Yes, homeopathy is dead.
Details concerning its long-anticipated demise were released at about this time last year, by the editors of The Lancet. Needless to say, their report came as a surprise to thousands of successful homeopathic practitioners, hundreds of thousands of satisfied homeopathic patients, and dedicated scientists involved in ongoing research in homeopathy in laboratories and clinics around the world.
But the editors of The Lancet appeared unconcerned with reactions from these quarters. Though they confirmed, that which even they could not dismiss with a peremptory wave, that homeopathy is experiencing an explosive growth in popularity around the world, faced with this fact they nevertheless rest their evaluation of homeopathy’s demise on the same basis as they and their ilk have done for the past 200 years. Blithely, they reiterate yet again their presumption that homeopathic dilutions are “absurd” – needless to say, without adducing any actual evidence to that effect. And they glibly reference “150 years of unfavorable findings” as testimony against homeopathy, without seeming to notice that the testimony comes from the same quarter today, as it did 150 years ago, namely, the community of skeptics.
In short, the editors of The Lancet have done nothing more than to display their faith in the assumed monarchy of their own gold standard, as though the coin of veracity had only one face – needless to say, their own face, the face of controlled research. Appropriately enough, they conclude their obituary with a reference to Kant, who reminded us, “…we see things not as they are, but as we are…”
…though the irony of this invocation appears to have escaped them.
In any case, what the editors of The Lancet predictably fail to notice, is that the 150 years they reference have produced no direct evidence against homeopathic practice, and, further, offers living testimony to the fact that what has persisted over that period of time is controversy, that is to say, disagreement, in other words, a difference of opinion: in short, the issue remains undecided, the controversy unsettled, the lines drawn precisely where they have been drawn for nearly two centuries. And yet the editors of The Lancet have the gall, or gullibility, to claim victory out of the deadlock.
But, except for purposes of self-serving propaganda, there is no apparent reason why skepticism should win the day today, when it has failed to do so for the past 150 years. The fact is, homeopathy has always worked, it works today, and it will work again tomorrow.
Simply, it’s called a difference of opinion, based on competing bodies of evidence. In a word, it reflects the fact that the intervening years have produced no definitive proof on either side. Instead, we have on the side of the skeptics, a series of controlled trials showing that homeopathy doesn’t work; while on the side of homeopathy, we have an enormous literature documenting homeopathic effects, and the constantly increasing witness of countless individuals who believe in observed results rather than careful calculations. It is true, we would acknowledge, that our eyes can deceive us. But it is also true, what the skeptical community likes to deny, that vision can be sharp and perception discerning, and furthermore that numbers can be wrong, wrongly counted, wrongly applied, and wrongly interpreted.
Of course, this really is all the editors of The Lancet have documented, that we are faced with a conflict, their method versus ours. Is anyone surprised they like their method better than they like ours? Did anyone expect they had changed their mind in the last few months, from the opinions they have held for 150 years? Is repetition of long-held notions supposed to represent the advance of science?
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There are those who think The Lancet is, or should be, a beacon for civilization, rather than a bullhorn for bureaucrats or an apologist – wittingly or otherwise – for the pharmaceuticals. Sadly, however, statistical analysis is in such favor these days, that a mere digit carries inordinate weight in the legislatures of the world, and in the hearts and minds of some in the scientific community itself, to the detriment of the rights of the public to choose their own health care.
But the editors of The Lancet trivialize concern for those rights as representing a “…politically correct laissez-faire attitude … towards homoeopathy…” and, oddly, see a movement to eliminate free choice as evidence of “enlightenment” in our legislative bodies. Perhaps worse, in taking this position, the editors of The Lancet seek to elevate scientific opinion to the level of public guardian, protector of the public welfare, arbiter of truth, making of science nothing more than a church, and of government, the priesthood. Those with contrary views or “discredited” methods need not apply.
Certainly, it might be advisable to avoid such provocative comparisons, but the point is this: right or wrong, science is a system of belief, not a method of governance.
As reflecting their belief system, the difficulty with the position adopted by the editors of The Lancet rests, first, on the inability of common sense to grasp that which is unfamiliar, and which goes against the grain of intuition. But in a universe populated by quantum events, black holes, and dark matter, the editors of The Lancet can not seriously believe that tagging ultra-dilute homeopathic remedies as “absurd” has any purpose other than propagandistic manipulation.
As reflecting their belief system, the difficulty with the position adopted by the editors of The Lancet rests, second, on a failure of method, that is, on the inability of controlled research to extend its reach from the efficacy trial in conventional medicine, to the far-flung practices to which its adherents would like it to be applied. The true believer insists that the controlled trial can appropriately be applied to everything from homeopathy to dowsing, from telekinesis to high-end audio. Yet it is by no means clear that this peculiarly gifted stepchild of the conventional medical system is really up to the task – though, whether it is up to the task, or not, is admittedly a fair question.
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From the beginning, the goal of controlled research has been to clarify the effectiveness of specific medical interventions in alleviating specific medical symptoms, or well-delineated (allopathic) complexes. An early, fairly quaint example is found in the work of Dr. C. H. Parry, in the late eighteenth century, who conducted a crossover study comparing the effectiveness of two varieties of English rhubarb versus Turkish rhubarb, in alleviating cases of diarrhea. Quaint or otherwise, however, his research is thoroughly comparable to the essential characteristic of the most sophisticated research studies conducted today, for example, in examining the effectiveness of Vioxx in controlling pain, SSRI’s in controlling depression, and Thalidomide in resolving infertility problems.
Lest I inadvertently offend anyone’s sensibilities, let me emphasize that reference to these infamous medicaments is not intended to reflect negatively on conventional medications, but to highlight that controlled research has as its primary purpose only the measurement of effects of medication (or other treatment intervention) on a specific symptom or condition. The controlled trial does not generally aim to assess safety of a medication, nor treatment protocols, nor anything other than the specific effect of a specific medicine upon a specific symptom.
The importance of this fact in our present context is simply this: in homeopathy, as a rule, such a direct link between a single symptom and a specific medication, or remedy, is simply non-existent. Although this is, of course, an oversimplification, as regards controlled research it remains an important issue for the ample reason that the dramatically differing method of action of homeopathic remedies introduces numerous confounders into the experimental theatre, confounders, needless to say, to which researchers have rarely paid sufficient attention.
This is not to suggest that the controlled trial cannot measure homeopathic medicine. What it does suggest is that the process of measuring homeopathic action is not as direct as the more fanatical devotees of the controlled trial like to pretend. But in one way, the skeptic is in fact correct: if we claim that homeopathy has a real effect in the real world, then we ought to be able to demonstrate that capacity under experimental conditions. In this connection, the editors of The Lancet have hit the nail on the head: hitherto, homeopathy has for the most part failed to demonstrate its healing powers under the gaze of the experimentalist.
Many homeopaths have rationalized this failure on the basis of the unique character of homeopathic remedies in acting on the “energic” or “spirit-like” domains, or because of the necessity for extreme individualization of treatment in homeopathy. But these objections miss the point, for, in spite of all of this, we still claim to cure disease, and therefore the simple fact is that, at the end of the trial, the patient ought to be healthier than at the start, regardless the mechanism that effected the transition.
Therefore, the failure of homeopathy to convincingly demonstrate its curative powers demands an explanation. But the explanation is simpler than might have been expected: in a word, the task of designing a trial that accurately measures outcomes is complex, and has not until recently begun to attract the serious attention it deserves. But, in the wake of recent improvements in trial design, even in the last 5-10 years, we already see a dramatic shift toward trial outcomes reflecting positively on homeopathic efficacy. (1, 2) It is most germane to note that these recent studies are often conducted by professionals well versed in experimental design as well as clinical practice of homeopathy, a necessary combination of skills that have hitherto been mostly lacking, especially in the rag tag assortment of trials trotted out by the editors of The Lancet for their funeral dirge.
Taking a simple example, when one gauges efficacy of Belladonna against placebo, but counts only 5 of the 1040 symptoms associated with Belladonna, then one will unavoidably undercount symptom production by verum. In fact, one will undercount by roughly 99.52%.
The thoughtful skeptic might object, that these figures exaggerate the problem because, of the 1040 symptoms, many are close duplicates. This is a legitimate objection; therefore, perhaps a truer calculation could be made if we reduced the number of symptoms from 1040 to 200, or 100, or to even fewer distinct symptoms. However, sadly for our skeptical critic, even a little reflection reveals that this leaves us…
…admitting that such a trial still produces a greater or lesser undercount in the number of symptoms produced by verum;
…confirming the common observation that the necessity to account for confounders weakens the findings in a controlled trial; and
…confirming a) that counting can be simultaneously precise and inaccurate; b) that calculations can be accurate and wrong; and c) that statistical outcomes are in and of themselves meaningless, until we analyze how data has been generated.
Which makes one wonder, how, exactly, does one differentiate supposedly “objective” measurement from supposedly “subjective” observation?
These, after all, are the kinds of questions that led to the introduction of measures – in and around the time of Dr. Parry’s investigations – that we now take for granted, to guarantee accuracy in research into mainstream medical practices: placebo control, blinding, randomization, crossover designs. One wonders, why have comparable measures not been long since introduced, to assure that outcomes from research, as applied to disparate practices, can also withstand critical scrutiny?
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The editors of The Lancet reported that homeopathy is dead…
…but perhaps they misspoke themselves. Perhaps they intended instead to remark on the appalling failure of controlled research to demonstrate its superiority to empirical practice, for a period of time spanning nearly 200 years, in spite of its extravagant and hitherto unsubstantiated claims to the contrary.
Simply, the controlled trial is not a “gold standard,” if for no other reason than it is not a “standard” at all. If one thinks about it, after all, a “standard” is an entity, an object, against which other objects are measured. Thus, “gold” is indeed a standard – put a nugget of gold in the hand of a poor man and he is rich; put a nugget of gold in the hand of a rich man, and he is richer. A scale, by comparison, may weigh a nugget of gold at 1 ounce, and a nugget of fool’s gold at 1 ounce – but the scale cannot tell which is which.
But the skeptic claims to be an expert in calculation, not in grammatical constructions, so we must turn away from semantics to substance: as with any tool, the accuracy of the controlled (or other “systematic”) trial depends on the quality with which it is forged, and the skill with which it is applied. And that is the seat of the controversy that has persisted for at least 150 years: have research scientists adapted the controlled trial as well to homeopathy, as they have to the conventional practices around which it was originally developed?
More important, what is seemingly always obscured in the haze of self-congratulatory rhetoric with which the skeptical statistician surrounds himself, and what is otherwise well known and universally acknowledged, in reality, there is only one gold standard in science; it is known as “replication,” better described as “independent corroboration.”
But the advocates of the controlled trial have no patience with independent corroboration (of which “replication” is but one variety). They have no patience, even, for acknowledging that “evidence” includes more than numbers, that “systematic” describes a well-conducted case study as well as the process of calculation, and that “objectivity” is as apt a descriptor of good field observation as it is of counting. And they have no patience to await confirmation of observations and measurements from the domain of the laboratory or the ruminations of the theorist, preferring instead to proclaim, on what mystical basis is unclear, that there are no new discoveries forthcoming, worth waiting for.
Somehow, we have let the skeptics obscure the fact that bias and error were identified before the advent of placebo controlled research, and that they persist in the wake of randomization and the chi square.
In a word, the controlled trial has never been validated; it has never proven itself against alternative (independent) forms of measurement, except in the domain of allopathic medicine, with which it has evolved hand in glove for the past 300 years.
It took nearly three centuries for controlled research to develop to its present state as a universally applauded allopathic art form, from its humble origins in Dr. Parry’s investigations into the anti-diarrheal properties of rhubarb. But can the controlled trial accurately measure homeopathy? Or high-end audio? Or cranio-sacral therapy?
Findings from quantitative trials confirm and refine observations from conventional medical practice, and are enriched by discoveries in the laboratory. This is known as independent corroboration. But in homeopathy, in high end audio, in cranio-sacral therapy, and in other domains that ignite the fury of the “dispassionate” skeptic, results produced by the conventional controlled trial stand in marked contrast to empirical evidence. In these domains as well, laboratory findings are inconclusive at best, and theory simply has no alternative explanation for the events described in the literature.
But never mind that you have evidence to support your views and preferences, if the evidence is not carved from an approved tablet. And never mind that you experience a benefit from practices a skeptic happens to abhor. Never mind that you like Coke better than Pepsi. Never mind that you think the expensive interconnect cable improves the sound of your hi-fi: your perceptions are wrong, they must be wrong, for they have been rendered wrong by the technologists of the blinded trial, who are smarter than you are. And if you persist in disagreeing with them, it is just you’ve forgotten …their wisdom is grounded in numbers – or, more accurately, on probabilities – and readily reveals the truth to anyone with fingers on which to count.
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Truly, The Lancet occupies a prominent and enviable position on the world stage. But such a position comes with responsibilities, not just privileges. It is time, in short, for the editors of The Lancet to acknowledge the presence of others in the assembled company: pride is not a substitute for balance; numbers complement reason, but don’t replace it.
The editors of The Lancet have forgotten that politics is not synonymous with science, regardless how strongly we adhere to our beliefs, or how long we persist in them, even if we hold them dear for 150 years, or more. Differences of opinion must be reconciled, not obliterated by legislation or prejudice. The editors of The Lancet forget that methodology is only an aide in the pursuit of truth; it is not, cannot, and must not be elevated to status as a slogan for an imagined elite.
The editors of The Lancet reported that homeopathy is dead.
They would do well to scrutinize their sources, and double-check their facts.
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References
1. 2005. An Overview of Positive Homeopathy Research and Surveys, Compiled by The European Network of Homeopathic Researchers (ENHR), April.
2. 2002. Homeopathy: The Scientific Proofs of Efficacy. Guna S.r.l. (Milan). Compiled jointly by the Homeopathy and Biological Medicine Research and Permanent Training Institute, with Guna S.r.l. (This volume is reviewed in the present issue of Homeopathy for Everyone.)
