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:
We can all benefit from Ben Goldacre’s wisdom. For instance, in 2004 Goldacre received the Association of British Science Writer’s (ABSW) award for “the best feature on a science subject in a national or regional newspaper (2003) [1] for an article on MMR: Never mind the facts [2]. The major sponsor of the award of £2000 was MMR manufacturer and defendent Glaxo SmithKline [1]. This has not been disclosed in many Guardian articles mentioning MMR, nor was it recently in Goldacre’s BMJ piece MMR, the scare stories are back [3].
I also wonder whether this is one of the best examples of Goldacre’s work. Goldacre cited four studies three of which were subsequently reviewed by Cochrane 2005 [4]. Of these Cochrane stated:
“The study demonstrates the difficulties of drawing inferences in the absence of a non-exposed population or a clearly defined causal hypothesis”. (Re: Taylor 1999)
“The number and possible impact of biases in this study was so high that interpretation of the results is impossible”. (Re: Fombonne 2001)
“The interpretation of the study by Madsen was made difficult by the unequal length of follow up for younger cohort members as well as the use of the date of diagnosis rather than onset of symptoms of autism”. (Re: Madsen 2002)
The fourth study mentioned was the most remarkable of all, the Peltola letter to the Lancet of May 1998 which recorded no cases of autism or inflammatory bowel disease following 3 million applications of MMR in Finland simply because they were not in the follow up criteria of the larger study [5].
Moreover, there was a complex of funding issues unrelated by Goldacre. The Peltola study received funding from MMR defendent Merck [5]. The department of Elizabeth Miller who contributed to the Taylor study [6] benefited from funding by MMR defendents SmithKline Beecham and Aventis Pasteur [7]. At least one MMR study authored by her and Brent Taylor received funding from SmithKline Beecham [8]. The Fombonne study disclosed no interests [9] but according to a later study [10]:
“In the United Kingdom, Dr Fombonne has provided advice on the epidemiology and clinical aspects of autism to scientists advising parents, to vaccine manufacturers, and to several government committees between 1998 and 2001. Since June 2004, Dr Fombonne has been an expert witness for vaccine manufacturers in US thimerosal litigation. None of his research has ever been funded by the industry.”
So you can’t be too careful!
[1] ABSW Science Writers Award 2003
[2] Ben Goldacre, Never mind the facts, Guardian 11 December 2003
[3] Ben Goldacre, MMR, the scare stories are back, BMJ 21 July 2007
[4] V Demicheli, T Jefferson, A Rivetti, D Price,[Review] ‘Vaccines for measles, mumps and rubella in children’, Cochrane (Wiley 2005)
[5] Heikki Peltola, Annamari Patja, Pauli Leinikki, Martti Valle, Irja Davidkin, Mikho Paunio, No evidence for measles, mumps, and rubella vaccine-associated inflammatory bowel disease or autism in a 14-year prospective study, Lancet vol 351, May 1998, p. 1327-8
[6] Brent Taylor, Elizabeth Miller, C Paddy Farrington, Maria- Christina Petropoulos, Isabelle Favot-Mayaud, Jun Li, Pauline A Waight, Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association, Lancet vol 135, 12 June 1999.
[7] According to Geier M and Geier D (P3R to PEDIATRICS,’ Thimerosal does not belong in vaccines’ 8 September 2004) this funding was disclosed by Elizabeth Miller to the Committee on Safety of Medicines in 2002, and this was not denied by Dr Miller in her response
[8] E Miller, P Waight, C P Farrington, N Andrews, J Stowe, B Taylor, Idiopathic thrombocytopenic purpura and MMR vaccine. vol. 84 p.227-9 March 2001
[9] Eric Fombonne, FRCPsych and Suniti Chakrabarti, FRCPCH, No Evidence for A New Variant of Measles-Mumps-Rubella-Induced Autism, PEDIATRICS Vol. 108 No. 4 October 2001, p. e58
[10] Eric Fombonne, MD, Rita Zakarian, ME, Andrew Bennett, PhD, CPsych, Linyan Meng, MSc and Diane McLean-Heywood, MA, Pervasive Developmental Disorders in Montreal, Quebec, Canada: Prevalence and Links With Immunizations, Published online July 3, 2006 PEDIATRICS Vol. 118 No. 1 July 2006, pp. e139-e150 (doi:10.1542/peds.2005- 2993)
Competing interests: Autistic son
Curioser and curioser …
And yes, this appears to be very much about one man’s opinion.
Goldacre’s defence of MMR vaccination should also be viewed in the context of a study recently undertaken in the US. The new survey indicates a strong correlation between rates of neurological disorders, such as ADHD and autism, and childhood vaccinations.
The survey, commissioned by Generation Rescue, compared vaccinated and unvaccinated children in nine counties in Oregon and California. Among more than 9,000 boys age 4-17, the survey found vaccinated boys were two and a half times (155%) more likely to have neurological disorders compared to their unvaccinated peers. Vaccinated boys were 224% more likely to have Attention Deficit Hyperactivity Disorder (ADHD), and 61% more likely to have autism.
For older vaccinated boys in the 11-17 age bracket, the results were even more pronounced. Vaccinated boys were 158% more likely to have a neurological disorder, 317% more likely to have ADHD, and 112% more likely to have autism.
Laughing my socks off ... 
54 comments
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December 11, 2007 at 10:10 pm
freefromcensorship
Hello,
I’ve been reading & commenting on a few of the ‘homeopathy blogs’ with interest. However, on one blog, freetochoosehealth, almost all my comments are being deleted, however polite. Today I have had two posts deleted that were just saying ‘Happy Christmas’.
This confused me. I think that everybody should be free to make choices about their health based on all the best information we have. Censoring comments suggests an unwillingness to engage in debate. If you hold strong beliefs, you should be prepared to defend them with argument and evidence, or re-evaluate them if you can’t do so. Censorship doesn’t help anyone.
I’ve put up a blog of my own, just containing the titles & a link to each of FTCH’s posts. I won’t delete comments on there (if I have no choice, I will always explain why), and anyone from any side of the debate is welcome to write whatever they want, without censorship. I would rather hope that you can all manage polite & reasoned discussions, but I won’t delete what’s not.
Please join me, and submit comments on both freetochoosehealth and http://freefromcensorship.wordpress.com/
Many thanks,
‘Duck’.
December 11, 2007 at 10:49 pm
yeshomeopathy!
So Goldacre is in the pocket of the pharmaceutical industry and he fudges his information. What a surprise! As the homeopathic industry is about to surpass the conventional pharmaceutical industry in India I’m sure they are looking with trepidation at the U.K. A little preventative medicine.
December 12, 2007 at 10:21 am
ross
I’m sorry, are you really quoting a telephone survey as evidence of vaccines causing harm?
Really?
And I’m sure it’s tremendously exciting for you to believe GSK are going round buying off science writers by sponsoring awards ceremonies so they will write MMR fluff pieces. But you do realise the MMR vaccine is out of copyright?
December 12, 2007 at 1:37 pm
laughingmysocksoff
Yes I am Ross. And this is why. If you don’t consider this a valid method of evidence-gathering then I suggest you take it up with the CDC.
You’ve kind of missed my point in quoting John Stone’s letter. Whether or not Goldacre should have disclosed the prize money in his articles connected with MMR might be a moot point, but the fact he’s quoting studies that Cochrane deemed fairly badly flawed in support of his opinion while simultaneously claiming to champion robust high quality evidence (and dissing all homeopathic trials as too flawed and biased to count as evidence) is a point I felt was well worth making. Pots and kettles come to mind.
December 12, 2007 at 2:31 pm
ross
http://www.guardian.co.uk/life/feature/story/0,,1103958,00.html
I cant speak for Goldacre but as far as I can see the article isn’t stating these studies are definitive:
“It’s not perfect. Science textbooks are always being updated, and that’s a good thing. If more evidence came out to suggest that MMR caused autism, everyone would happily start changing their mind:”
And you seem to be selectively quoting the the cochrane review, you notably ommited its conclusion:
“No credible evidence of an involvement of MMR with either autism or Crohn’s disease was found. No field studies of the vaccine’s effectiveness were found but the impact of mass immunisation on the elimination of the diseases has been demonstrated worldwide.”
Do you not appreciate the irony of quoting the criticisms in the cochrane review and then trying to trump it with a telephone survey?
Yes the CDC use telephone surveys to establish prevalence levels of Autism. But I think you need to look up the difference between correlation and cause.
Sorry, long post.
December 12, 2007 at 3:04 pm
laughingmysocksoff
My kids play top trumps Ross. Personally it’s not a game that interests me much.
You’re still missing the point here. Homeopaths aren’t the ones claiming the mantle of “pure” unequivocal “quality” science to support their conclusions. Goldacre is, particularly in his rants against homeopathy. Let me find what he said again in the Guardian piece … “Evidence-based medicine is beautiful, elegant, clever and, most of all, important. It is how we know what will kill or cure you. These are biblical themes…” Hmmmm.
Demonstrating that he’s not above using flawed studies to support his conclusions, which is what he accuses homeopathy’s supporters of, just shows that he has no basis on which to claim some sort of ‘scientific’ or moral superiority. All I’m saying is that all the evidence is flawed in some way, and it’s interpretation very much more a matter of subjective opinion than Ben Goldacre would have us believe. There’s always two sides (at least) to every story. You can pick holes in my evidence ad nauseam, but I can do exactly the same with yours, and neither of us has any sound basis on which to claim the greater “truth”. THAT is the current state of affairs with the evidence base for homeopathy.
So to claim otherwise — as Goldacre, King, Horton, Baum, Colquhoun, Ernst et al regularly do — is to make a false claim. The evidence base doesn’t give us a clear answer either way. The jury’s still out. On that basis, to attempt to persuade PCTs to withdraw funding from homeopathic services in the face of growing demand from GPs and public alike is, at the very least, premature. It’s certainly unscientific and personally I consider it also unethical.
December 12, 2007 at 3:36 pm
ross
“All I’m saying is that all the evidence is flawed in some way,”
On this I would agree, there is no such thing as a perfect trial.
“The jury’s still out.”
If a well designed repeatable RCT shows positive results for Homeopathy, then yes my mind is changed. So yes in a way the jury is always still out. In the meantime we have to go on the best available evidence. Currently the best available evidence shows Homeopathy performs no better than placebo.
(yes I know you will want to argue the toss about the various meta-analysises [what is the plural of meta-analysis anyway])
So on your final point I strongly disagree, it is absolutely not wrong to persuade PCTs to withdraw funding for Homeopathy. It is up to Homeopaths to state the case. And the case must be evidence of efficacy, not “public demand”.
Anyway, I’d better go do some work.
ps
are you a practising Homeopath? because quackometer is struggling to find someone to take part in his challenge.
December 12, 2007 at 3:59 pm
homeopathy4health
Quackometer is raging in negative bias, I’m not surprised he can’t find anyone…
December 12, 2007 at 5:05 pm
yeshomeopathy!
On thinking about this entry: I see that there is not just one incident by Goldacre of serious accusations founded on poor studies that don’t pan out but a series of them, which makes it a serious pattern of lying. He lacks accountability and this is especially problematic since his funding through “awards” is coming from pharmaceutical companies.
ross said “So on your final point I strongly disagree, it is absolutely not wrong to persuade PCTs to withdraw funding for Homeopathy”
When you have people like Goldacre making unsubstantiated accusations it is not the best climate to get funding in.
If you look more carefully at this blog in total you will see there is substantial serious evidence that homeopathy works. Instead, like Randini, you and Lewis demand parlour tricks- more a publicity stunt to debase homeopathy.
December 12, 2007 at 5:52 pm
ross
All I’m asking for is some good quality RCTs, is there one that I’ve missed?
December 12, 2007 at 7:20 pm
laughingmysocksoff
That’s a matter of opinion, not fact, and depends on a very subjective definition of “best available evidence”. The evidence base is open to differing interpretation. It’s not incontrovertible, and your argument stands or falls on your definition of “acceptable evidence” which all of you seem to approach in a very black-and-white manner — ie. if it doesn’t meet your self-defined exacting criteria (the assumptions behind which are open to serious question), then it doesn’t count at all. This is plainly nonsense, since all evidence is in shades of grey. Evidence of lower quality (patient values, experience, clinical evaluation, literature reviews) is part of the picture in aggregate, all of which should, if a hypothesis is correct, be in agreement. Since that’s not the case here — conspicuously so, if the so-called “high” quality evidence is interpreted as being in direct contradiction of the remaining evidence base — then the hypothesis is weak.
I’ve posted this on another thread, but here it is again:
Any theory that relies on dismissing large bodies of evidence as non-existent, no matter that the evidence is lower quality than the highest quality evidence available, is not very scientific. A theory should be capable of explaining all the available evidence satisfactorily. The homeopathy-is-no-more-than-placebo hypothesis is not only unproven, but on very shakey ground precisely because it relies on adopting this very black-and-white approach to the evidence base.
December 14, 2007 at 9:34 pm
jdc325
“That’s a matter of opinion, not fact, and depends on a very subjective definition of “best available evidence”.”
If I may quote from AP Gaylard’s blog (because he puts it better than I ever could) – “Certain types of evidence are not “deemed“ to be better than others, they are better. RCT’s are only better because they reduce the effect of bias by randomising the allocation of patients to the treatment or control group”.
“A theory should be capable of explaining all the available evidence satisfactorily.” I actually think that this is the case with the scepticism regarding homeopathy. Perfectly reasonable explanations have been provided by various commentators for the available ‘positive’ pieces of evidence for homeopathy.
Placebo, regression to the mean, publication bias etc have all been offered and I don’t think that these explanations have yet been properly addressed by homeopaths.
PS – I noticed that you were happy to quote the Cochrane collaboration in your post. Perhaps you’d be interested in a book by the founder of the Cochrane Collaboration – Testing Treatments, available from Amazon. http://www.amazon.co.uk/Testing-Treatments-Better-Research-Healthcare/dp/071234909X?tag=bs0b-21
December 15, 2007 at 11:20 am
laughingmysocksoff
This idea that certain types of evidence are better than others still relies on a set of base assumptions that are a matter of opinion and open to question.
What we’re trying to do here is to make sick people better, right? That’s the sole purpose of medicine. Keep that uppermost in mind and see if you can follow my logic here.
RCTs and the whole philosophical approach that underpins them are predicated on a number of assumptions, not least of which are that the entire “valid” healing effect under consideration resides in the pharmaceutical intervention being tested, that all humans function in pretty much the same way, and that to treat organic illness you simply introduce a biochemical agent into the organism that alters or interferes with the specific biochemical/metabolic pathways affected in the disease under consideration. Therefore to test for the efficacy of said interventions you subject them to testing in as many people as you possibly can, filtering for the impact of all other recognised factors, in order to determine their efficacy. Perfectly reasonable conclusion that seems like self-evident “truth” if you’ve never stepped outside that way of thinking. But is it?
Look around you. Everywhere in medicine now (and beyond it to the other biological sciences as well) rigid determinism and linear logic is starting to break down in recognition that it’s inappropriate to the study and treatment of living systems. The theories don’t fit the data well enough. Such linearity as exists is only relative and contingent. If you apply linear cause-and-effect based treatment to complex chronic conditions, something else invariably pops out of whack (side effects) so you have to treat the side effects, then the side effects of the side effects’ treatment, and so it goes on until the patient is so drugged up to the eyeballs they pop their clogs. People are getting sicker and sicker and chronic disease is constantly increasing. Biomedicine is failing dismally here because in the absence of obvious linear causation, it simply has no answers. Clinging to the idea that there’s a “germ” for every condition and that you only have to find it and then find something to knock it out, just isn’t standing up in the face of the multifactorial complex “syndromes” that are very much on the rise.
So if the whole premise of treatment is open to question, so is the means of testing for efficacy and so is what constitutes “best evidence”. This is already being widely recognised in the redefinition of the “evidence mosaic” underpinning EBM. If successful healing interventions in chronic disease are found to be as multifactorial and mutually interdependent as the conditions themselves, then it becomes conceptually inappropriate to attempt to fragment the approach into its component parts and expect a single part to carry the entire “healing effect”.
The “best evidence” must, in such circumstances, default to the ultimate question: does it make sick people well? The answer to this question in respect of homeopathy appears to be a pretty resounding “yes” if the large number of satisfied patients and increasing GP referrals are anything to go by. And the very fact that there’s such a marked variance between this — the “does it make sick people well?” test — and what’s presently regarded as “best evidence” from trials of the therapy’s remedies should be an enormous red flag in any rational assessment of the situation.
December 15, 2007 at 12:35 pm
Andy Lewis
Dogs often get anxious when the postman arrives and feel it necessary to bark loudly to ensure he or she goes away. Cynics doubt that the dog barking has anything to do with the postman leaving, but the ‘best evidence’ must in such circulstances default to the ultimate question: does the postman go away when the dog barks? The answer to this question appears to be a pretty resounding ‘yes’ and a large number of dogs are very satisfied with their barking abilities. And the very fact that there is such a marked variance between this fact and what their owners believe based on rational understanding of postmen, must raise an enormous red flag to believing the rational capabilities of the dogs’ owners.
laughingmysocksoff : are you satisfied with your barking abilities?
December 16, 2007 at 3:40 pm
laughingmysocksoff
Woof, woof.
Nice try Andy. The thing is, we’re not dealing with humans and dogs here, regardless of your opinion of homeopaths, and even supposing it’s possible to guess at a dog’s line of reasoning when you’ve no idea what it’s like to be a dog. We’re dealing with humans and humans, so in the absence of any evidence supporting a discernible difference between the average intelligence and perspicacity of either group, you can only assume that both groups have equal abilities to make rational assessments based on their observations as well as to be equally oblivious to all the various questionable a priori assumptions they’re factoring into their hypotheses. It’s getting stale, mate.
December 16, 2007 at 6:14 pm
Andy Lewis
You would have thought so, wouldn’t you?
December 16, 2007 at 6:31 pm
Andy Lewis
laughingmysocksoff – let me make myself clear and spell it out to you. If your argument for homeopathy depends solely on the reliance of testimonial then you are behaving exactly like the dog who believes they are scaring off the postman. It is called the post hoc fallacy and is the foundation on which homeopathy is built. Basically, just because one event follows another, does not mean that one event causes another.
In the case of the dog, the reason the postman leaves is because the postman must deliver next door – there is an unexamined third factor. The dog barks because the postman arrives. That is the only application chain of causality here. In the case of homeopathy the chain of causality is that people take homeopathy because they were ill. It stops there. When people get better, they invert the chain of causality.
The mechanisms within our bodies are hidden from our consciousness. We cannot intuit chains of causality from the processes within out bodies on an individual level – no matter how hard you wish this to be true.
In the case of the dogs, you would do a controlled study to see how many postmen left with and without barking. In the case of homeopathy, a controlled study would look at the difference with and without the magic shaking that goes on. When such studies are done properly – the postman leaves anyway. What other conclusions can you draw?
December 17, 2007 at 10:27 am
OhReally
Off point, but has anyone seen what happened on Gimpys blog?
givescienceachance just trashed Homeopath bloggers (II) by asking bloggers to explain about how RCTs work. Nobody has been able to answer it! AMAZING!
Makes the usual stuff like Andy Lewis’s post above look stupid.
December 17, 2007 at 12:11 pm
Mary P
On the question of “best available evidence”, I would like to see some discussion of How Can We Regulate Medicines Better?. Ahuja commented on the paper in The Times, We’re dying for a better drugs test but I haven’t seen much coverage elsewhere.
I mention it here as it does seem as if there is some concern about what may be construed as “best evidence”.
December 17, 2007 at 5:29 pm
laughingmysocksoff
The argument for homeopathy doesn’t depend solely on the reliance of testimonial, Andy, and to attempt to reduce it to that is pretty ludicrous. Neither is the post hoc fallacy relevant here. There’s a very simple test for the dog to perform if he wants to determine whether his behaviour has any effect on the postman’s. He waits for the postman to come and he doesn’t bark. He tries that for a few days, then decides to see if wagging his tail has any effect. He tries that for a few days and then tries running round in circles. After a few days of that he chases the cat out the cat flap into the postman’s path. A few more days and a slightly freaked cat later, he concludes that whatever he does, the postman does the same thing so his behaviour has no impact on the postman’s. He’s still not too sure why it is that the postman doesn’t turn up at all one day a week, but he’s pretty sure it has nothing to do with him.
Analogues of all the dog’s tests and more have been performed repeatedly with respect to homeopathy over the last 200 years. Have a nice long consultation and give nothing at all, and nothing fundamental changes, even if the patient does feel a bit better for the next few hours. Have a nice long consultation and give a remedy that has little correlation with the individual’s state, nothing changes. Give the correct remedy for the individual’s state, with or without the nice long consultation, and with consistently close temporal association you have a reaction. There’s 200 years’ worth of consistency and replicability throughout this body of work, enabling predictability in use and continual reconfirmation.
It doesn’t always work out that way, of course, and whether that’s down to the “wrong” remedy, the circumstances, or any other of a number of possible factors, who knows? Exactly the same is true of biomedical interventions, despite all those DBPCRCTs behind them, and equally little is understood about why an intervention doesn’t work in the particular cases it doesn’t. But there’s enough consistency and replicability to comfortably demonstrate that something in the homeopathic process is working.
As I’ve reiterated ad nauseam, the observations and the data simply don’t fit your hypotheses. They might seem very plausible from a superficial appreciation of homeopathy that takes place largely in your imagination, but they don’t come anywhere close to explaining the reality of homeopathic practice where it counts — in the detail of individual case histories and the sequence of temporally associated events in each. And if the hypothesis doesn’t fit the observations, then no matter how hard you might wish it to be true, the hypothesis doesn’t fit the observations.
Nonsense. Don’t judge every other human being by your own level of development in consciousness, the extent of disconnection between your mind and body, or your own model of bodily processes. There is enormous variation here. Many people are capable of intuiting patterns of causal association for their illnesses. (And it’s patterns of causal association, or a web of causality rather than chains. The latter is far too linear a perspective in the context of chronic complaints.) This is the sort of data that biomedicine writes off as insignificant or irrelevant because it perceives no direct connection or relation to the complaint, but it’s this very data that homeopaths regard as crucial to selecting an effective remedy.
And equally well many people are more than capable of recognising when an intervention hits the right spot. Again, this is something people have tried to point out to you on the blogs — it’s an awareness of effect and its precipitating proximal cause that’s as clear as the hammer hitting the thumb instead of the nail or the first few gulps of the alcoholic beverage at the Christmas party going straight to the head. Yet those sensations don’t occur with remedies that miss the mark.
December 17, 2007 at 7:40 pm
ross
“givescienceachance just trashed Homeopath bloggers (II) by asking bloggers to explain about how RCTs work. Nobody has been able to answer it! AMAZING!”
No s/he just dribbled out some nonsense rambling psuedoscientific waffle. Which is presumably why you didn’t offer a link for people to judge for themselves.
http://gimpyblog.wordpress.com/2007/12/03/homeopath-bloggers-ii/#comment-1158
December 17, 2007 at 10:38 pm
laughingmysocksoff
Here we go again with the knee-jerk dismissive reaction to things you don’t fully understand. Very human, but not very scientific. What are you lot all so frightened of?
You’re not going to understand things like this if you’ve never stepped outside the model you use to interpret the world to question its fundamental a priori assumptions. I’ve used this analogy before, but it’s like two fish swimming in the ocean and one says to the other “so what’s this ocean you keep talking about then?” You can’t seem to grasp that the whole edifice you take to be incontrovertible “truth” is completely dependent on a set of initial assumptions that are subjectively determined and open to question.
Givescienceachance drew attention to some of these. There are more. I’m not sure OhReally’s interpretation of the thread is the same conclusion I’d draw since it’s apparent that most respondents can’t get their heads around what Givescienceachance is talking about, but these are absolutely fundamental issues in this discussion about homeopathy’s validity, because what we’re all ultimately arguing about is different ways of perceiving the world and validating the “truth” of any of it.
The sceptic view puts a lot of faith in perceived objectivity, denigrating anything that seems overly subjective, while failing to realise that its perceived “objectivity” has been wholly compromised by the subjectivity of the initial conditions. The homeopathic view acknowledges the subjective viewpoint and accords it as much validity as any notion of objectivity, knowing the objectivity is in many ways illusory. This is the principal reason why we can’t even agree about what constitutes valid “evidence”.
This is not “pseudoscience”, but the very nuts and bolts of what underpins the scientific approach. It’s the philosophy of science we’re talking about here, which we have to get into if we’re ever going to resolve this 200 year-old impasse. I talked about this on Gimpy’s blog a while back, but there’s a theorem from formal logic we can usefully use here which in very general terms states that the only way you can resolve a conflict between two apparently irreconcilable systems of thought is by recourse to a system of a higher order which is capable of encompassing the both.
The question is, are you up for stretching the boundaries of your world view or aren’t you? Because if you’re not, we’ll be here for another 200 years. At least.
December 17, 2007 at 11:55 pm
ross
RCTs are elegantly simple. In my view you are only obsfucating because they don’t give the result you want.
You can wrap it up in postmodern bollocks all you want, Homeopathy either does what it claims or it doesn’t.
December 18, 2007 at 12:55 am
M Simpson
” There’s 200 years’ worth of consistency and replicability throughout this body of work, enabling predictability in use and continual reconfirmation.
It doesn’t always work out that way, of course, and whether that’s down to the “wrong” remedy, the circumstances, or any other of a number of possible factors, who knows?”
Laughing, we have already established that direct contradictions don’t trouble you, but can you perhaps explain how you can describe something as consistent, replicable and predictable and then *in the next sentence* admit that “It doesn’t always work out that way”? Do you actually know what these words mean or is that too ‘subjective’?
If what you say is true, then it’s also true that my ability to pick six winning Lottery numbers every week is consistent, replicable and predictable. Although of course it doesn’t always turn out that way.
December 18, 2007 at 1:23 am
laughingmysocksoff
Do you live in the real world M? Or just in your idealised black-and-white notion of it? Nothing is 100% predictable 100% of the time. This applies every bit as much to pharmaceutical interventions sanctioned by due scientific process as it does to homeopathic ones. Not one intervention works for all of the people all of the time.
That doesn’t mean that replicability and consistency can’t be established to a perfectly reasonable and acceptable degree. This, after all, is the foundation biomedicine is built on. I just didn’t want you to go thinking homeopaths claim their therapy works for all of the people all of the time either. It doesn’t. But that doesn’t negate homeopathy any more than biomedicine’s failures negate biomedicine. Evidence so far suggests that, if anything, homeopathy’s failures are marginally less than biomedicine’s.
December 18, 2007 at 1:29 am
laughingmysocksoff
RCTs are elegantly simple in theory. Rarely so in practice. In my view you’re only obfuscating because you can’t tell the difference between the map and the territory.
December 18, 2007 at 8:54 am
gimpy
Err laughingmysocksoff you can be snooty and condescending about the people who post on my blog once you have answered the questions there you appear to have run away from.
In particular the case of Crohn’s disease and
What level of proof would you need to accept that homeopathy does not work?
and
Do you think that homeopathy can be used to cure non-self limiting conditions, if so could you provide an example of one, you only need one, incontrovertible example, with references, of homeopathy curing a non-self-limiting condition?
You seem to prefer wishy washy arguments where no facts are presented and you cannot seem to conceive that homeopathy might not work. This is the fatal flaw in your thinking. I know that many scientific theories relating to my field are valid but nevertheless I can design experiments which might show that they are not valid. You, and other homeopaths, cannot do this. Until you can you are operating firmly in the realm of faith and religion, not the real world.
December 18, 2007 at 12:33 pm
laughingmysocksoff
Gimpy, it’s Christmas, or hadn’t you noticed? Some of us have a life. At the moment I’m hard pressed just to answer comments on my own blog let alone keep up with the other blogs. And if people on your blog are arrogant and condescending, then they’ll get that reflected back to them.
I’ve already said umpteen times that there is something in the homeopathic process that has an effect. A therapy doesn’t prevail for 200 years and still demonstrate a consistently high satisfaction rate if there’s nothing going on. Experience is experience. It happens. You can’t make it unhappen and you can’t turn evidence into non-evidence just because it doesn’t fit the definition of incontrovertible. (See my latest post on the nature of evidence.) So it’s not a case of evidence, it’s a case of presenting a satisfactory rationale for the happenings that’s superior to the existing one. On that I have an open mind, but so far, nothing the sceptics camp has presented has come anywhere close to explaining the observations.
Yes I do think homeopathy can precipitate the resolution of non-self-limiting conditions. But you’re going to have to define what evidence you require for a “cured” case to be “incontrovertible” since it’s already well established that we have different attitudes to what constitutes valid evidence.
Welcome to the real world, Gimpy! We are all operating in the realm of faith and belief!! The underlying assumptions on which “hard science” is built are a matter of faith and belief, not incontrovertible truth. One of these beliefs is that apparent objective validity has no limitations. Another is that events are independent of the people who are intimately involved with those events. Your tests only “work” as long as you restrict your vision to a limited set of parameters that conform to those beliefs and a certain level of approximation, yet all the while there is far more going on. The more subtle the effects you’re testing for, the more the other stuff becomes apparent. This isn’t just the case with testing homeopathy, as I’ve already shown with the meta-analyses of SSRI trials, so it’s inappropriate to draw a notional line between homeopathic and conventional investigations in this regard. This is an issue with the very foundations of the premises used in constructing proof systems, and this is the fatal flaw in your thinking.
December 18, 2007 at 1:12 pm
ross
“Gimpy, it’s Christmas, or hadn’t you noticed?”
there may be so called “evidence” it is christmas, not in my proof system. you are restricting your vision to a limited set of parameters that conform to those beliefs and a certain level of approximation.
the observations and the data simply don’t fit your hypotheses. They might seem very plausible from a superficial appreciation of christmas that takes place largely in your imagination, but they don’t come anywhere close to explaining the reality.
or something.
December 18, 2007 at 6:09 pm
OhReally
Gimpy keeps asking:
What level of proof would you need to accept that homeopathy does not work? and so on
Even when someone does post an answer Gimpy and the Bent Minds ignore it.
And they won’t answer anyone else’s questions. They just run away from them screaming “It’s too difficult!”
December 18, 2007 at 6:11 pm
OhReally
Cool joke ross
December 18, 2007 at 8:29 pm
M Simpson
“Do you live in the real world M? Or just in your idealised black-and-white notion of it? Nothing is 100% predictable 100% of the time.”
Not only do I live in the real world, I also own a dictionary. You should invest in one. But you probably already own a dictionary AND don’t own a dictionary at the same time. I really do find your ability to doublethink coherently fascinating.
But you know, some things are 100% predictable. What about your old stand-by, gravity. If you drop two items of different masses (with equal or negligible air resistance) at the same time they will hit the ground at the same time. Every time. And we can extend this predictability so that we can work out precisely how a spacecraft will behave millions of miles away.
“That doesn’t mean that replicability and consistency can’t be established to a perfectly reasonable and acceptable degree.”
Really? Can you give us some figures? Pick any homeopathic remedy and any condition that it cures and tell us what the replicability is? How consistently does it perform? If this has been established to a reasonable and acceptable degree, it must have been published somewhere.
December 19, 2007 at 9:49 am
gimpy
Laughingmysocksoff, those questions are very important (and easy to answer). Your answers will be invaluable to those of us who are trying to understand your way of thinking. Your extreme reluctance to answer does reflect badly on you and I don’t buy into your excuses of time. You are quite happy to post long, rambling posts here but you cannot answer any direct question. Why not? To make it easy for you I will provide answers to the questions and you can choose one.
Do you think the case of Crohn’s disease described on my blog was successfully treated by homeopathy?
a) Yes
b) No
c) Don’t know/refuse to answer
What level of proof would you need to accept that homeopathy does not work?
a) I don’t need proof, I know it works.
b) This level of proof………..
c) Don’t know/refuse to answer
Do you think that homeopathy can be used to cure non-self limiting conditions, if so could you provide an example of one, you only need one, incontrovertible example, with references, of homeopathy curing a non-self-limiting condition?
a) Yes, here is my example…………
b) No.
c) Don’t know/refuse to answer
December 19, 2007 at 2:02 pm
laughingmysocksoff
Don’t forget M that heads and tails are two sides of the same coin; north and south opposing poles of the same magnet. You seem to perceive a degree of irreconcilable polarisation in what I say that simply isn’t there until you create it through your apparent tendency to polarise everything in this debate into either black or white and then drive a wedge between the two and declare them incompatible.
It’s published in all the homeopathic literature which consists almost entirely of case histories, distillations of symptom pictures collected from provings and clinical confirmations, and symptom indexes. These form the basis on which just about every homeopathic prescription is made. You don’t give a remedy unless its recorded as having either produced or cured the symptoms you’re taking into account in the patient’s overall state. So the vast majority of successful prescriptions, certainly for remedies that have been in use since Hahnemann’s time, are based on long-established replicability. Biomedicine doesn’t come close to this sort of careful replicable matching of remedy to patient.
As to quantification, no comprehensive studies have been done. In any case, you can’t separate the remedy’s replicability from the skill of the homeopath prescribing it. If the remedy isn’t the right one for the case, then it won’t work in that instance. Another one will.
December 19, 2007 at 2:04 pm
laughingmysocksoff
Gimpy if you choose not to believe me, that’s your choice. Doesn’t make the fact any less true.
I’ve answered your questions above. Just because they don’t fit into your predefined boxes of acceptable answers doesn’t mean they’re not answers. Closed questions and predefined criteria for what’s admissible as “evidence” are not science. Science requires an open mind. Oh, and the extracts from the case of Crohn’s disease you published didn’t provide enough information to make any assessment one way or the other.
December 19, 2007 at 9:01 pm
M Simpson
“As to quantification, no comprehensive studies have been done. In any case, you can’t separate the remedy’s replicability from the skill of the homeopath prescribing it. If the remedy isn’t the right one for the case, then it won’t work in that instance. Another one will.”
In other words, despite what you said earlier (“That doesn’t mean that replicability and consistency can’t be established to a perfectly reasonable and acceptable degree.”), replicability and consistency have never been established to any degree whatsoever.
December 19, 2007 at 11:22 pm
laughingmysocksoff
Rubbish, M. That’s not what I said at all. The whole basis of the therapy is replicability and consistency. The vast majority of times a homeopath makes a successful prescription, it’s based on the replicable and consistent application of the remedy they prescribe. So on that basis you could argue that replicability is demonstrated in possibly as much as 98% of successful homeopathic prescriptions.
But you asked specifically about quantifying the replicability of individual remedies, and I responded that you can’t separate the effect of the remedy from the skill of the prescriber in order to arrive at any precise quantity for the remedy alone. If you prescribe remedy A for 10 people and it’s only the right remedy for 6 of them, then you can’t conclude from that that the remedy only demonstrates replicablility in 6 out of 10 cases. The remedy may well have close to 100% reliability and replicability in cases for which its suitable, but there’s no way of establishing that because pattern recognition is not an exact science, as biomedical practitioners know only too well, and patients don’t always get the most suitable remedy for their state first time.
This is just an inevitable stumbling block in trying to apply quantitative analysis to individualised treatment. In many ways it’s not dissimilar to the apples-and-oranges problems encountered in meta-analyses of trial data.
December 19, 2007 at 11:47 pm
M Simpson
So the four people who received remedy A and nothing happened, that was not because the remedy didn’t work but because it was the wrong remedy? So what you’re saying is…
(drum roll please, because I think we’re approaching something fundamental here)
… homeopathic remedies work pretty much every time Except When They Don’t.
December 20, 2007 at 12:31 am
laughingmysocksoff
Away and crawl back under your bridge M! If your sole purpose in being here is to attempt to shoehorn everything I say into either the black or the white box and then get all excited about the apparent contradictions that you’ve introduced into it by doing that, what on earth is the point? What I said was perfectly clear and stands on its own merits for anyone to read. It’s not amenable to your black-and-white summary interpretations and (drum roll please, because I think we’re approaching something fundamental …) all you’re succeeding in doing here is evidencing the extreme polarisation in your own thinking.
December 20, 2007 at 8:16 am
Andy Lewis
No laughingmysocksoff, M has a very good point. This is a critical phrase: cases for which its suitable. Can you tell before or after the remedy was given which cases were suitable? If you say after, we will be laughing all Christmas.
But if you say before, how can you tell which is which? Are there only a small group of real homeopaths who get it right every time.
Fascinating stuff.
December 20, 2007 at 10:09 am
gimpy
Interesting that you acknowledge that the Crohn’s disease report doesn’t provide you with enough evidence to make up your mind. The FoH are touting it as successful treatment and even issued a press release to publicise it. It’s rather lax of them to claim successful treatment if other homeopaths, such as yourself, have doubts.
As for cured conditions. Well a medical diagnosis before treatment clearly showing presence of disease and one after clearly showing absence of disease would be a starting point. Surely that’s not too much to ask, we can quibble over the rest once you can show this.
We still don’t know if you would be prepared to consider the possibility that homeopathy does not work.
December 20, 2007 at 10:36 am
ross
Gimpy said :”We still don’t know if you would be prepared to consider the possibility that homeopathy does not work.”
Well on an another post he said there was nothing that would convince him Homeopathy dosn’t work.
Perhaps he has changed his mind?
December 20, 2007 at 10:55 am
gimpy
Ahh forgot about that Ross. Now how can claim to have an open mind when he won’t consider the possibility his beliefs are mistaken. So as he has said
it would be fair to assume that he doesn’t consider homeopathy a science?
December 20, 2007 at 11:15 am
ross
who knows, but I think he has just invented quantum cognitive dissonance.
or something.
December 20, 2007 at 11:30 pm
laughingmysocksoff
The process is in many ways no different to making a biomedical diagnosis. It’s pattern-matching. And nobody gets it right first time every time because the pattern isn’t always clear, just as in biomedical diagnosis.
You assess the symptoms of the entire state of the individual as you’ve been able to gather from the interview, correlate those with remedies that have been demonstrated to exhibit those patterns and decide which has the balance of probability. In some cases, the remedy required is crystal clear. You give it, and the reaction is equally strong and clear. And in just about every instance where this is the case, then the indicated remedy does exactly what you expect it to first time every time.
Many cases though don’t exhibit such a clear picture, particularly where there’s chronic disease of many years’ standing. Even in a 90 minute interview, it’s not always possible to gather enough of the right kind of information. Where differentiation between remedy states might hinge on, say, the quality of pains (eg. burning vs stabbing) then you’re not going to get the information you need if the patient says I don’t know, it just hurts. A number of remedies may rank equally in relation to the information you have to hand and the differences between them can be subtle, so you then need to decide which to prescribe first. In these instances, you might have to give a remedy, then judge the reaction to it to either confirm or eliminate it from the list of likely contenders.
This is also no different to biomedical practice where a drug for a given condition might prove unsuitable for the patient and need to be changed to a different one. You can’t always tell in advance what will work, but that doesn’t mean you’re not prescribing on clear principles and replicable data.
December 20, 2007 at 11:31 pm
laughingmysocksoff
Gimpy I said your reporting of the Crohn’s disease case doesn’t provide me with enough information to make up my mind. I haven’t seen the publication yet.
December 21, 2007 at 10:33 am
gimpy
laughingmysocksoff, I linked to the original article in my blog post so you have no excuse for not reading it. In fact you were willing to discuss in detail my interpretation of the article, now it turns out you hadn’t read it at all. How can you consider yourself capable of critical thought if you aren’t prepared to do background reading before venturing an opinion.
December 22, 2007 at 8:03 pm
laughingmysocksoff
Mea culpa, Gimpy. You’re right, I’ve no excuse on that one. I’ve been remiss in not examining the original. Doesn’t mean I’m not capable of critical thought, but that I’m also capable of shooting my mouth off when hard pressed for time. Can’t guarantee it won’t happen again, but I’ll do my best to make sure it doesn’t. I’ll now go study it, and let you know what I think. OK?
December 22, 2007 at 8:49 pm
gimpy
Hey no problem laughingmysocksoff. I’d by lying if said I read all the source literature all the time too.
December 22, 2007 at 9:23 pm
laughingmysocksoff
OK. I’ve reviewed this case.
The fact that the patient has been largely symptom-free for a period of 2 years with just one major flare-up in that time is atypical for the normal disease pattern, particularly as apparently evidenced in this patient by her experience prior to homeopathy.
However, with the (very notable) caveat that it’s very hard to judge from case reports, from my personal opinion and perspective, I’d be looking for a better reaction to the prescription than has been shown here. The condition seems to be being held in abeyance but there’s little evidence of real cure. The susceptibility to succumbing to this symptom complex when under stress, though reduced, still appears to be present. The necessity for the frequency of repetition and the use of different remedies for limited totalities of symptoms would ring warning bells for me and have me going back to re-analyse the case. From the symptoms described, I think one major candidate has possibly been left out of consideration, and that’s Bambusa arundinacea — bamboo. But I could be completely wrong here — that’s just what hit me when I read it.
December 24, 2007 at 7:50 pm
David Colquhoun
What baffles me about this discussion is why the ‘alternative medicine’ industry is so keen to support Andrew Wakefield who was a perfectly ordinary doctor and (not-very-good) scientist.
Not only was there nothing in the least alternative about him, but he also had a string vested interest in the outcome of his work because of his patents on the single vaccines, just the sort of thing that you always (and quite rightly) criticise.
And before anyone says anything, I have never taken a penny from the pharmaceutical industry for my research. I value my independence too much to do that.
December 27, 2007 at 11:06 am
laughingmysocksoff
Good point David. It epitomises in many ways the whole crux of this debate, not just about MMR but about homeopathy as well: it’s this question over what to give strength and weight to in the evidence hierarchy and what is and is not “valid” evidence, which I’ve addressed elsewhere and will continue to address in forthcoming posts.
As for your implied question, I can’t speak for the “industry” bit, not least because as a collective noun it implies a degree of coherence, cohesion and focus that simply doesn’t exist, but I can try to explain how I and many of my colleagues look at this issue.
This would be a good point IF Andrew Wakefield’s research was all there was to it, but it’s a fact that there are over 1000 sets of parents who can demonstrate a remarkable consistency in circumstances leading up to the diagnosis of autism in their children. Some of these parents are scientists like yourself, some physicians, and they’re a long way from being stupid. They know what they observed. They’ve got medical records, “before” and “after” videotapes, challenge/dechallenge/rechallenge data, all sorts of corroborating evidence. But nobody seems to want to hear this. The entire medical profession seem to deny the very possibility. Government don’t want to know either. As far as medical science (though medical science alone) is concerned, all these careful observations with their independent corroboration, documentation and testing of the hypothesis are just “anecdotal evidence” and hence, so the dogma goes, totally “invalid”.
Then one man pops his head over the ramparts of what’s looking increasingly like Fortress Biomedicine and says “wait a minute …” It doesn’t matter who he is. Andrew Wakefield gets support not because he’s Andrew Wakefield, with or without whatever qualifications, abilities and interests he may or may not possess, and which may or may not affect the validity of his research, but because he’s been someone willing to take this seriously, do some research and risk his reputation to spearhead a movement giving a voice to the many people who know beyond all reasonable doubt (at least in legal terms) that their children’s condition had some causal connection with the administration of this vaccine. So the bottom line is that discrediting Wakefield is no more than shooting the messenger.
The reason so many CAM practitioners support his efforts is because we end up working with so many of these children: not just the autistic ones, but all manner of children who’ve never been well since a routine vaccination. Why? Because GPs tell the parents it’s nothing to do with the vaccine, that any association is all in their imagination, and there’s nothing they can do about it anyway. What are these parents to do? Where do they turn? What choices do they have when nobody in “conventional” medicine will listen to them? So some turn to CAM practitioners because a) they’ve no involvement in any vaccination programme so no investment in denying any causal link, b) they have a lot more confidence in the value of case history as evidence, and c) they might, even though their therapies don’t meet conventional standards of “proof”, be able to help their children. And CAM practitioners, because they take account of the aetiology of the case and give it significant weight in their choice of treatment, have frequently confirmed to their own satisfaction from the response that there’s good reason to support the parents’ in their suspicions.
Of course they’re perfectly aware they have no rigorous scientific proof, but there’s no rule which says they can’t form a provisional hypothesis on the basis of their own observations and assessment and support calls for more thorough research on a possible link.
It looks very much to me like the parents of MMR-damaged children are saying “Look! We’ve seen black swans! Here’s our independently verified observation records. Here’s a video of them.” while medical science says “That’s not evidence. All swans are white”. It then sets out to “prove” it on its terms. It examines a few swan populations, produces a few rather flawed studies (including a couple on Danish swan populations where the primary suspect for the black swan gene has been absent from the gene pool since 1992, but where, unaccounted for in the latter study, the whole basis for recording black swan sightings changed around the same time) and continues to state categorically that there can be no possibility of black swans. And all despite the fact that this hypothesis is, by its nature (per Popper), unverifiable.
Raise the drawbridge! Lower the portcullis! Stuff that genie back in the bottle and get Pandora to sit on the lid! Vaccination is the sacred pox-ridden cow of biomedicine. We have to keep the faith regardless of the gathering flocks of black swans swimming about in the castle moat. Regardless of the fact that we’ve never tested the cumulative and combined effect of ever increasing numbers of childhood vaccinations administered within a short space of time to immature and vulnerable immune systems. Regardless of the explosion in conditions featuring dysfunctional immune response that have developed concurrently in highly vaccinated populations. Regardless of the number of conventional physicians expressing their own doubts about the safety of vaccines. Regardless of the countries who have taken precautionary measures and changed their policies to delay childhood vaccinations until the immune system has had more chance to mature. We have to close ranks, have to present a united front, because any admission of a connection will produce so many claims for compensation it will have punitive financial implications for our governments (not, of course, the pharmaceutical industry because they made sure they got themselves a get-out clause).
I salute your personal commitment to financial independence from the pharmaceutical industry, David. I’m not so sure about your ideological independence though, or the quality of your science. There are just far too many pieces to this jigsaw puzzle that haven’t been examined yet and too many dead canaries in the coal-mine to be ignored or dismissed as “invalid”.
May 8, 2008 at 12:54 am
Burnsey
Hmm.. obviously Goldacre may have some flaws in his argument, for example the Cochrane review on the four studies he cited on MMR were rather interesting, however in my opinion this is rather undercut by the fact that in the overall review by Cochrane (which as I’m sure you know was not undertaken lightly) they did conclude that there was no credible evidence linking Crohn’s disease or autism to MMR, much like the other studies (with thier flaws).
As for the case to that Goldacre is in the pocket of the drug companies I personally believe (as you may have guessed by now I am more than not in the favour of Goldacre) that this is not the case. Goldacre is frequently critical of drugs companies, both on rebranding drugs and on thier fudging of scientific data.
Also what interesting here is that Goldacre is by definition a sceptic, so he is used to approaching a new idea with the view that it is wrong. MMR is actually case for him arguing the opposite, but for me I believe him to be correct, but I still defineately find your argument compelling on what is a foggy issue.
January 18, 2009 at 6:21 pm
The One Show starting early again - Page 7 | hilpers
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