Homeopathy and the Limits of Science

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My last posting, asking whether the National Center for Complementary and Alternative Medicine should be shuttered, has generated some interesting comments. The most interesting was provided by reader Alexandria Kung, who suggested that any movement to banish NCCAM constitutes medical ethnocentrism (see the fifth comment here). Her idea is that westernized medicine is not the only way to heal people, and that we need something like NCCAM to investigate healing approaches from other cultures and traditions. We have more common ground than might be expected.

In my response, I would like to be clear that I strongly believe a proposition that I’ve learned is viewed skeptically by many in the complementary medicine community: science is not just another religion.

That is, the results of science cannot be viewed with the same relativism that would be appropriate when considering, say, different moral attitudes about wasting water in desert versus temperate cultures. Science is a method of inquiry for obtaining understanding about natural phenomena. We demand certain things to be true for it to be subject for scientific study, such as that a process or experiment is repeatable and subject to carefully controlled interventions (though there are special exceptions, such as studying the Big Bang). Its purview, in the grand scope of all of human experience, is narrow; what it knows with confidence is far, far narrower.

If we can agree that medicine is about making people feel better, we can further agree that the line between distress due to psychogenic factors (such as having a stressful family or work life) and distress due to an organic pathology is quite murky. But, it is clear that there’s a few organic pathologies, such as infections, or leaky heart valves, where years of scientific effort have led to ways to dealing with those organic pathologies which leaves a person feeling better for a long time. That’s not to say that the track record of science/evidence-based medicine is stellar across the board – far from it. Look at “Overdosed in America” by John Abramson for counterexamples.

But for those kind of interventions where the evidence is clear, I cannot see any room for a “medical ethnocentrism” argument. I would claim that no matter what part of the globe or culture you are in, if your child is dying of an infection, or of a leaky heart valve that can be corrected by surgical intervention, then you would do whatever you could to get the antibiotic or surgery for your child. And, you should. Similarly, I think that female genital mutilation is wrong, and I don’t think that this view is western ethnocentrism. Let’s agree that the bulk of cultural practices are things science has nothing to say about, nor should it. But with respect to certain organic pathologies or physical interventions, there are clear guides to action that transcend cultural boundaries.

Now, people go to doctors for a lot of reasons. Only some fraction of them are things that are either treatable or need treatment (as opposed to simply letting the body heal itself). Be that as it may, and given that some of these will be psychogenic in nature, clearly not all such people are in need of a pill or a surgical intervention. For these, I do think that there is a role for healers of all kinds of culturally-contingent stripes, from witch doctors to faith healers. Whether they also dole out what are placebos or not is irrelevant. Placebos, in the hand of someone you trust, are effective facilitators of the body’s own natural healing processes, since they give you a psychological boost, and probably reduce your cortisol levels and improve physiological functioning in all sorts of ways. For a thought provoking discussion of how a rational person should pick the right placebo purveyor, see the last bit of the Snake Oil Science book I recommended in my last posting. But such a healer, in a country where options exist, would be rightly accused of criminal negligence if they provided their treatment to someone dying of an infection or desperately needing surgery.

I’m against NCCAM spending money on the scientific basis of homeopathy, because the combination of the meta-analyses done so far plus the lack of any credible mechanism means that there is no scientific basis to homeopathy. I think it has come time to make the call, in terms of science, and move on. While I’m against spending funds on the scientific basis of homeopathy, I am certainly for continued research on alternative medicine (just not, as I stated at the end of my last posting, under the aegis of NCCAM, unless it is reformed). There are other once-alternative approaches, such as the use of willow bark starting in 400 BC, which have been found to have a scientific basis, and I’m sure there are more out there which will be found to have a scientific basis.

But most importantly, perhaps, I think that our finding no scientific basis to homeopathy does not have the implications that many who find this approach helpful may fear, and here is precisely where I have some agreement with the “medical ethnocentrism” argument. One of those fears may be that, in a culture which holds science to such high esteem, anything that is found to not have a scientific basis might be outlawed. This is clearly a decision that is beyond the power of science to make. We do many things, and specifically, many things that make us feel better, without scientific basis. I can’t imagine a world otherwise, but Aldous Huxley did a reasonable job of trying in his “Brave New World.”

So long as people want the service of them, homeopaths will continue to exist. Likewise with marriage counselors or yoga instructors or dietitians. I don’t expect to find a scientific study that proves the efficacy of marriage counselors or yoga instructors or dietitians any time soon. I don’t think I need one to decide whether to seek their services. Homeopaths, like marriage counselors and yoga instructors, and hugs from someone you love, make a lot of people feel better, and that’s a good thing.

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Comments

Dana, I suspect that Malcolm is already aware of these papers, because you pasted the same list into your response to his post about NCCAM last month. I also suspect that you are aware of the criticisms that have been made of the papers you cite. Just to keep you up to date, here is a recently published (Homeopathy, Volume 98, Issue 2, April 2009, Pages 127-128) comment on the Rutten & Stolper paper, and here is a comment on the authors' response.

Homeopathy may not be yet proven effective for "everything" (as some meta-analyses have tried to determine), but you seem unaware of the meta-analyses that have shown efficacy...and other reviews that have also shown efficacy. Further, you seem unaware of others reviews of the 2005 Lancet meta-analysis that was highly controversial and of questionable rigor:

-- K. Linde, N. Clausius, G. Ramirez, et al., "Are the Clinical Effects of Homoeopathy Placebo Effects? A Meta-analysis of Placebo-Controlled Trials," Lancet, September 20, 1997, 350:834-843. Even critics have called this meta-analysis "completely state of the art." It reviews 186 studies, 89 of which fit pre-defined criteria for its meta-analysis. Homeopathic medicines had a 2.45 times greater effect than placebo.

-- J. Kleijnen, P. Knipschild, G. ter Riet, "Clinical Trials of Homoeopathy," British Medical Journal, February 9, 1991, 302:316-323. This is the best objective meta-analysis of clinical research prior to 1991. This meta-analysis reviewed 107 studies, 81 of which showed efficacy of homeopathic medicines. Of the best 22 studies, 15 showed efficacy.

Responses to the “junk science” review of research published in the Lancet (2005) by Shang, Eggers, et al.:

-- Lüdtke R, Rutten ALB. The conclusions on the effectiveness of homeopathy highly depend on the set of analysed trials. Journal of Clinical Epidemiology. 61, 12:1197-1204. doi: 10.1016/j.jclinepi.2008.06/015.

-- Rutten ALB, Stolper CF, The 2005 meta-analysis of homeopathy: the importance of post-publication data. Homeopathy. 2008, 97:169-177. doi:10.1016/j.homp.2008.09/008 (These two reviews and re-analyses of the Shang data threw into doubt the narrow analysis of Shang and team.)

-- WB Jonas, TJ Kaptchuk, K Linde, A Critical Overview of Homeopathy, Annals in Internal Medicine, March 4, 2003:138:393-399. Although this is not a meta-analysis, it is still a very good review of the clinical literature in homeopathy.

-- Vickers AJ. Homoeopathic Oscillococcinum for preventing and treating influenza and influenza-like syndromes. Cochrane Reviews. 2007. http://www.medscape.com/viewarticle/485935. Four treatment trials (N=1,194) found “promising” results from Oscillococcinum in the treatment of influenza or influenza-like syndrome. Three prevention trials (N=2,265) did not find efficacy of Oscillococcinum in the prevention of these conditions. Because Oscillococcinum is made from the liver & heart of a duck and because ducks are reservoirs of flu viruses, this drug make sense, biologically. It has been used in homeopathy since the 1920s and thus verifies that homeopaths have been knowledgeable of avian sources of flu virus for a long time.

-- J. Jacobs, WB Jonas, M Jimenez-Perez, D Crothers, Homeopathy for Childhood Diarrhea: Combined Results and Meta-analysis from Three Randomized, Controlled Clinical Trials, Pediatr Infect Dis J, 2003;22:229-34. This meta-analysis of 242 children showed a highly significant result in the duration of childhood diarrhea (P=0.008).

-- Frass, M, Dielacher, C, Linkesch, M, Endler, C, Muchitsch, I, Schuster, E, Kaye, A. Influence of potassium dichromate on tracheal secretions in critically ill patients, Chest, March, 2005;127:936-941. This is an impressive study was conducted at the University of Vienna and published in the leading respiratory medicine journal...with substantially significant results in the homeopathic treatment of people with chronic obstructive pulmonary disease (COPD is the #4 reason that people in the USA die). The medicine used in this trial was Kali bichromicum 30C. At present, two different universities are conducted trials to replicate this important study.

-- Bell IR, Lewis II DA, Brooks AJ, et al. Improved clinical status in fibromyalgia patients treated with individualized homeopathic remedies versus placebo, Rheumatology. 2004:1111-5. Participants in active treatment showed significantly greater improvements in tender poit count and tender point pain, quality of life, global health and a trend toward less depression compared with those on placebo. “Helpfulness from treatment” in homeopathic patients was very significant (P=.004). People on homeopathic treatment also experienced changes in EEG readings. The evidence of clinical benefits coupled with the objective evidence of EEG readings combine to verify a therapeutic effect from a physiologically active medicine.

Alternative medicine is the way of the future. More people are seeking Homeopathic/Alternative care to conventional medicine on an everyday basis. People are begining to see medicine as just give me a pill and go away. Doctors are not looking for the cause of the problem just what is the pill that will cover up the condition. Which in turn will cause more symptoms.

We have been in the business of homeopathic/Alternative care for quite some time. I have studied what modern science currently does, but if you look over the last hundred years at how many "fixes" have been recalled and somehting new comes out. The current medicine is just a temporary fix until a newer version comes out. The products we sell, like a Neti Pot will always be around. Because they have proven successful for centries, not just for a 9 month FDA test.

I think the writer has not spent enough time to read the phylosophy of homeopathy- The organon art of healing
(http://www.homeopathyhome.com/reference/organon/organon.html), along with the book The chronic dieases by Dr Samuel Hahnemann (http://archive.org/stream/chronicdisease00hahn#page/n7/mode/2up).
Reading those books would have changed much the authors opinion about Homeopathy completely. Not only it contributed much and healed many people, it also helped on preventing some serious illnesses. where do you think Louis Pasteur has taken the idea of rabbies vaccine? He was inspired by the Homeopathic remedy made from rabid dog saliva.
The Chronic Diseases puts some light on the "smart" methods so called Medical doctors did in order to save people lives. It ended up by making them killed. Not on purpose off course, but that was the result.
Now, Swiss goverment have checked and declared that Homeopathy is indeed valuable and most patients feel much better and get cured due to homeopathic treatment.
check it out here (i did not put on purpose Dana Ullmans' report for suspecting me as one of his supporters) http://www.naturalnews.com/035714_homeopathy_Switzerland_health_care.html
So.... now we have to deal with facts! what can you say about Homeopathy? is it Placebo- sure not- babies, animals and people in coma, respond to Homeopathic remedies. I can mention many more reasons, including some people i have seen taking Homeopathic remedies which changed their lives.
My question is - can you answer this?
I do not really expect you to....

We do accept that homeopathy

We do accept that homeopathy cannot treat every disease that exists, but same is the case with other medicines too. Further, treatment with homeopathic medicines is long lasting and without any side effects. The point here I want to make is that a coin always has 2 sides. Its not so that the reach of this branch is low so its not effective, homeopathy can work miracles in some cases where the allopathy cannot work. I believe that homeopathic treatment will surely reach out to billions across the globe.

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