Did we not have a flurry of systematic reviews of homeopathy in recent months?
And were they not a great disappointment to homeopaths and their patients?
Just as we thought that this is more than enough evidence to show that homeopathy is not effective, here comes another one.
This new review evaluated RCTs of non-individualised homeopathic treatment (NIHT) in which the control group received treatments other than placebo (OTP). Specifically, its aim was to determine the comparative effectiveness of NIHT on health-related outcomes for any given condition.
For each eligible trial, published in the peer-reviewed literature up to the end of 2016, the authors assessed its risk of bias (internal validity) using the seven-domain Cochrane tool, and its relative pragmatic or explanatory attitude (external validity) using the 10-domain PRECIS tool. The researchers grouped RCTs by whether these examined homeopathy as an alternative treatment (study design 1a), adjunctively with another intervention (design 1b), or compared with no intervention (design 2). RCTs were sub-categorised as superiority trials or equivalence/non-inferiority trials. For each RCT, a single ‘main outcome measure’ was selected to use in meta-analysis.
Seventeen RCTs, representing 15 different medical conditions, were eligible for inclusion. Three of the trials were more pragmatic than explanatory, two were more explanatory than pragmatic, and 12 were equally pragmatic and explanatory. Fourteen trials were rated ‘high risk of bias’ overall; the other three trials were rated ‘uncertain risk of bias’ overall. Ten trials had data that were extractable for meta-analysis. Significant heterogeneity undermined the planned meta-analyses or their meaningful interpretation. For the three equivalence or non-inferiority trials with extractable data, the small, non-significant, pooled effect size was consistent with a conclusion that NIHT did not differ from treatment by a comparator (Ginkgo biloba or betahistine) for vertigo or (cromolyn sodium) for seasonal allergic rhinitis.
The authors concluded that the current data preclude a decisive conclusion about the comparative effectiveness of NIHT. Generalisability of findings is restricted by the limited external validity identified overall. The highest intrinsic quality was observed in the equivalence and non-inferiority trials of NIHT.
I do admire the authors’ tenacity in meta-analysing homeopathy trials and empathise with their sadness of the multitude of negative results they thus have to publish. However, I do disagree with their conclusions. In my view, at least two firm conclusions ARE possible:
- This dataset confirms yet again that the methodological quality of homeopathy trials is lousy.
- The totality of the trial evidence analysed here fails to show that non-individualised homeopathy is effective.
In case you wonder why the authors are not more outspoken about their own findings, perhaps you need to read their statement of conflicts of interest:
Authors RTM, YYYF, PV and AKLT are (or were) associated with a homeopathy organisation whose significant aim is to clarify and extend an evidence base in homeopathy. RTM holds an independent research consultancy contract with the Deutsche Homöopathie-Union, Karlsruhe, Germany. YYYF and AKLT belong to Living Homeopathy Ltd., which has contributed funding to some (but not this current) HRI project work. RTM and PV have no other relationships or activities that could appear to have influenced the submitted work. JRTD had no support from any organisation for the submitted work; in the last 3 years, and for activities outside the submitted study, he received personal fees, royalties or out-of-pocket expenses for advisory work, invitational lectures, use of rating scales, published book chapters or committee membership; he receives royalties from Springer Publishing Company for his book, A Century of Homeopaths: Their Influence on Medicine and Health. JTRD has no other relationships or activities that could appear to have influenced the submitted study.
If one had wanted to add insult to injury, one could have added that, if, despite such conflicts of interest, the overall result of this new review turned out to be not positive, the evidence must be truly negative.
93 Responses to Another meta-analysis of homeopathy shows how devastatingly negative the evidence truly is
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This looks like another invalid report. Poorly designed along the wrong lines and therefore only capable of producing a nil result, it doesn’t of course show that homeopathy doesn’t work, only that the study design was flawed from the start being built on false ideas about what homeopathy is and how it works. The clues lie in the first few lines, “non-individualised homeopathic treatment (NIHT)”. Homeopathy depends on individualised remedy selection for its success and that is a fundamental principle – like cures like. If you try and do it any other way it’s not homeopathy and the results will reflect that.
what a load of utter rubbish!
have you ever heard of ‘clinical homeopathy’?
Indeed I have. Why do you ask?
because of this:
While ‘classical homeopathy’ relies on individualised prescribing according to the ‘like cures like’ principle and selects the optimal remedy for each patient based on the findings from provings, clinical homeopathy resembles more the way drugs are prescribed in conventional medicine; it selects the appropriate remedy according to the condition of the patient, while largely disregarding the ‘like cure like’ principle.
However, clinical and classical homeopathy are not mutually exclusive; in fact, there is considerable overlap between the two approaches, and they are often used in parallel by the same clinician. In other words, if the symptoms of a patient reveal a very clear indication for a certain homeopathic remedy, clinical homeopathy is used even by classical homeopaths. For instance, Arnica is considered a clear indication for cuts and bruised; so is Coffea for insomnia, Drosera for cough, Opium for constipation etc., and these remedies would be employed regularly by classical homeopaths.
Clinical homeopathy is also used by many non-homeopaths as well as by consumers when they self-prescribe. It does not require an understanding any of the principles of homeopathy nor its fine details. Moreover, clinical homeopathy is also the predominant approach in veterinary homeopathy.
Indeed, here is an example of a homeopathic study in pigs which involved no individualisation (or blinding for that matter) yet which the BHA claims is evidence that homeopathy works as well as antibiotics (it isn’t, as the article at the link explains!). No wingeing about the ‘correct’ type of homeopathy when homeopaths think they can fool the public into believing they are looking at positive results.
Double standards anyone?
http://www.rationalvetmed.org/papers_a.html#Albrecht1999
Oh, and we mustn’t forget Mark Elliott’s laughable paper on Cushing’s disease in dogs and horses:
http://www.rationalvetmed.org/papers_e-f.html#Elliott2001
Again, no individualisation (or blinding, or decent data) but because Mark claims the results are positive then anything goes.
I’ve said it before, the homeopathic definition of a robust trial is one which gives them the results they want!
Niall
So help me out here please. Where should I read up the protocol which describes the conditions for a successful trial of homeopathy? Thank you.
read any of the following books and try to understand them:
https://www.amazon.co.uk/Evidence-Based-Medicine-How-Practice-Teach/dp/0702062960/ref=sr_1_1_sspa?s=books&ie=UTF8&qid=1550668631&sr=1-1-spons&keywords=evidence-based+medicine&psc=1
https://www.amazon.co.uk/How-Read-Paper-Evidence-Based-Medicine/dp/1118800966/ref=sr_1_14?s=books&ie=UTF8&qid=1550668749&sr=1-14&keywords=evidence-based+medicine
https://www.amazon.co.uk/Pocket-Guide-Critical-Appraisal/dp/072791099X/ref=pd_sbs_14_5/259-2887139-5684006?_encoding=UTF8&pd_rd_i=072791099X&pd_rd_r=37c98de4-3512-11e9-8777-855236dc2bf4&pd_rd_w=i95JO&pd_rd_wg=s0LL5&pf_rd_p=18edf98b-139a-41ee-bb40-d725dd59d1d3&pf_rd_r=9ZC9NGQ46KPT5A04ZP12&psc=1&refRID=9ZC9NGQ46KPT5A04ZP12
no, read them all!
@Nick Biggins
Here’s one suggestion for a proper scientific trial of homeopathy and homeopaths. Enroll a suitable number of patients (do a power test in advance to determine how many) and as many homeopaths as you like. The patients are assessed by the homeopaths and treated with one or more homeopathic remedies as are judged appropriate for their condition(s).
The actual medicines supplied are randomized by a third party to be the “real thing” or an identical-looking placebo, labelled in the same way as the real thing. (The patients and the homeopaths are thus blinded as to whether the treatment is genuine or placebo.) Treatment can be changed over time, if that’s deemed to be required by the homeopath, but a given patient will always receive either a genuine, potentized product or a placebo according to the randomization scheme.
After a pre-determined time (to be specified by the participating homeopaths) the homeopaths merely have to decide whether a given patient was treated with an authentic homeopathic remedy or a placebo. If the correct calls exceed the incorrect calls by a statistically pre-specified margin, then homeopathy works and homeopaths know what they’re doing. If not…
The essence of this simple protocol has been around for very many years (it was first suggested by the skeptic James Randi for homeopaths applying for his million-dollar challenge) but for some unaccountable reason it has never been tried in practice.
Dear Frank, I like this idea. A simple uncomplicated (and cheap) approach which makes it do-able. I don’t know how well that sits with EE but I see no need to over-complicate something. There would need to be good impartial oversight. Incidentally I bought just bought two of the books EE recommended to me today on clinical trials so will work my way through these when they arrive.
I had heard health problems intervened with James Randi before somebody eventually offered to take up his challenge.
Follow this blueprint, but come about with a significant result in favour of homeopathy and then have it repeated by some independent party. If they come around with about the same positive results, you are quite near the target:
https://journals.sagepub.com/doi/abs/10.1046/j.1468-2982.1997.1702119.x
You will want to access the full article with help of a library.
@Nick Biggins
Several people have taken up the Randi challenge for various pseudo-scientific ideas (never homeopathy — you might like to pause and think more about why), but no-one has got beyond the preliminary test stage. Randi himself is now 90 years old and he retired from actively maintaining the challenge several years ago.
“Where should I read up the protocol which describes the conditions for a successful trial of homeopathy?”
Well you yourself have said (of a trial that found against homeopathy) it should at least involve individualised homeopathy. You’ve now seen several examples of trials involving non-individualised homeopathy which have been accepted by homeopaths because they were able to convince themselves they gave positive results.
Why are you suddenly asking for a written protocol for homeopathic trials when it was you who started the discussion about protocols for homeopathic trials?
The point is that homeopaths don’t give two hoots about ‘protocols’ as long as the results confirm their preconceptions. No amount of dissembling and nit-picking will get you off the horns of that particular dilemma
The hypocrisy astounds me.
Niall
Niall, I can’t speak for other homeopaths and I doubt you can really either. The world is a fickle and curious place and I agree there are inconsistencies I cannot reconcile. I speak only for myself and what I know. Nothing ‘sudden’ in my interest either, not when I have been doing this as long as I have. I admit to being baffled by what occurs and so I have bought a couple of books on clinical trials recommended to me by EE to learn a bit more about the methodology. Don’t hold your breath though!
this is isopathy, not homeopathy [it does not follow the like cures like assumption]
The study was conducted to establish whether homeopathic / isopathic potencies differed to placebo. The method of manufacture being identical to homeopathic and isopathic potencies appeared to confirm that there is a difference between placebo and medicine made using the potentising process.
I hate to teach a homeopath the essentials of homeopathy: ISOPATHY DOES NOT FOLLOW THE MAIN AXIOM OF HOMEOPATHY AND THEREFORE IS NOT HOMEOPATHY!
I am getting tired of trying to teach you like a 1st year student. this blog has a different aim.
Hmmm… I think Nick Biggins is not a real homeopath. Doesn’t even know the basic principles and makes up fake remedy substitutes.
Bjorn, I am real. 4 years study in London then registered for my RSHom. Nothing wrong with my understanding of the classical principles. So how good a judge of people are you? Homeopathy came first. Then Isopathy, Tautopathy, Nosodes, Bio-chemic remedies etc. which follow the same method of manufacture. The study link I posted looked at whether a substance potentised using this method would be distinguishable from placebo, which it seems it was. To split hairs a little and to clarify, it was not about homeopathy but about the concept of potency validating the manufacturing process. At least that’s how I understood it.
Nick: If you are so positive about it, that homeopathic preparations differ from pure solvent or substrate then you might be interested to make a little money? What about € 50,000.-?
If “yes”, see here: https://www.gwup.org/challenge-home
Norbert, I’ve seen that before. I don’t need £5000 and the money wouldn’t motivate me anyway. What would is being part of a well constructed trial. I heard Charles Darwin found a novel way to demonstrate how potentised Ammonia Carbonate behaves differently to water. I haven’t tried the experiment but it would be relatively cheap and simple to do.
nice to not need money!
but this is not primarily about cash – it’s about proving that homeopathic remedies can in any way be differentiated from placebos.
I interpret you declining as saying that it can’t be done; and I entirely agree with you [for once!]
I don’t think you read my reply properly Norbert. If had you would have learned that I am interested. Very interested! I will take another look at it although I am a homeopath and maybe disqualified from involvement on those grounds alone! (Conflict of interest).
@ Mr. Biggins,
I am aware that measuring unit and the importance of decimals for an effect size are not of great importance for homeopaths like you, but let me point out that €50.000 is not the same as £5.000. It corresponds to ~£43.455. But… probably still small change for you.
As an expert in homeopathy with life-long experience, may I ask you for your opinion why NO homeopath on the WHOLE PLANET seems to even consider accepting the challenge?!
Are all homeopaths as rich as you apparently are? What about all the homeopaths in e.g. India (>200.000 registered homeopathic doctors, according to the lobby webpage HRI)?
Nobody interested in becoming rich and a superstar in the homeopathy faith community?!?
Or… can you think of any other explanation for this lack of interest?
😉
Nick, no you would not be rejected from participation in the challenge. We initiated it for people like you who have a keen interest to prove the claim that homeopathic preparations have properties depending on the starting material of the potentizing process, even when this material is no longer present in the final remedy.
@ Nick Biggins
You heard wrong, then. Darwin’s experiments with drosera and dilute solutions of ammonium salts were documented in chapter 7 of his 1875 book about insectivorous plants. You can find the full text online:
http://darwin-online.org.uk/content/frameset?pageseq=1&itemID=F1217&viewtype=text
There’s no mention of potentised remedies, just dilute solutions. The effect became weaker and more difficult to observe with reducing concentration, with a limit beyond which there was no effect. All the ammonium solutions used had ammonium salts present, none were ‘ultradilute’. There is no mention of homeopathy, or support for homeopathy, here.
Thanks for clarifying that.
Would that mean that the marketers of non-individualised homeopathic remedies are committing health fraud? (& if not, why not?)
Perhaps, but there is a ‘buckshot’ approach some suppliers call homeopathy and yet if you study the principles and spend a lifetime applying them (as I have) you can begin to voice an opinion, based on experience not flawed and embarrassing reports.
“spend a lifetime”???
talking BS again?
Nick Biggins, aged 48, trained in classical homeopathy 16 years ago and established a successful homeopathic and radionic practice. He recently developed the Encryptagrams to provide a range of therapeutic stimuli for assisting complex health conditions. A catalogue of Encryptagrams is available, as is further detailed information on their use and method of action on the subtle and physical body.
Agreed. What you describe is indeed the case. Clinical prescribing is a less sophisticated (less detailed analysis) method for selecting a remedy. This inevitably reduces the likeliehood of the simillimum being found in each and every case with lowered statistical significance for the efficacy being the obvious outcome. That is why I believe my previous comments are true and accurate.
I disagree
I was 48 a very long time ago. I am not really interested in coming here to deceive you all as is suggested. I followed the training I was given (also a very long time ago) and am still baffled by success in the results I achieve with people. You can ridicule me but its really not about me, its about homeopathy.
no, it’s all about placebo
So the ‘return of old symptoms’ after a homeopathic remedy is placebo? Herings Law of Cure – the cure of symptoms in the reverse order in which they appeared – that too is placebo? The children who curl up and go to sleep when they don’t even seem aware they have been given a remedy – that is placebo? The dog with the cough for 6 months which dissappears in a week after their owner has given it Psorinum 1m. That too is placebo?
if not, why can these anecdotes not be confirmed in controlled clinical trials?
show us data, not anecdotes!
if not, why can these anecdotes not be confirmed in controlled clinical trials?
show us data, not anecdotes!
The data is there in what I observe isn’t it?
The trials you suggest I believe were designed to test a single drug effect on many people all at the same time, for a single condition. Why would you expect that test model to work with homeopathy which doesn’t adhere to these principles of modality matching? My anecdotes are not invented I assure you.
you are in urgent need to learn what is acceptable as medical evidence.
“The trials you suggest I believe were designed to test a single drug effect on many people all at the same time, for a single condition.”
NOT TRUE
please learn the essentials before blasting out nonsense after nonsense.
There may have been verifiable data extractable from your observations, had they been conducted under properly controlled conditions. Given the absence of the latter, all we are left with is unverified and unverifiable anecdotes.
Dear Mr. Biggins,
have you heard of the “No true Scotsman” fallacy?
https://en.wikipedia.org/wiki/No_true_Scotsman
Would you agree that it applies to the way you deal with the issue of clinical homeopathy?
Yes, whenever a study or analysis goes wrong, then one of the reasons for this failure for sure is that it was not proper homeopathy that was applied. You never hear such complaints when the authors manage to form some positive result, however.
Norbert, this was pretty easy and quick to find.
https://www.bmj.com/content/321/7259/471
Nick, how is this paper to contradict me? The intervention is isopathy, that is, the allergen that made the people suffer, was the starting material for the homeopathic remedy. And this was applied without further anamnesis to find out the patients further symptoms to give the whole picture. Conclusion: This trial was far off from homeopathy as thought of by Hahnemann. But it is considered by homeopaths to have a positive outcome – so it is evidence “that homeopathic dilutions” differ from placebo – which should be understood to have positive effects.
Have you ever heard of any homeopath to dismiss this trial, for it is not really homeopathy?
Norbert, I’m not really linked in with other homeopaths very much any more so I can’t tell you what others do or don’t think about scientific studies. I can only say I am personally interested. It is curious to me that the firmly held opinions of many commentators appear elaborate, detailed and academic but I have yet to meet another homeopath here.
This is an interesting study in ways that are nothing to do with the study itself.
The funding for the Mathie systemic reviews would appear to come from the (long defunct) Manchester Homeopathy Clinic. There is very little information available on it but it would appear to have last been run by a Dr George Burns. It was given to the British Homeopathic Association (BHA) who are closely intertwined with the Faculty of Homeopathy. The BHA transfered the money and Mathie to the Homeopathic Research Institute.
PV is Petter Vikseen and a trustee of the HRI. He has been a recipient of grants from the HRI.
AKLT is very likely “Professor” Aaron To. It has proved impossible to determine To’s academic credentials. This bio http://homeopathyhongkong.com/message-from-president.html is not helpful and raises questions lots of questions. To is not only involved with Living Homeopathy Ltd but is President of the Hong Kong Association of Homeopathy and the Macau Association of Homeopathy. To has also donated money to various homeopathy “campaigns”.
The potential for conflict of interest is very high in the small world of homeopathy research. The potential for bias even higher.
Oh Edzard!
Who art in his ivory tower
Earnie be thy name
Thy Kingdom won’t come
Thy will wont be done
Either on earth or online
Give us this day thy daily blog
And show us our meta analysis
As we forgive those whose meta analysis gets spun against us.
Lead us not into temptation to throttle you
But deliver us from Henness
For thine has the ‘data’
The power of the emotive
For ever and ever
Amen
cute
yes, lovely to think that I am inspiring poets
That was poetry? Had me fooled!
well, homeopathic poetry perhaps
All rubbish. As Dana says, homeopathy needs to be individualised. It’s not valid otherwise.
Apart from when it isn’t in Frass studies..
Double-standards? Surely not.
Oh https://homeopathic.com/product/oscillococcinum-for-fluinfluenza/
Double standards or shoddy science?
Australian Report key facts:
An extensive investigation by Gerry Dendrinos of the Australian Homeopathic Association (AHA) into NHMRC’s conduct, combined with an in-depth scientific analysis of the report by HRI, revealed evidence of serious procedural and scientific misconduct in producing this report:
NHMRC did the homeopathy review twice, producing two reports, one in July 2012 and the one released to the public in March 2015.
The existence of the first report has never been disclosed to the public – it was only discovered through Freedom of Information (FOI) requests.
NHMRC say they rejected the first report because it was poor quality despite it being undertaken by a reputable scientist and author of NHMRC’s own guidelines on how to conduct evidence reviews.
FOI requests have revealed that a member of NHMRC’s expert committee overseeing the review process – Professor Fred Mendelsohn – confirmed the first review to be high quality saying – “I am impressed by the rigor, thoroughness and systematic approach given to this evaluation [….] Overall, a lot of excellent work has gone into this review and the results are presented in a systematic, unbiased and convincing manner.”
NHMRC said the results of the second report published in 2015 were based on a “rigorous assessment of over 1800 studies”. In fact results were based on only 176 studies.
NHMRC used a method that has never been used in any other review, before or since. NHMRC decided that for trials to be ‘reliable’ they had to have at least 150 participants and reach an unusually high threshold for quality. This is despite the fact that NHMRC itself routinely conducts studies with less than 150 participants.
These unprecedented and arbitrary rules meant the results of 171 of the trials were completely disregarded as being ‘unreliable’ leaving only 5 trials NHMRC considered to be ‘reliable’. As they assessed all 5 of these trials as negative, this explains how NHMRC could conclude that there was no ‘reliable’ evidence.
Professor Peter Brooks, Chair of the NHMRC committee that conducted the 2015 review, signed conflict of interest form declaring he was not “affiliated or associated with any organisation whose interests are either aligned with or opposed to homeopathy”, despite being a member of anti-homeopathy lobby group ‘Friends of Science in Medicine’
NHMRC’s guidelines state that such committees must include experts on the topic being reviewed, yet there was not one homeopathy expert on this committee.
@nick biggins
https://edzardernst.com/2018/01/homeopathy-the-2015-nhmrc-report-and-its-criticism-re-analysed/
https://edzardernst.com/2017/05/homeopathy-the-nhmrc-report-revisited/
https://edzardernst.com/2017/04/ombudsman-investigates-flawed-homeopathic-study/
https://edzardernst.com/2015/03/the-final-verdict-on-homeopathy-its-a-placebo/
You’re kind of late with your comment.
Yes, that’s me. Late to the party. Thanks.
@ Nick Biggins
So, if all of this criticism holds true, you surely are able to indicate one single condition, where the findings of this review are wrong. Please indicate which high quality studies were ignored by NHMRC which had the potential to turn their results when considered properly? Which indication is there where proper reliable evidence exists that shows homeopathy to be outperforming placebo? Hint: Check Mathie’s now four reviews on homeopathy before you answer.
Jashak, I’m sorry you’ve lost me there. I got involved in this thread to discuss the subject matter it presented.
@Nickedabigun: I’m not a professional homeopath but I do practice it on myself. For instance I only use a 1/3rd as much sugar as recommended when making cookies, one-fewer scoops of coffee in my Mr. Coffee, I cut my Ibuprofen pills in quaters, use 10W 5, instead of 10W 15 when I change my oil, only use half the screws supplied in do-it-yourself furniture, never do I “wash, lather, repeat”, I reuse dryer sheets and due to military “homeopathic-training” use way less toilet paper than regular civilians! And when I am sick I never take the homeopathic remedy “until symptoms subside”….I wait until symptoms subside THEN take 1/2 the recommended dose.
So I can relate perfectly to the homeopathic lifestyle that has been so beneficial to you.
@Mickeyheeny. What can I say? Your’e so near to perfect it’s scary.
Norbert, I just looked quickly at the conditions set out for this: “The applicant identifies which of the 12 bottles contains which drug, using any method and procedure of his choice.” There is no method I am aware of that can do this. I only work with potentised medicines made by homeopathic pharmacies. I don’t use blank sugar pills (placebo), although I don’t ignore its possible involvement when treating people. But, I have no way of knowing if a bottle I am staring at contains a potentised medicine or not. All I ever know (after giving it) is whether a treatment produced a change or not.
I think they would provide the materials. and if you know that it was verum after giving it to a patient, than you have a very good method for telling which is which.
Nick, it is a little awkward to follow this discussion because your answers appear at random places in this thread.
“Any method or procedure” would include anything you may think of to allow you to identify the contents of the bottles. This includes testing the effects on patients (provided you contact your ethics committee first). So if you have a patient that would require Arsenicum album then you would be able to judge from his reaction after taking a few pills if it was Arsenicum album you gave him or not.
Nope. All you know is whether or not the patient’s condition changed after you gave them the treatment.
Correct. That’s fundamentally all I and they are interested in achieving.
there’s a difference between achieving something and taking credit for it.
Correct again. And if I only helped people at the percentage rate of placebo (which in itself is a very difficult thing to assess accurately) I wouldn’t have been in business for long.
If you truly believe that, you are already wrong. Success in business does not correlate with the truth… I would go on so far as to say it correlates more with lying, but I am quite content even with just “it’s not among the most causative of factors”.
A good bit of marketing, a fair bit of empathy, an adequate share of the market to begin with and you’re good to go, you could even make money by just hugging people. And you could have them almost unanimously feel “helped” in the process.
To the question “who is in position to judge whether you are helping people at the percentage of placebo or not”, the definitive answer is not you (not aimed at you personally, but in general).
The simple explanation is that people who come to you are either:
1) Disappointed with conventional medicine, and therefore more eager to believe in alternative medicine and see improvement where there isn’t any, or attribute improvement to any alternative modality but not conventional medicine.
2) Already head over Heel(s) (yes, the manufacturer) about homeopathy, and are their own success stories (and, consequently, yours) already.
3) The odd few that will see improvements that we know (but you don’t want to understand) are attributed to the natural cause of disease, regression to the mean etc. and will simple-mindedly attribute it to the homeopathic preparations.
4) The vast majority of people that will simply not come to you because they got their problem treated anyway, or have too serious a pathology to trust homeopathy.
For these, and a number of other reasons, your sample is rigged in ways you (and I) may not even begin to imagine.
In short, you count too many successes and rarely have a chance to fail, let alone the tremendous majority of failures you do not even have a chance to get your hands on, probably because they care about their health, or, of course, in part, perhaps even by chance alone.
When homeopathy is tested in properly designed trials, a very important distinction is ascertained (in proper trials), which almost invariably never materializes in everyday homeopathic practice (otherwise, it would not be a “business”). It is given an equal opportunity to succeed and fail. And then it is exposed as a placebo through the utterly not-interesting-for-scientists statistical analyses. The few trials that do show an effect serve as noise for the systematic reviews and meta-analyses, and, while you have to be stubborn and hold the marginal overall effect sometimes found as a grudge against conventional medicine, you never take a breath and stop-by the earlier chapters to see the (literally) dozens of poor-quality trials that have to be ignored, which is a not-marginally significant proof that homeopathy is all about bad or fraudulent trial design that has for decades been masquerading as science.
Take a step back and re-evaluate that all and give a chance to yourself to acknowledge that you may have been “wrong” for your entire professional life. Have you ever considered that? Are you bold enough to even suggest it may be possible?
Hi James, a lot said there and you obviously have many thoughts, which over the years I have had too. Yes of course I have wondered whether my practice was a ‘sham’ on more than one occasion. I mean seriously doubted myself and the validity of the whole thing. What convinces me is my own experience, since I am able to (and do) self prescribe and observe the results upon myself. On one ocassion I took Pyrogen 200c single dose which caused me considerable pain for a couple of weeks at least. You will no doubt have a well rehearsed explanation. I have driven patients away with treatment that caused skin eruptions to erupt, along with the verbal outpouring of dissatisfaction that accompanies it. If I was to employ placebo consciously I would use larger pills (than the tiny white ones I do use), have them in different colours to produce a variety of reactions, wear a white lab coat, etc etc. None of which I do. I mostly posted them in plain envelopes with ball point pen numbers on.
Finding out whether you only help people at “the percentage of placebo” would require a placebo-controlled trial.
Doctors used ineffective treatments like routine bleeding for centuries, possibly even millennia, before discovering that they didn’t work for the conditions that they were used for.
in any case, the argument ignores all the other factors such as regression to the mean, natural history of the condition, social desirability, etc.
I was assuming that the slightly odd expression “the percentage rate of placebo” included all of those in addition to the placebo effect itself.
A common tactic amongst quacks is the non-sequitur: “I couldn’t have been in business successfully for all these years if this were all just BS”. I’d point to the Catholic Church, Scientology or Chiropractic before becoming too enamored with that whopper.
Wrong Michael Kenny. I am being very specific, quantifiable in fact. “Non-sequiter tactic”? No, just happened to help people at a much higher rate than placebo. Not interested in BS either. That’s not what I’m about.
How do you know?
@nick: I will agree regarding: “just happened to help people at a much higher rate than placebo” IF in fact you are referring to the fact you charged your “patients” a much higher rate (£ or $) than they would have paid swallowing sugar-pills at home.
“Not interested in BS either”. Well I gave 3 examples of what I consider BS, perhaps if you agree BS does exist and persists in society perhaps you can enlighten us as to a “real BS” endeavor? If in fact homeopathy isn’t….what IS?
Nick, I do not have rehearsed explanations. People that disagree with homeopathy don’t simply do it just because… It’s always experience, it starts like that. Experience turns to a belief, then to a passionate race to validate that belief. In this course, lots of experiences are gathered and, sooner than later, it becomes impossible to discern success from failure. And this is where I want to intervene. It is OK to have experiences and hold on to them. The problem is that people that support homeopathy make tedious efforts to present it as science. It is not science and this is my sole objection, from start to end (nothing else, really). And there is a simple reason for that, which can also be illustrated by your own point, that you once took Pyrogen 200C single dose that caused you considerable pain for a couple of weeks.
Science is all about reproducibility. If you take Pyrogen 200C single dose and experience the same pain every time, then you can have a hint. If you give this to enough people, and it causes that type of pain (more or less) to lots of them, we have a stronger hint. If you make sure many of them have no idea what it is they are getting and they still get the pain, things are admittedly in your favor. This entire process, repeated a few dozens of times over the course of enough years, leads to enough data to come to a conclusion (systematic review). This is an incredibly dependable process and has helped medicine attain its current state-of-the-art.
In homeopathy, nothing is reproducible and it is very very tiresome to read/listen to all the multiple “explanations”, as to why it is not, many of which are even mutually exclusive, because… as a scientific explanation doesn’t really exist, lots of stuff have to be made up to fill the gaps.
Furthermore, it has been well documented in most systematic reviews, that most trials of homeopathy are of truly poor quality, and they produce favourable results for homeopathy. The link is very clear, poorly designed trials of homeopathy produce mostly positive results while more robust trials produce mostly negative results. There should be a simple explanation for this and I assert there is. The poor design may normally be attributed to inexperienced scientists (an oxymoron??), but if the scientists are experienced, the only explanation left (unless you have something better to propose) is that it is intentional, in order to force the positive results. See, I cannot really think of any other rational reason why good scientists would design poor trial frameworks, so if you have something more plausible, you can say so. In any case, both outcomes are damning for homeopathy, scientists into homeopathy are either relatively incompetent, causing poor trial designs that mislead the public, or actively mischievous, rigging trials to produce favourable results.
Apart from all this, however, I would only stand to one simple observation. Homeopathic effects are not reproducible, and the dozens of reasons usually given as explanations of this fact are completely irrelevant from a scientific standpoint… and that’s it. Science calls irreproducible effects random. In short, it doesn’t matter that you call it homeopathy or how you reason about it…it is a randomness with an extremely intricate and involved cover story. What you often call the similimum, is simply the pill that happened to coincide with an observed effect that happened to be favourable (or simply relevant, or even just notable, for any reason) at the time of occurrence. You do your best to detect it but it is simply pure coincidence.
This is not too tough to test, actually. Go ahead, mix up the bottles and the pills, give some of your clients completely randomly selected ones (but keep asking the questions dilligently, empathy always matters), they are going to be happy as ever! You yourself could try taking one Pyrogen 200C every day. You may notice a different symptom each day. But then again, we all get various symptoms almost every day. Why does it have to be the pill?
All I am saying is, you’ve made your observations, you’ve counted your successes, you’ve had your strong experiences, now it’s time to give your trade a chance to fail, but a true one. If you want to be fair…you have to really crash-test it. Random pills, mixed up, regardless of symptoms, record results carefully. You will always have successes and failures, in proportions that depend on how you want to see things. You obviously should try it on people who don’t know you are doing it, of course, because it is very very very easy to cheat yourself in the process, and you don’t want to do that, do you?
To cut a long story short, homeopathy is not reproducible and that’s the biggest problem with it, it is simply an interesting cover story for random effects.
James, that’s all very clear and I can accept all that you say as it stands. It looks like homeopathy lacks reproducibility, not least of all because once the remedy is given the patient (by our terms) has been ‘altered’ by it and giving the same remedy a second time will almost certainly not have the same effect due to the patient’s susceptibility having been affected dynamically. That’s classical homeopathy’s position and it’s not the same when you give a material dose of something to study its effects. My appearance initially here was to defend homeopathy which I am still inclined towards and I accept that placebo is implicated too. Placebo is another diverse topic in its own right and difficult to summarise, but if I only ever helped 30% of the people I treated I would not have survived. Saying this elsewhere in this blog has been misconstrued as my ruthless attitude to exploiting people, which it never was about in the first place. Samuel Hahnemann is quoted as saying it is “the medicine of experience.”
your patients seemed to get better because of:
placebo effects
natural history of their conditions
regression to the mean
etc.
No they improved due to placebo and homeopathy. Where the two cross is not being explored in this conversation. I am quite prepared to accept that homeopathy may not be experimentally reproducible as you have suggested. That doesn’t appear to stop efforts to do so and EE even appears to accept their validity. My experiences with treating myself and others go far beyond what science has been able to isolate and term placebo. Self healing as a phenomena is not new and preceded the scientific term by thousands of years. Those who have no direct experience are at a disadvantage here and can only keep an open mind or insist they know better.
“Those who have no direct experience are at a disadvantage here and can only keep an open mind or insist they know better.”
always the last resort of quacks: YOU HAVE NO OWN EXPERIENCE!
but I do Nick!
so don’t try to patronise me.
get some understanding of science instead.
Not sure what your point is. I am not patronising anyone. An overwhelmingly positive experience of homeopathic treatment would lead you to know, trust and believe that experience. If it produced a major and beneficial change in your life you may feel compelled to defend your opinion regardless of what science calls it. If you never experienced a radical homeopathic cure I can understand why you would think it nonsense. It’s fairly pointless for me to go into my own many anecdotal experiences here concerning reactions (which go way beyond what I would have expected in quality and quantity), all annexed here conveniently as placebo. Here these experiences don’t count, they can’t be quantified according to science because they are not reproducible on its own terms. Surely the method of enquiry needs to be re-considered then? Why would I undertake a double blind trial when the outcome is a foregone conclusion?
you still have not understood that there are many more phenomena involved than just placebo, have you?
why don’t you inform yourself a bit?
I am willing to do that. I have just received The Pocket Guide to Critical Appraisal which I bought at your recommendation. Also still waiting for another book from Amazon which is coming from USA called How to Read a Paper: The Basics of Evidence-Based Medicine. Cause and effect are troublesome partners. Will I find an explanation of how I prove remedies or produce symptoms of the remedy I take when I am not aware of the effect they will have?
I hope so.
meanwhile, please stop posting nonsense.
“In homeopathy, nothing is reproducible and it is very very tiresome to read/listen to all the multiple “explanations”
Do you know and understand the protocol? Individualization is why it’s not “reproductible” within the framework of your standardized tests
just in case this was a serious comment – in this area one never knows – here is what you were looking for:
https://edzardernst.com/2018/09/homeopathy-yet-another-systematic-review-fails-to-prove-its-effectiveness/
Homeopathy, the air-guitar of medicine.
🙂
I play a real guitar. But that’s a different conversation.
Good, then you ought to know the difference 😀
Between a sick person you haven’t been able to help and one who has improved under your care? I doubt even you know how much or whether you helped some of your patients. But you will like to think you did because of the outcomes.
No, between a sick person you have been able to help and one who has improved under your care.
Exactly.
You hit the nail right on the head Biggins!!
Maybe you have some insight after all? We commonly call this, ‘wishful thinking’.
That never helped anyone for real more than temporarily soothing the mind. But we can understand why homeopaths tend to give their shaken water magic credit for anything that appears to be a positive result but ignore the one’s that don’t or explain their ‘failure’ away.
In psychology an important explanation of this fallacy is called survivorship bias.
Here’s also a rather longish but very readable discourse on this common cognitive error
Other effects that are at play in homeopath’s heads are the observer-expectancy effect, the optimism bias, selective perception, choice-supportive bias, egocentric bias, confirmation bias and probably more. As you see the mind has many mechanisms by which it tries to fool you.