“What Doctors Don’t Tell You” about homeopathy? [Respectful Insolence]

We in the US certainly have our share of pure quackery; there’s no denying it. After all, we have to take “credit” for inflicting the likes of Joe Mercola, the ever-libeling conspiracy crank and hilariously off=base scientist wannabe Mike Adams, Gary Null, Robert O. Young, and many others on the world. Unfortunately, we sometimes export our quacks elsewhere. Such was the case with expat Lynn McTaggart, who with her husband Bryan Hubbard moved to London to inflict their woo on our friends the Brits.

I first heard of her when I encountered her mystical magical belief that our thoughts can heal the world (and even has a website saying as much complete with advertisements urging readers to “learn about their psychic abilities,” although it’s been “down for maintenance” a long time), basically a variant of that incredible New Age nonsense known as The Secret. I later heard about her through her most visible and apparently successful project, What Doctors Don’t Tell You (WDDTY). As Guy Chapman describes and Josephine Jones catalogues, it is a publication that touts every form of quackery and medical pseudoscience known to human beings. Not surprisingly, McTaggart is antivaccine to the core. Also not surprisingly, she loves to threaten her critics with spurious libel suits.

The reason I mention WDDTY and its creator is because a reader of my not-so-super-secret other blog sent me an article from that fabled repository of nonsense claiming to make The Doctors’ case for homeopathy. The reader asked us to treat the claims seriously and fairly, and I tried. I really, really did. However, the article represents (to use one of my favorite metaphors) a steaming, stinking load of fetid dingos’ kidneys from a scientific and medical standpoint, so much so that I couldn’t restrain myself from unleashing at least some not-so-Respectful Insolence at it. Also, since the source is a British publication, even if one owned by an American expat, letting a character as quintessentially British as Orac have at it seems appropriate, particularly given that it is Orac as channeled through an American with the temerity to take the ‘nym of a character from an obscure 35-year-old British SF series.

What appears to have “inspired” this article, whose author is not identified as far as I can tell, is the pressure being put on the UK government to ban homeopathic remedies within the National Health Service, something that certainly sounds like a good idea to me. After all, it’s not for nothing that I like to refer to homeopathy as The One Quackery To Rule Them All given that it is arguably the form of alternative medicine based on the silliest and most easily demonstrably ridiculous concepts. The first is the “Law of Similars,” which postulates that to treat a symptom you must use something that causes that symptom in healthy people. The second is even more ridiculous, namely the “Law of Infinitesimals,” which states that diluting a homeopathic remedy makes it stronger. Specifically, homeopathy claims that serially diluting a remedy with vigorous shaking between each step (succussation) to the point where it is incredibly unlikely that a single molecule of that remedy remains will produce ever more potent remedies. That doesn’t even get into the methodology of “provings,” which is how homeopaths claim to be able to figure out which remedies should be used for what symptoms and have produced things as outright dumb as homeopathic plutonium and homeopathic antimatter.

So what does WDDTY have to say about homeopathy? Let’s take a look:

Ever since the birth of the National Health Service in 1948, homeopathy has been an integral part of the medical care offered by GPs and hospital doctors. Costing a tiny fraction of the NHS’s overall drug bill—£4 million out of £113 billion last year—homeopathic remedies have offered any NHS doctor who cared to do extra training a clinical alternative to the monoculture of pharmaceutical drugs. Some 400 doctors who took the training now offer homeopathy in addition to standard medical care.

But this option is now under threat, largely as a result of a decade-long propaganda campaign mounted by a small band of British ‘sceptics’ who have lobbied the UK government to ‘blacklist’ homeopathic remedies.

Gee, you say that as though it were a bad thing. I know that if I were a Brit I wouldn’t want my tax dollars going to support such incredibly silly pseudoscience. Eight years ago, I visited London and, while I was there, made it a point to have my picture taken in front of the Royal London Homeopathic Hospital as a joke. Unfortunately, the Royal London Homeopathic Hospital was no joke. Almost a year ago, I visited London again to give a scientific talk and extend that to a vacation. Although the Royal London Homeopathic Hospital is no more, magically renamed to the Royal London Hospital for Integrated Medicine but offering the same nonsense, homeopathy in the NHS is still not a joke. Let’s just put it this way. Homeopathy is such utter pseudoscience that £4 million is far too much to be paying for it, even if it is a tiny fraction of the entire NHS budget. In fact, spending even £1 on homeopathy is £1 too much.

At this point, though, I do have to admit to some envy of my British skeptic friends. Over the years, I’ve lost track of how many times I’ve seen British quacks complaining about how a “small band of British ‘sceptics’” causes them them so much problem and, apparently, has an outsized influence on the British government, to the point of endangering what little funding there is left for homeopathy. It’s a narrative that I’d love to believe as true. You never hear this in the US, where quacks aren’t complaining about a “small band of American ‘skeptics’” eliminating homeopathy in the US. The best we’ve come up with is the FDA re-examining how it regulates homeopathy. On the other hand, maybe I shouldn’t feel so bad. After all, we have our biggest cranks, like Mike Adams, complaining that a small band of skeptics utterly controls Wikipedia, all led by an American, Susan Gerbic.

Not surprisingly, WDDTY paints the whole kerfuffle as two things: The aforementioned campaign by British skeptics to “suppress” homeopathy and, of course, a “turf war” on the part of MPs who are physicians to “suppress” homeopathy. Again, the complaint is made as though suppressing homeopathy were a bad thing. I certainly don’t consider eliminating such obvious quackery to be undesirable—quite the opposite, in fact.

Now here’s the funny thing. WDDTY openly admits that many homeopathic remedies don’t contain a single molecule of the starting remedy, quoting Professor Colin Blakemore, head of Britain’s Medical Research Council, who sounds just like me in saying, ““If we were to accept the principles of homeopathy, we would have to overturn the whole of physics and chemistry.” As I like to put it, it is simply incredibly implausible that so many well-supported principles of physics and chemistry are not just wrong, but spectacularly wrong, but that’s what would have to be true for homeopathy to work. Apparently WDDTY is so very, very offended that there are scientists telling it like it is about homeopathy and that some of them are actually a bit intemperate in their characterization, which is funny, given how often WDDTY paints conventional medicine as being hopelessly in the thrall of big pharma in equally intemperate terms. Particularly unhappy is a GP named Noel Thomas:

This kind of invective means it’s a dialogue of the deaf, says Noel Thomas, a GP in South Wales. “Opponents make much of the ‘consistent failure to demonstrate effect beyond placebo’ when trials of homeopathy are studied; this is untrue. It is depressing to see the interests of patients being threatened by a small posse of poorly informed and discourteous critics, who mix a little science with denigration and abuse,” he says.

“Only a very few critics confine themselves to what they regard as scientific principles—people who believe that science knows everything about everything, and nothing remains to be explained—scientific ‘fundamentalists’, perhaps.”

Ah, yes. You knew that was coming: The charge of “scientific fundamentalism.” As long as I’ve been in the skeptic biz blogging about pseudoscience like homeopathy, I’ve come to recognize that whenever an advocate of quackery like homeopathy starts whining about “scientific fundamentalism” or “scientism,” it’s because he doesn’t have any science to back up his own position. Indeed, the use of the word “fundamentalism” is very much a case of projection, and inevitably what follows is predictable:

Dr Thomas has put his finger on the nub of the issue. The war is not about evidence, but scientific ideology. Because homeopathic medicines often contain not a single molecule of an active ingredient, opponents mock them as an affront to rationality—and indeed, a threat to the whole of science. Hence the hostility from lobbying organizations such as the self-styled Sense About Science and The Good Thinking Society (a name eerily close to Orwell’s dystopian “Ministry of Truth”), whose attacks echo those of the medieval Vatican against Galileo: it cannot be true, so it’s not.

No, we don’t mock homeopathic “medicines” a threat to the whole of science (although, to be fair, we do mock them as an affront to rationality, because they are). WDDTY also invokes what I like to call the “Galileo gambit,” something I first wrote about over 11 years ago. As I like to say whenever I hear a quack invoking Galileo, for every Galileo, Ignaz Semmelweis, Nicolaus Copernicus, Charles Darwin, Louis Pasteur, etc., whose scientific ideas were either ignored, rejected, or vigorously attacked by the scientific community of his time and then later accepted, there are always untold numbers of others whose ideas were either ignored or rejected initially and then were never accepted—and never will be accepted because they were wrong. The reason the ideas of Galileo, Semmelweis, Copernicus, Darwin, Pasteur, et al, were ultimately accepted as correct by the scientific community is because they turned out to be correct! Their observations and ideas stood up to repeated observation and scientific experimentation by many scientists in many places over many years. The weight of data supporting their ideas was so overwhelming that eventually even the biggest skeptics could no longer stand. That’s the way science works.

None of this stops quacks from invoking Galileo’s name a way of characterizing scientists who criticize their pseudoscience as doing so based on the equivalent of religious beliefs. Of course, the critics of homeopathy have science on their side. What does WDDTY have? Why, anecdotes, of course! Several of them, in fact. There’s a patient who had a peritonsillar abscess, supposedly resolved with homeopathic belladonna. Of course, homeopathic belladonna preparations tend to be less “strong”—i.e., less dilute to the point of having actual remedy in them—with potentially enough left to have anticholinergic effects, such as decreasing the saliva production that the patient was having trouble swallowing. One also notes that abscesses can spontaneously drain, commonly after manipulation. What’s more plausible, that homeopathic belladonna cured a peritonsillar abscess within minutes or that it drained spontaneously? Then, of course, there were a whole lot of anecdotes about patients with chronic pain treated with homeopathy who did much better. Never mind the usual confounding effects like placebo effects, regression to the mean, and the like.

Particularly amusing is WDDTY’s attempt to argue that nonhuman uses of homeopathy rule out “placebo effects” as the cause. How does he know it helped? Proponents of alternative medicine will claim that quackery like acupuncture “works” in animals because it couldn’t possibly be due to placebo effects, but they are only sort of correct. The reason is that the only way we can know what animals are feeling is through the observations of humans, who interpret those observations as the animal either being in pain or getting better. Thus, placebo-like effects can occur in animals, but in reality they are a result of a change in perception of the animal’s condition by the owners, who expect results and, after treatment, look for results. If they believe acupuncture will work, often they report results. It’s difficult enough to quantify pain reliably in humans; in animals, it’s even harder. Add to that the tendency of most conditions to regress to the mean or to slowly improve, and, if the acupuncture or chiropractic adjustment is performed as improvement is beginning or around the time when the symptoms are at their worst (which is often the time when treatment will be sought), then it can appear that the treatment “worked.” There appears to be a phenomenon in veterinary medicine known as caregiver placebo effects, which appears to be a real phenomenon. Indeed, frequently, there is little or no correlation between owner-reported observations of animal pain and objective measures.

Then there are attempts to make turn the plural of anecdotes into valid data when it’s not:

In 2006, Tom Robinson, a Dorset GP who offers both conventional medicine and homeopathy, published a 12-month audit of his homeopathic treatments.2 His records showed that he used them for roughly one in 10 patients, the top conditions treated being ear, nose and throat problems, mental health issues, skin disorders and “miscellaneous, such as ‘tired all the time’, bruising, motion sickness, leg cramp, chilblains—all situations,” he says, “where conventional medicine has nothing to offer.

“An analysis of the responses to the homeopathic medicines revealed that 78 per cent of my patients noted an improvement following treatment, even when prescribed in a standard 10-minute GP consultation.”

The paper cited was published in Homeopathy and completely useless, a case series with no control group that boiled down to basically a patient satisfaction survey.

Not surprisingly, WDDTY also invokes flaws in conventional medicine:

A year ago, Lancet Editor-in-Chief Richard Horton reported on a closed-door Wellcome Trust conference in which medical science was pilloried for “questionable research practices”, “many a statistical fairy tale”
and “a research culture that occasionally veers close
to misconduct”.

As a result, says Horton, “much of the scientific literature, perhaps half, may simply be untrue”.5

Of course, the fact that pharmaceutical medicine has a poor evidence base doesn’t necessarily make a stronger case for homeopathy.

Imagine my relief that WDDTY admitted that problems with conventional medicine don’t mean that homeopathy works. It’s disingenuous as hell, of course. If WDDTY didn’t mean to imply that problems with conventional medicine mean that homeopathy works, why were these problems mentioned? As Ben Goldacre says:

Quacks citing problems in pharma make me laugh. FLAWS IN AIRCRAFT DESIGN DO NOT PROVE THE EXISTENCE OF MAGIC CARPETS.

— ben goldacre (@bengoldacre) January 31, 2013

Yet that is exactly what WDDTY is arguing, while denying that that’s what it is arguing.

Then there’s the “let’s count the randomized controlled trials” gambit:

Much of the data have come from places like Brazil and India, where homeopathy is welcomed as a valuable part of their national healthcare systems. In India, homeopathy is taught in universities and medical schools, sending thousands of qualified doctors every year out into hospitals and the community, and carrying out clinical trials on a range of chronic conditions, including cancer.

By the end of 2014, homeopathy had been tested in 104 RCTs for 61 different medical conditions: 41 per cent were positive; 5 per cent were negative; and 54 per cent were inconclusive.6

One notes that the source of this number is the Faculty of Homeopathy, who published its results on a webpage without peer review. I noticed that at least a few of these studies are ones I’ve blogged about before, describing their poor methodological quality and why they don’t show what homeopaths think they show. Personally, I’ll stick with Sense About Science’s interpretation that “over 150 clinical trials have failed to show that homeopathy works. Some small-scale studies have yielded positive results, but this is due to poor methodologies or random effects.”

Hilariously, near the end, WDDTY tries to argue that homeopathy is “more than just water,” resurrecting some of the silliest pseudoscientific claims about how homeopathy might “work.” One such claim is that there is “electromagnetic communication between in cells” that is affected by homeopathy. This claim is based on work by Jacques Benveniste’s thoroughly debunked experiments from the 1980s and from more recent work of Nobel laureate Professor Luc Montagnier, whose work I deconstructed in detail five years ago. The other “mechanism” by which homeopathy “works” is, according to WDDTY, the ever-popular nanoparticles. Nope. Sorry. That explanation doesn’t fly.

Homeopathy is pseudoscience. In fact, it’s such obvious pseudoscience and it’s so easy to explain why it is pseudoscience that I frequently use it as an example when teaching basic skeptical principles—as do many skeptics. There is no scientific basis for homeopathy, which is rooted in prescientific vitalism and whose precepts were dreamt up before basic chemical principles like Avogadro’s number had been worked out. Even as early as 1842, Oliver Wendell Holmes could explain why homeopathy was a delusion, penning the immortal Homeopathy and Its Kindred Delusions. Unfortunately, 174 years later and 173 years after the death of homeopathy’s creator Samuel Hahnemann, there exist publications like WDDTY that actively promote the quackery that is homeopathy. Of course, cupping is thousands of years old and still practiced by elite athletes despite its being equally quackery. Truly, the battle against irrationality in human beings is akin to the task faced by Sisyphus.

Yet we must continue to push that boulder up that hill.