Dec 17 2012
A truly homeopathic defense of homeopathy
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57 Responses to “A truly homeopathic defense of homeopathy”
The obvious thing to do would be to find a professional homeopath who would volunteer to help, give him/her some Milli-Q water, and have him/her use it to make two samples: 1) a homeopathic remedy prepared normally, and 2) another sample prepared exactly like #1, except that there’s no succession. That would be the right way to do it.
I don’t get it. They say that there are “remedy nanoparticles” and “nanoparticles of source material”, yet given that nanoparticles are (by definition) many times larger than the atoms, ions or molecules from which they are composed, they will run up against the Avogadro limit even sooner during the dilutions and still end up with a product containing none of the original material, as with any homeopathic preparation.
What difference does it make if the particles of remedy are in the form of nanoparticles or a simple solution? You’re still conjuring mass out of thin air. The implications of this technique for the synthesis of gold from absolutely nothing at all are particularly astounding.
They clearly have no confidence in that hypothesis, given that they constantly wobble between supposing that those particles are genuinely in there, and that actually it’s some special property of silica (an extant hypothesis) yet they don’t commit to the alternative either.
As funny as homeopathy research is, I think that the existence itself of homeopathy is western medicine fault. I think plausible that Samuel Hahnemann got it right when diluting his preparations to non-existence, hence trans-locating his venoms into remedies much more efficient than some of those employed by conventional medicine at the moment (The benefits of bloodletting only began to be seriously questioned in the second half of the 1800s.): he let their patients’ bodies free of coming back to the mean plus a little dose of hope.
On a trip to France our tour bus passed by the Boiron factory, quite a large building. It struck me as more than a little ironic that a place used for manufacturing homeopathic products needs to be all that big…
Was this blog a REAL blog…or a placebo. You’ve got a word salad…but no real substance, just attitude.
I love it when you describe Iris Bell’s writing as “science-y.” Yeah, don’t ya hate it when someone draws from experimentation and describes results!?
I especially loved your assertion: “Bell claims that homeopathic remedies are an example of hormesis, which is ridiculous.” And yet, no information or explanation is provided for why homeopathic remedies are not an example of hormesis. The fact that there are hundred of studies that confirm hormetic effects is ignored (how surprising!). And I really love the references Gorski provided to his statement (oh whoops, he didn’t provide any references…aw shucks). Like the rest of this blog, Gorski’s assertions are standing firmly in thin air.
The fact that Gorski has also chosen to omit any reference to various hormones and cell signal agents in the body that respond to doses as small that they are known to have action at doses of 10 to the negative 10 or negative 19th power. The article below was published in a high-impact journal, though Gorski is such a hack that he’ll now deem Archives in Internal Medicine as a quack journal now.
Eskinazi, D., Homeopathy Re-revisited: Is Homeopathy Compatible with Biomedical Observations? Archives in Internal Medicine, 159, Sept 27, 1999:1981-7.
Get real next time.
I completely agree with Dana Ullman on this – okay, well the last line of his comment anyway.
“Get real next time.” – I just wish he’d tell all his patients that the next time they ask him for a Homeopathic “remedy”.
The homeopathic remedies were chosen to have been based on various metals “so chosen that the metals would not arise either as impurities or as contaminants.”
Huh?
I wonder if that’s any relation to a piece of woo that landed in my blog’s moderation queue recently, saying something about David Wolfe and “bad calcium”. (Tangentially related to the topic as the post was about calcium, though not about dietary or supplemental calcium. I haven’t moved the comment out of moderation because I haven’t had time to figure out how I want to respond to it yet, and I’m not about to let woo stand unchallenged on my site, even if it’s just a reference to woo.)
Being curious, I googled the name and found out that silica supplements are transmutated into calcium in our body, even though we shouldn’t take calcium supplements because calcium isn’t used to build bones, only arthritis and shells around cancerous tumours. But apparently the calcium that arises from the silica is ok?
So when the paper says “so chosen that the metals would not arise either as impurities or as contaminants” maybe they also think that something can transmutate into a metal, but only if the metal isn’t already there.
It makes a fairy-tale kind of sense.
The one time I used a silica test kit (it was a field kit! I would expect actual university researchers to have something even more sensitive) it had specific instructions to do the test in a PE beaker or vial and to not use glass containers due to the silica in the glass.
Also, having a concentration plateau with further dilution is something I’ve seen before. My DI water was contaminated.
Dana, none of your comments in any way refute the fact that Dr. Bell’s article is nothing more than speculative chaining of unrelated ideas. The burden of proof is not on the critic to prove homeopathy is not hormesis, the burden of proof is on promoters of homeopathy to prove that it is. Science does not advance by simple assertions of cause and effect – it advances by empirical evidence. There are numerous experiments that could be conducted on homeopathic remedies, with good controls, that could test the basic assertions of the practice. They aren’t done, despite being extremely simple, because homeopaths are not interested in proof. They consider assertion enough. And not too deep inside, they probably realize that their actions are mostly worthless.
Unless, of course, you can provide those “hundreds of studies that confirm hormetic effects” and I just happen to be ignorant of them. And naturally, assuming an intellecutally honest discussion, these “hundreds of studies” must be of homeopathic levels of dilution – not merely low but measurable and physiologically active doses that demonstrate different effects as the dose increases. Really what one needs is an examination of the full range of doses, from, say 10x the dose at which hormetic effects occur down to 1/1000th the same dose (which is still several orders of magnitude above the dilution found in a 12X preparation). Taking an observed effect and extrapolating it without proof is bad practice – for instance, someone watching the tide go out shouldn’t assume that water will continue to recede until all water in the ocean vanishes.
Also, could you provide a more recent source than one that is 13+ years old? The existence of a single paper doesn’t really prove much beyond existence. Surely there is more than one article in a respectable, non-vanity, high-impact journal that is pro-homeopathy? The reason I ask is that there are many ways single papers can appear (see for instance, the discussion of Myers, 2004 on this page), and cherry-picking single, decades-old papers at the expense of ignoring the much larger body of evidence and discussion is pretty textbook pseudoscientific quote mining.
One also notes that Dana apparently didn’t bother to click on the link I provided, in which Dr. Novella explains why the idea that homeopathy works through hormesis is indeed ridiculous. This post was long enough already; strategic use of links allow interested readers to explore concepts more deeply without cluttering up the prose with a lot of explanations, particularly when such explanations have already been posted. But Dana knows that.
“As funny as homeopathy research is, I think that the existence itself of homeopathy is western medicine fault.”
Two things. Homeopathy is pre-scientific western medicine. Just like blood letting and the other nostrums used that it replaced.
Dr Gorski, hormesis does happen to be the correct low-dose dose-response, for all things. But that has nothing to do with homeopathy which is wrong for all the reasons you have articulated and then some.
I have a draft write-up which explains this in some detail which I would be happy to send you.
Very briefly, organisms are active matter which uses the free energy of substrates to maintain its metabolism and to exhibit regular behavior, regular as in exhibiting few degrees of freedom compared to potential degrees of freedom as in S=k*Ln(omega). An active system can only exhibit regular behavior if it is controlled to exhibit regular behavior. Using the free energy of substrates to instantiate that control system is what keeps organisms in a self-organized state. The most important aspect of a control system is that it exhibit stability, that is when it experiences a pertubative influence it responds so as to counter that perturbation, that is it exhibits negative feedback. This negative feedback has been demonstrated experimentally for many substances (thousands) and in many organisms (hundreds).
Materials have effects on physiology because they interfere with the control of physiology by itself. If a material did not interact with physiology it would have no effects. If the interaction is within the control range, then physiology can respond with negative feedback and counter any negative effects sufficiently to exhibit seemingly positive effects from the interfering material. If the dose exceeds the compensatory range and negative effects are observed, then the dose is beyond the low dose range and so is beyond the hormetic range.
Why hormetic effects are usually associated with a larger phenotype is due to an idiosyncratic aspect of eukaryote evolution which I explain in my draft.
Minor point, but it’s Avogadro, not Avagadro.
@Andres,
The only thing that Hahnemann “got right” was that the prescientific medicine of his day did more harm than good. That’s no longer true. Since about 1900, conventional medicine has done progressively more good than harm. Homeopathy was better in Hahnemann’s day only because it did nothing. It’s ludicrous that people continue to use it today instead of the effective medical treatments that are now available.
Indeed, by Andres reasoning, we should also include a prayer to Hermes Trismegistus with each medical intervention, because in the past it was better than bloodletting.
Science marches on, discarding that which is found to be ineffective. Homeopathy, in fact most CAM, does not, accumulating accretions of practice, facile rationalization and whatever science it can co-opt to claim some poor measure of social capital and keep the patients rolling in. And they accuse Big Pharma of being greedy and dishonest…
David,
I’m appalled that you would place David Bowie, an icon if the 70′s in the same sentence as homeopathy!
Next time go with Ozzy Osbourne!
Does anybody else see the snake in image C? That must be the nano-particle that gobbles up the bad DNA.
How nice of Dana to show up and rant a bit.
In any event I just came to comment quickly:
It is interesting to note that there was more non-noble metal in their samples than noble metals. Non-noble metals are much more common, cheaper, and oxidize thus making it much more likely for them to wear down and be present as contaminants than noble metals. Are they really that blinkered that they are surprised that things like platinum, gold, osmium, and iridium are present in much lower amounts than things like iron, chromium, nickel, etc?
Talk about getting the results to fit your conclusions.
Probably OT here but: What is the rationale for prescribing a Z-pak and Loratidine for a sinus infection? Does this actually work for anyone?
ICP-OES is pretty damned sensitive, so when we use acids to dissolve samples, they are supplied as especially clean low-metal versions, delivered in plastic bottles. Ridiculously expensive.
Homeophathers (?) are probably too cheap to buy the good stuff.
@Amalthea,
“What is the rationale for prescribing a Z-pak and Loratidine for a sinus infection”
Instead of asking us, you should ask the doctor who prescribed it and ask what studies supported his reasoning.
Antibiotic treatment is not indicated for most clinically diagnosed cases of sinusitis. Please read http://www.sciencebasedmedicine.org/index.php/antibiotics-for-sinusitis/
Also see http://www.ncbi.nlm.nih.gov/pubmed/22591294 for a discussion of the risk of cardiac death with zithromax.
Also, while decongestants are reasonable for sinus symptoms, loratidine is an antihistamine and is not indicated, as it may dry out secretions and tend to impede drainage.
Thank you. I will ask when I get a chance to do so.
It’s also possible that some of the original material stuck to the sides of the container. Very high C dilutions are often made by the “Korsakov method”. Hahnemann’s method required fresh containers at each step, but at 200C that’s a lot of containers. With the Korsakov method you use one container and simply empty it after each step, assume that any residue left over is probably about 1/100 of the original, then refill and do your tapping thing. It’s probable that some portion of the original substance never actually leaves.
Boiron’s Oscillococcinum at 200C of duck heart and liver is diluted by this method. If homeopathy is the perfect woo, then Oscillococcinum is perfection squared: the stuff it’s supposedly diluting, said to be found in abundance in the offal of a Muscovy duck, doesn’t even exist in the first place.
I think a better term to use to describe the effects of homeopathy is “homeopathetic”.
No, it’s definitely off-topic. Way, way off-topic.
@Dana
If there is activity in nano-range it’s still a classic receptor binding and it does not cause the opposite effect predicted in homeopathy. The only “homeopathic” phenomenon could be the up- or downregulation of a receptor using higher doses, but that implies “higher dilution-higher effect” is wrong.
All this futile intellectual noodling about the properties of water/ethanol from Iris Bell, cheered on by the likes of DUllman, simply ignores the fact that the market is dominated by sugar tablets from which the liquid solvent and all its allegedly marvellous structural properties have been evaporated.
Dr. Gorski quoted Iris Bell’s end-of-dinner salad:
“The adaptive changes that the remedy evokes ultimately strengthen systemic resilience. The successfully treated individual can resist and rebound from subsequent challenges from higher intensity homeostatic disruptors of the organism as a complex network, at global and local levels of organizational scale.”
This is a totally wilted salad. So many squishy words that sound so impressive and mean nothing. Evokes…how and what? Resilience…a trampoline reference or perhaps something about once again smiling while eating another one of Great Aunt Sophie’s fruit cake? Resist and rebound…sounds like an exercise infomercial involving large rubber bands. Disruptors…always a favorite science-y word, used incorrectly, and often designed to evoke Romulans saying “Set your disruptors on stun!” And the finale, managing to network the global and local, would make AT&T’s copywriters happy.
I am glad Iris Bell has a mailing address. I feel like sending her George Orwell’s essay “Politics and the English Language,” along with a copy of Strunk & White’s “The Elements of Style.” Clearly she has read neither which is astonishing as it is reported she graduated from Harvard, Stanford and did a residency at UCSF. Did she speak to no one while she was there? Did they not talk to her? How does one get degrees from such places with only a nanounderstanding of basic language and communication? It all just nanobubbles my mind.
This is something that has bothered me for a while, namely the number of Phd’s in disciplines like chemistry that run companies like HEEL and Boiron. And most of them have degrees from reputable universities in Germany and France and not from degree mills in Barking Mad, Arkansas. So either they have to be spectacularly incompetent, inept and borderline morons -or- they’re happily in on the scam.
Or, they’ve “seen it work,” heard all the anecdotes/propaganda, and become convinced that there Must Be Something There. Then contort themselves trying to rationalize how that could possibly be, when all their scientific knowledge says otherwise. Articles like this are PERFECT for such people – it provides enough validation to smooth over the cognitive dissonance. So long as they don’t think too much about it, which of course they don’t because that amplifies the dissonance again.
Never underestimate the power of motivated reasoning.
Anyone who is interested in a book-length discussion of Scott’s point should read Snake Oil Science by R. Barker Bausel. It’s actually pretty easy to convince yourself that something works even when it doesn’t.
It’s actually pretty easy to convince yourself that something works even when it doesn’t.
Very true, especially if outcomes are being magnified by placebo responses, but does anyone need to be convinced of anything for CAM to thrive?
I suggest that you merely need to have unsatisfied medical needs and someone saying “why don’t you try this?”. This looks to me like an irresistible grass-roots phenomenon –it is an instinctive adaptive response to medical distress — and one that is not going to go away any time soon.
Even when there are efficacious FDA-approved methods, people are tempted to try unproven methods first if the mainstream remedies are expensive to obtain or have a high rate of side effects.
So it is no wonder that nigh on two centuries of ridicule and reason have not succeeded in eliminating homeopathy, nor for that matter, any other form of CAM. (Look at OWH’s elegant rebuttal of the principles of homoepathy in 1842)
Is it time for a rethink? What are we trying to achieve here? The pure scientists will presumably see no reason not to continue to push rationality as they see it, dreaming of a far-off day when science rules everything. We doctors might need to look at the matter more realistically: if it is not possible to eliminate CAM use, what should be our aims concerning it?
Thinking logically and clearly is actually pretty difficult. You have to think about how you might be wrong even when you feel that you are right (especially when you feel that you are right). The only way you can know that you are right is if you have a complete train of valid logic that leads from valid data to your conclusion. Feeling that you are right does not enter into it at all.
What is a “pure” scientist? And if rationality is the hallmark of such a person, then we need to eliminate a number of sciences from the purity angle as the worlds they work in are not rational at all.
So this anecdote mentions antibiotics but isn’t quite so off topic. Thought you would find it interesting.
In 1995 or thereabouts, my young son occasionally got ear infections. Antibiotics were prescribed for that, but it wasn’t clear if they were useful in simple ear infections. He went to a regular private pediatric practice, but a number of the parents were interested in alternative medicine and the physicians were as well. So one time I was there and my son was diagnosed with a simple ear infection, one of the practitioners said he qualified for a new study they were doing treating ear infections homeopathically. I knew about homeopathy because I had friends who believed. But I also knew about Avogadro’s number and can do a little math. So I asked if this was a double blind study with placebos. She took a breath and said yes. So I said sure, we are in. (Why not see if the infection cleared up on its one for a couple days if it isn’t causing him distress, I thought.)
Well, when we got to her office to continue, she asked why I said yes. When I explained my reasoning, she said that they were having trouble getting their targetted enrollment, because when parents found out that their child might be given a placebo instead of the homeopathic remedy, they would change their mind about participating. They expected to get 75 patients in one winter (should be easy given the size of the practice) but I heard that the next year they were still trying to get children enrolled. Never heard the results either, although they said I would.
We ended up changing doctors after that for other reasons, and now my son has aged out of pediatrics. But I just looked up the website for that practice and sure enough their mission statement now emphasizes CAM.
DinSeattle -
Cue hilarity-induced bronchospasm in 3…2…1…
“The pure scientists will presumably see no reason not to continue to push rationality as they see it, dreaming of a far-off day when science rules everything.”
What is a “pure” scientist? And if rationality is the hallmark of such a person, then we need to eliminate a number of sciences from the purity angle as the worlds they work in are not rational at all.
Yes, not well expressed. I had in mind those science-oriented persons for whom “quackery” is merely a side show, just one of several areas in which society is thought to be badly in of need scientific guidance. These persons assume that their present understanding of “what the science says” will always inform as to what is best for society. And it probably usually will, too.
However, I would expect doctors to be more aware of some of subtleties of medical practice, meaning those ways in which medical usage and outcomes don’t quite fit simple therapeutic models, or at least not without the introduction of our own unproven assumptions, such as that placebo and other non-specific influences are too trifling for science or medicine to bother much with and that they will, furthermore, remain so under all conditions.
Doctors might also have more concern for overall patient outcomes under the conditions that apply at this point in medical history, which means being advised by bitter experience that what seems right can have unexpected consequences. Doctors might thus ask themselves questions that would not occur to the average skeptic, such as:
“If we succeeded in eliminating homeopathy, what would CAM users turn to instead, and would that do more harm, or less?”.
” Are present levels of hostility and ad hominem towards CAM supporters and users supportive of, or erosive of an already weakened public trust? Are not we all, with some notable exceptions, striving towards common ends, where the true enemy is illness? Should our rhetoric be tuned to that realization when dealing with honest belief, no matter how mistaken it looks?”
“If mainstream medicine were the only recourse open to the public for every illness, no matter how minor it was, and no matter how lacking it was in evidence-based solutions, would there be more or less unsatisfactory medical outcomes and adverse treatment reactions? Or would there simply evolve a thriving, even more dangerous, underground version of CAM?”
” What would be economic impact of the elimination of CAM, assuming that some of the untold billions now spent upon it would be transferred onto the mainstream?”
“If placebo reactions are shown to be likely from a specific use of an “alternative” at the individual’s own choice, can that have acceptable cost/risk/effectiveness over “usual medical care” (there are already some discomforting studies on this matter).
And perhaps most importantly: “If we cannot stop people using CAM, what can we do to make it safer?”
As I have said before, few people can follow the often necessarily abstruse scientific arguments. Their very vehemence can actually foster suspicion that the true aim is to reduce rightful choice and to protect self-interests.
As Daedalus2 suggests, true scientists should be prepared to think the unthinkable, or at minimum be prepared to test out unpalatable propositions.
(To clarify where I am heading, the mainstream is entitled, even obligated, to express the opinion that most CAM methods “work”, to the extent that they work, as placebo and to indicate what limitations that imposes upon outcomes.
I think statements beyond that need to be critically examined as to their implications and how they will be read by those we wish to influence. For example, the seemingly obvious, commonly expressed dogma that “all of medicine should be held to the same standard of evidence” carries the clear inclination that CAM can be rightfully suppressed on these grounds, even though the mainstream is demonstrably not yet fulfilling that aspiration itself, and those very standards are being increasingly shown up for their arbitrariness and, sometimes, their short-term unreliability. )
@Harriet: Not that I dissent about homeopathy, I just dissent about some effective medical treatments that are highly used today —mammography, statins (clearly not effective on primary prevention, that would be my case), PSA screening, neuraminidase-inhibitors…
As a matter of fact, I also dissent about the proved uselessness of some vitamins —like ascorbic acid in high doses.
@William: He, he! Just in case! Praying elicits the relaxation response, you know.
@ pmoran
What you seem to be saying is this:
If someone (a) can create a treatment that has no plausible basis in the body of our current scientific knowledge (e.g., homeopathy and reiki) and (b) manage to have that treatment excepted from the usual legal prohibitions against misrepresentations of fact in the sale of products or services, in this case of their mechanism of operation and/or effectiveness (or at least fly under the legal radar), then it is perfectly acceptable to sell these treatments to the public. (We’ll assume for the purposes of our discussion that there is no concern about the safety of these products or services.)
If not, what did I miss? If so, two questions:
1. At what point would the monetary cost of such treatment outweigh the benefit to the public you apparently see in allowing the sale of these products and services? Is there a dollar limitation you would impose? Or does the cost not matter?
2. Would you confine the sale of these products and services to those currently in use, or would you permit the sale of any such product or service without limitation. For example, in his post today Scott Gavura wrote about “Bodywork,” which has the same lack of plausibility as homeopathy and reiki. As long as some placebo effect can be induced with this treatment, do you think it is permissible for the inventor to sell “Bodywork” to the public? If not, how do you distinguish it from those products or services you would permit?
Thank you.
If someone (a) can create a treatment that has no plausible basis in the body of our current scientific knowledge (e.g., homeopathy and reiki) and (b) manage to have that treatment excepted from the usual legal prohibitions against misrepresentations of fact in the sale of products or services, in this case of their mechanism of operation and/or effectiveness (or at least fly under the legal radar), then it is perfectly acceptable to sell these treatments to the public. (We’ll assume for the purposes of our discussion that there is no concern about the safety of these products or services)..
:
Well, no, I don’t find that perfectly acceptable. I, too, despise those who exploit people’s medical needs this way, even while being aware of the paradox that such products can inadvertently satisfy the medical compulsions of some and .perhaps produce a modicum of true relief for others. We simply shouldn’t have to countenance an infinite number of placebos fattening up more and more crooks.
What I have said pertains to that large body of CAM that is sustained by honest belief or, as often as not, simply by “this is worth a try”. .
If such a method was “excepted from the usual legal prohibitions against misrepresentations of fact in the sale of products or services” I assume that it was not possible to prove knowing fraud. With de novo medical claims that should be a little easier these days, as surely the courts would expect a body of supporting research for any important medical claims.
1. At what point would the monetary cost of such treatment outweigh the benefit to the public you apparently see in allowing the sale of these products and services? Is there a dollar limitation you would impose? Or does the cost not matter?
One of the functions of the medical profession is to advise health care payers such as governments what they should pay for. The only possible, practical, general rule is the “working better than placebo” one. So most of CAM is, and it should also remain, a private expense over which we have utterly no say. Some private health insurers cover CAM, but presumably always at a higher premium, so that the user is still paying. .It is only in the highly hypothetical and unlikely case where CAM was banned (as the result of skeptical success?) that there would be substantial added financial strain on the mainstream.
2. Would you confine the sale of these products and services to those currently in use, or would you permit the sale of any such product or service without limitation. For example, in his post today Scott Gavura wrote about “Bodywork,” which has the same lack of plausibility as homeopathy and reiki. As long as some placebo effect can be induced with this treatment, do you think it is permissible for the inventor to sell “Bodywork” to the public? If not, how do you distinguish it from those products or services you would permit?
In practice, it is not so much what one permits, but what it is worthwhile going after. Trying to eliminate every last variant of “quackery” would soon have the courts doing little else. Also, we can’t stop religions offering eternal life in paradise (sometimes with 72 virgins!) to its adherents upon the fulfillment of certain conditions, so that it is futile trying to outlaw something simply because it is scientifically outlandish.
With medical products and services the key thing is the nature of the claims. So far as I can see Bodytalk makes no major medical claims. The minute it did, I would be challenging it in the courts ( and quite possibly losing, or inducing an ineffectual slap on the wrist, judging from past efforts.to get various forms of CAM regarded as fraud..) Body talk might also be treated leniently because “any reasonable person” might be expected to recognize that it is not meant to be taken as serious medicine. Some forms of CAM have little more medical significance than a cosmetic commercial and there will be some point at which caveat emptor must kick in.
@pmoran
With all due respect, I find your answers unconvincing. You don’t seem to have any reliable standard for determining what is “acceptable” CAM and what is “unacceptable” CAM. This leaves everyone to make his own decisions without any basic principles to guide him. I thought that is what the scientific method/evidence-based medicine/science-based medicine were designed to avoid. My comments to your comments are below, with apologies for my somewhat crude method for distinguishing your comments from mine, but it was just the easiest way to do it.
PM: What I have said pertains to that large body of CAM that is sustained by honest belief or, as often as not, simply by “this is worth a try”.
JB: But how do you determine which CAM treatments are the result of “honest belief” and which ones are not? I assume many CAM treatments were originally the result of “honest belief.” Homeopathy is an example. But after 200 years we have sufficient knowledge to know that it is implausible and ineffective. The four humours and bleeding were originally the result of “honest belief” and were abandoned when the evidence proved otherwise. Do you accept all treatments that we know are implausible and ineffective but which are/were the result of “honest belief,” and, if not, how do you distinguish among them? How do you determine the intent of the person offering the sale of the CAM goods or services – whether he has an honest belief or is a charlatan? Why does that make any difference? And what are your standards for deciding a CAM treatment is “worth a try” if there is no plausibility and no good evidence of effectiveness behind it?
PM: If such a method was “excepted from the usual legal prohibitions against misrepresentations of fact in the sale of products or services” I assume that it was not possible to prove knowing fraud.
JB: Not at all. At least in the U.S., state legislatures have passed practice acts which give naturopaths, chiropractors and acupuncturists the authority to use all sorts of implausible and ineffective means, like applied kinesiology, cranial sacral therapy, colonic irrigation, IV doses of minerals and vitamins, chelation for “detoxification,” peat baths – the list goes on and on. And the U.S. Congress has basically relieved homeopathy from any requirement that safety or effectiveness be proven. These are all absolutely fraudulent, yet permitted under state and federal law. That has not made them immune from suits for fraud, as I explained in my posts about Boiron.
PM: One of the functions of the medical profession is to advise health care payers such as governments what they should pay for.
JB: Maybe so, but the governments don’t listen to their advice. If they did, all these CAM diagnostic methods and treatments would not be available.
PM: So most of CAM is, and it should also remain, a private expense over which we have utterly no say.
JB: But that is exactly what I am talking about — cost to the individual. Are you not disturbed by the fact that some people are paying money, sometimes large sums, for ineffective treatments, and should not the medical profession speak out against this?
PM:It is only in the highly hypothetical and unlikely case where CAM was banned (as the result of skeptical success?) that there would be substantial added financial strain on the mainstream.
JB:I don’t know what you mean.
PM: In practice, it is not so much what one permits, but what it is worthwhile going after. Trying to eliminate every last variant of “quackery” would soon have the courts doing little else.
JB: No, all it takes is simple regulation stating that you can’t sell a product or service to the public based on a misrepresentation about its effectiveness. Actually, that is already the law but CAM seems regularly to escape this basic principle of commerce, partly because of the perverse scope of practice and other laws I mentioned.
PM: Also, we can’t stop religions offering eternal life in paradise (sometimes with 72 virgins!) to its adherents upon the fulfillment of certain conditions, so that it is futile trying to outlaw something simply because it is scientifically outlandish.
JB: At least in the U.S., religious expression is protected by the Constitution. CAM is not.
PM: With medical products and services the key thing is the nature of the claims. So far as I can see Bodytalk makes no major medical claims.
JB: I don’t see any difference in the claims made by Bodytalk and other CAM diagnostic methods and treatments. I am not sure what you mean by “medical claims.” All CAM procedures appear to me to make some form of “medical claim” even if it is some vague promise of “healing.” In addition, just because the claim is based on a mechanism of action that is not recognized in medicine (e.g.” energy healing,” such as reiki and therapeutic touch) I don’t think that exempts them from being characterized as medical claims.
PM: Body talk might also be treated leniently because “any reasonable person” might be expected to recognize that it is not meant to be taken as serious medicine.
JB: That is not true. If the public were as scientifically literate as you suggest we wouldn’t have any sort of CAM. Even if you are correct that “any reasonable person” might not believe it, we can’t turn our backs on the less intelligent or less educated and leave them to the charlatans.
In sum, I see no reason for the medical profession, or anyone else, to abandon plausibility (at the very least) and effectiveness as the benchmarks of medicine: conventional, alternative, complementary, integrative, or what have you. There should be only one standard for all medicine.
With all due respect, I find your answers unconvincing. You don’t seem to have any reliable standard for determining what is “acceptable” CAM and what is “unacceptable” CAM.
I do. As I said above — “ And perhaps most importantly: “If we cannot stop people using CAM, what can we do to make it safer?”
In my view, the emphasis of healthfraud activism so far as the medical profession is concerned should be upon patient and public safety, while accepting that we cannot make it totally safe without unacceptably oppressive legislation, or science-based without impossibly unwieldy adjudication processes on each and every claim and having to also take into account paradoxical placebo responses..
You had taken safety out of play in your hypothetical example with: :. ” We’ll assume for the purposes of our discussion that there is no concern about the safety of these products or services..”
But you are right to point out that without taking into account the safety of the product/method after taking into account the claims that are being made for it it is difficult to separate one CAM method from another.
In sum, I see no reason for the medical profession, or anyone else, to abandon plausibility (at the very least) and effectiveness as the benchmarks of medicine: conventional, alternative, complementary, integrative, or what have you.
It is plausibility along with the results of efficacy studies that allows us to hold the firm opinion that these methods could only work as placebo. What few skeptics have considered is that we have no scientific basis on which to pronounce on the overall “effectiveness” of placebo medicine as used in the wild except to say that placebo responses will be largely limited to producing subjective outcomes. I am prepared to argue that out with anyone.
When we think of placebo we also tend to think of mere symptom relief, but people can bring a variety of other needs into medical interactions, and for a number of very likely reasons they may not always find it easy to satisfy them with the available mainstream options. It may not be in the public interest to try and close off all other options. I assume that the law courts, like the medical profession, have a duty to seek optimal outcomes for the public, often steering a course between conflicting objectives…
There should be only one standard for all medicine.
I see so many things wrong with this as a mantra apart from the fact that we should therefore have the courts pursuing a considerable section of the mainstream. There are no safe and efficacious evidence-based treatments for many conditions yet it carries the implication that even then someone (who?, how?) has the right to prevent people (and doctors) exploring other options — which may even end up helping a bit.
It arouses paranoia, for it logically obliges you to root out CAM everywhere you find it. .There can be no half measures, because the standard that is being urged upon you is the extremely error-averse one that the mainstream has homed in upon through its all-absorbing but necessary interest in intrinsic treatment efficacy. On that standard, lack of evidence for a medical claim, with anecdote barely counting, has almost the same implications for medical practice as contrary evidence. That approach has its place, but it was never one that was going have a happy ride outside of its native context — we have seen how it causes people to dig their heels in, and question OUR motives.
Since you want constructive input, the mantra that I am exploring goes like this “these things may help people feel better for psychological reasons, but they should not be relied upon alone for any serious illness”.
Note that I am talking largely about communications with the public, especially those tempted to engage with CAM. I hesitate to step onto legal ground, but I suspect that the laws of most countries probably have it about right. They, too, focus upon restricting unsupportable medical claims and areas where there are direct threats to public safety.
@pmoran
A brief comment, and then I’ll stop for now, as we could go on forever and this is not wholly relevant to David’s post. Although I disagree with much of what you say, you have given me an idea for a post and we can take up the discussion again then.
Now for the comment. You said:
“Since you want constructive input, the mantra that I am exploring goes like this ‘these things may help people feel better for psychological reasons, but they should not be relied upon alone for any serious illness’.”
This simply gives the public two competing claims, one from the CAM promoters who say their potions and treatments do things that they do not do, and one from the medical profession, which says they are placebos and may make someone feel better. I don’t think the public is any more likely to believe the medical profession than the CAM promoters, and maybe less, as one of the typical claims of CAM practitioners is that the medical profession has an incomplete understanding of their practices. Hence the need for effective regulation that stops these false claims from being made in the first place. Or, at the very least, actually applying consumer protections already in place.
And you said:
“I hesitate to step onto legal ground, but I suspect that the laws of most countries probably have it about right. They, too, focus upon restricting unsupportable medical claims and areas where there are direct threats to public safety.”
Definately not true in the U.S. As I pointed out, the state practice acts gives chiropractors, acupuncturists, and naturopaths the right to use many “unsupportable medical claims,” including “areas where there are direct threats to public safety,” such as cracking necks to “correct subluxations” which are claimed to be the source of all sorts of medical problems. This is but one example. You merely need to go online and look at the outlandish claims being made.There is also the substantial issue of patients foregoing or delaying effective treatment based on the advice of CAM practitioners to use their potions and treatments as actual remedies for disease.
So, for now, Happy Holidays. Perhaps we can take this up again in 2013. This will be possible because, most fortunately, the world did not end today as predicted by a group of folks who, like sellers of CAM products and treatments, have little understanding of basic science or respect for the scientific method.
“Since you want constructive input, the mantra that I am exploring goes like this ‘these things may help people feel better for psychological reasons, but they should not be relied upon alone for any serious illness’.”
This simply gives the public two competing claims, one from the CAM promoters who say their potions and treatments do things that they do not do, and one from the medical profession, which says they are placebos and may make someone feel better. I don’t think the public is any more likely to believe the medical profession than the CAM promoters, and maybe less, as one of the typical claims of CAM practitioners is that the medical profession has an incomplete understanding of their practices. Hence the need for effective regulation that stops these false claims from being made in the first place. Or, at the very least, actually applying consumer protections already in place.
Just one cogent comment from me.
I disagree, apart from the application of consumer protection laws where there is obvious danger or provable intent to defraud.
My statement helps resolve the otherwise stark conflict that exists between one group of people insisting that a dubious treatment helps them feel better, and another saying baldly “it doesn’t work”, with the further implication that there is some foolishness going on somewhere (and it does not lie with me). That creates instant, unproductive antagonism and an unresolvable stalemate that you will come up against the minute you try and introduce legislation that “stops false claims being made in the first place.”
It allows a focus upon those areas where the science is clearer and easier to expound, because if anyone can cure real illnesses they must be able to produce unmistakably cured patients with objective evidence.
It does not require raising the public to the level of scientific sophistication of the authors of this blog. It builds upon common knowledge, that illness is subjective and influenced by what is in the mind, while diseases can be objectively measured. They might value the opinion of “science” but still wish to try out anything that offers relief from sometimes desperate straights.
It allows a focus upon those areas where the science is clearer and easier to expound, because if anyone can cure real illnesses they must be able to produce unmistakably cured patients with objective evidence.
That should read “serious diseases”.
Exactly. Peter cannot give anything resembling even a partially objective criteria as to what makes CAM acceptable or not.
Jann: “With all due respect, I find your answers unconvincing. You don’t seem to have any reliable standard for determining what is “acceptable” CAM and what is “unacceptable” CAM.”
David: Exactly. Peter cannot give anything resembling even a partially objective criteria as to what makes CAM acceptable or not.
These two quotes are from my actual responses to questions from Jann about the “acceptability” of CAM.
Jann:”If not, how do you distinguish it from those products or services you would permit?
PM: In practice, it is not so much what one permits, but what it is worthwhile going after.
ALSO
Jann: You don’t seem to have any reliable standard for determining what is “acceptable” CAM and what is “unacceptable” CAM.
PM: I do. As I said above — “ And perhaps most importantly: “If we cannot stop people using CAM, what can we do to make it safer?” (Emphasis in original)
PM: In my view, the emphasis of healthfraud activism so far as the medical profession is concerned should be upon patient and public safety, while accepting that we cannot make it totally safe without unacceptably oppressive legislation, or science-based without impossibly unwieldy adjudication processes on each and every claim and having to also take into account paradoxical placebo responses..
PM: You had taken safety out of play in your hypothetical example with: :. ” We’ll assume for the purposes of our discussion that there is no concern about the safety of these products or services..”
Note that Jann had specifically taken safety, my main “objective criterion” off the agenda, before accusing me of having no standard by which to judge the tolerability of CAM., You have taken his words in isolation.
Elsewhere I make it clear that safety includes the impact of any specific claims that are being made for the method, and I have also allowed for the prosecution of frank fraud, where that can be established under prevailing laws.
Does this help?
Assuming safety isn’t an issue; what’s the problem with CAM?
The only problems with CAM after removing safety from the table are legal & ethical:
Is it ethical to allow somebody else be mislead?
Is it legal for a CAM provider to take money under such circumstances?
Neither of these questions are medical questions. Certainly practitioners have professional standards, but these standards don’t cover everyone who might support CAM. So really, medical professionals need only categorize into CAM & non-CAM & grey zone. Let the other questions be answered by the broader public.
***********************************
But my real point here is that the “safety assumption” is a terrible assumption. People do not operate in a vacuum where they evaluate safety, efficacy, ethics, as well as financial & legal requirements in neat, separate compartments. Trust is built overtime–if it is built in a ND recommending safe, ineffective treatment for minor ailments, where would one turn first for treating major ailments? So we should assail strongholds of CAM where the most damage can occur and where the most long-term threats can reside. Proportionally smaller resources can be spent chasing down the smaller, more harmless problems.
Always Curious,
This website might answer your questions:
whatstheharm.net/
AC,
“Assuming safety isn’t an issue; what’s the problem with CAM?”
1) Safety can be an issue, and it is often a unrecognised because there’s no reporting system.
2) It can result in missing out on treatments that actually work.
3) It can result in delayed diagnosis.
4) CAM providers often advise against vaccinations.
5) CAM providers often advise against using treatments that are science-based.
6) It can create a mindset within the patient that is anti-science
7) It tends to promote irrational, magical thinking within the population.
There’s probably more, but that will do for now.
BJ:Assuming safety isn’t an issue; what’s the problem with CAM?”
1) Safety can be an issue, and it is often a unrecognised because there’s no reporting system.
2) It can result in missing out on treatments that actually work.
3) It can result in delayed diagnosis.
4) CAM providers often advise against vaccinations.
5) CAM providers often advise against using treatments that are science-based.
6) It can create a mindset within the patient that is anti-science
7) It tends to promote irrational, magical thinking within the population.
There’s probably more, but that will do for now.
Most of these ARE safety issues, BJ.
Where the treatments themselves are dangerous, we should be able to gather injured patients and use the courts to control or ban their use. That does not require the miraculous conversion of whole populations of not very interested persons to scientific modes of thought.
The main risks lie where CAM is resorted to for serious illnesses. This is usually a matter of quite determined personal choice and most often resorted to when the mainstream has little to offer or is also in use, so it is less easy to legislate against, especially with the globalization of CAM. There is always Mexico, or the Internet, or some nut who says that his special diet will cure cancer.
So does it mainly come down to public trust, as Always Curious also implies? How do we foster that? All I am suggesting for a start is that we are scrupulously honest about the limitations of mainstream medicine and what our own science permits.
We should also try to better understand the CAM sub-culture. You have cobbled together a Frankenstein version of it. They are all bits of truth, but I think few CAM users would be responsive to this characterization.
CAM use could equally be seen as a healthy, instinctive, rational (at the personal level) response to serious medical needs. What is amazing is that so many people have sufficient faith in mainstream medicine and its science so as to choose NOT to use CAM, even when suffering or dying.
Thank you for demonstrating my point–separating safety from considerations of CAM is a fruitless exercise. And I agree that painting all CAM users & supporters with the same brush is counterproductive. In order to minimize the harm done, identifying the faults of CAM & reasons people turn to it are essential. I gather from pmoran that he thinks the demonization is interfering with some of the problem-solving steps.
Many people I know who’ve turned to CAM did so because they feel (rightly or wrongly) that the “medical establishment” has failed them. A completely different cross-section feels that they are taking their health care seriously when they follow the science sections in the media, read Weil & watch Oz. This population is necessarily stupid for following their instructions, they are simply ignorant of the factors that invalidate suggestions by folks like Weil & Oz.
The lesson to free-speech valuing societies should be clear: SBM has a message, but it needs to make that message clearly, continuously, correctly, and available to the public at large.
Hmmmm, trying to figure out Always Curious. Looks at title of article, and body of article and sees it is about claims dealing with homeopathy. Homeopathy is just one small nugget of CAM, and is perhaps the most ridiculous of all. Or the one with the best profit margin considering the barrels of cash Boiron makes by putting fancy labels cake decorating non-pareils.
Now I must ask: Always Curious do you have some information that shows homeopathy’s use should be defended? Because all I see is a very expensive placebo, and from the above article lots of hand waving about “nanoparticles” by those who profit from those who do not know homeopathy is just a bunch of nothing.
Perhaps, Always Curious, your question would be better handled at today’s contribution from Dr. Novella:
http://www.sciencebasedmedicine.org/index.php/why-do-people-turn-to-alternative-medicine/
He actually has personal experience with at least on of the persons mentioned above, Iris Bell. She and he participated in a debate:
http://theness.com/neurologicablog/index.php/my-day-with-the-homeopaths-part-i/
Chris,
I just noticed Novella’s latest post & will read it soon. I was responding to comments (which had wandered off track to CAM in general from homeopathy in specific), not to the article specifically. Above, Jann Bellamy had posed a hypothetical situation that I understood as “What if we ignore safety in our discussion of CAM treatments?”. After further inspection of my first post, I see that my non-use of blockquotes is the reason for the confusion. I wanted that as a jumping off point to illustrate that safety cannot be disentangled from treatment. I have no interest in defending homeopathy or any of its spurious claims. It would be very simple for the government to decide to regulate homeopathy to death and remove it from pharmacy shelves. But apparently the mix of money & politics isn’t right to make this a reality yet.
Ah, yes, the effects of Royal Copeland and his political lesson at Tammany Hall will be with us for many years. Even if politicians protected it, it still does not make homeopathy any more effective.
@ Always Curious:
I did not suggest that we “ignore” safety as a concern. I simply removed it from consideration for the purposes of discussion. Pmoran and I appear to agree that safety of CAM products and services is a big problem. What I was trying to determine is what other standards he had for judging whether CAM products and services should be legal. As best I can tell, cost and misrepresentation of facts in the sale of goods and services are not issues for him because (again, best I can tell) it is too difficult to stop their sale based on those standards. If this is true then I presume, according to his standards, we could do away with the large body of law that (in the U.S. at least) attempts to regulate the financial markets, manufacturing standards, the labor market and the like unless there is an issue of bodily harm.
Oh, and I forgot, “frank fraud” is also an issue for pmoran. I don’t know what “frank fraud” is, although pmoran appears to think it is sufficient to prosecute frank fraud after the fact rather than regulate conduct so that fraud doesn’t occur in the first place. I imagine Bernie Madoff’s victims would disagree with pmoran’s after-the-fact remedy.