Skeptical about skeptics? I’m skeptical about that.

There is a website calling itself “skeptical about skeptics“. It is… odd. It appears to be the brainchild of Craig Weiler, described by RationalWiki as “an American parapsychology activist, known for posting anti-skeptic rants on the internet”.  It features screeds by Rupert Sheldrake, Deepak Chopra, Dean Radin and others.

In psychology, motivated reasoning is an emotion-biased decision-making phenomenon used to reduce cognitive dissonance, and it informs beliefs around others on whom one’s own outcomes depend.

In other words, if you believe in the lizard overlords and the skeptics say the lizard overlord theory is bunk, then motivated reasoning would lead to you deciding that skeptics are all in the pay of the lizard overlords.

Weiler has this to say about skeptics:

Why should we be skeptical about skeptics? Isn’t skepticism about approaching new ideas rationally and examine evidence objectively before jumping to conclusions? Shouldn’t we avoid believing anything and everything that comes our way.
Of course we should; that is the foundation of science after all.

Yes, this is perfectly correct. The opinion of skeptics is just opinion, albeit usually backed by a mass of fact. This is why attacking Randi or some other prominent skeptic is a sterile and pointless exercise: even if James Randi turned out to be the operator of a Satanic temple, that would not undermine in the least his exposure of crooks and charlatans, because in doing this he published the evidence in full.

But it is also possible to go completely overboard on skepticism to the point where it’s just overwhelming bias against new ideas. They are rejected out of hand and evidence is disregarded before it is even seen. This is actually quite common. You can pick pretty much any controversial topic and there will be a wide range of opinions ranging from true believers to dogmatic deniers, whether we’re talking about climate change or UFOs or bigfoot, it doesn’t matter. There will be people of all types.

So here the agenda emerges. Yes, there is a spectrum form true believers to dogmatic deniers. Dogmatic deniers of things like UFOs and bigfoot are not skeptics, and they are vanishingly rare. The skeptics who look at UFOs and bigfoot and similar fields tend to be very nice people, who are capable of listening patiently and respectfully even to people who are quite obviously insane. They review the evidence, they conclude that a more parsimonious explanation exists. Skeptical Inquirer is full of articles by folks like this.

Climate change, though is a different kettle of fish. The dogmatic deniers here call themselves skeptics but they are not. Neither are holocaust skeptics, evolution skeptics and the like.

The essential difference is this: science as a body of thought encompasses all valid opinions and weighs them according to merit. Science says that psychic phenomena are implausible, violate known laws of nature, and are not supported by credible evidence. Psi advocates portray this as denialism, but it’s not: it’s a reasoned conclusion form the available facts. Dogmatic denialism would refuse to even look at the experiments of proponents, but this is not what happens. What science actually does is infinitely worse for the psi proponents: it provides a simpler explanation without reference to empirically unverifiable phenomena.

This site focuses on the people who fall in the dogmatic denier category because they present themselves as being the most truthful and objective, which they are not. They call themselves skeptics and they would be harmless save for the fact that they have a lot of influence in academia and the mainstream media and are invested in making sure that mainstream sources, such as Wikipedia reflect their point of view. (And only their point of view.)

This is the part I find most interesting because I know a lot about how Wikipedia works. Wikipedia follows an unashamedly rationalist view. In any subject which is rightly the province of scientific inquiry, the scientific consensus view will prevail, and as the consensus changes, so will Wikipedia. There are issues at the margins, but by and large that is how it goes.

Wikipedians tend to be vested in Wikipedia and the commitment to make it factually accurate and informative. Active research scientists do not usually form part of the Wikipedia community, they are too busy publishing, but occasionally they do appear and it’s very often because they have a view they are advocating in the literature, which is not widely accepted, and which they want Wikipedia to present as fact. So yes, there are a number of people who are deeply invested in making Wikipedia reflect their point of view.

Let me list a few in no particular order:

I should state up front that I feel quite bad about this. It must be very hurtful to be so vested in something, and to have one of the world’s most prominent sources of information state that you are wrong. It is extremely important that Wikipedia should be scrupulously fair in these matters, and what you find in the content is that, by and large, we are.

If you believe in homeopathy, quantum flapdoodle, morphic resonanceparapsychology or subtle energy, you’re not going to enjoy Wikipedia. The same applies to Truthers, Birthers,  Ufologists, Cerealogists,  Wikipedia unashamedly follows the mainstream view, and this is by design.

The Wikipedia approach to fringe theories is to describe them accurately, but to defer to the scientific consensus as to their validity. Believers can’t accept this because they think that their belief is correct and science is not. Proponents seem keen to do absolutely anything to get their point of view represented as fact – anything, that is, short of the only thing that will work: getting it accepted by the scientific community.

Nearly any controversial subject you care to name has another side to the debate that you probably haven’t heard. It is the goal of Skeptical About Skeptics to show you the reasons why you’re only getting one side of the story.

No, this is the fallacy of false equivalence. Climate change deniers and vaccine denialists insist that there are two sides to the debate, but ignore the fact that the scientific consensus, supported virtually unanimously in both cases, not only shows the deniers to be simply wrong, it also includes all the disconfirming evidence they prefer. Their arguments are fallacious, cherry-picked, misrepresented or outright invented, and they seem valid only because they are presented outside the context of the mass of studies showing them to be incorrect or misleading. And the denialism is dangerous. It has held back decisive action on climate change, it has resulted in outbreaks of serious vaccine-preventable diseases, which have in turn led to serious harm including death.

In science, any compromise between a correct statement and a false statement, is a false statement.

The challenge

The challenge for any believer is to provide evidence in a way that distinguishes your claims from pseudoscience, pathological science and plain nonsense. If the arguments you use would apply equally to blatantly fraudulent claims like those of homeopaths, then you need to go away and work on your evidence, not shout at the nasty reality-based community for refusing to accept your claims.

So proponents of extraordinary claims, must provide extraordinary evidence. They also need to understand that skepticism is not a bias, it is the bedrock of the scientific method. Proponents of remote viewing discount the evidence that they were duped by Uri Geller, on the basis that it comes from skeptics. Project Alpha may be the best known example of skeptics showing that believers in paranormal claims failed to apply critical thinking skills.

Cranks belittle some skeptics as being stage conjurers, not scientists. Reflect on this: if a scientist accepts your proof of a claim at odds with the known laws of physics, but a stage conjurer shows it to be attributable to sleight of hand, who’s more likely to be right? The cranks will say: the scientist. But everybody else will be familiar with the image of the honest scientist, not worldly wise, and will readily understand that the stage conjurer, a trickster through and through, is much more likely to be able to spot fraud.

Homeopathists, for example, criticise John Maddox’s debunking of Jacques Benveniste’s “memory of water” experiments because Randi was involved, therefore it’s pathological skepticism. The criticism is invalid, what the skeptics did was to identify a failure of blinding, this is perfectly legitimate. Randi spotted what a scientist, not accustomed to misdirection and cognitive bias, could not. If a conjurer can spot the flaw in your experiment then the experiment is flawed, not the conjurer.

Independent replication and crank magnetism

In order to be persuasive, you have to provide evidence that is unambiguous and can be independently replicated without prior belief – your methodology has to test the premise, not seek to confirm it. Pseudoscientists and pathological scientists conduct tests designed to demonstrate their premise, while scientists test it and try to prove it wrong.

If the validity of a finding requires you to acknowledge that by the same reasoning some other questionable thing, say homeopathy, might also be valid despite the scientific consensus, then you are doing it wrong.

Remember crank magnetism: the tendency of people who believe one set of crank ideas, to believe other, often increasingly ridiculous, crank ideas.

Your claims must stand or fall on their own merits, in isolation, and if you rely on other ideas as validation for your own then those other ideas must be well-founded. Otherwise you look like a crank – and a credulous one at that.

Personalising the dispute

One way of showing the world that you are wrong is to personalise the dispute. Very few scientists and skeptics do this in respect of anything important (arguably Richard Dawkins, who can be a titanic cock at times, does fall into this trap). I personally find it amusing to mock Dana Ullman, but my criticism of his writing is based on what he writes, not on the fact that he is dishonest.

Skeptical About Skeptics seems to comprise predominantly of personal attacks on people it holds responsible for the nasty reality that refuses to accept fringe ideas. Susan Blackmore, Jerry Coyne, Richard Dawkins, David Deutsch, Edzard Ernst, Chris French, Martin Gardner, [P. Z. Myers], James Randi, Michael Shermer, Richard Wiseman and others.

It’s a living embodiment of Ernst’s Law: if you’re a scientist investigating alternative medicine and the quacks don’t hate you, then you’re probably not doing your job right.

Much of the criticism is based on the difference between formal scientific language and the language one might use in informal discussions.

For example: scientifically, the correct statement in respect of telekinesis is that it is incompatible with current understanding of the nature of matter, there is no remotely plausible mechanism by which it might work and all experiments purporting to demonstrate telekinesis turn out to be seriously methodologically flawed; properly controlled experiments uniformly fail to demonstrate its existence.

Informally, one might say that there is no such thing as telekinesis.

Technically, that’s incorrect: it’s not formally possible to prove a negative in this sense, at least until we have total knowledge of every facet of human consciousness. As far as everyday reality is concerned, it’s close enough.

The difference is only important if you are an advocate of telekinesis. And if you are, then you will squeeze every last drop of potential doubt out of that scientifically correct statement.

Science doesn’t know everything? Sure. Therefore we can fill in the gaps with any old bollocks? Not so much.

Sheldrake

Sheldrake is a specimen of pathological belief. He absolutely believes in morphic resonance, and he will apparently do anything to have it accepted as valid short of properly controlled scientific experiments. He’s howled about Wikipedia presenting it as nonsense, on the basis that the world of science tends to ignore it (or point and laugh) rather than actively refuting it.

The site has an extended rant against Randi by Sheldrake, based on Randi’s refusal to accept that dogs can sense the return of their master using morphic resonance or psychic powers or whateverthefuck.

Sheldrake could, of course, submit to a properly controlled test. If he’s right, he stands to win a million dollars. The problem is – and I am pretty sure he understands this – the JREF judges were not born yesterday. They have decades of experience of people who, consciously or unconsciously, practice sleight of hand, misdirection and the various other techniques of stage conjuring in order to produce the appearance of psychic power.

As far as Sheldrake is concerned, rejecting morphic resonance automatically makes you wrong, and all he needs to do is find a hook on which to hang your wrongness. That’s not science. In science, you have to prove your claims, and you have to do it in a way that can be independently (read: by a neutral observer) replicated. Sheldrake has not done this, so his claims are regarded as unfounded and – because they violate many of the established principles on which everyday science bases its work – pseudoscientific.

There is only one way to fix that, and it’s by proper experiments. However, in terms of public discourse, you might persuade a decent sized following by reversing the burden of evidence and then noisily attacking your critics for using informal or rhetorical language instead of the formal language of science. That’s what Sheldrake does. Meanwhile, science moves on, because in the end you can deny reality as loudly as you like, reality has a long history of not caring.

Sheldrake appears to believe that he can make his claims, and it’s up to others to disprove them. He is this: wrong.

Disagreeing with Sheldrake appears to be one of the litmus tests for validity, according to this site. It rambles on endlessly about Lewis Wolpert and how he refuses to accept the evidence of psi. How evil. It’s almost as if there is no good empirical evidence for it, once sleight of hand and bias are carefully eliminated.

In the end…

In the end, “skeptical about skeptics” is a mish-mash of special pleading, nit-picking, begging the question and reversal of the burden of evidence.  It exists solely because its authors have failed to establish their claims by the only route that matters: properly controlled, independently repeatable experiments.

It boils down to a bunch of pseudoscientists bleating about the fact that their pseudoscience is not taken seriously.

It’s not even interesting criticism, because the agenda is so transparent.

Quacklash follows NHS Lanarkshire’s decision to cease referrals to Glasgow Homeopathic Hospital

The poor homeopathists appear to be puzzled over the NHS Lanarkshire decision to end referrals to the Glasgow Homeopathic Hospital.

I can see why they would be puzzled. The report on which the decision is based is impenetrable if, as homeopaths must, you discount anything that conflicts with your beliefs.

The display their puzzlement in a piece entitled “Concerns Regarding NHS Lanarkshire’s Decision to Cease Referrals to the Centre of Integrative Care (Glasgow Homeopathic Hospital)” on the site homeopathyheals.me1 run by homeopath Louise McLean. It is instructive to see how they raise as “concerns” items that are fully addressed and often directly refuted within the published record.

Written by a Patient

The website is run by and on behalf of homeopaths. Who is this mysterious patient and do they, like the majority of homeopathy proponents, have a vested interest they are not declaring?

The NHS Health Board Meeting on 9th December 2014, was held to give the reasons for their decision to no longer refer patients.

Wrong. It was held to review and endorse or decline the recommendations of the Director of Public Health and Health Policy, based on an extensive review of the evidence and a public consultation which received a large amount of input.

The consultation report notes an overwhelming effort by homeopathy believers to preserve referrals: had this succeeded they would no doubt be presenting this as an endorsement by the NHS of the efficacy of homeopathy. We already know that they are unable to distinguish between popularity and efficacy.

There were a number of concerns about how the information was presented at the meeting to the Health Board members, who then voted nine in favour of ceasing referrals, three in favour of continuing referrals to the many services at the hospital, (who raised very pertinent issues and concerns that were disregarded by the majority), as well as 1 abstention.

OK, so it was not a close call by any measure. A resounding endorsement of the recommendation for withdrawal. Of course homeopaths have concerns: they always do, when something doesn’t go their way, but:

SHC [the Scottish Health Commission] confirmed in November 2014 its view that if referrals were stopped, it would not constitute major service change

So that’s pretty clear: a body independent of the review found no actual concerns for patient outcomes.

NHS Lanarkshire have caused concern throughout their flawed Consultation:

Flawed? From the report to the Board:

During the course of process on homeopathy the following bodies have been consulted – the CMT, the Modernisation Board, Lanarkshire NHS Board, the Homoeopathy Review Group, and the Homoeopathy Stakeholder Reference Group. Scottish Health Council (SHC) and Scottish Government have been kept informed at all stages of the process. SHC confirmed in November 2014 its view that if referrals were stopped, it would not constitute major service change. As part of the evidence gathering and the consultation appropriate engagement with patients, the public and health staff was 9 undertaken allowing for individual and collective responses. A review of the consultation process was undertaken and shown to be positive. (emphasis added)

Dr. Kohli explains in detail the input solicited over a four-year period:

The fact this process has taken place over a four year period involving such a wide range of groups and individuals, underlines how thorough we were in gathering as much evidence and opinion as possible.

He notes that many impassioned responses were supplied by believers, but states that:

“I looked at all this evidence and concluded, like many other studies, that the principles on which homoeopathy is based are scientifically implausible and there is insufficient evidence that homoeopathic remedies improve a patient’s clinical outcome.”

So: reality versus opinion. As usual.

Due to refusing to write to the patients who attend the hospital to inform them about the Consultation in order that they can take part and the poor advertising of the Consultation, which extended its closure date.

This is disingenuous.

Among those invited and who took part in the review were Lanarkshire CIC patients, GPs, health professionals, patient representatives from the CIC, members of the public and Public Partnership Forum (PPF) representatives.

The consultation had a mass of positive input from believers in homeopathy, explicitly including users of the service:

The fact this process has taken place over a four year period involving such a wide range of groups and individuals, underlines how thorough we were in gathering as much evidence and opinion as possible.

See the important bit? “Evidence and opinion”. Opinion is not evidence, other than of the existence of that opinion.

Our consultation exercise alone received around 6000 responses, almost 75 per cent of which came from outwith Lanarkshire.

And the original consultation summary makes it absolutely clear that most of these were from believers. From the report itself:

The Review Group received input from patients in several ways including:
• A survey of 153 patients who attended clinics in Lanarkshire with a 70% response rate. Eighty-eight per cent of responders indicated that overall the treatment made them feel better than before. Across all age ranges the treatment received most often was homoeopathic remedies with or without other interventions.
• The Lead Clinician at the CIC produced three separate reports all of which showed that patients had a positive impact on their health.
• Unprompted, 32 patients wrote letters of support for CIC services to the Chair of the Review Group.
• Eleven e-mails were received from interested individuals and these were replied to along with a copy of the open letter describing the review process.4
• A petition, ‘Save the Glasgow Homoeopathic Hospital’, was received in April 2013 by e-mail from Homoeopathy Heals Me! with over 6,000 signatures.

You cannot legitimately complain that the voice of the patient was not heard. The problem is that you never successfully addressed the one thing that is actually important: the absence of credible evidence of efficacy. Indeed:

I accept that there will always be views from some patients expressing benefit from the service and I also recognise that the majority of those who responded to our consultation expressed a preference for continuing to use the CIC.

However, there has been extensive investigation of the effectiveness of homoeopathy and there is no good-quality evidence that it is effective as a treatment for any health condition.

The report acknowledges that homeopathy is popular, no further data points are needed there, the issue is that there is no credible evidence that homeopathy actually works other than as a placebo.

Calling it a ‘Homoeopathic Review’ when actually the Consultation question was entirely different – ‘Should NHS Lanarkshire refer patients to the Centre for Integrative Care (Glasgow Homoeopathic Hospital)?’ This is a totally different question than implied on the front page and poster relating to the Consultation. It also shows that the Board did not fully understand the integrative care model at the hospital that has a wide number of services available and not all patients attending the hospital receive homoeopathy.

The Glasgow Homeopathic Hospital has indeed tried the standard quack technique of rebranding itself as “integrative”, here’s what Dr. Kohli found in respect of the services the centre apparently considered to uniquely identify its services:

Synthesised evidence was sought on a number of therapies offered by the Centre for Integrative Care for homoeopathy, mindfulness-based cognitive therapy (MBCT), HeartMath, mistletoe for cancer symptoms and music and movement therapy.

The literature reviewed in relation to homoeopathic care for various conditions including fibromyalgia (coping with pain and depression), prevention and treatment of influenza and influenza-like illness, therapy for preventing or treating the adverse effects of cancer treatment, attention deficit/hyperactivity disorder (ADHD) and insomnia, found insufficient or no evidence to support homoeopathy.

Reviews of MBCT for the treatment of various conditions including fibromyalgia, chronic diseases, stress reduction for breast cancer, chronic fatigue syndrome and anxiety and depression concluded that there is some evidence that MBCT improves psychological health in breast cancer patients and improves mental health and symptom management in patients with chronic disease.

No systematic reviews or meta-analyses were identified for HeartMath.

Reviews of mistletoe extracts for cancer patients had differing results – a Cochrane Review concluded that there was insufficient evidence while two other studies concluded that mistletoe extract may be associated with better survival and that there was some evidence to support the effects on quality of life. Limitations of the studies were highlighted however and a caveat added to treat the findings with caution.

Some reviews of music and movement therapy, while concluding that listening to music may help to reduce anxiety, reduce pain and respiratory rate and have a beneficial effect
on the quality of life for people in end-of-life care, did not have strong evidence. The therapy appeared to have benefit for patients with Parkinson’s disease but concluded that
future studies should include greater numbers of patients.

Wait: mistletoe? Ping @LeCanardNoir: Steiner Alert!

Homeopaths will read this and focus on the things for which there is said to be some evidence. That of course is part of the problem: in offering this list of therapies, the CIC shows a complete absence of clinical judgment. Therapies are offered regardless of the evidence of efficacy. That is profoundly disturbing when the conditions under treatment include cancers.

Any treatments which are, presumably coincidentally, reality-based, can more appropriately be provided by other areas of the NHS, as Dr. Kohli says:

From 1 April, patients with long term conditions will still be able to access a whole range of services which cover many of the conditions previously referred to the CIC.

The services available in Lanarkshire, and accessible through GP referral, include:
• Self-management groups and programmes
• Counselling
• Psychology
• Psychological therapies
• Cognitive Behavioural Therapy
• Acupuncture
• Pain Management.

Adding a masseur to a homeopathy clinic does not make it a massage clinic, it makes it a quack clinic with a few people who might not be quacks. The massage can be provided elsewhere without the side-effect of endorsing bullshit.

The report to the Board describes in great detail the services that will provide all the treatments needed by the patients and whihc can be supported by any kind of evidence.

During their September Board meeting, NHS Lanarkshire broke into private session to discuss the Consultation report, which is not usual, on what was supposed to be a transparent public Consultation. This raises the question – what exactly was discussed at this closed meeting?

Several possible reasons for this: presence of a noisy group of supporters, discussion of the input listed as MSP1 and MSP2, two MSPs whose names the board clearly does not wish to publicise, perhaps even the notorious homeopathy tactic of attempting to smear opponents.

Why did NHS Lanarkshire go to the trouble and costs of holding the public Consultation if they were then going to decide to totally disregard the public views, when the overwhelming result was to continue to allow referrals? Why were NHS funds spent on a public Consultation when they were never going to adhere to the result of public opinion anyway?!

So a consultation on a service known to be popular but not based on evidence, is valid only if it places popularity above evidence? That’s an interesting idea, and would certainly protect homeopathy services, but it’s rather obviously wrong.

One might just as well ask: given that homeopathy is known to be popular but bogus, why would anyone go to the trouble of undertaking a review if popularity were to be the dominant measure of validity?

The consultation was not about popularity, it was about the service as a whole. Popularity was listed as a point in favour, lack of credible evidence was listed as a point against. The NHS has limited funds, so popular but ineffective therapies are likely fall by the wayside.

What message does this send out to other health professionals working elsewhere in the NHS when this award-winning hospital has received several 100% patient satisfaction ratings, meeting all its patient objectives and outcomes expected of this tertiary service, and delivering cost-effective care to a cohort of patients that have complex conditions who have generally exhausted all other means of conventional NHS care before their referrals? Yet their services are being cut and patients denied access.

There is a very clear message here: if your practice is not grounded in reality and good evidence, your days are numbered. Fortunately this does not apply to more than a tiny proportion of health professionals in the NHS. It does apply to homeopaths, but they are in the main not health professionals – there are only about 400 medically trained homeopaths in the UK, the rest are just lay people playing doctor

The report makes it absolutely clear: any treatment that has a credible evidence base will continue to be available.

 

This decision by NHS Lanarkshire to cease referrals seriously puts at risk the whole future of the NHS Centre of Integrative Care for all patients throughout Scotland who rely on the many services that are available at the hospital, as it was reported in The Herald that a spokesman for NHS Greater Glasgow and Clyde said: “We are reliant on the ongoing commitment from other NHS Boards to make use of the inpatient services to maintain their viability.”

So what?

SHC confirmed in November 2014 its view that if referrals were stopped, it would not constitute major service change

That is unambiguous: the Scottish Health Council does not consider this a major service change, there will be no clinically significant effect on patients. Appropriate, for a homeopathy centre!

Their problem is not NHS Lanarkshire, it’s with their dependence on fantasy-based treatments. If the centre relies for its continuing existence on referrals for a therapy which is, by resounding scientific consensus, bogus, the NHS can hardly be held to blame .

http://www.heraldscotland.com/news/health/health-board-to-stop-sending-patients-to-homeopathic-hospital.114310546

We know that Robert Calderwood the Chief Executive of Greater Glasgow & Clyde Health Board has also stated publicly for several years that should another Health Board around Scotland decide to cease referrals to the hospital, then it’s survival would be put in jeopardy. This is now an urgent and very concerning situation and requires political support and pressure.

Urgent? Very concerning? Not really. The closure of a centre that offers fantasy-based treatments is not a pressing concern for anyone other than the believers in the fantasy. Again:

SHC confirmed in November 2014 its view that if referrals were stopped, it would not constitute major service change

As always, the homeopaths are begging the question. “Given that homeopathy works, it is wrong not to provide it” – a point which fails because the premise, that homeopathy works, is objectively false.

We do hope that national funding may be found to secure this hospital’s future to continue to make the hospital services available for all patients in Scotland, which will put an end to the postcode lottery, allow portability of care and equality of access to this national centre of excellence that is providing gold standard care for patients, and which is individualised, person-centred, holistic and integrative and the best care available for those with complex, long-term, chronic conditions.

Why would national funding be found? An extensive review of the evidence recommends against the NHS funding homeopathy. This conclusion is backed by the then Chief Scientific Advisor, and by his successor, and by the Chief Medical Officer.

The patient’s voice is rarely heard here, nor the facts that are truly representative and mean the most to the patients who are affected.

Rubbish. The patient’s voice was heard loud and clear in the consultation, and this is noted repeatedly throughout both the consultation report and the report tot he board, as highlighted above. The patients and the quacks who exploit them resoundingly failed to provide evidence to counter the overwhelming scientific consensus that homeopathy is bogus.

We do hope that the hospital’s future can be secured for the many thousands of Scottish patients who depend on its many and varied services, not readily available elsewhere n the NHS.

Nobody depends on access to quackery other than the quacks themselves.

1 Isn’t it odd how there are no websites promoting the idea that giving measurable amounts of pharmacologically active substances can cause objectively testable changes in the human body – almost as if homeopathy were so utterly implausible that it requires propaganda to overcome a yawning gap between reality and the claims of its proponents.

Evidence-based medicine and prejudice-based medicine: the case of homeopathy

One of the most amusing things about homeopaths is their occasional outbursts of wrongteous anger over other people’s failure to acknowledge the wonders of magic water.

They are unable to comprehend how anybody could possibly review the evidence and not be persuaded. They cannot comprehend this because they rationalise away all conflicting information. Belief is a powerful human emotional force, and a homeopath can no more accept the implications of atomic theory and germ theory than a fundamental baptist can accept the validity of atheism.  Their belief defines them as people and they feel a need to understand rejection in a way that does not challenge it.

So to the title of this post: Evidence-based medicine and prejudice-based medicine: the case of homeopathy. It’s the title of a paper in Cadernos de Saúde Pública and it is a blatant reversal of the reality. It states that physicians reject homeopathy because they are unfamiliar with the evidence, and because they are prejudiced. These are precisely the reasons why homeoquacks write papers like this.

I wrote this to the editors. I wonder if they will print it?


 

In Evidence-based medicine and prejudice-based medicine: the case of homeopathy (2014 Nov; 30(11):2368-2376.), Barros NF, Fiuza AR. assert that rejection of homeopathy is due to prejudice and lack of awareness of its benefits.

In making this argument, they effectively reverse reality: it is homeopaths, not doctors, who exhibit dogmatic refusal to accept contrary evidence.

There have been three separate government-level reviews of the clinical evidence for homeopathy: Switzerland [1], the UK [2] and Australia [3]. The first two both concluded resoundingly against it, the third is still in draft and also concludes against it. The US National Center for Complementary and Alternative Medicine, a body set up in order to evaluate and provide evidence for complementary and alternative medical practices, notes that [4]:

· There is little evidence to support homeopathy as an effective treatment for any specific condition.
· Although people sometimes assume that all homeopathic remedies are highly diluted and therefore unlikely to cause harm, some products labeled as homeopathic can contain substantial amounts of active ingredients and therefore could cause side effects and drug interactions.
· Several key concepts of homeopathy are inconsistent with fundamental concepts of chemistry and physics. There are significant challenges in carrying out rigorous clinical research on homeopathic remedies.

The clinical evidence is the evidence most supportive of homeopathy, because it is most susceptible to confounding factors such as observer bias, expectation effects, regression toward the mean, and natural course of disease [5]. As Ioannidis notes [6], it is normal to find that an ineffective treatment will accumulate a net positive clinical evidence base. This is inherent in the system of scientific publication as it currently exists. Ioannidis has also pointed out that if prior plausibility is low, the chances of a positive outcome being false, increase substantially.

The prior plausibility of homeopathy is, to all intents and purposes, zero [7]. It was invented from whole cloth in the late 18th Century by a German doctor, Samuel Hahnemann, and as with just about everything else believed by doctors of the time, it is simply wrong. This is evident from consideration of two of its cherished doctrines:

* The “law of similars” is based on extrapolation from Samuel Hanemann’s experience of cinchonism: he concluded that cinchona (which contains quinine) cures malaria because the symptoms are alike. In fact, as is now well known, cinchona cures malaria because quinine adversely affects the plasmodium parasite which is the cause. In reality there is no evidence that like cures like as a general or even common principle. This effect requires pharmacologically active doses of quinine to be present.

* The “law of infinitesimals” is based on Hahnemann’s stated belief that “there can be no amount of matter so small that it does not retain its essential character”. This was refuted in the late 19th Century with the discovery of the atomic nature of matter.

It is probably well enough known by now that typical homeopathic dilutions surpass the point at which Avogadro’s constant says that no trace of the starting material is likely to remain. Homeopaths claim that an “energetic imprint” is left due to the process of “potentisation”, but there is no evidence this is true: a homeopathic remedy manufacturer acknowledged to the British parliamentary review that remedies cannot be distinguished other than by label (2), and one manufacturer was found during an FDA visit to be failing to add the ingredient at all in a significant proportion of remedies [8]. No complaints of lack of effect were noted.

Over the years people have attempted to develop a plausible theory of how homeopathy might work. They have failed. The purported “memory of water” turned out to be down to experimental error [9], and claims of nanoparticles, residual silicates etc. [10]are attributable to well known experimental confounders . There have been resorts to the most fantastical conjectures such as quantum entanglement of patient, practitioner and remedy [11], an entirely absurd concept. None of the theories proffered to date overcomes the absence of any plausible mechanism by which useful bioavailability might be achieved [12]. Homeopathy advocates tend to fall back on explanations based around the empirically unverifiable “vital force”: Hahnemann believed explicitly (and increasingly incoherently) in this immaterial force [13]. Medical science discarded vitalism over a century ago [14].

The authors reference the concept of “allopathy”. This is a pejorative coined by Hahnemann to describe then-current medical practice, which attempted to balance the humours by opposing them (thus an excess of “sanguinity” would be treated by exsanguination, i.e. bloodletting) – the term is today much abused [15]. These practices were indeed barbaric and profoundly wrong, but they do not represent modern medicine in any meaningful sense. Ironically, Hahnemann’s rejection of these practices led to the purported success in outbreaks of disease which is so trumpeted by homeopaths today: when a patient has typhoid or cholera, doing nothing in a clean hospital is infinitely preferable to bloodletting in a dirty one.

While the reality-based scientific and medical community essentially ignores homeopathy as an irrelevance, homeopaths resolutely refuse to accept this and pursue with dogged persistence the belief that homeopathy is rejected only because of “prejudice” – while themselves using terms like “allopathy” which are in themselves based entirely on prejudice.

Advocacy of homeopathy is faith-based, not evidence based, and this will remain the case unless and until homeopaths can deliver objective evidence of its underlying doctrines sufficiently powerful to overcome the current understanding of physics and human biology.

  1. FOPH. Programm Evaluation Komplementärmedizin (PEK). Federal Office of Public Health [Internet, in German]. Bern: FOPH; 2005
  2. Science and Technology Committee – Fourth Report, Evidence Check 2: Homeopathy. London: HMSO; 8 Feb 2010
  3. NHMRC draft Information Paper: Evidence on the effectiveness of homeopathy for treating health conditions
  4. Homeopathy: An Introduction, NCCAM – http://nccam.nih.gov/health/homeopathy
  5. An exploration of the relationship between placebo and homeopathy and the implications for clinical trial design, Haresnape, Claire. JRSM Short Rep. Sep 2013; 4(9): 2042533313490927. DOI: 10.1177/2042533313490927
  6. Why Most Published Research Findings Are False, John P. A. Ioannidis. PLoS Med 2(8) II; August 30, 2005 DOI: 10.1371/journal.pmed.0020124
  7. Considering prior plausibility in clinical trials does not mean ignoring scientific evidence Gorski, David H. et al. Trends in Molecular Medicine , Volume 20 , Issue 11 , 600 – 601 DOI:10.1016/j.molmed.2014.10.001
  8. Warning letter 7/26/12 to A. Nelson & Co, Ltd. FDA http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/2012/ucm314629.htm
  9. “High-dilution” experiments a delusion, Maddox, J. et al. Nature 334 (6180): 287–290
  10. Testing the nanoparticle-allostatic cross-adaptation-sensitization model for homeopathic remedy effects. Bell, I. R. Homeopathy. 2013 Jan;102(1):66-81. doi: 10.1016/j.homp.2012.10.005
  11. Winnowing the chaff of charlatanism from the wheat of science. Ernst, E. Evidence-based Complementary and Alternative Medicine 03/2009; 7(4):425-6. DOI: 10.1093/ecam/nen089
  12. The Memory of Water, The Science of Medicine. Novella, S. P. Skeptical Inquirer, Volume 35.3, May/June 2011
  13. [Homeopathy and philosophy] (in French). Pinet, P. Rev Hist Pharm (Paris). 2006 Nov;54(351):349-67.
  14. The Lucretian swerve: the biological basis of human behavior and the criminal justice system. Cashmore, A. R. Proc Natl Acad Sci U S A. 2010 Mar 9;107(10):4499-504. doi: 10.1073/pnas.0915161107
  15. Misuse of the Term “Allopathy” Jarvis, William. National Council Against Health Fraud http://www.ncahf.org/articles/a-b/allopathy.html

 

Winston

Winston v: To give a forthright, well-informed and authoritative slapdown.

David Tredinnick was thoroughly Winstoned on Radio 4 this morning! What a lunatic.

Named after The Right Honourable Professor The Lord Winston FMedSci FRSA FRCP FRCOG FIBiol FREng(Hon) after he called David Tredinnick’s beliefs in astrology, homeopathy and assorted other woo “lunatic“.

Tredinnick

Tredinnick v: To undermine the credibility of something by publicly advocating it, especially by causing people to investigate the reality-based perspective.

I thought homeopathy on the NHS was a good idea but then some tit who believes in astrology Tredinnicked it in the radio – I checked the evidence and it turns out to be complete bollocks!

Spare a thought

Spare a thought this Christmas for the poor homeopathy shills. They are so confused at the moment it’s painful to watch.

On the one hand, political decisions validate homeopathy, trumping science. On the other hand political decisions go “against the evidence” by finding homeopathy worthless and de-funding provision.

One minute skeptics are ineffectual, the next it’s skeptics to blame for the end of funding for homeopathy in Glasgow.

Homeopathy manufacturers undermine their shills by settling and even pulling out of the market and even when when there is a rare signal victory (essentially plaintiffs ought to know that homeopathy doesn’t work, so can hardly complain when it doesn’t), the court goes on to undermine it by finding the homeopaths’ chief witness, Dana Ullman, “unreliable” and discounting his testimony, and expressing “serious reservations regarding the effectiveness of the product”. As Pyrrhus might have said: “one more such victory and we are lost”.

TV crews “unethically” use covert filming to unmask dangerous and fraudulent claims by homeopaths, and homeopaths’ own societies inexplicably also condemn these practices instead of standing up for quacks who are only profiteering from anti-vaccine lies and fearmongering offering informed choice and gentle natural alternatives to vaccines.

Shills finally get a robustly provable mechanism, in water memory, supported by a Nobel prizewinner, only to have the Nobel prizewinner say that his work “cannot be extrapolated to the products used in homeopathy“.

Homeopathy skeptics are told they are “clueless about medicine“, and mere hours later, The Right Honourable Professor The Lord Winston FMedSci FRSA FRCP FRCOG FIBiol, one of Britain’s best known and most eminent doctors, denounces belief in homeopathy as “lunatic”. Challenged by a shill with the claim that he doesn’t understand homeopathy, Winston responds with evidence that yes, he really does, not least because a member of his close family was a homeopath.

David Tredinnick bravely fights for homeopathy, and then lets the side down by supporting medical astrology and asserting that surgeons can’t operate at the full moon because blood doesn’t clot.

Pity the poor homeopathy shills: every shot they fire lands squarely in their own feet.

Proud member of the reality-based community

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