Pointless poll on a medical absurdity


Unbelievable. The BMJ hosted a written debate on homeopathy. The side for homeopathy blathers on about various studies and meta-analyses and mostly just vaguely suggests positive results; when they get specific, the best they can say is that homeopaths use fewer antimicrobials. And their summary is truly ignorant.

Doctors should put aside bias based on the alleged implausibility of homeopathy. When integrated with standard care homeopathy is safe, popular with patients, improves clinical outcomes without increasing costs, and reduces the use of potentially hazardous drugs, including antimicrobials.

We should set aside the fact that there is no mechanism to allow water to magically retain the power of non-existent molecules? I cannot do that, sir. I also cannot set aside the ludicrous rationales provided for the medical utility of plain old water, which suggest that homeopathic practitioners are gullible fools.

The side against homeopathy could be better; the ‘for’ side is admitting that their mechanism is hand-waving and jiggery-pokery, but that trials show that it actually works. The ‘against’ side mentions that the controlled studies shoot it down, but could use more details.

Numerous trials have tested the clinical efficacy of homeopathic remedies. Their results depend critically on the study design: uncontrolled studies almost invariably yield positive findings (for example, Spence and colleagues’ observational study), whereas this is not true for the most rigorous of the 250 or so controlled clinical trials (such as a study in headache by Walach and colleagues).

Accompanying the debate is an online poll. The alt med known-nothings have been hard at work.

Should doctors recommend homeopathy?

Yes 60.49%

No 39.51%

Meanwhile, while a pointless debate goes on, the University of Toronto has had a course taught by a homeopathic anti-vaxxer on alternative medicine. No longer, fortunately.

University officials have said that the course will no longer be taught, and that Landau-Halpern is no longer part of the staff. But how she made it into the U of T in the first place remains an open question, though Gunter pointed to one explanation: Landau-Halpern happens to be married to the dean of the university’s campus that held the course.

And the University of Minnesota still maintains a den of quackery called the Center for Spirituality and Healing, and the university medical center offers a vaguely non-judgmental description of homeopathy.

Homeopathy is thought to create a healthful balance within the body. It is also thought to unlock the body’s natural power to heal itself.

Right. And the Earth is thought to be flat, by some.

Comments

  1. says

    Polls like this only demonstrate how important it is for there to be strict control of medical practice, because the average person doesn’t have a clue and can easily be hustled by whatever nonsense the next self-deluded snake-oil salesman comes up with.

    Sure, once you look into these things it’s easy to see it’s nonsense, but most people have neither the time nor the inclination to do so. They rely utterly on getting good, professional advice. Allowing scams like homeopathy to be presented as if they were medicine throws these people to the wolves. It puts the biggest burden on the people least capable of bearing it and that’s a shameful (if all too common) way for a society to behave.

  2. madtom1999 says

    Take a dip in the sea – all homeopathic remedies end up here so it should cure you of everything for free!

  3. Al Dente says

    It is also thought to unlock the body’s natural power to heal itself.

    They admit the placebo effect exists.

  4. F.O. says

    If homeopathy is true, then physics as we know it must be rewritten.

    Imagine the incredible portents that await us thanks to these strange properties of matter!
    New energy sources? New materials? Less invasive diagnostic techniques? Interstellar travel?

    Yet, the proponents of homeopathy are strangely silent on this topic, and oddly reluctant to put their money where their mouth is: they are content with how this weirdness works , they display not the slightest interest in going deeper.

    Truly homeopathy is the death of curiosity.

  5. kalil says

    I was just re-reading the old Ambrose Bierce Devil’s Dictionary. In it, he offers the following:

    HOMŒOPATHY, n. [1.] A school of medicine midway between Allopathy and Christian Science. To the last both the others are distinctly inferior, for Christian Science will cure imaginary diseases, and they can not. [2.] A theory and practice of medicine which aims to cure the diseases of fools. As it does not cure them, and does sometimes kill the fools, it is ridiculed by the thoughtless, but commended by the wise.

    HOMŒOPATHIST, n. The humorist of the medical profession.

    I actually hadn’t realized that woo was so old (Devil’s Dictionary was published in 1906). Smart folks recognized it for what it was even then.

  6. Al Dente says

    F.O. @4

    So the magical pill which, added to a tank full of water, will drive a car for a thousand miles/kilometers/stadia/something lengthy, is homeopathic.

  7. coragyps says

    Maybe some crack investigative reporter- Geraldo Rivera, perhaps- should look into how homeopathic preparations are actually manufactured these days. I would like to see some secret-camera footage of a bunch of folks in lab coats and face masks thwacking bottles against leather pads, and then pipetting a hundredth of the contents into another bottle for the next operator to thwack.
    Or do you think someone has invented an autothwacker and done double-blind studies to show that it’s just as effective as hand-thwacking? And do homeopaths ever advertise their product as “hand-thwacked?” Would anyone buy it if they did?

  8. amrie says

    When integrated with standard care homeopathy is safe, popular with patients, improves clinical outcomes without increasing costs

    Pretty much anything that’s both safe and popular with patients (people in general) will improve clinical outcomes at least a little bit. Have your patients play with a kitten/puppy for 15 minutes every day, it’s cheaper than homeopathy.

    and reduces the use of potentially hazardous drugs, including antimicrobials

    That’s not because the treatment works, that’s because you give your patients a placebo pill instead of antibiotics when they refuse to accept that 1. they don’t need it and 2. it won’t work because it’s a virus infection.

  9. dick says

    I really must get on with marketing my brand of homeopathic whisky, (guaranteed no hangovers). At twenty bucks a bottle, it’s a steal.

  10. oualawouzou says

    When integrated with standard care homeopathy is safe, popular with patients, improves clinical outcomes without increasing costs, and reduces the use of potentially hazardous drugs, including antimicrobials.

    And a generous portion of Nutella is “part of a complete and healthy breakfast (that includes whole wheat bread, a bowl of unsweetened oatmeal, strawberries, 250mL of milk and half a grapefruit)”.

  11. slithey tove (twas brillig (stevem)) says

    obligatory:
    xkcd’s “Placebo Blocker”
    .
    nota bene:
    When integrated with standard care homeopathy is …[good stuff]
    yeah, tell me all about it. all that “good stuff” can also come from daily prayer, reading the I Ching, etc etc, when integrated with standard care. I infer, that statement is saying that the healing would be ineffective without the homeopathy integrated with it.
    The goodness of homeopathic care, I suspect, comes from the homeopaths attention to the victimclient. That the “bedside manner” is far more important than most realize. All I see in homeopathy is bedside manner training, with bottled water (labelled as “cure”) as a simply a prop to occupy the ~client.

  12. says

    Doctors should put aside bias based on the alleged implausibility of homeopathy.

    Willing suspension of disbelief is great in sciences fiction; not so great in science or medicine.

    @coragyps

    “Hand-thwacking.” I see employment opportunities for millions of adolescent boys.

  13. Rich Woods says

    @Al Dente #6:

    So the magical pill which, added to a tank full of water, will drive a car for a thousand miles/kilometers/stadia/something lengthy, is homeopathic.

    It get’s even better: add just one-hundredth of that pill to the tank of water, and it’ll power a fusion rocket for a light-year.

  14. slithey tove (twas brillig (stevem)) says

    All standard pharma commercials list all the potential downsides of the drug they’re advertising. What harm can come from drinking water where the “bad stuff” has been diluted beyond existence?
    What harm in drinking water? I suspect that may have something to do with the rising prevalence of homeopathy.
    Maybe we can get the Dihydrogen-Monoxide fearmongers to debate the homeopaths. I got my popcorn waitin.

  15. says

    Yep, homoeopathy is very effective at providing a placebo effect for people who simply needs some time and rest to get better. That’S the thing: many people believe that they NEEEEEEEEEED some pills and homoeopathy gives them pills.
    It’s like my kid who needs a packet of bandaids a week to get her over tiny scratches.

  16. jaybee says

    improves clinical outcomes without increasing costs

    Doesn’t increase costs? Homeopathic remedies are a multi-billion dollar per year industry. Perhaps big pharma really is big, but big homeopathy is catching up.

  17. mynax says

    “without increasing costs” — so the homeopaths are going to work for free, and not charge for doses of magic water?

  18. slithey tove (twas brillig (stevem)) says

    re @15:
    Like the patients who, having a cold, go to a doctor and demand antibiotics. Even when the doctor tells them antibiotics don’t work against viral infection (colds being virii), they’ll refuse to leave until the doctor prescribes an antibiotic. They’ll come back in a week, no longer with a cold and proudly declare, “see, I told ya so!! The antibioes worked, I’m cured. You know nuthin with your MD letters attached to your name, big deal.”

  19. numerobis says

    Does the placebo effect depend on cost? If so, someone should make a sugar pill that you need to fill out a form to get. The form asks which charity should get the profits. Then you mark it up to homeopathic prices. Everybody wins!

  20. says

    various studies and meta-analyses and mostly just vaguely suggests positive results

    Once they’ve decided to engage with the scientific method at all, it’s all over. The only hope they have is end-runs or faith.

    If they were smart they’d be having a site called “recently published- studies”.com or “Presigious Atheist Skeptical Research Not Richard Dawkins Journal.com” publish them and they could screech “PUBLISHED IN PRESTIGIOUS RESEARCH JOURNAL!” (prestigiousresearch.com is available at this moment… aaaact now!!)

  21. says

    Does the placebo effect depend on cost?

    Please contact us for BeSt pure 100% Placibin-extract from placebo seeds grown in our farms. We seel only best Placebo extract! No scam! Patented process!!

    (The scary thing is you could probably patent a method of extracting Placibin but you’d have to prove infringement if someone was using placebos the contained placibin derived by your method.)

  22. gshelley says

    It’s not just that there is no plausible mechanism. Even If there was a way for water to form a permanent 3D structure that could then serve as a template to create a second 3D structure of whichever of the thousands of molecules present is the one that is wanted, that would be diluted in just the same way as the original molecule.

  23. briquet says

    @5: I know what you mean–mentally I think of homeopathy as new quackery even though I technically know better. The most amazingly disastrous story of it from the 19th century:

    Brilliant mathemetician George Boole (think “Boolean Logic”) was sick after having caught a cold. His wife was into homeopathy. Since the cause of the illness was “damp” she tossing pouring buckets of water on him. He ended up dead at 49.

    https://en.wikipedia.org/wiki/George_Boole#Death

  24. komarov says

    Perhaps homeopathic remedies should come with similar labels like tobacco products (that sadly still hang around nonetheless):
    – “Not actually effective”
    – “Not recommended for actual illness”
    – “Does not cure cancer. Sorry”
    – “Your doctor just wanted to get rid of you”
    – “Suitable for children but you ought to buy them real sweets”
    – “Possibly superior to tapwater*”
    – “Take this instead of the real medicine and your doctor will be rid of you”
    – “Not suitable for medical emergencies”
    – “Please do not donate to relief organisations”

    *With a long small-print disclaimer regarding variations in water quality etc.

    And I was wondering among the same lines of F.O.’s energy source. All you’d have to do, really, is add a few joules (less is more) of energy to the water and dilute it. A technician with a hotplate, a bottle of water and a few beakers and pipettes could power entire civlisations! And before someone complains about conservation of energy, let me paraphrase a quote from the opening post:

    People should put aside bias based on the alleged implausibility of homeopathic energy.

    I am currently looking for investors, by the way. A pilot project will cost just a few billion dollars and you can get in on this exciting new venture today!

    Re: Numerobis #19:

    I dimly remember reading about experiments where the placebo effect depended on what colours the capsules had. One colour scheme would result in a greater effect than another, something among those lines. I wouldn’t be surprised if you got the same effect if you told people the prescription was very expensive* or really did make them go through special procedures like forms just to get their ‘highly potent medicine’.

    *… and then charged their insurance pennies, presumably. Placebos pose enough ethical challenges without overpricing.

  25. microraptor says

    jaybee # 16

    Doesn’t increase costs? Homeopathic remedies are a multi-billion dollar per year industry. Perhaps big pharma really is big, but big homeopathy is catching up.

    Actually, Big Pharma is one of the primary producers of homeopathic meds. There’s plenty of money to be made selling it with fewer regulations to get in the way of profits.

  26. slithey tove (twas brillig (stevem)) says

    Dr. Orac would like a word of Respectful Insolence:
    [Orac] frequently call homeopathy The One Quackery to Rule Them All, but there are times when [Orac’s] not so sure that that’s the case.

    sorry to get all URLy, but Orac’s site is well worth ~ ~perusing.
    (he is actual MD. I know cuz he says so right there on his anonymous blog)
    ;-)

  27. anthrosciguy says

    Providing a “remedy” that isn’t effective increases costs even if the “remedy” is free. And it isn’t free.

  28. footface says

    “Balance” makes me run the other way. That and “energy” and “vibration.” To me, they signal that someone can’t even bother concocting a convincing lie.

  29. cologchem says

    The BMJ Christmas issue is out early this year. The above topic fits right into that issue along with papers on disappearing teaspoons and what happens to magazines in doctor’s offices.

  30. screechymonkey says

    slithey tove @18,

    Even when the doctor tells them antibiotics don’t work against viral infection (colds being virii), they’ll refuse to leave until the doctor prescribes an antibiotic.

    Two questions:
    1. Are doctors so incapable of saying “no” to a patient that they’ll compromise public health by handing out unnecessary antibiotics just because the patient stamps his or her feet a little?
    2. Does this trick work for scoring Vicodin, too?

  31. parasiteboy says

    @PZ

    The ‘against’ side mentions that the controlled studies shoot it down, but could use more details.

    I’m not sure what you are referring to in this last part or why you have the against side in comic sans. In reading the whole “against” side there is nothing that comes close to “we need more details” statement.
    Ernst’s last paragraph shows where he stands.

    In summary, the axioms of homeopathy are implausible, its benefits do not outweigh its risks, and its costs and opportunity costs are considerable. Therefore, it seems unreasonable, even unethical, for healthcare professionals to recommend its use.

  32. Hairhead, whose head is entirely filled with Too Much Stuff says

    Grrrr! Any story about homeopathy gives me a thundering headache.

    I had a good friend who was a brilliant educator of persons with learning disabilities; she single-handedly over the course of her career brought children who had been written off as uneducable back into the system and to graduation and effective, employed adulthood.

    But as she grew older, she developed high blood pressure. She had a couple of stroke-precursors and her medical doctors put her on medication. She said she didn’t like the medication, and one day announced to me that she was seeing a homeopath, and on his suggestion had dumped all of her scientific meds and was dosing herself with vials of water. I argued strenuously enough that she became upset and I had to hold my peace.

    Within a year she had two strokes and died. I was involved in the cleanup of her estate and possessions:; made sure not to acquire the name and address of the homeopathic doctor, for if I had, I would have jumped in my car, drove to his office, pushed my way in and punched him in the face.

    Again, Grrr! (which does not fully express the depth of my feelings regarding homeopathy and its practitioners).

  33. philhoenig says

    If I recall correctly, the mechanism involves the homeopath tapping the vessel with a special wooden rod and having intentions for the water to remember whatever active ingredient’s being diluted, which also explains how it’s only the thing that water will remember, and not the billions of poisonous substances it may have also come into contact with.

    And yet all the representations of homeopaths I see are people in white coats, like a stereotypical scientist. Surely robes and a pointy hat that says “wizard” would be more appropriate attire.

  34. slithey tove (twas brillig (stevem)) says

    re 38:
    sympathies. sincerely.
    tempted to share some “shouldas”. so here goes.
    shoulda got the homeoquack’s name and, instead of getting violent, go all lawyerry on him. Sue him for ‘malpractice’, and, AND, ‘wrongful death’. Regardless whether the charges get tossed, dismissed, or acquitted, it would still have served “justice” to (at least) marginally punish him for advice that led directly to morbidity.
    sorry to be kinda glib, but, I think that’s what I woulda done if I were in a similar situation where the perpetrator of the morbidity was so clear.
    I’ll shut up now. deepest sympathies for your loss.

  35. Dunc says

    Doctors should put aside bias based on the alleged implausibility of homeopathy.

    Actually, I’m perfectly happy to put aside the implausibility… There’s just one condition: you have to be able to robustly demonstrate that it actually does something first. Show me an unarguably real effect, and we’ll worry about the mechanism later. You’ve had over two hundred years to come up with something

  36. wcorvi says

    The REALLY SCARY thing to me is how we treat toxic wastes. “The solution to pollution is dilution.” Thus, as we dilute all these toxins, they get STRONGER!!!!!

  37. says

    “Doctors should put aside bias based on the alleged implausibility of homeopathy. When integrated with standard care homeopathy is safe, popular with patients, improves clinical outcomes without increasing costs, and reduces the use of potentially hazardous drugs, including antimicrobials.”

    In other words homeopathy appears to work when it is used with real medical procedures which are proven to actually work.

  38. xno-archive says

    Presumably we also need to give up our “bias” against the alleged implausibility of perpetual motion machines and burning witches.
    The Great Endarkenment rolls on.
    What next? A university hosting a debate about whether the invention of fire was an impious affront to the gods?

  39. Monsanto says

    The side against homeopathy could be better; the ‘for’ side is admitting that their mechanism is hand-waving and jiggery-pokery, but that trials show that it actually works.

    I don’t know how you can argue that “just applesauce” doesn’t have great healing power. An apple a day… and all that. What I don’t think you understand, PZ, is that homeopathy is based on Einstein’s theory of relativity, quantum mechanics, string theory, and even chemistry and complicated mathematics. No one explains this better than Dr. Werner:

  40. Colin J says

    numerobis @19:

    Does the placebo effect depend on cost?

    The 2008 Ig Nobel prize for medicine was awarded to Rebecca Waber and Dan Ariely for demonstrating that expensive placebos are more effective than inexpensive placebos. According to the Wiki of All Knowledge, anyway…

  41. Thumper: Who Presents Boxes Which Are Not Opened says

    When integrated with standard care homeopathy is safe, popular with patients, improves clinical outcomes without increasing costs, and reduces the use of potentially hazardous drugs, including antimicrobials.

    Bolding mine.

    Like, seriously? Can these people really not see what they just wrote?

  42. numerobis says

    Colin J: fantastic! That’ll be my next business idea. I’ll call it Placebo For Charity.

  43. says

    I just got an invitation to an integrative medicine conference. Actually, I got like four invitations so far. All it has done is make me determined not to go to any conferences run by that group any more. Their general conferences have previously been very good, but how can I trust them now?

    I worry, as doctors really don’t get enough training in critical thinking. IMHO.

  44. says

    @slithey give- Orac and his alter ego do comment here occasionally. His actual identity and specialty are one of the internet’s least guarded secrets.

  45. slithey tove (twas brillig (stevem)) says

    re 50:
    sayamika, yes. Orac is well known and known to comment here as well as at his Respectful Insolence site. sorry for just playing along with his faux outrage when he was doxxed, revealing his full identity.
    Sorry to glibly try satirizing the trope “everyone lies about their identity on the internet”.
    sorry
    this not my blog. Not the place to playact.
    and.
    my satirism is so bad, I’m the only one who sees the satire.