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.

Comments

[Pamala Sheppard]

I hope your "friend" Sheila will forgive you. You are definitely opininated and have actually done no scientific research at all. To call everything but hard core science baby psychology told me everything I needed to know. I call bullshit. Life is a very mystical voyage chock full of things you know nothing about. Like homeopathy. And astrology. And anything to do with the mind and soul.

[Arthur]

Hi Pam:
Sorry you felt you had to insult me. I've actually done quite a bit of science, not all of it "hard core." But hard core or soft, it comes down to data, evidence. As I noted, the definitely "soft" mindfulness meditation passed muster. It works. I embrace it. Homeopathy doesn't. It's really quite simple.