Chatting to a homeopath

September 12th, 2007 by Ben Goldacre in homeopathy, podcast | 43 Comments »

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Sorry there was no column last week. I have not been killed in bizarre sexual experiment that went horribly wrong, a problem came up and I was out of earshot on my way to a conference, no excitement this time. Anyway, on my way through Manchester yesterday I came across Prof David Colquhoun having a debate with Felicity Lee, the previous Chair of the Society of Homeopaths. The debate itself was the kind of thing you’d expect and there’s a recording here:

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But meanwhile, as well as doing lots of fun interviews with jolly famous science types on a posh broadcast recorder, I’ve also been carrying a little mp3 device around in my pocket, in case of serendipitous encounters. I said hello to Felicity and we had a chat on a bench, which you can listen to here:

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Felicity has a very interesting history. Before becoming chief homeopath she used to work as a pharmacist in “Medicines Information”. They are the people you ring, as a doctor, for a quick clinically relevant precis of the latest research on efficacy for a given treatment, and they’re very handy indeed.

So Felicity knows about evidence, she has worked applying it for a living, and I hoped she could offer some insights into philosophical aspects of the meaning of evidence in homeopathy, and namely this: if the power is in the pill, as homeopaths claim, then why do they also say that you can’t measure the benefits like you would with any other pill?

As you can hear I wasn’t in combat mode – I never really am, I find this stuff interesting more than irritating – although it did get a bit wearying. Ultimately it was like those circular conversations you can end up having with the devoutly faithful, except Felicity’s beliefs didn’t seem to be labelled as “faith”, which I felt made things a little more tiring than they needed to be.

I guess there are more important things to homeopaths than my happiness.

Anyway, I’m posting it up unedited on the off chance that anyone is interested in having this kind of thing on in the background while they make some toast. If a budding media student wants to edit down to the interesting bits without making a hash of either of our views then feel free and I’ll post it, although I quite like the idea of unedited witterings in the background; and if any vaguely senior homeopath, vitamin industry person, stats god or evil big pharma suit wants to have a chat and see what kind of mood I’m in, give me an email on ben@badscience.net as ever.

Oh, and in case you forgot: Positive Internet are gods, and alexlomas is a very clever man.

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43 Responses



  1. ellazimm said,

    September 12, 2007 at 6:32 am

    What kind of bizarre sexual experiment might you have been killed in? I know what I think about homeopathy but the thought of you locked in a hotel room with a trampoline, a crate of grapefruit, and a crop-wielding Nazi typist is just too hard to get out of my mind.

  2. BSM said,

    September 12, 2007 at 7:32 am

    “Makes me wonder if it is too far fetched to imagine Homeopathy as merely a far superior form of placebo compared to the conventional placebos used in medical trials.”

    Even Peter Fisher has admitted that homeopathy may merely be an “advanced form of placebo” effect. The basis for his continuing support of the water and sugar retailers masquerading as suppliers of effective medicine presumably lies in that word “advanced”, whereas, advanced or not the crux of the matter is that it is just a placebo effect.

    Frustratingly I have been trying to nail that quotation to a linkable citation and have not been able to track it down. Perhaps Ben can recall its source, was it in that debate that he had with Peter at the Natural History Museum?

    www.badscience.net/?p=339

  3. stvb2170 said,

    September 12, 2007 at 9:11 am

    I notice that you are on the look out for a vitamin industry person again. I’m confused here as the bandolier evidence based medicine website advocates taking a vitamin pill every day in its top ten tips for healthy living.

    Do you disagree with vitamin supplements outright, or just think that they overstate their case?

  4. doris said,

    September 12, 2007 at 9:22 am

    At the risk of provoking scorn,I will say that I have known a practising homoeopath for weveral years.
    She is a person of greatand compassion and yes,I have sought her help in the past,despite my atheist and secular convictions and my scientific education.
    The time given and the relationship established are crucial;on reflection,I believe the placebo efect is implicit.
    Indeed,homoeopaths stress that they aim to help the body heal itself.
    That said,no good seeking remedies for diabetes,cancer,severe injury,etc.
    A number of GPs work alongside homoeopaths here in Bath.My late,much-missed GP prescribed remedies regularly to those who asked.
    Finally,what about the use of homoepathy in veterinary paractice?
    There is much,admittedly anecdotal,evidenceto sugest that animals respond well;a variant of the human placebo efect?

  5. coljac said,

    September 12, 2007 at 9:24 am

    A very good interview. Ben did a great job of trying to pin her down on the real issues, and it became starkly clear that in fact she had no answers – only vagaries about “differences in philosophy”. Definitely good listening for the skeptically minded.

    The problem with the placebo effect is that it works – would it even be possible to construct a scientifially based, ethical system to reap this benefit as well as homeopathy does? (Getting doctors to spend as much time with their patients as homeopaths to seems like a tall order).

  6. David Colquhoun said,

    September 12, 2007 at 9:24 am

    The nearest I’ve got to what BSM wants is the statement documented at my old page
    www.dcscience.net/improbable.html#fisher2

    At the end of his paper, Fisher, P. & Scott, D. L. (2001). A randomized controlled trial of homeopathy in rheumatoid arthritis, there is this statement.

    “Over these years we have come to believe that conventional RCTs [randomised controlled trials] are unlikely to capture the possible benefits of homeopathy . . . . It seems more important to define if homeopathists can genuinely control patients’ symptoms and less relevant to have concerns about whether this is due to a ‘genuine’ effect or to influencing the placebo response”

    But of course at other times Fisher has denied strenuously that it is only placebo.

    Incidentally the outcome of this trial was that homeopathy didn’t work. Oddly enough Felicity Lee mentioned arthritis in her interview with Ben, but did not seem to be aware of this paper!

  7. asmilwho said,

    September 12, 2007 at 9:31 am

    Hallo Ben,

    here is a nice article about homeopathy:

    arstechnica.com/articles/culture/the-pseudoscience-behind-homeopathy.ars

  8. superburger said,

    September 12, 2007 at 10:32 am

    about 7:30 minutes into the 2nd interview a bell tolls. nice.

  9. spindle said,

    September 12, 2007 at 11:10 am

    I’ve just listened to both. The “debate” is not really worthwhile, just the usual arguments from both sides and (as the moderator says) nobody’s mind is changed.

    The discussion with Felicity Lee is fascinating, because she’s honest enough not to retreat into mumbo-jumbo particle physics or any of the other standard homeopathic squid ink “explanations”, and you’re left with just a vacancy. She has no evidence, no explanations, and no explanation for her belief in homeopathy despite her clearly knowing what counts as good evidence and the fact that there’s no good evidence for it. I found it quite difficult to listen to in places, because there’s obviously a conflict between her belief in homeopathy and her knowledge that there is no proof for it, and the mental conflict is apparent.

    Ben also gives a very clear rebuttal of the standard “randomised trials can’t work with homeopathy” bullshit, and again Felicity has no response – she doesn’t try to baffle with the usual circular arguments and obfuscation, she can clearly see that randomised trials would be appropriate, and that in the cases where they have been done, homeopathy doesn’t work any better than a placebo. Again, the conflict between “homeopathy has an effect beyond the placebo”, “homeopathy can be scientifically tested”, and “scientific tests have shown that homeopathy has no extra effect”.

  10. jackpt said,

    September 12, 2007 at 11:36 am

    It wasn’t toast, it was cold last night’s kebab (the salad is good for you) but it’s uncomfortable listening because she’s nice. Your interview technique reminds me of Columbo: “One more thing…” :)

  11. Crispy Duck said,

    September 12, 2007 at 12:03 pm

    A three-way trial would be interesting – have there been any? The trial would compare three groups – one taking “real”, “active” homeopathic remedy, one taking a placebo homeopathic remedy, and one taking nothing. The first two groups would also get the full hour of compassion and support, the third would just have their symptoms noted and be sent home after an NHS/GP-style 7-minute consultation.

    We would expect the “compassion+homeopathy” group to perform similarly to the “compassion+placebo” group, and both to perform better than the “bugger off” group.

    I don’t see how homeopaths can even acknowledge the existence of the placebo effect without realising how Samuel Hahnemann (sp?) came to his erroneous conclusions in the first place…

  12. maninalift said,

    September 12, 2007 at 12:07 pm

    I’ve just listened to the first few seconds of the debate. I noted that the phrase “so logically…”, as it ever is, was used to paper over a gap in the logic.

    The same phenomenon occurs with the statements “statistically/ mathematically/ logically/ scientifically speaking” which always seem to be used to preface statements utterly lacking in the rigour of the any of these disciplines.

    Perhaps the explanation is that if you see logic or statistics or science as just a way of speaking that can be applied here and there then you have probably not understood how it relates to whatever it is about which you are talking.

    Of course one can speak more or less in the language of a given discipline or field of study but it is nonsense to say “theoretically speaking X is the case” and “statistically speaking Y is the case”.

  13. zakmundo said,

    September 12, 2007 at 1:21 pm

    Clearly her point is that one cannot separate the homeopathic pill from the homepathic practicioner. Whether right or wrong, this should lead, at the least, to a well aimed question about her opinions on the efficacy of homeopathic pills bought over the counter at Boots etc.

  14. BobP said,

    September 12, 2007 at 1:33 pm

    I like the idea of an “advanced placebo” in #1 and #3 – do you think there is the potential to make money out of it? How many RCT’s could have had different results if an advance placebo had been used instead of an ordinary one?

    Doris – no scorn. I’m an ex acupucturist; when I tried earning a living at it, I was no good but I’m comfortable with my former mates practicing acupucture & I consult one myself every now & then.

    However, the theory of acupuncture is non-existent (or inconsistent, which is the same); its experimental basis is zero; and anyone who tries to provide a scientific justification for acupuncture is talking through their rear end.

  15. doris said,

    September 12, 2007 at 2:01 pm

    I quite agree,BobP;there is no satisfactory theoretical basis for any of them: perhaps it’s the comfort factor.
    That said,I am still intrigued by the reports on animals’ responses to acupuncture,homoeopathy etc.
    Any first-hand accounts out there?

  16. csrster said,

    September 12, 2007 at 2:10 pm

    You want first hand accounts of animal homeopathy?

  17. maninalift said,

    September 12, 2007 at 2:21 pm

    To me there are two questions with regard to Homeopathy in the NHS.

    The first is whether it is a worthwhile investment of resources given it’s efficacy whether by placebo or homeopathic mechanism.

    The second is how do you reconcile it with the way “scientific medicine” is regulated. The options I see are:
    (1) Review the evidence properly and if you conclude that the effects are purely placebo cease funding or recommending homeopathy on the basis that it is unethical to mislead the patients (this is the usual attitude to placebos).
    (2) Review the evidence properly and if you conclude that the effects are purely placebo carry on regardless on the basis that it is harmless to allow placebos to be prescribed in this special case which is also clearly separated from mainstream medicine.
    (3) Try your hardest not to review the evidence because it is much more convenient to have a level of uncertainty that allows placebos to be prescribed without the ethical dilemma of being sure that that is all they are.

  18. AitchJay said,

    September 12, 2007 at 2:22 pm

    Only listened to Ben’s so far, and the bell in the background is well timed..

    I thought she was good and quite reasonable – she didn’t get defensive or hysterical when challenged – sure, light on the answers, but still reasonable.

  19. superburger said,

    September 12, 2007 at 2:23 pm

    even the homeopaths poster boy, Peter Fisher has said that animals and baby experiments can be susceptible to a placebo response (he says it a video debate with ben, somewhere on this site)

  20. Bogusman said,

    September 12, 2007 at 3:30 pm

    I had an interesting chat with Mrs Bogus the other day. She is a midwife and uses various complementary therapies in her practice, including homeopathy, reflexology and acupuncture. I asked he how she could square her evidence-based practice of midwifery with the mumbo jumbo of all the above. She acknowledged, quite happily, that she is dealing in placebo effects but said that at the time of the “treatment” it is important to her that she believes in what she is doing. I think this says something about the significance of double blind tests in this area.

    For myself, I have been around her and sometimes her clients, for long enough to recognise that there is value in the outcomes of these interventions even if the purported mechanisms are deeply unsound.

  21. Dr T said,

    September 12, 2007 at 3:39 pm

    Hi Crispy Duck,
    I like the idea of your trial, but to really nail whether it’s all the empathy and discussion from the practitioner rather than the water, you would have to add another treatment to the trial – homeopathic consultation without prescription. The experimental design is getting a little unwieldy here, but I would be concerned that a empathy + pure water (err, isn’t that what it is anyway.:-P) wouldn’t factor out the ‘ritual’ element of taking a ‘medicine’. And to really get the design balanced, your last one would have to be a GP’s 7 min consult + homepathic rememdy.

    Can’t see this one being carried out…

    BobP – re the efficacy of Acupuncture. I remember seeing a trial on telly with the ‘Rough Science’ woman (whose name ecapes me) doing an acupuncture trial with a v. powerful MRI scanner. It showed that there were changes in brain activity during acupuncture (ok, n=6, I think so it ain’t a Nature paper, but it was a start to testing it properly) Unfortunately I can’t remember what the outcome was, so it’s not a great story – Anyone out there remember?

  22. wilsontown said,

    September 12, 2007 at 4:35 pm

    Bogusman:

    I think that you’re right that there is some value in things like homeopathy. If it makes people feel better, even if only through the placebo effect, can that be a bad thing.

    There’s an ethical problem here, though, and that is that homeopathic remedies do not claim to be placebo: they claim to be better than placebo, for which there is no good evidence.

    And is it right to spend taxpayers money on something that is simply a good placebo?

  23. Bogusman said,

    September 12, 2007 at 5:09 pm

    I would venture to suggest that it can be. If the benefits are genuine and the costs are low then why not? For me the interesting issue is that of the mental gymnastics required to deliver the “therapies” with a straight face when your education tells you that they are pure placebo.

  24. doris said,

    September 12, 2007 at 6:31 pm

    I’ve read the JREF entry,Wilsontown; as you say,plenty of scope for observer bias:smells detectable by vets in ‘blinded’ trial.
    I suggest csrster reads it as well: i’ve yet to meet an animal who can give an acount of anything.
    To return to the practitioner I know: she helps an awful lot of people,many of whom are living at the bottom of the heap: she provides free help and advice to recovering drug addicts and homeless people,amongst others.Placebo effect or not,she is giving some kind of hope to some very unhappy and distressed people;several of her clients are now free of drugs and moving towards a more constructive way of life.
    I suspect this has more to do with her dedication and commitment than the remedies employed.

  25. BobP said,

    September 12, 2007 at 7:00 pm

    Dr T

    I remember it. The acupuncturist was Hugh MacPherson of FTCM ( www.ftcm.org.uk/ ) – a very nice bloke. It was a typical TV trial, they looked at brain activity changes during real acupuncture vs sham acupuncture and there was a difference – however there was only 1 subject in each group, and there was no link to clinical benefits.
    * Nothing proved *

    There are a few decent trials with back pain etc which show a benefit – FTCM was involved with many of them. I’ve been of touch with that stuff for a few years, I can’t remember how many, or whether acupuncture was better or the same as e.g. manipulation.

  26. Dr T said,

    September 12, 2007 at 9:22 pm

    Thanks BobP
    I certainly remembered there weren’t enough subjects in the telly trial!

    I’ve had a look at some of the FTCM papers on back pain – seems to be ok w.r.t. methodology and outcomes, but of course, as an open trial, placebo can’t be ruled out. I liked the MRI approach because it showed a way testing a therapy in a truly ‘blind’ trial. I wonder if they followed it up…?

    this paper is free from pubmed, if anyone is interested:
    www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=16980316

  27. Dr* T said,

    September 12, 2007 at 9:44 pm

    Dr T,

    I saw your additions on other pages and thought I was getting forgetful as I hadn’t made those entries!

    **Distances himself from Dr T**

    ;)

  28. Dr T said,

    September 12, 2007 at 10:08 pm

    LOL Dr*T – great minds think (or are named…) alike, of course!
    Sorry about that – I had no intention to name steal.If I can find a way, I’ll change my username….

  29. Robert Carnegie said,

    September 12, 2007 at 10:22 pm

    Since modern homeopathic stuff consists of water or a chalk pill anyway, in chemical terms, the difficulty in a trial would be producing a dummy treatment that isn’t accidentally homeopathic.

    I gather some of the fundamentalist faithful homeopathists believe that the actual act of prescription and even preparation of the drug are included as sacraments, and the taking of the nostrum completes the arc of trust – so that if a mischievous scientist steals the homeopathy pills and substitutes fakes, the ritual link between homeopharmacist and patient is not disrupted. They are still acting in good faith.

  30. Martin said,

    September 13, 2007 at 2:02 am

    Doris, your friend sounds wonderful; helping drug addicts and the homeless with a sympathetic ear and supplying her time for free. If only all homeopaths were like this, I’d have no problem embracing it as a treatment. My problem is when money is diverted away from the NHS to pay for an expensive placebo.

  31. Dr Aust said,

    September 13, 2007 at 8:27 pm

    Re the BBC show w acupuncture, this was the one with Kathy Sykes, who is a sensible person but was way off her ground in the health arena and got taken for a ride. David Colquhoun has given the programme the once over on his old blog here:

    www.dcscience.net/improbable.html#bbc2

    ..and there is also a bit about how the programme was found officially to have “misled the viewers” here:

    www.dcscience.net/improbable.html#bbc4

    On the comment about animals and homeopathy, wilsontown has already pointed out the major reason why this is balls (above). Another reason (apart from it being the human who “judges” the animal’s recovery) is that pet animals rather obviously respond to the mood / behaviour of their owners – see “Dog Borstal” for TV examples. So if the owner feels better (because they think Tiddles is looking better), Tiddles will probably perk up, or calm down, or whatever.

    NB Apart from working on babies, as has already been observed, this also works for small children. Take it from an owner, or see any number of TV parenting shows.

  32. clobbered said,

    September 13, 2007 at 11:45 pm

    Has there been a trial in which groups are first separated according to whether they are inclined to trust medicine or not? I.e. take one group of die-hard rationalists and have either a doctor or a homeopath administer to them the randomised pill (real drug/sugar pill/”homepathy” pill) and then do the same with a group of people who profess themselves homeopathy believers.

    I.e. maybe statistically for a population the sugar pill and the homeopathy pill are equivalent in inducing the placebo effect, but maybe for a given individual, one is more likely than the other to induce a placebo effect depending on who is administering it.

    Hell, maybe my mind is more likely to induce a placebo effect when a sugar pill is presented as a headache cure by a curt Head of Neuroscience at Oxford than by some loving caring monk, and maybe for others it is the reverse.

    Come to think of it, is there any record of how the placebo effect differs depending on the perceived status of the person prescribing it (nurse/doctor etc)?

  33. Kelly Spark said,

    September 14, 2007 at 3:24 am

    However I can’t see the good of Colquhoun’s (and other same) activity. Is it necessary to spent a lot of time in fruitless discussions about problems, which you can solve? Quacks, charlatans, homeopaths and other CAM therapists don’t react to your criticism and persist in their dishonest practice! Ann Walker was the only person, who actively answered your criticism. The rest don’t even pay attention to you and continue to prey upon the credulous. For example, this odious Patrick Holford! Certainly, he will never dare to follow the lead of Ann Walker. Your criticism fails in the object. Holford merely snarls a bit at your criticism and hold on doing what he likes. And his dishonest business prospers.
    But Holford is merely one of them! There is a crowd of such “actors”.
    It’s terrible situation. But can’t we take more drastic measures against these dishonest practicians?
    They are diabolically active. But if you (or, for example, mentioned Colquhoun) can’t be as active as they are, then what for on the earth to spend the time in vain discussions? :(

  34. wilsontown said,

    September 14, 2007 at 10:27 am

    Here’s an example of Holford taking ‘a great interest’ in Prof. Colquhoun’s site:

    dcscience.net/?p=159

    Holford also seems to be hassling people who posted comments at Improbable Science.

  35. projektleiterin said,

    September 14, 2007 at 1:15 pm

    Now he sounds quite British, funny.

    For someone so skeptical about homeopathy he was quite nice to Felicity. It reminded me of the situation where an unprepared student is desperately looking for answers and the teacher knows that she does not know them, has pity with her, but nevertheless knows that he has to proceed with the inquiry.

  36. Dr Aust said,

    September 14, 2007 at 2:00 pm

    Agree one has the feeling of going round and round in circles with the alties.

    But… if sites like this and David Colquhoun’s arm the sceptical with more info / evidence with which to debunk Woo as they come across it in whatever circles they move in, that can hardly be a bad thing, no?

    Re. Patrick Holford, he certainly does seem to be making Ann Walker-esque noises, and he did direct his long threatening letter (demanding an apology and “reserving the right to take further action”) not only to David C(see link posted above by Wilsontown), but also (via cc) to the Holfordwatch crew, to Ben, AND to people (several of them posters here) who have posted comments on DC’s blog or at Holfordwatch agreeing with and sometimes expanding on what DC has written.

  37. NickConnolly said,

    September 15, 2007 at 9:41 pm

    If homeopaths have ethical problems with double-blind trials then why not do those trials on plants?
    If homeopathic remedies are not all in the mind then they should work on plants. Any placebo effect will be limited by a plants lack of a central nervous system.
    Of course the general care of the plant will effect its well being so to some extent there will be something akin to a placebo effect on a non-blind trial. However if the person caring for the plants has no idea which plants are being treated then that effect can be neutralised.
    Plants would also have the advantage that the specific illness could be induced without any ethical issues.

  38. Dr T. fortunei said,

    September 16, 2007 at 7:53 pm

    Hi NickConnolly,
    re plants and homeopathy – Yup, they have thought of that. There are a few articles looking at the effect of homeopathic treatments on plant diseases and a discussion on the use of plant models. I’ve just been wading thro’ the following (it might be limited access:
    www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6WXX-49NPHTK-7&_origin=SDEMFRHTML&_version=1&md5=c6d7f3cb5a8d1d87f75d40f105eb88ef
    and frankly it is rather tough going. To someone familiar to the science literature it is really odd reading an explanation of the mean and variance, but at least they are trying.
    However, from a cursory read (if you have full access) although they find an effect of homeopathic arsenic on the plant virus, I think there is a flaw in their analysis – they had lots of leaf discs, but they were split between dishes, and they have not analysed the block element of their design. Of the articles I have looked through ther eare quite a few that suffer from rather weak statistical analysis. I must mail them and ask for the raw data…!?

  39. NickConnolly said,

    September 16, 2007 at 9:33 pm

    //Of the articles I have looked through ther eare quite a few that suffer from rather weak statistical analysis.//

    …but maybe if they dilute the statistics enough they’ll actually get good at it…

    Thanks for the link. I’ll look it up.

  40. Dr T. fortunei said,

    September 16, 2007 at 10:12 pm

    hahaha nice one, nick ;-)

  41. NickConnolly said,

    September 17, 2007 at 4:53 am

    //I’ve just been wading thro’ the following…//

    Reads to me as if they’ve screwed up somewhere and then reported something fishy about there experiment “The treatments generally induce a decrease in system variability, as evidenced by the decrease of the index of dependence on experiments (η). It is noteworthy that this decrease is induced also (and even more markedly) by centesimal potencies, which do not act at the first level (hypersensitive response in terms of lesion number). A similar decrease in system variability emerged from a 3000 data point collected in a parallel research performed on the same model and involving treatments with water conditioned by weak microwave radiations.” – i.e. the treatments appeared to have other statistical effects.

    Still largely unkooky until the end: “The polarity between the effects observed in a standard plant and in the system, regarded as a whole, recalls the polarity of water accepted in quantum physics as a free electric dipole laser,[37] where the apparent dualism particle/wave is solved by the fundamental equations of relativism.” [!???!!]

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