The recent stunt by the New Zealand Skeptics Society might be very amusing, but it fails to add much to the debate on homeopathy. The skeptics swallow large amounts of homeopathic remedy to attempt to show its overall uselessness. Unfortunately, this demonstration is no more significant than an atheist demanding that God strikes him dead with a thunderbolt to prove his existence and then claiming that proves God does not exist, because he survived. I suspect it does little more than ignite acrimonious debates and certainly proves nothing at all. One hopes that none of the skeptics involved were diabetic – ingesting that much lactose (the principle ingredient) might push them into a coma.
There is no real scientific theory to explain the “effects” of homeopathy above and beyond the obvious one of placebo effect. I recall reading an article in New Scientist (that I can no longer locate) which described an elegant experiment that demonstrated that protein molecules being created by DNA, folded themselves into their normal shapes much faster than simple molecular attraction would allow, suggesting that, perhaps, water maintains a memory of the shape of the protein molecule; helping the long strand fold into its working shape. This is a far cry, of course, from suggesting that water maintains the memory of the shape of arnica after a 30C dilution. It also ignores the fact that the single glass of water you use to swallow the arnica would contain billions of other different “memories”. It also gives no insight into how that “shape” (should it exist) can alleviate symptoms caused by entirely different molecules.
The lack of a coherent scientific theoretical basis does not necessarily invalidate homeopathy. The claim “we have no idea how this works, but it does work” is not an unreasonable one (we can call it awaiting a scientific theory), if one can prove a reproducible effect. This is the essential problem with homeopathy. Occasional RCTs may show an effect above and beyond the placebo effect, but this effect is not reproducible in subsequent trials, particularly trials with larger numbers of subjects and more rigorous designs. The net result is that, when analysed together, homeopathic trials demonstrate only placebo effect and a little observer bias. Shiang et al’s meta-analysis Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy (Lancet 2005; 366: 726—32) showed that, once they were controlled for observer bias, homeopathic trials demonstrated only an effect similar to placebo, whereas comparative conventional medicine trials produced an effect far above the placebo effect. I have not seen a convincing homeopathic rebuttal to this study, though several have been attempted.
I have several colleagues who use homeopathic remedies on a regular basis in their practice. I have no particular objection to this. I occasionally deliberately use a placebo to help a patient overcome a problem that is clearly volitional rather than pathological. Some would charge that this is unethical and an abuse of the patient’s right to choose. I say that is politically correct nonsense.
I do, however, have a problem with the pharmacies selling these remedies over the counter. As far as I am concerned, they may as well be charging for magic water. Homeopathy proper requires a great deal of input from the practitioner to determine the symptoms and settle upon an individualised regime. Buying an over-the-counter homeopathic medicine for “allergies” is simply purest quackery, regardless of what you may think of homeopathy itself.
I also have grave doubts about practicing homeopathists with little or no medical training. These people are not skilled enough to recognise an illness that requires conventional medication urgently. In fact, their very suspicions about the nature of “allopathic medicines” may make them resistant to referring a patient on to their general practitioner. This disadvantaging of patient occurs far more often than you would like to think. Fortunately serious harm or death is rare.
Complementary medicine needs to follow the rules of proper scientific enquiry – develop a theory, test it, reject it for another. Instead, most CAM studies consist of anecdotal series or poorly design small trails that serve little purpose than to fool a lay person. I am not a skeptic about homeopathy – I am prepared to view it with an open mind, But that does not mean I will uncritically accept anything thrown at me.
Show me some real science. I will be listening.
Peter Cresswell provides some amusing and interesting links on this issue.