Guardian “Bad Science” columnist Ben Goldacre today criticizes this “tedious” article on “Complementary Medicine” that appeared in his own newspaper. It will be interesting to see if The Guardian publishes Ben’s letter. The article, by Osteopath Nicola Sturzaker, was apparently inspired by the negative response to the recent proposed certification of homeopathic remedies. Her article is the usual collection of fallacies and woolly thinking. She starts by playing victim:
The launch this month of the national rules system, designed to bring homeopathic remedies into line with licensed medicines and allow packaging on homeopathic products to describe the illnesses they claim to treat, brought a predictable collective sneer from the established medical profession.
Yes, but she fails to mention the sneering is predictable only because homeopathic medicine predictably doesn’t work. Sturzaker is claiming this response is unconstructive. If the quoted comments were all that were offered, I would agree – it would just be ad hominem. But the negative comments are backed by numerous studies. For example, this recent review of 110 homeopathy trials published in the Lancet that shows homeopathy is nothing more than placebo. The sneering comments are made following an examination of the evidence that shows homeopathy doesn’t work, and the sneering is because homeopaths and alties in general continue to ignore these studies. What else is left for real doctors to do? Quoting scientific studies is apparently useless as homeopaths just ignore them: sneering at the way homeopaths ignore science is a valid response.
The issue at stake (the lower levels of evidence-based proof that homeopathic treatments have to provide compared with conventional drug treatments) is well worth debating and, in truth, the latest decision in favour of homeopathy may actually have tipped the balance too far.
This is a strange comment. Too far? How does she know? On what basis is it “too far”? And how far “too far” has it gone? Homeopathy either works or it doesn’t; there is either evidence it works or there isn’t. If the evidence is that it doesn’t work, it shouldn’t be certified at all – there is no degree of partial certification that is far enough but not “too far”. And if evidence is not going to be used as the criterion, how does one know how far to go before it is “too far”? This is just woolly thinking.
Michael Baum, emeritus professor of surgery at University College London got his in early: "This is like licensing a witches' brew as a medicine so long as the bat wings are sterile," he said, before going on to further dark murmurings about "witchcraft".
Yes, I think that is a pretty good analogy..
The first is the implied infallibility of the mainstream health professions, namely that their methods are always right, and ours are always wrong. Clearly, neither is true. Anecdotally, we all know of cases where GPs failed to notice something serious and doled out take-two-aspirin-and-go-to-bed-early advice when the realities were far more serious.
Here we start with the fallacies – a straw man. No one is claiming evidence based medicine (EBM) is infallible – “always right” as she puts it. What is claimed is that (a) there is evidence EBM works – better than chance and better than placebo, and (b) homeopathy doesn’t work. Of course, it’s easier to attack this straw man version of EBM than it is to show evidence that homeopathy works.
The second half of the paragraph, and much of what follows, is just a fallacious appeal to science was wrong before. Of course doctors are sometimes wrong and they sometimes miss a serious illness, but that doesn’t mean that homeopathy works.
Again and again, doctors refer to evidence bases as their catch-all for ruling out complementary medicine. In practice this is fine - though it comes from the profession that brought you thalidomide and is beginning to wonder whether rushing herceptin through the net was really so wise.
Another appeal to science was wrong before. As Ben writes: “thalidomide pops up from 1957”. It’s just a red herring: she doesn’t describe any alternative to “evidence bases as [a] catch-all for ruling out complementary medicine”. This criticism of “evidence bases” without any alternative demonstrates the vacuousness of Sturzaker’s article and of alties in general.
However, the medical profession is a multi-million pound industry backed by pharmacological giants. The complementary sector cannot compete - we cannot pay for trials, we do not have multi-nationals encouraging treatment dependency.
Nonsense. Homeopathy is a multi-million dollar business with plenty of money for poor studies biased to show it works. They have money for trials, but they shy away from well designed trials because well designed trials all show homeopathy doesn’t work.
It is the exact opposite - if there is a theory underlying all complementary medicine, it is that the human body works quite well on its own and needs tweaking as little and as naturally as possible. If you want clinical evidence - how about millions of years of human history?
LOL – “if there is a theory underlying all complementary medicine…” If? At least she acknowledges this is in doubt. The claim that things were just fine before EBM is just plain absurd: before 1900 life expectancies in the US were in the 30s and 40s, many women died in childbirth and many children died before reaching adulthood. Millions of years of human history, indeed.
Ironically, one of the few areas that a large-scale trial has been done is the area that started this current row. Homeopathic medicine is indeed controversial, as in order for a homeopath to treat a patient, the person's individual symptoms have to be taken into account in order to make an individualised prescription. This means that homeopathy does not perform exceptionally well in random controlled trials - where one group of people are all given the same medicine and another group are given a placebo.
Nonsense. There is a perfectly straightforward way to test homeopathic individual remedies and procedures. The subjects of the trial all visit a homeopath, and all get the full consultation and individualized homeopathic prescription exactly as specified by the homeopath. Then, using a randomized double-blind protocol, half the patients get the specific individualized homeopathic remedy as prescribed by the homeopath, and the other half get sugar pills. (Yes I know they’re both getting sugar pills – you know what I mean.) Not that difficult, really.
When homeopathic trials are based upon individualised prescriptions we see a very different picture. At the end of 2005, the results of a large six-year study of 6,500 patients at Bristol Homeopathic Hospital reported 75% improvement in their health.
Nonsense, again. As Ben points out, the study was not a trial at all. As I wrote here, all that happened is that patients who visited a homeopath were simply asked by the homeopath treating them if they “felt better”, and 75% of them apparently said yes. Big deal. As Ben ends his letter:
It is this level of ignorance about the most basic concepts in evidence based medicine which makes the debate with alternative therapists so fabulously circular.
And, I would add, frustrating. But it’s a debate we can’t shirk.