May 26 2011

CBC Program on Homeopathy

Recently CBC in Canada aired a program on homeopathy for their series on consumer protection called Marketplace. The segment was titled Cure or Con and was generally a good program. It was not a hard-hitting skeptical treatment of homeopathy, but it was a fair treatment of the evidence and arguments concerning homeopathy. There was no “false balance”, although they did give homeopathy proponents an opportunity to tell their side of the story.

Generally the program was considered a “win” among skeptics – a rare bit of good journalism on a controversial and complex topic.

Of course, the homeopathic community was not pleased (a reliable sign that the show did a good job). Just read the comments beneath the program linked above and you will see a long list of displeased homeopathy advocates running through the list of logical fallacies and making many misstatements of fact. The homeopathy community, in fact, organized a negative feedback campaign in response to the segment.

Such feedback tests the journalistic integrity of reporters and outlets that have taken an unpopular position on a topic, or one that displeases a vocal minority. I am glad to see that CBC has not caved to this feedback, and in fact they have responded with a statement that supports high standards in science journalism.

The Complaint

The official complaint was made by Kathyrn Robbins, prompting an ombudsman review. She dismissed the report as biased (an easy charge to make – bias is often in the eye of the beholder) and made a number of specific, and very typical, pro-homeopathy points. She wrote:

“How homeopathy works is indeed a mystery — but when did mystery become a logical basis for concluding that something does not work or is, even worse, a con?”

This is the standard defense of not only homeopathy but any magical treatment. There are two main errors in this statement. The first is that it is a straw man – the basis for the conclusion that homeopathy does not work is largely from direct clinical evidence that homeopathy does not work, regardless of its plausibility or putative mechanism. Homeopathic preparations are indistinguishable from placebo – the standard interpretation of which is that they do not work. Defenders of homeopathy accuse critics of ignoring positive studies, but it is they who are cherry picking. Systematic reviews of all the clinical evidence overwhelmingly show that homeopathy is a placebo.

Second – there is a profound difference between not knowing how a treatment works and our most basic and fundamental science telling us that it cannot possibly work. This is not just about a “mystery” or lack of knowledge – we can reasonably assess the plausibility of a scientific claim based upon the scientific knowledge that we have so far accumulated. We can do this while simultaneously acknowledging the limits of our current knowledge, and the wild card of the unknown.

With respect to homeopathy, most preparations do not even have a single molecule of active ingredient remaining after their extreme dilution. So how can they possibly have a physiological effect on the body? Homeopaths resort to the most implausible, essentially magical, explanations – that the remedies contain the “spirit” of the substance that was diluted in them, or that water retains the “memory” of the substance (which can somehow survive being placed on a sugar pill, evaporating, being absorbed in the body, and traveling through the blood).

This is not just a “mystery” – for homeopathy to work major chunks of our understanding of reality would have to be wrong. This is scientific implausibility in the extreme. A reasonable approach to take to such claims is that the evidence that they are true has to be at least equal to the evidence that tells us they cannot be true. There would need to be a mountain of high quality evidence for homeopathy to be taken seriously, but instead we have evidence that is essentially negative. The only reasonable conclusion to draw from massive implausibility and negative evidence is that homeopathy does not work.

How do homeopathy apologists answer this charge (when not ignoring it)? The ombudsman’s report indicates:

While she agreed that the bulk of evidence in support of homeopathy was anecdotal, she said that the more than 200 years of such successes “cannot be discounted. . .people will not continue to pay for treatments that do not work.”

This is not a justifiable premise, given what we know of human psychology, mechanisms of self-deception, and a few thousand years of cultural history. Anecdotal evidence can be discounted (by solid scientific evidence). Millions, even billions, of people can be deceived by confirmation bias, statistical naivete, placebo effects, and other mechanisms of self deception. We also have numerous historical examples of popular treatments we now know to be worthless or harmful.

In fact the entire history of human knowledge (factual knowledge about how nature works) is one of cultural beliefs (largely superstition or philosophy-based or simply quirky cultural history) being systematically replaced by science-based ideas. When we started to take a rigorous systematic look at nature with methods that control for bias we found that almost everything we believed about the world was wrong.

Proponents of homeopathy want to go backwards – they want to eschew scientific knowledge for the messy and biased methods that created uncounted superstitions and primitive beliefs – i.e. anecdotes. Why – because anecdotes give them the answer they want, and science doesn’t. But also our brains are programmed to respond to anecdotes, to be compelled by personal stories. We emotionally have a hard time discounted the personal experience of others, and especially ourselves. It takes critical thinking skills and knowledge of the mechanisms of bias and deception to overcome this emotional gut response – but that is what science requires.

Robbins goes on to say:

“Here are the facts: You cannot scientifically prove that homeopathy does or does not work.”

Ah – the last refuge of the pseudoscientist. Your science cannot test my woo. How has she established the “fact” that homeopathy is somehow immune to scientific investigation? If there is a real effect from homeopathy, as proponents claim, then we should be able to document that effect statistically. Putative mechanism is irrelevant – such an effect can be measured. This is simply a lame special-pleading excuse for the scientific evidence not supporting one’s view.

Further – homeopathy apologists often try to maintain, simultaneously, that the science does support homeopathy (by cherry picking the positive data), and then when it’s pointed out that the evidence is actually negative, they switch to “science can’t test homeopathy.”

CBC Response

The CBC gives a cogent defense of their journalistic methods and adequately defends their conclusions. In fact, they justify a much harsher treatment of homeopathy than the one they gave. In an attempt to seem fair, they softened their blow considerably. The soft approach did not prevent the backlash from true-believers, however.

I much prefer the no-nonsense approach taken by the British Commons committee that the CBC report cites for justification, writing:

The most recent significant study of homeopathy came from a 2009 British Commons committee following months of testimony. The committee considered the ultra-dilution notion “scientifically implausible” and that systematic reviews and analyses “conclusively demonstrate that homeopathic products perform no better than placebos.”

Among its conclusions: “We regret that advocates of homeopathy, including their own submissions to our inquiry, choose to rely on, and promulgate, selective approaches to the treatment of the evidence base as this risks confusing or misleading the public, the media and policy-makers.”

In fact the report called homeopathy “witchcraft” – an accurate description.

Regarding the issue of balance, the CBC reports writes:

The achievement of balance does not mean mathematical equivalence; rather, the important principle is that different views are, in the words of the CBC policy, “reflected respectfully.”

This is reasonable. It avoids the trap of false balance. It also explains the soft approach taken. But I do think a journalist must also consider what the real story is, and not just reflect everyone’s views. The real story hear is that homeopathy is witchcraft. It can’t work, and the evidence shows it doesn’t work. An interesting angle to this story is why people believe in it anyway – what flaws of psychology and neurology are at work. And also how it is marketed and aggressively promoted.

Conclusion

Homeopathy is a con – a massive 200 year old con. That’s the real story. Journalists should not be afraid to tell that story, and they should (to borrow an old cliche) wear the criticism of true believers as a badge of journalistic honor.

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18 responses so far

18 Responses to “CBC Program on Homeopathy”

  1. Jim Shaveron 26 May 2011 at 10:34 am

    Once again, Steve, you have done an exemplary job of summarizing medical facts, logical fallacies, and just plain stupidity with respect to homeopathy. Granted, homeopaths are easy targets for people with well-functioning brains. But as long as they are out there bilking unwary people to the tune of hundreds of millions of dollars per year, heros like you need to keep fighting in the best way you can — with unapologetic reasoning.

  2. Paulieon 26 May 2011 at 11:26 am

    Its always fun reading this kind of stuff – thanks as always Steve!!

    The Aussies did a good segment on today tonight totally ripping into homeopathy recently; we had some great skeptical minds on it too.

  3. daijiyobuon 26 May 2011 at 3:49 pm

    Homeopathy actually CAN’T be a con.

    Because when I search naturopaths’ web sites even now, they tell me NDs are “science-based”, that naturopathy is one of the “branches of medical science” and contains homeopathy, and that homeopathy is powerful.

    So there.

    -r.c.

    ;)

  4. ccbowerson 26 May 2011 at 8:35 pm

    I find it hard to believe that anyone who actually knows what homeopathy is would believe it. It seems that most people who buy such products don’t realize what they are buying, and assume that these products are more like “natural remedies.” A major reason why homeopathy has stuck around so long in the US it got a priviledged status that it didn’t deserve due to the FD&C act in the 1930s, and very little has been done since to fix that. How can we change this when there doesn’t seem to be enough desire to do so? Perhaps we should play up stories of people who forgo rational treatment and then die from their treatable/curable illness? Things like this happen all the time and get little exposure.

  5. RyanJLindon 26 May 2011 at 9:24 pm

    I cannot believe the comments on that link you gave, Steve. Totally embarrassing. If these people had their way, how long would it take for us to be back in the Dark Ages? Yeesh.

  6. Paulieon 26 May 2011 at 10:31 pm

    @ccbowers

    I can see your point when you say ‘I find it hard to believe that anyone who actually knows what homeopathy is would believe it. It seems that most people who buy such products don’t realize what they are buying, and assume that these products are more like “natural remedies.” ‘

    However, I’m a pharmacist and (unfortunately due to the powers of head office *grumble*) we sell homeopathy. You would be surprised how many people I have explained, clearly, what homeopathy is and they STILL choose to buy it. I remember when I was a final year student, had one woman come up to the counter with a number of “teething pain” products including a homeopathic one. I quickly said to her, pointing to the homeopathic medication, “well this one defiantly isn’t going to work”. She asked why and I explained. This seemed to anger her and she demanded to speak to the registered pharmacist (not a silly student) who proceeded to tell her, almost word for word, what I had told her. She snatched the homeopathic remedy, and yelled at the pharmacist “WELL I’M TAKING THIS ONE ANYWAYS”. *sigh*

    Fortunately there are a lot of patient’s who see the light and end up not taking the products; most even laugh out loud at how stupid the whole concept is.

    What frustrates me the most is that we have them in pharmacies. It’s absurd. But it’s not the pharmacists fault, it’s the non-practicing people in head office who have sold their souls to the devil who choose to stock these items just to gain a her bucks. We can’t get rid of it, even if the pharmacy manager doesn’t want to stock it (they tend not to be the owners, just managers). For example, my manager refused to stock ear candles for obvious reasons and he got an ear full (pardon the pun) from head office and was forced to stock them…

  7. eiskrystalon 27 May 2011 at 4:13 am

    people will not continue to pay for treatments that do not work.”

    …as i’,m sure Harold Camping instantly lost all his followers after his first prediction turned out to be wrong…or at least i’m definitely sure they won’t stay after the 2nd is proved wrong…

    hahahahahahahahahahahahahah

  8. wim_vandenbergheon 27 May 2011 at 7:02 am

    A Belgian government agency (http://www.kce.fgov.be) recently came out strongly against homeopathy with a new report saying there isn’t a shred of evidence that it works. Here is a link to the report (should be in English):
    http://www.kce.fgov.be/index_en.aspx?SGREF=5211&CREF=19928

    Here is a short news story about it as well:
    http://www.youtube.com/watch?v=G0XOqa7KmTk

  9. Steven Novellaon 27 May 2011 at 9:03 am

    Pauli,

    I see what you are saying. But in my imaginary utopian world pharmacists would refuse to stock pseudoscientific products – the head office be dammed. If they stood together as a block, they could pull it off.

    Part of the problem is that you do not feel empowered to defend your profession from the powers that be. That can change.

    In every revolution there is one man with a vision (now all you need is a stylish goatee)

  10. ccbowerson 27 May 2011 at 10:13 am

    @Paulie

    Don’t get me wrong… I didn’t intend to impy that people would never buy homeopathy, but I was trying to emphasize how most people don’t really know what they are buying when they see “homeopathic remedy.” In your example, I don’t think the person bought the product because they liked your description of homeopathy, but because your dismissal of homeopathy offended her in some way. I’m not faulting you, but she may have purchased many homeopathic products before, and was unwilling at that moment to admit that those products were a waste of money. So her purchase was for spite, and to maintain her sense of being a reasonably intelligent person who would not let her child suffer. Perhaps she purchased that product at that time, but perhaps the next time she hears something bad about homeopathy she will let it sink in a bit

    “But in my imaginary utopian world pharmacists would refuse to stock pseudoscientific products – the head office be dammed. If they stood together as a block, they could pull it off.”

    The first few words says it all. In most circumstances pharmacists have little/ no say in what gets stocked. The only way this will be done is through a change in laws, and/or in a change in public perception. I’m not holding my breath (though I could happen at some point).

    Principled stances on large scales lose to $$, unless the law steps in, especially when the public doesn’t know to care. If public opinion shifts somewhat, homeopathic products get some negative attention, and pharmacy organizations ban together, then I agree with you. But it will take many factors

  11. ccbowerson 27 May 2011 at 10:16 am

    I think the way to shift perception is through stories of actual harm, e.g. where someone forgos cancer treatment for homeopathy and dies. You don’t really have to look to far to find these examples, they just don’t get exposure

  12. Paulieon 27 May 2011 at 12:06 pm

    @Steve

    I wish! Apparently we had a strike in the 80s for an hour or something (I may be exaggerating), we’re useless at standing up for ourselves. And our union is about as useful as a block of lead as a floaty. I’m not the political type soI am trying my best to educate the kids/ undergrads – we had a good discussion today in a pain tutorial about this kind of thing because someone said accupuncture is good for osteoarthritis and said “everyone uses it!!” needless to say I gave them a good 20min rant and this generated alot of discussion (so proud!!). My main msg was ‘use your brain, be honest, and don’t let the head offices getting you!!’ I’m also trying to get some of the lecturers allow me to develop a critical thinking lecture introducing the undergrads to logical fallacies and integrating it into the already highly critical ‘CAM’ lectures we have. (if you have any suggestions about what should be in this steve feel free to let me know!!). Baby steps…

    @ccbowers

    Dw I didn’t assume you thought no one listens,I was just trying to show a point :) even if you explain to patients nicely what these things are they get angry at you sometimes. You can’t win all the battles

    Ps if some words make no sense I appolpgose – stupid itouch autocorrect!

  13. Paulieon 27 May 2011 at 12:09 pm

    Pss: Steve, I too have the same utopia!! Lol.

  14. daedalus2uon 27 May 2011 at 12:30 pm

    If pharmacies bend over backwards to accommodate the religious who refuse to sell birth control pills or Plan B, why can’t pharmacists who refuse to sell quackery be accommodated too?

  15. ccbowerson 27 May 2011 at 2:29 pm

    “Pss: Steve, I too have the same utopia!! Lol.”

    I would settle for a utopia that didn’t have unscientific perspectives, specifically CAM, infiltrating our professional programs. But I agree that the Utopia Steve describes would be great.

  16. ccbowerson 27 May 2011 at 2:36 pm

    “Why can’t pharmacists who refuse to sell quackery be accommodated too?”

    Its because the quackery we are talking about are purchased OTC, and therefore do not require a pharmacist for purchase. They are sold by cashiers, technicians, etc. I think the most we can ask of individual pharmacists is to honestly offer the information about such products whenever a purchase is made. I find it analogous to a radio program that is syndicated (or TV or other media). It is not possible for a given host to control the various commercials that run across the country, so they make due with whatever power they have.

  17. Willon 27 May 2011 at 5:04 pm

    Thanks for covering this topic Steve!

  18. factsonlyon 08 Sep 2011 at 10:40 am

    re: “So how can they possibly have a physiological effect on the body?”

    Steve,

    Your inability to understand that plausibility is not a scientific paradigm and speaks nothing of a drug’s efficacy surprises me considering your education.

    From a first year chemistry book:

    “In this age of sophisticated drug design and biotechnology, the simple lithium ion is still the most effective treatment of this destructive psychological disorder [bipolar affective disorder]. Remarkably, in spite of intensive research, scientists still do not fully understand the biochemical action of lithium that leads to its therapeutic effects.”

    How is it plausible that this would have such a great effect when it is chemically similar to another abundant alkali metal ion, Na+, which has no such effect on bipolar?

    Plausibility has nothing to do with science. And unfortunately it seems you choose not to either.

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