11 Jan 2009

Guest post by Gordon; A medical expert's assessment of homeopathy

Pure, refreshing, and lacking all medicinal properties.

Oh this is delicious. I had another comment from the person who was unhappy with my assessment of homeopathy recently, and whose contribution was so hilarious that I dedicated a post to answering her/him.

Well s/he came back and it's beautiful. I showed Gordon what this person wrote and he decided that he wanted to leave a comment. But I don't want his words of wisdom buried away as a comment on a post written last year so I offered him the opportunity to write a guest post for my award winning (snarf) blog. He has agreed.

So, I take great pleasure in introducing the first even contribution to the blogosphere (he's not written so much as a comment before; too busy doing properly useful stuff like trying to cure cancer and that) from the man known to some as Gordon! (Yay! Applause!)

Homeopathy: a lucrative hoax founded on belief and not evidence

by Gordon

Anonymous wrote, "You may well know chemistry,but you certainly do not know homeopathy..."

I feel that it is important to state some simple facts about homeopathy and why it is not only a belief system founded on the supernatural, but potentially harmful. Yes I am a doctor, yes I do conduct clinical trials and have a passion for pharmacology, so perhaps I'm biased, but here goes....

fact 1. Homeopathy has never demonstrated effectiveness - ever. Period.
We define causality in therapeutics by its effectiveness compared with some sort of control. The simplest, easiest control is comparison of the treatment in question with "nothing" or "placebo". Lets say for argument's sake that homeopathy could have a measurable benefit even in the absence of any scientific explanation of how it works. If a benefit can be shown to be causal, all things being equal, homeopathy must demonstrate a greater benefit in persons receiving it compared with nothing at all. Simple as that. Anecdotes, telling of individual cases of suggested benefit are completely meaningless. Why? Because spontaneous remissions and disease stabilization happen in individuals, even in cancer (my speciality). Its the cohort effect that matters and provides the measure of effectiveness ie. benefit in a group of individuals treated either at the same time or one after another.

So...A simple study taking as the "lowest bar", the easiest possible comparator to beat, i.e. nothing, should be able to demonstrate efficacy for homeopathy shouldn't it? Well actually, no it can't....I challenge ANYONE to show me a randomized (all bias removed), prospective study where homeopathy has shown any benefit above "nothing whatsoever". I have no doubt at all, that this will not be possible, ever. The reason is simple, homeopathy is placebo and therefore it will never be possible to demonstrate superiority over "nothing at all". (You know, sometimes in real therapeutics, we try to demonstrate non-inferiority of a new therapy over an old one. We need large numbers, often thousands of patients to do this. Taking this to its logical conclusion with comparison of one placebo over another, the numbers of patients required to show a difference could be astronomically large or even infinite. Meaning in reality that such a difference can never be shown!)

The anecdotes that we see relating to little Timmy's "asthma getting better" time and time again are utterly meaningless. It demonstrates a total failure on the part of those believers purporting efficacy of homeopathy to simply consider whether the suggested effects of this approach can work when the numbers of treated individuals are greater than one. Do we ever see response rates? Of course we don't. Could anyone out there tell me for example if the homeopathic treatment response rate for urticaria (or anything) is say 20%? I thought not. Running even a non-randomized study, gathering data to present some simple evidence of efficacy is too much and would collapse the arguments of the "homeopathy-peddler". Asking for randomized data may be a little much I suppose, but benefit rates? That should simple right ? Even that is too much, and would expose the lucrative fraud that is homeopathy.

Fact 2. Science has no explanation for how homeopathy could work in the first place. It simply goes against natural science, the thing that brought us, yes you guessed it....civilization including the Internet that you are reading this on!!!

Take a quick look at the history of science and it is clear that we have a thorough but still very incomplete knowledge of how our universe works. Certainly some of the 20th century's great scientific discoveries revealed some uncomfortable truths (take that to mean testable theories that hold true), as revealed through the wonders of quantum mechanics or relativity as two examples.

We all know that if a cake is divided into more and more parts, we ultimately get less and less. Try dividing a cake into 100, million pieces sometime and see how much cake you end up with! At the heart of pharmacology, the study of drugs that do work, the law of mass action is central. Simply put, the action of any agent is related to how much of it is around.... How easy is that to understand? Homeopathy believers, take this fundamental natural law, equivalent to saying "things fall when dropped", and turn it on its head. "No", they say, "..When things become dilute, they acquire a potency!" Moreover, they state that this potency can modify biological systems in a direction that can be exploited as therapy.

A quick examination of this homeopathic principle makes it clear that it is rooted in belief and nothing else. The same sort of belief that has led humans throughout history to believe in ghosts, elves, sun gods, animal sacrifice, etc...Without evoking some supernatural unproven, invented "idea" about what happens when a substance becomes dilute, my smallest child can tell you that if you mix a fruit cordial with enough water, it tastes like water...That's because folks, and here's the rub...With enough dilution that's what it becomes. But you all know that don't you?

A very famous pharmacologist, the late Jaques Benveniste, who I once respected for his work on platelet activating factor and allergy, caused one hell of a fuss some years back when he proposed that homeopathic dilutions of an allergy inducing antibody called IgE could still cause degranulation of histamine from mast cells, an event linked to allergy. Quite rightly he stated this as an observation without explanation but one which was statistically robust. I found this fascinating. It was reported in Nature which I can tell you has one hell of a high bar for evidence based reporting. However, Benviniste was discredited when it shown that robust reproduction of his experiments were not possible. The claims were false. Dilutions of an active agent cannot retain their initial activity. This original Benveniste paper is I believe, the closest homeopathy ever came to being considered science. Since then (1988), the truth has been somewhat different.

fact 3. Duping vulnerable individuals with falsehood is financially lucrative and is not subject to any regulatory control, compared with real medicines.

Lets be absolutely clear about this. Homeopathy is a big business and makes its peddlers money. Homeopathy is quasi-therapeutics, based on no evidence, yet somehow is legal ! I'm baffled at this. For a real drug, it requires years of painstaking research in the laboratory and clinic. Years and perhaps hundreds of thousands, may be millions of US dollars worth of funding before it even achieves a licence (IND) to allow the first experiments or clinical trials in human beings. Even then, the rate of success of a drug getting into routine practice after reaching this massively important stage is very low, around 10%. Studies are then required to establish the right dose (phase 1), and whether there is any meaningful activity (phase 2). Only when this has been shown, is there the opportunity to conduct the definitive randomized controlled phase III trial. Only if the activity of the experimental drug "beats" this control, will the study be positive (you would be astonished at how many negative phase III trials are out there). Even with a positive phase III trial, there is no guarantee that an agent will "change clinical practice", because the difference in efficacy (often minimal) could be insufficient to justify the costs of that new medicine. Agencies such as the FDA and the EMEA are around to make sure that before a licence to sell a drug as a medicine is given, the evidence base for its activity is sound.

Given all of this investment in what is a "odds-against" enterprise, is it surprising that massive global pharmaceutical companies are needed to deliver new medicines ? But wait, there is another way. Lets just state that a homeopathic remedy is effective, bypass of this testing and regulatory bullshit and just get our remedies to market!! That way we can sell a panoply of remedies for all sorts of not really serious ailments. Rashes, bowel issues, you know the sort.....Of course its good business. If I were of lower moral standing I would have done this ages ago myself. Imagine how much money I could get if I used my MD PhD credentials to con people into paying for my magic water!

Perhaps the only justification for not sanctioning homeopathists is that they peddle water, and as we all know water is harmless....Or is it ? I think that people duped into spending money on homeopathy need to have the best information about what they are spending money on. If they were appropriately informed, I think the market would rightly collapse. Why should "water" be a solution for patients where conventional cancer therapy fails to work (for example), in the absence of any evidence, either laboratory-based or early trial evidence of activity. Much better for a patient to be offered treatment in a clinical trial. The possibility that asthmatics or any other patients with potentially life threatening conditions might be treated with homeopathy, fills me with horror. But then, perhaps the homeopathist would defer to the conventional therapy for "such serious conditions". Now that's what I call a cop out. Where are your balls homeopathists???

The idea that the UK National Health Service in the UK uses tax payers money to fund a homeopathic hospital at a time when there is major rationing and lack of availability of effective therapy, is nothing short of scandalous. But this is a fight that other distinguished colleagues have waged for sometime.

In summary, homeopathy is an often lucrative belief system based on no evidence whatsoever. Let me say that again: no evidence whatsoever. Those who support it have no grounds to do so. They are in the same camp as people who believe in astrology or any other supernatural phenomena. Their view of the natural world is distorted by the invented, rather than the demonstrable. Homeopathy is dangerous because it offers something that does not exist, efficacy without evidence. I have no problem about people spending their hard earned bucks on sugar pills (hell, we still have cigarettes to get rid of). What I do have a problem with, are the liars who purport to know something about this universe that we live in, without the slightest evidence, then attempt to convince the most intellectually vulnerable in our society to believe it too. Its just wrong. I invite anyone reading this who disagrees, to challenge what I have said. I don't expect much of a response....


davidbraziel said...

Excellent post and well done - with well reasoned, thorough, sensible arguments like that you clearly have no place on the Internet :)

On a lighter note have you ever heard Dara O'Briain on the subject of Homeopathy?

"They always say : Its impossible to overdose on Homeopathic medicine and I say, well you could effin' drown!"

Anonymous said...

Hey, love the post Gordon. Considering I was one of the many who were duped at some stage by this nonsense, and spent a fortune for the priviledge of being told not to eat chocolate or drink coffee and paid for some silly drops (to dilute, obviously), I feel I can also comment on the ridiculous fables they exclaim to be fact.
As you know I finally found my "cure" in a drug that took a long time to become legal (scientifically) and I will always be in my debt to, I'm sure, the many people who made it possible.
Your post (hopefully) will make some people think about where to spend their time and hard earned money.
I also promise never to delve into the falsehoods and money laundering ways of homeopathy. (Can't even bring myself to put a capital H on it) lol
Miche xx

Sharon said...

@David, on Gordon's behalf, thanks.

He bought me O'Briain's latest DVD at Xmas and we watched it the other night with my bro and SIL, all of us cracking up. He's da man. We chortled gleefully at his digs at homeopaths and nutritionists.

@Miche, ta missus. And yes, proper medicine helps people make the most of life. That these people claim to help people deal with seizures (as my anonymous commenter did) infuriates me.

David Colquhoun said...

Excellent summary. Thanks.
Most of the alternative medicine industry is simply fraud, but loopholes in the law protect its profits, and political correctness prevents most medical organisations from saying so.

Jean said...

I really enjoyed your post Gordon (I had to check to see which character Gordon is...my little fella is into Bob). When my son was first diagnosed I did what most parents do and surfed the net. I was beyond horrified at the sea of (expensive) "therapies" and even "cures" that were available. The cruelty of these vultures who prey on vulnerable parents is shocking. Maybe some of them are heartfelt and genuine...but none of them were cheap!! Most parents would remortgage their house without a second thought if we thought we could buy a cure for autism, so we're an easy group to target. Besides homeopathy, there's people selling mega doses of vitamins supposed to have amazing effects...I'm a nurse and I know that many of these doses are considered dangerous. There's people insisting it's 'leaky gut' which no one can seem to diagnose. Some blame vaccines even though countries which have no vaccine schedules for kids have the same rate of autism as everywhere else. The pseudo-science can be very seductive to frightened parents searching for answers. It's great to hear a bit of reason. Three cheers!

kristina said...

Just wanted to say, thank you Gordon (and Sharon!) so much for this----I've gotten too many comments asking about homeopathy and now I can point people to this assessment.

Gimpy said...

Excellent post and welcome to the blogosphere.

I have to say I am increasingly in favour of heavy regulation in the alternative medicine sector as a whole and homeopaths in particular. Time and time again they have demonstrated that they are not reasonable, not open minded and not capable of upholding sensible behaviour. Not only that, because they are true believers and cannot believe they could be wrong, they invent fantastical conspiracy theories surrounding the efforts of hard working, mostly honest, researchers in both the private and public research communities.
People who undermine science and evidenced based medicine for their own ends are risk health and lives of innocent people as seen in the MMR scare and the AIDS situation in South Africa. I minded to see such behaviour as criminal manslaughter and harm.

Despairing PhD scientist said...

Hear hear, Gordon.

And that goes, I think, for all of us in the biomedical sciences.

It was a black day for rational thinking when the MHRA started allowing the labelling of homeopathic water with the things the water purported to "treat" - without, naturally, asking for any evidence of efficacy. Another of The Blessed Tony (Blair)'s gifts to us (not his direct decision, but he made it quite clear that he thought it was a "consumer affairs" matter with no wider implications, and also that he was keen to encourage the UK homeopathic remedy "industry").

For a summary of the view from the scientific learned societies, see e.g. this editorial from the Physiological Society's magazine Physiology News.

Sharon said...

@David Colquhoun, perhaps it's time for the medical organisations to rethink their positions on this stuff.

@Jean, I should have said who Gordon is again!
It's so sad the way autism is written about on the web. It freaks the parents of recently diagnosed children out, instills a sense of hopelessness and often drives them into the arms of the quack peddlers. This condition seems to attract much more than it's fair share of bullshit. It's nice to meet another parent who sees through it all.

@Kristina, thanks. It's sad that people still think that homeopathy deserves any of their attention at all when they're thinking about helping their autistic children.

@Gimpy, I've been asking him if he wants to write something for ages, but for some reason he stuck to grant applications and papers, up until now. Actually his schedule will be a bit less hectic from now on so perhaps I'll get a few more posts out of him.

@Despairing PhD scientist, that's just so wrong. Thanks for the link too.

Manuel said...

tremendous post and huzzah for calling a spade a spade

AnnB said...

People really struggle with any diversion from the so-called norm, that's why they will suggest anything as a cure. They want to fit your boy into a custom made box, their idea of community is uniformity. If someone is out of step, they must be made to fit in, ingesting any sort of bunkum is usually a good place to start when you have a limited view of the world. Vive la differance I say. I imagine suggesting a cure for Autism must sound quite hurtful to you - what's needed here is a cure for society's insane desire for uniformity. Keep up the amazing work, my hat remains off to you.

Heike said...

Well, i can't agree. Sorry. I would in no way have anything to say about homeopathy and autism, equally, i wouldn't say aspirin does anything for Cerebral Palsy. But both do work for certain ailments. We have sucsessfully treated our son's pneumonia with homeopathy (on pediatrician's prescription, he's both a alleopathic and homeopathic doctor). It's Ok if you don't want to give homeopathy any of your time, but it would be nice to be a bit more generous in expressing your views rather than "gloating at the misinformed". It doesnt' do your otherwise reasonable arguments much credit. I thouroughly enjoy your blog and your general stand on disability (you know, your "there is noting to cure" approach) and your exposure of quacks, but I find the tone used in post like these hard to take. No hard feelings, though, and happy new year from down under.

Sharon said...

@Manuel, thanks. Great that you managed to get "huzzah" in there, a real old Belfast expression that!

@AnnB, the attitude of so many people to diversity is certainly responsible for making more people prone to fall for this cheat. Thanks too for your kind words.

@Heike, although I think it's unbelievable that qualified doctors will also play the part of homeopath, at least such a person will know when a condition needs real medicine and when it's safe enough to prescribe placebo. Homeopathy has never been shown to work in proper test conditions better than placebo, and the placebo effect accounts for all the times people say that they have seen it work for them or their children.

Homeopathy practitioners are all engaged in a charade. They are well trained in their charade, they have studied the right books and know the diluting, shaking and vial banging actions well, like actors learning the plays of Shakespeare. Their depth of knowledge is impressive, even if it is wholly imaginary.

I'm sure my position on this can be seen as gloating, but I am angered by the homoeopaths' promotion of a useless therapy in the 21st century, when we know enough about the world to see that it doesn't and can't possibly work for the reasons Gordon outlined above. Have you read some of the comments the homeopaths left here? My tone is only as hard as they have invited, with their talk of legal threats and assessment of my ignorance.

I read yesterday about a homeopath working in Tanzania to treat people with AIDS. He chose that country specifically as the law there gives alternative medicine greater protection than other countries. The work of homeopaths in persuading South Africans (with the help of credulous players in its government) that vitamins and homeopathy were of more use than proper medical treatment resulted in the early deaths of many people. These are among the reasons why I talk harshly about this.

I'm glad you enjoy the blog and have no hard feeling at all that our views diverge on this matter. My main focus here is autism, disability and society. I write about quackery sometimes as unfortunately, it's very relevant to current thinking on autism.

Happy new year to you too.

Anonymous said...

I don't have a huge discourse to post here. Just a note that I am a rational adult, and am someone who very happily has used used homeopathy as a complementary treatment alongside conventional medicine for both myself and my animals for many years now ... with enormous success i might add. I found the naysayers will remain so, no matter what is said. but once they try it, will see its place alongside conventional treatments. thanks.

Mary said...

I agree with you anonymous. People have used homeopathy and other natural therapies for hundreds of years now. Like you do with animals even. How do you explain placebo in animals?

This post is rubbish. Well 1st of all, how do we know if you are who you say you are. If you really are a doctor then your a cog in the system and are probably in the pocket of the big pharma companies. You will deny the truth when its staring you in the face and keep giving people drugs with horrible side effects. Remember thalidomide?!

Bock the Robber said...

Mary -- I agree with you. Homeopathic medicine doesn't have horrible side-effects like Thalidomide had.

The reason?

It's water.

Sharon said...

@Anonymous, thanks for commenting. I'm glad you and your animals got better again from whatever it was that ailed you. I really don't need to try it to know that any perceived benefits can be explained by the placebo effect.

@Mary, are you for real? You've crammed every altie talking point into a short comment so well done for that.

@Bock, succinct and true. Thanks.

Mark Coughlan said...

Whats your stance on the older forms of alt med, acupuncture?

Sharon said...

Hi Mark, I'm not sure if you were asking Gordon or me. He's probably not going to have time to respond to comments so I'll have to do. Anyway, our views on this topic overlap.

There have been some studies of the older alt therapies recently, especially acupuncture & they have shown no benefit beyond placebo. Good analysis is here. Although I'm no expert in medicine/biology I know enough to say that the explanations given for acupuncture's supposed methodology is just made up.

There are 2 types of "medicine"; that which has been tested and found to work, which becomes mainstream or evidence-based real medicine, and that which hasn't been shown to work and which goes under a variety of names including integrative, complementary or alternative medicine.

Bock the Robber said...

As far as I know, acupuncture has nothing to do with homeopathy. You might as well ask what his stance is on the invasion of Gaza.

jothemama said...

Obviously there is no winning over the argument that a remedy has ever been shown to have any effect in a clinical trial.

However, I do take issue with the idea that all homoeopaths are money grubbing opportunists.

My mother was a homoeopath, and she both undercharged and charged on a sliding scale, depending on people's need. Both she and the homoeopath made/make themselves available pretty much most of the time, when needed.

Sure, all I can do is argue with anecdotal stories of success, of remedies successfully doing what they are said to do.

If it's all placebo, praise be, as my mother and I, my homoeopath, the previous posters, we're all miracle healers, it seems.

My deluded belief in homoeopathy makes my baby's fever go down, and away, shortly after taking the remedy! I'd better start hiring myself and my healing placebo hands out publically.

Sharon said...

I'd say they are related Bock. There's either medicine that works or treatments that don't. Acupuncture, reiki, crystals, that foot rubbing thing; it's all sold as beneficial to health or as treatments for various conditions when non of it works.

Sharon said...

@jothemama, there's a good explanation for why you and those other people perceived benefits and misattributed them to the treatment given here (pdf).

Your mum might not have charged much or even worked for free, and she may have worked hard, but it still doesn't mean that her remedies worked. And when what you do doesn't work, to charge anything for it, is too much.

If homeopaths just marketed themselves as caring, listening people with whom a burden shared is a burden halved, or like hair stylists and beauticians, people who work to make you feel good about yourself, then OK. But they should not get any state funding or support, the rules about how they practise and regulate themselves must be tightened, and their promotions of medical cures should end.

Bock the Robber said...

Sharon -- I think treatments that are demonstrated to work have something in common. They work and they are genuine.

Everything else is just a jumble of stuff about which some people make claims.

However, apart from spurious claims, they have nothing else in common.

Therefore, since the claims are unfounded, they have nothing whatever in common with each other.

They just all happen to be without basis, and that's not much to have in common.

Heike said...

Come on. Can we agree to disagree in a civilized manner. Have you ever done the "swap minority" or "swap issue" test?
If you swap the word "homeopathy" for "Islam" would some of the comments made here be considered sufficiently tolerant and accepting? People have their views, and are entitled to it. And we can discuss them, but let's stay polite and respect other people's opinion. I happen to believe in both aleopathy and homeopathy, both in different circumstances. As does my classically trained and Steiner homeopathy trained pediatrician. There are times he proscribes homeopathy for those who want to try it. And there are times he sends me straight off to the chemist or hospital. It's ok if people swear by it, and it's equally ok if people think its codswallop. Why get so hung up either way. Live and let live. Unless a homeopath charges an extravagant amount of money to "cure" something that they can't cure, and something that doesn't need curing, let the be. The same goes for any alleopathic medicine that is heralded as medicine's gift to the world. Try it. If it works for you, and doesn't send you broke, fine. Inform yourself. If a medicine, homeopathic or other, sounds too good to be true, is most likely is. But please respect other's opinion like you'd like others to respect yours.

Anonymous said...

well Gordon, I bet you never thought your first post would be so controversial....or did you?

David Colquhoun said...

You ask for tolerance, and I'm quite happy to regard most alternative medicine as a voluntary self-imposed tax on the gullible. Let them get on with it, BUT only as long as they obey the law AND do no harm.

The law says
"One of the 31 commercial practices which are in all circumstances considered unfair is "falsely claiming that a product is able to cure illnesses, dysfunction or malformations" "

If you can't produce evidence, you are breaking the law.

Homeopathy is fine as long as it is being used to cure your cold in seven days when otherwise it would have taken a week. But what do you think of homeopaths who offer to prevent or cure malaria, or to cure AIDS? I would call that culpable homicide. What would you call it?

Portlairge said...

Acupuncture and homeopathy are vastly different and there is evidence to show that acupuncture works for many different maladies. I work in the healthcare field in a clinic that practices true evidence based medicine and we offer acupuncture as one of our services. The head of the program is an MD and he is also a licensed acupuncturist. There are studies to show that acupuncture works and it is endorsed by NIH for several conditions, one of which is headaches.I don't have time to quote some of the studies but I will find them and send them on.
I love this blog and I am 100% behind your stance on homeopathy but don't see chinese medicine and acupuncture as coming under the same umbrella.

davidbraziel said...

Portlairge, Is acupuncture really all that different. Can you point to the studies that prove its efficacy?

I'm not saying you are wrong but it seems so unlikely to me that acupuncture would have any more than the placebo effect. And I also think it surrounded by a lot of the same sort of mumbo jumbo which seems unnecessary if there is a genuine scientific proof.

Portlairge said...

Hi Sharon and davidbraziel:
Sorry it took so long for me to get back to you. It's been a bit of a crazy week. Here are some of the studies as promised
* Berman BM, Lao L, Langenberg P, Lee WL, Gilpin AMK, Hochberg MC. Effectiveness of Acupuncture as Adjunctive Therapy in Osteoarthritis of the Knee: A Randomized, Controlled Trial. Annals of Internal Medicine. 2004; 141(12):901-910.

Ann Allergy Asthma Immunol. 2008 Nov;101(5):535-43.Links
Acupuncture in patients with allergic rhinitis: a pragmatic randomized trial.

Anesth Analg. 2008 Dec;107(6):2038-47.Click here to read Links
Acupuncture for the management of chronic headache: a systematic review.

Hope these help.

Club 166 said...

Great post, Gordon!! Sorry I missed it when it first was posted.

I like how some commenters have muddied the conversation by bringing in something that may have a bit of efficacy (acupuncture) in certain situations, and then extrapolating to say that if that works at all then so does homeopathy!

There are many things wrong with the American health system, but at least we don't give tax dollars to pay for homeopathy.

As the sum of technical knowledge in the world has gone up, and the average level of scientific education has gone down, I fear that we may be reverting to a time when wizards and other charlatans rule the world.