No, not as in actually good evidence that it works, we’re still waiting for that and I daresay we will be until someone throws an alabaster model of a water molecule at the statue of Hahnemann in Berlin and makes him bleed. No, instead there’s been interesting things happening in the evidence-based medicine movement with regards to homeopathy in the last few weeks and I thought I should write something on it for those readers who are perhaps more involved in atheism and humanism than skepticism.
So I was prompted to write this by a video I just caught wind of over Facebook. It’s a very basic introduction to homeopathy by Ben Goldacre (but more importantly his incredible eyebrow waggling) for the Bristol Science Festival in October (I think). I’ve found a few of these basic introductions, and I urge you all to go and watch Here Be Dragons if you haven’t already, and spread it around to people who perhaps aren’t all that involved in skepticism. Anyway here’s the video:
Now it’s a good introduction, but he makes a point right at the very end that I’m not all that keen on. He says, “is it alright to deceive patients in order to help them get better? And that’s something that only you can decide on.” I wholeheartedly disagree with that last part. The whole medical establishment has been moving towards greater openness between doctor and patient for many years now, and it would be a travesty to go back on that in order to preserve patient choice. After all, what’s the point in choice if it’s not an informed one? It sounds all democratic but this isn’t like a preference in a political candidate. There is a very good way to determine which treatment is the best, and that’s the very simple question: does it work? The evidence doesn’t show homeopathy to be any better than placebo, so we shouldn’t be helping people get better through it purely by ignorance. We would have a problem if a doctor allowed a patient to choose meatballs as a cure for cancer purely because they didn’t know any better, and the same should be true with other treatments.
Now I’m sure Ben Goldacre doesn’t really disagree with me here (although maybe not, more on that later), and that he was probably trying to keep it short and didn’t want to go into the more boring arguments, hoping that anyone who thought about it would come to the conclusion that dishonesty in healthcare is a bad thing. But if anyone is thinking about this in a bit more depth, I have a post on this blog about why we shouldn’t allow homeopathy to claim efficacy, even if we know it’s a placebo (and I’d also like to add the point that it’s a bit arrogant to say “we know it’s a placebo, but we’ll let these ignorant people take it anyway because it’ll do them good to keep them in the dark.”). You may remember that I originally didn’t have a problem with homeopathy but changed my mind completely in the space of a few days after reading around the subject. You can read all about that by following this link and starting at the bottom.
The main thing that’s been happening in the last few weeks is the Evidence Check on Homeopathy that is being carried out in the Parliamentary Committee for Science and Technology. There were two sessions, the first one is on YouTube starting here (I’m linking to YouTube because I understand they take videos off the Commons website after a while), and the second one can be found here. I can’t find it on YouTube so that’s on the Commons site, it works best in Internet Explorer because Firefox plugins are a faff.
Ben Goldacre was a witness at the first evidence check as well as Edzard Ernst of Trick or Treatment, Tracey Brown from Sense About Science, Jayne Lawrence, James Thallon, and on the side of the homeopaths Robert Wilson, Peter Fisher, Robert Mathie, as well as Paul Bennett from Boots.
Now skeptics have been all over this like a rash. A glorious, skeptical rash. Paul Bennett’s admission that Boots doesn’t really know whether or not homeopathy works, but they’ll sell it anyway as long as they can make money, was picked up in the mainstream media too, and prompted this open letter from the Merseyside Skeptics Society, which I reproduced a couple of weeks ago. There were some absolutely startling claims made during the proceedings, such as (paraphrasing) ‘a trial with less than 500 participants cannot be statistically significant’, followed by citing a study which only had 25 participants. The other studies cited by Robert Wilson have been most elegantly ripped limb from limb, also by the MSS, so go and read that if you like, it’s well worth reading.
On the whole I thought the committee did fairly well. As usual, Britain’s best MP, Dr Evan Harris, was an absolute star and if you live in the Oxford area, make sure you vote for him, but there was another member who asked ‘is there any evidence that homeopathy does not work?’, evidently not realising what a daft and irrelevant question that was, and IIRC none other than the chair of the committee kept asking repeatedly ‘Can you show one specific example of a peer-reviewed trial which proves the effectiveness of homeopathy?’, even though throughout the hearings there had repeatedly been testimonies saying that even if there was one that showed the effectiveness, it wouldn’t prove it because every now and again you will get an anomalous result. Picking one that showed it worked would be cherrypicking.
In the second hearing there were representatives from the Department of Health and the MHRA. It all fell down on Mike O’Brien, one of the ministers for health, who basically said there were two justifications for homeopathy, the fact that it had the placebo effect (like… any treatment you could possible conceive of), and the fact that there is a significant lobby of people who believe that homeopathy works. He also said that he didn’t need evidence to justify the NHS spending and institutional support for homeopathy, he needed justification to change the policy from its current situation. I really don’t understand that, surely you need to justify spending, not justify stopping it. I was really waiting for someone to ask him what would be sufficient justification for changing the policy. Would he need the whole homeopathy lobby to disappear? Would he like another few meta-analyses showing it doesn’t work? The second part was best ripped apart by Martin over at the Lay Scientist, who I’m sure will have more to say about the head of the MHRA as soon as he recovers from his broken hand.
So I mentioned that I wasn’t sure about where Ben Goldacre stands on some things about homeopathy. The MSS had as their question of the week a few weeks ago:
Should alternative medicine be viewed as a tax on scientific illiteracy? Do those who know have a responsibility to educate those who don’t? Should educators make special efforts for people who wear scientific illiteracy as a badge of honour? Or should medical interventions, legitimate and pseudoscientific, be subject to state regulation and required to back up claims of efficacy with robust scientific data?
It was in response to something written in Bad Science by Goldacre, which I still haven’t read. Now I am certainly not of the opinion, as Goldacre seems to be, that we should let people spend their money on rubbish just because they haven’t read up on what exactly homeopathy is and the latest meta-analyses on whether it works or not. Sorry but it would be like letting people go on a dodgy aeroplane because they weren’t smart enough to get an engineering degree and know that it wasn’t up to scratch. But it’s not that simple, of course, just like any other moral question, so I went with a thought experiment. If I went to a shop and bought bleach and decided to drink it, then that’s my own fault, I suppose that’s a tax on the fatally stupid. But the bottle of bleach would have ‘harmful’ and ‘toxic’ written on the side of the bottle in big letters, and probably tell you not to drink it. The same should be true of homeopathic remedies. Whilst I wouldn’t ban their sale, they shouldn’t be able to claim effectiveness for something that they can’t prove, just like any other product. It’s false advertising if nothing else. As Evan Harris said in the evidence hearing to illustrate a slightly different point, you couldn’t say that paracetamol is effective for heart conditions.
Anyway so this has turned into another mammoth post (sorry), and mainly about things that have been covered elsewhere (sorry again), but well worth putting together for anyone who hasn’t heard about these things. Till next time.