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The difference between science-based medicine and CAM

“Alternative medicine,” so-called “complementary and alternative medicine” (CAM), or, as it’s become fashionable to call it, “integrative medicine” is a set of medical practices that are far more based on belief than science. As Mark Crislip so pointedly reminded us last week, CAM is far more akin to religion than science-based medicine (SBM). However, as I’ve discussed more times than I can remember over the years, both here and at my not-so-super-secret-other blog, CAM practitioners and advocates, despite practicing what is in reality mostly pseudoscience-based medicine, crave the imprimatur that science can provide, the respect that science has. That is why, no matter how scientifically implausible the treatment, CAM practitioners try to tart it up with science. I say “tart it up” because they aren’t really providing a scientific basis for their favored quackery. In reality, what they are doing is choosing science-y words and using them as explanations without actually demonstrating that these words have anything to do with how their favored CAM works.

A more important fundamental difference between CAM and real medicine is that CAM practices are not rejected based on evidence. Basically, they never go away. Take homeopathy, for example. (Please!) It’s the ultimate chameleon. Even 160 years ago, it was obvious from a scientific point of view that homeopathy was nonsense and that diluting something doesn’t make it stronger. When it became undeniable that this was the case, through the power of actually knowing Avogadro’s number, homeopaths were undeterred. They concocted amazing explanations of how homeopathy “works” by claiming that water has “memory.” It supposedly “remembers” the substances with which it’s been in contact and transmits that “information” to the patient. No one’s ever been able to explain to me why transmitting the “information” from a supposed memory of water is better than the information from the real drug or substance itself, but that’s just my old, nasty, dogmatic, reductionist, scientific nature being old, nasty, dogmatic, reductionist, and scientific. Then, of course, there’s the term “quantum,” which has been so widely abused by Deepak Chopra, his acolytes, and the CAM community in general, while the new CAM buzzword these days to explain why quackery “works” is epigenetics. Basically, whenever a proponent of alternative medicine uses the word “epigenetics” or “quantum” to explain how an alternative medicine treatment “works,” what he really means is, “It’s magic.” This is a near-universal truth, and even the most superficial probing of such justifications will virtually always reveal magical thinking combined with an utter ignorance of the science of quantum mechanics or epigenetics.

So, yes, much of CAM is either very much more like religion than science in that CAM is immune to evidence. True, the scientific “explanations” change, and CAM practices might evolve at the edges based on evidence, but the core principles remain. You don’t see, for example, homeopaths or naturopaths deciding that homeopathy doesn’t work because science and clinical trials overwhelmingly show that it is nonsense. You don’t see chiropractors leaving chiropractic in droves because they’ve come to the realization that subluxations don’t exist and they can’t cure allergies, heart disease, gastrointestinal ailments (or anything else) but rather are in reality physical therapists with delusions of grandeur. Ditto reiki, acupuncture, therapeutic touch, and “energy healing.” These practices persist despite overwhelming evidence that they do not work and are based on magical thinking, not science. All of the scientific studies and clinical trials funded by NCCAM and other CAM-friendly organizations never actually take the next step from all the negative studies of CAM and come to the conclusion that they should stop using such modalities.

The key difference between SBM and CAM

No one is saying that the record of SBM is perfect when it comes to changing nimbly with new evidence, and any imperfection in the record of SBM and evidence-based medicine (EBM) actually being, well, science- and evidence-based, is a favorite target of CAM apologists. Hence there are frequent claims circulating that only 15% of medicine is actually evidence-based. It’s a bogus claim, a myth, as Steve Novella has pointed out. In reality, studies appear to converge on estimates that approximately 80% of interventions are based on compelling evidence, and between 30-60%, depending on the specialty, are based on randomized clinical trials. That’s not good enough, but it’s far better than CAM apologists would lead you to believe, and it’s certainly far better than anything in CAM.

Nonetheless, it has been recognized for a long time that EBM/SBM is sometimes slow to change in response to new evidence. Indeed, there was an aphorism I heard while in medical school that outdated treatments and procedures don’t die off completely until the physicians who learned them during residencies or fellowships die off. I learned that that’s not entirely true. There is, after all, a gap of around 20 years between the time a generation of physicians retires and dies off; so such practices actually die off much sooner. I keed, I keed, of course, but the point is valid.

There is the opposite problem in EBM/SBM as well, namely a tendency towards a “bandwagon” effect wherein a new therapy is widely adopted before there is solid evidence of its superiority (or at least of its non-inferiority with alternate benefits). I’m a surgeon, so I know that, unfortunately, the surgical world is very much prone to this sort of problem. Surgeons tend to like shiny, pretty new toys and to do spiffy new procedures that prove that they are the biggest, baddest scalpel cowboys in the all the land. These tendencies have led to a number of procedures becoming widely adopted before they were definitely shown to be superior. Laparoscopic cholecystectomy is the example that I like to use the most; it swept the surgical world over 20 years ago without compelling evidence for its safety. Later, it was found that the incidence of common bile duct injury was much higher after laparoscopic cholecystectomy than conventional cholecystectomy. That incidence fell as more surgeons became more facile at the procedure, but it was years before there was compelling evidence that the laparoscopic approach was truly superior. History seems to be repeating itself today with robotic surgery. At the risk of offending some of my surgical colleagues, I’ve yet to see compelling evidence that doing, for example, a radical prostatectomy with the da Vinci robot is truly superior to doing it using what was the new way ten or fifteen years ago but is now the old way, using laparoscopy. From my perspective evaluating existing evidence, the da Vinci is as safe and effective as laparoscopy, but if it is sufficiently more so to justify its much greater cost I haven’t seen the evidence yet. I sometimes joke that if it were possible to do breast surgery (my specialty) with the da Vinci, then I’d be all for it. Maybe I’ll have to look into that. I could be bigger than Armando Guiliano, and time’s wasting. I probably only have 15 or 20 years left in my career to make an international name for myself.

But how often are medical practices found to be ineffective and abandoned? How much do we test existing practices in light of new data? There have been a number of studies looking at this issue, which is already a marked contrast to CAM, where ineffective practices are, as far as I can tell, never abandoned. The most recent of these caught my eye last week. Published in the Mayo Clinic Proceedings by a team from the National Cancer Institute, the University of Chicago (one of my alma maters!), Northwestern University, George Washington University, and Lankenau Medical Center and entitled A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices, this study seeks to get a handle on the answer to that very question for these reasons:

We expect that new medical practices gain popularity over older standards of care on the basis of robust evidence indicating clinical superiority or noninferiority with alternative benefits (eg, easier administration and fewer adverse effects). The history of medicine, however, reveals numerous exceptions to this rule. Stenting for stable coronary artery disease was a multibillion dollar a year industry when it was found to be no better than medical management for most patients with stable coronary artery disease.1 Hormone therapy for postmenopausal women intended to improve cardiovascular outcomes was found to be worse than no intervention,2 and the routine use of the pulmonary artery catheter in patients in shock was found to be inferior to less invasive management strategies.3 Previously, we have called this phenomenon (when a medical practice is found to be inferior to some lesser or prior standard of care) a medical reversal.4, 5, 6 Medical reversals occur when new studies—better powered, controlled, or designed than their predecessors—contradict current practice.4 In a prior investigation of 1 year of publications in a high-impact journal, we found that of 35 studies testing standard of care, 16 (46%) constituted medical reversals.4 Another review of 45 highly cited studies that claimed some therapeutic benefit found that 7 (16%) were contradicted by subsequent research.7

Identifying medical practices that do not work is necessary. The continued use of such practices wastes resources, jeopardizes patient health, and undermines trust in medicine. Interest in this topic has grown in recent years. The American Board of Internal Medicine launched the Choosing Wisely campaign,8 a call on professional societies to identify the top 5 diagnostic or therapeutic practices in their field that should not be offered.9 In England, the National Institute for Health and Clinical Excellence has tried to “disinvest” from low-value practices, identifying more than 800 such practices in the past decade.10 Other researchers have found that scanning a range of existing health care databases can easily generate more than 150 low-value practices.11 Medical journals have specifically focused on instances in which more health care is not necessarily better. The Archives of Internal Medicine created a new feature series in 2010 entitled “Less is More.”12

One can’t help but note right from the introduction of this paper that SBM/EBM does continually reevaluate its practices and treatments, testing which ones work and which ones do not and comparing current practice against new treatments. Granted, the intensity of this effort seems to be a more recent development, with the implementation of the Patient Protection and Affordable Care Act, but is it really? This article suggests that the answer is: perhaps not.

The authors specifically examine the question of how much of the medical literature consists of what they refer to as “medical reversals,” as described above. Specifically, they tried to estimate what percentage of the medical literature consists of articles that question current medical practice, particularly that consist of high quality evidence suggesting that current practice needs to be changed or that a standard-of-care intervention doesn’t work, doesn’t work as well as a non-standard-of-care intervention, or is actually harmful. How the authors did this, I find easier to let them describe:

Two reviewers (C.T., A.V., M.C., J.R., S.Q., S.J.C., D.B., V.G., or S.S.) and V.P. read articles addressing a medical practice in full. On the basis of the abstract, introduction, and discussion, articles were classified as to whether the practice in question was new or existing. Methods were classified as one of the following: randomized controlled trial, prospective controlled (but nonrandomized) intervention study, observational study (prospective or retrospective), case-control study, or other methods. End points for articles were classified into those that reached positive conclusions and those that found negative or no difference in end points. Lastly, articles were given 1 of 4 designations. Replacement was defined as a new practice surpassing an older standard of care. Back to the drawing board was defined as a new practice failing to surpass an older standard. Reversal was designated when a current medical practice was found to be inferior to a lesser or prior standard. Reaffirmation was defined as an existing medical practice being found to be superior to a lesser or prior standard. Finally, articles in which no firm conclusion could be reached were termed inconclusive. The designation of an article was also performed in duplicate. When there were differences in opinion between the 2 reviewers, adjudication first involved discussion between the 2 readers to see whether agreement could be reached. If disagreement persisted, a third reviewer (A.C.) adjudicated the discrepancy. Less than 3% of articles required discussion, and less than 1% required adjudication. A table detailing each medical reversal was constructed (Supplemental Appendix; available online at http://www.mayoclinicproceedings.com), and the third reviewer (A.C.) reviewed all reversals.

So what did the investigators (Prasad et al) find? They examined ten years’ worth of NEJM original reports, from 2001 through 2010, for a total of 2,044 original articles. Of these, 1,344 (65.8%) addressed a medical practice, of which 911 (68%) were randomized controlled trials, 220 (16%) were prospective controlled but non-randomized studies, 117 (9%) were observational studies, 43 (3%) were case-control studies, and 53 (4%) used other methods. Of these 1,344 reports, 981 (73%) studied a new medical practice, while 363 (27%) addressed an existing practice. Overall, 756 articles (56%) found that a new practice surpassed the existing standard of care at the time (replacement), while 165 (12%) failed to find that a new practice was better than existing practices. In terms of what we’re really interested in, of the 363 studies examining an existing practice, 146 studies (40%) were reversals, while 138 (38%) upheld standard practices. Here’s a breakdown from the article for your edification:

JMCP_xxx_Figure01

Of the reversal articles, not surprisingly most (76%) turned out to be randomized clinical trials, and interestingly, the percentage of each type of trial didn’t change much over the decade-long study period:

JMCP_xxx_Figure01

The one problem I had with this study was that it only looked at one journal: The New England Journal of Medicine. I can understand why the authors might have chosen that particular journal. It’s very high impact, and, with the exception of a recent distressing tendency to let some low quality CAM articles slip in, one of the more rigorous medical journals out there that isn’t a specialty journal; i.e., it accepts articles covering all areas of medicine. It’s not a basic science journal; it generally only publishes original studies that are either clinical trials, epidemiological studies, or at the very least highly translational. It also, from my reading, only rarely publishes really preliminary clinical work, such as phase I clinical trials. On the other hand, one has to wonder whether the results would be generalizable to the rest of the medical literature.

For example, according to this study, articles in the NEJM that tested new practices were far more likely to find them beneficial than articles that tested existing ones (77.1% vs 38.0%), while articles that tested existing standard-of-care practices were far more likely to find those practices ineffective than articles testing new practices (40.2% vs 17.0%). Looking at such numbers, I can’t help but wonder if there is a publication bias for finding new therapies effective and/or for finding existing therapies either ineffective or harmful, particularly in the NEJM, which is among the highest of high-impact medical journals. Think about it. Who thinks that their findings are substantial enough and interesting enough to be seriously considered for publication in the NEJM? It’s investigators who have found that some new therapy works for a common or very serious disease, but it wouldn’t surprise me if it’s also authors who have found compelling evidence that a commonly used existing standard of care is either not effective or is even dangerous.

It’s also informative to look at some of the medical practices that were the subject of reversal articles. For instance, it was thought that certain vaccinations could increase the risk of relapse in multiple sclerosis, but two studies showed no increased risk. One looked at tetanus, hepatitis B, and influenza vaccination; the other at hepatitis B vaccination. One showed that delayed drainage of effusion in otitis media did not result in worse outcomes than immediate placement, resulting in a change in practice. Another key reversal came in the form of a 2003 study that showed that high-dose chemotherapy followed by bone marrow transplantation did not improve survival in advanced breast cancer. This was a huge one, and almost immediately oncologists stopped doing bone marrow transplants for breast cancer. Another showed that the use of pulmonary artery catheters in acute lung injury didn’t improve outcomes and was associated with more complications. (When I was a resident in the 1990s, all of these patients got pulmonary artery catheters.) A couple of these I’ve written about, such as vertebroplasty. More recently, there was a study that showed no benefit to routine PSA screening for prostate cancer in American men.

Indeed, I can’t help but mention here that the whole reevaluation of routine screening for cancer, such as PSA screening for prostate cancer and mammography for breast cancer, topics I’ve written about numerous times for this blog, are examples of exactly that: SBM/EBM evaluating current practices in light of new data and determining whether they should be changed or abandoned. Routine PSA screening for men at average risk of prostate cancer has more or less been abandoned, for example, while current mammography practices are being questioned as promoting too much overdiagnosis and likely will evolve in response.

Choosing wisely

Perhaps the most prominent example of the efforts EBM/SBM makes to continually reevaluate its practices is the Choosing Wisely initiative. Scott Gavura brought it up last year, and I’ve mentioned it elsewhere. It’s basically an effort by organized medicine to reduce the use of what are known as “low value” tests (i.e., tests that provide little or no benefit but are often costly and can produce complications and more invasive testing). If screening tests are a problem, there are also a lot of tests that are ordered too frequently or for dubious indications. The reasons can range from laziness to defensive medicine, but whatever the reason, such tests cost money, can lead to incidental findings that need further workup, and can even lead to overdiagnosis. In 2010, Dr. Howard Brody published a challenge to his physician colleagues in The New England Journal of Medicine. It was an amazing article, in which Dr. Brody challenged physician specialty organizations thusly:

In my view, organized medicine must reverse its current approach to the political negotiations over health care reform. I would propose that each specialty society commit itself immediately to appointing a blue-ribbon study panel to report, as soon as possible, that specialty’s “Top Five” list. The panels should include members with special expertise in clinical epidemiology, biostatistics, health policy, and evidence-based appraisal. The Top Five list would consist of five diagnostic tests or treatments that are very commonly ordered by members of that specialty, that are among the most expensive services provided, and that have been shown by the currently available evidence not to provide any meaningful benefit to at least some major categories of patients for whom they are commonly ordered. In short, the Top Five list would be a prescription for how, within that specialty, the most money could be saved most quickly without depriving any patient of meaningful medical benefit. Examples of items that could easily end up on such lists include arthroscopic surgery for knee osteoarthritis and many common uses of computed tomographic scans, which not only add to costs but also expose patients to the risks of radiation.

Some specialty organizations have done just that, and the result is called Choosing Wisely. To begin, nine specialty societies have produced lists of Five Things Physicians and Patients Should Question, which Choosing Wisely describes as “evidence-based recommendations that should be discussed to help make wise decisions about the most appropriate care based on a patients’ individual situation.” The clinical societies that have participated include:

  • American Academy of Allergy, Asthma & Immunology
  • American Academy of Family Physicians
  • American Academy of Hospice and Palliative Medicine
  • American Academy of Neurology
  • American Academy of Ophthalmology
  • American Academy of Otolaryngology — Head and Neck Surgery Foundation
  • American Academy of Pediatrics
  • American College of Cardiology
  • American College of Obstetricians and Gynecologists
  • American College of Physicians
  • American College of Radiology
  • American College of Rheumatology
  • American Gastroenterological Association
  • American Geriatrics Society
  • American Society for Clinical Pathology
  • American Society of Clinical Oncology
  • American Society of Echocardiography
  • American Society of Nephrology
  • American Society of Nuclear Cardiology
  • American Urological Association
  • Society for Vascular Medicine
  • Society of Cardiovascular Computed Tomography
  • Society of Hospital Medicine – Adult Hospital Medicine
  • Society of Hospital Medicine – Pediatric Hospital Medicine
  • Society of Nuclear Medicine and Molecular Imaging
  • The Society of Thoracic Surgeons

It’s an impressive list. Naturally, being a cancer surgeon, I can’t resist looking here at the recommendations made by the American Society of Clinical Oncology (ASCO). Interestingly, two out of the five recommendations were breast cancer-related:

  • Don’t perform PET, CT, and radionuclide bone scans in the staging of early breast cancer at low risk for metastasis.
  • Don’t perform surveillance testing (biomarkers) or imaging (PET, CT, and radionuclide bone scans) for asymptomatic individuals who have been treated for breast cancer with curative intent.

It’s true. Far too often we do a million-dollar workup for patients with early stage breast cancer, and there is pretty much zero good evidence that these workups improve survival, improve care, or otherwise do anything except cost a lot of money, delay definitive treatment, expose the patient to radiation, and provoke worry in both patient and practitioner. I realize this is anecdotal experience, but overuse of these tests in early stage breast cancer doesn’t appear to as much of a problem in big cancer centers as it does in community cancer hospitals. But it is a problem in a lot of places.

One thing that disappointed me was that the Choosing Wisely list from the American College of Radiology didn’t appear to include any breast cancer-related recommendations. For instance, routine breast MRI before surgery for breast cancer increases the rate of mastectomy and, worse, contrary to the stated intent for preoperative MRI, does not decrease the rate of reexcision. On the other hand, it’s refreshing to see a recommendation that most surgeons instinctively know to be true:

Avoid admission or preoperative chest x-rays for ambulatory patients with unremarkable history and physical exam.

Performing routine admission or preoperative chest x-rays is not recommended for ambulatory patients without specific reasons suggested by the history and/or physical examination findings. Only 2 percent of such images lead to a change in management. Obtaining a chest radiograph is reasonable if acute cardiopulmonary disease is suspected or there is a history of chronic stable cardiopulmonary disease in a patient older than age 70 who has not had chest radiography within six months.

Of course, although doctors carry a large share of the responsibility for unnecessary tests, medications, and care, they are not alone in being responsible for the overuse of various medical tests and interventions. The classic example, of course, is the use of antibiotics for viral infections, which is something that patients often demand in the mistaken belief that it will help them and that many doctors use because patients ask for it and it’s easier to give in than to spend the time it takes to explain why it’s not medically indicated. Another contributor to the problem is that many of these tests have a significant financial incentive. It’s the same problem that contributes to the slowness of the decline in use of some treatments shown not to be effective.

Lest any reader think that I don’t put my money where my mouth is, I will mention that I was recently appointed co-director of a state-wide program designed to increase quality of breast cancer care by promoting adherence to evidence-based guidelines and one of our primary goals this year will be to promote adherence among our member hospitals to the Choosing Wisely guidelines.

We change, but it’s messy and slow

One reason why EBM/SBM is slower than we might like to eliminate outdated and ineffective practices is simple. It’s not easy. Evidence from science, epidemiology, and clinical trials takes a long time to come in. It’s often very messy. When a practice comes into question, there will often be conflicting evidence, and it often takes a number of studies before conclusions about the practice firm up to the point where they are incorporated into evidence-based guidelines and become standard of care.

Often, practices that are later reversed come into usage based on premature and inadequate evidence. Often, small trials look promising, and physicians start using a treatment based on them. Sometimes such practices become standard based on short term outcome measures, and when long term data become available previously unsuspected harms become apparent. Sometimes it’s excessive confidence in the appropriateness of the proposed mechanism used to explain why the treatment should work. What is needed, according to Prasad et al (and I agree), is more rigor:

As such, we favor policies that minimize reversal. Nearly all such measures involve raising the bar for the approval of new therapies6, 83, 84 and asking for evidence before the widespread adoption of novel techniques. In all but the rarest cases,82 large, robust, pragmatic randomized trials measuring hard end points (with sham controls for studies of subjective end points) should be required before approval or acceptance. Our position is in contrast to efforts to lower standards for device and drug approval,85 which further erodes the value of the regulatory process.

One can’t help but note that this is in marked contrast to CAM studies, in which CAM advocates ask us to accept much less rigorous types of evidence to accept modalities. As Steve Novella has frequently pointed out, as rigorous randomized clinical trials show that most CAM interventions are no better than placebo, the refrain we frequently hear is that we should look at “pragmatic” trials. In this context, pragmatic doesn’t mean the same thing. What Prasad et al are referring to are randomized trials that reflect real-world practices. What I mean by “pragmatic” trials in the context of acupuncture are more observational trials of how the treatment is used in the real world. As I’ve said many times, this is putting the cart before the horse. Normally pragmatic trials are done for treatments that have already been shown to be efficacious in randomized clinical trials. They can’t show efficacy by themselves. They are designed to test how treatments already shown to be efficacious in randomized trials function once let “out into the wild” (i.e., the real world). Frequently, outside the rarified, rigorous world of randomized clinical trials, treatments are less effective.

It should also be pointed out that, just because a treatment was “reversed” in a clinical trial doesn’t necessarily mean that the older practices reversed were wrong. However, as Prasad et al put it:

The reversals we have identified by no means represent the final word for any of these practices. Simply because newer, larger, better controlled or designed studies contradict standard of care does not necessarily mean that older practices are wrong and new ones are right. On average, however, better designed, controlled, and powered studies reach more valid conclusions.94 Nevertheless, the reversals we have identified at the very least call these practices into question. Some practices ought to be abandoned, whereas others warrant retesting in more powerful investigations. One of the greatest virtues of medical research is our continual quest to reassess it.

So, yes, “conventional” medicine doesn’t always get it right. Occasionally it gets it wrong, on rare occasions spectacularly wrong. But unlike most CAM modalities, EBM/SBM is self-correcting. It actually does abandon treatments that don’t work. The process might be messy and ugly at times, but it does happen. For example, many years ago, angina pectoris was sometimes treated with a surgical procedure known as mammary artery ligation. The idea was that tying off these arteries would divert more blood to the heart. The operation became popular on the basis of relatively small, uncontrolled case series. Then, two randomized, sham surgery-controlled clinical trials were published in 1959 and 1960. Both of these trials showed no difference between bilateral internal mammary artery ligation and sham surgery. Very rapidly, surgeons stopped doing this operation. A similar example is one I mentioned above: bone marrow transplantation for advanced breast cancer, which was similarly rapidly abandoned after randomized clinical trials showing it to be no better than the previous standard of care. I’m not saying that this happened without conflict or disagreement; proponents of these therapies can always find reasons to discount the clinical trial evidence. But in the end evidence and science do win out.

Now compare this to CAM practices. Can anyone name a CAM treatment that was abandoned by CAM practitioners as a result of research and randomized clinical trials showing that it doesn’t work? A single one? I can’t. That’s the difference between CAM and EBM/SBM. The day that I see a CAM practice go extinct, like bilateral internal mammary artery ligation for angina pectoris, is the day that I might start to take seriously CAM practitioner claims that they are science-based.

Posted in: Clinical Trials, Diagnostic tests & procedures, Homeopathy, Medical Academia

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77 thoughts on “The difference between science-based medicine and CAM

  1. James David Adams Jr in his paper mentioned that modern medicine is carpenter approach: if the hammer does not work, get a bigger hammer http://www.audesapere.in/articles/Design%20flaws.pdf

    whereas homeopathy system of medicine is based on nature’s fixed laws and principles which do not change. Homeopathic medicines which were effective 200 years back are still effective for patients unlike conventional medicines and procedures which gets abandoned/reversed every few decades once their side effects are obvious to general public or the number of deaths caused by them are too high. By the time corrections are made in conventional system of medicine, its too late.

    1. stuastro says:

      quack quack quack

    2. David Gorski says:

      Thanks for potential blog fodder, either here or at my not-so-super-secret other blog, Nancy. :-)

    3. Rork says:

      “Homeopathic medicines which were effective 200 years back”
      Us nerds say “positive probability only on a null set” for this situation.

    4. windriven says:

      “Homeopathic medicines which were effective 200 years back are still effective for patients ”

      How true! Zero homeopathic medicines were effective 200 years ago and zero are effective today.

      BTW, what precisely are you a doctor of and from whence came your ‘credentials’? I’m guessing a box of Post Toasties but it wouldn’t flabbergast me to learn that you have an actual MD from an accredited medical school. But then that is even more frightening, isn’t it?

      1. The legal status of homeopathy medicine in India is on an equal footing with conventional [Bachelor of Medicine and Bachelor of Surgery (MBBS)], Ayurveda (recognised since 1969), Unani, and Siddha medicine. It is recognised by Central Council of Homoeopathy , Deptt. of AYUSH, Ministry of Health & Family Welfare, Govt. of India since 1973.

        Regular full time 5.5 years graduate medical degree [Bachelors in Homoeopathic Medicine and Surgery (BHMS)] that includes one year compulsory internship (approx 4800 hours in total)is absolutely necessary for becoming qualified & to get license to practice homeopathy medicine in India. And to do regular full time M.D. in any one of the 7 specialisations (Medicine, Paediatrics, Psychiatry, Pharmacy, Organon, Materia Medica, Repertory) of homeopathy medicine, you have to spend three more years after BHMS.

        1. Chris says:

          Malik:

          The legal status of homeopathy medicine in India is on an equal footing with conventional [Bachelor of Medicine and Bachelor of Surgery (MBBS)],

          And yet you still have no idea the difference between syphilis and a stuffed up nose.

          So where is that evidence that homeopathy effectively treats syphilis?

        2. How terribly terribly sad that homeopathy ( which any sane person can see is a pseudoscience and quackery) can be so legitimized in India by the offering of a medical degree in homeopathy and surgery!! It is a contradiction in terms.Even more sad is that there is a Paediatric branch- no child should be subjected to CAM, not because it could be harmful in itself, but because such a practitioner cannot think rationally or scientifically.How could he or she when applying non – scientific principles to treating the child.How terribly sad.

  2. Stephen H says:

    Surely any comparison between real medicine and the “alternatives” should look at where science was when those alternatives (which as “Doctor” Malik points out do not change) were first imagined. So, prior to germ theory we had acupuncture. We had homeopathy. We had chiropracty. Some of these “alternatives” existed prior to electricity, and when doctors used leeches to bleed patients of “humors”.

    Seriously, get a grip. Medicine may be sometimes slow to move, but it is lightning-fast compared to the alternative. To quote “Doctor” Malik in her comment above, “Homeopathic medicines which were effective 200 years back are still [considered by her and her ilk] effective for patients…”. This ignores the fact that knowledge changes, and tools change. Does she suggest that germ theory is wrong? Or that electricity is not at all applicable in the treatment of patients? I gather acupuncturists quite like it, while chiroquacktors sometimes order X-Rays to show those “subluxions”.

    How about computers – are they part of medicine’s “bigger hammer”? I think I prefer today’s medicine to that of 200 years ago – and my life expectancy makes very clear which version works.

    1. 1. Real is Homeopathy. Homeopathy for everyone in need.

      2. Homeopathy is of the view that pathogens are involved in disease They alone are not the real cause of the disease. They can thrive only if the person has low immunity and offers favourble condition for their growth. It’s the environment in which they operate plays a more important/decisive role.

      3. Conventional medicine is lightning fast because it acts like a brute force on organism. Those who are able to sustain the onslaught they survive, others not. Homeopathy could be lightning fast or slow depending the degree of similarity between disease and medicine prescribed.

      4. Show me the proof that life expectancy improved *only* due to conventional medicine.

      1. Chris says:

        “2. Homeopathy is of the view that pathogens are involved in disease They alone are not the real cause of the disease”

        Sure, sure. Just show us how well homeopathy is for syphilis. Hahnemann had a miasma named that, and claimed to cure the disease. In the real world it is treated with antibiotics, but how would you treat it? And what verifiable evidence do you have to prove it works? A Fourier transform won’t do, it has to be a paper that shows lab reports that the magic water got rid of the bacterial infection.

        1. homeopathic remedies don’t kill germs directly but creates the physiological micro-environment unsuitable to sustain microbial infection

          International Journal of Clinical Pharmacology and Therapeutics
          Homoeopathic treatment of otitis media (1997)
          http://www.sandiegohomeopathy.com/downloads/Otitis.pdf
          n=131, duration of pain of 2 days in homeopathy-group (n=103) & 3 days in conventional (antibiotic, antipyretic, secretolytics) group (n=28). 70.7 % & 56.5% of children receiving homeopathy & conventional respectively did not have another ear infection the next year

          1. Chris says:

            Syphilis is not an ear infection. Ear infections are not always bacterial, and may resolve without anything. Try again, and make sure it is the right bacterial infection.

            Here, since you do not know anything about syphilis: http://www.cdc.gov/std/syphilis/stdfact-syphilis.htm

          2. Harriet Hall says:

            That study was a poorly designed observational study without proper controls. And even if you accept its findings (which I don’t) it doesn’t even begin to prove your claim that homeopathic remedies created the physiological micro-environment unsuitable to sustain microbial infection.

      2. Carl says:

        “4. Show me the proof that life expectancy improved *only* due to conventional medicine.”

        We can’t, because you will try to claim credit for hand washing or clean underwear. And therefore magic is real, right?

        Nice try, Nancy Drew.

        1. Hollyanne says:

          to be fair to us people working on the bottom of Maslow’s Hierarchy of Needs, hand washing and clean clothing does improve life expectancy. i get paid based on that evidence :). though i’m sure if i presented a policy stating improving laundry conditions would cure all our clients with cancer or chlamydia i would lose my job.

      3. Stephen H says:

        You have ignored most of my post. Do you believe in germ theory? Should medical practitioners (including the fakers such as yourself) wash their hands? Is electricity a useful part of health treatment? What is a virus?

        Don’t try ducking out of the hard questions. You’re saying that we knew everything we needed to know two hundred years ago, and then just saying “real is homeopathy”. Which is some semantic gibberish that holds no meaning. Likewise your “homeopathy could be lightning fast or slow…” – the reality is that sometimes you get lucky and conditions improve despite your intervention. Mostly, people are good at recovering from health issues. With proper medical care they can recover fully, but the body does its own self-help. So instead of setting a broken leg you sprinkle your magic water – six months on, the bones have knitted and the patient can walk – with a limp and a walking stick. Is that a good “intervention” as opposed to seeing a qualified medical practitioner and getting the job done right?

        Sorry Ms Malik, but you’re walking and talking like a duck.

        1. Chris says:

          ” Do you believe in germ theory?”

          Obviously, she does not, or does not even know they exist.

          She has been asked for proof that syphilis is curable with with homeopathy. It was, after all, one of the miasms identified by Hahnemann, possibly because it was a fairly common and identifiable disease.

          Instead she sends bad papers on ear infections and stuffy noses/sinuses being cured with homeopathy. Neither are even near the symptoms of syphilis, which was identified as a bacterial infection in 1905 (using the wikepedia article).

          By the way, she has been dodging that question for over five years. She was banned by page 5 of that thread.

  3. Bobby Hannum says:

    I unfortunately clicked on the link Malik provided. I cannot help but paraphrase a classic film:

    That is one of the most insanely idiotic things I have ever heard. At no point in your rambling, incoherent article were you even close to anything that could be considered a rational thought. Everyone in this room is now dumber for having listened to it. I award you no points, and may god have mercy on your soul…

    1. David Gorski says:

      OMG. How did such an article ever get published?

      1. stewiegriffin81 says:

        I strongly suspect that it is because James David Adams Jr is on the editorial board of the World Journal of Pharmacology: http://www.wjgnet.com/2220-3192/g_info_20100722180841.htm

        For more horror and amusement (although more horror than amusement), you can see another completely crap article by him in that same journal: http://www.wjgnet.com/2220-3192/full/v2/i3/73.htm

  4. Egstra says:

    “Drugs do not cure or treat diseases. The body heals itself; drugs promote this
    ability of the body to heal itself. Placebos are assumed to be inactive; however, placebos can also promote the ability of the body to heal itself. Placebos are actually treatments that can stimulate endogenous healing mechanisms.”

    I couldn’t get past this amazing paragraph… who ARE these people?

    1. Harriet Hall says:

      Science-based doctors know full well that drugs don’t heal the body. Consider pneumonia: antibiotics don’t heal the lungs, all they do is attack the bacteria that are causing the infection, so the lungs are left free to heal themselves. Science-based doctors also know there is no evidence that a placebo ever promoted the ability of a body with pneumonia to heal itself.

    2. Placebos, like drugs, facilitate the ability of the body to heal itself.

      The body’s healing response is activated
      a. By the patient’s anticipation of the cure because they expect to get better after visiting the doctor.
      b. By the reassurance given by the doctor that he will be cured (empathy)
      c. When given a medicine but not told that it is actually a placebo.

      Placebo also has a therapeutic value. The placebos have surprisingly positive clinical effects on patient’s medical condition because it involves the secretion of dopamine.
      Ref: Understanding Evidence, http://drnancymalik.hpathy.com/2012/08/17/understanding-evidence/

      Samuel Hahnemann, the father of Homeopathy system of medicine, recognises the power of placebo 200 years back.

  5. Cory Franklin says:

    The pulmonary artery question:
    For all intents and purposes the question is closed but I believe it reveals a far more complicated question. I used as many PA catheters in the 1990′s as anyone and I didn’t agree with the findings. Not that the outcomes weren’t better (or were worse) with PA catheters but that was an oversimplified question.
    First- PA catheters were a diagnostic, not a therapeutic tool. To measure outcomes as the indicator of value for a diagnostic tool is a far more parlous enterprise – e.g. patients who have CT scans for head trauma fare worse than those who don’t.
    One may counter that in a truly randomized sample that wouldn’t be true, and that is undoubtedly correct, but the studies that randomized PA catheter patient couldn’t truly randomize lung injury since it is such a complex diagnosis. If they are placed in sicker patients, outcomes will be worse. Randomizing that in lung injury, where there are a multitude of etiologies is quite difficult, if not impossible.
    Second- as a diagnostic tool, it depends on how it is used. It becomes a management tool and that depends on the user, which can’t be randomized. There were simple protocols used in the studies but they were just that, simple. It is impossible to protocol all the management decisions afforded by a PA catheter, and even if one could, as minutes become hours, and hours become days, the options become limitless. Impossible to randomize.
    Third, they provide diagnostic information which give intelligent users information.
    90% of users think they are just some volume measurement tool to obtain a PCWP.
    If you use them like that, you won’t obtain any real benefit because you can divine the same information clinically almost all the time. Example- virtually no one I know used the PA catheter to obtain mVO2 to calculate shunts, a critical aspect of lung injury. This info by itself it does nothing to improve outcome but it makes users more intelligent. You understand the pathology of ICU disease better. How do you measure that? In fact, I used to say you had to put in more PA catheters so you could learn to put in fewer PA catheters, that is as you understood different conditions you could extrapolate the information you had learned about cardiac output, shunt, resistance an O2 utilization. the studies on outcome don’t take that into account. Experienced observers understand the limitation of outcome as a variable- it’s like wins in baseball. Ultimately that’s all that matters but if you are only looking at final scores, you have a limited understanding of the game.
    I am certain I was better with the option of putting in a PA catheter in very sick patients. I saw it too many times. There were only a few times I believe it made an actual outcome difference in a single patient so I believe the literature as far as it extends.But it doesn’t extend that far. What about what I learned for future patients? Knowledge and understanding have their own value- you may argue they are not worth the expense and danger to the patient- fair enough, but that is obviously not a black and white issue, as it is portrayed
    Ironically, the argument is over for a very simple reason. Even if we were to reintroduce the PA catheter today, few people know how to use them. Even fewer than 20 years ago, and that wasn’t that many then. You would see the same thing again. Just measure a PCWP and give fluids then lasix – or lasix then fluids. People actually believed that was good management.

    1. David Gorski says:

      Sure, a lot of these are not as simple as that, but it’s not possible to discuss each one in depth in this post, even as long as it ended up being. However, from my perspective, I remember the knock-down, drag-out debates over routine PA insertion and PCWP monitoring versus highly selective use of the PA catheter, as I was a resident at the time they were going on back in the early to mid-1990s.

      There was, as you might recall, one main intensivist (Shoemaker) who advocated PA catheter monitoring in just about everyone and using it to maximize O2 delivery by almost any means necessary. On the other side were critics like Robin, who as early as 1985 wrote a(n) (in)famous article for the Annals of Internal Medicine entitled The cult of the Swan-Ganz catheter. Overuse and abuse of pulmonary flow catheters, in which he stated:

      The use of pulmonary artery flow-directed catheters has assumed epidemic proportions without clinical trials establishing improved outcome as a result of their use. During the past 10 years, however, it has become clear that improved outcome is found only in small groups of patients and that use of these catheters is associated with considerable risks of morbidity and mortality.

      He also called for randomized clinical trials. I never really appreciated how weak the evidence was supporting routine use of PA catheters until the early 2000s, when those RCTs showing no improved outcomes were published.

      1. Cory Franklin says:

        Knew them both.
        Neither one had a completely accurate take on it. I don’t believe either of them had put one in in over a decade when they wrote their stuff.

    2. windriven says:

      At last a thread on this post that is interesting and meaningful. Can we all please leave Malik to stew in her homeopathic juices? To misquote Officer Barberry, “move along. Nothing to learn there.” My Labrador retriever has a better grasp of causality. She (the Lab) can also tell the difference between a bite of cheese and a bite of air that passed over a piece of cheese 100 or so times. I’ve checked with her and she distinctly prefers the actual cheese.

      1. Stopthequacks says:

        I really want to agree with you and just ignore the stupidity but…

        Futile though it probably will be, there is a pertinent question for Ms Malik to answer.

        Nancy has stated that homeopathy can’t cure a broken bone. One of her homeopathic chums, who Nancy is helping compile a list of “enemies of homeopathy” I kid you not :
        http://fighting-for-homeopathy.blogspot.co.uk/p/our-foes-names-and-faces.html.
        Sandra Hermann-Courtney, has stated on several blog comments that homeopathy can cure broken bones. There is clearly mutual respect.

        So homeopathy has a chance to self correct. Which is it Nancy, cure or doesn’t cure and on what evidence do you base your response? The article is about resolving contradictory findings, and medical science has a well established, if still far from perfect process to do that, as is made crystal clear in this article.

  6. Harriet Hall says:

    Another cause of overuse of tests is the legal system. Doctors sometimes practice “defensive medicine” and order tests so they won’t be crucified in court for not having ordered them. Doctors who have been sued are especially prone to this.

    When a friend of mine was on the witness stand in a malpractice suit, he testified that he hadn’t thought it likely that the trauma patient had had a skull fracture. The lawyer countered, “Then why did you order those skull x-rays, doctor?” “He answered, “So I could tell you I did them.”

  7. @Chris 29 July “…..make sure it’s a right bacterial infection”

    Homeopathic & antibiotic treatment strategies in recurrent acute rhinopharyngitis (2005)
    http://www.ncbi.nlm.nih.gov/pubmed/15751328
    Inflammation of the mucous membranes of nose & throat.
    DBRPCT
    In 499 patients homeopathy yielded significantly better results than antibiotics in terms of effectiveness, number of complications and quality of life

    1. Chris says:

      The common cold and symptoms of allergy are often not bacterial infections, and resolve on their old.

      Again, syphilis is NOT rhinopharyngitis (a runny nose and congested sinuses!). Come on! Hahnemann knew what it was, and claimed to cure it. Why don’t you?

      Try again, only make sure the infection is from Treponema pallidum, a spiral shaped bacteria.

      1. Chris says:

        “resolve on their old.” should be “esolve on their own.”

        Either it is the lack of sleep or laughing to hard for the typos. I need more coffee.

        1. Bobby Hannum says:

          Okay, this made me laugh.

          1. Chris says:

            Yeah, even more typos. I think I’m going to get a triple Americano. :-)

    2. windriven says:

      Your link is to an article in Homeopathy. Are you kidding us?.. Akin to “A New Approach to Transforming Pb into Au by Exploiting Quantum Electrokinematics” appearing in the pages of Alchemy Illustrated.

    3. pmoran2013 says:

      Actually antibiotics are probably not a very good response to the ordinary run of recurrent sore throats and colds, and they probably would be expected to induce more side effects than any inert treatment. The study is also of poor quality and the principal author apparently works for Boiron, which most people will recognise as a seller of homeopathic products.

      We may be repeating history herein. Homeopathy initially gained credibility as a medical treatment through being a less damaging resort than many mainstream treatments of the times for placebo-responsive and potentially self-limiting conditions.

      Nancy Malik, You seem to understand that many of the apparent “effects” of homeopathic treatment could occur with placebo. Would you go a little further and agree that homeopathic remedies should not be used alone in serious illnesses, especially wherever there are clearly effective conventional methods?

      1. Self limiting disease: A person with a disease will get cured once the disease has run its course of action. But the medical treatment can shorten the time to bring the disease to an end more quickly.

        Many of the apparent “effects” of conventional or homeopathic treatment could occur with placebo because placebo effect size in clinical trials is same in both conventional and homeopathy
        http://thewrightdoctor.com/wp-content/uploads/2010/11/Placebo-effect-sizes-in-homeopathic-compared-to-Conventional-Drugs.pdf

        1. weing says:

          Thank goodness you don’t deal with real diseases. It would be unethical to treat meningococcal meningitis, septic shock, respiratory failure, various organ failures, etc with your nostrums. Self-limited illnesses will resolve if you do nothing. So, yes, you can as Voltaire noted in his day, entertain the patient while nature and time effect the cure.

        2. Chris says:

          Syphilis is not self-limiting. This is one reason why I want you to provide verifiable proof from PubMed that homeopathy offers a guaranteed cure of this bacterial infection.

          So far you have only provided cures of self limiting conditions like ear infections and stuffed up noses.

        3. pmoran2013 says:

          You haven’t answered my question.

          Also, that study tells us nothing whatsoever about placebo influences because we don’t know how much of the improvements noted in the placebo arms of those trials are due to spontaneous resolution of symptoms. For example the 69% resolution at five days of otitis media is usual with no treatment, as is the 30-40% resolution of childhood diarrhoea.

  8. Stopthequacks says:

    An anagram of Nancy Malik is Any link, CAM! Which seems to describe the modus operandi, I didn’t include “Dr” as she isn’t.

    Good article but clearly utterly lost on some…same old stuff spouted and the key points ignored, who would have guessed?

  9. Joelle says:

    What are your thoughts on nootropics?

  10. Rachel Irene says:

    If I don’t believe in magic, the placebo effect won’t work for me. I’d rather pursue evidence-based treatment and possibly any placebo effect from that.

  11. mousethatroared says:

    I guess I’m being simplistic, but these discussions always leave me wondering, if the placebo response is so great for pain and subjective symptoms things like fatigue (as some folks on this board seem to suggest), why do my symptoms of pain/fatigue respond so much better to particular medications (anti-inflammatories, DMARDS, levothyroxine) while some medications/interventions (changes in diet, muscle relaxants, antibiotics, some PT, Prilosec, etc) seem to offer little to no benefit. My experience seems to agree more with the folks that suggest most of the benefit observed from placebos is reporting bias, not any real relief for patients like me.

    1. Skepticrat says:

      Because it’s far more complex than that. Physical, psychological, placebo and pharmaceutical factors all vary, and mood, expectations, experiences etc all play a part.

      Sorry you’re in pain. It’s utterly miserable when it just doesn’t stop.

  12. WilliamLawrenceUtridge says:

    Placebos, like drugs, facilitate the ability of the body to heal itself.

    Placebos, unlike drugs, have no effect on the body, which is already doing its best to heal itself. It’s like waving a magic wand then starting your car – you can claim the wand is necessary, but your car will start just fine without it.

    The body’s healing response is activated
    a. By the patient’s anticipation of the cure because they expect to get better after visiting the doctor.
    b. By the reassurance given by the doctor that he will be cured (empathy)
    c. When given a medicine but not told that it is actually a placebo.

    If we’re talking about homeopathy still, then you’re essentially conceding the pills are worthless and the visit to the homeopath is akin to some sort of medicine-focussed mental health counsellor – a nice person you can talk to about your symptoms who won’t do anything to help but at least you feel better. I agree, that’s about all homeopaths are good for.

    Placebo also has a therapeutic value. The placebos have surprisingly positive clinical effects on patient’s medical condition because it involves the secretion of dopamine.

    Sure, nobody here would argue that nonspecific effects during a consultation is important, but why not accompany them with real medicine? If the body is going to release dopamine irrespective who talks to them, why not talk to a doctor, get screened for possibly dangerous health problems, and avoid all the health-harming nonsense of the homeopathic mindset such as opposition to vaccination? Why bother with the expense of buying the homeopathic pills, or the opportunity cost of preparing them in the first place? Your “placebo effects are good” defence of homeopathy discounts the fact that you can get placebo effects from a variety of places including kisses from your mommy, and a real doctor – so why bother with the sugar pills and nonsense?

    Samuel Hahnemann, the father of Homeopathy system of medicine, recognises the power of placebo 200 years back.

    Yep, and about 100 years after he recognized this, people started testing medical treatments, discarded the ones that didn’t work (almost all of them) and used their newfound understanding of biology and chemistry to greatly increase the lifespans and reduce the suffering of people the world-over. A single good-ish observation 200 years ago does not justify slavish devotion to the whole of a person’s set of ideas in perpetuity. I mean, Hippocrates was somewhat correct in saying “let food be your medicine”, but that doesn’t mean we should stop vaccinating (and ignore the fact that with morbid obesity – food is rather the problem).

  13. Bonnie Harris says:

    The theory behind both vaccines and homeopathy is that of “similars”, that a low dose of an agent resembling the one that causes the illness will prevent against that illness. Homeopathy just uses smaller doses of natural agents. Science hasn’t been able to prove why it works yet, so it is discredited. We saw the same thing with cranberry juice and UTI’s for many years. Until scientists could prove that how it worked, they didn’t believe it and called it an old wives’ tale. I’m sure in a few years we’ll find out why homeopathy can work for certain patients. Right now there’s too much money in pharmaceuticals to spend time trying to do that however.

    1. Harriet Hall says:

      No, the theory behind vaccines is not that of similars, and vaccines are intended to prevent a specific illness, not to treat a variety of illnesses that produce similar symptoms. And vaccines only work because they contain a small amount of an agent, whereas homeopathic remedies are said to work when they have been so highly diluted that not a single molecule of the agent remains. If homeopathy had been proven to work, science would not have discredited it just because they didn’t know how it worked, they would have accepted it into the therapeutic armamentarium and then tried to figure out how it worked. Penicillin was proven to work and was enthusiastically accepted long before we understood how it worked. And we already understand very well why homeopathy can “work” for certain patients. Jay Shelton wrote a whole book about it: “Homeopathy: How It Really Works.” I recommend you read it.

    2. Stopthequacks says:

      Bonnie
      The overwhelming evidence suggests it (homeopathy) does not work. So there is not much point looking for a mechanism. You start from a position that it does work and that simply is not proven. It is rather like asking why unicorns evolved horns, as unicorns haven’t been proven to exist it’s just plain ridiculous to ask the question.

      A vaccine actually contains something, and is not acting under any, non-existant “law” of similars there is no relation between vaccines and homeopathy. We know the mechanisms of vaccination.

      Most homeopathic remedies contain nothing (and do nothing).

    3. Chris says:

      “Homeopathy just uses smaller doses of natural agents.”

      Actually, it does not use “smaller” doses, it uses no doses of natural agents.

      What they do is a serial dilution, for anything with a “C” in it they take one part in a hundred (the C represent a hundred like in Roman Numerals), and then take one part of that, and dilute it into a hundred parts of of solvent. The typical homeopathic remedy is “30C”, which means that it is one part remedy to 10 raised to 60 (that 2*30), because it is 100*100….*100, 30 times… or:
      one part in a number which is a “1″ followed by 60 zeros.

      In short one part of solution versus the more than they number of atoms on this planet.

      One simple reason why we know it does work is that you can’t get something out of nothing, and we know that if you dilute past Avogadro’s Number, you are more likely to have contaminants instead of the original remedy. Because there is no way to get pure water, alcohol or even sugar pills.

      Homeopathy is just a pre-science concept that lingers on by using real science terms very badly.

      1. David Gorski says:

        Precisely why I use homeopathy as an example. :-)

    4. There is no good evidence that Cranberry juice helps UTI – don’t give stupid examples to justify homeopathy!

    5. Stephen H says:

      What is this “too much money in pharmaceuticals” crap? People have thrown money at studies of homoeopathy and other quackery, and the evidence is in. Properly conducted trials all show no meaningful effect.

      There is no “grand conspiracy”. Your access to cheap and useful information about your own health is greater than at any time in history. And still, people say “you don’t like it because of x, so you’re covering it up”. I left my Illuminati robes at the dry cleaner’s, and unless you’re Jewish I can’t tell you about how the banks are run – but… bullshit!

      Ockham’s razor – the simplest explanation is usually correct. And the simplest explanation for why there has never been a properly conducted study showing homeopathy to be useful, is that IT IS NOT!

      And as someone utterly lacking in medical training, even I can tell you that vaccines are not based upon “similars”. They are based around something very complicated called the immune system. I could go on, but will almost certainly say something that proves how little I know.

      Science works because it takes an idea, tests it and if the idea fits accepts it. Does the Earth go around the Sun or vice versa? Dunno – how can we tell? And so someone smart thinks of a way to find out. In fact, we knew the Earth went around the Sun for millennia prior to Galileo – but tended to forget it. And so astronomers used complicated charts to account for planets that swooped in weird circles – when in fact gravity explained the movements. Then in the late 19th century, other scientists were having trouble with their (much more accurate) observations. They didn’t comply with what Isaac Newton said. Finally, Einstein came up with a new theory about gravity, which is “close enough” for most things. But there are some areas of “concern”.

      Science works because it tests, and disposes of the stuff that doesn’t work. Homoeopathy, having been around for 200 years, has not changed at all (as “Doctor” Nancy Malick tells us all). Homoeopathy has also, in that 200 years (and consistent with similar quackery), constantly failed to demonstrate any effect other than placebo. I would say that prescribing a placebo for a treatable illness is immoral – wouldn’t you?

      In the meantime, there is a very simple explanation for why homoeopathy “works” for “certain patients”. It involves gullibility, and treatment of self-correcting conditions. It goes along the same lines as “If I take nothing for my cold I’ll be better in two weeks, but if I take Vitamin C I’ll be better in only 14 days”. Show evidence of homoeopathy curing any pre-existing condition that is definitely existent in the patient, and is not self-limiting (e.g. colds), and the doctors who have posted on this page will come knocking down your door. At the moment, there is no evidence and so absolutely no reason for anyone sensible to spend money on a non-solution.

    6. Skepticrat says:

      Actually, cranberry juice is pretty much useless for treating UTIs and very little help preventing them except a teeny possibility in the elderly. Do keep up.

  14. WilliamLawrenceUtridge says:

    The theory behind both vaccines and homeopathy is that of “similars”, that a low dose of an agent resembling the one that causes the illness will prevent against that illness.

    Oh good lord no. Vaccines deliver a measurable dose of a specific antigen (usually quite few, as low as 7 molecules I believe) and work through the well-recognized and empirically validated though complex and imperfectly understood action of the immune system. It is based on a match between an antigen and a disease and its efficacy is demonstrated by the reduction in diseases within a population.

    Homeopathy delivers a nonexistent dose of a randomly chosen (sometimes fictional – moonlight anyone?) agent which is matched based on symptoms and is purported but not show to work through a mechanism that is illusory (if a mechanism is even proposed, there are several competing mechanisms, none of which have even been proven to work, let alone be correct). Its efficacy is demonstrated by the effects of a nostrum on healthy individuals.

    In addition, vaccination is only applicable for a limited set of certain diseases. It claims an important but highly restricted efficacy and is not claimed as a panacea. Homeopathy claims to be able to cure all diseases and treat all symptoms.

    Comparing the two is akin to saying yogic flying has the same theory as a Boeing 747, or a steam engine operates on the same principles as a perpetual motion machine, or astrology is validated by the existence of psychometric personality tests, or alien abductions are validated by the laws of ballistics. It reveals far more about the claimant than it does about the subjects.

    Homeopathy just uses smaller doses of natural agents.

    Do you understand the reason why Avogadro’s number is invoked? Once you get beyond a certain dilution (12C I believe), there is no chance that an original molecule will be left in the homeopathic solution, let alone the tiny amount sprayed on a ball of lactose. You simply can’t claim that homeopathy works through the action of molecules, which is why proponents have to handwave things like “quantum” or “water memory”. See Jay Shelton’s Homeopathy: How it really works for a more complete description of what homeopathy actually is, because you are apparently ignorant of its specifics.

    Science hasn’t been able to prove why it works yet, so it is discredited.

    Actually, science proves nothing. Science tests, and if the results are positive, the hypothesis tested gets little more than a notation of “didn’t fail”. Your statement also assumes that it does work, which puts the cart before the horse – multiple tests, particularly high-quality test, have shown repeatedly that it doesn’t work. If homeopathy showed a consistent, well-validated pattern of actually making a difference, scientists would be excited because they would be uncovering hitherto-unknown principles of physics and chemistry. But when tested, lactose pills without any homeopathic preparations sprayed on them have exactly the same influence as lactose pills with such preparations. Now, homeopaths pretend this means that both pills are effective, while rational people recognize the truth – homeopathy is exactly as much nonsense as you would expect.

    We saw the same thing with cranberry juice and UTI’s for many years. Until scientists could prove that how it worked, they didn’t believe it and called it an old wives’ tale. I’m sure in a few years we’ll find out why homeopathy can work for certain patients.

    First off, you might be premature in claiming cranberry juice is effective. The actual results are more complicated. If there is an effect, it certainly doesn’t seem to be a strong one. Second, you’re still assuming it works rather than testing to see if it does work. Third, it has been 200 years now, and we have yet to find evidence that homeopathy works for anyone; why do you expect that to change?

    Right now there’s too much money in pharmaceuticals to spend time trying to do that however.

    Heh wrong. Homeopathy is quite a lucrative business to be in, I’m surprised Pfizer isn’t ponying up to that particular cash cow. But in addition –pharmaceuticals having lots of money invested in them does not preclude homeopathy being effective. Lots of homeopaths do (normally terrible) studies on homeopathic preparations. When they do good studies, the results are usually negative. When you pool the studies, the results are negative. So even when you get proponents testing their remedies, when adequate controls are used, homeopathy fails no matter how much money Boiron or GSK makes in a year.

    If homeopathy works, particularly if it is as “powerful” as proponents claim it to be, it should be easy to demonstrate. Yet, when proper controls are used, each group is indistinguishable. Why is that? Perhaps because homeopathy doesn’t work.

  15. WilliamLawrenceUtridge says:

    The legal status of homeopathy medicine in India is on an equal footing with conventional [Bachelor of Medicine and Bachelor of Surgery (MBBS)], Ayurveda (recognised since 1969), Unani, and Siddha medicine. It is recognised by Central Council of Homoeopathy , Deptt. of AYUSH, Ministry of Health & Family Welfare, Govt. of India since 1973.

    The meticulous regulation of nonsense still produces nonsense. Legally mandating that the tooth fairy must leave a minimum of $5 per tooth, or that all reincarnation must occur on the fourth business day of the month, in no way indicates that either exist.

    Also, comparing your credibility to that of Ayurveda doesn’t help, as that is just as much nonsense as homeopathy. “Eat yogurt, it’s better for you than potato chips” – brilliant insight. Simply astonishing.

    Regular full time 5.5 years graduate medical degree [Bachelors in Homoeopathic Medicine and Surgery (BHMS)] that includes one year compulsory internship (approx 4800 hours in total)is absolutely necessary for becoming qualified & to get license to practice homeopathy medicine in India. And to do regular full time M.D. in any one of the 7 specialisations (Medicine, Paediatrics, Psychiatry, Pharmacy, Organon, Materia Medica, Repertory) of homeopathy medicine, you have to spend three more years after BHMS.

    Wow, you have to waste an astonishing amount of time before you can declare yourself a pretend doctor of imaginary medicine.

    1. Egstra says:

      This blog really needs a like button.

      1. WilliamLawrenceUtridge says:

        I agree :)

    2. Stopthequacks says:

      No hydrology option?

    3. Stephen H says:

      I think I have found the example you were looking for…

      http://en.wikipedia.org/wiki/Indiana_Pi_Bill

    4. I doubt if any court of law anywhere in the world would accept the opinion of a homeopath to give expert opinion.A conventional (science based) medic is held responsible for his actions in a court of law, the homeopath can just shrug off any conviction with ” but your honour, I am not a doctor! “How convenient for them!

  16. Jeannie says:

    Please consider doing further research on CAM. Even if you watch Morgan Freeman’s “Through the Worm Hole” you will begin to see how quantum physics (science) actually gives proof of why CAM’s work.

    1. Harriet Hall says:

      Quantum physics does not give proof of why CAM’s work. Some people speculate that it does, but they fail to understand quantum physics and fail to understand what constitutes proof. Anyway, before you try to explain why or how something works, you have to establish that it does work. Most of CAM has not been established to work other than as placebo.

      1. Harriet Hall says:

        Jeannie, your website describes you as a “Spiritual and Complementary Health Care Practitioner, Helping you to Release what is holding you back from achieving your life’s dreams, Teacher, Psychic, Clairvoyant, Clairaudiant, Channel, Medium, Telepath, Hypno-Therapist, Meditation, Past Life Regression, Enlightenment, Ascended Master Channel, Releasing, Reiki, Arcing Radial Light Practitioner, Certified Matrix Energetics Practitioner, Certified Matrix Energetics Study Group Leader and helping you to tap into your INNER GENIE to CONNECT to YOUR natural intuition–those gut feelings that never steer you wrong!” This is a science-based medicine blog, and none of the things you do are based on science. If you choose to comment here, you will be expected to support your opinions with peer-reviewed studies published in reputable scientific journals, not movies like the one with Morgan Freeman.

        1. I agree with Harriet, this is a science based medicine blog.it is one thing when supporters of homeopathy and other pseudoscientific CAM voice an opinion, but an entirely different situation when practitioners of voodoo, magic and mysticism log in.The only good thing about this is that medics who don’t see any harm in CAM, can now see what they are up against before accepting the integration of CAM into mainstream medicine.A bunch of quacks and cranks…

    2. WilliamLawrenceUtridge says:

      Jeannie, quantum effects normally occur only on small particle levels, at most perhaps a single large molecule.

      How do you explain the scaling-up of the quantum effects to macroscopic scales and meaningful timelines when you consider scientists expend considerable energy just getting single atoms to show coherence over more than a hundred milliseconds?

      How do quantum effects, which generally affect single molecules and lose their special properties within milliseconds, result in specific, health-positive changes for whole organs? Particularly when quantum effects require two particles to be in contact initially and isolated from any outside forces to maintain entanglement.

      Quantum effects generally imply merely that two particles initially in contact separating but retaining similar states (i.e. spin states, or polarity) for a limited duration if not acted upon by another force, as little as a single photon. Further, this is a physical effect, not a mental one – to get quantum effects to occur, you need machines, extremely expensive machines that can generate quantum states on isolated molecules, then measure the results in deep isolation from outside influences. I am unaware of any experiments illustrating quantum mechanical effects that can be generated by a human independent of said machines.

      You might try reading How to Teach Physics to your Dog by Chad Orzel, a quantum physicist (specifically quantum photonics I believe) who explains the basics of quantum mechanics. He specifically addresses the health claims on pages 219-223.

      There are lots of fascinating experiments and counterintuitive results regarding quantum physics. The phenomena are actually well understood, tested to a dozen decimal places of accuracy, among the best and most reproducible results in science. Yet despite these incredible successes, no quantum physicist believes that it explains CAM results – only CAM practitioners who don’t understand quantum physics.

    3. Stephen H says:

      I hadn’t realised that Morgan Freeman understood quantum physics. I do know that I’m not smart enough to say anything useful about it – but I am at least smart enough to know that I’m dumb.

      Morgan Freeman is a very good actor.

    4. Stephen H says:

      Please, someone with a clue of how to do decent work on Wikipedia, go to that show’s page at http://en.wikipedia.org/wiki/Through_the_Wormhole and update it to make clear the difference between entertainment and science.

      I don’t have the skills, but the Wikipedia entry is basically an ad as it currently stands. About an “American science documentary television series” – which if Jeannie reports accurately is somewhat over-selling the series’ credentials. (Although I can see no reference to CAM, or to scam, or to “quantum medicine”.)

      1. We already know ( from overwhelming trials) that homeopathy does NOT work.Now Jeanie wants us to look at Quantum physics to get proof of how it works!! The trouble with people such as Jeanie who have no insight into basic science ( let alone Quantum Physics) is that they really cannot evaluate clinical response. I don’t think any logical reasoning will help. They are so deluded or might actually have a real delusional disorder making them incapable of logical reasoning.

      2. WilliamLawrenceUtridge says:

        Unfortunately wikipedia relies on reliable sources to justify any changes – unless an independent source has reviewed the series and pointed out that it is nonsense, then the page is unlikely to change. RationalWiki on the other hand, allows more direct and pointed commentary and is explicitly from a skeptical perspective.

  17. lilady says:

    test post

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