By comparing treatments of unknown effectiveness with homeopathy, that is known not to work, a homeoquack concludes that there’s nothing wrong with using quackery. Hilarity ensues.Alastair Hay (@homeopathical) is a homeopath. He doesn’t seem to understand the null hypothesis for homeopathy, or the reasons why skeptics challenge homeopathy. He wrote a series of web pages telling everybody that he doesn’t understand these things, so I will try to help him understand.
Homeopathy is placebo – ban homeopathy
Right out of the gate, an incorrect assertion. The reason homeopathy should be banned is not that it’s placebo, but that it’s fraudulent. There’s nothing wrong with giving people an inert pill if you tell them that’s what you’re doing, but homeopaths don’t do that: they tell all sorts of lies about “like cures like” and so on, they deliberately undermine people’s trust in their doctors (most homeopaths have no medical training whatsoever), they claim to be able to treat and cure serious disease, something they emphatically cannot do. They spread antivaccination nonsense, they are often germ theory denialists.
They are a bunch of mendacious quacks and that is why they should be shut down.
Homeopathy… there’s nothing in it, it’s a sham.
Homeopathy is a con as the medicines contain nothing.
You are a ‘deluded fool’ to believe it works.
True, but not relevant to the reasons why homeopathy should be banned.
It’s a great leap to go from concluding that something is placebo, to banning it.
True, but that’s not why homeopathy should be banned so it’s a straw man.
A total of 164 random controlled trial, (RCT) papers in homeopathy (on 89 different medical conditions) have been published in good quality scientific journals.
- 43% had a balance of positive evidence
- 6% had a balance of negative evidence
- 49% were not conclusively positive or negative
- 2% of the RCTs do not contain data that are suitable for analysis
Yes, as long as you ignore plausibility, mechanism, the refutation of the core dogmas, and the consensus of systematic reviews, it’s easy to find things that support your belief. That’s another reason why homeopathy should be banned: the use of cherry-picked studies to deny the scientific consensus is the hallmark of a mendacious quack.
A sobering thought then, for homeopaths: Pretty much half of the data utilised is neither positive or negatively conclusive.
It’s worse than that. The doctrine of similars is refuted. The doctrine of infinitesimals is refuted. There is no remotely plausible mechanism of action. Not one single result refutes the null hypothesis. Taken as a whole, the body of knowledge is entirely consistent: homeopathy cannot and does not work.
However, by comparison, out of 1016 systematic reviews of RCTs in conventional medicine:
- 44% of the reviews concluded that the interventions studied were likely to be beneficial (positive)
- 7% concluded that the interventions were likely to be harmful (negative)
- 49% reported that the evidence did not support either benefit or harm (non-conclusive)
Bait and switch. The process that arrives at the conclusion that many medicines are either ineffective or have overstated benefits, also leads to the conclusion that homeopathy is not effective.
These statistics reflect the fact that research in homeopathy is a relatively new field (hence a smaller numbers of trials leading to fewer systematic reviews), but the trends seen in the evidence base to date are similar to conventional medicine.
False. They reflect the fact that medical science is a science, whereas homeopathy is a pseudoscience that is fighting a desperate rearguard action to try to retain its credibility in the face of overwhelming evidence that it is bogus.
So, what do we know about the placebo effect?
Placebo is more than just ‘nothing’, hence the term ‘placebo effect’.
False. A placebo is inert. [W:Placebo effect]s are a confounder, not a clinically useful effect; the reason for controlling for placebo effects in medicine is that the placebo effects are transient and unreliable. They are not curative.
To maximise its effect you can apparently employ some interesting tactics:
Give big tablets, even better, give big, coloured capsules, hell no, suggest two at a time, often, from branded boxes from someone in a white coat… Oh and charge a fortune for it.
Bait and switch. You can certainly change the placebo effect by switching pill colour and size, giving two rather than one, a saline injection is a more powerful placebo than a pill and so on, but the idea of charging huge sums for it is pretty much unique to homeopathy. In medicine, placebos are used mainly in clinical trials, while doctors do use placebos (such as antibiotics for viral illness) there is a strong debate about how ethical this is, and the doctors do understand that it’s a placebo, a key piece of self-knowledge which eludes most homeopaths.
You may be surprised then, to hear that homeopathic medicines are nearly always small and white, taken one at a time and quite often, infrequently, from an unbranded packet from someone in ‘civilian’ clothes who will either have included the tablets into their consultation fee or asked you to order them from a homeopathic pharmacy for a pricely sum of about £5 per item.
Irrelevant. The theatre of the consultation is a major part of the placebo effect in homeopathy, and the very fact of “alternative-ness” and the fraudulent claims for a unique and profound method of healing are also undoubtedly part of it.
Maybe we’re missing a trick here? Well, the pharmacologists aren’t…
Here’s a quote from Trends in Pharmacological Science Volume 33, Issue 3, March 2012, Pages 165–172 Utilizing placebo mechanisms for dose reduction in pharmacotherapy
“The pairing of a placebo and a pharmacological agent may achieve satisfactory treatment outcomes in combination with a lower dose of medication.”
Irrelevant. This is a conscious use of placebo as an adjunct to a known effective therapy. Homeopathy is a deceitful use of a placebo in the absence of an effective therapy. Can you see why those two might be different, ethically and clinically?
Here is the breakdown of clinical evidence for 2,500 common medical treatments from the study in the British Medical Journal
The reality is 66% of the treatment procedures and drugs that are commonly used in conventional medicine have no or little evidence of benefit, yet they are still prescribed. (British Medical Journal, 2007)
Zombie argument. This has been refuted a thousand time. The study itself specifically cautions against Hay’s interpretation; this is an assessment by numbers of treatments on the books, not by numbers of treatments in clinical practice – the clearly beneficial treatments are likely to be the most heavily used (e.g. antibiotics), the ones of unknown effectiveness are likely to be the oldest and therefore least studied in modern studies, the ones that are unlikely to be beneficial are very often the ones that hit the headlines because NICE sends out guidance to stop using them.
And what would this chart look like for homeopathy? The answer is not so much to Hay’s liking.
Now, I’m not actually an advocate of banning conventional medicines, not even the ones for which there is ‘unknown effectiveness’… This isn’t a blog about conventional medicine bashing, but more about demonstrating the illogical and somewhat paradoxically, unscientific skeptic’s agenda.
But medical science definitely does advocate honesty, and that’s why there have been very high profile withdrawals of treatments where evidence showed more harm than benefit (e.g. Vioxx). Whether you would ban a treatment of unknown efficacy is irrelevant, medicine does withdraw treatments that are known not to work, and homeopathy is known not to work. It is not unproven, it is disproven. Exploiting the honesty of medical science to undermine it, while punting a treatment that has no credible evidential basis is blatantly dishonest.
You may be surprised to learn that I’ve actively encouraged some clients to take conventionally prescribed medications, some of which have worked very well, when homeopathy hasn’t done all we wanted it to do. Their relief is all the more interesting since some of these conventional medications have been openly regarded as not significantly different to placebos!
How very magnanimous of you, allowing some of the people you treat to also take the advice of someone who, unlike you, is medically qualified and has access to drugs that have plausible mechanisms of action and are based on valid physiological principles.
You remember up at the top where we were talking about why homeopathy should be banned? This is why. What you should have said is that you never advise any patient to discontinue any medically prescribed treatment, because – and I really cannot stress this enough – you know less than fuck all about medicine. Yes, you actually know less than nothing, because not only do you have no real knowledge, the “knowledge” you do have is wrong.
But IS homeopathy placebo?
To accept that a response to a homeopathic medicine is purely placebo is, for me, a hard pill to swallow… pun intended.
That’s because you’re a homeopath. The idea that water cannot turn into wine is hard for a Catholic priest to accept, too.
Put yourself in my position… I’ve seen just over 1000 different clients, the majority of whom have initially followed a conventional healthcare path.
Quite frankly, they believed in the conventional route, or their parents did, more so than they believed in homeopathy, hence they tried the conventional route first. They took medicines in the form of big coloured tablets or capsules daily, they may even have had surgery, yet these medicines didn’t do all that was expected of them. Surely, the placebo response should have kicked in sooner than when they chose me as a last resort? But it didn’t.
That’s because you don’t understand what’s really going on – either the placebo effect or the null hypothesis – but we already established that.
You treat children? With your dangerous anti-medicine bullshit, that is worrying. I hope you advise the full spectrum of vaccinations, but I bet you a pound you don’t.
Of those 1000 or so clients whom I’ve seen, most, but not all, have derived benefit, often long-lasting or even permanent benefit from treatment. The benefits are both observable and palpable. I find it more amazing still, astonishing even, if their favourable responses are really just from having a chat and dishing out sugar pills. I just find that claim more implausible.
Sure you do, that’s why you’re a homeopath. Now here’s implausible for you: a complete system of diagnosis and cure discovered by a single ma, with no parallel discoveries by anyone else, no subsequent rediscovery of the same things, that remains entirely true and correct despite the fact that it was invented before there was anywhere close to sound knowledge of physiology or biochemistry, before genetics was even discovered, before the discovery of viruses and most other pathogens, before even the discovery of the atomic nature of matter.
That’s incredibly implausible.
RCTs of evidence for the effectiveness of homeopathic and conventional intervention are pretty similar.
False. Shang et. al. matched homeopathy versus medicine trials specifically and found that homeopathy trials produced weak evidence of nonspecific effects, while medicine trials produced strong evidence of specific effects.
Homeopaths and manufacturers of homeopathic medicines could do more to maximise the placebo effect but they don’t.
False. Drug makers do maximise placebo effects (e.g. by pill colour), homeopaths theatre of consultation absolutely does maximise the placebo effect (and appears to be “the thing and the whole of the thing” in some cases).
To conclude something is ‘placebo’, is not the same as concluding it is ‘ineffective’.
False. Placebo effects are derived form the administration of ineffective treatments.
The placebo effect whether derived via conventional or homeopathic medicines is still an effect.
Misleading. It is transient and nonspecific, it is not curative, and it is not clinically reliable.
If I can help people get better by just having a chat and dishing out sugar tablets that’s astonishing!
You can’t. You’re merely distracting them while they get better anyway.