Scientific ‘evidence’ socks … er, sucks?
While musing on the nature of evidence, and what is or is not considered ‘evidence’ in all the various contexts evidence is used, I came across this excellent rapid response in the BMJ back in 2004 by Clifford Miller, “a practising English lawyer, graduate in physics and a sometime examining lecturer on law, standards and ethics (particularly, the law of evidence) to Masters student technologists at the Imperial College of Science Technology and Medicine”.
He writes, in the context of the imputed association between MMR vaccination and the onset of autistic states, on “The Unreliability of Scientific Papers as Evidence”:
“Reliable evidence is that which is authentic, accurate and complete. In short, scientific evidence is incomplete if used for purposes outside the strict confines of science because it fails to take account of evidence of lay witnesses of the facts and is hence only applicable to the narrow and specific confines of scientific enquiry and not the broader ones found in other fields of human endeavour.
“Examples in point include the parental evidence of symptoms in the MMR cases or that of Gulf War veterans about their symptoms. A court (or the Legal Services Commission in the case of MMR) in contrast, ought to take that oral evidence into account for the very reasons science dismisses it. The point, unfortunately is not as well taken by our legal system as it might be. We have seen this recently with the Legal Services Commission in the MMR cases and in the cases of Gulf War veterans.
“Science treats evidence of lay witnesses of fact as inadmissible (as ‘anecdotal’ only) for reasons which are inapplicable in Court, but science does so for two main reasons. The higher scientific standard of proof (in effect, irrefutability) only admits evidence which can be tested scientifically for reliability. Oral witness evidence is discounted by medical science because medical scientific method does not currently have or recognise a mechanism for testing oral evidence to the scientific standard and so, for the sake of rigour, excludes it.
“Neither of these propositions apply in Court. Evidence of the direct witness of the fact, whether oral, or more frequently now, by way of written statement, is always admissible and is, in fact, the keystone of the trial system of evidence and the primary source of information a court uses to make decisions of fact. The Court has and applies its own mechanisms for testing witness evidence (eg. cross-examination). Further, the Court applies a far lower standard of proof, namely a balance of probability and not the unnecessarily high one of irrefutability applied by science.
[...]
“Governments also take advantage of the confusion and often use the term ‘evidence’ interchangeably with ‘proof’ when dismissing evidence they choose not to agree with or set unreasonably high standards of proof for the kind of decision required. The press and public alike are continually hoodwinked by this approach.
“In law ‘evidence’ is nothing more than information. It is information which one party proposes in support of, or to undermine, a disputed proposition. ‘Proof’, however, depends upon the decision-making process concerned. For the public interest, the standard of proof is sometimes based on risk and sometimes on other factors. In civil courts it is ‘balance of probability’. In criminal it is ‘beyond reasonable doubt’. And science requires irrefutable proof: a remarkably high standard.
“It is a fundamental error to apply the wrong standard of proof to the decision making process concerned and yet it seems to happen regularly.
“For issues of public safety, such as medicines like MMR or vaccines in the Gulf War, or the BSE crisis, the risk standard ought to be applied.
“However, instead, we, the public, are told frequently by officials in government there is no scientific evidence of a causal link between one thing and another. Whereas, often evidence to the contrary does in fact exist, it is not evidence that the officialdom concerned may either choose to or sometimes be at liberty to accept as proof of the issue. This is much the same for the BSE crisis with the government as it was for the Courts in relation to Gulf War syndrome or the Legal Services Commission for MMR. Whereas in the case of courts, the court has to rely on the expert evidence presented, in the case of public health officials like the Chief Medical Officer, he is in a position to assess the reliability himself, with the aid of his own experts if necessary. However, in the latter case, the risk standard of proof ought to be applied to decision making in the public interest rather than the scientific standard, which is only applicable to proof in science.
“In the scientific context, the only answer to a scientific issue that scientific journals should involve themselves in is a scientific one and they should only trouble themselves with the scientific standard of proof. If MMR did not cause autism, or vaccines in the Gulf War did not cause other problems, then it is for scientific journals to publish irrefutable scientific proof of what ails the 1000 or so children and the numerous afflicted Gulf War veterans.
“The current political debates about these kinds of issues are ones science could answer, if only the scientists got on with it and stopped playing politics.
“It is, for example, no answer to Wakefield to claim there is no scientific evidence of a link between MMR and autism. That just shows science has not found one that it can accept as proven to its very high standard of proof. It does not prove there are none, nor that there is no proof to other more realistic and practical standards for day-to-day decision making. It also leaves the public confused and distrustful of science.
“Buried in the MMR debate and little known to the general public is formal confirmation of a link between immunisation and the so-called allergy epidemics in the developed world. According to the US National Academies’ Institute of Medicine (IoM) Immunization Safety Review Committee (1), for at least two years it has been known that current vaccination programmes can expose children to risk of various problems ranging from allergy to infection. The IoM have also confirmed (2) that reasonable theories exist to explain how too many immunizations can overwhelm an infant’s immune system.
“A clear indication of the possibility of the existence of a causal connection between vaccination and the emergence of the various allergy and other issues over the last 20 years is the contemporaneous substantial increase in vaccinations as reported by the IoM (3). This shows an increase from 4 vaccinations per child in 1980 to up to 20 now.
“Whilst the IoM considered (4), as regards asthma in particular, and allergies in general, it had inadequate evidence to accept or reject a causal relationship, it accepted there is cause to consider that there might be a connection. Effectively, all the IoM statement amounts to is an admission by the most authoritative governmental authority in the US that they will not accept any evidence unless it provides the answer to a scientific standard of proof, and until someone produces that proof, they will not apply a risk standard, such that it is immunization as usual for children.
“The IoM’s conclusion is also not a reliable one for government to apply to the risk standard of proof because the IoM rely upon the scientific standard of proof and that is the wrong standard to apply for a decision based on risk. Irrefutability is too high a hurdle. Similarly, parents taking practical day-to-day decisions risk their child’s health if they wait for scientific proof, because proof to such a standard also takes too long to be produced.
Quite. Yet note that the MMR vaccination was foisted upon the population at large on the basis of those same scientific standards of evidence. So scientific standards of evidence conclude the vaccine has “proven” efficacy and “safety”, despite the fact that trials of the vaccine are limited and have no long-term follow-up. Scientific standards of evidence also conclude that there’s no adequate association between MMR vaccination and autism, despite the fact that documentary evidence acceptable as prime evidence in a court of law presents compelling evidence to the contrary.
What’s wrong with this picture? The aim of science is to arrive at an explanation and understanding of observed phenomena and their causal mechanisms that is, above all, utterly faithful to those observed phenomena. Not politics, not commercial expediency, not pre-existing theories or biases. The observed phenomena. Full stop, end of story. Consequently any hypothesis that meets those conditions should be acceptable to anyone observing the phenomena under consideration because the degree of fit will be such as to render any alternative explanation superfluous and irrelevant.
But when there is such substantial variance between the observed phenomena according to day-to-day standards of evidence and the preferred ’scientific’ hypothesis, then something has to have gone badly wrong, and the scientific process has become subverted by something other than the aim to explain the observed phenomena. If the two are not congruent, then the scientific proces has failed.
Tags: autism, evidence, evidence-based medicine, Homeopathy, MMR, science, scientific, vaccination
December 18, 2007 at 1:29 pm
“But when there is such substantial variance between the observed phenomena according to day-to-day standards of evidence and the preferred ’scientific’ hypothesis, then something has to have gone badly wrong”
Well, no. It just proves how open to bias and subjective appraisal anecdotal evidence actually is. In the case of MMR, rates of autism are the same in vaccinated and non-vaccinated populations; the theory that MMR causes autism is therefore false.
Anecdotal evidence can be used to form the basis of a testable hypothesis, but it is only with rigorous testing that this hypothesis can be proved true or false.
December 18, 2007 at 5:00 pm
Socks - I hope you or Clifford Miller are never falsely accused of a terrible crime. Let’s imagine there was excellent forensic evidence that you were not giulty but several people were testifying to your guilt - maybe maliciously, maybe by mistake. I bet you would be crying like a baby in your remand centre, hoping that the judge does not take your advice on discarding scientific data because it is not ‘utterly faithful’ to the testimony of witnesses.
And, is that the Clifford Miller who is a solicitor for the nuclear and oil industries and who also happens to be a prominent antivax advocate with his own full page on whate.to? And do you think he knows what ’strawman’ means?
December 18, 2007 at 5:46 pm
Andy- You are talking about medicine as if it is a single scientific experiment by reducing the treatment of sick people to very narrow arguments and very weird analogies like your crime one.
But I see that also behind this is the threat and implication of crime which seems to fit into your threats about danger and doom concerning non-MD homeopaths treating sick people. This also then extends to the argument that homeopaths are killing the 50 million people in Africa suffering from AIDS who are not being given conventional medicine by the grace of pharmaceutical companies and governments. Somehow homeopaths are preventing this.
But back to the UK- consumer intelligence, preferences and experiences mean piss all to you.
From narrow arguments and assumptions you seem to have built up quite a bit of personal hysteria that you want to spread as far and wide as possible.
December 18, 2007 at 5:49 pm
Oh really? A new survey indicates a strong correlation between rates of neurological disorders, such as ADHD and autism, and childhood vaccinations. While this doesn’t point the finger specifically at MMR, it’s necessarily one of the vaccines implicated.
The survey, commissioned by Generation Rescue and modeled on the CDC’s own methodology for conducting similar surveys, compared vaccinated and unvaccinated children in nine counties in Oregon and California. Among more than 9,000 boys age 4-17, the survey found vaccinated boys were two and a half times (155%) more likely to have neurological disorders compared to their unvaccinated peers. Vaccinated boys were 224% more likely to have Attention Deficit Hyperactivity Disorder (ADHD), and 61% more likely to have autism.
For older vaccinated boys in the 11-17 age bracket, the results were even more pronounced. Vaccinated boys were 158% more likely to have a neurological disorder, 317% more likely to have ADHD, and 112% more likely to have autism.
(More on this and other studies done on the link between MMR and autism in my preceding post.)
Yes, this is true, BUT — and it’s a huge BUT that’s really the crux of this whole argument — you have to be extremely careful to make sure that the assumptions that underly your testing are not themselves predicated on bias and subjective appraisal, otherwise all you succeed in doing is filtering for mechanisms of action that conform to your bias and your subjective assessment of the fundamental nature of what you’re testing. I submit that this is the case here.
The fact that there is such implacable opposition between the conclusions drawn from hard and soft evidence for both these cases — MMR/autism and homeopathy — is a major red flag. If the hard evidence were as “true” as it sets itself up to be, then the soft evidence should also be demonstrably in agreement. The truth is the truth after all, surely? If it’s true we shouldn’t have any difficulty agreeing about it. But we are, because there are huge numbers of people convinced beyond all reasonable doubt (through a perfectly admissible form of evidence in law and any other circumstance in daily life) that the observations they’ve made are valid. If there were just one or two isolated cases, then it would be reasonable enough to assume unrelated coincidence, but the anecdotal evidence in both situations is substantial, consistent, convincing, and continually accruing.
In any circumstance where this is the case, then the reasonable step to take at this point would be to re-evaluate the assumptions that underly the scientific assessment, since any credible scientific hypothesis MUST fit the observed data. The null hypothesis in both instances is not credible to those who have given anecdotal evidence. It doesn’t fit the data.
As far as I can see, any hypothesis that has to rely on dismissing or denying a large body of evidence and ridiculing and vilifying those who bring that evidence to light is on very very shaky ground. Those are the principal tactics of the sceptic position. Where’s the actual science here? Most of what I’ve seen quoted is as flawed as you perceive the evidence in support of homeopathy to be, which equates to an equivocal status, not an incontrovertibly conclusive one. Meanwhile EBM is moving towards the definition and acceptance of an “evidence mosaic” comprising a number of different types of evidence all of which are required to be in agreement.
December 18, 2007 at 6:49 pm
Andy I’m not advocating discarding scientific data, I’m only saying it needs to be reassessed and thoroughly questioned in the context of its foundational assumptions. And your analogy is a bad fit for homeopathy’s case because the body of anecdotal evidence we’re talking about is considerably more substantial and robust than the word of a couple of witnesses, while the “forensic” evidence is wholly inconclusive.
What I principally object to here is:
a) the trumpeting of equivocal, inconclusive scientific evidence as “conclusive proof” (it’s nothing of the kind),
b) the denial of all anecdotal evidence and uncontrolled clinical data and its dismissal as “not one jot of evidence”,
c) the persistent self-righteous claims to represent ’science’ when the science in question is flawed and open to serious challenge on valid scientific grounds, and
d) the continual knee-jerk vilification of anyone who speaks out in homeopathy’s favour.
This isn’t good science. This looks to me far more like a dogmatic insistence on clinging to the map rather than the territory. The thinking demonstrated is frequently black-and-white and I’ve yet to see much evidence of any appreciation of the subtleties of interpreting trial data and its essentially equivocal nature. It reminds me very much of the situation at the coal face now where machines and tests have assumed diagnostic responsibility and are relied on to the exclusion, frequently, of common sense. The same thing seems to be happening with trial data. Sophisticated statistical analyses mask the variability of the raw data and the biases applied in its interpretation and seem to give this aura of exactitude and incontrovertibility which is not borne out in the detail.
December 18, 2007 at 6:49 pm
yeshomeopathy! Hysteria? Narrow Arguments? Assumptions? Getting back to the post in question - the argument is made that personal testimony in MMR like court cases should be superior to scientific assessment. I simply make an analogy that the author would not be claiming this if his neck was on the line. The argument from Clifford is a nonsense. He makes claims for scientific evidence that are not true and he confuses proof (in the mathematical sense) with scientific notions of proof which are contingent and provisional.
The whole thrust of this argument is just plain wrong. Evidence rarely lines up like ducks in a row. Contradictory evidence is the staple of both legal and scientific investigations. The trick is not to attempt to shoehorn all the evidence into some sort of false agreement, but to weigh evidence and take into accounts its reliability and strength. To argue that simple testimony from fallible human beings is vastly superior to carefully collected, analysed and openly published scientific data from multiple independent sources appears to be an inversion of reality. And all Clifford can do is use daft straw man arguments to justify it.
We see on the web many personal testimonies from parents about how their child’s autism was caused. Some blame WiFi, diet, jabs (different sorts), mobile phones, heavy metals, genetics. We know they cannot all be right and yet each testimony is heartfelt and sincere. Most probably have made a sort of post hoc error of some sort. Their autism was diagnosed following some unusual event and that has latched in their minds as the reason. How do we find out true causes? Careful science. Do you really have a better way?
December 18, 2007 at 7:09 pm
laughingmysocksoff - a body of anecdotal evidence does not increase in strength according to the number of people making the claim. That is the meaning of the phrase “the plural of anecdote is not data”. It is possible for all anecdotes to be based on the same underlying false assumptions and so all to be wrong. It is quite possible for millions of people all to be wrong about the same things - you must agree with that - the financial strength of Northern Rock, the presence or weapons of mass destruction in Iraq, alien abductions, various religious beliefs - take your pick.
In short, it is only you who appears to shoehorning science into expecting certainty. You will find sceptics arguments much more subtle than that if only you stopped your bluster and settled down and listened, and then maybe answered some simple questions.
My first question would be: do you think my criticisms of homeopathy are sincere?
December 18, 2007 at 8:14 pm
If large amounts of anecdotal evidence constitute proof then what does that say about all the people who believe in ghosts, who put their faith in psychics or who claim to have met alien creatures? Are all these things, for which there is not one jot of actual evidence, also true simply because millions of people think so?
December 18, 2007 at 10:02 pm
M Simpsom: The woo factor argument- you had to get that in.
And there were many scientific studies and actual evidence that Vioxx was harmless or at the very least minimally harmful. Does that make it true?
Historically and currently, is there actual evidence that many pharmaceutical drugs and medical procedures are dangerous, not just minimally risky, but downright dangerous? Yes! Based on this track record is actual evidence or trials really all that effective in determining risk?
As much as you think discussing the deficiencies of conventional medicine is skirting the issue when someone is defending homeopathy, this has to factor into any argument or discussion of a viable medical treatment whether mainstream or alternative.
For what I see is your main concern is that homeopathy is dangerous.
Is there actual evidence that homeopathy is dangerous? No, just your opinion. I can feel your worry and sympathize. I’m hoping that you think woo thinking is simply stupid but not dangerous, otherwise we would have a thought-policing mentality here.
If you give an opinion that homeopathy is “dangerous” not based on actual evidence then you can’t have it both ways: i.e. give an opinion about its harm and even state it is dangerous based on that opinion and then ask homeopaths for actual evidence.
December 18, 2007 at 10:37 pm
Okay, let me put it another way. What is the difference (if any) between the vast amount of anecdotal evidence for the existence of alien visitors (and ghosts and psychics) and the vast amount of anecdotal evidence for homeopathy?
Let’s see if you can answer the question rather than answering several other questions that we haven’t asked.
December 18, 2007 at 10:39 pm
Well, are you saying that it is dangerous or harmful to believe in ghosts, psychics or dare I say it God?
December 18, 2007 at 10:48 pm
yeshomeopathy! Says:
“Well, are you saying that it is dangerous or harmful to believe in ghosts, psychics or dare I say it God?”
I you base your medical treatment on either ghosts, psychics or religion then yes that would be dangerous
December 18, 2007 at 10:54 pm
No, I’m saying “What is the difference (if any) between the vast amount of anecdotal evidence for the existence of alien visitors (and ghosts and psychics) and the vast amount of anecdotal evidence for homeopathy?”
If you don’t want to answer, just say “I decline to answer that.” (I’m tempted to ask where you’re reading these other questions you keep answering, but that really wouldn’t work here, would it?)
December 18, 2007 at 11:38 pm
And I am really keen to hear a yes/no/decline to answer to my question;
Do you think my criticisms of homeopathy are sincere?
it should take a few keytaps to answer.
December 19, 2007 at 2:01 am
Simpson and NJ: I’m a little confused- are we talking about your delusions that medicine is generally minimally harmless and scientific and your ignoring of the fact that the iatrogenic evidence proves danger? In other word, that your belief in and requirement that homeopathy prove itself in the same way that medicine does is similar to someone who believes in aliens?
Lewis: Yes, your questions are disingenuous. They are more statements of bravado and criticalness rather than real questions. They do not come from a place of inquiry rather a place of rigid pre-judgement. There are MANY answers to your questions right on this blog- but you brush them aside as if you had some sort of expert knowledge instead of the ignorance of real medicine that you exhibit.
So can you all provide me with evidence that conventional medicine is not dangerous when the rate of serious iatrogenesis is conservatively 3-4 % and some say 10%. We are talking 3-10 people out of 100 having serious side effects.
Can you prove to me that homeopathy is dangerous?
December 19, 2007 at 9:03 am
“Lewis: Yes, your questions are disingenuous.”
This was my question “Do you think my criticisms of homeopathy are sincere?” An answer one way or the other would be great.
As for harmful medicine. Real medical interventions carry risks - especially in life critical situations. Doctors take risks such that lives may be saved. That is real, difficult adult medicine. Sometimes those risks do not payoff and the patient is harmed. Absolutely. But if lives are saved and people are here now that would not be if lives were not saved then that is good.
Ambulances take risks by travelling at high speed. There is one accident per day in the UK. Should we introduce homeopathic ambulances that travel very gently and holistically? That is not a rhetorical question.
And yes, drugs have side effects. That is because they have effects too. Homeopathy has neither bar the side effects of misinformed patients - that can be very dangerous. Doctors and patients balance the side effects against the intended benefits. If they there is a net benefit then most people will take them. Some malaria tablets cause some people to have unpleasant side effects. The side effects of not taking preventions can be death. A choice.
Can I prove that homeopathy is dangerous? Well I think the question I should be asking is that can you prove that homeopathy is safe? It is your practice, you should be in a position to demonstrate safety of what you do. Checking up on your safety record is not others responsibility. If I was the owner of a business and did not take steps to demonstrate the safety of my production process, the HSE would be quite rightly down on me like a ton of bricks, even without ‘proof’ that I was doing harm. It’s called taking responsibility.
Can you show that people given malaria prophylaxis do not go on to contract malaria? Can you show that homeopathic AIDS clinics give better outcomes than conventional clinics? Can you show that homeopathic asthma treatment is effective over the long term? And if not, don’t you think these practices are just irresponsible?
December 19, 2007 at 2:06 pm
“Oh really? A new survey indicates a strong correlation between rates of neurological disorders, such as ADHD and autism, and childhood vaccinations. While this doesn’t point the finger specifically at MMR, it’s necessarily one of the vaccines implicated.”
If you have time, please read over this excellent critique by Orac:
http://scienceblogs.com/insolence/2007/06/fun_with_phone_surveys.php
December 19, 2007 at 2:18 pm
Hello Andy,
Thank you for your response.
Again you use the “dangerous” word which has very significant consequences. It is a strong word for something that is your opinion- because I haven’t seen any evidence from you that it is dangerous except your argument that by seeking a homeopath you will not seek a conventional medical opinion or treatment. That is based on many assumptions about how the majority of consciencious homeopaths function.
You also have an opinion that it is not effective.
I am not suggesting that people should not seek conventional medical care especially in critical care situations and in an ongoing way.
I could also add in terms of your ’something may be missed and death may ensue’ argument that medical doctors miss diagnosis more frequently than expected and that poorly mixed drugs also create mortality. But this is also an opinion- except I have evidence for it.
So I have an opinion based on evidence and you have an opinion based on conjecture. Well, I will stop here and enjoy Christmas- I hope you have an enjoyable one too.
December 19, 2007 at 2:56 pm
Actually this conversation reminds me of a bible verse:
1 Timothy 6:20
O Timothy, keep that which is committed to thy trust, avoiding profane and vain babblings, and oppositions of science falsely so called:
The reason this comes to mind is because I am presently having opposition from scientists in regard to the manifestation of Jesus Christ.
This is exactly what the scriptures immediately previous to this one discuss. I have done some research solidly based on eye witness testimony which scientists continue to overthrow with weak arguments.
You can read about my research here in an article I called “Armchair Archeology”
http://ablebodiedman.blogspot.com/
regards
Geoff
December 19, 2007 at 3:44 pm
How on earth did this post get onto the wordpress intro page in the “science” category.
I’m laughing my socks off at that irony.
December 19, 2007 at 4:38 pm
@yeshomeopathy! : If you’re suggesting that people should seek conventional medical care, “especially in critical care situations”, presumably that’s your admission that homeopathy doesn’t work? Or at least your admission that you’re not sure and so are hedging your bets? Or is it so you can claim a homepathic cure after conventional treatment?
December 20, 2007 at 12:02 am
Well, well, well … this is all very fascinating.
What started out as an argument for giving anecdotal evidence more than zero credibility has ended up being interpreted as an argument that anecdotal evidence should be raised above scientific evidence and taken instead of it, at which point everyone starts shrieking!! Amazing! It’s really quite hilarious what you lot talk yourselves into once you get going.
Perhaps they know something you don’t
This is all so ludicrously polarised. How on earth can anyone turn what is essentially an argument supporting a pluralist approach to healthcare based on a pragmatic “evidence mosaic” into this ridiculous notion that any one therapy should be all things to all men, and that to concede one therapy is better in some situations and another in others is somehow an admission that one or the other doesn’t work at all?!!
A therapy is a tool for helping sick people get well, not a religion or a football team! The sole reason this blog came into existence was because of the lies and disinformation being spread by the sceptic camp in respect of homeopathy, specifically the factual inaccuracies cited in Ben Goldacre’s recent comment piece in The Lancet. And they are factual inaccuracies. The “hard” evidence for homeopathy is presently equivocal and inconclusive. It does not prove in any way conclusively that homeopathy is equivalent to placebo, or that it’s not. That’s just the simple fact of the matter. You can interpret that in any number of ways, precisely because the evidence is equivocal (d’oh …).
The mantra that “there is no evidence in support of homeopathy” is a lie. That’s the bottom line. If you were all shouting “there is no evidence in support of homeopathy that we accept” you’d be telling the truth and I’d have no problem with it, but that critical qualification is never there.
December 20, 2007 at 8:08 am
laughingmysocksoff
i>What started out as an argument for giving anecdotal evidence more than zero credibility has ended up being interpreted as an argument that anecdotal evidence should be raised above scientific evidence and taken instead of it, at which point everyone starts shrieking!!
let me remind you what you said…
But when there is such substantial variance between the observed phenomena according to day-to-day standards of evidence and the preferred ’scientific’ hypothesis, then something has to have gone badly wrong, and the scientific process has become subverted by something other than the aim to explain the observed phenomena. If the two are not congruent, then the scientific proces has failed.
That sound like to me a statement that says if testimony ad scientific evidence do not agree then it is the science that has failed.
In short, you appear to be saying that testimony has a superior status to scintific evidence otherwise why should be assume it is the science that has failed and not that we have suspect testimony on our hands.
Can you clear this up for us?
And - the avoided question:
Do you think my criticisms of homeopathy are sincere?
December 20, 2007 at 8:47 am
Yes Andy that’s it - science fails medicine as testified by many people who stop taking their drugs because of side effects, who have been damaged by vaccines, who die as a result of medication.
December 20, 2007 at 9:01 am
@Mr Socks Off:
“this ridiculous notion that any one therapy should be all things to all men, and that to concede one therapy is better in some situations and another in others is somehow an admission that one or the other doesn’t work at all?!! ”
Well, if it’s not an admission that homeopathy doesn’t work, could you perhaps draw a line for reference, indicating the kinds of illnesses and conditions that homeopathy does work for, and conditions that people should be treating with conventional medicine?
December 20, 2007 at 9:51 pm
homeopathy4health - so when parents are certain that MMR has caused their childs autism but tons of science says that it is almost certainly not true, you believe the parents I take it. How do they know?
And you ducked again…
Do you think my criticisms of homeopathy are sincere?
December 20, 2007 at 10:45 pm
OK. This is not going to be a short comment, and I make no apologies for that because the arguments need to be examined in depth, but hopefully it will make clear what I’m trying to get across from this.
Remember we’re talking about the specific nature of homeopathy and its evidence base here, so applications of general principles in relation to evidence must be appropriate to the context. For the purposes of trying to grasp what I’m saying, please put the whole implausibility issue to one side because what we’re concentrating on is a) the suitability of using controlled trials to test the validity of an individualised therapy as it stands, and b) where its body of clinical and anecdotal evidence fits into that assessment.
FACTS: Over the space of 200 years, homeopathy has been refined into what appears to be a subtle and finely differentiated individualised therapy, for which there’s a considerable body of clinical and anecdotal evidence showing efficacy. The therapy was founded on empiricism, derived through the classical observationalist-inductivist approach, and built on replicability. Responses to successful prescriptions show a lot of individual variation, but in well-established chronic conditions frequently involve a brief period of symptom exacerbation, followed by a general improvement in the way the patient feels in themselves. This often precedes measurable changes in the symptoms themselves which, with time, reduce and disappear. Partially successful prescriptions (close but not quite close enough) may result in some temporary amelioration of the presenting complaint, but generally a different prescription is required to obtain the desired reaction. Unsuccessful prescriptions may produce one or two temporary changes but nothing lasting, and the remedy generally has no other effect.
FACTS: Clinical trials have proven effective to a reasonably acceptable degree in establishing efficacy for pharmaceutical interventions which introduce large doses of biochemical agents into the body, producing a measurable effect in most people. It’s not particularly subtle: the higher the dose generally the less individual variation there is. Nevertheless, it’s clear that not all the effect of treatment resides in the agent itself, so the remainder is assumed to be almost entirely due to the psychosomatic impact of believing something helpful has been ingested, and this is controlled for in testing by giving dummy medication, randomising the administration of it amongst testers and blinding the administrators so no other subtle extraneous effects like administrator’s expectations can intrude. Data is gathered on testers’ responses and any effect over and above placebo is assumed to be a property of the pharmaceutical intervention. All well and good, if a bit crude and approximate.
One of the foundational requirements and assumptions underpinning this whole methodology is that the agent being tested has a common effect. The strength of statistical measures applied to the trial data derive from the assumption that you are measuring a pretty much identical process in a group of pretty much identical subjects, ie. that there is homogeneity. Otherwise, what on earth are you measuring? Of course, we recognise that there is individual variation in humans, but we accept the level of approximation in the testing because we’re working at the level of what is common.
But when you’re dealing with an individualised therapy, you tip the balance in the other direction. You’re emphasising the individual elements over the common. The whole basis of your approach has changed. You’re not bursting doors open now. You’re looking for the individual key for every lock. That changes the way in which you test for and interpret success in opening doors because there are different variables at play, and different ways of assessing whether or not the door is in the process of opening. Consequently, and in the light of the substantial and consistent clinical evidence for the therapy, you have to think very carefully about what results from these trials might be telling you before jumping to the same conclusions you would if you were testing an intervention designed to work at a common level.
If you say fine, let’s allow homeopaths to select an individual remedy for each tester, then run the test, you’re relying in large part on the skill of the homeopath to select the right remedy in the right potency first time, something which, in practice, probably only happens in around 50-60% of cases. In a clinical situation, first prescriptions would be reviewed at follow-up and the prescription adjusted accordingly until the desired reaction is achieved, but trials haven’t (to my knowledge) allowed for this. So at the very least you’ve introduced a variable into your test that’s not being adequately accounted or controlled for. If you then run the test and find the results don’t indicate the same efficacy or replicability rates as you’re seeing from complete case histories in practice, then it’s not appropriate to draw conclusions about the therapy as a whole and the reliability of its evidence base without taking this into account and running further tests to differentiate. From the perspective of the therapy, all you’ve really tested in this scenario is the abilities of the individual practitioners involved to get it right first time for that particular group of individuals enrolled for that trial. This doesn’t tell you very much about the effect of remedies, or the effect of the therapy as a whole.
If you say fine, let’s go the other way and find remedies which might have a more common action, then you inevitably end up in the realms of isopathy — treating with idem rather than similar (eg. a remedy prepared from an allergen identified as common to a group of people) — which is not homeopathy and has never produced as good results in a clinical setting even if it does have some impact on symptoms. It might be able to show that ultra dilutions demonstrate an effect beyond placebo, but it’s no test of homeopathy.
These are just two of many angles on the issue. In a lot of ways, testing an individualised therapy poses similar problems to undertaking meta-analyses of clinical trials. You’re comparing apples with oranges, grapes, pears, bananas and the whole contents of the fruit bowl. You’re no longer looking at the fruit as just fruit or subjecting it to tests that are designed to test the common properties of all fruit: you’re approaching it and treating it in all its individual variation, relating to apples as apples, oranges as oranges, etc, and maybe mistaking Asian pears for apples. The more subtle and individualised the process becomes, the more uncontrolled and unacknowledged variables are introduced, the more variable and equivocal the aggregate results will be. And this is exactly what the trial data show.
When you come to perform a meta-analysis of accumulated trial data, you’re compounding the problem all over again. You’re trying to draw conclusions from a bowl of mixed fruit each item of which is in itself a bowl of mixed fruit. You’re also (and this applies to other trials too) making generalised assumptions about bias and applying them to all trials regardless of the individual biases (which are enormously variable) in the researchers concerned. And you wonder why results are equivocal or merely end up echoing the biases of the researchers conducting the meta-analysis? Controlled trials have their limitations and it’s important to realise what they are.
Hence the conclusion from many researchers that this means of testing homeopathy is not a suitable research tool and that other forms of evidence are needed to establish efficacy to sufficiently rigorous standards. There is good and valid scientific reason for doing so. So the assumption that homeopathy is bogus because it doesn’t appear to measure up to the “gold-standard” is no more than opinion that’s failed to examine the underlying reasons why that might be so.
Not avoided — I thought you were addressing that to yeshomeopathy!.
Yes I think many of your criticisms of homeopathy are sincere. Some of them, from my perspective, are misinformed, others rather narrow in their logic, and most are overstated, which makes it difficult for homeopaths to accept them as they are. Yet there’s been many good points made which homeopathy as a profession needs to address. However, you also have a tendency to indulge in witch-hunts which makes it very hard to have a reasonable discussion about any of this. It blows all the sincerity clean out the window.
Despite this, I can see very easily how you come to the conclusions you do. As I’ve said before, many homeopaths know that only too well because they’ve been there, but their own explorations have taken them beyond that position and convinced them otherwise. This is why much of the sceptic reaction comes across as similar in many respects to xenophobia.
If there was less hysteria, vilification and deliberate attempts to trap homeopaths into appearing to say what they haven’t said at all in all of this, you’d probably find homeopaths willing to take part in your experiment. It’s not a bad test as these things go, though the strong suspicion remains that even if the results were sufficiently positive you’d find a way to discredit them. But in the present climate you’re unlikely to find anyone willing to climb onto what looks suspiciously likely to morph into a ducking stool.
December 20, 2007 at 11:47 pm
“you’re relying in large part on the skill of the homeopath to select the right remedy in the right potency first time, something which, in practice, probably only happens in around 50-60% of cases”
This is fascinating. After 200 years of refining this therapy, homeopaths are still making incorrect prescriptions 40-50% of the time? Has this figure changed over time? Is it an average, with inexperienced homeopaths getting it wrong much more often but experienced homeopaths getting it wrong much less frequently? Because surely any testing would need to be done using the most experienced homeopaths available, who one would hope to be able to correctly prescribe more than 60% of the time.
Also, and this really is something I don’t understand, what effect does an initial wrong remedy have on a patient? If you give a homeopathic remedy to someone for whom it is not appropriate, surely that is the same as giving it to someone in a proving. So if provings are replicable then surely the patients who receive a wrong remedy will develop, however mildly, the symptoms associated with that remedy when it was proved?
If I’m making a mistake at any step here, please correct me but if the above is true then it flies completely in the face of the claim that homeopathy has no side effects.
December 21, 2007 at 12:25 am
Thank you for answering my question.
What strikes me most about homeopaths is there incurious nature. So much breath on explaining why you cannot test it. So few homeopaths saying how you can test it. And the excuses for not testing tend to be weak.
First, even if you were, say, only getting it right first time in, say, 50% of cases, that should still show up above a placebo. Getting a 50% hit rate aint too bad, say, compared with some cancer treatments - if it were true.
Secondly, you must recognise the existence of problems such as the placebo effect, regression to the mean, misattribution of cure, wishful thinking etc. Don’t you? So, given these enormous problems, how do you know homeopathy works? How reliable is this ‘clinical and anecdotal’ evidence you speak of? You do recognise these problems, no?
December 21, 2007 at 12:38 am
Andy Lewis: I am sure that MMR caused my own child’s autistic behaviours (see Purpose of my blog) and that homeopathic MMR caused the reversal of this state.
Science’s ‘evidence’ does not always stack up in the real world (as I and laughing has said) and is subject to considerable bias.
I do understand your criticisms (I’m sure I’ve said that before) or maybe it was another pseudosciencer clone, you’re all starting to sound the same.
December 21, 2007 at 8:37 am
homeopathy4health - How can you be sure. Sure is a strong word.
December 21, 2007 at 9:05 am
I am sure. And this scientific ethos of ‘I don’t believe it’ creates a lot of uncertainty in the ordinary person to disbelieve their own senses about their own health and those of others. Of course this then takes them to highly paid ‘experts’ who may not have any relevant research to hand to confirm or deny. There is a lot of uncertainty in medical treatment and lack of direct experience due to the divorce between those who do the research and practitioners.
December 21, 2007 at 10:17 am
homeopathy4health - don’t you think that this might be the difference between us? Your willingness to be sure? But you did not say why you are sure - just that you distrust uncertainty in the scientific world.
This is interesting. One of my beliefs is that the reason why some people turn to ‘alternative’ medicine and seek strange explanations is that they have a low tolerance of uncertainty. They do not like the apparent lack of control that doubt and ignorance imposes. Scientists, on the other hand, live with uncertainty and except it - in fact uncertainty is what drives their inquisitiveness to discover. But for some people, there is a huge mental desire in many people to have explanations for all things. When real reasons cannot be found - as in the case of autism - alternative explanations on latched onto, no matter how little evidence there is for these beliefs.
Out of interest, are you the sort of person who believes ‘there is a reason for everything’?
Homeopathy, to me, looks to be a way for people with a low tolerance of uncertainty, to pretend to themselves they have control in their lives. Homeopathy pretends to provide an all-encompassing philosophy of health and a hope for cures, in the face of the massively complex and unknowable issues surrounding health, life and death. Real medicine cannot provide that comfort - it is a tricky, uncertain business. One piece of evidence I find to support this is homeopaths’ complete unwillingness to subject themselves to testing of their beliefs. I see no desire in the homeopathic community to really test fundamental aspects of the practice. Rather, the tiniest piece of confirmatory evidence, no matter how weak (like anecdotes) is used to bolster their current certainty. I have yet to see a homeopath answer a question like ‘what would it take to change your mind?’. This is an everyday question for scientists. I have answered that question myself with my challenge. If homeopaths could pass that test, I would change my mind. What would change yours? Or are you too afraid of the uncertainty that such a question brings?
To me, I live comfortably with the knowledge that we don’t know everything or can control every aspect of our lives. If no good explanation is available for an event, I don’t need a pretend one to fill that void. To me, the central gift that science gives us as a way of thinking is not just knowledge, but knowledge about what we can say with some certainty we know and knowledge about what we do not know. I would call this wisdom.
I would rather live not knowing than with pretend knowledge.
December 21, 2007 at 1:46 pm
M Simpson raised a good question a few posts back, and one that I’ve never heard a homeopath answer, or even attempt to answer.
One of the main claims of homeopathy is that it is free from side effects. When homeopathic treatment fails due to incorrect remedy selection what prevents the proving process occuring in the patient? Have any case studies been published where the incorrect administration of a remedy has led to unwanted side effects, or does the patients body know that the remedy it is recieving is meant as a cure?
December 21, 2007 at 3:49 pm
Andy Lewis says:
“I have yet to see a homeopath answer a question answer a question like
‘what would it take to change your mind?”‘
I am a homeopath who has been in full time practice for 13 years in 2 countries and have been a homeopathic patient for 30 years.
For me, what would change my mind would be to see people no longer get better - often dramatically - in my prescription of homeopathic medicine.
Here are a few real life examples from my own practice:
- a woman who has just given birth rapidly and is in a state of shock - trembling uncontrollably, clinging to everyone around, and drinking glass after glass of cold water to cool her feverish anxiety, settle back onto the bed, release the vise grip on her attendants,stop trembling, stop drinking, suddenly return to herself and smile at her baby.
- a woman, who over a few months, has just been diagnosed with MS. - and is experiencing symptoms like ataxia, slurred speech, numb extremities - returned to a state of good health within a few days of receiving a homeopathic remedy. The MS symptoms have never returned.
- a child,who every night was subject to terrors, in which he screamed uncontrollably, knew no one and thrashed about in fear at his hallucinations, now able to sleep through the night, no more terrors, only good dreams.
- a man, with nightly insomnia and fiercely itching eczema on his face, arms and legs, with a wife and children ready to leave him he was so irritable and unpleasant to live with…….eczema completely gone, able to sleep restfully, peace restored in his family
- a teenager,at a family reunion, stung by a horse fly, his face swelling alarmingly, the inflammation moving by the minute toward his throat - literally within minutes of administering a remedy, the inflammation reversed its order, his family agape - antihistamines, epipen and escape car at the ready - all superfluous. There was no trace of any swelling or ill effects 5 minutes later.
- again, another event. witnessed by a crowd of previous homeopathic skeptics…… an artist, who had developped a ganglion on his wrist which had gradually increased in size to that of a golf ball. Last Christmas Eve, he took a remedy. By Boxing Day, it had shrunk to the size of a pea, to the astonishment of his family and friends, who monitored its progress.
A year now…..it has not grown back.
Shall I go on ? I could. on and on and on……..
NOT seeing these results from my own homeopathic practice- that is what it would take to change my mind.
-
December 21, 2007 at 4:29 pm
Accepting that we do not know all the answers is a very righteous thing to do.
I see most people standing hard and firm on what they are convinced is the right decision.
In fact when I look around at what is happening in the world does what I see measure the value of what the most intelligent people are thinking?
If what is happening in the world is not a result of what the most intelligent people are thinking then I guess they are not too intelligent then!
Even if the value of what I see happening in the world is not a result of what the most intelligent people are thinking then you must admit that it would be hard to argue that what is happening must be a result of decisions which people made.
These people must have thought they were making the right decision.
This reminds me of another bible verse:
Gensis 3
4 “You will not surely die,” the serpent said to the woman. 5 “For God knows that when you eat of it your eyes will be opened, and you will be like God, knowing good and evil.”
you will be like God, knowing good and evil.
………….. the original sin.
regards
Geoff
December 22, 2007 at 7:10 pm
It really is extraordinary how much mirroring is going on here between the two “camps” (for want of a better word). To homeopaths, this appears to be one of the principle reasons the sceptics cling so tenaciously to their perspective where deterministic predictability, determined materialism and linear logic seem to hold sway!! Speaking personally, I think life would be deadly dull if that were so. The fact that we know so little about ourselves, the world and the universe we inhabit is the source of enormous inspiration and an unrelenting curiosity to explore, to continually push the boundaries and see where it all leads.
No, because I don’t think much of what goes on in life is reasonable (in all senses of the word). If, as is postulated, individual awareness filters out around 95% of sensory input, then the data we’re basing our reasoning on, no matter how ’scientific’, is ridiculously paltry. It seems that most of the time we’re merely looking in the mirror of ourselves and objectifying what we see. Is there really any “out there” out there? Who can tell for certain? Ultimately we can only experience life through our subjective experience of it. As Einstein is quoted as saying, “Reality is merely an illusion, albeit a very persistent one.” But damn! What an illusion!
You’re spot on when you say
It’s no different in homeopathy. It’s equally tricky and uncertain, precisely because that’s the nature of dealing with any one individual and their unique case of illness. If anything I think it can be more so: the level of differentiation required can sometimes be enormously subtle. Generalisations, averages and repeated demonstrations of replicability are all very well, but at the end of the day, we come down to the uniqueness of one person, with their particular illness in their particular circumstances and their particular environment, all of which play a part in their condition. Can we say with any certainty that our interventions — whether homeopathic or biomedical — are going to have the desired effect? Of course not. But we give them responsibly and in good faith, based on what we have assessed as reasonable probability, and hope for the best. And if the best doesn’t transpire, we do our utmost to find out why it didn’t work and to try something else which might make a difference. (And anyone inclined to scoff at this and bemoan the lack of certainty and “science” should stop mistaking the theory for the reality and spend a lot more time observing what goes on in conventional primary care settings and hospitals up and down the country.)
What inspires homeopathy’s practitioners is the discovery that its principles appear to hold good in the real world of medical practice and give us hope that, applied diligently, we can make a real difference to people’s suffering. One of the many reasons so many conventionally trained doctors and veterinary surgeons are seeking training in homeopathy is that it’s principles seem to fit what they are continually observing through interacting with their patients in practice. Yes, it involves a paradigm shift in the way we understand lifeforms in health and disease, but it’s one which people very rarely step back from once they’ve made that leap. And if it’s hard enough for non-biomedically qualified homeopaths to deal with the level of opposition and ridicule, it’s far worse for those within the biomedical community. Do you honestly think so many would follow this path if it didn’t have something going for it? Colquhoun may lament the fact to his heart’s content, but the fact is that demand for training in homeopathy is continually growing, and much of it from biomedically-trained individuals.
Homeopathy is a long long way from being perfect and homeopaths make no claim that it is, or that the profession doesn’t have some growing up to do and lessons to learn. All we claim is that homeopathy appears to be at least as effective in many instances as biomedical interventions, but without the crippling and lethal side-effects or anything like the astronomical cost. Time and again we witness dramatic cures that just aren’t amenable to any other explanation than that something in the remedial process had an effect.
The examples that lynne gave are very typical of all practitioners’ experience. If they weren’t, then to be honest there would be little point in continuing to study as hard as it takes to become a decent homeopath, especially in the face of so much opposition and ridicule and, it has to be said, no more than a subsistence level of income. These are the cases that keep our resolve intact through the long hard slog of the more deep-seated chronic conditions that can take months or years to unwind. Homeopathy is no magic bullet, even though there are many cases in which it seems to act like that, and chronic cases can present in a layered fashion where it’s necessary to, in effect, remove one layer at a time to return the patient to health. Often this happens in the reverse order in which the condition developed. But making an impact IS possible and you’ve seen many people personally attest to that on these blogs.
I think you’re incorrect when you say
Many of us have answered that. Nothing is likely to convince any of us that what we’ve witnessed and experienced didn’t happen. It happened. You can’t unhappen it. And as lynne said, if by some strange happenstance all homeopaths suddenly experienced it as no longer working, then we might have good reason to doubt it. Also, if there is a better explanation for it all than the rationale homeopathy provides, then most of us would probably accept it. To date, no rationale offered by the sceptics has come anywhere close to explaining consistently what goes on time and again in the nitty gritty detail of individual cases. And you’re wrong if you think that homeopaths aren’t constantly questioning what they observe and experience. This is an essential part of reflective practice. The dangers of self-delusion are well recognised, and when you’re practicing such an apparently implausible therapy then you want to be doubly, trebly sure.
December 22, 2007 at 7:43 pm
Homeopathy’s claims to produce no side-effects are based on the principle that when the focus of treatment is the whole individual rather than the disease, then there’s nothing which, by definition, can be a “side-effect” to that. However you could well argue that there’s an element of semantics here and that unfamiliar and unwanted symptoms could be seen to fit that designation.
It is possible to induce proving symptoms, particularly if a remedy is repeated too often inadvisedly. Many homeopaths will have had at least one case of a child exhibiting the mental pattern of Chamomilla (not a pretty sight) from being given too many OTC teething granules. It’s not always easy to convince people that they need to give the remedy only when symptoms show that it’s needed. The habit of pharmaceutical dosing regimes is deeply ingrained and many OTC remedies perpetuate that notion in their guidelines for use — inadvisable IMO. The critical point here though is that the symptoms are transient, and, if they appear at all, will generally last no more than 24 hours. In the instance of a Chamomilla proving, discontinuing the administration of the remedy will stop the symptoms and no permanent damage ensues.
This is in rather stark contrast to the side-effects produced by pharmaceutical interventions.
Many homeopaths will counsel patients in what they might experience following the administration of a remedy. It’s also the case that a good healing reaction can be preceded by a brief aggravation in symptoms. Again, this generally lasts no more than 24 hours, and since it frequently indicates the remedy is a good match, most patients will accept the temporary discomfort. They’ve usually been through much worse under biomedical treatment and knowing what to expect makes a big difference to how the experience is dealt with.
The same goes for volunteers for homeopathic provings. Volunteering to step into the unknown and get sick with wholly unpredictable (in a blinded proving) complaints for the benefit of others is not something everyone will countenance, but the knowledge that the symptoms are transient and produce no permanent changes helps enormously.
December 22, 2007 at 9:53 pm
Laughing thanks for your reply.
I’ve just used an internet remedy finder (ABChomeopathy.com) to find some remedies for a few conditions. First I searched for a remedy to help with drowsiness while driving home from work in the evening. The remedy suggested was phosphorus. If this remedy is not correct for me (which you said happens about 40-50% of the time for first remedy selection) and I used the remedy, I would begin to prove the remedy, causing further drowsiness. Even if this only lasted for ~24hrs this would still be very dangerous when I drove home that evening.
I also found a remedy for suicidal feelings. Pulsatilla Nigricans was selected. If a suicidal patient took this remedy, but it was the wrong remedy for them, the proving process would be even more dangerous. It wouldn’t matter that the symptoms produced by the remedy only lasted 24hrs if they killed themselves after 2hrs due to an agravation of their symptons.
These are obviously extreme cases but, given that there isn’t even any effective regulation of homeopaths in the UK, what safeguards are there to prevent them happening? It is because homeopathy claims to be side effect free that homeopathic remedies avoid the nasty business of safety and efficacy testing. To prevent cases such as those I’ve mentioned above should all homeopathic remedies be licenced and only released following suitable testing?
December 22, 2007 at 10:33 pm
Interesting points John. And hard to answer because extremes like this are always within the realms of possibility. However, it seems to be the case that for people exhibiting pathology (as opposed to provers setting out with the intention to test remedies) if a remedy isn’t right then it just seems to sail right on past them without producing any proving symptoms of note. Unless you’re repeatedly dosing which, as I’ve already said, is inappropriate and not recommended.
Of course a proper homeopathic case-taking would never prescribe a remedy on a single symptom. Every symptom of your state would need to find its match in a single remedy for a confident prescription. For chronic complaints, self-prescribing is really not to be recommended.
I’d also have to say that although Pulsatilla nigricans can have suicidal ideation, it’s usually a cry for help. The Pulsatilla state lacks the resolve to follow through, so even if you were proving Pulsatilla, you’d probably end up being more of a pain to your nearest and dearest than in any real danger of topping yourself.
Also Phosphorus is extraordinarily sensitive to external impressions, so were you to doze off at the wheel, chances are you’d be equally likely to start into wakefulness at the slightest hint of danger.
What can I say? Life is full of risks. Homeopathy may lack “effective regulation” but the safeguards in place for conventional medicine don’t impress me muchly. Personally I’d rather take my chances with homeopathy and risk being among the 0.001% theoretically harmable than end up being one of the 4.5% of the population definitely harmed or killed by pharmaceutical interventions. And the lack of regulation of homeopathic remedies has far more to do with the prevailing assumption that there’s nothing in them than any claim about lack of side-effects!
What’s more, stimulants like alcohol have proven ability to turn reasonable human beings into homicidal maniacs, yet there’s no really effective regulation of alcohol availability that stops that happening every Friday night.
Specks of sawdust and planks of wood come to mind. And you can’t have it both ways. How can you agitate for more regulation at the same time as professing the whole therapy to be impossible?!
December 22, 2007 at 11:55 pm
Laughing thanks for the reply again.
You’ve correctly inferred from my posts that I am skeptical about homeopathy (although it was probably fairly obvious from the nature of my questions).
When writing about the dangers of incorrectly prescibed remedies I was merely playing devil’s advocate. While I may be of the opinion that homeopathic remedies will have no effect, good or bad, members of the homeopathic community clearly think they do.
You mention harm caused to patients by conventional medicine. While this is obviously true you cannot say that steps have not been taken to minimise patient risk within the medical community. I am sure more could be done, but also know that the regulatory system in conventional medicine is constantly working to prevent future errors. Besides which, any problems in medicine do are not really relevant to this discussion.
As you say the lack of licencing regulations for homeopathic remedies does come from the assumption that they are nothing more than sugar pills or water. From the position of a homeopath, or a body representing homeopaths, this is not an belief that is held. Surely the homeopathic community should be taking steps to avoid the possibility of cases like those I mentioned above. If this is not the case it would appear it is homeopaths who are trying to have it both ways.
December 23, 2007 at 1:03 am
“However, it seems to be the case that for people exhibiting pathology (as opposed to provers setting out with the intention to test remedies) if a remedy isn’t right then it just seems to sail right on past them without producing any proving symptoms of note.”
Now I’m laughing my socks off!
You’re saying that a remedy given to somebody who doesn’t need it will produce an effect in that person if it’s part of a proving but not if it’s just a misdiagnosis.
How does it know?
December 23, 2007 at 8:58 am
Of course the homeopathic community take such steps! Just because it’s not formalised into legislation doesn’t mean it doesn’t exist. Have you ever heard of such cases? Instances where homeopaths have been implicated in unfortunate outcomes are incredibly rare, and even then can be open to question in that they can fail to take account of patient choice. Patient education is something most of us take very seriously. Forewarned is forearmed, and knowing there’s a possibility of these things happening means that most people are able to step back and witness the feelings rather than saddling up and riding them into the sunset.
On the contrary. I think they’re highly relevant because they emphasise the considerable gap between the ideal and the achievable reality. Is it realistic of biomedicine’s proponents to expect standards from homeopathy that biomedicine is itself unable to achieve? Medicine is an inexact science and there are no guarantees, whether legislation to that effect exists or not. Even such legislation as exists has proven toothless for people that have really been in need of its support. There is evidence enough to suspect that corporate and government interests may weigh in more heavily at the end of the day. Like I said, specks of sawdust and planks of wood …
I find it interesting that so many of the discussions on this subject seem filled with fear on behalf of a mythical Jo(e) Public who’s presumed to be a powerless, helpless bear of little brain, even less common sense and no ability to make up his/her own mind. I’ve yet to meet a person that fits this description outside of an institution where there are people devoted to their full-time care.
December 23, 2007 at 9:27 am
Good one, M!! You certainly got my socks going there too. How can the remedy possibly “know”?!!! That’s the daftest notion I’ve heard yet. It’s the state of the recipient of the remedy that determines their reaction to it!!
It’s an observation from practice. It’s often the case that active pathology displaces symptoms of a pre-existing state. Anyone can make this observation: it’s not a uniquely homeopathic perspective: eg. succumb to a good dose of the flu and your habitual heartburn and indigestion go into remission for the duration. The active pathology is the stronger dis-ease — so the rationale for this observation in relation to proving symptoms is that the strength of an active state is much less prone to perturbation by a remedy that doesn’t accurately mirror it than the state of a prover who is generally in reasonable health. People vary enormously in their sensitivity, of course, so some will experience nothing at all and others will notice more.
It’s also the case that someone engaged in a proving is observing themselves very closely so will tend to have a heightened awareness of subtle and transient changes which someone who’s mind is elsewhere might completely miss.
December 23, 2007 at 11:59 am
Laughing you ask if I’ve heard of any cases like the ones I mentioned. No I haven’t but I’d say that is more due to lack of any effect, rather than the diligence of homeopaths. My point is that homeopaths who believe that these effects are possible should be the ones pressing for legislation. Apart from a moral duty to prevent occurances such as these, bodies representing homeopaths should be aware that cases such as these would reflect badly on their proffesion and, as such should be concerned.
Also your observations don’t really match your hypothesis. Do you have any evidence that the flu puts heartburn and indegestion into remission. Isn’t it more likely that a patient suffering flu feels so crap and tired that they are likely to take less notice of their heartburn. They’re also likely to be eating far less, which would account for any reduction in indigestion.
You also say that someone engaged in proving has a heightened state of awareness to any changes. Surely this is just due to the fact that they are looking for changes and are more likely to erroneously attribute these to the effects of the remedy. Both of these effects are best explained as psychological responces, rather than real physiological effects.
December 23, 2007 at 12:02 pm
“Anyone can make this observation: it’s not a uniquely homeopathic perspective: eg. succumb to a good dose of the flu and your habitual heartburn and indigestion go into remission for the duration.”
You’re telling me that you can only have one ailment at once? That ‘flu somehow “drives out” indigestion and heartburn??
More likely, I’d suggest, because if you have ‘flu, the last thing you feel like doing is over-stuffing your face with rich foods - the main causes of indigestion and heartburn.
December 23, 2007 at 4:56 pm
I’m saying that, according to the homeopathic perspective, you can only be in one state at a time. A lot of people experience remission of chronic symptoms when an acute supervenes. You can rationalise it whatever way you like, but it remains the case.
This homeopathic perspective on disease states largely hinges on viewing people’s complaints in terms of characteristic single remedy patterns. It’s a way of categorising symptom expressions that’s essentially no different in process — though different in outcome — to biomedicine’s categorisation of symptoms into groupings of discrete disease entities. It doesn’t necessarily mean it has any objective ‘reality’, any more than discrete disease entities do (at the end of the day you have one individual and a whole mixed bag of symptoms which may, or may not, involve the presence of pathognomonic micro-organisms: you can define and categorise that in many ways) but as a model it works pretty well. Employing that perspective in treatment regimes appears to be consistently valid and effective, which is why it’s become part of the homeopathic process, and it makes sense in terms of the rest of the model.
That process, in 6544 patients through a period of 6 years, produced results (both subjective and objective) which showed it to have been beneficial in over 70% of cases. Sure there’s no control group, but if 70% of 6544 people all suffering chronic complaints got better all of their own accord, including 301 cancer patients who were assessed as being much better (26%), better (27%) and slightly better (20%), while only 1% were much worse, 1% worse, and 8% slightly worse, why on earth are we bothering with all those expensive pharmaceutical interventions? The conclusion has to be that either homeopathy is doing something useful here, or people are far better off left to their own devices. Either way, it doesn’t look particularly good for biomedicine. (Homeopathic Treatment for Chronic Disease: A 6-Year, University-Hospital Outpatient Observational Study. Spence, David S and Thompson, Elizabeth A. Journal of Alternative and Complementary Medicine Volume 11, Number 5, 2005, pp. 793-798.)
December 24, 2007 at 3:58 am
laughingmysocksoff,
You wrote;
“Sure there’s no control group….”
Despite that peccadillo, the evidence is rock solid.
If Homeopathic remedies are so linked with the ’state’ of the recipient, and can be used to treat disorders such as anxiety, panic and suicidal tendencies, surely chronic skepticism should respond to Homeopathic treatment.
If not, why not ?
December 24, 2007 at 9:19 am
The evidence is that the health of 70%+ of 6544 people, all suffering chronic complaints, including non-self-limiting conditions, which had failed to respond to biomedical intervention, improved over the 6 year study period. That doesn’t say it was homeopathic treatment that was responsible because of the lack of control group, but it does have rather serious implications for biomedical interventions and their massive expense to the NHS.
It does
Chronic scepticism has been ‘treated’ by homeopathy many times. A large number of the successful cases became homeopaths themselves. You volunteering?
December 24, 2007 at 10:11 am
John — sorry, your very good questions got lost amongst the rest for a moment there.
Of course the profession is concerned, which is why so much effort in recent years has gone into codifying ethics, putting continuing professional development and professional conduct procedures in place, and working towards a single register. Regrettably, the single register initiative is a mess right now and many of us are angry about that and the fact that some strong personalities evidently came to dominate the negotiations. The profession has some growing up to do yet, and a better balance to achieve in the hierarchies of its membership organisations, but to be fair, it’s working to put in place in just a few years what took decades to evolve in conventional medicine, and with very limited resources.
I covered this in my response to Rich.
Ahhh no … real physiological effects occur. Having taken part in several provings I can personally vouch for that. They arise within the proving timescales, peak, and resolve as the remainder of the proving effects reduce in intensity. Yes, you’re looking for changes, but a lot of them are pretty unmistakeable. And often they’ll be symptoms you’ve never experienced in your life before. If they’re similar symptoms to your habitual complaints, then their characteristics will be different to your normal experience of them. And when your symptoms are compared to those of other provers, then the same symptoms and the same characteristics are found to have occurred in several people. Provers’ characters and demeanours can change as well, which will often be something that their supervisors and families will pick up on before they do, and again the patterns here will be consistently reported throughout the proving group.
Individual responses to the proving will vary — some will have an intense experience and produce dozens of symptoms, others may seem to be hardly affected and only produce a handful of the most marked common symptoms. But it’s the fact that these symptoms are evident throughout the proving group that makes it unlikely they’re just psychological oddities. And that proving ‘group’ may be individuals who have no physical proximity to each other or even knowledge of each other.
It’s then the job of the proving coordinator to assemble all the data and exhaustively compare the different provers’ experiences looking for the common threads. A lot of reported symptoms will be rejected at this stage as insufficiently robust to attribute to the remedy. What is retained is what is distinctive and characteristic. This will be completely different from one proving to the next, and reprovings of the same substance by different people in a different location at a later date will produce the same distinctive and characteristic themes, symptoms and psychological patterning evident in the first proving.
Homeopathic literature contains 200 years’ worth of this data. It’s replicable, and a reliable indicator of any remedy’s potential efficacy in people who’s overall state matches its distinctive and characteristic themes, symptoms and psychological patterning.
December 26, 2007 at 6:04 am
As you admit, the results could be attributed to Homeopathy, or to doing nothing at all. The results could also be due to some other uncontrolled or unrecorded effect. Without the control, it is simply not evidence at all.
For the above reasons, failure of ‘biomedical intervention’ cannot be inferred.
The correct Homeopathic remedy for skepticism is a credible result from trails that meet the demands of the scientific method.
Homeopaths should co-operate with skeptics in these trails if only to prove to themselves that it works.
December 27, 2007 at 11:25 am
Of course it’s evidence! These observations were made, recorded and verified. Without the control all you can say is you don’t know WHY over 70% of these 6544 improved over the study period. You can’t say there’s no evidence for their improvement, OR deny that their case histories record that they had experienced no such improvement under “conventional” treatment.
That’s not a homeopathic remedy. That’s a conventional remedy.
I think you need to do some reading of the trial literature. Homeopaths have been cooperating in, designing and performing clinical trials for decades.
January 3, 2008 at 1:40 am
Laughingmysocksoff,
If I understand you correctly you accept that technically, the reported improvements could be due to Homeopathy, or to doing nothing at all. However, you consider the results to be so startling that there must be something at work, and that something is Homeopathy. If not, then the results must be due to the cessation of allopathic treatment. Without getting all Bertrand Russell on yo’ass, that’s not logical.
I contend that without a control it is not possible to parse the two possibilities. I could agree with you concerning the venomous nature of allopathy or not, and still not find a role for Homeopathic remedies in these trials. I could also attribute the result to any number of uncontrolled mechanisms, and that’s without questioning the validity of the data itself.
Homeopaths acknowledge they cannot provide a plausible mechanism and ask that skeptics accept Homeopathy largely on the basis of anecdote alone. We get the idea, but it’s a lot to ask.
I have looked at the trails, and find them unconvincing. What positive results there are, do not appear to be commensurate with Homeopathy’s strident claims.
Plausibility aside, the problem for skeptics is the quality and reliability of the data. Homeopaths answer this criticism by claiming bias in the mind of the skeptic, and the scientific method itself.
There is no doubt that bias exists on both sides, but not all biases are equal.
Perhaps you know of the basketball experiment where an audience is asked to count the number of passes made between players wearing either black or white shirts. Thirty seconds into the game, someone wearing a gorilla suit runs around the court in full view before departing. Typically, more than half the audience fails to see the gorilla. Of those that do not, many steadfastly refuse to believe that gorilla was there, and confabulate or claim conspiracy. The general lack of observation is due to inattentional blindness, but refusal to accept that fact is hubris.
Would you expect those in that last group to be objective observers of anything ?
The so-called ‘placebo effect’ is present not only in medicine, but almost all human matters. Subjects can be convinced that a drink is orange juice by its colour, or the way it is presented. The list is endless. Where the placebo effect is not due to measurement noise, it is effectively the result of persuasion, and human beings are easily persuaded.
Anecdotal evidence is generally unacceptable to skeptics - not out of slavish, uncritical adherence to a scientific hegemony, but because human beings are appalling observers !
It is quite contrary for Homeopathy to maintain that the observer is part of the system and then ask exemption for Homeopaths and their patients - especially in the light of your astonishing remark that nothing would change your mind.
The scientific method, where hypothesis must fit the observed data works in physics, geology, engineering and so forth. Science attempts to remove human bias as much as is possible. It is not perfect, but it is certainly closer than uncontrolled anecdotal reporting.
The frequently invoked ‘quantum uncertainties’ do not impact upon the countless practical applications of science that surround you, and to exclude medicine from scientific purview just because it concerns health, something close to our being, is special pleading.
To ask that science be perfect and ‘know everything’ before it can be applied to Homeopathy is simply reductionism. Creationists argue in the same manner; unless science can exposit each and every step of evolution, then it hasn’t made its case.
I have read your objections to double-blind trails. I could comment upon about them, and no doubt you would post a spirited rebuttal. Posts could oscillate in this manner until one of us becomes bored.
Lmso, I appreciate that you have to field a lot of comments from skeptics, and maintaining this blog must take considerable effort, but much of what you write is misdirected and repetitive.
How about injecting some new information into the debate?
On another site, Le Canard Noir has posted a challenge to Homeopaths.
httpwww.quackometer.net/blog/2007/12/simple-challenge-to-homeopaths
.html
You will know of this, so I need not repeat the details here.
As far as I can see, this test is within Homeopathic lore, and should show a result free of any of the purported biases.
Posting references to existing trials may be all well and googled, but they are third-hand, mostly inconclusive, open to interpretation or of dubious provenance.
This trail is different because it is simple, cheap and the Internet makes the process transparent. All involved will be accountable for what they write before and after the trials.
These trails would not be for the benefit of skeptics alone. The lack of consistent, plausible explanation means that Homeopathy has much to learn. This is an opportunity to learn something.
For the skeptics it addresses the claim of potentised water which we find so hard to swallow. No Quantum Mechanics, Post-Modernism or institutionalised bias.
I cannot speak for all skeptics, but I would want the tests to be fair and honest for both sides. I simply want to know the answer. If the tests provide a creditable result for Homeopathy, I will be amazed, but then again, I like to be amazed.
I think that you should take this test, and ideally recruit some of your colleagues.
What do you say?
January 3, 2008 at 12:10 pm
Apologies for the delay in replying, I’ve been busy enduring Christmas…
>>You’re telling me that you can only have one ailment at once? That ‘flu somehow “drives out” indigestion and heartburn??
>I’m saying that, according to the homeopathic perspective, you can only be in one state at a time. A lot of people experience remission of chronic symptoms when an acute supervenes. You can rationalise it whatever way you like, but it remains the case.
I’m sorry, but this just *isn’t* the case. An example: I’ve had a very painful shoulder for some months now. It hasn’t responsed to painkillers/anti-inflammatories, so I’ll be going back to the doctor shortly. I’m sure that given time, and rest (unfortunately more rest than I can give it at the moment) it’ll get better by itself. For the last three weeks I’ve also had a stinking cold. This hasn’t improved the shoulder one jot.
I appreciate that this is anecdote, not evidence, but then, as a homeopath you will no doubt be prepared to accept it as such. The “homeopathic perspective” is obviously flawed.
(Additionally, I banged my shin sharply on the corner of a low coffee table the other day. This improved neither my cold, nor my shoulder.)
January 3, 2008 at 4:16 pm
I too would like to add to Humber’s wise words and formally ask laughingmysocksoff to participate in the quackometer simple challenge.
I hope I have made it is easy and as cheap as possible for homeopaths to demonstrate what they say has merit. If you have suggestions as to how to make it easier to show a positive result for homeopathy then I am happy for you to use them as long as they maintain the statistical significance of the original test (so that we have an unambiguous result), is blinded carefully and is public.
All the debate on these boards could be silenced in a second if just one homeopath in the world was prepared to take up such a test of their claims. All of us sceptics would be humbled if you passed.
January 3, 2008 at 5:45 pm
A G A I N S T D R B E N G O L D A C R E
Cultural Dwarfs and Junk Journalism is Martin Walker’s fourth book charting the development of the corporate science lobby that has grown rapidly since New Labour came to power in 1997. One of the most recent exponents of the Lobby is Dr Ben Goldacre who has regurgitated a bad ‘Science’ column in the Guardian newspaper since 2003.
Like other quackbusters Goldacre claims to write factually based and scientifically accurate articles about health, medicine and science either supporting scientists and doctors or criticising individuals involved in alternative or nutritional health care. Goldacre’s writing, however, actually reflects the ideology of powerful industrial, technological and political vested interests.
Goldacre who it is claimed is a Junior doctor working in a London NHS hospital is actually a clinical researcher working at the centre of New Labour’s Orwellian spin operation that puts a sympathetic gloss on anything shown to create adverse reactions from MMR to Wi-Fi, while at the same time undermining cost-effective and long tried alternative therapies such as acupuncture and homoeopathy. Goldacre is involved with public health researchers well known for trying to prove that those who claim to be adversely affected by pollutants in our modern high-technology society, suffer from ‘false illness beliefs’.
Cultural Dwarfs and Junk Journalism, investigates Goldacre’s role in industry lobby groups and puts another point of view in defense of some of the people whom he has attacked, belittled, satirized, castigated, vilified, maligned and opined against in his junk journalism.
Cultural Dwarfs and Junk Journalism: Ben Goldacre, quackbusters and corporate science, is available from the Slingshot Publications web site as a free download, from mid-day on Wednesday January 2nd.
http://slingshotpublications.com/index.html
January 3, 2008 at 8:44 pm
cool, perhaps if I keep on being mean about homeopathy on teh internets I can get a job in this New Labour Orwellian spin operation. I’m all yours big farmer.
January 3, 2008 at 9:59 pm
Humber, thanks for your well argued and considered reply. It’s nice to see someone finally willing to get down to the essentials. The majority of your general comments on the nature of human beings and their observational abilities I completely agree with. The thing is though, exactly the same comments are applicable to those who call themselves scientists and sceptics as those who call themselves homeopaths, and I could pick just as many holes on the same basis in any number of conventional trials as you can in homeopathic ones. We’re all in the same boat.
Ultimately all scientific theory — no matter how well “proven”, how apparently coherent or how useful in making predictions — is no more than metaphor, analogy, models, maps. We cannot know what the ultimate reality is since we can only experience reality in a subjective way and measure it either directly through our senses or indirectly through devices we’ve designed to extend the range of our senses. So scientific “fact” in fact amounts to no more than models and maps of common and consensus experience. The trouble starts when people mistake the map for the territory, imagine that the particular metaphor they’re employing is reality, and start fighting about who’s version of reality is “right” and who’s is “wrong”. There is no right and wrong. There’s just different ways of modeling it and different degrees of coherence in those models. Some are highly coherent and some are highly incoherent, and the fact that humanity employs many widely different and sometimes contradictory metaphors for different areas of human experience is indicative of the limitations of any one model to map the totality of human experience, of the conceptually fragmented nature of human intelligence, and of how far we still remain from any comprehensive model for our state. Don’t forget that what we take for “truth” and validity is entirely conditioned by whatever highly subjective cultural metaphor we’re immersed in, and where different models clash, they merely demonstrate the limitations of their applicability, not the “truth” or otherwise of any analogy over any other. As Einstein said “Few people are capable of expressing with equanimity opinions which differ from the prejudices of their social environment. Most people are even incapable of forming such opinions.”
Amongst our maps of common experience, the ’scientific’ cultural metaphor gives more weight to objectified observations that are made with greater frequency by more people, and that can be made in a replicable and predictable way as an apparent result of performing certain prior actions or observations or by following a methodology dictated by a theoretical framework derived from the apparent temporal and functional relationships mapped between any series of observations and actions. However, to assume that reliability and replicability equate to some greater degree of “truth” is illogical, as is to assume that ‘truth by committee’ is the only valid way to relate to reality with a high degree of coherence. All we can say is that the observations are more common, more objectified, more reliable and more readily replicable, not that they are any more “true”, since we have no way of knowing whether uncommon experience is any less coherent with ultimate reality than common experience, or to what extent the strength of individual