Homeopathy deconstructed in the FASEB Journal

Well, this is encouraging to see: A scientific journal publishing an article debunking pseudoscience, in this case the pseudoscience of homeopathy. (Grrrlscientist might object to the use of Hogwarts in the title, in essence comparing homeopathy to the wizardry of Harry Potter's world. So would I, actually. Such a comparison is an insult to Hogwarts.) In any case, I thought it'd be a nice little tidbit, a warmup for tomorrow's Your Friday Dose of Woo, if you will, to discuss it briefly.

It starts out with a quote from Oliver Wendell Holmes:

Do you think I don't understand the hydrostatic paradox of controversy? If you had a bent tube, one arm of which was the size of a pipe-stem and the other big enough to hold the ocean, water would stand at the same height in one as in the other. Thus discussion equalizes fools and wise men in the same way, and the fools know it.

Genius.

This analogy applies to so many things, not just homeopathy. Heck, Deepak Chopra is living proof of the truth of this statement. So are "intelligent design" creationists. (I'm going to have to remember this quote and use it in the future--liberally.) But advocates of homeopathy prove it perhaps better than any other purveyors of woo, as FASEB Editor-in-Chief Gerald Weissmann understands:

THE HYDROSTATIC PARADOX has never been so well illustrated as by current discussions of alternative medicine and its poster child, homeopathy. Hahnemann's system, a therapeutic regimen unchanged since the Age of Mesmer, is making a comeback in the Age of Oprah. In 1810, Hahnemann (1755-1843) rebuked Enlightenment medicine in an over-ideational treatise called The Organon of the Rational Art of Healing...Not content to play the spiritual card, Hahnemann took swipes at the science of his day. Anatomy, physiology, and pathology, he argued, presented only "dim pictures of the imagination." Since disease was not caused by any discrete physical agent, but to man's lack of harmony with the "vital force" of nature, he asked "Has any one ever succeeded in displaying to view the matter of gout or the poison of scrofula?" More than a century after crystals of monosodium urate were shown to be the matter of gout by Garrod, and the poison of scrofula was found to be M. tuberculosis by Koch, homeopaths still believe that Organon's vital force of nature is at the root of gout and TB.

You'd think that something as patently scientifically ridiculous as homeopathy, the concept that a substance can be diluted to the point where not a single molecule of that substance remains and still be able to have activity in disease, a concept that violates the laws of chemistry and physics as we understand them, would have faded into justly deserved obscurity by now. You'd think that a concept that ridiculous even by "common sense" (the idea that a homeopathic remedy can become stronger the more you dilute it) would have become nothing more than a historical oddity by now. You'd be wrong. These days, modern homeopathists have come up with new and more bizarre forms of woo to justify the unjustifiable, even invoking quantum mechanics in outrageous (albeit admittedly sometimes entertaining) ways to explain how homeopathy could "work" and how water could somehow retain a "memory" of substances with which it had come in contact.

Unfortunately, as the article points out, famous and powerful people fall for this nonsense. For example, Prince Charles happens to be a big booster of alternative medicine, including homeopathy, even going to far as to say in a speech before the World Health Organization:

In May 2006, Prince Charles addressed the World Health Assembly in Geneva to argue for homeopathy and its kindred therapies. He urged a return to remedies "rooted in ancient traditions that intuitively understood the need to maintain balance and harmony with our minds, bodies and the natural world." He complained about modern biomedicine: "It seems to be that in our ceaseless rush to modernize, many tried and tested methods which have shown themselves be effective have been cast aside as old-fashioned or irrelevant to today's needs." . . . In 1985, he caused a stir by warning the British Medical Association that "the whole imposing edifice of modern medicine, for all its breathtaking successes is, like the celebrated Tower of Pisa, slightly off balance." Last year, he funded a commission headed by a bank executive as lacking in scientific credentials as the Prince himself, to "look at the effectiveness, especially from a financial point of view, of integrated healthcare."

British scientists struck back, with an open letter criticizing the use of non-evidence-based medicine by the National Health Service, but, like many true believers, Prince Charles blithely ignored it:

Prince Charles was unfazed--on the day the Open Letter was published, he stopped at St Tydfil's Hospital in South Wales to watch alterative medicine at work. He accepted a "spiritual" crystal, as if he were Albus Dumbledore, headmaster of Hogwarts School, accepting the Philosopher's Stone. Unlike Dumbledore, however, who only professed witchcraft and wizardry, Prince Charles called up every form of "integrative therapy" against Alzheimer's disease (9) . One notes that when Prince Charles and other fans of unproven or disproved medical practices use terms such as "integrated therapy" or "alternative medicine," they're following the lead of creationists who hide under the term "intelligent design"--these are all convenient slogans that permit the credulous to con the gullible.

Personally, I find the comparison of Prince Charles to Albus Dumbledore to be rather offensive. Dumbledore was a much more intelligent and admirable--and, yes even scientific, at least in terms of the fantasy world in which he exists--character than Charles will ever be. I'll forgive Weissmann that, though, because it's truly heartening to hear a major scientific journal recognize that "integrated therapy" is more a marketing ploy than anything else. As Professor Michael Baum pointed out:

As for the Prince's "financial point of view," Professor Michael Baum, another of the signatories, noted that Britain had spent 20 million pounds refurbishing the Royal Homeopathic Hospital. Had that sum of money been spent on making available herceptin and aromatase inhibitors, it could saved 600 lives a year in one health district alone.

That's the price of dabbling with quackery like homeopathy, particularly in a national health system in which diversion of resources to quackery results in diversion of resources away from effective, evidence-based therapies. But patients like it, regardless if it's effective or not; so it's politically popular.

We in the States aren't spared the attack of this particular form pseudoscience, of course, and the article points that out. Special scorn is reserved for the National Center for Complementary and Alternative Medicine, which, despite the overwhelming scientific implausibility of homeopathy and the lack of evidence for any efficacy for it greater than placebo, maintains only a tepid "skepticism" towards it that borders on acceptance, apparently based on the concept that, if so many people believe in it there must be something to it (either that, or not wanting to tick off the credulous):

The NIH seems happy with research on homeopathy and kindred therapies. Its website replies "yes" to the question "Is NCCAM funding research on homeopathy?" while admitting that "Homeopathy is an area of complementary and alternative medicine (CAM) that has seen high levels of controversy and debate, largely because a number of its key concepts do not follow the laws of science (particularly chemistry and physics)."

No kidding. But NCCAM seems content enough not to let a little thing like conflict with well-established laws of chemistry and physics stop it from "studying" homeopathy, as Weissmann points out:

However, when it comes to homeopathy, NCCAM is careful to issue a disclaimer: "It has been questioned whether a remedy with a very tiny amount (perhaps not even one molecule) of active ingredient could have a biological effect, beneficial or otherwise." Nevertheless, NCCAM has contributed $250,000 towards a clinical trial of "verum LM" (a homeopathic medicine diluted 1:50,000) for fibromyalgia at Dr. Andrew Weil's Program in Integrative Medicine at the University of Arizona. Weil is the guru who in a 1986 book, Health and Healing announced that "Sickness is the manifestation of evil in the body." Hahnemann redux, one might say.

Personally, in this time when the NIH budget is declining and it's getting harder and harder for even worthy scientific studies to be funded, I resent the waste of giving our taxpayer dollars to Andrew Weil to "study" hokum like homeopathy. Other forms of alternative medicine, such as herbal medicine, fine. Many of our medicines have come from plants, and I'd bet there are lots of potential remedies out there yet to be discovered. But to waste taxpayer money funding something as patently ridiculous as homeopathy! I view it as yet another manifestation of the triumph of faith over reason that seems to be the order of the day and a symptom of the same malady that results in huge swaths of the population not accepting evolution as valid science.

Leave it to Oliver Wendell Holmes, though, to see through the sham that is homeopathy 150 years before NCCAM sprung up to "study" it anew, as Weissmann describes in a section amusingly called Dilutions of Grandeur:

But Boston in 1834 had permitted curious forms of the healing art to flower and Holmes was appalled. By 1842, he had had enough and wrote the definitive critique of the practice: "Homeopathy and its Kindred Delusions." He found that homeopathy was "lucrative, and so long as it continues to be will surely survive, --as surely as astrology, palmistry and other methods of getting a living out of the weakness and credulity of mankind and womankind."

Holmes nailed it exactly. Homeopathy remains extremely lucrative today, and so persists, even though the claims for some homeopathic products are so patently ridiculous that it's hard to believe that anyone would take them seriously. Even now, there are few better demolitions of homeopathy than what Holmes wrote 164 years ago, and it's instructive to note that even science as it existed in the mid-19th century was more than up to the task of conclusively demonstrating what a sham homeopathy is. The transcript of Holmes' speech is well worth reading in its entirety, not the least reason because of its carefully modulated sarcasm. As quoted in the article, Holmes also wrote at another time:

Some of you will probably be more or less troubled by that parody of medieval theology which finds its dogma in the doctrine of homeopathy, its miracle of transubstantiation in the mystery of its dilutions, its church in the people who have mistaken their century, and its priests in those who have mistaken their calling.

Bingo. Homeopathy shares far more with religion than with any science- or evidence-based medicine.

Scientific and medical journals dedicated to sound science and evidence-based medicine would do well to emulate Oliver Wendell Holmes and not be shy about speaking out against quackery such as homeopathy. For whatever reason, 19th century medicine seems to be making a comeback in this nation, with powerful patrons and now a government bureaucracy in the very heart of American biomedical science (the NIH) protecting and promoting it. If this persists, I'm just afraid that we'll soon see 19th century mortality rates returning with these 19th century medical concepts, as well. I'm glad to see that the FASEB Journal spoke out (although I fear that it will be in for a deluge of angry letters from the credulous). I only wish more scientific and medical journals would follow the FASEB Journal's lead.