Trick or treatment? The truth about homeopathy
Continuing our debate on ‘The Best and Worst of Medicine’, Michael Baum and Edzard Ernst call for homeopathy to be put in the sin bin of history.
spiked and Wellcome Collection have launched a brand new website to debate the best and worst ideas, phenomena, developments and practises in the history of medicine, in the run-up to two big live debates in London on 26 June and 17 July. Here, Michael Baum and Edzard Ernst argue that homeopathy is one of the worst, lingering ideas in the world of pseudo-medicine.
Once upon a time, doctors had little patience with the claims made for alternative medicines. In recent years, however, the climate has changed dramatically. It is now politically correct to have an open mind about such matters; ‘the patient knows best’ or ‘it worked for me’ seem to be the new mantras.
While this may be a reasonable approach to some of the more plausible aspects of alternative medicine, such as herbal medicine, we believe it cannot apply across the board. Some of these ‘alternatives’ are based on obsolete or metaphysical concepts of human biology and physiology that have to be described as absurd. Proponents of such concepts will not subject their interventions to scientific scrutiny, suggesting that the mere attempt of critical evaluation is sufficient to chase the healing process away. An open mind, it is widely held, is an essential precondition for any scientific inquiry – yet we believe there are limits to this principle.
Homeopathy is amongst the worst examples of faith-based medicine that wins shrill support from celebrities and other powerful lobbies in place of a genuine and humble wish to explore the limits of our knowledge using the scientific method. Homeopathy is based on the like-cures-like principle (‘Similia similibus curentur’) and the concept of the memory of water.
The like-cures-like principle holds that, if a substance causes certain symptoms in healthy volunteers (like onions cause a runny nose), then this substance constitutes an effective treatment for conditions associated with those symptoms – so, for example, a homeopathic remedy from onion cures a common cold. The second principle posits that serial dilution in combination with vigorous shaking of a substance (homeopaths call this ‘potentation’) does not render that substance less but more powerful. Thus the most ‘potent’ homeopathic medicines are so highly diluted that they do not contain a single molecule of the original substance. These axioms are not only out of line with scientific facts – they are also directly opposed to them. If homeopathy is correct, much of physics, chemistry and pharmacology must be incorrect.
To have an open mind about homeopathy or similarly implausible forms of alternative medicine – for example, Bach Flower remedies, iridology, spiritual healing or crystal therapy – is therefore not an option. After many years of considering these subjects, we have come to the conclusion that a belief in these forms of alternative medicine exceeds the tolerance of an open mind. We should start from the premise that homeopathy and similarly irrational treatments cannot work, and that, until proven otherwise, any positive evidence simply reflects publication bias or design flaws. If not, we must believe that water has a selective memory, recalling the 1x 10 molecule of the mother tincture in favour of the multitude of molecules that are likely to be present in concentrations orders of magnitude greater.
So far homeopathy has failed to demonstrate efficacy in independently replicated randomised clinical trials (RCTs) and systematic reviews of well-designed studies (1). Homeopathic physicians seem to clutch on to the straws of poorly designed or underpowered studies to retain their credibility, or they claim that the RCT is an inappropriate methodology to assess their belief system in the name of postmodern relativism (2). We are certain that no kind of evidence would persuade homeopathic evangelists of their self-delusion. Yet we challenge them to design a methodologically sound trial, which, if negative, should give rise to a serious debate about ending homeopathic treatments. This is not a double standard; both of us have been involved in studies that have challenged our favoured remedies and the practice of our specific disciplines.
Should there be limits to open minds?
Should we keep an open mind about astrology, perpetual motion, alchemy, alien abduction and sightings of Elvis Presley? No, and we are now happy to confess that our minds have closed down on homeopathy and similarly irrational concepts in the same way. Here’s why:
- Homeopathy is based on an absurd concept that denies progress in physics and chemistry. One hundred and sixty years after the publication of ‘Homeopathy and its Kindred Delusions’, an essay by Oliver Wendell Holmes, we are still debating whether homeopathic remedies are placebos or not (3). We feel it is time to move on.
- Homeopathy is advocated for mostly self-limiting conditions – for example, it ‘cures a cold in seven days’, practitioners say; in fact a cold normally clears up within that timeframe. The totality of the evidence from 200 years of inquiry remains unconvincing as to homeopathy’s efficacy (4).
- There are no ‘advances’ in homeopathy. The field is stagnant and further attention to it is a waste of resources.
- Homeopathic principles are ‘bold conjectures’. There has been no spectacular corroboration of any of its founding principles. An example of the spectacular corroboration of a bold conjecture is that the planet Pluto was predicted by observing minor discrepancies in the orbit of its neighbouring planet Neptune and its discovery was counted as a spectacular corroboration of a bold conjecture (although in 2006 the International Astronomical Union downgraded Pluto’s status from that of a planet to a dwarf planet). In medicine, the same might apply to the discovery of antibiotics.
Yet homeopaths remind us of Galileo’s battle with the dogma of his day. Just as, in the fullness of time, this heretic was proven right so will homeopaths be, they say. The Galileo argument is a syllogism, a kind of logical argument in which one proposition (the conclusion) is inferred from two others (the premises) of a certain form. Van Gogh was a great artist not recognised in his lifetime. We are artists who have so far not sold a single painting, ergo ‘we are great’. After almost 200 years, we are still waiting for the ‘heretics’ of homeopathy to be proven right. During the same time, the advances in our understanding of disease, progress in therapeutics, surgery and prolongation of the length and quality of life by so-called ‘allopaths’, have been breathtaking (5).
The true sceptic therefore takes pride in closed-mindedness when presented with absurd assertions that contravene the laws of nature or deny progress in science. As the late Petr Skrabanek once lamented: ‘If your mind is too open your brain slides out.’ (6) Our brains are too precious to be hazarded in this way and our minds are too tightly closed when asked to consider the possibility that homeopathic remedies are anything other than placebos offered by a kindly practitioners with ample time at their disposal.
Does any of this really matter?
But hey, what’s wrong with offering placebos for the worried well with self-limiting conditions? Well, firstly it is considered unethical for modern medical practitioners to sink to this kind of deception that denies the patient his autonomy. Secondly, by opening the door to irrational medicine alongside evidence-based medicine, we are poisoning the minds of the public, an effect that extends far beyond the realm of healthcare.
Thirdly, if we don’t put a break on the increasing self-confidence of the homeopathic establishment, they will cease to limit their attention to self-limiting or non-specific maladies. Already an investigative journalist has exposed the willingness of homeopaths to offer homeopathic prophylactics for malaria (7) and the UK Society of Homeopaths recently organised a conference on homeopathy for AIDS (8).
An open mind is normally a prerequisite for scientists. But there are limits. We believe that, in the interest of progress, the overtly false and regressive concepts of homeopathy and similarly absurd alternative therapies deserve a closed mind.
Michael Baum worked for 30 years as a surgeon specialising in breast cancer, and is now professor emeritus of surgery at University College London. Edzard Ernst is the world’s first professor of complementary medicine. Formerly a clinical doctor, he has studied homeopathy and practised this and many other treatments. He has now built a world-class reputation for successfully applying science to test the value of alternative therapies. He is author with Simon Singh of Trick or Treatment? Alternative Medicine on Trial, published by Bantam Press. For more on the spiked/Wellcome Collection debate on ‘The Best and Worst of Medicine’, click on the icon below.
(1) ‘Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy’, Shang A et al, Lancet 2005, 366:726-732; ‘A systematic review of systematic reviews of homeopathy’, Ernst E, Br J Clin Pharmacol 2002; 54:577-582
(2) Physiological and physical evidence of the efficacy of smallest entities, Kolisko L, 1923
(3) ‘Homoeopathy and its kindred delusions’, Holmes OW, 1842. Re-published in Examining Holistic Medicine, Stalker D and Glymour C, Prometheus Books, 1989
(4) ‘Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy’, Shang A, Huwiler-Müntener K, Nartey L, Jüni P, Sterne JAC, Pewsner D et al, Lancet 2005; 366:726-732; ‘A systematic review of systematic reviews of homeopathy’, Ernst E, Br J Clin Pharmacol 2002; 54:577-582
(5) ‘Medical Milestones. Celebrating key advances since 1840’, Chew M and Sharrock K (eds), BMJ 2007; 334 (suppl):s1-22
(6) ‘The demarcation of the absurd’, Skrabanek P, Lancet 1986; 1:960-961
(7) ‘Voodoo on the NHS’, Whyte J, The Times (London), 15 July 2006
(8) HIV/AIDs Symposium Web Flyer [pdf], The Society of Homeopaths, 2007