Dec 23 2009

More Homeopathy Apologetics

It seems that one criterion to being a practicing homeopath is the requirement to publicly embarrass oneself .  Dana Ullman now regularly does this over at the Huffington Post. Dr. Werner, however, in a single YouTube video, may have won for the most embarrassing homeopathy nonsense of the year.  Her mutilation of Einstein and relativity is self-parody.

Here’s another one from John Benneth – the science of homeopathy. He discusses the latest nonsense about “nanocrystalloids” in homeopathic remedies which emit radio frequencies. This is just empty jargon to jazz up the same false claims of homeopaths that their remedies contain the energy signature or essence of what was diluted in them. But this is not supported by any reputable science.

And here is the recent review by The Parliamentary Science and Technology Select Committee on homeopathy in the UK where Robert Wilson of the British Association of Homeopathic Manufacturers admits that there is no evidence to support the effectiveness of homeopathic remedies, but they sell them anyway.

And now, Amy L. Lansky, PhD, a computer scientist and now homeopathy proponent, writing for Mercola.com (a site that promotes every sort of medicine – as long as it is unscientific), decides to enter the fray for the most embarrassing homeopathy apologetics.  After a bit of whining about persecution, she attacks homeopathy’s critics, referring to a recent editorial by Michael Baum and Edzard Ernst:

Not surprisingly, their commentary also reflects a complete ignorance of homeopathy and the range of studies that support its effectiveness. For example, their article incorrectly uses the term “potentation” instead of “potentization” for the method used to create homeopathic remedies (more on this later). The authors also insist on citing a single negative meta-analysis study that has already been shown to be methodologically flawed, while ignoring many positive studies in respected publications, including two other meta-analyses that showed positive results.

Calling Edzard Ernst completely ignorant of homeopathy is rich. He is not a computer scientist like Lansky, but an actual professor of complementary and alternative medicine (if you search PubMed on Ernst E and Homeopathy, you will find more than 70 peer-reviewed published articles by Ernst). He has thoroughly studied the evidence for homeopathy, from a sympathetic point of view, but was simply appalled by the grossly unscientific nature of homeopathy.

Picking on the editorial for using the term “potentation” instead of “potentization” is just absurd – not to mention a non-sequitur. It is not a substantive criticism. Meanwhile  Lansky claims that Edzard cites “a single negative meta-analysis.” This is a demonstrable lie (or such appallingly sloppy scholarship that there is functionally no difference). In the commentary Lansky is referring to, Should We Maintain an Open Mind about Homeopathy? – there are several relevant references to back up the claim that the evidence does not support the efficacy of homeopathic remedies for any indication, not just a single meta-analysis.

I think the meta-analysis Lanksy is referring to is – Shang A, Huwiler-Muntener K, Nartey L, et al. Are the clinical effects of homeopathy placebo effects? Comparative study of placebo-controlled trials of homeopathy and allopathy. Lancet. 2005;366:726-732. This analysis certainly does call into question whether there is any effect in homeopathic concoctions above and beyond placebo effects. It was not a perfect study – no study is, and meta-analyses are always very tricky. But the basic conclusions of the study are valid.

But that is far from the most significant reference cited by Baum and Ernst, who also cited three systematic reviews of homeopathy. Perhaps Lanksy does not know what a systematic review is – by definition they are systematic – they look at all the evidence. In fact, one of the references was to – Ernst E. A systematic review of systematic reviews of homeopathy. Br J Clin Pharmacol. 2002;54:577-582. That’s right – a systematic review of systematic reviews conducted by Ernst himself. It doesn’t get more thorough than that. From the abstract:

Eleven independent systematic reviews were located. Collectively they failed to provide strong evidence in favour of homeopathy. In particular, there was no condition which responds convincingly better to homeopathic treatment than to placebo or other control interventions. Similarly, there was no homeopathic remedy that was demonstrated to yield clinical effects that are convincingly different from placebo. It is concluded that the best clinical evidence for homeopathy available to date does not warrant positive recommendations for its use in clinical practice.

So Ernst, by referring to his review of reviews, was actually citing eleven published systematic reviews of homeopathy. This review was done in 2002, so he also included a more recent systematic review from 2007 – also negative. Yet Lanksy accuses Ernst, essentially, of cherry picking. Then proceeds to cherry pick a few positive studies herself. This is the kind of astounding intellectual malfeasance we have come to expect from homeopaths and their apologists.

Lansky then explains for us how homeopathy works:

Homeopathic practice is based on a single law of therapeutics called the Law of Similars. This law states that a substance that can cause the symptoms of a disease can also cure it. In fact, that’s exactly what word “homeopathy” means: similar (“homeo”) suffering (“pathy”). For example, one reason that the remedy Coffea Cruda (made from coffee) can be curative for insomnia is that coffee can cause sleeplessness. Interestingly, allopaths sometimes utilize the Law of Similars, but are unaware of it when they do and are perplexed by the phenomenon.

Ask any conventional doctor why Ritalin (a substance that would normally cause hyperactivity) can treat hyperactivity in children, and they’ll scratch their heads in confusion. Ask a homeopath, and it’s a no-brainer: the Law of Similars.

Well, I am a “conventional” doctor and my head remains unscratched. There is, in fact, nothing paradoxical about the mechanism of Ritalin or other CNS stimulants in the treatment of ADHD at all – if you actually know something about it. The AD part of the diagnosis is attention deficit – a deficit of brain activity related to focused attention. Stimulating brain activity therefore allows for increased attention.

Even the hyperactivity part responds to stimulants, partly because of increased focus. But also, the frontal lobes of the brain are responsible for inhibiting our urges and behaviors. Frontal lobe activity, especially what is called “executive function,” is decreased in those with ADHD. Stimulants increase the activity of the frontal lobes – they increase the inhibition that is essential to executive function, and thereby decrease the hyperactivity.

What Lansky derides as “allopathy” (a derogatory term only used by enemies of science-based medicine) derives from basic-science knowledge of how the brain works, and what is dysfunctional in those exhibiting a specific set of signs and symptoms. This is followed up by clinical studies showing clear efficacy for treatments based upon our basic-science models of neuroscience and ADHD specifically.

Lansky clearly made no attempt to understand any of this prior to spouting off about what conventional doctors “know.”

What is homeopathy based on? Lansky gives us only a made up “law” – the Law of Similars. But that is not an explanation at all, just an assertion. There is no such thing as a law of similars. It is based on no knowledge of chemistry or biology. Two centuries of scientific investigation following the invention of homeopathy has failed to provide a jot of evidence for any such phenomenon. It is based entirely on superstition – specifically sympathetic magic, which was a common belief system in pre-scientific cultures.

And how, exactly, does Lanksy think this made up law explains the action of Ritalin?

Regarding the homeopathic preparation of coffee for the treatment of insomnia, I believe James Randi demonstrated the absurdity of this specific claim by downing an entire box of this preparation without the slightest bit of drowsiness.

Next she attacks mainstream medicine and the use of pharmaceuticals:

Of course, homeopaths add fuel to the fire. The fundamental philosophy of homeopathy implies that the primary tools of allopathy are harmful. In particular, homeopaths believe that suppressing symptoms with anti-pathic drugs – drugs that oppose the symptoms of a disease rather than mimic them – cannot cure and can even do harm. If a symptom is suppressed – for example, if a seasonal allergy is suppressed by an antihistamine – it is only temporarily palliated.

This is a gross mischaracterization of modern medicine – but is a standard canard of alternative medicine critics of science-based medicine. Not all treatments in medicine are symptomatic. Many are curative. Antibiotics for infections and eradicate the infection. Insulin for diabetes is not treating symptoms – it is replacing a missing or insufficient hormone to reestablish proper glucose balance. Some treatments are preventive – such as medication to reduce high blood pressure, or aspirin to prevent heart attacks or strokes. There are many more examples.

But much of modern medicine is considered symptomatic – but this should not be derided at all. If a patient is having seizures because of damage to the brain, and I give them a drug to prevent the seizures I have not cured them, but I have stopped the significant manifestation of the injury.

And of course, her claims are based upon the assumption that homeopathic preparations do anything – but the evidence (as well as basic science) clearly indicates that they do not.

She continues:

Unfortunately, if a substance succeeds in completely suppressing a symptom, there may be an illusion of “cure,” but the real result is more sinister. Another key tenet of homeopathy is that the true result of suppression is a deepening of the underlying disease state – because the energy of the disease is now forced to manifest in a more serious way.

Right – this is a “tenet” of homeopathy, just like a tenet of any faith. It is a belief, nothing more. Again – there is no reductionist basic science on which this is based. What is the “energy of the disease?” Where is the evidence to support this assertion? This is nothing but magical thinking.

And, of course, experienced clinicians are well aware of the real risks of masking symptoms while not addressing an underlying condition. This is basic clinical skill. Homeopaths have nothing legitimate to say about science-based medicine, so they are content to attack their “allopathic” straw men.

She then touts homeopathy as a system of treatment for poor countries. Exploiting poor nations who are suffering from serious health issues was something that even motivated the World Health Organization out of their usual torpor to make it clear they do not support homeopathy to treat the diseases that plague the third world.They specifically denounced homeopathy for the treatment of TB, diarrhea, malaria, and HIV/AIDS.

Conclusion

There is so much more nonsense, but it always takes longer to clear up misinformation than to0 spread it. Lansky concludes with this:

The skeptics manage to create a lot of smoke in an effort to hide homeopathy from public view.

Wrong. Skeptics are trying to expose homeopathy – the real homeopathy – to the public. We want the public to know exactly what homeopathy is – superstitious nonsense. We want them to know that homeopathic preparations are typically diluted to such a degree that no active ingredient is left. We want it made clear that the principles of homeopathy are little more than old superstitions and magical belief, dressed up with some modern-sounding jargon.

And we certainly want them to understand the evidence-based for homeopathy. Systematic review after systematic review has failed to demonstrate any effect for homeopathic concoctions beyond the placebo effect. They are, essentially, placebos being sold as if they were real medicine. And further, homeopaths and their apologists, in order to further their sales, attack science-based medicine – doubling down on their deception and malfeasance.

The smoke is all coming from the homeopaths, and we only want to clear it away, to have an honest scientific assessment of homeopathy. If that were to take place, it would vanish overnight.

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20 responses so far

20 Responses to “More Homeopathy Apologetics”

  1. ralfnauskon 23 Dec 2009 at 9:13 am

    Thank You for this review. I especially liked Lansky’s ‘argument’ that in essence Homeopathy must be a valid treatment because Prince Charles and the whole Royal Familiy support it. Of course that is a very strong scientific evidence – how could Prince Charles ever be mistaken.

  2. DevoutCatalyston 23 Dec 2009 at 9:26 am

    “Unfortunately, if a substance succeeds in completely suppressing a symptom, there may be an illusion of “cure,” but the real result is more sinister…”

    These alt med types are really into the guilt trip. You’ll live longer with us, trust us. And you’ll die sooner with them, trust us. And when they don’t deliver, when one of theirs dies prematurely, well, it was that time they worked with toxic chemicals ages ago — modern life did this to them. They can never look themselves in the mirror.

    I watched a documentary on the Cuban doctors that travel to third world countries. Backwards communist Cuba. What message of hope do they bring to the poor? Vaccines, and standard medical care. Homeopathetic fantasies of being savior to the poor masses reveal the soul of the homeopath: amateur human beings all.

  3. gfb1on 23 Dec 2009 at 10:50 am

    heh, heh… :)
    i’m a regular reader and have to know:

    ” … an actual professor of COMPLIMENTARY and alternative medicine … ”

    slip of the finger or freudian slip?
    or, maybe, just maybe, a little holiday pfun?!!

    in any case, i had a good chuckle.
    thanks for the good readings and have a happy new year!!

  4. anandamideon 23 Dec 2009 at 12:33 pm

    An enjoyable and interesting post, as ever (the ADHD-Ritalin explanation in particular!).

    Just a small correction: the spokesman for the Homeopathic Pill Manufacturers Association states that there *is* evidence for the efficacy of homeopathic remedies. The purely commercial line you reproduce actually belongs to Paul Bennet from Boots, a major street pharmacy in the UK – whose byline deliciously reads ‘Trust Boots’.

    The video itself is comic joy especially for the comment from one of the MPs on the panel, who suggests that the pill manufacturers association might want to show some of their evidence to Boots.

  5. banyanon 23 Dec 2009 at 1:00 pm

    I’m always curious to see the best evidence for homeopathy that’s being relied on. Looking through Amy Lansky’s references 3-8, I note the following:

    3 and 4 are meta-analyses; no substitute for good individual trials. I didn’t even read these.

    5 mentions that homeopathy in combination with standard treatment helps diarrhea in very young children, but the results never mention how it compares to the placebo group even though the methodology states that they used one. How could they publish something like that in good faith?

    6, I’m somewhat honored to say, was performed right here at the University of Arizona, where I’m currently studying Law. Gary Schwartz was actually one of the co-authors. The way the methodology is presented, it could be interpreted generously and be a really good, positive study. I’m guessing they played somewhat fast and loose with the placebos, from what I know of Schartz’s other studies and just how much respect he has for tightly controlled methodology, but I can’t really say for sure.

    7 is presented as a good study. There’s nothing in the report that I can see that would indicate that it’s not. It claims to be randomized and double-blinded and the results state: “The homoeopathy group had a significant objective improvement in nasal airflow compared with the placebo group (mean difference 19.8 l/min, 95% confidence interval 10.4 to 29.1, P=0.0001)” which sounds like a good objective measure to me. I want to just say that they probably did something funky with the methodology, and I’m sure they did, but can I say that and really be honest? After all, I don’t know that for sure. I could say that its worthless until replicated, but then I’m just calling for more homeopathic research, and I don’t actually want that to occur because it’s a waste of time and money and possibly unethical. What do you do with something like this?

    8 just refers to the research section at http://www.nationalcenterforhomeopathy.org. There are a lot of articles there, but reading a few of them, most of them are not even the least bit controlled. If there are any studies that even pretend to be well-performed, they’re hidden amidst a bunch of muck.

    So nothing here comes close to meeting the extremely high standard of evidence that would be required to demonstrate something so ridiculously implausible as homeopathy, but I am curious how you respond when presented with articles like 6 and 7 that do not seem to be bad studies on their face. I feel really uncomfortable just saying, “Yeah, but you just know they screwed up with something” even though that’s what I think.

  6. HHCon 23 Dec 2009 at 2:47 pm

    Knew a patient who had hyperactivity, mental retardation, and expressed behavior was mainly violent. On Ritalin his aggression significantly decreased. I know this information because I monitored the drugs and the behavioral programming. But the hospital staff in western Iowa felt the ” true nature” of this young man was being suppressed. So off of Ritalin he went. They felt the risks of the drug were too great, and he should be able to express his true self. I guess he fit in with the distorted mentality of the alcholic, drug-addicted hospital staff. Of course, the staff represented members of hostile groups from the community.

  7. Eternally Learningon 23 Dec 2009 at 3:40 pm

    Here’s a funny line at the bottom of the article about the author:

    “Amy L. Lansky, PhD was a Silicon Valley computer scientist when her life was transformed by the miraculous homeopathic cure of her son’s autism”

    If everything that she is saying in this article is true, then why is it “miraculous” that her son was cured by homeopathy? She puts forth Homeopathy as not only effective, but explainable; complete with “Laws” and so on. If what they do is so scientific and replicatable, then why do homeopaths still have autistic or even just plain sick children?

  8. Joeon 23 Dec 2009 at 5:32 pm

    @ banyan on 23 Dec 2009 at 1:00 pm wrote “… 7 is presented as a good study. There’s nothing in the report that I can see that would indicate that it’s not.”

    Although it sounds familiar, I don’t recall reading that paper (and I didn’t look it up to refresh my memory). I have problems with reports that are “too good to be true” because homeopathetic remedies (and herbs, and “supplements”) can be spiked with true, active ingredients.

    If the clinician is ‘in on’ the fraud, it can be difficult to detect it because they can supply truly inactive preparations for chemical analysis. There are some examples here http://www.ncahf.org/pp/homeop.html of homeo preps that contain active ingredients (including arsenic, probably unintentional). There is an ongoing, unpublished project which is finding a significant number of homeopathic, OTC products that are spiked with actual OTC drugs; which are not innocuous if you shouldn’t be taking them.

    That is a potential problem with Randi’s demonstration- if you down a whole bottle of a “homeopathic” product you may overdose on a spiked drug.

  9. criticaliston 24 Dec 2009 at 12:35 am

    banyan,
    regarding refeernce 6 (Improved clinical status in fibromyalgia patients treated with individualized homeopathic remedies versus placebo, Rheumatology 2004), the problem is in the statistical analysis of the results.
    When you look at the Table of results on p581 (you may not have access to the full article), the strange thing is that they don’t look very convincing for the effects the authors claim.

    I cant reproduce the full Table here, but to give an idea:
    For the main outcome measure, a score rating of pain from 0-18, the results were
    Treatment 14.8 (3.9)
    Placebo 16.1 (2.7) n=26, mean(SD)
    The other positive results they claimed:

    71.3 (36.3) vs 82.8 (36)
    19.2 (5.7) vs 19.9 (5.3)

    They analysed 9 outcome measures of which 4 are claimed positive at a p value of <0.05.
    The statisticcal analysis they perform to get these positive values is bizarre. They descrive a "analysis of covariance using a one way ANOVA, covaried for baseline value of each dependant measure",

    My medical statistical knowledge is basic, but I know damn well when people are playing tricky with the maths. Anyone with familiarity with medical research papers can look at those numbers , and considering the size of the study and the standard deviations be certain there are no clincially significant differences.

  10. granton 24 Dec 2009 at 11:59 am

    How ironic that Lansky says that Ermst has “a complete ignorance of homeopathy.”

    Edzard Ernst trained as a homeopath and began his medical career at a homeopathic hospital in Munich.

  11. colluvialon 25 Dec 2009 at 12:19 am

    “Interestingly, allopaths sometimes utilize the Law of Similars, but are unaware of it when they do and are perplexed by the phenomenon. Ask any conventional doctor why Ritalin (a substance that would normally cause hyperactivity) can treat hyperactivity in children, and they’ll scratch their heads in confusion. Ask a homeopath, and it’s a no-brainer: the Law of Similars.”

    Does Lansky really think that Ritalin is administered in homeopathic doses? If Ritalin is not a homeopathic preparation, why does she think she has anything to say about it? Maybe she also thinks that arsenic, belladonna, fly agaric, and many of the other toxic homeopathic “remedies” could be administered in doses similar to Ritalin with therapeutic effects. What will she put her faith in – active doses or imaginary (homeopathic) doses?

  12. SimonWon 27 Dec 2009 at 6:53 pm

    Prof Ernst also worked in a homeopathic hospital. If anything I think the Prof was rather biased in favour of homeopathy, because it took him an unreasonably long time to reach the conclusions he now holds. Although those conclusions were reached via a very thorough review of homeopathy.

  13. eiskrystalon 29 Dec 2009 at 5:02 am

    I wouldn’t trust a “computer scientist” to medically treat me. Actually I wouldn’t trust a “computer scientist” to fix my computer either.

  14. Shamrockon 02 Jan 2010 at 1:16 pm

    Excellent article. I found the youtube posting interesting as well.

    Could you provide the reference for the WHO stance on homeopathy for those disease(s). A worthy point and I have not been able to find it on ISI.

  15. Hector Moraleson 03 Jan 2010 at 6:29 am

    The problem remains the same, however. You see, the conspirators, that is, everyone who doesn’t agree with them, are responsible for undermining every honest, sincere and scientific (a really blind and out of control) study which would have demonstrated the integrity of our products, I mean our research.
    This vast conspiratorial campaign, organized by wealthy, anonymous blue-bloods (primarily from the New England region) who are heavily invested in the stocks and bonds of multinational medical corporations, plot against us night and day. They are ruthless, greedy anti-Americans without concern for anyone or anything, except their wallets.
    That, my friends, is the problem!

  16. Hector Moraleson 04 Jan 2010 at 8:42 pm

    And the carnage continues.

    Without a doubt the deniers of ADHD have caused needless pain to those who have been afflicted, and often crippled, with this damn disorder. To be subjected to their unfounded, boisterous, clamoring criticism of the disorder and the pharmacological treatment for it, adds more insults to injuries for these folks.

    For many, that’s all they have known; their lives consist of invalidating comments and and actions from every direction. Teachers, principals, coaches, parents, bosses, peers, grandparents, siblings overwhelm the innocent victim of this hideous brain malfunction. Do you think a little fella comprehends the science behind his behavior that offends so many?
    He thinks,
    “I am no good.
    I am terrible.
    I am evil.
    There is nothing good about me.” And he has no concept that speaking loudly and disrupting the class is something he can control.
    In fact, his capacity to attend to his own behavior is so limited he’s not even aware of what he just said or did
    that got others so upset. He’s clueless.
    He’s alone.
    Completely alone.
    No one understands.
    He doesn’t understand.
    He is ashamed, deep-down.
    Day after day he learns not to trust himself
    on the deepest of levels.
    He learns to hate himself for letting others down.

    He is a curious, sweet boy who doesn’t want to or intend to do anything offensive.
    He wants to learn but he can’t and he has no idea why he can’t,
    but, he does learn that he is no good.
    That is the only thing that makes sense.
    No one sees he cares about others with a tender, good heart.
    No one understands how much he would love to learn, explore and express himself intelligently.
    No one knows he is in hell.

    Deniers!
    offer him
    your remedy,
    won’t you?

    I hear the ancient’s cry, “I don’t know how. But I know I was once blind and now I can see.” But the learned, prominent men said it was the work of devils.

  17. Hector Moraleson 07 Jan 2010 at 12:57 pm

    The most scientifically valid point that Baughman and his lobby prove is that “ALL” psychiatrists are criminals.
    Give us your list of these felons with names, addresses, relevant documentation and other pertinent information to turn over to authorities.
    Be specific, Fred. Name names.

  18. [...] may recall that Steve has been criticizing a certain homeopath named John Benneth for his incredible flights of–shall we say?–fancy used in defending homeopathy. As a [...]

  19. [...] Steve discussed here, and Orac had some fun with here. (Steve’s deconstruction of Benneth’s nonsense brought [...]

  20. RetroEncabulatoron 11 Apr 2010 at 4:42 pm

    Benneth’s video strongly reminded me of this classic, from Rockwell Automation, discussing their marvelous new Retro Encabulator technology.

    http://www.youtube.com/watch?v=RXJKdh1KZ0w

    The least Benneth could do is pronounce the damn buzzwords correctly. Mike Kraft (the star of the Retro Encabulator video) is far more convincing.

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