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Placebos as Medicine: The Ethics of Homeopathy

Is it ever ethical to provide a placebo treatment? What about when that placebo is homeopathy? Last month I blogged about the frequency of placebo prescribing by physicians.  I admitted my personal discomfort, stating I’d refuse to dispense any prescription that would require me to deceive the patient. The discussion continued in the comments, where opinions seemed to range from (I’m paraphrasing)  “autonomy, shmatonomy, placebos works” to the more critical who likened placebo use to “treating adults like children.”  Harriet Hall noted,  “We should have rules but we should be willing to break them when it would be kinder to the patient, and would do no harm.” And on reflection, Harriet’s perspective was one that I could see myself accepting should I be in a situation like the one  she described. It’s far easier to be dogmatic when you don’t have a patient standing in front of you. But the comments led me to consider possible situations where a placebo might actually be the most desirable treatment option. If I find some, should I be as dogmatic about homeopathy as I am about other placebos?

Nicely, Kevin Smith, writing in the journal Bioethics, examines the ethics of placebos, based on an analysis of homeopathy. Homeopathy is the ultimate placebo in routine use — most remedies contain only sugar and water, lacking a single molecule of any potentially medicinal ingredient. Smith’s paper, Against Homeopathy — A Utilitarian Perspective, is sadly behind a paywall.  So I’ll try to summarize his analysis, and add my perspective as a health care worker who regularly encounters homeopathy.

The first third of the paper is a concise summary of the scientific absurdity of homeopathy.  Hahnemann’s “Law of Similars”, based on a single observation of the effects of  quinine on malaria, is the basis for the non-scientific process of “provings” to match symptoms to substances. The results of provings are compiled in the Homeopathic Materia Medica, which homeopaths select their remedies from. (So now we have remedies based on products including  “sleep”, Stonehenge, shipwrecks, ascending colons, light bulbs, and vacuum cleaner dirt.) Smith summarizes this law as:

More fundamentally, there is simply no plausible or rational basis for supposing that substances that produce particular symptoms can cure the same symptoms. The assumption that ‘like cures like’ places the onus on  proponents of homeopathy to elucidate the special logic involved: to the knowledge of the present author, a satisfactory account of this logic has not been made.

Hahnemann’s second law, the “Law of Infinitesimals” is as absurd as the law of similars. That a product can gain potency and effect with dilution, and that effect persists (and even grows stronger) even after being diluted completely away defies physical laws. Smith points out the contradiction between the idea that water is touted to have a memory of the “proved” substance, yet has forgotten everything else that has every been dissolved in it:

The fact that physiological chaos does not ensure whenever we drink a glass of water provides a simple but powerful refutation of the ‘memory’ concept in homeopathy.

Smith then covers the research on homeopathy. Given its premise is implausible (or impossible), it is not surprising that the highest quality clinical trials have demonstrated no efficacy beyond placebo effects.  Yet positive trials are to be expected from statistical effects alone. And when combined with bad design, weak blinding and other potential biases, it should not be surprising that a supportive clinical trials appear in the literature — and some even show up in Cochrane reviews. His conclusion is very much along the lines of the position taken by SBMers:

From Hume onward, it has been accepted that extraordinary claims require extraordinary evidence. Considering the extent to which the fundamental tenets of homeopath run counter to established rules of science and reason, empirical evidence in support of homeopathy would have to be particularly robust, in view of the fact that acceptance of homeopathy would entail a major epistemic scientific revolution.

So it’s implausible, the remedies contain no medicinal ingredients, and, not surprisingly, it works no better than a placebo. Yet it is popular, even among some physicians and scientists. But is it ethical? And here’s where we get to the meat of the ethical analysis.

Non-Invasiveness/Cost-effectiveness

Placebos, as commenters to my past post noted, do have one merit. If the alternative to antibiotics for a cold is homeopathy for a cold, then homeopathy is probably a better therapeutic choice, because “no treatment” is the preferred treatment. There are many medical conditions for which we have few effective medical therapies, and in some cases the impetus to prescribe a placebo may be simply to obtain the psychological (placebo) effects associated with their use.  And given the habit (as I described last month) for some physicians to select impure placebos (those containing subtherapeutic or non-toxic ingredients), then isn’t a pure placebo like homeopathy sometimes preferable? Here’s where Smith gives homeopathy credit:

In cases where ineffective medication is considered to be in the best interests of the patient, which form of such medicine should be prescribed?

The answer to this question seems clear: the ineffective medicine that is the least invasive and least expensive should be used. On these criteria, homeopathy scores highly.

So in situations where a placebo is felt to be in the patient’s best interest, homeopathy might be felt to be favorable, particularly if an “impure” placebo has a greater potential for unwanted effects.   But Smith makes a small error here: Homeopathy isn’t always the least expensive option – a point I’ll return to.

Holism

Holistic is a popular term among alternative medicine proponents and is usually used to deride science-based medicine, with the fallacious claim that various alternative treatments treat the “whole patient” while medicine does not. And as has been described elsewhere on this blog, the extended consultation offered by alternative medicine providers is probably the source of most if not all of the benefits of treatments. However the non-specific benefits of talk therapy, dialogue, empathy and reassurance are not limited to homeopathy, and can be incorporated into science-based practices.  And importantly, since homeopathic “remedies” can be purchased in pharmacies and other stores without consultation, the “holistic” approach, and its benefits, are by no means certain when consultation is omitted. For these reasons, Smith rejects holism as providing any unique support for homeopathy.

Placebo effects

In the research setting, placebo effects are any measured response in patients that receive the inert (placebo) treatment. But as has been noted on this blog, there are actually multiple elements and observations that sum into what’s described as “placebo effects.” Some of what can contribute to the apparent efficacy of a placebo may not be due to patient-reported outcomes: Researcher bias, poor blinding, and weak overall study design and conduct can all add to the measurement of, and subsequent conclusion that a placebo has effects. Even a disease’s natural history, or regression to the mean can lead one to conclude a correctly-timed placebo treatment is effective.

Smith does not dive deeply into placebo effects, but makes two arguments against homeopathy’s value as a placebo. First, he notes that placebo effects are generally restricted to subjective symptoms like pain and fatigue, with no evidence supporting any meaningful disease-modifying effects. This limits the usefulness of homeopathy to those conditions for which there is some evidence to show that there may be placebo effects. Smith then raises the ethical appropriateness of a key component of successful placebo use: in order for placebos to work, patients must believe something that is untrue. From a utilitarian perspective, Smith notes that lying may be acceptable when it (on balance) is an overall positive — that is, it generates a positive utility.  However, patient autonomy must also be considered — the right for patients to make an informed decision about their treatments. Smith suggests that if you personally rank autonomy above the potential placebo benefits, then the use of homeopathy is untenable from an ethical perspective.

But are homeopaths deliberately deceiving their clients? Smith argues (and I agree) that most homeopaths genuinely believe “remedies” to be effective — so they are not acting in bad faith when they advocate their use. However, the fact remains that patients that are told that homeopathy is effective are being given information that is contrary to the scientific evidence. Consequently Smith describes their actions as “ethically unacceptable” regardless of their sincere (but wrong) beliefs.

But what about placebo use by health professionals? While routine use of placebos wouldn’t be considered ethically acceptable, Smith notes that reinforcing the efficacy of a conventional medication, in a way that could enhance potential placebo effects, is acceptable. This is a routine part of the pharmacist’s dialogue with patients – understanding and addressing concerns, summarizing therapeutic effects, and managing overall treatment expectations. It can be done in a non-deceptive way that should maximize the non-specific effects.  But what about pure placebos?  Smith gives the example of  battlefield use of saline injections for pain as a circumstance where pure placebo use would be ethically acceptable. So in situations where no other options exist, perhaps. But as a matter of course, providing pure placebos would not be considered ethically appropriate.

Autonomy

What if patients elect to choose homeopathy, despite counsel that the product is inert? I’ve encountered this situation in the pharmacy: when asked for advice, I inform the patient that the product has no active ingredients and has no medicinal effects. They’re usually grateful for that, but sometimes my advice will be challenged or ignored, and they’ll purchase it anyway. In situations where it’s clear that the patient may be avoiding appropriate consultation or treatment, I may press my argument further. But once I’ve described the scientific evidence, and given my advice, I’m comfortable letting the patient make their own purchasing decision. And that’s consistent with Smith’s analysis:

If utility is generally maximized by allowing patient autonomy, then patients should be free to choose homeopathy. Secondly, exercise of autonomy provides psychological benefits for the agent: it is well accepted that denial of free choice, or coercion, results in reduced happiness in the subjects concerned.

Smith describes the challenge of drawing lines between paternalism and autonomy, concluding that restriction of autonomy is probably reasonable when the risk of self-harm is greater — which is consistent with the case for restricting drugs to “prescription-only” status. While risks of contamination and unwanted medicinal effects do exist, the more common and real risk is probably the avoidance of proper medical treatment — which is one of the major disutilities of homeopathy.

Failing to Seek Medical Care

While some might be willing to accept the use of homeopathy in cases where placebo effects are possible and probably adequate, most draw the line when homeopathy is positioned as a substitute for effective medical treatment. Yet that’s the case when homeopathy is promoted as malaria prophylaxis, a substitute for vaccination, or even as a treatment for HIV or tuberculosis. Probably the best approach to mitigating this risk, while promoting individual patient autonomy, is to ensure that adequate information is provided to patients so that they are well informed of the lack of medicinal ingredients and the demonstrated lack of efficacy, beyond placebo, for any condition. Smith questions the ability of CAM practitioners to provide reliable advice on efficacy, and describes the promotion of a therapeutic doctrine, rather than reliable advice, as “ethically unacceptable.” He further characterizes any harms resulting in those unable to give fully informed consent (e.g., children or non-competent adults) as “ethically indefensible.”

Waste of Resources

If you’ve never bought it before, homeopathy is not cheap: its prices are comparable to conventional products with active ingredients.  Given the lack of efficacy, every dollar spent on homeopathy is a waste of resources, in that it could otherwise be put to more effective use — for plausible treatments, or anything else, for that matter.  So from a utilitarian perspective, Smith argues that this expenditure is unethical. Smith notes that homeopathy may not just act as a substitute for other care due to its lack of effect: When the homeopathy fails to work, conventional care may subsequently be sought.

Smith makes the same ethical evaluation of research into homeopathy, where because of  a lack of “logico-scientific validity”, human trials of homeopathy are ethically contentious and an inappropriate use of resources.

Credibility Issues

One of the issues that concerns me as a pharmacist is the veneer of credibility that homeopathy gains when it’s packaged and positioned alongside conventional medicine in pharmacies.  I suspect that most consumers expect the products on pharmacy shelves to contain medicinal ingredients, and to have some sort of evidence to support their sale. If I substituted placebos for prescription drugs, I’d quickly lose my license to practice. And if I sold boxes of toothpaste or tissue that were empty inside, I’d probably be out of business pretty quickly.  So I’m dismayed when I see pharmacies selling cough syrups without active ingredients, sending an unwarranted message of homeopathy’s effectiveness.

Another credibility issue arises from an educational perspective, when homeopathy is “integrated” into science and and medical education as well, increasing the perception that homeopathy has medical credibility.  Smith sums it up:

“…inappropriate ‘approval’ for homeopathy serves as a disutility, as it will tend to magnify several negative outcomes, namely resource wastage, risk of patients failing to seek effective healthcare, and reduced patient autonomy through the promulgation of erroneous medical knowledge”

Smith goes on to note a number of other concerns documented repeatedly at SBM, including a weakening of a societal commitment to scientifically-established treatments, as well as the confusion of ineffective treatments such as homeopathy with treatments that he describes as genuinely complementary, such as mediation, relaxation, music and exercise — something that has been described here as the CAM Trojan horse.

Conclusion

So where does that leave us? Unfortunately we cannot simply sum up the arguments in a formula to give us the ethical answer. It seems clear that the ethical downsides to homeopathy outweigh its benefits under most circumstance I can envision.  Smith uses the example of an ineffective defibrillator to point out that the use of such a device device in the context of medical care would be “morally unjustifiable.”  He notes,

Because it is inherently ineffective, homeopathy cannot be ethically neutral. It follows that the purchase, deployment or promotion of homeopathy is morally unacceptable.

Perhaps there may yet emerge a framework where placebos can be ethically (and judiciously) justified. Homeopathy isn’t it. So what should health professionals do? For one, we should stop promoting homeopathy, and the sale of homeopathic remedies.  We should advocate against the allocation of limited health resources to researching, facilitating or providing homeopathy. We should avoid giving homeopathy undeserved credibility by selling it alongside actual medicine, or allowing it to be sold without clear labelling that describes its lack of ingredients and effectiveness. And when we’re asked, we have an ethical responsibility to explain why we believe homeopathy is no ‘alternative” at all.

Reference

ResearchBlogging.orgSmith K (2011). Against Homeopathy – A Utilitarian Perspective. Bioethics PMID: 21320146

Posted in: Homeopathy, Medical Ethics

Leave a Comment (243) ↓

243 thoughts on “Placebos as Medicine: The Ethics of Homeopathy

  1. daijiyobu says:

    Re: “homeopathy isn’t it.”

    To quote from the title of that great Barry Beyerstein piece on naturopathy, “there’s no there there.”

    Yet, that sect of sCAM labels homeopathy “powerful” and “electromagnetic”, and they’ve written it into law:

    http://www.oregon.gov/OBNM/Aboutnaturopathy.shtml

    The government decreeing that it is so, on behalf of that sect.

    ;(

    -r.c.

  2. Ed Whitney says:

    It is correct to note that two factors affecting the ethics of placebo use are the natural history of the condition and the availability of effective specific treatments for same. Common viral URIs get better on their own, specific treatments are not usually available, and placebos may be employed in that setting.

    Homeopathic preparations are biologically inert, but the process of homeopathic case-taking is probably not psychologically inert. Many details of the individual’s symptoms, regarded as “noise” by mainstream practitioners, are regarded as “signal” by homeopaths. Alleviating and exacerbating factors may be elicited at a level of detail which would be tedious for busy clinicians to record, but their elicitation has two effects on the patient. First, the patient can talk at length about idiosyncratic features of the condition which are dismissed as irrelevant by mainstream practice, since they are non-contributory to the diagnosis; being able to talk at length and be listened can have a therapeutic effect. Second, seemingly irrelevant questions about the effects of blankets, warm drinks, the effects of wet or warm weather, of specific foods, the right or left-sidedness of the complaints, etc, may increase the awareness of the patient and thereby increase his or her sense of control over the course of the condition.

    The “laws” of similars and infinitesimals can be nonsense, the “remedies” may be ineffective, but the process of deciding on a remedy is an exercise in bringing awareness to the way that the person is experiencing the condition, and this is probably not without effect.

  3. vicki says:

    If you want the placebo effect, what’s wrong with recommending chicken soup for a cold? (Or garlic or miso soup for the vegetarians.) Ease the symptoms, and having the doctor or pharmacist recommend it might add to the placebo effect.

  4. cervantes says:

    It seems absolutely clear to me that medical providers — physicians, pharmacists, and others — have obligations not only to the immediate relief of their patients, but to their longer term benefit and also to the cause of science and the broader health of culture and society. In the long run, legitimizing anti-scientific charlatanry is an undeniable evil and a disservice to the individual patient and potentially to every patient who might come before you. Providers have no more fundamental obligation than their duty to the truth.

  5. Mojo says:

    @Ed Whitney:

    …the process of deciding on a remedy is an exercise in bringing awareness to the way that the person is experiencing the condition, and this is probably not without effect.

    Research published in the journal Homeopathy last year suggests otherwise:

    Nuhn T, Lüdtke R, Geraedts M. Placebo effect sizes in homeopathic compared to conventional drugs – a systematic review of randomised controlled trials. Homeopathy. 2010 Jan;99(1):76-82.

    CONCLUSIONS: Placebo effects in RCTs on classical homeopathy did not appear to be larger than placebo effects in conventional medicine.

    Note that this was looking specifically at trials of “classical” homeopathy, i.e. involving consultations to decide on individualised remedies.

    If it isn’t even capable of producing an enhanced placebo response, one is left wondering what homeopathy is good for.

  6. Mojo says:

    Sorry, I messed up the formatting there – the last two paragraphs are mine, not a quotation.

  7. Ken Hamer says:

    “it is not surprising that the highest quality clinical trials have demonstrated no efficacy beyond placebo effects.”

    I still think the above would be better written:

    “it is not surprising that the highest quality clinical trials have failed to show any efficacy beyond placebo effects.”

  8. Ken Hamer says:

    I also think there’s a big difference between someone prescribing a placebo in the interest of improving a patient’s mental, emotional or psychological health, and those selling placebos (i.e. homeopathy) for a profit, knowingly or otherwise.

  9. BKsea says:

    I have struggled myself to balance the individual benefits of prescribing placebos against the societal impacts due to loss of trust from institutionalized prescription of placebos. I, for one, would be aghast to discover I was being prescribed placebos without my knowledge.

    What occurs to me is whether we can obtain informed consent to prescribe placebos up front. The patient could elect to be given placebos if the physician concludes it is the best course of action. Then, there is no breach of trust or paternalism. Also, because the consent is arranged up front, the patient would remain unaware that the medicine was really placebo.

  10. I absolutely agree with the conclusion that as healthcare professionals we ought to discourage the use of homeopathy and other ineffective and pseudoscientific approaches. For my own part, I would give greater weight than it seems the original article gives to the “disutility” of homeopathy as an expression of a larger set of theories, even a world view, that are ultimately incompatible with a scientific understanding, and I think pretty clearly untrue.

    I think more harm is done than most people realize by the philosophical precepts that most often accompany regular utilization of homeopathy and many CAM methods. These include an inappropriate reliance on personal narrative as evidence, an acceptance of faith in the unseen or untestable as an appropriate component to an overall approach to healthcare, a tendancy towards postmodernist relativism towards not only moral claims but claims about the nature of the physical world, and a general suspicion of and disdain for the precepts that underlie the scientific approach: methodological naturalism, rationalism, reductionism, and so on.

    Sure, the casual use of homeopathic remedies as a placebo treatment which does not include eschewing conventional therapy is pretty harmless. But I do think it runs the risk of lending an aura of legitimacy and acceptability not only to homeopathy but to the philosophical and epistemological notions that homeopathy and many CAM approaches, which seem otherwise incompatible with each other, embody. These notions seem to me a real danger in the “Age of Endarkenment,” or “Age of Unreason” as Susan Jacoby describes it, in which the rationalist philosophy of the Enlightenment that nurtured the flowering of modern science is no longer respected. People can start to abandon the idea that reality is knowable, and that there are right and wrong answers to questions about the physical world and our relationship to it which we can find through the application of reason. They begin to believe that simply believing in something is enough.

    By not objecting to the marketing of ineffective, pseudoscientific treatments, and by believing that the principle of autonomy requires us not to discourage such treatments through aggresive and effective regulation of medical products and the claims made for them, we run the risk of encouraging not only the use of these treatments, which might in themselves be harmless, but encouraging the philosophical notions behind them which are ultimately inimicable to a scientific approach.

    The reason users of one CAM method are frequently users of others as well seems to me to be that these methods share a fundamentally anti-scientific and anti-Enlightenment philosophical foundation which appeals to individuals on a level beyond the perceived effectiveness of the treatments themselves. And the power of people to ignore reality and inconvenient facts in order to protect their beliefs is tremendous and should not be underestimated. Promoting sound, science-based information is not enough. We need to challenge the anti-scientific principles behind approaches like homeopathy, and that may mean taking a stronger stand aginst such methods even when the use of them as placebos seems in itself benign or even potentially beneficial.

  11. Jan Willem Nienhuys says:

    BKsea:

    the individual benefits of prescribing placebos against the societal impacts due to loss of trust from institutionalized prescription of placebos.

    In the article by Scott the emphasis is on one sickness and one placebo for it. But the physician that prescribes a placebo to one of his or her patients should
    consider the possibility that the patient comes back for more and that the doctor then must confess to having lied.

  12. pmoran says:

    Mojo Nuhn T, Lüdtke R, Geraedts M. Placebo effect sizes in homeopathic compared to conventional drugs – a systematic review of randomised controlled trials. Homeopathy. 2010 Jan;99(1):76-82.

    CONCLUSIONS: Placebo effects in RCTs on classical homeopathy did not appear to be larger than placebo effects in conventional medicine.

    I’d like a closer look at this study. The findings contradict other evidence.

    Among the questions: – did these studies all involve placebo-responsive outcomes? Were placebo influences being dampened in the “classical homeopathy” studies by patient awarenss that they may be being supplied a placebo?

  13. Ed Whitney says:

    Mojo:
    This looks like an interesting study! The Table 1 lists the homeopathy studies that were included in the analysis, and the text says that there is a data supplement on the internet that lists the studies of conventional care, but the journal web site did not have the data supplement. I have e-mailed the author in Germany to ask for the supplement. Figuring out just how a placebo control of homeopathy is supposed to work will be a challenge. The placebo response rates varied greatly in the included studies. Thanks for pointing to the study. Hell, I never even knew there was a journal of Homeopathy!

  14. SloFox says:

    I think Brennen McKenzie’s comment is spot on. Thank you for posting it. His argument highlights the primary reason why recommending CAM for its placebo effect undermines the practice of science-based medicine.

    Personally, I have a hard time recommending any therapy proven NOT to work to my patients. The physician-patient relationship is founded on trust. While there are certainly occasions when it is justifiable if not necessary to be paternalistic I don’t think it should ever come at the expense of trust.

    I think vicki is on to something as well. I have often recommended measures for symptomatic relief that may or may not work. The important thing is not to bill them a cure but as a method for symptom management. Patients can be enabled to manage their experience of illness and that seems to be beneficial. Chicken soup, hot baths, resting, warm compresses, etc. are benign measures that patients can take to improve the severity of symptoms, may produce a placebo effect and don’t necessitate any deception whatsoever.

    It can often be more complicated when patients already undergoing CAM modalities and swearing by their effectiveness ask me my opinion. In such cases I still think honesty is best and if it means bursting someone’s bubble then so be it. Tactfully explaining the science without being judgmental is, I believe, a moral obligation.

    Unfortunately, the current system of healthcare makes time a scarce commodity for financial reasons. Until more physicians are able to find the time to adequately educate their patients, help them understand their disease, its symptoms, and likely clinical course we’ll always be at a disadvantage relative to the pseudo-scientists.

    1. Harriet Hall says:

      @SloFox,
      The chicken soup, baths, etc. can be classified as “comfort measures.” I think this is a useful term, because it makes no unsupported therapeutic claims. There are many things we can, and should, do to increase the patient’s comfort without pretending that they cure or shorten the course of a disease. Things that are truly “complementary” to medicine. Distraction is another very useful concept: anything that takes the patient’s mind off the symptoms. If conventional medicine did more to help the patient “feel better” instead of concentrating on what will make the disease better, fewer patients might be tempted to defect to CAM providers.

  15. libby says:

    Since you are discussing ethics in medicine, perhaps you should take a look at a 2004 Australian meta-analysis, “The Contribution of Cytotoxic Chemotherapy to 5-year Survival in Adult Malignancies” in Clinical Oncology (2004) 16: 549-560.

    The conclusions of these Australian oncological experts, Drs. Graeme Morgan, Robyn Wardy, Michael Bartonz, called into question the misrepresentations of the data on what perhaps you might refer to as science-based cancer treatment. For instance the misleading application of relative risk factors to inflate the more realistic absolute risk factors appears even to fool unsuspecting and overworked doctors administering drugs to patients.

    Perhaps those who spend much effort and time attacking what they are unwilling to investigate properly would be better served by cleaning up their own back yard.

    From the Abstract:

    Results: The overall contribution of curative and adjuvant cytotoxic chemotherapy to 5-year survival in adults was estimated to be 2.3% in Australia and 2.1% in the USA.
    Conclusion: As the 5-year relative survival rate for cancer in Australia is now over 60%, it is clear that cytotoxic chemotherapy only makes a minor contribution to cancer survival. To justify the continued funding and availability of drugs used in cytotoxic chemotherapy, a rigorous evaluation of the cost-effectiveness and impact on quality of life is urgently required.

    By the way, I have just started taking my homeopathic remedy for hayfever and am now sitting comfortably at my computer without eyes tearing, sinuses stinging, nose dripping. It took about 32 hours for the positive effects to occur and although this means nothing to you (testimonial evidence), I don’t really care since it works exceedingly well with none of the side effects that I was getting from your wonder drugs: aching kidneys, dizziness, intense fatigue.

  16. Libby, I am glad you are feeling better. That’s great. Good luck and I sincerely hope you experience no recurrence of your hay fever, which can be so much nastier than non-sufferers realize.

    You are to be commended for citing evidence. Good habit! However, the contributors on this blog have got you beat when it comes to criticizing and acknowledging errors, problems and glitches in the practice of medicine. They are painfully aware (as Dr. Mark Crislip wrote about so well just a few days ago in his post, “Ambiguity”). The entire point of science-based medicine is to be self-critical and to improve, to “clean up our back yard” — that’s the job.

    Ironically, the evidence you cited is actually a fine example of this — not an exposé of a scandalous error, but rigorous documentation of medicine’s efforts to do better! It’s the paper trail of doctors and scientists looking for and finding ways to improve. And that’s exactly why cancer survival rates are so much higher than they used to be.

    In any event, the (admitted) imperfections of medicine do not and cannot excuse the (denied) imperfections of homeopathy. Homeopathy has a strong track record of failing to be self-critical. Indeed, it is characteristic of homeopaths to fiercely reject and ignore all criticism and evade acknowledging the implications of best scientific evidence. And that is a much more serious problem than any other imperfection.

  17. daedalus2u says:

    Nice article. I completely agree that the use of placebos in essentially every circumstance is unacceptable, the only exceptions being when known effective treatments are not available or can not be made available during the needed therapeutic window. This limits placebo use to essentially only triage situations where the condition is known, effective treatments are known, but those effective treatments are unavailable within a therapeutic window, and nothing more effective than placebo is available.

    The circumstances where this would be acceptable include pain relief on the battle field due to insufficient supplies of morphine. It would be acceptable in an end-of-life situation where treatment would be futile and is essentially palliative care. Even in those circumstances, lying to the patient is never acceptable. Placebos should only be administered with the statements to the effect that “this will make you feel better”, with the emphasis that the treatment will make the patient feel better, not that there is any expectation of clinical improvement.

    A clinician can only do this if the clinician has “clean hands”, that is if the clinician has not generated the circumstance where there is the unavailability of a known effective treatment and if the clinician is not being dishonest about what is being administered. For example a homeopath can’t ethically go to where there are no effective treatments available (the rural undeveloped world) and then administer placebos. A health care provider can’t use a placebo because they lack prescription writing authority.

    This triage exception only applies when the clinician knows how to treat the underlying condition but those treatments cannot be made available during the therapeutic window. So placebos can’t be used to treat any unknown conditions. It does not apply to any conditions the clinician diagnoses as psychogenic. Psychogenic disorders require psychogenic treatments not placebo treatments. If a clinician does not know how to treat psychogenic conditions (or any other conditions), the clinician needs to refer to someone who does. It also does not apply when the clinician knows what an effective treatment is, that effective treatment is available, but the patient refuses to receive the effective treatment and wants a placebo instead. The duty of the clinician then is to not treat, not to go along with the patient’s delusion world view.

    If all positive effects of placebos are simply attributed to delusion, hallucination and perceptual error on the part of the patient, then the triage exemption to administering placebos becomes more restrictive. A clinician can’t lie to a patient, even when the clinician believes that a lie is what the patient wants to hear and that a lie will benefit the patient. If a clinician is thinking “this placebo will give you the delusion of feeling better”, the clinician can’t lie and say something else.

    However, because placebos do (at times) have physiological effects, there must be physiology that mediates the physiological placebo effect. Triggering the physiology of the placebo effect pharmacologically is “technically” not a “placebo”. This is a subtle point and is one where there is not universal agreement. It hinges on what is the definition of “placebo” and to what mechanism(s) positive effects following the administration of a placebo are attributed.

    If there was a treatment that could pharmacologically trigger the physiology of the placebo effect, that treatment could have very broad clinical use. This is what I think my nitric oxide stuff could be used for, something to pharmacologically trigger the placebo effect. As such, it could be used in conjunction with any “real” treatment because maximizing the placebo effect will (in most all cases) improve “real” treatments. It could be used instead of every CAM treatment because it will trigger the placebo effect better because it does so pharmacologically. Even though it triggers the placebo effect, because it does so pharmacologically, it isn’t really a placebo.

  18. libby says:

    Paul Ingraham:

    Thanks for your reply.

    Re western medical studies on homeopathy, assuming that our scientists are objective, it seems odd that none of them cared to travel to Cuba and investigate their use of homeopathy in their health care system. Given that the WHO extols Cuban health care as “one of the world’s most effective and unique”, one would expect that they deserve a visit to examine what they see in it.

    After all it is only 90 miles from the US, a very short flight.

  19. Harriet Hall says:

    Libby offers testimonial evidence that using a homeopathic remedy relieves symptoms of hay fever. I used to have terrible hay fever and I no longer have it at all, so I offer my testimonial evidence that NOT using a homeopathic remedy CURES hay fever permanently. :-)

  20. BillyJoe says:

    I also have a personal testimonial.
    I was once bedridden with a sudden onset of severe back pain. Within 36 hours I was walking, within three days I was running, and within four weeks I ran a marathon. I didn’t use homoeopathy either.

  21. pmoran says:

    Libby, some of us are very familiar with the Australian study on chemotherapy.

    For some reason it excluded childhood cancers and leukemias, the cancers where chemotherapy does save most lives. Also some of the included cancers displayed up to 40% improvement in 5 year survival with chemotherapy — quite respectable..

    Nevertheless the averaged figures show that chemotherapy does contribute little to survival rates for many common cancers.

    So, yes indeed, why ever use chemotherapy for them?

    There are three possible reasons, two of which are reasonably sound.

    1. As palliation. These figures refer to long term survival rates only. Even in cancers that it cannot cure, chemotherapy can produce worthwhile relief of symptoms and prolongation of life. Sometimes that is a mere few months on average, but that figure will itself obscure more dramatic and worthwile benefits for some. .

    2. Cancer is rarely wholly predictable. Occasionally good results can be obtained in cancers that are usually resistant to chemotherapy. In such cases it can be reasonable to offer it as a 2-3 month trial, with the intention of stopping it if there is no worthwhile response by then.

    3. I am sure that chemotherapy is often used under circumstances where it is extremely unlikely to help, through teh same desperation that leads patients, their families and some doctors try “alternatives”, even less likely to help.

    If that is consuming resources that would be better applied elsewhere, or it is doing more harm to patients’ qualities of life than good, then it should be stopped, at least when at public expense.

    This last is what that paper is about.

  22. daedalus2u says:

    Actually curing hay fever is one of the anecdotes I have about using my bacteria. I used to have hay fever which I needed to take systemic stuff for every day. The hay fever season after I started using my bacteria I didn’t have to, and haven’t needed to since. That was before I read up on the role of NO in the immune system and how low NO potentiates mast cell degranulation and increases the activation of NFkB so a placebo effect is unlikely.

    My anecdote also shows that not using homeopathy can make hay fever go away.

    On the other hand, since homeopathy is made stronger by dilution, then reducing the dose of a homeopathic remedy to zero should make it an even stronger homeopathic remedy than using it in non-zero amounts. So everyone who has been cured by not using a homeopathic remedy just shows how well homeopathy works!

    Since the most that something can be diluted to is zero, the person untreated with any homeopathic agent already has the most powerful possible homeopathic therapeutic dose. Administering any homeopathic agent would only make the already existing dose weaker and by homeopathic principles can only make things worse.

  23. libby says:

    Harriet Hall:

    At what point did I say the positive benefits from my homeopathic remedy for hayfever was something other than testimonial evidence? The familiar straw man argument perhaps?

    You avoided the more interesting comment, that the Cuban health care system uses homeopathy. And you also avoided the Australian study that criticizes the over-emphasized benefits of cytotoxic chemotherapy in most types of cancer.

    One point on testimonial evidence. I agree that you cannot scientifically prove anything with it, but it’s interesting that our court system relies heavily on testimonial evidence to put transgressors away for years, even when it’s only one witness, and yet modern science treats all testimony, even in large numbers, as completely useless information.

    Interesting. Perhaps in 100 years scientists will scoff at our outdated thinking patterns.

  24. libby says:

    To pmoran:

    I quote you as saying, “Also some of the included cancers displayed up to 40% improvement in 5 year survival with chemotherapy — quite respectable..” (regarding the Australian meta-analysis listed earlier)

    Let’s analyze what you mean by the word “some”. Out of 22 types of cancer in the study (US), only 1 (Hodgkins’ Disease) hit 40.3%. That’s 1 out of 22 that you are saying is “some”. I would characterize it as a “small fraction”.

    One hit 37.7% (Testis), one hit 12.0% (Cervix), one at 10.5% (non-Hodgkins’s Lymphoma) and the rest all well below significant. A whopping 9 cancers out of 22, displayed no benefit at all, a 40% rate.

    Even if you consider 10% and 12% as significant, that’s only 4 cancers out of 22. The common breast cancer was 1.7%, and yet the medical community pushes many women into chemotherapy, knowing full well the figures do not back up such a costly strategy.

    Again from the study:

    “As the 5-year relative survival rate for cancer in Australia is now over 60%, it is clear that cytotoxic chemotherapy only makes
    a MINOR CONTRIBUTION TO CANCER SURVIVAL (Emphasis mine). To justify the continued funding and availability of drugs used in cytotoxic chemotherapy, a rigorous evaluation of the cost-effectiveness and impact on quality of life is urgently required.” Morgan, G. et al. (2004). Clinical Oncology
    16, 549-560

  25. libby says:

    To Harriet Hall (Part 2):

    You state: “I used to have terrible hay fever and I no longer have it at all, so I offer my testimonial evidence that NOT using a homeopathic remedy CURES hay fever permanently.”

    Not doing something for a condition only makes logical sense when the not doing something bears some relation to the condition, for example, not eating ice cream could help with corpulence.

    However since you were cured of hayfever, the not taking of a homeopathic remedy would have no bearing at all on the fortunate occurrence since homeopathy does not operate on the principle of avoiding remedies to cure patients.

    Your post is really quite silly and as a result I will spend no more time responding to your entries.

  26. libby says:

    To Billy Joel:

    Take a look at my post again and you will see that in brackets I characterized my experience as testimonial evidence. You discovered nothing because I told you what it was. Here’s the quote:

    “…I have just started taking my homeopathic remedy for hayfever and am now sitting comfortably at my computer without eyes tearing, sinuses stinging, nose dripping. It took about 32 hours for the positive effects to occur and although this means nothing to you (testimonial evidence), I don’t really care since it works exceedingly well with none of the side effects that I was getting from your wonder drugs: aching kidneys, dizziness, intense fatigue.”

    On the other hand, medical doctors are pushing breast cancer patients towards chemotherapy treatments that have an appalling contribution rate of 1.7%. In other words, chemotherapy for breast cancer has been proven to be ineffective, leading to the rather bizarre consequence that it is still widely used in modern medicine.

  27. Harriet Hall says:

    @libby,
    My post was meant to be silly. I even added a smiley face. Billy Joe “got it” and responded in kind. I’m surprised you didn’t catch on.

    I didn’t respond to the Cuba comment because it didn’t deserve a response. The WHO’s opinion of Cuba’s healthcare system and the fact that homeopathy is used in Cuba are not reasons to go to Cuba or to take homeopathy seriously, and no observation of their health care system could trump the scientific evidence.

    Science does not totally disregard testimonial evidence: it considers it when deciding what might be worth studying. Testimonial evidence led to the very studies of homeopathy that we have used to reach the provisional conclusion that it doesn’t work except as a placebo.

    “Perhaps in 100 years scientists will scoff at our outdated thinking patterns.” It took far less than 100 years for scientists to scoff at Hahnemann’s outdated thinking patterns. (Despite which, some people still believe in homeopathy!). If you think the future will see the scientific method rejected in favor of testimonial evidence, I’m afraid you are badly mistaken.

  28. Harriet Hall says:

    @Libby,
    ” chemotherapy for breast cancer has been proven to be ineffective”
    Demonstrably false statement. Despite pmoran’s cautions, you are just digging yourself in deeper.

  29. BillyJoe says:

    libby,

    “Take a look at my post again and you will see that in brackets I characterized my experience as testimonial evidence.”

    If you understand the role of testimonial evidence why did you offer it here outside that role?

    You offered it here as evidence for the effectiveness of homoeopathy. But testimonial evidence can only be used to decide if it would be worthwhile to conduct a clinical trial of homoeopathy. But those trials have already been done and the answer is in the negative. Therefore your testimony can not be of any use.

    And why bring up chemotherapy in the treatment of breast cancer when we are talking about homoeopathy? How does the efectiveness or ineffectiveness of chemotherapy in the treatment of breast help your argument about homoeopathy?

  30. libby says:

    To Billy Joel:

    I told you it was testimonial evidence to show you I understand
    the differences in types of evidence. It happens to be the truth by the way, and it is illogical to always characterize testimonial evidence as a lie. Many criminals have been put away with testimonial evidence.

    Take a look at Harriet Hall’s responses as an example of a fundamentalist belief system. I show via the Australian study that chemotherapy is insignificant in its role as a cure for breast cancer. That’s a fact, and I proved it with data. According to the figures, breast cancer treatment is BELOW average in its effectiveness, the average being 2.1% and breast cancer treatment coming in at 1.7%. That puts breast cancer chemotherapy 19% less effective that the average contribution, the average of 2.1% deemed by the Australian researchers as a minor contribution to cancer survival. Chemotherapy for breast cancer is less than a minor contribution. I used the term insignificant.

    So here we have a doctor who actually thinks that a 1.7% below average contribution from cytotoxic chemotherapy is acceptable, not because that is an impressive figure, but because some patients might find ineffective chemotherapy palliative to their condition. How does anyone discover that? Through testimonial evidence of course, quite acceptable when supporting the pharma drug culture. Or perhaps a few months might be added to their lives, a far cry from curing a condition.

    Now I can’t win whether I use scientific data OR testimonial evidence, unless I buy into the mythical lexicon that modern medicine is always on the right track and everything else, even the lauded Cuban health care system, is wrong and should be stamped out.

    By the way, the Cuban example of a non-capitalist health system is not even worth a look. Think about the lack of curiosity in that belief system.

  31. pmoran says:

    Libby, I think you are interpreting those figures in as mean-spirited a way as you can.

    You again ignore (as does the paper you quote) the role of chemotherapy in the short term palliation of cancer.

    I am also not sure why you would doubt the “significance” of 10-12% extra patients NOT having inevitably suffered a miserable decline and death at certain times, in many cases also having been permanently cured of their cancer. Bear in mind that most of the figures being quoted here refer to relatively brief courses of adjuvant chemotherapy in high risk patients. .

    I have allowed that some other use of chemotherapy is difficult to justify on cost-effectiveness grounds, but here is an anecdote to illustrate how difficult it can be for doctors.

    I operated on a young chap for bowel cancer, removing the primary but finding metastases in both lobes of the liver. Biopsy confirmed this.

    He asked about chemotherapy, but as he had no relevant symptoms and no form of the chemotherapy available at that time had not been shown to be very effective against colorectal cancer, I advised against it, for now. I knew that the oncologists I normally referred patients to would agree.

    However the patient independently arranged to see another oncologist who commenced him on 5FU, a treatment I expected to be ineffective. Blow me down, if his liver metastases shrank, became calcified, and when I last heard he was perfectly well and stable four years later!

    As I said, it can be difficult to predict results and a trial of chemo can often be justified even when against the odds. It is wrong to continue it if the patient is not responding.

  32. libby says:

    To Billy Joe (part 2):

    Let’s talk about the scientific evidence against homeopathy. The Lancet study of 2005 on homeopathy lauded by Richard Dawkins as the meta-analysis of meta-analyses bears these issues.

    #1 Who funded the study? Well they won’t tell you. They tell you there is a funding model, but they essentially say that the funding is irrelevant because none of the results are swayed by those who paid for it. So who had an interest in the outcome of the study? Why am I denied that information? If it were the Swansea Community Women’s Choir that’s one thing, but if it were GlaxoSmithKlein, it’s quite another. Compare the transparency of the Australian study on Chemotherapy I have cited where each of the authors have their connections to the pharmaceutical industry listed for all to see. One received an educational grant, one was on an advisory board, and the other was listed as having “no conflict of interest”. Quite a difference in disclosure between the 2 studies.

    #2 Out of 108 studies they accepted as unbiased, they chose 8. They did not say which studies they selected, or which type of homeopathy made up the final cut, but they did say that of the unbiased studies, some that showed benefits must have been biased even though no bias could be found. Say what?

    #3 They didn’t mention whether or not proper homeopathic protocol was used. As an example, there are over 100 remedies for headaches. If you select one remedy and administer this one to all subjects who say they have a headache, then you are not following proper protocol. Depending on the type of headache and other factors, a remedy is selected for that particular person. It is conceivable that in a room full of headache sufferers, many different remedies would be used. Now I don’t know if they followed proper protocol, for instance, whether they were taken on an empty stomach (very important) because they don’t say. But we do know they only used one remedy of out many. How they selected the particular remedy is difficult to say, because, again, they don’t tell you. But in all likelihood the approach was either set up to fail or it failed through ignorance or carelessness.

    So my question is, if homeopathy is so obviously nonsense, why did the Lancet study authors compile such a sloppy, irresponsible study? If homeopathy is just a placebo, you wouldn’t have to carry out such risible procedures. In fact, the utmost importance should have been given to methodology so that non-gullible thinkers like myself couldn’t start picking it apart.

    But they didn’t do that. Why?

  33. libby says:

    To pmoran:

    Thanks for your response.

    I don’t believe that palliative care is the issue here. It might be an important issue in some cases, but the expectation of chemotherapy, at least in the general public, is to cure cancer or at least prolong life significantly.

    The breast cancer figures are particularly troublesome because there is now a pandemic of cases as you well know of this terrible affliction. On my small street alone there have been 3 cases recently, and I know all of them.

    Now if the 1.7% contribution of chemotherapy is accurate, and no one has contested that, women are being subjected to the treatment without being told the figures. In fact the figures shown by the medical system are quite different, listing wildly high survival rates past 5 years.

    I have no problem with a doctor who said, here are the honest figures and the decision is yours. You have all the facts. But I do with the idea of inflating the success rates and giving a muddied view of the real story, born out by this meta-analysis.

    And I certainly take issue with the attacks on things I am finding effective. To me this is more a matter of freedom than anything else. It has been stated on this board something to the effect that homeopathy should be made illegal because it is dangerous. That’s not freedom but domination.

    I still have yet to get any thoughtful reply on why Cuban doctors use homeopathy and why we are not there asking them about it. I do know that these remedies are NOT patentable making them of little interest to the free-market pharmaceutical industry.

  34. west says:

    @ libby
    “I still have yet to get any thoughtful reply on why Cuban doctors use homeopathy and why we are not there asking them about it. I do know that these remedies are NOT patentable making them of little interest to the free-market pharmaceutical industry.”

    Just because something cannot be proven to work does not prevent it from getting a US patent. It doesn’t take a lot of looking to find numerous examples of this. But that is besides the point, the point is that homeopathy has no effect that can be empirically measured. I would call it a faith before I called it medicine. It belongs in the church, not in the clinic.

    The reason Cuban doctors use homeopathy is because Cubans are normal people like everyone else, prone to the same misconceptions that we all are.
    The reason nobody is asking Cuba about homeopathy? How would homeopathy be any different in Cuba than it is here? Why would I assume the question to be significant?
    If someone told me that leprechauns actually exist in Ireland I would not invest very much in verifying that claim.

  35. @Libby, could you please point out the post where someone stated that homeopathic products should be illegal? What I generally have seen on this board is that homeopathy should not be allowed to make claims of efficiency without showing good evidence of those claims or at least some plausible science based mechanism for working.

  36. daedalus2u says:

    Libby, The reason Cuba uses homeopathy is because it is cheap, doesn’t take any infrastructure and can be administered by uneducated people completely ignorant of science and physiology. The Cuban government is more concerned about controlling its people than with providing them with effective medical treatments. Treatment modalities that require providers to be educated (i.e. medical school) and to be trained to think (to do the differential diagnosis), represent a threat to the top-down social power hierarchy that has run Cuba for the past 50 years. Getting the population accustomed to magical thinking results in a population that is more easily lied to and that will accept what ever BS the “leaders” say, just because they are the “leaders”.

  37. libby says:

    west

    Let me take you back to some of the GlaxoSmithKline lawsuits where the company was caught marketing Paxil with UNDISCLOSED side effects and where Avandia caused a 43% higher risk factor for a heart attack, information GSK knew but suppressed. GSK has set aside billions in ANTICIPATION OF FUTURE LEGAL FEES AND SETTLEMENTS. They are expecting trouble in the future and have already made plans to suppress negative effects from future products. Think about that for a moment.

    We know there are drug companies out there like that, all in fact. We have studies like the 2005 one in Lancet on homeopathy, funded by some unknown entity (perhaps GSK itself) and we trust the results because we believe in science. We trust somehow that capitalist robber barons will somehow fund a study to separate fact from fiction and are perhaps even willing to compromise their profits.

    To believe that this is a system model for discovering truth is to live in a conceptual world.

    When we know of a health system that is not connected to corporate profit only 90 miles off the coast of Florida (a 30 minute flight perhaps), we don’t even give it the time of day because they don’t have non-transparent studies like we do.

  38. libby says:

    daedalus2u

    I agree with you that homeopathy is cheap. Cuban officials have mentioned this. Vaccine production is so expensive that they can only administer it to high risk subjects.

    As for your political comments, you have no proof that the “Cuban government is more concerned about controlling its people than with providing them with effective medical treatments.” You have no proof that skilled medical experts “represent a threat to the top-down social power hierarchy” in that country, or that their population is more easily lied to than say, the US population, where 83% believe God played a role in the origin of life on this planet (Gallup).

    Feel free to insert some real supportable facts into your posts at any time.

  39. libby says:

    micheleinmichigan:

    I can’t really remember. It might have been here or somewhere else.

  40. weing says:

    “When we know of a health system that is not connected to corporate profit only 90 miles off the coast of Florida (a 30 minute flight perhaps), we don’t even give it the time of day because they don’t have non-transparent studies like we do.”

    Their health system is connected to government profit. That does not make it any more likely to be transparent than ours. Maybe even less. Here at least we are aware of the conflicts of interest. I am all for having the drug companies make all their studies available, not just the ones that show the desired results. Be that as it may, none of this is proof of homeopathy.

  41. libby says:

    micheleinmichigan (part 2):

    Homeopathy has been generally characterized as dangerous in the sense that some might opt for this useless placebo instead of something much more effective, like chemo-therapy drugs for breast cancer that display a below normal contribution rate of 1.7%.

  42. Harriet Hall says:

    @Libby,

    You made me laugh. That is the first time I’ve ever been accused of having a fundamentalist belief system!

    You said “chemotherapy for breast cancer has been proven to be ineffective” and that is demonstrably false. Even the paper you cited demonstrates it to be false. It showed that chemotherapy was effective, albeit at a low rate.

    Every chemotherapy regimen had to be proven effective in studies before it came into general use. All it would take to disprove your blanket “ineffective” statement is one study (one black swan to disprove that all swans are white). Here’s one from the BMJ:

    “Adjuvant chemotherapy with cyclophosphamide, methotrexate, and fluorouracil (CMF) in patients with operable breast cancer benefits the long term prognosis. After median follow up of 28.5 years, Bonadonna and colleagues (p 217) report combined results of two previously published randomised controlled trials and one observational study. Their experience shows that CMF adjuvant chemotherapy at least halves patients’ long term risk of relapse and death.” http://www.bmj.com/content/330/7485/0.1.full

    In addition to the points pmoran made, I’d like to stress that the benefits of chemotherapy vary drastically with the type of cancer, the stage, the presence of metastases, etc. Lumping all chemotherapy into one package and getting an overall effectiveness rating is very misleading.

  43. Harriet Hall says:

    @Libby,
    “Let’s talk about the scientific evidence against homeopathy”

    No, let’s talk about the scientific evidence for homeopathy. The burden of proof is on the person making the claim. Do you have anything more than testimonial evidence?

    But before we waste any more time, tell us what it would take to convince you that homeopathy was ineffective? Could any amount of evidence change your mind, or would you cling to your testimonial evidence no matter what?

  44. libby says:

    weing

    I really am enjoying the avoidance of my Lancet study criticisms.

    In any case, you state that “Their health system (Cuba) is connected to government profit.” What does that even mean?

    Gov’t funded health systems in Europe have been lauded as exceptional compared to the dismal rating of the privately run health care system in the US. The US system is so savaged by corporate profit that 47 million were not covered medically until Obama came to power. HMO’s were denying coverage on patients who had pimples as a teenager.

    These sorts of things do not happen in a gov’t system. Cuba has a gov’t system just like all of the industrialized world except the US. However they don’t have the financial resources of these richer countries due in large part to the US’s embargo on it.

    We are not aware of the conflicts of interest in our system as you opine, or if we are, we’re not talking about it. Studies are not disclosing their funding sources, and studies are the backbone of our medical structure.

    Again avoidance of the issue seems to be the mantra.

  45. libby says:

    Harriet Hall:

    Breast cancer chemotherapy is ineffective and I supported that statement with data. You called it false based on testimonial evidence from another poster.

    What possible reason would I have to continue further discussion with you?

  46. Harriet Hall says:

    @Libby,
    “Breast cancer chemotherapy is ineffective and I supported that statement with data. You called it false based on testimonial evidence from another poster.
    What possible reason would I have to continue further discussion with you?”

    I called it false based on the very study you cited and I provided further data, not testimonial evidence. What possible reason would I have to continue further discussion with someone whose reading comprehension is so poor?

  47. libby says:

    Harriet Hall:

    The Australian study DID NOT SAY, IMPLY or DEMONSTRATE in any way whatsoever that chemo-therapy for breast cancer was “effective”. That is at a complete variance with the data and conclusion of the study.

    It characterized the average of chemo for 22 cancers as of a “minor contribution” (2.1%). Chemo for breast cancer was below average coming it at a dismal 1.7% contribution rate.

  48. Harriet Hall says:

    libby,

    What do you think the 1.7% contribution means?

  49. weing says:

    libby,

    You have got to be kidding. If a government can fool it’s people to use distilled water instead of expensive meds, that it can’t afford for whatever reason, it won’t try?

    I’m not going to try to defend a system that doesn’t provide coverage for its citizens. Anyway, it has nothing to do with the effectiveness of homeopathy.

    Regarding the Lancet paper. You asked who funded the study. I checked out the article and it states that it was funded by the Complementary Medicine Evaluation Program of the Swiss Federal Office for Public Health and one of the authors received grants from the Swiss National Science Foundation. So, what are you talking about when you say they won’t tell you? Why should I bother wasting my time checking out your other points when your first point is baseless?

  50. libby says:

    Harriet Hall:

    Do you administer drugs to your patients on the basis that contribution rates hovering below 2% are effective? Or do you simply tell them that the drugs are effective without mentioning the rate? How does it work?

  51. libby says:

    Harriet Hall:

    When you administer drugs made by GSK, do you mention that they have been involved in lawsuits where they suppressed negative effects to augment profits, and the company has presently set aside billions anticipating further legal issues.

    I’m just wondering how much truth you infuse into your own practice?

  52. Harriet Hall says:

    @ libby,
    “Do you administer drugs to your patients on the basis that contribution rates hovering below 2% are effective? Or do you simply tell them that the drugs are effective without mentioning the rate? How does it work?”

    Don’t change the subject. The subject is whether chemotherapy is effective for breast cancer, not how we present information to patients. You claimed to have proof that chemotherapy was ineffective for breast cancer. You don’t. I presented counter-evidence; you chose to ignore it.

    How it works: you tell the patient what the evidence shows for the specific type and stage of cancer they have, and let them make an informed decision.

  53. Harriet Hall says:

    @libby,

    “When you administer drugs made by GSK”
    Actually, I could never remember which drug was produced by which company. And I don’t know of any doctor who gives patients that kind of information about drug companies. The behavior of the company is irrelevant to the question of whether a specific drug is safe and effective. I went by the best published evidence.

  54. weing says:

    “I’m just wondering how much truth you infuse into your own practice?”

    Hmm. Do you tell vegetarians that Hitler was also a vegetarian? It’s true, but what would be the point?

  55. pmoran says:

    Libby, If you read how those figures were derived I am sure you will think differently. Node-positive breast cancer patients, i.e. those at higher risk of recurrence and death had a 6.8% higher chance of five year survival, and thus of being permanently cured.

    Is that “significant” enough for you, if 1.7% isn’t?

    This cancer is also often very sensitive to chemotherapy, when used as palliation. Remissions can be quite prolonged. These figures say nothing about that.

    There are indeed fringes to the question of chemotherapy in breast cancer where the benefits in certain cases are more arguable in relation to cost and risk, but I am aghast that you think that those treating this condition are being motivated by anything other than trying to stop women suffering a miserable decline and death.

  56. daedalus2u says:

    There is considerable thought that Hitler’s doctor, Theodor Morell was a homeopath. But he also gave Hitler non-homeopathic drugs.

  57. pmoran says:

    Libby, for what other conditions would you consider using homeopathy alone? When would you consider conventional care, mainly?

    It is not a trick question or a trap. Give me an honest answer and I will explain.

  58. libby says:

    weing

    Well that’s a great story but not truthful.

    If you actually investigated Cuban health care you would not misrepresent it as you just did. The Cuban health care system is NOT based on homeopathy, rather homeopathy is one component of it.

    Now when you talk about “expensive meds”, are you referring to the 9 out of 22 chemo treatments that had no effect whatsoever but are still used. Or were you talking about the other 9 that showed negligible effects. Just wondering.

    I reread my copy and there is no mention of what you say. I don’t doubt what you say but it’s possible the study was so heavily criticized for non-transparency that it was inserted later.

    And if you don’t want to respond to the rest of my post then bugger off.

  59. Harriet Hall says:

    @libby,

    Do you have no sense of humor whatsoever?

    Please refrain from using language like “bugger off.” We are trying to have a civil discussion here, and we have been polite to you.

    The Cuban health system is irrelevant to the question of whether homeopathy is effective. If you have scientific evidence that it is effective, present it to us; if you don’t have anything but testimonial evidence, just admit it.

  60. weing says:

    I never said that the Cuban health care system is based on homeopathy either. I have learned to mistrust totalitarian governments from having lived under them.
    If 83% of Americans can believe that God played a role in the origin of life on earth, then a similar percent can believe that homeopathy is effective. That doesn’t make either of them true. Sounds like you may need to get an actual copy of the article from the journal to make the claim that they put it in after criticism. What is more likely is that your copy has been edited to suit someone’s purposes. Now I will do as you so nicely requested.

  61. libby says:

    pmoran:

    Thanks for you reply and I will look at your re-interpretation of the data.

    Re other effects from homeopathy. You are asking for testimonial evidence and so I am reluctant to offer it up as I have no proof of what in fact happened.

    Nonetheless I will do that.

    My first encounter with homeopathy was due to the failure of modern medicine to deal with my 4 year old’s asthma. Cortico-steroid inhalers were making the asthma slightly better but his general health was deteriorating quickly. He was looking very sickly. At this stage we were completely on side with modern medicine as the only reasonable path to take. But out of fear for his survival we looked for alternatives. In our city there is a homeopathic store that makes its own remedies. I told them my son’s condition and they gave me 4 bottles. Stopping the inhaler we moved to the remedies. In 2 weeks his asthma disappeared and after 17 years it has not returned.

    It is possible that the inhaler had a delayed effect but unlikely, given his deterioration until the drug was discontinued. It is even possible that he grew out of his asthma but again that appears unlikely given it was only a 2 week period where improvement started during that period.

    Understand I am completely confounded as to how this happened. It seems so unlikely and at the time I needed another miracle. I tried the remedies for hayfever from the same store but alas, no effect at all. I tried various alternatives, grape seed extract, a type of inhaler with a powder produced by a drug company (sorry can’t remember the name) that appeared to have no side effects but was only about 45-55% effective. Welcome of course but also very difficult to manage since the effects would not last long. I tried salt water in the nasal channel and finally garlic juice, very painful for only 1 1/2 hour of relief.

    Then I finally arrived at a homeopath that others raved about. She had a remedy specific for this region but frankly, I was not expecting much. But it worked very well. Again I don’t see how it could work, and no remedies had worked I would be on the side of Dawkins & Randi talking about wu medicine, etc, but the result is there. I then had a kidney stone issue that doctors couldn’t seem to control except through pain management drugs. My homeopath gave me a remedy that was supposed to dissolve the stone. In about 2-3 days there was no pain. I don’t know if the stone dissolved. Again the remedy could be nonsense but it did seem to work.

    My daughter has fibromyalgia, something modern medicine has little to offset that I know of. The drugs bore some unwanted effects with little benefit. She continued to be active through the affliction, playing soccer etc, but always “paid the price” during and afterwards with severe nerve/muscle pain and general fatigue. After one visit and remedy from a different homeopath, she is playing soccer with no after affects. That has never happened. It could be placebo and I can’t rule that out but again, if so, a fortunate effect.

    My own belief is that homeopathy is very complicated and there are many failures. Homeopaths rarely say this or that will work, but usually say try this and if it doesn’t work we’ll try something else. It seems to be based on failures until a success is found. Not always but it is common. It is very strange and it would be much easier for me to not think it works. But here I am sitting in front of the computer starting into my hayfever season and I have no symptoms. 3 days ago I was a mess. The effects took about 32 hours.

    Conventional medicine: accidents – standard care is very good in this area, antibiotics for serious bacterial afflictions, can’t think of much else.

    My apologies for the length of this entry.

  62. BillyJoe says:

    libby,

    There are lots of possible explanations for why your conditions resolved.

    In a previous post I mentioned my own illness where I experienced a sudden onset of severe back pain which spontaneously recovered, without any treatment, to the extent that I could walk again within 36 hours, run within a few days, and run a marathon within four weeks. There is a little more to this story though. Because I had been training for this marathon for twelve months, I didn’t want to miss out on the event, so I seriously considered getting some form of help (usually I just let time cure me of any injuries).

    I was actually thinking more along the lines of physiotherpay but it doesn’t matter what the treatment was. The point is that if I had done so, I would probably now be a convert to that type of treatment. If someone had sent me off to a homoeopath, I might also believe in homoeopathy like you do, though I would hope that, by now, someone would have shown me how my assumptions could be wrong – which is all posters here are trying to do for you.

    Your assumptions about homoeopathy, based on your personal experience with that treatment, could be wrong. And, as I say, there are many ways in which you and I could be fooled. This is why we have science-based medicine. We need to find out what actually helps by means of, in this case, double-blind placebo-controlled clinical trials.

    You will probably say that you have enumerated 4 personal/family anecdotes where homoeopathy “worked” and think that this is pretty convincing. Unfortunately it isn’t. As we say here, the plural of anecdotes is not evidence. You still have to do those clinical trials.

    I have one more personal/family anecdote. My son had severe eczema for years which suddenly resolved within weeks when he was about four years of age. We had been using conventional treatments which certainly helped but didn’t resolve it. For a long time my wife wanted to take him to an allergist (yes, we are not into alternatives). For a long time I resisted (I’m not heavily into conventional medicine either when I can avoid it). Eventually I relented. However, there was a two month wait for an appointment and our son’s recovery occurred a few weeks prior to the appointment which he never attended.

    The other thing to mention is that our stories can get messed up over time. I have related my stories as accurately as I can remember them as presumably you have as well. But memory is unreliable as the science on memory tells us, and I know both your stories and my stories cannot be an accurate summary of what actually happened. Memories are taken out of long term storage every time we recall them, they get altered in the very process of remembering them, and are then placed back into long term storage in this altered form.

    Reality is a bitch sometimes.

  63. Harriet Hall says:

    @libby,

    I asked before and I’ll ask again: What evidence would convince you that homeopathy is no more effective than placebo? Would any kind or amount of evidence change your mind, or would you disregard any negative evidence and cling to your belief based on your personal experience?

    Another related question: is there any quackery or CAM treatment modality that you reject? If so, why do you reject it?

  64. libby says:

    BillyJoe

    I am open to other interpretations as I admitted a number of times in the testimony. The most convincing for me is the repeated success with hayfever every summer.

    I do agree that memory can be untrustworthy, but the hayfever remedy is consistently effective each year, reinforcing my acceptance of its worth.

    I’m delighted to be able to avoid the antihistamines but it does shake my belief system which before homeopathy was quite simple, follow the only reasonable path of conventional medicine, supported by medical studies.

    In one entry I explained that my experiences with homeopathy do not provide an easy way to evaluate it. Richard Dawkins is calling for a study that involves homeopaths to administer not just one remedy for one ailment but any remedy that fits each member of a group with a similar ailment. He must now respect the criticisms of the Lancet 2005 meta-analysis he once lauded. I think what he is proposing is reasonable.

    With homeopathy being such an elusive field, I’m not sure the NHS should cover it until homeopaths fine tune their skills and create better standards for themselves. There are very good homeopaths and others not so good, and also dabblers who have incorporated it into their main field, such as naturopathy.

    The advantages doctors have over homeopaths is their thorough understanding of the body through their rigorous educational path, whereas I sometimes see holes in the knowledge of homeopaths. Their training is not as rigorous and it should be. On the other hand doctors tend to assiduously follow standard procedures that sometimes don’t make sense.

    e.g.

    I had an ophthamologist demand I take a dilation drug and I refused. It was around the time the federal gov’t had fired 4 medical officers for insubordination. The officers had made it public that they were being pressured to approve drugs they deemed a danger to public health. He brushed off the firings, got impatient, and then looked inside my eye without the drug only to see everything he needed, although he had to twist around a bit more to get a good look.

    His umbrage at my refusal was ridiculous, given the slight advantage it offered him. And he was visibly angered by my disobedience.

  65. libby says:

    Here’s an excerpt from a TV broadcast July 3, 2002, about the health officers who were eventually fired for trying to protect the public:

    KEN SHAW: Good evening. Health Canada is the government agency Canadians rely on to protect them from unsafe drugs. But that trust is being shaken tonight by stunning allegations. Four senior Health Canada scientists have told CTV News the agency has approved dozens of drugs that may be downright dangerous. The drugs in question are veterinary drugs, medicine given to livestock that eventually find their way up the food chain to humans. The scientists know they may be risking their jobs by blowing the whistle, but say the public needs to know. CTV’s food specialist Jennifer Tryon has the details in this exclusive report.

    JENNIFER TRYON (Reporter): These Health Canada scientists are breaking the code of silence, revealing they feel pressure to approve certain drugs that may not be safe.

    SHIV CHOPRA (Health Canada Scientist): We were being pressured to pass drugs of questionable safety because of the pharmaceutical companies.

    MARGARET HAYDON (Health Canada Scientist): The public doesn’t know what happens at Health Canada, and this is why I’m here to speak out.

    GERARD LAMBERT (Health Canada Scientist): Our job is at stake, but I think what is important is public safety.

    TRYON: One example is a veterinary drug called Tylosin. It’s used to fight bacteria in chickens. Banned in Europe, some studies show it can cause deadly food poisoning and make the human body resistant to certain antibiotics. Worst-case scenario?

    CHOPRA: People are picking up these bacteria and other bugs that are becoming resistant, and then they die from it because there’s nothing left to treat them with.

    TRYON: Dr. Cris Basudde alerted Health Canada to the possible risks. But the drug was approved in May.

    DR. CHRIS BASUDDE (Health Canada Scientist): I ended up being reprimanded, being branded disrespectful to colleagues.

    TRYON: CTV News obtained a copy of a letter reprimanding Basudde for his approach in disagreeing with the approval process. It stated, “Please consider this letter as a written reprimand. Failure to address this behaviour will result in more severe disciplinary action.” Drug companies and these scientists agree the approval system is flawed. Health Canada puts the onus on drug makers to prove their products are safe. To recoup their R&D investment, companies need drugs need to be approved, and quickly. These scientists say that’s what leads to pharmaceutical pressuring.

    IAN ALEXANDER (Health Canada): Health Canada staff are not being pressured by manufacturers.

    TRYON: But the pharmaceutical industry admits it is lobbying Health Canada, not to approve unsafe drugs, but to speed up the drug approval process.

    GERRY HARRINGTON (Non-Prescription Drug Manufacturers Association): If it hadn’t created some internal pressures, I’d be frankly a little disappointed almost because you expect some sort of response to what is a very serious issue from our standpoint.

    CHOPRA: The risk is the public. Our children, our community of Canada.

    TRYON: The dissident scientists say they won’t be satisfied until there’s a full Senate investigation into why Health Canada continues to approve drugs some of its senior most scientists say could one day harm Canadians. Jennifer Tryon, CBC News, Ottawa.

    SHAW: For details on the effects of veterinary medicines on humans, log on to our website, ctv-dot-ca. And we’re going to take a closer look at the whole issue of food, health and diets starting tonight in special reports we call “what you eat.” Later in this newscast, men and their growing obsession with body image.

  66. JPZ says:

    @libby

    Here are the facts that the government doesn’t want to tell you – a “safe” designation doesn’t mean “absolutely safe under any circumstance.” It means, “Well, we don’t think it is going to hurt anyone under reasonable conditions of use based on the facts, but several facts are hard to interpret based on limited evidence. Until we know more, we have to weigh these unusual facts against the larger weight of evidence and decide if the risk outweights the benefit. So far, we think the benefit outweights the risk. But, we might need to change our mind if new facts arise.”

    Sinister, isn’t it. Safety is a guess. If someone wants to “expose” “dangerous” drugs, the process is wide open to criticism if you take some studies out of context. I am not saying that misconduct doesn’t happen (it does), but the system of drug safety and approval is extremely complex and critics can exploit public ignorance of that system to sow public fears. But, more than anything, continue to be a skeptic – but include the homeopaths and fear-mongers as well.

  67. JPZ says:

    @weing and daedalus2u

    I am so calling Godwin’s Law on you both. Sorry it took me so long to get into this thread. Libby is seriously debating all of you, and you go all “Hitler” on her. Get real.

  68. libby says:

    JPZ

    Thanks for your posts.

    I definitely include homeopaths in my skepticism as I criticized their lack of knowledge and standards in a recent post, but some of them are very good as well.

    The whistle blowing and subsequent firing in my country of high-level health officers tasked with product safety approval shocked the public and weakened people’s faith in the medical system. What surprised me was the silence of the doctors. I would think they would have condemned the actions of Health Canada against their 4 officers, but they didn’t seem to care, even though the doctors are the ones who prescribe drugs whose safety was being called into question.

    I don’t understand that at all.

  69. weing says:

    JPZ,

    In that case, I am calling Godwin’s law on you. :)

  70. Libby, You realize that the interview you posted doesn’t suggest that unsafe drugs are being prescribed to humans, right?

    These are veterinary drugs that are given to livestock that may increase the risk of antibiotic resistant bacteria.

    It is a concern, but it does not seem incredibly relevant to whether you use dilation drops in your eyes.

    It does seem relevant to whether you buy handle and consume livestock products.

    I’m sorry your doctor was curt with you. Considering your manners on this board, I think it’s possible that he was curt not because you declined the medication, but because of how you declined the medication.

  71. jpz, Libby is not seriously debating anyone. Her arguments are based on insinuating questions like ““I’m just wondering how much truth you infuse into your own practice?” and poor logic like. ‘Cuba has a low infant mortality rate and long life span due to their public health system, some Cuban hospitals use homeopathy, therefore American doctors are negligent in not studying why homeopathy works.’

    In fact, I haven’t seen one CAM proponent post on this website that does seem capable of presenting a series of logical arguments in support of their belief.

    The only exception I could consider is pmoran, who is not really a CAM proponent. Or possibly you JPZ, if you ultimately come out of the closet, we’ll see.

    I came to this board reasonably neutral about many CAM treatments. I think that it has been the CAM proponents more that the SBM proponents that have convince me that CAM is mostly hogwash (or possibly hog antibiotic treatment, if I want to be more current).

    It seems to me that a valid working therapy, wouldn’t rely upon such weak arguments to prove it’s worth.

  72. libby says:

    One of my issues with doctors in general is they avoid discussing the corruption within their field. We even have one doctor on this thread who stated that she is unconcerned about the suppression of safety information by drug companies. That’s supporting the corruption, unfortunately not an atypical attitude among doctors.

    GSK got approval and marketed Paxil and Avandia knowing they were dangerous and they lied about their safety. People died as a result. GSK has set aside billions for future transgressions, and no one in the field cares. Now imagine what would happen if even one person died from homeopathy.

    I would feel much better about conventional medicine if doctors took an active role in demanding that pharmaceutical companies be honest, that regulatory boards do their job, and that no one be fired for trying to protect the public. It would be easy. If a drug company is caught lying, then doctors will not prescribe any of their products.

    This does not happen. Not even close. In my own country when 4 health officers were fired the doctors fell silent.

    Whenever I have to take any conventional drug, I wonder, was this one approved under duress, was information on its safety suppressed, am I putting myself at risk because no one stood up against internal corruption within the system, if I die from the side effects am I at best a number useful to a lawyer in a lawsuit?

    And as Chomsky has opined, if you want to propagandize something without anyone knowing, you limit the extent of the discussion. So on this website, drug company corruption never makes it, pressure upon regulatory boards never makes it, death via information suppression never makes it. And if you bring it up, as you point out, a Hitler reference is not far away.

    That’s because whoever brings it up is being disobedient to the system.

  73. libby says:

    micheleinmichigan

    You just made up a quote, attributed it to me, and then attacked it.

  74. daedalus2u says:

    Libby, the reason ophthalmologists use drugs to dilate the pupil is so that they can get a better view of the whole retina. The reason they do it routinely before the exam is because it takes time for the drugs to work. Could your ophthalmologist see your entire retina? I hope so for your sake. If he/she couldn’t, would he/she have bothered to tell you and struggle to get you to accept the drugs and then wait for them to take effect? Spending more time on your appointment would mean less time for other patients. Is it fair to them to compromise their appointments because of your intransigence?

    Your “example” is not compelling. I am not surprised that an ophthalmologist would take umbrage at being lectured about medical officers being fired for insubordination. What did that have to do with him/her? Or with you being given drugs to dilate your pupils? Nothing at all.

    If you don’t want a doctor to treat you according to the standard of care, make sure the doctor knows that when you make the appointment. Most professionals won’t accept clients who won’t allow them to do their work according to industry standards. Electricians, plumbers, engineers, architects all have to do their work according to Code, or they can lose their license and have significant liability. Why would a doctor be different?

  75. @ Libby’ my quote is from your statement “When you administer drugs made by GSK, do you mention that they have been involved in lawsuits where they suppressed negative effects to augment profits, and the company has presently set aside billions anticipating further legal issues.
    I’m just wondering how much truth you infuse into your own practice?”

    My paraphrase, as indicated by the use of ‘ rather than ” is an observation of your Cuban argument. My apologies on the confusion. That is my summary of my reading of your Cuban argument. If is not a good summary, please feel free share what you believe the Cuban’s are doing correctly, that U.S. doctors should be studying.

  76. JPZ says:

    @micheleinmichigan

    Well, using a “Hitler” analogy on someone automatically makes your own argument stupid (that is what Godwin’s law means). I was actually surprised to see someone pull that on SBM, but maybe I was the only one to guffaw loudly. Internet arguments were a lot more stupid in the days when people coined “Godwin’s Law.”

    As for libby, my initial impression was that she (I am assuming “she”) was arguing based on personal experiences and some verifiable facts, e.g. Cuba, that cancer study, etc. That is a relatively sincere starting point, right? She has also applied fairly good logic to several of her point-counterpoint posts. To me, that made her “serious” even if some of her points are not “accurate” when compared to a larger body of evidence. Although, I may have to eat my words if she throws around more groundless statements like, “That’s supporting the corruption, unfortunately not an atypical attitude among doctors.” When was that survey done?

    “Closet CAM Practitioner” sounds kinda creepy, actually. I know very little about CAM in general, but, as a scientist, I appreciate putting beliefs about health and healing to the test. I am learning more and more about CAM (and criticisms of CAM) as I participate here. I know quite a lot about dietary supplements and other nutritional products, and I hope my participation here can be educational in that respect. I learn a lot from those discussions as well.

  77. Libby “It would be easy. If a drug company is caught lying, then doctors will not prescribe any of their products”

    That is only easy if you don’t have to be the doctor who watches someone die because you were boycotting a drug company.

    The consumer/patient is free to boycott any drug they please and risk their own death. For a doctor to make that decision for the patient would be seriously unethical.

    Why is it that didn’t occur to you?

    Also, why are you criticizing U.S and Australian doctors for a Canadian political decisions. Don’t you guys have whistle blower laws up there? Perhaps you should be criticizing Canadian voters for not doing anything about Canadian political decisions. Isn’t that what your voting system is for?

  78. JPZ, I did not mean to sound creepy or suggest you were creepy. It’s a common phrase amongst my friend, one can be a ‘closet car enthusiast’, etc.

    Would you prefer something along the lines of “JPZ, if you ultimately reveal a previously undisclosed enthusiasm for CAM.”?

    Which is somewhat mote, since I now know, that you know, very little about CAM in general.

    I thought that Goodwin’s law was that any internet discussion that goes on long enough will ultimately degenerate into Hilter references.

    Maybe I am unconsciously combining Goodwin and Murphy.

  79. “friend” should be “friends”

    I am a bit antisocial, but I think I can still use the plural.

  80. JPZ says:

    @libby

    “If a drug company is caught lying, then doctors will not prescribe any of their products.”

    I can appreciate your idealism, but that would be asking a doctor to punish their patients. AHP (which became Wyeth then Pfizer) did a lot of lying to sell more Fen-Phen, but withholding tigecycline or Prevnar on principle would kill patients.

    “Now imagine what would happen if even one person died from homeopathy.”

    Just to inject some more humor into this thread and to have another chance to quote comedian Dara O’Briein, “You could f**kin drown.”

    http://nutrition-industry.blogspot.com/2011/03/science-doesnt-know-everything.html

  81. JPZ says:

    @micheleinmichigan

    Oops, I did mistate Godwin’s Law! But, you know who else corrected people when they were wrong? Hitler! LOL

    But seriously, I think what I said is an allowable corollary of Godwin’s Law:

    http://en.wikipedia.org/wiki/Godwin's_law

  82. Harriet Hall says:

    Apparently Libby is not talking to me any more, and she has not answered my direct questions. Yet she indirectly attacks me:

    “We even have one doctor on this thread who stated that she is unconcerned about the suppression of safety information by drug companies.”

    That is an insulting and false misrepresentation of what I said.

    I assume she is referring to me. She asked “When you administer drugs made by GSK, do you mention that they have been involved in lawsuits where they suppressed negative effects to augment profits, and the company has presently set aside billions anticipating further legal issues.”

    I answered that I did not. I don’t think it is necessary to tell patients about lawsuits and legal funds. All that is relevant is whether the best scientific information supports the safety and efficacy of the drug. That does not mean I am not concerned about the suppression of safety information. I most certainly am.

  83. @JPZ, Possibly a matter of personal preference.

    Hitler can be handy when one is looking for a universally agreed upon bad guy to demonstrate an idea. Like if someone said, ‘ just because Hitler liked puppies, does not automatically make puppies bad.’

    Or if one is talking about something that is genuinely linked to a feature of Hitler’s core principles, like eugenics, it’s a fair point.

    I balk at attempts to defeat someone’s argument by pointing out how their views (unrelated to core principles) are like Hitler’s, ie ‘Hitler supported socialized medicine, therefore socialized medicine is evil.

    To be honest, I think weing was being characteristically oblique and du2 was following suit, so I couldn’t say how to rate their comments on my scale, since I didn’t “get” them. Unless it’s a “huh?” rating.

  84. weing says:

    michelinmichigan,

    My reference was to the puppy kind. Just because drug companies are profit driven doesn’t mean their drugs are no good and should not be used.

  85. weing says:

    sorry for misspelling your name

  86. west says:

    @ libby regarding your response to my quote…

    In no way am I denying anything unethical that may have happened in the past regarding anything at all. My main point is that without some kind of scientific (measurable) basis for its effect I do not see reason to invest any significant amount of resources into its research.
    I may be missing something but it seems to me the scientific basis for homeopathy is non existent. I have only a basic knowledge of chemistry and physics yet i feel certain that this is the case. Simple math will let you know just how much original ingredient your dealing with (none). To think that “water memory” can cure symptoms of something and yet be in no known way detectable at all does not make sense to me. There is also the argument to be made that most if not all water molecules have been in contact with a lot of other molecules and would thus have memory polluted beyond any homeopathic use. I know there is some kind of loop hole for this but it seems unfair to say “oh yeah this will fix that” without giving any sort of real explanation.
    to me the most damning fact is that each water molecule would could not “remember” any ionic compounds (like salt) because they don’t exist as the original compound in the water solution. So how can you have salt as an ingredient for one remedy and sodium and chlorine for another remedy and call them different? They would in fact be the same.
    These simple, yet damning points about homeopathy are not met with opposition based on evidence, only faith.

    Another thing to note is that you seem quick to questions doctors and there ethics or pharmaceutical companies and their motives when it comes to the media and research. What really gets me is that you imply that someone who would implement a homeopathic treatment would be above this.

    I suggest to you that anyone is capable of doing immoral things whether or not they are involved in science based medicine or homeopathy.
    I would say that a large company who would produce homeopathic solutions would be just as inclined to do the exact same things that you condemn science based medicine for.

    On a slightly different point I would also say that seeing how few homeopathic doctors have the diverse medical knowledge that a fully trained doctor would have they would inherently make less effective doctors.

    Sorry if I got off point or something this comment section is getting large!

  87. weing – Thanks for clarifying.

    I think I like your spelling of my name better. I can now picture myself as that cheery michelin man.

  88. weing says:

    I do need new tires.

  89. JPZ says:

    @micheleinmichigan

    Thanks for getting me to go back and read their posts. Neither weing nor daedelus2 invoked Reductio ad Hitlerum. Using Hitler in a Hitler-relevant analogy for “shock value” is not the same as comparing someone else or their comments to Hitler.

    @weing and daedelus2

    My bad. I shouldn’t have called Godwin’s Law on you both. Your analogies were appropriately shocking. I am still not crazy about Hitler analogies, but that is a matter of personal preference and background.

    @libby

    Your comment, “And if you bring it up, as you point out, a Hitler reference is not far away” is not entirely correct, and I apologize if I misled you into believing that a Hitler reference had been used against you.

    And, I am sick of typing the word “Hitler.” :(

  90. JPZ says:

    I was getting bummed from typing that name over and over again, so I went back and watched this hilarious comedy routine about homeopathy. I also thought a joke was in order for the whole group:

    That Mitchell and Webb Look: Homeopathic A&E

    http://www.youtube.com/watch?v=HMGIbOGu8q0

    Draw it on with a Biro! LMAO

  91. libby says:

    micheleinmichigan

    I’ll make this short.

    Everything you said I disagree with.

  92. libby says:

    daedalus2u

    Your post is a good example of compartmentalized thinking.

    The pharmaceutical industry is pressuring a regulatory body to approve drugs that are unsafe BUT let’s trust them with a dilation drug.

    I can’t really say much more to someone that thinks like that other than to say no wonder there’s so much corruption in the medical field.

  93. libby says:

    micheleinmichigan

    You state: “The consumer/patient is free to boycott any drug they please and risk their own death. For a doctor to make that decision for the patient would be seriously unethical.”

    So you have no problem prescribing drugs made by a rogue company who’s actions have killed people? That IS ethical in your opinion?

  94. vicki says:

    Libby,

    Following your line of reasoning, I would like to know how much time you spend working to eliminate police departments, given the record of corruption in many of them? If you report a crime in Cleveland, will you be upset that the desk sergeant doesn’t tell you about cases of corruption in the Los Angeles or New York Police Department?

    Do you sleep under the stars rather than give money to the building industry, in which there is proven corruption? How do you feel about imported goods, given the history of organized crime involvement in the loading and unloading of goods?

    Corruption is, alas, a thing that happens among humans. Boycotting large industries or fields of endeavor because of it will leave you with little or nothing.

  95. libby says:

    west

    I disagree with your assessments.

    I have criticized homeopaths on this board and said that the knowledge doctors possess on the human body is admirable.

    I have already explained the problems with evaluating homeopathy and Richard Dawkins is trying to correct that. His concept for a proper study following protocol and asking homeopaths to administer whatever remedy is individually appropriate to a group with a similar aliment is the right approach. I would add that the funding should come from a neutral source, for instance not GSK or Matrixx Initiatives (homeopathic company).

    I also disagree that since people are corrupt, the corruption within companies is unavoidable. That’s too deterministic for me. Doctors could and should as a group demand that the products they administer have not had safety information suppressed by the companies or the regulatory bodies. And they should be vocal about any corruption that comes forward. That won’t happen if they can’t even admit that corruption exists.

    What they shouldn’t do is sit idly by and watch health officers being fired for disobedience because they have tried to protect the public. Because I used a Canadian case as an example only, micheleinmichigan seems to think these are regional issues that don’t cross national boundaries, even though large drug companies are multinational.

  96. Libby as a patient, I can not prescribe drugs (Which is probably just as well). But, since we have a regulation system, criminal and civil legal system to deal with “rogue companies”, I feel that it is redundant and a conflict of interest to expect doctors to control pharmaceutical companies by basing their prescribing decisions on the historical behavior of the company rather than the current scientific evidence of safety and effectiveness.

    I take it you don’t use electrical power, since the actions of the coal industry which makes up a good portion of Canada and U.S. electrical supply, has killed people.

    Solar powered computer, is it?

    There are other mechanisms for controlling corporations beside boycotts. Regulation and civil lawsuits are two of them.

    This is one reason that I vote, write letters to politicians and disapprove of tort reforms that cap damages that corporations can be forced to pay for corruption, fraud, etc.

  97. libby

    “micheleinmichigan

    I’ll make this short.

    Everything you said I disagree with.”

    LOL, so you don’t actually have an argument, you just have a blanket disagreement.

    Classic.

  98. Because I used a Canadian case as an example only, micheleinmichigan seems to think these are regional issues that don’t cross national boundaries, even though large drug companies are multinational.

    Actually, I think that Canadian’s are responsible for firings by the Canadian government. I think that U.S. citizen’s are responsible for the actions of the U.S. government.

    As a consumer, I use my purchasing power to make consumer votes across national lines. But I don’t knowingly risk the lives of other people when I do that. For instance, I don’t make sure that a life preserver isn’t manufactured in a dangerous sweat shop in China before I throw it to a drowning person.

    I’m sure you disagree. :)

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