Homeopathy, quackery and the CAM movement

I’ve a friend, let us call her Shelia, who is a homeopathic practitioner. We agree on much, but not this. Homeopathy is quackery, pure and simple. It’s based on the utterly moronic notion that a substance that has been dissolved in water leaves behind a “trace” or a “memory” of its presence even after the water has been diluted to the point where no residue of the original substance remains.

The theory, developed originally in the late 1790s by Samuel Hahnemann, assumed that “like cures like” — or that a substance known to cause a disease in the healthy will cure it in one suffering from it. So, he hypothesized, the cure is the diluted essence of the compound originally believed to have caused the disorder. Wikipedia has a nice entry on it.

Shelia worries that I do not fully grasp the important role that homeopathy has in maintaining the well-being and health of the people of the world. She wonders, from time to time, if I have read the literature, seen the latest studies, appreciated the supportive data base. She wondered, just the other day when we were working on a local project that we both support, whether I really had an open mind?

That triggered an extended trail of thoughts which I decided to share with whothehellever reads these bloggy barfs of mine.

Of course I have an open mind. You can’t be a good scientist without one. I am/was a very good scientist with all kinds of sciency-cred to back it up. But, as every good scientist learns early on, there’s a trick you need to learn: the mind cannot be totally open or all manner of useless shit drifts in. You need to put some filters in place.

So, with all those filters engaged, here’s the bottom line:

I. Homeopathy cannot work. It is biologically, biochemically, biophysically and psychoneurologically impossible. An inert substance cannot have a causal impact on biological function. There is no such thing as a “memory” of a removed substance. Distilled water is just distilled water — after you’ve distilled out everything else.

II. So, there can be no reliable, replicable study (or studies) that show a therapeutic effect over and above that of any number of placebo effects. Any study that shows a clinically effective outcome for a homeopathic procedure must be contaminated by any of a score of different methodological flaws. I could go on about this topic for hours … days…. I used to teach this stuff.

III. This obvious truth, of course, doesn’t mean that homeopathy doesn’t “work.” It does but its value is derived wholly from its placebo effects which are very strong. I’m making this point as clearly as possible. The “working” part must be partialled out between the supposed effects of the homeopathic compounds and the known effects of placebos. It practically never is — and when it is, the effect size of the homeopathic variable approaches zero.

IV. This also doesn’t mean that there won’t be occasional findings that suggest that homeopathy has a greater clinical impact than genuine pharmaceuticals. But such a finding only shows that the drugs currently in use are, themselves, ineffective and, because they often have side effects (which are impossible with homeopathic compounds), they fail against placebos.

In short, no compelling scientific evidence for a clinical effect of any homeopathic remedy can possibly exist beyond that of a placebo. It would be the scientific equivalent of data that showed that pigs could fly or faster than light propulsion was possible or that precognition was real (and, yes, Daryl Bem, a well-known psychologist at Cornell published a study showing just this — it was quickly shown to have been methodologically flawed and, of course, all efforts to replicate failed). 

So, my beef with homeopathy isn’t with the fact that you won’t find evidence of clinical data that suggest that it can have a positive clinical effect — it is that homeopaths don’t grasp that it isn’t the remedy that’s doing the job. It’s the powerful psychological impact of the compound, the “bedside manner” of the homeopath and, importantly, that the practitioner is a firm believer whose convictions are picked up by the client.

Placebo effects are so strong that recent studies have shown that they work even when the participants in the study know that they are taking a placebo!

It’s a lot like psychoanalysis. It too doesn’t work despite the fact that many clients in psychoanalysis show improvements over time. The reasons they do are numerous but have nothing to do with the clinical effectiveness of psychoanalysis. It took decades of research to show this and many devoted psychoanalysts still don’t get it.

Clinical psychology and psychiatry are now driven by “evidence-based” therapies and psychoanalysis ain’t one of ‘em. Modern medicine is, likewise, driven by evidence-based procedures and homeopathy ain’t one of ‘em.

Now, the next important question is: Is homeopathy dangerous? Generally speaking, no. Most minor disorders cure themselves over time and it can be comforting for a homeopath to provide counselling and advice. A lot of people with minor psychological problems (mild depression, stress from life’s travails) go to astrologers who actually play a role here. Lots of folks couldn’t handle the stigma of seeing a psychotherapist (and many communities ostracize those who do) but their neighbors all think seeing an astrologer is fine — and a good astrologer, like a good Tarot card reader or a careful, caring naturopath or homeopath is really doing “baby” psychotherapy.

But it can be devastating in cases where serious illness is present and needs proper medical attention. My friend Shelia is a reasonable, if somewhat gullible, soul and she pays attention to these things. She’s careful (well, as careful as someone not trained in medicine can be) to refer people to real physicians if she suspects a serious underlying problem. But not all homeopathic practitioners do this. There are far too many instances of outright quackery and too many making false promises and far, far too many setting up phony clinics and unscrupulous alternative “medical” centers.

This is where the serious problems come in.

Is my mind open? Sure. Stating that homeopathy can’t work doesn’t mean a closed mind any more than stating that pigs can’t fly does.

And citing a new study that shows a positive effect of homeopathy would have as much impact on me as the one on precognition Daryl Bem published in, I might add, one of my field’s most prestigious journals. When it can’t be true, it can’t be true. Claiming that one is closed-minded is just silly.

If the proposed remedy for suffering has a legitimate, possible foundation for actually working then the classic scientist, the one with the classic “open mind” will, in fact, be open. The recent movement to acknowledge the powerful therapeutic effects of mindfulness (and other forms of) meditation is an excellent example. These approaches, once thought to be on the margins of medicine and psychotherapy have, by virtue of careful and replicated scientific study and a solid neurocognitive theory, become an accepted part of modern psychology.

But this little sideshow on homeopathy is really just a minor affair. There’s a much deeper, better funded, more connected movement here. It’s the so-called “CAM” or “complimentary alternative medicine” program. It’s touted as being an “alternate” form of medical treatment that “compliments” traditional, evidence-based medical practice.

It’s a monstrous, expensive and intellectually dishonest fraud. I’ll save my diatribe against it for another day. It’ll take far too long and this entry is long enough.

In passing, let me note that I sent this blog entry to Shelia before posting it. I wanted to give her a chance to respond. I expected her to do so. Nothing…. Sad. I guess her mind isn’t so open.

Or, more likely, recognizing that what she’s made her life’s work and her primary source of income is a sham is something that she just can’t deal with. I understand. In fact, I wish I never sent it to her. Like I said, I do like her. She’s a good person, just like me.

A Thought on Ferguson

Riots erupted across the country over the decision not to indict Darren Wilson, the officer who killed Michael Brown in Ferguson, MO. Arguments about whether Brown charged him or fled or whether the shots were in self-defense or unprovoked are, when you pull away all the layers of obfuscation, irrelevant.

The real issue is that young black men are targets wherever they go. They are harassed, stopped, frisked, interrogated, arrested, framed and killed in numbers wholly out of proportion to their representation in the population.

This fact, simple and bold, is where the problem lies. We saw it in the Zimmerman case; we’re seeing it here. Anyone who wants to take an hour or two out and surf the Internet can find scores of other cases.

We need to stop splitting hairs over what are essentially meaningless details and focus on the deeper issues.

Exploding Brains

My brain did, indeed, finally explode — well, metaphorically speaking. As reported today, the Republicans in the House filed a formal suit against President Obama for abuse of executive power.

Now, given the dust-up over immigration or the nonsense over the XL pipeline you might think this is where the GOP’s annoyance would be focused.

Nope, it was at the ACA or “Obamacare.”

Now, given the fact that no Republican in the House voted for the ACA and that they have introduced bills to repeal it over fifty times and that they have, using various surrogates, initiated dozens of law suits in Federal courts to have it overturned that this suit would be in the same vein.

But you’d be wrong.

It was filed because, they have argued, President Obama used executive orders in a manner that exceeded his constitutional authority to:

(a) extend the time period that companies had to come into compliance with the act and,

(b) set aside funds to subsidize insurance companies which are caught in a bind during the run-up period to full implementation of the ACA.

In short, they are suing the president for not implementing  rapidly enough the very act they’ve spent the last five years railing against and trying to undo!

Boom.

Net Neutrality: Liars and Hypocrites

Why does this keep happening? Why do Republicans always make the wrong choice? Why do they deliberately misrepresent the truth? Do they now own the trademark on “hypocrisy?”

Ted Cruz recently took a swipe at net neutrality that was classic. He compared it with Obamacare — as though it was a government bill designed to impose controls on the Internet. The gambit is classic: make it look like it’s something that (“hated”) governments do and that, by opposing it he is, somehow, allowing us to remain free of unnecessary regulations.

Now either Cruz is a total idiot or he is assuming that voters are — and we know the answer to that one.

The Affordable Care Act was, as many have noted, a piece of legislation designed to fix health care problems. Yes, it imposed some governmental controls and regulations. Cruz may hate that but over time everyone else is coming to like it for one blindingly simple reason: it’s working.

But drawing this parallel with net neutrality is bizarre. Net neutrality is what we now have! There’s nothing to fix, nothing’s broken. Opposing it means bringing government into the picture. Net neutrality isn’t a piece of legislation. It’s the lack of legislation.

If Cruz had even a dollop of honest belief in conservative, small government principles, he’d be a banner-waving net neutrality cheer leader. Net neutrality means what it says. The net stays neutral. Everyone gets the same services. Businesses that use the Internet rise and fall based on their business models. Smart, effective business practice is rewarded, not-so-smart is not. Everyone gets treated the same. It’s Cruz’s vaunted populism.

Abandoning net neutrality means that the government comes in and imposes regulations and sets usage patterns. It takes away from the free market system currently operating. It is everything that Cruz rails against on a nearly daily basis. How can he take this position?

Well, you can guess. First, Obama favors net neutrality so he’s against it — Cruz and company have this knee-jerk reaction. It gets him brownie points with his base. But there’s more here.

We need to ask, who benefits from abandoning net neutrality? The big communications companies and the big corporations. Abandoning the neutral net means that Internet providers can charge differential rates to their customers. If you pay a higher premium for using say, Comcast’s services, your messages get priority. They go out first and faster. Those paying a lower rate become, literally, second-class clients. So who do you think has the cash to pay for the high-end services? Could it be the folks who also have the wherewithal to bankroll Cruz’s campaigns, who shovel corporate cash to corporate-friendly Republicans? So much for the level playing field. So much for all that talk about helping small businesses.

Kind of pisses you off just thinking about this doesn’t it? Sure got my knickers in a twist ‘cause I’m a very small player but I do love my fast Internet connectivity. I also cannot abide Ted Cruz’s hypocrisy.

WSOP 2014: Report on the Final Table

Last year I made a prediction on who would win the coveted bracelet for the WSOP Main Event. I made the same prediction I’d made the previous couple of years. I was right every time!

I predicted that the player who got lucky would win. Yeah, that’s a cop-out but it makes sense. You have nine skilled players, each of whom is experienced and understands the game, the situation and the legacy of this event. They have strategy coaches, mind-set coaches and have spent months analyzing their opponents.

In poker (and most other competitions), when everyone is pretty much equal in skill the role of chance is magnified. So, the obvious prediction: whoever gets lucky is going to take the title.

This year I didn’t make a prediction (too busy with so many other things) but if I had it would have been the same — and it would have been wrong. This year’s final table was different and quite wonderful to watch — if you’re a poker junkie that is.

It was won by Sweden’s Martin Jacobson in one of the most masterful displays of virtually perfect poker I (or anyone else) have ever witnessed. Because the WSOP and ESPN show every hand (and not just the big “TV moments”) it was possible to watch the ebb and flow, the shifting chip stacks, the decisions made and the emotions expressed. Riveting.

Looking back over the 300+ hands played over some 16 hours one thing struck me. There were no monster suck-outs. No one hit a magic river card, no gut-shots on the end, no miracle two-outers to pull someone’s chestnuts out of the fire. Recall Joe Cada’s win back in ‘09 when he hit three sets at critical moments which propelled him to the win. There were very few big hands this year and few critical coin flips.

Mostly it was careful, nuanced, balanced play where chips moved slowly but inexorably from one seat to another — and Jacobson was masterful. He just didn’t make any mistakes. Yes, he folded hands where he was best and, yes he bet into hands where he was not but those weren’t mistakes. They were well-judged poker moves and each time he recovered the chips lost. He was almost as though he knew, understood, that he was playing the game a tick above the others, that he appreciated that a small edge in decision-making ability would, over time, win.

This year’s finals also reflected a broad style-shift. In recent years, with more young, aggressive players entering major tournaments play had become much more dramatic with 3-bets, 4-bets and 5-bet shoves common moves. This year 4-bets were rare and the pre-flop all-in shove restricted to those with desperately short stacks. As a result there were few big hands that either crushed a player or gave someone a huge boost. Does this auger a change in preferred style? Don’t know, of course. We’ll have to see what happens.

Did Jacobson “get lucky?” Yes, of course, you have to to win any tournament. But his “lucky” moments were subtle and many might not have spotted them. They came early on when he had a dangerously short stack. He was forced to make the only move left when this happens: the pre-flop “all-in.” He made it some 18 or 19 times. Most of the time he took the pot uncontested but, critically, no one woke up with a big hand or hit the flop hard. This was very lucky. I emailed friends after this sequence of all-ins that I was now picking him to win it all — not because he was getting lucky but because everything about the way he played a short stack said that he understood the game better than the rest. All he needed was some chips to maneuver with and his share of randomness.

One last note: Jacobson said he had spent the months since the final table was set preparing. He said he spent well over 500 hours running simulations exploring the complexities of small-stack situations, big-stack settings, in-position options,  short-handed play, analyzing opponents’ playing styles, whatever. Compare this with Mark Newhouse who, quite remarkably, made the final table two years in a row.[1] Newhouse said he didn’t play a hand of poker since July. He came to the final table with the 3rd biggest stack and imploded. Out in 9th, just like last year.

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[1] BTW, I really got ticked at everyone saying that the odds of this happening were over a half-million to one. They are, but only if you were to select a random player and estimate the likelihood of making two successive final tables. But if you ask what the probability of one of last year’s group making the final table this year it’s 9/6,680 or roughly one in 740. And that’s a “mathematical” estimate. In reality, with lots of dead money and last year’s final group comprised of world class players, the likelihood of a repeat is far lower. It’s still unlikely but not as weirdly so as everyone keeps saying.