19 November 2007

Homeopathy, dilution is not the solution

Since I did science on Friday, I'm going to do some health today to make up for it. These two articles appeared in the Guardian only a few days apart. Homeopathy is "Western Medicine" in that it was invented by an Englishman, but it is not modern nor is it scientifically supported. Its a much bigger deal in England than it is here in the US. The first article is by Jeanette Winterson and is appropriately titled In defence of homeopathy. She starts, as many do, with an anecdote.

Picture this. I am staying in a remote cottage in Cornwall without a car. I have a temperature of 102, spots on my throat, delirium, and a book to finish writing. My desperate publisher suggests I call Hilary Fairclough, a homeopath who has practices in London and Penzance. She sends round a remedy called Lachesis, made from snake venom. Four hours later I have no symptoms whatsoever.

Interesting sure, but as the quote says "The plural of anecdote is not data." So lets get down to where Winterson starts talking about the real criticisms of homeopathy, mainly its use of absurdly diluted substances to treat illness.

Objections to homeopathy begin with what are viewed as the impossible dilutions of the remedies, so that only nano amounts of the original active substance remain, and in some cases are only an imprint, or memory. Yet our recent discoveries in the world of the very small point to a whole new set of rules for the behaviour of nano-quantities. Thundering around in our Gulliver world, we were first shocked to find that splitting the atom allowed inconceivable amounts of energy to be released. Now, we are discovering that the properties of materials change as their size reaches the nano-scale. Bulk material should have constant physical properties, regardless of its size, but at the nano-scale this is not the case. In a solvent, such as water, nano particles can remain suspended, neither floating nor sinking, but permeating the solution. Such particles are also able to pass through cell walls, and they can cause biochemical change.

The argument that water somehow remembers the chemical activity of a substance that was is absurd. If water remembered and acted like all the chemicals it had come into contact with you could be bathing in water that is going to act like Queen Victoria's stomach acid. I don't even know what the argument for their pills is. Winterson's use of the "nano" is an appeal to the authority of buzzwords that most people don't understand.

So, three days later Ben Goldacre asks if its A kind of magic? He discusses the placebo effect and regression to the mean as the real reasons that the anecdotes support homeopathy. He goes on to talk about how supporters of homeopathy react to this type of criticisms.

With alternative therapists, when you point out a problem with the evidence, people don't engage with you about it, or read and reference your work. They get into a huff. They refuse to answer calls or email queries. They wave their hands and mutter sciencey words such as "quantum" and "nano". They accuse you of being a paid plant from some big pharma conspiracy. They threaten to sue you. They shout, "What about thalidomide, science boy?", they cry, they call you names, they hold lectures at their trade fairs about how you are a dangerous doctor, they contact and harass your employer, they try to dig up dirt from your personal life, or they actually threaten you with violence (this has all happened to me, and I'm compiling a great collection of stories for a nice documentary, so do keep it coming).

They don't take it well. People don't tend to act rationally when defending something that isn't rational. Thats the nature of the beast, so I'm not surprised to find that he has been threatened. But the irrationality of the homeopaths is not the main point of his essay. The point is that homeopaths, like AIDS/HIV, evolution and global warming denialists, hurt science understanding of the general population.

By pushing their product relentlessly with this scientific flim-flam, homeopaths undermine the public understanding of what it means to have an evidence base for a treatment. Worst of all, they do this at the very time when academics are working harder than ever to engage the public in a genuine collective ownership and understanding of clinical research, and when most good doctors are trying to educate and involve their patients in the selection of difficult treatment options. This is not a nerdy point. This is vital.

There are many points on which I am willing to concede that science doesn't or can't know everything. But this is not one of them. A logical look at the dilutions says that homeopathy doesn't work the way it claims. Yet the idea persists. Part of me can understand the need to believe that something simple can cure us, but the logical part of me balks. And I can't ignore that no matter how I try.

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