Wednesday, 13 April 2016

If Jesus was a Homeopath

If there was ever a patron saint of critical-thinking it would have to be St Thomas the Doubter.

At my old Church of Scotland Sunday School in a little village by the Firth of the Tay I always loved the bible stories which were read to us. But even in those days I always felt Thomas got a rough deal. All he had done was to ask for evidence, he never said anyone wasn't being truthful, he just asked for proof and he's been reviled by history for the past 2,000 years or so.

Recently I looked up the actual story in my old bible and reminded myself of the rhythm and beauty of the words of the King James version.

St. John chpt 20, vs 24-29

But Thomas, one of the twelve, called Didymus, was not with them when Jesus came. The other disciples therefore said unto him, We have seen the Lord. But he said unto them, Except I shall see in his hands the print of the nails and put my finger into the print of the nails, and thrust my hand into his side I will not believe.

And after eight days again his disciples were within, and Thomas with them. Then came Jesus, the doors being shut, and stood in the midst, and said, Peace be unto you. Then saith he to Thomas, Reach hither thy finger, and behold my hands; and reach hither thy hand and thrust it into my side: and be not faithless, but believing. And Thomas answered and said unto him, my Lord and my God. And Jesus saith unto him, Thomas, because thou hast seen me, thou hast believed: blessed are they that have not seen, and yet have believed.

The names Thomas and Didymus both mean ‘twin’ by the way.

Apparently theologists see this as an example of Jesus, not castigating Thomas but being prepared willingly to present proof when it was requested. I like this idea. It sounds like Thomas was giving Jesus a chance to shine and to demonstrate how not to take offence when questioned about a claim.

And I thought how refreshing that attitude to evidence was and I began to imagine how the scene might have gone if Jesus had been a homeopath; a group notoriously reluctant to provide anything approaching reasonable quality proof:

But Thomas, one of the twelve, called Didymus, was not with them when Jesus came. The other disciples therefore said unto him, We have seen the Lord. But he said unto them, Except I shall see in his hands the print of the nails and put my finger into the print of the nails, and thrust my hand into his side I will not believe.

And after eight days again his disciples were within, and Thomas with them. Then came Jesus, the doors being shut, and stood in the midst, and said, Peace be unto you. Then saith he to Thomas, Reach hither thy finger, and behold, my garment is rent where the spear has passed through and behold, my hands are pretty sore, I can tell you. And Thomas answered and said unto him, But I would behold thine wounds with mine own eyes. And Jesus spake unto Thomas saying, Art thou calling me a liar?

Thomas's heart was heavy and he was sorely grieved. He spake saying, No Rabbi, yet I wouldst see the marks, how about I reach thither my hand and thrust it into thy side? And Jesus was angered and said unto Thomas, No way, that's gross. Look Sonny-Jim I've got a sheaf of parchments here from people who swear they have seen the marks, what other proof dost thou need?

And Thomas read the words which were given him and afterwards he reached out to move the garments of Jesus to one side that he might better see the mark. And, he beheld there was no mark and neither were there the prints of the nails in his hands. This Thomas told unto Jesus and asked why it was so.

And the anger of Jesus increased and he said unto Thomas, It's quantum, mate. Obviously you can't actually see them; if you look at them they disappear; it's quantum. Hast thou been reading that apostate Newton again? Stick to Einstein, he was a good Jewish boy, he knew a thing or two about quantum; quantum's great, what would you know – have you even studied medicine? Anyway, why dost thou touch my person? And, turning to the disciples Jesus said unto them, You lot saw that, that's technically assault, why doest these sceptics get so aggressive?

And yea at his command the sky darkened and the heavens opened and the wrath of God descended upon them with fire and hail and a great clashing of cymbals, verily the room wherein the disciples were was filled with the Holy Spirit burning like bright flame unto the very walls and timbers and the sound of His rage was heard throughout the land and the mountains shook and the ground trembled.

At this the disciples were sore afraid and cast themselves to the ground in their misery. And Thomas was among their number and thought unto himself, I wonder if it's too late to be a Zoroastrian instead?

Doesn’t have quite the same ring really, does it!

Sunday, 27 March 2016

Homeopathic hypocracy and vivisection

What do you think of when you consider homeopathy - holistic, safe, trusted? Well, what about vivisection?

Even I, as someone highly sceptical of homeopathy, didn’t consider laboratory animals would be used to test homeopathic remedies. Surely that would be anathema to a practice which preaches gentleness and holism. For years I believed the British Homeopathic Association (BHA) when they proudly declared in their journal “Homeopathic medicines are NOT tested on animals and our Memorandum of Association clearly sets out that we may only ‘undertake and finance research into the problems of medicine WITHOUT vivisection’ 3(E)” [emphasis in the original].

Well, I was wrong – it appears their veterinary colleagues didn’t get the memo.

The magic of homeopathy: getting the public to believe anything

In 2014 the Honorary Secretary of the British Association of Homeopathic Veterinary Surgeons (BAHVS) stated in a letter in the veterinary press (1) “If one is bringing data, it should be the truth” and suggested the truth regarding homeopathy might be found in a series of “more than 800 veterinary papers” published on a homeopathy website owned by veterinary homeopath Mark Elliott (2).

Since first entering the debate surrounding veterinary homeopathy one of my preoccupations has been studying the evidence presented by homeopaths in support of their practice. I have gone as far as to devote a website to this activity which now contains critiques of some 200 articles and scientific papers on the subject of complementary and alternative veterinary medicine, none of which provides any evidence for the effectiveness of homeopathy – veterinary or otherwise. I had begun to despair of ever finding the proof of which homeopaths talked with such glib confidence and consequently told myself there would be little point in making a close study of the much heralded “800 papers”.

However, the question of evidence for homeopathy has always been central to the debate. So, somewhat against my better judgement, I turned my attention to the list in question. Perhaps this would be where the convincing proof homeopathy was all it was claimed to be would finally be found. I began by reading the first section, with authors whose names started with 'A'.

First impressions weren't promising - a jumble of languages, odd fonts, strange formatting and broken links greeted me as I scrolled down. Undeterred, I pressed on to discover there were thirty-nine papers in 'A' section, although after removing papers which had been published twice in different locations the number dropped to thirty-six.

Despite the claim these were all “peer reviewed papers” I found a multitude of symposia proceedings, article reviews and case reports - there was even a book review! Closer scrutiny revealed a number of studies didn't actually involve homeopathy at all; three being concerned with isopathy, and two with herbal medicine. Three others found homeopathy to be ineffective.

The potential for bias was rife, with some trials sponsored by the manufacturers of the substance under test and nineteen published in pro-homeopathic journals. Not one of the papers was double-blinded and only a handful claimed even to be single-blinded. Some dated back to the 1970's, so old no references were to be found online.

The most shocking aspect of the list though wasn’t the misleading promise of ‘truth’ from the BAHVS, it was the scale of the vivisection involved. In the name of the gentle art of homeopathy, hundreds of laboratory mammals were variously burned with lasers, scalded, incised, crushed, irradiated, had their jaw and leg bones fractured, were poisoned with strychnine, injected with formaldehyde, dry-cleaning fluid and cancer cells, and infected with sleeping-sickness. One experiment in a later section measured the effect of homeopathy in mice on “writhing induced by intraperitoneal acetic acid”. And it wasn't just mammals. One paper involved a group of unfortunate snails having their equivalent of a central nervous system dissected out for study.

And yet, even after all that, not a single one of these studies was fit for purpose. Inadequate methodologies, publication bias, vested interest and small group sizes ensured the mass sacrifice had been in vain. We still hadn’t come anywhere near proving homeopathy as a viable system of medicine.

It seems the homeopathic definition of ‘truth’ is different from that used by everyone else. It is apparently so elastic as to allow a mere book review to be transformed into a peer-reviewed paper; studies of herbal remedies to be proof homeopathy is effective; and to allow a single paper to be presented as two separate pieces of evidence. Homeopaths must think we’ll believe anything, on the one hand promising remedies are "NOT tested on animals" yet at the same time using exactly this type of evidence in support of their cause. The only explanation I can possibly think of is the authors of the “800 papers” must simply have hoped noone would read them and in this way they could completely pull the wool over our eyes. Perhaps this then, is the real magic of homeopathy.

I am trying to resist, but now my gaze is starting to drift down the page and I notice the first paper in the ‘B’ section also has nothing to do with homeopathy, being concerned instead with testing a herbal remedy. This doesn’t bode well.

1 - Marston (2014) - Truth, evidence and marketing of drugs (letter) - Veterinary Times 7 April, vol 44 no 14 
2 - Anon (2014) Veterinary Papers Peer Reviewed: Animal/Lab Studies by Name of Lead Author, A Research Database and Information for Homeopathy and its use in Veterinary Medicine [online:]  [accessed 23/12/15]

Thursday, 4 February 2016

Homeopathy and Phrenology - kindred spirits

Few Veterinary Surgeons or Nurses would be convinced if we were told that it was possible to diagnose disease by feeling for lumps and bumps on our patients’ skulls. Yet 100 years ago many people believed just that. Phrenology, as it was called, was practiced by many prominent public figures of the day, including Royalty all of whom were convinced of its merits. It was even practiced on animals. The subject was debated at length by scholars and intellectuals and was supported by masses of detailed text books and articles in specialist journals. Nowadays Phrenology is defunct and discredited and the only sign that it ever existed is the occasional porcelean head marked with impressively named bumps usually found in curio shops.

The reason that these days few people have even heard of Phrenology is simply that real evidence for its effectiveness was found wanting. While in selected cases Phrenology apparently produced miraculous results, when the totality of cases was looked at, no clinical effect was found. Science proved what common sense should have told people all along; that there is no reason why bumps on heads should reflect anything other than... well, bumps on heads. Phrenology owed its existence solely to the blind faith of its practitioners and their willingness to rely only on favourable data whilst ignoring the rest.

Now consider something that is still used widely in human and veterinary medicine today, also by worthy and intelligent people but which has an even more unlikely basis than Phrenology. Homeopathy is a treatment invented two centuries ago at a time when purging and bleeding were common-place in the treatment of disease but which, unlike its more violent contemporaries has remained unaltered since. In homeopathy, remedies are made by taking basic ingredients such as Peregrine falcon, condoms, or the Berlin wall (these are genuine examples) and diluting them to such levels that a quantity of remedy equivalent to all the atoms in the known universe wouldn’t contain even a single molecule of the original. Yet even though there is no trace of anything other than water in their remedies homeopaths claim incredible results in the treatment of any condition you care to name including SARS, AIDS and cancer. Despite the fact that this underlying principle defies both common sense and scientific rationale, critics of homeopathy are dismissed as being out of harmony with today’s holistic New Age in the same way that critics of Phrenology were once called out of touch with the progressive Victorian Age.

When we look at the research we find that, like Phrenology, almost all supporting evidence for homeopathy is found within specialist journals and texts written by homeopaths themselves.  Much of this literature is questionable, suffering as it does from publication bias and is incapable of being replicated by independent researchers. Other, more objective studies have combined the results of multiple trials and in no case has any firm evidence been found in favour of homeopathy.

In conclusion homeopathy, like Phrenology before it, has many supporters, all of whom are convinced that it works; yet it has no basis in science and should have no place in the Veterinary profession founded as it is on rational principles.  Like Phrenology, homeopathy is an illusion sustained only by the faith of its followers and their selective use of evidence.

In the story of the Emperor’s new clothes, people are unwilling to admit what is obvious for fear of being ridiculed by others. Well, it’s about time we admitted that if our homeopathic Emperor appears to be wearing no clothes then, no matter what excuses he tries to come up with, the Emperor really is making a spectacle of himself.

(This was originally published in the letters pages of the Veterinary Nursing Times)

Monday, 11 January 2016

Homeopaths' bogus arguments - No. 12

Homeopathy is a different way of knowing and works perfectly well within its own frame of reference – it cannot be judged by science.

This ‘everything is subjective’ line is a well worn trope heard from many practitioners of CAVM – how can science ‘prove itself’, much less disprove anything which operates oustide its purview? Such commentators though want it both ways as we will see.

The point hinges on the very philosophy of science itself and disingenuous homeopaths as well as well-meaning but na├»ve scientists will suggest that any scientific argument against homeopathy is, at its root, prejudice. Homeopathy, it is claimed, is merely one of many ways of looking at the world and understanding it. As such, although different from science, it is deserving of equal respect. Good scientists, critics say, recognise this and should always have doubt. Well, that last point is certainly true, but it doesn’t mean doubt can be filled in with any old far-fetched nonsense which springs to mind.

To be clear, the core philosophy of science has little to do with the way medical trials are conducted or the usefulness evidence-based medicine. Certainly, medicine employs scientific tools – the double blind placebo controlled trial, confidence intervals, metanalyses and so forth but medicine (and by extension EBM) is no more a science than engineering is, both use science but that does not make them science; they are technologies.

One of the best illustrations of scientific principles is simply if something is going to claim scientific credentials then those credentials must be able to be tested by science. That’s it really, nothing more – 'Put up or shut up' in other words. Science isn't even about finding answers, being far more concerned with asking questions.

Philosophers of a post-modern bent (and possibly a few who like to sound clever!) will argue science is just 'another way of knowing' and that all healing (and other) modalities are equal but different. While this makes for interesting debate it is meaningless in practical terms in the real world. We know much of how the universe works. Consequently we know if a culture believes it is possible for humans to fly unaided while it might be polite of us not to directly contradict or otherwise disrespect members of that particular culture, even a homeopath would be ill advised to take politeness so far as to step out of a high window on their say-so. You can't have one set of facts, or truths for one group and a different set for another.

Critics are regularly castigated by its adherents for describing homeopathy as unscientific. Quite the opposite we are told, loudly and with vigour, homeopathy does indeed work by scientific principles (inevitably quantum physics as a rule), non-homeopaths are just too feeble-minded to see it. Yet, when the paucity of their ‘scientific’ evidence is pointed out to them, instead of doing the scientific thing by upping the ante and performing better tests homeopaths instead accuse critics of prejudice and bigotry while at the same time doing a volte face and hiding behind the skirts of New-Age philosophising. From this refuge they will claim they’ve changed their mind and actually homeopathy can't be tested by science afterall (that is until the next poorly performed trial comes along which claims even the smallest of effects from homeopathy, at which point all the mental gymnastics and philosophical navel-gazing get quietly shelved!). This really is wanting to have one’s cake and eat it, but that isn't how science works.

Homeopathy craves all the kudos and credibility science brings but will not accept the scientific process and the discipline that comes with it – mainly the discipline of discarding cherished beliefs in the face of contradictory evidence. It is homeopaths who are attempting to prove homeopathy by science, not scientists. If they were content to present themselves as practitioners of a mystic, unexplainable and untestable philosophy this whole debate would have a very different tone.

Thursday, 7 January 2016

Homeopaths' bogus arguments - No. 11

"But we don't even know why mainstream drugs work, why pick on homeopathy - what about anaesthetics!"

This particular argument runs along the lines that since, allegedly, we don’t know how many conventional drugs work we should basically cut homeopathy some slack and give it the benefit of the doubt. A favourite example is anaesthetics with claims that we have no idea how they work and no information as to their safety or cost-effectiveness, the implication being that if anaesthetics (which obviously do work) have no known mechanism of action then homeopathy also must work even though it also has no known mechanism of action.

This is simply another tu quoque argument – flawed and designed to mislead. There are several problems with it, not least of which is that even if we really did have no idea how pharmaceutical drugs worked it still wouldn't mean it was ok to go on using homeopathy. We don't have to worry about that though because not only is this argument illogical, it is based on a falsehood, presumably put about in the hope that readers won’t bother to check the far-fetched claims being made in the defence of homeopathy.

In fact we have a very good idea of how pharmaceuticals work, including anaesthetics. Take Alfaxan (alfaxalone) for example, a popular veterinary anaesthetic agent. Alfaxalone binds to specific binding sites on the gamma animo butyric acid (GABA) sub-type A receptors on the cells of the Central Nervous System. GABA is a major inhibitory neurotransmitter. When GABA binds to the GABA-A receptors this results in opening of chloride channels into the cells and an influx of chloride ions, resulting in hyperpolarisation of the cells and inhibition of neural impulse transmission. Alfaxalone enhances the effects of GABA at the GABA-A receptors, so causing greater inhibition of neural impulse transmission and, thereby, unconsciousness. This information, along with safety and cost data is widely available in textbooks and via the internet. Why anyone would want to pretend we don't know how anaesthetics work when it is so clear we do is a mystery, but possibly reflects the limited grasp medical and veterinary homeopaths have of proper medicine.

Even if we didn’t know exactly how anaesthetics and other pharmaceuticals worked we do know they have recognised, analysable, physical content. We know exactly what they are. Their mode of action, even where not known precisely, will involve a number of pre-existing mechanisms, all firmly grounded in the known facts of neurology, physiology and biochemistry. All pharmaceuticals, including anaesthetics, follow predictible, rational patterns – if I dilute an anaesthetic it will have a reduced effect, if I use a stronger concentration it will have a more profound effect. And anaesthetics actually work. If I get the dose correct and use the proper delivery route my patients will go to sleep – every single time.

The rational basis of real drugs means if someone makes the claim that a particular pharmaceutical doesn’t work, or has unacceptible consequences that claim can be investigate using proven scientific principles and, depending on the results, the drug will either be withdrawn from use or have its safety profile enhanced. To take extreme examples of both – thalidomide was withdrawn from use in the middle of the 20th century after investigation showed it was causing an unacceptible level of deformities in new-born babies whereas claims the MMR vaccine caused autism in children were discovered to be without foundation once the research was carried out, consequently the MMR vaccine is now one of the safest, most widely researched drugs on the market.

Homeopathy on the other hand has no rational basis and no content other than sugar or water, its ‘mode of action’ is a pure fiction. Infact several pure fictions, depending on what you believe – quantum, nano-bubbles, spallation, cavitation, the life-force etc… You’ll find a different ‘mode of action’ at every website you care to visit on the subject. Unlike real drugs, homeopathy follows no rational or predictable pattern – behind the closed doors of the consulting room it is reported to have profound effects yet when looked at objectively those effects vanish to the margins of statistical significance. When homeopathy declines to perform when tested by science homeopaths, instead of upping the ante and doing better research, simply make excuses; the energy has been ‘antidoted’ (by pretty much any substance you care to mention), or it’s being tested by people who don’t ‘understand’, or it’s the ‘wrong type’ of homeopathy – not individualised, or isopathy – or we’re looking at the ‘wrong results’. Yet all those excuses go out of the window if the results look even vaguely like they support the idea homeopathy works. Homeopaths’ view of a well-conducted trial is one that proves, not tests homeopathy, and that's not how proper science works.

Finally, with homeopathy if you dilute it, it supposedly gets stronger, not weaker. And no theory of homeopathy’s ‘mode of action’ has ever managed to explain that one. Why homeopathy should get more quantum activity, nano-particles, energy signatures, micro-clusters or whatever the more dilute it is, remains a total mystery, even to the most imaginitive of those practitioners and multi-national corporations who profit by it.