Black is white.. day is night.. less is more.. nothing is everything (yes, homoeopathy again)

One of the more reliable sources of online laughs recently has been the comments thread following a ludicrous letter criticizing the rather wonderful Professor Edzard Ernst that appeared in the Times Higher Educational Supplement a couple of weeks back.

The letter was penned by Michelle Shine, a London homeopath. Shine is criticizing Ernst for applying critical appraisal to CAM therapies (well, she would, wouldn’t she?).

Apparently, in Michelle’s view, this is not what a Professor of Complementary Medicine should be doing. He should be “giving leadership”…

Hmm. You might think this is precisely what Ernst is doing. He is leading by example, demonstrating to the “CAM community” that, if they really want to be integrated with the mainstream of medicine, they have to adhere to the same standards of evidence we demand for other treatments.

Sounds like leadership to me.

It also sounds like what academics are supposed to do – serious investigation, critical analysis, and trying to get to the root of what works, and what doesn’t – and how what does work, works.

But apparently that isn’t leadership (according to Michelle). Or what a Professor of Complementary Medicine is supposed to do (according to Michelle).

Professor and PR – they both begin the same way? Errm?

From the tone of her letter, Michelle Shine thinks Ernst’s job is not to study CAM. Rather, his job is to promote it. We can infer, I think, that this means uncritically promote it, which is what homeopaths like Michelle do for homeopathy. As many different Bad Science bloggers have recounted, the non-medical homeopaths mostly think that homeopathy is an “entire self-consistent healing philosophy”, and can treat anything, from asthma to major depression to cancer to HIV/AIDS. Oh, and it can prevent malaria as well [not] [1].

Rather more shamefully, Michelle Shine implies that by studying CAM, rather than promoting it, Ernst is “betraying” the ideals of the person who funded the Exeter Complementary Medicine Chair – the late building magnate Sir (John) Maurice Laing (1918-2008).

Shine writes:

“Sir Maurice Laing originally funded the chair that bears his name at the Peninsula Medical School in Exeter because he was passionate about CAM. His wife, Hilda, had suffered for years from tuberculosis and was cured of this serious disease through the use of a CAM discipline, very possibly homoeopathy.

There is a significant body of high-quality scientific research supporting homoeopathy, which can now be added to more than 200 years of case histories – all of which verifies homoeopathy as a valid system of medicine.

Consequently, Ernst’s “interventions” on behalf of homoeopathy/CAMs must be causing Sir Maurice to turn in his grave.”

Why the THES printed this snide personal attack at all escapes me.

Apart from anything else, it is not true. Even the bit that implies Laing must have wished he had hired a PR man.

A quick google through the THES archive reveals an obituary for Laing, published earlier this year. The piece includes quotes from Edzard Ernst’s reminiscences at a Memorial Service for Laing.

“Interestingly, while much of the research carried out by Professor Ernst was at odds with Sir Maurice’s strongly held belief in the value of alternative medicine, [Sir Maurice] never pulled the plug on the post, instead stumping up yet more money when it was needed.

After ten years, the £1 million endowment ran out and Professor Ernst turned to him for more funding after promises of money from other sources fell through. Sir Maurice sent a cheque in the post for another £500,000, made out in his name.

“It took him no time at all to comprehend and respect that I had no plans to promote anything and was devoted to scientifically testing these treatments,” Professor Ernst said. “He began to hear from numerous sources that I was not sufficiently supportive of the field, but he kept encouraging me to do the rigorous science.”

Which suggests that Laing, unlike Michelle Shine and her homeopathic friends, understood that University Professors are supposed to be serious scholars, and also that establishing something as a viable treatment in medicine requires evidence that it works.

Last week Edzard Ernst responded directly in the THES to Shine’s jibes. His response is worth reproducing in full.

“In our book Trick or Treatment? Alternative Medicine on Trial, Simon Singh and I evaluate the evidence for or against some 40 alternative therapies. We stress that several are backed by encouraging evidence while others are not.

In the case of homoeopathy, we conclude that “there is a mountain of evidence to suggest that homoeopathic remedies simply do not work”, which should not be surprising because they “typically do not contain a single molecule of any active ingredients”.

Homoeopaths have reacted by stating that:

  • we misrepresent data
  • we are bought by big pharma
  • I was fired by the General Medical Council
  • I am a bad scientist, a fraud and a quack.

Now Michelle Shine has added to this long list of insults and lies by claiming that I am “falling short of (my) job remit” and that I cause Sir Maurice Laing (who endowed my chair) “to turn in his grave” (Letters, 3 July).

During many meetings, Sir Maurice encouraged me to conduct the most rigorous research possible, regardless of what it might find. Shine points out that my remit is to “speak for complementary medicine to government, the public and within the university”. But this is precisely what I have done during the past 15 years, publishing about 1,000 articles in medical journals. However, to speak “for” a subject does not mean telling untruths. We all seem to have got used to homoeopaths misleading the public, but British scientists and academics are bound to insist on the best evidence available to date.”

So Ernst is a man of integrity, as was Sir Maurice Laing.

Unlike, one is forced to conclude, many homeopaths.

In the meantime, the comments thread below Shine’s letter has featured, over this last fortnight, a selection of bad science people (supporting Ernst, and pointing out the falsehoods in Shine’s letter) and of homeopaths giving Shine their vocal support.

One homeopath who showed up is William Alderson:

William trained at The London School of Classical Homoeopathy. He had originally sought homeopathic treatment out of desperation, but it was not simply the success of the treatment that convinced him of the importance of homeopathy. When he read Samuel Hahnemann’s Organon of Medicine and discovered that this was a medical system with a sound scientific basis, he determined to find out more, and ultimately to train as a homeopath himself. (emphasis mine)

Goodness. As William Alderson’s bio reveals, he is a man of many and varied talents. Unfortunately, the ability to tell whether something has a “sound scientific basis” is clearly not among them.

I especially had to laugh when I read Alderson’s comment that:

“The effects of [homeopathic] potentised remedies are highly implausible only if you limit your scientific approach to that of chemistry, and if you rigorously use an inappropriate test. If a wider range of scientific investigatory techniques are used, and if appropriate tests are used, then the results have the chance of according with the clinical evidence – 200 years of clinical evidence.”

Ho hum. And day is night, and black is white. At least in William Alderson’s homeopathic parallel universe (homeoverse?).

A brief recap. It has been repeated ad nauseam that, for homeopathic remedies to have biological actions, one would have to explain how “no molecules” can do more than “some molecules”. “Potentised” means, or course, “diluted with shaking, which shaking is believed by homeopaths to impart magical healing properties”. Following the dilution, there are no molecules of “remedy substances” left. None.

For this potion to do something, one would also have to explain how water magically “remembers” having once had something dissolved in it, when that stuff is not there any more. Water molecules “jostle” one another on a molecular scale at such a speed that any “space” left by a substance that was once there would be gone in a matter of a picosecond (a millionth of a millionth of a second) at the very most, and probably much quicker.

In addition, absolutely no credible science exists to show that a homeopathic remedy is distinguishable from pure water. James Randi famously offered a million dollars to anyone who could credibly demonstrate a “paranormal phenomenon” (homeopathy would qualify, see the noted Horizon programme a few years back), while Edzard Ernst and Simon Singh have recently offered ten thousands pounds of their own money to anyone who can show by any scientific method that homeopathic remedies are distinguishable from water.

No claimants have shown up to claim Ernst and Singh’s prize, and Randi still has his million bucks.

Finally, the homeopathic canard about “sceptics don’t use proper tests” (put another way: “Double blind trials to test our healing power? No fair!”) has been magisterially debunked by Ben Goldacre in his definitive pwning of homeopathy, and in many other places too.

So everything – everything – in Alderson’s ringing statement is…. well, frankly, rubbish.

As an academic used to correcting students’ misconceptions, I thought I ought to re-phrase Alderson’s statement to make its breath-taking ludicrousness a bit clearer. Or better still, I will correct it along the lines of a student project report or thesis, to make it clear what Alderson is really saying:

Key:

Bold black for Alderson’s original words

Blue for the new edits to clarify the meaning

Red for deletions

“The effects of potentised remedies are highly implausible only if you limit your scientific approach to that of using all the known laws of physics, chemistry and biology, and if you rigorously use an inappropriate test the same established tests proven over decades of experience to be the best way to test medical treatments.

If a wider range of scientific and pseudo-scientific investigatory techniques are used, including techniques that are inadequately controlled and or/spurious, and if inappropriate tests are used that do not rigorously exclude experimenter, observer and reporter biases, then the results have the chance of coming out apparently positive – according with the subset of the available “clinical evidence” that we homeopaths like to bang on about, namely 200 years of anecdotes, famously the least reliable kind of medical evidence there is. We will ignore the more rigorous clinical evidence that does not suit our a priori belief-based position, namely all the blinded trials and meta-analyses that demonstrate that homeopathy is simply an elaborate placebo.”.

Incidentally, it is not terribly surprising that William Alderson has appeared to fight Shine’s corner, as they seem to be close associates. Both are, or have been, associated with a recently set up charity HMC21, or “Homeopathy: Medicine for the 21st century”. Michelle Shine, according to this homeopathy website, was formerly Chair of the group, while William Alderson is the secretary.

HMC21 says its purpose is to:

“promote homeopathy, and to defend the right of people in the UK to choose homeopathy as a therapy within the National Health Service”

Obviously the way to do that is for people like Michelle to accuse Edzard Ernst of being dishonest, and for Alderson to back her up with 42-carat nonsense.

Let’s hope their squeakings are treated with the derision they deserve.

Are you listening, Vice Chancellors?

And… is it too much to hope that the Vice Chancellors of those Universities offering “B.Sc. degrees” in Homeopathy and other belief-based nonsense might be reading these exchanges in their THES? And getting a reminder of the difference between scholarship and education on the one hand, and promotion and pseudoscience on the other?

Thought for the day

Finally, before I sign off, I thought I would try my hand at writing an advertising blurb for HMC21, and for the many homeopaths who seems to be able to achieve a stunning level of unconscious quantum doublethink when it comes to their preferred brand of belief-based wibble.

“Don’t like the physical laws of this universe? Insist on being judged by the laws of a parallel one you thought up specially!

Choose Homeopathy now!”

Just don’t expect me not to complain if you are trying to spend my taxes on promoting your parallel reality.

———————————————————————

1. Over at his Thinking Is Dangerous blog, Dr* T recently celebrated the 2nd anniversary of the Simon Singh / Sense About Science BBC Newsnight investigation of homeopathic practitioners and pharmacies who recommended homeopathic malarial prophylaxis to people proposing to visit malaria-endemic countries. The anniversary has now triggered a series of other badscience bloggers to post comments about the British Royal Family’s favourite quackery. Enjoy.

50 Responses to “Black is white.. day is night.. less is more.. nothing is everything (yes, homoeopathy again)”

  1. gimpy Says:

    Good points and good summary Dr Aust. It’s remarkable just how ingrained the culture of nastiness and deceit is in homeopathy. Its proponents are perfectly happy to assassinate character, ignore and misrepresent evidence and when their flawed reasoning is pointed out to them – ignore all criticisms and repeat the same old canards. The profession is dishonest to its core and its practitioners so wrapped up in themselves that they are coddled from scientific and medical realities.

  2. Dr* T Says:

    Excellent summary Dr Aust. Michelle Shine put in an odd Freedom of Information request here containing this telling phrase:

    “Indeed, a Professor should be an expert in his field and Ernst proclaims to have studied a number of CAM therapies, yet our research reflects that this might not be so. Therefore to have knowledge of his studies would put our minds at rest.”

    “Our” minds? The request was made by Michelle Shine alone. What research?

    A second, more recent FOI request contained this line:

    “I have been a qualified and registered homeopath (with the Society of Homeopaths) for the last 15 years and I am very keen to attend insightful teaching seminars or lectures, given or inspired by Professor Ernst).”

    I’m not sure that she is being completely truthful here. Homeopaths not being completely truthful, eh? Who’d have thought…..?

    Dr* T

    (Also, Thanks for the website link – very kind)

  3. She-Liger Says:

    http://postpostscripti.wordpress.com/2008/07/09/the-answer-to-quacks-times-higher-education/

  4. She-Liger Says:

    Doctor, are you a fool or a scoundrel? I hope that the former, though it is not better.
    Don’t you understand that Edzard Ernst is as the same villain as other homeopath? He is not better!

    “…So Ernst is a man of integrity, as was Sir Maurice Laing…”
    O-o-o-oh! What a poignant scene. Two quacks playing a roles of honest investigators! I simply cry because of delight :) :( :)

    Nevertheless, open your eyes and switch on your brains.

    All Ernst’s actions are merely the attempt to legitimize the homeopathy! Moreover – to do it with most dangerous way – declaring the right to test CAM methods to CAM practitioners THEMSELVES and forbidding/limiting the participation of scientists in this testing!

    We must not believe Ernst. We shall believe him only when (if) he’ll CEASE to be homeopath.

  5. apgaylard Says:

    She-Liger said: “All Ernst’s actions are merely the attempt to legitimize the homeopathy!”
    Ernst & Singh wrote: We suggest that you ignore the occasional media hype and instead rely on our conclusion … that homeopathy acts as nothing more than a placebo. For this reason we strongly advise you to avoid homeopathic remedies if you are looking for a medicine that is more than just make-believe. [Trick or Treatment p.140-141]

    This seems a mighty strange way to attempt to, “legitimize the homeopathy”. I’d be happy if all homeopaths and their appologists were as positive as Ernst about homeopathy.

    If he is a homeopath that would only seem to make his statements stronger evidence against the delusion; if he was to (and this is a merely hypothetical device) switch sides and ‘join’ the pro-homeopathy homeopaths he would have no credibility at all.

    What have I missed here, aside from the audible grinding of axes?

  6. draust Says:

    AP – I don’t really get what bee in her bonnet “She-Liger” has about Ernst.

    I do think that She-Liger clearly doesn’t understand Ernst’s “path” to his present position on homeopathy.

    Ernst probably learned about homeopathy as a medical student in Germany or Austria in the 70s; the medical schools there have historically often offered optional courses in things like herbal medicine, or acupuncture, or even homeopathy. The latter was often taken by students with an interest in more “medical humanities” types of ideas, of which there is historically a strong strand in German education, partly tracing back to the philosophical ideas of Rudolf Steiner. So conventional doctors in the Gerrman tradition who were interested in thing like counselling, or in other “person-centred” approaches, or who treated a lot of people whose symptom reporting likely had a strong psychological element (people with back pain might be an example) would often know about, and use, complementary therapy ideas.

    Ernst alludes to this in various interviews, including the Guardian one which is linked in the post.

    When Ernst says – in a line that homeopaths like Shine and Alderson sometimes quote:

    “Then you start working in a homeopathic hospital and people get better…”

    – it is absolutely clear from the context that he is talking about the well-known “people say they feel better”, that we know from innumerable anecdote / “survey” studies like the (again oft quoted by homeopaths) Spence et al. Bristol homeoepathic patient survey (briefly discussed by David Colquhoun here.

    NB The full passage from the Guardian interview with Ernst that contains the above quote is:

    “[Ernst's] first post [after qualifying as a doctor] was in a homeopathic hospital in Munich, where he was greatly impressed. “If you study medicine and pharmacology, you know [homeopathy] can’t work,” he says. The active substances in homeopathic medicines are so diluted that pharmacology says they cannot have an effect. “Then you start working in a homeopathic hospital and people get better. Is that a miracle? It certainly is very impressive for a young doctor.

    “Looking back, I wonder if a lot was a placebo effect.” Placebo to him, however, is not a negative. He would never assume people who get better on placebos were not ill in the first place. “I would like to have an institute of placebo research, but the funding would be even worse. You would get placebo money! But it’s absolutely fascinating what’s happening there. It is what gels mainstream and complementary medicine together. As doctors, we don’t want to realise it. We pride ourselves that therapy does the trick.”

    Thus one of the key themes of Ernst’s research is teasing out any real therapeutic effect of the intervention / medicine per se from the placebo effect, taken in its widest meaning (i.e. to include “therapist effect”). With homeopathy he finds the evidence clearly shows it is an (elaborate ritual) placebo, precisely what the science would tell you it has to be.

    It all seems clear enough to me, anyway.

    Incidentally, the last para I just quoted from the Guardian is very similar to what Ben Goldacre has said about placebo effects – and about people with “medically unexplained symptoms” – in his columns over the years.

  7. She-Liger Says:

    to apgaylard

    “What have I missed here, aside from the audible grinding of axes?”
    You have missed here, that besides the pro-homeopathic “switch of sides” there is anti-homeopathic “switch of sides”, but Ernst has NOT DONE the latter. He is homeopath. It is main thing. And his gab is merely his gab! The tongue has not bones and can bend by any way. Today Ernst is speaking against homeopathy, but tomorrow he will speak pro homeopathy. He is still homeopath! Don’t forget about it. Thus it is quite probable that his great speeches against homeopathy might be merely a trick to get financial and legal support for homeopathy and provide the command role for CAM-practitionres themselves in testing of CAM.
    Now do you understand why could these axes ding? While he remains homeopath, it could be the battle FOR homeopathy, but not against it.

    And generally! Devil take it! Why is just homeopath leading the battle against homeopathy??!!! Why do all of you suffer it? Or can’t quackbasters find other leader, who wouldn’t be homeopath?
    I was persuading David Colquhoun for TWO years to do it!!! In vain!!! Like a wall!!! He only takes offence like little boy and wants to do NOTHING… :( Why on the earth hasn’t he written the book against homeopathy himself, for example? He has a huge material! But he doesn’t want to do real actions, he wants merely to gab :((
    [Doc, do you seek "scotocephalic"? ;) Here is the first exemplar for you :) ]

  8. She-Liger Says:

    Doc, I know the expression “bee in bonnet” :), you could leave it without explanations. Good expression ;) and evidently has Scottish roots :)) Russians say in similar cases: “What fly has bitten you?”, but it is not so picturesque :))

    However, you are as usual! – a lot of words, but – in vain.

    Doctor! Dear! Certainly it is very interesting thing – to investigate the placebo effect! But why must the homeopath do it? Why – quack?!!
    Believe me: good medicine – so-called “mainstream” – knows this method of cure even better – (psychological influence, authority of doctor, placebo, etc, etc) ! I say as medical specialist in third generation! Good doctors could do it always! Moreover, good doctors must CAN it! In any case, my grandmother (she was excellent high-gifted doctor!) could treat patients so. Yes, medicine is both science and art even now, in XXI century.
    But talk must be about good medicine! Why do you try to believe quacks better in such questions as doctor’s art?
    I think – simply you know nothing about real medicine. You are not medical doctor. And – more important! – you are not from medical dynasty. Yes, really – some things exist in this profession, which don’t be described in textbooks for medical students. But good doctors know them and can teach young doctors.
    Thus – don’t believe charlatans! Real medicine knows all things better!

  9. apgaylard Says:

    She-Liger:
    It seems that you have become fixated on a label: The proof of the pudding is in the eating. Its only fair to judge him on the evidence of what he says.

    We have no evidence that Ernst’s path is anything but away from homeopathy. Eight years ago (Jnl. Expl. Epidemiology 53, 11 (2000): 1188 ) he commented that after taking the quality of the trials conducted in homeopathy lead to a conclusion that, “homeopathic remedies are, in fact, placebos.” His position has been consistent since. Our host has already explained something of his history. There is no sense in not permitting people to have their opinions changed by evidence. This is a scientific virtue.

    Adopting an attitude of ‘once a homeopath always a homeopath’ isn’t going to help sway the honest but misguided. It just isn’t reasonable.

    Neither do I think that this whole issue turns on Ernst’s position. Yes, some vocal homeopaths are upset with him; but their list also includes Richard Dawkins, David Colquhoun, Michael Baum, Simon Singh, Dick Taverne, Ben Goldacre, James Randi, Robert L Park.

    There are other critical books written by scientists (Baussell’s Snake Oil Science for instance. In fact this book summarises some really good work done by scientists on the placebo effect)

    Now, we might want particular people to do particular things (like write books) but to be a grown up is to accept that they are free to do as they wish. Just be greatful for the contributions made by those on the homeopath’s list.

    As a medical specialist, perhaps you would care to publish a contribution on this topic?

  10. Dr Aust Says:

    I strongly suspect the reason David Colquhoun doesn’t write a book about homeopathy is that he has better things to do. And homeopathy has been debunked so many times, by so many people, in print, on the blogs, on radio, on TV… that the thought of writing a whole book about it would probably cause any sane scientist to blow a fuse. Ben Goldacre has also said more than once that he is “bored with homeopathy”, and I can see why. Once you’ve said everything you have to say about homeopathy’s idiocies, you don’t really want to say it again.

    As has been repeatedly stated (e.g. by the excellent Gerald Weissmann here), the basic dilutional daftness of homeopathy was blindingly obvious as early as the 1840s:

    “[Homeopathy is] lucrative, and so long as it continues to be [so] will surely survive, —as surely as astrology, palmistry and other methods of getting a living out of the weakness and credulity of mankind and womankind.”

    Oliver Wendell Holmes
    “Homeopathy and its kindred delusions” 1842
    (full text here, among other places).

    Oliver Wendell Holmes noted and debunked all the major idiocies about homeopathy; the daftness of “like cures like”, as set out by Hahnemann; the ludicrousness of the idea that the more you diluted the remedy, the more potent it supposedly became; and the extreme implausibility of the ultra-dilutions, which would require volumes of water exceeding those present in all the world’s seas. Read his essay if you don’t believe me.

    Of course, the fact that homeopathy is still with us over a hundred and sixty years later just testifies to the power of belief and wishful thinking. Or, if you prefer Holmes’ formulation, “weakness and credulity”, plus the desire of people to make a living peddling wibble to the unwary.

    Incidentally, Oliver Wendell Holmes also spotted the likeness of homeopathy to a religious movement, something many Bad Science bloggers have commented on over the last few years:

    “Some of you will probably be more or less troubled by that parody of medieval theology which finds its dogma in the doctrine of homeopathy, its miracle of transubstantiation in the mystery of its dilutions, its church in the people who have mistaken their century, and its priests in those who have mistaken their calling. ”

    Holmes, Medical Essays

  11. She-Liger Says:

    apgaylard,
    you are vastly mistaken – his homeopathic title and position are not merely “a label”. Using your metaphor, it is just “the taste of the pudding”. Moreover – it is “the paste”, which this “pudding” (i.e. Ernst. Very non-tasty old stale pudding ;)) ) is made of . He WORKES as a homeopath, he runs Chair of CAM, he receive money for homeopathic investigations from the fund of lover of homeopathy. And his results are just “a label”.
    In his case it is very little step – to change opinion. He must change himself.
    If he cease to be homeopath actually and I shall sheathe the sword.

    Dr. Aust
    “…I strongly suspect the reason David Colquhoun doesn’t write a book about homeopathy is that he has better things to do…”
    Oh, yep!! He has better!..!!! To become the co-author in homeopath’s book!! The pitch of perfection!! Rr-r-r-r-rh!!! :((((
    Don’t defend him, Doc! Or else I’ll tear him to tatters :)
    He had made a mistake.

  12. draust Says:

    She-Liger / S*******, can we have an end to these conspiracy fantasies about a person (Ernst) you have never met, and whose public statements and (copious) writings all give the lie to every one of your daft rantings?

    And as I have also said, give the David Colquhoun stuff a rest. Or confine it to your own blog.

    If you can’t behave here, and stick to commenting on-topic and without personal attacks, I shall have to start editing or even deleting your posts.

  13. She-Liger Says:

    Dear Doctor,
    you’ll get into trouble if you will think so superficially.
    Don’t take offence because of trifles. Think about main things.
    And try to understand the importance of question.

    Sorry.
    Good-bye!

  14. apgaylard Says:

    doc:
    Thanks for the Holmes quotes. Very apt. Excellent de-bunking of Shine by the way. Perahps it’s a core characteristic of these people that words take on new meanings:
    evidence = anecdote
    high-quality trial = low quality trial with the right result (or customer satisfaction survey)
    science = nonsense
    higher physics = made up excuses
    quantum mechanics = magic
    cost effectiveness = expensive AND ineffective, or cheap AND ineffective.
    philosophy of science = problems you have

    As you say, there’s a whole black is white thing going on here.

  15. Ian H Says:

    apgaylard, your last post brought an old SF reference to mind – Clarke’s Law: Sufficiently advanced technology is indistinguishable from magic.

    Does it seem to anyone that as quantum physics seems ‘magical’ to many (I include myself in this, and I (just) graduated in Physics and now teach it) it is being used to ‘justify’ so many things that it has nothing to do with?

    On the plus side, homeopathy and many other ‘alt’ therapies provide me with many examples for teaching logic, scientific reasoning, double blind trial techniques to my students. What’s impressive is that the 11-12 year olds understand the basics as well as the older ones, and frequently better than their parents…

  16. draust Says:

    Nice one, AP.

    You could also add:

    “tried and tested” = doesn’t work
    “works in harmony with your body’s systems” = has no effect
    “treatment” = anything you can persuade someone to part with cash for
    “individualised” = only arrived at after much paid-for navel-gazing
    “potentising” = shaking and ritual hocus-pocus
    “treating the whole person” = using CAM “treatments” that don’t work while muttering about “spirituality”
    “cured” (by CAM therapy) = got better on its own
    “appropriate test” = one whose artifactual results I like
    “inappropriate test” = one whose real results I don’t like
    “valid system of medicine” = if I say so then it IS, SO THERE
    “leadership” = endless promotion while smiling on TV-AM sofas
    “scholarship” = blathering about quantum wibble, or making excuses
    “entanglement” = tripping over your own bullsh*t

    ..and not forgetting, of course, the original:

    “potentised remedy” = water

  17. Mojo Says:

    @draust: ““individualised” = only arrived at after much paid-for navel-gazing”

    Actually, the point of individualisation is that it gives the homoeopath an excuse if the patient doesn’t get better: the first remedy prescribed was not the correctly individualised one. The homoeopath then prescribes a series of different remedies, and the last one given before the patient eventually shows some improvement (or even a worsening of their condition – see “aggravation” ) is declared to be the correct one.

  18. Woobegone Says:

    She-Liger, I could just as well accuse you of being a homeopath on the grounds that you’re attacking Ernst, one of the best known critics of homeopathy in this country. How do you propose to prove that you’re not a homeopath at heart?

  19. draust Says:

    Cheers Mojo. That’s priceless.

    You have to say that they have a first-rate act going there:

    Patient doesn’t improve: We just need more homeopathy but with a different remedy!

    Patient does improve: It was all due to cure by wonderful homeopathy!

    Erm… what is wrong with this picture?

    One can see why it strikes James Randi as a form of “mental misdirection” confidence trick.

  20. Mojo Says:

    Patient gets worse: “Look! It’s working!”

  21. Dr John Crippen Says:

    What an outstandingly good review of the current state of homeopathy. Well done.

    One thing that both fascinates and baffles me is the general attitude of the media to homeopathy and other quack therapies. You touch on this when you say:

    “Why the THES printed this snide personal attack at all escapes me.”

    The answer is simple but infuriating. For reasons that escape me too, most of the media LOVE alternative medicine. Investigative journalists spend hours, weeks, years, investigating hospitals and doctors, but devote so little time to exposing quacks. How DO all these Vitamin selling nutritionists get so much air time? Why isn’t Ernst lauded as the open minded, fair, analytical scientist he clearly is? He dismisses nothing out of hand. He will look at anything. All he asks is “bring me some evidence”. If you don’t bring the evidence, you don’t get his support.

    A few weeks ago some poor woman died after persisting with a detox diet consisting of six pints of water a day and no sodium. If a qualified doctor had (for whatever reason, and there may be one mad enough to do it) treated a patient like this, there would have been front page headlines in every Red Top newspaper, cries for more regulation of doctors, cries for the GMC to be scrapped, cries for the doctor to be struck off or even prosecuted. (On which topic, I continue to wonder why a manslaughter charge has not appeared.) But it wasn’t a doctor. It was a nutritionist. Damages paid of over 3/4 of a million pounds and she is still practising. Newspapers not interested.

    Crazy

    John

  22. Mojo Says:

    I wouldn’t quite agree with you on the Ernst quotation, “Then you start working in a homeopathic hospital and people get better…”

    It isn’t entirely down to people saying they feel better; many of them actually will be better simply as a result of the natural history of their condition. People are unlikely to turn up at a hospital, even a homoeopathic one, because they are feeling particularly good. It is probable that a lot of the patients in the Spence customer satisfaction survey actually were better after the treatment than before. The study merely fails to provide any evidence that the homoeopathy was responsible.

  23. She-Liger Says:

    Woobegone
    I gave an advice to switch on the brains ;)

    Am I digging within his heart, eh? Where do you see it? I am interested in neither his heart nor his soul. He could be even devil at heart! Let it go hang! And you can be anybody at your heart it! And I can do so.
    Important thing – that he wouldn’t be homeopath actually.

  24. Claire Says:

    “most of the media LOVE alternative medicine”

    or at least are happy to give it uncritical promotion – here is a recent example from the Manchester Evening News, entitled “Ask the experts” (!)

    Most maddening is that it’s a jumble of sensible advice (e.g. the eye-test question) and promotion of CAM modalities, but all presented as equally valid.

  25. draust Says:

    Thanks, Dr C. Though I would have to say that Ben Goldacre’s The End of Homeopathy is the best single demolition of the homeopaths’ flim-flammery that I know.

    I agree that the “free pass” the Nutri-loons and similar get from the press is baffling. What is even more annoying is that in the rare cases where adverse things do get reported, the line is usually “oh, regulation is now being proposed” (e.g. by the Prince of Wales et al) when the regulation being proposed is utterly toothless… so that all the Quacktitioner Royal and his Alt.Reality pals are really proposing is to cloak all sorts of nonsense in spurious legitimacy.

    I was pondering the legal situation of the “Natural Nutritionist” in the case you refer to. The “patient” didn’t actually die, but she is permanently disabled and unable to work – hence, I guess, the size of the insurance payout.

    I was thinking that the appropriate charge – since as I understand it you cannot by definition have “attempted manslaughter” – would be GBH. I suppose the “practitioner” would likely defend such a charge by claiming “consent”, but I would love to see a case like this brought.

  26. draust Says:

    Claire – you are right about the Manchester Evening News’ notoriously dim-witted Ask the Experts CAM-boosting page. I have to avoid reading it these days as I find myself wanting to write shouty letters full of swearing.

    Interestingly, among the CAM bollocks it also has a regular cosmetic surgery adviser (!!) – not a surgeon, of course, someone who runs a clinic. I find this rather revealing about the mindset of the people they think they are pitching the page to.

    The MEN page features also tend to follow the classic formula of:

    “blithe statement of utter bullshit plus later small-print hedging and disclaimers”

    For instance:

    “Yes, osteopathy can help your child’s asthma.”

    (A big “Bullshit!” to that one)

    “But again, I never make any promises, because every human body is different and responds differently to manual therapy treatments.”

    (hedging to cover yourself when it does bugger all)

    And then right at the bottom:

    “The above advice is not a substitute for seeing your GP”

    (which will doubtless make Dr Crippen happy when the parents consult him about the recommended “cranial osteopathy”)

    PS As I recall, the resident homeopath on this page has a “B.Sc. degree in Homeopathic Medicine” (sic). I am pretty sure this marks her out as a graduate of the University of Central Lancashire in Preston, who should be ashamed of themselves for offering such a course.

  27. She-Liger Says:

    Doctor,
    “some supplement” to your reasons are here and (in German) here.

    Generally, there is Russian proverb “the law is like thill, which way we’ll turn it to, thereto we’ll come” :)) It means – clever lawyer can handle a law how he wants.
    In our case, good lawyer can always find the way to defend the interests of patient. It is justly, because the talk is about human health vs. dishonesty of quacks.

  28. draust Says:

    Thanks for the links. Part of the debate about regulating the “Alt-ists” in the UK is about whether they would be regulated as strictly as in Germany. In Germany “Heilpraktiker” (health practitioners) are certainly subject to de-licencing if they endanger people, and that includes “not recognising something that should mean they send the person to a conventional doctor”.

    I doubt, however, that there is much stomach in the UK for “professional regulation” this strong. What the people pushing for regulation want – and that mainly means the Alt.Reality lot – is something much more wishy-washy. They largely propose to judge practitioners according to what they themselves collectively regard as acceptable practice. But everything we have seen so far with their voluntary “professional codes” shows us that they will not impose meaningful standards or disciplinary procedures.

    Prosecution is also certainly possible. The difference in that respect between Germany and the UK is not so much the law, I think, as the desire to use the law in this way. Laws already exist in the UK that could be used – fraud, and even causing bodily harm in extreme cases. But the Police and the Crown Prosecution Service (and indirectly the politicians) have to want to use the laws, and to bring the cases. Personally I would love to see it, but I’m not holding my breath.

  29. Dr John Crippen Says:

    Dr A

    You are right; she did not die, so I was dreaming about manslaughter; and there is no offence of attempted manslaughter; OK, so gbh will do; and its not attempted gbh. It’s gbh

    JOhn

  30. Claire Says:

    Dr Aust – firstly, thank you for converting my ugly loser-length link to the elegant blue writing link thing. Was in a bit of a rush so forgot to tinyurl it but mastering the blue writing is on my to do list!

    Regarding the Manchester Evening News ‘expert’ on paediatric asthma [/irony] I find this kind of thing particularly misleading:

    “…If I am totally honest, I don’t really know why osteopathy helps asthma, but I have seen children able to stop their medication following treatment. We don’t fully understand the causes of asthma, so it isn’t surprising that we don’t fully understand why treatments such as osteopathy help…”

    Under the guise of “total honesty”, how reassuring, he drops in the idea that one’s child might be able to stop their medication following treatment – nimbly avoiding an actual claim of cure. Curiously, no recommendation to parents to contact Asthma UK or have a root around in the BTS/SIGN asthma guideline, which curiously fails to mention osteopathy as an effective treatment.

    And, of course, no mention that, particularly if not properly cared for, asthma can be fatal, though thankfully infrequently. This is from Asthma UK:

    “There were just over 1,300 deaths (1,318 ) from asthma in the UK in 2005 (27 were children aged 14 years or under). On average, 4 people per day or 1 person every 7 hours dies from asthma”

    http://preview.tinyurl.com/6zgtyc

  31. apgaylard Says:

    Ian H:
    In the case of Clarke’s Law and homeopathy I’d re-frame it as “Sufficiently archaic concepts indistinguishable from magic.”

    On the topic of quantum mechanics being used to justify anything people want to justify I’d recommend the works of Milgrom, Hankey, Chopra, Weingärtner and a whole host of others.

    Quantum mysticism, or flapdoodle (Gell-Mann) is rampant.

  32. Moochie (aka Detlef Pelz) Says:

    I am so glad that there are people like you, David Colquhoun, Edzard Ernst and Simon Singh, Richard Dawkins, Michael Baum, Dick Taverne, Ben Goldacre, James Randi, Robert L Park and so many, many others, both those well-known and those less well-known, out there helping to pull the wool of ignorance from people’s eyes — it is both heartening and a reminder of just how important it is for people to think critically and rationally about the most important aspects of their lives.

    The planet faces crises of increasingly devastating consequences, so the need to think critically and rationally about all of our actions, each and every day, is absolutely imperative.

    My heartfelt thanks to all of those who have the courage to face reality, and who are encouraging their fellows to do likewise. Our futures depend on this more now than ever before.

    M.

  33. draust Says:

    Thanks Moochie/Detlef. You’ve certainly made my day listing me alongside those guys.

    Another couple of blogosphere anti-nonsense crusaders who deserve a great hat-tip are “Orac” (who is a cancer surgeon) over at Respectful Insolence, and Yale neurologist Steven Novella, whose blog is Neurologica.

    One of Ben Goldacre’s repeat lines about the usefulness of blogging is

    “equipping the geekily sceptically-minded with the tools and arguments to debunk nonsense in their own backyard”

    – or words to that effect. I really think he has something. So with that scepticism… pass it on!

    Apart from venting on the blog, I also like to harangue my MP once in a while (in the politest possible terms) about relevant issues. I think the last three were idiotic licencing of homeopathic “remedies”, crypto-creationist ID nonsense in schools, and the recent UK parliamentary votes on hybrid embryos and the 24 week time limit for terminations. I have come around to the view that MPs get bombarded with letter-writing campaigns by the pressure groups (homeopaths, ID proponents, Christian anti-abortion activists) and that they need to know there are plenty of us out here who care enough about rationalist positions to write letters too.

  34. Moochie Says:

    You’re most welcome, Dr Aust. I think I might be one of those “geekily sceptically-minded” people Ben Goldacre wrote about. I am not a scientist nor particularly sensible about a great number of things, but I’m learning, even at my age (58), and I do my little bit to further critical thinking in those around me. And although born with a crankily stubborn rational streak, I find blogs like yours of inestimable value in refining my thoughts and words with which to confront bloody-minded stupidity wherever I find it.

    My current campaign is to tell the pharmacies around the area they can have all of my business just as soon as they stop selling homeopathic snake oil. No takers yet, but I gain great amusement when other customers overhear my offer being made, and why it’s being made.

    There’s no reason that being rational can’t be fun.

    My best wishes to you and yours.

  35. Justathought Says:

    draust said

    What the people pushing for regulation want – and that mainly means the Alt.Reality lot – is something much more wishy-washy. They largely propose to judge practitioners according to what they themselves collectively regard as acceptable practice.

    Isn’t that the basis on which the medical profession assesses malpractice?

  36. draust Says:

    Isn’t that [judging practitioners' conduct according to what they themselves collectively regard as acceptable practice] the basis on which the medical profession assesses malpractice?

    Yes and no.

    Yes, there is self-regulation in medicine; but no, it is definitely NOT the same as what the Alternative Practitioners want for themselves. The difference is the standard you set, and the vigour with which it is enforced. And also the culture of accountability (or lack of).

    Conventional health providers routinely get sued for “medical negligence”, and doctors can, and do, get struck off (removed from the register and banned from working) for “professional misconduct”. Speaking as a “medical spouse”, it is a rare doctor who has not been investigated or been involved in a patient case that gets investigated.

    Examples of anything similar happening with Alternative Practitioners are vanishingly rare, mainly because the standards they set out for themselves are so super-elastic that next to nothing can ever be considered “misconduct” or “negligence”. In essence, they construct the system to give themselves a free pass.

    This is a natural outgrowth, though, of a set-up that does not require treatments to be based on reproducible evidence in the first place. If you don’t have a clear idea of what is the correct thing to do in a given set of circumstances, how can you decide if what was done was incorrect?

    No time to write at more length now (just back from conference and sorting Jr Aust out for first day at school), but will post something more on this (hopefully with examples) soon.

  37. Justathought Says:

    This is a natural outgrowth, though, of a set-up that does not require treatments to be based on reproducible evidence in the first place. If you don’t have a clear idea of what is the correct thing to do in a given set of circumstances, how can you decide if what was done was incorrect?

    So how does this relate to medical treatments which change and then change back again later? Were these treatments not based on “reproducible evidence” at first, but then were later … er … and then weren’t again – or the other way round? Surely the “correct thing to do” can’t become incorrect and then correct again.

  38. draust Says:

    Surely the “correct thing to do” can’t become incorrect and then correct again.

    Well it can, of course, since the judgement of “correct thing to do” will be based on “the best evidence available at the time“. Sometimes, especially in the past, this best evidence wasn’t all that good, and depended a lot on opinions and received or traditional wisdom. Recognising that fact, and that evidence from randomized, controlled (and often blinded) trials is indispensable, has itself been part of the process of moving to what is now called “evidence-based medicine”, or “science-based medicine”.

    Part of what this movement / way of thinking tries to do is ask not just: “what is the evidence for/against XYZ?” but also “how strong is this evidence?” – e.g. is it really strong / pretty much conclusive, or is it “just a bit suggestive and could easily be revised by further, more definitive, work”?

    In a general way, experimental evidence and the theories derived from it in science are always clarified, updated or even replaced by better experimental evidence. That’s how it works. Scientists accept this. CAM people typically don’t.

  39. Justathought Says:

    You mean like Prozac, Vioxx and all those other drugs with all their evidence from randomized control trials?

    If medicine is “science-based”, is there another science in which the evidence changes quite so quickly and absolutely? And back again too!?

  40. givescienceachance Says:

    Conventional health providers routinely get sued for “medical negligence”, and doctors can, and do, get struck off (removed from the register and banned from working) for “professional misconduct”. Speaking as a “medical spouse”, it is a rare doctor who has not been investigated or been involved in a patient case that gets investigated.

    Could you provide some figures for these statements? How routine is it for health providers to get sued? How rare is it for a doctor not to be investigated? What are the commonest reasons for suing or investigating a health provider?

  41. draust Says:

    Hmm. Is that you under a new Nom de Net, JustAThought / “givesciencea chance”? Your IP address is a bit of a giveaway.

    Assuming (however unlikely) that this is a genuine question rather than a wind-up, I’m afraid those aren’t the kind of numbers I would know If you are interested in researching the subject, you could start at the General Medical Council’s pages on making complaints about doctors here. There is also no shortage of solicitors’ help pages about how to bring a medical negligence lawsuit in the UK – try googling:

    “medical negligence” UK

    – for tons of examples – a typical one is here.

    I would humbly suggest that the vast numbers of ambulance chasers lawyers offering to help you sue for medical negligence on a “No Win No Fee” basis means such lawsuits are fairly common.

  42. givescienceachance Says:

    The question is serious, because if the level of complaints is so high, doctor’s training should be oriented to reducing at least the most common causes. A lot of people, I suspect would identify discrepancies between the GMC’s “Good Medical Practice” guidelines and the behaviour of their GP or other doctor, so perhaps the number of complaints is not a measure of the success of the procedure but of some weakness in doctor’s training.

  43. She-Liger Says:

    Yes? Weakness?!..
    And what level of complaints does quack’s practice have?!! Different homeopaths, chiropractors, healers and other creatures??!!
    Don’t hope to corner us by your “sly” questions!
    Yes, there are some bad doctors among GPs. Negligible quantity. Not all GPs. Not by a jugful.

    But ALL your “favourite” quacks are ripe to be brought to justice. All! Without exception!

  44. draust Says:

    “A lot of people, I suspect would identify discrepancies between the GMC’s “Good Medical Practice” guidelines and the behaviour of their GP or other doctor.”

    Would they? I don’t think the statistics actually say that. We just hear a lot from the people who are unhappy, and far, far, less from much larger number who are broadly happy. “Gloom gloom, gloom, and doom” sells more newspapers than “things are going pretty well”.

    There is an obvious problem of ever-rising expectations of healthcare, as even a cursory reading of the newspapers or the medical blogs makes clear. People often feel some doctors “don’t have time for them” – CAM practitioner advertising plays on this a lot. Well, the NHS pays for standard GP consults to be 8-10 minutes long – that is hardly the GPs’ choice/fault. There are various solutions that can and are being tried, but the solution does not lie in suing the doctor.

    CAM practitioners would have you believe the solution lies in consulting them. I don’t agree. If you want to see a psychotherapist, then see a psychotherapist, not a quack selling you imaginary remedies.

    “doctor’s training should be oriented to reducing at least the most common causes [of complaints]“

    The causes of complaints are actually complicated, involving what happened, what the complainant thinks happened and (fairly obviously) the complainant’s previous views on / attitude to doctors.

    Leaving this aside, there already have been many changes to medical training in the last decade or so, and it is an ongoing process. For instance, since the mid-90s there has been a far greater emphasis on communication skills in medical training, largely driven by what patients want/need. The work of Michael Balint and his followers has been increasingly influential, especially in General Practice, and I saw one doctor writing somewhere recently that “we are all Balintians now”.

    There are also many other examples of training changes driven by where problems occur – more training in prescribing for junior doctors when they first go into hospital, for instance. Finally, there is also increasingly a sort of “critical incident error analysis” process, more like what the airline industry does, to handle close calls or major incidents in hospitals.

    However, as one recent correspondent to the British Medical Journal put it, one has to understand

    “the inevitability of error in human activity.”

    No matter how well you train people, they will make some mistakes, especially in an arena where what happens is, by its nature, not routine. The best solution is to keep improving the training, and to keep working on systems to spot the inevitable errors before the errors can cause harm.

  45. givescienceachance Says:

    Thank you. Apart from the snide remarks about psychotherapy and advertising (which seem to stem for your opinions rather than facts), I agree with much of what you say. Indeed it seems that what is happening accords with what I suggested should happen: complaints should feed into the training process.

    When making a comparison with CAM therapies, however, there are points which should be borne in mind. For example, doctors see more patients on average than CAM therapists, so if the percentage of people complaining were the same, there would be far fewer complaints about CAM therapists numerically and fewer practitioners affected. A lower incidence of complaints need not represent a failure of the complaints process, but a simple mathematical difference of scale.

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