As a group blog, Science-Based Medicine brings a variety of perspectives to issues of science in medicine. However we align around a few core principles which define what science-based medicine is, and how it should be practiced. One principle we emphasize is the importance of subjecting the evaluation of all health interventions and treatments to a single, science-based standard. One of the biggest successes of the alternative medicine industry, worldwide, has been the embedding of different regulatory standards for the evaluation and approval of so-called “non-drug” products such as supplements, herbal products, and non-scientific treatment systems like homeopathy or traditional Chinese medicine (TCM). The implications cannot be overstated: this different and lower standard is now so firmly entrenched in most health systems that few seem to question its rationale, or consider the consequences. As a practicing pharmacist I spent the first decade of my career working within this regulatory framework without ever stepping back to question why we regulate some products differently. I started reading, took the red pill, and here I am today. (more…)
Archive for Homeopathy
A couple of months ago, a reader sent me an article that really disturbed me. In fact, I had originally been planning to write about it not long after I received it. It is, as you might imagine given my specialty and what disturbs me the most wehen I encounter quackery, a story of a cancer patient. Worse, it’s the story of a cancer patient in my neck of the woods. True, it’s not in the same country, but my cancer center is only around two or three miles from the Detroit River and the Canadian border; so it’s plenty close enough. Too close, in fact. Reading the story, in fact, I realized that it features a form of cancer quackery that, as far as my searches have been able to tell me, we haven’t covered before here at SBM, which alone makes it worth taking on, even though the story is two months old. The “cure” is called Cantron, and it is deeply rooted right here in my metropolitan area. Not only that, its siren song and false promises are attracting patients from across the boarder in Canada. Bernie Mulligan is one such patient:
I had never heard of Dr. Shantaram Kane, a chemical engineer in Mumbai, India. I don’t know how he heard of me, but he apparently knows I am critical of homeopathy. He e-mailed me out of the blue to tell me about a study he had published in 2010 in the journal Homeopathy: “Extreme homeopathic dilutions retain starting materials: A nanoparticulate perspective.” The full text is available online here. It was lauded in an accompanying editorial. Incredibly, it is an uncontrolled study.
Kane recognizes that a major objection to homeopathy is that, at high potencies, not a single molecule of the starting material is present. He says his study found nanoparticles of the parent metal in 200C dilutions of metal-based remedies. He says his findings represent a paradigm shift. In other words, there really is something there when we assumed there wasn’t. (more…)
On Friday, you might have noticed that Mark Crislip hinted at a foreshadowing of a blog post to come. This is that blog post. He knew it was coming because when I saw the article that inspired it, I sent an e-mail to my fellow bloggers marking out my territory like a dog peeing on every tree or protecting my newfound topic like a mother bear protecting her cubs. In other words, I was telling them all to back off. This article is mine.
Mine! Mine! Mine! I tell you!
My extreme territorial tendencies (even towards my friends and colleagues) notwithstanding on this issue aside, if you read Mark’s post (and if you didn’t go back and read it now—seriously, go now), you might also remember that he was discussing a “reality bias” in science-based medicine (SBM), a bias that we like to call prior plausibility. In brief, positive randomized clinical trials (RCTs) testing highly implausible treatments are far more likely to be false positives than RCTs testing more plausible treatments. That is the lesson that John Ioannidis has taught us and that I’ve written about multiple times before, as have other SBM bloggers, most prominently Kimball Atwood, although nearly all of us have chimed in at one time or another about this issue.
Apparently a homeopath disagrees and expressed his disagreement in an article published last week online in Medicine, Health Care, and Philosophy entitled Plausibility and evidence: the case of homeopathy. You’ll get an idea of what it is that affected us at SBM like the proverbial matador waving his cape in front of a bull by reading this brief passage from the abstract:
Prior disbelief in homeopathy is rooted in the perceived implausibility of any conceivable mechanism of action. Using the ‘crossword analogy’, we demonstrate that plausibility bias impedes assessment of the clinical evidence. Sweeping statements about the scientific impossibility of homeopathy are themselves unscientific: scientific statements must be precise and testable.
Scientific. You keep using that word. I do not think it means what you think it means. Of course, his being a homeopath is about as close to a guarantee as I can think of that a person doesn’t have the first clue what is and is not scientific. If he did, he wouldn’t be a homeopath. Still, this particular line of attack is often effective, whether yielded by a homeopath or other CAM apologist. After all, why not test these therapies in human beings and see if they work? What’s wrong with that? Isn’t it “close-minded” to claim that scientific considerations of prior plausibility consign homeopathy to the eternal dustbin of pseudoscience?
Not at all. There’s a difference between being open-minded and being so “open-minded” that your brains threaten to fall out. Guess which category homeopaths like Rutten fall into. But to hear them tell it, homeopathy is rejected because because we scientists have a “negative plausibility bias” towards it. At least, that’s what Rutten and some other homeopaths have been trying to convince us. This article seems to be an attempt to put some meat on the bones of their initial trial balloon of this argument published last summer, which Steve Novella duly deconstructed.
Before I dig in, however, I think it’s necessary for me to “confess” my bias and why I think it should be your bias too.
I usually rely on the Secret. Every two weeks or so the Universe offers up some bit of wacky whimsey and I have a topic for an SBM blog entry. This week the Universe has failed me. Nothing has crossed my LCD so I have no studies to evaluate and I have been unusually busy at work preventing my browsing the Interwebs for material. But try telling that to the Managing Editor. I write half to amuse myself, half to learn about the topic, and half to clarify in my own mind the topics at hand (1). So this week is content free idle thoughts for my own benefit.
I have been reading 13 Things That Don’t Make Sense by Michael Brooks. The book concerns topics in science that are unexplained by the current understanding of the laws of the universe or contradict the dominant paradigm. Well, almost. His final topic is homeopathy, and it is the one topic whose conclusions, while qualified, belong on Failblog. The first chapter concerns dark matter and dark energy and how what we can see makes up only a small fraction of the content of the universe. (more…)
Although I write the definitive entries on topics in this blog, new information trickles in after publication. The new studies are often not worth an entire entry, recapitulating prior essays, but the new information is still worth a mention. What follows are updates on topics covered in prior SBM posts.
In Oregon we are having a small outbreak of infections from consumption of raw milk. Not a surprise, since milk is a wonderful culture media and the udder is just down the gravity well from the cows anus. Raw milk violates the classic dictum “Don’t shit where you eat” although I understand the saying concerned dating in its original conception.
Although the sale of raw milk is illegal in muchof the US, the law can be bypassed by owning the cow rather than buying the milk, a reverse of dating advice. Such is the case in Oregon, where 48 people are time sharing the cows responsible for the current outbreak. There has been the spread of pathogenic E. coli to at least 5 people, mostly children, and has lead to the hospitalization of at least 3 children.
Of course, it is hard to get infected. Humans have lived in Filth and Squalor (like Minneapolis and St. Paul or Buda and Pest) for centuries, drinking and eating contaminated food and enough survived perpetuate the species. Most infections in the past would have been from consuming contaminated food and drink. I have wondered if the reason fevers are often associated with diarrhea and/or vomiting is that it an evolved response for removing infected material as soon as possible.
Five consumer lawsuits are pending in the U.S. against Boiron, the world’s largest manufacturer of homeopathic products. One lawsuit is also pending in Canada. As reported in a previous post, the U.S. plaintiffs claim they purchased homeopathic products, such as Coldcalm, Oscillo, Arnicare and Chestal Cough Syrup, based on Boiron’s misleading and false statements that they are effective for various ailments. Therefore, these plaintiffs allege, Boiron has defrauded consumers, as well as violated various consumer protection laws. Boiron denies these claims.
we can summarize . . . by saying it has extreme implausibility and the clinical evidence shows lack of efficacy. It should not work, and it does not work. There is no legitimate controversy about this.
Which raises an interesting question: how does one defend a product that appears to be indefensible? Let’s take a look. (more…)
Last week I wrote about a regrettable piece on homeopathy that was published in Scientific American Brasil. There have been gratifying developments. Within hours, the editor in chief of Scientific American, Mariette DiChristina, appeared in the Comments. She said that Scientific American does not condone the pseudoscience of homeopathy, that the piece clearly should not have been published, that it would never have been published if Scientific American had been consulted beforehand, and that she had complained to the responsible parties. I was very grateful for her response to my article, for her intervention, and for her willingness to speak out in support of good science.
Lo and behold, two days later Ms. DiChristina reported that the editor of Scientific American Brasil had written a letter of apology and had published it on the website. Here is a full translation:
There is a disturbing lack of protection for the consumer of “complementary and alternative” products and services. I can think of no other area of commerce where misleading, as well as out and out false, information is so regularly employed, without consequence, to entice the consumer into forking over his hard-earned cash. Nor do I know of any other manner of goods or services where giving consumers patently false information is protected by law.
Consider first the fact that nonsensical gibberish is enshrined in state law in the form of “CAM” practice acts, which give practitioners of implausible, if not wholly discredited, diagnostic methods and treatments carte blanche to ply their trades. For example, as has been discussed before on SBM, state law defines chiropractic as the detection and correction of subluxations, which, as many chiropractors themselves admit, do not exist. State practice acts define acupuncture in such pseudoscientific terms as “modulation and restoration of normal function in and between the body’s energetic and organ systems and biomechanical, metabolic and circulation functions using stimulation of selected points.”
As well, naturopathy practice acts allow “mixing and matching treatments including traditional Chinese medicine, homeopathy, herbalism, Ayurvedic medicine, applied kinesiology, anthroposophical medicine, reflexology, craniosacral therapy, Bowen Technique, and pretty much any other form of unscientific or prescientific medicine that you can imagine.” State practice acts also permit the indiscriminate use of the term “doctor” and “physician.” Scope of practice is broadly defined as “primary care.” (more…)
I recently received an e-mail from one of SBM’s readers in Brazil, Felipe Nogueira Barbara de Oliveira, a PhD candidate in Medical Science who holds an MS in Computer Science and is who is trying to promote critical thinking and scientific medicine in his country. He sent me a jpeg copy of a short piece that was published (in Portuguese) in the April, 2012 issue of Scientific American Brasil. He was appalled that this appeared under the aegis of Scientific American, and so was I. He provided the translation which follows.
Warning: this is painful.
The Questioned Effectiveness of Homeopathy
Application of this technique in agriculture shows recuperation of plants and environment.
Homeopathy is known as an alternative treatment for human beings, but few people know about its utilization on animals, plants, soils, and water. This technique is the target of critiques regarding results and efficacy. One of them is about the “placebo effect” of its remedies, which do not contain any trace of the raw material used in its preparation. To answer this criticism, a clarification is necessary: homeopathy is not related to chemistry, but to quantum physics, because it works with energy, not with chemical compounds that can be qualified and quantified. (more…)