Two recent and related papers, published in the Journal of Clinical Epidemiology and Homeopathy (the journal of the Faculty of Homeopathy, the UK’s professional organisation of medically qualified homeopaths), have reconstructed the analysis carried out by the authors of The Lancet’s much vaunted 2005 meta-analysis, on the back of which the journal triumphantly editorialised “the end of homeopathy”, and have placed on record the fact that the study was hugely flawed and in some instances just plain incorrect.
These papers emphatically underline the position this blog has taken from the outset — that the underlying data does not support the assertion that homeopathy is no more than placebo. The jury is still out, and those that claim otherwise are misrepresenting their personal opinion as proven scientific fact when it’s nothing of the kind.
Dutch homeopathic physician Lex Rutten, working with colleague C F Stolper and statistician Rainer Lüdtke, has exhaustively analysed the data used in the meta-analysis. (It’s worth noting here — for those that aren’t already aware of the fact — that much of the underlying data for the study was only provided some months after publication following outcry from both homeopathic and conventional physicians and researchers alike, and that the study’s original publication violated The Lancet’s requirements for transparency. In other words, had The Lancet followed their own rules, the study should not have been approved for publication in the first place.)
In the paper for Homeopathy (Rutten, A L B & Stolper, C F. The 2005 meta-analysis of homeopathy: the importance of post-publication data. Homeopathy (2008) 97, 169–177), Rutten and Stolper set out to answer the following questions:
What was the outcome of Shang et al’s predefined hypotheses?
Were the homeopathic and conventional trials comparable?
Was subgroup selection justified?
The possible role of ineffective treatments. Was the conclusion about effect justified?
Were essential data missing in the original article?
Results: The quality of trials of homeopathy was better than of conventional trials. Regarding smaller trials, homeopathy accounted for 14 out of 83 and conventional medicine 2 out of 78 good quality trials with n < 100. There was selective inclusion of unpublished trials only for homeopathy. Quality was assessed differently from previous analyses. Selecting subgroups on sample size and quality caused incomplete matching of homeopathy and conventional trials. Cut-off values for larger trials differed between homeopathy and conventional medicine without plausible reason. Sensitivity analyses for the influence of heterogeneity and the cut-off value for ‘larger higher quality studies’ were missing. Homeopathy is not effective for muscle soreness after long distance running, OR = 1.30 (95% CI 0.96–1.76). The subset of homeopathy trials on which the conclusion was based was heterogeneous, comprising 8 trials on 8 different indications, and was not matched on indication with those of conventional medicine. Essential data were missing in the original paper.
The authors conclude:
A review of data provided after publication of Shang et al’s analysis did not support the conclusion that homeopathy is a placebo effect. There was intermingling of comparison of quality and comparison of effects, and thus matching was lost. The comparison of effects was also flawed by subjective choices and heterogeneity. The result in the subgroup from which the conclusion was drawn was further influenced by the choice of cut-off value for ‘larger’ trials. If we confine ourselves to the predefined hypotheses and the part of this analysis that is consistent with the comparative design, the only legitimate conclusion is that quality of homeopathy trials is better than of conventional trials, for all trials (p = 0.03) as well as for smaller trials with n < 100 (p = 0.003).
Rutten and Stolper’s comments on cut-off values for sample size are particularly telling:
Cut-off values for sample size were not mentioned or explained in Shang el al’s analysis. Why were eight homeopathy trials compared with six conventional trials? Was this choice predefined or post-hoc? Post-publication data showed that cut-off values for larger higher quality studies differed between the two groups. In the homeopathy group the cut-off value was n = 98, including eight trials (38% of the higher quality trials). The cut-off value for larger conventional studies in this analysis was n = 146, including six trials (66% of the higher quality trials). These cut-off values were considerably above the median sample size of 65. There were 31 homeopathy trials larger than the homeopathy cut-off value and 24 conventional trials larger than the conventional cut- off value. We can think of no criterion that could be common to the two cut-off values. This suggests that this choice was post-hoc.
The knee-jerk sceptical response is likely to point out that the authors are homeopaths and they would say that wouldn’t they? But the authors restrict themselves to an uncontentious and easily verifiable critique of Shang et al’s data and analysis and make no conclusions one way or the other about what the data are saying about homeopathy.
They conclusively demonstrate that for the subset of 21 high quality homeopathic trials (as defined by Shang et al), a positive or negative conclusion for homeopathy is crucially dependent on the exact number of trials selected. Re-running the data using different cut-off values for sample size indicated that all but 3 of 20 possible cut-off values lead to a significant effect for homeopathy if all higher quality trials are considered, more in line with the results of 5 earlier meta-analyses of homeopathic trials. A firm positive conclusion is found, for example, merely by omitting four trials that showed Arnica is ineffective for muscle soreness after long-distance running, a condition for which neither homeopathic nor conventional treatment provided any relief (and which one could argue hardly constitutes a medical condition in the first place, being a perfectly natural and inevitable consequence of abnormal exercise).
In the Journal of Clinical Epidemiology paper (Lüdtke, R & Rutten, A L B. The conclusions on the effectiveness of homeopathy highly depend on the set of analyzed trials. Journal of Clinical Epidemiology 61 (2008) 1197-1204), Lüdtke and Rutten conclude:
Our results do neither prove that homeopathic medicines are superior to placebo nor do they prove the opposite. This, of course, was never our intention, this article was only about how the overall results and the conclusions drawn from them change depending on which subset of homeopathic trials is analyzed. As heterogeneity between trials makes the results of a meta-analysis less reliable, it occurs that Shang’s conclusions are not so definite as they have been reported and discussed.
What does all this mean in plain English? It’s a pretty good bet the study was deliberately skewed to support the initial presumption that homeopathy equates to placebo.
As Einstein once remarked “Not everything than counts can be counted; and not everything that can be counted counts.” Or perhaps we could go one step further. That a prestigious journal such as The Lancet should base an editorial and extensive publicity campaign passing judgement on an entire therapy on a study of such dubious quality which violates its own publication guidelines is more in line with Wordworth’s assertion: “Science appears as what in truth she is; not as our glory and absolute boast, but as a succedaneum, and a prop to our infirmity.”
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December 7, 2008 at 3:51 pm
jeff garrington
You may want to read two comments on the paper you refer to.
Hawk and Handsaw and Science Based Medicine, links below.
They draw a different conclusion from yours. I have followed your blog for a number of months and have become increasingly dissapointed with your defense of Homeopathy.
However would you care to comment upon the articles in the two blogs linked below.
http://hawk-handsaw.blogspot.com/
http://www.sciencebasedmedicine.org/?p=242
December 7, 2008 at 8:05 pm
paul
HHHHHMMMMM hhhhhmmmmm.
It will be interesting to see what sceptic comments this post brings out of the woodwork?
December 8, 2008 at 1:43 am
stavros
Are these seriously your conclusions from the papers?!? I am not counting the Homeopathy journal for obvious reasons, but the other paper, if anything, just re-enforces Shang’s analysis! See Dr. Gorski’s discussion of the obvious. Quoting:
“In other words, if a random effect meta-analysis is used, one can torture marginally significant odds ratios out of the data; if a meta-regression is used, one can’t even manage that! In other words, this study actually shows tht it doesn’t really matter too much which high quality studies are involved, other than that adding lower quality studies to higher quality studies starts to skew the results to seemingly positive values.”
You people might disagree with the criteria Shang used, but his meta-analysis based on those pre-selected criteria is absolutely valid. And his conclusions remain firmly there, surviving all the challenges thus far.
paul: the skeptic comments would be: total scientific implausibility; going against well established scientific laws and theories; *and* the collection of meta-analyses shows simply a placebo effect. I am sorry, where is the evidence in favor of homeopathy (especially considering the miraculous claims made by homeopaths)?
December 9, 2008 at 5:34 pm
laughingmysocksoff
Jeff, Stavros, I think you guys have rather missed the point.
This blog doesn’t set out to stand as a “defense of Homeopathy”. This blog sets out to show that the underlying data are equivocal; open to different interpretations, the validity of which are in dispute. The publication of these papers shows that other interpretations are putatively valid and that the debate is still alive and well. It is far from being “the end of homeopathy”. For as long as this remains the case, it’s not only premature but dishonest to claim — as many sceptics have done — that their case is ‘scientifically’ proven and that there is “no evidence” for homeopathy, because that is a matter of opinion.
This argument has been going on for over 200 years already and it’s no further forward than when it started. This is because it’s a completely pointless exercise setting out to convince people whose minds are already made up. So why would I be trying to do that?
After all, anyone with an open mind on the subject can simply go try homeopathy for themselves (for as long as it’s still available for them to do so which, thanks to sceptical efforts, is increasingly hard for them to do within the NHS). It beats trying to wade through argument and counterargument any day, though I’m still consistently gobsmacked at the amount of time some people appear to have available to spend online doing this, and dissing something they have no direct experience of — how ‘scientific’ is that?.
You’re perfectly entitled to your opinions and it bothers me not one jot that you hold them. So one more time for emphasis now, what bothers me, and why I started this blog, is the dishonesty inherent in claiming opinion as fact, plastering that opinion-masquerading-as-fact all over the media and internet, bludgeoning NHS PCT commissioning administrators over the head with it, and claiming the mantle of ‘science’ in an attempt to give some kind of ‘authority’ to that opinion.
Maybe I’m just old-fashioned, but I believe strongly it’s incumbent on anyone who claims to be a ‘scientist’ to be honest about the state of the evidence base, not to conflate their own opinion and biases with the data. Sceptics are pretty hot on accusing homeopaths of doing that, but don’t seem to be aware of the extent they’re doing the same thing themselves.
We can all make our own interpretations of the data, filter out what we think is irrelevant, emphasise what we think is important, but what we’re not entitled to do is claim that part of the process as anything other than what it is — opinion and interpretation.
Whether something is implausible or not depends entirely on where you’re coming from and what preconceptions you bring to bear on the subject, all of which are open to question. The debate is healthy. Trying to silence it isn’t.
December 9, 2008 at 8:39 pm
paul
So what is evidence? Well done LMSO for having the patience to carry on repeating your message about subjective interpretation.
http://www.bmj.com/cgi/content/extract/337/oct30_1/a2281
http://www.politics.co.uk/opinion-formers/press-releases/royal-college-physicians-sir-michael-rawlins-attacks-traditional-ways-assessing-evidence-$1245035$365674.htm
Both these articles would appear to substantiate the view that evidence should be gathered from a number of sources, including outcome studies.
A question that is often raised is the lack of any biological mechanism to support the idea of using similars. The question i would like to ask is what can be observed when a hand is immersed in a bucket of very cold water for 5 minutes or more? The answer is that after being taken out the hand feels cold and flabby. What then happens after 5 minutes or more is that the hand then begins to warm up, and will eventually feel a lot warmer than it was before being immersed. It is this observation of the initial and then the secondary action upon which the treatment of similars is based. The idea of similars is to use the reactive power of the organism, that is the biological mechanism of similars.
The question that I would like to ask relates to why this action has never been fully studied, and why has the direction of symptoms never been studied. Do they not exist or are they simply anomalies that are not looked into as they do not have any importance within the conventional view of treatment? What is the purpose of science other than to examine observable and repeatable occurances? Of course i keep forgetting, they cannot be real as they are part of a system of medicine that is practiced by people who are unhinged and deluded, so therefore their observations cannot be accepted as having any validity. Nor of course all those countless adults, children, and animals who have experienced its benefits.
December 10, 2008 at 12:13 pm
stavros
laughingmysocksoff:
there is truly no evidence for homeopathy. This is not a matter of opinion, it is a matter of seeing at all these reviews that mention that the better quality the study, the less positive the results. And the collection of meta-analyses strongly points to the placebo effect. Again, taking into consideration the miraculous claims of homeopathy the results clearly do not support it! Even more so if you add the scientific implausibility.
Then you go on to destroy homeopathy by yourself: “This argument has been going on for over 200 years already and it’s no further forward than when it started.”
For 200 years homeopaths have not been able to demonstrate neither the scientific foundations of homeopathy, nor their efficacy. To me it seems absolutely justified that the Lancet has taken everything into consideration and declared “the end of homeopathy” in the sense that money should now be directed to more promising areas (after 200 years of no progress). In matters of health, you cannot gamble with the life of people. You need to go with proven treatments. Homeopathy had its chance for two centuries and failed to convince the scientific community of its merits.
December 10, 2008 at 6:29 pm
jeff garrington
“These papers emphatically underline the position this blog has taken from the outset — that the underlying data does not support the assertion that homeopathy is no more than placebo.” I’m afraid that that is only your opinion.
Please follow the links I offered you. The “data” even when skewed shows Homeopathy no more than placebo. As Stavros points out, 200 years and still no further forward. Sorry!
December 10, 2008 at 8:34 pm
paul
For 200 years homeopaths have not been able to demonstrate neither the scientific foundations of homeopathy, nor their efficacy.
I’m sorry but have i missed something? If it hasn’t been scientific in its foundations and effective why do people keep coming back?
Ah of course i keep forgetting you think those people are all stupid or deluded.
Why is it that a well trained homeopath can tell when they have given the wrong remedy?
Ah of course the placebo effect has acted upon their stupity or delusional state.
Why is it that people who have “tried everything else so i’ll try homeopathy” (TEETH) find that it helps?
Ah of course those stupid delusional homeopaths use a better quality of placebo than all the other forms of medical intervention.
Why is it that a system of medicine which has as one of its primary principles the concept of individualisation keeps failng to pass the test of lumping everything together?
Ah of course, in my stupid delusional state i forgot. The true principle of medicine is all about the herd. We cannot be individuals we have to all be immune together. Silly me.
So what about outcome studies?
Ah silly me. These are completely unbalanced by the principle that “the homeopath was such a nice person that i didn’t want to upset them so of course i had to say i got better”.
Of course random trials are the only form of evidence that are applicable.
Ooops well hold on a moment, what about all the treatment we give that hasn’t been tested that way.
Silly me, i forgot. We know they work because we’ve been using them for ages now and people tell us they get better with them.
December 10, 2008 at 8:45 pm
paul
Sorry my last post contained a mistake.
It isn’t because of a better quality of placebo that (TEETH) patiennts get better.
Silly me how could something such as a “homeopathic medicine” have any quality about it.
I should have said “a better quality of convincing the person that in spite of being to see evey form of therapist of doctor they could be referred to I am really the person who is going to delude them into getting themselves better without the help of any sort of medicine and i am going to do this by simply giving them a chance to repeat to me everything they’ve told countless other therapists and doctors on numerous occasions and of cause i am going to give them a drink of water at the end treatment”.
December 10, 2008 at 11:07 pm
stavros
paul: “If it hasn’t been scientific in its foundations and effective why do people keep coming back?”
do you know anything about science? Is this the argument from popularity?!?
“Why is it that people who have “tried everything else so i’ll try homeopathy” (TEETH) find that it helps?”
do you know anything about human psychology, the placebo effect, and the vast array of cognitive biases we are susceptible to? Do you know that this is exactly why the scientific method was developed -to put aside personal beliefs and misjudgements?
Also, show me the evidence for your claims that they “find that it helps”.
“Why is it that a system of medicine which has as one of its primary principles the concept of individualisation keeps failng to pass the test of lumping everything together?”
There have been many individualized trials of homeopathy. Do your homework before posting something.
“Ah silly me. These are completely unbalanced by the principle that “the homeopath was such a nice person that i didn’t want to upset them so of course i had to say i got better”.”
That’s why objective metrics instead of customer satisfaction surveys are used in real science. The plural of anecdotes is not data.
“Of course random trials are the only form of evidence that are applicable. ”
This is just a strawman. There are other lines of evidence as well, and homeopathy fails at every single one of them! Molecular biology? No effect. Maybe there is a chemical mechanism? No, nothing there. Nothing at all at the level of basic science. So, we can only do clinical trials. And guess what is the outcome? Failure.
Paul, if you want to defend your case (which you cannot as it is defenceless), you have to do much better than constructing fallacious arguments and using satirical rhetoric.
December 11, 2008 at 6:57 am
jeff garrington
Ah the concept of individualization, odd to object to trials on a blog that is currently discussing the apparent positive outcome of random controlled trials for Homeopathy. I say apparent since it is only positive if you juggle the figures hold your breath and see only what you what to see. Paul follow the links I posted, read and understand, Homeopathy is placebo.
December 11, 2008 at 7:23 am
paul
My understanding of this thread is that the evidence so far as RTC’s are concerned has been inconclusive and that making a final judgement is just a case of overblowing your opinuion. And it is also clear that you see that we fully understand all the facets of how human and animal organisms interact with their environment.
December 11, 2008 at 12:29 pm
jeff garrington
Paul, go look at the reviews of the papers. Nothing is overblown in the reviews.
The links are posted above.
December 11, 2008 at 2:41 pm
laughingmysocksoff
The papers themselves stand as valid interpretations of the data, whether or not you agree with those interpretations, and whether or not you think the data should be viewed in different ways. Again, this is opinion and highly dependent on the initial preconceptions you bring to the data. Your interpretation is not the only potentially valid one. As I’ve said many times here, your conclusion is not about the data. It is about the underlying understanding you bring to bear on it.
Stavros, you state:
Do you know that our cognitive biases are not only inseparable from, but instrumental in creating the very reality science seeks to describe? That the act of observation itself has an impact on what is being observed? The full implications of quantum physics still haven’t been properly integrated into our science even nigh on a century after they were first introduced.
This is why the argument still continues after 200 years. William A Tiller puts it better than I can, even though it was 30 years ago now that he wrote this
As Tiler says, “the scientific method is really “to provide the necessary and sufficient protocol for anyone, anywhere, to successfully duplicate the experimental result.”" This is the basis of homeopathy and how it’s been practiced for the last 200-odd years. If you follow the protocol, you can duplicate the experimental results with an acceptable level of consistency, as 200 years’ worth of case history demonstrates. If you try and shoehorn that protocol into a different protocol, like an RCT, your duplication of the experimental results will not be so robust, as the equivocal results of RCTs clearly demonstrate.
And claiming any firm conclusion — either way — from a meta-analysis of such a heterogeneous data set is skating on thin ice at the best of times.
December 11, 2008 at 2:53 pm
laughingmysocksoff
Stavros, you said
Perhaps you’d like to explain then
i) how it is that in all other branches of medicine case history is accepted as a critical and integral part of the evidence base,
and
ii) how you can draw the conclusion of inefficacy when exactly the same effect is observable in higher quality trials of conventional drugs
December 11, 2008 at 10:34 pm
stavros
“The full implications of quantum physics still haven’t been properly integrated into our science even nigh on a century after they were first introduced.” oh dude, that’s really pathetic… The Quantum Mechanics argument! This is seriously very, very low…
And once again, taking into consideration the miraculous claims of homeopaths, the complete absence of basic science, and the consistent results from meta-analyses, the Lancet was more than justified to try and redirect resources to other more promising areas.
Also, quoting William Tiller works probably against your case -although it seems you align very well with Tiller in this idea that somehow intention and human consciousness alters our environment! I quote you: “That the act of observation itself has an impact on what is being observed?” Yes, on subatomic scales! And NOT because of the act of observations per se, but because of inherent properties of the descriptive wavefunctions. In any case, appealing to QM is probably the lowest defence for homeopathy (or any other woo for what matters!)
And changing the definition of science or appealing to other ways of knowing is also really low. Demonstrate which are these other ways of knowing and why they are better than science.
December 11, 2008 at 11:14 pm
Ulrich Berger
laughingmysocksoff, before we get too deep into quantum mysticism let’s talk about simple facts. You say that “Rutten and Stolper’s comments on cut-off values for sample size are particularly telling” and cite them with
“Cut-off values for sample size were not mentioned or explained in Shang el al’s analysis. Why were eight homeopathy trials compared with six conventional trials? Was this choice predefined or post-hoc? [...] We can think of no criterion that could be common to the two cut-off values. This suggests that this choice was post-hoc.”
Now, if you had read Hawk/Handsaw’s postings on this issue (linked in the very first comment by jeff garrington above) or if you had read Shang et al (2005), then you would see that this argument is bullshit. Shang et al clearly defined in their Lancet paper that
“Trials with SE [standard errors] in the lowest quartile were defined as larger trials.”
So that’s it. The interesting question is: Why was such an unfounded and ridiculous accusation published in the allegedly peer-reviewed journal called “Homeopathy”? I would like to answer by citing from Ars Technica:
“Homeopathy is not science. The journal has a negative scientific value because it does not distribute scientific knowledge, but rather disseminates wishful thinking about reality. It is the very essence of anti-science.”
http://arstechnica.com/journals/science.ars/2008/11/20/elsevier-beyond-the-pale-of-scientific-respectability
December 12, 2008 at 8:16 am
The Lancet & Homöopathie: 2 Studien weisen auf grobe Fehler der Meta-Analyse von Shang et al. 2005 hin | H.Blog: Homöopathie & Forschung
[...] They conclusively demonstrate that for the subset of 21 high quality homeopathic trials (as defined by Shang et al), a positive or negative conclusion for homeopathy is crucially dependent on the exact number of trials selected. Re-running the data using different cut-off values for sample size indicated that all but 3 of 20 possible cut-off values lead to a significant effect for homeopathy if all higher quality trials are considered, more in line with the results of 5 earlier meta-analyses of homeopathic trials. A firm positive conclusion is found, for example, merely by omitting four trials that showed Arnica is ineffective for muscle soreness after long-distance running, a condition for which neither homeopathic nor conventional treatment provided any relief (and which one could argue hardly constitutes a medical condition in the first place, being a perfectly natural and inevitable consequence of abnormal exercise).« (Quelle: Socked! Conclusions of The Lancet’s “end of homeopathy” study discredited) [...]
December 12, 2008 at 8:46 am
The Lancet & Homöopathie: Reaktionen auf Rutten, Stolper und Lüdtke | H.Blog: Homöopathie & Forschung
[...] They conclusively demonstrate that for the subset of 21 high quality homeopathic trials (as defined by Shang et al), a positive or negative conclusion for homeopathy is crucially dependent on the exact number of trials selected. Re-running the data using different cut-off values for sample size indicated that all but 3 of 20 possible cut-off values lead to a significant effect for homeopathy if all higher quality trials are considered, more in line with the results of 5 earlier meta-analyses of homeopathic trials. A firm positive conclusion is found, for example, merely by omitting four trials that showed Arnica is ineffective for muscle soreness after long-distance running, a condition for which neither homeopathic nor conventional treatment provided any relief (and which one could argue hardly constitutes a medical condition in the first place, being a perfectly natural and inevitable consequence of abnormal exercise).« (Quelle: Socked! Conclusions of The Lancet’s “end of homeopathy” study discredited) [...]
December 12, 2008 at 9:04 am
jeff garrington
I’m afraid I’m with Stavros on this. Quantum Entanglement etc. I have provided links in the past, to articles published, that effectively dismiss your argument. Quantum doesn’t apply in the real world (the big world) If it did, i paste once again, “Milgrom still doesn’t get it: the double slit experiment stops working as soon as it becomes possible to know which slit the particle went through whether or not anyone actually knows it [37]. In a DBRCT, the person in charge always has the key regarding who got verum and who got placebo. From the point of view of the patient and practitioner the key might be like a set of “hidden variables” and entanglement should not occur anyway [27,29]. (I’m indebted to this comment for pointing this out.) You can’t get all post-modern about knowledge when experiments [28,29,37] make it this clear.” http://shpalman.livejournal.com/11213.html
I take this to mean that if you have the possibility of knowing the correct remedy, then entanglement cannot happen.” No response from you on those articles.
The same for the article on this current blog. It appears that you are digging a deeper hole each time. Yes case history is important, but how effective is the treatment in the recovery process. How effective are the drugs used. Drugs can be tested, and to date each time the Homeopathic pill/drug is tested. There is simply no effect from the drug – pill. Torture the data as much as you want, the results speak for themselves. No effect beyond placebo. Data is not a matter of opinion, however much you want it to be.
December 12, 2008 at 9:06 am
paul
Goodness me LMSO you have a great deal of patience.
Stavros.
I take it from your criticisms that you have a complete understanding of how human and animal organisms react to all the various types of stimuls the recieve? If you haven’t how can you criticise a thread which is basically pointing out that our knowledge of how everything works is incomplete, and therefore there will always be doubt in any form of understanding.
You say that homeopaths have a complete absence of basic science. Quite a claim really when all of the practice of homeopathy has been based upon observations from its practical application. And isn’t that what science is. Observations of phenomena. You prescribe a correct medicine and this happens. You prescribe a wrong medicine and, well generally very little happens. Fortunately most good homeopaths will know the difference. So how do we know the difference? See my feeling is that someone who is interested in the scientific method might well want to enquire into this?
Now of course you will clearly take umbrage with this as you clearly need to take umbrage with something. But to refute all the evidence that has been gathered through this practical application means you think the people gathering it are, as previously mentioned, deluded or stupid? So which do you think it is?
December 12, 2008 at 9:38 am
stavros
paul this is not what this thread was about. LMSO claimed that the Shang study was discredited (it’s in the title) when obviously this is not the case! It only turned into the deepest realms of pseudoscience after LMSO last two comments.
“You say that homeopaths have a complete absence of basic science. Quite a claim really when all of the practice of homeopathy has been based upon observations from its practical application.” no paul. I have explained what I mean when I say lack of basic science -please read my comments carefully before distorting my statements. Simply, it means that there is no scientific reason to assume that homeopathy works as it goes against well established science (laws of similar, high dilutions, water memory etc.).
“I take it from your criticisms that you have a complete understanding of how human and animal organisms react to all the various types of stimuls the recieve?” No one is claiming that and this just shows that you are more than willing to misrepresent my positions in order to try and defend your case. The fact that our knowledge is incomplete doesn’t mean a thing about whether homeopathy works or not. Can you not see the fallacy in this type of arguments? With the same reasoning I can claim any other crazy idea is correct because we don’t know everything yet! But unfortunately paul and LMSO this is not how we progress. We need a way to tell the good ideas from the bad ones. And this is called science, reason, and evidence. And homeopathy has failed in those areas.
“But to refute all the evidence that has been gathered through this practical application means you think the people gathering it are, as previously mentioned, deluded or stupid?” Paul, I am tired of you not comprehending my comments and constructing straw men arguments. I will not reply to any other comment of yours if it is full of fallacies again. I explicitly said that the plural of anecdotes is not data or evidence. Medical science cannot work this way. Also, which part of “cognitive biases” did you not understand?
You can start appealing to other ways of knowing or the limitations of our knowledge if that makes you comfortable. It will not change anything but just delude yourselves =and we all know it. These are the lowest forms of fallacious reasoning and I am sorry to say that if your descend into this abyss continues I am not willing to participate, thank you. It is another thing to try and point out some mistakes in your reasoning in regards to the meta-analyses, and a whole other thing to try and point out the obvious fallacies in your latest “arguments”.
December 12, 2008 at 10:01 am
Ulrich Berger
(reposted because including a link sent me into the spam-queue… )
LMSO, before we get too deep into quantum mysticism let’s talk about simple facts. You say that “Rutten and Stolper’s comments on cut-off values for sample size are particularly telling” and cite them with
“Cut-off values for sample size were not mentioned or explained in Shang el al’s analysis. Why were eight homeopathy trials compared with six conventional trials? Was this choice predefined or post-hoc? [...] We can think of no criterion that could be common to the two cut-off values. This suggests that this choice was post-hoc.”
Now, if you had read Hawk/Handsaw’s postings on this issue (linked in the very first comment by jeff garrington above) or if you had read Shang et al (2005), then you would see that this argument is bullshit. Shang et al clearly defined in their Lancet paper that
“Trials with SE [standard errors] in the lowest quartile were defined as larger trials.”
So that’s it. The interesting question is: Why was such an unfounded and ridiculous accusation published in the allegedly peer-reviewed journal called “Homeopathy”? I would like to answer by citing from Ars Technica:
“Homeopathy is not science. The journal has a negative scientific value because it does not distribute scientific knowledge, but rather disseminates wishful thinking about reality. It is the very essence of anti-science.”
December 12, 2008 at 10:32 am
jeff garrington
Paul a homeopath would argue that the treatment is individualized. So one pill cannot treat all conditions in all the people. Hence Homeopathy cannot be tested in double blind trials. Yet the apparent positive result from going over the data from double blind trials, and suddenly these trials are ok. How come?
Basic science, 1. describe one simple lab experiment that undergraduates can perform to show the effectiveness of homeopathy, 2. how many molecules of the original substance in a shaken solution of 30x?.
Homeopaths are currently invited to take part in a trial in order to prove the difference between each sugar pill. So far none have come forward. This offer has now been extended to University Departments offering an (extremely dubious) B.Sc in Homeopathy. If they accept the challenge and fail, would you alter your opinion about Homeopathy. If they accept and succeed I will change my opinion.
So Paul how do you know the difference. How do you know its the pill that’s made the difference, since one pill that affects one person will not affect another (individualization) D.B.T’s are used to exclude bias from any experiment, so that we are not confused by our own preconceptions. Good trials do this, poor trials allow bias. Good trials show Homeopathy no better than Placebo, do you know of any “good” trials that show a positive. Can you name one self limiting condition that Homeopathy can treat.
People who go to Homeopaths with self limiting conditions often do get better. The care shown, the extended consultation, are of course invaluable. “Scientific Medicine” can learn a lot from the patient practitioner interaction. However there is nothing in the pills, this is elaborate placebo. I suspect you make a living out of Homeopathy, so it is difficult to come to terms with this unfortunate fact, to do so and carry on would mean you are lying to your patients.
However the current blog is about a recent paper, please follow the links provided, http://hawk-handsaw.blogspot.com/2008/11/i-know-i-said-life-was-too-short.html
December 12, 2008 at 8:36 pm
paul
Paul, I am tired of you not comprehending my comments and constructing straw men arguments. I will not reply to any other comment of yours if it is full of fallacies again. I explicitly said that the plural of anecdotes is not data or evidence. Medical science cannot work this way. Also, which part of “cognitive biases” did you not understand?
i understand your arguments very well.
But they are the same old arguments that have always been presented. And as once said by some geezer who lived around the same time as homeopathy came to be formulated. “They come on in the same old way, and we shall knock them down in the same old way”. Duke of Wellington.
And that way is that we shall go on treating those who come to us. We shall observe the reactions they produce and assess whether the prescription was correct or not. And how shall we know this, through observing the changes. You think that we have no concept of “cognitive bias”?
If all the reactions were due to placebo why do we see restoration of health in a systematic way
return of old symptoms
from internal to external
from top to bottom
And why when an incorrect medicine is give are these things not seen? If as you say it was all due to placebo how are these things possible?
This is just a strawman. There are other lines of evidence as well, and homeopathy fails at every single one of them! Molecular biology? No effect. Maybe there is a chemical mechanism? No, nothing there. Nothing at all at the level of basic science. So, we can only do clinical trials. And guess what is the outcome? Failure.
Molecular biology, and chemical mechanisms. Are these all that we know of how things interact? We have no idea about the sensitivities of organisms to various stimuli? We have no idea how infentissimal doses interact with organisms. There are certainly many theories that relate to how they may act, but they are not of any importance in comparison to our goal which is to observe the restoration of health of our patients after a correct remedy is given. And it is this last point which people find the most difficult to comprehend.
And thak you for no longer participating in this discussion. You are entitled to your opinion that my arguments are based upon a false reasoning, based upon my understanding of your understanding of how things work that is actually quite reassuring. This discussion is ultimatetly about things much weightier than our OPINIONS. I am happy with knowing that my knowledge is limited, it is because of this that i constantly check and recheck what i am doing.
December 13, 2008 at 1:05 am
stavros
“Molecular biology, and chemical mechanisms. Are these all that we know of how things interact?” No, these are just examples.
“We have no idea how infentissimal doses interact with organisms.” better make that “no doses” for dilutions more than 12C.
With your last comments both of LMSO and paul (invoking QM, human consiousness, quoting Tiller etc), it has become evident to anyone reading this thread that you are implying that science has shown homeopathy to be just a placebo, but hey, there are other ways of knowing, science is not always correct, and we have many gaps in our knowledge.
Fair enough, that’s all I have been saying from the beginning: that homeopathy fails in science. In other methodologies homeopathy might prove efficacious -like what paul proposes: give treatments to patients until one of them works, and observe the changes! Way to go paul. Very scientific. No windows open for bias, human errors, and oh, our old friend, placebo effect, getting into the picture.
Science: you are doing it wrong paul!
December 13, 2008 at 6:13 am
paul
You really hven’t undertood have you
December 13, 2008 at 3:10 pm
stavros
sorry paul, that’s exactly what you’re implying when you question the appropriateness of science to evaluate homeopathy, and when your arguments include Quantum Mechanics and appeals to not knowing everything and other ways of knowing.
Oh and, Science: you are doing it wrong paul!
December 13, 2008 at 7:11 pm
paul
Have i mentioned quantum mechanics? And i am not questioning the appropriateness of science to evaluate homeopathy. I am questioning the appropriateness of THE science used to evaluate homeopathy. I will refer here to the excellent posts that LMSO has put up here on the subject of how limited RTC’s are at evaluating the processes that take place in the theraputic setting.
Oh and science, i am doing it all wrong! What is science but a way of knowing. It is knowledge gained through study or practice. There is no clear definition of how to go about “science”, so to say i am doing it wrong smacks of ….. well arrogance really.
February 4, 2009 at 10:40 pm
fred
you can not use a yard stick to measure a volume of water.
February 15, 2009 at 11:03 pm
brian
‘there is truly no evidence for homeopathy’
thats wishful thinking. Evidence for the success of homeopathy goes back to near its inception. A trial was conducted during a cholera epidemic, in which patients in alondon hospital were tested with botu conventional and homeopathic medicine. The results were to be tabled in parliament. The day came when the conventional results were presented, but the homeopathic were not. But homeopathy by then had friends in high places and the results were demanded to be shown. They showed homeopathy to be successful in reducing deaths to 16% (compared top 49% in conventional medicine).
Its written up in Divided Legacy, vol 2.
Those who say there is no evidence may as well say there is no evidence for aspirin.
Jeff Garrington is just as biased as the conventional doctors in that test. His Hawks-handsaw blog is a geologist’s blog, who pontificates on what he is not qualified to. he is entitled to his opinion, but thats all it is.
Disappointing of you Jeff!
February 15, 2009 at 11:38 pm
brian
Stavros:
‘I explicitly said that the plural of anecdotes is not data or evidence. Medical science cannot work this way’
Medical science doesnt work very well, when we see dangerous procedures, treatments like SSRI foisted on the public, only later to have labels detailing their dangers AFTER theyve injured the public:
http://www.ssristories.com/
Why do u persist in the illusion that medical science can be trusted by the public?