Respectful Insolence

The “success” of NCCAM grants on homeopathy

One of the great benefits of having been a blogger for nearly eight years now is that I now have a rich history of thousands of posts. True, there are the occasional posts that I wish I hadn’t written and even the occasional post that I consider to be not particularly good, but for the most part I’m proud of my work and would put my blog posts up against nearly anyone else’s. Another benefit of having such a long history is that, from time to time, I get the opportunity to revisit really old posts. Having written about these issues for so long, I find it really gratifying when I can revisit a story or an issue with new information and put my inimitable spin and commentary on it.

I’ve been writing about NCCAM for a long time, which is why I want to take a trip down memory lane in order to follow up on a post from a few years back, which was entitled The The National Center for Complementary and Alternative Medicine (NCCAM): Your Tax Dollars at Work. Specifically, I want to follow up on one specific study I mentioned that was funded by NCCAM. It is a study of homeopathy. Yes, in contrast to the protestations of Dr. Josephine Briggs, the current director of NCCAM, that NCCAM doesn’t fund studies of such pure pseudoscience as homeopathy anymore (although she does apparently meet with homeopaths for “balance”), prior to Dr. Briggs’ tenure NCCAM actually did fund studies of the magic water with mystical memory known as homeopathy. Two grants in particular I singled out for scorn. The principal investigator for both grants was Iris Bell, who is faculty at Andrew Weil’s center of woo at the University of Arizona. The first was an R21 grant for a project entitled Polysomnography in homeopathic remedy effects (NIH grant 1 R21 AT000388).

Here’s the abstract:

DESCRIPTION (provided by applicant): Classical homeopathy is a 200-year old system of complementary and alternative medicine (CAM), which claims that a substance that can cause symptoms in a healthy person (provings) can cure similar symptoms in a sick person (Law of Similars). In a design synthesizing homeopathic provings, health psychology, and psychophysiological methodologies, this revised 3-year R21 exploratory study (NCCAM PAR 03-153) will assess the effects of two different homeopathic, plant-derived remedies ([A]: Nux Vomica 30c or [B]: Coffea Cruda 30c) on polysomnographic sleep recordings of adult human subjects of both sexes (N=60). Primary Specific Aims are: I. To evaluate the effects of two different active homeopathic remedies versus placebo on standard sleep stages and spectral EEG in human subjects; and II.To determine the effects of two different active homeopathic remedies versus placebo on nonlinear characteristics of sleep EEG in human subjects; The Secondary Aim is: III. To assess the contribution of baseline individual difference traits and subjective expectation in modifying the physiological outcomes above. The study will examine the interaction of the remedy effects with two different human personality traits associated with insomnia and overlapping those of persons reported in classical homeopathy to respond most strongly to each remedy. Subjects will fall into two subclinical groups of otherwise healthy persons: (i) those who score high on the personality trait of hostility (Type A/coronary-prone; contained within remedy picture of Nux Vomica)(n=30) and (ii) those who score high on the personality trait of anxiety sensitivity (panic-prone; contained within remedy picture of Coffea Cruda)(n=30). All subjects also will report insomnia from drinking coffee (a symptom common in homeopathy to both remedy types) and will replace it with a non-coffee caffeinated beverage for at least 7 days before and for the duration of the study (beverage coffee is reportedly a clinical antidote for many homeopathic remedies). During the 4-week protocol, on the first two nights of each study week, they will undergo at home, all-night polysomnographic sleep recordings, i.e., on days 1 and 2 (baseline 1), 8 and 9 (placebo), 15 and 16 (baseline 2), and 22 and 23 (remedy [A] OR remedy [B]). All will receive placebo at bedtime on day 8, single-blind (placebo given before any remedy to eliminate risk of carry-over effects and/or experimenter intentionality on placebo responses, problems reported in previous homeopathic provings). At bedtime on day 22, half of the subjects from each personality type will receive one dose of Nux Vomica and half will receive one dose of Coffea Cruda on a randomized, double-blind basis. All participants will also record subjective sleep and symptom patterns over the 4 weeks. Statistical analyses will include hierarchical linear models and general linear models. The chosen remedies in 30c doses each showed specific and different effects on sleep electroencephalograms of healthy animals in previous studies. This study will contribute to our long-range goal of understanding the neurophysiological and biopsychosocial mechanisms of classical homeopathic remedy treatment in patients with specific clinical conditions.

Leaving aside the utterly scientifically bankrupt nature of the hypotheses and the methods of testing the, which involve homeopathic provings, health psychology, and psychophysiological methodologies, NIH R21 grants are exploratory grants designed to test preliminary hypotheses. As such, they are much smaller than the usual flagship R01 grants and don’t require much preliminary data. Actually, technically they don’t require any preliminary data, the idea being that an idea that is based in sound science designed to explore a promising novel hypothesis could potentially be fundable, but in all my years in the lab I’ve never seen an R21 funded with no preliminary data. Be that as it may, there’s no way that anything having to do with homeopathy could be based in sound science, but apparently that didn’t stop NCCAM from funding the polysomnography grant (1 R21 AT000388) for three years and scoring total funding of $583,974. If we estimate an indirect cost rate of approximately 50%, that means Dr. Bell scored roughly $389,000 in direct costs to do this study, the rest going to the University of Arizona. (These days, R21s are usually only funded for two years to a maximum of $275,000 in direct costs.) Even so, just the very nature of homeopathy, how it involves diluting compounds to nonexistence (note that Bell is using 30C preparations, which means they’ve been diluted 1060-fold, or approximately 1037-fold more than Avagadro’s number), should have been enough to kill this grant in any respectable study section. The same is true of the second grant, which was entitled Dilution and succussion in homeopathic remedy dose-response effects (NIH grant 1 R21 AT003212).

Here’s its abstract:

DESCRIPTION (provided by applicant): The purpose of this revised R21 exploratory grant to NCCAM in response to PAR-03-153 is to extend the PI’s previous human olfactory psychophysiology research and develop a quantitative electroencephalographic (qEEG) bioassay for registration of individually active (salient) versus inactive homeopathic remedies or placebo. Homeopathy’s founder, Samuel Hahnemann MD, originally proposed olfactory sniffing as a valid route for clinical remedy administration. Convergent basic science evidence suggests that succussion (vigorous shaking) in the preparation of homeopathic remedies from animal, mineral, and plant sources, may persistently modify the physical structure of solvent to generate order, i.e., a unique informational signal, even in ultra-diluted solutions beyond Avogadro’s number. Torres and Ruiz (1996) proposed that stochastic resonance in sensory systems is a model for optimizing detection of a weak signal (homeopathic remedy information) by addition of noise (succussions). No previous research has directly examined the effects in human populations of a given remedy dilution prepared with different numbers of succussions. Specific aims for the study are: I. To evaluate the feasibility of using acute evoked responses in quantitative electroencephalography (qEEG) alpha power during olfactory administration to detect the presence of a single homeopathic remedy (Sulphur) at different numbers of succussions per dilution step, prepared at a given dilution; II. To determine the feasibility of using the magnitude of acute evoked responses in quantitative electroencephalography (qEEG) alpha power during olfactory administration to detect the presence of a single homeopathic remedy at two different homeopathic serial dilution factors (prepared with a given number of succussions per dilution step); III. To evaluate the generalizability of findings for a separate polycrest remedy (Pulsatilla). Subjects will be N=108 (n=54/remedy) young adult volunteers with moderate (not excellent global health) prescreened for potential remedy salience of either Sulphur or Pulsatilla and tested in a two-phase study (one remedy per phase). Each participant will undergo pre-screening with the Homeopathic Constitutional Type Questionnaire for high criterion scores for symptoms of one of the two test remedies, followed by three laboratory sessions spaced one week apart (dilution sequence subject allocation balanced within each remedy type for 6c, 12c, and 30c potencies). Each session will involve eight presentations within a complete block design of randomized double-blind, placebo- controlled (both succussed remedy-free solvent and succussed plain distilled water) olfactory sniff tests (using time-locked sniff-EEG recordings via an airflow pressure transducer), using a given remedy dilution prepared with stirring only, 10, 20, or 30 succussions. The present study fills a major need in homeopathic clinical research to explore and understand remedy-related and remedy-person interactive factors that could contribute to well-known problems in replicability. Findings from this and follow- up studies via subsequent R01s could improve standardization of homeopathic remedy manufacturing and prescribing used in patient care and thereby advance the quality of clinical treatments and research for this leading form of complementary and alternative medicine worldwide.

Yes, as hard as it is to believe, this is an actual, NIH-funded grant. Yes, it’s an R21, and, yes, one could argue that it’s fairly impressive (for a believer in homeopathy) that Dr. Bell would like to actually test the effects of succussion on the production of homeopathic remedies. Or it would be, were it not for the science that shows that diluting remedies far beyond Avagadro’s number leaves not a single molecule left of the original remedy and that there is no even remotely plausible mechanism by which homeopathic remedies so diluted can work. The way that homeopaths hand wave as above, using terms such as “homeopathy remedy information” should tell you all you need to know.

Putting aside just how nonsensical homeopathy is, I can’t help but note that this is now all money that’s already been spent. As scientists, how do we judge the value of what came out of a grant like this? Given that, as a general rule, it’s often very hard to judge the value of the actual science funded by a grant as it’s being done or shortly thereafter, we have to rely on imperfect metrics. These include (1) publications that derive from the work done using the grant funding; (2) new grants that derive from the data generated from work done on the grant; and (3) patents that derive from work. In all fairness, we also have to take into account the fact that these two grants are R21s, which means they’re designed to fund preliminary research, which by its very nature is riskier and less likely to pan out than research funded by a nice, “safe” R01 backed by ten papers’ worth of preliminary data. Some R21s based in the soundest and most interesting of science will result in not a whole lot of results; it’s the nature of the beast. (Preliminary “risky” research is, well, preliminary and risky.) Fortunately, when it comes to finding this out, it’s not as difficult as it once was, as the NIH now requires that all papers that result from NIH-funding be reported and made available to the public through PubMed Central, albeit sometimes after a year embargo to satisfy the for-profit publishers. So let’s take a look at the publications credited to these grants so far:

Here are the publications deriving from the polysomnography/homeopathy grant (1 R21 AT000388):

  1. Menk Otto L, Howerter A, Bell IR, Jackson N (2010). Exploring measures of whole person wellness: integrative well-being and psychological flourishing. Explore (NY) 6(6):364-70.
  2. Brooks AJ, Bell IR, Howerter A, Jackson N, Aickin M (2010). Effects of homeopathic medicines on mood of adults with histories of coffee-related insomnia. Forsch Komplementmed 17(5):250-7. PMID: 20980764.
  3. Bell IR, Howerter A, Jackson N, Aickin M, Baldwin CM, Bootzin RR (2011). Effects of homeopathic medicines on polysomnographic sleep of young adults with histories of coffee-related insomnia. Sleep Med 12(5):505-11. PMID: 20673648.
  4. Bell IR, Koithan M (2006). Models for the study of whole systems. Integr Cancer Ther 5(4):293-307. PMID: 17101758.

Here are the publications deriving from the succussion grant (1 R21 AT003212):

  1. Bell IR, Howerter A, Jackson N, Brooks AJ, Schwartz GE (2012). Multiweek resting EEG cordance change patterns from repeated olfactory activation with two constitutionally salient homeopathic remedies in healthy young adults. J Altern Complement Med 18(5):445-53. PMID: 22594648.
  2. Bell IR, Brooks AJ, Howerter A, Jackson N, Schwartz GE (2011).Short-term effects of repeated olfactory administration of homeopathic sulphur or pulsatilla on electroencephalographic alpha power in healthy young adults. Homeopathy 100(4):203-11. PMID: 21962194.
  3. Menk Otto L, Howerter A, Bell IR, Jackson N (2010). Exploring measures of whole person wellness: integrative well-being and psychological flourishing. Explore (NY) 6(6):364-70. PMID: 21040885.

So far, this is not promising. For all six papers (there’s one claimed for both grants), only one appears to be in a “real” journal (i.e., a journal that is not devoted to “alternative” or “integrative” medicine). That journal is Sleep Medicine. All of the other these journals, although ostensibly “peer-reviewed” and, for whatever unknown but almost certainly ridiculous reason, indexed in Medline, are the lowest of the low. Any journal whose title is Homeopathy is clearly devoted to pure pseudoscience. Explore: The Journal of Science and Healing is a journal known for its publication of truly ridiculous studies. Perhaps my favorite of the bunch is from a few years ago and involved looking at whether positive “intent” could be embedded in chocolate, much the way that Masuro Emoto tries to embed “intent” into water. And, of course, the Journal of Alternative and Complementary Medicine, Forschende Komplementärmedizin (Research in Complementary Medicine), and Integrative Cancer Therapies are well-known as go-to journals for all varieties of dubious “integrative” medicine. For instance, the former advertises that it will publish papers in, among other things, homeopathy, naturopathy, subtle energies, energy medicine, or whatever. (My personal favorite, something I haven’t quite yet figured out yet, is the topic of “integrative biophysics,” which is one of the topics listed as being relevant to this particular journal.)

Of course, it’s not enough simply to point out that these three journals are shams masquerading as real scientific journals. You never know. Maybe these three papers are simply awesome. Yes, I know it’s highly unlikely when the topic is homeopathy, but, as always, it’s necessary to dive into the papers themselves. So let’s look at a few of these papers, chosen because they piqued my interest in some way and they represented the number of papers I could get through in the time I had to write this. I’ll start with #3 from the succussion/dilution grant, which is also #1 for the polysomnography grant. It’s also published in the second woo-iest of the journals, Explore. Or maybe it’s the first woo-iest of the journals. After all, it doesn’t limit itself to just one quackery, the way Homeopathy does. Looking at the paper, I have a hard time figuring out what the relevance is to either grant, as it is not so much about homeopathy at all. Rather, it’s about what the authors abbreviate as WSCAM (which echoes in my mind as “W-SCAM”). WSCAM stands for “whole systems complementary and alternative medicine” and consists mainly of homeopathy, traditional Chinese medicine (TCM), Ayurveda, and naturopathy, defined as systems that “focus on the whole person indicators of health, including patients’ experienced global well-being.” To this, Bell wants to apply “nonlinear dynamical systems theory thusly”:

Investigators have proposed using scientific concepts drawn from complex nonlinear dynamical systems theory towards improving the external validity of the clinical evidence base on WSCAM studies [8, 11, 12]. Several medical specialties are using methods of complex systems science to evaluate the functioning of body systems in an effort to increase diagnostic capability and assess patterns of disease [13–19]. Study designs such as these are well suited to non-reductive WSCAM studies that evaluate whole-person outcomes, because they attempt to quantify complex variables. In complexity theory the person is an indivisible complex adaptive system of interacting and interdependent parts, nested within and responsive/reactive to a complex environment. Synthesis of WSCAM with complexity theory suggests the need for characterizing WSCAM outcomes in terms of both (a) global and local outcomes and (b) positively and negatively valenced systemic behaviors (i.e., symptoms, signs) [8].

Basically, Bell et al looked at the results of different measures of psychological health, calculating what is known as the “P:N” (positive to negative affect) ratio on a bunch of college students enrolled in an introductory psychology course, tried to figure out if the “ratio of positive to negatively valenced mood has a unique relationship to overall well-being different from its individual components,” and dividing the students up into what they called “flourisher” and “languishers.” Ultimately, they claim that their goal is to “apply complex systems theory” to additional studies and ask if that can “improve well being.” As I said, this study is purely observational and not even particularly interesting. It’s also only tangentially related to the grant, perhaps specific aim 3, which is “to assess the contribution of baseline individual difference traits and subjective expectation in modifying the physiological outcomes.”

Next up is a paper published in 2011. This trial was, in essence, a homeopathic proving, in which Bell et al had healthy college students sniff various homeopathic remedies while hooked up to an EEG machine. I kid you not. Even more bizarre, the students were screened and tested thusly:

College student volunteers (ages 18–30, both sexes) from an introductory psychology course were screened for good health and relatively elevated Sulphur OR Pulsatilla symptom scores on the Homeopathic Constitutional Type Questionnaire. Subjects underwent a series of 3 once-weekly double-blind sessions during which they repeatedly sniffed the remedy matched to their CTQ type and solvent controls. Each remedy was given in a 6c, 12c, and 30c potency, one potency per week, in randomly assigned order. Solvent controls included both plain distilled water and a water-ethanol (95%) solution. All sniff test solutions were further diluted just prior to laboratory sessions (0.5 ml test solution in 150 ml distilled water). Within a session, remedies and control solvents were administered via 2-second sniffs (8 sniffs of each of 4 different succussion levels for the potency in randomized order). Primary outcome variable was relative EEG power (alpha 1 8–10 hertz; alpha 2 10–12 hertz) averaged over 19 electrode sites, including all succussions for a given potency.

That’s right. Your tax dollars funded a study in which students sniffed homeopathic remedies, two of which, the 12C and 30C, were diluted to near-non-existence and non-existence, respectively. In the introduction the investigators went on and on about the “nonlinear” nature of the alleged dose-response of homeopathic remedies in previous studies. One wonders if it ever occurred to them that this would be the result one would expect if what they were seeing were spurious results; i.e., no consistent dose-response curve. It doesn’t matter, though. This study was massively unimpressive. If you look at the tables, you’ll see that there is no consistent “dose-response” curve. “Effects” fluctuate up and down as dilution increases. In Table 2, only one measure was statistically significantly different, and that appears to be only because the 12C dilution produced a lower power than either the 6C dilution or the 30C dilution. I’ll grant the investigators that that’s “nonlinear,” but it also goes against homeopathic “theory,” which claims that diluting the solution makes the remedy more potent.

Table 3 looks at the number of succussion steps. Basically, the investigators looked at whether succussion in addition to dilution matters. Again, I kid you not. Basically, the investigators looked at four different “succussion” levels: no succussion (stirred), 20 succussions, 40 succussions, and 100 succussions). Remember, whenever they are criticized for claiming that their remedies become more potent the more that they are diluted, homeopaths will piously and condescendingly tell us that homeopathy is so much more than just dilution. The succussion steps are supposedly absolutely critical, as they “potentize” the solution of the homeopathic remedy. You might remember that the founder of homeopathy, Samuel Hahnemann himself, recommended slapping the remedy against a Bible to succuss it. Three out of the four measures were not statistically significantly different, and the one that was shows no consistent change in one direction based on the number of succussion steps. In other words, this is about as close to a negative study as can be. Given the number of repeated measures that the investigators looked at, I would have been shocked if they hadn’t found one or two seemingly “positive” results; however, there is no consistency to them that would suggest a real effect. In any real world scientific application, this would be a negative study. It looks like nothing more than noise interpreted as signal. It is rather amusing, though, how inconsistent effects that follow no dose-response are touted as a feature, not a bug, of homeopathy.

Speaking of this very feature, I’ve saved the paper published in the “real” journal for last, specifically the paper in Sleep Medicine. This paper actually took some reading, unfortunately, but I didn’t think I could avoid discussing it because, well, it’s the only paper from these grants that appeared in a real journal. In brief, this study examines the effect of two homeopathic remedies, Nux Vomica or Coffea Cruda, on insomnia associated with caffeine use. Following the homeopathic principle (for which there is no evidence that it works as a general rule) of like cures like, Bell et al made homeopathic remedies out of unroasted coffee beans (Coffea Cruda), but I can’t figure out the rationale for using Nux Vomica, which is basically strychnine, but apparently homeopaths use it for insomnia, colds, flu, bladder infections, and “premature, profuse or erratic menstruation periods wherein the patients tend to faint before the start of their menstruation cycle.” Why? Who knows? The one thing I do know is that it’s a really good thing that most homeopathic remedies are diluted to nonexistence. One wouldn’t want to be taking strychnine at pharmacological doses. In any case, Bell et al describe the use of these two remedies thusly:

Clinically, homeopaths report that Coffea Cruda patients are mild and timid, but also irritable and oversensitive to all types of sensory stimuli, especially noise, as well as to positive emotions [25,26]. Nux Vomica as a homeopathic remedy is used clinically to treat people with competitive, irritable and impatient Type A-like behavioral patterns and tendencies to abuse alcohol, caffeine, and other substances. Both Coffea Cruda and Nux Vomica patients report insomnia in the middle of the night as a symptom [27]. Taken together with the clinical reports, the animal EEG sleep data provide a basis for selecting Coffea Cruda and Nux Vomica as candidate homeopathic remedies to test in the first homeopathic PSG research on human subjects.

I’m sold. How about you? Note that reference 27 is a book quoting Hahnemann. I also can’t help but note that every single reference used as a basic science justification for this study, some of which were animal studies claiming that Coffea Cruda or Nux Vomica could decrease caffeine-induced changes in sleep in rats, all came from not just woo journals but homeopathy journals. I took a look at the papers, and, as one might expect, they were…underwhelming. But what about this study?

The experimental design was rather complicated:

Young adults of both sexes (ages 18–31) with above-average scores on standardized personality scales for either cynical hostility or anxiety sensitivity (but not both), and a history of coffee-induced insomnia, participated in the month-long study. At-home polysomnographic recordings were obtained on successive pairs of nights once per week for a total of eight recordings (nights 1, 2, 8, 9, 15, 16, 22, 23). Subjects (N=54) received placebo pellets on night 8 (single-blind) and verum pellets on night 22 (double-blind) in 30c doses of one of two homeopathic remedies, Nux Vomica or Coffea Cruda. Subjects completed daily morning sleep diaries and weekly Pittsburgh Sleep Quality Index scales, as well as Profile of Mood States Scales at bedtime on polysomnography nights.

As the authors readily acknowledge, obtaining polysomnographic (PSG) measurements at home is not a trivial matter. In any case, the factor they were interested in was the PSG sleep time. Well, not exactly. According to the methods section:

Based on the clinical literature and animal studies, primary outcome variables of interest were total sleep time, slow wave sleep, stage changes, and awakenings after sleep onset, as a function of verum remedy versus placebo across all subjects. Given the exploratory and early research phase nature of the current study on human subjects, however, PSG sleep onset and rapid eye movement (REM) latencies, REM and other NREM stages, as well as actigraphic measures of TST, sleep onset latency, sleep efficiency, and fragmentation index, were examined secondarily for possible effects.

One thing I found highly irritating about this paper is the way that they reported their findings. Rather than showing the data in a straightforward bar graph or a table with clear descriptions of what each number means, we’re treated to a single table, (Table 2) showing regression findings, which are described as being within-subject Analyses on means for combined remedy nights (22/23) versus means for combined placebo nights 8/9, controlling for gender, personality scores, total time in bed, and means for combined baseline nights (1/2/15/16). Unfortunately, even after reading the paper, I’m not sure exactly how authors controlled for baseline nights. Another thing I noticed right away is that the 95% confidence intervals were large. Really large, as in at least half the value of the actual number, often considerably more.

Also rather curious were the findings themselves, which were that overall PSG for the remedy week showed significantly longer TST, increased NREM sleep including more minutes in stage 2 and increased slow wave sleep (SWS), with a trend toward increased minutes of stage 4 sleep (β=5.8, p<0.10) compared with placebo. The homeopathic remedies also led to more sleep disruptions after sleep onset, with significantly increased awakenings, number of stage changes, and more type 2 arousals compared to placebo. Sound familiar? Once again, it’s the same thing we’ve seen before: Mixed, inconsistent results.

There’s also another issue that is mentioned in the discussion, but the authors’ explanation is not convincing. The authors note that one possible interpretation of the data could be that the changes in sleep during the remedy week could be due to the passage of time and the adaptation of the subjects to the study protocol and equipment, rather than remedy effects. They are correct but not so convincing in their dismissal of that concern, in which they argue that everything is hunky dory because analyses were controlled for baselines taken on nights 1 and 2 and on nights 15 and 16. Here’s the problem. The very experimental design calls for a single-blind placebo during the earlier intervention week. Why single blind? Try not to laugh:

The study design was deliberately structured with single-blind placebo preceding allocation to one or the other of the two remedies double-blind, in order to address a different potential methodological and theoretical concern, i.e., the reported risk of non-local or entanglement confounds of placebo and remedy effects, when treatment arms are administered double-blind in a closed system of a homeopathic study. Keeping the experimental system open with single blind placebo may have provided a strategy to reduce the risk of entanglement between placebo and remedy effects [62–65].

Yes, Bell et al just invoked quantum entanglement. If you don’t believe me, check out references 62 through 65. Go ahead. I’ll wait. At least I was grateful when I read the paper that Bell actually refrained from citing Lionel Milgrom. Little victories matter. In any case, see how pseudoscience twists a normal protocol. There could very well be bias introduced by always having the placebo first and by having it be only single-blinded. However, because of some fantastical worry about “entanglement,” instead of doing the study the way it should be done, totally double blinding it and not restricting whether subjects got the placebo or the “real” homeopathic remedy to one week, they do it in a way that makes it less rigorous and more prone to effects not due to the intervention. Of course, given that homeopathic remedies are basically water packed into sugar pills and then allowed to evaporate, the very concept of a “placebo” in a homeopathy trial is rather risible. After all, the homeopathic remedies are every bit as much placeboes as the placeboes. Be that as it may, this trial is not particularly convincing, either. Even the authors concede that their “present findings do not address the question of whether or not either of the homeopathic remedies tested here would be therapeutic for certain people with insomnia.” Now that’s an understatement.

Two years ago, NCCAM director Josephine Briggs assured Steve Novella, Kimball Atwood, and myself that NCCAM is a lot more rigorous now and that trials like these two would never be funded under the new regime. That’s reassuring, but it doesn’t convince me. For one thing, Briggs wouldn’t say that no trial of homeopathy would ever be funded by NCCAM, even though she conceded that homeopathy is based on principles that are so unscientific as to be incredibly implausible. While I understand that it’s hard for the director of an NIH center to say “never” about anything, what this told me is that Dr. Briggs would be willing to fund homeopathy research if it met some level of scientific rigor. What about homeopathy could have sufficient scientific rigor to be worth throwing hundreds of thousands of dollars at is never said, and another director might be more lax in judgment. Besides, there is a training grant whose principal investigator is—you guessed it!—Iris Bell and whose purpose involves preparing its fellows to be able to study all sorts of dubious alt-med modalities, including homeopathy. Yes, it’s the University of Arizona CAM research training program.

So even though NCCAM claims not to fund pure quackery anymore (although that’s debatable), it does fund education in quackery in the form of training grants. As for grants like those of Iris Bell, it’s depressing to think that NCCAm threw a half million dollars at studies this execrable, in addition to studies just as bad. It’s your tax dollars still at work, funding woo. When will it ever end?

Not as long as NCCAM exists.

Comments

  1. #1 david
    November 19, 2012

    One effect of funding Bell’s two ridiculous grant proposals is that it gave her an opportunity to teach medical students about woo for the past several years.

    Great post. One of your best.

  2. #2 Eric Lund
    November 19, 2012

    Yes, Bell et al just invoked quantum entanglement.

    There is a (probably unintentional) joke in this statement. One of the fundamental laws of quantum entanglement is called Bell’s Theorem. (Of course, that’s a different Bell, who AFAIK is not related to Iris.)

  3. #3 lilady
    November 19, 2012

    I’ve commented before on the NCCAM blog about funding of educational grants to train more “CAM” practitioners…which really do NOT meet funding criteria as outlined by the Deputy Director, Dr. Killen…

    https://nccam.nih.gov/research/blog/niche#comments

    So, who is going to submit another comment on that thread?

  4. #4 Denice Walter
    November 19, 2012

    Flourishers and languishers? Sounds like descriptions from a Victorian novel.

    When I stop laughing. I’ll read the rest..

  5. #5 Denice Walter
    November 19, 2012

    And experiencing *worry about ‘entanglement’*?
    Don’t we all?

  6. #6 lkr
    oregon usa
    November 19, 2012

    …so, to get a grade in Psych 101 at the UAriz, you agree to take sugar pills from loons in the Med School?

  7. #7 Alain
    November 19, 2012

    @ Denice Walter,

    I had to google (translate) the word, entanglement.

    More on topic, does NCCAM give grants to undergrad students? I’d love to replicate the sleep study and I have a few ideas in mind :D

    Alain

  8. #8 AdamG
    November 19, 2012

    Many of my colleagues in genomics have had difficulty getting R21′s and R01′s funded lately due to the NIH budgetary situation. Reading this article just makes me sad and angry…these idiots get hundreds of thousands of dollars for nothing while my friends and colleagues with actual research to do get the shaft.

  9. #9 Alain
    November 19, 2012

    @ lkr,

    Don’t know about UAriz but here (bishop’s university), they give some point to be guinea pigs in all kinds of studies, even homeopathic ones.

    Alain

  10. #10 Pareidolius
    The mean streets of Hahnemannburg.
    November 19, 2012

    It was like that in Hahnemannburg, it was a city of flourishers and languishers. The flourishers with their fancy wheels and staid, expensive threads, and the languishers, oh, the languishers. The layabouts. The roués. The rakes in their brightly colored, shabby velocipedes and palanquins, moving languidly through the succussed and distilled mist. The constant tension between these two factions was the engine that kept the city, a city with barely a pulse, alive. An endless, wan competition, if you will, of Lachesis vs. Nux Vomica that kept Hahnemannburg on the edge of its seat, always waiting for the other shoe to fall, if indeed they had any shoes.

  11. #11 Dangerous Bacon
    November 19, 2012

    Ever notice how much “diluted” and “deluded” sound alike?

    Not to mention “succussed” and “concussed”.

  12. #12 lilady
    November 19, 2012

    “Someone” (cough), Dr. Killen, has been lurking here on RI…

    I just got an email notification that Dr. Killen responded to my last post on the NCCAM website:

    http://nccam.nih.gov/comment/327#comment-327

  13. #13 kruuth
    November 19, 2012

    Gotta protect that nest egg…me wonders if this kind of BS would open the door to flat-earthers or holocaust deniers as well.

    On another note, I remember a few years ago having an interesting discussion with a friend of a friend of my mother’s who was a homeopath. We were at a dinner party and dad and I just let him hang himself with his own words. He liked to use the “I don’t treat x, I treat a person with x” and dad started just slowly disassembling his argument until I finally brought up the whole Avagadro’s number, followed by asking if succussions would be more or less effective if you used a Catholic bible, or a King James, then we all started wondering if you were a Muslim homeopath if you could use a Qua’ran, or a Torah if you were Jewish. The guy blew up and started screaming about how we were hurting his livelihood(this was a dinner party but unbeknownst to us he was trolling for business). He finally got up and left when dad asked how a homeopath would treat a case of strep throat.

    Good times.

  14. #14 Denice Walter
    November 19, 2012

    @ Pareidolius:

    Is Hahnemannburg your abode? That sounds like Fourth Street with its fabled sidewalk cafe, taquierias and respected brewpub- not far from the square with its disheveled courthouse and distraught, tiled fountain. Yes, I remember it well.

    I have often enjoyed traipsing through the distilled mists myself, usually worrying about entanglements. As I vacillate between languishing and flourishing here in my tower on the great dark cliffs, I surmise that memories appear to succuss us all.

    Part 1:
    I smell a French biscuit/ cookie which triggers memories of water and about water with memory..

  15. #15 Mephistopheles O'Brien
    November 19, 2012

    If I understand it correctly, if the experimenter does not know whether a substance is a homeopathic remedy or a placebo, its quantum wave function remains a probability wave – it has both placebo and remedy characteristics. Once the experimenter knows which substance is a remedy, its wave function collapses. This leads to two questions:

    1. Wouldn’t it be possible to still double blind by having a disinterested third party, not associated with the collection or processing of the data, give the experimenter the randomized substances? The wave function would have collapsed based on this person’s knowledge.

    2. Should we refer to homeopathy as Schrödinger’s remedy?

    My apologies to Erwin Schrödinger.

  16. #16 Renate
    November 19, 2012

    @ Kruuth
    Your dinner-party reminds me on the Tim Minchkin: Storm
    http://www.youtube.com/watch?v=HhGuXCuDb1U

  17. #17 JustNuts
    November 19, 2012

    When will they do a study where they compare succussions done with a bible versus the koran? And which bible works best? King James? New English? Or the Jehovah’s Witness version? For historical authenticity, perhaps they should use the Dead Sea scrolls, Greek texts, Latin translations or what?

  18. #18 Peebs
    in the throes of Risus Sardonicus..
    November 19, 2012

    At the mention of Nux Vomica being belted on a bible.

  19. #19 Grant
    http://sciblogs.co.nz/code-for-life/2012/09/02/bad-science-baking-soda-fungi-cancer-nuclear-fallout-rosacea-and-hilary-butler/
    November 19, 2012

    University of Arizona. Same place Dr. Pagel’s group works at – got ‘$US 2 million in funding from NCCAM (the US National Center for Complimentary & Alternative Medicine) to apply imaging techniques that can measure pH towards studying “the effectiveness of personalized baking soda therapy to treat breast cancer.”’ (quoting from my blog.)

    I got the impression at the time there might be a “department of woo” at U/ Arizona. Reading “who is faculty at Andrew Weil’s center of woo at the University of Arizona” I’d say I’m ‘happy’ to see my instincts confirmed, but happy isn’t the right word. This doesn’t sound good. Does the university have no standards?

  20. #20 Shay
    November 19, 2012

    @justnuts

    The King James, because everybody knows that Jesus speaks English.

  21. #21 imr90
    W. Mass.
    November 19, 2012

    Why can’t I get a grant to develop my perpetual motion machine? Are they so closed to ideas that challenge their preconceived notions that they will not even allow a preliminary study? What are they afraid of? They are obviously prejudiced against the impossible.

  22. #22 Narad
    November 19, 2012

    Wouldn’t it be possible to still double blind by having a disinterested third party, not associated with the collection or processing of the data, give the experimenter the randomized substances? The wave function would have collapsed based on this person’s knowledge.

    Forcing an eigenstate is about measurement itself, not knowledge. This is different from the uncertainty principle, which is epistemological in nature at the end of the day. The true hilarity abides in the “open” versus “closed” “systems” gibberish, from my perspective.

  23. #23 Denice Walter
    November 19, 2012

    @ imr90:

    Well, I don’t know about you getting a grant but perhaps you can wrangle an internet radio show @ ProgressiveRadioNetwork or write for Natural News: they are the vanguard, heralding paradigm shifting, scientific revolutions- at least one or two a month!

  24. #24 THS
    November 19, 2012

    Wha-? Baking soda to treat breast cancer? Oh, better, “personalized baking soda therapy”? Baking soda can be used to convert cocaine hydrochloride to its free base form. Smoke & believe, I guess. And a $ 2 million dollar grant for to develop imaging around that? In this funding ear? Pass the pipe…

  25. #25 THS
    November 19, 2012

    oops, read “funding era”.

  26. #26 thenewme
    November 19, 2012

    Re: baking soda for breast cancer treatment….AAAARGH!

    It’s a frequently-discussed topic on BCO, but check out this gem from a long-time forum participant who just happens to be a woo-affiliate marketer. You just can’t make this stuff up:

    “As for the baking soda discussion. I was thinking about how someone was saying it produces acidity and then this lightbulb went off. I did an acid wash on my concrete patio. The directions were to spray it on the cement, and the acidic colorant, eats into the concrete and etches it and you get a new color that permeates, not just sit on the surface. Well, this etching process would continue unless you stop it. The way to stop the acid from eating up the concrete?? Baking Soda! I washed it down with a mixture of baking soda and water and the etching stops. Baking soda is not acidic. It is alkalie and it neutralizes acid. So it only makes sense that it is healthy. Hey, I remember my grandparents drinking sodium bicarb all the time for every ailment. Now it is bottled by some drug company and put into a slightly different form so they can “patent” it and charge more. It looks like the old ways are becoming the better new ways again. Look to big pharma to try to ban baking soda once word gets out, just like they are doing with iodine…”

    WOW.

  27. #27 Mephistopheles O'Brien
    November 19, 2012

    @Narad,

    Forcing an eigenstate is about measurement itself, not knowledge.

    True enough. And since it has proven impossible to date to conduct a measurement that distinguishes a sufficiently powerful homeopathic solution from solvent…

  28. #28 Alain
    November 20, 2012
  29. #29 Marc Stephens Is Insane
    November 20, 2012

    I just saw Pete Townshend recommend homeopathy to David Letterman for help with tinnitus, a condition they apparently have in common. Townshend said he’s tried all kinds of alternative medicine for his tinnitus but a homeopathic doctor helped him a great deal.

    And I used to have such respect for Townshend, as a musician and writer at least. I thought he was smarter than that.

  30. #30 Marc Stephens Is Insane
    November 20, 2012

    Now that I think about it, didn’t Townshend, Clapton and other rockers from that era claim a doctor who used a type of accupuncture machine got them all off heroin? I have to check that out. Maybe Townshend’s woo roots run deep.

  31. #31 Krebiozen
    November 20, 2012

    didn’t Townshend, Clapton and other rockers from that era claim a doctor who used a type of accupuncture machine got them all off heroin?

    That was cranial electrostimulation, IIRC, not as implausible as acupuncture, and with a little evidence behind it.

  32. #32 Lenoxus
    November 20, 2012

    Has any proposed or established homeopathic remedy ever been rejected by a homeopathic study? Like “Oh, we used to think diluted calcium would treat mononucleosis but it turns out it doesn’t.” I’m assuming the answer to this is NO. Which is rather telling, isn’t it?

  33. #33 JustNuts
    November 20, 2012

    “baking soda for breast cancer treatment” ???

    Well, this could easily be played into one of the “one cause for all cancers” dogmas where the proponents say “acidic” environments precipitate cancers. Massive intake of baking soda (oral, in IV solution, baths, enemas, etc.) could be erroneously promoted to neutralize that evil acidic environment.

  34. #34 Beamup
    November 20, 2012

    @ Lenoxus:

    By construction, no homeopathic remedy can ever be rejected. You give it to healthy people, record everything they experience, and then the remedy becomes a cure for everything they experienced during the proving.

    Since the entire concept of “check whether it actually works as predicted” is entirely absent, there is no place in the process where a remedy might fail. EVERYTHING is a remedy for scads of stuff; they just worry about making lists of what those scads are.

  35. #35 Bronze Dog
    November 20, 2012

    Nicely made point, Beamup.

    I remember reading about one conversation between a skeptic and a homeopath about the “proving” test. The skeptic says they should do it in a controlled manner, testing the remedy versus a placebo (nocebo?) to see if the proving’s symptoms are real or imagined. The homeopath complained that it was a waste of good provers.

  36. #36 Militant Agnostic
    November 20, 2012

    @Bronze Dog

    I wonder what makes a good homeopathic prover, since they seem to be in short supply. I am thinking extreme gullibility and a fanciful imagination.

  37. #37 Bronze Dog
    November 20, 2012

    A touch of hypochondria probably helps, too.

  38. #38 xyz
    rational thought if there were a positive result
    November 21, 2012

    Just a technical note about infinite dilutions.
    Couldn’t homeopathy be testing wall material related to the Ksp in waters impure by modern multi mega ohm standards?

    What if the succussion vessels were silver or copper something “for purity” and ye olde distilled water contained some volatile fatty acids. They might really be testing dilute microbial biocides, eh?

  39. #39 MCA
    November 23, 2012

    IMHO, everyone who gets rejected for any NIH grant in any other area should forward their grant in hardcopy form to the NCCAM with a short letter saying “How about you fund some real science?”. After the first 20,000 or so, hopefully the NIH will get the message and shut them down.

  40. [...] reports and case series are useful for generating hypotheses, not proving or disproving them. And NCCAM has a long history of funding ridiculous homeopathy research which identifies no benefits but doesn’t discourage homeopaths [...]

  41. [...] and bloating and there you have it: Dr. Oz’s Homeopathic Starter Kit. Of note, I’ve written about the utter ridiculousness of Nux Vomica before. There’s zero scientific plausibility, basis, or evidence that it (or any other homeopathic [...]

  42. #42 dr medha durge
    India
    February 5, 2013

    its difficult to expect any worthy homeopathic research product from nccam for 2 reasons
    1)the real good individualised homeopathy is not researched nor practiced
    2)all the research protocols are designed for conventional medicine.these need to change if you need to prove or test homeopathy.

  43. #43 Militant Agnostic
    February 6, 2013

    Is that the sound of special pleading that I hear.

    Individualized homeopathy has been studied and found wanting.

  44. #44 lilady
    February 6, 2013

    @ Militant Agnostic:

    Individualized homeopathy? Like this testimonial?

    http://www.homeopathy4all.com/index.php?option=com_content&view=article&id=49&Itemid=2

  45. #45 lilady
    February 6, 2013

    Open each of the *testimonials* at the link I provided to read how to treat vitililigo with homeopathy.

  46. #46 JGC
    February 6, 2013

    Why do the protocols have to change? Be specific. I mean, it is for some reason other than the fact homeopathy always failed when tested according to these protocols–right?

  47. #47 Marc Stephens Is Insane
    February 6, 2013

    lilady,

    I find the first sentence of this report from the Mayo Clinic very revealing.

    Or was that your point?

    http://www.mayoclinic.com/health/vitiligo/DS00586/DSECTION=treatments-and-drugs

  48. #48 lilady
    February 6, 2013

    @ Mark: I was *hoping* that Dr. Durge would *enlighten us* about single case *testimonials* and why she thinks a homeopathy product would work where there is loss of pigmentation.

    Certainly, any successful homeopathy product tested in a RCT double-blinded trial, which restored pigment, would be welcomed all over the world by doctors and by patients who seek cures for this sometimes quite disfiguring condition.

  49. #49 Marc Stephens Is Insane
    February 6, 2013

    Not to mention the Mayo clinic tells us that vitililigo sometimes goes away all by itself. Without any magic sugar water pills.

    So in order to test magic sugar water pills science has to come up with an entirely new “paradigm” of test protocols?

    Why aren’t the homeoquacks working to devise such protocols and prove us wrong?

    Oh yeah, they can’t. It’s just magic sugar water.

    As an aside, worldwide, is homeoquackery most popular in India? There’s a disproportianate representation of extreme homeoquackery on these skeptic boards from homeoquacks from India. I thought it was more of a UK phenomenon spurred on the Royal family support.

  50. #50 Marc Stephens Is Insane
    February 6, 2013

    I should clarify: most of the North American homeoquacks don’t make claims as drastic and far-fetched as the Indian homeoquacks on these boards. Andy Lewis’s Quackometer board has homeoquacks from India who claim they cure AIDS, cancer, malaria and brain disorders routinely with their magic sugar pills.

  51. #51 herr doktor bimler
    February 6, 2013

    1)the real good individualised homeopathy is not researched nor practiced

    We can all agree that no-one is researching or practicing good homeopathy.

  52. #52 Lawrence
    February 6, 2013

    @MSII – they are only interested in developing test protocols that would show that homeopathy would work……

  53. #53 Krebiozen
    February 6, 2013

    MSII,

    As an aside, worldwide, is homeoquackery most popular in India? There’s a disproportianate representation of extreme homeoquackery on these skeptic boards from homeoquacks from India. I thought it was more of a UK phenomenon spurred on the Royal family support.

    I would hazard an educated guess that it is most popular in Europe, particularly in France and Germany since it was developed in Germany and Boiron (the largest homeopathic remedy manufacturer) is a French company. Its popularity with the British royals may be because of their German ancestry, though homeopathic remedies are, sadly, commonplace in British pharmacies.

    A number of practices of European origin that you might not expect are popular in India; psychoanalysis for example, and homeopathy also appears to have flourished there. There was a plethora of quack remedies everywhere in India when I was there a couple of decades ago, so I imagine it is fertile ground for such beliefs. For example I had a receding hairline (now long departed) at the time, and was constantly pursued in the street by men with alleged cures for baldness, which was amusing at first.

  54. #54 Chemmomo
    Land Without Preview
    February 6, 2013

    dr medha durge @42

    the real good individualised homeopathy is not researched nor practiced

    If that’s the case, would you agree that it should be researched as it ispracticed ? Demonstrating efficacy for a single, optimal, ideal “real good individualized” application won’t help if it doesn’t apply to actual usage.

    all the research protocols are designed for conventional medicine.these need to change if you need to prove or test homeopathy

    Would you care to share with what you believe would be an appropriate test design? Or at least specify what types of changes are needed?

  55. #55 Chemmomo
    See previous location
    February 6, 2013

    Checking for italics – hoping the intent comes through in spite of above formatting