Dec 12 2007

Homeopathy Apologetics from Dana Ullman

In this stunningly absurd article Dana Ullman summarizes his new book: The Homeopathic Revolution. He begins with a bit of revisionist history by which he accuses the medical profession of revisionist history-making. He writes:

Historians commonly remark that whichever country wins a war or whichever worldview dominates another, the history is told through that country’s perspective or that dominant point of view. This is certainly true in the history of medicine.

The notion that what is accepted in modern medicine as scientific is the result of spoils having gone to the victors is positively post-modern. Ullman argues that mainstream medicine won a culture war against homeopathy and now uses its dominance to suppress homeopathy. The argument defies the history of science itself.

It is certainly true that cultural contingency has played a role in the history of science, but never-the-less that history is dominated by the survival of ideas that are scientifically valid over those that are not. We accept relativity today and not the ether not because Einstein won some political popularity contest over his predecessors, but because the theory of the ether failed to account for experimental data, and the theory of relativity (both special and general) made predictions that so far have turned out to be true.

I will acknowledge that over the very short term power and resources are an advantage. The old guard may impede the overturning of one idea and the acceptance of a competing idea. But this has never been true in the long term – a new generation of scientists always comes up to overthrow the old guard and bring in new ideas. Also, over the last few centuries of science, scientific progress has accelerated to the point that ideas no longer have much of an opportunity to calcify into place. The “long term” advantage of being a better scientific theory is becoming shorter and shorter term all the time.

Homeopaths like Ullman, however, having lost the scientific war of ideas over the last 200 years are trying to rewrite history to claim that their defeat was not a scientific one but one of culture and power. Nonsense.

Homeopathy – the child of Samuel Hahnemann, was based upon many ideas that were never vindicated by science. Hahnemann believed that substances became more potent when diluted, that they could be diluted without limit and without losing their chemical activity, that the body would not permit two substances that cause the same symptoms to exist at the same time thereby allowing for “like to cure like”, and that superficial personality characteristics determined biological function. All of these notions were contradicted by the later developments in chemistry, biology, physiology, and medicine. Science has moved past Hahnemann just as much as it has moved past the ether, animal magnetism and N-rays.

In fact, ironically given Ullman’s ludicrous claims, it is only cultural inertia that allows homeopathy to survive at all. If homeopathy had to fend for itself in the free market of ideas and meritocracy of science, it would be gone tomorrow.

Next Ullman tries to ridicule the mainstream criticisms of homeopathy, but only manages to either attack straw men or completely misrepresent homeopathy in order to defend it. For example:

The fact that homeopaths interview a patient to discover his or her unique symptoms has been spun to make homeopathy seem like a quirky system that revels in inane facts about a patient. However, the detailed symptoms and characteristics of the patient that homeopaths collect may seem inane only to people who are not familiar with the unique and critical nature of these individualizing features of each person. Homeopathy provides a sophisticated method by which a patient’s characteristics are applied to selecting and prescribing the most effective homeopathic medicine.

There is no spin here -homeopathy does “revel in inane facts about a patient.” I wonder why Ullman does not mention or defend any specific “inane fact” – I suspect that is because in so doing he would reveal his position to be nonsensical and to justify homeopathy’s critics.

For example a homeopathic history may include the question: “How does music affect you? What type of music do you listen to?” or “How do you stand and react to contradiction?” Homeopaths would have us believe (under the highly marketable banner of “holism”) that such inane facts are necessary in order to know which homeopathic remedy is best to treat your headaches. What is the basic science behind such claims? Zippo. Doesn’t this contradict the notion of like cure like? Yes, but this is homeopathy – don’t ask too many nasty “reductionist” questions.

Ullman’s follows with a rant against mainstream medicine – which is nothing more than a logical fallacy (tu quoque, or you too) intended to be a distraction from the real issues: that the evidence strongly shows that homeopathy does not work and that there is no scientific justification for any of the claims of homeopathy.

Utterly predictably, Ullman goes after Big Pharma, writing:

There is big big money to be made in drug sales, and brilliant marketing has led too many of us to ignore or excuse this bully side of medicine.

Right – the pharmaceutical industry is a business. Ullman also quotes extensively of Marcia Angell, who is also critical of the pharmaceutical industry. However, he takes Angell out of context – she is largely criticizing the industry from a liberal political perspective, arguing that it should be nationalized. This is a political fight about how best to organize healthcare – not about science. And of course, Angell is highly criticized from the libertarian right (such as by Elizabeth Whelan), who very nicely defends the pharmaceutical industry without being an apologist for it. Ullman doesn’t quote Whelan, however.

In short, Ullman is exploiting a political fight about the industry and misrepresenting that to argue that drugs don’t work. He writes;

Sadly and strangely, physicians do not see that there is something fundamentally wrong with the present medical model. Instead, once an old drug is found to be ineffective or dangerous, doctors and drug companies simply assert the “scientifically proven” efficacy of a new drug.

Ullman is arguing (like so many pseudoscientists do) that the fact that homeopathy is using the same treatments as it did 200 years ago is a virtue, and that drugs do not work because old drugs are always being found to be ineffective or dangerous. This is a complete distortion, however.

It is patently not true that older drugs are found to be ineffective as a rule. I prescribe many drugs that are decades old and still work quite well – non-steroidal anti-inflammatories, penicillins, tricyclic anti-depressants, ergotamines, the classic anti-seizure drugs, etc. The list of drugs that have been around for decades and are still considered efficacious is long.

Ullman, however, is misinterpreting the fact that newer drugs are often improvements on older drugs – they are more effective and/or have fewer side effects. This does not mean the older drugs don’t work or are toxic – it just means the newer drugs are better. Ullman’s statements are so willfully absurd that any reasonable practicing physician could not take them seriously.

Because Ullman cannot plausibly argue that homeopathy is scientific (although this never stops a homeopath) he must try to drag down modern medicine and claim that it too is not scientific. He writes:

Modern medicine uses the double-blind and placebo-controlled trial as the gold standard by which effectiveness of a treatment is determined. On the surface, this scientific method is very reasonable. However, serious problems in these studies are widely acknowledged by academics but remain unknown to the general public. Fundamental questions about the meaning of the word “efficacy” are rarely, if ever, raised.

It’s not just reasonable on the surface, it pretty good in practice also. Of course there are many limitations to clinical trials in practice – they are only as good as the methods used, results are often difficult to interpret or contradictory, and many studies have significant design flaws. This is why we interpret the literature, not a single study, and often a medical question has to evolve in the literature until truly reliable studies are done.

He says that questions of efficacy are rarely considered. As someone who has sat in a room with researchers all discussing how to design upcoming trials, this statement strikes me as childishly naive. In my experience clinical researches agonize over the question of how to measure efficacy. For example, in one of my areas of clinical research, ALS, the research community has looked at dozens of outcome measures trying to figure out how best to measure efficacy. In fact, each trial is not just a test of the specific treatment but a test of how to best do clinical trials for ALS. It is a central question that is endlessly debated and tweaked. “Rarely, if ever, raised.” What world is Ullman living in?

In the end Ullman’s article, like all of his writing about homeopathy and modern medicine, is just silly. He attacks a cartoon charicature of modern medicine, crafted for ideological purposes. His statements about the history, science, and practice of medicine are so at odds with reality that anyone directly familiar with scientific medicine is justified in ignoring and dismissing his ramblings for what they are – an ideological distraction from scientific reality.

The article is also an excellent example demonstrating that homeopaths have no interest in genuinely engaging with mainstream medicine. You cannot engage in honest discussion with someone who’s views you so thoroughly distort and misrepresent. What homeopaths apparently want, as Ullman demonstrates, is a change of venue. They want to reframe the conflict between scientific medicine and homeopathy so that it is not about science (since they have already lost the scientific war) but about culture, politics, and ideology. That’s the fight they want, because in that venue lies and distortions are an advantage, and homeopaths are much better at that than scientists who are dedicated to honesty and transparency.

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Orac’s take on Ullman’s article

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