Dialogue with a homeopath

In my continuing Twitter distraction phase, I’ve recently bumped into a(nother) homeopath, initially drawn by I don’t recollect what, but whatever it was stimulated a saunter over to her public website (because that’s what it’s for), drawn to this. As I read, my brow soon furrowed at, not so much a total ‘medicine-is-bad-therefore-homeopathy-works’ screed (and no mention of Big Pharma conspiracy); more a ‘medicine-is-deficient-therefore-homeopathy-for-the-gaps’ appeal for ‘integration’ (the nom du jour for ‘alternative’ via ‘complementary’), based on short-comings in ‘conventional’ medicine (though pleased to note that she did not resort to the non-label ‘allopathic’).

Emphasis of claimed homeopathy-fill-able niches was followed by a brief history lesson for the homeopathy-uninitiated, replete with some of the plethora of logical fallacies which tend to accompany these things, including links to material by one or two familiar homeopathy luminaries, and the ever handy argumenta ad populum, which all makes for ready marketing material.

Nothing I haven’t come across before, and so, rolling my eyes, I was driven to comment:

Predictably, this was not well received, and summarily deleted. Which always rubs me up. However, following an exchange in which I was accused of negativity, sarcasm (admittedly) and futility, receptivity to ‘sincere’ questions was apparently indicated. Rapidly rattling a few off by Tweet proved unproductive (because she’d blocked me), so I re-attempted, with toned-down tone, through comment below the post on her website. After all, unlike certain homeopathy apologists, she comes across as a relatively decent type. And she was good enough to both allow and respond.

Which I consider warranted some retort. Aware this ran the risk of my being re-deemed too disagreeable and remove-able, I reproduce my comment here (in case anybody else finds it of any interest):

  1. The cow pox virus causes symptoms similar to those of small pox virus. But it is/was not used as treatment for small pox (symptoms). It was used to test whether it would yield protection against small pox. Moreover, inoculation/vaccination requires presence of an agent to bring about immunisation. It is both inaccurate and dishonest to compare this to homeopathy, in which the ‘substance’ is diluted out of the preparation. There is no such thing as a homeopathic vaccine.
  1. I can confidently state that homeopathy does not stimulate the immune system – because there is no evidence that it does any such thing. (Indeed, if it did so, it could be very dangerous.) If homeopaths are going to ‘theorise’, then some kind of sound scientific foundation is required upon which to build a theory/hypothesis. Rather, without such background, they employ convincing scientific language, without basis. That is pseudoscience. (Oh, and linking to material by Dana Ullman is not to your credit.)
  1. Towards the end of your piece, you bullet point six instances of appeal to popularity and/or authority (followed by a quote that does likewise). This is classic logical fallacy. (Astrology is very popular – it is also nonsense.)
  1. I don’t discount [Hahnemann] because ‘he lived a few centuries ago’. If you’ll permit me to quote myself:

‘In Hahnemann’s day, when the world knew little of what actually caused disease, and physicians still laboured under the humoral system, it would, one imagines, have readily appealed to be offered a gentle alternative to some drastic remedy aimed at relieving the symptom, such as bleeding to cool you when struck down with a fever. Prognosis would likely be no worse; in fact, it may even have been better, in that you were not going to be bled to death. That Hahnemann was looking for a better, gentler way is to his credit; he was of his time, and to look to an alternative vis vitalis philosophy was certainly no battier than convention. It is understandable why it caught on. Then. But today, when modern science has brought us knowledge of the real causes of disease – and the means to treat them – to stick to such an unscientific philosophical approach to medicine is foolishly irresponsible.’

Consider also that your discussion of Hahnemann and cinchona bark is erroneous. In 1991, German pharmacologist, W. H. Hopff repeated Hahnemann’s experiments with cinchona – and found no difference compared with placebo in healthy human volunteers. The likely explanation for Hahnemann’s wrong ‘results’ is that he experienced pathological allergic reaction to a normally ineffective quantity of quinine – upon which he founded a quasi-religious movement. But quinine is only effective against the malaria parasite at pharmacological dosage – homeopathic dilutions are totally ineffectual (and it is dangerously irresponsible to encourage others to believe otherwise.)

I don’t struggle to believe it is ‘scientific’ – because it palpably is not. Please do not feed me the “Just because we don’t know how it works, doesn’t mean it doesn’t work” line. I’m not much interested in the ‘how’ (because there is no scientific basis for the mechanisms proposed and unquestionably accepted). It’s whether it does. Though you reach for ‘some double blind studies’ (which is interesting… because do not classical ‘individualising’ homeopaths reject their applicability?), you don’t mention the meta-analyses which have put this to bed. I do think there is potential for productive discussion on the value of good care (– but not the ‘remedies’.) However, despite your declared abhorrence at the way some homeopaths practice, you don’t air your objections to them. Why not? I’m frequently appalled by the many claims to cure (e.g.) various cancers, as repeatedly made on Twitter/blogs/websites. It needs more objection from within – following ‘Hahnemann’s original methods’ is clearly not the way.

(Continued:) Which, contrary to my unfair prediction, wasn’t deleted, instead garnering a friendly response, but which again could not go unmet:

  1. I’m not quite clear why you’re defining ‘homeopathic’ to me – I understand the derivation of the word. But you’d already moved on to discussing minute doses before you mentioned cow and small poxes. It was Hahnemann (who you seemingly revere) who emphasised dilution. But the analogy is bogus.
  2. I wonder whether you’ve read the Conclusions of the abstract of those two papers:

Linde et al:

‘The results of our meta-analysis are not compatible with the hypothesis that the clinical effects of homeopathy are completely due to placebo. However, we found insufficient evidence from these studies that homeopathy is clearly efficacious for any single clinical condition. Further research on homeopathy is warranted provided it is rigorous and systematic.’

Kleijnen et al:

‘At the moment the evidence of clinical trials is positive but not sufficient to draw definitive conclusions because most trials are of low methodological quality and because of the unknown role of publication bias. This indicates that there is a legitimate case for further evaluation of homoeopathy, but only by means of well performed trials.’

The latter somewhat conflicts with the conclusion you quote (am I looking at the same paper?). But they don’t read particularly positive to me. Just the usual bleating for more research funds. Come on, you’ve had 200 years to sort this; meanwhile medicine has moved on, and then some! Whilst homeopathy apologists scramble for anything remotely suggestive of positive outcome that they can cherry pick, whilst refusing to entertain the bountiful literature confirming otherwise. (You cite Linde et al, 1997, but not Linde & Melchart, 1998; why?) I don’t know the methodological details of those two papers, but would they happen to include studies involving any subjective survey scoring, by any chance? Because they’re usually good for some ‘positive’ data. (Which raises all sorts of issues in a conversation perhaps worth having re good empathetic care.) Or are they analyses of straight pill studies, with no consultation? Funny, but when that happens, and the results turn out unfavourable, why is it the homeopaths claim the trials are invalid? Because such trials failed to consider the ‘individualisation’ process which engenders anticipation of those ‘remedies’, which will only ‘work’ in concert with the ongoing individualised care process? It is thus impossible to assign individuals to trial groups for meaningful controlled comparison, and so such trials are inapplicable to (classical) homeopathy. You seem to make this point yourself later (4.)… after citing references reviewing trials. Yet you don’t cite this:

http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cam02a_information_paper.pdf

Cholera, eh. A bacterial infection yielding symptoms of varying severity, from which, though often lethal, many patients will recover. There was no trial between the homeopathic and conventional hospitals; so we don’t know the proportion of severe cases in either; we don’t know the state of their overall health before contracting the illness; and we don’t know the relative conditions of the two hospitals. Did you read the quote above, regarding the state of medicine in Hahnemann’s time, when there was actually no treatment for cholera? Dr McCloughlin is correct: it is highly likely that conventional medical treatment at that time actually did for many patients, who, if they’d been left untreated, may have recovered. But that’s no evidence for homeopathy. It is scientifically baseless to attach higher recovery rates in the homeopathic hospital as attributable to homeopathic treatment – rather, in all probability, they just happened to recover, having not succumbed to the actions of conventional ‘heroic’ doctors. (Oh, and what, specifically, was this treatment? The causative bacterium had not then been isolated. So, they used, what, low doses of something else thought to cause diarrhoea? In what vehicle? Water, by any chance? Which certainly would not do extremely dehydrated people any harm, I would imagine.)

But consider how scientific medicine has moved on in under two centuries since: it has acquired knowledge of the causative agent of cholera; developed a vaccine against it; how to prevent it, and how to treat and cure it when outbreaks occur. Homeopathy? Nada! Like the point I made about malaria – any do-gooding homeopath who purports to be able to homeopathically treat cholera is dangerously irresponsible… and should stay away from disaster zones where it can become a major problem.

  1. Homeopathic study data from India? I’m frequently flabbergasted! Please tell me, having stated that the practice of some homeopaths leaves you ‘speechless’, that you don’t buy all of that. Are you ever suspicious at the claims to successfully treat any malady you care to mention – including many irresolvable diseases and intractable cancers? I consider it mass exploitation of the gullible. And I see no homeopathy apologists on Twitter calling them out on it (rather, they often flag them up). Call me arrogant if you like, but I do condemn it. But I wish more among the homeopathy community would, rather than keep quiet like religious moderates who tolerate extremists.
  2. Schism? Well, it seems it is usually homeopaths that bend over to distinguish homeopathy from medicine (which they denigrate, as though this justifies homeopathy). You seem of the integrationist bent. It is perhaps, in some cases, beneficial as good empathetic care – and (conventional) medicine might benefit from taking this on board. But homeopathy is not ‘medicine’. Because it doesn’t use any. And it has no monopoly on good care.

The ‘replication’ of Hahnemann’s cinchona thing? Well, it was a properly controlled trial. Has anybody ever confirmed Hahnemann’s ‘conclusions’ on cinchona since by testing it properly? Let’s get up to date – can homeopathy treat malaria? No, it cannot. As for the other ‘tests’ you mention… are these the ‘provings’ which formed the basis of Materia Medica? Are you satisfied with reliance on a near two-hundred-year-old text based on such ‘experiments’? Again, to me, this suggests a religious reverence. That’s the strange phenomenon.

(TBC… ?)

Update 3/11/15: Sally Lloyd has revamped her website and, coincidentally, my comments have been removed.

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