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A lot of hot air has been expended on homeopathy’s apparent inability to “prove” itself in clinical trials. Many people, many of whom call themselves scientists, seem only to need this fact, plus the therapy’s apparent implausibility, to jump to the conclusion the whole thing is nonsense on stilts, and work themselves up into lathers of righteous indignation about the fact that it continues to be practiced. I’ve gone into this a couple of times in the comments to posts on this blog, but this question really does deserve detailed examination, because the issue is not at all as simple as it might seem.

The presupposition of clinical trials is that there is a stable, locally active cause that is only active in the treatment group, irrespective of blinding and the circumstances of the trial or any changed clinical context as a result of the trial. In plain English, this means that the whole basis of clinical trials is predicated on the assumption that the bulk of the treatment effect resides in the physical substance that’s being trialed. It’s a localist hypothesis, proceeding — in homeopathy’s case — from the following logic:

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While musing on the nature of evidence, and what is or is not considered ‘evidence’ in all the various contexts evidence is used, I came across this excellent rapid response in the BMJ back in 2004 by Clifford Miller, “a practising English lawyer, graduate in physics and a sometime examining lecturer on law, standards and ethics (particularly, the law of evidence) to Masters student technologists at the Imperial College of Science Technology and Medicine”.

He writes, in the context of the imputed association between MMR vaccination and the onset of autistic states, on “The Unreliability of Scientific Papers as Evidence”:

“Reliable evidence is that which is authentic, accurate and complete. In short, scientific evidence is incomplete if used for purposes outside the strict confines of science because it fails to take account of evidence of lay witnesses of the facts and is hence only applicable to the narrow and specific confines of scientific enquiry and not the broader ones found in other fields of human endeavour.

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I’ve been taking a closer look at what Ben Goldacre regards as ‘good science’, given that he makes such grandiose and sweeping claims about the respective quality of research into both homeopathy and pharmaceutical interventions in both his recent Guardian article, What’s wrong with homeopathy? and the accompanying comment piece in The Lancet, Benefits and Risks of Homeopathy.

In the Guardian, he claims:

I look about 12, and I’m only a few years out of medical school. This is all good fun, but my adamant stance, that I absolutely lack any authority, is key: because this is not about one man’s opinion, and there is nothing even slightly technical or complicated about the evidence on homeopathy, or indeed anything, when it is clearly explained.

He then goes on at great length, much of it speculative, to give his reasons for why just about all homeopathic research is meaningless nonsense full of nothing but bias and conventional medical research is robust.

But thanks to a rapid response on the BMJ’s website, we learn the following from John Stone:

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So now we have another prominent ‘scientist’ joining the chorus. Sir David King, the government’s chief scientific advisor, speaking to MPs on the innovation, universities and skills select committee about his role, laid into sections of the media (for their “campaigns” against GM foods and the MMR vaccine) and the Department of Health over its decision to allow homeopathic remedies to be licensed by the Medicines and Healthcare Products Regulatory Agency, the public body that licenses drugs.

“How can you have homeopathic medicines labelled by a department which is driven by science?” said King. “There is not one jot of evidence supporting the notion that homeopathic medicines are of any assistance whatsoever.”

(Reports in the Guardian, the Daily Telegraph, the Daily Mail)

Make no mistake, this “not one jot of evidence” is nothing more than a mantra which those continually repeating it seem to hope will eventually become accepted as some sort of “truth” merely through repetition. In no sense does it bear any relation to the actual state of the evidence base for homeopathy. It is, quite simply, a lie.

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