Fisher whines about the criticism:

Homeopathy has long been surrounded by controversy. As long ago as 1846 it was denounced as ‘ludicrously absurd’ and an ‘outrage to human reason’ and more recently it has been claimed that ‘Accepting that infinite dilutions work would subvert more than conventional medicine; it wrecks a whole edifice of chemistry and physics’.

Particularly galling to Fisher appears to be the Commons Science and Technology Committee report in February 2010, which concluded that “There has been enough testing of homeopathy and plenty of evidence showing that it is not efficacious.” Which there has, based on basic science considerations that show that homeopathy can’t work and all the clinical trials, which, taken in their totality, are most consistent with nonspecific effects and placebo responses. Taking the nonexistent prior plausibility of homeopathy into account and the equivocal clinical trial data, the most reasonable conclusion is that homeopathy does not work. Then, taking its history into account, it is further reasonable to conclude that homeopathy is pseudoscientific nonsense based on purely magical thinking.

None of this stops Fisher then rapidly segueing into an appeal to popularity and presenting the central idea of homeopathy (the law of similars, or “like cures like”) as though it were a scientific fact rather than an ancient concept based on sympathetic magic. He even invokes the same tired (and scientifically inaccurate) comparison to hormesis. Finally, he finally gets into the meat of his “argument,” such as it is. First he references a paper he wrote for Webmed Central, entitled Homeopathy In Upper Respiratory Tract Infections? The Impact Of Plausibility Bias. Basically, Fisher and colleagues try to turn the prior plausibility argument around, but they do it in a manner designed more to appeal to fairness than actual science. For example, here’s how Fisher presents the argument:

Responding to these issues Lex Rutten, George Lewith, Robert Mathie and I have recently introduced the concept of ‘plausibility bias’ based on analysis of the discrepancy between evidence.

Fisher notes that a lot of clinicians still use antibiotics for upper respiratory tract infections (URTIs), even though most are viral infections and copious data demonstrate that antibiotics usually do little or no good and do not decrease the risk of serious complications. Fisher blames this on “plausibility bias” for antibiotics because we have a mechanism by which they work and bemoan a “plausibility bias” against homeopathy in URTIs and in acute otitis media, citing clinical studies suggesting that homeopathy is efficacious in these conditions. Here’s where the appeal to fairness comes in:

We concluded that the differing conclusions of the meta-analyses of the homeopathy and conventional medicine subsets, and particularly the homeopathy URTI subset, do not reflect the nature of the evidence, nor its quality, but negative ‘plausibility bias’. Negative plausibility bias obstructs a fair evaluation of the evidence around homeopathy; its extent and implications have not been adequately recognised or discussed. It should not impede further research, but we must recognise that such new research in homeopathy, if positive, may have limited impact on practice until a plausible theoretical framework is established.

This is almost identical wording to that found in Fisher’s Webmed Central article. The argument is also nothing more than a gussied up version of saying “two wrongs make a right.” Think of it this way. Fisher is unhappy that so many clinicians continue to overprescribe antibiotics for conditions for which they are unlikely to be effective. So am I, actually. I do not like it when physicians practicing EBM do not follow the evidence. However, the answer to this problem is not to start using magic water for these conditions instead or, to paraphrase Fisher, to give that magic water a “fair evaluation.” The answer is for physicians to have more backbone in not prescribing antibiotics for viral illnesses and to educate patients that antibiotics don’t do any good for these conditions so that they don’t pressure their doctors into prescribing them. Homeopathy has already had a “fair evaluation.” It’s had an even more than fair evaluation. It’s failed time and time again. The homeopathy proponents can come up with are occasional studies that with barely statistically significant results that are far more likely to have been due to either random chance, poor trial design, or bias. It can’t be emphasized too much that none of this is adequate to overthrow the mountains of evidence in physics, chemistry, and biology that render homeopathy, if not impossible, about as close to impossible as can be conceived.

Fisher and company are then fairly clever in proposing a clinical trial of homeopathy:

The specific research we propose, conducted in primary care, is to test the hypothesis that homeopathy averts, reduces or delays antibiotic prescriptions in the management of acute otitis media or other URTI.
There are a number of considerations to be taken into account in designing such a study. These include:

  • Trials using an antibiotic treated group in uncomplicated URTI are unethical since the evidence suggests that they do more harm than good in this situation.
  • Trials should be of relatively long duration: URTI are often recurrent and the disadvantages of antibiotics are most evident in this context.
  • Homeopathic prescribing requires skilled practitioners.
  • Homeopathy is associated with strong patient preferences; previous RCTs in primary care have foundered on this issue [37].

The research question would not be: ‘Can ultra-diluted medicines exert physiological effects?’. A clinical trial is a clumsy and expensive way of answering such a question, which would be much better answered by biological models. A number of such models have been described [38], and their further development might enable homeopathy to become framed in the plausible theoretical background that it requires.

Unbelievable. Fisher and company argue that it is unethical to test antibiotics in a clinical trial of uncomplicated URTIs because they are ineffective and might “do more harm than good” but somehow think it’s ethical to test an ineffective therapy based on magical thinking in a clinical trial.They then go on to conclude that there should be a “pragmatic” and “large scale” controlled clinical trial. As I and others have pointed out before, “pragmatic” trials represent an inappropriate methodology to determine if a therapy works, because they are not blinded, often not well controlled, and therefore subject to all the biases to which less rigorous clinical trials are subject. Rather, the purpose of pragmatic trials is to test a therapy in “real world” conditions after it’s been demonstrated to be safe and efficacious in proper randomized clinical trials in order to see how much its efficacy and safety decline away from the ivory tower environment under which many clinical trials are run. Even then, there are lots of problems with pragmatic trials due to their less rigorous nature. In any case, using pragmatic trials to test efficacy is a blatant attempt to lower the standard of evidence.

Fisher also gets it backwards. For real medicine (as opposed to fake medicine like homeopathy) the usual order of business is to demonstrate effects in preclinical models (i.e., cell culture, biochemical assays, and animal studies) first before even phase I clinical trials, much less randomized clinical trials, much less pragmatic trials are even considered. Of course, it is these very basic science considerations that render the entire concept of homeopathy so utterly ridiculous from a scientific standpoint and produce estimates of its plausibility that are so very, very low.

Basically, what Fisher is doing is a tried-and-not-so-true (albeit frequently effective) technique of obfuscation by arguing that, since EBM/SBM is not perfect that “alternatives” are needed and that SBM/EBM practitioners don’t practice what they preach. He even tries to turn the most potent criticism of homeopathy (namely its utter lack of plausibility) against SBM by claiming that plausibility is just a “bias.” It’s true that SBM is not perfect, and there are a lot of physicians who use methods that are not adequately science-based. There are even practices in “conventional” medicine that go against findings from clinical trials. There’s no doubt about it; SBM can be messy, and rooting out non-SBM practices (such as antibiotics for viral URIs) can be frustratingly slow and difficult. The answer is not to lower the standard of evidence to be “fair” to magical thinking like homeopathy; the answer is to maintain a high standard of evidence and use it to decrease the use of non-EBM/SBM medicine. In this specific case, that would mean eliminating the use of antibiotics for URTIs and eliminating homeopathy altogether unless homeopaths can come up with evidence supporting homeopathy as rich, varied, and convincing as the evidence showing it to be impossible on the basis of basic science plausibility alone.

The problem with homeopathy is that reality has a pro-science bias. What Fisher views as a “plausibility bias” is nothing more than science passing judgment on the pseudoscience of homeopathy.

Comments

  1. #1 Lawrence
    August 24, 2011

    Let me get this straight, he wants to test against antibiotics, in situations where antibiotics aren’t normally effective (and can’t clear up viral infections) – whereas, if a person just drank “magic water” they’d get better anyway once the virus was cleared from their system?

    If the person is going to get better anyway, regardless of treatment, it definitely doesn’t seem like a situation that lends itself to any kind of test.

  2. #2 Vicki
    August 24, 2011

    Is his argument really that one useless treatment (homeopathy) for viral infections should be used to convince people to stay away from another useless treatment, and that this somehow would show that the first treatment is useful?! I might as well argue that antibiotics for viral infections are useful because they keep patients away from homeopaths.

  3. #3 Mu
    August 24, 2011

    I like his RCT design, it’s self fulfilling. Unfortunately for him, you could replace his large scale study with a simple survey to primary health care providers with the questions “do you prescribe homeopathic remedies”,”do you prescribe them as first measure” and “do you prescribe homeopathic remedies and antibiotics at the same time?” Anyone answering yes,yes,no will automatically be a positive in their study, while any other combination doesn’t influence the result as they are looking at delay in prescribing antibiotics.
    Completely eliminates the patient preference too.

  4. #4 MikeMa
    August 24, 2011

    It would seem most interesting that this clown is comparing his woo to an ineffective treatment modality. I support this effort wholeheartedly.

    Antibiotics are ineffective against viruses, so don’t use them for that. Homeopathy is ineffective against, well, everything so don’t use homeopathy at all. Perfect.

  5. #5 Beamup
    August 24, 2011

    According to homeopathy, water somehow “remembers” the presence of the remedy and transmits its healing power to the recipient of the remedy, while somehow magically forgetting all the poop, urine, dirt, and other contaminants that it’s been in contact with.

    While often claimed, this isn’t actually a problem. According to homeopathy, the effect of the “poop, urine, dirt, and other contaminants that it’s been in contact with” will be to cure anything which might be caused by ACTUAL “poop, urine, dirt, and other contaminants” therefore it’s actively beneficial for said water to have been in contact with such. It would, in fact, be fair to characterize this as a straw man since homeopaths don’t actually invoke such forgetting, and their claims don’t actually lead to this being a problem.

    There are more than enough GOOD arguments against homeopathy without resorting to straw men, however pithy.

  6. #6 Orac
    August 24, 2011

    Got any links to homeopaths making this argument that the “effect of the ‘poop, urine, dirt, and other contaminants that it’s been in contact with’ will be to cure anything which might be caused by ACTUAL “poop, urine, dirt, and other contaminants” therefore it’s actively beneficial for said water to have been in contact with such”? I, for one, have never seen homeopaths make this argument, and I daresay I’ve risked frying my brain by reading quite extensively the “literature” of homeopaths. I am, however, always open to being educated. On the other hand, given how much I’ve read about homeopathy by homeopaths, I’d be surprised if this were a major argument frequently used by homeopaths and I haven’t encountered it before.

  7. #7 Mojo
    August 24, 2011

    @Lawrence:

    If the person is going to get better anyway, regardless of treatment, it definitely doesn’t seem like a situation that lends itself to any kind of test.

    It is, on the other hand, a situation that lends itself perfectly to the use of homoeopathy.

  8. #8 Mojo
    August 24, 2011

    @Beamup:

    According to homeopathy, the effect of the “poop, urine, dirt, and other contaminants that it’s been in contact with” will be to cure anything which might be caused by ACTUAL “poop, urine, dirt, and other contaminants”

    Actually, that would be “isopathy”, not homoeopathy.

    In homoeopathy it would be used to treat symptoms similar to those caused by a remedy made from the poop, urine, dirt, and other contaminants. To figure out what those symptoms are they would carry out what they call a “proving”: they would give the diluted remedy (not the actual poop, urine, dirt and other contaminants) to healthy volunteers and see how they feel. The prophet Hahnemann recommended using 30C remedies for these “provings”.

    Because at the very least the person running the “proving”, will be fully aware of what the remedy being “proved” is made from they can (whether consciously or unconsciously) select those symptoms and impressions that fit with their concept of what the remedy ought to cause as being its characteristic symptoms.

  9. #9 qetzal
    August 24, 2011

    So being biased against things that are implausible is bad thing? Up is down yet again….

  10. #10 Denice Walter
    August 24, 2011

    I think that homeopathy has a useful function as a measure of a person’s relationship to reality and amount of science education they received. We can instantly separate the wheat from the chaff and the sheep from the goats if we know what they think about homeopathy.

    By the principle of crank-magnetism, anti-vaxxers should buy into homeopathy ( see ads @AoA), taking the saying “Less is more” literally as well as figuratively: this would explain why they get all in a tizzy over “contaminants” at “3 parts per billion” ( because to them, “3 per billion” is much stronger than “3 per million”) *and* in addition, it illustrates why they don’t get too upset at *undiluted* industrial chelators ( according to their “logic”, a “1 in a trillion” is much stonger than “1 per 1″).

    One of the idiots I survey advocates “gentler treatments” like homeopathy, herbs, juicing, and supplements in contrast to the rapid-fire, take-no-prisoners pharma- armamentaria of SBM. This protocol takes time: we could all learn a lesson of patience from our ancestors**. Healing takes time which hurried moderns don’t seem to understand because they lack spiritual attributes and character. It takes months to de-toxify, de-stress, and re-build. During which your condition might subside all on its own: although you’d probably never know that if you had spent so much time, effort, and money into woo-ful self-care. After being “instructed” about natural health “secrets”, many would attribute the “healing” to their own “taking charge of their own health” and their guru’s “brilliance”.

    ** who didn’t have much choice in the matter.

  11. #11 Dangerous Bacon
    August 24, 2011

    Peter Fisher’s use of tu quoque (“you do it TOO”) and “Your science can’t measure my woo” are straight out of the altie playbook. How dull and predictable. At least Lionel Milgrom (another defender of homeopathy) dazzled us with quantum theory.

    Fisher: “Homeopathy has long been surrounded by controversy. As long ago as 1846 it was denounced as ‘ludicrously absurd’ and an ‘outrage to human reason'”

    Now there’s a great motto for practitioners of homeopathy. “Making people laugh since 1846″. :)

  12. #12 Kevin Bonham
    August 24, 2011

    @ Orac – Is Avagadro’s number really germaine here? That’s just a number that tells you how many atoms in a mole, which is just a number that corresponds with a particular unit of mass measurement. I suppose if you put it in the context that the most concentrated solutions are rarely more than say 10 molar (10 moles/liter = 6 x 1024 molecules/liter) then it makes sense, but just floating out there on it’s own, the number doesn’t really have much meaning.

    @ Mojo #8

    To figure out what those symptoms are they would carry out what they call a “proving”: they would give the diluted remedy (not the actual poop, urine, dirt and other contaminants) to healthy volunteers and see how they feel.

    But what would you dilute it with? Presumably all the water you’re diluting with also has the poo in it, so it seems to me you’d need to use water gathered directly from the combustion of hydrogen or something… Or does anyone know if water vapor loses it’s memory? Maybe you’d just need to do simple condensation.

  13. #13 Mephistopheles O'Brien
    August 24, 2011

    @Kevin Bonham – Yes, Avogadro’s number is significant here. Suppose you started with a 1 molar solution (~6 x 10^23 molecules of solute per liter of solvent). Once you dilute it beyond C12, you will have less than 1 molecule of active component per liter if I’ve done my math right. At C13, you’d need to consume on the order of 100 liters of solution in order to ensure you get a single active molecule.

    If you start with much purer initial solutions (say, 10 molar)you can push that out a little. But still, in any dilutions above C12 or so the odds that you will get even one molecule of active component in a standard dose (typically measured in milliliters) are small.

  14. #14 Krebiozen
    August 24, 2011

    From memory of my reading about homeopathy, I think distillation is thought to wipe water’s memory clean, like a sort of mystical degausser. I prefer to stick with Tim Minchin’s assessment, as it is much funnier.

    Kevin,
    Avogadro’s number is relevant for a ball-park calculation: assume that you start with one mole of any original substance diluted in one liter of water, once you have diluted that 1 in 10^23 there is likely to be only one molecule of the original substance left in one liter of your dilution. In practice homeopathic dilutions are likely to start with considerably less than 1 mole and will require less dilution to reach a point at which it is unlikely there is a single molecule of the original substance left.

  15. #15 Kevin Bonham
    August 24, 2011

    @ Meph and Krebiozen – Right, I didn’t mean to imply that there’s anything wrong with the idea that 30 hundred-fold dilutions will dilute anything to meaninglessness, that’s why I said in the context that very concentrated solutions are generally not more than 10 molar, it does make sense. If you could make solutions that were a few hundred trillion molar… Ok, I guess even then C30 would be overkill.

    My comment is probably me just underestimating the general knowledge of Orac’s readers – I tend to think of blogging in terms my parents (educated but not in science) would understand.

  16. #16 sng
    August 24, 2011

    The poop argument always makes my inner 12 year old giggle with delight.

    But don’t they claim that succussion is important? So that because the poo shouldn’t be remembered?

  17. #17 Mephistopheles O'Brien
    August 24, 2011

    Kevin – I do agree that Orac’s statement was shorthand for something that’s been discussed in far more detail elsewhere, and could be confusing without that context.

  18. #18 Zoidberg
    August 24, 2011

    The label of one homeopathic product said that homeopathic preparations “never have side effects.” So I bet they don’t have plain old “effects” either.

  19. #19 Acupuncture Parker CO
    August 24, 2011

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  20. #20 mikmik
    August 24, 2011

    How does homeopathy treat dehydration?

  21. #21 killinchy
    August 24, 2011

    @Mephistopheles O’Brien (post # 13)

    I see from your post that you are one of those deluded souls that think that matter is discontinuous. John Dalton was wrong, wrong, wrong.

  22. #22 Gray Falcon
    August 24, 2011

    @killinchy

    Do you have any evidence that atomic theory is wrong? I’ve studied the properties of expanding and compressing gasses, these properties are based largely on atomic theory, and are essential to most refrigeration systems.

  23. “It’s very rare that you find the relevant information on the net but your article did provide me the relevant information. I am going to save your URL and will definitely visit the site again.

    Posted by: Acupuncture Parker CO | August 24, 2011 12:20 PM”

    Sounds like a bot spam to me.

    Karl Withakay

  24. #24 scott
    August 24, 2011

    @ comment 16 by sng

    True the poop, urine and dirt has not been magicalized through succussion, so I suppose homeopaths would be able to rationalize it away as irrelevant.

  25. #25 cervantes
    August 24, 2011

    Presumably homeopaths would treat dehydration by finding something which a “prover” thought produced symptoms similar to those of dehydration, then diluting it to nothingness. Unfortunately it wouldn’t work because the dose of water would be too small.

  26. #26 the bug guy
    August 24, 2011

    My inner 12-year old asks if flushing acts as succussion in relation to poo water.

  27. #27 Prometheus
    August 24, 2011

    So, the homeopaths want to see if the use of homeopathic remedies will reduce the use of antibiotics in acute otitis media and URI’s? Given that real medicine has already shown that the vast majority of URI’s and most cases of otitis media will spontaneously resolve?

    This is brilliance!

    Give the homeopathic remedy (which is nothing more than placebo) first and then seen how many patients come back for antibiotics. Since the vast majority of cases will spontaneously resolve, the 1 – 2 day (or longer) wait enforced by the study will mean that a large proportion of the patients will be better (and won’t be begging for antibiotics) by the time they manage to get back in to see the “doctor”.

    Here’s how I’d modify this study to make it really legitimate:

    Subjects are randomly given either the homeopathic nostrum selected by the “doctor” or a similar-appearing lactose pill or vial of water. They are instructed to give the “medication” three days to work unless they experience “danger” symptoms (e.g. increasing ear pain, high fever, purulent cough, etc.). Then we compare how many of each group return for further treatment (e.g. antibiotics) and also how many seek medical care in Emergency Depts, Urgent Care clinics, etc.

    It’s amusing that the homeopath apologists are so anxious to compare their worthless treatment to a real medication (antibiotics) used in what we know is a worthless fashion (i.e. using antiobiotics against viral infections). It’s almost as though they’re trying to say, “Doctors sometimes use real medicine in dumb ways, so using dumb medicine (homeopathy) isn’t so bad.”

    Prometheus

  28. #28 Mephistopheles O'Brien
    August 24, 2011

    @killinchy,

    OK, I’ll bite, there’s got to be a punchline here somewhere.

    Why see here, Mr. Bones – why do you say John Dalton was wrong, wrong wrong?

  29. #29 Krebiozen
    August 24, 2011

    @killinchy
    No matter how many times I bang my head on my keyboard, I can’t shake my delusion that matter is discontinuous.

  30. #30 Sastra
    August 24, 2011

    sng #16 wrote:

    But don’t they claim that succussion is important? So that because the poo shouldn’t be remembered?

    IIRC the main purpose of the succussion ritual is to impart the homeopath’s intention into the mixture. The supernatural — and despite its physical substrate homeopathy is basically a form of the supernatural — always seems to come down to the idea that mind is a special, unique kind of force or substance “above” the natural world of matter. So with every shake there is a kind of mind-to-matter relationship going on below the surface: as the ingredient is successively diluted or purified it more and more resembles the mental aspect of reality — and is therefore more easily affected by the mental aspect and willpower of the homeopath. If the homeopath doesn’t want the water to remember the poo, it won’t.

    Is this right? Is this how they think? Did I read it somewhere? I’m not sure if I saw it spelled out in an essay on homeopathy or if I just extrapolated it from various bits and pieces and put it together. I suppose I could be offtrack — Orac (who has “risked frying (his) brain by reading quite extensively the ‘literature’ of homeopaths”) would probably know.

    At any rate I bet that if you presented the above explanation to an altie in a warm, positive voice they’d nod along and buy it. It sounds about right.

  31. #31 Mephistopheles O'Brien
    August 24, 2011

    I believe that killinchy’s comment is humor, I’m just hoping for a bigger laugh line.

    Reality? What a concept – R. Williams

  32. #32 The Very Reverend Battleaxe of Knowledge
    August 24, 2011

    Man, I thought the last atomic theory denialist was Ernst Mach, and he died 101 years ago! I suppose Hans Dehmelt was wrong, wrong, wrong when he won a Nobel Prize for trapping individual atoms in a magnetic trap and watching them dance around for days at a time.

    None of this stops Fisher then rapidly segueing into an appeal to popularity and presenting the central idea of homeopathy (the law of similars, or “like cures like”) as though it were a scientific fact rather than an ancient concept based on sympathetic magic.

    If you read your Frazer, in The Golden Bough, when he discusses the principles of magic, he analyzes them into two “Laws”, the Law of Similars, which he calls “Homoeopathic Magic”, and the Law of Contagion, which he calls “Contagious Magic”. Sympathetic Magic is a general term for the two taken together. Sounds like he had homeopathy dead to rights 125 years ago.

    I have to admit, I’m wondering how it’s possible to dilute something 1060 times. There aren’t 1057 atoms in the Solar System, even assuming they’re all hydrogen (for maximum number), and remember >99% of them are in the sun.

  33. #33 lilady
    August 24, 2011

    Well, leptospirosis is a zoonotic bacterial disease caused by exposure to fresh water that has been contaminated by animal urine, more prevalent in warmer climates. There is a study published in a recent Homeopathy journal about an oral vaccine against this bacterial illness by a homeopathic potion that was prepared with 4 strains of the circulating leptospirosis bacteria.

    Homeopathy. 2010 Jul;99(3):156-66.
    Large-scale application of highly-diluted bacteria for Leptospirosis epidemic control.
    Bracho G, Varela E, Fernández R, Ordaz B, Marzoa N, Menéndez J, García L, Gilling E, Leyva R, Rufín R, de la Torre R, Solis RL, Batista N, Borrero R, Campa C.
    Source

    Finlay Institute, Ave. 27, La Lisa, Havana City, Cuba. gbracho@finlay.edu.cu
    Abstract
    BACKGROUND:

    Leptospirosis is a zoonotic disease of major importance in the tropics where the incidence peaks in rainy seasons. Natural disasters represent a big challenge to Leptospirosis prevention strategies especially in endemic regions. Vaccination is an effective option but of reduced effectiveness in emergency situations. Homeoprophylactic interventions might help to control epidemics by using highly-diluted pathogens to induce protection in a short time scale. We report the results of a very large-scale homeoprophylaxis (HP) intervention against Leptospirosis in a dangerous epidemic situation in three provinces of Cuba in 2007.
    METHODS:

    Forecast models were used to estimate possible trends of disease incidence. A homeoprophylactic formulation was prepared from dilutions of four circulating strains of Leptospirosis. This formulation was administered orally to 2.3 million persons at high risk in an epidemic in a region affected by natural disasters. The data from surveillance were used to measure the impact of the intervention by comparing with historical trends and non-intervention regions.
    RESULTS:

    After the homeoprophylactic intervention a significant decrease of the disease incidence was observed in the intervention regions. No such modifications were observed in non-intervention regions. In the intervention region the incidence of Leptospirosis fell below the historic median. This observation was independent of rainfall.
    CONCLUSIONS:

    The homeoprophylactic approach was associated with a large reduction of disease incidence and control of the epidemic. The results suggest the use of HP as a feasible tool for epidemic control, further research is warranted.

    2010 Elsevier Ltd. All rights reserved.
    Comment in

    * Homeopathy. 2010 Jul;99(3):153-5.

    PMID:
    20674839
    [PubMed – indexed for MEDLINE]

  34. #34 Mephistopheles O'Brien
    August 24, 2011

    I’m wondering how it’s possible to dilute something 1060 times.

    Take 1 ml of solution, add it to 99 ml water, the bang it against a leather bound bible a few times. Take 1 ml of new solution, add it to 99 ml water, and bang it against a leather bound bible a few times. Repeat 28 more times. You’ll have used 3 liters of water, and the final 100 ml MAY – just MAY – contain an active molecule, but it’s extremely unlikely.

  35. #35 The Very Reverend Battleaxe of Knowledge
    August 24, 2011

    @ Meph O’B:

    Yeah, naively, I get that, but let me put it another way. There are maybe 5 x 1047 molecules of water in the world’s oceans. Now given that the water you pour down the drain doesn’t have time to flow out to sea, evaporate, fall as rain, reach the reservoir, and come back out of your faucet, where does the water come from to dilute anything 1060 times? I know one source of error is to use combinations without replacement when you want combinations with replacement (like they threw the lotto ball back in the bin after drawing it), and I guess you should stop counting when the chance of a single molecule of the active ingredient being present becomes negligible, but I’m still confused. Gotta read up on combinatorics, I guess. (Why doesn’t spellcheck like the word “combinations”?)

  36. #36 rob
    August 24, 2011

    there are an estimated 10^80 atoms in the universe. if you diluted something to 40C, you have diluted the original ingredient to 1 part in 10^80. that concentration is like there is only 1 atom of the ingredient in whole visible universe.

  37. #37 herr doktor bimler
    August 24, 2011

    No matter how many times I bang my head on my keyboard, I can’t shake my delusion that matter is discontinuous.

    If matter were discontinuous then your head would slip through the keyboard. Typically Atomist, ignoring the evidence in front of you.

  38. #38 herr doktor bimler
    August 24, 2011

    Homeopathy has long been surrounded by controversy.
    “Controversy” does imply a two-sided debate, with both sides bringing their arguments to bear.

    to test the hypothesis that homeopathy averts, reduces or delays antibiotic prescriptions in the management of acute otitis media or other URTI.

    That is, when patients turn up in the clinic demanding antibiotics in a situation where they are ineffective, doctors who offer homeopathic nostrums will be able to assuage those demands more effectively than doctors who ‘just say no’. Am I reading the proposal correctly?

    Perhaps this patient-mollifying capacity of homeopathy could be called the “I Please” response. What’s that in Latin?

  39. #39 The Very Reverend Battleaxe of Knowledge
    August 24, 2011

    Anyway, I’ve lost count of the number of people I’ve seen using some product that says “homeopathic” on it, and asked them: “You know what that means, right?” After they say something like, “Sure, it means it uses natural herbs or something”, I explain the theory of homeopathy to them. They are uniformly flabbergasted. A few simply refuse to believe it but even they agree that “That’s f*cking nuts!” I really think if we could get the word out effectively as to what the word “homeopathy” really means, 99% of the public would laugh it off the stage.

  40. #40 Roadstergal
    August 24, 2011

    No matter how many times I bang my head on my keyboard, I can’t shake my delusion that matter is discontinuous.

    You have to do one more round of dilution every time you bang it.

    My favorite joke about homeopathy, though, remains the one I heard James Randi tell. “Did you hear about the patient on homeopathic drugs who died of an overdose? He forgot to take it.”

  41. #41 V. infernalis
    August 24, 2011

    Orac,

    Sorry for the off-topic post, but I call upon your skills to look at a recent article on the effects of DHA (fish oil supplements) on cold symptoms in infants. It was a double-blind RCT with a large sample size published in Pediatrics, so it sounds reputable, but given all of the hype over fish oil that Ben Goldacre has documented, I’m still skeptical. Here’s the link to the article:
    http://www.ncbi.nlm.nih.gov/pubmed/21807696

  42. #42 Michael5MacKay
    August 24, 2011

    lilady @ #33. You do know that that Leptospirosis study has been thoroughly debunked, don’t you? Including by Orac on this very blog: http://bit.ly/forJz2

  43. #43 LW
    August 24, 2011

    The Very Reverend Battleaxe of Knowledge, I think the trouble you’re having is that you’re imagining the whole initial quantity of remedy (strychnine, let’s say) being diluted 10^60 times. It is not.

    Suppose you have one ml of strychnine. You pour in 99 ml of water, shake vigorously, and dump out 99 ml. Now you have a container with 99/100 ml of water and 1/100 ml of strychnine, right? The rest of the strychnine goes down the drain and we don’t try to dilute it any further. Now we pour in 99 ml of water, shake well, and dump out 99 ml. We’re down to 1/10000 of the original strychnine, but we’ve used only 198 ml of water. If we poured the original 1 ml of strychnine in 198 ml of water — if we tried to dilute the whole original quantity — we’d only have a container that was 1/198 strychnine, a big difference. Do this again, and we’ve used only 297 ml of water and have only 1/1000,000 ml of strychnine left to dilute.

    That’s how we can eventually get a (theoretical) dilution of 10^60 without using all the atoms in the universe.

  44. #44 Mephistopheles O'Brien
    August 24, 2011

    The Very Reverend Battleaxe of Knowledge – you’re quite correct, though, if you were to try to dilute 1 molecule of anything with 10^60 molecules of water that would be on the order of 10^34 liters of water. Or 1,000,00,000,000,000,000,000,000,000,000,000,000,000,000,000 liters.

    Which is rather a lot really.

  45. #45 The Very Reverend Battleaxe of Knowledge
    August 24, 2011

    Aha, LW! Thanks—that makes sense. I was forgetting about all the strychnine or whatever you throw away. Thanks.

  46. #46 The Very Reverend Battleaxe of Knowledge
    August 24, 2011

    Just looked up the density and molecular weight of strychnine—if you dumped that 1 ml into the oceans and it thoroughly mixed, that would only be C13. Is that homeopathic?

  47. #47 lilady
    August 25, 2011

    @ Michael5Mackay: Doh…I should have known that Orac covered this already. The article that I read in a Homeopathy magazine said they had prepared the vaccine and were administering it orally within one week of isolating the four subtypes of the bacteria that were circulating during the outbreak. I don’t think it was “attenuated” like oral polio and oral typhoid vaccines are.

    So, did they take a minim of river water and put it into potable water, then dilute it to provide the proper dilution to make a gazillion liters of “vaccine”?

  48. #48 Rogo5
    August 25, 2011

    Proof that homeopathy doesn’t work: Robert Courtney.

    More about it here, if you want to read up on it: http://www.nytimes.com/2003/06/08/magazine/the-toxic-pharmacist.html

  49. #49 carykoh
    August 25, 2011

    @V.infernalis

    I don’t have access to the full article, but a brief look shows that they’re reporting a secondary outcome as a primary, a definite no-no. I’d be happy to go into more detail, but don’t want to hijack the thread. Here’s the link to the original study design, I can’t believe peer reviewers don’t look at this more:

    http://clinicaltrials.gov/ct2/show/NCT00646360?term=prenatal+dha&rank=1

  50. #50 Giliell
    August 25, 2011

    Don’t be unfair on homeopathy.
    I recently made a very good experience with it. It is so strong, it even works through closed bottles!
    During our recent holidays, my kids caught cold and I wanted something against their cough.
    When I came home from the pharmacy I ound out I’d been sold sugar-water that actually claims to treat dry coughs*.
    It also said I should contact a doctor if thigs don’t get better within 5 days.
    Believe me or not, after 2 days of having the unopened bottle in the cupboard**, the cough had almost vanished.
    Now everybody is free to guess what I’d be thinking if I believed in homeopathy…

    *If you ask yourself why I didn’t check there and then: foreign country, foreign language, hubby “parking” in second row

    ** No idea why I didn’t throw it away there and then

  51. #51 augustine
    August 25, 2011

    gillell

    Believe me or not, after 2 days of having the unopened bottle in the cupboard**, the cough had almost vanished.

    Great example. Had you taken Science Based medicine, you would have consumed unnecessary medication and then ingrained a belief system that the medicine is what made you better.

    That’s not science. Thats belief and faith.

  52. #52 Mu
    August 25, 2011

    A, not giving the medication is the ultimate form of homeopathy, infinitesimal dilution. Just like making the driest martini by waving the cork of a vermouth bottle over a glass of gin.

  53. #53 killinchy
    August 25, 2011

    Ah, Mestopheles O’Brien, you think I was being humorous in denying the work of John Dalton? Yes, of course I was.

    Anyone believing that homeopathy has any value is simply denying that matter is discontinuous. Homeopathy was invented before Dalton published and so homeopathy was as good as any other idea.

    But, not any more.

    I’m not surprised that the founder of homeopathy never got round to accepting that matter is discontinuous. As somebody pointed, Mach never did, and he presumably read Einstein’s paper on Brownian Movement.

    This question is not rhetorical: Do homeopaths deny that matter is discontinuous?

  54. #54 Beamup
    August 25, 2011

    I, for one, have never seen homeopaths make this argument, and I daresay I’ve risked frying my brain by reading quite extensively the “literature” of homeopaths.

    It’s the inescapable implication of the “law” of similars. Things that cause symptoms, when diluted cure said symptoms. Ergo a homeopathic preparation of feces, for instance, would supposedly cure diarrhea.

    @ Mojo:

    I know. I was simplifying since I presumed that everyone here knew that so it would be an understandable shorthand.

  55. #55 Calli Arcale
    August 25, 2011

    Killinchy — I suspect few homeopaths think it through that far. In other words, by alleging that they deny matter is discontinuous, you may be giving them too much credit.

    Mu — Your description of a homeopathic martini reminds me a lot of my uncle’s idea of a gin and tonic. :-D

  56. #56 Beamup
    August 25, 2011

    A bit more detail on my argument may help here.

    You make the statement about “forgetting.” Unless homeopaths expressly claim that the water does indeed forget (which could be demonstrated by appropriate quotations, which I don’t recall ever seeing on this particular point – but if provided, I will admit to being wrong), then that statement can only be justified if it is a logical consequence of what homeopaths DO claim. I have argued that in fact the logical consequence of what homeopaths claim is that there is no problem with the water remembering, and in fact a benefit. Hence they have no NEED to invoke the water forgetting such, and it is inaccurate to portray it as a logical conclusion of their claims.

    Ergo, I need not provide quotations of homeopaths arguing such unless you can demonstrate my reasoning from homeopathic “law” to be faulty.

    Or, if quotations from homeopaths claiming forgetfulness are provided, then that is firm proof that it’s not a straw man and I will admit my error.

  57. #57 Giliell
    August 25, 2011

    It’s the inescapable implication of the “law” of similars. Things that cause symptoms, when diluted cure said symptoms. Ergo a homeopathic preparation of feces, for instance, would supposedly cure diarrhea.

    So water that has come in contact with vitamins will lead to malnutrition?

  58. #58 Beamup
    August 25, 2011

    That would seem a logical consequence of the “laws,” yes. Accordingly I’d have no problem with that being used as an argument demonstrating the lunacy of homeopathy.

  59. #59 Krebiozen
    August 25, 2011

    The RationalWiki page on homeopathy is worth reading IMO.

    Hahnemann believed that the original substance was still present in the final dilution, since he preceded Avogadro. The “water memory” idea seems to have been a response to the problems posed to homeopathic theories by Avogadro i.e. that not a single molecule of the original substance remains after dilution. Some might call it special pleading.

    RationalWiki also points out that the purest laboratory water available contains impurities at the equivalent of 4C. So even the purest water still has homeopathic amounts of poo in it, and Minchin’s Law holds.

  60. #60 Collin
    August 25, 2011

    Perhaps it’s just my autism, but it sounds to me like Fisher’s hypothesis is even more ridiculous than has been noted. Like he’s saying that homeopathy affects the doctor by curing him/her of the habit of prescribing antibiotics. IOW, the patient isn’t even there.

    Mu, an even stronger medication can be made by taking the bottle an infinitesimal distance from the shelf. This can be done mentally, preventing the stress of actually having to use one’s hand to pick up the bottle. Most pharmacies charge an infinitesimal amount of money for this. Some even deliver 0-packs of these bottles, for a 0% handling fee, to the infinitely small store nearest you!

  61. #61 Julia
    August 26, 2011

    “While often claimed, this isn’t actually a problem. According to homeopathy, the effect of the “poop, urine, dirt, and other contaminants that it’s been in contact with” will be to cure anything which might be caused by ACTUAL “poop, urine, dirt, and other contaminants” therefore it’s actively beneficial for said water to have been in contact with such. ” By this logic then, would contact with disinfectants, vaccines, and/or antibiotics cause and infection or something like it? How far down the rabbit hole or through how many Inception realities can you go? I am an atheist/monist looking at Fisher’s experiment finding out how many molecular angels can dance on the head of a pin.

  62. #62 Beamup
    August 26, 2011

    By this logic then, would contact with disinfectants, vaccines, and/or antibiotics cause and infection or something like it? How far down the rabbit hole or through how many Inception realities can you go? I am an atheist/monist looking at Fisher’s experiment finding out how many molecular angels can dance on the head of a pin.

    That would also seem a logical consequence of homeopathic “law.” So, like Giliell’s example, it’s a good one to demonstrate just how stupid the whole idea is.

  63. Well that was an interesting read, I never believed in homeopathy..

  64. #64 lilady
    August 26, 2011

    Oops, who opened the can of Spam?

  65. #65 Rohan G
    August 30, 2011

    Calling all skeptics… calling all skeptics. Please vote in this online poll:

    http://www.guardian.co.uk/commentisfree/poll/2011/aug/30/homeopathy-nhs

  66. #66 lilady
    August 31, 2011

    @ Rohan G: Done, now if we could only get a “poll” going in the United States about funding CAM treatments…a girl can dream can’t she.

  67. #67 Visitante
    March 3, 2012

    The read of this article is fully appeal to autorithy,
    -Straw man fallacy (i.e: Homeopathy is absurd, inlogical).
    -Ad-hominem fallacy (is stupidy, is magic and misticism).
    -False historical dates (is magic).
    -Appeal a pseudoscientific old anthropology tesis (homeopathy is equivalent to magic).
    -Use opinions, not arguments for defense a point view (i.e. Controversy whit Fisher).
    -Appeal for the emotions (i.e. Homeopathy is absurd, unlogical, inconsisten).
    -Especulation (i.e. All homeopathy essays is product por defect o bad trial design).
    -Poor and bad argument for defense your thesis (i.e. Homeopathy contrary ALL physicis, biological and chemical laws). In effect the argument “contrary to laws.. ” is false .
    -Use false extrapolation (i.e. Reiki and homeopathy).

  68. #68 Chris
    March 3, 2012

    Visitante, why are you subjecting us to your fractured arguments on old articles? Could you try again in proper English, and completely explain your statements with actual evidence?

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