Respectful Insolence

Last week, I pointed out that, when referring to a therapy and considering whether it should be tested in clinical trials, plausibility does not mean knowing the mechanism. Today, I intend to elaborate a bit on that. As my jumping-off point, I couldn’t ask for anything better (if you can call it that) than an article by homeopaths published last week online in Medicine, Health Care, and Philosophy entitled Plausibility and evidence: the case of homeopathy. You’ll get an idea of what it is that affected Orac like the proverbial matador waving his cape in front of a bull by reading this brief passage from the abstract:

Prior disbelief in homeopathy is rooted in the perceived implausibility of any conceivable mechanism of action. Using the ‘crossword analogy’, we demonstrate that plausibility bias impedes assessment of the clinical evidence. Sweeping statements about the scientific impossibility of homeopathy are themselves unscientific: scientific statements must be precise and testable.

Scientific. You keep using that word. I do not think it means what you think it means. Of course, his being a homeopath is about as close to a guarantee as I can think of that a person doesn’t have the first clue what is and is not scientific. If he did, he wouldn’t be a homeopath. Still, this particular line of attack is often effective, whether yielded by a homeopath or other CAM apologist. After all, why not test these therapies in human beings and see if they work? What’s wrong with that? Isn’t it “close-minded” to claim that scientific considerations of prior plausibility consign homeopathy to the eternal dustbin of pseudoscience?

Not at all. There’s a difference between being open-minded and being so “open-minded” that your brains threaten to fall out. Guess which category homeopaths like Rutten fall into. But to hear them tell it, homeopathy is rejected because because we scientists have a “negative plausibility bias” towards it. At least, that’s what Rutten and some other homeopaths have been trying to convince us. This article seems to be an attempt to put some meat on the bones of their initial trial balloon of this argument published last summer, which Steve Novella duly deconstructed.

Before I dig in, however, I think it’s necessary for me to “confess” my bias and why I think it should be your bias too.

In which I confess my bias

Regular readers might have noticed that I write about homeopathy a lot. You might wonder why. Indeed, sometimes I myself wonder why. After all, if you want to come up with a list of the top three most ridiculous alternative medicine modalities with a large following, surely homeopathy will always be on the list, along with energy healing modalities (such as reiki) and a third nutty modality to be named later whose identity will be left for the reader for later given that there is likely to be some disagreement about it.

In any case, among highly implausible alternative medicine “healing systems,” homeopathy is at or near the top of the heap, reigning supreme. After all, given its twin pillars of “like cures like” and the law of infinitesimals, the former of which says that to relieve a set of symptoms you choose a remedy that causes those symptoms in healthy people and the latter of which says that those “like” remedies get stronger if they are highly diluted in serial steps–but only if they are vigorously shaken or “succussed” between each step. The first principle has no basis in physiology, pharmacology, biochemistry, or medicine (the claims of homeopaths to co-opt a real phenomenon known as hormesis notwithstanding), while the second principle so thoroughly violates the laws of chemistry and physics that, for it to be true huge swaths of these disciplines that have been well-established through hundreds of years of experimentation and observation would have to be not just wrong, but spectacularly wrong. One must concede that it’s possible that this latter principle might be true, but the odds that it is are about as infinitesimal as the amount of starting remedy in a 30 C homeopathic remedy. (That’s a 1 in 1060 chance, for those not familiar with homeopathy.) For all practical intents and purposes, the chances that homeopathy can work is zero. It is just water with its believer’s magical intent imagined into it.

So ridiculous is homeopathy that I sometimes feel that I and my fellow skeptics are firing Howitzers at an ant when we take so much time and effort to explain why homeopathy is nonsense. On the other hand, it is homeopathy’s monumental lack of scientific plausibility that makes it a perfect teaching tool to explain the difference between science-based medicine (SBM) and evidence-based medicine (EBM). Specifically, because clinical trials have unavoidable shortcomings and biases, even at a p=0.05, which would imply only approximately a 5% chance that a given trial’s apparently positive results could be due to random chance alone. As John Ioannidis has taught us, in clinical trials as practiced in the real world, the chance is much higher that any given positive trial is a false positive. It also means that, the lower the prior plausibility of a remedy working, the higher the chance of false positive trials. This is exactly what we see in homeopathy, hence the panoply of homeopathy trials showing “positive” results in which the treatment group is barely different from the control and/or the results barely reach statistical significance. With something like homeopathy, which violates the laws of so many sciences, it is relatively easy to make the case that it takes a lot more than a few equivocal clinical trials to show that so much well-established science is wrong. Apparently positive clinical trials of homeopathy are measuring, in essence, the noise inherent in doing clinical trials.

Although most physicians and clinical investigators don’t think about it consciously they tend to have a bias for plausible hypotheses and treatments in evidence-based medicine and against implausible hypotheses. That is a good thing. Unfortunately, this bias is certainly not inherent in EBM, as I have described may times before. EBM, after all, relegates basic science considerations to the very bottom rung of its ladder of evidence, below even expert opinion. Clinical trial evidence and epidemiology are all, and, although EBM aficionados deny it, the way EBM is practiced it does appear to worship the randomized clinical trial (RCT) above all else. In fact, that “plausibility bias” that most physicians have often manifests itself as difficulty believing that there is a problem with EBM, that EBM can go so off the rails when it comes to CAM because it really has no mechanism to take plausibility into account. Indeed, I’ve wondered before whether the reason prior plausibility is not built right into EBM is because the founders of EBM suffered from it. They assumed that treatments would not reach the stage of large RCTs if they had not proven themselves plausible first through preclinical evidence in laboratory studies, animal experiments, and studies of pathology and lab tests. Under this view, it simply never occurred to the gods of EBM that something as ridiculous as homeopathy could reach the stage of RCTs because they suffered from plausibility bias that blinded them to the very possibility of that happening!

Whether that’s true or not, I don’t know, but it would explain a lot. Either way, as I’ve pointed out, SBM tries to restore to EBM what it is missing: A consideration of prior plausibility based on scientific considerations. In practice, this is more useful for eliminating incredibly implausible treatments, such as homeopathy and reiki, than it is for putting hard numbers on prior plausibility for treatments because it is not always necessary to estimate a pre-trial probability of success, except when it so low that it would take an incredible amount of evidence to overturn existing knowledge, as it would for homeopathy or reiki. Here’s my plausibility bias: For something like homeopathy or reiki, either of which would require the rewriting of huge swaths of science to become plausible, I consider it reasonable to require supporting evidence at least in the same order of magnitude of quantity and quality as the evidence showing that homeopathy or reiki cannot work to make it reasonable to start to think that either could work. Or, to put it much more simply, extraordinary claims require extraordinary evidence.

That’s my plausibility bias. I’m biased in favor of science and reason and against magical thinking like homeopathy and reiki. You should be biased too.

The homeopaths attack

After I had stopped laughing in response to seeing homeopaths lecture scientists on what is and is not scientific, I delved into the paper. Rutten et al try (and fail–after all they are homeopaths) to establish their scientific bona fides righ in the second paragraph:

The authors of the present paper are doctors and scientists with an interest in homeopathy, committed to the scientific method in researching and practising it. We are qualified in medicine and science and started practising these in conventional contexts, gradually becoming convinced that homeopathy is an effective option, supplementary to rather than conflicting with conventional medicine. We concur with Hansen and Kappel that the disagreement concerning the interpretation of reviews of randomised controlled trials (RCTs) is rooted in prior beliefs and their influence on the perception of evidence. We do not concur, however, with their assumption that the homeopathy community’s positive view of the evidence is due to a rejection of the naturalistic scientific outlook. We ourselves, for example, do not reject any part of the naturalistic outlook.

My first temptation was to point out that the very fact that they are homeopaths means that they are either deluding themselves or lying when they claim that they do not reject any part of the naturalistic outlook. Homeopathy, after all, is rooted in the principles of sympathetic magic, not science. For instance, homeopathy’s law of similars (“like cures like”) is uncannily similar to Sir James George Frazer’s Law of Similarity as described in The Golden Bough (1922) as one of the implicit principles of magic. In addition, the concept that water can somehow retain the imprint of substances with which it’s been in contact, which really underlies the belief among homeopaths that remedies diluted to nonexistence (basically anything diluted more than around 12 C–14C or 15C, to be safe) can have biological effects, is very much like the Law of Contagion. Read the following passage from The Golden Bough and tell me that it doesn’t sound almost exactly like homeopathy:

If we analyse the principles of thought on which magic is based, they will probably be found to resolve themselves into two: first, that like produces like, or that an effect resembles its cause; and, second, that things which have once been in contact with each other continue to act on each other at a distance after the physical contact has been severed. The former principle may be called the Law of Similarity, the latter the Law of Contact or Contagion. From the first of these principles, namely the Law of Similarity, the magician infers that he can produce any effect he desires merely by imitating it: from the second he infers that whatever he does to a material object will affect equally the person with whom the object was once in contact, whether it formed part of his body or not. Charms based on the Law of Similarity may be called Homoeopathic or Imitative Magic. Charms based on the Law of Contact or Contagion may be called Contagious Magic.

A later passage by Sir Frazer is an excellent criticism of the two pillars of homeopathy:

Homoeopathic magic is founded on the association of ideas by similarity: contagious magic is founded on the association of ideas by contiguity. Homoeopathic magic commits the mistake of assuming that things which resemble each other are the same: contagious magic commits the mistake of assuming that things which have once been in contact with each other are always in contact. But in practice the two branches are often combined; or, to be more exact, while homoeopathic or imitative magic may be practised by itself, contagious magic will generally be found to involve an application of the homoeopathic or imitative principle.

See what I mean when I say that the ideas behind homeopathy resemble sympathetic magic far more than they resemble science? From my perspective, all homeopaths–and I do mean all homeopaths–hold views that reject science, no matter how much they fool themselves into thinking they are scientific and buy into the naturalistic world view. I could go on to demonstrate how much of homeopathy is rooted in prescientific vitalism, using Samuel Hahnemann’s own words, but I think you get the idea. Homeopathy is magic water made magic using thought processes akin to those used in voodoo when voodoo practitioners make voodoo dolls.

It is also rather interesting how Rutten et al are so willing to accept science when it comes to RCT evidence but reject the much larger and far more robust body of science that underlies the pre-trial assessment of prior probability that says that homeopathy can’t work. They willfully reject the concept that extraordinary claims require extraordinary evidence, and homeopathy is nothing if not a highly extraordinary set of claims. Instead, Rutten et al make an analogy to crossword puzzles. This analogy is actually rather apt, but not in the way our unhappy homeopaths think it is. Basically, here is the analogy as described by Rutten et al:

Sometimes new evidence overturns theory, but sometimes not; the context is crucial. This has been expressed in terms of a crossword analogy (Haack 1998): the correctness of an entry in a crossword depends upon how well it is supported by the clue, whether it fits with intersecting entries, how reasonable those other entries are, and how much of the crossword has been completed. In this analogy, for homeopathy, the primary entry is: “Does it work (other than by placebo effects)?” The secondary intersecting entries are concerned with “How does, or could, it work?”

Although Rutten et al will never admit it, this analogy is an excellent one for why the occasional “positive” clinical trial of homeopathy does not overthrow the existing scientific paradigm that concludes that homeopathy can’t work, that it is nothing but water, and that any apparently positive effects seen are due either to placebo, random chance, or bias and/or shortcomings in the RCTs. Such trials do not fit with “multiple intersecting entries” in physics, chemistry, and biology that are all consistent with the impossibility of homeopathy; i.e., they do not fit into the crossword puzzle. The only way they could be made to fit into the crossword puzzle would be if homeopathy were shown in a reproducible fashion to cure incurable diseases, such as metastatic pancreatic cancer, in which case homeopathy might go into the crossword puzzle and force the puzzle solver to start rethinking other answers to fit with homeopathy.

In other words, clinical evidence could make us question the rest of the “crossword puzzle” but only if it’s clinical evidence that is so extraordinary in result, quality, and quantity that it starts to rival the existing evidence from multiple disciplines that do not support homeopathy. No such evidence exists for homeopathy, and, in fact, the overall weight of the clinical evidence is consistent with homeopathy not working any more effectively than placebo. Indeed, Ruten et al wrongly relegate the question of how homeopathy could work to a secondary question, and here’s why: When, for a therapy to work the very laws of physics would have to be, as I say so often, not just wrong but spectacularly wrong, the question of how it could work is not secondary. This is in marked contrast to drugs (which inevitably work by either binding to a biological molecule or otherwise reacting somehow), in which case not knowing the exact mechanism is not as concerning. Even cases like the discovery that H. pylori causes duodenal ulcers is not a refutation of this principle with respect to homeopathy. After all, as implausible as the hypothesis that it was a particular bacterial species that was responsible for peptic ulcers in many cases, it did not require the violation of the laws of physics to imagine that a bacterial infection could somehow cause ulcers.

Rutten et al spend considerable verbiage listing the usual suspects for homeopathy, including old meta-analyses, various clinical trials, and, of course the infamous basophil degranulation experiments by Jacques Benveniste. These have been fodder many times before on this blog; so I don’t really want to dwell on them other than to note that in particular Rutten et al reserve most of their vitriol for a meta-analysis and systematic review of the literature by Shang et al published several years ago in The Lancet that found that homeopathy effects are placebo effects. Basically, Rutten et al basically rehash Rutten’s criticisms of Shang’s analysis, criticisms without merit. In fact, the apologia based on “clinical evidence” is nothing that we haven’t heard before and nothing worth rehashing here (other than a link to my previous deconstruction) because the point of Rutten et al is to attack what they call “plausibility bias.” All the trotting out of clinical evidence that allegedly supports homeopathy is in reality a massively flawed lead-in, a thin mint wafer to cleanse the palate, so to speak, to the main argument, which is based on how Shang’s meta-analysis and other clinical trials allegedly support homeopathy but are often cited as evidence against homeopathy.

First, Rutten et al distinguish between homeopathic dilutions in which there might still be some of the original remedy left (generally less than 12C or so, but in reality any homeopathic dilution that gets higher than 7C (10-14) is probably in the femtomolar range or lower, and there aren’t very many substances that have significant biological effects at such a low concentration. None of this stops Rutten et al from proclaiming:

There are obvious sources of pre-trial belief. These include well documented paradoxical low-dilution effects. The basic idea of homeopathy is the exploitation of the paradoxical secondary effects of low doses of drugs. Secondly, reverse or paradoxical effects of drugs and toxins in living organisms as a function of dose or time are very widely observed in pharmacology and toxicology. They are variously referred to as hormesis (the stimulatory or beneficial effects of small doses of toxins) hormligosis, Arndt- Schulz effects, rebound effects, dose-dependent reverse effects and paradoxical pharmacology (Calabrese and Blain 2005; Calabrese et al. 2006; Bond 2001; Teixeira 2007, 2011).

Repeat after me: Hormesis does not justify homeopathy. It’s an analogy that homeopaths love because it’s a hypothesis that states that some substances that are toxic at high doses might be benign or even beneficial at lower doses. (Look back to the fun I had with Ann Coulter’s invocation of hormesis to try to convince you that radiation from the Fukushima nuclear reactor is in fact good for you for an explanation.) This is, of course, wishful thinking on the part of homeopaths, representing extreme over-extrapolation. Hormesis might apply to low doses, but much of homeopathy involves no dose; i.e., dilution far, far beyond the point where it is highly unlikely that even a single molecule of the original substance remains. Rutten et al try to dodge this question by claiming that most homeopathic remedies are not “ultramolecular dilutions” (i.e., dilutions far beyond Avogadro’s number that leave nothing behind). Even if that’s true, many homeopathic dilutions are “ultramolecular” dilutions, and homeopathy does postulate that dilution and succussion do increase the potency of homeopathic remedies. Have Rutten et al forgotten the Law of Infinitesimals?

They haven’t, though. After trying to argue that most homeopathic remedies are not “ultramolecular,” Rutten et al then cite a bunch of dubious in vitro studies claiming that ultramolecular dilutions can have biological effects. I’ve looked at many such studies (for instance, this study of homeopathic remedies on human breast cancer cell lines), and quite often what you find is shoddy methodology, effects of solvents and contaminants, and other potential explanations for the observed results that do not involve having to throw out huge swaths of physics and chemistry. Amusingly, Rutten et al even admit that such results have a serious problem:

A more recent meta-analysis evaluated 67 in vitro biological experiments in 75 research publications and found high-potency effects were reported in nearly 75 % of all replicated studies; however, no positive result was stable enough to be reproduced by all investigators (Witt et al. 2007).

Can you say “publication bias”? Sure, I knew you could.

Can you also say: Anecdotal evidence? Sure, I knew you could:

The other major source of our prior beliefs is practice experience. This may be regarded the lowest level of evidence, but it is under-rated by many (Vandenbroucke 2001). After adding homeopathy to conventional treatment, many unsuccessful cases improved (Marian et al. 2008). The repetitive character of such experiences gradually updated our belief, consistent with Bayesian theory (Rutten 2008).

In other words, Rutten et al admitting that the source of their “positive plausibility bias” towards homeopathy is based on anecdotes. That is, after all, what “practice experience” is: Anecdotes, confirmation bias, and the like. It’s the same reason that Dr. Jay Gordon, for instance, believes that vaccines cause autism when the evidence from large epidemiological studies does not support that belief. He sees what he thinks are cases of “vaccine injury” manifesting itself as autism and, because he believes that vaccines cause autism, attributes his patients’ autism to vaccines. Rutten et al also cite non-blinded, non-randomized “real world” (pragmatic) trials as contributing to their pre-test plausibility bias towards homeopathy.

Pre-trial belief: Science versus anecdote

We have argued that EBM has a shortcoming, and that shortcoming is that EBM does not adequately consider prior probability in assessing evidence. In EBM, clinical evidence is all, and evidence from RCTs (or even better, meta-analyses or systematic reviews of RCTs) rules the heap. This is not unreasonable when RCTs are only performed for hypotheses that have been developed through a scientific process that takes preclinical observations and builds upon them, such that existing evidence deems them reasonably plausible. CAM in general and homeopathy in particular are not such a case. RCTs of homeopathy in essence measure noise, but only positive noise. Some studies will appear to be positive, and publication bias will make sure that the studies where patients receiving homeopathy do worse are unlikely to be published so that we see in the literature only negative studies or studies apparently positive due either to random chance, either alone or combined with poor study design and/or bias. We and others have proposed taking prior probability into consideration, both for deciding what hypotheses to test in clinical trials and how to interpret the results of existing clinical trials.

The fact is that we have always taken plausibility into account in deciding which clinical trials to perform. We have to because we don’t have unlimited resources, human subjects, or researchers to test in an RCT every hypothesis that comes along. We just don’t. In fact, our resources are currently more constrained than they have been in at least 20 years, with NIH pay lines hovering around the 7th percentile in some institutes. Moreover, the very foundations of medical ethics as laid down in the Helsinki declaration require that human subjects experimentation have a strong background of basic science backing it up. The question is: How do we want to prioritize which trials get done? On what do we base our estimates of prior plausibility that color our decisions regarding which clinical trials to carry out and how to interpret data from existing clinical trials? Homeopaths like Rutten and colleagues would propose that we base our estimate of prior plausibility on anecdote, magical thinking, and dubious in vitro and clinical trial evidence, ignoring the massive, well-established prior implausibility of homeopathy that a rational scientific assessment will arrive at. Scientists base their assessment of prior plausibility based on as objective as possible an interpretation of existing scientific data.

I know which one I would choose.

I also have a message for Rutten and is merry band of homeopaths. You accuse us of “plausibility bias” as though that were a bad thing. It’s not. As Mark Crislip pointed out, what plausibility bias should really be called is reality bias. We are biased towards reality. Homeopaths are biased towards what they think is reality but is in actuality magical thinking.

Again, I know which one I choose.

Finally, we don’t have unlimited resources to test every hypothesis that anyone can think up. There isn’t the money. There aren’t enough scientists. Even leaving aside the serious ethical problems that come with testing highly improbable remedies on human subjects, there aren’t enough human subjects to test the promising drugs that have a reasonable probability of working (i.e., of being efficacious and safe) based on preclinical testing. Resource constraints have always existed, and scientists have never just tested whatever the heck they felt like testing. Plausibility has always been a major part of deciding which experiments to do, which promising compounds to take to clinical trials, which treatments to try. Think of it this way: We could estimate plausibility as carefully as we can based on scientific testing, evidence published in the existing scientific literature, and data from small pilot clinical trials. Or, taking the approach of Rutten et al, we can estimate plausibility from anecdotal experience, questionable experiments and clinical trials, and considerations that completely ignore the laws of physics and chemistry.

Again, I know which method I choose.

Comments

  1. #1 Tom Morris
    May 14, 2012

    As a philosophy grad student, I’d like to apologise for the way that this bullshit got published in a journal that has the word ‘philosophy’ in the title. Rutten et al. have, as far as I can tell, completely misunderstood the point of the crossword analogy and what it is actually attempting to illustrate.

  2. #2 Michael Ralston
    May 14, 2012

    This may just be picking a nit, but I think it’s somewhat important to point out anyway:

    An implausible treatment modality isn’t actually more likely to produce false positives than a plausible one. It’s just that it’s so much LESS likely to produce a true positive that almost all the positive results you get from implausible modalities are going to be false positives.

    Or in other words, if you run 100 trials of a set of implausible modalities and a set of plausible modalities, you should get the same number of false positives in both – but the plausible modalities will have actual positives, too.

  3. #4 chris
    May 14, 2012

    Wouldn’t it be great if this article could be published in the same magazine as a refutation of the previous one? Could this happen?

  4. #5 dt
    May 14, 2012

    From the abstract:

    It is claimed that homeopathy conflicts with scientific laws and that homoeopaths reject the naturalistic outlook, but no evidence has been cited.

    (my emphasis)
    They found nothing published to say that that homeopathy conflicts with scientific laws? Where have they been looking – where the sun don’t shine?

  5. #6 Michael Hughes
    May 14, 2012

    Once again they’ve diluted their knowledge down so far as to be indistinguishable from nothingness.

    I’m torn between laughing at it and crying because people still believe it.

  6. #7 formula 21 formen
    May 14, 2012

    Wouldn’t it be great if this article could be published in the same magazine as a refutation of the previous one? Could this happen?

  7. #8 Julian Frost
    May 14, 2012

    formula 21 formen is a spammer.

  8. #9 Spam on Edge
    May 14, 2012

    Julian you missed the point, the comment was relevant to Orac’s post, so the blog f21f links to is not the main thrust. I understood what f21f said, and he managed to comment on the article rather than just commenting on the comments like we always do.

  9. #10 MikeMa
    May 14, 2012

    There will always be people who, for whatever reason (money, power, control, relevance, rebellion), prey on the fringes and the desperate found there. Homeopaths are leeches on society and by virtue of medicine’s finite reach, will remain in force sucking life from the unwell or unwise.

  10. #11 NJ
    May 14, 2012

    SoE@9:

    Julian you missed the point

    Ummmmm, no. You did.

    Compare comment #7 with comment #4. The spammer simply copied a previous comment in toto, ergo the spam comment was not “relevant to Orac’s post”.

  11. #12 harold
    May 14, 2012

    An implausible treatment modality isn’t actually more likely to produce false positives than a plausible one. It’s just that it’s so much LESS likely to produce a true positive that almost all the positive results you get from implausible modalities are going to be false positives.

    Exactly, there’s an implied conditional probability.

    The chances of getting a positive result of p or better because of chance alone is, of course, p.

    The chances of getting a positive result because the technique “worked” can only be imagined, but let’s call that number “w”. The more plausible the hypothesis, the higher w is. For example, if I did a redundant experiment testing whether aspirin was effective at relieving tension headaches, assuming adequate design, a positive result would be expected, and it would be reasonable to conclude that positive results confirmed a well known effect of aspirin.

    The conditional probability that a result of statistical significance level p is a true positive can be thought of as –

    w/(p +w)

    The more plausible that initial hypothesis, the more likely it is that positive results are true positives.

    Since we can’t usually know “w”, all of this is not all that important, except where it is clear that w is either fairly large or fairly small. Where w is very small, i.e. where the initial hypothesis is intuitively unreasonable, mild statistical significance of results needs to be viewed with skepticism.

  12. #13 Shay
    May 14, 2012

    There’s a difference between being open-minded and being so “open-minded” that your brains threaten to fall out.

    Orac, you’re channelling Sister John Marita who used to teach me in 7th grade. Are you sure you’re not a Dominican nun, come back to haunt me?

  13. #14 Denice Walter
    May 14, 2012

    When I read Frazer as a teenager**, I never expected that it would be relevant to 21st Century denizens of the industrialised world ( notice I didn’t say “western”).

    Yes, alt med partisans keep saying ‘scientific’ and calling their work ‘science’. As if. Herein lies their appeal to the masses who may possibly have an impoverished idea of what science is and more precisely, *how it works*.

    Here’s how it goes: they masquerade as scientists and ‘splain how SBM is shakey whilst their own forays into the quaking bogs of pseudo-science are truly on solid ground.
    This chicanery relies upon several inter-locking parts to achieve their prevaricating aims:
    lying about credentials ( their own and others’)
    sending up a smokescreen of obfuscation concerning research methods
    quoting “research” and “journals” that are abysmal
    making up biological entities and processes
    using conspiracy to explain their down-trodden status
    dismissing SBM as compromised research ( pharma-funded)
    pretense, mis-representation and more lies.

    Because their audience may not be able to differentiate what ‘reasonable’ and ‘plausible’ *are*, woo-meisters manage to con many people who*, through no fault of their own*, may not have had the background that would develop into the ability to separate the sheep from the goats and the goats from the jackals. To make matters worse, woos instruct their charges into NOT trusting authorities, officials and professionals, regalling their followers by tales of corruption on a grand scale in medicine, industry and government. “Don’t trust them, trust ME.” ( Perhaps their audience can’t read motivation as well).

    My own personal selections for *ne plus ultra* woo involve examples in which a vital essence or spiritual soul substance pops up to complete the explication of ‘how it works’. Occasionally, ‘consciousness’ itself is the magical mysterioso, imbued with numinosity, a “gift of the g-ds”. But then, I’m biased toward reality myself.

    ** and I still have my copy!!!

  14. #15 Dangerous Bacon
    May 14, 2012

    Even though Orac’s passing reference to Jay Gordon represents a nearly homeopathic dilution (when the entire length of the article is taken into account), the odds that Jay will turn up in the comments after doing a vanity search are far greater than 10 to the sixtieth power.

  15. #16 MARTHA GROSSO
    May 14, 2012

    Indeed a great post, Apart from this I am a medical student and I am researching about world’s pioneer doctors. I am gathering information about Dr Susan Lim Singapore . As far as I got to know she performed the first successful liver transplant in Asia. She has received many awards & accolades. Around the globe, cases have been directed to her because of her skill set and technical expertise, and her continued research in new technology and developing cures. I will greatly appreciate if you can point to any further resources about her.

  16. #17 Militant Agnostic
    May 14, 2012

    @16 – That was some of the best disguised spam I have seen in a long time.

  17. #18 harold
    May 14, 2012

    One thing to beware of, as noted in the original piece, is a possible bait and switch by homeopathy advocates.

    One thing they might try to do is to take some genuinely active compound, not dilute it beyond detection, show some effectiveness, and then claim that as “evidence for homeopathy”, broadly defined. If it isn’t based on “like cures like” and extreme dilution, it could just be a standard active compound. If it doesn’t test claims specific to homeopathy, it doesn’t test homeopathy.

    I have a cousin who is a farmer. As it happens, by an annoying coincidence, one branch of my family is from the rural area I was raised in, and gets hayfever in that area (I do, and I have two cousins who also do). Of mild interest, only men (but not all men) in our family get the havfever, so it may even be related to some trivial x-linked issue.

    My cousin swears by some “homeopathic” hayfever remedy that he gets over the counter at some local store.

    I’ve tended to write it off as placebo, but another, perhaps more likely, possibility, is that it isn’t really homeopathic, but rather, just some kind of not-excessively-dilute active compound, possibly herbal in origin, but with some kind valid pharmaceutical activity. Anybody can call anything “homeopathic”, and it’s highly plausible that someone might use the term loosely as a marketing mechanism.

    It isn’t evidence for homeopathy unless it tests homeopathic principles.

  18. #19 MikeMa
    May 14, 2012

    Ah, harold, one cannot test homeopathic principles if the concoction actually contains an active ingredient. In other words, if its homeopathic, it cannot work:)

  19. #20 W. Kevin Vicklund
    May 14, 2012

    “Homeopathic” allergy remedies (such as Hyland’s Hayfever) contain 3X (=1/1000th) dilutions of common allergens (such as ragweed) in quick dissolve tablets. This is likely to be equivalent to Sublingual Immunotherapy (SLIT) tablets, which contain allergens at about 25 mcg/mL concentrations, and have demonstrated some efficacy in clinical trials (about 1/3 – 2/3 the efficacy of allergy shots).

    In other words, it’s conventional medicine (40% of immunotherapy in Europe is SLIT) slapped with a homeopathic label and no quality control. And several times the cost.

  20. #21 Kelly M Bray
    May 14, 2012

    If in homeopathy remedys get stronger when they are diluted, then do homeopaths get stupider the more they study?

  21. #22 Denice Walter
    May 14, 2012

    In my mind’s eye, the image of a bumper sticker is slowly forming:

    *Reality-biased and PROUD of it!*

    OK, I’ll run that past my cohorts at our meeting at the Pakistani restauant and see how it flies…

    Reporting, researching, teaching and counselling *reality* is certainly better than the alternative… and it’s how we ROLL.

  22. #23 harold
    May 14, 2012

    W. Kevin Vicklund –

    “Homeopathic” allergy remedies (such as Hyland’s Hayfever) contain 3X (=1/1000th) dilutions of common allergens (such as ragweed) in quick dissolve tablets. This is likely to be equivalent to Sublingual Immunotherapy (SLIT) tablets, which contain allergens at about 25 mcg/mL concentrations, and have demonstrated some efficacy in clinical trials (about 1/3 – 2/3 the efficacy of allergy shots).

    In other words, it’s conventional medicine (40% of immunotherapy in Europe is SLIT) slapped with a homeopathic label and no quality control. And several times the cost.

    Thank you very much for confirming what I suspected.

    My cousin lives in Canada and might or might not be able to get better allergy treatment at no cost (although drugs and elective therapies are often directly charged for in Canada). The particular part of rural Canada I was raised in is noted for the extreme frugality of its inhabitants, and my cousin is a strong example of that admirable trend, so I doubt if he is paying very much for the stuff.

    MikeMa -

    Ah, harold, one cannot test homeopathic principles if the concoction actually contains an active ingredient. In other words, if its homeopathic, it cannot work:)

    Agreed, completely.

    But again, note my concern with the bait and switch.

    My cousin took a product that was labeled “homeopathic” and it probably had some beneficial effect.

    He told me, and initially I wrote off the beneficial effect as placebo, because I know what “homeopathy” actually means.

    However, we were probably both wrong. It probably has some benefit for him, but it isn’t really homeopathic.

    Okay, so what’s the problem? The problem is, now my cousin associates the term “homeopathic” with a somewhat effective product.

    Bait and switch. Apply the label to a product that does have active ingredient, then say, “that ‘homopathic’ product worked, therefore the concept of ‘homeopathy’ works”.

  23. #24 MikeMa
    May 14, 2012

    @harold,
    I was in our local coop in search of kale for the wife and looked over the pharmacopeia isle, fully 20% of the shelf space in the store. There was a large section generally for homeopathic crap but it does indeed include items with non-homeopathic dosages of active ingredients.

    I think they found that in certain markets having a homeopathy label actually boosts sales. It certainly boosts the price. You have given me an idea for when I have more time there. I will look to see if there are homeopathic amounts (meaning zero) of some ingredients while sneaking in normal amounts of some active medicine. I’m guessing cold & allergy stuff will fit that bill.

  24. #25 zackrobbin
    May 14, 2012

    I work in a food co-op as a sysadmin, and I have to say my reality bias is making me increasingly uncomfortable with our homeopathic products.
    With everything else, we’re very concerned about ethical production and marketing, and about accurate labeling that doesn’t disguise the nature of the products.
    maybe I should try to start a movement. Homeopathic products (I can’t bring myself to call them “medicines” or even “remedies”) should be required by law to carry the statement: “Warning. This product probably contains nothing but water and magical thinking, and there isn’t a shred of evidence it will do you any good.”
    Other than that bullshit, co-op’s are great, though.

  25. #26 Ken
    May 14, 2012

    A little off-topic, but I prefer to think that I’m just early since I can’t imagine Orac won’t cover it. There’s an AutismOne/Generation Rescue conference in the Chicago area in a couple of weeks, and they’re sending out flyers to area businesses. In part they read,

    This AutismOne/Generation Rescue conference… formerly cost $300 per person to attend. It is now reduced to only $25.

    There’s more at the Sun-Times in an interview with Jennie McCarthy, http://www.suntimes.com/lifestyles/12512693-423/jenny-mccarthy-promotes-options-for-autism-treatment.html .
    Apparently they’ve found some deep pockets to cover the difference, which leaves open the question of why, if this information is so critical, they’re charging anything in the first place.

  26. #27 Marc Stephens Is Insane
    May 14, 2012

    Ken,

    It seems the conference is in fact free; the $25 charge is for “shop supplies”:

    *$25 materials & proccessing fee convering 5 days of all general session tracks and features.

    (From their website registration page. I presume they meant “covering 5 days…”)

    And besides, for $25 you get the honour of meeting her royal highness McCarthy herself. I know people who went to ComicCon and paid $25 for a photo and autograph with Adam West in front the Batmobile…

  27. #28 Mephistopheles O'Brien
    May 14, 2012

    paid $25 for a photo and autograph with Adam West in front the Batmobile…

    I could pay money for that. I did get a lovely picture of Marta Kristen (Judy Robinson from Lost in Space [the TV show, not the movie]) this year.
    FWIW, she’s a lovely, gracious, and interesting person.

  28. #29 herr doktor bimler
    May 15, 2012
  29. #30 Marc Stephens Is Insane
    May 15, 2012

    I loved this comment from R. Johnston:

    The only person with whom McCarthy should be allowed to talk about autism is her therapist.

    That would make a great slogan for pro-vac protesters for T-shirts and picket signs! Wish I lived in Chicago.

  30. #31 Kelly M Bray
    May 15, 2012

    Autismone is pushing a talk by a Dr. David Berger. Nothing on this blog about him.

  31. #33 ken
    May 15, 2012

    OOps wrong Dr. Berger

  32. #34 Marc Stephens Is Insane
    May 15, 2012

    No, it’s THIS Dr. David Berger. A “holistic” pediatrician who cleverly calls his practic “wholistic”:

    http://wholisticpeds.com/

    Dr David is a Board Certified Pediatrician who specializes in holistic pediatric primary care, nutritional and detoxification therapies for autism, ADHD and related disorders and immune dysregulation such as allergies, asthma and autoimmune disorders. He also sees adults with these medical conditions. In addition, Dr David works with women and men who wish to do preconception and prenatal counseling, testing and treatments to try and optimize the health of the pregnancy and baby.

    One of the cornerstones of his practice is a challenged chelation test to “prove” the child is riddled with heavy metals, toxins, mercury, venus, mars and saturn.

  33. #35 Spam on Edge
    May 15, 2012

    NJ you had me hella confused until I realised I still had Chris on killfile >_<

  34. #36 Chris
    May 15, 2012

    I did not make Comment #4. One of the perks/problems of using a common name. Of course you will not see this, so all of the other references to comment numbers will be screwed up for you Spam on Edge (a username I do not recognize).

  35. #37 Marc Stephens Is Insane
    May 15, 2012

    Oh my, Dr. Berger is doing some vitamin D research in regard to autism prevention. I’m not a researcher, but there’s something that strikes me as fundamentally wrong about this methodology:

    Recruiting Pregant Mother’s of Children With Autism for Vitamin D/Prevention Study

    Wholistic Pediatrics has been asked to be a recruitment and participation site for a new study that is investigating a potential role of Vitamin D deficiency in the development of Autism. Vitamin D deficiency has been associated with many chronic conditions including weakened immunity, autoimmune diseases, cancer, diabetes, and declining cognitive function and memory. It has been theorized that vitamin D deficiency during pregnancy and early childhood may contribute to children developing autism.
    This goal of this study is to see if vitamin D supplementation can prevent the recurrence of autism in siblings of families with at least one child with Autism, by recruiting mothers of children with Autism who then become pregnant. Vitamin D levels of the mother are collected during the pregnancy, the mother will then be started on vitamin D3, and then the baby will be assessed for Autism at 18-24 months of age. Please contact our office at 813-960-3415 or info@wholisticpeds.com if interested in participating in the study.

    Click Here for Study Protocol and Criteria

    How would anyone ever know if the yet-to-be-born children would ever have developed autism with or without the vitamin D?

  36. #38 Spam on Edge
    May 15, 2012

    Duh, Spam on Edge is Genomaps in reverse!!

    Whilst policing the spam police, I was spamming YOU cryptically all along.

  37. #39 Phoenix Woman
    May 15, 2012

    Harold @ 19: I noted a while back that Nelsons “Homeopathic” Acne Gel, which actually is efficaceous against acne, does a little scam of the sort you describe. Their thing is to list all the homeopathically-diluted stuff as the “active” ingredients, whereas one of the “inert” ingredients listed is our old friend tea tree oil, which was proven by real science way back in the 1930s to have powerful antimicrobial effects.

  38. #40 Colin Day
    May 16, 2012

    Why should I believe that a reality-based worldview as biased? Biased with respect to what?

  39. #41 David
    May 18, 2012

    I always fail to follow Orac’s logic when he dismisses homeopathy on theoretical grounds, considering that there is a significant body of research, easily accessible online, into anomalous phenomena, much of it unrelated to homeopathy (though perhaps inspired by it), that points to anomalous properties of water that might serve as the underlying mechanism for homeopathic action.

    Surely if homeopathy is a real phenomenon then a change to our current paradigm would be required, but the chance of this is not infinitesimal as Orac absurdly claims: considering the history of science, the chance is rather close to 100%.

    I am not implying at all that such a change of paradigm will be driven by anomalous results in the field of homeopathy, but merely pointing out that Orac’s ‘eschatological’ vision of science, in which nothing major could ever be overthrown in future, has already and repeatedly been disproven by the actual march of scientific enquiry.

  40. #42 Beamup
    May 18, 2012

    @ David:

    None of the interesting properties of water is even vaguely in the same realm as something which might make homeopathy work.

  41. #43 JGC
    May 18, 2012

    David @ 41

    I’m curious–exactly what anamolous property or properties of water do you believe might serve as an underlying mechanism for homeopathic action?

  42. #44 Calli Arcale
    May 23, 2012

    “Surely if homeopathy is a real phenomenon then a change to our current paradigm would be required, but the chance of this is not infinitesimal as Orac absurdly claims: considering the history of science, the chance is rather close to 100%.”

    That’s about the most ridiculous overstating of the “science was wrong before” gambit that I’ve ever seen. Science has been wrong before, therefore homeopathy has a nearly 100% chance of having some basis in reality? So, because science was wrong about the luminferous ether (for instance), homeopaths must be on to something?

  43. #45 Marc Stephens Is Insane
    May 23, 2012

    JGC,

    Not only does water have “memory” as homeoquacks claim, but water can also read! I just saw some woo-crap from a lunatic who sells “programmed water”.

    What she does is affix a label to a vial of water, indicating what that water should cure or relieve. The water “reads” the label without any other ingredients added to the water (this is her emphasis–why 0even bother pretending that there’s duck liver or Berlin Wall?) and then knows what it has to do to when the sucker who buys the stuff drinks it.

    Are quack claims getting bolder and bolder? Why not just talk to the water and tell it to relieve a cold?

    WHO BELIEVES THIS CRAP?!!! AND WHY?!!!

  44. #46 Travis
    May 23, 2012

    Surely if homeopathy is a real phenomenon then a change to our current paradigm would be required, but the chance of this is not infinitesimal as Orac absurdly claims: considering the history of science, the chance is rather close to 100%

    As Calli Arcale said, this is ridiculous. Science having been wrong does not increase the chances that homeopathy works. When we found that Newton’s theories were incomplete this did not overturn all of the previous work on forces. Ideas that ran counter to that theory did not have a near 100% chance of being correct at that point. According to the statement you made one could say that Aristotelian physics has a near 100% chance of being correct because physics could be overturned. Our understanding of previous results change, and new predictions can be made made, but the effect of homeopathy will not likely change with new revolutions in science. The studies have been done an it does not work. Our understanding of just why it does not work might be modified but those results are most likely not going to change.

  45. #47 Mephistopheles O'Brien
    May 23, 2012

    I think, but do not guarantee, that the syllogism reads thusly:

    1. It would take a new scientific paradigm to account for homeopathy being a real phenomenon.
    2. Homeopathy is a real phenomenon.
    3. Therefore, a new scientific paradigm will emerge (chance ~100%).
    Q.E.D.

    Naturally, we wait with bated breath for the hard evidence of statement 2.

  46. #48 Travis
    May 23, 2012

    That might be the right interpretation. Though I am really not sure, it is worded so poorly. When I read it now I still get the impression they are saying that the chance of homeopathy being correct must be close to 100%.

    Maybe they can clarify the meaning.

  47. #49 herr doktor bimler
    May 23, 2012

    Rephrasing Mephistopheles O’Brien:

    (1) Our understanding of fundamental forces has been wrong in the past.
    (2) Therefore our understanding of fundamental forces is almost certain to change in the future, shifting to something that is even closer to the truth than the current paradigm.
    (3) Therefore that future paradigm is close to 100% to be one that accommodates homeopathy, despite the absence of evidence for that phenomenon.
    (4) PROFIT.

  48. #50 JGC
    May 24, 2012

    The ‘water can read’ claim is easily testable–for instance, we could label water “Rattlesnake Bite” and test its efficacy. Think the seller would volunteer to be bitten?

    Me neither.

  49. #51 Mephistopheles O'Brien
    May 25, 2012

    Herr Doctor,

    I concede your interpretation is better than mine, now that I re-read David’s message. Though i might change his point to:

    1. Paradigm changes have happened before in science, therefore they’re likely to happen again.
    2. Orac says the chance of paradigm shift is infinitessimal.
    3. Therefore Orac is wrong.

    Though that clearly ignores Orac’s context, that this paradigm shift refers to one that would allow for homeopathy. i suppose, though, if paradigms are going to shift they might be utterly random.

  50. #52 jim
    London
    May 28, 2012

    I think it’s a case of the Politician’s Fallacy, actually. The “logic” as I read it goes

    1. There is a near 100% chance that something requiring a change to our current paradigm will be scientifically validated in the future.
    2. Homeopathy is something that would require a change to our current paradigm.
    3. Therefore there is a near 100% chance that homeopathy will be scientifically validated in the future.

  51. [...] Once again, plausibility does not mean “knowing the mechanism of action.” (And I even wrote that one less than a month ago!) Yes, we have a plausibility bias in science, and that’s a good thing. In fact, that’s why I prefer to call it a reality bias. [...]