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A Promising Sceptic

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A Promising Sceptic

Robert Todd Carroll, Ph.D, was a professor of philosophy at Sacramento City College till he retired in 2007. He set up the ◦Skeptic's Dictionary on-line in 1994. It was also published as a book in 2003. The following sums up and relates to several key points of his entry 'homeopathy' in that Dictionary. - TK
Robert Todd Carroll, modified photo.
Robert Todd Carroll. Photo with permission.

Homeopathy originated in the 1800s, when bloodletting was a popular medical practice. The originator was Christian F. Samuel Hahnemann (1755-1843). His alternative medicine was more humane and less likely to cause harm than many of the conventional practices of his day. His medicines were basically common liquids and unlikely to cause harm in themselves.

Hahnemann put forth his ideas of disease and treatment in The Organon of Homeopathic Medicine (1810) and Theory of Chronic Diseases (1821). The term 'homeopathy' is derived from two Greek words: homeo (similar) and pathos (suffering).

Hahnemann believed that very small doses of a vigorously shaken and diluted (in one word: succused) medication (substance) could have very powerful healing effects, but also issued dire warnings about the perils of diluting medicines too much. This might have serious or even fatal consequences if the medicines became too powerful, he said. Eventually he claimed that there was no need for patients to swallow the medicines at all; but merely smell* them. Unfortunately, that latter idea seems unfounded, for there is nothing left to sniff for higher potencies, only water diluted with water up to nearly 100,000 times.

* Compare: One of the most comprehensive investigations done to date on aromatherapy failed to show any improvement in either immune status, wound healing or pain control among people exposed to two often-touted scents, lavender and lemon. They are two of the most popular scents tied to aromatherapy. "But the human body is infinitely complex. If an individual patient uses these oils and feels better, there's no way we can prove it doesn't improve that person's health," says William Malarkey, professor of internal medicine, and one of a troika heading the study. (Holland 2008).

Two potency scales are in common use: the decimal, which proceeds by 1:10 steps, and the centesimal (1:100). Starting from the original "mother tincture" (in the case of a plant this is an alcoholic extract) a 1:10 or 1:100 dilution is made. This is succussed (shaken and diluted) and the resulting solution is known as the first potency. This now serves as the starting point for the next step of succession (diluting and shaking), which results in the second potency, and so on. The 1:10 potencies are usually indicated by x or D and the 1:100 by c; thus Aurum met (Gold) 6c means the 6th centesimal potency of the metal gold.

Hahnemann believed it was the spirit in the body that did the balancing and harmonizing needed for keeping healthy. His medicines were designed to help the vital spirit work its ways, and his remedies were determined by the patient's symptoms, not by the supposed disease causing those symptoms.

Homeopathic "laws" that were not laws

Many of Hahnemann's ideas did not tie in greatly with experiences. One of his basic assumptions was that whatever caused derangement symptoms in a healthy person could be made a homeopathic emedy for a disease with similar symptoms. However, many common homeopathic preparations are prepared from common foods that may not (easily) produce other symptoms than satiety, like milk, honey, several vegetables, and so on. Also, many so-called disease tokens found by overindulging in substances, are general body reactions to (symptoms of) just that, and not particular symptoms that speak much of the poisoning effects of a substance itself.

Another of Hahnemann's notions was that any remedy would cause the patient to get worse before getting better and that one could minimize this negative effect by significantly reducing the size of the dose. That notion is debatable.

Hahnemann experimented on himself with various drugs over several years and concluded that medicines should be given in single doses, not in complex mixtures. But today, many homeopaths do administer complex mixtures.

Coffee, chess, tea, wine, brandy and spices were forbidden to those persons who gradually poisoned or "half-poisoned" themselves by homeopathic substances, but beer was allowed. The result was arrays of symptoms that were ascribed to the substances that went into potentised preparations. But people differ in their responses, and it is an open question what and whose symptom descriptions fit best, if any. Accordingly, one hundred homeopaths preparing a remedy for one patient might theorietically come up with one hundred different remedies - or fifty, or twenty, or ten, for that matter. Opinions differ, and at times widely.

Further, another source of error is that Hahnemann based the provings of remedies largely on symptoms only supposed to have been produced in his chronic patients.

It stands out from this that Hahnemann's methods of testing or guessing (theorising) are defect. For one thing, he was not actually testing the medicines for effectiveness on sick people but for their effects on healthy people (!). And he had to rely on subjective evaluations of his provers. Later investigators should use more controlled methods of proving.

Great customer satisfaction with homeopathic preparations are no scientific evidence that they work per se. Nor is anecdotal evidence, no matter how impressive it may sound.

The World Health Organisation states that homeopathy is the second most used medical system internationally, with over $1 billion in expenditures for such therapy. Twenty to thirty percent of French and German physicians use homeopathy in clinical practice. In Great Britain, five homeopathic hospitals are part of the National Health System, and over 30% of generalists use homeopathy. In the United States, there are more than 500 physicians and 5000 nonphysicians using homeopathy in clinical practice, and 2.5 million Americans currently use homeopathic medicines - of which two-thirds are self-prescribed - spending more than $250 million annually. - McPhee et al. Current Medical Diagnosis and Treatment, p 1763.

Doing clinical trials on potential medicines

Carrol thinks that finding a statistically significant difference, positive or negative, between an experimental (drug therapy) group and a control group in one trial of a drug should usually be taken with a grain of salt. So should not finding anything statistically significant. It is not uncommon for twenty trials of a drug to result in several with positive, several with negative, and several with mixed or inconclusive results.

Of the hundreds of studies that have been done on homeopathic remedies the vast majority have found no value in the remedies. But some have.

If homeopathic remedies do not work, there is no need for a theory as to how they work. In one hitherto unpublished study I documented that a certain sort of replicas of homeopathic preparations - ◦MGA replicas - work on bacteria from common tap water. Using regular procedures for checking the amount of bacteria in water samples, the town veterinarian in Trondheim came up with astounding results: For three different deliveries to him, the samples that had been put into an ◦MGA box for a while each, nothing added to their contents in any way, yielded more bacteria than the rest of the samples. Even though the veterinarian's counting of bacteria was faulty - he gave up counting the bacteria of some samples because there were too many - the overall results were there were well over 16 times more bacteria in the samples that had got "MGA box" treatment. The documents are public. The figure 16 is a geometrical average and a misleading too, in that some of the bacteria in their Petri dishes had multiplied too much for the veterinarian to count them all; he just put "above 1000" - something like that - as his count for some of the samples.

Against such hitherto unpublished findings, findings that Carroll and others know nothing of, he says a bit askew that no reviews conclude that there is good evidence for any homeopathic remedy (HR) being effective. I doubt that. You may say I am somewhat sceptical to the statements of a sceptic. Ironical, isn't it? Or rather: It is as it should be . . . An advancing sceptic needs to get sceptical to scepticism itself too, before it is too late -

Findings

In the last two decades so-called meta-analyses have been used to evaluate the effectiveness of homeopathy. Such analyses include and draw on many groups of studies and draw conclusions based on the results as a whole. It is also known that end results depend in part on just how the analyses are designed. There is a possibility that different researchers using the same data, may in the end hold different views on what the data mean.

A review of the reviews of homeopathic studies has been done by Terence Hines in his book Pseudoscience and the Paranormal (New York: Prometheus Books, 2003: 358-362). More than 100 studies have failed to come to any definitive positive conclusions about homeopathic potions. The findings are consistent: homeopathic "remedies" are not effective.

Health organisations such as UK's National Health Service and the American Medical Association have issued statements that there is no convincing scientific evidence to support the use of homeopathic treatments in medicine. Others have stated differently.

But let us look a bit better into this highly interesting material, for it shows up that sometimes researcher attitudes are funneled into flawed "research findings":

Lancet matter

In 2005 The Lancet medical journal published a meta-analysis of 110 placebo-controlled homeopathy trials and 110 matched conventional-medicine trials based upon the Swiss government's Program for Evaluating Complementary Medicine (PEK). The study concluded that its findings were compatible with the notion that the clinical effects of homeopathy are nothing more than placebo effects.

However, this last study has been criticised "for being methodologically flawed on many levels". Peter Fisher writes: "The final analysis which concluded that 'the clinical effects of homoeopathy are placebo effects' was based on just the eight 'larger, higher quality' clinical trials of homeopathy. The Lancet's press release did not mention this, instead giving the impression that the conclusions were based on all 110 trials [and] we have no idea which eight trials were included in the final, damning, analysis." (Lack of transparency).

Among other, severe objections is that a large part of the meta-analysis was based on "one remedy only" to many different patients. Such a procedure violates the ground rules of homeopathy, which takes into account symptom gallery of each patient before deciding on a remedy. That is, in typical homeopathy the choice of remedies is related to the patient, and not a single disease. This kind of "breaking homeopathy on the wheel" accounted for 44% of the homeopathy studies analyzed in the Lancet meta-analysis.

Further, in 32% of the homeopathy studies analyzed, all patients received a mixture of different commonly used homeopathic remedies. Much depends on what goes into such a mixture, a homeopath has to tell.

In only 16% of the homeopathy studies analyzed, patients were given a single, individualized remedy. Again, results would depend on both the kind of remedy given to each, how well it appears to match the symptom complex of each, and also the potency of the remedy given.

The above gives substance to the criticism of masquerading material published in the British Lancet, that is is "methodologically flawed on many levels" (above), which is a shame. And our understanding of homeopathy can continue to grow with better, properly designed research studies.

A source: Peter Fisher: Homeopathy and The Lancet. Oxford Journals: Evidence-based Complementary and Alternative Medicine (eCAM). Vol.3, No. 1, p. 145-147.
[ecam.oxfordjournals.org/cgi/content/full/3/1/145]

On the Bright Side of It

A 2006 meta-analysis of six trials evaluating homeopathic treatments to reduce cancer therapy side effects following radiotherapy and chemotherapy found "encouraging but not convincing" evidence in support of homeopathic treatment. (S. Milazzo, N. Russell, E. Ernst. Efficacy of homeopathic therapy in cancer treatment. European Journal of Cancer, Volume 42 , Issue 3 , Pages 282 - 289)

In the British Medical Journal (Kleijnen et al, "Clinical Trials of Homeopathy. BMJ 302; 316-23, 1991), where a meta-analysis of 1991 covered 107 controlled trials. 81 of them showed that homeopathic medicines were effective, 24 showed they were ineffective, and 2 were inconclusive. The professors who published the material concluded, "The amount of positive results came as a surprise to us.".

There is room for more along this line, such as:

  • An independent group of physicians and scientists evaluated clinical research prior to October 1995. They reviewed 186 studies, 89 of which met their pre-defined criteria for their meta-analysis. They found that on average patients given a homeopathic medicine were 2.45 times more likely to have experienced a clinically beneficial effect. When reviewing only the highest quality studies and when adjusting for publication bias, the researchers found that subjects given a homeopathic medicine were still 1.86 times more likely to experience improved health as compared with those given a placebo.
  • A group of researchers at the University of Glasgow and Glasgow Homeopathic Hospital conducted four studies on people suffering from various respiratory allergies (hay fever, asthma, and perennial allergic rhinitis). In total, they treated 253 patients and found a 28% improvement in visual analogue scores in those given a homeopathic medicine, as compared with a 3% improvement in patients given a placebo. (The result was significant at P = 0.0007.). . . . The researchers conclude from their research that either homeopathic medicines work or controlled clinical trials do not.

(A book, Bellavite and Signorini's Homeopathy: A Frontier in Medical Science (Berkeley: North Atlantic Books, 1995) is referred to and recommended by homeopathic doctors.)

What Now?

It normally works well to keep one's wit and study evidence, and keep unsettled things in suspense too. One should not settle on a firm conclusion by slanted evidence and lack of evidence, and all too common flaws of research designs, for doing so shows lack of sound discerment and judgement.

It may come as no suprise that patients will feel better or actually get better after seeing a homeopath. That is quite another matter. The case of Wendy Kaminer shows how this can be so. She is a critic of various irrational behaviours, but also a satisfied user of homeopathy, fearing "that someone would find out I'd consulted a homeopath" (1999; p. 3). She confesses:

Maybe I'm acting rationally after all . . . not using homeopathy if it works would be . . . irrational. I care only if medicine works, not why.

So . . . why would I want to start doubting - and diminishing - their effectiveness? Why not be susceptible to placebos?

She has focused on her belief that homeopathy works, saying "Don't take my word for it, try it yourself." And that is permitted for so many.

At this point Robert T. Carroll says that if something seems to work, he would rather want to investigate it. I agree with that. He says:

If a homeopathic remedy did cure me of my knee pain, I would want to investigate what was in the remedy . . .

If I could yo-yo the pain by stopping and starting the homeopathic remedy under double-blind conditions, I would have to conclude that the potion was having the effect and would have to become an advocate of that homeopathic remedy. This is just to say that homeopathic remedies can be empirically tested.

Yes, they can. Homeopathic preparations are more or less ideal for double-blind investigations that use placebo medicine.

Holding conclusions in suspense or not

Homeopathy itself is very effective or it wouldn't have lasted and grown for the past 200 years, Carroll points out. It is very popular in Europe, especially among the royal family of Britain. There are schools of homeopathy "all over the world", and the fact that it is condemned as unscientific by some orthodox doctors is for many people a positive merit, not a criticism.

Potentised preparations are probably safe, he corcurs, and that one potential danger is in the encouragement to self-diagnosis and treatment. Another danger lurks in not getting proper treatment by a conventional medical doctor in those cases where the patient could be helped by such treatment, such as for a bladder or yeast infection, or for cancer.

My understanding of homeopathy is different from Robert Carroll's. But then again, I have been actively involved in exploring sides to it for several decades, first-hand and by studies. Also, the town veterinarian of Trondheim and I have documented that some potentised preparations affect bacteria a whole lot.

Moreover, Dr Karin Lenger has proved that various high-potency homeopathic remedies really are different. Her research report was first published in Subtle Energies and Energy Medicine Journal, Volume 15 Number 3 2004, and later published as "Homeopathic Potencies Identified by a New Magneti Resonance Method: Homeopathy—An Energetic Medicine" in Hpathy Ezine, December, 2006. [◦Link].

It would be good if advocates of homeopathy address the main points of sensible, informed sceptics carefully. - TK


COLLECTION
Scepticism as to homeopathy, END MATTER

Scepticism as to homeopathy, LITERATURE  

Bellavite, Paolo, and Andrea Signorini. Homeopathy: A Frontier in Medical Science. Berkeley: North Atlantic Books, 1995.

Bellavite, Paolo, and Andrea Signorini. The Emerging Science of Homeopathy: Complexity, Biodynamics, and Nanopharmacology.. 2nd ed. Berkeley: North Atlantic Books, 2002 (limited view at Google Books)

Fisher, Peter. "Homeopathy and The Lancet." Oxford Journals: Evidence-based Complementary and Alternative Medicine (eCAM). Vol.3, No. 1.
[ecam.oxfordjournals.org/cgi/content/full/3/1/145]

Hahnemann, Samuel, and Constantine Hering. ◦Organon of Medicine. 4th American Edition. Philadelphia: Radde, 1869 (at Google Books). —— The one who started homeopathy wrote in 1810: "The results of my convictions are set forth in this book." He revised them in a sixth edition from ca 1842, a work that unfortunately did not come much to light for a long time. The work is a historical document.

Hahnemann, Samuel. ◦Chronic Diseases: Their Peculiar Nature and Their Homoeopathic Cure. (Theoretical Part) New Delhi: P. Jain, 2005. (At Google Books) —— Dr. Hahnemann thought well of his healing system, "Homoeopathy, the great gift of God!" and "This teaching was founded upon the steadfast pillar of truth and will evermore be so. The attestation of its excellence, yea, of its infallibility (so far as this can be predicated of human affairs), it has laid before the eyes of the world through facts." - Samuel Hahnemann.

Hines, Terence. Pseudoscience and the Paranormal.. New York: Prometheus Books, 2003.

Holland, Earle. "Aromatherapy may make you feel good, but it won't make you well." 2008. Research Communications. 3 March 2008. Columbus, OH: Ohio State University.
http://researchnews.osu.edu/archive/aromathe.htm

Kaminer, Wendy, in Robert T. Carrol. ◦The Skeptic's Dictionary. 1994-2011. Online. —— Recommended reading

Kleijnen et al. "Clinical Trials of Homeopathy." British Medical Journal302, 1991.

Lenger, Karin. "Homeopathic Potencies Identified By A New Magnetic Resonance Method: Homeopathy—An Energetic Medicine." Hpathy Ezine, 2006.

McPhee, Stephen J., Lawrence M. Tierney, and Maxine A. Papadakis. Current Medical Diagnosis and Treatment. Ill. annot. 46th ed. New York: Lange Current Series / McGraw-Hill Professional, 2007.

Milazzo, S., N. Russell and E. Ernst. "Efficacy of homeopathic therapy in cancer treatment." European Journal of Cancer, Volume 42 , Issue 3.

Ullman, Dana. ◦Essential Homeopathy: What It Is and What It Can Do for You. Novato, CA: New World Library, 2002 (Free view at Google Books).

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