Frankly dilutional

In which I have the strong feeling that it’s Déjà vu all over again.

Ah, me. Homeopathy.

* Sigh *

Like most scientists who write about alternative medicine and pseudoscience, I am heartily sick of writing about homeopathy. After all, how many  times can you explain all the reasons why it is nonsense? The delusions (dilutions?) of its practitioners and disciples seem un-dentable. Of course, as one is often reminded on the internet, once people have accepted something on faith, it is hard to change their mind with mere facts. As a result of this,  most of the time all I can manage to rouse myself for, even in the face of the truly profoundly homeopathological (see e.g. here, or here, or here for examples) , is a bit of humorous derision.

However, if you have the chance, however small, to do something about the tide of homeopathic nonsense, you probably should.

Which is why I have just signed this petition about homeopathy, started by Sense About Science, to pressure the UK medicines licencing agency the MHRA  to mandate proper (as in “factually accurate and non-misleading”)  information on the homeopathic medicines sold in chemists (pharmacies) in the UK.

Which reminded me that some four and a bit years ago, before the legislation allowing the current misleading labelling (see below for details of why it is misleading)  to go forward, I had written an editorial about it for Physiology News (original PDF version of the editorial here, and PDF of full issue here). Which is reproduced below. [Apologies for the slightly sonorous tone. Learned society magazine, and all that.]

Now, one thing that you may note in the editorial is that all the learned scientific societies also thought the labelling changes – allowing the packaging to make specific claims about what the particular homeopathic medicine could “treat” – were a joke.

Not that the last Government was listening.

Now, while I fear the present UK Government listens even less to scientists than the last one did, one can always hope. And in the meantime, one can at least have a go at shaming the MHRA.

So please go and sign up.

[Note: I have added hotlinks to the editorial, and changed one or two words and some pagination – which in the original version was dictated by space considerations! – but otherwise it stands as written in Oct 2006.]

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Physiology News, Winter 2006

Homeopathic “Mumbo-Jumbo”

Many scientists these days have at least the odd moment when they feel that their view of the world is under threat from a tide of what the journalist Francis Wheen, in his best-selling book, termed ‘mumbo-jumbo’.

For scientists, ‘mumbo-jumbo’ manifests itself in the rejection of scientific understanding of how the physical world works in favour of mystical beliefs derived from a range of sources.

The examples are too numerous to list, but as the debate swirls it occasionally coalesces around particular issues. Recent flash-points are the challenge to evolutionary theory from so-called Intelligent Design’ (statement from the Royal Society here), and the question of whether complementary and alternative medicine has any scientific basis.

Homeopathy has recently taken centre stage in this latter debate. In May 2006  an open letter signed by 12 senior doctors and scientists (including several Physiological Society Members) urged that alternative therapies unsupported by evidence of efficacy should not be used in the NHS. Later, the demonstration that homeopathic pharmacies advised homeopathic formulations, which have no antimalarial action, as malaria prophylaxis garnered national media attention.

Following the homeopathic malaria remedy media exposé, it might be thought that the scientific absurdity of homeopathy had been clearly demonstrated. Imagine, therefore, the surprise of many scientists and doctors when the Medicines and Healthcare Products Regulatory Agency (MHRA), the body charged with controlling the safety of medicines in the UK, decided to allow homeopathic remedies to be sold with packaging featuring – for the first time in 30 years – claims about what the remedy purports to treat.

Previously a homeopathic remedy in a high street chemist would have been labelled ‘6c dilution of Gelsemium sempervirens, or something similarly obscure. It can now be sold, quite legally, as ‘NoCold-Max cold and flu remedy … homeopathic’.

And as the web site of the European Council for Classical Homeopathy puts it:

To make such a claim, the manufacturers need only show that the product has been used to treat those particular conditions within the homeopathic industry.’

No scientific basis. No clinical trials. No evidence of effectiveness.

The homeopaths, and the companies that produce over-the-counter homeopathic remedies, are understandably delighted.

Well, you might say, so what? The placebo effect is not new, and a fool and his/her money are soon parted. Most scientists would agree that the labelling is a joke, but in a world awash with ridiculous claims, why get worked up?

Well, firstly, perhaps, because the MHRA, acting on our behalf, is supposed to care – their web site states they ‘enhance and safeguard the health of the public by ensuring that medicines and medical devices work, and are acceptably safe.’ How they reconcile the first part of this statement with the change in the homeopathy rules is not clear.

Secondly, because – at the risk of sounding incredibly pompous – there is a principle at stake, namely that decisions of this kind should be made on the basis of scientific and medical evidence and understanding.

Finally, the MHRA’s decision to allow licencing and sale of homeopathic remedies in this way is likely to be widely interpreted as approval of alternative remedies in general. This in turn will foster the perception that they work.

The Physiological Society, like other scientific societies, has been asked by the campaign group Sense About Science to comment on the MHRA decision, and has issued a statement reaffirming its belief in scientific evidence, and decisions based on it.

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‘The Physiological Society is concerned with the scientific investigation of how the body works … It is our view that “alternative medicine” has, with very few exceptions, no scientific foundation, either empirical or theoretical. As an extreme example, many homeopathic medicines contain no molecules of their ingredient, so they can have no effect (beyond that of a placebo). To claim otherwise it would be necessary to abandon the entire molecular basis of chemistry. The Society believes that any claim made for a medicine must be based on evidence, and that it is a duty of the regulatory authorities to ensure that this is done.’

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The Physiological Society’s statement is not, note, a blanket dismissal of all the things the public commonly regard as complementary therapies. Physiologists have long studied the effects of exercise upon the body, and the physiological actions of plant-derived substances. Work goes on into the possible physiological basis of acupuncture, or the physiological effects of alterations in diet.

But scientists want evidence, not anecdotes and hand-waving. If proper science shows real physiological effects, beyond those of a placebo compound or sham intervention, and if these can be made to work as a treatment, what you have is a therapy. Rather than being a question of ‘alternative’ or ‘mainstream’, it is down to what works – or more precisely, what we can be sure works because it can be shown to work in a properly-designed scientific experiment.

Which highlights something else we should be thinking about – our failure, as professional scientists, to inform enough of the public about what proper controls are, and exactly why some experiments are convincing, and others are not. About what the placebo effect is in medical experiments and trials. About what homeopathy actually is – you would be surprised how many people, including a good few bioscience graduates I have met, think it means ‘herbal remedies’ rather than ‘infinitely dilute nothing’ – and why it is scientifically nonsensical.

None of these is terribly complex to explain, and many of them go to the heart of what science is, and how it is done. In many ways, this seems a golden opportunity to use the public interest to put across how science offers a clear way to divide what actually works from what doesn’t.

As the immortal Richard Feynman put it:

‘Science is a way of trying not to fool yourself. The first principle is that you must not fool yourself, and you are the easiest person to fool.’

As this issue went to press, The Society’s statement, along with many others, was being passed to interested members of the House of Lords in advance of a debate on the new homeopathy regulations on 26 October. By the time you read this, we should know if it did any good. But whatever the result, get polishing your homeopathy-debunking speech.

And I like to think Feynman would not mind us pinching his lines.

About Austin

Middle-aged grouchy white male. Hair greying but hasn't all fallen out yet. Spreading waistline ill-concealed by baggy jumper.Semi-extinguished physiology researcher turned teacher. Known for never shutting up. Father of two children (aged 6 and 2) who try to out-talk him. Some would call that Karmic Revenge.
This entry was posted in Annoyances, Grumbling, Medicine, Pseudoscience. Bookmark the permalink.

9 Responses to Frankly dilutional

  1. Steve Caplan says:

    Austin,

    Absolutely BRILLIANT title and great post. Couldn’t agree with you more!

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  3. Many thanks, Steve – though I guess you are probably the one person here who hasn’t previously had to sit through my grumblings about homeopathy….!

    PS Lots more (usually in less measured tones) here, if you’re interested.

    • Steve Caplan says:

      Austin,

      I’m always prepared to hear grumblings about homeopathy and other related bits of superstition (phtoo, phtoo, *throws salt over the shoulder*). It’s a pet peeve of my own for a long time.

      In no way do I intend this as a defense for homeopathy, but I do want to note that I think there is a general problem in many places with the way physicians relate to their patients and complaints. I think in many cases, a lack of understanding or showing empathy for real pain (that might not be specifically related to a disease) has led many people to question the ‘traditional’ medical system and look for alternatives. Of course, homeopathy is obviously ‘barking up the wrong tree’, and what is necessary is a better education for physicians so that they can deal more efficiently and sympathetically with patient’s issues–even if they are “minor” ones.

      • Austin says:

        Hi Steve.

        I broadly agree. Some doctors can be a bit brusque, especially inexperienced younger ones (and surgeons?!), though more experienced docs (and most I’ve known) are usually very keen not to do anything that alienates the patient, whatever the patient’s odder beliefs.

        I can’t remember if I’ve said that my Other Half (aka “The Boss”) is a medical doctor (an Internist, in US parlance, though now working a a non-acute sub-specialism), She certainly would never “monster” any Alt.Therapy beliefs the patient has, though she would usually tell the patient what she thinks of the medical evidence for (or more likely not for!) A.N.Other therapy if they ask. She also wouldn’t discount a patient’s reports of pain, regardless of what she though its origins might be. But she has been doing it a long time, and seems to be pretty good at dealing with patients with “mixed” physical/ psychological/ life problems.

        I would also say a lot of it comes down to the time factor. Compared to homeopaths and other Alternative types, mainstream doctors are always pressed for time (standard family practice appointments in the UK are 8-10 min, for instance). In the US system there may be more time, but at a direct (and often quite hefty) financial cost. The Boss is lucky that she works in a sub-specialism where they get 15-30 min a patient. Anyway, she is very clear that “listening to people” is key, and so are most docs, but under pressure the ideal may not always be met.

        It has always been clear that many alternative therapies rely on the “sympathetic ear and giving the patient a chance to talk” (and talk) for their placebo/treatment effect. Hence my favourite shorthand term for homeopathy, which I’ve been trying to popularize on the Internet for some years, is:

        “Stealth psychotherapy”

        Finally, if a patient is already convinced that conventional medicine has failed them, and has a deep belief in the wacky stuff, then a conventional doc may struggle to win them over. The doctor and the patient have to be able to communicate for the relationship to help the patient get better, so in such cases it may be there is not much the conventional doc can do.

  4. cromercrox says:

    Up to a point, Lord Copper. Whereas I agree with you completely, and will go and sign the petition, many of the people subscribe to crackpot non-remedies because they are scared about science. I went to a Rudolf Steiner school, the heart of grow-your-own-birkenstocks knit-your-own Arnica alternative quackpottery, and have fallen out with former classmates who are homeopaths and (at the same time) antivaxers because of ‘all the poisons’ that the ‘pharmaceutical industry’ insists on injecting into ‘our kids’. They simply won’t listen to reason, because, they say, big pharma is in league with the scientists and are in it to make money. No amount of scientific evidence will ever sway them that this isn’t a multi-billion-dollar cover-up.

  5. Didn’t know you’d been to a Steiner school, Henry. Steiner/Waldorf schools, whilst being attractive in some ways because of their un-structured non-competitive child-centred-y-ness, are certainly hotbeds of crackpottery in many ways. Apart from their attracting the “poisons and toxins” crew in large numbers as parents, there is also the lurking influence of Rudolf Steiner’s weirder racial theories – see e.g. this recent guest post on David Colquhoun’s blog and the subsequent (unreadably long) discussion.

    On the wider point, agreed there are some people one can never persuade, as they have bought the “Evul Big Pharma Conspiracy” meme in its full flower. I guess when one writes and talks about pseudoscience one tells oneself one is talking to the undecided middle, who can perhaps still be swayed by reason.

  6. PS Especially for Henry, here is something about Steiner/Waldorf schools, featuring the personal views of Pink Floyd guitarist Dave Gilmour.

    • cromercrox says:

      Michael Hall – that’s my alma mater. Didn’t know Gilmour sent his kids there, though I did know that John Paul Jones (of the mighty Zep) was a school run Dad, though. I agree with Gilmour’s view here – Michael Hall was a very good school for those who already had some motivation. Those who didn’t tended to drift. I arrived there aged 14 as a misfit veteran of horrible public schools, and throve – but I already knew how to read and write. The five years I spent at MH were very happy.

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