HOMEOPATHYAND THE NEW FUNDAMENTALISM Lionel Milgrom
The New Fundamentalism: what is it? • It is based on an extremely narrow interpretation of science and evidence-based medicine (EBM). • It denies efficacy for any therapeutic modality that cannot be ‘proven’ in RCTs. • It ridicules, ignores, or misunderstands any explanation of homeopathy’s efficacy, and current research data supporting such explanations, especially from outside biomedicine. • It uses experimental bias, hear-say, even innuendo in order to discredit homeopathy (e.g., Ernst’s recent claim that negative trial data supposedly obtained by the Nazis has been deliberately covered up for over 60 years. See Ernst E, The truth about homeopathy. Br J Clin Pharmacol 2008;65(2):163-4; and Milgrom LR and Moebius S. Is Using Nazi Research to Condemn Homeopathy Ethical or Scientific? Bri J Clin Pharm 2008;66(1):156-7) • It is itself, therefore, unscientific; indeed, it is anti-scientific.
The New Fundamentalists: the most voluble • In the UK: • Edzard Ernst , Professor of CAM at the University of Exeter; • Richard Dawkins, Oxford professor, academic/author; • David Colquhoun, UCL professor of pharmacology, • Michael Baum , Emeritus professor of oncology, and his co-signatories of the Times letter (23/05/2007) urging health authorities to cut funding for homeopathy/CAMs. • Sense About Science , which includes science writer and broadcaster Simon Singh, and Labour peer Dick Taverne; • Ben Goldacre, Guardian journalist; • From the US, • Magician, James Randi • Physicist, Robert L Park
The New Fundamentalists: what to they want? • They see themselves as ‘defenders of reason’ against a tide of irrational belief in, among other things, ‘quack’ medicine. • After all, how can homeopathic medicines work if there are no molecules of the original drug substance present? • So, New Fundamentalists want to tell us how to think, e.g., the latest from Ernst and Baum “All serious thinkers should have a closed mind on the subject of homeopathy: it is anti-scientific and simply does not work.”(The Worst Medicine, 07/05/2008: Wellcome Collectionhttp://www.spiked-online.com/index.php?/wellcome/bestandworst/C142/) • In the UK, they want:- • Total exclusion of all ‘quack’ therapies from the NHS: • Closure of state-funded homeopathic hospitals; regardless of the many who benefit from them. • Their activities have lead to reductions in NHS referrals to the RLHH, which is threatened with closure. • But 206 MPs signed an EDM to debate the fate of the RLHH. • Guardian journalist Tom Whipple, sent an email asking them why and on what evidence they had decided to sign the EDM.
The New Fundamentalists: what did they get? • Some typical responses: Andrew George: “The primary purpose behind adding my name to this EDM is to offer an alternative treatment where conventional medicine has failed, providing that it can be clinically proven that the homeopathic option will not cause harm.” (‘First; do no harm.’ – Hippocratic Oath) “If the treatment helps some patients then within reasonable financial constraints and ensuring that decisions are fully informed then patients with the support of their GP could be prescribed the homeopathic option.” Frank Field “I support the EDM because I have been a beneficiary of homeopathy medicine. Sometimes the drugs don’t work. The NHS has been treating me for eczema for more years than I can remember without total success. “I do believe one aspect of getting well is that people believe that they will get well. It is not the only aspect and as the health budget has almost doubled in real terms I believe there is a place for homeopathic medicines for those who wish to use them.”
The New Fundamentalism: propagating porkies • In the history of science, paradigm shifts are nothing new, but… • What’s different is that we live in an age of easily accessible mass communication. • The New Fundamentalism’s ‘quack-busting’ message is propagated by some (but by no means all) in the media who share their (mainly biomedical) scientific backgrounds and beliefs, e.g., Ben Goldacre. • And they are a tad economical with the truth….
The New Fundamentalism propagates porkies • From Nick Cohen: “The cranks who swear by citronella oil”. Observer; Sunday, 28/10/2007. • http://www.guardian.co.uk/commentisfree/story/0,,2200815,00.html. • “….Yet dismissing homeopathy as quackery given by and for the feeble-minded is surprisingly hard. Anti-elitism dominates our society and many feel uncomfortable saying that the six million people who take alternative medicines are foolish - to put the case against them at its kindest. They sincerely believe in phoney remedies and sincerity trumps sense in modern culture.” • And, “(homeopathy’s) effects can be positively deadly.”
The New Fundamentalism propagates porkies • The lie of homeopathy’s ‘deadliness’ has been repeated in The Lancet.Ben Goldacre. Benefits and risks of homeopathy. The Lancet 2007;370 (issue no. 9600): 1671-2: Udani Samararasekara. Pressure grows against homeopathy in the UK. ibid. 1677-8. • ….Homeopathic malaria prophylaxis, attacked as deadly by Simon Singh on Newsnight …. • ….And the Government’s Chief Scientist, Sir David King has also got in on the act(evidence to the Select Committee on Innovation, Universities, and Skills, 06/12/07). • Presumably, fear over homeopathy/CAMs ‘deadliness’ arises from their replacing conventional treatments….? • ….But aren’t they all forgetting something…?
The benefits of modern medicine • In 2006 in the UK there were:- • 940,000recorded accidents by doctors and hospitals (government thinks this an underestimate: more like1,190,000) • 300,000hospital-acquired infections • 250,000serious adverse drug reactions (again an underestimate, closer to1,200,000). • That’s2.68 million Britonsharmed by conventional medicine (4.5% of the population). • Chair of the Commons Public Accounts Committee, Edward Leigh, said:- • “These figures would be terrifying enough without our learning that there is undoubtedly substantial under-reporting of serious incidents and deaths….” (See,Leigh E. A safer place for patients: learning to improve patient safety: 51st report of session 2005-06 report, together with formal minutes, oral, and written evidence. House of Commons papers 831; 2005-06, TSO (The Stationery Office). 6th July 2006). • Why? Drs don’t want to face legal action from Pxs or disciplinary action from the GMC. • In the US, conventional medicine is the third biggest killer after heart disease and cancer. • More people die by conventional medicine in the US than by firearms.(Seehttp://www.health-care-reform.net/causedeath.htm)
The benefits of modern medicine • Malaria: second biggest killer in the world – ~1,000,000 new cases/year – a child dies every 30 seconds…. • Big Pharma’s response: New anti-malarial drugs are not profitable so tend not to get involved in researching them – leaves it to charity, e.g., Bill Gates. • Current anti-malaria drugs can cause schizophrenia.(See World Health Organisation: Review of central nervous system adverse events to the antimalarial drug mefloquine (1985–1990).Geneva: WHO, 1991. Report no: WHO/mal 91.1063). Up to 22% of Lariam takers have reported serious adverse psychological events (see Mathew Parris, ‘I THINK I’D RATHER HAVE MALARIA’, The Times 04/04/1998) • ….Prozac ‘no better than placebo’….Statin side-effects…. • ….Withdrawal of Vioxx, Paxil, Bextra, Baycol…. Northwick Park antibody trial….only 15% of CM products tested by RCTs….‘skewing’ of drug trials results in order to protect share price and investors(See, for example, http://www.google.co.uk/search?hl=en&q=Zoloft%3B+trials+questioned&btnG=Search&meta=) • ….Not to mention antibiotic abuse and the rise of MRSA…. • ….MMR and the attempts to discredit Dr Andrew Wakefield(See Martin Walker; ‘The Guardian, the Science Lobby, and the rise of Scientific Corporatism’, 22/01/2008http://www.whale.to/vaccine/walker13.html) • ….The invention of ‘new diseases’ to sell more drugs(known as disease mongering; see, Moynihan R, Heath I, Henry D. Selling sickness: the pharmaceutical industry and disease mongering. British Medical Journal 2002;324:886-891). • ….And then there’s vaccination….
The benefits of modern medicineThe vaccination myth? “Scientific medicine has taken credit it does not deserve for some advances in health. Most people believe that victory over the infectious diseases of the last century came with the invention of immunisations. In fact, cholera, typhoid, tetanus, diphtheria and whooping cough, etc, were in decline before vaccines for them became available - the result of better methods of sanitation, sewage disposal, and distribution of food and water."Taken from 'Health and Healing' by Dr Andrew Weil http://www.vaccinationdebate.com/
AND THEY CALL HOMEOPATHY/CAMS !!!DEADLY!!!
The New Fundamentalists: what they forget • New Fundamentalists claim there is no proof or evidence that homeopathy/CAMs have efficacy (possibly beyond a placebo response). • But even if that were true (which it isn’t)…. • “…. absence of proof is not proof of absence. In fact, from a methodological and statistical standpoint, absence of proof is very difficult to prove….” • Dean R Hess, Editorial; Respiratory Care, July 2002, Volume 47(7), p757.
BAD SCIENCE? • 2005: Shang et al. ‘Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy’. Lancet. 2005;366(9487):726-32. • Lancet editorial (by Horton) proclaims ‘the end of homeopathy’. • Appeared during August when news is sparse – the media pounced. • Actually, this research was outright scientific bias and was roundly criticised by many scientists working in the field (none of which was reported by the media). See JACM 2005; 11(5): 779-785: • Horton Deplores Breach; As Do We His.George T. Lewith, Harald Walach, Wayne B. Jonas: • Shang et al. Carelessness, Collusion, or Conspiracy?David Peters: • Bias in the Trial and Reporting of Trials of Homeopathy: A Fundamental Breakdown in Peer Review and Standards?Michael Frass, E. Schuster, Ilse Muchitsch, Jeff Duncan, Walter Gei, Gloria Kozel, Christa Kastinger-Mayr, Anton E. Felleitner, Christian Reiter, Christian Endler, Menachem Oberbaum: • Failure to Exclude False Negative Bias: A Fundamental Flaw in the Trial of Shang et al.Helmut Kiene, Gunver S. Kienle, Tido von Schön-Angerer: • Understanding Placebo Effects in Homeopathic Clinical Trials.Trevor Thompson, Marjorie Weiss: • Sir: Is That Bias?David Reilly.
BAD SCIENCE? • Deconstructing Shang et al. From Dr Peter Fisher in PubMed: • "The final analysis which concluded that ‘the clinical effects of homoeopathy are placebo effects’ was based on just eight 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." • "One of the most serious criticisms is the complete lack of transparency (which incidentally goes against the Lancet’s own guidelines for conducting such meta-analyses): we have no idea which eight trials were included in the final, damning, analysis." • "The literature references are not given, nor any information on the diagnoses, numbers of patients, etc., nor can these be deduced from the article.” • “Prof. Egger has refused several requests to disclose the identity of the eight trials. This is not even a matter of scientific method, but of natural justice: the accused has the right to know the evidence against him."
Memory of water Roy R, Tiller WA, Bell I, Hoover MR. Mat Res Innovat 2005;9(4):559-576 (On-line; www.matrice-technology.com) 280 water molecules/icosahedron http:/www.lsbu.ac.uk/water/homeop.htm The Memory of Water hypothesis is based on conventional physics and chemistry concepts of supra-molecularity arising from hydrogen bonding and other well-known weak interactions between water molecules. But MoW has been dismissed out of hand as a ‘belief in undetected sub-atomic fields’ (See Sagar SM. Homeopathy: does a teaspoon of honey help the medicine go down? Curr Oncol 2007;14(4):126-7, and Milgrom LR. Homeopathy, fundamentalism, and the memory of water. Curr Oncol 2007;14:221-2)
Memory of water Evidence from the physical sciences A. Chaplin M. Water Structure and Behaviour. Online document at: www.lsbu.ac.uk/water/. Excellent section on homeopathy. Exhaustive and regularly updated B. Thermo-luminscence: 1.Rey L. Thermoluminescence of ultra-high dilutions of lithium chloride and sodium chloride. Physica A 2003;323:67–74.2. van Wijk R, Bosman S, van Wijk EP. Thermoluminescence in ultra-high dilution research. J Altern Complement Med 2006; 12(5): 437–443. C. Thermo-chemistry and Electrochemistry:1. Elia V., Niccoli M. Ann New York Acad Sci, 1999; 879: 241. 2. Elia V., Niccoli M. J Thermal Analysis and Calorimetry, 2000; 61: 527. 3. Elia V., Niccoli M. J Thermal Analysis and Calorimetry, 2004; 75: 815. 4. Elia V., Baiano S., Duro I., Napoli E., Niccoli M., Nonatelli L. Homeopathy, 2004; 93: 144–150. 5. V. Elia, E. Napoli, M. Niccoli, L. Nonatelli, Ramaglia A., Ventimiglia E. J Thermal Analysis and Calorimetry, 2004; 78: 331. 6. Elia V., Marchese M., Montanino M., Napoli E., Niccoli M., Nonatelli L., Ramaglia A. J Sol Chem, 2005; 34: 947.
Memory of water: composition vs structure D. Materials science - epitaxy • Sceptics claim that since there is no difference in composition between a remedy and the pure water used, there can be no differences at all between them. • Materials science shows “…. that it is structure (not composition) that (largely) controls properties, and structures can be changed in inorganic phases without any change of composition.”(e.g., diamond and graphite) • “The burden of proof on critics of homeopathy is to establish that the structure of the processed remedy is not different from the original solvent.”Roy R, Tiller WA, Bell I, Hoover MR. Mat Res Innovat 2005;9(4):559-576 (On-line; www.matrice-technology.com) • Using Raman and Ultra-Violet–Visible (UV–VIS) spectroscopy Roy et al distinguished two different homeopathic medicines (Nux vom and Nat Mur) and differentiated their 6c, 12c, and 30c potencies. • “Materials science concepts and experimental tools offer a new approach to contemporary science, for making significant advances in basic science studies of homeopathic medicines.”Rao ML, Roy R, Bell IR, and Hoover R.Homeopathy (2007) 96, 175–182.
MoW and biology? There is a long way to go, but think of the chemistry inside cells as like watching a play at the theatre. The molecules of life – DNA, proteins, enzymes, lipids, vitamins, etc – are the principle ‘actors’ and they transfix our attention. But the ‘stage’, scenery, direction, even the theatre itself is made up of coordinated water molecules which allow these principle actors to perform. Pressure changes in the membranes of the myelin sheath of long axonscause tightly-packed cholesterol-lecithin complexes to coil and stretch which, via lined-up water molecules, causes protein pores to open and close, allowing transmission of ions across the membrane. Such a mechanism is vitally important for the transmission of neural impulses.
Why ‘believe’ in science? • Which means it might be possible to eventually explain homeopathy in scientific terms. • So why can’t the New Fundamentalists ‘get’ this? __________________________________________________ • Science is ‘special’: it is based on ‘facts’; • These are claims about the world established by careful unprejudiced use of the senses; • These ‘facts’ are used to ‘prove’ theory. • But isn’t science also based on assumptions about the world? • And don’t these assumptions somehow ‘colour’the facts?Need to go deeper and ask, • What is science? • What is evidence? • How do we get there?”
Why ‘believe’ in science? • Deductive vs inductive logic…. • All humans are mortal; John Smith is human; ergo, he is mortal. • In the farmyard, the turkeys are fed every day; the farmyard operates in a uniform manner; ergo, the turkeys will be fed tomorrow. • When we reason with deductive logic we can be sure that the conclusion will be true if the premises are true. • When we reason with inductive logic we can end up drawing false conclusions from true premises (what happens to turkeys on Dec 24th??!!). • Induction leads us to believe that the future will resemble the past. • What has this got to do with science? Science relies on induction! • It is widely assumed that science starts with observation which provides a secure basis from which knowledge can be derived via induction. • But David Hume (18th C) argued it is all a matter of CUSTOM or HABIT and that the use of induction cannot be rationally justified at all! • Science doesn’t ‘prove’ or ‘disprove’ anything: the word ‘proof’ should only be used when describing deductive logical operations, like maths. • Offering a ‘reward’ to ‘prove’ homeopathy/CAMs work is a just a stunt and not a cheap one at that.
Simple or Naïve Induction • A large proportion of our beliefs are obtained by projecting from observed (past or present) events to cases that are either unknown, unobserved, or in the future. For example: • Every swan I have ever seen has been white. • Ergo; the next swan I see will be white. • But what if the next swan I see is black? • ALARM! Is it a swan? Easier to say it isn’t! Or: maybe it was a trick of the light and I never saw it! • This arises from what is called ‘Naïve Inductivism’, which asserts that: • Purely objective observations can be made which lead to irrefutable facts: • That generalisations can be induced from these facts: • That scientific laws and theories result from these inductions • Karl Popper attempted to address the limitations of Naïve Inductivism with his Principle of Falsification. • He argued that if a scientific theory cannot be tested by falsification, then it is pseudo-science (e.g., Freud, Marx), and should be rejected. • But scientists don’t work like that and there have been some notable successes by NOT rejecting theories when falsification apparently has happened (e.g., Newton’s theory of gravitation and the orbit of Uranus).
Evidence-based assumptions • Evidence is scientific – the result of research: • “I don’t believe in anything I can’t prove. My only true belief is in science and its ability to sort out belief from fact…My job is to establish whether or not they (CAMs) are evidence-based. There is no aspect of belief in this at all.”(Edzard Ernst; The Times, 24/12/2005) • Ernst is being a scientistic logical positivist, i.e., adopting the view that natural science has authority over all other interpretations of life, e.g., philosophical, religious, mythical, spiritual, or humanistic explanations, and over other fields of inquiry, e.g., the social sciences.
EBM and the philosophy of science • The current notion of Evidence-Based Medicine (EBM) assumes that:- • Scientific evidence provides objective ‘facts’ about the world. • Scientific beliefs stand or fall in the light of this evidence. • But this is a view based explicitly in the early 20th C philosophy of logical positivism. • Developments in the philosophy of science since the 1920s have posed serious challenges to logical positivism (Popper, Quine, Ayer, Kuhn, and particularly from Post-Modernists – Foucault, Derrida, Feyerabend, Lakatoé, etc), and therefore to the concepts of EBM which are based on it. • Thus, a recent Post-Modernist deconstruction of EBM discourse compares it to a ‘fascist’ structure for its intolerance of pluralism in healthcare systems (See, Holmes D et al. Deconstructing the evidence-based discourse in health sciences: truth, power, and fascism. Evidence-Based Healthcare 2006;4:180-186.
Observation is not objective • Observation is dependent upon and coloured by our individual senses and our background beliefs and assumptions (Columbus….!) • What we see is never what ‘really is’ (goes right back to Kant in the 18th C, and further to some ancient Greek philosophers), even under the most highly controlled experimental settings. • Kant said we can’t know anything about the ‘things-in- themselves’ (ontology) from which sensory data emanates. • A modern interpretation of quantum theory goes even further, and says there are no ‘things in themselves’. All there is, is what we can know (epistemology) about the world (Zeilinger). • Does a tree crashing in a forest make a sound if nobody hears?
Observation is not objective • Past experience is involved implicitly in what constitutes evidence, but this also includes the knowledge and standards constructed and adopted by ‘epistemological communities’: • In other words, decisions about what constitutes evidence are also inherently SOCIAL; for we all experience the world through a certain lens (paradigm – Kuhn): • What constitutes knowledge also depends upon cultural and social values: these are just as subject to critique as the knowledge itself. • Thus, our acceptance or rejection of evidence can also lack objectivity, for our natural tendency is to reject evidence which does not fit with currently held theory. • Hence positive results from even the highest standard RCTs in homeopathy will be rejected by those who do not ‘believe’ in the possibility that ultra high dilutions can have an effect. Catch 22! • So don’t expect to collect on Ernst and Singh’s Thousands or Randi’s Millions!
So What is Science? • It may be described as a conformist society which represents only the currently accepted paradigm. • Consequently the ‘society’ of science defines ‘reality’ relative to the accepted paradigm (e.g., the size of the universe pre- and post- Edwin Hubble in the 1930’s-40’s). • Students are educated in the accepted paradigm: alternative paradigms tend to be ignored. • So, the ‘society’ of science plays a part in determining what scientists observe – and how science is funded. • And as with all things social, there are ‘fashions.’ • From that perspective, New Fundamentalism is decidedly retro….
So What is Science? • But the ‘society’ of science now feels itself misunderstood, and under threat from ‘irrational’ belief systems (creationism; religion, etc), and a climate of politically-correct anti-elitism. • A symptom? In the developed world, between the ages of 9-16 kids are being turned off science (Japan, the worst). Schreiner C and Sjøberg S. Science education and youth’s identity construction – two incompatible projects? In, Corrigan D, Dillon J, and Gunstone R (eds). The re-emergence of values in the science curriculum. Sense Publishers, Rotterdam, 2007. • There has been a ‘dumbing down’ of science education: decline in real ‘hands-on’ experience via health & safety legislation. • Very little teaching of the history or philosophy of science. • The ‘society’ of science feels that its ‘message’ is not getting across to the public. So, over the last 10 years there has been a big ‘push’ on the Public Understanding of Science (PUS?!). • Media courses being offered at universities and more people with science training (many from the biomedical sciences; to graduate and post-graduate levels) joining the media.
So What is Science? • In a ‘media age’, however, the sound-bite rules. • Science has to compete for time and space in a crowded and commercialised media market. • Inevitably, this leads to over-simplification of complex scientific issues. • So, naïve inductivism is making a come-back! • Combine this with a certain crusading zeal to inform and educate the public, and we have…. • The New Fundamentalists’ attempting ‘to rid the world’ of unreason, thoughtless belief, and anything that cannot readily be ‘proved’ and explained by ‘black and white’ deterministic science, e.g., homeopathy/CAMs.
CONCLUSIONS • If ‘in science’s house there are many rooms….’ then New Fundamentalists are straight out of the basement: they are ‘old school’ naïve inductivists. • They attack homeopathy as un- or even anti-scientific but:- • The New Fundamentalism is itself deeply flawed: • It is challenged by Popper’s ideas on falsification, Kuhn’s notions on paradigms, and Post Modern deconstruction of logical positivism and EBM: • New Fundamentalists ignore, ridicule, or have no comprehension of evidence that supports homeopathy (e.g., claiming that the Memory of Water hypothesis constitutes ‘a belief in undetected sub-atomic fields’): • They use misinformation, misdirection, bias, hear-say masquerading as evidence (e.g., appeal to Nazi research) to ensure their views prevail: • As such, New Fundamentalists are not only themselves unscientific, they demean science.
CONCLUSIONS • THIS IS A BATTLE FOR HEARTS AND MINDS…. • Against skilful, crusading, implacable opponents who want neither peace nor rapprochement; • Who see themselves as ‘defenders of Enlightenment values against a rising tide of irrational beliefs’ (Richard Dawkins); • And are hell bent on ridding the NHS of homeopathy/CAMs provision. • THIS IS UTTER HUBRIS AND MISDIRECTION. • They proselytise a narrow one-size-fits-all interpretation of evidence, medicine, and science which is NOT the epitome of Western Enlightenment. • A pluralistic, humanitarian outlook on life which respects individual human rights, is. • The New Fundamentalism threatens the rights of patients to own their own health and healthcare, and to express their freedom of informed therapeutic choice within the NHS. • In this respect, it is doubly dangerous, so…. • TIME TO ‘LOCK AND LOAD’. • Time to getANGRY; to getUNIFIED;to getBUSY DEFENDINGhomeopathy/CAM.
FAMOUS LAST WORDS…. • “There are more things in heaven and earth, Horatio, than are dreamt of in your philosophy.”From Hamlet by W. Shakespeare • “Science appears as what in truth she is; not as our glory and absolute boast, but as a succedaneum, and a prop to our infirmity.”William Wordsworth • “Science is a broad church full of narrow minds, trained to know even more about even less.”Prof Steve Jones (geneticist and science populariser) • “I tell you; we are here on earth to fart around; and don’t let anybody tell you different.” Kurt Vonnegut (writer)