Bad Science piece sneaks undetected into Time Out’s “Alternative Health Special Issue”

November 18th, 2005 by Ben Goldacre in alternative medicine, bad science, homeopathy, statistics | 62 Comments »

Ben Goldacre
Time Out, London
November 16-23 2005

I feel a bit mean, since you’re all having so much fun here, but let me quickly point out a couple of things about homeopathy. First, it doesn’t work. Second, it’s old fashioned and paternalistic. And third, that’s what they say about us: how weird is that?

We’ll do them in order. Stick with me here: at least if you disagree, you’ll disagree with a whole lot more panache by the end. So how do we know homeopathy doesn’t work? By the modern miracle of “counting”. There’s no voodoo here: you take 100 people on homeopathic pills, and 100 people on placebo sugar pills, and you count up how many people get better in each group. The answer is, people on placebo do just as well as people on homeopathic pills. You can’t argue with that fact. You can try and argue around it, but the people in these studies are all individuals: are you denying the reality of their experiences?

Occasionally, yes, you hear about a clinical trial which has found that homeopathy did perform better than placebo. But if you take the figures from all these little trials, and add them all up, and do one big count, you find, again, that homeopathy is no better than placebo. This is called a “meta-analysis”. There have been lots of them. No wriggling. It’s just counting, and if you doubt the methods, or the references, then come to, and we’ll all happily talk you through it. Nothing is hidden here.

But it’s more complicated than that. What is a placebo? It’s not just a sugar pill: a placebo is about much more than that. Placebo is about expectation, and the cultural meaning of the treatment. Green sugar pills are a more effective treatment for anxiety than red sugar pills. Weird. Why? Your guess is, well, almost as good as mine: and my guess is, it’s because of the cultural meaning of the colours “green” and “red”.

The experiments are endless. Salt-water injections are a more effective placebo treatment than white sugar pills – not because there’s anything especially useful about salt water injections, but because the ceremony of performing an injection is a much more invasive, authoritative and dramatic thing to do to someone.

It gets much better. An experiment in the 1950s found that a placebo operation for angina was just as effective as the real one. I read the academic article again today. In the discussion section, do they say: “Woah, placebo operations work, how weird is that?” No. Because nobody ever notices how completely weird the placebo effect really is.

Branding, of course, is the key with your little white sugar pills. Marketing, after all, is engineered cultural meaning. So a four-way comparison, of sugar pills and aspirin, in either unbranded aspirin tubs or mocked up Disprin brand packaging, showed that brand-name packaging kills pain. The huge wealth of cultural background material – the adverts, the word-of-mouth endorsement, the childhood experiences – everything that the packaging plays on, it’s all part of the pill.

So sneery rationalists, who buy generic, unbranded tablets like aspirin and ibuprofen instead of Disprin or Nurofen: they’re wrong too. It’s perfectly rational to believe that expensive Nurofen is more effective than cheap unbranded ibuprofen, even if they’ve both got the same active ingredient – but only, in a perverse turn, if that’s what you believe.

And this is the key also to alternative medicine: homeopathy is a “complex intervention”, rich in cultural meaning, drawing on attractive contemporary ideas like individualism, patient empowerment, and personalised healthcare, not to mention word of mouth. More importantly, all alternative therapies also offer something missing from modern medicine: the “containment” of symptoms, with understanding and certainty.

A transparent modern medic will say: “I can’t be exactly sure what the cause for your problem is. This treatment might make it better, but, well, it might not.” Nice. “Oh, and it also might have these side effects.” Thanks. Sometimes we even finish off with: “What do you think?”

Enter the alternative therapist: they understand your problems, whatever they are; they’re privately employed, so they have all the time you need; and they have an answer. In fact, they can give you an attractively complicated, wilfully obscure, authoritative explanation for whatever is going on in your body. Energy, chakras, some fictitious and chemical sounding dietary deficiency, whatever you’re buying, they’re selling. They maintain the power imbalance, in their therapeutic relationship with you, because they play up their exclusive access to arcane knowledge, and their authority.

If that’s not old-fashioned medical paternalism, I don’t know what is. Sure, it feels like it works, they’re bigging up the placebo with all the authority and technical flammery they can muster. It’s positively Victorian. Doctors don’t do that any more, but it seems it was popular: there’s a demand, a need, a gap in the market. You know how people sometimes say “doctors should give homeopathy to their patients”? Well we can’t, because to do that, we’d have to lie to our patients. No thanks.

So spend your money. If you want interventions that might work (damn right they have side effects, this is potent stuff) then come to us. But if you prefer your treatment served with extra lies, expense, reassurance, and paternalism: then you’ll be needing a time machine, or an alternative therapist.

If you like what I do, and you want me to do more, you can: buy my books Bad Science and Bad Pharma, give them to your friends, put them on your reading list, employ me to do a talk, or tweet this article to your friends. Thanks! ++++++++++++++++++++++++++++++++++++++++++

62 Responses

  1. Michael P said,

    November 23, 2005 at 2:00 pm

    “Whether or not diluted remedies have an effect does not, therefore, have any influence over homeopathy.”


    “Whether or not the little bottle of water cures your cancer, we still make bundles of cash”

  2. BSM said,

    November 23, 2005 at 3:22 pm

    An important point tha has only been alluded to thus far is that the real size of the placebo effect needs to be considered for various medial settings. In some psychosomatic illnesses it may be all you need, but for a broken leg its real effects are probably negligible.

    There is an awkward middle ground with nasty chronic diseases like cancer, for which the the may be no genuine “mind over body” effect on actual survival rates, but the ability to live with the disease in a better frame of mind is valuable.

    It is dangerously easy for conventional medics to give unnecessary ground to the woos by saying that they at least evoke a useful placebo response, but we should keep our critical guard up and employ some objectivity in assessing the power of that response.

    Conversely, if the SCAMmers were not just in it for the money and the public credibility and really wanted to help medicine, they would properly embrace attempts to tease out the relative merits of the placebo power of their favourite therapy.

  3. John A said,

    November 23, 2005 at 7:44 pm

    John B I am aware of the “like cures like” philosphy underlying homeopathy whereby drugs which may cause a particular symptom in high concentrations are used to treat that symptom at lower doses. However, as I understand it the problem exists that some compounds may be toxic at high concentrations or may (obviously) make the symptoms you are trying to make better worse. For that reason they are often diluted down. I don’t think it is uncommon that homeopathic treatments are heavily diluted to the point that no molecule of the original substance exists. Hence the criticism is well founded. If the homeopathists will admit to this being a silly aspect to their theory and abandon it, we will stop criticising that aspect.

    However the notion that a vague statement that “like cures like” should be a framework for developing medical treatment is a weak theory with no explanatory power. At the time it was as bad as any other theory around but nowdays it is showing its age. Just to prempt the inevitable, yes occasionally “like cures like”, and sometimes “opposite cures opposite”. But both statements are facile, prone to being twisted post-hoc to fit an argument and neither is a sound basis for treating an illness. Convential medicine is not developed from the idea that “opposite cures opposite” (allopathy) despite what the homeopaths might have us believe. They are not even competing. Homeopathy is one weak theory based on metaphorical reasoning whereas convential medicine is a whole hoarde of theories all building on each other and based on centuries of experimental knowledge (and more importantly the more recent one).

    Either a treatment works or it doesn’t. If some (non-potentised) homeopathic treatment works it is probably because the ingredient has an active compound. In this instance “like cures like” is supported but also several more specific theories within the body of knowledge that underlies convential medicine to do with the pharmacological effect of the compound. But if our current scientific knowledge cannot explain how it works homeopathy cannot offer an explanation either. It has no explanatory or predictive power. So in what way is homeopathy a theory with any useful purpose?

  4. Bob O'H said,

    November 25, 2005 at 9:31 pm

    I hope this means you’ll be releasing a new line of placebos, in different colours, in time for Christmas.


  5. Ben Goldacre said,

    November 25, 2005 at 10:48 pm

    Actually, can anyone be bothered to make a nice looking “placebo” logo in a capsule, or something? There’s a t-shirt in it. Which in itself will double sales.

  6. BSM said,

    November 26, 2005 at 5:38 pm

    “Actually, can anyone be bothered to make a nice looking “placebo” logo in a capsule, or something?”

    Placebin- does exactly what it says on the tin.

    Support your Local Homeopath-
    a joint message from Thames Water and British Sugar

    for when doing nothing is good enough

    Colonic Irrigation-
    just going through the motions

    Craniosacral Therapy-
    scratching heads and tickling bums

    Alternative Medicine-
    more quacks than your local pond

    Back. Crack. Quack.

  7. Morag said,

    November 26, 2005 at 9:54 pm

    “Actually, can anyone be bothered to make a nice looking “placebo” logo in a capsule, or something?”

  8. Deetee said,

    November 27, 2005 at 2:45 pm


  9. Ben Goldacre said,

    November 29, 2005 at 1:15 pm

    It’s such a great joke that everybody else has made it first.

  10. Ben Goldacre said,

    January 29, 2006 at 4:21 pm

    Another fantastic letter from the Society of Homeopaths. I’m not quite sure how I came to be known by them as “the allegedly infamous quack-buster Ben Goldacre”. Who alleged my infamy, why did they allege it, and when? I may have to sue over these allegations of infamy.

    17.11.05 – Letter to Time Out
    Re: The Bitterest Pill

    Dear Sir,
    We object very strongly to the highly opinionated article by the allegedly infamous quack-buster Ben Goldacre (The Bitterest Pill, p.24) in Time Out (November 16 – 23). Goldacre used this opportunity to talk about placebo and cited homeopathy as a prime candidate. He must be ignorant of the fact that over 20 rigorous and scientific trials have demonstrated that homeopathy has an effect over and above placebo and this includes large-scale trials on farm animals, which presumably are not susceptible to the idea of placebo.

    In his dismissive conclusion, he asserts our therapy is served with, “extra lies, expense, reassurance and paternalism”. What complete rubbish! The Society of Homeopaths has over 1200 Registered Members, none of whom would recognise themselves in this stupid remark and nor would their patients.

    The Society was pleased to see, however, that despite Goldacre’s views, that homeopathy was placed firmly in the ‘acceptable’ therapies in the same issue (Alternative Health Special, p.146).

    Yours sincerely

    Melanie Oxley
    Communications Manager

  11. Mick James said,

    February 27, 2006 at 11:29 am

    Surely homeopathy is the best explanation of the placebo effect? We all drink water all the time, which by now will be imprinted with the “memory ” of virtually every substance known to man. So our taps are constantly dispensing an endless supply of free medicine?

    So why do we not just get better automatically when we get ill? Well, a lot of the time people do just get better, and that is clearly due to this unseen homeopathy . Unfortunately, the the near-infinite medical potency of tapwater is such that it creates a lot of “therapeutic noise”. The body simply doesn’t know which of the healing voices to listen to. So it’s probably the therapeutic intervention of giving someone a sugar pill, and saying, “this will cure your arthritis” attunes the body to listen out for the healing memory of the homeopathic molecules–in the water they drink to swallow it!

    So far from disproving homeopathy, the placebo effect confirms it. If we could only train our bodies to listen better to the homeopathic cures flooding our veins, then we could shut down the NHS. Thames Water might want to jack up the water rates a bit though.

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