A recently published survey at PLOS One of UK primary care doctors reports that 97% have prescribed an “impure placebo” at least once in their career. Most news reporting of this survey leave off the “impure” bit.

Let’s take a closer look at what this means.

The survey asked about “pure” placebos, which are inactive sugar pills or a similar inactive treatment, and “impure” placebos, which are effective medicines given in a way that might not have a clinical effect. The survey found that only 12% have ever prescribed a pure placebo, and only 1% do it on a regular basis. However, 97% have prescribed impure placebo ever, and 77% on a regular basis.

The survey had a 48% response rate, which is not bad for a survey, but this is why surveys are not considered strictly scientific. The low response rate introduces the potential for systematic bias – perhaps people who choose to respond do so because of a  certain attitude or belief that biases their responses.

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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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NECSS – The Northeast Conference on Science and Skepticism, is just two weeks away, and we have an exciting update.

We have moved the SGU private recording to a new, better, and bigger venue and are expanding the seating by two to 27. Two people also canceled so we have four tickets to sell.

Two tickets will be raffled to all people who pre-register for the conference prior to midnight April 1st (this included everyone who has already registered). Two will be auctioned off on eBay here:

http://cgi.ebay.com/ws/eBayISAPI.dll?ViewItem&item=151016886498

http://cgi.ebay.com/ws/eBayISAPI.dll?ViewItem&item=151016885797

The four tickets also include VIP all access to NECSS – all workshops, all events, Friday night Stimulus Response show, and the speakers dinner. Plus you will get to have a private lunch with me and George Hrab after our workshop on Friday and George will give a private performance.

And, you get to have a private lunch with the SGU cast on Saturday prior to our live show.

Go to www.necss.org to register for the event. You can follow the links above to submit your bid on eBay. If you win one of the two raffles you will be reimbursed for anything paid so far for registration.

Check out the lineup for this year – NECSS is going to be a great science and skeptical conference. I hope to meet many of my readers there. Please come up to the SGU table while I’m there to say “hi.”

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

It is tempting to make arguments about how and why particular aspects of human psychology evolved. I will not be getting into an evolutionary psychology discussion in this post, I will just say I find such arguments offer a plausible framework for understanding human psychology, regardless of whether you think they can be scientifically tested.

A recent example is a paper by researchers at McMaster University. The title of their press release  reads: It’s in the cards: Human evolution influences gamblers’ decisions, study shows. 

The study actually says nothing about human evolution. It simply demonstrates an aspect of human behavior – the evolutionary explanation is pure speculation, not tested or demonstrated in the study itself.

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The human brain is perhaps the most complex machine that we have investigated, especially the higher cognitive functions. Psychologists have been working for decades to untangle the complex set of genetic, neurological, environmental, and situational factors that ultimately result in human behavior, with a great deal of success.

There are a few standouts – seminal experiments that not only demonstrate something interesting about human nature, but also create an entire paradigm of psychological studies that other researcher replicate with various modifications. One such such is the marshmallow test, first conducted by a team led by Walter Mischel then at Stanford University.

The first series of such studies Mischel published in 1972 took a group of preschoolers and offered them their choice of three rewards: a cookie, a pretzel, or a marshmallow. The researcher then told the children that they could eat their treat whenever they want, but if they hold off the researcher would return with an additional treat. The study was a test of self-control and the ability to delay gratification.

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I recently received the following question:

Why do we, and animals generally, have single or twin body parts, but not not triple or quadruple ones? Surely three eyes are better than one. (Four legged animals tend to have two front legs the same and two back legs the same) . And why is one side of the body a mirror image of the other anyway?. Why dont we just have two lungs or two eyes that look exactly the same?

This is an interesting question. First, however, I have to address the premise that animals in general display bilateral symmetry. This is mostly true for vertebrates, but not for many invertebrates. Sea stars, for example show radial symmetry, and have 5 or more radially symmetrical arms. Spiders have 8 legs and more than two eyes.

Most animals (the vast majority) do have some form of symmetry. Sponges are a notable exception.

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As Carl Sagan observed, “randomness is clumpy,” which means that sometimes, for no specific reason, I write two or more blog posts in a row about the same topic. Perhaps it’s not entirely random, meaning that when a topic is being discussed related news items are more likely to come to my attention.

In any case, there was recently published yet another meta-analysis of acupuncture, this time specifically for low back pain. The findings and interpretation add to the pile of evidence for two important conclusions:

1 – Acupuncture does not work.

2- Acupuncturists refuse to admit that acupuncture does not work.

I would further infer from these two unavoidable conclusions the dire need for a greater understanding of the core principles of science-based medicine.

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Sometimes the targets of our skeptical analysis notice, and they usually are not pleased with the attention.

Last year the Acupuncture Trialists Collaboration published a meta-analysis of acupuncture trials in which they claim, “The results favoured acupuncture.” The report was widely criticized among those of use who pay attention to such things. In my analysis I focused on the conclusions that the authors drew, rather than their methods, while others also had concerns about the methods used.

The authors did not appreciate the criticism and went as far as to publish a response, in which they grossly mischaracterize their critics and manage to completely avoid the substance of our criticism.

To review, the original meta-analysis concluded:

Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture.

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