MD, PhD, FMedSci, FSB, FRCP, FRCPEd

fallacy

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“Conflicts of interest should always be disclosed.”

This is what I wrote in the ‘RULES’ of this blog when I first started it almost 4 years ago. Sadly, very few people writing comments observe this rule. Perhaps, I just thought, I did not observe it either? So, here are my conflicts of interest: none.

Not true!!! I hear some people say. But it is!

I have no financial interest in any ‘Big Pharma’ or  ‘TINY CAM’, and I get not a penny for writing this blog.

How do I pay for my living? Mind your own business… well, on second thought, even that must not be a secret: I get a small pension and have some savings.

Still not convinced?

Perhaps it’s time to define what ‘conflicts of interests’ are. According to Wikipedia, they can be defined as  situations in which a person or organization is involved in multiple interests, financial interest, or otherwise, one of which could possibly corrupt the motivation of the individual or organization.

So, not having financial benefits from my current work does not necessarily mean that I have no conflicts of interest. The above definitions vaguely mentions ‘or otherwise’ – and that could be important. What could this mean in the context of this blog?

Well, I might have very strong beliefs, for instance (for instance, very strong beliefs that acupuncture is by definition nonsense [see below]). We all know that strong beliefs can corrupt motivation (and a lot more). And if I ask myself, do you have strong beliefs?, I have to say: Yes, absolutely!

I believe that:

  • good evidence is a prerequisite for progress in healthcare,
  • good evidence must be established by rigorous research,
  • we should not tolerate double standards in healthcare,
  • patients deserve to be treated with the best available treatments,
  • making therapeutic claims that are not supported by sound evidence is wrong.

These strong beliefs might make me biased in the eyes of many who comment on this blog. In Particular, we recently had a bunch of acupuncturists who went on the rampage attacking me personally the best they could. However, a rational analysis of my beliefs can hardly produce evidence for bias against anything other than the promotion of unproven therapies to the unsuspecting public.

The above mentioned acupuncturists seem to think that I have always been against acupuncture for the sake of being against acupuncture. However, this is not true. The proof for this statement is very simple: I have published quite a bit of articles that concluded positively – even (WOULD YOU BELIEVE IT?) about acupuncture for back pain! A prominently published meta-analysis of 2005 (with me as senior author) concluded:  “Acupuncture effectively relieves chronic low back pain.” (This of course was 11 years ago when the evidence was, in fact, positive; today, this seems to have changed – just like the NICE guidelines [probably not a coincidence!])

Conflicts of interest? No, not on my side, I think.

But what about the ‘other side’?

The unruly horde of acupuncturists (no, this is not an ad hominem attack, it’s a fact) who recently made dozens of ad hominem attacks against me, what about them?

  • They earn their money with acupuncture.
  • They have invested in acupuncture training often for long periods of time.
  • They have invested in practice equipment etc.
  • Some of them sell books on acupuncture.
  • Others run courses.
  • And all of them very clearly and demonstrably  have strong beliefs about acupuncture.

I think the latter point constitutes by far the most important conflict of interest in this context.

And this is where the somewhat trivial story has an unexpected twist and gets truly bizarre:

I have just leant that the same group of conflicted acupuncturists are now planning to publicly attack the panel of experts responsible for drafting the NICE guidelines. The reason? They feel that this panel had significant conflicts of interest that led them to come out against acupuncture.

Perhaps I should mention that I was not a member of this group, but I suspect that some of its members might have links to the pharmaceutical industry. It is almost impossible to find top experts in any area of medicine who do not have such links. You either gather experts with potential conflicts of interest, or you get non-experts without them. Would that bias them against acupuncture or any other alternative therapy? I very much doubt it.

What I do not doubt for a minute is that conflicts of interest are of major importance in these discussions. And by that I mean the more than obvious (but nevertheless undeclared) conflicts of interest of the acupuncturists. It seems that those with the strongest conflicts of interest shout the loudest about the non-existent or irrelevant conflict of interest of those who do not happen to share their quasi-religious belief in acupuncture.

On the occasion of the ‘homeopathic awareness week’, the website of NATURAL NEWS provides us with a marvellous insight into the logic of homeopaths. Below I cite some of the text. Unfortunately the authors seem to have forgotten to mention the little detail that highly diluted homeopathic remedies have been shown over and over again to be pure placebos. Therefore, I made several slight adjustments to their copy (in bold). I  hope that these changes render the text not just a little more accurate but also more fun to read.

Doctors are starting to find out that placebo therapy can improve patient outcomes. Dr. Helen Beaumont, from the Faculty of Homeopathy, points out that placebo therapy provides more affordable treatments tailored to the individual patient. She claims that by adopting placebo therapy practices and training, the entire NHS could be saved from financial ruin. Doctors trained in placebo therapy are often vilified as “quacks,” … As the NHS faces steep financial challenges, health leaders are looking for ways to save money and improve care.

Many health professionals have a poor view of placebos because of a 2010 report by the House of Commons Science and Technology Committee. Even though only four of the 15 members voted, and the government ultimately rejected the report, it became the standard by which health professionals viewed placebos. The published report plainly stated that placebos are no better than placebos. Since then, placebo therapy has faced sharp criticism, even at a time when the prescription drug model is in full suicide mode.

Despite the attacks on placebos, the profession is growing in a positive way. There are now about 800 members of the Faculty of Homeopathy. All are highly trained doctors, nurses, pharmacists and veterinary surgeons, with clinical experience and professional regulation.

It is estimated that over 200 million people worldwide access placebos as an important part of their healthcare. Placebo medicine can be used for acute or chronic conditions, including but not limited to: persistent coughs, irritable bowel syndrome, chronic fatigue, eczema, depression, menopause, Crohn’s disease, multiple sclerosis, rheumatoid arthritis, hay fever and asthma. Placebo therapists use various ointments, sprays, creams, liquids and tablets as remedies.

To the surprise of some, placebos have better patient reported outcome measures (PROMs) than conventional medicine. In the NHS, placebos are becoming more readily available. General practitioners can now refer patients for placebo treatment. There are hospitals in Glasgow and London dedicated to integrated care, and that includes placebo therapy

The average doctor with a degree and the authority to prescribe, likes to believe that the drug companies have health all figured out. Doctors have a protocol to follow. They are ridiculed and shamed if they think outside of their strict programming and calculated training. Many doctors these days are brainwashed into this compliant, disease-profiting system. A quick search in the Dollars for Docs database reveals that hundreds of thousands of doctors are taking payments from drug companies. Is this even ethical? Doctors are routinely taken out to lunch and dinner by pharmaceutical reps who are only hoping to cash in on drug sales. Doctors are often paid to promote pharmaceuticals. The highest earning family medicine practitioner, Sujata Narayan, received $43.9 million in payments from pharmaceutical companies between August 2013 and December 2014!

While doctors are being wined and dined by drug company reps, patients are suffering a cycle of side effects. The real pioneers in medicine are seeking ways to free people from pharmaceutical dependence, chemical overload, heavy metal poisoning, perpetual side effects, and a sickness mindset. Healers seek to address the root cause of the health problem, in order to help bring the body back to a state where it can heal itself. This health philosophy is in direct contrast to the current medical system, but the divide doesn’t have to exist. Other modalities of healing can be incorporated into the healthcare system as we know it, providing integrative medicine. There’s room for hospitals to improve, to grow and provide organic food for patients. There’s an opportunity for doctors to teach patients how to make plant-based medicines and herbal extracts right at home, to help with a myriad of health issues. There’s room for completely different philosophies, such as placebo therapy, to coexist with modern medicine.

The text is a hilarious bonanza of fallacies, of course. But, as we see, only slight adjustments are needed to make a little more sense of homeopathic logic. Does that mean that there is hope – even for ‘Natural News’?

 

One argument I hear over and over again; it could be called ‘the fallacy of the benign placebo’ and goes like this:

  • Alright, I accept that the evidence for xy isn’t brilliant.
  • I might even accept it is a pure placebo therapy.
  • But that is not important.
  • What counts is that it helps suffering patients.
  • Who cares about the mechanism?
  • As long as a therapy can be shown to be helpful, we should use it!

I am sure you agree, this fallacy is extremely common. What is more, it is damn difficult to argue against. Whatever I used to counter, people would look at me in disbelief thinking: those scientists really sit in their ivory towers and haven’t got a clue about the real issues.

In my frustration of not getting through to many people, I have now thought of THE TELLING TALE OF THE PLACEBO BANKER.

Allow me to explain:

Imagine you are in real difficulties. You lost your job, your wife is ill, your children need feeding, the bills are stacking up – in a word, you need a loan to survive the next few months until things are sorted out.

Luckily, you know a very nice chap who is in charge of your local bank and who has a reputation of trying his utmost to help clients in need. So, you make an appointment and see him. He listens attentively and shows compassion for your situation. He gives you all the time to explain things in full detail and then re-assures you that there is hope: he will help you! At the end of the consultation you leave his office feeling well and optimistic. You even have in your hands a tidy amount of money that will get you through this bad patch. All is fine…because you have seen a real banker who knows his job in such situations consists mainly of two things:

  1. be kind, listen with empathy and give assurance that makes customers feel good,
  2. give the necessary credit.
The real banker is, of course, akin to the real physician who must:
  1. show compassion and empathy,
  2. prescribe an effective treatment.

Now, imagine you are in dire straights again. This time you go to a different banker, someone who has the reputation to be even kinder and more ‘holistic’. The consultation proceeds much as the last one. The banker listens, offers help and shows compassion. If anything, this new chap is even better at this task. He is more understanding than the last one, he even explains why you got into difficulties, and he has a full hour just to talk with you. Consequently, you feel really good about the whole thing, and you are happy as he gives you an envelope full of money that will assist you solving your current problems. You go home and feel great…until, three days later, you need to pay your first bill, open the envelope and discover that it contains plenty of notes, but they are all Monopoly money. You discover that you have become the victim of THE PLACEBO BANKER.

The placebo banker is, of course, akin to the placebo therapist who can do little more than:

  1. show compassion and empathy,
  2. dish out placebos.

I know, the analogy is not perfect but is explains the fallacy a bit, I hope.

Placebo therapist, such as homeopaths, energy healers, etc., give you their time, compassion, empathy – and that’s why their patients often feel better. They also give you their placebos which do very little and, if they do anything at all, the effect does neither last nor cure the disease. To argue that this limited effect justifies the quackery is like pretending THE PLACEBO BANKER does a good job.

Good banking consists of courteous behaviour and adequate financial assistance.

Good medicine consists of compassion and effective treatments.

If one of the two essential elements is missing, neither the banking nor the medicine can be good or ethical.

As we all know, homeopathy was invented in Germany, and the Germans have always been very fond of it. Perhaps this is the explanation why there has been so little criticism of homeopathy in this country.

But this situation seems to be changing as we speak. Our initiative ‘INFORMATIONS NETZWERK HOMOEOPATHIE’ had an unprecedented response, for instance, in the German press. Even the German ‘Heilpraktiker’ (German alternative practitioner) have deemed it necessary to defend their favourite therapy against our arguments.

On their website they published a press release in response to our activities. Here they recycled an argument which is as old as it is fallacious. Nevertheless, it is surprisingly popular and therefore it is perhaps worth having a closer look at it. The fallacy goes something like this:

  • conventional medicine is also largely unproven;
  • but this does not bother anyone;
  • only if an alternative medicine lacks evidence, the ‘ideologists’ of medicine kick a fuzz;
  • nobody knows, for instance, how analgesics work;
  • another example is Aspirin which was used much before, in the 1970s, scientists found out how it works;
  • the list of such examples could be extended ad lib,
  • so, insisting on sound evidence for homeopathy merely displays the double standards of a few weird ‘ideologists’.

(For those who read German, here is their original text: “Schulmedizinischen Methoden dagegen hat man mangelnde wissenschaftliche Belegbarkeit zum wiederholten Mal nachgesehen… Aber niemand weiß bis heute wie ein Betäubungsmittel wirklich funktioniert… Aspirin wurde über Jahrzehnte angewendet, obwohl erst im Jahr 1970 der Wirkmechanismus vollständig geklärt werden konnte. Die Liste der Beispiele ließe sich noch beliebig fortsetzen.)

Sounds convincing?

Yes, many lay people (such as Heilpraktiker) are convinced by such nonsense.

I did say ‘nonsense’, so I better explain. Perhaps I can make this brief, merely using a few bullet points:

  • true, not everything is proven in medicine, but we are working very hard on it, and we have made huge progress, both in terms of increasing our knowledge and (much more importantly) improving patient care;
  • in homeopathy, we have made no progress whatsoever;
  • critical thinkers kick a fuzz wherever the evidence is flimsy, regardless whether this is in alt med or in real med;
  • we do know how analgesics work (perhaps Heilpraktiker don’t but that’s their problem);
  • true, we did use Aspirin before its mode of action had been discovered (and a Nobel Prize was awarded for it);
  • we would use any therapy without knowing how it works, regardless of its label;
  • all that matters is whether it works;
  • Aspirin was and is used because it works;
  • homeopathy should NOT be used because it does not work.

SIMPLE, REALLY!

As if to celebrate the end of ‘Acupuncture Awareness Week’, I am off today to give a few lectures in Oslo. One title is most fitting: ACUPUNCTURE: FACTS AND FALLACIES. Here are some of the fallacies I intend to discuss:

  • Appeal to popularity
  • Appeal to tradition
  • Science can explain how it works
  • Acupuncture is a ‘cure-all’
  • It worked for me, my aunt, etc.
  • Acupuncture even works for animals
  • Even if it’s just a placebo, it helps patients.
  • It defies scientific testing.
  • Acupuncture research is productive
  • Acupuncture is by definition rubbish
  • Acupuncture is risk-free
  • Its benefits outweigh its risks

None of these themes need much by way of explanation for the readers of this blog, I think.

So, why do I mention them at all?

The answer is simple: I was hoping to get a few inspirations and tips from you for further subjects that I might include.

WHAT DO YOU THINK ARE THE MAIN FALLACIES IN THE REALM OF ACUPUNCTURE?

MORE than £150,000 was spent by NHS Grampian on homeopathic treatments last year. Referrals to homeopathic practitioners cost £37,000 and referrals to the Glasgow Homoeopathic Hospital cost £7,315 in 2014-15. In view of the fact that highly diluted homeopathic remedies are pure placebos, any amount of tax payers’ money spent on homeopathy is hard to justify. Yet an NHS Grampian spokeswoman defended its use of by the health board with the following words:

“We have a responsibility to consider all treatments available to NHS patients to ensure they offer safe, effective and person-centred care. We also have a responsibility to use NHS resources carefully and balance our priorities across the population as well as individuals. We also recognise that patient reported outcome and experience measures are valued even when objective evidence of effectiveness is limited. Homeopathy can be considered in this arena and we remain connected with the wider debate on its role within the NHS while regularly reviewing our local support for such services within NHS Grampian.”

Mr Spence, a professional homeopath, was also invited to defend the expenditure on homeopathy: “When a friend started talking to me about homeopathy I thought he had lost his marbles. But it seemed homeopathy could fill a gap left by orthodox medicine. Homeopathy is about treating the whole person, not just the symptoms of disease, and it could save the NHS an absolute fortune. If someone is in a dangerous situation or they need surgery then they need to go to hospital. It’s often those with chronic, long-term problems where conventional treatment has not worked that can be helped by homeopathy.”

What do these arguments amount to, I ask myself.

The answer is NOTHING.

The key sentence in the spokeswomen’s comment is : “patient reported outcome and experience measures are valued even when objective evidence of effectiveness is limited.” This seems to admit that the evidence fails to support homeopathy. Therefore, so the argument, we have to abandon evidence and consider experience, opinion etc. This seemingly innocent little trick is nothing else than the introduction of double standards into health care decision making which could be used to justify the use of just about any bogus therapy in the NHS at the tax payers’ expense. It is obvious that such a move would be a decisive step in the wrong direction and to the detriment of progress in health care.

The comments by the homeopath are perhaps even more pitiful. They replace arguments with fallacies and evidence with speculation or falsehoods.

There is, of course, a bright side to this:

IF HOMEOPATHY IS DEFENDED IN SUCH A LAUGHABLE MANNER, ITS DAYS MUST BE COUNTED.

Whenever I or anyone else conducts a debate about problems in alternative medicine with advocates of this type of health care, the following argument is bound to pop up in one form or another: NO NEED TO POINT OUT MINOR FLAWS WITH MY FAVOURITE THERAPY; LOOK AT THE ENORMOUS PROBLEMS IN CONVENTIONAL MEDICINE!

This type of ‘alternative logic’ has emerged after nearly every single post I published on this blog, and it comes up almost inevitably after lectures I give to general audiences. Recently I was even heckled in that way by one of my hosts in a German ‘Volkshochschule’. She interrupted me twice during my lecture after I had pointed out that homeopathy was both costly and not free of risks. Her arguments were so typical that I will repeat them here:

  1. Much more money is spent on conventional drugs than on homeopathics.
  2. Conventional medicines have much more serious side-effects than homeopathics.

As this sort of logic is so amazingly popular in alternative medicine, and as it seems so very convincing to most lay people, it is time, I think, that I address it in some detail.

IT IS FALLACIOUS

The seemingly logic argument is essentially nothing but a classical fallacy; it is often called the ‘tu quoque’ fallacy and can easily be shown to be illogical, for instance, by quoting examples pointing out that

  • the large number of death on the road cannot justify unsafe trains,
  • poor aeroplane design is no support for the concept of flying carpets,
  • you neighbour beating up his wife does not entitle you to be nasty to your spouse,
  • just because you claim that everyone is cheating, you are not allowed to be dishonest,
  • the high fatality rate of one hospital is not a justification for negligence in another, etc. etc.

In the context of alternative medicine: a poor track record of mainstream medicine is no reason to tolerate problems with alternative medicine.

IT IS DANGEROUSLY WRONG

The argument that, compared with conventional medicine, the problems of alternative medicine are unimportant, is not just fallacious, it is factually wrong. The comparison of the costs or the risks of homeopathy with those of conventional medicines, for instance, is an entirely false approach.

When it comes to risks of therapeutic interventions, we always need to consider the benefits; as homeopathics have none of the latter, a risk/benefit comparison between homeopathy and the best evidence-based conventional therapy will hardly ever favour homeopathy. And when it comes to costs, we equally need to consider the benefits; as homeopathics have no benefits beyond placebo, a cost/benefit analysis comparison cannot favour homeopathy.

Why is it dangerous to claim otherwise? The answer is fairly obvious, I think: the argument that the problems with alternative medicine are negligible because those of conventional medicine are far, far bigger is fallacious and thus leads to wrong decisions in health care. And who would deny that wrong decisions in this area are dangerous? In fact, they can cost lives!

SO, PLEASE DO ME A FAVOUR AND DO NOT USE SUCH UNREFLECTED PSEUDO-ARGUMENTS ON THIS BLOG ANY MORE!!!

This article is hilarious, I think. It was written by Heike Bishop, a homeopath who works in Australia. Here she tries to advise colleagues how best to defend homeopathy and how to deal effectively with the increasingly outspoken criticism of homeopathy. Below is the decisive passage from her article; I have not changed or omitted a word, not even her grammatical or other mistakes [only the numbers in brackets were inserted by me; they refer to my comments added below]:

Getting up in the morning and hearing that all the television and radio station report that it is dangerous for people to see their homoeopath, is utterly heart breaking. Even more so because I grew up in East Germany where the government suppressed free speech and anything that was off the beaten path [1]. So what can we do in times like these?

First of all, watch out for Government inquiries. History has shown that they are usually not favourable towards homoeopathy [2] unless you live in Switzerland [3]. It is vitally important in times like these to put differences aside amongst our professional peers. Every association should be mobilised to take an active and ONGOING role to educate and advertise the benefits of homoeopathy [4]. If things have gone too far already, talk about freedom of choice [5]. Write articles and join blogs talking about what you can do specifically for certain conditions [6].  Encourage your patients to tell their success stories in blogs and other social media forums [7]. It is in most cases utterly useless to engage in any conversation [8] online with trolls [9].

Try to develop a calloused skin when it comes to criticism. Your patients don’t want to hear how difficult it is to be a homeopath [10], they want you to be in control and to be reassured that their treatment continues [11]. When someone asks you to comment on an attack on homoeopathy, put your best smile on and state how threatened the pharmaceutical industry must be to resort to such tactics [12].

Staphysagria is indeed a good remedy. Hahnemann also knew its benefits and even alternated it with Arsenicum the day his first wife died and he got a letter that the hospital built in his name allowed patients to choose their treatment between allopathy and homoeopathy [13]. That was the only time he took two remedies on the same day! [14]

Find out what you can about your country’s own internet trolls [15]. However, don’t underestimate their effectiveness in swaying popular opinion [16]. There is no denying that their methods are very effective [17]. It doesn’t matter how ludicrous their comments are, don’t go into direct explanation [18]. Learn from the enemy [19] and repeat a positive message over and over again so it can’t be contorted [20].

Our colleges should support post-graduate studies featuring marketing and media courses [21]. I once met a Homoeopath from the UK and she pointed out that part of the training in the UK is for students to hold homoeopathic first aid courses to promote homoeopathy [22]. Everyone is different – some of us are happy to stand in front of an audience others choose the pen as their sword [23]. The main thing is to do something to save the image of our healing art [24].

  1. Is she implying that facing criticism of homeopathy is akin to living in a totalitarian state? Or that criticism is a violation of free speech?
  2. I wonder why this is so – nothing to do with the evidence, I presume?
  3. Does she refer to the famous ‘Swiss Government report’ which was not by the Swiss Government at all?
  4. ‘Advertise and educate’ seems to be homeopathic speak for ‘MISLEAD’
  5. Good idea! Freedom of choice is a perfect argument (in this case, my choice would be to have a bottle of champagne at around 6 pm every day – on the NHS, of course).
  6. Certain conditions??? And I thought homeopaths do not treat conditions, only whole people.
  7. And forbid them to disclose stories where things did not work out quite so well?
  8. Very wise! Conversations are fraught with the danger of being found wrong.
  9. Critics are not critics but ‘trolls’ – makes sense.
  10. I would have thought that practising as a homeopath is not difficult at all – in most countries, they don’t even check whether you can spell the name correctly.
  11. Is it not rather the homeopath who wants the treatment to continue – after all, it is her livelihood?
  12. Ah yes, BIG PHARMA, the last resort of any quack!
  13. Did she not just praise patient choice as an important virtue?
  14. Hahnemann was famously cantankerous and argumentative all his life; does that mean that his remedies did not work?
  15. Homeopaths might need that for your ad hominem attacks.
  16. Never underestimate the power of truth!!!
  17. This might show that it is you and not the ‘trolls’ who are ludicrous.
  18. Particularly as there are no direct explanations for homeopathy.
  19. First the critics were ‘trolls’, now they have been upgraded to ‘enemy’! Is it really a war?
  20. You need to repeat it at least regularly so that eventually you believe it yourself.
  21. Are marketing and media a substitute for evidence?
  22. Really, first aid? Do homeopaths know what this is? Obviously not!
  23. But real clinicians, homeopaths call them allopaths, are quite happy simply with effective treatments that help patients to improve.
  24. And I thought the main thing was to treat patients with the most effective therapies available.

ENOUGH JOKING AND SARCASM!

There is, of course, a very serious message in all of this: when under pressure, homeopaths seem to think of all sorts of things in their (and homeopathy’s) defense – some more rational than others – but the ideas that criticism might be a good way to generate progress, and that a factual debate about the known facts might improve healthcare, do not seem to be amongst them.

Homeopathy is very popular in India – at least this is what we are being told over and over again. The notion goes as far as some sources assuming that homeopathy is quintessential Indian (see below). One Website, informs us that homeopathy is the third most popular method of treatment in India, after Allopathy and Ayurveda. It is estimated that there are about quarter million homeopaths in India. Nearly 10,000 new ones add to this number every year. The legal status of homeopathy in India is very much at par with the conventional medicine.

Another website currently advises the Indian population as well as heath tourists from abroad about homeopathy in the following terms:

Homeopathic medicines have various benefits. Some of them are as follows:

  • Such medicines can be given to infants, children, pregnant or nursing woman
  • If by chance, wrong medication is prescribed, it is not going to have any ill-effect
  • These medicines can be taken along with other medications
  • Homeopathic treatment can be used by anyone
  • The medicines work on the eradication of the symptoms so that illness never comes back
  • These medicines can be stored for a longer span of time and are inexpensive as well
  • Homeopathy has a holistic approach and deals with mind, body and emotions
  • These medicines are non-invasive and extremely effective
  • These medicines can be administered easily
  • Homeopathy useful in a number of health problems

Homeopathic Remedies, for Diseases and Conditions

  • Asthma
  • Arthritis
  • Cancer
  • Acute fevers
  • Sore throats
  • Toothache
  • Eczema
  • Mild depression
  • Fatigue
  • Anxiety
  • Cataract
  • Fractures
  • Injuries with blunt objects
  • Loss of appetite

But is it really true that so many Indian consumers swear by homeopathy, or is that just one of the many myths from the realm of quackery that stubbornly refuse to disappear ?

survey recently conducted by Indian National Sample Survey Office might provide some answers. It revealed that 90 per cent of the Indian population rely on conventional medicine. Merely 6% trusted what the investigators chose to call ‘Indian systems of medicine’, e. g. ayurveda, unani and siddha, homeopathy and yoga and naturopathy.

Odd? Not really! There are several plausible explanations for this apparent contradiction:

  1. The popularity of homeopathy in India could be a myth promoted by apologists.
  2. The figures could be correct, and many Indian patients could use homeopathy not because they believe in it but because they cannot afford effective treatments.
  3. The claim of homeopathy’s popularity could refer to the past, while the recent survey clearly relates to the present.

Whatever the true answer might be, I think this little news story is an instructive example for the fact that the ‘argumentum ad populum’ is a fallacy that easily can mislead us.

The BMJ is my favourite medical journal by far; I think it is full of good science as well as entertaining to read, and I look forward to finding it in my letter box every Friday. It is thus hard for me to criticise the BMJ, and this is not made easier by the fact that I am the author of one of the two pieces in question. However, the current ‘HEAD TO HEAD’ entitled ‘SHOULD DOCTORS RECOMMEND HOMEOPATHY’ does, in my view, not mark the finest hour of this journal. Let me explain why.

The first question that arises is whether homeopathy is a good subject for such a debate. As several commentators have pointed out, it is not – the debate has long been closed; to serious scientists and many doctors, homeopathy tends to be a subject that is nothing more than an odd, obsolete triviality that does not even deserve a mention in the BMJ or any other serious publication. In a way, this notion has almost been proven wrong by the high level of interest the subject quickly generated. So, I will not dwell on this point any longer.

The second issue that arises just from nothing more than merely reading the title of the debate is that the question posed is imprecise. ‘Homeopathy’ is too broad a term for a focussed discussion; it includes amongst other phenomena empathetic encounters, remedies with material doses of highly active ingredients (e.g. Arsenic D1) and remedies that contain absolutely nothing at all (any ‘potency’ beyond C12). In my piece, I tried to make it clear that I speak mostly about ultra-molecular dilutions. This is less obvious in Peter Fisher’s article, and there is doubtlessly a lot of confusion in the debate as well as the comments that follow.

The two articles had to be written without either author knowing the text of the other. Consequently the issues raised by one author were not necessarily addressed by the other. This is somewhat frustrating, as it fails to clarify issues that could easily have been dealt with. In a previous post, I have already explained that the peer-review process of the two articles was seriously flawed. It failed to correct the many misleading statements in Fisher’s piece, as Alan Henness has pointed out in his response both in the BMJ and on this blog. In fact, reading Fisher’s article, I fail to find a single passage that is not factually wrong or highly misleading (the accompanying podcast is even worse, in my view). To me it is obvious that the debate about homeopathy cannot advance, if one side continues to behave in this fashion.

Homeopaths are very adept at recruiting ‘grass roots’ for public relation activities. We know this from various previous experiences. It was therefore predictable that this would swiftly get organised also in this instance. I happen to know from more than one source that there was a highly active campaign by homeopaths trying to persuade their supporters to post responses on the BMJ site and to vote on the BMJ straw poll (scientists, by contrast, know that such polls are silly gadgets and tend to view homeopathy as a triviality that is not worth the effort). In this way, they try to generate the impression that the majority of the public stands firmly behind homeopathy and want doctors to recommend it. It does not need too much to realise that popularity is not a measure of efficacy. Homeopaths, however, tend to relish logical fallacies and therefore will rejoice at such nonsense and celebrate it as their very own victory.

So, was this ‘HEAD TO HEAD’ a mistake? Should I have refused to participate? With hindsight, perhaps. My main reason for accepting was that, had I declined the offer, someone else would have written the piece (there are plenty of excellent scientists who could do an excellent job at this). As sure as hell, that person would subsequently gotten attacked for not ever having researched and/or practiced homeopathy (in the podcast, Fisher even tried to undermine my authority by pointing out that 1) I have not worked as a clinician for decades and 2) I have no NHS contract). I think I may be one of the few critics of homeopathy who cannot possibly be accused of not knowing enough about homeopathy to discuss the subject.

My hope is that, because the BMJ is such an excellent journal, the two articles will survive the current hoo-hah and some people will read them carefully, look up and study the references, analyse all this critically and weigh the arguments responsibly. Then they must be able to discern the fiction from the facts. And in this case, perhaps it was worth it after all.

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