I’ve seen some bullshit in my time but this piss-poor attempt at a defence of homoeopathy by Denis MacEoin just about takes the biscuit:
Last week, novelist Jeanette Winterson published an intelligent and lucid account of why she believes homeopathy works. Three days later, along came Ben Goldacre, who gave us a longer piece showing us all the errors of Winterson’s ways. Yesterday, Tom Whipple reiterated several hoary, tired, and inept anti-homeopathy arguments in order to condemn the 206 MPs who signed an early day motion in support of NHS homeopathic hospitals.
Do read all three linked articles to catch up on the background to all this, however it is worth noting that Winterson’s ‘evidence’ in her article consists of a twee tale of how she had cold, obtained a bottle of liquid woo from her homoeopath and felt better afterwards.
Goldacre’s article was laden with his usual sarcasm.
In it, he paraded his superior knowledge and accused homeopaths of “killing patients” and being “morons”. As a fellow sceptic I understand where he is coming from; I identify with his pro-science stance, and have as little time for unscientific nostrums as he, but I came away from this piece with a feeling of embarrassment, a conviction he doesn’t know what he’s talking about, just like Whipple. I don’t mean all of it. The homeopathy community has its fair share of fools and charlatans, and many practitioners and gurus come from the counter culture. I have as little patience for them and their metaphysical weirdness as does Ben. But I’m also aware of an entirely rational world of doctor homeopaths, and many non-doctors who prefer to work alongside conventional medicine and would sooner die than manufacture a remedy from moonshine and call it “Luna”. By tarring all homeopaths with the same brush, Goldacre does both them and their patients a disservice.
Back when I was studying psychology, one of our favourite methods of winding up the medical students, and especially any would-be psychiatrists, in the SU bar was to start off a loud, and easily, overheard conversation on the subject of ‘white coat syndrome’, the propensity for members of the public to treat even the most egregious idiot as if they were the fount of all knowledge provided that they were wearing a white lab coat. That’s the game that Denis is trying to pull off here
Yes, there are some qualified doctors who believe in homoeopathy, many more who don’t and a far few who’ve cottoned on to the fact that shipping some of their more intractable hypochondriacs off to a homoeopath is a pretty good way of prescribing placebos without the risk of getting stuck with a medical negligence lawsuit- none of which provides any scientific evidence that homoeopathy works in the slightest.
I said he doesn’t know what he’s talking about, and I meant it. I am sure he has not acquired any homeopathic qualifications, and I’m confident he has not sat in with an experienced homeopath for a year or so or worked at a homeopathic NHS hospital. He has read a few books and set himself up as the arbiter of things homeopathic. That is not a good basis for critical understanding.
Goldacre rarely refers to his qualifications, as his biography on Bad Science notes:
I do not present myself as a “leading expert”, and I rarely even mention being a doctor, on the grounds that “arguing from authority” is one of the biggest problems in the way that science is misrepresented by the media.
Read on, however, and you’ll discover that:
Ben studied Medicine at Magdalen College Oxford where he also edited Isis, the Oxford University Magazine. He left in 1995 with a First: before going on to clinical medicine at UCL, he was a visiting researcher in cognitive neurosciences at the University of Milan, working on fMRI brain scans of language and executive function, worked at Liberty the human rights organisation, and was also funded by the British Academy to do a Masters degree in Philosophy at King’s.
By way of contrast, MacEoin’s biography on CiF states:
Dr Denis MacEoin is a former lecturer in Islamic Studies, and has written extensively in the field. He recently authored a major report on hate literature in UK mosques, Hijacking British Islam. Writing as Daniel Easterman and Jonathan Aycliffe, he has published 25 novels, translated into over a dozen languages. He is currently the Royal Literary Fund Fellow at Newcastle University.
I know who I consider to be better qualified to talk about the scientific efficacy, or otherwise, of homoeopathy, but its also worth noting what Wikipedia can add to MacEoin’s profile:
[MacEoin] has been married to homoeopath and health writer Beth MacEoin since 1975. Beth is the author of around 20 books on natural health, including the NMS book, Natural Medicine: A practical guide to family Health, which was published by Bloomsbury at the end of 1999, and “Homeopathy: Medicine for the 21st Century” (Kyle Cathie, 2006).
So our self-professed sceptic has a wife who makes a [presumably] tidy living selling books on this particular brand of woo – bit of a vested interest, then, which really should have been disclosed. Although perhaps he thinks that Ben’s read one of his wife’s books, which is why he’s so pissed off.
His ignorance is most grossly displayed in the preface to his piece:
“Time after time, properly conducted scientific studies have proved that homeopathic remedies work no better than simple placebos.”
What utter hooey. There has never been a proper trial of homeopathy. There have been countless trials based on the methodology applied to orthodox medicines, as if homeopathy is a form of orthodox medicine. Some have been positive, most negative. This proves nothing, because what they have tested was never homeopathy in the first place.
You see! That’s where all us real sceptics are going wrong – you just can’t test homoeopathy using the same methods used to test conventional medicines, i.e. using the scientific method.
In which case, of course, homoeopathy is not scientific in the slightest – which seems to be the bit of basic logic that’s escaping MacEoin here.
In orthodox trials, all patients in the “real” group are given the same drug for the same length of time. Homeopaths do not work like that. For one condition, they may select one of a dozen or more remedies, chosen after long and detailed interviews. They see patients repeatedly over the course of months or years, refining and changing prescriptions, and watching a steady development that follows a strong internal logic. It is a long process.
Ah, I see… So that’s how homoeopathy ‘works’.
You give the patient a bottle of liquid woo to take for a couple of months, and if they don’t feel any better after that you ‘refine’ the ‘treatment’ by giving them different types of woo until you hit on something does manage to convince them that they feel a bit better, all using a ‘strong internal logic’…
…called trial and error.
Actually in certain specific contexts, such as stress, anxiety and maybe even mild depression, I can see exactly how homoeopathy ‘works’ and may even ‘work’ reasonably well.
There is a wonderful story that the late R D Laing used to tell of his days in practice as a psychiatrist, in which he was treating a patient for depression and during one consultation, rather than give the patient the usual psychoanalysis routine, Laing simply struck up a conversation with them and spent the whole hour chatting and engaging in small talk. By the end of the hour, the patient was happily chatting away, cracking jokes, etc. at which point Laing told him that his time was up, to which the patient responded by complaining that they hadn’t talked about his problems.
Laing responded by asking the guy why the hell he wanted to talk about his ‘problems’ when he’d clearly cheered up and was feeling much better for having had a good conversation.
When it comes to some of the milder psychological ailments a trip to the homoeopath may well be rather more beneficial to some patients than visiting a GP. Homoeopaths will typically spend an hour or so talking to their ‘patients’ during a consultation, where an NHS General Practitioner has, as I recall, something like 6-8 minutes allotted to each consultation, and as with the patient in Laing’s anecdote, its the attention they receive and the opportunity to talk and have someone listen to them that has the beneficial effect.
All of which still means that the bottled woo they leave the room with at the end of it all is entirely irrelevant – a placebo is a placebo is a placebo.
But this is how homeopathy works: mangling it for the chance to jump on the clinical trial bandwagon is not science. No scientist of repute carries out tests of A by running trials of B. All the vaunted meta-analyses that proclaim the ineffectiveness of homeopathy are scientifically illiterate, as Ben Goldacre seems to be in this instance.
The orthodox scientific approach to testing homoeopathy is to take each specific ‘remedy’ in turn and test it against a placebo in a standard double-blind study, and there have been any number of studies carried out in this way in which, uniformly, those that turn out to be methodologically valid and free from bias show that the specific ‘remedy’ being tested doesn’t work – i.e. the results are no better than those of the placebo.
MacEoin argues that this approach is invalid when testing homoeopathy because a homoeopath will periodically ‘refine’ the treatment given to a patient – instead of sticking for six or twelve months months with a potion that can be shown scientifically to have no effect, they’ll periodically move the patient on to a different potion…
…one that can be also shown, scientifically, to have no effect either.
What MacEoin claims isn’t being tested here is the homoeopaths’s claim that nothing plus nothing plus nothing plus no effect plus fuck all happened equals something – that you can improve people’s health by giving them a whole bunch of nothing in sequence.
It doesn’t take a scientific experiment to figure out that adding together a series of zeros will give you another big fat zero – a bit of basic mathematics will take care of that.
He must know something as elementary as this about homeopathy, yet he puts up an Aunt Sally, “proves” homeopathy does not work, and calls all homeopaths “morons”. This is not science, and as someone who believes strongly in science, I would challenge the good doctor to prove that his vaunted trials had anything to do with homeopathy at all.
No, no, no, no, no… In science it’s not the job of sceptics to prove that things don’t work, its the job of those who support and believe in a particular hypothesis to prove that hypothesis to be correct, with the obvious caution that one of key conclusions of the meta-analysis studies of homoeopathy that I’ve read is that the only studies that claim to demonstrate that homoeopathy does ‘work’ and produces effects that cannot be accounted for by simple placebo effects are those that uniformly flawed in their methodology and biased in their results and conclusions.
That’s the bit that really unscientific here, the bit where those who do believe in homoeopathy appear to routinely present biased and methodologically unsound ‘studies’ as ‘proof’ that it works and then accuse others of unscientific behaviour when they point out that such studies don’t stand up to the scrutiny of peer review.
It would be to his credit to come clean on this and to help design trials that would match the homeopathic way of prescribing. If he isn’t willing to do that in collaboration with homeopathic doctors who know as much as he does about the science and are not morons, he is demeaning the very notion of scientific medicine.
Actually such a trial is relatively easy to conceive, you simply do a double blind study in which you exchange placebos in your trial group in much the same way that homoeopaths exchange their bottles of woo with the patients who’re getting the ‘treatment’ for ‘real’ – in fact the question that should be asked is why no homoeopath has yet to conduct such a simple and straightforward study themselves?
My own hypothesis would be that its because there are some questions to which homoeopaths would rather science didn’t provide definitive answers – anyone out there care to put that to the test?
It’s worth remembering that at the unspoken heart of this particular dispute lies a gravy train of public funding for homoeopathy via the NHS – homoeopaths not only want us sceptics to prove them wrong but they want to keep coughing up public funds to pay for homoeopathic treatments (i.e. placebos) until we do. That’s the real reason why supporters of homoeopathy are getting antsy about us sceptics popping up to announce that they’ve got no ‘scientific’ clothes on.
No one is suggesting that homoeopathy should be banned – frankly, if people want to piss their own money away on such things then that’s up to them – it when they also want the government to piss away tax revenues on this kind of thing that a line needs to be drawn.