The "frontier science" of homeopathy?

If there's one type of so-called "complementary and alternative medicine" that I've always been very up front about, it's that I consider homeopathy to be the ultimate in pseudoscientific twaddle when it comes to CAM. The reasons should be obvious to anyone with a background in basic science. After all, homeopathy is nothing more than the most magical of magical thinking writ so large that it's a wonder than anyone can believe it.

Think about it. What are the two main principles of homeopathy? The first is "like cures like," which postulates on the basis of the prescientific observations of an 18th century German named Samuel Christian Hahnemann. In reality, this principle is nothing more than sympathetic magic at its root, resembling strongly Frazer's Law of Similarity, which is one of the implicit principles of magic. There's no scientific support for this principle. Even more ridiculous is the law of infinitesimals, which is in essence the claim that the serial dilution of homeopathic remedies with succussion (shaking) somehow makes the remedy more potent. This was a tenuous claim even more than 200 years ago, but when Avagadro's discovery made it abundantly clear that homeopathy is pseudoscience by permitting a simple calculation that demonstrated that typical homeopathic dilutions of 30C (thirty serial one hundred-fold dilutions) are highly unlikely to have a single molecule of the compound left in them. Of course, that hasn't stopped homeopaths from going through all sorts of contortions of logic and science to try to claim that homeopathy is anything more than water and that the benefits claimed for homeopathy are anything more than placebo. They've claimed that not only does water have memory but that the memory persists long enough and is somehow able to transmit the healing power of the remedy to the human body, biology be damned, sometimes abusing quantum theory most hilariously along the way.

Recently, I've come across homeopathy apologists claiming that homeopathy should be considered "frontier science."

It starts out with a healthy dose of persecution complex:

Much to the dismay of many people cured by homeopathy around the world, a recent wave of strong opinion held by a very few asserts that homeopathy is not scientific, or, at the very least, is "bad science". Unfortunately those writing blogs claiming that Homeopathy is bad science have a very closed view of what science truly is and what the future of science may look like. Much of their postulating is borne out of fear. Fear of what they do not understand, and fear of a perceived threat to the scientific status quo from which they derive security. Hence, they vehemently attack a form of health care that has profoundly helped thousands of people all over the world.

Gee, I wonder if he's talking about little ol' me. Probably not, although whoever he's talking about sounds like my kind of blogger. Of course, being lectured by a woo-meister about a lack of understanding of "what science truly is" is truly rich. So is the claim that homeopathy is some sort of "threat" to the "scientific status quo." Sound familiar? It's the same sort of complaint that "intelligent design" creationists make for their pseudoscience: That, any day now, ID is going to show just how wrong all those evolutionary biologists are. So far it hasn't, and homeopathy is, if anything, even less convincing on a scientific basis than ID. Of course, trying to play the martyr card is always a good way to make one's view seem "dangerous" and thus hide its utter implausibility. Indeed, ID creationists have taken this tactic to a ridiculous extreme by recruiting Ben Stein to don a pair of too-tight black schoolboy shorts trying to look like Angus Young from AC/DC and narrating an entire movie (Expelled!) that does nothing but play the martyr card. Whenever you see someone playing the martyr card like that (even to the point of likening critics to the Inquisition), it's often a good indication that they're defending woo, and this is no exception.

Another indication that we're dealing with pseudoscience is when its defender starts dealing with claims in such a way as to exempt itself from the normal methodology of science:

These recent attacks on homeopathy rely heavily on misunderstanding and selective misinformation. The constant cry is that homeopathic remedies are placebo and can therefore do nothing. When homeopaths assert that remedies work on animals and therefore cannot be the placebo effect, they blame the biased observer. Tell that to my sister who was able to cure her entire herd of sheep sick with highly contagious pinkeye with the use of a homeopathic remedy. These critics have even gone so far as to say that the reason homeopathy "seemed" successful in the cholera epidemic of 1854 was because conventional medicine was so harmful:

"So, while hideous medical treatments such as blood-letting were actively harmful, the homeopaths' treatments at least did nothing either way." (The Guardian, Ben Goldacre November 16th 2007).

Ben always was a smart one, one of the rare journalists who really gets it when it comes to pseudoscience. He's quite correct. I also particularly like the part about homeopaths asserting that remedies work on animals. I'm guessing by "assert" he means he has no scientific evidence in the form of randomized trials to back up that assertion; otherwise he would have said so. As for the cholera epidemic, one always has to be very careful about trusting 150 year old anecdotes describing uncontrolled trials like this:

Mr. Goldacre's statement is at odds with the excellent therapeutic results of homeopathic patients reported at the time of the epidemic:

"In 1854 London was struck by an outbreak of cholera. This gave homeopaths a chance to show what they could do. Among the patients admitted to the orthodox hospitals the death rate was 52 per cent, while at the homeopathic hospital, where 61 patients were admitted, only 10 died (16 per cent)." (English Homeopathy in the 19th Century; Campbell)

Not only is it clear that homeopathic treatment was successful, but the "Bad Science" author admits the harm conventional medicine was doing. In this day and age of prescription drug therapy which is rife with harmful, even leathal side affects, can we really say conventional medicine is any better than it was in 1854? Remember the Hippocratic oath: "first do no harm".

Of course, this anecdote is entirely consistent with Mr. Goldacre's observation. Moreover, this was not a randomized trial. We have no idea if the two groups were equivalent, and even if they are it's entirely possible (even likely) that the results could be explained by a harmful effect of "conventional" medicine that increased the baseline mortality rate from cholera. Remember, surviving cholera is a matter of keeping hydrated more than anything else. Anything that increases the level of dehydration will increase mortality rates, and any form of bleeding or, as was more common in the 1850s inducing purging with toxic metals such as antimony, cadmium, or mercury would certainly have a high likelihood of doing just that. At best, this anecdote tells us nothing.

Next, we're treated to a bunch of whining about the 2005 meta-analysis of trials of homeopathy that appeared in the Lancet. Naturally, because the study found that homeopathic treatments were equivalent to placebos and that the larger and better designed and controlled the trial, the less likely it was to find an effect of homeopathy, homepaths really hate this article. They much prefer an older and less well-designed meta-analysis from 1997, also published in The Lancet, which is the one that they always cite. Of course, meta-analyses always have to have rigorous inclusion criteria, and what was unique about the 2005 article is that the authors looked at 110 matched placebo-controlled trials of homeopathy and of "conventional" interactions and compared them. They found strong evidence for specific effects by "conventional" remedies and very weak evidence for homeopathic remedies, which, when taken in its totality, was most compatible with the notion that homeopathic effects are placebo effects.

He finishes off with the "science is faith" canard, which has become such a laughable cliche among the defenders of woo, that its use should be prima facie evidence that what is being defended is pseudoscience.

More recently, he's been arguing that randomized clinical trials are not applicable to testing whether homeopathic remedies work, in a lovely diatribe against "evidence-based medicine," arguing that anecdotes favored by homeopaths are just as good as those randomized clinical trials that we "dogmatic" and "close-minded" advocates of scientific medicine insist on:

In homeopathy we discuss our science to a great extent with cases. This is in contrast with mainstream medicine, where journals are filled with double blind studies, more recently called "Randomized Clinical Trials", or abbreviated RCT's. The double blind studies are seen as the ultimate in science, the holy grail to prove if something works or not. Many homeopaths have the feeling that they are not effective for homeopathy, or even further that they cannot be used in homeopathy. But double blind studies can also be done in homeopathy as for instance; David Riley has done in 2 studies with hay-fever. He proved homeopathy did work, but the point is that homeopaths didn't learn anything from it.

Case series are considered a valid form of evidence in science- and evidence-based medicine. However, they are considered a generally weak form of evidence because there is no control group and they are prone to all sorts of biases and confounding factors, including selection bias and regression to the mean, something this homeopathy apologist seems not to understand:

If I talk about my experience, skeptics will dismiss that as "anecdotal evidence." I understand their point of view. It's where I started out. But look at it from my point of view for a moment. It's like if I start a new garden. I plant some seeds and later plants come up. How do I know that any single plant is where it is because I planted it there? Maybe an animal moved that seed. Or maybe I'm sharing the garden and my neighbor planted that seed on my side. Perhaps. But when I look at my whole garden I can clearly see that it's the garden I intended, or not. That's how it is with homeopathy, both when considering a single improved symptom and a single successfully cured patient. Collective anecdotal evidence can be that obvious and compelling.

Of course, it's impossible for me to resist pointing out that "collective anecdotal evidence" was "obvious and compelling" for hundreds of years that bloodletting could treat all sorts of diseases and conditions. Indeed, "collective anecdotal evidence" can be very deceiving, thanks to the placebo effect and quirks in human thinking. Indeed, it was the very realization that this is true that led scientists towards more and more controlled trials, culminating with the advent of the double-blind, randomized placebo-controlled clinical trial.

It should also be pointed out that, as has been discussed before, when prior probability is left out of the equation, even randomized clinical trials of therapies with a low estimated probability of working based on scientific considerations (and, boy, does homeopathy fit that description) can produce an unfortunately high percentage of false positive results. Single studies can't "prove" anything, particularly if they are of low quality. In any case, the claim that homeopaths "didn't learn anything" from studies that allegedly showed that homeopathy worked should not be surprising, given that they never learn anything from the many more studies that show clearly that homeopathy doesn't work. Sinking even deeper into crank arguments, we're also treated to a claim that a randomized clinical trial is a "black box":

That is indeed the central point, the insight. Double blind studies are a kind of black box idea, one symptom is evaluated when one impulse is given (mostly a medicine), but there is no idea what is going on inside the black box. Sometimes the researcher does not even want to know what is going on. Researching one facet is often done out of reasons of simplification; the living organism is too complex to take everything into account, but that is just the pitfall. Reduction of complex problems into simple ones can be revealing, but especially in living systems it can also lead to distorted conclusions. That is what we can see in practice: promising treatment leads, after a while, to disappointments as the benefits turn out to be not that great and the side-effects are growing. It was more complex than originally thought.

The main problem lies in the black box. It is typical that in the past double blind studies were called "double blind studies", it expresses that nothing is understood.

The issues of reductionism and homogeneity in patient selection and methodology are legitimate issues when it comes to applying the results of randomized clinical trials more broadly, but clinical trials are anything but a "black box." Rather, they represent a transparent methodology (at least after the blinding is lifted and the data analyzed) designed to minimize the possible effects of failures in human cognition and normal human biases on the results of the study. Moreover, our intrepid critic of RCTs neglects to mention (or fails to understand) that determining how a drug or treatment works is not the purpose of RCTs; figuring out if it works and how much is, although collecting and analyzing blood, urine, and even tissue samples from trial subjects often does shed light on the mechanism by which the treatment works. Moreover, clinical trials often measure quantitative, objective endpoints (examples: tumor size, death), whereas it's rare to see a homeopathic "case study" that measures such parameters. Finally, "double blind" does not refer to nothing being understood but merely to the way that investigators and patients are blinded to the treatment group. But RCTs are not the real problem homeopaths have with science. I bet you can tell where this is all going:

What is the black box? It is the energy field, the soul or psyche or whatever one wants to call it, which is denied by mainstream medicine, by the materialism paradigm. That leads to strange and counter intuitive notions; like that intelligence does not exist, but is defined as the results of a test. The test then is not the result of intelligence, but intelligence is a result of the test. What other option does one have when there is no mind or soul? Behaviorism is a very striking example of this direction. [Homeopathic] case studies can show the in depth structure of disease, the origin in the mind and that gives understanding of health and disease. Statistics are then not necessary anymore. One can even say that statistics are only needed when understanding is lacking.

Yes, indeed! It's that nasty materialistic assumption behind science that really bothers homeopaths, not the science itself. The reason is simple. Homeopathy is magical thinking, and it's hard to find a better concession that this is true than the paragraph above, which would not be out of place on the Discovery Institute website penned by that dualism maven himself with zero understanding of evolution, Dr. Michael Egnor. If it weren't magical thinking, then why would it be necessary to invoke nonmaterialistic ideas about the mind and bemoaning the lack of soul in that evil "materialistic" science?


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I can only assume that he started smoking something before tapping out that last paragraph. That is just complete gibberish. It doesn't even make sense. It's really insulting that we are actually expected to take these people seriously.

By Richard Eis (not verified) on 04 Mar 2008 #permalink

Thanks for that verbal meandering...

Frontier science?
I thought the frontier was something new and unknown. A concept from the 18th century that hasn't developed since then is hardly "frontier". Homeopathy is "frontier" in the same way as Wonderland is Frontier.
Maybe it's the 18th Century part they're referring to.

By T. Bruce McNeely (not verified) on 04 Mar 2008 #permalink

Punching behaviorism is not precisely what you would expect from a champion of "frontier science". You'd expect him to pick more up-to-date targets, not dusty old approaches abandoned 50 years ago.

By Christophe Thill (not verified) on 04 Mar 2008 #permalink

"Frontier science" my dog's left bollock! At the risk of sounding like a dictionary pedant, the last time I looked a technique that has been tested and found not to have any effect above that of a placebo is called a Failed Science.

If Homeopaths don't like it, can they please direct their complaints to Reality and the Laws of Physics rather than us?

By Lilly de Lure (not verified) on 04 Mar 2008 #permalink

A correction if I may.

The person behind goodscience is in fact female and an editor of Interhomeopathy. I will spare her blushes by not identifying her but she has left many many bizarre posts on my blogs and those of others (DCscience, Quackometer, etc) that suggest she is not particularly educated in matters of science or medicine.

A friend of mine was telling me that, whether or not homeopathy was "scientific," she knew that it worked for her on a number of occasions. I tried to explain to her that she did not know that it worked, because feeling better after taking something could be due to all sorts of reasons other than the homeopathic remedy. Correlation is not causation.

She couldn't get the concept. Seriously. She kept saying "but it worked." Regression to the mean, placebo effect, coincidence -- none of it made any sense to her as possibilities. "All she knew" was her own experience -- which was that homeopathy worked. For her. Maybe it doesn't work for other people, she wouldn't say anything about the science of it all (since I was going to push it). But this was her own experience, so it was different.

I bring this up as particularly aggravating because my friend is a nurse. A trained RN. And the need to distinguish correlation from causation even in personal experience was a strange and unfamiliar idea which apparently came at her from some completely foreign mindset.

"I can only assume that he started smoking something before tapping out that last paragraph. "

I doubt that whatever it was, it was NOT prepared in homeopathic dilution.

Many people, like Orac, consider homeopathy the non plus ultra in quackery. I cast my vote for naturopathy because it includes homeopathy and EVERY other stupid idea.

I am guessing you mean Avogadro?

One more reminder: After three years of blogging I've decided that comments that do nothing more than correct typos or spelling errors are incredibly lame. My policy is now to delete them with extreme prejudice after I have corrected the error, if any.

As usual, Orac is being too hard on homeopathy, which daily blazes new trails into the therapeutic forest.

For instance, homeopathy successfully treats chemtrail-induced illnesses (with the aid of potentiating orgone energy), in what can only be described as a perfect storm of woo:

It makes perfect sense to administer fake remedies for imaginary diseases - in fact it arguably should be the standard of care.

By Dangerous Bacon (not verified) on 04 Mar 2008 #permalink

DB, please tell me that site is a joke. Please, please, please. I mean, they actually ask, What Have You Got To Lose Except Your Illness? And I so want someone to hack in and add "And Your Money?"
Obviously, homeopathy can indeed cure you from teh Gov'mint Conspiracy (tm). We all know that, right?

Just a note to say that Mr Ben Goldacre the journalist is in fact Dr Ben Goldacre the neurologist:

The website is well worth a good look around.

Cheers, UJ

By Ugly John (not verified) on 04 Mar 2008 #permalink

One problem with having fake remedies as the standard of care for treating imaginary diseases is the unpleasant side effect of wallet lightening. Then, of course, there is the risk of encouraging the patient to continue with fake treatments when s/he has a real disease.

Yes, Ben Goldacre gets it, I'm afraid, largely because he isn't a journalist; to be specific, he is a medical doctor and (I am fairly sure) currently the UK equivalent of what in the US would be a "Psychiatry Resident" (doctor in advanced training in psychiatry) - although he may be on some kind of research fellowship at the moment. He certainly works in the UK health system as a doctor part of the time, and has University connections, so in some ways his job is not altogether unlike Orac's, except in psychiatry rather than surgery.

Goldacre tends to not use the "Doctor" bit when writing in his journalistic persona, as like the blog owner here ( I guess) he feels that it should be the argument and the evidence that counts, rather than "appeals to authority". Appeals to authority (talking about stuff they are ignorant about) are a frequent tactic of Bad Science Woo types, e.g. the AIDS denialists saying: "but (Nobel Laureate) Kary Mullis said HIV doesn't cause AIDS!" ...or the "Orthomolecular" people insisting "but the great Linus Pauling said Vitamin C prevented cancer".

Back on the thread, the homeopath's blog is truly crazy, and the comments threads there full of equally crazy people. I'm amazed sane folk like Gimpy have the energy to argue with them; I've given up, as I find I rapidly lose the will to live.

The "Frontier Science" tag is, of course, a total Load. I am pretty sure "frontier" is one of those words, especially in close conjunction with "science", that score high on the Quackometer's Woo-detecting algorithm. "Frontier" certainly works that way in the U of Arizona's "Center for Frontier Medicine in Biofield Science" - NB simply the TITLE there would score "10 Canards" from the Quackometer, I predict.

However, remember that all this laughable garbage about "Energy Fields" is getting perilously respectable in some unexpected quarters these days - see the "Backgrounder" from NCCAM here on "putative energy fields" - mainly because it is not Politically Correct to call it "horse shit".

One of the reasons that Ben Goldacre 'get's is' when it comes to pesudo science, and particularly medical matters, is possibly connected with his research work. Oh, yeah, and his full time employment as a doctor.

Would only that more journalists were so qualified.

Ah, but being a medical doctor is no guarantee that a person will "get it" when it comes to woo. After all, Deepak Chopra, Mehmet Oz, Andrew Weill, and many, many, other woo-meisters are also M.D.'s.


Orac wrote "Ah, but being a medical doctor is no guarantee that a person will "get it" when it comes to woo."

I have long thought that is a huge problem, one can spot those woo-meisters (that you named) coming from miles away (given that this is my hobby). However, I recall a quackbuster many years ago (the name, sadly, escapes me) explaining that he became involved after he tried to find a patient (with a terminal illness) a promising clinical trial. It turns out- he was hoodwinked, his patient was ill-used, and he is (understandably) perennially angry. I wonder- if a responsible doctor was fooled, what chance do I have?

Orac wrote:

"I am guessing you mean Avogadro?

One more reminder: After three years of blogging I've decided that comments that do nothing more than correct typos or spelling errors are incredibly lame. My policy is now to delete them with extreme prejudice after I have corrected the error, if any."

Orac unfair to us pedants! (Yes, it's "us", and not "we".)

By John Monfries (not verified) on 04 Mar 2008 #permalink

Orac wrote:

Ah, but being a medical doctor is no guarantee that a person will "get it" when it comes to woo. After all, Deepak Chopra, Mehmet Oz, Andrew Weill, and many, many, other woo-meisters are also M.D.'s.

I was wondering why so many MDs do turn to woo.

Is it the false certainty that they get from woo? Deciding what the best action for a particular patient is from the mass of sometimes uncertain and conflicting experimental data must be a struggle for doctors to deal with.

By Chris Noble (not verified) on 04 Mar 2008 #permalink

Damn you Orac! You lured me into the trap of reading the comments on a woo friendly site! Now I have oatmeal running out of my ears.

By Kerry Maxwell (not verified) on 04 Mar 2008 #permalink

Quoted in the post above:

If I talk about my experience, skeptics will dismiss that as "anecdotal evidence." I understand their point of view. It's where I started out. But look at it from my point of view for a moment. It's like if I start a new garden. I plant some seeds and later plants come up. How do I know that any single plant is where it is because I planted it there? Maybe an animal moved that seed. Or maybe I'm sharing the garden and my neighbor planted that seed on my side. Perhaps. But when I look at my whole garden I can clearly see that it's the garden I intended, or not. That's how it is with homeopathy, both when considering a single improved symptom and a single successfully cured patient. Collective anecdotal evidence can be that obvious and compelling.

I've read this odd analogy over several times and what I get is this: Even if an outcome is the result of some unknown agent external to the procedure, if it is an outcome I (homeopathy) intended, then I (homeopathy) get to take credit for bringing it about.

I can see where double blind studies (or rationality) might put a crimp in his methodology.

"Frontier Science" is the flip side of "Paradigms in Crisis".

ID, psi and homeopathy are frontier sciences where the confirming results are always just around the corner.

Evolution, materialism and HIV/AIDS are paradigms in crisis that are always just about to collapse under the weight of all the "anomalies".

Any minute now! Just you wait!

By Chris Noble (not verified) on 04 Mar 2008 #permalink

Thanks for the plug DrAust. Now the homeopaths have implied that my willingness to argue with them is a personality flaw and I suspect my ex-girlfriends may agree but while I doubt that I will ever change their minds I may change the minds of ambivalent individuals considering using homeopathy.
I also share Orac's incredulity that some MDs would turn to the dark side of woo but personally I am more disappointed in research scientists who rely on the the tools the scientific method has equipped us with but are willing to disregard them when it comes to homeopathy. The likes of Benveniste, Milgrom and Roy haver much to answer for.

For MDs who dabble in Woo I think there is a distinction to be made between those who occasionally use it in some form - typically as a way to employ the placebo effect and/or a form of stealth talk therapy - and those who have totally "Embraced The Darkside" and chucked the science out of the window (e.g. Chopra, Weill, and John Briffa in the UK).

An interesting account of the "thought process" that can go into the first kind (using though not really buying completely into) is found on Anthony Campbell's blog. Campbell is retired, but he was a consultant (attending physician) at the Royal London Homeopathic Hospital, as well as MRCP, kind of "board certified in internal medicine". However, Campbell never really seems to have believed in homeopathy's philosophy, and he clearly doesn't now -read his piece for why.

Like Gimpy I find it a little easier to see how doctors (who have a focus specifically on the patient getting or even feeling better rather than de facto on the scientific truth) can sometimes go for this than can scientists. It is amazing to me that people like Lionel "Quantum Nonsense" Milgrom (see links in Orac's piece) can spend thirty-plus blameless years in meticulous color chemistry research... and then suddenly go Darkside and embrace Woo like a convert.

Personally I suspect people who go this route from science to Woo have often had some sort of personal "Road to Damascus" Woo experience where they feel it has "cured" their chronic back pain, or similar. This then overwhelms their rational skepticism. The tragedy of such people is that they become talismans for lots of other Woo-ites... "Look! This guy WAS A SCIENTIST and NOW he works on Energy Medicine! It MUST have some scientific truth....!" *sigh*

These are often also, I suspect, the folk who end up on NCCAM study sections hading out the cash-for-Woo - although since they have ditched skepticism for advocacy they are really the last people that should be doing the job.

"homeopathy successfully treats chemtrail-induced illnesses"

One can never stop progress !

Now, does it successfully trat EMF sickness, vaccine-induced autism and Bigfoot bites ?

By Christophe Thill (not verified) on 04 Mar 2008 #permalink

On the recommendation of a homeopath, I recently bought a copy of the optimistically titled 'The Science of Homeopathy' by George Vithoulkas. I'm very glad I did: as a science book it's worthless but it is absolutely hilarious. Few other books I own contain quite so much comedy payload for so little money. Where else, for example, would I have found out that the "etheric substance" used in homeopathy travels faster than light, has negative mass and produces a levitational - instead of a gravitational - force?

George Vithoulkas is a legendary homeopathic guru. He is also famous (infamous?) as the man who suggested homeopathy was a better treatment for syphilis that antibiotics. You can read about this on Wikipedia here. He was actually taken to task for this by British doctor and medical homeopath Anthony Campbell, whom I mentioned in a previous posts.

For a summary of Vithoulkas' philosophy see his website here. Warning - it will make your head hurt. A sample:

"The human body is an energy complex that generates all forms of known energies but beyond that is sustained by subtle formulative energies that tend to bring about optimum coherence and maintain equilibrium, harmony, and homeostasis.

These subtle energies are animating the spiritual-mental, the psychic-emotional, and the physical planes. Each plane has its own vibrational frequency and is constituted of multiple complex fields structured in a hierarchical way."

PS Can anyone spot the "Frontier"?

More "In Search Of..." than Star Trek.

(Sorry, was thinking of space...the final frontier)

By Antiquated Tory (not verified) on 05 Mar 2008 #permalink

Dr Aust said:

PS Can anyone spot the "Frontier"?

Between insanity and inanity?

By Lilly de Lure (not verified) on 05 Mar 2008 #permalink

Treatments may be alternative and they can challenge our root understandings of health and disease. They can be weird and mysterious. MRI was consider pretty wacky not that long ago. But the results of any interventions must be measurable. A shift in aura or a change in CHI might be a very good thing, but it it is not an outcome measurement.