Natural History Museum Homeopathy Debate – Booking Now

November 17th, 2006 by Ben Goldacre in bad science, homeopathy | 52 Comments »

I'm talking at this Natural History Museum thing on Thursday 30th Nov at 7pm with Dr Peter Fisher, Clinical Director of the Royal London Homeopathic Hospital, bookings on 020 7942 5555, seats going fast…

Should be good fun, at first it was to speak "against" somebody called Dr Marysia Kratimenos, but now they've got Dr Peter Fisher. He is obviously the biggest cheese in Uk homeopathy, a very nice man, a very clever man, a very well informed man, an extremely reasonable man, a man who takes an extremely moderate and defensible view on homeopathy, a man I've chatted to on the phone, a man I don't think I'd disagree with on much, if anything, and a man who I would say is almost completely unrepresentative of the majority of the practising homeopathy industry in the UK. I guess amongst other things that raises the question "what is homeopathy?" I'm always interested to hear what he has to say so it'll be fun for me at any rate. 

Do come along and play if you like.

www.nhm.ac.uk/visit-us/whats-on/events/detail.jsp?key=7886&x=0&y=0

Does Homeopathy work?

Does Homeopathy work?

suitable for Anyone Anyone

Talk

 

30 November 2006 19:00

Chamomilla for toothache, lycopodium for nausea and sepia for exhaustion; homeopathy claims to cure by treating like with like. By taking a tiny amount of a substance that provokes the same reaction as the sufferer's illness, the illness itself is treated. Complementary therapy is becoming increasingly popular, with an estimated 400,000 users. But is there any evidence it works? Reviews of clinical trials, used to test the effectiveness of medicines, fail to provide convincing evidence. Yet many practitioners and users maintain that it is successful. Join us to hear and debate the evidence on both sides, and decide for yourself.

This event is free, but booking is required; please call 020 7942 5555. The event takes place in the Darwin Centre (entrance via Queensgate). This event is free of charge.

 

 


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52 Responses



  1. martin g said,

    November 17, 2006 at 7:12 pm

    Well, I know I’ve mentioned it before, but it’s still bothering me – and I still don’t have an answer :

    How could I wash out my ( notional ) old homeopathic medicine bottles ? ( if I had any )

    Surely the act of washing ( with water at least ) would dilute any remaining drops of the mixture even more, and make it yet more potent ?

    And things could escalate alarmingly if they’re rinsed out a few times – ummmm, couldn’t they ?

  2. Ithika said,

    November 17, 2006 at 9:34 pm

    I think more to the point – what is the homoeopathic treatment for blunt force trauma? How do they recommend you treat battle wounds? Bromine vapours for male infertility (while sitting in a hot room)?

  3. bfwallis said,

    November 17, 2006 at 9:53 pm

    How could I wash out my ( notional ) old homeopathic medicine bottles ? ( if I had any )

    Obviously you would wash them out with something that has the opposite intended effect of the homeopathic “remedy” in question.

    For example, if the “remedy” is supposed to lower fever by raising body temperature, then you would clean them out with something that lowers body temperature, like aspirin.

  4. TimW said,

    November 18, 2006 at 12:02 am

    And the ideal amount of aspirin (in this example) to use would be zero, so consider them already washed out.

    Er…

  5. TimW said,

    November 18, 2006 at 12:14 am

    Anyway, what I was going to say was that it never occurred to me (I know nothing) that there was such a thing as a Homeopathic Hospital, what a great but tragic experiment that would be! But I had a look at their website, and sadly (well, fortunately) it looks like Homeopathy as such is only a small part of their programme. Maybe it’s time they changed their name?

  6. causan dux said,

    November 18, 2006 at 1:21 am

    Blimey, some debate!

    He believes homeopathy works (yes, he does) and you don’t disagree with him on “much, if anything”. I deduce you believe homeopathy works.

    He’s “a man who I would say is almost completely unrepresentative of the majority of the practising homeopathy industry in the UK.”
    Could well be. He is however rather representative of this majority in one key (one might say defining) way: like most of them, he believes homeopathy works.

    What am I missing here? You’re trying to inveigle your way into homeopathists’ affections by seeming to agree with them, and then you’re going to surreptitiously up their dosages? Too subtle. In my view the only correct approach to a homeopathetic is to accord them a Trotskyist cranio-trattorial encounter experience.

  7. CB said,

    November 18, 2006 at 9:11 am

    There doesn’t seem to be much doubt that homeopathy DOES work – it works via the placebo effect. Its when people think it works over and above placebo and come up with bullshit explanations for why it works that there’s trouble.

  8. wilksie said,

    November 18, 2006 at 9:33 am

    “I think more to the point – what is the homoeopathic treatment for blunt force trauma? How do they recommend you treat battle wounds? ”

    Unfortunately I think homeopaths would like to be allowed to treat battle wounds.
    They believe that arnica should be the FIRST CHOICE of treatment for trauma in every casualty department.

  9. JohnD said,

    November 18, 2006 at 10:17 am

    Hope it goes well, Ben.

    Don’t forget to take your Argentum Nigricum for anxiety before a big event, and have some Kali Phosphoricum with you for your exhaustion afterwards.
    But all through the debate, keep rubbing in the Nil Carborundum.

    John

  10. doctormonkey said,

    November 18, 2006 at 11:11 am

    it is tempting to rehash all of the anti-homeopathic feeling and arguments here, if only for the sense of catharsis that it would bring when disgust rises at homeopathy being taken seriously

    BUT it would be interesting to think about strategies to use in a debate such as this to use against this friendly and reasonable homeopath: it must not be personal and should be against all of homeopathy rather than what he can then describe as a “lunatic fringe”.

    my suggestion would be the lack of placebo controlled RCTs showing support for homeopathic treatments and you could also challenge him to define homeopathy and see if he includes the “lunatic fringe” in his response which then allows you to draw in the apparent lack of consistency in homeopathy in terms of the concept of a homeopathic vaccine and the resonance machines that mean that the water you buy isn’t even claimed by the homeopath to have any of the stuff in it or to have ever had any of the stuff in it.

    i won’t be able to make it to the evening (work in another part of the country) :-( so please make sure you post a report!

  11. Dr Aust said,

    November 18, 2006 at 11:41 am

    Re. DrMonkey’s comment, how about bringing up Over-The-Counter (OTC) homeopathic remedies and the MHRA?

    After all, since traditional homeopathy claims that it works because the treatment is “personalized to you by your homeopath”, and since the OTC remedies are NOT personalized, then according to trad homeopathic belief they CAN’T WORK.

    If a homeopath does think the OTC remedies are “valid”, it can only be because they work via placebo effect.

  12. Mojo said,

    November 18, 2006 at 1:00 pm

    martin g wrote: “Well, I know I’ve mentioned it before, but it’s still bothering me – and I still don’t have an answer :

    How could I wash out my ( notional ) old homeopathic medicine bottles ? ( if I had any )

    Surely the act of washing ( with water at least ) would dilute any remaining drops of the mixture even more, and make it yet more potent ?

    And things could escalate alarmingly if they’re rinsed out a few times – ummmm, couldn’t they ? ”

    In fact, this is pretty much exactly how homoeopathic remedies are prepared using the “Korsakov method”, in which a small bottle originally containing the mother tincture is repeatedly emptied and then refilled with solvent. It is assumed that a small amount of the solution adheres to the inside of the bottle at each stage, and that this means that a 1 to 100 dilution occurs each time.

    If you don’t believe me, take a look at this page from the Helios website, on which they describe their remedy-making machine: www.helios.co.uk/technical.html

    “The machine repeatedly empties and refills in a single vial (Korsakov method) until the desired potency is reached, the whole process being computer-controlled to ensure stability and accuracy.”

    Not also that, as in this case, the Korsakov method often uses water rather than alcohol or an alcohol/water mixture as the diluent. Helps keep costs down.

  13. Dr Aust said,

    November 18, 2006 at 5:08 pm

    Re Mojo’s post 12:

    But again…. does this correspond to the appropriate homeopath-priest ritual shaking? ..so is it a REAL homeopathic remedy?? Do they have to have a “trained homeopath” on site to press the “on” buitton on the machine?

    This sort of reminds me of the time I visited a winery in the US that made Kosher wine. They explained that the wine stayed kosher if, and only if, everything that was done as part of the process of making it was explicity ordered by the resident Rabbi. They had, they told us, three local Rabbis working there in shifts. If a vat needed sterilizing before putting the wine in it, the Rabbi had to say “yes, sterilize the vat”. If this happened, the wine stayed kosher. If they just went ahead and sterilized the vat as usual but WITHOUT express Rabbinical orders, then the wine wasn’t kosher and more and had to be chucked down the drain.

    Of course, the difference is that kosher, whatever it’s cultural roots (which may have originally had something to do with reducing the risk of food-borne diseases), clearly constitutes a RELIGIOUS (mystical) “value” given to the food.

    Homeopathy, on the other hand, misleadingly pretends to be something other than faith healing.

    BTW, the fact that homeopathy is/was precisely a religion was stated clearly as long ago as the 1850s by the eminent American surgeon (and Dean of Harvard Medical School) Oliver Wendell Holmes: for more on this, and a good read, see the article at:

    www.fasebj.org/cgi/content/full/20/11/1755

    - by the wonderful Gerald Weissman MD.

    The quote from Wendell Holmes is at the end, so I will repeat it here for those who can’t be bothered with the whole Weissmann article:

    “Some of you will probably be more or less troubled by that parody of medieval theology which finds its dogma in the doctrine of homeopathy, its miracle of transubstantiation in the mystery of its dilutions, its church in the people who have mistaken their century, and its priests in those who have mistaken their calling.”

    Oliver Wendell Holmes, Medical Essays

  14. doctormonkey said,

    November 18, 2006 at 5:17 pm

    #11 – Dr Aust (always good to see you posting :-) )

    I think this point is even harder for a homeopath to answer as I cannot see an answer to this not forcing him to either say OTC homeopathic remedies don’t/can’t work or he has to admit that you don’t need a homeopath.

    I will be interested in the response.

    One that might be used is that homeopathy has a very wide array of treatments and so a homeopath may be needed to guide a person to the correct treatment but, as with drugs like aspirin and paracetamol, some things may be generally good for non-specific problems and these are the ones availalbe OTC.

    I think that part of this point may come from the point of view of a physician-doctor (As opposed to “real” PhD-doctor) who also uses homeopathy as this is much of the case with the drugs used by physicians (although as ours have effects they can also have nasty side effects and so we regulate their availability, not really a problem with homeopathy BUT THIS IS NOT A RANT!!!).

    A further point with homeopathy is the different solutions or preparations they come in because these are very important as it is these that have the “memory” of the active ingredient and yet there appears to be no standardisation of these. One hoemopathy using GP I know felt that these solutes (if I remember my chemistry A-level correctly) were important for holding the memory and yet there seems to be no concensus on which to use, some use alcohol, some water, some a mixture and I thought I understood that some use tablets but that may just be my imagination.

  15. Mojo said,

    November 18, 2006 at 5:23 pm

    doctormonkey wrote: “I think this point is even harder for a homeopath to answer as I cannot see an answer to this not forcing him to either say OTC homeopathic remedies don’t/can’t work or he has to admit that you don’t need a homeopath.”

    They also can’t use the excuse about DBPC testing not being appropriate to homoeopathy when they’re talking about OTC preparations. Either they perform as claimed or they don’t.

  16. Dr Aust said,

    November 18, 2006 at 5:41 pm

    The OTC homeopathic remedies are often pills, Dr M – the infinitely diluted nothing solution (of whatever) is incorporated / impregnated (Mojo can probably tell us how) into a pill.

    Does this mean the small remaining water content of the dry tablet has the memory? …Hmmm. Go figure.

    Perhaps the pill has vibrations…

    …I am reminded of Jacques Benveniste claiming that the mystery “substance vibrations” in the homeopathically-diluted water could be recorded via a soundcard into a sound file and then sent over the net… …see:

    www.digibio.com/cgi-bin/node.pl?lg=us&nd=n4_3

    - .And remember Benveniste was the nearest thing to an eminent scientist who ever took up homeopathy – see the obits from the BMJ and Guardian:

    www.bmj.com/cgi/content/full/329/7477/1290

    www.guardian.co.uk/obituaries/story/0,,1331927,00.html

    …What’s that quote attributed to Einstein:

    “Only two things are infinite…the universe and human stupidity….

    …and I’m not that sure about the universe”

  17. Mojo said,

    November 18, 2006 at 7:24 pm

    “The OTC homeopathic remedies are often pills, Dr M – the infinitely diluted nothing solution (of whatever) is incorporated / impregnated (Mojo can probably tell us how) into a pill.”

    I think they just drop the diluted remedy onto the pills and let it evaporate.

    Of course, once they have made one pill they can easily produce more by “grafting”. This involves putting an active pill with a lot of blank pills so that it can magically transfer its magical properties into them. Honest. I’m not just making this up!

  18. David Mingay said,

    November 18, 2006 at 9:37 pm

    Isn’t the invitation to the event misleading when it says: “By taking a tiny amount of a substance…”? Shouldn’t it read: “By taking no amount of a substance…”? Or would that too clearly indicate to the potential audience how idiotic the whole idea of homeopathy is and put them off coming along?

  19. Mojo said,

    November 18, 2006 at 9:52 pm

    I hope Ben makes this clear.

  20. FlammableFlower said,

    November 20, 2006 at 5:02 pm

    What about the comment that homeopathic medicines don’t have any side effects? So if you take the wrong medicine (for example self-diagnosis OTC) then it can’t have an effect unless you have that illness.

    Are there really no cases of people taking or being prescribed a remedy and then it doesn’t work and they have to be admitted for regular treatment / die?

    There was a case of a complementary therapist in Ireland who was accused by the families of being implicit in the deaths of two clients by persuading them stay on complementary therapies when they needed conventional medicine. I don’t know if this was a homeopath or not. (Just to cover my arse – this was just alleged…)

  21. superburger said,

    November 20, 2006 at 7:38 pm

    I would love to come, but sadly can’t. Will you be making an mp3 of the debate available. I believe a downloadable mp3 is known as a podcast……

  22. doctorfrank said,

    November 20, 2006 at 10:35 pm

    #20 There are certainly cases of patients taking homeopathic remedies/placebos/nothing solutions and refusing to countenance medical treatments until too late. This stuff is magical therapy at it’s very worst as many people believe it has a foundation.

    Will be booking my place and planning my heckles now. Let us know your theme Ben……………..

  23. superburger said,

    November 21, 2006 at 12:37 pm

    If i can suggest a question?

    I would like to know how Dr Fisher settles the conflict that arises between his use of homeopathy in a clinical setting (i.e. not as part of a consenting research programme) and his duty under section 3c of the GMC’s “Good Medical Practice’ document to

    3c provide effective treatments based on the best available evidence

    www.gmc-uk.org/guidance/good_medical_practice/good_clinical_care/index.asp

    As homeopathy has been shown, using the best availably evidence, to be nothing more than placebo, how can he justify using it on patients?

  24. AndrewT said,

    November 21, 2006 at 2:13 pm

    Superburger – some placebos are better than others. well known, Ben’s mentioned it in the past.
    Lets take Nicotine Repalcement Therapy (NRT) as an example.
    Quit rate of 4% on NRT patch, quit rate of 2% on patch with no active ingredient. NRT better than placebo.

    Now consider a (hypothetical) homeopathic DBPC trial. Go to homeopath. Get given either homeopathic remedy, or ‘placebo’. This is a pill with no ‘magic water’ impregnated on it.
    As homeoapthy consultation is a powerful placebo, it has a quit rate of 8%. But so does our ‘placebo’ in this case, having a quit rate of 8%. Conclusion. Homoeopathy no better than placebo.
    But. Its better than the NRT patch, because its a v. powerful placebo.

    Which is why i happen to think homoeopaths are right when they say the DBPC trial is not appropriate for homoeopathy. But they are right for the wrong reason. And they’ll never be able to admit [i]why[\i] they are right because it’ll involve admitting its all placebo. You can’t do a DBPC if your treatment arm is a placebo…

    The point being that if its a v. powerful placebo, it can be better than Traditional Western Medicine. And you can be happy doing it safe in that knowledge.

    But here’s the rub. There is NO evidence to suggest that homoeopathy is a better placebo than any other snake oil on the market. And until then, i’ll settle for 5 mins with the GP and take my prescribed 2 paracetemol and bedrest.

  25. Ben Goldacre said,

    November 21, 2006 at 2:25 pm

    homeopathy advocates often obfuscate on this issue rather to their discredit. it’s actually perfectly easy to do (unblinded) randomised trials comparing homeopathic clinic treatment against treatment as usual (eg GP care alone, or waiting list), which is clearly the appropriate trial to do. unfortunately we’ve just had things like the bristol “customer satisfaction survey” which was rather childishly dressed up (by media and to an extent the promotional activity around the study itself) as if it was this kind of “waiting list control” trial.

    incidentally there is evidence that homeopathy is not the best placebo on the market, a recent elegant BMJ paper compared placebo pill with placebo ritual (modelled on acupuncture) and found the more involved ritual had the greater benefit.

    placebo is not about pills, its about the cultural meaning of the whole process of treatment, there are excellent reviews on this by Daniel Moerman, available in book form or journal articles.

  26. doctormonkey said,

    November 21, 2006 at 6:07 pm

    i now regularly sacrifice black chickens and the occasional goat with patients, not only does it help to dress up the ritual of placebo but it also means a nice meal…

    i think that a fair proportion of examination in GP surgeries is completely cosmetic and a placebo as i know that it will not change the outcome but the patient expexts it and it is easier to examine them than to explain that i don’t think i need to… plus you do sometimes find something but not often.

    i think superburger’s comment in #23 is important – it should allow you to draw out the lack of evidence for/about homeopathy and that is something i think needs addressing if they want to be taken seriously and not as a cult.

  27. superburger said,

    November 21, 2006 at 8:55 pm

    I’ve no doubt that some placebos are more effective than others- i believe it’s been shown that a big green pill is more effective than a small white one. And voodoo – that’s surely the most powerful placebo known…..

    There isn’t a problem with people giving out homeopathic remedies to people – I do have a problem with medics giving out water and sugar at considerable expense (how much does a consultant cost the taxpayer per hour?)

    Any ‘health care professional’ should have a GCSE in science – which is enough to tell you that homeopathy is a sham.

    consultants are not stupid human beings – so how they can ignore 200+ years of serious medical science is beyond me.

    That placebo and cultural setting can be incredibly important is a fascinating topic – but it cannot be right for a physician to practice 19th century witchcraft on the government dime.

    It must surely conflict with GMC code of conduct and if I found out my rather excellent GP was recommending homeopathy or was working in a surgery that did, I would be out of there as fast as you could say “sick note” – my confidence in the GP as a believer in empircal, rational medicine would be gone and i could no longer trust them to provide evidence based healthcare.

    Anyway, Ben, are you going to make a podcast for us provincial types who can’t make it to kensignton enjoy?

  28. Dr Aust said,

    November 21, 2006 at 9:13 pm

    doctormonkey wrote

    “I now regularly sacrifice black chickens and the occasional goat with patients, not only does it help to dress up the ritual of placebo but it also means a nice meal…”

    I think your GP cultural sensitivity trainers would have been proud of you, Dr M… respecting peoples’ individual health beliefs derived from their deeply-felt cultural heritage etc etc.

    I suppose, playing Devil’s Advocate for a minute, the Q is what would you do if you had a patient who clearly BELIEVED in the power of some “traditional” / “spiritual” hocus-pocus (let’s say homeopathy, but could be anything) and who was suffering from “life malaise” (i.e. nothing you could treat) , or even from what you were pretty sure was completely psychologically-generated pain. Would you be prepared to co-opt their “traditional beliefs” to help persuade them to believe they are getting better??

    Sorry, know I’ve made this point before in other guises. But it seems to me to get to the crux of it in some ways.

    It’s all in the interpretation, innit?

    Which reminds me of a story told me by one of my friends, now a neurologist in the US, who spent his teens in a Xhosa area of S Africa where his parents worked as missionaries. The standard therapy when people were ill was that they would go to a specifically-designated village “healing hut” and stay there while the whole community chanted and prayed for them to get better. According to my friend this usually did the trick. “Proof of prayer healing” or placebo? Depends which side of the argument you come from, as Tony Blair would say. Or whether you have any understanding of science.

    Talking of placebos, I seem to remember someone once doing a study where they gave patients a placebo pill specifically TELLING them it was a placebo pill WITH NO ACTIVE INGREDIENTS and it still produced measurable effects, Anyone recall this? There may even be multiple examples.

  29. Dr Aust said,

    November 21, 2006 at 9:22 pm

    PS I’m with superburger here – the point is whether we give cultural “beliefs” equal status with scientific medicine and spend public money on them.

    If rich idiots like the Royals and the Noble Lords who spoke in favour of homeopathic remedies in the recent House of Lords MHRA debate want to blow their cash on seeing a “homeopathic physician” – it’s their money.

    If the NHS builds a multi-million pound homeopathic hospital and starts referring people there as if it were an evidence-based intervention – it’s OUR (tax) money.

    It could instead be paying for Stop Smoking clinics in lots of GP surgeries, or alcohol concern workers to target young problem drinkers in A&E on Friday and Staturday nights… reckon these between them would be far more cost-effective in improving the nation’s health.

  30. doctormonkey said,

    November 21, 2006 at 9:50 pm

    In a slightly more serious response to Dr A’s posts, from my somewhat tongue-in-cheek comments, I think that a sensitivity to a patient’s health beliefs is central to working with them but that does not justify spending NHS money on this rubbish.

    If I am presented with evidence that it works (as with acupuncture and some problems including knee pain and chronic headache), then I am happy to recommend it even if I am still unhappy with the suggested reasons why it works. I am a practical doctor on the frontlines, I need evidence that something works. There appears to be none that homeopathy works yet it remains.

    Almost every week we see some widely accepted piece of traditional Western medicine consigned to the scrap heap as it is shown not to work, from stopping antibiotics for sinusitis (and using short course, high dose steroids) to pulmonary artery catheters in ITU. The continuing absence of anything from the seemingly vast homeopathy industry/cult continues to worry me and the refusal to accept the validity of the tests themselves is worse.

    If homeopathy does not accept that placebo controlled, double blind RCTs is the way to see if something works then it has no role in the NHS as everything else must stand up to this scrutiny or fall by the wayside it seems.

    Sorry for the mini rant, I am avoiding working!

  31. AndrewT said,

    November 22, 2006 at 11:44 am

    A point i didn’t fully expand on is that whilst DBPC trials are probably inappropriate for homoeopathy, as Ben rightly points out an unblinded study can be done. But this inappropraiteness to do DBPC is basically cited as a carte blanche to do NO trials, unblinded or not. And that is lunacy.

    I assume the paper Ben refers to is T Kaptchuk et al. From the conclusion:
    “placebo effects seem to be malleable and depend on the behaviours embedded in medical rituals.”
    i’m going to have to disagree that homoeopathy may not be a good placebo, because the effective homeopath (oxymoron?) will set it up with an hour long consultation, individual ‘symptom taking’, asking lots of questions about life, consult the big leather book etc. a highly ritualised process. As placebo is not just about pills, so homoeopathy is not just about pills…

    Dr Aust:
    Re ‘devils advocate’. I’ve seen it in action. My ex honestly believed that illness was caused by an imbalance of energy in the body. She wouldn’t have it any other way. She also suffered a lot from psychosomatic illnesses that seriously affected her QoL. And thus needed a treatment that would rebalance her energy. didn’t care what as long as it was surrounded by new age nonsense. And it worked. where her GP hadn’t for 4 months. Thats because she was a fruitcake though, rather than anecdotal justification of homoeoapthy. The point being, some people ‘need’ this as opposed to TWM. Should she get it on the NHS? Probably not…

    Anyone know of any papers on the link between psychosomatic illnesses and CAM? I’d be well interested in them…

  32. Mojo said,

    November 24, 2006 at 4:20 pm

    “As placebo is not just about pills, so homoeopathy is not just about pills…”

    But homoeopaths (well, most of them) claim that the pills actually do something. that’s why we get all the stuff about the “memory of water”, clusters, quantum entanglement etc.

    What about the OTC homoeopathic nostrums, purporting to treat a variety of conditions from colds to carsickness, that I can buy by picking them up off a shelf in Boots and walking to the checkout? No ritual consultation there, so presumably no more placebo effect than any other sort of pill. These, surely, are just about the pills.

    And as they are sold to treat a single condition without being individualised to the patient, there can be no possible reason that DBPC trials should not be an appropriate test.

    Have any of the representative bodies for homoeopathy ever said anything about this?

  33. Stewbee said,

    November 24, 2006 at 8:32 pm

    I’m with everyone who thinks our taxes should not be spent funding homeopathy ‘treatments.’ Why not do what I did and email NICE asking it to review homeopathy. If enough of us ask we might just get somewhere. Here’s the link
    www.nice.org.uk/page.aspx?o=ts.home

  34. doctormonkey said,

    November 28, 2006 at 8:28 pm

    depressed now.

    just had a get together with other junior doctors, mentioned homeopathy in passing in a negative context and got evils from a fellow trainee.

    there is no hope.

    good luck with the debate Ben, give’em hell!

  35. AndrewT said,

    November 29, 2006 at 12:11 pm

    Its sold out. But following the link Ben gives, it says
    “you can still watch and participate live online on the Nature Live website”
    Huzzah!

  36. Dr Aust said,

    November 29, 2006 at 10:39 pm

    Re post 35:

    - Either a tree-hugger or perhaps someone who had been brainwashed by
    the “cultural context / validity of patients’ individualized health beliefs” crew…?

    What reason did they give for disapproving of your, erm, informed scepticism, Dr M?

    I always assume that approval of homeopathy in the medical context comes from the “If we don’t have anything to give you for X, and you believe this might work, it is valid to encourage people to explore X ….” – re-empowerment, locus of control etc etc.

    If the doctor concerned really BELIEVED a homeopathic medicine had any intrinsic BIOLOGICAL ACTIVITY… now that would really worry me because it effectively means they are happy to reject the whole scientific basis of medicine.

    Not to labour it, but Mrs Dr Aust says that she directs the fairly numerous patients for whom there is no obvious “allopathic” remedy and who are insistent on alt therapies to (in order)

    (i) the ones with some evidence base (e.g. some herbs, light therapy, acupuncture, all in certain settings)
    (ii) the ones with something in them (e.g. herbs) and a long-standing “folk use” track record
    (iii) varieties of “self-pampering to feel better” things (massage, relaxation, aromatherapy)

    …but not to homeopathy ‘COS IT’S A CON.

  37. Dr Aust said,

    November 29, 2006 at 10:40 pm

    PS Break a leg Ben.

    PPS But if you’re going to, make sure you have your Boots homeopathic arnica handy.

  38. Noah Quiescence said,

    November 30, 2006 at 11:42 pm

    a frustrating evening

    Dr Fisher’s intro (sales pitch) was carefully staged, blinding an unprepared (unlike him) audience with data, meta-analyses and numbers and such like – Ben noted at least twice that it was not the right situation to discuss these matters in detail.

    What surprised me – I did put my arm up to ask him, but there was no time – is that if I remember correctly, the last set of figures with which he concluded his “survey” of “proper scientific evidence” that homeopathy works were

    49% positive
    3% negative
    48% inconclusive

    now, if I remember correctly, there was a faintly triumphant tone in his stressing the first figure and referring, rather dismissively, to the third as “the rest”. Maybe actually uttering 48 would bring out its actual closeness to 49? Don’t know. In his position, if I had planned to clinch the argument with figures I would have chosen another set altogether.

    I hope that the message got through that proper scientific evidence is still lacking…except that they somehow tried to invalidate scientific methods and pre-empt the results of any value: something to do with the intrinsically very particular level at which homeopathy operates.

    One more thought: perhaps trying to catch out somebody like Dr Fisher (with a foot in both camps – I just don’t get it) on the particular matter of vaccines may not be the best area in which to expose the irrationality and inherent danger of it all. Indulge me for a minute if I put to you that at some intuitive level vaccines can be seen to act in an homeopathic manner, and therefore would still make sense to his “homeopathic” left arm… Another example: I have had it put to me by one of the many holier than me, pure and resplendent, homepathically-enhanced mothers that Methylphenidate can be in a sense seen as a homeopathic kind of intervention – a stimulant to treat hyperactivity. See what I mean.

    All in all, it was a joy to see(you) Ben in person. And, true to late form, the cheeky scamps made an appearance.

  39. Ben Goldacre said,

    December 1, 2006 at 12:46 am

    just got back from this, undoubtedly one of the most entertaining debates i’ve ever been part of. the crowd were rabid, shouting down, classic homeopath reasoning, it felt, oddly, like that scene in “man on the moon”, the andy kaufman film, where he’s wrestling feminists.

    can’t wait for the video to go up, will post a link when it does. the audience is the homeopathy industry in its true colours, often seen in the wild, rarely captured on film…

  40. curranhung said,

    December 1, 2006 at 11:19 am

    An excellent evening’s entertainment – thank you a hundred times, Ben and Dr Fisher. And what an audience …

    I don’t have a totally closed mind when it comes to complementary therapies, so I went expecting – hoping – for some good rational debate, and I was prepared to be persuaded out of my sceptical position on homeopathy into one which was at least sympathetic.

    However, I came away unconvinced and extremely put off by the silliness of some of the contributions of the homeopaths and their supporters.

    Dr Peter Fisher is a clever man who uses science to support his position as a homeopath in the NHS. He gave a Powerpoint presentation which flashed up tables of statistics which showed, he said, that well-controlled trials and studies demonstrated that homeopathy had an efficacy which was not the result of a placebo effect. I’m not able to judge if the meta-analysis he showed proved his point because I’d want to read the actual articles myself before taking his word for it but I had the distinct feeling that he was cherrypicking his sources. He said that many of the studies which showed that homeopathy doesn’t work were based on BAD SCIENCE. But are all of them flawed?

    I’d heard enough conversations in the queue beforehand to realise that many of the audience were a “rent-a-crowd” group of homeopaths who had been encouraged to attend by their websites and newsgroups and I wondered how Ben would cope because they were quite aggressive in promoting their views. I suppose they feel defensive because they find themselves often under attack and the subject of ridicule.

    However, they’re a friendly lot – these homeopaths – and several tried to engage me in conversation. Maybe they thought I was one of them or maybe they wanted a convert, as they are ever eager to proselytise. I’m ethnically Chinese and the suggestion was made that I would know about alternative medicine because of my background. I was asked questions like, “Are you a sceptic or are you one of us?” One woman asked me, even before the debate began, “How are you going to vote?”

    Ben arrived a bit late because of traffic problems, so I spent the 15 minutes or so studying the rest of the audience to see if I could “spot the homeopath”, or at least a supporter of homeopathy, because it seemed to me that they form a distinct sub-culture and one that is in part pretty eccentric and often downright loopy. There was one man who was so sinister that he could have walked out of the pages of an M R James ghost story.

    Dr Fisher, I have to say, does not belong to this sub-culture. He’s not loopy or eccentric or sinister, does not eschew orthodox medicine and does not advise against vaccinations. Another homeopath (a woman who is one of the bigwigs in the homeopathic world) also said that homeopaths are not against orthodox medicine. She seemed pretty sane and sensible too. I wonder if they’re embarrassed by their co-believers.

    I’m unable to say which is the more representative of the world of homeopathy in general but the lunatics certainly formed a lot more than just a fringe at this meeting.
    Ben was amazingly patient and appeared to suffer fools maybe not gladly but at least with forbearance and courtesy. There was enough nonsense spouted to give him material for a year’s worth of Guardian Bad Science articles. One woman collared him at the end with a long, boring and completely irrelevant tale of her cat’s homeopathic treatment. I don’t know how he kept a straight face but he did decamp as soon as she had finished.

    I was one who changed my vote. We were given one of those hand-held electronic voting devices and were asked at the start of the debate, “Does homeopathy work?” – answer YES, NO or NOT SURE. I voted “not sure”. At the end, when we were asked the same question, I voted “no”, because I felt that their case really had not been made, although there was anecdotal evidence in plenty and a couple of crazy rants too.

    It seemed that several of the audience felt the same. An NHM member of staff read out the voting figures at the end. I’m not sure if I got them down accurately but I noted down that at the start of the debate, the audience’s answers to the question were 57% YES, 22% NO. At the end, the answers were 52% YES, 26% NO. The remainder were NOT SURE. We’ll be able to see for sure when the video goes up.

    As Dr Fisher will doubtless point out, this is no proof that homeopathy is a sham and the number involved is far too small anyway. However, I think (assuming I got the figures right) that they do show that Ben made his case better than Dr Fisher.

    For me the major sticking point is how this homeopathy is supposed to work. In the past I have myself resorted to acupuncture and herbal remedies as a last resort because I can see (sort of) how they might work and of course there are many phenomena for which there is no (as yet) rational explanation. However – memories in water? P-l-eeeeze!!

    One homeopath told me that it wasn’t the dilution that made the difference. Oh, no. It was the energy from the shaking that did it.

    Er, right.

  41. Rakster said,

    December 1, 2006 at 12:04 pm

    I was there last night as well, I was the person who asked Dr Fisher what a “presensitised biosystem” which I don’t think he answered properly at all. The gist of what I heard him say was “for a homeopathic treatement to work, you have to be ill first, that way you can get better.” Okaaaay. And he used the words “imbalance in the body” which is getting far too close to energy fields and chakras for my liking!
    It did seem to be an outing for rent-an-alternative-practioner-mob, I was genuinely surprised that the audience was so heavily weighted towards the pro-homeopathy side.

    I went to the debate as while I’m clear on my opinion on homeopathy (it’s a load of wafty nonsense that has no place being funded by Mr and Mrs T. A. Xpayer), I’m not very good at explaining to people why I think it’s rubbish, it usually ends with me growling at them and leaving the room. So I figured that if I heard a reasoned debate and considered the aurguments carefully, it might make me more effective at putting my PoV across. I did try this on my flatmate when I got home but the free wine wiped out any chance of a reasonable conversation.

    I found Peter Fisher to be aggressive and confrontational, clever chap though he is. I also see from my notes (random though they are, again, blame the wine) that he used the phrase that homeopathy can “stimulate the body’s forces” which I’m sorry, from a *real* medical doctor is inexcusable.

    Loved the question about homeopathic polonium 210 as well, that was inspired…

    I also enjoyed the irony that the debate was being held in the “Glaxo Smith Kline Studio”. It’s all a big pharma conspiricy, I tells thee…

    Great job Ben, and a thoroughly enjoyable evening!

  42. Ben Goldacre said,

    December 1, 2006 at 12:17 pm

    i actually thought Fisher was pretty okay, i rather rate him, he’s rational and courteous.

    i mean, i guess it’s fair to say that he spent the first half of his talk telling us about something silly richard dawkins apparently once said about homeopathy in an introduction to somebody else’s book 7 years ago, and then some tv program he thought was a bit rubbish from 4 years ago, but it was a popular science event, and apart from that, and perhaps a teeny bit of arguable “cherry picking” of literature, i thought he was very pleasant and reasoned, as ever.

    what was really striking to me was the difference between Fisher and the audience of homeopaths. as i said when i first posted, before the event, Peter Fisher is not representative of the wider homeopathy industry, and they showed themselves in their true colours last night.

    so much about the discussion that was hugely amusing, i really can’t wait for the video to get posted.

  43. AgentR said,

    December 1, 2006 at 6:38 pm

    I went last night and enjoyed it very much. Ben’s pitch was very good, and all the better for not using PowerPoint. (I was interested to see Ben’s actually a bit better looking than his pic in the Guardian.)

    My one regret is that I didn’t get to ask Peter Fisher my question on air: “What concerns me is those homeopaths who ‘rubbish’ mainstream medicine. What mechanisms does the homeopathy profession have for disciplining people who give rash advice?”

    I did manage to ask him afterwards and he was pretty scathing about these people and said he has long advocated some kind of disciplinary structure. His anger and frustration were obvious. THAT would have been good to get out in the open on air. It’s an admission that there are rogue elements and they are not subject to any controls. I suppose it’s a different debate to yesterday’s topic but perhaps a more crucial one?

    Oh, and Ben, I think you are too kind re Dr. Fisher’s presentation. He also spent the first five minutes saying ‘of course homeopathy works’ because lots of people believe in it and it’s been going for a long time. Puh–leeeze!!!

  44. Ben Goldacre said,

    December 1, 2006 at 6:44 pm

    the reality is, whatever you think about him, dr peter fisher is not the homeopathy industry: the people in that room were the homeopathy industry. can’t wait to see the video.

  45. doctormonkey said,

    December 1, 2006 at 7:50 pm

    Response to #35 and also my interpretation of the posts made by those able to attend:

    Dr A – unfortunately I did not get a chance to challenge the misguided F2 SHO but this is what happens when one trains outside London…

    On a more general point, I think that we are running into a key problem here: the difference between COMPLEMENTARY medicine and ALTERNATIVE medicine (sorry about the capitals and the probable spelling mistakes).

    Dr Fisher and the rational wing of the homeopaths see homeopathy as complementary to science/sanity based medicine, that it has something valid to add in addition to…

    On the other hand, far too many people (possibly rightly) recognise the problems of feeling that both homeopathy and science/sanity based medicine are valid in the same philosophical world; some of these then reject science/sanity based medicine in favour of homeopathy, and so it is then an allternative. On the other hand, many of us reject the homeopathy and so we “believe” in science/sanity based medicine.

    By the way, did Dr Fisher explain why RCTs don’t work for homeopathy? and please let me know if I have just stated the bleedin’ obvious above or if it really is the problem with having an argument with homeopaths (that there are 2 flavours).

  46. doctormonkey said,

    December 1, 2006 at 7:57 pm

    mmmmm, flavours, can i have a chocolate flavoured homeopath? (roasted)

  47. doctormonkey said,

    December 1, 2006 at 8:24 pm

    oops x 2

    i had meant to be responding to #36 and i failed to properly respond.

    i try to have a consistent policy on CAMs.

    it has 2 underlying principles:

    1) i am a scientist and have a curiousity about how and why the world works
    2) i am a frontline doctor and have a duty to provide my patients with the best evidence based medicine i can

    therefore, i change my practice in 2) according to research even if i do not have a suitable answer for 1)

    examples of this are my use of short courses of high dose steroids (40mg prednisolone) for acute sinusitis rather than antibiotics because that is what the latest research seems to show i should do. the other example is my referral of patients for acupuncture (among other therapies) for back pain and knee pain from OA because the research appears to support this (particularly the review by Dr Edzard Ernst)

    therefore my reservations about CAMs are that they by definition lack evidence or we would use them in scientific/sane medicine

    to run through how this is applied in the examples given about Frau Dr A:

    herbal medicine – it works but can be messy, interacting with other medicine in unpredictable ways, is less predictable than scientific/sane medicine treatments and i am concerned that herbal medicine practitioners may not all be “safe”

    acupuncture – see above, if it has evidence :-) if not :-( still want to know HOW though

    light therapy – does not extend beyond brighter bulbs for SAD, also must plead ignorance of details

    i am not sure i would recognise anything as “long-standing “folk use” track record” if nothing else, look at all of the bad examples of this from within scientific/sane medicine!

    “pampering” therapies have their place and the manipulation part of massage can be as valid as some elements of physio and i would not discount the benefits of pampering in itself but… i want an evidence base for more benefit than that

    i hope that no one is offended by the quantity i have posted in the last few minutes but i thought i might make an interesting case study of a front line doctor and my response to CAM

  48. Dr Aust said,

    December 1, 2006 at 10:47 pm

    Light therapy shows some promise in depression but is one of those things which need more trials, Dr M – there is a Cochrane review on it at:

    www.update-software.com/ABSTRACTS/AB004050.htm

    What I meant by the “long standing folk use / track record” bit was as in something like valerian extracts for mild insomnia. Valerian has been trialled and meta-analysed: a systematic review by Edzard Ernst in 2000 found “sparse evidence” or “not enough”, though some positive results in better trials.

    www.jr2.ox.ac.uk/bandolier/band81/b81-7.html

    …and there are some later trials as well – for an interesting look at the argument relating to “should I recommend valerian for sleep problems” see:

    ebm.bmj.com/cgi/content/full/9/3/68

    …arguably in a case like this (evidence thin but some indication of benefit) the “long-standing folk use” of valerian for sleep disturbances might also factor in as a mild positive indication.

    An interesting “straw man” question is: “Does EBM mean: “only well-conducted randomized double-blind placebo-controlled trials count as evidence”?”

    As I understand it the answer is no, and ALL evidence (even down to anecdotal) is evidence. But the different kinds get a ranking and the DBPCRCT comes top.

    On a different issue, the one complaint that the alties make that I have a little bit of sympathy with is that they can’t get large trials of (e.g.) herbal remedies going as, since there are no patented drugs to be sold with exclusive rights, there is not enough cash to be made for someone to bother (contrast drug companies). Therefore, they argue, the trial evidence on alt remedies is always going to be based on smaller studies which are underpowered.

    Of course, the supplement companies do make money out of herbal remedies, so the argument is a cheat in some ways. I have no doubt that if they had to show evidence of efficacy to get the stuff on the market (instead of just flogging it as “a supplement”) they would run bigger trials.

    Incidentally, herbalism is far more “mainstream” in Germany, with medical schools often offering courses in herbal medicine and many more doctors prescribing herbal remedies… may be why Mrs Dr A is a bit more sympathetic to herbs than some.

    It is important to think “risk-benefit” for herbal medicines, though, e.g. WRT side effects and drug interactions. I had one friend who took St J’s Wort and then went out in the sun and got a nasty skin-rash due to its photosensitizing effect.

    In Der Vaterland you have to have a degree level training and a recognised professional accreditation to be a non-medically-qualified “medical herbalist” – so they are regulated quite tightly. Comes back a bit to what one of the posters above said about Peter Fisher and his view of the “mad fringe” of barking homeopaths (see malarial prophylaxis passim ad nauseam).

  49. TimW said,

    December 1, 2006 at 11:02 pm

    Ben, I bet you’re looking forward to seeing the video.

    ;-) So am I.

  50. doctormonkey said,

    December 2, 2006 at 12:28 am

    Dr A, I am pleased to see this about light therapy.

    I can recall one particular patient who appeared to have depression it turns out but initially complained in part that she felt low and thought that her dark front room was part of the problem – I advised (would have loved to prescribe) a higher Watt light bulb!

    My reservations about herbalism are as you say – the side effects can be nasty and the practitioners are too mixed a bunch and they may not only lack the skills to diagnose but also the training to know when they are out of their depth (a key part of medical training known as referral to a specialist/dumping back on the GP)

  51. doctormonkey said,

    December 6, 2006 at 9:24 pm

    i’ve heard from the NHM (Natural History Museum) about the webcast:

    “Many thanks for your email. We are aiming to get the session up on the archive for Tuesday 12th December, so please check the Nature Live archive section then. The address is www.nhm.ac.uk/nature-online/nature-live/video-archive/nature-live-video-archive.html

    i’m looking forward to it

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