Guest post by Richard Rasker
Last summer, I strolled through my garden, enjoying the abundance of flowers and insects. At the far end, the garden gave way to shrubs and reedy grass and a tiny pond that, contrary to past years, hadn’t dried out completely yet.
And right there, at the water’s edge, is where I stumbled upon IT.
At first I thought the small white object was a twig or something similar, but upon closer inspection it turned out to be a small bone – looking remarkably like a human femur, albeit a bit eroded. So I looked around in the vicinity, to see if I could find any more bones. This was not the case, but what I DID find was even more breathtaking: a slender, 2-inch long gauze-like wing.
Immediately a mind-blowing realization dawned: there are fairies in the back of my garden!
Of course I had to be careful not to get carried away based on this single observation, so I spent the following months painstakingly searching for more corroborating evidence. And what I found was astounding: at least a dozen similar bones and wings, and even a very small tuft of brownish hair. And the bogs and marshes a few miles from my home proved an even richer treasure trove. Of course I also identified remains of numerous dead animals, mostly mice and other small rodents, but the femur-like bones I found were definitely too long for mice.
So I can now safely reveal my findings: fairies do exist after all! This is truly world-shattering!
Now what does this have to do with homeopathy, one may ask? The answer is simple: the gathering of evidence for the viability of homeopathy (and many other alternative modalities) is fully analogous to the way that I found scientific evidence for the existence of fairies:
- People (scientists or homeopaths) believe that they stumbled upon something special.
- They almost immediately consider their finding as either a type of revelation, or as something that lends strong support to their prior belief.
- They then set out to gather more evidence in support of the phenomenon they found, thus affirming their belief.
- And after a lot of painstaking work, the conclusion is reached that the observed phenomenon indeed exists!
Recently, a commenter on this blog tried to bolster the validity of homeopathy by naming a couple of scientists who did exactly this: they started believing in homeopathy, not because of proper clinical trials with homeopathic medicines, but because of revelation-type experiences, or because of hypotheses and/or observations that appeared to explain and support one important prerequisite of homeopathy, the so-called ‘water memory’.
These scientists come up with all sorts of hypothetical mechanisms how this water memory is supposed to work. Usually, quantum physics is invoked – even though real quantum physicists are unanimous in condemning this as nonsense, because quantum physics doesn’t work the way that homeopaths say it does. Nevertheless, these believers in homeopathy come up with ‘explanations’ that involve entanglement, or ‘coherence domains’, or stable nanostructures in water. And there are still lots of other mechanisms dreamed up by believers in homeopathy that aim to explain the all-important water memory.
First of all, most of these hypotheses are completely bonkers, without any real-world evidence to back up the suggestions and claims made – and none of these scientists have so far succeeded in distinguishing an arbitrary homeopathic dilution from plain water, even though some claim that they can find minute differences for a few very specific substances. Just too bad that these results have not been replicated by other scientists, and that they have not been published in any peer-reviewed scientific journal. And even if these results are legitimate, the effect found is absolutely tiny – just like all other homeopathic research with positive results.
But for the sake of the argument, let’s assume that these findings with regard to water memory are real (although no two researchers agree on even the basics of the purported mechanisms). Does this provide enough evidence to make us accept that homeopathy is a viable system of medicine?
No, of course it doesn’t!
Even if water would retain certain ‘nanostructures’ or ‘coherence domains’ or ‘quantum-entangled particles’, this means just that: that an almost undetectable ‘something’ apparently persists in water. It says NOTHING about how this tiny something can have a huge range of highly specific therapeutic effects, necessitating a hugely intricate structure (of which not a trace has ever been found). It says nothing about how this something finds its way from the water to the specific parts of the body to exert those beneficial effects, or about the way that this something interacts with the organism. It does not tell us why this something only ends up in water if it is shaken, or why this something becomes more potent with higher dilutions, or how this something can pass from homeopathic water to sugar pellets while retaining its very special water-based(!) structure – or why, in spite of this all, literally nobody can distinguish a homeopathic dilution from plain water.
Saying that the existence of water memory proves that homeopathy is real is like saying that the existence of those bones and wings I found proves that fairies exist. It is a totally unwarranted inference, and an excellent example of, in the words of Dr. Harriet Hall, Tooth Fairy science: these people spend lots of time, effort and money doing very serious research into all sorts of mechanisms and effects to explain how homeopathy works, but totally neglect to answer the primary question first: does homeopathy work at all? And even worse: these people think that the tiniest glimmer of an effect supporting their hypothesis immediately proves all of homeopathy right. Which is not so much jumping to conclusions, but making leaps of astronomical proportions that would have made even Neil Armstrong jealous. This is not how science works.
For homeopathy, I think that the primary question is answered pretty definitively: even after 227 years, homeopaths have not succeeded in coming up with even ONE ‘remedy’ that is efficacious beyond a shadow of a doubt. NOT ONE.
And to add insult to injury, nothing in science even remotely supports the very core tenets of homeopathy, the similia principle and the law of infinitesimals. ‘Like’ does NOT ‘cure like’, and higher dilutions most certainly were never found to become more potent medicines – quite the contrary, as is observed on a daily basis literally everywhere.
Most other ancient and traditional forms of medicine have come up with at least some treatments or herbs that turned out to have scientifically proven efficacy and have become part of modern medicine – but not homeopathy. Homeopathy DOES NOT WORK, PERIOD.
(Although, to be fair, homeopathy has given us one important insight with regard to medicine: that for many ailments, simply doing nothing is often the best choice. Because most conditions resolve naturally, without medical intervention.)
On a friendlier note: I do not think that those people who study water memory mechanisms and other similarly elusive effects are useless as scientists. Their painstaking research into things like nanostructures in water may one day produce interesting and useful new scientific insights. But it would benefit them greatly if they would distance themselves from homeopathy and its associated pseudoscience, because that is truly a dead-end street, bringing them nothing but scorn and derision.
And oh, about those bones and wings that I said I found? Those were of course likely from frogs and dragonflies, respectively. Or maybe I was the victim of a prank, or maybe I simply made up the whole story. Believe what you will, but you probably agree with me that almost any explanation one can think of is more likely than the fairy scenario. And this again is analogous to homeopathy: almost any explanation one can think of is more plausible than the explanation that mere shaking and diluting magically transforms water into a highly specific medicine.
One important question: How can the “water memory” still work, when it has been dropped on pure sucrose (called Globuli)? This is because the vast majority of homeopathics are prescribed in solid form, not liquid.
I have asked this often but never got a satisfactory answer.
This is just one of many, many questions that homeopathy so far has never answered (or even tried to answer).
Their reasoning is simplistic in the extreme: ‘Water memory is proven = homeopathy is proven’. They totally ignore the huge number of new questions (including yours) that arise as a result of this ‘explanation’. And this alone indicates that homeopathy believers are incompetent as scientists, simply because they never ask questions that may disprove their belief.
I’m almost inclined to create a list of questions that must be answered before we can even start thinking about taking homeopathy seriously. However, this would be a waste of my precious time, because I would be doing the work that those homeopathy researchers should do, and, more importantly, because the answers to each and every one of those questions is quite clear already: ‘We can find no evidence for [list of mechanisms and other prerequisites for homeopathy to work]’.
I had a look at the website http://www.omglobules.com
They say, of their globuli: “Made from 100% Pharma Grade Sugar, our Globules and Pills are unmedicated and chemical free”.
Chemical free? I always thought sucrose was a chemical? I always thought all matter in the universe was made of chemicals?
Apparently, they finally managed to not only dilute the ‘active ingredient’ into oblivion, but the ‘inactive ingredient’ as well. Which means that you get 100% Homeopathic Memory Imprint, and nothing else.
Quite an achievement!
I wonder how long it will be before someone drags dark energy and/or dark matter into homeopathy or some other CAM modality. They go their mile with “It works at the quantum level” already……
I wrote a lengthy and considered comment to this. Then tossed it in the trash.
Instead, I will leave this here.
A phrase that would serve you well to learn, Mr. unscientific.
Cracked pot, meet heavily-worn kettle. At least I’m good for boiling a cup of tea. You’re not competent for even that.
It seems that after all my comment made Richard very nervous. Neither “has” nor Ernst nor you could answer me what are the important contributions of the special “guests” on the blog.I find it more interesting that you try to attack scientists just because you don’t like what they publish. I do not see anywhere in your comment refuting the results of those studies, you only complain that” the differences are very small ” being that the magnitude of the effect of water memory is equivalent to many physical phenomena or drugs such as aspirin, antidepressants and other antidrugs (AINES).
I think, however, that the ridiculous thing is that you mention that none of those publications “lack of empirical basis” and were “not peer-reviewed” but you only chose three articles in Homeopathy Journal that, you should know yourself, are peer-reviewed. By the way, one of those articles, that of Marc Henry, is an independent replication of Louis Demangeat’s results. Coherent domains have a lot of empirical basis in other conventional physics journals, it is one of the most promising models of water dynamics and is soon aiming to be mainstream.
Some of your questions are answered in the articles about “bonkers”. Try to draw attention by shouting that what you do not like is “tooth fairy science” is just a distraction and an ad hominem, quite useless.
We don’t need to provide you any peer review papers, because it isn’t our claim that’s being tested. You have been asked, repeatedly, to provide the evidence to back your assertions. Your response, every time, has been to play your Argument from Authority and Ad Hominem cards, as if the fact that homeoquacks publish peer-reviewed  papers and we do not inherently makes them Right and us wrong. Yet in doing so, you generate all the evidence we need to conclude your own arguments have no substance: if you had real evidence you would throw that in our faces and gloat as you watch us eat humble pie. Even by homeopaths’ own standards you are extraordinarily useless. And your own inability to see that you are hindering, not helping, yourself is your problem, not ours. We can play this game all day: baiting you into presenting your empty ass to the world, till everyone is laughing at you, not with you. Sorry-not-sorry-at-all.
What you are doing here is demonstrating is the power of Just-so Stories from Authority Figures to convince innocents and fools that just because they Say it, that makes it True. This is something for which I believe K12 education (never mind religion, advertising, and other self-serving institutions) has a great deal to answer for, for wrongly impressing on kids that “learning” is the process of memorizing stated facts recited to them by an authority figure, and regurgitating those facts faithfully on demand (exams, TV quiz shows, etc).
Which could go a long way to explaining the current state of the world, full as it is of people that believe that he who speaks loudest and most confidently is therefore Right, while she who cautiously couches every statement in caveats and uncertainty is weak and unconvincing.
Yet one of these is recognizably the behavior of science and the other the behavior of religion. And one does not need to be a published author in Nature to determine which is which: just a willingness to learn for oneself (which includes learning how to be wrong, admit that you’re wrong, and work to become less wrong over time). Plus a little bit of book smarts so you don’t have to reconstruct the entirety of human knowledge and insight completely from scratch within your own lifetime.
As someone who is not a K12 teacher but whose personal path and professional career have both criss-crossed education over the decades, learning—and learning how we learn—is a topic of great interest to me. Just as medicine is an abiding interest, coming from a semi-medical family and having tried and failed to learn medicine myself. And understanding the ways in which we human beings deceive ourselves, both unintentionally and deliberately, whether vanity or desperation; hoo-boy, I could write an autobiography of that.
Perhaps in a different life I could’ve been a pretty good physicist, and a published one at that. And bringing all that acquired scientific knowledge and generated insight to my dissections of your homeocrap would make not one jot off difference, because you would simply choose another way to weasel out from under my august and authoritative criticisms (e.g. Argument from Popularity).
Which is why I am not here to dissect homeopathy nearly as much as I am to dissect you. Because as a lifetime student of the human condition, I find it both fascinating and hilarious/appalling in equal measure, the way that humans like me and you lie to ourselves. And when you cross that line, from deceiving yourself to lying to (and endangering) others, from victim to abuser yourself, I am already there, for the blood sport as much as the hope my ignorant, fallible, amateur insight might do a little good as well.
So: Evidence or GTFO, you tiny blustering cockwomble. I won’t ask nicely again.
 Bear in mind that homeopaths’ peers are, by definition, also homeopaths. The likelihood of them finding scientific fault with the paper is, well, homeopathic. As folks here can tell you, a peer review process is only as good as the peer reviewers themselves. If reviewers make no effort to tear the paper apart (i.e. they have no interest in disproving it) then they are of no more use than a rubber stamp. This is a known problem in real scientific publishing, never mind AltMed’s circle jerk of confirmation bias. Another reason we are unimpressed by your cries of “we have peer-reviewed papers” (which you refuse to link so we can check if their peer review was any good at all).
Given your serious bout of commentary diarrhoea, I’d rather say that you are the nervous one …
No, your comment did not make me nervous. It just made me realize that homeopaths are even more short-sighted and scientifically incompetent that I already knew them to be.
Please allow me to correct you: the Homeopathy journal is not a scientific peer-reviewed journal. Yes, it is peer-reviewed in that deluded fools ostensibly read the work of other deluded fools, although I am not quite sure why – as even the most far-fetched pseudoscientific nonsense and outright lies are approved for publication. I wouldn’t even be surprised if a lot of the published ‘research’ was simply made up from A to Z in order to promote homeopathy.
But even if Homeopathy were a respectable journal, there is a bit of a problem: the research into the phenomena we are talking about (water memory, water nanostructures and quantum effects in water) has nothing whatsoever to do with homeopathy or medicine. They deal with things that lie firmly inside the realm of chemistry and physics. So these remarkable findings should not be published in a pseudoscientific rag such as Homeopathy, but in respectable journals that deal with physics and chemistry. There are over 200 real scientific peer-reviewed journals on physics alone – but to my knowledge, NONE of those ever published any work from those homeopathic ‘researchers’. Why do you think that is?
Anyway, this point of yours is moot for another reason altogether. From my text:
“But for the sake of the argument, let’s assume that these findings with regard to water memory are real …”
This is followed by the key point in my article: that proof of ‘water memory’ does not say anything about homeopathy, because it does not address any essential questions about homeopathy.
Homeopaths are just hell-bent on proving the existence of water memory because without this memory, even they know that they have to concede that homeopathy is nonsense.
In other words: water memory is just an essential prerequisite for homeopathy to work, but it does not in and of itself prove the viability of homeopathy in any way. Just like movement of electrical charge is an essential prerequisite for neural systems to work – but it does not in any way prove the existence of functional brains.
So even if this ‘water memory’ is indeed found to exist, with publications in major peer-reviewed scientific journals, then this STILL is not proof for the viability of homeopathy AT ALL.
Any viability of homeopathy is proven by repeatedly showing that it has significant and consistent therapeutic effects beyond placebo. So far, this condition has not been met, which means that homeopathy must be considered to be a fictional, non-functional system of medicine. And any research into mechanisms behind homeopathy is therefore Tooth Fairy Science.
Del Guidice’s theory was published in a physics journal, specifically in Physics Review Letters, one of the best known mainstream physics journals. I suppose that if I am a “pseudo-expert” as RPG says, you will have no problem understanding the paper published by italian scientist.
Indeed it was published in Physics Review Letters.
Plenty of time for his work to be duplicated and verified by others and for its impact to be felt by science.
Hasn’t happened, has it?
Anyway. What about evidence of efficacy which you seem unable to provide for some reason? Are you going to carry on with your demonstrations of cranks describing how they count angels on pinheads?
Are you actually so naive to think that you are the first pseudo-expert to post long disproven pro-homeopathy arguments on this blog?
Do you actually think that you have defeated anyone with these arguments?
You are a true court jester.
In 2002 “A systematic review of systematic reviews of homeopathy”
“The recent observation of solute clusters in highly diluted water has been interpreted by several homeopaths as increasing the plausibility of homeopathy . This novel finding requires independent replication. Furthermore, this observation (if confirmed) does not lend itself to explaining how solute clusters could have any effects on human health. Thus both the clinical evidence and the basic research underpinning homeopathy remain unconvincing.”
How can you say that the basic research “isn’t convincing” if you just quote an article? Edzard, are you a physicist and did you evaluate the evidence? If you’re not, do you have any expertise in physics or at least in engineering with experience that would allow you to make those kind of conclusions?
“Conflict of interest: The author is a trained homeopath; he has no financial interests in this area”
In 2012 “A critique of the Swiss report Homeopathy in Healthcare”
“The authors stated that ‘nobody involved in the compilation had any financial or other conflicts of interest’. But this is demonstrably incorrect. Being homeopaths themselves, they clearly had a strong interest in producing a report that might motivate the Swiss government to rule that homeopathy will in future be covered by the Swiss health insurance system”
Edzard should be able to explain how in one article he says be “trained homeopath without conflict of interests” and in another accuses the authors of a report of “being homeopaths with conflict of interests”.
The Swiss study? You’re welcome.
Heck, you can prove anything “true” just by never ever attempting to disprove it. But then all you’ve got is a Religious Truth, not a scientific one. And this is not a religious forum, so best of luck trying to impress us with that. So go play with yourself in the corner, and when you’ve finished your business we’ll still be over here kicking the tyres as always.
Do you pretend that content that fits on a page in length full of opinion comments disproves a report of more than 200 pages? Are you kidding?
“disproves a report of more than 200 pages”
Aaaand, that’s Appeal to Bulk. (Effectively, Appeal to Authority meets Firehosing. Or “Never mind the quality; just feel the width!”)
But if those 200 pages are in fact wrong, and a single sentence just happens to capture that wrongness with remarkable concision, then why would you argue that their verbosity should nevertheless outweigh its merit?
Unless accuracy isn’t what you really care about.
As it happens, my comment links to a far more detailed and useful dissection of your “Swiss report”. So you could, if you wanted, peruse the arguments made there and then engage with the most salient here. Debunking one or two would be sufficient. But if you’d rather just keep on blowing your farts in our faces while telling us all about the mighty storm wind that now pins us to the ground…
LOL. “Wind” indeed. (And that’s no small insult coming from me!)
Rasker, give me the list of conventional drugs that have an effect “without a doubt”, I do not want your interpretation, quote the text of the Cochrane reviews with those exact words. If you can’t do it, your claim doesn’t make sense.
@Ocean: “Rasker, give me the list of conventional drugs that have an effect “without a doubt””
Okay. Pay us.
Do you want us to prepare you a curated list of all conventional drugs (of which there are more than 10,000) for which there is evidence of efficacy beyond placebo? That’s probably a million man-hours of work, tracking down, assessing, and collating the research (including seeking and obtaining expert advice), plus the capex for setting up and maintaining the database to hold those results. Let’s say $50M, 100% payable up-front and no refund if dissatisfied at the result, because we trust you as far as we can throw you.
Or, if you are happy to take a list only of drugs that have had a Cochrane review, that should cut the workload down a fair bit; in which case we’ll do the whole job for $2M and a bargain at that price.
Or, you know, you could just go onto the damn Cochrane site yourself and read through the reviews database they already generously provide, and we won’t even charge you a plugged nickel for that.
But, look, if you choose to play stupid games with us, okay then: you get to win stupid prizes. You want us to invest hundreds or thousands of hours of our own personal time, running ourselves ragged like blue-arsed flies studiously collecting and compiling a vast trove of curated information that we already know you don’t want or need. And your only reason for demanding it is so that when we (quite sensibly) say “no, we are not going to do all that for you”, you can cry and point and declare: “Hah! That proves it! You don’t have any evidence yourself!” From which you can merrily extrapolate whatever assertions you wish, from “ALL of your arguments are therefore worthless” to “None of that evidence even exists!” You must think us completely stupid, or yourself incredibly original. Or both. LOL.
So (with apologies in advance to our gracious host): F**k You, Pay Us!
Pay us the money to fund it, and we’ll happily hire a bunch of starving pharmacology postgrads to do the job right and provide you precisely the answer you asked for (instead of the answer you patently want).
Alternatively, you may now limit your ridiculous request to something realistic which can be reasonably completed within an hour by anyone here at no extra charge, e.g. provide a representative sample of 2–3 Cochrane reviews that find good evidence for efficacy beyond placebo. (Thereby proving: 1. We know how to find it, and 2. The evidence exists.) And then, should a productive conversation follow from that, we can see where it goes. But we are not holding our breath.
(Oh, and don’t think we overlooked your sly “without a doubt” either. It’s an embarrassingly predictable tell when everyone who knows anything about science knows that there’s no such thing as “correct without doubt”, only degrees of confidence as to whether its arrived-at answer is not-wrong; and even that is only provisional unless and until new and better evidence comes along to contradict it, and so on.)
But honestly, we’re most disappoint in your efforts to date. A more vigorous crank would’ve at least had the big paper balls to complement his carefully-contrived-to-be-unwinnable challenge with the bold offer to pay us $10,000 should we succeed, for what that’s worth.
3/10 for endurance; -1/10 for creativity; -∞/10 for not-faceplanting-in-your-own-silly-traps. Learn to troll better, you amateur. We weren’t all born yesterday, unlike some.
None of that answers what I asked, what are the Cochrane reviews that say that conventional drugs have “proven efficacy beyond all doubt”?
“None of that answers what I asked”
No, and nor was it meant to. What I have told you is what it will cost you to obtain the answer you asked for. I have also explained why your “beyond all doubt” is an absolute nonsense.
Look, we both already know that your question was carefully contrived to be impractical/impossible to answer. It is a classic crank tactic; part of the JAQ-off school of [sic] thought. Even by homeopath standards you can’t do sophistry for crap.
So you can stop being a prick, pay us, or piss off.
You are welcome to replace your lousy bait trap with a reasonable question that is not beyond-onerous for folks here to respond to. And they might even do so, although you’ve tried their patience well beyond manners.
Or you can continue with your ridiculous hollow posturing: just Don Quixote’s underpants atop a white horse, without even the noble knight himself present. But we’ve all had our fill of playing windmills, so unless you’ve got some other game we’ve not yet tried then we are bored now.
See the list of General Anaesthetics on Wikipedia.
What do conventional drugs have to do with this? I’m talking about homeopathic products, none of which have been found to do anything beyond placebo.
Even if all conventional medicines turned out to be ineffective, then that still would not change the fact that homeopathic ‘remedies’ don’t work.
Ah, the ‘argument by semantics’: if you can’t prove your point by producing factual information, make silly demands about the actual wording instead of the meaning of the words.
I have a better idea: YOU come up with a Cochrane review that actually names even ONE (just one) homeopathic product with a proven efficacy beyond placebo.
YOU claim that homeopathy works, so YOU have to come up with evidence to that effect. I already showed (and repeatedly, at that) that any earlier arguments you contributed were not valid, or did not prove your claim. So I think it is your turn to name homeopathic ‘remedies’ that actually work, and provide peer-reviewed scientific evidence to support this. So far, you have produced nothing of the kind.
Please Rasker, you have said that homeopathic medicines are ineffective because no Cochrane concludes that they “have efficacy beyond all doubt.” It should be the same for conventional drugs, why don’t you show me where Cochrane reviews use the term “efficacy beyond doubt”?
No, I did not say that. Amazing how you get things wrong, especially given the fact that the real quote stands out considerably for being in bold text:
“even after 227 years, homeopaths have not succeeded in coming up with even ONE ‘remedy’ that is efficacious beyond a shadow of a doubt. NOT ONE.”
These were my exact words, and as you can see, I don’t mention Cochrane at all. It is a claim that I personally make, in plain English. You were the one who demanded that I come up with Cochrane reviews with these exact words.
And my claim is true: no homeopath has ever come up with a homeopathic preparation that has shown significant therapeutic effects in high-quality clinical trials.
Should you insist on referring to Cochrane: there are several Cochrane reviews of homeopathic products, none of which were found to be efficacious. And of course our gracious host published Cochrane’s conclusions as well.
Homeopaths should of course be able to easily disprove my claim, simply by naming one homeopathic product that actually shows therapeutic efficacy in scientifically sound trials. After all, they claim that they see homeopathy working wonders every day. Which makes it all the stranger that they don’t come up with any evidence whatsoever, as that would give an enormous boost to homeopathy’s popularity, and result in fame and fortune for homeopaths (and no doubt Nobel Prizes as well).
But these miracle workers are of course far too modest and too busy saving people from illness and suffering to be bothered by such trivialities such as fame, fortune, Nobel prizes and worldwide recognition … and evidence. Because they just know that they are right.
Here’s a thing, Ocean.
What about Propofol? It’s a general anaesthetic agent. I doubt you’ll find any triple blind placebo controlled trials of it on Cochrane because – well – would you fancy a placebo GA?
How do we know it works, then?
Because it self-evidently f*****g does.
Like many other drugs and surgical procedures.
And NOT like ANY homeopathic nostrums.
Your powers of logic and argument are sadly lacking, Ocean. How many times are you going to get your arse handed to you on a plate here? You’ve nothing to back up your fabulistic claims and have to rely on hanwaving and whataboutery.
Propofol—like, say, the rabies vaccine—doesn’t require randomized controlled double-blinded testing to determine its efficacy because its effect size is so humungous that it totally overwhelms all random noise. The patient is either conscious (can be safely operated on) or unconscious (will scream in pain); either lives (if vaccinated soon enough after infection) or dies (otherwise inevitable as rabies is 100% fatal once symptoms appear). Animal trials as successful precursor, a small sample size (possibly observational), unblinded, with a historical control will be sufficient to detect the signal; indeed it would be utterly unethical to run such a human “gold standard” trial in that situation. There will still be other tests performed, of course, e.g. to determine safe therapeutic window, and to compare against other treatments already in use (no sense replacing an existing treatment unless the new one is more effective; or equally effective at lower cost/fewer side effects/some other significant advantage).
Those drugs and conditions will be a minority though, and it’s far more common for a promising drug to have a less dramatic effect that is far harder to distinguish an effect from significant variations in the severity and progress of the disease and the body’s own attempts to heal itself, without compensating for all that noise first. Hence the need for large, properly randomized, properly blinded human trials to sift genuine (i.e. statistically significant) signal, if any, out of that random crud.
Conversely, there are plenty of accepted surgical procedures developed over the years, as products of surgeons’ personal experiences, that prove to be less than stellar when put to statistical test. (Something Dr JMK, DC, and me recently pondered on in another thread.) Again, impossible to do randomized controlled double-blinded human trials for those; or even get close without committing gross crimes against humanity. But there are still good, if somewhat less powerful, tools that can yield valid analyses when “gold standard” trials are impractical.
However, the ultimate goal and overall operation of all these scientific tools is always the same: to detect if a treatment is effective not by confirming what’s already hoped for/believed (“it works”), but by doing their damndest to prove that the treatment doesn’t work, finally conceding that it may indeed work after all only if and after they have completely failed to succeed at that. That is a distinction which @Ocean and fellow True Believers will never understand, because they cannot think outwith the bounds of Religion—for if they could, they probably wouldn’t remain True Believers for long. Luke 4:12 is there for a reason, y’all.
Rounding off with something a bit more topical than fairy giblets: while we’re waiting for Pfizer to publish the full paper, their PR dept is already kicking into gear, announcing they halted their phase 3 trial early as the hoped-for effect proved to be dramatic enough that they detected it in the incoming data while the trial was still running (at which point it would be unethical to continue observing the untreated placebo arm; memories of Tuskegee, obviously). So: yay science. You go, gal.
So as with all things in medicine, “It’s a bit more complicated than that” when you get into all the endless details and working to understand why things get done in the way they get done, and not some other way instead. And some of that is science, and some of that is not, and @Ocean and friends will never get any of that either, because they can’t handle Complicated and Uncertain, any better than they can handle the math of counting past One. And that is why we laugh at them too, the mentally self-stunting little unremarkable cowards.
Cochrane Review: “We found very low quality evidence for the effects of propofol and the other drugs used for sedating people in the ED in terms of complications (side effects, including pain at the injection site) and participant satisfaction.”
I do not see you interested in removing the propofol, you could start with hormone therapies for transgender people who do not have quality evidence, paracetamol and some vaccines such as seasonal influenza, antidepressant drugs, AINES, mucolytics with small size effects.
“IN TERMS OF COMPLICATIONS”
No mention of efficacy. Because the fact that it works is so overwhelmingly self-evident.
You really are an idiot.
@Ocean: Exactly what Richard said. Perhaps if you’d bolded “in terms of complications” instead?
Dear Dog, man, give it up already. Even Roger can mount better arguments than you—and he’s a certified Idiot. The only thing you mount is your own leg!
With regard to @Ocean. Or other fans of homeopathy:
“Never play chess with a pigeon.
The pigeon just knocks all the pieces over.
Then shits all over the board.
Then struts around like it won.”
Who’s playing? M’sharpening my teeth.
Del Guidice’s theory has been disproved in: Martin Bier en David Pravica: Limits of quantum coherent domains in liquid water. Acta Physica Polonica B 2018; 49:1717–1731.