Sugar pills are the future …
Ben Goldacre’s March 1st Bad Science piece for the Guardian, Don’t laugh, sugar pills are the future, in which he comments on the latest research to show that SSRIs are not much more effective than placebo in treating depression is, as usual, a bit thin on the ground with the actual science itself, even if his title might turn out to be remarkably prescient. And, wonder of wonders, I even agree wholeheartedly with a substantial amount of his earlier piece on February 27th, based on the same study, A quick fix would stop drug firms bending the truth. But far more interesting is the piece by Clive Cookson in the FT, Is there an ethical way to fine-tune the placebo effect?
In commenting on the recently-published meta-analysis of both published and unpublished trials of SSRIs led by Irving Kirsch at the University of Hull, which follows his more limited analysis of published studies in 2002, Cookson writes
Anti-depressants do not work, chorused newspaper headlines this week. The truth is quite different. The research in question showed that new-generation drugs, such as Prozac and Seroxat, relieve depression very well - but so do dummy pills.
This is the crucial point. Not, as Goldacre opines
It was fun to hear universal jubilation over the new meta-analysis showing once again that some antidepressants aren’t much cop in mild or moderate depression.
Cookson goes on to say
The study, led by Irving Kirsch at the University of Hull, is the latest testament to the power of the placebo. Analysing the drug companies’ own clinical trial data, the researchers found that four widely prescribed drugs improved patients’ score on the standard clinical test for depression by 9.6 points, while placebo pills gave a remarkable 7.8-point improvement.
As the researchers said in the journal PLoS Medicine: “The response to placebo in these trials was exceptionally large.” This set the bar for demonstrating efficacy so high that - except for severely depressed patients - the difference between treated and placebo groups did not reach a “statistically significant” level.
And continues
But researchers are only just beginning serious investigation of placebo power. “We do not really know what the mechanism is,” says Dr Derbyshire. “In fact, there may be lots of different mechanisms. For example, placebo painkillers somehow activate the brain’s endorphins [natural painkillers] while placebo aspirin activates a natural anti-inflammatory effect.“
Exactly. Now we’re getting a bit closer to the mark.
I’ve talked elsewhere about the non-local aspects of homeopathic treatment and the quantum mind-like effects observable and said
I’m saying the qualitative principles of quantum mechanics have the potential to model some of the observations which have been made in respect of homeopathy and many other of the more subtle, holistic therapies. Let’s get one thing straight right away. These effects are not specific to the therapy. They just become more apparent in the context of the therapy because of its level of subtlety and its holistic nature. They’ll be occurring just as much with conventional medicine too, but will be far less obvious to observers who are looking at things in a much more focused and linear way.
Here it would seem that evidence is starting to become clearer. And we need some new terms. ‘Placebo’ can’t be used to describe the specific effect of the patient’s expectation that the pill they’re taking will help them, at the same time as being a dustbin term for all non-specific effects of treatment. Personally I think it’s time the word placebo was restricted to its original sense and use: a dummy pill administered by a physician when he wants the patient to believe he’s taking the real McCoy. Using it in respect of intangible but verifiable effects of treatment is confusing the picture and leading to a derogatory attitude to these effects when we should be studying them free from such prejudice.
I’m going to suggest that there are 3 principle components in this effect: i) the effect due to the patient’s conscious expectations, ii) the effect due to the physician’s expectations transmitted to the patient through conscious entanglement, and iii) the effect due to conscious entanglement with the nature of the substance being prescribed.
The effect of patient expectation is clear and logical enough. Physician expectation also plays its part. In a February 2000 article in the Guardian on the rise of complementary medicine, Healing in Harmony, Jerome Burne wrote
Medicine is both an art and a science, but science has been firmly in the driving seat for 40 years. The arrival of CM practitioners may allow some of the more intangible aspects of the healing profession to re-emerge into the light, such as the power of the doctor’s own belief. “When I was starting out as a doctor, my professor told me about a new migraine drug,” recalls Marshall Marinker, professor of general practice at the University of London. “I prescribed it to a number of my patients, and it worked brilliantly. Many were completely cured. But then I began thinking about its mechanisms and how to design a trial, and it somehow stopped working so well. I never again got such good results as when I totally believed in it. I don’t think you can measure that sort of thing in clinical trials, but it is absolutely vital to the way medicine should work.”
The final effect, conscious entanglement with the nature of the substance being prescribed, is possibly going to be a harder stretch for some. Yet it seems the most plausible mechanism to explain how, as Derbyshire says above, “placebo painkillers somehow activate the brain’s endorphins while placebo aspirin activates a natural anti-inflammatory effect”.
And as it happens, this hypothesis also posits a rationale for homeopathy, explaining why effects should be observed when patient expectations aren’t relevant, and also why the wrong remedy has no effect.
So when Goldacre writes “Sugar pills are the future, if only there was a way to give them with integrity, and a straight face” he may very well find that the last laugh is, resoundingly, on him. There’s plenty of integrity and straight faces among homeopaths …
Tags: anti-depressants, Ben Goldacre, Clive Cookson, depression, evidence, Guardian, homeopaths, Homeopathy, Irving Kirsch, placebo, placebo effect, Prozac, Seroxat, SSRI, sugar pills
March 4, 2008 at 2:53 pm
I would add that belief coupled with desire may be the ultimate clue to any healing.
We live in a world of contrast- when we see what we don’t want, out of that is born the desire of what we do want. Match that with the belief that what you take or do
(medication, homeopathic remedy, placebo, meditation, etc) causes the emotions of the person to improve from say…despair or frustration, to say…hopefulness.
The improved vibrational state of the person leads them towards their desire to be well, and over time, sometimes quite quickly, their health improves.
Homeopathy is “vibrational” or “energy” medicine, and I suspect that it has the ability to help improve a person’s vibration…and that once the emotions have shifted to a better feeling place, healing on a deep level can begin.
“There is only a stream of wellbeing which you are allowing or not”- Abraham-Hicks
March 5, 2008 at 6:17 pm
I’m not so sure homeopathy is part of belief or “placebo” effect or that it is simply part of “allowing” emotional improvement. But I like the thinking that sees a process going on that is not simply a direct chemical change in the body or not a direct chemical change in the body.
It seems to me to be much more energetically intrinsic to the make up of the the body, the deeper make up. The elements of long lasting effect is not something that can be measured though with current science based techniques which measure primarily cause and effect. Time. Interesting, that someone with some significant clinical experience can appreciate that.
If you are attempting to get a handle on homeopathy via science and direct response it won’t work and perhaps the placebo concept will help. But homeopathy is far more than placebo.
March 5, 2008 at 8:52 pm
— It it seems the most plausible mechanism to explain how, as Derbyshire says above, “placebo painkillers somehow activate the brain’s endorphins while placebo aspirin activates a natural anti-inflammatory effect”. —
The problem is that there is no explanation of the mechanism of how this actually happens. Perhaps the placebo effect can be explained by homeopathy rather than the other way around?
March 5, 2008 at 10:19 pm
“But homeopathy is far more than placebo.”
We await the evidence for this statement with much anticipation.
March 6, 2008 at 12:17 am
Andy, canard master: the fact that you appear to spend MOST of your waking hours attempting (unsuccessfully) to debunk it proves that its is far more than placebo. Why would you spend so much time on this except that it has some awesome power for you. You are even afraid to take a homeopathic remedy.
March 6, 2008 at 9:53 am
Scary sugar pills!!!
March 6, 2008 at 11:46 am
A new quackbusting blog, associated with Telegraph journalist Damian Thomson, counterknowledge.com
Thompson et al have already defamed Frontline Homeopathy as ‘dangerous and lethal’ for treating a pneumonia in Senegal - ignoring the followup of the patient’s recovery.
March 6, 2008 at 1:54 pm
Yes, Andy I can see that fear motivates you- gotta hand it to dem sugar pills.
Damian Tomson et al- Well, now four per cent of all hospitals beds in the UK devoted to the misadventures of conventional medicine and lets find one homeopath in Senegal to denigrate….
March 6, 2008 at 3:57 pm
I went and read the article by Damian Thompson:
The elderly gentleman in question arrived with the symptoms of acute pneumonia, diagnosed by journalist Damian as viral pneumonia (which will NOT respond to anti-biotics I may add ), and after receiving two homeopathic remedies, this nearly dead gentleman left to go meet up with his buddies!! The relieved homeopath told him to return in a few hours to be checked up on by her.
So what is the problem! None! Another wonderful story of homeopathy’s amazing ability to cure.
March 7, 2008 at 12:08 am
homeopathy works in ways that you scientists don’t yet understand. I have seen many of my patients recover from a diverse array of ailments. Not one has not recovered. Let me be clear, over my 12 year career as an integrated health care professional, many states that conventional treatment cannot cure - like depression - I have treated, successfully. Why don’t you try it
good blog laughing, just googled it tonight!
christen.
March 7, 2008 at 8:13 pm
Andy, dear duck, open your little black eyes and look around you! It’s all hiding in plain sight. The only thing that stops you seeing it is your preconceptions about the nature of life, disease, what constitutes an ‘effective’ healing intervention and the rationalisations you use to pull the whole thing together.
First you have to define what you mean by ‘placebo’.
Are you restricting your definition to the much derided effect arising solely from the patient’s expectation that the pill they’re taking will make them better? This is what most people seem to mean by ‘placebo’ and if so, homeopathy is definitely far more than placebo. Most of the reasons why have been given exhaustively (and exhaustingly) in other posts here and elsewhere.
If, on the other hand, you’re including all the other various barely-recognised-let- alone-understood non-specific aspects of treatment in that catch-all term, then you may have a point — Hahnemann proclaimed right from the start that homeopathy’s mechanism of action was through ‘immaterial substance’ — but you’re using the term wrongly to describe these effects and reacting to them in a totally inappropriate way. These are not some kind of ‘non-effect’! They’re extraordinarily powerful and when harnessed efficiently (which they’re generally not in DBRCTs) have potential that, as early studies appear to be indicating, might well be superior to conventional pharmaceutical interventions.
When you also take into account the absence of toxic chemical side-effects, the minimal environmental impact and extremely low cost of production of homeopathic remedies, then there’s very good reason to be exploring the potential of this therapy much more extensively.
Don’t laugh, sugar pills are the future.
March 7, 2008 at 8:39 pm
Why should that be a problem? You don’t need to know how or why something works to make use of the fact that it does. Nobody knows how or why gravity happens, but it doesn’t stop us observing it and using it to an extraordinary degree of precision.
These are mechanisms that have been used in healing since time aboriginal. The explanations of how they work are all out there, formulated in any number of different ways depending on the culture they’re found in, none of which, unfortunately, are acceptable to a determinedly materialist ’scientific’ perspective. Though of course that doesn’t mean they’re ‘wrong’ or that they don’t exist.
Personally I think a scientifically acceptable formulation will be found in the research being done on quantum entanglement effects in consciousness — ‘quantum mind’ type theories. It’s not there yet, but it looks like the most promising area of exploration.
Perhaps. Though ‘placebo effect’ is going to need a thorough redefinition first. The pointy white hats have got to go too.
March 7, 2008 at 9:36 pm
— Though ‘placebo effect’ is going to need a thorough redefinition first. The pointy white hats have got to go too. —
It already has a thorough redefinition … within homeopathy, where there is a much more precise recognition of the range of actions in response to treatment than in orthodox medicine.
I think that one day the people in pointy white hats will find that they have also been given wrap-around jackets and padded walls, since they insist on refusing homeopathic medical treatment for their condition. Some people really would rather die than have homeopathy.
March 7, 2008 at 9:47 pm
— Why should that be a problem? —
Because those who believe that homeopathy is inexplicable and claim that it is an example of the unexplained placebo effect are simply demonstrating a prejudice for one inexplicability over another, rather than a scientific approach to the facts.
I find it extra-ordinary that some people can claim to be scientific and yet confuse “evidence” with “science”. That they then constrain the definition of evidence to such an extent that it becomes scientifically valueless makes the whole thing even more absurd. But then a “canard” is a false rumour after all, and whether it lays claim to representing the world in ‘noir et blanc’ or ‘rose’, it should be exposed as unreal.
March 7, 2008 at 10:08 pm
Well, laughing, if you are genuinely interested in the placebo effect, then I can recommend the book Placebo by Dylan Evans. Easy read. And pulls together the latest research and thinking on the subject.
For most people, when they talk about the placebo effect, it means the broad range of reported effects due to treatment with an inert intervention. This ’soft’ placebo can be broken down into:
- normal improvement in health
- disease gets better anyway (short term illnesses)
- regression to the mean (chronic illnesses)
- psychological reinterpretation of severity of illness - ’someone is looking after me’.
- wrong attribution - people credit the intervention they would like to have been the cause.
- desire to please therapist - under reporting symptoms to them.
- selective reporting/cognitive biases.
and so on.
There may well be ‘hard’ placebo effects to where a belief can genuinely alter physiological states such as temperature, swelling, pain response etc. The evidence for this is not as strong as we might think, although most would agree that it exists to one extent or another.
Homeopathy can be best explained by the placebo. This is supported by the nature of complaints most treated and advertised by homeopaths - chronic, low grade illnesses where the above effects play most strongest. Few homeopaths claim to be able to treat conditions where the effects could have no role - cancer, serious viral illness etc.
One of the biggest criticisms of homeopaths is they act as if the above phenomena do not exist. Do you not doubt that illness can get better on its own? That chronic illness can be cyclical? That people may feel better, rather than be better? If so, why the hostility to proper blinded, randomised trials?
Also, although placebo might well be dramatic at times, the above analysis would obviously suggest it is not a panacea. You cannot invoke placebo to sure all manner of illnesses. Surely, it then behoves homeopaths to act within the constraints of this knowledge?
March 7, 2008 at 10:10 pm
Actually, le canard noir is more than a false rumour. Petit Robert defines un canard as:
A false piece of news released to the press in order to mislead the public.
At least the quackometer is truthful about one thing.
March 7, 2008 at 10:20 pm
givescienceachance - I make serious and sincere points and you respond with a cheap attack. Homeopaths’ refusal to engage with sincere criticism will be their undoing. Every time you do this, you loose just one more little bit of credibility.
March 8, 2008 at 9:16 pm
I would be interested to know how you define, or ensure, an ‘inert intervention’?
March 9, 2008 at 1:28 pm
Evans’ view is a very restricted idea of the sum total of non-specific effects active in treatment. And if you think
I suggest you check out a dictionary.
Errr … no. If you want to pontificate on what homeopaths treat and how it can best be explained, you actually need to study the therapy in use, not draw inaccurate conclusions based on what you imagine is going on. Homeopathy is not adequately explained by the placebo effect according to your definition of it. Few homeopaths in the UK claim to treat serious conditions because the law in this country forbids us to do so. I suggest you study the use of homeopathy in India. You’ll find plenty of cases in the homeopathic hospitals and clinics there of successful treatment of serious conditions, including cancer and serious viral illness.
Where’s your evidence in support of the statement that homeopaths act as if these phenomena don’t exist? Looks like a case of ‘let’s make it up as we go along’ to me. Of course illnesses get better on their own! Of course chronic conditions are cyclical! Leaving aside non-medically qualified homeopaths for a minute, do you honestly think that large numbers of qualified medical doctors, having studied conventional medicine, then homeopathy, and left conventional treatment behind because they find homeopathy a superior modality, don’t know when they’re seeing an effective clinical intervention?!! As Sir John Weir said back in 1940 “I suppose not one of us has approached homeopathy otherwise than with doubt and mistrust; but facts have been too much for us.”
As for more recent trends, Reilly states “Hospital doctor referrals to the GHH [Glasgow Homeopathic Hospital] Integrative care unit have grown from 5% in 1990 to 20% in 2005. The rise in referral rate from GPs, and in the numbers trained in the UK reflects the positive attitude which many doctors now have towards this treatment. Practitioners are rating the treatment as useable and useful in NHS practice with around 80% reporting continued integration of homeopathy in their NHS general practice 2 years after attending basic training.”
When you give a treatment and you see an immediate and sustained improvement which doesn’t fit the pattern of the normal progression of the illness or its cycle of remission, and you can repeat this consistently based on clear theoretical guidelines, then you are working with an effective intervention. If this were a conventional pharmaceutical intervention, you would have no problem whatsoever accepting this as evidence of its efficacy. However, since it’s homeopathy you assume it can’t possibly be an effective intervention because you think homeopathy is impossible, so therefore it’s a ’spontaneous remission’ or somesuch. How unscientific is that!
What an utterly extraordinary statement!! Let me get this right. You think that the current ’scientific’ consensus in its woeful inadequacy at explaining vast numbers of phenomena associated with life processes should somehow constrain what people do to explore the possibilities of healing with other modalities? When those other modalities have demonstrated their efficacy time and time again? When people of their own free will chose to explore these possibilities for their own healthcare? And when this same ’scientific’ consensus is responsible for the premature and unnecessary deaths of thousands of people every year as a direct result of its normal use in practice? In such circumstances I think it behoves any concerned clinician to “first, do no harm” and second, to use therapies that have repeatedly shown themselves to be effective in situations where it matters — in clinical practice.
How do you know you can’t invoke non-specific effects to cure all manner of illnesses? Studies and explorations in this area have only just begun and it’s freely admitted that knowledge is sketchy at best. How would you even begin to invoke those effects successfully if you don’t even know what they are? Of course you could always go study homeopathy …
Honestly Andy, you don’t do yourself any favours coming out with such statements. Who do you think you are? The Thought Police? It’s abundantly plain you’re not a clinician. If you were, you’d know full well that all your nice ’scientific’ theories have a tendency to spring leaks all over the place when you’re attempting to help real people suffering from real illnesses. It’s those very leaks that lead a lot of GPs and other frontline healthcare professionals to study, then practise, homeopathy.
March 9, 2008 at 2:00 pm
This comes across as a bit disingenuous, Andy, given some of your writings on the subject. You’re hardly going to attract the sort of attention that leads to your ISP pulling the plug on your site if your points are merely serious and sincere, and if you choose a double entendre for a handle then surely pointing that out hardly constitutes an ‘attack’?
That aside, I do know there’s seriousness and sincerity in your points. Personally I think that the sceptical camp have made some very good points in amongst all the invective that our fledgling profession needs to pay serious heed to. Expressing them the way you do though pretty much guarantees that nobody’s going to engage with you, and those who express themselves similarly, when you make them, so you are just as much responsible for creating the lack of engagement as any homeopath. Nobody’s going to talk seriously with anyone screaming at them that they’re nothing but liars, cheats and morons.
I know you haven’t done that here, but hey! we’re homeopaths. We take the totality of expression into account …
The other point worth making about serious and sincere engagement is that it involves a bit of give and take. One of the things that characterises the sceptical dialogue is the complete refusal to acknowledge the validity of any perspective other than the fundamentalist interpretation of what might loosely be termed the ’scientific’ world view. I’ve gone into great length elsewhere to show that most thought systems construct their own proof through the circularity of their logic and the scientific world view is no exception.
Something that’s not amenable to proof within your own circular logic is simply not amenable to proof within that system. However, that doesn’t mean it doesn’t exist or that it’s not provable within a system of higher order.
March 9, 2008 at 6:31 pm
Big Response. let’s try to deal with some stuff…
Barney - an inert intervention, without getting too quibbley, is something like a sugar pill where you would expect no medical effect from the pill itself.
socks - Have you read Evans book? What specific elements do you think he leaves out? And as for me checking out a dictionary, what would be your definition and understanding of a placebo and how would it differ from mine. Please be as specific as you can.
You ask me “Where’s your evidence in support of the statement that homeopaths act as if these phenomena [placebo etc] don’t exist?”
Quite simply that homeopaths appear to take their own personal experience and the anecdotes of others as sufficient proof of the efficacy of their actions. If you were sincere in recognising your own capacity to be fooled by the placebo effect, natural remission etc, then you would be much more cautious in your claims. But homeopaths act as if they cannot be fooled. That the strength of their own conviction is sufficient. Your Indian example is just the same. How do you know that Indian homeopaths are successful at treating cancer? Where is the data as apposed to the bragging?
You ask me to accept that when you see an improvement that does not fit your preconceptions of what should happen then that is proof enough. Well, we will have to disagree. This whole discussion is about the placebo effect. By its very nature, quick and sudden improvements might well be reported. How can you tell the difference? Do you have special insight as to when the placebo effect should not work and how strong a response you should get?
You then launch into a bout of wishful thinking asking again to believing in the “possibilities of healing with other modalities”. This is begging the question because it presumes their are other modalities. I doubt that homeopathy is another modality so you cannot use this as a presumption in trying to convince a sceptic. Give some data as to the effectiveness of what you say and all will be well.
How do I know you can’t invoke non-specific effects to cure all manner of illnesses? Well, I don’t. But such a thing would be extraordinary and so one would be wise to ask for some evidence before trusting your life in such matters.
You then sort of accuse me of calling homeopaths “liars, cheats and morons” but admit that, actually. I have not done so. Have I ever? I believe homeopaths are simply deluded that’s all. Well meaning, but deluded. It can happen to us all, that is why you need to think critically. I have accused some homeopaths of specifically misrepresenting the truth and have always given clear evidence fo this - such as the Society of Homeopaths assertions about their role in dealing with rogue homeopaths.
And as for my problems with my ISP, do you really want to defend Joseph Obi? This guy was mostly ripping off alternative health practitioners. You ought to be giving me a medal for services to CAM rather than attacking my sincere questions.
You then say ” take. One of the things that characterises the sceptical dialogue is the complete refusal to acknowledge the validity of any perspective other that the fundamentalist interpretation of what might loosely be termed the ’scientific’ world view”.
This is all well and dandy philosophising, but I am not using anything too complication or too ’scientific’. All I am doing is simply asking for some unequivocal data to suggest what you do is not the placebo effect. What is wrong with that? What ‘higher order’ are you appealing too? Please be specific about this as I think this is just a red herring.
March 10, 2008 at 12:45 am
I’ve not read the book, but I’ve read the reviews, Evans’ own distillation of its main hypothesis, and other articles he’s written based on the ideas in the book. As I said, his view is a very restricted idea of the sum total of non-specific effects active in treatment. I find his thinking too linear and his reasoning at times painfully circular.
But if you’re using Evans’ work to support your assertion that homeopathy is no more than placebo, think again. His predictions about what conditions are and aren’t amenable to placebo response by pegging ‘placebo’ to Acute Phase Response don’t come anywhere close to matching response data from homeopathic cases. His central tenet that all placebo response is due to the patient’s belief in the efficacy of the treatment they’re being given is blown out of the window where babies and animals are concerned (and where deeply sceptical individuals have also produced positive responses). This argument has been gone over again and again Andy. The observations don’t fit the theory. The observations don’t fit the theory. The observations don’t fit the theory. The observations don’t fit the … how many more times?
Evans tells us that depression is something that’s going to respond well to placebo, so let’s look at the Bristol study and see what happened. 201 patients, outcome scores -3 0%, -2 0%, -1 1%, 0 23%, +1 18%, +2 34%, +3 19%, unscorable 4%, affected by other factors (including other treatments) 1%. 71% of patients reporting some improvement. Possibly what you might expect if you think homeopathy is placebo as per Evans’ definition. So far, a good fit.
Asthma is not included in Evans’ list of conditions likely to respond to placebo (even if APR symptoms may be evident), so you would expect results here to be weighted more to the no effect or negative if your hypothesis holds true. Bristol study results for asthma in under 16 year olds: 195 patients, outcome scores -3 0%, -2 0%, -1 2%, 0 6%, +1 14%, +2 26%, +3 49%, unscorable 3%, affected by other factors (including other treatments) 0%. 89% of patients reporting improvement, with a massive 49% in the much better category. Not such a good fit, but natural remission may be a factor (though noting that 30-80% of natural remissions relapse).
Evans tells us cancer will absolutely not respond to placebo, so if homeopathy is just placebo then there clearly should be no positive response of note. The Bristol study monitored 301 cancer patients, so a larger sample than the 2 conditions already mentioned. Outcome scores -3 1%, -2 1%, -1 8%, 0 15%, +1 20%, +2 27%, +3 26%, unscorable 2%, affected by other factors (including other treatments) 0%. 73% of patients reporting some improvement. This doesn’t fit at all.
Paradoxically, the condition which you would expect to score highest if homeopathy is placebo actually scored the lowest.
Andy we can hardly be ‘fooled’ by the placebo effect when the placebo effect is part and parcel of the treatment. It’s one of a range of non-specific effects we’re invoking, but by no means the only one. Your conclusion is overstated. Homeopaths (leastways, not the ones I know and work with) don’t act as if they can’t be fooled. You seem to forget that most of us have come to homeopathy sceptical of its claims, many of us from a conventional medical background, and have put them rigorously to the test before satisfying ourselves that they were robust enough. To then take the step of investing considerable time, effort and personal expense in studying such an implausible therapy, with little in prospect apart from job satisfaction, you have to be pretty damn sure it’s really doing something!
The emphasis on case history is as much a product of sceptical misinformation that there’s no evidence in support of the therapy as it is of anything, but it’s also the case that with a highly individualised therapy such as this, case history has to be the primary clinical evidence base. The therapy relies on far too many detailed data points for these to be assembled by any other means. Provings elicit a range of symptoms which can be used as prescribing guidelines, but until those exact symptoms have been clinically cured by that remedy, then they remain unconfirmed. Homeopaths use a grading system which produces confidence ratings according to the number of clinical verifications recorded for every symptom in every remedy.
So yes, the data is in individual case histories, supported in many cases by objective parameters. Most homeopaths in India are too busy helping people to devote time and scarce resources to conducting studies to satisfy a handful of sceptics on another continent, but they do document their cases. No therapy persists and gains in popularity unless it’s effective. Cured cases, particularly cured cases when conventional medicine has failed, are the therapy’s best advocates and are why it continues to grow. If you want to question the existence of such individuals and dismiss documentation of their cures as ‘bragging’, well of course you’re perfectly free to do so, but this doesn’t elevate your opinion to fact. As I’ve said before, an argument that relies on dismissing others as liars, cheats, frauds and morons in order to support its conclusions is on very shaky ground.
If the placebo effect relies on the belief of the patient that what they’re receiving will help them recover, then there are far too many instances of immediate and powerful response where that belief simply isn’t there. You can keep trying to shoehorn homeopathy into your placebo theory as long as you like Andy, but like I keep saying, the observations don’t fit the theory. The observations don’t fit the theory. The observations don’t fit the … and that’s essential for this to be good science.
LOL!! No less a bout of wishful thinking than your own in imagining that the scientific world view is the be all and end all of everything. The hubris of this perspective is quite extraordinary. Of course there are other modalities. What on earth do you think the human race used for medicine in the 10,000+ years before the advent of ’scientific’ medicine?! And if you think that Traditional Chinese Medicine works on the same principles as Western medicine, think again. Any form of medicine is nothing but a historical variable in any human community. Biomedicine is no different.
Would it really be extraordinary? From an anthropological and historical perspective you could argue that this method of treatment is the norm rather than the exception. But by all means ask for evidence. And it’s entirely up to you to be the judge of what sort of evidence you find convincing. As it is for any other individual going through their own process.
I can see how you come to that conclusion, but since your view of homeopaths is so often of your own construction and bears little relation to the genuine article, it begs the question are you really just looking in the mirror when you say that?
Oh come on now Andy! You’d be hard pressed to extract any notion of defending Obi from my comments about your ISP problems. I said “You’re hardly going to attract the sort of attention that leads to your ISP pulling the plug on your site if your points are merely serious and sincere.” We all need to take responsibility for how we communicate and what sort of responses we attract as a result. The fact that there’s seriousness and sincerity in your comments doesn’t mean that’s all there is. And it’s the other stuff that tends to make the dialogue a little … shall we say … tricky.
This is a frustrating medium at times though. It seems to amplify issues out of all proportion to how they’d come across in person and I’m betting that if we sat down in the same room to talk about this the dialogue would be completely different and probably a lot more enjoyable. Yet it has its uses. Particularly when it comes to catching sight of our own projections.
Well the thing is that the philosophy is utterly crucial here because it’s the foundation on which the entire edifice is built. Everything above that level is purely circular logic. However, if you’re defining ‘placebo effect’ as the effect due to the patient’s belief in the therapy, then go check out Christopher Day’s work. Animals, particularly farm animals, are not going to be going in for the belief thing.
This is the whole area that needs to be teased out and explored. In a sense, you and other sceptics are in the right ballpark in saying that homeopathy is placebo in that its effects are predominantly non-material in origin — which, after all, the therapy has said right from the start. But you’re totally incorrect in imagining that all this effect amounts to is the patient’s belief. Think about it. Impasses like this usually end up resolving when it’s recognised that both sides are correct in some ways, but not in others.
The ‘higher order’ I’m appealing to is a theoretical system capable of encompassing both the biomedical model and the homeopathic without conflict or contradiction. It’s what’s needed to resolve this, in my not so humble opinion.
March 10, 2008 at 2:43 am
Lmso,
The very existence of the placebo effect shows how tenuous is the link between perceived health (or illness) and reality, yet you seem to think that you can determine its presence and level. Nice claim.
Beware the self-assessment trap.
http://www.apa.org/journals/features/psp7761121.pdf
The placebo effect is complex and fickle. It is not restricted to medical trails alone, though for health, it may have some specific attributes.
Unlike the other senses, taste and smell are connected to the hypothalamus, a primitive area of the brain. Taste and smell can invoke powerful memories and feelings, uniquely in fact. They just happen, whether you like it or not.
You go to a party, and have a good time. Why should that happen? Why shouldn’t a placebo have an effect ? On what rational basis should one accept one but not the other?
I posit that visceral (and most conscious) experience is one placebo effect or another. Can you refute that?
There is an explanation for the effect upon children. Naive vitalism.
“One of the key issues in conceptual development research concerns what kinds of causal devices young children use to understand the biological world. We review evidence that children predict and interpret biological phenomena, especially human bodily processes, on the basis of ‘vitalistic causality’. That is, they assume that vital power or life force taken from food and water makes humans active, prevents them from being taken ill, and enables them to grow.These relationships are also extended readily to other animals and even to plants. Recent experimental results show that a majority of preschoolers tend to choose vitalistic explanations as most plausible. Vitalism, together with other forms of intermediate causality, constitute unique causal devices for naive biology as a core domain of thought.”
Another;
Vitalism is the belief that internal bodily organs have agency and that they transmit or exchange a vital force or energy. Three experiments investigated the use of vitalistic explanations for biological phenomena by 5- and 10-year-old English-speaking children and adults, focusing on 2 components: the notion that bodily organs have intentions and the notion that some life force or energy is transmitted. The original Japanese finding of vitalistic thinking was replicated in Experiment 1 with English-speaking 5-year-olds. Experiment 2 indicated that the more active component of vitalism for these children is a belief in the transfer of energy during biological processes, and Experiment 3 suggested an additional, albeit lesser, role for organ intentionality. A belief in vital energy may serve a causal placeholder function within a naive theory of biology until a more precisely formulated mechanism is known.
As for instant response, do you not think that a GP’s patients do not perk up at the mere prospectof good health, or when he or she reaches for the prescription pad?
Animals can’t speak, but vets do. Too contentious to matter.
The Bristol report has been done before, Lmso. Anecdotal, no follow up, no biopsies, no control…..
As far as LCN’s site goes, I was not aware of how much quackery there was until I stumbled upon the Quackometer. I don’t see that Andy’s language is disproportionate with the crimes that he uncovers.
I also agree that the level of philosophy, logic or proof required of homeopathy is no more than you use when you check your bank statements against income and expenditure.
March 10, 2008 at 11:40 am
socks - so you have not read Evans book and yet you dismiss it as ‘circular reasoning’ and ‘restricted’. I asked you to be specific and you have given a broad brush answer. Can you back up your views specifically?
As for animals and babies - the answer is easy. I think you are failing to separate out the issues clearly. A hard placebo response due to the patients beliefs is only one way we can be fooled by a medicine’s effectiveness. I have detailed the other ways above and I said that homeopaths ignore them. You have demonstrated again that you ignore them. Babies and animals are still susceptible to regression to the mean, false attribution, wishful thinking on behalf of the owner/parent and so on. And their may well be a placebo effect with animals and babies. Which distressed babies and animals do you know that are not comforted by a the kindness and attention of their owners/parents?
I am well aware of the homeopathic vet Christopher Day and his work. I have one of his books in front of me and, yes, I have read it. In it, he recommends that cats suffering from burns or scalds should be given Cantharis 30c and Urtica 6c. If your cat is has been shot, then he recommends Arnica 30c. My feeling is that the RSPCA should prosecute him.
Next you bring up the Bristol Homeopathic Study. This study is famous for failing to take into account all the effects I have been mentioning. If failed to find any sort of baseline to which it could compare its results. We do not know what would have happened to these patients if they did not take homeopathy and so any comparison is meaningless. For cancer, it failed to take into account the fact that almost all were undergoing conventional treatment, it failed to take into account those that had died or were too ill to respond. It failed to take into account those that did not respond because they were disillusioned or in some other way unhappy enough with the Bristol clinic not to respond. That 30% of the people who responded, despite all of this, were still unhappy with their experiences should cause massive alarm bells. The paper has been described as no more than a customer satisfaction survey and homeopaths who continue to use it as evidence of the effectiveness of homeopathic treatment look like being intellectually dishonest. Its an advertising press release, not science.
Although, could this be an example of the ‘alternative modalities’ and ‘higher order systems of belief’? Well to me, it just looks like sloppy thinking. I hope we can all aspire to better. 8What is this ‘higher order’ you speak of? Can you give one specific example of a way of looking at evidence or the world that would add to the scientific method constructively , give new insights, and allow the integration of homeopathy with reality-based medicine?
March 16, 2008 at 3:30 pm
Misleading the public said: Its an advertising press release, not science.
Well, in the absence of any science on which he can base his opinions, that comes a bit rich.
For example, he can offer no scientific explanation of how the placebo effect works - sorry, his so-called “hard” placebo effect, to be distinguished from all the other effects that people like him have lumped in with it.
Nor can he can offer a scientific analysis to demonstrate after the event that a case has resolved as a result of “regression to the mean” or “natural history of the disease” or “wishful thinking” or “false attribution” as opposed to being a result of treatment, which is the absolute minimum for a test of a scientific explanation. As for being able to predict such a result, the true test of a scientific theory, forget it! That is not even remotely on the agenda.
What could be an explanation in the absence of a theory does not invalidate an explanation based on a theory. Quite the reverse, a consistent theoretical analysis of evidence represents a significant advance on explanations of the “it might be” sort. As such, homeopathy is a real advance on anything he has to offer.
Finally, to call the statistical interpretation of evidence based on an unacknowledged, undefined and unproven theoretical approach “reality-based” is bizarre.
March 18, 2008 at 2:29 pm
Humber, Andy … apologies for the delay in getting back to you. Been out of town for a week.
Yes indeed. It’s very clear how each of you are reasoning and superficially your arguments seem pretty sensible. Yes regressions to the mean can be a factor, false attribution is possible, wishful thinking is possible, etc, etc, but these postulated explanations simply don’t fit a huge number of cases treated by homeopathy, particularly those with several years of follow up and progression in severe chronic conditions. As I keep on saying … and on … and on … the observations don’t fit the theory.
This is really the point at which theoretical speculation has to give way to proper observation. If you’re not involving yourselves in clinical situations where you can test out your theories in actuality, then you remain within the realms of your imaginations. It may all look very plausible from this perspective but it just doesn’t hold water in the clinic.
I’ve quoted Sir John Weir before, but he summed it up pretty well in 1940 when he said “I suppose not one of us has approached homeopathy otherwise than with doubt and mistrust; but facts have been too much for us.”
And Humber, babies a couple of months old are unlikely to have any concept of biology, vitalist or otherwise. Regression to the mean, false attribution or wishful thinking doesn’t adequately explain instant cessation of serious acute illness with poor prognosis immediately following administration of the correct, and only the correct remedy (as previously established in case history and consistently replicable). You’ve just got to see this happen. Only when you can link your theories to individual and detailed observations in the clinic can you argue from a standpoint of scientific validity. Until that point it’s no more than idle speculation.
March 19, 2008 at 12:29 pm
laughingmysocksoff - there is nothing speculative about saying that homeopathy cannot work given what we know about how matter is constructed. It is rock solid science. You say you want to do proper observation but constantly fall into various thinking traps. The human mind is excellent at remembering successes; not so good at remembering our failures. Coupled with problems like regression to the mean and so on, gives a perfectly reasonable explanation as to why people believe homeopathy works: regression to the mean shows patient improvement; this is falsely attributed to the action of the homeopatjic pill; failures are not given so much weight as successes; the desire to believe is strong with much phsychological investment placed in believing - and there you have it. All you need to know about homeopathy.
This is not idle speculation, but the only plausible explanation for the effects you describe. To show thatthis explanation was wrong, you woul dhave to remove all the biases that we all live with - trials. Despite the string claims made for homeopathy, whatever trials there are always appear to be scraping around in the statistical noise.
March 19, 2008 at 11:11 pm
So perhaps Andy Lewis could explain why Dr J.T. Kent was able to specifically identify 12 (yes twelve) different reactions to a homeopathic remedy, relating those reactions to the state of health of the patient (including degrees of pathological change) and providing prognoses based on these reactions.
It is still possible to use his analysis to identify pathology in a patient by observation of the patient’s reaction to a homeopathic remedy, and to have this confirmed by physical investigations. That is evidence of a scientific approach to medicine which cuts through all the nonsense of “if”s and “maybe”s thrown around by those desperate to deny homeopathy.
Patients do not simply exhibit a reduction in symptoms after homeopathic treatment, and to continue to pretend that that is the only reaction is to refuse to consider facts in favour of holding onto a belief. The actual reactions are much more complicated, even more so nowadays than in Kent’s day, since modern drug treatments generate much more complex distortions of the body’s natural processes than before.
Your “plausible explanation” is relevant only to your imaginary problem; it is utterly irrelevant and implausible as an explanation of real events. Furthermore it has no scientific theory to support it, and no means of being properly tested - and that includes DBRCTs. A good scientific analysis accepts the biases in the real world and explains the reasons for them and their implications. It can also predict consequences. When you do not have the theoretical tools to clearly distinguish between the effect of a treatment and any other process of change in a patient, you have no basis for standing in judgement over those who can - you have no science.
What you do have is idle and noisy speculation.
March 20, 2008 at 5:54 pm
We stand in two different worlds. How would you objectively determine who was right? How could you convince me that homeopathy is not a delusion? What would it take for a homeopath to reconsider their position?
These are scientific questions. I can answer them the first. I know what would change my mind. Can you answer the second?
March 21, 2008 at 12:25 am
We certainly do stand in two different worlds if you consider these to be scientific questions. Even more so if you think you have asked two questions when you have actually asked three.
No-one can be right until they have a perfect understanding of the world about us. Science involves shifts to better paradigms, but we are a long way from perfection of our knowledge. One of us may have a better explanation, but to know who does, we have to be able to compare scientific theories and their ability to explain and predict in the field of health and illness.
I have no idea how to convince you that homeopathy is not a delusion as this opinion of yours is founded on a belief, not a scientific explanation capable of being tested.
Homeopaths would reconsider their position, I am sure, if they were presented with a better scientific theory of medicine. Indeed if they were presented with ANY other scientific theory of medicine there would at least be a basis for reasonable debate.
What it comes back to all the time is the fact that you will not provide the scientific foundations for your opinions, and yet you continually maintain that your opinions are based on such a foundation. Until you provide the scientific theory which forms this foundation, there is no evidence that you stand in the real world which we inhabit, but only the suspicion that your views are simply idle speculation.
March 21, 2008 at 2:49 pm
I am sorry givescienceachance, but I can only say that you are being absurd. I have a feeling that you really do not understand science. The thrust of my argument here is that homeopaths ignore basic scientific precautions in evaluating their effectiveness. They do no take into account regression to the mean, selection bias and placebo effects. These ideas are base in logic and well understood psychology. The fact that ‘real’ placebo effects may well be poorly understood does not invalidate this position. It is the homeopaths who refuse to base their beliefs on any sort of science. ‘Like cures like’? What is the physiological basis for this general principle? There is none. The ‘Law of Minimum Dose’? Again, what material and biological basis is this ‘Law’ based on? What experimental evidence is there for this? Absolutely none. It flies in the face of not just science but common sense.
A scientific view would say homeopathy is nonsense - you cannot dilute to the levels homeopaths say they do an expect a material effect. In order to posit an effect, you have to reach out to non-scientific and pseudoscientific concepts - miasms, ‘energy’, ‘water memory’.
You could easily convince me I am wrong by being able to do any blinded experiment that could tell 30C dilutions apart. I have made this clear on the ‘challenge to homeopaths’ on my web site. I do not believe you are giving science a chance because you cannot adopt the scientific standpoint of saying what would change your mind.
March 21, 2008 at 11:29 pm
— The thrust of my argument here is that homeopaths ignore basic scientific precautions in evaluating their effectiveness. They do no take into account regression to the mean, selection bias and placebo effects.
But they do. You need more than a cursory knowledge of homeopathy to understand this, though.
— The fact that ‘real’ placebo effects may well be poorly understood does not invalidate this position.
The fact that the mechanism of homeopathy is poorly understood does not invalidate it either.
— ‘Like cures like’? What is the physiological basis for this general principle? There is none.
This principle was derived from clinical evidence, and is supported by the physiological fact of homeostasis.
— The ‘Law of Minimum Dose’? Again, what material and biological basis is this ‘Law’ based on? What experimental evidence is there for this? Absolutely none.
All medication, orthodox or homeopathic, is based on using the minimum necessary, because it is obvious to any medical practitioner that anything more than that is at best a waste, and at worst harmful.
— A scientific view would say homeopathy is nonsense - you cannot dilute to the levels homeopaths say they do an expect a material effect.
But that is an assumption and is unproven. In fact there is evidence that it is incorrect, abundant evidence as a result of the work not only of homeopaths but of non-homeoapaths too.
— In order to posit an effect, you have to reach out to non-scientific and pseudoscientific concepts - miasms, ‘energy’, ‘water memory’.
No, you only have to accept that science is more than chemistry.
— You could easily convince me I am wrong by being able to do any blinded experiment that could tell 30C dilutions apart.
This has been done repeatedly. At the same time blinded experiments were developed not because of a growth in the scientific understanding of orthodox medicine, but because of the absence of such an understanding. They are not capable of producing conclusions other than in the context of a theoretical framework.
Which brings us back to the central problem: in all the comments you have made, you have still failed to supply the scientific theory underpinning orthodox medicine and your opinions. You cannot seriously justify attacking a theory when you can not offer any other to replace it. I have said what would probably change a homeopath’s mind, so why don’t you provide it?
March 22, 2008 at 11:05 am
-The fact that the mechanism of homeopathy is poorly understood does not invalidate it either.
The difference is that there is evidence of a placebo effect. There is so little for homeopathy.
- you cannot dilute to the levels homeopaths say they do an expect a material effect. - But that is an assumption and is unproven.
No it is not an assumption. It is a solid conclusion based on rock solid material science. There is no unequivocal evidence to dispute this.
-No, you only have to accept that science is more than chemistry.
What will you add? Miasms and Life Forces?
— You could easily convince me I am wrong by being able to do any blinded experiment that could tell 30C dilutions apart. - This has been done repeatedly.
References please. Rao et al is not one of them. So stupid an experiment that it hurts.
Why should I supply a theory explaining medicine. Medicine is mutli faceted and draws on much physics, chemisty and biology that is all very well understood. It is not complete, but that is the nature of science. Progression in understanding.
Meanwhile homeopathy, remains stuck in discredited 19th Century superstition.
And I am still not clear what would change you mind. Could you spell it out in two or three sentences? Describe the experiment or data that would cast doubt on your beliefs?
March 23, 2008 at 11:41 am
— Why should I supply a theory explaining medicine
Because without a theory there is no science.
No theory of medicine = no science of medicine.
No science of medicine = no basis for criticising theories of medicine.
No science of medicine means that your opinions are beliefs only.
No science of medicine means no framework for interpreting evidence.
There is no such thing as evidence in the abstract, it can only be understood in a theoretical framework.
When you talk about evidence and fail to define the theoretical framework you are using, it is impossible to evaluate your opinions scientifically.
Let me make it easy for you.
For a start, just define the placebo effect scientifically, that is, in such a way as the results, causative factors and processes can be identified and understood.
March 24, 2008 at 7:15 pm
givescienceachance - your failure to compregend medical science is probably due to you trying to shoehorn the way homeopathic ‘theory’ works and then insist that medicine follows suit. Homeopathy tries to create a unifying theory of all things medical with its “similia similibus curentur” waffle. Medical science has no overarching simple medical principle like this beacuse it recognises that life does not work according to simplistic maxims.
Medical science draws on very many areas of science that are well understood. e.g. a small snapshot - radiotherapy uses the theories of fundamental particle interaction with matter, antibiotic resistance - evolutionary theory, drug and protein modelling - quantum mechanics. At its root though, all medical science depends on a biochemical understanding of life and not a world view based on mysticism, magic or mumbo jumbo.
Placebo, and the understanding of their effects, draws mainly on the science of psychology - expectancy effects, conditioning and motivational effects. There may even be effects best understood through direct biochemical brain interactions. But you appear to miss the main point about placebos and why drugs are tested against placebo. Maybe the role pacebo is minimal or non-existent. Drugs are tested against a possible placebo effect - it does not mean one is present.
So, what is the scientific framework that supports the interpretation of homepathy? Come on. Can you answer that?
March 25, 2008 at 3:46 pm
So we come to the terribly post-modern position of there being no grand narratives for medicine, and hence no science:
— Medical science has no overarching simple medical principle like this beacuse it recognises that life does not work according to simplistic maxims.
But then it is followed by a weaselly statement that:
— At its root though, all medical science depends on a biochemical understanding of life.
So there is a grand narrative, but it has not been worked out yet, which explains:
— Placebo, and the understanding of their effects, draws mainly on the science of psychology - expectancy effects, conditioning and motivational effects. There may even be effects best understood through direct biochemical brain interactions.
Basically this means that there is no theoretical explanation of placebo effect, or even that:
— Maybe the role pacebo [plays?] is minimal or non-existent.
SO:
There is no scientific theory for medicine, because life is too complex
There is a scientific theoretical approach based on a biochemical model
Placebo may be psychological (psychology being a science!), which may be biochemical.
Placebo may not even exist.
And you say that I do not understand medical science? If it is like this nobody could possibly understand it. I think you scepticism is misplaced and should be applied to anyone who suggests that this view of medicine is scientific.
March 28, 2008 at 10:02 pm
GSAC thanks for your contributions! You’ve made points very similar to the ones I’ve tried to get across in digging down to the philosophical foundations of all thought systems. There comes a point when you have to examine your foundational assumptions. For as long as you take those to be a given, all you’re doing is indulging yourself in circular logic. That proves nothing other than that circular logic is circular logic.
Apologies for being absent again — too much work on at the moment to spend much time on blogs, but I’ll dip in as I can.
Andy wrote:
ROFLMAO!! Ah … no. What’s “rock solid science” is that homeopathy can’t work by any material means. But … d’oh … homeopathy has never claimed to work by any material means. Hahnemann’s writings are abundantly clear on the subject and eschew all material interventions in favour of working with what he terms the ‘wesen‘ of both the patient, the disease and the remedy.
And since we’re dabbling in German here, there’s a nice differentiation in the language between different kinds of knowledge that we simply don’t have in English. ‘Wissen‘ is the kind of intellectual knowledge you gain from study. ‘Kennen‘ is knowledge gained through participative experience. Andy you’re pitting your ‘wissen‘ up against both the ‘wissen‘ and ‘kennen‘ of homeopaths. As I said before, unless you get yourself into a clinic to test out your theories in practice, this discussion really has nowhere further to go. Science has to be grounded in empiricism. That’s its foundation.
March 28, 2008 at 10:40 pm
— As I said before, unless you get yourself into a clinic to test out your theories in practice, this discussion really has nowhere further to go. Science has to be grounded in empiricism. That’s its foundation.
LMSO, I beg to disagree. Science is the fusion of rationalism and empiricism, the attempt to harness different approaches to achieve a single end. The problem is that drug research fails to unite them: RCTs are an attempt to acquire scientifically valid results without acknowledging a theory; whilst the biochemic model includes a number of theoretical premises untested in practice.
It is the separation of the gathering of evidence from the framework of a theory which leads to the total confusion seen in Andy’s last post. The so-called ’sceptics’ claim that science supports their position, but they are unable to produce that science. Basically it has been replaced by a belief system which is incapable of adapting to take account of the facts. As with any such orthodoxy of belief, challenges are met not with reasoned arguments but with hysterical outbursts.
By contrast homeopathy has always united rationalism and empiricism in the first true science of medicine, created (hardly surprisingly) at the birth of the industrial revolution.
March 29, 2008 at 10:50 am
It looks like we might be getting to the bottom of this. laughingmysocksoff appears to suggest that homeopathy depends on non material causes. This might be disputed by many homeopaths, but I am happy to accept that laughingmysocksoff believes in a non-material basis for homeopathy. But what it does depend on is not made clear - is it supernatural miasms and life-forces? If so, you have lost the argument that homeopathy has any claim to science.
givescienceachance is obviously irritated by this as it denies what has been argued. Is homeopathy science? Despite questioning, givescienceachance has not been able to state what science homeopathy is based on. And yet appears to deny that medicine has any scientific underpinning. A bizarre reversal of reality. Should we stop teaching biology and chemistry in schools and start teaching life-forces instead. Forward into the Middle Ages for our classrooms?
givescienceachance also misrepresents RCTs. Of course they do not make assumptions about mechanisms. That is not their purpose. They are there solely to establish a degree of confidence as to whether there is a real effect worth investigating and understanding. I have made it quite clear on my blog that RCTs are not a good tool for homeopathy as they can never supply the confidence required to overcome the complete implausibility of homeopathy. The fact that the sum totallity of evidence from RCTs is pathetic is just the final nail for homeopathy - we do not need RCTs to know it is nonsense. When homeopaths start coming up with plausible and rational mechanisms for why we should consider homeopathy a better discussion can be had. But it looks like homeopaths cannot even agree as to whether it is should have a supernatural or natural philosophy.
March 29, 2008 at 7:10 pm
what would be wrong with teaching life-forces? Einstein equated energy with matter.
March 29, 2008 at 8:54 pm
Andy says:
— givescienceachance also misrepresents RCTs. Of course they do not make assumptions about mechanisms. That is not their purpose.
I fail to see how Andy’s statement is itself anything other than a total misrepresentation, since what I actually said was:
— RCTs are an attempt to acquire scientifically valid results without acknowledging a theory.
He goes on to say:
—They [RCTs] are there solely to establish a degree of confidence as to whether there is a real effect worth investigating and understanding.
This implies that it is possible for evidence to have an absolute validity in its own right, whereas it is in fact always seen through a theoretical perspective. Lack of clarity about the nature of this perspective invalidates the interpretation of the evidence by removing it from the context which gives it meaning. In the case of RCTs, failure to make clear the scientific principles which govern (a) what is being investigated and (b) what measures are being used to evaluate the outcome means that the results do not constitute “real effects” but beliefs. In short, the absence of a theory of medicine invalidates RCTs as a scientific test.
If orthodox medicine is scientific, it must have a theory of health and disease which can both explain and predict. If it has this, then Andy should be able to state it. He has yet to do this, and so he has yet to demonstrate that his views are scientifically founded rather than simply beliefs. Furthermore, until he has done this his attacks on homeopathy are not scientific but “idle speculation”.
As for the term “non-material”, THAT needs clarification before we can be certain that what Andy means by it is what he alleges LMSO means by it. For example, is magnetism non-material or material, and if it is non-material is it natural or supernatural?
March 29, 2008 at 9:53 pm
givescienceachance - RCTs depend on the deep and sophisticated scientific technique called ‘counting’. You count how many people got better with treatment and count how many people got better in a control group. What “theoretical perspective” of medicine do you want to look at this through? Facts can be established before a theoretical understanding of them is established. Did the fact that the Sun rises every day exist before the heliocentric model was established? Galileo established the fact of the equivalence principle before Newton and Einstein shed their light on this. The fact of atomic genetic inheritance was established before an understanding of DNA was establisjed. You make the same mistake of misunderstanding scientific theory as creationists.
March 29, 2008 at 10:06 pm
As for a general ‘theory of medicine’ - it is only quack medicine that seeks to obtain such a thing. You are creating a straw man. Only quackery seeks to explain illness through single unifying causes.
Osteopaths/Chiropractors have their ’subluxions’ as their medical theory of everything. Acupuncturists have their Chi and Meridians as their theory of everything. Nutritionists see illness as deficits in nutrients or surfeits of ‘toxins’. Homeopaths use syphilitic miasms or whatever. Its all pseudscientific ballony. No evidence for any of these things exists.
Medical science does not see illness as having a single cause, but multiple interacting causes. Your demand to seek one is a straw man. Scientific medicine does though require all explanations of illness to be based on a scientific footing, whether that be drawn from biochemistry, psychology, physiology and require treatments to be plausible according to established principles of science. Homeopathy cannot claim entitlement here.
And yes, this is a ‘material’ view of the world and that includes the known ways in which matter interacts according to the standard model - through the fundamental forces of electromagnetism, gravity, and the two nuclear forces. Life forces do not fit into this picture. There is no evidence for them. No need to invoke them to explain anything and so belong squarely in the realm of wrong pre-scientific ideas. Only people like homeopaths cling desperately to them against the evidence.
March 30, 2008 at 12:04 am
Andy, you say:
— You count how many people got better with treatment and count how many people got better in a control group.
So how do you know they got better if you do not have a scientific basis for establishing what is better and what is worse, that is, a theory of health and disease?
As for facts, before Dalton nobody knew that there were whole number relationships between elements in a compound. Yet the very experiments which prove this were conducted not only after Dalton’s discovery but before it too - regularly. All that changed was the way the results were viewed. The facts were invisible because the wrong theoretical perspective was being used. It is the same for the sun rising. Before the heliocentric theory of the solar system the sun rose, but after it the Earth turned. Common sense was shown to be nonsense.
— As for a general ‘theory of medicine’ - it is only quack medicine that seeks to obtain such a thing.
I am afraid you are wrong. All medicine seeks such a theory as a matter of necessity. Take the following statements from a mid-nineteenth century orthodox medical work, as it is quoted in an orthodox medical work published in 1990: “The Newton of medicine has not yet appeared, and unfortunately we may fear … that we shall never see the genius who will convey that to medicine which physics found in algebra and which chemistry found in a pair of scales. Medicine is still what those sciences were a hundred years ago, a collection of unconnected theses.”
— Only quackery seeks to explain illness through single unifying causes.
What is that supposed to mean? How is it relevant to homeopathy? In homeopathy the causes of illness are many and varied, but the principle governing the relationship between cause and effect can be applied consistently. The same cannot be said for orthodox medicine.
You continue to use the terms “scientific ” and “pseudoscientific”, but these are meaningless without the proof of a science of medicine to justify your views.
Finally, can you prove that “the fundamental forces of electromagnetism, gravity, and the two nuclear forces” have no bearing on nature of living organisms? The evidence is that they do, so any model of such organisms needs to incorporate these forces. The biochemic model does not, whereas the homeopathic theory does. As a result homeopathy is as far ahead of orthodox medicine as Copernicus was ahead of Ptolemy.
March 30, 2008 at 12:28 am
In what way are fact invisible before a theory unites facts? My feeling is you are being obscurantist.
Let’s just cut to the chase and call your bluff. What does homeopathy have to say about the weak nuclear force? Precisely, how is homeopathy ahead in this regard? Please answer this and be specific.
Once you have answered this, perhaps you could tell me just one thing that homeopathy has added to our understanding of human life? In what way has your ‘complete homeopathic theory of medicine’ added to human knowledge? Where is the homeopathic birth control pill, anaesthetic, antibiotic? How does homeopathy add to our understanding of evolution, genetics and the diversity of life? Where are the homeopathic heart transplants, hip replacements? Where is homeopathic support for premature babies? Where is homeopathy in understanding genetic disorders, trauma and emergency medicine? What diagnostic techniques has it given us? Where is the homeopathic CAT scan, the ultrasound, the electron microscope? Can you name one are where homeopathy routinely saves lives where scientific medicine cannot? In short, where is this miraculous homeopathic science?
March 30, 2008 at 9:11 am
To ANDY Lewis - do you see homeopathy as SCIENCE or as MEDICINE? You think that homeopathy is trying to add something to our understanding of the world or to cure sick people? Why do you try to put everything into the same pile?
March 30, 2008 at 9:20 am
ANDY LEWIS writes: “Facts can be established before a theoretical understanding of them is established.”
Exactly, if you go to a clinic of a good homeopath, you can see many facts of people getting better. You will never see them published, though, as homeopaths are often forbidden by law to treat serious conditions, do you want them to disregard this, break the law and be all put in prison, as it happens sometimes in the States?
Now - after you have checked that there are FACTS of people getting objectively better, it’s up to those who have some spare time and money to indulge in pure research to try to provide theoretical understanding for these FACTS. Most homeopaths are busy treating people, so you cannot count on them to do this.
March 30, 2008 at 1:08 pm
Are you always like this, Andy? Here you are yet again demanding answers and then alleging that someone who points out your errors is “obsrurantist”. All you have been asked to do is provide an answer to what should be a very simple question: If orthodox medicine is scientific, what is the scientific theory it is based on?
Getting hysterical suggests that you do not have an answer, and that this is challenging the foundations of your belief in medicine as a science.
Let me try making it easy for you again. Obviously defining the placebo effect was too difficult - even though you happily claim that homeopathy is based on that.
You seem very fond of referring to diseases and demanding which ones homeopathy can cure. Perhaps you can provide the scientific theory which underpins the definition of diseases? That must be easy, since diseases are the basic starting point for orthodox medicine.
March 30, 2008 at 1:20 pm
By the way, as regards your comment:
— In what way are fact invisible before a theory unites facts? My feeling is you are being obscurantist.
If you did not understand the examples, please just say so. Otherwise they are self-explanatory, since they are both cases of the significance of “facts” being unrealised until an appropriate theoretical perspective came into existence.
It is interesting to note that in Ptolemy’s day there existed both a theory that the Earth went round the sun and the knowledge that the Earth was round. So why was it so difficult to establish Copernicus’s heliocentric system? Could it be the same reason as lies behind the refusal to accept the facts of alternative medicine, namely vested interests?
March 30, 2008 at 3:02 pm
The question is based on false premises - which I have made abundantly clear. It is begging the question. For the confused - scientific medicine draws on many areas of science and does not seek a single overarching theory.
Now, can you answer my question? Basically, what is scientific about homeopathy?
When the ‘facts’ of alternative medicine emerge, then minds will change.
March 30, 2008 at 3:04 pm
And if I am peering through your homeopathic rhetoric correctly, are you denying the existing of viral/bacterial based illnesses? Of medical microbiology in general?
March 30, 2008 at 3:11 pm
ez asked: “To ANDY Lewis - do you see homeopathy as SCIENCE or as MEDICINE?”
Neither. It it is pseudoscience and quackery. Homeopaths appear to want it to be both a SCIENCE and MEDICINE. Although, it does depend on who you talk to because there is much confusion out there.
March 30, 2008 at 7:55 pm
— there is much confusion out there
Too right, Andy! Part of this confusion come from the fact that people like yourself cannot answer the simplest questions about the science of orthodox medicine, and yet continually assert that it is scientific.
For example, I asked if “you can provide the scientific theory which underpins the definition of diseases? That must be easy, since diseases are the basic starting point for orthodox medicine.” Instead of an answer I get a lot of nonsense about “homeopathic rhetoric”. Are you saying that there is no need for a theoretical analysis of diseases for medicine to be scientific? What kind of science are we talking about where nothing appears to have any theoretical foundations?
You assert that homeopathy works by the placebo effect, and yet you cannot explain this effect. You deny the need for an overarching theory, though orthodox practitioners recognise the need for one. You reject the theoretical analysis of homeopathy on the grounds that you consider it unscientific, yet you offer nothing but excuses and evasions and demands that I defend homeopathy. ‘From what?’ I ask. What is the scientific argument I am supposed to defend it from?
I am gradually being forced to the conclusion that you are profoundly ignorant of medicine, and that this is the reason you are incapable of answering any requests for concrete explanations. If this is so, how on earth do you justify your attacks on homeopathy? How can you attack one approach to medicine if you are ignorant of all approaches? Ultimately your attacks would have to be founded on prejudice and belief, not on science.
Please don’t get me wrong, everyone is entitled to have religious beliefs, whether faith in a god or gods whose existence is unprovable, or faith in an idea of a science the existence of which is unprovable. However, I do not accept that anyone has the right to force others to abide by their beliefs by removing their access to alternative views. That is totalitarianism.
March 30, 2008 at 10:09 pm
let’s ge tone thing straight. I do not believe ‘homeopathy works by the placeno effect’ and have never said such a thing, I have said that homeopathy is a placebo, but that is entirely different. There is a real difference between a placebo and the placebo effect. Whether a placebo therapy works or not is a an entirely different matter. For my part, I believe most homeopathic beliefs about effectiveness are due to false attribution. People get better. Homeopathy claims benefit. A reversal of cause and effect.
I have not evade your questions about the sceintific underpinnings of medicine. I have given clear answers. I have yet to see a homeopath on this thread answer anything.
Let’s give a ‘for instance’. Influenza is caused by a virus. If infected with a virus that your imune system has not seen before, it can multiple very quickly and cause illness. Do you doubt this?
March 31, 2008 at 1:27 pm
Do you link to the same website for some other reason than agreeing with it? The following occurred earlier in this thread:
le canard noir Says:
March 7, 2008 at 10:08 pm
… Homeopathy can be best explained by the placebo.
But to take on your other explanation:
— For my part, I believe most homeopathic beliefs about effectiveness are due to false attribution.
This argument is fine *IF* you can distinguish between results due to medical intervention and results due to an unaided healing process. If you cannot, then it is purely hypothetical and certainly not scientific. Perhaps you could explain the scientific basis for distinguishing between these processes?
— I have given clear answers.
Like the following?
— Influenza is caused by a virus. If infected with a virus that your imune system has not seen before, it can multiple very quickly and cause illness.
You start by asserting that influenza is caused by a virus. Then you say that influenza is dependent on the state of the person’s immune system. By my count that is two causative factors, both of which are necessary, but neither of which is sufficient for influenza.
March 31, 2008 at 8:09 pm
But I also say quite clearly:
For most people, when they talk about the placebo effect, it means the broad range of reported effects due to treatment with an inert intervention. This ’soft’ placebo can be broken down into:
- normal improvement in health
- disease gets better anyway (short term illnesses)
- regression to the mean (chronic illnesses)
- psychological reinterpretation of severity of illness - ’someone is looking after me’.
- wrong attribution - people credit the intervention they would like to have been the cause.
- desire to please therapist - under reporting symptoms to them.
- selective reporting/cognitive biases.
Now, are you ever going to aswer a direct question or not?
March 31, 2008 at 10:10 pm
So we are going to go round in circles, are we?
In your comment before last you stated: “I do not believe ‘homeopathy works by the placeno [sic] effect’ and have never said such a thing.”
Now you admit to saying: “Homeopathy can be best explained by the placebo.”
You then restate what you say “most people” think the placebo effect is, having said that: “For my part, I believe most homeopathic beliefs about effectiveness are due to false attribution. People get better. Homeopathy claims benefit.”
Clearly you include yourself among “most people”. However, among medical researchers the expression ‘placebo effect’ is normally used to refer to what you call “‘hard’ placebo effects … where a belief can genuinely alter physiological states such as temperature, swelling, pain response etc.”
Where is the clarity in this? Where is the clarity in anything you have posted here? The only clear conclusion a reasonable person can draw from this is that you keep changing your story to fit the moment. That is not a scientific approach, but sophistry. I ask you: “are you ever going to aswer a direct question or not?” I think not. I think you know that there is no scientific support for your beliefs, and you will just keep ducking and diving in an attempt to sustain the illusion that you know what you are talking about.
You are a fraud and a quack, and it has been a pleasure to expose you as such.
April 1, 2008 at 9:53 am
On the Misfortunes of Andy Lewis
If you follow on behind Le Canard Noir
You get a feeling of ‘je ne sais quoi’,
For the route you find he’s taken
Is so utterly mistaken
There’s no choice but to call out “Au revoir!”
Still you wonder if perhaps he just forgot
That in science statistics aren’t the lot;
That no matter if it’s dreary
You have to have a theory
So what you know explains what you do not.
But then perhaps it’s knowledge that he lacks
Since his arguments are always full of cracks,
And the increase in his rage
Is not difficult to guage
If you simply read the meter of his quacks.
The publishing of nonsense is not new:
In pamphlets, magazines and weblogs too
The glorious old tradition
Of ignoring erudition
Will support whatever money wants it to.
April 1, 2008 at 7:47 pm
And you contunue to attack the person and not the argument. Fail to answer any questions and just blutser through.
To repeat: what science is homeopathy based on? Have you an answer?
April 1, 2008 at 9:56 pm
I did not continue to attack the person. I continued to describe the person as the person revealed himself to be. What would you call someone who states two opposite things to be true and expects to be believed both times?
The only thing you are consistent about is describing your own behaviour and attributing it to homeopaths. Such as blustering through.
As for the science homeopathy is based on, there is homeostasis for a start. Will you now produce a single scientific principle in support of your own opinions? I doubt it.
April 3, 2008 at 12:05 pm
Homesostasis? Really? Are you sure? Would you care to explain?
Whew, I bet this is going to be good, I’m looking forward to hearing some real science for a change, the stuff that GSAC thinks is science. Not the stuff that scientists call science.
April 3, 2008 at 3:24 pm
Yeh, I am q
April 3, 2008 at 3:25 pm
Yeh, I am quite interested too. Homesostasis? Can you explain to us what this has to do with homeopathy? How it gets around the ‘zero molecules’ might be a good place to start.
April 3, 2008 at 6:30 pm
GSAC could be onto something here because if you think about it logically then there must be some connection. Homeostasis. Homeopathy. See? That’s no coincidence.
April 4, 2008 at 3:12 pm
Openminded:
“Not the stuff that scientists call science.” Do you mean all that stuff Andy has been unable to provide when asked?
“Homeostasis” Etymologically of course there is a connection. Historically the principles were identified before homeopathy and form part of the explanation of homeopathy, but the word itself was not coined until later.
I am not convinced that either you or Andy Lewis know what homeostasis is, so rather than get into an argument about it, why don’t you explain what it is and we can go on from there. Since Andy believes in science in medicine, he should be able to cope with this bit of science even if he failed with diseases, placebo and counting to 3.
April 4, 2008 at 8:43 pm
Look, let’s be adult about this. Let’s assume we’ve all read the wiki entry on homeostasis and have agreed that this provides a reasonable explanation. You have made the claim that homeostasis is the science that homeopathy is based on. The onus is on you to explain how. I’m sure Andy and I will manage to keep up.
April 5, 2008 at 8:35 am
Well, if we are discussing things with people who derive their knowledge from wikipedia articles…
April 5, 2008 at 9:25 am
OK. Let’s be specific. What biological mechanisms allow homeopathic treatments to enable homeostatsis in humans?
April 5, 2008 at 3:19 pm
Andy: “What biological mechanisms allow homeopathic treatments to enable homeostats