Good medicine: homeopathy

Isaac Golden states that the argument is repetitive. He is right, and it will continue to be repetitive until homeopaths either produce sound evidence for their claims or stop making them.

The appeal to popularity will always be fallacious. The repetition of "it works" will similarly remain fallacious, because homeopaths maintain that it works better than placebo and assert bizarre reasons for this, while science finds that it works no better than placebo and accounts for all observations without recourse to unproven and largely unprovable hypotheses.

So much for the repetitious element.

As to why homeopathy is under attack, I would have thought that was obvious. Homeopaths make claims which are easily characterised as dangerously fraudulent.

Ainsworths have been selling homeopathic "vaccines" against serious diseases (http://www.bbc.co.uk/news/uk-england-devon-20991335), a practice which even the British Homeopathic Association and Faculty of Homeopathy denounce (http://www.guardian.co.uk/society/2013/apr/15/homeopathy-measles-mp). The BBC have mounted two separate sting operations both of which found that every single homeopath consulted was prepared to offer ineffective homeopathic preventives to people travelling into high risk malaria zones, and in most cases did not even accompany this with basic advice on bite avoidance (http://news.bbc.co.uk/1/hi/programmes/newsnight/9341713.stm). Probably the single most shocking case I have seen is that of Penelope Dingle, an Australian who was led by her homeopath and her naturopath husband to try to cure colorectal cancer with homeopathy. She was admitted to hospital in agony with her bowel obstructed by the cancer and on the point of rupturing. A treatable cancer with good prognosis was not treated with standard of care, resulting in pain, misery and ultimately an early an unpleasant death (http://www.homeowatch.org/news/dingle_finding.pdf). The Advertising Standards Authority was unable to cope with the overwhelming number of homeopaths making unsupportable claims - over 150 complaints covering more than 100 websites in the first few weeks after their remit extended to vendors' own websites (http://www.nightingale-collaboration.org/news/83-asa-respond-to-complain...).

Mr. Golden seeks to explain skeptical opposition by allusion to the "pharma shill gambit" (http://www.sciencebasedmedicine.org/index.php/the-pharma-shill-gambit/). This is not and never has been accurate. We are attacking homeopaths not because we are being paid to do so, nor even because homeopathy is pseudoscience, but because the homeopathy community has consistently failed to act responsibly and limit itself to claims of symptomatic relief of minor self-limiting ailments, where the use of an inert "remedy" is unlikely to kill anybody.

Homeopathy will continue to be a focus of opprobrium until it puts its house in order and stops making indefensible claims - or provides actual credible evidence to support its ideas, something which I think will arrive some time after the heat death of the universe at the present rate of progress.

Dr Morgan makes good points but fails I think to appreciate a nuance of the debate.

Homeopathy has its back against the wall, at least n the West. Financial constraints and scientific literacy are against it, and its traditional weapons of politics and special pleading are increasingly effectively countered by a well informed, well organised skeptical movement.

Homeopaths cannot support the scientific consensus any more than turkeys would support Christmas.

As we see here, they display what they feel is righteous anger towards critics. But righteous anger demands that first you are, well, right. Homeopaths are wrong about two things: the evidence and who to blame. Attacking skeptics for presenting the scientific consensus that homeopathy is an 18th Century whimsy with no factual basis, is pointless, it's just shooting the messenger.

And misrepresenting the evidence (cf. the "Swiss government report" that is provably no such thing) does not help.

In short, the homeopathy apologists here seem to be angry with reality as science interprets it, and taking out their anger on those who simply articulate this fact.

They are engaging not in righteous anger, but in wrongteous anger. And they don't seem to realise that they are not alone, there is no shortage of mutually incompatible nonsensical health claims refuted by science (see, for example, my blog Guy Chapman's Blahg).

The funny bit is watching proponents of these mutually exclusive theories supporting each other, because the one thing they all agree on is that science is /wrong/, at least about them.

Milgrom seeks to excuse homeopathy based on the claim that "over 50% of conventional medical procedures funded by the National Health Service (NHS) also have little or no basis in science" and by reference to the cost of pharmaceuticals to the NHS.

Dr. Ben Goldacre, a co-founder of the AllTrials initiative which seeks to get all clinical trial data into the public domain, is also known as a critic of homeopathy. Goldacre is right where Milgrom is wrong: the solution to problems with the evidence base of medical science is not to allow any old nonsense, it is to strengthen the evidence base of scientific medicine.

There is also an issue of prior plausibility. It is plainly unreasonable to compare a medical intervention with weak evidence but scientifically plausible mechanism of action, with homeopathy, a practice for which no plausible mechanism has ever been advanced.

Sir Mark Walport and Professor Sir John Beddington are scientists. To a scientist, the idea that a cure may be effected by taking a substance which is claimed, on rather vague and unspecific grounds, to be linked to a symptom, and diluting it well past the point that no scientific instrument can detect it, is indeed ludicrous.

As scientists they place the burden of proof on those making a claim, in this case homeopaths, and they are right to conclude that the burden has not been met.

The rationalisations provided by homeopaths to try to remedy this issue have consistently failed to carry mainstream support. Benveniste’s experiments were shown to be wrong, Ennis’ can’t be replicated, Montagnier’s are self-published, not replicated, and he himself says cannot be extrapolated to cover the substances used in homeopathy. Some homeopaths even claim quantum entanglement of non-entangled non-quantum objects, dubbed “patient-practitioner-remedy entanglement”, though theoretical physicist Professor Jim Al-Khalili comments: “Let me make this very clear: if you think QM allows for homeopathy […] then you'd better take a proper course in QM” - a view which does appear to accurately reflect the consensus view of physicists towards notions generally denigrated as “quantum woo”.

The core of the scientific method is that every assumption can be challenged. We have the field of quantum mechanics because Einstein challenged Newton. A properly scientific validation of homeopathy must begin with honest and objective tests of the doctrine of similars and the doctrine of inifinitesimals, which are axiomatic for homeopaths. There must be independently reproducible results which are consistent with homeopathy and not consistent with anything simpler. The tests must work whether you believe in homeopathy or not.

As it stands, purported scientific tests of homeopathy have more in common with the experiments of Blondlot and his supporters, who all thought they had replicated his detection of N-rays. Their error was seeking to confirm a hypothesis rather than testing it, and this is taken as a vital lesson on the dangers of confirmation bias by today's scientists.

The same problem also accounts in part for the overstatement of results in pharmaceutical trials, to which Milgrom alludes, and is one of the reasons why that fault cannot be used to justify homeopathy.

So Milgrom’s argument is ultimately fallacious because whatever the dispute about the evidence for specific treatments in medicine (and indeed homeopathy), few if any mainstream treatments are based on ideas which are disputed - rejected, even - by scientific consensus.

For a drug to have an effect on a biological system when administered at measurable and pharmacologically active doses, does not offend our understanding of the nature of matter. For a substance with no objectively provable connection to a disease, to cure the disease when administered at what any objective measurement will say is zero dose, is self-evidently much more of a problem.

To overcome objections to forms of energy that have never been measured (admittedly not asserted by all homeopaths, but the lack of any uniformity or mechanism for objective resolution of disputes is another and much longer discussion), and apparent conflicts with very fundamental physical laws, will require evidence of a much higher order than the papers Milgrom cites, as is evident from the fact that the consensus remains despite their publication.

To be persuasive, results must not only be consistent with the claim that homeopathy has effects, they must also be inconsistent with the null hypothesis of placebo effects, natural course of disease, cognitive errors and experimental biases, all of which can, unlike homeopathy, be objectively shown to exist and none of which, unlike homeopathy, appear to conflict with other well proven principles of science.

It beggars belief that homeopaths still think that somehow - despite the overwhelming scientific evidence - that homeopathy has anything to offer over and above a placebo effect.
The "laws" of homeopathy are not laws. They were dreamed up by Samuel Hahnemann back in the early 19th century in an era when much of modern science was still to be discovered. The "laws" are nothing of the sort -they are disproved theories. The fallacy of "like cures like" was disproved as long ago as 1861 by Oliver Wendell Holmes. As for serial dilution and potentisation, for either of those to be true would require new paradigms in chemistry, physics and biology. Just because something is claimed as being true because it's ancient and/or popular doesn't actually make it true. Remember at one time long ago it was considered that there were just 4 elements - earth, air, fire and water. Logical fallacies such as argumentatum ad populum abound in the parallel universe that homeopaths and supporters of other forms of so-called "alternative medicine" inhabit. If you want to see just how wrong homeopaths can be, I suggest a web search for "Venus light proving".
Homeopathy is scientific nonsense - a fact from which there is no escape. However, let's consider whether there is any benefit to be gained from the whole process. Homeopathic consultations are significantly longer than the typical GP consultation. Thus, there may be a benefit gained somewhat akin to psychotherapy. Does this last and produce any effect over and above placebo? The evidence says not. What about any other benefits? Again, the evidence from high-quality studies says not. Homeopaths, like other purveyors of so-called "alternative medicine" often quote impressive results from hundreds of studies as being evidence of benefit, typically in the form of a Gish Gallop. In order to accept that as being true would require a suspension of critical thinking skills. The seminal review of homeopathy by Shang et al was published in The Lancet back in 2005. In their meta-analysis, they were very careful to look at all the available trials of homeopathy. They scrutinised the trials for quality, finding that many of the studies were of poor quality. When the high-quality trials were subjected to meta-analysis it was clear that homeopathy offered no benefit over and above a placebo effect.
Homeopaths will often claim - erroneously - that it is not possible to test such an individualised system of "medicine" in a clinical trial. Perhaps they are unaware of the trials of personalised therapy that are now a standard part of cancer research. Finally, we should remember that when confronted with the harsh realities of failure, homeopaths will either deny the facts or claim that it was somehow the patients' fault for deviating from the prescribed therapy (a common finding in the world of "alternative medicine".
If anyone is seriously considering homeopathy, I would direct them to the website www.whatstheharm.net and also advise they search for the harrowing story of Penelope Dingle from Western Australia.