Nov 04 2008

Homeopathy Still Sucks

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Comments: 20

This is perhaps the most deceptive science press release I have seen in a while. The title is “New Evidence for Homeopathy” – but the papers do not include any new evidence. These studies are nothing more than a reanalysis of a prior meta-analysis, which is kind of like refried refried beans.

In 2005 the Lancet published a meta-analysis of homeopathy trials and compared them to trials of conventional medicine, concluding that the evidence supports the conclusion that homeopathy is nothing more than a placebo. This meta-analysis, however, suffered from the problems of all meta-analyses – they are only as good as the literature they review, the criteria used to pick studies, and the techniques used to combine the data. In general  a meta-analysis is a very weak form of evidence, and they have a poor track record of predicting large definitive clinical trials.

Systematic reviews are much more reliable than meta-analysis. A review looks at all published trials for overall patterns. For example, are there any high quality studies, do the better studies tend to be positive or negative, and is there consistency of outcomes among trials of the same treatments for the same conditions. Systematic reviews of homeopathic treatments have been negative – because the literature is generally negative. For example, here is a review of all homeopathic treatments for childhood conditions, which concludes:

The evidence from rigorous clinical trials of any type of therapeutic or preventive intervention testing homeopathy for childhood and adolescence ailments is not convincing enough for recommendations in any condition.

Or pick a condition – asthma:

There is not enough evidence to reliably assess the possible role of homeopathy in the treatment of asthma.

There is no indication for which any homeopathic remedy has met a reasonable burden of evidence that it actually had any physiological effect.  This is not surprising, since homeopathy is a pre-scientific magic-based system. The principles of homeopathy are, simply put, magical thinking that 200 years of subsequent science has shown to be absurd. Like cures like, for example, is simply an expression of sympathetic magic. There is no scientific basis for it. The law of infinitessimals states that the more your dilute a remedy the more powerful it becomes – in direct contradiction to chemistry and physics (not to mention common sense). Homeopathic remedies contain (generally) no active ingredient. They are water. They cannot work, and it is therefore not surprising that they don’t.

Given the lack of plausibility and lack of compelling evidence for efficacy, homeopathy is a scientific dead end. It survives only because of cultural inertia, dedicated practitioners and believers who are not science-based, financial motivations, and ineffective quality-control regulations.

The original meta-analysis was interesting in that it tried a new approach – to see if there is a difference between the pattern of evidence in the homeopathic literature and the pattern of evidence in studies of mainstream treatments. I think, however, that a meta-analysis was the wrong approach, for the reasons I stated above. There are simply too many new variables that can bias the interpretation. This opened the door for dedicated homeopaths to point out those weaknesses, and make it seem like mainstream scientific medicine is biased against homeopathy – well, only in that science-based medicine is appropriately biased against unscientific or disproved modalities. It also opened the door for reinterpretation of the data in a worthless and biased fashion toward homeopathy so that proponents can put out a press release with the absurd headline of “new evidence for homeopathy.”

And of course the apologists for unscientific medicine are jumping on the bandwagon. Dr. Brian Kaplan reported on the meta-analysis proclaiming “The Tide is Turning.” Here’s a bit of history – homeopathy is already well beyond it’s peak. It has been largely displaced and now relegated to a fringe. It has made a bit of a comeback, riding along the wave of gullibility called “complementary and alternative medicine,” but already there is a pro-science push back. I don’t pretend to know how this will all play out, but the notion that the tide is turning in favor of homeopathy defies the history of medicine.

Like the CAM movement in general, homeopaths have long since lost the battle within science. They are therefore fighting a propaganda and political war. This is an effective strategy – change the venue to one you can win. The creationists have learned to do this in their battles against evolution and “materialism.” Similarly, proponents of unscientific medicine have broadened their war to one against “scientism” – a strategy reflected in Kaplans blog entry. He even equates efforts to fairly apply a scientific standard in medicine to Richard Dawkin’s war against God.

He writes:

And if they are not considered sufficiently qualified there is always the greatest exponent of Scientism on the planet (besides the magician, James Randi) Professor Richard Dawkins to call upon to prove that homeopathy is nonsense. After thousands of years of unsuccessful efforts, this man has finally disproved the existence of God so what chance has homeopathy got against him? We, homeopaths lie vanquished in the gutter next to God licking our wounds. What can we possible say except that at least we are in good company?

That’s right – if you’re against homeopathy, then you are against God. This is further evidence, in my opinion, that these individual struggles against pseudoscientific notions like homeopathy are part of a greater cultural war. Science has largely displaced mysticism as the dominant explanatory model in modern culture. The mystics, gurus, prophits, psychics, cultists and charlatans of the world are not happy about that. They are waging all-out war against science – science in medicine, science in the classroom, science in government, and science in culture.

Their strategy is to portray science as biased, Western, cultural hegemony, narrow-minded, and just another belief-system. They are using fancy philosophical terms like “scientism” and “materialism”, and made up words like “Darwinism” to make science into just another “ism”.

The skeptical movement gets what is going on and is pushing back. The mainstream scientific and academic communities, in my opinion, are still largely clueless, but they are slowly catching on. The broader public is increasingly divided, and the gulf seems to be widening.  At the same time they seem to compartmentalize – still respecting science and what it can do, but also fascinated by spiritualism and pseudoscience.

We will just have to wait and see where it all leads, but in the meantime skeptics have their work cut out for them.

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20 responses so far

20 Responses to “Homeopathy Still Sucks”

  1. TSkidCon 04 Nov 2008 at 10:17 am

    Hi Steve. I love, love, love this blog and the Skeptics Guide to the Universe podcast.

    I would differ with you on just one small thing in this post. After you quote Kaplan talking about Dawkins, you then make this statement:

    “That’s right – if you’re against homeopathy, then you are against God.”

    I don’t think that is what Kaplan is saying. He isn’t equating opposition to homeopathy to opposition to God. I think he is actually taking a sarcastic swipe at Dawkins implying that Richard is pompous enough to think that he has disproved the existence of God. And if he can disprove God (which Kaplan seems to be implying, he can’t), then he could certainly disprove homeopathy. I think his point here is that Dawkins uses fallacious arguments in disproving God, and these are the same fallacious arguments used to disprove homeopathy.

    Anyway, just a small difference of interpretation.

    Thanks again for the amazing service you are providing.

  2. DevoutCatalyston 04 Nov 2008 at 10:33 am

    > The Tide is Turning.

    The tide is always turning according to some. Even if homeopathy’s claims were true, aren’t they fighting over the merest of supposed effects? Do they ever claim, via the evidence, to have hit one out of the park as a dramatically effective therapy for something?

  3. Perky Skepticon 04 Nov 2008 at 12:25 pm

    “We, homeopaths lie vanquished in the gutter next to God licking our wounds. What can we possible say except that at least we are in good company?”

    Wow. :)

    There ought to be a new category of Internet Law for this. It’s beyond Poe, beyond Godwin… It’s like… Godot’s Law!

  4. Steven Novellaon 04 Nov 2008 at 12:48 pm

    TSkidC – I see what you are saying, but I think there was the clear intention of siding homeopathy with God. He is uniting them together in that the skeptics, whom he characterizes as agents of “scientism” are attacking both – not just by using the same methods, but by promoting the same philosophy. If you are against the underlying philosophy of homeopathy (life energy, spiritualism, etc.) then you are also against God.

  5. superdaveon 04 Nov 2008 at 1:34 pm

    Homeopathy is definitely one of the more winnable battles. Unlike say, evolution, the science that debunks homeopathy actually IS intuitive.

  6. themightylearton 04 Nov 2008 at 2:42 pm

    I agree with Steve,

    I think it is quite obvious that the they are trying to frame their issue in the same lines as the theist, non-theist one. The purpose is simply to posit themselves as fighting the same fight, that against close minded, materialist, skeptical atheists (as Steven was accused of being not too long ago by the IDiots at the (UN)Discovery Institute). I think they are really trying to say that God has something to do with it. He clearly believes in God, he claims they’re in good company no?

    It is basically saying that those that are against homeopathy are the same people that are also fighting belief in God! *GASP* Why surely such people can’t be trusted, ’cause they’re evil God haters. So why the hell should we trust what they have to say on homeopathy? We shouldn’t, they’re ATHEISTS!

    I think that pretty much sums up this line of reasoning no?

  7. jt512on 04 Nov 2008 at 3:38 pm

    Systematic reviews are much more reliable than meta-analysis. A review looks at all published trials for overall patterns. For example, are there any high quality studies, do the better studies tend to be positive or negative, and is there consistency of outcomes among trials of the same treatments for the same conditions.

    Systematic reviews are not superior to meta-analyses. You can do everything in a meta-analysis that you can in a systematic review, plus you can combine the results of small trials to provide a summary effect measure with the statistical power of a large trial.

    Using meta-regression, you can statistically control and quantify the effects of prognostic factors, such as study quality, on effect measures, whereas in a systematic review you can only describe these effects qualitatively.

    Jay

  8. CaladanGuardon 04 Nov 2008 at 3:58 pm

    Nice to see Edzard Ernst’s name on that paper. He’s probably one of the best allies both sides have strangely enough. Science-based testing that doesn’t seem to favor either side, if any of their ‘treatments’ work I’m sure he’d acknowledge it. But when it comes down to science, one army is at a distinct advantage in this war. (Psst, it’s not the woo)

  9. sonicon 04 Nov 2008 at 4:14 pm

    I think Steven is missing the point of the Kaplan article.

    From Dr. Kaplan’s article:

    “And never, never forget the main message of this post: Medical doctors retain the inalienable right to prescribe placebos as long as those placebos can be shown unequivocally to have an effect on patients. Whether that effect is positive or negative seems to be besides the point!”

    Kaplan’s reference to the NY Times article-
    “Half of US Doctors Prescribe Placebos” is the key point.

    He seems to be saying that placebos are useful to the practice of medicine and that the ones homeopaths use are not as dangerous as the ones MDs use.

    His statement about Dawkins is an attempt to show that the people attacking homeopaths and those who go to them are so gullible as to believe that science has disproved the existence of God.

    I don’t think that Kaplan is in anyway suggesting a link between the belief in god and the use of homeopathy.

    Kaplan’s argument has flaws. You too (Tu Quoque) covers it though.

  10. Steven Novellaon 04 Nov 2008 at 4:29 pm

    Sonic – I did not miss that aspect of Kaplan’s blog entry. It was just tangential to the subject of this blog. His blog article was actually a bit disjointed – the placebo article (which he also misinterpreted, but that is a separate issue) really has nothing to do with this meta-analysis. He is just taking random pot-shots at the critics of homeopathy.

    It is difficult to say definitively what Kaplan “meant” because his argument is incoherent, so logically analyzing it is difficult. What I think is clear, however, is that he is putting the critics of homeopathy and those promoting “scientism” (like Randi) and those seeking to disprove God (like Dawkins) on one side, and proponents of homeopathy and believers in God on the other (“we are in good company”). He doesn’t get a pass because he failed to make a coherent logical argument.

    But since you bring up the placebo article – this is apples and oranges. What the study called “placebos” was any prescription no directed at the underlying cause of the patient’s complaint. In other words, If I prescribe vitamin B12 to a patient who has low B12 and headaches, that’s a “placebo” treatment for the headaches if I think the low B12 is not necessarily related to the headaches but I want to treat something to help the therapeutic relationship and make the patient feel as if something is being done. This is an admitted gray area of clinical practice, but should not be equated with knowingly prescribing inert substances.

  11. Fifion 04 Nov 2008 at 5:24 pm

    Homeopaths don’t believe they’re prescribing inert substances, they believe that homeopathic remedies are more than a placebo. In light of that, I’m not sure what MDs practices regarding placebos have to do with homeopathy or how placebos can be used to defend homeopathy or homeopaths in any way. Unless, of course, the person making the comparison is admitting that homeopathic remedies are inert substances with no medicinal value so should be considered equivalent to giving a placebo.

  12. Fizziziston 04 Nov 2008 at 10:01 pm

    I think in the end science will always win due to the fact that we are always going to have one thing that they do not have which is actual evidence to support our claims.

  13. sonicon 05 Nov 2008 at 5:09 am

    Steven,
    I see what you mean. He does draw a line.
    I can certainly agree that his argument is disjointed and does not add up to the conclusion.

  14. Sastraon 06 Nov 2008 at 4:49 pm

    The God reference is probably intended to take advantage of the fact that the general public already compartmentalizes different truths and different ways of knowing — and sees them as equally valid. They’re convinced that the most important facts need to be accepted on faith and personal experience.

    Apologists are quick to insist that you can’t “prove” God through science — you can only do it through personal experience with God. That’s the most trustworthy — and humble — method of discovering truth. In the same way, the quacks argue, you can’t “prove” homeopathy through science — you can only do it through personal experience. Try it, and see if it works for you. Ask God to reveal Himself to you, and then see if He does.

    Both situations are sucker bets, relying on subjective validation and a person’s willingness to find and frame results in order to demonstrate the depth of their spiritual nature. The more sensitive you are, the less scientific evidence you need. Skepticism is the sign of someone who has “closed their heart.”

    The structure is already there.

  15. alyricon 07 Nov 2008 at 7:36 pm

    “That’s right – if you’re against homeopathy, then you are against God. ”

    Doubtful. This bloke seems to like non sequiturs – you can’t disprove the existence of God using science so therefore your efforts to disprove the efficacy of homeopathy will be equally flawed. Pure logical fallacy but there it is.

  16. humberon 09 Nov 2008 at 9:06 pm

    @perky skeptic

    “We, homeopaths lie vanquished in the gutter next to God licking our wounds. What can we possible say except that at least we are in good company?”

    Wow. :)

    Wow, indeed. They are usually quite assertive that they are simply right.
    Good company does not outstay its welcome.

  17. [...] this a bad thing? We all know, through common sense, a lack of actual data and Steven Novella, that homeopathy is not effective at treating medical conditions such as AIDS, or anything else [...]

  18. Sorenon 24 Nov 2008 at 7:49 am

    “Life must be lived forward, but can only be understood backwards”

    Thus spake Kierkegaard. Only Sonic has the slightest clue about what Kaplan was saying. It was based on Dawkins’s activities in the UK.

    1. He publishes the God Delusion with massive PR.
    2. Soon after this he makes a controversial TV programme in which he angrily denounces CAM and in particular, homeopathy.
    Thus the comment is a joke about Dawkins. Lighten up ladies and gentlemen. ‘Life is too important a thing ever to talk seriously about it.’ (Wilde) Anyone bothering to google Kaplan will see that he also practices Provocative Therapy, the use of reverse psychology and humour in psychotherapy.

    On the serious side, he does strongly object to attempts to exclude homeopathy from the National Health Service of the UK on the basis that it is not evidence based, leaving the entirely false impression that orthodox medicine is evidence based. Look at this graph that shows just how evidence based conventional medicine is.(http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp)

    Thus his argument is essentially political. And as far as politics and God is concerned: Let’s see what chance an atheist has of running for President of the USA. The great tragedy of Dawkins and co is that whatever they say, they know that billions of people will continue to ‘irrationally’ believe in a god.

  19. Sorenon 25 Nov 2008 at 5:46 am

    You have filed my comments under a new thread when they were intended to apply to the threat ‘Homeopathy still sucks’

  20. [...] Dr. Steven Novella summarizes homeopathy well: “Given the lack of plausibility and lack of compelling evidence for efficacy, homeopathy is a scientific dead end. It survives only because of cultural inertia, dedicated practitioners and believers who are not science-based, financial motivations, and ineffective quality-control regulations.” [...]

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