May 29 2007
Last week I applauded the courage of Dr. Born for fighting against pseudoscience and quackery in the UK National Health Service by urging them to drop coverage for the utter nonsense that is homeopathy. Peter Fisher, director of the Royal London Homeopathic Hospital, has now answered Dr. Born with an open letter of his own. It is a droll patchwork of unsupported assertions, straw men, propaganda, and assorted other logical fallacies.
The fallacies started right in the title of the piece: “Open letter, closed minds.” What is truly closed minded is to assert that homeopathy and other alternative methods work despite a lack of theoretical or empirical support. The dismissal of appropriate scientific criticism as “closed minded” is a standard favorite in the world of pseudoscience, so it is no surprise. It is so common and abused it warranted an article just on this topic.
Peter Fisher wrote:
The Royal London Homoeopathic Hospital (RLHH) is the largest and most integrated public-sector provider of complementary and alternative medicine (CAM) in Europe. We offer real patient choice: safe, effective, drug-free and self-empowering treatments for many common medical problems provided by well-qualified doctors and nurses.
It’s somewhat reassuring to see that the pro-CAM propaganda is the same across the pond as here in the US. Fisher is repeating the common appeal to health freedom – all they are doing, he argues, is offering people a choice and allowing them to be self-empowered. This is a complete non-sequitur – the only real question is does homeopathy work. He includes in his statement that the CAM treatments offered are effective, but this is in contrast with the scientific evidence and the overwhelming consensus of scientific opinion.
Finally, he appeals to irrational fears and resistance to modern pharmacology, stating that the treatments they offer are “drug-free.” This is ideology. The method of treatment does not really matter. All that matters – and should matter – is scientific plausibility and evidence for safety and efficacy.
As part of University College London Hospitals NHS Foundation Trust, one of the UK’s leading academic medical centres, we are fully part of the NHS.
This is nothing more than an appeal to authority. He is attempting to argue that CAM is legitimate because it is already integrated into the clinical, research, and educational systems of UK medicine. He misses the point entirely that the criticism of CAM is that they have these trappings of legitimacy without ever having earned them through objective scientific and scholarly validation. Simply stating that, yes we do indeed have these trappings of legitimacy is not responsive (although it is an effective diversion from the real issues).
The hospital has been responsible for a number of “left field” NHS innovations. For example, we established the first NHS acupuncture service in 1972. Evidence has steadily built up to prove that it is an effective treatment for various painful conditions. As well as establishing the first NHS acupuncture clinic, we trained practitioners, conducted some of the most significant research, and are currently developing cost-effective ways of integrating acupuncture into the NHS.
Now he is attempting to validate one pseudoscience with another. In fact, the totality of acupuncture research does not support its use for any indication. As this recent research review states “The effectiveness of acupuncture remains unclear.” “Unclear” is a kind way of saying unproven – despite many studies. So what evidence or proof is Fisher referring to?
The RLHH also introduced complementary cancer care into the NHS, now provided by many oncology centres, and established the first NHS musculoskeletal medicine service. These services offer patients the choice of non drug-based therapies. There is great further potential in this area.
Again, the appeal to fear of drugs and to choice. Is offering patients treatments that do not work really expanding their choices?
Fisher also appeals to the promise of future “potential in this area.” This is a common ploy of the pro-CAM crowd. Clinical studies that are outright negative are characterized as indicating “the need for further research,” rather than just “negative.” CAM treatments are often referred to as not “yet” proven. And we are endlessly reassured of the amazing potential of CAM and lured with the promise of finding the “diamond in the rough.”
And yet, after decades of research there is not a single CAM modality (not including ones they attempted to appropriate from scientific medicine, like nutrition or physical therapy) that has been adequately proven to be safe and effective and was added to the list of legitimate scientific modalities. The world of CAM has added literally nothing to the practice of medicine or to the health of people.
(note: Statements in the negative as above are always qualified with “to my knowledge or experience.” So, I invite you to find a genuinely CAM modality that has crossed the threshold into scientific medicine and post it in the comments so I can address it. The only contenders I can think of are herbal remedies, but these are in the gray-zone of CAM because they are, in fact, drugs. Also, herbal compounds have been incorporated into pharmaceuticals from the beginning. So I acknowledge that some herbs may be found to have useful pharmacological activity.)
Recent research carried out at the hospital includes a clinical trial of acupuncture, showing it to be effective, and cost-effective, for chronic headache, and a trial of Ginkgo in dementia. Recent publications include Cochrane and other systematic reviews, clinical trials of homeopathy in depression and eczema, and innovative epidemiological work, looking at “effectiveness gaps” in primary care.
This is nothing less than dishonest misdirection. Referencing a single positive study does not trump the body of scientific evidence that says acupuncture does not work. He also pulls the common ploy of citing ongoing research – as if the fact that something is being studied renders it legitimate. The link he provides is to the National Center for Complementary and Alternative Medicine (NCCAM) – a biased organization shoved down the NIH’s throat by ideologues in Congress, and over the protests of scientists. He doesn’t mention that the link he provides states that: “a trial sponsored by the National Institute on Aging of more than 200 healthy adults over age 60 found that ginkgo taken for 6 weeks did not improve memory.” Yes – the best evidence to date on Ginkgo and memory is negative, but (we are again reassured) this is all very promising, and a larger study is under way.
We are focused on benefit to patients, which is why we emphasise patient choice and integration.
This is absurd. If the focus is on benefits to patients, then the emphasis should be on scientific plausibility and evidence – not the ability to choose modalities that don’t work, and not the integration of a double standard for unscientific nonsense.
But we do not shy away from the scientific debate around homeopathy. Homeopathy is enigmatic: remarkably popular, widespread and persistent, despite the scepticism of. It is simply not true to say that it is unsupported by evidence. A review of 119 randomised, peer-reviewed clinical trials of homeopathy at the end of 2005 showed 49% positive results for homeopathy. Only 3% were negative. Economic studies consistently show that integrating homeopathy in medical practice results in better outcomes for the same cost.
Fisher states that homeopathy is enigmatic, but what he really means is that popular support for homeopathy is the enigma because that popularity is in the face of extreme scientific implausibility and a lack of adequate evidence.
He then tries to characterize skepticism toward homeopathy as outdated and obsolete by making a personal attack against “retired professors of biomedical background.” Well how about the skepticism of the majority of the scientific community? How about the skepticism of this working academic clinician? How about the appropriate skepticism of anyone who knows the slightest thing about chemistry and physics?
Fisher’s characterization of the scientific evidence for homeopathy reveals his poor scholarship in this area. Yes, there are many studies in homeopathy, and yes many of them are positive. But he fails to address the actual criticism of this research leveled by homeopathy’s critics – that there is an inverse correlation between the quality of the study and the size of any effect, and the best studies (the only ones actually worth considering) are all negative. The fact that there are many poor quality and biased studies of homeopathy out there (combined with the file drawer effect as an added bias toward publishing positive studies) is meaningless. Proponents of homeopathy have failed to produce a single positive study that is adequately designed, controlled, and executed.
They have also failed (and Fisher fails to even discuss this) to provide an adequate explanation for why the claims of homeopathy are not impossible within the framework of modern science. Homeopathy is nothing more than pre-scientific witchcraft. Its “laws” are rituals based upon magical thinking. There is no mechanism how, even with the most creative theories possible within the framework of science, that water can retain the memory of complex molecules that have been diluted within it in the past (and only the ones desires – not all the other molecules that have been diluted in that water previously).
Given that we know, as much as we know anything in science, that homeopathic “remedies” are just water and cannot possibly have any therapeutic effect beyond a placebo effect (homeopathic pills are literally placebos) – what the body of homeopathic research actually teaches us is something quite different than what Fisher concluded. It is showing us what a body of clinical research will look like when the underlying phenomenon does not exist. It is showing us why we need carefully controlled trials that rule out fraud and bias. It is showing us the effects of self-deception, and the statistical effects of publication bias. It is showing us the weaknesses of meta-analysis, and the many ways in which statistics can be manipulated to create the appearance of an effect where none exists.
Serious, competent scientists, medical researchers and academics who are adequately free from the mind-numbing effects of ideology know this – and they overwhelmingly reject homeopathy. This cannot be closed-mindedly dismissed as closed-mindedness, nor the obsolete traditionalism of retired professors. The rejection of homeopathy stems from the valid and necessary scientific underpinnings of legitimate medicine. It is good to see the backlash against those who would undermine those scientific underpinnings. It is also somewhat reassuring to see that the CAM response to that backlash, in this case embodied in Fisher’s letter, is as intellectually weak, flaccid and pointless as CAM itself.
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