Lactose Intolerant
The recent stunt by the New Zealand Skeptics Society might be very amusing, but it fails to add much to the debate on homeopathy. The skeptics swallow large amounts of homeopathic remedy to attempt to show its overall uselessness. Unfortunately, this demonstration is no more significant than an atheist demanding that God strikes him dead with a thunderbolt to prove his existence and then claiming that proves God does not exist, because he survived. I suspect it does little more than ignite acrimonious debates and certainly proves nothing at all. One hopes that none of the skeptics involved were diabetic – ingesting that much lactose (the principle ingredient) might push them into a coma.
The lack of a coherent scientific theoretical basis does not necessarily invalidate homeopathy
”There is no real scientific theory to explain the “effects” of homeopathy above and beyond the obvious one of placebo effect. I recall reading an article in New Scientist (that I can no longer locate) which described an elegant experiment that demonstrated that protein molecules being created by DNA, folded themselves into their normal shapes much faster than simple molecular attraction would allow, suggesting that, perhaps, water maintains a memory of the shape of the protein molecule; helping the long strand fold into its working shape. This is a far cry, of course, from suggesting that water maintains the memory of the shape of arnica after a 30C dilution. It also ignores the fact that the single glass of water you use to swallow the arnica would contain billions of other different “memories”. It also gives no insight into how that “shape” (should it exist) can alleviate symptoms caused by entirely different molecules.
The lack of a coherent scientific theoretical basis does not necessarily invalidate homeopathy. The claim “we have no idea how this works, but it does work” is not an unreasonable one (we can call it awaiting a scientific theory), if one can prove a reproducible effect. This is the essential problem with homeopathy. Occasional RCTs may show an effect above and beyond the placebo effect, but this effect is not reproducible in subsequent trials, particularly trials with larger numbers of subjects and more rigorous designs. The net result is that, when analysed together, homeopathic trials demonstrate only placebo effect and a little observer bias. Shiang et al’s meta-analysis Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy (Lancet 2005; 366: 726–32) showed that, once they were controlled for observer bias, homeopathic trials demonstrated only an effect similar to placebo, whereas comparative conventional medicine trials produced an effect far above the placebo effect. I have not seen a convincing homeopathic rebuttal to this study, though several have been attempted.
I have several colleagues who use homeopathic remedies on a regular basis in their practice. I have no particular objection to this. I occasionally deliberately use a placebo to help a patient overcome a problem that is clearly volitional rather than pathological. Some would charge that this is unethical and an abuse of the patient’s right to choose. I say that is politically correct nonsense.
I do, however, have a problem with the pharmacies selling these remedies over the counter. As far as I am concerned, they may as well be charging for magic water. Homeopathy proper requires a great deal of input from the practitioner to determine the symptoms and settle upon an individualised regime. Buying an over-the-counter homeopathic medicine for “allergies” is simply purest quackery, regardless of what you may think of homeopathy itself.
I also have grave doubts about practicing homeopathists with little or no medical training. These people are not skilled enough to recognise an illness that requires conventional medication urgently. In fact, their very suspicions about the nature of “allopathic medicines” may make them resistant to referring a patient on to their general practitioner. This disadvantaging of patient occurs far more often than you would like to think. Fortunately serious harm or death is rare.
Complementary medicine needs to follow the rules of proper scientific enquiry – develop a theory, test it, reject it for another. Instead, most CAM studies consist of anecdotal series or poorly design small trails that serve little purpose than to fool a lay person. I am not a skeptic about homeopathy – I am prepared to view it with an open mind, But that does not mean I will uncritically accept anything thrown at me.
Show me some real science. I will be listening.
Additional
Peter Cresswell provides some amusing and interesting links on this issue.
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Feb 12 10 9:20 am
Here:
http://www.newscientist.com/article/dn3817-icy-claim-that-water-has-memory.html
Feb 12 10 7:18 pm
Cheers, Will. Unfortunately, that is not the reference I was looking for.
This is more what I had in mind.
Feb 12 10 10:31 am
As one of the people who participated in the overdose, I can say that it wasn’t intended to ‘ignite acrimonious debate’. It was to raise the issue of pharmacies selling homeopathic remedies without informing customers of the (lack of) science behind them. As Vicky Hyde pointed out, 94% of homeopathy users don’t realise that the products countain not one molecule of active ingredient. We got television exposure on TV1 and TV3 news, and the lead story on Close Up. That wouldn’t happen without some sort of publicity stunt.
We read the labels on the bottles, and people were asked whether or not they were diabetic before taking the pills.
“I am not a skeptic about homeopathy – I am prepared to view it with an open mind”
I think you are confused about what a skeptic is. A skeptic is someone who *does* have an open mind. If we are presented with sufficiently robust evidence for something, say that homeopathy has a greater effect than a placebo, then we will accept it.
Apart from that, I agree with most of what you’ve written. Unless homeopathy can be back up by rigourous science, it has no place in a doctor’s surgery or on a pharmacy’s shelves.
Feb 12 10 9:44 pm
I think you are confused about what a skeptic is
Not really. At around midnight (which is when I finished this post), I’m just generally confused
What I meant to say was “While I am skeptical of homeopathy, I am prepared to view it with an open mind”.
I don’t have an editor to pick up my more egregious errors. Judging by the state of our newspapers, neither do they.
Feb 12 10 11:17 am
Having seen a homeopath about 4 or 5 times, I can understand why scientific confirmation of the validity of homeopathy will be difficult to obtain.
The homeopath (as confirmed by the lady from the NZ Homeopathic association on closeup last night) takes down pretty much any and all symptoms as related by the patient, their past history of complaints, their diet and exercise regime, and also takes a personal history whereby the homeopath discerns the patient’s mood, their personality type (ie what sort of behaviours they are prone to) and any personal difficulties the patient may be facing.
The homeopath then uses all this information to drill down to what a suitable remedy may be, and a number of different remedies may apply to the problem. Therefore it is easy to see why a RCT study can’t be performed- the remedies given to a group of 20 patients seen in a day can all be different even if a great number of them are presenting the same physical complaint, since their prior history, gender, personality, as well as their mental and emotional condition is also included in the choice of remedy.
Feb 12 10 9:54 pm
This is also precisely why selling “homeopathic remedies” OTC at a pharmacy is simply charlatanism.
However, you are not correct about RCTs – there are a number of quite reasonable ones out there – usually involving a homeopath interviewing every patient but then prescribing homeopathic/placebo medication in a random fashion (i.e. the patient does not know whether the prescription is homeopathic remedy or plain lactose pills). The same technique is used in comparing homeopathic remedies to allopathic medicine.
This method can produce some selection bias, of course, because it is usually only single blinded.
Feb 20 10 7:21 pm
(Channeling a homeopathy supporter)
“If you only get your information from places like the AMA and The Academy of Medical Sciences, it is small wonder you think the “science is settled”. The conventional medical community couches ones data-gathering in such a way as to virtually preclude contrary conclusions to the current theory. This is most apparent in data-cleaning techniques where “outliers” are removed without once considering whether the real facts are actual in those outliers, as they sometimes are. It is for these reasons (and others chiefly to do with statistical analysis) I tend to be extremely skeptical of anything presented as indisputable when there are clearly intelligent non-fanatics who disagree. My skepticism is increased when I observe the clear commercial and political aspirations of many who advocate allopathic “medicine”. Wegener tells us that the scientific “consensus” can be completely wrong, despite hundreds of studies in peer-reviewed journals. I will continue to reserve my judgement on these matters.”
(Channeling ends)
Complementary medicine needs to follow the rules of proper scientific enquiry – develop a theory, test it, reject it for another.
Bravo. Well said.
However, you have a damning double standard.
Why are you so rigorous in (correctly) insisting on the rules of proper scientific enquiry for investigation homeopathy when you don’t insist on the same treatment for global warming?
Why are you prepared to happily ignore the decades of painstaking research done by NASA and all the other scientific communities on the planet?
They have jumped through those very hoops that you insist that they jump through.
Repeatedly!
They have indeed followed the rules of proper scientific enquiry in investigation of global warming.
The global warming deniers, however, have not.
The scientific consensus did not happen by magic or nefarious politiking.
Instead, most CAM studies consist of anecdotal series or poorly design small trails that serve little purpose than to fool a lay person.
Oh yes. They fool people very well. It sounds all very “sciencey”.
You can find homeopathy-friendly blogs that will give you tons of “sciencey evidence”.
There are plenty of very professional, respectable sounding doctors who will swear black and blue that homeopathy is the real deal.
Yet the scientific consensus on homeopathy is that, to be blunt, it’s CRAP.
That scientific consensus is not just “group think”.
The medical researchers are not just a bunch of “political animals”.
Nor are they a “coterie of AMA big-pharma”.
Nor are they a few of “your friends”.
Please ditch the double-standard.
Follow the rules of proper scientific enquiry…for ALL scientific subjects.