Jun 18 2007

A Challenge from a Homeopath

The following letter was forwarded to an informal advisory group on medical topics for the Committee for Skeptical Inquiry (CSI, formerly CSICOP).

Dear sirs,

I am a homeopathic medical doctor, living and practicing homeopathic medicine in Cyprus.

The question if homeopathy works, I think it has been answered from the millions of people who have been cured from this medical system for more than 180 years. Except if you consider them all crazy. The only answer remaining to be answered is how the homeopathic medicines work, although some answers have been discovered in the field of quantic physics.

Now if you have any doubts about the effectivenes of homeopathy we invite you in a puplic clinical research, on an disease which we will agree together, and make a double blind trial to check out the results of homeopathy versus placebo.

We will put independent observers to see the results. Of course if the results are positive in the agreement we sign you must apologize to the public in your country and worldwide for your wrong ideas about homeopathy, and instead of accusing you will have to promote homeopathy.

If you have a real scientific approach you should have in mind that scientific way of thinking must be away of aforism, and dogma, and must adjust its theory to explain the reality. If we do the opposite, that is trying to squizz the reality in our mental theories, then we are not scientist but we act like the church and theology. I don’t believe you want to push medicine back to medieval age.

So, this is a challenge for you.

I am the President of the Cyprus Medical Homeopathic Organization.

Yours sincerely
Dr Christos Hadjicostas, MD – MD Hom.

I reproduce the letter as written without corrections. Clearly English is a second language for Dr. Hadjicostas, but he makes his points clearly enough. He states: “The question if homeopathy works, I think it has been answered from the millions of people who have been cured from this medical system for more than 180 years. Except if you consider them all crazy.”

Dr. Hadjicostas here is appealing to anecdotal evidence and is suggesting that the volume of evidence – millions of people over 180 years – should be compelling. But unreliable evidence is not made more reliable by numbers alone. Anecdotal evidence is unreliable no matter how much of it there is. For example, the humoral theory of illness persisted for three thousand years with millions of people treated, and yet this is not sufficient reason to think that purging the green bile humor will cure anyone of disease.

There are numerous other examples from history. In the early 20th century there was a widespread belief that radioactive tonics could cure just about anything and give people strength and vigor. Dr. Abrams made a fortune selling his black box for the diagnosis and treatment of all illness – literally millions of people swore by his treatments – until it was discovered that the black box contained little more than useless and unconnected machine parts.

Dr. Hadjicostas follows up with a false dichotomy: “Except if you consider them all crazy.” So either, he is suggesting, we must consider those who believe they were helped by homeopathic remedies as legitimate evidence for the effectiveness of homeopathy, or crazy. But there are more options, the most important of which is that they are normal human beings who are susceptible to a range of psychological factors and observational biases – those factors and biases that make us poor observers and that render anecdotal evidence so misleading.

Every serious medical scientist understands the nature of the placebo effect and the misleading nature of anecdotal evidence. A century of medical research has clearly shown this and evolved to control for these factors. Dr. Hadjicostas does not seem to understand this basic principle of medical research, and is not only relying upon anecdotal evidence but is suggesting that it is so compelling it is sufficient to force an exploration for new laws of nature to explain homeopathy’s alleged effect.

Dr. Hadjicostas wrote: “The only answer remaining to be answered is how the homeopathic medicines work, although some answers have been discovered in the field of quantic physics.”

The reference to quantum physics to explain apparently impossible effects, such as homeopathy, is becoming almost ubiquitous among promoters of pseudoscience. The strange behavior of atomic and subatomic particles described by quantum mechanics does not apply to the macroscopic world. Quantum effects do not apply to people, and quantum mechanics cannot rescue homeopathy or any similar pseudoscience from extreme scientific implausibility.

Dr. Hadjicostas next challenges CSI to collaborate in a double-blind placebo controlled trial of a homeopathic remedy is some disease. This sounds fair as far as it goes, but there are numerous reasons to be concerned about any such collaboration.

First there are the usual logistical and ethical concerns. Any human research must be done through an investigational review board (IRB) and follow all the ethical protocols that are currently in place. This is not like testing dowsers – the proposed study would need to be designed and executed like any medical research. But let’s assume this can be done.

Other considerations include choosing a disease that is as objective as possible in terms of diagnosis and outcome, and meaningful outcomes can be measured over a fairly short period of time. Finally, since homeopathy is unproven, it cannot replace established treatment in the research protocol – especially for a serious disease or one that is not self-limiting. You cannot withhold proven effective treatments from study patients. There are significant ethical barriers to studying a treatment which has no plausibility and for which there is already copious evidence of lack of efficacy.

Dr. Hadjicostas writes: “We will put independent observers to see the results. Of course if the results are positive in the agreement we sign you must apologize to the public in your country and worldwide for your wrong ideas about homeopathy, and instead of accusing you will have to promote homeopathy.”

This is the most naïve and absurd statement of his letter. It assumes that one study is sufficient to overturn all the research that has come before. There is a vast body of homeopathic research that all must be considered – one study would add to it but it is absurd to think that it should automatically trump all other research. They are trying to force scientists to go “all in” on one hand, but they don’t have any chips of their own to put up.

Further, the notion that if new research requires a change in the ultimate conclusion about a claim that those who changed their mind should apologize is downright childish. Scientists change their minds all the time in the face of new research. The fact is that given all the scientific knowledge we have right now the only sensible conclusion is that homeopathy has no scientific plausibility and the empirical evidence does not support its effectiveness. All any scientist can do is interpret the existing evidence. If that turns out to be wrong, no apology is necessary.

Dr. Hadjicostas seems so confident in the outcome of this research that he doesn’t even bother to state what he will do if the study is negative. Will he apologize to the world for promoting a useless unscientific treatment? Will he abandon homeopathy and work towards its demise as a medical treatment? He should. In fact, he should do that now on the strength of existing evidence.

He is betraying a double standard – one which makes all such collaboration a lose-lose situation for the serious scientists. No matter the outcome, the homeopaths will continue to support homeopathy. The last time such a collaboration took place (to my knowledge) was when James Randi visited the lab of Benveniste – a French homeopathy researcher, now deceased. Under Randi’s outside careful observation, all the miraculous positive results of Benveniste’s lab vanished. Did Benveniste abandon homeopathy or declare it had no effect? No.

What will Dr. Hadjicostas do if the study he proposes comes out negative? He doesn’t bother to say, but since he has already told us that he knows for certain homeopathy works and all we need to do now is figure out how it works, he doesn’t seem to be open to the possibility that homeopathy is worthless. I cannot say for certain how he would react to a negative study, but historically what has almost always happened is that the post-hoc excuses start rolling in. In the end we will have wasted a great deal of time, money, and effort and we will end up exactly where we started.

There is also great risk in such an arrangement. Even well designed studies may not yield the correct result. Medical research is messy and it often takes a series of studies to work out all the variables. Also just statistically there is a small but real chance of one study resulting in a P-value of 0.5% by chance alone. Further, when dealing with true-believers who clearly do not understand the state of biomedical research and confess to already being rock solid in their conviction, we run the risk of pious fraud. Such believers might be tempted to put their thumb on the scale, just to convince the world of what they already know to be true – and they will have suckered the skeptics into lending their stamp of approval on the process.

And that is the entire point of such a proposal. Dr. Hadjicostas was clear that he is already convinced homeopathy works, so he is not interested in the study to find out “if” it works. The proposal is a stunt, its propaganda. The ridiculous demands to apologize and promote homeopathy make that clear. Such demands from true believers are also endless – no matter how much data already exists to disprove a notion, they always want one more study to make their case (and then excuse away when it’s negative).

Having said all that, although risky such a collaboration could work out in the end if the skeptical scientists who help design and monitor the study are able to do so sufficiently to prevent any possibility of fraud, and if the outcome measures are sufficiently objective. The agreement of how to react to the outcome of the study will have to change, of course. What is reasonable is for both sides to sign an agreement – after the protocol is worked out – that the study is a fair and reasonable test of the efficacy of homeopathy for whatever specific indication is tested. However, any weaknesses of the study must also be acknowledged. That’s it. Statements constraining all future scientific interpretation of the evidence are too ridiculous to consider.

Dr. Hadjicostas ends with a paragraph asking, essentially, for intellectual honesty from the skeptics, and almost admonishing skeptics, saying: “I don’t believe you want to push medicine back to medieval age.” The irony is rich. Need I point out that it is homeopaths specifically, and alternative medicine proponents in general, who are actively pushing medicine back to a pre-scientific era through anti-scientific notions and intellectual dishonesty. The fact that Dr. Hadjicostas supports homeopathy given the current evidence and utter lack of plausibility, and justifies his support with anecdote and vague reference to quantum mechanics, tells us all we need to know about his scientific integrity.

Here is my counter proposal to Dr. Hadjicostas. Propose a detailed study protocol for a randomized, double-blind, placebo controlled trial of homeopathy for a specific indication that will prevent fraud, eliminate personal bias as a factor, that has objective and quantifiable outcomes, and meets ethical guidelines. The protocol should be in a form that has sufficient detail and all the components necessary to apply to an IRB for permission to study human subjects. The proposal should include a calculation of cost for an appropriate sized study and he should tell us where the funding is coming from. We can then review the protocol and make any necessary changes.

Assuming we can agree on a final protocol, then both sides can sign off on the legitimacy of the protocol and will stand by the outcome, as long as the proper monitoring is in place. Then we can let the chips fall where they may. Scientists do this all the time, and then live with the results. Homeopaths, on the other hand, have been dodging the evidence for 180 years.

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