Homeopathy is fraud

2007-11-24

in Rants, Science

It astonishes me that anyone takes homeopathy seriously as a kind of healing. Essentially, the idea is to take a substance that causes symptoms similar to those a person has (hot pepper for fever, etc) and then dilute it to an enormous extent, producing a solution that is essentially water. The dilution can be so extreme that it becomes probable that no molecules of the original substance are in a dose of the ‘medicine.’ This is then given to people who are told it will somehow help to make them well.

The solutions given are basically just water and/or alcohol, so they are fairly unlikely to harm anyone. Of course, they are as likely to have a positive medical effect as sprinkling the credulous with fairy dust. Any benefit is purely the result of the placebo effect. The fact that giving someone anything and saying it will make them better actually does in many cases is well understood.

As such, it is a bit shocking that such practitioners stay in business and that anyone takes them seriously. People are being misled (perhaps not lied to, since homeopathy practitioners may believe this stuff) and charged money for something useless. If nothing else, consumer protection organizations should be vocally and persistently objecting to this nonsense.

{ 104 comments… read them below or add one }

Milan November 24, 2007 at 5:14 pm
. November 24, 2007 at 5:20 pm

Ernst, E. “A systematic review of systematic reviews of homeopathy.” British Journal of Clinical Pharmacology. Volume 54 Issue 6 Page 577-582, December 2002

Homeopathy remains one of the most controversial subjects in therapeutics. This article is an attempt to clarify its effectiveness based on recent systematic reviews. Electronic databases were searched for systematic reviews/meta-analysis on the subject. Seventeen articles fulfilled the inclusion/exclusion criteria. Six of them related to re-analyses of one landmark meta-analysis. Collectively they implied that the overall positive result of this meta-analysis is not supported by a critical analysis of the data. Eleven independent systematic reviews were located. Collectively they failed to provide strong evidence in favour of homeopathy. In particular, there was no condition which responds convincingly better to homeopathic treatment than to placebo or other control interventions. Similarly, there was no homeopathic remedy that was demonstrated to yield clinical effects that are convincingly different from placebo. It is concluded that the best clinical evidence for homeopathy available to date does not warrant positive recommendations for its use in clinical practice.

Access online

. November 24, 2007 at 5:34 pm

“A study in the Journal of the American Medical Association indicated that Americans now visit alternative care providers nearly twice as often as traditional physicians, and the numbers are growing. In 1997, Americans spent an astounding $27 billion on visits to alternative practitioners, an increase of 45 percent over 1990. Sales of megavitamins alone rose from $0.9 billion in 1990 to $3.3 billion in 1997. And most of that money was not reimbursed by medical plans…

The responses are intriguing. The answer, it seems, it that people are alienated from an increasingly impersonal health care system. Traditional medicine is seen as expensive, impersonal and, in the end, not all that effective at promoting health, but rather at treating illness. On the other hand, alternative therapists are viewed as attentive, responsive and willing to give the patient a role in the treatment and its outcome.”

More

R.K. November 24, 2007 at 6:56 pm

What makes homeopathy different from other misleading doctrines (like astrology) that we tolerate because having the state suppress them would be worse?

Sure, people waste money on homeopathy. They may occassionally avoid real medical options because they trust in it. People are always going to do stupid things, and it is mostly better for the law to let them.

. November 24, 2007 at 6:03 pm

Samuel Hahnemann pioneered and always favored the centesimal or “C scale”, diluting a substance 1 part in a 100 of diluent at each stage. A 2C dilution is one where a substance is diluted to one part in one hundred, then one part of that diluted solution is diluted to one part in one hundred. This works out to one part of the original solution to ten thousand parts (100×100) of diluent. A 6C dilution repeats the process six times, ending up with one part in 1,000,000,000,000. (100x100x100x100x100x100, or 1006) Other dilutions follow the same pattern. In homeopathy, a solution is described as higher potency the more dilute it is. Higher potencies – i.e. more dilute substances – are considered to be stronger deep-acting remedies.

Hahnemann advocated 30C dilutions for most purposes (a dilution by a factor of 1060) and a common homeopathic treatment for the flu is a 200C dilution of duck liver, called Oscillococcinum in homeopathy. Comparing these levels of dilution to the number of molecules present in the initial solution, a 12C solution contains on average only about one molecule of the original substance. The chances of a single molecule of the original substance remaining in a 15C dilution would be roughly 1 in 2 million, and less than one in a billion billion billion billion (1036) for a 30C solution. For a perspective on these numbers, there are in the order of 1032 molecules of water in an Olympic size swimming pool and if such a pool were filled with a 15C homeopathic remedy, to expect to get a single molecule from the original substance, one would need to swallow 1% of the volume of such a pool, or roughly 25 metric tons of water.

. November 24, 2007 at 7:17 pm

Study: Acupuncture Works

A recent German study demonstrated that acupuncture, even fake acupuncture, worked better than conventional care to relieve chronic back pain.

. November 24, 2007 at 7:40 pm

The end of homeopathy?

November 16th, 2007 by Ben Goldacre in homeopathy, bad science |

Time after time, properly conducted scientific studies have proved that homeopathic remedies work no better than simple placebos. So why do so many sensible people swear by them? And why do homeopaths believe they are victims of a smear campaign? Ben Goldacre follows a trail of fudged statistics, bogus surveys and widespread self-deception.

. November 24, 2007 at 8:06 pm

“The placebo response is about far more than the pills – it is about the cultural meaning of a treatment, our expectation, and more. So we know that four sugar pills a day will clear up ulcers quicker than two sugar pills, we know that a saltwater injection is a more effective treatment for pain than a sugar pill, we know that green sugar pills are more effective for anxiety than red, and we know that brand packaging on painkillers increases pain relief.

A baby will respond to its parents’ expectations and behaviour, and the placebo effect is still perfectly valid for children and pets. Placebo pills with no active ingredient can even elicit measurable biochemical responses in humans, and in animals (when they have come to associate the pill with an active ingredient). This is undoubtedly one of the most interesting areas of medical science ever.”

tris November 25, 2007 at 3:44 am

. is on the money – we know not yet what a body can do. This kind of dismissal dismisses along with what homeopathy claims to do, all the things it might do by accident – and if it works at all, it is by doing things by accident.

If it is really true that there is no active ingredient in the medicine, then there is no active ingrediant in the medicine, and that a placebo has no different effect is no evidence against its effectiveness because it is a placebo.

We need to study the effects of placebos!

Neal November 25, 2007 at 5:06 am

The key to administering an effective placebo is convincing the patient that the treatment given is not a placebo. It would seem that this would give ignorant chumps a good option for very low side effect relief of certain symptoms with homeopathic remedies. Once you understand what homeopathy is, however, you need to be very good at deceiving yourself or fundamentally stupid for it to have any chance of being effective. Drat.

Litty November 25, 2007 at 12:26 pm

The argument that homeopathy is ok because placebos work is not convincing.

Even if placebos (and homeopathy) are better than no treatment, it doesn’t hold that they are better than an effective treatment. In cases where people should get real treatment get homeopathy instead, they are materially harmed.

The only good situations would be cases where people don’t actually need any medical treatment but believe that they do. Getting homeopathy in such cases would at least have the virtue of producing no physical side effects.

R.K. November 25, 2007 at 12:35 pm

The placebo effect is one of two explanations for why people who receive homeopathic treatment think it works. Consider the following

1. People seek treatment when they are sicker than normal.

2. People are at their ‘normal’ level of illness most of the time.

3. Regardless of whether treatment is received, a normal person will move back from the peak of illness towards normal health most of the time.

This doesn’t hold for degenerative illnesses like terminal cancer, but it holds for thinks like infections.

Even with chronic conditions – like a painful joint – there will be a natural oscillation in the degree of pain. If you seek treatment when it is at its most painful, it is probable that it will soon start decreasing in pain simply on the basis of that oscillation.

Milan November 25, 2007 at 12:43 pm

Sure, people waste money on homeopathy. They may occasionally avoid real medical options because they trust in it. People are always going to do stupid things, and it is mostly better for the law to let them.

This is a pretty good summation. That said, it makes sense to try to inform people about the uselessness of homeopathy. Arguably, that is because the application of basic reason demonstrates why it is useless. Having people who are able to critically evaluate arguments and evidence – about homeopathy or anything else – is extremely valuable in a society.

We need to study the effects of placebos!

Practitioners of homeopathy aren’t studying anything at all. They sometimes succeed in helping people despite how their theories and methods are utterly lacking in validity. That kind of rejection of critical consideration is hardly likely to advance medical science in relation to placebo effects.

Once you understand what homeopathy is, however, you need to be very good at deceiving yourself or fundamentally stupid for it to have any chance of being effective.

You just need to move on to believing in something else: fairy dust, praying to the god Thor, etc, etc.

The argument that homeopathy is ok because placebos work is not convincing.

I agree. I think the continued promotion of homeopathy despite demonstrations that it is useless is dishonest and irresponsible.

Regardless of whether treatment is received, a normal person will move back from the peak of illness towards normal health most of the time.

Good point. This is called regression toward the mean and is another factor that can bias clinical trials.

Milan November 25, 2007 at 1:00 pm

Obscure fact:

A clinical trial is actually described in the Bible: Daniel 1:1-16

“Submit us to this test for ten days.

Give us only vegetables to eat and water to drink; then compare our looks with those of the young men who have lived on the food assigned by the king and be guided in your treatment of us by what you see.’

The guard listened to what they said and tested them for ten days.

At the end of ten days they looked healthier and were better nourished than all the young men who had lived on the food assigned them by the king.

So the guard took away the assignment of food and the wine they were to drink and gave them only the vegetables.”

Milan November 25, 2007 at 1:16 pm

I Am the Very Model of a Psychopharmacologist

“I Am the Very Model of a Psychopharmacologist is set to Gilbert and Sullivan’s classic song with animation. Created by Stephen M Stahl, MD, PhD, of the Neurosciences Education Institute, Adjunct Professor of Psychiatry at the University of California San Diego, author of Essential Psychopharmacology. Credentials for neuropsychopharmacological hilarity.”

Alena November 26, 2007 at 1:42 am

When I came to Canada, I developed a life-threatening allergy to bee and wasp stings. The period from sting to anaphylactic shock became shorter and shorter, until I got to the point of less than 5 minutes. I always carried an epi-pen, but sometimes a single shot is was not enough. I had to go to the hospital by ambulance and waslalways afraid that I would be stung and collapse before I could get my medication or help. About five years ago I was invited to join a homeopathic study on allergic reactions. For more than three years I was injected with bee venom once a month in increasing amounts until I reached anaphylaxis. It was not fun, but it worked. My immune systems response seems to have been abated and I do not even need an epi-pen any more. I do not know if I am now permanently cured, but I am glad not to be at such risk. In principle, I would not go to a homeopathic doctor, but in this case, I was satisfied with the result. Regular doctors could not help me in any way.

Milan November 26, 2007 at 9:17 am

Mom,

It is good that your allergy abated, but we cannot draw broad conclusions about the usefulness of homeopathy from a single example.

Also, the treatment you describe isn’t consistent with homeopathic techniques as described above. The concentration of bee venom in the injections was sufficient to induce anaphylaxis. As such, it was far more concentrated than the kind of solutions described above. There is every reason to believe that such injections would have a biological effect, though there is no guarantee it would be positive. Homeopathy supposedly holds that less concentrated solutions are more medically effective – the converse seems to be the belief of those who created this study.

On the basis of a single case, it is also impossible to disentangle whether the abatement of the allergy was causally linked to the treatment. It could have been another lifestyle factor, of simply regression towards the mean. The overall statistical data from the study (along with their methodology) would be a more valid way of testing the hypothesis that such injections reduce the severity of bee allergies.

. November 30, 2007 at 4:53 pm

Is homeopathy good for society? How should it be regulated? Are there any good studies to this effect?

Possible pros: placebo, reduction of burden on healthcare system, economic benefits of the industry.

Possible cons: rejection of conventional medicine and science, exacerbation of untreated medical problems, scope for “fraud”, reduction of money spent on conventional medicine.

How do these things balance out in real life? What are your experiences?

. December 1, 2007 at 7:26 pm

Concern over HIV homeopathy role

Doctors and health charities have expressed concern about a conference which will examine the role of homeopathy in treating HIV.

The event includes discussion of what have been described as “healing remedies” for HIV and Aids.

One of the speakers believes that the treatment, involving flower essences, can be used to halt the Aids epidemic.

But the event, which marks World Aids Day, has been criticised by doctors who say the treatment is not effective.

About 80 homeopaths and workers from HIV projects are gathering for the workshop in south London today.

Anon December 4, 2007 at 11:11 pm

A very credible looking man tries to debunk homeopathy on YouTube.

. December 7, 2007 at 3:13 pm

Pity the poor UK homeopath…

Category: Alternative medicine • Humor • Medicine • Quackery
Posted on: December 6, 2007 10:34 AM, by Orac

…because, via Skeptico and DC’s Improbably Science, I’ve learned something that could only warm the coldest cockles of my evil scientific and skeptical heart. It’s something that tells us that, maybe, just maybe, what we bloggers do in favor of evidence-based medicine may actually be having an effect. British homeopath Manish Bhatia, Director of hpathy.com, has sent out a frantic e-mail bemoaning how those poor, poor homeopaths are having trouble making a living, going so far as to say that homeopathy is “bleeding to death” (great analogy, given that homeopathy is a lot like the medieval medical intervention of bleeding for everything).

. January 21, 2008 at 1:24 pm
. June 19, 2008 at 9:59 am

Competition puts homeopathy on trial
* 18 June 2008
* NewScientist.com news service

Want to win £10,000? Then prove that homeopathy works in proper clinical trials in which half the patients receive the treatment, half receive a placebo, and no one knows till the end who got what.

The challenge was issued on Monday by Edzard Ernst, professor of complementary medicine at the University of Exeter, UK, and science author Simon Singh, in the wake of what they call a smear campaign against them in response to their book Trick or Treatment, which explores the scientific evidence behind complementary remedies. “We’re saying to homeopaths, ‘put up or shut up’,” says Singh.

. August 13, 2008 at 1:21 pm

But to consider the issue more closely, we have to define alternative medicine with greater care. A 2004 government report divided the field into four big pieces: 1) biologically based practices, including herbs, special diets, and megavitamins; 2) energy medicine, which embraces the concept of magnetic fields; 3) manipulative and body-based practices such as massage and yoga; and 4) mind-body medicine, including prayer and meditation.

Costly attempts to demonstrate efficacy, paid for with taxpayer dollars, have been launched in each of the four areas. To date, as recently detailed, the results have been awful. Take the example of echinacea, an herb used by 40 percent of all natural product gobblers, who take it to ameliorate the symptoms of the common cold. Echinacea was rushed into numerous clinical trials. The result: The research shows that it doesn’t work. Or even sort of work.

Rather than admit that they’re discouraged or embarrassed by this cold, hard evidence, the alterna-crowd has claimed (OK, whined) that academic-type studies by definition are stacked against them. They consider the bedrock of Western medicine—the randomized, placebo-controlled, double-blind clinical trial—too hard-edged and difficult to implement, just the sort of cruel-hearted gaming of people and disease that so characterizes most things Western.

. February 26, 2009 at 11:10 am

FDA Approves Sale Of Prescription Placebo

“We couldn’t be more thrilled to finally get this wonder drug out of the labs and into consumers’ medicine cabinets,” said Tami Erickson, a spokeswoman for AstraZeneca. “Studies show placebo to be effective in the treatment of many ailments and disorders, ranging from lower-back pain to erectile dysfunction to nausea.”

Despite such ringing endorsements, some members of the medical community have spoken out against placebo’s approval, saying that the drug’s wide range of side effects is a cause for concern.

“Yes, placebo has benefits, but studies link it to a hundred different side effects, from lower-back pain to erectile dysfunction to nausea,” drug researcher Patrick Wheeler said. “Placebo wreaked havoc all over the body, with no rhyme or reason. Basically, whichever side effects were included on the questionnaire, we found in research subjects.”

Added Wheeler: “We must not introduce placebo to the public until we pinpoint exactly how and why it works. The drug never should have advanced beyond the stage of animal testing, which, for some reason, was totally ineffective in determining its effectiveness.”

In spite of the confusing data, drug makers say placebo is safe.

“The only side effect consistent in all test subjects was a negligible one—an almost imperceptible elevation in blood-glucose levels,” French said. “It’s unfair to the American people to withhold a drug so many of them desperately think they need.”

. March 16, 2009 at 10:30 am

Deluding Australia

One aspect that shocked me, though, was how popular homeopathy is there. We went into a pharmacy so I could get decongestants (this entire planet irritates my sinuses), and the homeopathic garbage was everywhere. Richard Saunders, my host (and arguably Oz’s most famous skeptic), told me that the homeopaths spend a lot of money to get their stuff into pharmacies there, including paying for attractive displays to make their diluted water more eye-catching. There was an entire wall devoted to homeopathic placebos in one place we went.

. June 1, 2009 at 11:31 am

Homeopathy urgently condemned for serious diseases

In a letter to the World Health Organisation today, early career medics and researchers are calling for the body to issue a clear international communication about the inappropriate use of homeopathy for five serious diseases. They say they are frustrated with the continued promotion of homeopathy as a preventative or treatment for HIV, TB, malaria, influenza and infant diarrhoea. The Voice of Young Science network has joined with other early career medics and researchers working in developing countries to send the letter, in advance of a ‘Homeopathy for Developing Countries’ conference in the Netherlands on 6th June.

. June 5, 2009 at 3:04 pm

Homeopathy kills
By Phil Plait on Science

Homeopathy is the antiscientific belief that infinitely diluted medicine in water can cure various ailments. It’s perhaps the most ridiculous of all “alternative” medicines, since it clearly cannot work, does not work, and has been tested repeatedly and shown to be useless.

And for those who ask, “what’s the harm?”, you may direct your question to Thomas Sam and his wife Manju Sam, whose nine-month-old daughter died because of their homeopathic beliefs.

The infant girl, Gloria Thomas, died of complications due to eczema. Eczema. This is an easily-treatable skin condition (the treatments don’t cure eczema but do manage it), but that treatment was withheld from the baby girl by her parents, who rejected the advice of doctors and instead used homeopathic treatments. The baby’s condition got worse, with her skin covered in rashes and open cracks. These cracks let in germs which her tiny body had difficulty fighting off. She became undernourished as she used all her nutrients to fight infections instead of for growth and the other normal body functions of an infant. She was constantly sick and in pain, but her parents stuck with homeopathy. When the baby girl developed an eye infection, her parents finally took her to a hospital, but it was far too late: little Gloria Thomas succumbed to septicemia from the infection.

Thomas and Manju Sam were convicted yesterday of manslaughter in Australian court.

Tristan June 5, 2009 at 3:23 pm

“And for those who ask, “what’s the harm?”, you may direct your question to Thomas Sam and his wife Manju Sam, whose nine-month-old daughter died because of their homeopathic beliefs.”

If the concern is harm, then its a reasonable question to ask – whether or not an actual homeopathic doctor would have let it get this far. If qualified homeopathic doctors would have given up on homeopathy earlier, then perhaps this is harm to a greater degree than mainstream homeopathy produces. Not to say that mainstream homeopathy doesn’t produce harm – just likely to a lesser degree. Kind of like the Mormon Church – it certainly hurts a lot of people, but it doesn’t hurt them quite as badly as the Fundamentalist Mormon Church.

Milan June 5, 2009 at 3:28 pm

The case demonstrates that homeopathy isn’t always harmless superstition. While most homeopaths would probably send a girl with horrible skin lesions to a doctor, plenty are apparently keen to advise parents against vaccinations. Inevitably, that means death from measles and other illnesses.

It’s really a disgrace that some universities offer courses in homeopathy.

Milan June 5, 2009 at 3:30 pm

Simon Singh’s book has statistics on the proportion of various sorts of alternative medicine practitioners who give life-threatening advice to their patients. For example: “This homeopathic treatment will protect you from malaria.”

Singh has incidentally been sued by British chiropracters, and a judge has ruled against him for a very dumb reason.

. June 18, 2009 at 11:50 pm

Homeopathy Awareness Week, 14 – 21st June 2009
Tuesday, June 09, 2009

Are you a journalist or presenter looking for someone to discuss Homeopathy Awareness Week? Then please get in touch.

The Society of Homeopaths are promoting “Homeopathy – a natural approach for the symptoms of hay fever”

Did you know there is no convincing evidence that homeopathy can help with hayfever, or for any other condition?

Did you know that homeopaths do not just treat mild self-limiting conditions such as hayfever, but they believe that they can treat serious diseases around the world such as malaria and HIV?

Did you know that the charity Sense About Science has recently called on the World Health Organisation to condemn the use of homeopathy in the developing world for life threatening disease?

. June 19, 2009 at 11:40 am

FDA Says Homeopathic Cure Can Cause Loss of Smell

“The FDA has advised consumers to stop using Matrixx Initiatives’ Zicam Cold Remedy nasal gel marketed over-the-counter as a cold remedy because it is associated with the loss of sense of smell (anosmia) that may be long-lasting or permanent. The FDA says about 130 consumers have reported a loss of smell after using the homeopathic cure containing zinc, an ingredient scientists say may damage nerves in the nose needed for smell and health officials say they have asked Matrixx executives to turn over more than 800 consumer complaints concerning lost smell that the company has on file. ‘Loss of the sense of smell is potentially life-threatening and may be permanent,’ said Dr. Charles Lee. ‘People without the sense of smell may not be able to detect life-dangerous situations, such as gas leaks or something burning in the house.’ The FDA said the remedy was never formally approved because it is part of a small group of remedies known as homeopathic products that are not required to undergo federal review before launching. The global market for homeopathic drugs is about $200 million per year, according to the American Association of Homeopathic Pharmacists. Matrixx has settled hundreds of lawsuits connected with Zicam in recent years, but says it ‘will seek a meeting with the FDA to vigorously defend its scientific data, developed during more than 10 years of experience with the products, demonstrating their safety.'”

. July 5, 2009 at 1:17 pm

That Mitchell and Webb Look: Homeopathic A&E (Accidents and emergencies, the British equivalent of the emergency room)

. August 21, 2009 at 11:59 am

Homeopathy not a cure, says WHO

People with conditions such as HIV, TB and malaria should not rely on homeopathic treatments, the World Health Organization has warned.

It was responding to calls from young researchers who fear the promotion of homeopathy in the developing world could put people’s lives at risk.

The group Voice of Young Science Network has written to health ministers to set out the WHO view.

However practitioners said there were areas where homeopathy could help.

In a letter to the WHO in June, the medics from the UK and Africa said: “We are calling on the WHO to condemn the promotion of homeopathy for treating TB, infant diarrhoea, influenza, malaria and HIV.

“Homeopathy does not protect people from, or treat, these diseases.

“Those of us working with the most rural and impoverished people of the world already struggle to deliver the medical help that is needed.

“When homeopathy stands in place of effective treatment, lives are lost.”

Dr Robert Hagan is a researcher in biomolecular science at the University of St Andrews and a member of Voice of Young Science Network, which is part of the charity Sense About Science campaigning for “evidence-based” care.

. September 9, 2009 at 12:54 pm

The placebo effect

Don’t try this at home. Several times a day, for several days, you induce pain in someone. You control the pain with morphine until the final day of the experiment, when you replace the morphine with saline solution. Guess what? The saline takes the pain away.

This is the placebo effect: somehow, sometimes, a whole lot of nothing can be very powerful. Except it’s not quite nothing. When Fabrizio Benedetti of the University of Turin in Italy carried out the above experiment, he added a final twist by adding naloxone, a drug that blocks the effects of morphine, to the saline. The shocking result? The pain-relieving power of saline solution disappeared.

So what is going on? Doctors have known about the placebo effect for decades, and the naloxone result seems to show that the placebo effect is somehow biochemical. But apart from that, we simply don’t know.

Benedetti has since shown that a saline placebo can also reduce tremors and muscle stiffness in people with Parkinson’s disease. He and his team measured the activity of neurons in the patients’ brains as they administered the saline. They found that individual neurons in the subthalamic nucleus (a common target for surgical attempts to relieve Parkinson’s symptoms) began to fire less often when the saline was given, and with fewer “bursts” of firing – another feature associated with Parkinson’s. The neuron activity decreased at the same time as the symptoms improved: the saline was definitely doing something.

We have a lot to learn about what is happening here, Benedetti says, but one thing is clear: the mind can affect the body’s biochemistry. “The relationship between expectation and therapeutic outcome is a wonderful model to understand mind-body interaction,” he says. Researchers now need to identify when and where placebo works. There may be diseases in which it has no effect. There may be a common mechanism in different illnesses. As yet, we just don’t know.

. September 9, 2009 at 12:56 pm

Belfast homeopathy results

MADELEINE Ennis, a pharmacologist at Queen’s University, Belfast, was the scourge of homeopathy. She railed against its claims that a chemical remedy could be diluted to the point where a sample was unlikely to contain a single molecule of anything but water, and yet still have a healing effect. Until, that is, she set out to prove once and for all that homeopathy was bunkum.

In her most recent paper, Ennis describes how her team looked at the effects of ultra-dilute solutions of histamine on human white blood cells involved in inflammation. These “basophils” release histamine when the cells are under attack. Once released, the histamine stops them releasing any more. The study, replicated in four different labs, found that homeopathic solutions – so dilute that they probably didn’t contain a single histamine molecule – worked just like histamine. Ennis might not be happy with the homeopaths’ claims, but she admits that an effect cannot be ruled out.

So how could it happen? Homeopaths prepare their remedies by dissolving things like charcoal, deadly nightshade or spider venom in ethanol, and then diluting this “mother tincture” in water again and again. No matter what the level of dilution, homeopaths claim, the original remedy leaves some kind of imprint on the water molecules. Thus, however dilute the solution becomes, it is still imbued with the properties of the remedy.

You can understand why Ennis remains sceptical. And it remains true that no homeopathic remedy has ever been shown to work in a large randomised placebo-controlled clinical trial. But the Belfast study (Inflammation Research, vol 53, p 181) suggests that something is going on. “We are,” Ennis says in her paper, “unable to explain our findings and are reporting them to encourage others to investigate this phenomenon.” If the results turn out to be real, she says, the implications are profound: we may have to rewrite physics and chemistry.

. November 11, 2009 at 9:58 am
Milan November 11, 2009 at 1:04 pm
Tristan November 11, 2009 at 2:22 pm

While it is certainly nonsense for justifying alternative medicine, it is true that matter doesn’t exist. Although, this is Newton’s discovery, not Einstein’s.

Milan November 11, 2009 at 4:03 pm

For guys who don’t believe in matter, Einstein and Newton sure used the term ‘mass’ in a lot of their most important equations…

Tristan November 11, 2009 at 11:01 pm

Sure, but think about what an equation means.

F=MA

F/A=M

So matter is equal to force over acceleration. Force divided by acceleration is not a substance. Substances are not equivalent to forces. Mass literally “is” a relation between force and acceleration for Newton. That’s not matter – that’s a force relation. That is completely distinct from the notion of matter as a substance, as hyle – “appropriateness for taking up a form”.

Milan November 11, 2009 at 11:05 pm

This is the kind of argument only a philosopher would make. Obviously, both Newton and Einstein think matter is something we can meaningfully talk about.

. January 19, 2010 at 12:51 pm

Mass “overdose” planned in protest of Boots pharmacy sale of “homeopathic remedies”

10:23, a pro-science, anti-homeopathy group, is planning an “overdose event” for Jan 30 at 10:23 AM UK time: “more than three hundred homeopathy sceptics nationwide will be taking part in a mass homeopathic ‘overdose’ in protest at Boots’ continued endorsement and sale of homeopathic remedies, and to raise public awareness about the fact that homeopathic remedies have nothing in them. Sceptics and consumer rights activists will publicly swallow an entire bottle of homeopathic ‘pillules’ to demonstrate that these ‘remedies’, prepared according to a long-discredited 18th century ritual, are nothing but sugar pills.”

. February 22, 2010 at 2:16 pm

NHS money ‘wasted’ on homeopathy
By Nick Triggle
Health reporter, BBC News

The NHS should stop funding homeopathy, MPs say.

The House of Commons Science and Technology Committee said using public money on the highly-diluted remedies could not be justified.

The cross-party group said there was no evidence beyond a placebo effect, when a patient gets better because of their belief that the treatment works.

But manufacturers and supporters of homeopathy disputed the report, saying the MPs had ignored important evidence.

It is thought about £4m a year is spent on homeopathy by the NHS, helping to fund four homeopathic hospitals in London, Bristol, Liverpool and Glasgow and numerous prescriptions.

Homeopathy is a 200-year-old system of treatment that uses highly diluted substances – sometimes so none of the original product is left – that are given orally in the belief that it will stimulate the body’s self-healing mechanism.

Supporters believe the remedies help relieve a range of minor ailments from bruising and swelling to constipation and insomnia.

But the MPs said homeopathy was basically sugar pills that only worked because of faith.

In medicine it is recognised that some people will get better because they believe the treatment they take is going to work.

The MPs said the NHS should not fund treatments on this basis.

Tristan February 22, 2010 at 2:30 pm

I think the main problem with homeopathy is an irrational approach to Placebos within the mainstream medical community. In my understanding, it is generally accepted that the placebo effect is significant, and this is why drugs are tested against placebos rather than against nothing. However, it is considered immoral to prescribe placebos to normal patients because it is dishonest.

Homeopathy works because of the placebo effect. But, that means it really works – because the placebo effect is real. The problem is it thinks it works because of properties inherent in the substances, and it is supported by a branch of (pseudo)-scientific practice which does resemble the practice of science in some ways, specifically that the results are believed in by those doing the work.

So, Homeopathy is simply placebo, but it is considered “honest” because those prescribing the drugs actually believe them not to be placebo. However, they are actually placebo, so it is actually dis-honest.

However, so long as the mainstream medical profession values “honesty” above “effective treatment” (and thereby excludes placebos from its own branch of research and from treating patients), pseudo-sciences will continue to reap the benefits of the placebo effect.

Tristan February 22, 2010 at 2:31 pm

“People are being misled (perhaps not lied to, since homeopathy practitioners may believe this stuff) and charged money for something useless. ”

Yes – except that placebo effect is not “useless” at all, it has well documented healing properties. The problem is that the mainstream medical community is unwilling to mislead and to research and sell “nothing” to the public.

Milan February 22, 2010 at 2:35 pm

For diseases with no real consequences (other than suffering), that might hold up.

What is really problematic is when people use homeopathy in place of real treatments. They take sugar pills instead of anti-malarial medication when traveling in Africa, or forsake antibiotics or chemotherapy when they are actually required.

Also, as the linked article mentions, if placebos make a person feel better, while doing nothing about the underlying condition, they may ultimately worsen health outcomes by effectively encouraging people to ignore their illnesses.

Tristan February 22, 2010 at 3:28 pm

I don’t think you understand what I’m getting at – Placebo is a “real treatment”. But while it is researched and studied to some extent, it isn’t put into practice because of “moral considerations”.

To be extremely clear: placebo only works precisely because you lie to the patient. The only difference in homeopathy is that “doctor” doesn’t believe s/he is lying to the patient.

My position is that homeopathy exists because the mainstream medical profession refuses to lie to patients. They could of course do this much more responsibly than doctors who have false beliefs about how their own treatments work.

“they may ultimately worsen health outcomes by effectively encouraging people to ignore their illnesses.”

Sure, maybe, or they might cure them because the body certainly does not cure itself of nearly all the illnesses it is capable of curing itself of. This is something it is hard to make generalizations about.

Milan February 22, 2010 at 3:38 pm

There are at least three kinds of conditions to which homeopathy could be applied:

1) Conditions for which proven treatments exist, which depend on known physical and chemical properties – In these cases, giving the people afflicted the real treatment provides both therapeutic and placebo value (because they are still getting attention and some sort of treatment).

2) Serious conditions for which there is no treatment – In these cases, perhaps a placebo is the best we can do.

3) Highly dubious, self-diagnosed conditions – Like people who have panicked themselves into thinking cellular towers or whatever are causing them all kinds of problems. If their ‘illness’ is the product of faulty thinking to begin with, perhaps more faulty thinking can be a remedy.

The most worrisome cases are those in which either (a) homeopathy is used as an alternative to a more effective treatment or (b) people are taken advantage of, by being made to pay excessively for ineffective treatments. Both of those are big problems for all sorts of alternative therapies.

A third category (where the treatment likely causes harm and provides only placebo benefits) doesn’t apply so much to homeopathy, but does for things like chiropractic (especially when used on children).

Milan February 22, 2010 at 3:39 pm

In any event, you may find Simon Singh’s book applying evidence-based-medicine standards to ‘alternative’ treatments interesting.

Tristan February 22, 2010 at 4:21 pm

You continue to ignore my point.

Milan February 22, 2010 at 4:39 pm

A placebo is only a ‘treatment’ in the most dubious sense of the word. In a few cases – such as talking to sad people – it is something that it might be honest for doctors to do. Otherwise, it seems fundamentally exploitative, even if it does cause patients to improve in some circumstances.

Medicine is now based around informed consent. That concept is right at the ethical core of the discipline. As such, when doctors choose to lie (even for good reasons), I would argue that they are no longer practicing modern medicine. They might as well start selling magical amulets.

Milan February 22, 2010 at 4:42 pm

There is a whole chapter in Singh’s book about the ethics of placebos. In short, it is a nice side-effect arising from real treatments, but is not something that should be exploited when treatments are unavailable or you don’t want to direct people towards them.

. February 22, 2010 at 4:47 pm

Related:

Nocebo
From Wikipedia, the free encyclopedia

Tristan February 22, 2010 at 4:56 pm

“Medicine is now based around informed consent. That concept is right at the ethical core of the discipline.”

And for as long as this outdated principle remains at the core, pseudo sciences like homeopathy will be able to exploit the power of lying to cure people. This is a real power, it actually works. Not perfectly, of course, but I think your view of placebo as treatment only in the dubious sense is quite outdated. Ideogensis (physical changes which have their origin in ideas) is a real phenomenon. See especially Doige’s “The Brain that Changes itself”, NY times review here: http://www.nytimes.com/2007/05/29/health/29book.html

Milan February 22, 2010 at 5:01 pm

Variants of positive thinking are always in style, when it comes to pop-medicine.

That’s not to say that there are never real effects, but rather that people are far, far too willing to accept that there are effects without rigorous statistical evaluation to back up that view.

Tristan February 22, 2010 at 5:11 pm

Well, it’s hard to have something seriously studied when the central moral norm of one’s discipline is opposed to it.

My point is that the continued strength of pseudo-science is only possible so long as the tired value of “informed consent” is held firmly at the centre of mainstream medical science.

Think about what placebo research really is, and how it differs from homeopathy – the difference isn’t in the experiments, so much as in the mechanism posited behind them. The real mechanism has to do with the beliefs of the subject, and ideogentic phenomena. But, since doctors are not allowed to believe in that (well, actually they are, see the book I cited), rather, since they are not allowed to exploit belief-mechanisms in subjects through lies, they have to posit some crazy story about a mechanism to do with dilutions in water. Of course, the water is diluted to the point where there is nothing in the water, but some b-s quantum story allows the doctors and the subjects to both believe the mechanism is in the object.

And then, of course, mainstream science opposes homeopathy because it can’t show a difference between the placebo results and the “real” results – of course it can’t! The real mechanism is not in the object but in the subject.

Tristan February 22, 2010 at 5:14 pm

I suppose what I should say to the title of this post, “Homeopathy is Fraud”, is to respond – “Fraud is medicine, but the medicine is not in the object – the medicine is in the subject/doctor interaction machine”.

Milan February 22, 2010 at 5:15 pm

Should people also be allowed to sell magic rocks that supposedly keep away tigers?

In particular, should people specifically accredited by the state as expert practitioners of an evidence-based profession be allowed to do so?

Milan February 22, 2010 at 5:17 pm

Informed consent is exceedingly important. That and requiring evidence for claims are the two central things that make medicine valuable.

Sacrifice either and you weaken it terribly, as a tool for improving human lives. Losing some ability to investigate highly dubious fringe theories on their own terms is a small price to pay.

Milan February 22, 2010 at 5:23 pm

The only barrier to knowledge about medicine should be the difficulty of understanding it. When a doctor explains how a treatment works, the patient should be able to go back to the literature and find out why. They should also be able to find out why we think it works the way it does, what experiences people have had with the treatment, what alternatives exist, etc.

That sort of open framework is the opposite of the neo-shamanism that you end up with when doctors lie to the patients ‘for their own good.’ That sort of attitude keeps patients ignorant about key personal choices. It also allows bad practices to endure in the medical community, such as doctors delivering babies without washing their hands (until comparatively recently) or doctors sending people to homeopathic hospitals.

Tristan February 22, 2010 at 5:42 pm

“The only barrier to knowledge about medicine should be the difficulty of understanding it. When a doctor explains how a treatment works, the patient should be able to go back to the literature and find out why. ”

This restricts you to medicines where the medicine is in the object and where the way the object acts on the subject is not effected by the knowledge in the subject.

Compare this to the way one would study any other mechanisms in nature – we know that knowledge alters subjects, so we are being unscientific by always allowing subject to knowledge about the medecine they are taking.

A big problem for placebo research, however, is a new kind of experimentation needs to be used – a new sort of control group would have to be developed, or a way of doing studies without control groups.

Tristan February 22, 2010 at 5:45 pm

As I keep saying, if we don’t develop a way to study “lying to patients for their own good”, the fringe of pseudo-medicine will continue to exist. The only way to get rid of it, is to envelop the truth in it into mainstream medicine. Otherwise you’re just complaining to people who aren’t interested in listening.

Milan February 22, 2010 at 5:46 pm

They have done plenty of experiments on placebos. The results of some of them are described on Wikipedia. The problem isn’t that placebos have no effect, or that they are impossible to study. The problems are those I listed above.

Medical science has reached the point where we can save people from scores of things that would have been fatal a few decades ago (much of that comes down to improved intensive care techniques). Should we really be undermining that by flirting with superstition? Particularly, when statistical methods are perfectly capable of identifying the magnitude and nature of placebo effects in well-designed trials?

Milan February 22, 2010 at 5:48 pm

The only way to get rid of it, is to envelop the truth in it into mainstream medicine. Otherwise you’re just complaining to people who aren’t interested in listening.

There will always be some people who think virgin blood or miraculous blessings will cure their ailments. What we can do as a society – and what the state can do – is work to give people good information on what works, how, and why. In addition, we can provide information to people on which things do not work, and why we believe that to be the case.

I don’t think ‘lying to people’ is the rich vein of medical innovations you seem to think it could be.

Tristan February 22, 2010 at 5:53 pm

“The problems are those I listed above.”

You didn’t list problems, you listed cases in which you think it’s appropriate to prescribe placebos. It’s unclear to me why you think there are ever any times when it’s appropriate to prescribe them, however, since you hold that “the patient should be able to go back to the literature and find out why.”

Looking at the wikipedia article, it seems to confirm my position:

“Placebos are widely used in medicine, and the placebo effect is a pervasive phenomenon;[2] in fact, it is part of the response to any active medication.[3] However, the deceptive nature of the placebo creates tension between the Hippocratic Oath and the honesty of the doctor-patient relationship.[4] The placebo effect points to the importance of perception and the brain’s role in physical health.”

So, basically.
1) Placebo effect is real
2) Placebo effect is part of how every drug works
3) There is a tension between honesty and the placebo effect
4) The Placebo effect indicates the importance of patients beliefs about healing for healing.

And, there obviously are problems for studying the placebo effect – you can not run a normal study because what would a “control group” look like?

Milan February 22, 2010 at 6:14 pm

(1) Some problems with placebos

  • “What is really problematic is when people use homeopathy in place of real treatments. They take sugar pills instead of anti-malarial medication when traveling in Africa, or forsake antibiotics or chemotherapy when they are actually required.”
  • “[I]f placebos make a person feel better, while doing nothing about the underlying condition, they may ultimately worsen health outcomes by effectively encouraging people to ignore their illnesses.”
  • “The most worrisome cases are those in which either (a) homeopathy is used as an alternative to a more effective treatment or (b) people are taken advantage of, by being made to pay excessively for ineffective treatments.”
  • “That sort of open framework is the opposite of the neo-shamanism that you end up with when doctors lie to the patients ‘for their own good.’ That sort of attitude keeps patients ignorant about key personal choices.”
  • “It also allows bad practices to endure in the medical community, such as doctors delivering babies without washing their hands (until comparatively recently) or doctors sending people to homeopathic hospitals.”

Medicine depends on evidence for advancement, and it relies on consent to remain ethical.

(2) Testing placebo effects

In many cases, this is not so hard. It goes back to the basic tactic of experiments: give different treatments and observe outcomes.

Say we are looking as post-surgical infection rates. We divide patients into three groups:

Group A gets no treatment over and above the hospital norms.

Group B is given an ineffective version of something that looks like a treatment (say, a sugar pill).

Group C is given a form of a treatment someone says is effective.

The difference between A and B is your placebo effect. The difference between B and C is the efficacy of the treatment.

If the treatment is homeopathy, B and C will have the same outcome. If it’s a new anti-infection wonderdrug (or effective procedure, like being careful about putting in IVs), then B and C will see different outcomes.

Milan February 22, 2010 at 6:17 pm

Simon Singh’s book contains many examples of ‘ineffective version’ studies, such as those that used stage-dagger type needles to simulate acupuncture, or that actually inserted needles at random, instead of along the ‘meridians’ that acupuncturists claim to manipulate.

Use fake acupuncture as a B group, see if the outcome with the C group differs, and you can determine if real acupuncture has any effect over and above that of a placebo.

And to anticipate the question: “What makes the ineffective version studies ethical?”

Patients understand that when they are participating in a clinical trial, some will receive treatments expected to be ineffective. Clinical trials allow us to collect data to evaluate the effectiveness of treatments, and some level of deception is sometimes part of that. Patients give informed consent to that when they choose to participate.

By contrast, a therapy that depends on deceiving people into thinking they are actually being treated does not meet the informed consent standard (though I can understand why doctors may want to get rid of annoying patients by giving them useless antibiotics or vitamins).

Tristan February 22, 2010 at 7:02 pm

“Use fake acupuncture as a B group, see if the outcome with the C group differs, and you can determine if real acupuncture has any effect over and above that of a placebo.”

This has nothing to do with the difficulties I’ve been trying to stress. I’m not interested in the differences between homeopathy and placebo – my position is that homeopathy works because it is placebo, not because it is different. It is the easiest thing in the world to compare something to a placebo – what is difficult is comparing placebo against nothing.

Your group A, B, C example does solve this problem for a specific situation. But would this be possible outside the specific situation of post-surgical infection? Where else can you have a group of people who are part of a study but don’t know they are part of a study?

Really what needs to be compared is the healing of people who go in and request a drug, and get placebos, against people who don’t go to request a drug.

Milan February 22, 2010 at 7:05 pm

You could test that too, though it is trickier. You could look at death rates from a particular disease, comparing those who sought a certain treatment to those who sought no treatment.

Of course, there are likely to be differences between the groups. Those who seek it out likely differ in personality from those who do not. If not that, they may differ in mobility, or another confounding variable.

All this said, medical statistics is a rich and important field. People really do make careers setting up these kinds of experiments, and interpreting longitudinal data and natural experiments.

Tristan February 22, 2010 at 7:55 pm

I’ve been speaking with my housemate about this, who is most of the way through medical school.

There are actually problems concerning the placebo effect for normal, non-placebo based medicin. For example, take the case of an anti-depressant which is shown by studies to be effective in 60% of cases, compared to 50% placebo effectiveness and 30% effectiveness for “checking back later, no treatment”. When the doctor offers the patient the drug, he does not explain “If I were able to offer you a sugar pill, there would be a 50% chance you would recover”. However, not saying this is lying. Saying it might be lying as well, since the patient would likely see the 60% and 50% figures and assume that the final 10% of the drug is “added on” to the placebo effect – when in fact this might not be the case – sometimes the placebo effect and the drug effect are entirely different mechanisms in brain chemistry.

I think it would be worthwhile to design experiments that, instead of comparing placebo against drug, concentrate on comparing placebo against nothing. The difference between “placebo effect” and “hair brain theory” is, after all, only the plausibility of the mechanism posited. The mechanism we posit is largely irrelevant, however, since we know almost nothing about the physical world, and almost certainly the mechanisms we posit to explain cognition are largely false. Experimental data is much more interesting than stories we tell ourselves about what is behind it.

Milan February 22, 2010 at 7:57 pm

I agree that the data is how we must ultimately assess whether one approach or another is effective.

Of course, it is possible for a treatment to be both effective and unethical.

Dr. Fraud February 22, 2010 at 8:44 pm

Yeah, i don’t really know. Here are some scientists who study it and communicate it understandably:

http://www.cbc.ca/quirks/archives/03-04/mar06.html#1

Tristan February 22, 2010 at 9:25 pm

“it is possible for a treatment to be both effective and unethical.”

Like homeopathy, for instance.

Sarah February 22, 2010 at 11:08 pm

I think it is far more important for doctors to tell the truth than for ‘alternative’ medicine to cease existing. The principle of informed consent strikes me as absolutely central to the doctor-patient relationship, and I think far more people would opt out of a mainstream healthcare system in which doctors were allowed to lie to you (which they would no doubt do for corrupt reasons, e.g. if bribed by drug companies, pushing their own business, or to cover up their mistakes) than do so at present.

Personally, I have no real objection to quacks offering their services for sale, provided that they receive no money from state agencies, that their ‘treatments’ have been demonstrated to be safe, and that they are legally prohibited from making any claims about effectiveness that are not supported by fairly robust experimental research. You’d also have to reform libel laws so that those who point out the inefficacy of ‘alternative’ medicine & the lies told about it would be preventing from suing. Most likely this would mean that ‘alternative’ medicine practictioners could make only very limited claims about effectiveness, if any at all, e.g. “our philosophy says that this treatment ought to do x, for this following reason, but no proper studies have been conducted so we don’t know if it works”.

I don’t have the energy to dig around for a link, but I seem to recall reading a piece in New Scientist about a trial where they told people they were receiving a sugar pill that people often found effective for their condition & the placebo effect still worked. Provided that there was evidence the placebo (probably administered with very specific wording you’d have to duplicate) worked for a given condition, one could prescribe cheap placebos (way preferable to homeopathy, which is expensive and thus squandering money that could be much better spent) whilst telling the truth e.g. “I am prescribing you sugar pills which have been shown to be effective for people experiencing pain like yours. Come back if it doesn’t improve within a few days and we’ll try something else.” There was a longer New Scientist piece in the subject in 2008: The Power of the Placebo Effect. There’s also an entry on the subject at The Skeptic’s Dictionary which references & links to a lot of interesting studies, including a NY Times article about many US doctors prescribing placebos (re. that article, I find it alarming that anyone would prescribe antibiotics for the placebo effect, given the problem of antibiotic resistance).

Sarah February 22, 2010 at 11:12 pm

Oooops, I meant reforming the libel laws so that people like Simon Singh don’t get sued by people like chiropractors, not the reverse. It would be important for the scientists to be able to sue the quacks for libel if the latter started telling lies about the scientists themselves, as well as about the science.

Tristan February 23, 2010 at 2:06 am

“I think it is far more important for doctors to tell the truth than for ‘alternative’ medicine to cease existing. ”

If you listen to the linked quirks and quarks interview, it becomes apparent that “telling the truth” might be simply impossible in many cases. If the placebo effect works by the same mechanism as the drug, and the drug works only as well or slightly better than the placebo – explaining this to the patient might even make the drug ineffective.

Milan February 23, 2010 at 8:11 am

Telling the truth is more important than exploiting the placebo effect, in most cases.

There may be exceptions, like telling dying soldiers that water is morphine when your field hospital has run out of drugs.

In normal circumstances, there are plenty of honest ways of producing the placebo effect. It arises in response to getting any sort of treatment at all. As such, talking to patients and other benign and honest interventions can trigger it. Doctors don’t need to become liars, just to capture the limited value the placebo effect offers.

Tristan February 23, 2010 at 9:33 am

My point is, it might be the case that doctors are already liars without knowing it when they prescribe drugs, and that if they start telling the truth, the drugs will stop working.

Milan February 23, 2010 at 9:39 am

If so, doctors and patients should know about it. If medications are ineffective, then we are wasting resources on them which are necessarily limited. Also, patients may be enduring complications and side effects while deriving no theraputic value.

One of the more promising likely future applications of genetics is learning which drugs are likely and unlikely to be effective with which patients, diminishing waste and side effects.

Tristan February 23, 2010 at 9:42 am

Did you listen to the interview which my roommate linked to?

Tristan February 23, 2010 at 9:45 am

“If medications are ineffective”

Stop thinking that medecine works because an objects alters a subject. Pharmacology is not a hitting a nail with a hammer. That’s an outdated kind of empiricism which draws artificial boundaries about the location in which mechanisms are allowed to be located. If the subject undergoes a change due to the drug/doctor/belief machine, then the drug/doctor/belief machine really is effective. It might be that some or many drugs can’t function outside of a drug/doctor/belief machine – so your position is we just need to get rid of all drugs in that category because they are not objective enough?

Milan February 23, 2010 at 10:02 am

Penicillin works by inhibiting the formation of peptidoglycan cross-links in the bacterial cell wall. It has nothing to do with psychology, though it might make a patient feel better to experience the placebo effect while it is happening. Similarly, Warfarin works by inhibiting vitamin K epoxide reductase, an enzyme that recycles oxidized vitamin K to its reduced form after it has participated in the carboxylation of several blood coagulation proteins, mainly prothrombin and factor VII. Morphine primarily works by binding to μ-opioid receptors. And so on and so on.

Drugs with no known mechanism of action, aside from the placebo effect, aren’t really medical treatments at all.

Milan February 23, 2010 at 10:08 am

You will also note that drugs and procedures work when patients are totally unconscious.

Also, when both doctor and patient wrongly believe that the patient has taken Drug A (but they have really taken Drug B), they experience the physical effects of Drug B (though perhaps the placebo effects of Drug A).

Sarah February 23, 2010 at 1:29 pm

doctors are already liars without knowing it when they prescribe drugs, and that if they start telling the truth, the drugs will stop working.Tristan, if you’d read the NY Times article I linked to then you’d see that doctors are aware of the placebo effect, are consciously making use of it & are trying to explain their decisions to patients in an ethical manner. The same point is made in Trick or Treatement. Moreover, it is nowhere near as straightforward as ‘if you tell the truth then it won’t work’ – that depends on the wording you use to explain the prescription decision and on the patient, so it is probably possible to tell the truth about prescribing a placebo and for the placebo effect to work.

R.K. February 23, 2010 at 1:54 pm

Doctors are certainly aware that they have a lot of sway over what people think. They are authority figures, and certainly appreciate that when they prescribe something, a placebo effect will likely arise from them doing so.

In cases where there is nothing to prescribe, perhaps they use their authority and serve the public best by simply saying so. Sending someone with the flu off with antibiotics may get them out of your hair, but it wastes money, may cause side effects for the person, and may foster antibiotic resistance.

Doctors can count on the placebo effect as a nice bonus that accompanies justified interventions. It probably isn’t something they should try to manipulate too much themselves.

Tris February 23, 2010 at 2:19 pm

There is no evidence here that people have listened to the very interestin quirks and quarks interview.

Milan February 23, 2010 at 2:24 pm

As a rule, I never follow audio or video links. They just take up way too much time. Plus, they are useless everywhere but on my home computer.

Linking to a text article lets a person spend ten seconds checking it out, or a few minutes reading it. Linking to video or audio obliges them to dedicate most or all of their attention for a longer span.

That said, you are welcome to keep linking to multimedia that other people might find useful.

Tristan February 23, 2010 at 3:03 pm

“you’d see that doctors are aware of the placebo effect, are consciously making use of it & are trying to explain their decisions to patients in an ethical manner.”

I know doctors are aware of it. If you’d listen to the interview, you might come the conclusion that I have, which is that the attempt to use the placebo effect within “ethical manner” is like trying to play guitar with one hand tied behind your back. And, that we don’t know to what extent tons of medications might work primarily because of the placebo effect, because we don’t know the interactions between the placebo mechanism and the drug mechanisms well enough.

So, most prescription might, to be effective, rely on concealing the real mechanisms by which the medicin works from the patient. We don’t know whether or not this is true, but we do know that if it turned out to be right we would not be able to tell the patients without reducing the effectiveness of the treatment.

Mainstream medecine and homeopathy might have more in common than we thought: they both might exploit mechanisms they don’t understand, and are only able to exploit them because they don’t understand them. (Understanding them would make exploiting them ethically problematic).

I conclude from this, that the current ethical value of truth and openness might have to fall if existing medicines are to remain effective.

. February 23, 2010 at 3:09 pm

“In the Committee’s view, homeopathy is a placebo treatment and the Government should have a policy on prescribing placebos. The Government is reluctant to address the appropriateness and ethics of prescribing placebos to patients, which usually relies on some degree of patient deception. Prescribing of placebos is not consistent with informed patient choice-which the Government claims is very important-as it means patients do not have all the information needed to make choice meaningful.

Beyond ethical issues and the integrity of the doctor-patient relationship, prescribing pure placebos is bad medicine. Their effect is unreliable and unpredictable and cannot form the sole basis of any treatment on the NHS.

. February 23, 2010 at 3:10 pm

Placebo >> Doctor-patient relationship relationship
From Wikipedia, the free encyclopedia

Critics of the practice responded that it is unethical to prescribe treatments that don’t work, and that telling a patient that a placebo is a real medication is deceptive and harms the doctor-patient relationship in the long run. Critics also argued that using placebos can delay the proper diagnosis and treatment of serious medical conditions.

The following impracticalities exist with placebos:

* Roughly only 30% of the population seems susceptible to placebo effects, and it is not possible to determine ahead of time whether a placebo will work or not.
* All placebo effects eventually wear off, thus making the placebo effect impractical for long term or chronic medical matters.
* Patients rightfully want immediate relief or improvement from their illness or symptoms. A non-placebo can often provide that, while a placebo might not.
* Legitimate doctors and pharmacists could open themselves up to charges of fraud since sugar pills would cost pennies or cents for a bottle, but the price for a “real” medication would have to be charged to avoid making the patient suspicious.

Milan February 23, 2010 at 3:15 pm

I don’t know where that claim about 30% effectiveness comes from, but if it is anywhere near correct it suggests that placebos aren’t and cannot be all that important.

Psychological illnesses are trickier, but when it comes to conditions and illnesses that can be fairly readily understood physically, it seems implausible that doctors would rely on an approach that will fail with something like 70% of people.

Milan February 23, 2010 at 3:18 pm

This is interesting: apparently, Alzheimer’s patients respond less to placebo effects:

“In order to assess the placebo component of a therapy, we used the recently developed open-hidden paradigm. A local anesthetic was applied, either overtly or covertly, to the skin of AD patients to reduce burning pain after venipuncture. The placebo (psychological) component is represented by the difference between the analgesic effect after open (expected) and after hidden (unexpected) application. We correlated the placebo component with both cognitive status and functional connectivity among different brain regions. We found that AD patients with reduced Frontal Assessment Battery scores showed reduced placebo component of the analgesic treatment.”

Note that this study replicates the procedure I described earlier for testing placebo effects.

Milan February 24, 2010 at 3:48 pm

Speaking of hand washing between baby deliveries:

“In 1847, Hungarian doctor Ignaz Semmelweis discovered that washing one’s hands with chlorine between deliveries practically eliminated fatal infections among laboring women. (His colleagues ignored him and later committed him to a mental hospital, where he was beaten to death by guards.)”

Milan July 12, 2010 at 9:41 am

XKCD on homeopathy:

Mousover text: “Dear editors of Homeopathy Monthly: I have two small corrections for your July issue. One, it’s spelled ‘echinacea’ and two, homeopathic medicines are no better than placebos and your entire magazine is a sham.”

. August 11, 2010 at 11:35 am

What the Hell is Homeopathy?

What I can’t wrap my head around, however, is homeopathy. What the hell is this?

There are thousands of homeopaths all over the world that spend big money and many years in school to get their designation. The homeopathic drug market is a multi-billion dollar industry.

In the US, homeopathic remedies are recognized and regulated by the Food and Drug Administration (FDA) and are manufactured by established pharmaceutical companies.

In the UK, homeopathy is provided and funded under the National Health Service (NHS).

In Canada, Health Canada’s new Natural Health Products Regulations uses “evidence submitted by applicants to critically assess the safety, efficacy and quality of all natural health products” including homeopathic remedies. I don’t know what kind of “evidence” these companies are producing about their “efficacy”, but they seem to be passing muster. How?

Homeopathy was invented, out of the clear blue sky, 200 years ago by a German doctor named Samuel Hahnemann. He wasn’t down with the medicine of the day which involved stuff like bloodletting, leeches and purging. He reckoned that instead of “balancing the body’s system by draining the bad stuff out of it, he would do the opposite and put more of the bad stuff in, but in tiny amounts.

. September 13, 2010 at 2:23 pm

11 September 2010 Last updated at 19:13 ET

NHS ‘should pull homeopathic hospital cash’
By Samantha Poling Investigations correspondent, BBC Scotland

The British Medical Association (BMA) has told a BBC Scotland investigation that NHS Scotland should pull the plug on Glasgow’s Homeopathic Hospital.

FoIs revealed the Scottish NHS spends about £1.5m on homeopathy, almost a third of the estimated UK spend of £4m.

But the BMA said the money should be withdrawn until the Glasgow facility produces satisfactory evidence about the effectiveness of its treatments.

Homeopaths and their patients insist they see real benefits from treatments.

However, the BMA’s director of science and ethics, Dr Vivienne Nathanson, said: “The funding of the homeopathic hospital should stop until and unless they can pull an evidence base to say which patients they are going to be able to help and where that help is more than the placebo effect.”

. November 13, 2010 at 7:16 pm
. August 19, 2012 at 5:26 pm

Boots keeps selling quack remedies intended for babies, even after they are banned from US import over fears of broken glass

Boots, which styles itself a “pharmacy-led Health & Beauty retailer” has caught a lot of flack for selling homeopathic “remedies” that contain no active ingredients. One report actually found a Boots pharmacist referring customers who asked a five-year-old child with a three-day bout of diarrhoea to homeopathic sugar pills (advice that could potentially kill the patient by leaving the underlying condition untreated).

. August 8, 2013 at 4:45 pm
. February 19, 2015 at 7:04 pm
. October 13, 2016 at 12:44 am

IT MAY not be as ancient as acupuncture, but homeopathy is the closest thing Germany has to a native alternative-medicine tradition. Practitioners line the high street. Upper-class Germans swear by it. Unusually, Germany gives homeopathy a privileged legal status. Whereas other medicines must meet scientific criteria, homeopathic remedies need not, and health insurers are explicitly allowed to reimburse for their use. This bothers sceptics such as Norbert Schmacke, a professor of medicine and the author of a book explaining why homeopathy is nonsense. “If you believe that water has memory,” as homeopaths do, you “might as well also believe in unicorns”, he says.

Nobody denies that some people are sincerely convinced they benefit from homeopathy. This is thanks to the placebo effect—the more one believes, the bigger the effect. But no respectable scientific study has ever shown anything beyond that. That is why a group of German professors and doctors, including Mr Schmacke, met in Freiburg earlier this year to issue a declaration. Homeopathy is “a stubbornly surviving belief system”, they argue, which “cannot explain itself” and relies on “self-deception” by patients and therapists.

. May 19, 2017 at 10:23 pm

Homeopathic remedies in legal hot water in U.S. but face scant Canadian pushback

In Canada, Health Canada is taking more laissez-faire approach to homeopathic products

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