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Of homeopathy, witchcraft and the placebo effect

I’ve been following with amusement — and some exasperation — the debate in England about ending National Health Service funding for homeopathic medicines. I particularly enjoyed reading about the doctor who first compared homeopathy with witchcraft — only to quickly apologize to witches.

“Homeopathy is not witchcraft, it is nonsense on stilts,” he told a meeting of the British Medical Association last June. “It is pernicious nonsense that feeds into a rising wave of irrationality which threatens to overwhelm the hard-won gains of the enlightenment and the scientific method.”

“We risk, as a society, slipping back into a state of magical thinking when made-up science passes for rational discourse and wishing for something to be true passes for proof,” he added.

My sentiments exactly.

At best, homeopathic medicines are placebos. And that’s exactly what a study published earlier this week in the journal Rheumatology has found.

Here are the details:

The study recruited 83 people with rheumatoid arthritis from three British clinics where they were receiving conventional treatment for that chronic and often debilitating inflammatory disease. (Rheumatoid arthritis patients were chosen for the study because homeopathy is often turned to by people desperate to get relief from their painful symptoms.)

Some of the study’s participants were then randomly assigned to five sessions of individualized homeopathic consultations, during which they received either actual homeopathic medicines or placebos. Neither the practitioners nor the patients knew which treatment was being handed out. The initial consultation was about an hour long. Subsequent ones ran about 30 minutes long.

Other participants were randomly assigned to receive either a fixed combination of homeopathic medicines for arthritis or a placebo, but without the consultations.

After 12 weeks, the 56 participants who remained in the study (the rest dropped out for a variety of reasons) used standardized assessments to self-evaluate their arthritis symptoms, including pain, inflammation, swollen joints and mood swings. Those who participated in the consultations — whether they received homeopathic medicines or a placebo — reported a significant improvement in their symptoms.

The participants who hadn’t participated in the consultations showed no improvement.

“Homeopathic intervention in patients with chronic, active but relatively stable [rheumatoid arthritis] has significant clinical benefits that are attributable mainly to the homeopathic consultation process. There appeared to be no specific benefit from the homeopathic remedies themselves,” concluded the study’s authors.

Or, as one of the authors told a British newspaper: “When you place the patient at the heart of the consultation you get a powerful effect. I think there are a lot of lessons here for conventional medics about the need for patient-centered care, instead of treating people as walking diseases.”

True, true. Conventional medicine has a long, long, long way to go to becoming patient-centered.

But that still doesn’t lift homeopathy above witchcraft.

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Comments (20)

  1. Submitted by Peter Gold on 11/17/2010 - 02:02 pm.

    Susan,
    Actually the study you quote was deeply flawed. It was poorly constructed and under-powered.

    Homeopathy is a system of medicine that has been practiced for over 200 years with an extensive and laudable clinical record. Tens of millions of patients currently use it around the world.

    It is not the lack of evidence – pre-clinical or clinical that is the problem for homeopathy. There are literally hundreds of high quality, basic science, pre-clinical and clinical peer-reviewed studies showing its effects. The system’s so called ‘implausibility’ is the primary reason for skepticism, even in the face of positive clinical evidence. For instance a systematic review of clinical trials, published in the British Medical Journal (1991) stated ‘we would accept that homoeopathy can be efficacious, if its mechanism of action were more plausible’.

    The skeptic’s claim of “implausibility” directed at homeopathy arises from the system’s use of very highly diluted medicines. These medicines are prepared through a series of sequential dilutions of medicinal substances with vigorous shaking at each stage of dilution, a process known as succussion. Thanks to the work of scientists at institutions like Penn State University, the University of Washington, Stanford University, Moscow State University, and London South Bank University, we now know that the properties and effects of substances are dictated by their molecular structures, not their chemical composition. Thanks to these same scientists, we also know that ultra-dilutions, like homeopathic remedies, do indeed contain stable and unique molecular structures with recognizable properties (Materials Letters. 62. 2008).

    What’s more, there have been numerous high-quality peer reviewed studies showing the biological effects of homeopathic remedies. The most frequently used experiment on ultra-dilutions has involved basophils. Basophils are white blood cells involved in the immune response. One series of experiments conducted in Europe over a period of 25 years on a multi-laboratory basis with independent replications has consistently shown the inhibition of basophil activation by high dilutions of histamine (Inflammation Research. 2009). Another study, a meta-analysis led by Claudia Witt M.D. of the Charité University Medical Centre, Berlin evaluated the quality and results of biological experiments with ultramolecular agitated dilutions. Seventy-three percent of these studies showed an effect with ultramolecular dilutions (Complimentary Therapies in Medicine. 2007). Yet another study – this one also the subject of repeated experiments over a long period – shows the effect of ultramolecular dilutions of aspirin on blood clotting (Clinical and Applied Thrombosis/Hemostasis. 2008). And there are others.

    No evidence of effectiveness?? Or misplaced and unscientific skepticism of how homeopathy could work? What is clear – those who choose to attack homeopathy should at least look at the scientific facts first.

  2. Submitted by Pat Thompson on 11/17/2010 - 02:51 pm.

    Thanks for the story, Susan.

    Here’s Steve Novella’s take on the study over at Science-Based Medicine: http://www.sciencebasedmedicine.org/?p=8269#more-8269

    Counter to Peter’s claims, Novella says the study was well designed generally, if a bit small. His main argument with the findings is that their conclusion that there were positive effects from homeopathic consultation (as opposed to consultation in general), since there was no comparative/controlled use of nonhomeopathic consultation in the study.

    And just one link to a recent peer-reviewed analysis of medical outcomes that found no effects beyond placebo from homeopathic interventions: http://www.ncbi.nlm.nih.gov/pubmed/20402610

  3. Submitted by beth knudtsen-spears on 11/17/2010 - 03:07 pm.

    There are lots more good studies (and poorly designed ones as well) documented by Dana Ullman.

    The question, I think, is are we WILLING to accept an effective form of medication that isn’t owned by the pharmacuetical companies.

    However, at the end of the day, homeopathy has helped me enormously as an allergy sufferer. I am grateful. No form of conventional medicine helped me.

  4. Submitted by Dan Hintz on 11/17/2010 - 03:19 pm.

    “There are literally hundreds of high quality, basic science, pre-clinical and clinical peer-reviewed studies showing its effects” yet you only cite a couple of out-of-context studies that do nothing of the sort. The sad part is that to some people, it may actually appear that you have written something coherent instead of just spouting nonsense.

    If homeopathic remedies actually were shown to work, don’t you think they would be embraced by the medical community? The problem is that real doctors and hosptials and drug companies, unlike homeopaths, are held accountable and can’t sell people things that don’t work.

  5. Submitted by Bill Gleason on 11/17/2010 - 04:01 pm.

    I’ve written for some time about the disgraceful situation at the Academic Health Center at the University of Minnesota which is, apparently, a hotbed of homeopathy. The director of the Center of Spirituality at the University has written in glowing terms about the use of dichromate as a a homeopathetic remedy. She cited an article in Chest that was subsequently debunked in the same journal.

    Sad, indeed, that an institution that claims to be practicing science based medicine would tolerate this quackery.

    For some further thoughts:

    Homeopathy at the University of Minnesota Academic Health Center? – Our Voices (Star-Tribune)
    Link: http://bit.ly/cBXZnK

    The University of Minnesota Academic Health Center actively encourages the practice of homeopathy(Periodic Table)
    Link: http://bit.ly/arvu3T

    The Old Dichromate Homeopathy Quackery Debunked Again (Periodic Table)
    Link: http://bit.ly/aVzl87

    William B. Gleason
    Associate Professor
    College of Medicine
    University of Minnesota

  6. Submitted by Tim Walker on 11/17/2010 - 04:05 pm.

    Susan Perry is absolutely right when she calls this bogus “therapy” what it really is, namely wishful thinking.

    For those who think homeopathy has worked for them, I suggest reading this article:

    http://www.csicop.org/si/show/why_bogus_therapies_seem_to_work/

    or: http://tinyurl.com/lywwun

  7. Submitted by Jacob Mirman on 11/17/2010 - 07:03 pm.

    It is easy to ridicule something you don’t understand, but it sounds really silly to people who do.
    I am a conventionally trained physician, graduate of the University of Minnesota with BA in chemistry and the UofM Medical School, and a specialist in Internal Medicine. I am also an expert in homeopathic medicine. I use both systems of healing depending on what I consider to be the best modality in a particular case. Homeopathy is not placebo. I have cured people with all sorts of physical and mental/emotional disorders by using classical homeopathy. I can show you, but first you must be willing to see. As they say, you can lead a horse to water, but…
    I have involved myself with some of the online discussions with the so called quack busters in Europe and here, only to realize the argument becomes twisted in a big hurry and leads nowhere, so it is not worth my time. I am open to talking with anybody willing to learn, but if you have already formed your opinion, we don’t have much to discuss.
    Jacob Mirman, MD, DHt,
    Life Medical
    St Louis park, MN
    952-933-8900
    jmirman@lifemedical.us

  8. Submitted by Jacob Mirman on 11/17/2010 - 07:09 pm.

    To Bill Gleason:
    Please provide a reference to the study that debunked the Potassium dichromate study published in Chest. I’d like to learn.
    Thank you
    Jacob Mirman, MD, DHt
    Internal Medicine and Classical Homeopathy
    Life Medical
    SLP, MN

  9. Submitted by Bill Gleason on 11/17/2010 - 09:26 pm.

    You are right Mirman, we don’t have much to discuss.
    There is this thing called Avogadro’s number…

    You’d like to learn. I’ll bet. If you know as much about homeopathy as you claim, you are certainly aware – or should be – of this study. It is a by now classic example of homeopathetic quackery and has even been cited by the Director of the Center of Spirituality and Healing at the Academic Health Center at the University of Minnesota.

    I’ve given you some links to use before, but here is another that cites the Chest study and the response in Chest by Professor Colquhoun.

    http://bit.ly/aGSp6F

    Bill Gleason

    For readers who are actually interested in learning a little more about homeopathy – that would not be you, obviously, Jacob, I’d recommend:

    Debunking Homeopathy, Cartoon Style
    Link: http://bit.ly/aQbCDw

    Homeopathy Debunked: http://bit.ly/9SAG0n

    If you took chemistry as a premed, you really should know better than to push potions that have no medicine in them…

  10. Submitted by Kathryn Berg on 11/17/2010 - 10:35 pm.

    If Susan Perry were to ask my dog about homeopathy, he would tell her that in fact, his long standing digestive disorders got better after homeopathy. Coincidence? I think not.

    If Susan Perry were to ask my young son about not having to have surgery for his lazy eye due to homeopathy, he would likely pull out the before and after pictures to let her know that in fact his eye was very crossed until he received a well chosen homeopathic remedy. Coincidence? His doctor doesn’t think so.

    Animals and young children are not susceptible to the placebo effect.

  11. Submitted by Larry Copes on 11/18/2010 - 09:01 am.

    I haven’t looked at the study on which you’re reporting, Susan, but you wrote at least one thing (that about a third of the original participants dropped out) that might have alerted you to the possibility that this particular study was flawed (as other commenters have claimed).

    I have a bias as an academic editor. But I suggest that an editor with statistical literacy might have helped you keep your own bias about this issue from compromising your journalistic integrity.

  12. Submitted by Peter Gold on 11/18/2010 - 09:41 am.

    Dan,
    You made a valid request – “show me more evidence”. There is an abridged bibliography of high quality research studies on the website of the National Center for Homeopathy (http://www.nationalcenterforhomeopathy.org/content/homeopathy-research-evidence-base-references). Many more high quality studies have been done since that time.

  13. Submitted by Dan Hintz on 11/18/2010 - 09:58 am.

    “Animals and young children are not susceptible to the placebo effect.”

    Yes, but their owners and parents are.

  14. Submitted by Pat Thompson on 11/18/2010 - 10:18 am.

    Kathryn, the link given by Tim Walker above addresses in a general manner the ways that effects can seem to be caused by a treatment (http://www.csicop.org/si/show/why_bogus_therapies_seem_to_work/). That’s why there are double blind, placebo-controlled studies.

  15. Submitted by Bill Gleason on 11/18/2010 - 10:36 am.

    Dan-

    Having been around the track – over homeopathy – for quite some time, I think it is pretty useless to argue with these folks.

    About all you can do is to provide some links for the average person to follow up, in case they are interested.

    But you aren’t going to convince these folks that homeopathy doesn’t work. Pointing out that there is no medicine in the medicine doesn’t even faze them.

    People still believe in witchcraft, exorcism, and faith healing. Not much you can say or argue is going to change this.

    My best,

    Bill Gleason, U of M faculty member (med school) and alum

    Professor Copes-

    “Compromise journalistic integrity”? Isn’t this an opinion piece, Professor Copes? Ms. Perry has hardly compromised her integrity with this piece. “Your own bias” ? – there is plenty of evidence out there to support Ms. Perry’s opinion that homeopathy is at the level of witchcraft.

  16. Submitted by Pat Thompson on 11/18/2010 - 11:23 am.

    Here’s an interesting exchange between commenter Jacob and skeptic/logician Robert T. Carroll. Topics covered include study design, the meaning of statistical significance, and the need for replication of results: http://www.skepdic.com/comments/homeocom2.html

  17. Submitted by Dan Hintz on 11/18/2010 - 12:01 pm.

    Bill, I think you are absolutely right. The problem is that the average person may not be capable of sorting through the psuedoscience and out of context citations of the true believers. Its one thing if you want to believe that homeopathy is making your allergies better or curing your dog’s digestive problems. Its another when you start treating serious conditions with fake medicine when there are real treatments available. Look what has happened with vaccines – vaccination rates are way down and once near-extinct diseases are making a comeback because people bought into pseudoscientific (and in some cases outright fraudulent) claims linking vaccines to autism.

    I guess all you can do is try – give them the facts and hope they are willing to understand and accept them.

  18. Submitted by Jacob Mirman on 11/18/2010 - 04:11 pm.

    To Dr. Gleason:
    You keep telling us that the Potassium dichromate study has been debunked. Yet, I have not seen a real study that debunked it. Empty opinions you link to don’t count.
    I am well versed in principles of chemistry, including Avogadro’s number. Unfortunately for your side of the argument, homeopathy has nothing to do with molecules in solution, because, as you are hinting at correctly, the dilutions are beyond Avogadro’s number and therefore submolecular. The effect we see is due to some phenomenon as yet unknown to science.
    Are you implying that science knows everything there is to know in nature? I hope not. Then what’s your point?
    You are medical school faculty? How about organizing a debate in front of medical students and faculty. That should be fun! Got goinads to do it? We’ll also invite Mary Jo Kreitzer, director of the Center for Spirituality and Healing, and whoever else wants to come. I gave her the article you are so upset about. Like I said, you can ridicule something you have little understanding about, but are you confident enough to go in front of public and defent your position using actual science?
    And for others interested in the subjest, I put together a good collection of abstracts of studies of homeopathic remedies vs placebo here: http://bookonhealing.com/appendix.html

  19. Submitted by Dan Hintz on 11/18/2010 - 05:22 pm.

    “[T]he dilutions are beyond Avogadro’s number and therefore submolecular. The effect we see is due to some phenomenon as yet unknown to science.
    Are you implying that science knows everything there is to know in nature? I hope not. Then what’s your point?”

    I think you have made Dr. Gleason’s point in your comment, Mr. Mirman. (sorry, but an MD doesn’t make someone like you a Dr.) As you point out, there isn’t any scientific basis for the “phenomenon” in question. The worst part is that you imply that Dr. Gleason as arrogant, when you are the one who is pushing so-called cures that have no scientific basis.

  20. Submitted by Bill Gleason on 11/18/2010 - 09:49 pm.

    Exactly, Dan

    “It surprises me that CHEST would publish an article (March 2005) on the effect of a therapeutic agent when in fact the patients received none of the agent mentioned in the title of the article.”

    “It is not mentioned in the title, but reading the article reveals that the ‘potassium dichromate’ was a homeopathic C30 dilution. That is a dilution by a factor of 10^60 [ten raised to the sixtieth power], and for those of us who believe in the Avogadro number, that means there would be one molecule in a sphere with a diameter of approximately 1.46 × 10^11 m. That is close to the distance from the earth to the sun. To describe this as “diluted and well shaken,” as the authors do, is the understatement of the century. The fact of the matter is that the medicine contained no medicine.”

    “The authors will doubtless claim some magic effect of shaking that causes the water to remember for years that it once had some dichromate in it. The memory of water has been studied quite a lot. The estimate of the duration of this memory has been revised downwards from a few picoseconds to approximately 50 femtoseconds. That is not a very good shelf life.”

    “It is one thing to tolerate homeopathy as a harmless 19th century eccentricity for its placebo effect in minor self-limiting conditions like colds. It is quite another to have it recommended for seriously ill patients.”

    That is downright dangerous.

    David Colquhoun, FRS
    University College of London
    London,UK

    Letter to the editor: Treating Critically Ill Patients With Sugar Pills
    David Colquhoun, FRS (Fellow of the Royal Society)
    doi: 10.1378/chest.06-2402 CHEST February 2007 vol. 131 no. 2 635-636

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