Letters in Guardian about the Placebo piece

August 31st, 2005 by Ben Goldacre in alternative medicine, bad science, homeopathy, letters, placebo, quantum physics, very basic science | 58 Comments »

Letters: Observing the benefits of placebos
Wednesday August 31, 2005
The Guardian

Ben Goldacre’s thought-provoking piece (A tonic for sceptics, August 29) moves forward the debate about homeopathy and complementary and alternative medicine (CAM). The argument is no longer about whether homeopathy works, but how it works. He is absolutely right, therefore, to single out the placebo effect as “the most interesting phenomenon in medicine”, and that it goes into the cultural meaning of treatment. But it’s a pity he stopped there, for the whole of western science is also culturally defined. For homeopathy, this raises two issues – one theoretical, the other practical.

Article continues
First, the observation problem. Physics teaches us that reality and our observation of it cannot be separated. The corollary – that any attempt at such separation can essentially destroy the “reality” under observation – is precisely what is perpetrated during blinded trials of homeopathy. Consequently, the double blind placebo-controlled trial, as applied to homeopathy and CAM, is the scientific equivalent of Nelson putting a telescope to his blind eye.

Second, if Goldacre believes “that in many cases, homeopathy does seem to help, as a complex intervention” albeit one that is “placebo, in all its rich glory” then there is no further need for debate. However homeopathy is deemed to “work”, it should be available alongside conventional medicine, where apart from its therapeutic benefits, its non-toxic and economic advantages would be appreciated.
Lionel Milgrom
London

Why is it that only the negative research results about homeopathy get the headlines? Take, for instance, the research done at the Institute for Pharmacy at the University of Leipzig: using concentrations of belladonna which were literally less than a drop in the ocean, statistically significant changes in the contractions of the gut of rats were measured consistently and repeatedly. The study used double-blind techniques designed to detect the placebo effect. It compared results obtained by following precisely the special stirring techniques used in homeopathy, or by ignoring them, and found a positive correlation in favour homeopathy.
Kevin Mannerings
Pforzheim, Germany


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58 Responses



  1. JK said,

    September 1, 2005 at 3:27 pm

    Lionel: You are making the Classical* mistake of apply a theory about quantum mechanics to teh everyday world. Even if you were correct, why do CAM-artists think they can have it both ways – science isn’t something you can cherry-pick for credibility. And even if homoeopathy is an effective way of delivering placebo, why should we pay thorugh the nose for a pile of mumbo-jumbo? I already pay for the NHS, I’ll get my placebos from a GP thanks.

    Kevin: Peer-reviewed citation?

    *I just crack myself up sometimes.

  2. John A said,

    September 1, 2005 at 3:33 pm

    > However homeopathy is deemed to “work”, it should be available…
    From the lack of evidence, homeopathy doesn’t appear to “work” any more than flapping your arms on a plane “works”.

    > The study used double-blind techniques designed to detect the placebo effect
    Considering it is an experiment on a rat gut in a dish, the idea of “double-blinding” does seem a little bit nonsensical. Similarly the idea that they may be a placebo effect does seem to be a little strange.

    I couldn’t find the rat experiment described above on pubmed but after a bit of a hunt I found this book chapter:
    Cristea A, Nicula S, Darie V. Pharmacodynamic effects of very high dilutions of belladonna on the isolated
    rat duodenum. In: Bastide M(ed), Signals and Images. Kluwer Academic Publishers 1997:161-170.
    And this webpage:
    www.entretiens-internationaux.mc/cristun.htm

    Which seems to match except that they are a Romanian group . However apparently a group in Leibzig has used a similar method involving a different preparation. There is no mention of blinding so I can only assume that the experimenters knew which preparation they applying at the time.

    From a quick look, it is not clear exactly what their method was and so it is impossible to rule out various systematic errors. For example, the experiment involves using a highly concentrated drug that has a strong effect. Their procedure may be to apply this drug to the gut in a dish, wash it out, test the homeopathic prep, wash it out and then test the non-homeopathic prep. If the washing out process is not perfect then the significant effect of the homeopathic solution may be due to a higher leftover concentration of this drug.

    Not the best “for instance” in defence of homeopathy…

  3. Ben Goldacre said,

    September 1, 2005 at 3:50 pm

    Nice. I think people should be forced to speak with footnotes and full references in a standard citation format during all forms of social interaction.

    Also, can I just say, I completely plan to steal your excellent “flapping your arms on a plane” metaphor for misattributions of efficacy in regression to the mean and placebo.

  4. BSM said,

    September 1, 2005 at 3:57 pm

    I have looked at the rat paper in some detail.

    1. Measuring “tone” in isolated bowel segments is a notoriously difficult model to use.

    2. The authors engaged in a data dredge, performing multiple statistical tests without regard to the overall p-value that they should achieve for statistical significance. Having obtained these results as a preliminary pilot study they should have repeated it definitively with a well-defined hypothesis and a clearly defined protocol to analyse the data.

    3. “During a working day, in the same bath, the low solutions were tested in an increasing order of concentrations and the high dilutions were tested at random.” The authors thereby systematically fail to allow for the effect of the tissue slowly degrading during the experimental period which is a serious confounder of their results.

    4. It is interesting to look at the data as reported. Examine one data point: Belladonna C45 produced a response reported as “+67.60±0.10″ (Mean + sem). With n=8, that means that the standard deviation of the responses was 0.28%. In other words, with 8 samples they all probably lay in the range 67.1-68.1%. While it would be lovely if biological experiments could work so neatly, these are the tolerances that you find in physics and engineering, not biology. I don’t know what was going on in their tissue baths but the least likely way that numbers like this could be produced is by any biological process acting on a tissue sample.

    In a similar vein, you should look at these successive data points.

    [list]
    [*]45______________ +67.60±0.10[*] 55______________ -27.80±0.30[*]75______________ +95.45±1.20[*]80______________ +82.39±0.60[/list]

    (Apologies if this forum does not accept the formatting)

    It is biologically unfeasible for sems to be so small with such large differences between successive dilutions. Now, I have no way of proving what was going on, but just bear in mind that if these data were graphed, the sem error bars would not be visible beyond the thickness of the line used to connect the points. Have a look at any pharmacology paper involving dose-response curves and see whether that ever occurs. It does not.

    5. Does this paper exist in a peer-reviewed form? It seems not.

  5. John A said,

    September 2, 2005 at 2:38 am

    OK I have spent more time reading this now. Seriously really shoddy.

    I think BSM has hit the nail on the head – true the wrong statistical methods are used but even if they used the correct tests they would still have achieved comparable results due to the bafflingly repeatable measurements they have. I would generously guess that they have made some systematic error in the calculation of the reliability of their measurements. Since the experimental protocols are not explained at all clearly and the raw data (and even axis labels) are unavailable it is impossible to to have any confidence in the validity of these results.

    A few points:
    1. Above C9 dilution the mean effect of the non-homeopathic treatment suddenly jumps from apparently amazingly significant to be not significant. In their methods they seem to be implying that the C1-9 and the C10+ dilutions were tested in “different baths” (and therefore perhaps on different days with different rats’ guts).
    2. They don’t comment on the notch in the effect in figure 2. However if their error estimates are correct then this appears significant. Of course if their errors are incorrect then this is just a noisy datapoint…
    3. They appear to have had their solutions prepared “especially for this research” by an external body (the Homeopathic Pharmacy in Bucherest).

    I await their long overdue Nature publication with baited breath.

  6. Dr S said,

    September 5, 2005 at 8:59 pm

    I was hoping The Grauniad would publish this in the letters section but it has not:

    Lionel Milgrom’s invocation of quantum physics (Letters, August 31)
    does not explain homeopathy. His published works misapply quantum
    theory when he claims that quantum entanglement of observer and
    observed explains why homeopathy fails under properly controlled
    conditions. It is well known, though sometimes denied by advocates of
    homeopathy, that the better the quality of clinical trials the less
    likely they are to show a benefit from homeopathic remedies. In other
    words, if you allow the whole rigmarole of a homeopathic consultation
    with individualised prescribing of remedies to proceed, but give some
    patients the ‘real’ remedy and compare their outcomes to others given a
    placebo then the effect of the ‘real’ remedy disappears. This is not
    mysterious.

    A properly parsimonious explanation of homeopathy accepts that
    homeopathic remedies are nothing but water or sugar pills and any true
    power of homeopathy derives from the benefits of a sympathetic listener
    and a nice cup of tea.

    The policy problem for the NHS is how to provide an appropriate service
    of sympathetic listeners, complete with tea-making facilities and a few
    potted plants to decorate the office, without needing to pretend that
    those little white pills have magical powers.

    However, as a veterinary surgeon my concern is that even if the owner
    is happy with the warm reception they get from the therapist and enjoy
    their cup of tea, the animal has still only received water or a sugar
    pill.

    Dr Simon Baker MRCVS

    Please note I’d responded without reading Ben’s original piece because I didn’t buy the paper that day, so the concept of the most parsimonious explanation that he and I advocate is partly coincidence and partly the fact that we are both right!

  7. MostlySunny said,

    September 6, 2005 at 12:09 pm

    I saw an advert for a Homeopathic Vet the other day… also offered Reiki healing as a service…

  8. Alasdair Sutherland said,

    September 8, 2005 at 1:02 pm

    In further reply to MostlySunny’s remark about homeopathic vets, my father who is a vet said that he had come across a “horse healer” who proposed to treat coccygeal pain in horses by trans rectal manipulation. Now, as am orthopaedic surgeon, I am familiar with this approach in humans with coccygeal pain, and it may even work. But is the coccyx in the horse not central to that long swishy thing (vestigial in humans, but useful for dislodging flys in horses and other quadruped mammals) at the back end?

  9. BSM said,

    September 18, 2005 at 6:47 pm

    The Observer, seems not to want exchanges of views to occur via its letters page, so, for what it’s worth is another unpublished letter:

    Original letter:

    observer.guardian.co.uk/letters/story/0,6903,1562384,00.html

    Reply:

    “Ed Skelding’s (Letters,4th September 2005) wholly erroneous assertion that the use of homeopathic remedies by veterinary surgeons like Chris Day demonstrates its efficacy demands correction. Unfortunately I am no longer surprised that the advocates of homeopathy advance such weak evidence as if it is the killer proof of their mystical belief in the power of magic water and sugar pills

    For the record, there has never been even a single report of the use of homeopathy in animals that was not adequately explained by anything other than wishful thinking on the part of the vet or owner, or coincidental recovery on the part of the animal. Only four placebo-controlled trials have ever been done, but homeopathy failed in each of them.

    As a veterinary surgeon I find it an affront to animal welfare that this nonsense is practised upon our patients.”

  10. BSM said,

    September 18, 2005 at 6:48 pm

    “But is the coccyx in the horse not central to that long swishy thing (vestigial in humans, but useful for dislodging flys in horses and other quadruped mammals) at the back end?”

    The woos never let the facts get in the way of a good story.

  11. janey said,

    September 18, 2005 at 10:29 pm

    This Lionel Milgrom is an interesting character. Writes an article about Benveniste in the New Scientist as a science journalist in the 1990s, but also appears in the homeopathy literature.

    I wonder if he makes the same Classical* error as above in these intriguing sounding papers about quantum entanglement explaining how homeopathy works?

    Milgrom LR, Patient-practitioner-remedy (PPR) entanglement. Part 5. Can homeopathic remedy reactions be outcomes of PPR entanglement? Homeopathy, 93:94-98, 2004.

    There’s also this very interesting email correspondence between Milgrom and a doctor following their involvement in a homeopathy experiment which failed to go the way Milgrom hoped.

    www.homeopathic.com/articles/media/2020_milgrom_to_turnbull.php

    * stolen joke from JK

  12. BSM said,

    September 21, 2005 at 5:22 pm

    ” I wonder if he makes the same Classical* error as above in these intriguing sounding papers about quantum entanglement explaining how homeopathy works?”

    He is wrong on many levels. A JREF member took the time to demolish his theory/metaphor/meanderings.

    forums.randi.org/showthread.php?s=&threadid=41223

    (The link may not work properly in a few days because the JREF forum is about to undergo an upgrade. If the link fails, go to JREF and search the forum for a thread with weak quantum in its title.)

  13. Kevin Mannerings said,

    November 7, 2005 at 10:57 am

    Ben Goldacre wrote:

    “Nice. I think people should be forced to speak with footnotes and full references in a standard citation format during all forms of social interaction.

    Also, can I just say, I completely plan to steal your excellent “flapping your arms on a plane” metaphor for misattributions of efficacy in regression to the mean and placebo.”

    Ben, that is a cheap shot. In my original letter, I gave full details of the authors of the research, it was edited out by the Letters Editor of the Guardian newspaper. The polite thing might have been for you to have informed me that you were going to republish my letter in the Bad Science
    website. My letter was written to the Guardian newspaper. I have not given any permission for it to be published elsewhere in an incomplete form, and I would have asked you to publish it in full, not in the incomplete version, as I quite agree with you, anyone referring to scientific research should give adequate details of sources. As you work for the Guardian, it would not have been difficult for you to contact me, I gave them my address, telephone number ( with voicemail box) and e-mail address.

    That would be good manners and good journalism.

    In my original letter, I pointed out that this was award winning research carried out by Franziska Schmidt, Prof. Dr. Karen Nieber and Prof. Dr. Wolfgang Süß from the Institute für Pharmacy, University of Leipzig. That would have given all readers every chance of indentifying correctly exactly what I was writing about. You can read a copy of the university press release here: www.uni-leipzig.de/presse2003/homoeopathie.html.

    The prize was awarded by the Internationale Gesellschaft für Homotoxikologie e.V. and the Internationale Gesellschaft für Biologische Medizin e.V.

    In my letter, I reported the facts as I found them and asked a question which implies journalistic bias. You might like to address that question.
    Good science journalism is not about childish cheap shots, it is about balance, covering both sides of a story in a fair manner, and trying to inform the readers. It means you have to report things you might prefer to ignore. Let me give you an example.

    There has been a powerful and polemic reaction to the reaction to the research done at Leipzig, a formal complaint of professional misconduct has apparently been lodged, which had been published on the internet.

    See the following for details: www.xy44.de/belladonna/.

    There has been a balanced and sensible response to the allegations by Prof Dr Wallach, University of Freiburg here, which gives full details of the allegations and the source of the research:www.psychophysik.com/html/ak03-gwup04.html. I agree with the essence of what Wallach is saying.

    The main allegations are that the “Verblindung” (double bind technique) of the research was not done properly, and that results which did not support the hypothesis were discarded. It is also claimed that it is not possible to create solutions of chemicals with the minute dilutions used in homeopathy, so that the research is a priori pseudo-science. This last allegation strikes me as nonsense, as the whole point of the experiment was to test whether homeopathic medicines have a physical effect. The logical way to do this is to follow the procedures used by the producers of homeopathic medicine.

    It is said that the authors of the critique are retired academics, who are not qualified in the field of pharmacy or medicine. There has been no public response that I can find from Leipzig. some of the original perhaps defamatory remarks made originally by the critics appear to have been withdrawn, so perhaps lawyers are at work in the background.

    now ben, please do let me have a copy of your permission to reproduce my letter in incomplete form from the guardian newspaper. on the general subject of homeopathy, i will get back to you in another post, as the shift key has given up on this pc…. regards, kevin mannerings, pforzheim, germany. kevin.manneringsatvr_web.de

  14. Kevin Mannerings said,

    November 7, 2005 at 3:50 pm

    Towards balanced coverage of the homeopathy controversy in the Guardian newspaper and in the writings of Dr Ben Goldacre.

    On the face of it, the evidence is devastating. A supposedly comprehensive study of medical research done by the Institute for Social and Preventive Medicine (ISPM) in Berne has established that homeopathy is no better than a placebo. The end of homeopathy, crowed the Lancet. You can find full details here: www.dzvhae.com/portal/pics/abschnitte/011005042421_lancet_kopie.pdf?PHPSESSID=1f1256bd26e85eaf6e94ae478ca978a6.

    It is no better than placebo, because it is placebo, in all its rich glory, announced that witty and clever chap, Dr Ben Goldacre, in an article in the Guardian.

    Is there another side to the story? Are those busy out witch hunting those charlatan homeopaths going to tell it to us?

    Yes there is. In Switzerland and Germany, homeopathic doctors are trained and qualified in the normal manner as doctors of medicine.
    In my experience, they are sophisticated scientists, they work in beautiful clean state-of-the-art hospitals, their work is supported by health insurance companies because they cure people in a cost-effective manner. What did they have to say about the ISPM study?

    You can read one reply here.

    www.dzvhae.com/portal/pics/abschnitte/141005102846_homoeopathie_stellungnahme_ispm-studie_righetti_2005-04-21_def_english.pdf?PHPSESSID=1f1256bd26e85eaf6e94ae478ca978a6

    Fortunately, it is translated into English, so the sceptics in here can get their teeth into it. To me, the criticism from the SAHOP is severe. Statistical manipulation, lack of expert knowledge of homeopathy, later covered up by post study inclusion of a former homeopath in the list of authors. The darlings didn’t have any knowledge of what they were talking about. But that doesn’t stop them for a moment. From what Dr Goldacre writes, he has no qualification or practical experience of working in hospitals with doctors who practice homeopathy either.

    Have a look at this one Ben. www.filderklinik.de/index.php?id=1,0,3

    As I’ve been there myself, I can tell you it is a beautiful, peaceful place, and if the NHS has anything like it, I’d like to know.

    You can go there and attend lectures by the doctors. They invite doctors from a conventional background like yourself to work with them and understand what they are doing. You could, if you want to, educate yourself about what you are writing about before you put pen to paper. They are dedicated, highly trained doctors, they understand all about how science works, but they want to go further and investigate the world from their point of view.

    And yes, they do scientific research in the normal manner to prove that their methods are not just the placebo effect in all its glory.

    Check out the Institute for Complementary Medicine (KIKOM) at the University of Berne here. www.cx.unibe.ch/kikom/en/index.htm

    The department was established following a democratic initiative by patients obtained a majority for it in the Canton of Berne in 1992.

    You will just love the subjects they are into, Ben: Traditional Chinese Medicine and Acupuncture, Neural Therapy, Anthroposophical Medicine and Classical Homeopathy.

    I can personally recommend the lectures of Prof Dr Heusser, the expert on Anthroposophical Medicine. They would be a useful antidote to the reductionist materialism you learned at Magdalen College.

    Before you go, you can check out some of their original research, which provides scientific evidence to contradict your view that it is all placebo and nothing more:

    Homeopathic treatment of children with attention deficit hyperactivity disorder: a randomised, double blind, placebo controlled crossover trial
    Heiner Frei1, Regula Everts2, Klaus von Ammon3, Franz Kaufmann2, Daniel Walther2, Shu-Fang Hsu-Schmitz4, Marco Collenberg4, Katharina Fuhrer2, Ralph Hassink5, Maja Steinlin2 and André Thurneysen3
    European Journal of Pediatrics

    Publisher: Springer-Verlag GmbH
    ISSN: 0340-6199 (Paper) 1432-1076 (Online)
    DOI: 10.1007/s00431-005-1735-7
    Issue: Online First

    And when you come back, please write us a nice friendly article on what you found. You are such a bright young chap, I’m sure it will be very interesting.

    Best regards,

    Kevin Mannerings
    Pforzheim, Germany
    Kevin.mannerings@vr-web.de
    Copyright Kevin Mannerings 2005.

  15. Danivon said,

    November 8, 2005 at 2:48 pm

    Can you copyright a letter you send to a newpaper? Can you complain when that letter has been edited by that newspaper, given that most newspapers reserve that right. I’d have thought that writing a letter to a public forum has the benefit that you can get it disseminiated far and wide, so you can’t complain when it had been. As far as I can see, Ben copied the letter as published by the paper, and so Kevin Mannerings’ complaints should be directed to the Guardian.

    Can you copyright a post in a blog, like this last one?

    If so, if you re-use any of the words or characters in the post in any order, I expect you to ask for prior permission and to send me a very large cheque.

  16. Chris said,

    November 8, 2005 at 3:34 pm

    Given that the articles in this blog are syndicated, I can’t see how anyone could claim copyright on a post. It was clear that the post would be sent out to anyone who signs up to the syndication and so that is contradictory.

    I find it a bit odd that Kevin has copyrighted his post anyway – is this to try and prevent others from quoting him in their posts?

  17. Kevin Mannerings said,

    November 8, 2005 at 3:50 pm

    Danivon, thank you for your questions. The letter, as I understand it, becomes the copyright of the newspaper, it can be reproduced with their permission. If the Guardian has given Ben Goldacre permission to reproduce letters sent to them, and put them up for ridicule on his bad science site, then I would like to know. Yes I could complain to the Guardian, but I prefer to ask here, as I would not find it polite to complain about something done by Ben Goldacre to the Guardian without first putting it to him.

    Is it unreasonable to ask to be informed about the republishing of a letter ? Is it unreasonable to be given a timely opportunity to clarify the content? Good journalism and good science imply allowing all participants in a debate a fair and timely opportunity to reply. Ben Goldacre made his comment over two months ago. I found it by chance yesterday. The Guardian reserves the right to edit letters, that is fine, so long as it remains in their newspaper.

    You ask whether a post in a blog can be copyrighted. I just did. Whether I could enforce that copyright is another matter.

    Will be happy to send you a very large cheque, would DIN A4 be big enough, any larger will cost more, charge 200 Euros for autographs to my fans, please transfer the money by paypal asap. Thanks.

  18. Kevin Mannerings said,

    November 8, 2005 at 3:56 pm

    Chris, I haven’t signed up to any syndication or anything else. Anyone who wishes to quote from my post in here may do so, provided they make the source clear.

  19. Ian said,

    November 8, 2005 at 4:05 pm

    Maybe I don’t remember correctly, but I’m pretty sure you *can* quote from something which is copyrighted. You’re allowed ‘fair use’, which I think is a percentage rather than an absolute amount, and you’re supposed to attribute, but otherwise book reviewers would never be able to give examples of prose!

    Am I the only person who is amused that the posts talking about this hospital (Filderklinik?) are spending as much time discussing the decor as the science?

  20. Rafiq said,

    November 8, 2005 at 4:09 pm

    Kevin,

    like any newspaper, the content of the Guardian – which is what your letter is – is widely copied and pasted on blogs all over the internet. Which is an excellent thing for discussion and debate. And if you’re worried about how they edited it why not just post the unedited version here?

  21. Kevin Mannerings said,

    November 9, 2005 at 11:23 am

    Rafiq, you are missing the point. People who write have rights. They can choose where their material is published. When I write a letter to the Guardian, I enter an agreement with them for it to be published in their newspaper, not on Ben Goldacre’s bad science site.

    If the Guardian has given Ben permission to publish the letters, they should tell writers that. If, on the other hand, he is stealing copyright, and holding up material for ridicule: yet another git who talks about science but doesn’t provide references, then it says something about the standards of journalism he adheres to. He can provide a link. Then readers can read the letter in the chosen context.

    The habit of ignoring the rights of individuals is typical of tabloid journalism. It is true there is any amount of copyright theft going on on the web, that does not mean it is legal. Try putting up stolen images of Britney Spears or Madonna in a compromising derogatory context, and you will soon find yourself talking to lawyers, who will explain it all to you.

    Ian, don’t be silly. I spent 7 words desribing the Filderklinik as a beautiful place. If you follow the links, you will find plenty of science on anthroposophic medicine. Why haven’t you commented on the science I posted?

  22. Ian said,

    November 10, 2005 at 3:19 pm

    Perhaps I’m the only one who did not recognise these therapies – I found these two definitions on www.heall.com, a rather interesting US-based site which, I suspect, is commercial rather than academic.

    anthroposophical medicine (anthroposophically-extended medicine, anthroposophical therapeutics): Medical phase of anthroposophy, the occult philosophy of Rudolf Steiner (1861-1925). Anthroposophical medicine, a purported “extension of practical medicine,” encompasses curative eurythmy. According to anthroposophy, the human organism consists of a physical body, a vegetal “etheric” body, an animalistic “astral” or “soul” body, and an “ego” or “spirit.” Anthroposophical “remedies” supposedly smooth the interaction of these components.

    neural therapy: Form of energy medicine (vibrational medicine) akin to acupuncture, developed in Germany circa 1930 by two brothers, Ferdinand and Walter Huneke (also spelled “Huehneke”). The Hunekes, both medical doctors, maintained that injections of local anesthetics into areas of “energy” disturbance (“interference fields”) could relieve pain, immobility, and dysfunction. Injection sites include acupoints, scars, and the sites of old fractures or past infection. Purportedly, neural therapy energizes “short-circuited” cells and helps to regulate “biological energy.” Proponents recommend it for hundreds of health problems.

    I was unable to get anything useful from the Filderklinik site as I am monolingual. I haven’t been impresed by the information I found after a few minutes looking for information on those therapies – perhaps there’s just nothing convincing in English.

    To be honest, I found other people’s rebuttals quite conclusive – and you have not, as far as I can see, answered their comments and arguments about the experiments done on rat intestine. Maybe I missed it.

    I was commenting on the other issues – including, but not limited to, descriptions of the site. That the place is beautiful and peaceful says nothing about the science, just the public relations department. It was established by a democratic initiative – does that mean we should now practice science by voting for what we think the results should be? People buy ‘magnetic’ copper bracelets to cure all kinds of things – that does not mean they work. I was trying to separate coments on science from irrelevant side issues, and I’m sorry that I didn’t make that clear.

  23. Kevin Mannerings said,

    November 11, 2005 at 1:04 pm

    Ian, thank you for your reply. You raise a number of points, I will get back to some later.

    You write:

    “To be honest, I found other people’s rebuttals quite conclusive – and you have not, as far as I can see, answered their comments and arguments about the experiments done on rat intestine. Maybe I missed it.”

    John A and RSM refer to the rat paper. (comments 4 and 5) I am not sure we are all talking about the same thing. With respect, “the rat paper” is not an especially convincing reference. This has nothing to do with a rat paper from Rumania. It is precisely this misrepresentation of what I originally wrote which annoys me.

    In my post above I referred to the report by Dr Wallach (Uni Freiburg) and gave a link. Unfortunately, it is all in German, but the problem is, there is a world of difference between homeopathy in Germany and Switzerland, done by qualified doctors, subject to full medical registration, training and supervision, and the self-regulated work done in the UK. If you want to get to the bottom of this, much of the literature is in German. Sorry.

    As I pointed out, the Leipzig researchers have been attacked and accused of data manipulation. Some of this appears to be over the top, but they have not replied yet.

    I should also point out, that in my original letter, I merely questioned why only negative results get publicity. I reported the Leipzig findings, based on the abstract put up by the Institute, but did not comment on them. The findings were and are newsworthy, as are the findings on the treatment of ADS I referred to.

    My own interest in this is in how science/science journalism deals with dissident scientists, fringe theories, rogues, corporate corruption of science, etc. This is an interdisciplinary field. It is in the nature of things that scientists who bring on controversial new theories get it in the neck. Gallileo is the most famous example in history, but who remembers that Einstein was cold shouldered by the physicists in his day, he could hardly get anybody to read his thesis, and because of his dyslexia, could not even tie down a job as a teacher in Schaffhausen? And that is without even considering what happened to him and many other great Jewish scientists like von Neumann after 1933.

    In my view, there is a witch-hunt going on against homeopaths which is based on ignorance. The Leipzig experiments are interesting, because of the design of the experiment. They cut the nonsense out and looked for a physical effect. That is the way forward.

    One brilliant science journalist I have looked at in detail is Arthur Koestler. He was the ultimate materialist rationalist, I interviewed him in the room where he eventually took his life in 1972. He sponsored the chair in parapsychology at Edinburgh with his life savings. It is in that spirit that I would like to see homeopathy investigated.

    In order to study homeopathy, you need to try and understand the practitioners. From the point of view of modern science and logical positivism, Rudolf Steiner is seriously bonkers, but that is only half the story. He was a trained scientist and a philosopher of note. His followers are dedicated, highly trained doctors. It is superficial and unscholarly to dismiss their work as charlatanism, without looking at it closely.

  24. quizzical said,

    November 11, 2005 at 2:06 pm

    Kevin Mannerings: “i will get back to you in another post, as the shift key has given up on this pc….”

    I’m not surprised, Kevin. Cool down. Don’t type so hard. Breathe. Type less. It’s all ok.

  25. BSM said,

    November 12, 2005 at 12:17 pm

    “As I pointed out, the Leipzig researchers have been attacked and accused of data manipulation. Some of this appears to be over the top, but they have not replied yet.”

    So, we should probably reserve comment.

    “there is a world of difference between homeopathy in Germany and Switzerland, done by qualified doctors, subject to full medical registration, training and supervision, and the self-regulated work done in the UK. If you want to get to the bottom of this, much of the literature is in German. Sorry. ”

    I am a vet and my homeopathic vet colleagues fill me with dismay not confidence when I have been able to examine any of their professional activities in sufficient detail to be able to form an opinion.

  26. BSM said,

    November 12, 2005 at 12:44 pm

    Kevin,

    I have struggled to find an original text of the Nieber paper. It is absent from PubMed for some reason, but I know someone in Denmark who has the German original and I’ll get him to summarise it for comment. So far, when I have come across supposedly solid homeopahic in vitro research it has failed at a first glance, but I now I have identified which study you were referring to I can look into it better. I’m glad you agree that the Cristea article was rubbish.

  27. BSM said,

    November 12, 2005 at 1:03 pm

    Pending getting a more complete answer here is my Danish contact’s previous comment on that paper;

    “Apparant weak points:

    1) Lack of blinding. The data collection method might be automated (that is not apparant from the article), but many other parameters, esp. dosage of stimulant and homeopathic substance appear to be manual, so blinding procedures ought to be in place.

    2) Lack of verification of chemical similarity between verum and control substance.

    3) This may become more clear if the actual protocol is available, but from the article it is not apparant that any prediction of the result was made. It appears that the result was simply analyzed and whatever result it yielded was deemed the effect of the homeopathic preparation. Such a metod is feasible, since experimental results may sometimes elude prediction, but it impacts the evaluation of the statistical significance of the result.

    4) The sample sizes and statistical methods are not apparant from the article.”

    I need to see the original, but the bit about blinding seems to contradict what you said, Kevin. Was the study blinded throughout its protocol from creation of the dilutions to the data analysis?

  28. Kevin Mannerings said,

    November 13, 2005 at 7:04 am

    The details of the Nieber paper are in the Wallach link I posted above.

    www.psychophysik.com/html/ak03-gwup04.html

    This includes a balanced analysis of the accusations of bad practice. Yes we should reserve judgement until they reply to the accusations. Dunno what the Cistea paper is.

    Quizzical, that is the way I am, but perhaps I should confess I am on drugs, taking a homeopathic medicine Naja Comp, which is based on the venom of the rattlesnake croatus terrorans (forget the exact latin name), I believe. The snake has a loud rattle and a venomous bite :-)

  29. quizzical said,

    November 13, 2005 at 4:43 pm

    Kevin,

    it seems to me that you don’t like the way this conversation is going, and you’re trying to get the owner of the site to take it down, by going on and on (and on and on and on) about how he didn’t have permission to post something from a newspaper on his blog, something that thousands of people do every day.

    Is that correct?

  30. Ian said,

    November 14, 2005 at 9:42 am

    I suppose I shouldn’t get personal. But…

    I’ve done a quick Google search for “Kevin Mannerings” and had several hits – many of which are connected to this story. I’m not sure if there are one or two Kevin Mannerings (some appear in Ireland, some in Switzerland, some Germany), but the writing seems consistent, as do the viewpoints. Raising questions, then not following up responses. Articles appear on a variety of topics, from alternative methods of livestock healthcare to socialist economics, historical analysis and graphology.

    Clearly a Renaissence Man…

  31. Kevin Mannerings said,

    November 14, 2005 at 10:03 am

    Quizzical, I am not trying to get the owner of the site to take down my letter. I made it quite clear from the start that I would have given him permission to publish the letter in full. In the context of the bad science blog, my letter, and my name has been sent around the world on google, as another example of bad science exposed by Dr Goldacre. He can provide a link. That would put the letter in its chosen context. It has been fed by e-mail to a community of sceptics dedicated to exposing fraudsters. All this on the basis of an incomplete letter, without the knowlege of the writer. That is an abuse of copyright and of the rights of people who write letters.

    It seems to me that you don’t want to understand this point, but would rather post childish personal innuendos about my obsessions, behind the cloak of anonymity. Is that correct ? By posting anonymously, you protect your name, but sneer at my efforts to protect mine.

    The conversation is very interesting. I am happy to debate homeopathy with sceptics.
    I have done nothing more than request Dr Goldacre, privately and publicly, to state whether he has permission from the Guardian or not to republish my letter.

  32. quizzical said,

    November 14, 2005 at 10:30 am

    I bet this site is the only place where you can post your full unedited letter and your, well, very long essays on the matter, in the same context, for all to see. This was not true in the Guardian newspaper, where it appeared, or these email lists and other places you have found on Google. I’d be pleased if I were you.

    And no, people don’t always bother to type in their full name and email address commenting on some random internet blog, ooooh it might be a conspiracy against you, and you personally. I think you have a lot to learn about the internet.

  33. Ian said,

    November 14, 2005 at 1:56 pm

    I apologise unreservedly to everyone who thought I was taking advantage of anonymity – especially Quizzical, because Kevin seems to think I am you. I’m not – I’m me. Glad that’s cleared things up.

    >It seems to me that you don’t want to understand this point, but would rather post >childish personal innuendos about my obsessions, behind the cloak of anonymity. >Is that correct ? By posting anonymously, you protect your name, but sneer at my >efforts to protect mine.

    I’m Ian Horsewell, BSc (Hons) in physics, and now a teacher of science. You are welcome to Google me and you will find several of my interests – I did not use the word obsession about your interests, please note – linked to my name (Science fiction, some science articles I wrote years ago and that I used to play bridge) I don’t think I sneered at anything, and certainly did not realise you were trying to protect your name. (Why?)

    As I said, there are several posts on different forums by someone who shares your name. As in your posts on BadScience – which other people here seem to have noticed and commented on – these posts make comments or claims, then do not follow up with details or responses. I made no judgement on the validity of any of your areas of interest, and am sorry if you feel I did. What I did do was comment on the width of your interests.

    >It has been fed by e-mail to a community of sceptics dedicated to exposing >fraudsters.

    I presume you’re talking about the people who read the BadScience blog. I wouldn’t have said we were dedicated, to start with. Sceptics – well, yes, but I don’t see it as a bad thing. If you think I sound sceptical here you should see me when a kid doesn’t have homework to hand in. As for ‘fraudsters’ – I think we’re all interested in trying to improve understanding of science, and perhaps that means pointing out to people when they’re mistaken. Perhaps I’m naive, but I’d like to think that many alternative healthcare practitioners are misinformed with good intentions rather than deliberately out to con people.

    You know, I don’t think anyone has actually asked, and of course feel free to ignore the question. I think it’s fair in context (but will obviously be interested if people disagree). Are you a practicing homeopath? Or a practicing scientist? You seem very committed to this discussion, is all.

    After this response I’m going to stop adding my comments for a little while; it feels like this has gone past friendly detached discussion, which is why I started following the blog in the first place. I’m ianhorsewell at hotmail dot com (obvious substitutions required) for reference.

  34. Kevin Mannerings said,

    November 14, 2005 at 2:07 pm

    Ian, what a clever chap you are. As far as I know, there are two KM’s in the world, the other one is a Candian ice hockey player. Have responded to allcomers here, will continue to. Your cowardly, anonymous smears don’t bother me. Put your name to them or shut up.

    The manner in which the personal backgrounds of supposed bad science cranks are researched and discussed on this blog is a nice example of the bad science mentality of the sceptics who meet here. What difference do my political views make to the validity of my arguments ? The same pathetic tactic was used on Lionel Milgrom, and it is the essence of the criticism against Melanie Phillips and Prof. Bradstreet. If you don’t like the content, attack the person behind it. The ultimate irrational blather.

  35. Ian said,

    November 14, 2005 at 2:34 pm

    >Ian, what a clever chap you are. As far as I know, there are two KM’s in the world, the >other one is a Candian ice hockey player. Have responded to allcomers here, will >continue to. Your cowardly, anonymous smears don’t bother me. Put your name to >them or shut up.

    And this is why I said I would stop posting – and will, after this post, unless people think you are justified in the use of ‘cowardly’, or ‘smears’. I think that my last post, giving my full name, occupation and email addess, nicely excludes the ‘anonymous’ part, but perhaps there’s a different use I’m not aware of.

    I’m withdrawing for a little while – but will make it permanent if anyone other than Kevin objects, and they are welcome to let me know in the forum or by email.

  36. FlickM said,

    November 14, 2005 at 2:51 pm

    Kevin, you troll, can you please stop being so revolting.

    Ian that was an exemplary posting but there really is no need to engage with nasty people like that. Please, just ignore him like everyone else has. It’s an attack on your time, that’s all, and I’m sure you’re worth more.

  37. Ben Goldacre said,

    November 14, 2005 at 4:49 pm

    Kevin, if you look here www.badscience.net/?page_id=7 you will see that personal abuse is only tolerated when it is funny. This is just rather unpleasant.

  38. Peter Wiggin said,

    November 14, 2005 at 7:38 pm

    But Ben, if somebody writes a letter with references, and you publish the letter without those references, and then *complain* about the lack of references, that does seem forgetful at best and a low joke at worst.

  39. Ben Goldacre said,

    November 14, 2005 at 7:49 pm

    Not me.

    www.guardian.co.uk/letters/story/0,,1559473,00.html

    But yes, I, Dr Ben Goldacre, do formally and unreservedly take back my joke, in comment #3, after pointing out that it was an aside, not particularly aimed at any one individual, which I have even made before, elsewhere.

  40. Peter Wiggin said,

    November 14, 2005 at 8:37 pm

    Fair enough.

  41. John A said,

    November 18, 2005 at 7:51 pm

    OK. Time to stop lurking – sorry for the long post…

    1) Sorry Kevin for assuming you meant the Cristea paper. I understand your annoyance but in my defence I think it is understandable why I did so and I fully qualified my assumption. You wondered in your original letter why the Leipzig research escaped the headlines. As there does not seem to be an English language version I do not think this surprising. What conclusion were we supposed to make from the mere existence of this study? Not that it matters since apparently:

    the authors have now admitted that their study was flawed; and that, as a consequence, the publication has been withdrawn from the journal Biologische Medizin and the Reckeweg Prize has been returned

    2) You said:

    their work is supported by health insurance companies because they cure people in a cost-effective manner

    I don’t think that is the reason they offer it. If the consumer irrationally prefers a more expensive treatment A over an equally effective but cheaper treatment B, an insurance company will offer treatment A in order to get the custom and pass on any additional cost in the treatment in the form of higher premiums. In fact, in one of the links you posted I read that the Swiss government has now withdrawn homeopathy from its coverage – believing that it is not cost-effective.

    3) The chief methodological criticism of the Lancet paper seems to be it’s reliance on a small number of large double blinded studies. I do not consider this to be too much of a problem since the aim is to try to minimise effects due to publication/cognitive bias etc. Generally I’d favour replication by an independent and sceptical group over meta-analysis since it solves the problem of publication bias. Someone getting Randi’s £1 million would definitely make me reconsider my position on homeopathy!

    4) I have only skim-read the ADHD study but I’m keen to discuss it. The statistical methods seem overly complex and so I’m a little suspicious that more simple tests failed to show an effect. Could just be I’ve missed something though – can anyone please explain to me why they fitted a model and didn’t just do a simple signrank test for example? Also the placebo treatment appears to be 20% ethanol – are homeopathic treatments made with ethanol – I thought water? Finally a critique of this I read here states that the investigator was not blind to treatment but that seems to be denied in the paper. Have I missed something?

    John.

  42. John A said,

    November 19, 2005 at 1:39 am

    Apologies, Randi‘s prize is $1 million not £1 million.

    Also, I’ve read the paper more thoroughly now and I understand their reasons for fitting a mixed model thanks to this page.

  43. BSM said,

    November 22, 2005 at 3:06 pm

    “This includes a balanced analysis of the accusations of bad practice. Yes we should reserve judgement until they reply to the accusations.”

    I am now completely bemused. You letter asked us to consider a paper whose authors had now been forced to withdraw from publication. Is that right?

    Did that withdrawal occur before or after your letter was published in The Guardian?

    I still lack and English translation of it, but there is no point in asking a German colleague to translate something that has been stricken from the published record.

  44. BSM said,

    November 22, 2005 at 3:58 pm

    apologies for the typos in that last post!

  45. Richard said,

    December 3, 2005 at 7:17 pm

    I tried the experiment : FLAPPING ARMS ON A PLANE

    IT WORKS!

    So Ben, be careful how you quote it!

    Experiment was undertaken as follows:

    As a skydiver, I took the precaution of of wearing a parachute (classed as safety equipment for the expiriment).
    Other equipment used was 1. Altimaster model II altimeter (calibrated to ground level, with accuracy of +/-50 feet).
    1 Protrack Barometric pressure timer altimeter (+/- 30 feet accuracy).
    Other equipment used: Helmet, gloves goggles and regular jumpsuit.

    I climbed on board a Twin Otter aircraft (I think any aircraft will do the trick however).

    The airplane took off and we climbed to jumping altitude 13,000 feet above ground level (QFE) ( as opposed to QNH, which is barometric pressure representing sea level at a given time).
    QFE is used for the safety of the expirement participant only, but in theory either QFE or QNH can be used to measure the reference altitude.

    On approcah to “exit” altitude, I commenced flapping my arms for 2 minutes. At the exit altitude 13,000feet I (sorry the subject) exited the aeroplane. Upon vertical separation from the aeroplane the following was recorded:

    A vertical accelaration was measured lasting 12.5 seconds at which point the subject arrived at the terminal velocity of 120 mph. The subject continued flapping his arms rigourously for 50 seconds more. During which time the subject was observed continuing a vertical from the aeroplane.

    CONCLUSION:
    The experiment worked! the subject noted being WARMER than usual at the colder altitudes.

    OTHER OBSERVATIONS: the subject deployed his parachute after 62.5 seconds from exiting and maintaining vertical seperation from the aeroplane, as there was a risk of collision with the big Green Planet. Therefore the experiment was terminated for safety reasons!

    Next week I will try it along with 22 other subjects. 11 will flap while 11 will not flap as a reference group!

  46. Dr. Klaus Keck said,

    December 3, 2005 at 9:01 pm

    Prof. Nieber has now withdrawn her paper, as published by the Univeristy of Leipzig:

    db.uni-leipzig.de/aktuell/index.php?pmnummer=2005425

  47. Deborah Horsewell said,

    January 11, 2006 at 10:18 pm

    Hello Ian

    I wonder if we are related? There can’t be tahat many Horsewell’s around.
    If you search Horsewell on the Net and you’ll see A Horsewell, Andy in Denmark – He’s my cousin – I wonder if Science runs in the family?

    Debs
    :)

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  55. UncleMonkey said,

    April 26, 2007 at 4:51 pm

    Doctor Ben,

    Doesn’t it get boring trying to convince homoeophiles that you can’t divide one gram of salt into 10E35 servings?

    You and I know we’re never going to be convinced that pure H2O can somehow remain parasalty when the last Na and Cl ions have been removed. Isn’t there a sort of unappealing combination of bullying and drudgery in endlessly reiterating the same challenge when you have no expectation of getting an intelligible explanation?

    Homoeopathy isn’t bad biochemistry/pharmacology; it’s nothing to do with science at all. Advocates seem to feel inadequate in the face of scientific medicine, cornered, even, and resort to the vocabulary of science, but this is *magic*.

    Far more interesting, I should think, to investigate why so many people prefer magic to science, and how it is that in anecdotal circumstances it sometimes works.

    (I write as one much perplexed by the sudden elimination of persistent pain of a compound fracture of the tibia, after my brother-in-law mumbled a spell and blew cheap local spirit over the site of the break. I had agreed to let him do this purely to please my wife, expecting no improvement at all. I still can’t work out how his confidence could make me feel better without my sharing it, but pain which had kept me from having a full night’s sleep for about eight months ended for good that day, without ever even a good twinge thereafter.)

    On the policy level, I can’t help thinking you’re deliberately missing the point.

    If I, knowing that homoeopathy is twaddle in the eyes of science, should nevertheless prefer going to a witch for a dose of 6E-38 g of buttercup oil to the course of vancomycin you want to prescribe, who are you to say it’s not mine to choose?

    The point of healthcare, as you doctors are all too prone to forget, is not to eliminate pathogens or produce some other objectively measurable change in the patient: it’s to make her feel better. She may be disappointed in the results of ignoring your advice, but until you can give an ironclad guarantee she will be pleased with your treatment, shouldn’t she have a choice?

  56. Ben Goldacre said,

    April 26, 2007 at 4:57 pm

    youre suggesting i go on about this, in a response to a post from septmeber 2005, almost 2 years ago?

    i have never said people should not be allowed to choose, i’ve never said it should be banned. i do this: i freely mock people for making false assertions about science and efficacy.

    why dont i write about why people prefer magic over science? oh hang on, i write about that all the time, in fact, thats what this placebo piece was about, in fact, thats exactly what i wrote about in last week’s column…

    i suggest you go and find the imaginary person your squabble is with and squabble with them.

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