Nov 04 2008

Homeopathy Still Sucks

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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 Рthey 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 Рstill 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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