Friday, July 24, 2009

Nothing Is Better than Something

Imagine you have gone to your physician and were told you needed a specific medicine to help you get better. Then your doctor told you that if the medication wasn’t working you could make it stronger by diluting in water. You were told to keep diluting it until there was only one molecule of the medicine left in the water. You were told this small amount of the medication would be extremely strong and would cure what ailed you. Would you have some misgivings about this advice? Most people would leave immediately, never go back and probably report the doctor to the medical board.

Yet, there are people who believe this kind of "medicine" really works. It’s hard to imagine this but millions of people swear this system has helped them with their medical problems. This treatment is called homeopathy. For many people homeopathy is a misunderstood concept. People often think homeopathy describes a remedy that uses natural herbs. This is not what homeopathy is. Regardless of this misconception, it is a popular treatment. If you Google "homeopathy" you will get over a million and a half hits most of which are favorable to homeopathic medicine.

Let me give you some background on what homeopathy real refers to. It was invented in the late eighteenth century by Samuel Hahnemann. He based homeopathy on a philosophy that believed all illness and disease was caused by "disturbances of the life force." Hahnemann lived during a time when the germ theory was just beginning to be understood. Humans had always wondered why people got sick and many ideas over the millennia had been advanced as to why people fell ill.

One of the more common theories on why people got sick was based on the idea that life could only be fully explained on the basis of a mysterious form of energy inherent to all living things. This strange force had nothing to do with the laws of physics and chemistry, however. People who held this view thought a healthy person was one in whom these forces were in balance. One became unhealthy when the forces were out of balance.

Hahnemann believed this vital force could be affected by internal events (like a person’s thoughts) or by circumstances outside an individual. He called this the "law of susceptibility." To cure this imbalance he devised a method based on the notion that "like cures like." In other words if you had a headache, the cure would be based on anything that would give you a headache. If Hahnemann could find a piece of bark or a root that would cause headaches he would then make a potion from it.

Hahnemann observed that if he swallowed a small amount of cinchona bark he would experience symptoms similar to malaria. Cinchona bark is used to produce quinine which in turn is an effective drug for the treatment of malaria. Aha! He thought he had found the miracle cure. Cinchona bark must have the vital force for curing malaria because in high enough doses it can cause malaria (it can’t).

To create the proper medicine for an illness he would find something that could cause symptoms similar to the illness. He would then dilute the chosen substance so much there was not enough toxicity left in the solution. He reasoned that the more he diluted a substance, the more powerful it became because the dilution would make the vital force even stronger. If this was true, then the more he diluted it, the stronger it became. Of course, he had no evidence this was true, it just seemed like a good idea to him.

This Principle of Similarities became the foundation for homeopathy. So, if rotten meat brings on nausea to the point of vomiting, then a solution with trace amounts of rotten meat, he declared, will cure nausea.

How much do homeopaths dilute their curing solutions? More than you can imagine. If you are really sick then serious dilution would be a lengthy process. A very small amount of the first dilution would be diluted again and again. This would be repeated until the initial substance barely existed. What remained would be equivalent to one drop of the cure diluted in all the water on earth.

Homeopathy proponents also believe that literally anything can be a potential remedy. Dr. Harriet Hall, a retired Air Force flight surgeon is convinced that homeopathy is absolute nonsense. When it comes to finding absurd things to act as a cure, her favorite is "eclipsed moonlight." She ponders as to how it is collected in order to prepare the remedy. Let me know if you find how out to harvest eclipsed moonlight.

What keeps this pseudoscience alive is that homeopathic practitioners and their patients swear these treatments work. Of course, swearing and belief do not a treatment make. There are many reasonable explanations why homeopathy "works." One of the strongest reasons is the power of the placebo. Since a placebo can be so effective, a treatment is not considered legitimate by the scientific community unless it can produce effects significantly greater than a placebo treatment would provide.

This is a very stringent standard because people can think a treatment is helping them when, in fact, it is the result of placebo. For example, a study was done where two groups of people were given either morphine for severe pain or an inactive placebo. Here’s the astonishing part. The people getting the "nothing" treatment were told they were getting a powerful new painkiller. The researchers were shocked to find out this group got just as much relief as the group who actually got morphine.

Placebos have been studied so extensively that we now know there is a pecking order of effectiveness. Some placebos work better than others. Here is a list of which placebos work better than others. It looks something like this (This list is taken from "The Placebo Effect" by Harriet Hall in the Skeptic magazine, Volume 15, Number 1, 2009):
  1. Placebo surgery works better than placebo injections.
  2. Placebo injections work better than a placebo pill.
  3. Fake acupuncture also works better than a placebo pill.
  4. Pills as capsules work better than pills as tablets.
  5. Big pills work better than small pills.
  6. The more doses a day, the better.
  7. The more expensive the pill, the better it works.
  8. The color of the pill makes a difference.

This doesn’t make any rational sense and we only partially understand how a placebo works. So far we know it works and it can work very well. When studies of homeopathic treatment take into account the results of the placebo, homeopathy is left standing naked.

What about "all the studies" supporters of homeopathy quote that show how legitimate homeopathy is? We must realize there are studies and there are studies. It is very easy to do sloppy science. This kind of science can verify all sorts of crazy notions. Consequently, only well-designed studies are acceptable.

To illustrate this point, we can observe the career of Edzard Ernst who is a physician and the world's first professor of complementary medicine. He used to be a passionate support of homeopathy. Then he began to do research. He and his team of researchers have published over 700 papers in scientific journals on alternative medicine. After fifteen years of studying homeopathy, he has concluded that "the evidence points towards a bogus industry that offers patients nothing more than a fantasy." Strong language from someone who used to be inside the camp.

If you are interested in what logic is used by supporters of homeopathy to maintain that it is an effective treatment, you only need to browse the writings of Louise McLean who is the Executive Director of the Alliance for Natural Health. You can find her writings here. You will find an article called, "Homeopathy Facts List – 54 Facts." As you read through this article of "facts" you may quickly realize the "intellectual bankruptcy of the homeopathic belief system." Here are some examples (my comments are in parentheses):

  • FACT 10: Outcomes of homeopathic treatment are measured by the LONG TERM curative effects of prescribing and complete eradication of the disease state. (Like scientific medicine is only concerned with short term effects? All measurements of long term effects from homeopathy have found no significant effects.)

  • FACT 20: In 200 years, there has never been a single homeopathic medicine recalled, unlike pharmaceutical medicines. (That’s because homeopathic "medicines" are not regulated by any government body. Therefore, they cannot be recalled. The FDA doesn’t regulate treatments that don’t work.)

  • FACT 30: The Homeopathic Hospitals are clean, with friendly, well informed staff. The patients are generally pleased with their treatment unlike many orthodox National Health Service hospitals. (She is obviously comparing the best Homeopathic Hospitals with the worst British Hospitals. Even if this were true, I’m not sure how this proves that homeopathy works.)

  • FACT 40: Homeopathy can never be properly tested through double blind randomised trials because each prescription is individualised as every patient is unique. Therefore 10 people with arthritis, for example, may all need a different homeopathic medicine. (This is merely an excuse for why all double blind tests of homeopathy have failed. It would be easy to design a test for each of the 10 people who needed 10 different homeopathic medicines. Supporters of homeopathy need to do this if they really want to be accepted as legitimate. I wonder why they have not done so?)

  • FACT 50: Hundreds of famous people throughout the past 200 years have enjoyed the benefits of homeopathic medicine. (Hundreds of famous people in the past 200 years have believed in witchcraft, psychics, or other foolishness. The belief of intelligent people is hardly a reliable standard to finding truth. Some of the most gullible alive are members of MENSA.)
What really keeps homeopathy alive is that it is supported by nice people; humans respond to what nice people say. If you were to visit a homeopath you would probably find it to be a very pleasant experience. He would sit and patiently listen to you as you tell your personal story. You might not get this much attention from your MD. The homeopath would make you feel special because he would pick out a "special" treatment designed just for you which would make you feel special. The remedy would be inexpensive and would most likely have little or no side effects (how could there be side effects when there is nothing to cause it?). You would tell your friends that you were very reassured because the homeopath had been interested in you as a person.

Who wouldn’t want to experience this atmosphere along with medical treatment? Scientific medicine could use more of this relational aspect in their treatment. Many of my clients tell me they will change physicians if their physician treats them poorly. Excellent.

The Gold Standard (double blind studies) for deciding what works and what doesn’t is the Gold Standard for a good reason. It minimizes human error and bias that is built into all human researchers, practitioners, and those of us who use treatment services. Hopefully, homeopathy will eventually go the way of bloodletting and purging. Philosopher Daniel Dennett at Tufts University has said that treatments based on "mysterious stuff" need to be relegated "to the trash heap of history." Amen.

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