Transcript HOMOEOPATHY & SCIENCE: THE STORY SO FAR……

HOMEOPATHY
AND THE
NEW FUNDAMENTALISM
Rx
Pr
Px
Lionel Milgrom
The New Fundamentalism: what is it?
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It is based on an extremely narrow interpretation of
science and evidence-based medicine (EBM).
It denies efficacy for any therapeutic modality that cannot
be ‘proven’ in RCTs.
It ridicules, ignores, or misunderstands any explanation of
homeopathy’s efficacy, and current research data
supporting such explanations, especially from outside
biomedicine.
It uses experimental bias, hear-say, even innuendo in
order to discredit homeopathy (e.g., Ernst’s recent claim that
negative trial data supposedly obtained by the Nazis has been deliberately
covered up for over 60 years. See Ernst E, The truth about homeopathy. Br J
Clin Pharmacol 2008;65(2):163-4; and Milgrom LR and Moebius S. Is Using
Nazi Research to Condemn Homeopathy Ethical or Scientific? Bri J Clin
Pharm 2008;66(1):156-7)
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It is itself, therefore, unscientific; indeed, it is antiscientific.
The New Fundamentalists: the most voluble
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In the UK:
• Edzard Ernst , Professor of CAM at the University of Exeter;
• Richard Dawkins, Oxford professor, academic/author;
• David Colquhoun, UCL professor of pharmacology,
• Michael Baum , Emeritus professor of oncology, and his cosignatories of the Times letter (23/05/2007) urging health
authorities to cut funding for homeopathy/CAMs.
• Sense About Science , which includes science writer and
broadcaster Simon Singh, and Labour peer Dick Taverne;
• Ben Goldacre, Guardian journalist;
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From the US,
• Magician, James Randi
• Physicist, Robert L Park
The New Fundamentalists: what to they want?
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They see themselves as ‘defenders of reason’ against a tide of
irrational belief in, among other things, ‘quack’ medicine.
After all, how can homeopathic medicines work if there
are no molecules of the original drug substance present?
So, New Fundamentalists want to tell us how to think, e.g., the latest
from Ernst and Baum “All serious thinkers should have a closed mind
on the subject of homeopathy: it is anti-scientific and simply does not
work.” (The Worst Medicine, 07/05/2008: Wellcome Collection http://www.spikedonline.com/index.php?/wellcome/bestandworst/C142/)
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In the UK, they want: Total exclusion of all ‘quack’ therapies from the NHS:
 Closure of state-funded homeopathic hospitals; regardless of the many
who benefit from them.
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Their activities have lead to reductions in NHS referrals to the RLHH,
which is threatened with closure.
But 206 MPs signed an EDM to debate the fate of the RLHH.
Guardian journalist Tom Whipple, sent an email asking them why and
on what evidence they had decided to sign the EDM.
The New Fundamentalists: what did they get?
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Some typical responses:
Andrew George:
“The primary purpose behind adding my name to this EDM is to offer
an alternative treatment where conventional medicine has failed,
providing that it can be clinically proven that the homeopathic option
will not cause harm.” (‘First; do no harm.’ – Hippocratic Oath)
“If the treatment helps some patients then within reasonable
financial constraints and ensuring that decisions are fully informed
then patients with the support of their GP could be prescribed the
homeopathic option.”
Frank Field
“I support the EDM because I have been a beneficiary of homeopathy
medicine. Sometimes the drugs don’t work. The NHS has been
treating me for eczema for more years than I can remember without
total success.
“I do believe one aspect of getting well is that people believe that
they will get well. It is not the only aspect and as the health budget
has almost doubled in real terms I believe there is a place for
homeopathic medicines for those who wish to use them.”
The New Fundamentalism: propagating porkies
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In the history of science, paradigm shifts
are nothing new, but…
What’s different is that we live in an age of
easily accessible mass communication.
The New Fundamentalism’s ‘quackbusting’ message is propagated by some
(but by no means all) in the media who
share their (mainly biomedical) scientific
backgrounds and beliefs, e.g., Ben
Goldacre.
And they are a tad economical with the
truth….
The New Fundamentalism propagates porkies
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From Nick Cohen: “The cranks who swear by
citronella oil”. Observer; Sunday, 28/10/2007.
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http://www.guardian.co.uk/commentisfree/story/0,,2200815,00.html.
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“….Yet dismissing homeopathy as quackery given by and
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And, “(homeopathy’s) effects can be positively deadly.”
for the feeble-minded is surprisingly hard. Anti-elitism
dominates our society and many feel uncomfortable
saying that the six million people who take alternative
medicines are foolish - to put the case against them at its
kindest. They sincerely believe in phoney remedies and
sincerity trumps sense in modern culture.”
The New Fundamentalism propagates porkies
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The lie of homeopathy’s ‘deadliness’ has been repeated in
The Lancet. Ben Goldacre. Benefits and risks of homeopathy. The
Lancet 2007;370 (issue no. 9600): 1671-2: Udani Samararasekara.
Pressure grows against homeopathy in the UK. ibid. 1677-8.
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….Homeopathic malaria prophylaxis, attacked as deadly
by Simon Singh on Newsnight ….
….And the Government’s Chief Scientist, Sir David King
has also got in on the act (evidence to the Select Committee on
Innovation, Universities, and Skills, 06/12/07).
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Presumably, fear over homeopathy/CAMs
‘deadliness’ arises from their replacing conventional
treatments….?
….But aren’t they all forgetting something…?
The benefits of modern medicine
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In 2006 in the UK there were:
940,000 recorded accidents by doctors and hospitals (government thinks this
an underestimate: more like 1,190,000)
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300,000 hospital-acquired infections
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250,000 serious adverse drug reactions (again an underestimate, closer to
1,200,000).
That’s 2.68 million Britons harmed by conventional medicine (4.5% of the
population).
Chair of the Commons Public Accounts Committee, Edward Leigh, said:
“These figures would be terrifying enough without our learning that
there is undoubtedly substantial under-reporting of serious incidents
and deaths….” (See, Leigh E. A safer place for patients: learning to improve patient
safety: 51st report of session 2005-06 report, together with formal minutes, oral, and
written evidence. House of Commons papers 831; 2005-06, TSO (The Stationery Office). 6th
July 2006).
Why? Drs don’t want to face legal action from Pxs or disciplinary action
from the GMC.
In the US, conventional medicine is the third biggest killer after heart
disease and cancer.
More people die by conventional medicine in the US than by firearms.
(See http://www.health-care-reform.net/causedeath.htm)
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The benefits of modern medicine
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Malaria: second biggest killer in the world – ~1,000,000 new cases/year – a
child dies every 30 seconds….
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Big Pharma’s response: New anti-malarial drugs are not profitable so tend not to
get involved in researching them – leaves it to charity, e.g., Bill Gates.
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Current anti-malaria drugs can cause schizophrenia. (See World Health Organisation:
Review of central nervous system adverse events to the antimalarial drug mefloquine (1985–
1990). Geneva: WHO, 1991. Report no: WHO/mal 91.1063 ). Up to 22% of Lariam takers
have reported serious adverse psychological events (see Mathew Parris, ‘I THINK
I’D RATHER HAVE MALARIA’, The Times 04/04/1998)
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….Prozac ‘no better than placebo’….Statin side-effects….
….Withdrawal of Vioxx, Paxil, Bextra, Baycol…. Northwick Park antibody
trial….only 15% of CM products tested by RCTs….‘skewing’ of drug trials
results in order to protect share price and investors (See, for example,
http://www.google.co.uk/search?hl=en&q=Zoloft%3B+trials+questioned&btnG=Search&meta=)
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….Not to mention antibiotic abuse and the rise of MRSA….
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….MMR and the attempts to discredit Dr Andrew Wakefield (See Martin Walker;
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….The invention of ‘new diseases’ to sell more drugs (known as disease mongering;
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….And then there’s vaccination….
‘The Guardian, the Science Lobby, and the rise of Scientific Corporatism’, 22/01/2008
http://www.whale.to/vaccine/walker13.html)
see, Moynihan R, Heath I, Henry D. Selling sickness: the pharmaceutical industry and disease
mongering. British Medical Journal 2002;324:886-891).
The benefits of modern medicine
The vaccination myth?
“Scientific medicine has
taken credit it does not
deserve for some advances
in health. Most people
believe that victory over the
infectious diseases of the
last century came with the
invention of immunisations.
In fact, cholera, typhoid,
tetanus,
diphtheria
and
whooping cough, etc, were
in decline before vaccines
for them became available the result of better methods
of
sanitation,
sewage
disposal, and distribution of
food and water." Taken from
http://www.vaccinationdebate.com/
'Health and Healing' by Dr Andrew
Weil
AND THEY CALL
HOMEOPATHY/CAMS
!!!DEADLY!!!
The New Fundamentalists: what they forget
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New Fundamentalists claim there is no
proof or evidence that homeopathy/CAMs
have efficacy (possibly beyond a placebo
response).
But even if that were true (which it isn’t)….
“…. absence of proof is not proof of
absence. In fact, from a
methodological and statistical
standpoint, absence of proof is very
difficult to prove….”
Dean R Hess, Editorial; Respiratory Care, July 2002,
Volume 47(7), p757.
BAD SCIENCE?
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2005: Shang et al. ‘Are the clinical effects of homoeopathy placebo
effects? Comparative study of placebo-controlled trials of
homoeopathy and allopathy’. Lancet. 2005;366(9487):726-32.
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Lancet editorial (by Horton) proclaims ‘the end of homeopathy’.
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Appeared during August when news is sparse – the media pounced.
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Actually, this research was outright scientific bias and was roundly
criticised by many scientists working in the field (none of which was
reported by the media). See JACM 2005; 11(5): 779-785:
• Horton Deplores Breach; As Do We His. George T. Lewith, Harald Walach,
Wayne B. Jonas:
• Shang et al. Carelessness, Collusion, or Conspiracy? David Peters:
• Bias in the Trial and Reporting of Trials of Homeopathy: A Fundamental
Breakdown in Peer Review and Standards? Michael Frass, E. Schuster,
Ilse Muchitsch, Jeff Duncan, Walter Gei, Gloria Kozel, Christa Kastinger-Mayr,
Anton E. Felleitner, Christian Reiter, Christian Endler, Menachem Oberbaum:
• Failure to Exclude False Negative Bias: A Fundamental Flaw in the Trial
of Shang et al. Helmut Kiene, Gunver S. Kienle, Tido von Schön-Angerer:
• Understanding Placebo Effects in Homeopathic Clinical Trials.
Trevor Thompson, Marjorie Weiss:
• Sir: Is That Bias? David Reilly.
BAD SCIENCE?
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Deconstructing Shang et al. From Dr Peter Fisher in
PubMed:
• "The final analysis which concluded that ‘the clinical effects of
homoeopathy are placebo effects’ was based on just eight clinical
trials of homeopathy. The Lancet’s press release did not mention
this, instead giving the impression that the conclusions were
based on all 110 trials."
• "One of the most serious criticisms is the complete lack of
transparency (which incidentally goes against the Lancet’s own
guidelines for conducting such meta-analyses): we have no idea
which eight trials were included in the final, damning, analysis ."
• "The literature references are not given, nor any information on
the diagnoses, numbers of patients, etc., nor can these be
deduced from the article.”
• “Prof. Egger has refused several requests to disclose the identity
of the eight trials. This is not even a matter of scientific method,
but of natural justice: the accused has the right to know the
evidence against him."
Memory of water
280 water molecules/icosahedron
http:/www.lsbu.ac.uk/water/homeop.htm
Roy R, Tiller WA, Bell I, Hoover MR. Mat Res
Innovat 2005;9(4):559-576 (On-line;
www.matrice-technology.com)
The Memory of Water hypothesis is based on conventional physics and
chemistry concepts of supra-molecularity arising from hydrogen bonding and
other well-known weak interactions between water molecules. But MoW has
been dismissed out of hand as a ‘belief in undetected sub-atomic fields’ (See
Sagar SM. Homeopathy: does a teaspoon of honey help the medicine go down? Curr Oncol
2007;14(4):126-7, and Milgrom LR. Homeopathy, fundamentalism, and the memory of water. Curr Oncol
Memory of water
Evidence from the physical sciences
A. Chaplin M. Water Structure and Behaviour. Online document
at: www.lsbu.ac.uk/water/. Excellent section on homeopathy. Exhaustive
and regularly updated
B. Thermo-luminscence:
1. Rey L. Thermoluminescence of ultra-high dilutions of lithium chloride and
sodium chloride. Physica A 2003;323:67–74.
2. van Wijk R, Bosman S, van Wijk EP. Thermoluminescence in ultra-high
dilution research. J Altern Complement Med 2006; 12(5): 437–443.
C. Thermo-chemistry and Electrochemistry:
1. Elia V., Niccoli M. Ann New York Acad Sci, 1999; 879: 241.
2. Elia V., Niccoli M. J Thermal Analysis and Calorimetry, 2000; 61: 527.
3. Elia V., Niccoli M. J Thermal Analysis and Calorimetry, 2004; 75: 815.
4. Elia V., Baiano S., Duro I., Napoli E., Niccoli M., Nonatelli L. Homeopathy,
2004; 93: 144–150.
5. V. Elia, E. Napoli, M. Niccoli, L. Nonatelli, Ramaglia A., Ventimiglia E.
J Thermal Analysis and Calorimetry, 2004; 78: 331.
6. Elia V., Marchese M., Montanino M., Napoli E., Niccoli M., Nonatelli L.,
Ramaglia A. J Sol Chem, 2005; 34: 947.
Memory of water: composition vs structure
D. Materials science - epitaxy
 Sceptics claim that since there is no difference in composition
between a remedy and the pure water used, there can be no differences
at all between them.
 Materials science shows “…. that it is structure (not composition) that
(largely) controls properties, and structures can be changed in
inorganic phases without any change of composition.” (e.g., diamond and
graphite)
 “The burden of proof on critics of homeopathy is to establish that the
structure of the processed remedy is not different from the original
solvent.” Roy R, Tiller WA, Bell I, Hoover MR. Mat Res Innovat
2005;9(4):559-576 (On-line; www.matrice-technology.com)
 Using Raman and Ultra-Violet–Visible (UV–VIS) spectroscopy Roy et al
distinguished two different homeopathic medicines (Nux vom and Nat
Mur) and differentiated their 6c, 12c, and 30c potencies.
 “Materials science concepts and experimental tools offer a new approach
to contemporary science, for making significant advances in basic
science studies of homeopathic medicines.” Rao ML, Roy R, Bell IR, and
Hoover R. Homeopathy (2007) 96, 175–182.
MoW and biology?
There is a long way to go, but think of the chemistry inside cells as like watching
a play at the theatre. The molecules of life – DNA, proteins, enzymes, lipids,
vitamins, etc – are the principle ‘actors’ and they transfix our attention. But the
‘stage’, scenery, direction, even the theatre itself is made up of coordinated
water molecules which allow these principle actors to perform.
Pressure changes in the membranes of the myelin sheath of long axons
cause tightly-packed cholesterol-lecithin complexes to coil and stretch
which, via lined-up water molecules, causes protein pores to open and
close, allowing transmission of ions across the membrane. Such a
mechanism is vitally important for the transmission of neural impulses.
Why ‘believe’ in science?
Which means it might be possible to eventually
explain homeopathy in scientific terms.
 So why can’t the New Fundamentalists ‘get’ this?
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 Science is ‘special’: it is based on ‘facts’;
 These are claims about the world established by
careful unprejudiced use of the senses;
 These ‘facts’ are used to ‘prove’ theory.
 But isn’t science also based on assumptions
about the world?
 And don’t these assumptions somehow ‘colour’
the facts? Need to go deeper and ask,
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• What is science?
• What is evidence?
• How do we get there?”
Why ‘believe’ in science?
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Deductive vs inductive logic….
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All humans are mortal; John Smith is human; ergo, he is mortal.
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In the farmyard, the turkeys are fed every day; the farmyard operates in a uniform
manner; ergo, the turkeys will be fed tomorrow.
When we reason with deductive logic we can be sure that the conclusion will
be true if the premises are true.
When we reason with inductive logic we can end up drawing false
conclusions from true premises (what happens to turkeys on Dec 24th??!!).
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Induction leads us to believe that the future will resemble the past.
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What has this got to do with science? Science relies on induction!
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It is widely assumed that science starts with observation which provides a secure
basis from which knowledge can be derived via induction.
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But David Hume (18th C) argued it is all a matter of CUSTOM or HABIT and that the
use of induction cannot be rationally justified at all!
Science doesn’t ‘prove’ or ‘disprove’ anything: the word ‘proof’ should only
be used when describing deductive logical operations, like maths.
Offering a ‘reward’ to ‘prove’ homeopathy/CAMs work is a just a stunt
and not a cheap one at that.
Simple or Naïve Induction
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A large proportion of our beliefs are obtained by projecting from observed
(past or present) events to cases that are either unknown, unobserved, or in
the future. For example:
• Every swan I have ever seen has been white.
• Ergo; the next swan I see will be white.
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But what if the next swan I see is black?
ALARM! Is it a swan? Easier to say it isn’t! Or: maybe it was a trick of the light
and I never saw it!
This arises from what is called ‘Naïve Inductivism’, which asserts that:
• Purely objective observations can be made which lead to irrefutable facts:
• That generalisations can be induced from these facts:
• That scientific laws and theories result from these inductions
Karl Popper attempted to address the limitations of Naïve Inductivism with his
Principle of Falsification.
He argued that if a scientific theory cannot be tested by falsification, then it is
pseudo-science (e.g., Freud, Marx), and should be rejected.
But scientists don’t work like that and there have been some notable
successes by NOT rejecting theories when falsification apparently has
happened (e.g., Newton’s theory of gravitation and the orbit of Uranus).
Evidence-based assumptions
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Evidence is scientific – the result of research:
“I don’t believe in anything I can’t prove. My only
true belief is in science and its ability to sort out
belief from fact…My job is to establish whether
or not they (CAMs) are evidence-based. There is
no aspect of belief in this at all.” (Edzard Ernst; The
Times, 24/12/2005)
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Ernst is being a scientistic logical positivist, i.e.,
adopting the view that natural science has
authority over all other interpretations of life,
e.g., philosophical, religious, mythical, spiritual,
or humanistic explanations, and over other fields
of inquiry, e.g., the social sciences.
EBM and the philosophy of science
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The current notion of Evidence-Based Medicine (EBM)
assumes that:
Scientific evidence provides objective ‘facts’ about the world.
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Scientific beliefs stand or fall in the light of this evidence.
But this is a view based explicitly in the early 20th C
philosophy of logical positivism.
Developments in the philosophy of science since the
1920s have posed serious challenges to logical positivism
(Popper, Quine, Ayer, Kuhn, and particularly from PostModernists – Foucault, Derrida, Feyerabend, Lakatoé,
etc), and therefore to the concepts of EBM which are
based on it.
Thus, a recent Post-Modernist deconstruction of EBM
discourse compares it to a ‘fascist’ structure for its
intolerance of pluralism in healthcare systems (See, Holmes D
et al. Deconstructing the evidence-based discourse in health sciences: truth,
power, and fascism. Evidence-Based Healthcare 2006;4:180-186.
Observation is not objective
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Observation is dependent upon and coloured by our
individual senses and our background beliefs and
assumptions (Columbus….!)
What we see is never what ‘really is’ (goes right back to
Kant in the 18th C, and further to some ancient Greek
philosophers), even under the most highly controlled
experimental settings.
Kant said we can’t know anything about the ‘things-inthemselves’ (ontology) from which sensory data
emanates.
A modern interpretation of quantum theory goes even
further, and says there are no ‘things in themselves’. All
there is, is what we can know (epistemology) about the
world (Zeilinger).
Does a tree crashing in a forest make a sound if nobody
hears?
Observation is not objective
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Past experience is involved implicitly in what constitutes evidence,
but this also includes the knowledge and standards constructed and
adopted by ‘epistemological communities’:
In other words, decisions about what constitutes evidence are also
inherently SOCIAL; for we all experience the world through a certain
lens (paradigm – Kuhn):
What constitutes knowledge also depends upon cultural and social
values: these are just as subject to critique as the knowledge itself.
Thus, our acceptance or rejection of evidence can also lack
objectivity, for our natural tendency is to reject evidence which
does not fit with currently held theory.
Hence positive results from even the highest standard RCTs in
homeopathy will be rejected by those who do not ‘believe’ in the
possibility that ultra high dilutions can have an effect. Catch 22!
So don’t expect to collect on Ernst and Singh’s Thousands or
Randi’s Millions!
So What is Science?
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It may be described as a conformist society which
represents only the currently accepted paradigm.
Consequently the ‘society’ of science defines
‘reality’ relative to the accepted paradigm (e.g.,
the size of the universe pre- and post- Edwin
Hubble in the 1930’s-40’s).
Students are educated in the accepted paradigm:
alternative paradigms tend to be ignored.
So, the ‘society’ of science plays a part in
determining what scientists observe – and how
science is funded.
And as with all things social, there are ‘fashions.’
From that perspective, New Fundamentalism is
decidedly retro….
So What is Science?
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But the ‘society’ of science now feels itself misunderstood, and
under threat from ‘irrational’ belief systems (creationism;
religion, etc), and a climate of politically-correct anti-elitism.
A symptom? In the developed world, between the ages of 9-16
kids are being turned off science (Japan, the worst). Schreiner C
and Sjøberg S. Science education and youth’s identity construction – two incompatible
projects? In, Corrigan D, Dillon J, and Gunstone R (eds). The re-emergence of values in
the science curriculum. Sense Publishers, Rotterdam, 2007.
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There has been a ‘dumbing down’ of science education: decline
in real ‘hands-on’ experience via health & safety legislation.
Very little teaching of the history or philosophy of science.
The ‘society’ of science feels that its ‘message’ is not getting
across to the public. So, over the last 10 years there has been a
big ‘push’ on the Public Understanding of Science (PUS?!).
Media courses being offered at universities and more people
with science training (many from the biomedical sciences; to
graduate and post-graduate levels) joining the media.
So What is Science?
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In a ‘media age’, however, the sound-bite rules.
Science has to compete for time and space in a
crowded and commercialised media market.
Inevitably, this leads to over-simplification of
complex scientific issues.
So, naïve inductivism is making a come-back!
Combine this with a certain crusading zeal to
inform and educate the public, and we have….
The New Fundamentalists’ attempting ‘to rid the
world’ of unreason, thoughtless belief, and
anything that cannot readily be ‘proved’ and
explained by ‘black and white’ deterministic
science, e.g., homeopathy/CAMs.
CONCLUSIONS
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If ‘in science’s house there are many rooms….’ then New
Fundamentalists are straight out of the basement: they are ‘old
school’ naïve inductivists.
They attack homeopathy as un- or even anti-scientific but:• The New Fundamentalism is itself deeply flawed:
• It is challenged by Popper’s ideas on falsification, Kuhn’s notions
on paradigms, and Post Modern deconstruction of logical
positivism and EBM:
• New Fundamentalists ignore, ridicule, or have no comprehension
of evidence that supports homeopathy (e.g., claiming that the
Memory of Water hypothesis constitutes ‘a belief in undetected
sub-atomic fields’):
• They use misinformation, misdirection, bias, hear-say
masquerading as evidence (e.g., appeal to Nazi research) to
ensure their views prevail:
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As such, New Fundamentalists are not only themselves
unscientific, they demean science.
CONCLUSIONS
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THIS IS A BATTLE FOR HEARTS AND MINDS….
• Against skilful, crusading, implacable opponents who want neither peace
nor rapprochement;
• Who see themselves as ‘defenders of Enlightenment values against a
rising tide of irrational beliefs’ (Richard Dawkins);
• And are hell bent on ridding the NHS of homeopathy/CAMs provision.
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THIS IS UTTER HUBRIS AND MISDIRECTION.
• They proselytise a narrow one-size-fits-all interpretation of evidence,
medicine, and science which is NOT the epitome of Western
Enlightenment.
• A pluralistic, humanitarian outlook on life which respects individual
human rights, is.
• The New Fundamentalism threatens the rights of patients to own their
own health and healthcare, and to express their freedom of informed
therapeutic choice within the NHS.
• In this respect, it is doubly dangerous, so….
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TIME TO ‘LOCK AND LOAD’.
• Time to get ANGRY; to get
homeopathy/CAM.
UNIFIED;
to get BUSY
DEFENDING
FAMOUS LAST WORDS….
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“There are more things in heaven and earth, Horatio,
than are dreamt of in your philosophy.” From Hamlet by W.
Shakespeare
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“Science appears as what in truth she is; not as our
glory and absolute boast, but as a succedaneum, and a
prop to our infirmity.” William Wordsworth
“Science is a broad church full of narrow minds, trained
to know even more about even less.” Prof Steve Jones
(geneticist and science populariser)
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“I tell you; we are here on earth to fart around; and
don’t let anybody tell you different.” Kurt Vonnegut (writer)