Ben Goldacre
The Guardian
Saturday December 1 2007
If you were going to be actuarial about media coverage – an eighth of a column inch for each premature death perhaps – then this paper would be filled with diarrhoea and Aids. Today is World Aids Day: so come with me on a world tour of Aids quackery.
South Africa is traditionally where we would start such a voyage, headed as it is by President Thabo Mbeki, a man who remains an HIV denialist and recently told a biographer that he regrets withdrawing from publicly discussing his beliefs. He has compared Aids scientists to Nazi concentration camp doctors and portrayed black people who accepted orthodox Aids science as “self-repressed” victims of a slave mentality.
Mbeki pursued his own investigations on Aids therapies, resulting in government endorsement of Virodene, a home grown South African drug. Medical treatment for Aids cost $1,200 a month, but Virodene cost $6, “medicine developed in Africa for Africa”. Virodene was in fact based on the industrial solvent dimethylformamide, which is toxic, potentially lethal, and with – bizarrely – no proof of efficacy against HIV.
The Democratic Alliance is putting questions in parliament to the presidency about the ANC’s possible financial involvement in the drug, following fresh recent allegations that tens of millions of rand in cash were ferried from the party to the Virodene company.
Meanwhile The Namibia Economist reports that a product using the same industrial solvent is about to be shipped to several health facilities in the Congo. Gambian President Yahya Jammeh claims he can cure HIV, Aids and asthma, using charisma, magic, herbs, and charms. “The cure is a day’s treatment,” he says, “asthma, five minutes.”
In Nigeria Jeremiah Abalaka, a general surgeon working independently, is selling large quantities of a vaccine and a treatment for Aids. He self-administered the vaccine before dramatically injecting himself with HIV-positive blood on six separate occasions. The Nigerian Academy of Science visited his clinic and concluded his claim could not be verified, although Abalaka is now suing the Academy. “Abalaka hasn’t even got the facilities in the lab to produce any vaccine,” says Professor Olusegun Oke, vice-president of the academy. “His lab is virtually bare.”
Before you feel smug and superior, the Society of Homeopaths are holding a conference in London today featuring the work of Peter Chappell, who also claims he can make an immediate impact on the Aids epidemic using music encoded with his Aids remedies.
“Right now,” he says, “Aids in Africa could be significantly ameliorated by a simple tune played on the radio.” Damningly, contemptibly, not one single person from the homeopathy community has spoken out to criticise this lunacy.
And of course our own rather grand Patrick Holford, Britain’s leading nutritionist, who sells bottles of vitamin pills with his beaming face printed on them, writes, in the “fully revised and updated” 2004 edition of his 500,000 copy best seller “The Optimum Nutrition Bible”, the alarming words: AZT, a drug still routinely used alongside other drugs in Aids treatment, “is proving less effective than vitamin C”.
Aids funding from the US to developing countries routinely comes with religiously motivated edicts that Aids workers should not engage with prostitutes, and of course needle exchanges for drug users are frowned upon. And finally, most evilly, multinational pharmaceutical companies fight tooth and nail against countries who try to manufacture Aids drugs off-licence in public health emergencies, even when using the perfectly legitimate Doha Declaration. Nationalise the lot, I say.
Peddlers of nonsense treatments – and newspapers – trade in emotive anecdotes. Three million people died last year of Aids, and that figure elicits insufficient emotion, outrage, and coverage, because it is the polar opposite of an emotive anecdote. Nature outguns any man-made weapon, and it remains our greatest challenge. Our greatest impediment is wishful, brutal stupidity.
Please send your bad science to bad.science@guardian.co.uk
orlando said,
December 4, 2007 at 9:50 am
Interesting article here touching on the outcome differences of abstinence vs harm minimization, preaching vs doing something practical tussle:
www.smh.com.au/news/national/courage-on-the-streets-kept-aids-in-check/2007/12/02/1196530481821.html
BobP said,
December 4, 2007 at 10:24 am
Re Oxfam – the herb garden is only available on the Ireland website, not in the UK or US – so it may be a bit of spin for the Catholic South.
And £18 is quite a lot of money for a few herb seeds, so I suspect that they are delivering more than just the seeds as part of the package. But I agree that the ad (as currently presented) is ambiguous.
Just in case they emulate the BBC and change the words, this is what it says at the moment –
This gift is part of a holistic approach that mixes traditional and modern medicine
(along with training, counselling, education and access to anti-retroviral drugs) for people affected by HIV and AIDS in Tanzania. Happy herbal days!
outeast said,
December 4, 2007 at 12:15 pm
Thanks for posting those press references, RC. I’m still somewhat sceptical – but there certainly seem to be legs to the rumour. Horrifying if true.
Bogusman said,
December 4, 2007 at 12:21 pm
If you read the small print on the Oxfam gifts they don’t actually guarantee that your donation will buy the item listed. So the £18 quid is probably going on something quite sensible.
ceec said,
December 4, 2007 at 4:45 pm
cvb – question about how often condoms fail (I assume you mean in use rather than in other tests)
There are quite a few hilarious scientific papers on condom slippage and breakage rates which you could find via pubmed if you are very keen. As far as I recall, breakage is more likely if there is not enough lubrication, or if two condoms are used at once (presumably this has a similar non-lubricating effect).
aswdodge said,
December 4, 2007 at 5:36 pm
@BobP
I think you’re right about the herb garden being spin. We have way too many naturapaths, homeopaths, chiropractors etc and their sympathizers in the south of Ireland.
Definitely figuring the catholic thing has something to do with it as I first saw this advertised in a newspaper and it contained all the items listed under healthy living (www.oxfamirelandunwrapped.com/browse/healthy_living.html)
except for the condoms.
@Bogusman
Whether they do spend the money on more worthwhile projects or not, it still lends credence to quackery.
Ella R said,
December 4, 2007 at 6:21 pm
I must say it is really rather disappointing.
But world is just not perfect, is it…
With all that commotion going on
around the SoH symposium on AIDS and homeopathy and complementary therapies
(wouldn’t call them medicine) lately,
I finally got to reading Ben Goldacre article
(and some other of his related articles and some of blog conversations on the internet).
But I haven’t learnt much except perhaps there is a lot of ego stuff
flying around. It is often arrogant and it is biased.
I was keen to read the article and mr. Goldacre certainly made some excellent
points, which could have been interesting to read about if the author had managed
to drop his personal agenda, which took a good third of the original article. The
good points made are swamped by sniding and haughty remarks and the
so much wanted clarity the author himself demands from
others is missing.
Among other suggestive remarks he says: that homeopaths love prescribing – as if GPs do not,
and lets not go into statistics – it is just one of
quite a few of mr. Goldacre personal opinions of no gravity. It’s neither here nor there,
(I don’t care if they do or don’t, will it help me is the question.)
And so what that has got to
do with anything, except his own subjective perception… it is just another
misleading … well, I cannot say information, because it ain’t…
As for the horrible homeopaths and other alternative/complementary
practioners that he meets in his life – it may be a repetative pattern
suggesting something that may deserve some attention.
How we express ourselves about others and our attitude towards them tells a lot about ourselves and not
about others (and this is what was little tiring about reading those blogs, will not do this again).
Have an independent communication coach read the article and you will
learn about personal work mr. Goldacre should do to be an objective journalist to handle
the need of a clearly presented case of evidence.
(And that reminds me, I want to look more into the placebo versus homeopathy issue…elsewhere.)
The issue itself is, however, definitely an exciting challenge:
Hippocrates said that it must be the whole person that is treated and, curiously, it is the
principle of holistic, complementary therapies nowadays, even though Hippocrates Oath is
officially physicians’ domain. Allopathic medicine is symptomatic, and does not deal with
the whole person.
To be a complementary (alternative) practitioner, ideally the well developed
emotional ballance is required, which is not always, even often, the case. With more complex inner issues at play,
these practitioners stand on a shiftier ground than the more mechanical/material medical science .
As a scientic with a brilliant brain and impressive results, one does not need
to bother with emotional intelligence. Emotions, rightly, have no place in scientific evidence.
One of my big questions on this exciting subject would for example be:
why double-blinded and other scientific trials be required for homeopathic remedies?
Everyone knows a homeopathic pill is a sugar pill, with no other chemicals (synthetic or natural)
present.
Five or even ten tubes of sugar pills would not do any damage to the body system whatsoever,
five or even ten tubes of common drug like paracetamol would.
No need for deep discussion here, common sense suffices.
Anything produced as a chemical medicinal drug should definitely be tested and
very strictly at that, because it can kill, and it did.
Why should it be necessary to test milk and sugar „scientifically“?
The issues around a homeopathy and other complementary disciplines are of a diferrent calibre and edging on disciplines such as
psychotherapy, quantum physics and philosophy.
Allopathic medicine is Newtonian based, operates on cruder level, is chemically
or mechanically invasive and in many, especially acute/emergency situations, is
indispensible and works amazingly. The progress modern medicine is astonishing.
But there is also more subtle level to our existence and our health and
they are, wanted or not, quantum based. The inner
processes in us influence our inner being/world, the matter adjust itself to the
direction of energy, (we materialise what we focus on, we give it an information), and that eventually,
with a principle of critical mass, makes a leap into our outer being/world, it
manifests on the cruder level. It actually seems to be very simple and even more
beautiful, elegant, clever and important than evidence-based medicine.
(Mr. Einstein told us that all matter is energy a hundred years ago.
And it has been here since the beginning of time, if time indeed exists, I really do not
see why the word “quantum” should be attacked and ridiculed
in connection to homeopaths and other complementary therapists,
since this is the level these therapies often work on and there isn’t other word to describe it better.
I can hardly describe a chair with the word “table”.)
Unlike symptomatic „do something“ allopathic medicine, complementary therapy is
directed towards the more subtle levels and endevours go to the core to help
resolve the underlying issues. It is oriented towards a way of „being“.
Many people (in long running chronic, not acute, state) seek allopathy, because they are not ready
to take responsibility for their state of being….and doctor will do something.
Many people seek complementary medicine because they want to find true health, not
just temporary fix and get back to that state that got them into illness in the
first place. Some of them are ready to shift within fundamentally, which
complementary therapies suppport.
And I agree, it is unfortunate that there are complementary therapists that
dissuade clients from visiting GP, taking antibiotics or vaccination (regadless
of the abuse of these in our society). An ethically working practitioner would
support a cooperation with a medical doctor. Which of course
brings on a problems of finding one, who would be open to an alternative
approach and take part in keeping an eye on a patient also during a complementary treatment.
But that brings us to issues like health care system organisation, and further to education and
public awareness of one’s personal right as well as responsibility to be healthy
and enjoy living a fulfulling life….and that’s another story….
Well, the issues are piling up on both sides. And what a shame!
I had a chance in my life to meet some brilliant allopathic doctors as well as
complementary therapists and see them as people and as professionals, and I
don’t see anything worth while in building even higher walls between those two.
It does not serve anyone.
Why all this energy that goes into the competetiveness and anger and attacks on
both sides, why isn’t this energy, and brainpower for that matter, used for working out how to
incorporate those two, how they could support each other…. We are all
different and all have different sets of talents and gifts, why not use those
to cooperate. Throughout the history, the ones that cooperated survived, not
those who fought. There are no winners in a battle. Wounded are on both sides.
Why not give the benefit of the doubt and see if there truly is a way of healing
devastating illnesses in this way of cooperation….
Why not say, hey, we know this much scientifically and this is how we test and prove and let’s see with what we could help…
Why not say, look, we’ve observed this and that shift in our clients vitality, let’s see how can this or that speed up and enhance healing…
Who would try to knock a toddler down and say „how dare you trying to walk“ …
Everything is in a toddle stage once.
A good scientist, says Tao, has freed himself of concepts and keeps his mind open to what is…
I doubt that there are many like this running around this planet…
I read somewhere just the other day that a great obstacle for our evolution is
not what we don’t know but what we think we know….
And it could not be more to the point in this particular case.
Best regards to you Mr. Goldacre and all who honestly strive to live a better life.
roobarb said,
December 4, 2007 at 8:11 pm
Ella R said
“One of my big questions on this exciting subject would for example be:
why double-blinded and other scientific trials be required for homeopathic remedies?
Everyone knows a homeopathic pill is a sugar pill, with no other chemicals (synthetic or natural)
present.
Five or even ten tubes of sugar pills would not do any damage to the body system whatsoever,
five or even ten tubes of common drug like paracetamol would.
No need for deep discussion here, common sense suffices.
Anything produced as a chemical medicinal drug should definitely be tested and
very strictly at that, because it can kill, and it did.
Why should it be necessary to test milk and sugar „scientifically“? ”
You are missing the point. The purpose of clinical trials is not only to demonstrate safety, but also to demonstrate efficacy.
If the NHS is to spend its (our)money on a treatment (any treatment) that treatment should be demonstrably beneficial. And, anticipating your next comment, arguing that some “allopathic” treatments have not been properly trialled is absolutely no defence. As your grandmother probably told you, two wrongs don’t make a right.
aswdodge said,
December 4, 2007 at 9:18 pm
Ella R said:
‘The inner
processes in us influence our inner being/world, the matter adjust itself to the
direction of energy, (we materialise what we focus on, we give it an information), and that eventually,
with a principle of critical mass, makes a leap into our outer being/world, it
manifests on the cruder level.’
I was unaware that energy has direction.
Can’t find reference to it here:
en.wikipedia.org/wiki/Energy
Sounds more like this:
skeptoid.com/episodes/4002
Let’s replace “energy” with “measurable work capability” and see if the sentence still makes sense (or makes sense at all).
spk76 said,
December 4, 2007 at 9:23 pm
Ella R – that’s quite a poem. It’s also an intriguing insight into the mindset that leads some people to believe homeopathy works.
But why the insistence on this nonsense word “allopathy”? “Medicine” is just what works. If homeopathy was shown to work tomorrow it would become part of “medicine”.
It’s also important to understand that modern medicine is at least as holistic as CAM. Granted most NHS doctors don’t have the luxury of being able to chat to their patients for an hour or two but modern medicine is absolutely focussed on treating the individual as a whole, bringing in experts from other fields as necessary, be they psychologists/counsellors, dieticians, physiotherapists, occupational therapists etc.
Sure there are some bad doctors around but the best of them look at the person in the round; they try to understand how the patient’s various problems affect their life, and they work within a multidisciplinary team to encourage the patient to gain independence and control of the care-giving/taking relationship and avoid reinforcement of negative behavioural outcomes such as over-reliance or surrender to the sick role.
They try to promote self-help and self-care, with the aim of enabling the patient to maintain optimal functioning and maximise quality of life.
Whereas the majority of CAM therapists, despite their touchy-feely pseudo-holistic accoutrements, are far more paternalistic and practitioner-centred. They maintain the power imbalance, in their therapeutic relationship with you, because they play up their exclusive access to arcane knowledge, and their authority, wouldn’t you agree?
muscleman said,
December 5, 2007 at 12:56 pm
roobarb wrote:
“If you consider that work done on surgeons’ gloves could be extrapolated to condoms, then this method www.pubmedcentral.nih.gov/articlerender.fcgi?artid=120672 suggests that some penetration of viruses is possible.”
Did you read that paper roobarb? If you did you obviously did not read the methods section. Or if you did all that technical stuff about growing bacteriophages blinded you to the little detail that they punctured the fingers of the gloves with an 18 gauge syringe needle, not huge but very, very definitely macroscopic. Not only once either.
The paper is a proof of principle methods paper showing that it is practically possible to detect viruses inside gloves using pcr. So they had to get some virus into a glove, preferably from outside. Not being idiots they did more than simply sit the gloves in some virus and waiting in vain for them to penetrate. No, they replicated the most likely form of viral penetration, from puncture accidents.
The article says nothing about how easy it is for viruses to cross intact latex (though few gloves are made of latex these days, too allergenic). Unless of course those gloves have been holed by the repeated application of a syringe needle.
I pays to do more than post what you find using google. Reading it to make sure it actually says what you want it to say helps…
JoanCrawford said,
December 5, 2007 at 2:15 pm
I received an email from Oxfam, as I had the same concerns as aswdodge and others about the apparent condoning by Oxfam of the use of herbs in AIDS treatment in Africa. Their thrust is essentially that the herbs will treat symptoms, not causes.
************
Thank you for your email and your enquiry about our ‘Herb Garden’ gift.
Please let me tell you more about this gift, as I hope this will alleviate any of your concerns:
Oxfam Ireland supports partner organisations that grow herbs or work with traditional healers that use herbs to alleviate some of the symptoms of AIDS such as diarrhoea, loss of appetite, skin rashes, head aches, etc. These herbs have undergone scientific research and have proven to be safe and effective for the purpose of which they are used. In one particular case a small increase of CD4 count has also been observed. Additional training, counselling and referral to health clinics and hospitals is also provided.
The herbs are no substitute for ARVs and other modern medicines, but in some areas they are the only means available and are what the individual wants to use as per their traditions. Oxfam Ireland is a strong supporter of increased access to essential medicines and ARVs via its advocacy and programme work. We are supporting the same partner organisations to promote and/or provide testing and counselling for HIV as well as ARVs and treatment of opportunistic infections through modern medicines. We also put a strong focus on education and behaviour change programmes coupled with delay of sexual debut, decreased number of sexual partners and consistent condom use. Tackling gender inequalities and poverty – the main factors that fuel the AIDS epidemic – are also at the core of Oxfam Ireland’s work.
If you would like any more information on Oxfam Ireland’s HIV and AIDS programmes, and the many aspects of our work in this area, please visit www.oxfamireland.org/whatwedo/longterm/.
May I wish you a happy Christmas and a peaceful new year.
Cora
Cora Ó Liatháin
Fundraising Executive
Oxfam Ireland
9 Burgh Quay
Dublin 2
t:+3531 6727662
DDI: +3531 6350406
f:+3531 6727680
John Coffin said,
December 5, 2007 at 6:59 pm
A note on the sex-with-virgin/child-rape ‘cure.’
This was a recurring belief in the West, at least until the early 20th century. Hence the lurid trade in ‘virgin’ (i.e. child) prostitutes that WT Stead wrote of.
The magical notion that an illness could be passed on to another has some logical congruence with the notion of ‘drawing out the heat’ of a burn by touching a hot iron or massaging frostbite with snow.
Don’t expect me to be able to explain it though.
roobarb said,
December 5, 2007 at 7:25 pm
Muscleman said
“roobarb wrote:
“If you consider that work done on surgeons’ gloves could be extrapolated to condoms, then this method www.pubmedcentral.nih.gov/articlerender.fcgi?artid=120672 suggests that some penetration of viruses is possible.”
Did you read that paper roobarb? If you did you obviously did not read the methods section. Or if you did all that technical stuff about growing bacteriophages blinded you to the little detail that they punctured the fingers of the gloves with an 18 gauge syringe needle, not huge but very, very definitely macroscopic. Not only once either.
The paper is a proof of principle methods paper showing that it is practically possible to detect viruses inside gloves using pcr. So they had to get some virus into a glove, preferably from outside. Not being idiots they did more than simply sit the gloves in some virus and waiting in vain for them to penetrate. No, they replicated the most likely form of viral penetration, from puncture accidents.
The article says nothing about how easy it is for viruses to cross intact latex (though few gloves are made of latex these days, too allergenic). Unless of course those gloves have been holed by the repeated application of a syringe needle.
I pays to do more than post what you find using google. Reading it to make sure it actually says what you want it to say helps…”
Thanks Muscleman for pointing out I attached the wrong article.
You didn’t need to be so fucking objectionable.
Here’s the article.
www.infectioncontroltoday.com/articles/4a1feat1.html
It may not be peer reviewed – I don’t know. All I’m saying is there APPEARS to be some evidence that viral penetration is possible after gloves deteriorate through usage. Certainly this is the view amongst many healthcare professionals (non-woo) in the NHS today.
And it doesn’t take much imagination to extrapolate glove usage to condom usage.
And FYI the vast majority of gloves used in the NHS today are latex. This probably ought not to be so, but it is true.
aswdodge said,
December 5, 2007 at 8:34 pm
@JoanCrawford
Got the exact same response word for word, but I am pretty happy with that answer.
R.B. said,
December 6, 2007 at 8:08 am
Postmodernist essay generator: www.elsewhere.org/pomo/
grimreader said,
December 6, 2007 at 12:28 pm
What about deterioration? How much is that a factor?
JoanCrawford said,
December 6, 2007 at 1:36 pm
Round here, we use Nitrile gloves, again because of latex allergies.
Ella R said,
December 6, 2007 at 5:06 pm
roobarb said:
You are missing the point. The purpose of clinical trials is not only to demonstrate safety, but also to demonstrate efficacy.
Yes, I know, but I am just not convinced the same measure should apply. It’s like putting apples and oranges together.
The efficacy aspect of homeopathy – definitely, but proper testing methods or efforts let’s say are pushed somewhat askew by of insisting that homoeopathic remedies should be tested as drugs. I don’t think we’re looking in the right direction here.
If the NHS is to spend its (our)money on a treatment (any treatment) that treatment should be demonstrably beneficial.
Yes, certainly, I could not agree more…
And, anticipating your next comment, arguing that some “allopathic” treatments have not been properly trialled is absolutely no defence.
Well, you should flex your anticipatory muscle a little more, I was not going to say that…what’s more, I do not try to defend anything, I am trying to find the most objective view over things possible…I am trying to understand…to make sense…
As your grandmother probably told you, two wrongs don’t make a right.
And here you are ‘arguing’ which point exactly? Did your grandma told you this…I guess she was right…(what were you up to?)
Ella R said,
December 6, 2007 at 6:04 pm
aswdodge said:
Ella R said:
‘The inner
processes in us influence our inner being/world, the matter adjust itself to the
direction of energy, (we materialise what we focus on, we give it an information), and that eventually,
with a principle of critical mass, makes a leap into our outer being/world, it
manifests on the cruder level.’
I was unaware that energy has direction.
I’d say it does, surprisingly. I guess if it has a flow, it has a direction.
Can’t find reference to it here:
en.wikipedia.org/wiki/Energy
Good one. First instance information, but have to start somewhere.
However, this is only a half of the issue. This is only the quantity, so I looked at the quality, too. First instance information, but have to start somewhere…
en.wikipedia.org/wiki/Energy_quality
Sounds more like this:
skeptoid.com/episodes/4002
Couldn’t you do better then that…??? Too much doubt dulls the bright mind, discourages the heart.
Let’s replace “energy” with “measurable work capability” and see if the sentence still makes sense (or makes sense at all).
Thanks. That is perfect. It makes even better sense.
Ella R said,
December 6, 2007 at 7:24 pm
to spk76:
Thank you,you sound nice.
No I would not agree. There is no arcane knowledge in CAM. No one has authority over me, i can always walk. And if they seem to suggest that they do have some ‘arcane knowledge’ i laugh, suggest some personal psychotherapy and walk.
CAM is generally uncharted territory of qualitatively different aspects of energy than modern medicine deals with. (Thousands of people have the experience…so there must be something in it. And I want to know what…so I am searching…)
And we know very little about it. (A lot of this is difficult to explain rationally and with logic – but in quantum physics logic does not apply, sorry mr. Ben Goldacre) Just like we knew very little about computers and internet 50 years ago, just like we knew very little about electromagnetic energy three hundred years ago. Life was full of ‘arcane’ stuff in the Iron Ages…and it seems man has a problem leaving the safe old Iron Ages…
(My apology, I know this is kindergarden stuff, but seems to escape many.) Obviously it is difficult to comprehend by our current brain capacity.
You explain very nicely how current system of medicine works. I agree. Especially in recent years, doctors do strive to give you as complex care as possible. They do not have na easy job, and they do not have time, in a current system, to talk to patient and reach some depth of understanding of each unique individual. They do look from many sides at the problem, but it still remains mostly on the level of anatomy and physiology.
But there is more to me then just this… so tell me…where that other bit comes from…how come i am not a robot made from bones and meat…
“Majority of CAM therapists, despite their touchy-feely pseudo-holistic accoutrements, are far more paternalistic and practitioner-centred. They maintain the power imbalance, in their therapeutic relationship with you, because they play up their exclusive access to arcane knowledge, and their authority”
…a bad experience talking?
I would not say majority, but a lot…I have the above described experience with doctors too. They can be pretty snooty about their own achieved accolades….So I’d say 50:50…
Have to dash.
Nice talking to you all…
Thanks
Ella
apricot said,
December 6, 2007 at 8:05 pm
John Coffin said:
‘the notion of ‘drawing out the heat’ of a burn by touching a hot iron or massaging frostbite with snow.’
This is treating like with like. I understand kitchen workers use the former, I didn’t know about the latter.
DrJon said,
December 7, 2007 at 9:33 am
To Ella R: I’m a scientist, and one of the things I work on is quantum computation, and I’m afraid that I can categorically state that your assertion that “in quantum physics logic does not apply” is absolutely untrue.
The problem with homeopathy in particular is that there is no evidence that it works, and no plausible mechanism by which it can work. Homeopathy contradicts what we know about physics and chemistry, and this cannot be explained by a further refinement of the physical model. So we have the situation that either established science, with all the evidence we have that it is a good model (medicine, power stations, aeroplanes, the internet), is closer to the way the universe actually is, or on the other hand that homeopathy is right – which means that all our scientific models (which work so well!) are wrong.
Three questions:
1, What would convince you that homeopathy doesn’t work?
2, Do you think that the basic physics and chemistry taught in school is fundamentally wrong (not just simplified , but wrong)
3, How can the existence of “vital forces” and “life energies” be demonstrated?
For homeopathy to be effective, for which there is no evidence, you’d have to agree with the second statement. I’m sure as an intelligent person you wouldn’t agree though.
Squander Two said,
December 7, 2007 at 4:59 pm
> And finally, most evilly, multinational pharmaceutical companies fight tooth and nail against countries who try to manufacture Aids drugs off-licence in public health emergencies, even when using the perfectly legitimate Doha Declaration. Nationalise the lot, I say.
What a brilliant idea. Then we’d have drugs every bit as effective as British Leyland, if not even more so.
IMSoP said,
December 8, 2007 at 5:35 pm
spk76: “Yes – there is a large body of opinion that the placebo effect is not any kind of effect at all but merely an absence of effect.”
On the other hand, some of Ben’s recent columns have referred to research showing a very real, measurable, and complex placebo effect, with references (to a body, not of opinion, but of evidence) – e.g. www.badscience.net/2007/09/542/ and www.badscience.net/2007/09/homeopathy-gives-you-aids/
Perhaps there are 3 scenarios here:
1) Homeopathy is a physical phenomenon (which seems unlikely on current understanding of physics)
2) Homeopathy is “applied placebo”, and placebo is a genuine psychological phenomenon, with measurable effects (in certain circumstances)
3) Neither homeopathy nor placebo produce measurable results, and any apparent results are errors in interpretation or observation (regression to the mean, etc, etc)
Interestingly, experiments can be designed to distinguish between scenarios 1 and 2, and between 2 and 3.
I agree that under anything but scenario 1, homeopathy is at best misdirected, and at worst immoral. But if the truth is closer to scenario 2, we have much to learn about the power and limits of psychological effects, and whether we can improve medicine by understanding their influence on treatment.
spk76 said,
December 8, 2007 at 6:36 pm
IMSoP: “On the other hand, some of Ben’s recent columns have referred to research showing a very real, measurable, and complex placebo effect, with references (to a body, not of opinion, but of evidence)”
There is also much research showing that placebo is nothing more than “errors in interpretation or observation (regression to the mean, etc”. In fact, one of the earliest papers to demonstrate placebo actions has subsequently been discredited.
Beecher, H. K. 1955. The powerful placebo. Journal of the American Medical Association, 159:1602-1606
Kienle GS, Kiene H. 1997. The powerful placebo effect: fact or fiction? J Clin Epidemiol. 50:1311-8
I think it’s fair to say, contrary to commonly held belief, the jury is still out with regard to whether placebo is a genuine effect or an absence of effect. Having trawled through a reasonable amount of the research myself, my own opinion currently is that placebo is equivalent to nothing. That is, indeed, the importance of placebo in double blind randomised controlled drug trials – to demonstrate real effects, drugs must be shown to have an effect above placebo.
Additionally, it bears thinking about that if a placebo had an effect, it wouldn’t be a placebo.
Since homeopathy is yet to be conclusively shown to meet that standard, it is reasonable to conclude that homeopathy is likely to be equivalent to placebo, i.e. it has no effect.
And although psychosomatic illness is a very real phenomenon, especially to sufferers, its underlying physiological basis is equally up for debate. It is also not necessarily as straightforward as all that to assume that as well as negative psychosomatic illness, there are also positive psychosomatic effects that can somehow be channelled to benefit healing. Again, there is much research indicating that such positive thinking, power of prayed etc. has zero effect, e.g. www.ncbi.nlm.nih.gov/sites/entrez?orig_db=PubMed&db=PubMed&cmd=Search&term=cancer%5BJour%5D%20AND%20110%5Bvolume%5D%20AND%20coyne%5Bauthor%5D
Ella R said,
December 8, 2007 at 9:29 pm
To IMSoP: I like both your comments, good food for thought…
IMSoP said:
Perhaps there are 3 scenarios here:
1) Homeopathy is a physical phenomenon (which seems unlikely on current understanding of physics)
Lots of things are unlikely on current understanding of many phenomenas…Not good enough argument to dismiss point one…So there is a possibility here…
Plus
2) Homeopathy is “applied placebo”, and placebo is a genuine psychological phenomenon, with measurable effects (in certain circumstances)
also possibility…
If the truth is closer to scenario 2, we have much to learn about the power and limits of psychological effects, and whether we can improve medicine by understanding their influence on treatment.
Spk76:
Since homeopathy is yet to be conclusively shown to meet that standard, it is reasonable to conclude that homeopathy is likely to be equivalent to placebo, i.e. it has no effect.
Again, there is much research indicating that such positive thinking, power of prayed etc. has zero effect.
Well, empirically for many people it works, so Spk76 statement is not valid.
It has an effect, and that’s why I am searching, I would like to know how…and there’s many many other that have the very personal experience of CAM and positive thinking, prayer…
The question is not does it work, the question is how it works….where is the bridge across this troubled water…
spk76 said,
December 8, 2007 at 10:10 pm
Ella R: “The question is not does it work, the question is how it works….where is the bridge across this troubled water…”
No, it doesn’t work. As shown time and again when put to the test in rigorously controlled trials (even those taking into account individualisation and the rest of the mumbo-jumbo), homeopathy (and much of the rest of CAM) turns out not to have a real effect at all. It is merely a misattribution of some non-specific perceptions of effect when there is in fact none. These can be variously put down to:
1. regression to the mean (many conditions, especially long-term chronic ones (those favoured by homeopathic and most other alternative therapists) wax and wane between periods of complete or partial remission and outbreaks of severe exacerbation, whilst mostly treading an average baseline. People go to real doctors during acute exacerbations and may turn to CAMsters in desperation, by which time their condition has settled down again to the mean level or even gone into remission, often with the additional help of real medicine)
2. fluctuation of symptoms
3. the effect of conventional treatments taken at the same time
4. experimental design flaws and errors
5. observer, recall and selection bias (e.g. people retrospectively mistakenly ascribe their improved condition to their homeopathic treatment, whilst conveniently neglecting the other factors contributing to the “cure” and ignoring the occasions when the homeopathy failed, i.e. confusing correlation with causation)
6. the natural history of the conditions being treated
7. habituation (many conditions, such as hay fever, eczema and asthma, eventually remit (children are often said to “grow out” of them) – what is really happening is a decrease in response to the stimuli due to repetition, i.e. the body slowly resets its thermostat, so to speak. This is why people may complain of having hay fever for years, having tried all the treatments, and then one day they no longer have it.)
8. small sample sizes of statistical invalidity
9. uncritical reporting of unreliable anecdotes
10. delusion, denial, deceit and fraud
With regard to homeopathy being successful (as a placebo) in non-serious illness, it is important to understand that the mistakenly perceived beneficial outcomes of homeopathic remedies are merely a consequence of their being used to treat minor, self-limiting or chronic relapsing/remitting ailments.
Generally, the kinds of conditions that most people use homeopathy for would get better or at least remit on their own anyway (allergies, hay fever, eczema, minor skin complaints, mild pain, insomnia etc., many of which having seasonal and emotional/psychological/stress-related components) – homeopathy offers nothing but disappointment, at best, death at worst, for those with severe and acute conditions that require genuinely effective treatment (cancer, septicaemia, HIV/AIDS, meningitis, malaria etc.)
In short, homeopaths trick patients into temporarily reinterpreting their symptoms due to a transient change in expectation and belief.
Placebo effects and CAM techniques are often erroneously thought of as having a kind of mystical or magical healing effect (with terms like quantum energy meaninglessly bandied about) outside of conventional science/medicine or a yet to be elucidated physiological basis – but they do not. Homeopathy and placebo are not cures, they are nothing.
Placebo effect = no effect.
Homeopathy = placebo.
The question is not “does it work?” or “how does it work” but “how are people fooled into thinking it does?”
Robert Carnegie said,
December 8, 2007 at 11:40 pm
It’s just occurred to me that the assertion, “reality is that which, when you stop believing in it, doesn’t go away” (Philip K. Dick), needs careful handling in respect of the placebo effect. Apparently something about the placebo isn’t real, but not the placebo itself and not its effect, I want to say. Oh, I’m confused.
But placebo effect no effect. So… perhaps most of us just have an everyday deficit of placebo? What can be done about that? Not homeopathy – not for people here – we unfortunately have a resistance to it.
Robert Carnegie said,
December 8, 2007 at 11:42 pm
Btw I meant ‘Placebo effect “” no effect.’ If that works. Why isn’t there a preview function here??
Robert Carnegie said,
December 8, 2007 at 11:44 pm
Placebo effect less-than more-than (not equals) no effect. Stop laughing.
aswdodge said,
December 9, 2007 at 2:54 am
@ Ella R
The flow of energy through an ecosystem does not mean “energy” has a direction. There is a difference between a flow of energy (e.g. heat energy moving from a hot environment to a colder one), and the direction of “energy” of our ‘inner processes’.
The difference is, of course, one of these is actually a real thing.
Ella R said,
December 9, 2007 at 7:51 pm
correction:
…I CAN’T put into equation…
and da VincI, of course…
Ella R said,
December 10, 2007 at 3:19 pm
I was thinking last night, well, this is not the place to talk about the personal…I guess you want facts.
I want facts , too.
But I can happily accept things the way they are…
Life is a work in progress…
Not understanding is not the worth thing that could happen to me.
But I can tell the effect of conventional drugs on me…they work on the body level, they’re cruder, stronger, faster (thank god for them),
…and I can also sense the effect of CAM treatment, it’s more subtle, more gentle, and is not in the body in the same manner as the chemicals. It is more like a sensetion (not feeling actually, that would be connected with emotions, and these sensations are emotionless), it is not a shift in physical comfort, it is a shift in perception…the colours change its brightness, time seems to slow down, the space expands, things are more clear, defined…
And this is from where I enter the quest…that is why it is not IF but HOW, because I want to know…
And that is why it is not for me either/or…I want both…
Modern medicine – we can explain, great, CAM way of working – not quite yet, that does not mean that it is not explicable…
Our brain/heart work is not that refined yet. Let’s face it, look at world around you…we are…pretty crude…
Denying my own personal (repeated) experience, would be denying my very own existence…
Errr…
No.
Squander Two said,
December 10, 2007 at 5:09 pm
> Additionally, it bears thinking about that if a placebo had an effect, it wouldn’t be a placebo.
I don’t think that’s true. Surely the placebo effect describes effects which are caused by psychological factors and not any sort of direct biomechanical reaction between the treatment and the outcome. Your statement only follows from the assumption that “placebo effect” means “no effect”, so may not be used in turn as backup for that assumption.
> Denying my own personal (repeated) experience, would be denying my very own existence…
I have a recurring dream that I can fly. I deny its truth. I have yet to deny my own existence.
Ella R said,
December 10, 2007 at 8:33 pm
My apologies, won’t happen again. Thanks, for being so tactful and diplomatic.
I read a press relese of European Committee for Homeopathy today. I thought it was good. Open, clear and certainly not biased.
Ella R said,
December 10, 2007 at 8:41 pm
@Squander Two
I have a recurring dream that I can fly. I deny its truth. I have yet to deny my own existence.
If dreams of flying are part of your reality…then…haven’t you already done it?
spk76 said,
December 10, 2007 at 9:09 pm
Squander Two: “I don’t think that’s true. Surely the placebo effect describes effects which are caused by psychological factors and not any sort of direct biomechanical reaction between the treatment and the outcome. Your statement only follows from the assumption that “placebo effect” means “no effect”, so may not be used in turn as backup for that assumption.”
I see where you’re coming from but “placebo effect” really describes “non-specific effects” – how these can be explained is rather controversial; a psychological explanation is just one of many. Personally, I favour the “no effect” explanation.
There is, after all, a very strong body of evidence that placebos don’t work.
This is why placebo is the gold standard for double-blind controlled trials.
When the control group are given a placebo, they are being given a blank, i.e. a pill with no active ingredients (just like homeopathy).
The effects that some people then perceive from receiving the fake pill are in fact just background noise, and this is why genuine medical interventions need to be proven to have an effect over and above placebo, i.e. placebo = no effect.
And it bears emphasising that the original quantitative claim that placebo is real (Beecher, H. K. 1955. The powerful placebo. Journal of the American Medical Association, 159:1602-1606) was subsequently thoroughly dismissed (Kienle GS, Kiene H. 1997. The powerful placebo effect: fact or fiction? J Clin Epidemiol. 50:1311-8).
And this is of interest:
“Hrobjartsson and Gotzsche published a study in 2001 and a follow-up study in 2004 questioning the nature of the placebo effect. (Hrobjartsson 2001, Hrobjartsson 2004) They performed two meta-analyses involving 156 clinical trials in which an experimental drug or treatment protocol was compared to a placebo group and an untreated group, and specifically asked whether the placebo group improved compared to the untreated group. Hrobjartsson and Gotzsche found that in studies with a binary outcome, meaning patients were classified as improved or not improved, the placebo group had no statistically significant improvement over the no-treatment group. Similarly, there was no significant placebo effect in studies in which objective outcomes (such as blood pressure) were measured by an independent observer. The placebo effect could only be documented in studies in which the outcomes (improvement or failure to improve) were reported by the subjects themselves. The authors concluded that the placebo effect does not have “powerful clinical effects,” (objective effects) and that patient-reported improvements (subjective effects) in pain were small and could not be clearly distinguished from bias.
These results suggest that the placebo effect is largely subjective. This would help explain why the placebo effect is easiest to demonstrate in conditions where subjective factors are very prominent or significant parts of the problem. Some of these conditions are headache, stomach ache, asthma, allergy, tension, and the experience of pain, which is often a significant part of many mild and serious illnesses.”
www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&uid=11372012&cmd=showdetailview&indexed=google
Squander Two said,
December 11, 2007 at 1:39 pm
> “placebo effect” really describes “non-specific effects” – how these can be explained is rather controversial; a psychological explanation is just one of many.
Fair enough. So let me rephrase.
Surely the placebo effect describes effects which are not caused by any sort of direct biomechanical reaction between the treatment and the outcome.
> There is, after all, a very strong body of evidence that placebos don’t work.
I’m hardly any sort of expert in this area, but doesn’t Ben often refer to the strong body of evidence that they do work? Would I be right in guessing that what we have here is two contradictory strong bodies of evidence, or — looked at another way — one inconclusive strong body of evidence?
> this is why genuine medical interventions need to be proven to have an effect over and above placebo
Well, that’s kind of the point, isn’t it? Showing that medicine merely has an effect over and above no effect is not good enough, but showing that is has an effect over and above the placebo effect is considered conclusive. If it’s true that the placebo effect is equal to no effect, tell me, how would you go about distinguishing between those two results?
IMSoP said,
December 11, 2007 at 1:46 pm
Very interesting – clearly there’s a lot more doubt surrounding the placebo issue than I’d assumed.
But I would like to pick you up on one logical flaw, best summed up here, but mentionned or implied a couple of times:
>
In fact, more-or-less the opposite is true – the placebo is the gold standard in controlled trials precisely because it *might* have an effect, at some level. If it was guaranteed to have absolutely no effect, researchers could save a lot of effort by not doing anything at all with the control group.
The idea of trial design is to fix all the possible variables except the one you’re testing; so the purpose of placebo treatments is to fix any possible variables arising from psychological effects of simply being treated, etc, which would obviously confuse the data you actually want – such as the effectiveness of a drug.
Now, at what level those effects take place, and even if there are any, is obviously open to debate – or, rather, research. Which brings me back to the position of considering that a potentially very interesting area of study.
[PS: IANAS (I Am Not A Scientist), although I did do a part-Psychology degree; so feel free to correct me if I’ve got something fundamentally wrong here.]
IMSoP said,
December 11, 2007 at 1:48 pm
Oops, the forum ate my quote (note to any software developers reading: never, ever, have comments without a ‘Preview’ button!)
These are what I meant to quote:
> There is, after all, a very strong body of evidence that placebos don’t work.
> This is why placebo is the gold standard for double-blind controlled trials.
spk76 said,
December 11, 2007 at 8:51 pm
Squander Two: “I’m hardly any sort of expert in this area, but doesn’t Ben often refer to the strong body of evidence that they do work? Would I be right in guessing that what we have here is two contradictory strong bodies of evidence, or — looked at another way — one inconclusive strong body of evidence?”
Yes, he certainly seems to. But as I said above, the evidence is rather inconclusive.
Squander Two: “If it’s true that the placebo effect is equal to no effect, tell me, how would you go about distinguishing between those two results?”
What I’m saying is that plenty of research shows that once you have accounted for background noise (regression to the mean, fluctuation of symptoms, other treatments taken at the same time, experimental design flaws, errors, observer, recall and selection bias, habituation etc.), it often turns out that the placebo effect is actually equivalent to no effect, i.e. they can’t be distinguished.
The placebo effect has become such an ingrained concept both in science and popular culture that it takes a while to get your head round to the idea that it might actually be nothing at all. It’s an intriguing notion, and as I say, there is some quite compelling research out there that casts doubt on the whole “placebo effect” idea.
IMSoP: “The idea of trial design is to fix all the possible variables except the one you’re testing; so the purpose of placebo treatments is to fix any possible variables arising from psychological effects of simply being treated, etc, which would obviously confuse the data you actually want – such as the effectiveness of a drug.”
Placebos aren’t necessarily there to screen out psychological effects that might confuse the data but are an attempt to screen out any kind of bias that can’t be due to the intervention under study.
It is of course a bit academic with regard to most drug trials these days though, as ethical considerations demand that new drugs are tested against the best existing drug.
However, I think it is worth considering that placebo may be nothing when we are evaluating CAM, most of which is probably nothing more than placebo…
It is often claimed, for example, that even if CAM is only placebo, it at least has some benefit and therefore some use but if placebo really does turn out to be nothing at all, then what does that say about those making a living from such practices?
Robert Carnegie said,
December 12, 2007 at 2:56 am
Re anecdotes: at one point (just one?) in James White’s novels and short stories about the “Sector General Hospital”, it’s mentioned that White’s doctors know what they mean by the phrase “personal involvement”. As it happens it’s science fiction and it means that they have had their brain overlaid with a mind-recording of the species that they are discussing, which has quite interesting effects, but the point is there’s a code, an understood phrase.
You could have a separate forum section here for bearing witness.
Annemieke said,
December 12, 2007 at 1:36 pm
Ella R, I like your comments a lot, and I agree with most of them.
You said: ‘I read somewhere just the other day that a great obstacle for our evolution is not what we don’t know but what we think we know’.
I agree, but in order to become aware of that, we have to be challenged.
So when you say: ‘Why all this energy that goes into the competetiveness and anger and attacks on both sides’, then in my opinion, that’s what is needed right now, to become aware of our dogma’s. On both sides.
But maybe the positive part of all this is, as each side is digging deep in order to prove their point, that it will reveal much what was not well known yet.
So I think this step is necessary, before we can move on.
Ella R said,
December 15, 2007 at 6:23 pm
@Annemieke
Yes, last week was definitely a time of some deep thoughts, and I came to the same conclusions (though it is kind of obvious anyway).
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