Yesterday I discussed a recent debate in which I participated at UCONN, focusing on the plausibility of homeopathy. Today I will discuss the clinical evidence, and address some of the strategies employed by my opponent in the debate, Andre Saine.

Does Homeopathy Work?

Yesterday I made the case that homeopathy is highly implausible in many ways, and after two hundred years of scientific advance this extreme implausibility has only become greater. Two centuries has apparently not been enough time for homeopaths to make their case and convince the mainstream scientific community. The only reasonable explanation for this is that homeopathy is simply not valid.

I also took the position that overall scientific plausibility must be considered when looking at any new claim – how well does it comport with existing scientific evidence? In medicine this means, when considering clinical evidence for a treatment, that evidence needs to be put into the context of the scientific plausibility of the treatment.

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Six years ago I was asked to participate in a group debate over the legitimacy of homeopathy at the University of CT (there were six speakers, three on each side). This year I was asked to participate in another homeopathy debate at UCONN, but this time one-on-one with Andre Saine ND from the Canadian Academy of Homeopathy taking the pro-homeopathy side. (I will provide a link when the video is posted online.)

While the basic facts of homeopathy have not changed in the past six years, the details and some of the specific arguments of the homeopaths have evolved, so it was good to get updated on what they are saying today. In this post I will discuss some overall patterns in the logic used to defend homeopathy and then discuss the debate over plausibility. In tomorrow’s post I will then discuss the clinical evidence, with some final overall analysis.

Believers and Skeptics

As with the last debate, the audience this time was packed with homeopaths and homeopathy proponents. When I was introduced as the president of the New England Skeptical Society, in fact, laughter erupted from the audience. But that’s alright – I like a challenge. It did not surprise me that the audience, and my opponent, were unfamiliar with basic skeptical principles. Andre, in fact, used the word “skeptic” as a pejorative throughout his presentation.

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I have had to take a two day break from blogging to prepare for a number of presentations I have scheduled. Today I will be engaging in a debate about homeopathy at the University of Connecticut. I did this once before, in 2007. I will give you a full report after the event.

Seating is limited and requires preregistration. But if you are in the area and want to see if there are any spaces left you can e-mail peter_gold (at) goldorluk.com.

March 22, 2013, 1:00 – 3:30 pm
Lowe Learning Center – University of Connecticut Health Center, Farmington, Connecticut

OK – I’m having one of those “someone is wrong on the internet” moments. But this someone is a fellow physician (Des Spence, a general practitioner from Glasgow)  and the swirling black hole of wrongness is not just on the internet, but published in a generally respected medical journal, the BMJ. Spense is writing in defense of homeopathy, but he is not a homeopath and acknowledges that homeopathy is “bad science,” and the pills are little more than placebos.  What he does do is marshal every “shruggie” bad argument, misinformation, and logical fallacy into a “Gish gallop” of apologist nonsense.

In his introduction he acknowledges that homeopathy doesn’t work, but then states:

Today, homeopathy is medicine’s whipping boy, repeatedly and systematically beaten to the ground. Yet despite explaining that the tablets are just placebos, homeopathy always gets up to take another beating. Some homeopathy is funded by the NHS, through general practice, and in the few homeopathic hospitals. This fact enrages the growling commissars of evidenced based medicine who want homeopathy purged from the NHS.

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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.

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Those of us in the science-based medicine community have been watching Dr. Mehmet Oz’s descent into abject quackery. It’s like watching a train wreck in slow motion – horrific, but gripping.  The purpose of this post is not to tell you that Dr. Oz’s journey toward the dark side is now complete, because that has already happened. Dr. Oz is a product of Oprah Winfrey, and Oprah exists in a skepticism-free zone, as do all of the moons in her orbit.

At first Oz gave mostly reasonable medical advice, but liberally sprinkled in the woo. But now that he has his own show, Dr. Oz is a neverending stream of nonsensical pseudoscience. A recent example deserves mention – Oz attempts to explain to his audience what homeopathy is. Like all such attempts from proponents, the results are simultaneously humorous and exasperating. For this program Oz is helped by Dr. Russ Greenfield, an “integrative” medicine practitioner, and fellow of Dr. Andrew Weil’s program at the University of Arizona.

Oz and Greenfield explain that homeopathy uses “tiny” doses of “drugs” to treat symptoms, like chronic pain (the topic of the day). This is deceptive on two levels – in most cases the doses are not tiny but non-existent. And further, most of the substances used to prepare homeopathic water are not drugs, but a range of ordinary, toxic, or fanciful substances.

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Recently the 1023 campaign conducted another homeopathic overdose. In coordination with this, James Randi issued a $1 million  challenge to the homeopathic community to demonstrate that there is any difference between homeopathic water and regular water (there isn’t). Last week skeptics around the world downed fistsfull of homeopathic pills (i.e. sugar pills) to demonstrate that there is no effect or side effect to the products. You can take a couple of boxes of homeopathic sleeping pills without feeling the least bit drowsy.

To be clear – the homeopathic overdose is a stunt, and nothing more. It is not an experiment or meant to be scientific in any way. It is a stunt for the camera – to raise public awareness of the fact that there are generally no active ingredients in homeopathic products. They are sugar pills that have been kissed with magic water – nothing else. This is an important campaign because generally the public lacks awareness of what homeopathic products really are. Most people I encounter have no idea what the claims of homeopathy are, and assume that homeopathic means “natural” or “herbal.”

It is true that by doing this skeptics are demonstrating that homeopathic products lack toxicity and side effects – a feature prominently promoted by homeopaths. Of course, they have no side effects because they have no effects. It is easy for nothing to cause no direct harm. (Indirect harm is another matter.) So homeopaths should be happy – we are simply educating the public about their favorite snake-oil and demonstrating how wonderfully safe they are.

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Dana Ullman, a notorious homeopathy apologist, actually has a regular blog over at HuffPo. For those of use who follow such things, the start of his blog there marked the point of no return for the Huffington Post – clearly the editors had decided to go the path of Saruman and “abandon reason for madness.” They gave up any pretense of caring about scientific integrity and became a rag of pseudoscience.

Ullman’s recent blog post is typical of his style – it is the braggadocio of homeopathy. I am sure others will skeptically dissect his piece so I won’t go into every point here. I want to focus on Ullman’s claim that the clinical and basic science research supports homeopathy. Here is the paragraph on which I want to focus:

Most clinical research conducted on homeopathic medicines that has been published in peer-review journals have shown positive clinical results,(3, 4) especially in the treatment of respiratory allergies (5, 6), influenza, (7) fibromyalgia, (8, 9) rheumatoid arthritis, (10) childhood diarrhea, (11) post-surgical abdominal surgery recovery, (12) attention deficit disorder, (13) and reduction in the side effects of conventional cancer treatments. (14) In addition to clinical trials, several hundred basic science studies have confirmed the biological activity of homeopathic medicines. One type of basic science trials, called in vitro studies, found 67 experiments (1/3 of them replications) and nearly 3/4 of all replications were positive. (15, 16)

Those numbers are references that allegedly support his claims – 14 papers (they are not all studies, some are reviews) that allegedly make the case that homeopathy works. Most reader do not independently check references to see if they say what the author claims. Some may foolishly assume that the editors at the HuffPo have done that already.

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Yes, I know I have been writing about homeopathy a lot recently. I am consciously making this one of my main topics of interest for 2011. Homeopathy is one phenomenon where the disconnect between public and official acceptance and the level of pseudoscience is greatest. It is also an area where acceptance is often based upon simply not understanding what homeopathy really is. If scientists keep beating the drum about how unscientific homeopathy is, perhaps we can have some effect on public belief and policy. Perhaps this is just wishful thinking, but then so is all activism.

Today I have some good news to report. The Canadian program, Marketplace, did an excellent piece on homeopathy. (You view it on YouTube in two parts: part I and part II.) Usually such mainstream media attention to homeopathy and similar topics falls into the trap of false balance – telling both sides and letting the audience decide. This is a reasonable journalistic default for political and social topics, but not for science. In science there is a level of objectivity and the logic and evidence is not always balanced on two sides of an issue. We don’t need to “balance” the opinions of an astronomer with the illogical ravings of an astrologer.

Fortunately, the Marketplace program did not default to the false balance mode.  Rather they took the far more appropriate consumer protection angle – which is the format of this particular show. I was especially happy about this because I have been saying for years that consumer protection advocates need to realize that fake medicine (so-called complementary and alternative medicine or CAM) is a huge consumer protection issue. Regulations meant to protect consumers from fraud and harm are being systematically weakened in the favor of product manufacturers and distributors and practitioners. It is a scandal worse than anything Ralph Nader has taken on in the past, and yet he seems to be nowhere on this topic.

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For those “shruggies” who still cling to the naive notion that there is no harm in worthless medicine, we have an update on promotion of homeopathic products for the prevention of malaria in sub saharan Africa. The General Pharmaceutical Council (GPhC) of the UK decided to drop their investigation of complaints against pharmacies that were recommending worthless treatments instead of proven and effective drugs for malaria prophylaxis.

Homeopathy is a prescientific philosophy-based system of treatment whose central ideas have been long discredited. Preparations are diluted to the point that there is essentially no active ingredients left behind, and so they are literally nothing but sugar pills or placebos. What’s more, there has been extensive clinical studies of homeopathy, most of it useless, but the well-controlled trials show that homeopathy does not work – for anything.

I did a literature search for homeopathic studies with malaria, and found one animal study published in the journal Homeopathy. The methods are pretty sparse, but there is no indication of blinding, and in any case the study is in mice, not people. Despite the highly preliminary nature of this one study, the authors conclude:

Although the mechanism of action is unknown, these agents would be good candidates as alternative or complementary medications in the treatment of malaria.

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