Continuing in the same issue was the official Voodoo Society response to the "Hoare Challenge"
[Volume 33, no. 32, 25th August 2003, pages 2-3.]
Homoeopathy: the magic challengeDear Editor, I wasn't going to say any more in the homoeopathy debate, but I've never been challenged to a duel before (Mr Hoare's letter, 23rd June issue), and this does seem to demand a response. First, I must express my appreciation to everyone who contacted me, either offering themselves as sceptical guinea-pigs for the exercise, or pointing out the obvious flaw in Mr Hoare's proposal, or even both. Wouldn't it be fun to take Mr Hoare up! However, the flaw is just so fatal that it really would be a waste of everyone's time. He proposes conducting a "homoeopathic proving" on a group of volunteer non-believers, that is the recording of every little sensation or symptom felt or imagined by a healthy human subject after taking a homoeopathic remedy. He didn't mention whether this would be blinded or not, or whether there would be a control group (people given a sham solution instead of the remedy), or whether any believing homoeopaths would also participate. Nevertheless, the problem is clear. To quote one of my amused correspondents, "I can just imagine a room full of sceptics on the one hand stoically denying the existence of any symptoms whatsoever and homoeopaths on the other claiming to be unable to bend down and pick things up without feeling dizzy or feeling the urge to lie down on cold surfaces or whatever." Quite. My original suggestion regarding "trials carried out by non-believers" of course referred to clinical trials, properly controlled and blinded, such as are being done on human patients at Exeter University to such resoundingly negative effect. Not quite the same thing! In addition, blinded provings have already been done, several times, and published, with the inevitable null results (for example, Goodyear et al., 1998; Vickers et al., 2001; Walach et al., 2001). Why go round this yet again, with subjects who might in any case be highly motivated to deny any symptoms they might feel? I just can't see the point, any more than I can see the relevance of these human-based findings to animal treatment. I'm indebted to Mr Hoare, however, for enlightening me that these provings are now done, not on the actual substance under test, but on the shaken-up water of the final ultra-dilute remedy (a 30cH potency contains none of the original solute). Nevertheless, this doesn't seem to me to clarify homoeopathic theory, but to make it even more nonsensical than I had thought. I well remember the occasion, many years ago, when in my ignorance and naivety I remarked to a colleague concerning homoeopathy that, "Well, perhaps there's something in it, some plants might have active constituents we haven't yet been able to isolate." It took several minutes with a calculator before I could be persuaded that there really was no active ingredient in the "remedies". I investigated further, intrigued to discover why anyone with sufficient scientific education to cope with O-grade chemistry might therefore espouse such a method. Unfortunately, every fresh piece of information, whether from mainstream or homoeopathic literature, merely baffles me still further in that respect. I entirely agree with Mr Jessop (11th August issue) that no amount of contrary evidence is going to sway committed homoeopaths, and this was confirmed explicitly by Mr Gregory (16th June). However, the veterinary homoeopathic fraternity is very fond of making completely unfounded claims of scientific respectability and proven efficacy (such as Mr Saxton's letter in the 7th April issue, which prompted my own original letter), and I feel very strongly that these claims must be challenged whenever they are made, for the benefit of the profession as a whole. I'm intrigued by the offence which the homoeopaths seem to rake over the use of the word "magic" to describe their methodology. In fact, this way of looking at homoeopathy has been proposed even within the homoeopathic community itself (Walach, 2000). To summarise, the author agrees that it is impossible to arrive at any rational explanation of how homoeopathic remedies might act within the usual understanding of pharmacology, and that the more rigorously scientific the clinical trial, the more non-existent the therapeutic effect. However, he accedes to the anecdotal assertion that homoeopathy works for convinced homoeopaths in clinical situations. What, therefore, is the mechanism? He proposes that the homoeopath himself is influencing the patient by "magically activating connectedness", and views the preparation of the remedy as a "sign" by which this activation is brought about - essentially a magic spell. There are a number of other similar papers which, while not using the term "magic" as such, nevertheless propose mechanisms whereby the homoeopath's belief or understanding is the crucial factor in the alleged efficacy of the remedy. These include reports of cases where improvement is reported before anything is actually ingested, but coinciding with the moment the homoeopath has understood the problem and decided on the remedy, and cases where the homoeopath simply writes the name of the selected remedy on a piece of paper, places this (face down for ease of reading) over a glass of water, and has the patient drink the water. (I'm sorry, the reference list is getting out of hand, but this can all be followed up from www.vetlab.co.uk/voodoo/). One veterinary author takes a similar line (Thoresen, 2003). This article tries to explain "the contradiction between the lack of results within blinded investigation and the often brilliant results within the clinics" by suggesting that the intention ("yí", a term borrowed from acupuncture, which, it is proposed, works in the same way) of the therapist is the prime element in the success of the method. Well, perhaps they're right. Perhaps we do inhabit a universe where magic actually works - for the wizard homoeopaths at least, if not for the scientific muggles. However, if so, Mr Hoare is sitting on a potential fortune. Never mind trying to persuade me that I feel certain specific symptoms when I ingest a solution of homoeopathic water. if he himself is able to do this to the point where he can correctly identify the "remedy" administered, he is undoubtedly in a position to walk off with the Million-Dollar Paranormal Challenge (www.randi.org). This is, of course, the prize offered by the James Randi Educational Foundation "to anyone who can show, under proper observing conditions, evidence of any paranormal, supernatural, or occult power or event". Homoeopathy falls squarely within this definition, as has already been agreed in connection with the unsuccessful attempt by BBC2's Horizon programme to win the prize by repeating the Madeleine Ennis experiment with ultra-dilute histamine, another alleged homoeopathic effect. The same challenge has been offered before of course. Oliver Wendell Holmes, in his 1842 essay Homeopathy and its Kindred Delusions, reported that: "In 1835 a public challenge was offered to the best-known Homeopathic physician in Paris to select any ten substances asserted to produce the most striking effects; to prepare them himself; to choose one by lot without knowing which of them he had taken, and try it upon himself or an intelligent and devoted Homeopathist, and, waiting his own time, to come forward and tell what substance had been employed. The challenge was at first accepted, but the acceptance retracted before the time of trial arrived." Perhaps the incentive wasn't quite attractive enough in 1835. However, a million dollars is a lot of money. What do you say, Mr Hoare? If you can net this, and from what you claim you should be able to do it easily, you'd be a rich man. If not, the rest of what you say rings pretty hollow to me. MORAG KERR, BVMS, BSc, PhD, CBiol, FIBiol, MRCVS, References GOODYEAR, K., LEWITH, G. & LOW, J. L. (1998) Randomized double-blind placebo-controlled trial of homoeopathic 'proving' for Belladonna C30. J. R. Soc. Med. 91(11), 579-82. THORESEN, A. S. (2003) Ein Beitrag zur Erklärung des klinischen Effects von Homöopatie und Akupunktur. Ganzheitliche Tiermedizin 17, 75-78. VICKERS, A. J., VAN HASELEN, R. & HEGER, M. (2001) Can homeopathically prepared mercury cause symptoms in healthy volunteers? A randomized, double-blind placebo-controlled trial. J. Altern. Complement. Med. 7(2), 141-8. WALACH, H. (2000) Magic of signs: a non-local interpretation of homeopathy. Br. Hom. J. 89, 127-140. WALACH, H., KOSTER, H., HENNIG, T., & HAAG, G. (2001) The effects of homeopathic belladonna 30CH in healthy volunteers - a randomized, double-blind experiment. J. Psychosomatic Res. 50(3), 155-160. |
Autumn begins, and the topic made it into the editorial sections of the journal. We had wondered if the editor was going to call time on this correspondence, but a short editorial on the front page of the 1st September issue actually seemed to be inciting the riot.
[Volume 33, no. 33, 1st September 2003, page 1.]
Strong attacks, strong defence"EVERY position must be held to the last man; there must be no retirement. With our backs to to the wall, and believing in the justice of our cause, each one of us must fight on to the end." Earl Haig's order to British troops in April 1918 might well strike a chord in many of those who have written to Veterinary Times in recent months defending the merits of homoeopathy. Those on the other side of the argument - and they have slightly outnumbered the proponents - also seem to feel the need to defend their positions aggressively. The topic has been debated in the correspondence columns of this and other publications on many previous occasions but rarely has it produced so many letters and comments. The suggestion has been made that enough is enough and that the debate should be brought to a close, but Veterinary Times prides itself on allowing readers to have their say - even if there are times when, mainly for reasons of space but occasionally to maintain proper decorum, letters have to be subjected to a little pruning. In the words of the late Dean Martin, "Keep those cards and letters coming in." We welcome them but we do urge correspondents to avoid repetition. If the letters in this issue cause you to put pen to paper or turn on the computer, rest assured your opinions matter to us. Having started with a quote, we will finish with one, these words of wisdom attributed to the French philosopher, Voltaire: "I disapprove of what you say, but I will defend to the death your right to say it." At Veterinary Times, we rarely disapprove.... |
It seems a pity that the 99% plus of the profession who do not espouse homoepathy can only muster a fraction more letters than the less than 1% which does. We're not sure whose side the editor is on - possibly neither. However, we do know that none of the homoeopathy-critical letters has been edited by any more than slight grammatical tidying, so if anyone has abandoned proper decorum, we'd like to know who it was. And given the prolix nature of some of the contributions, what on earth was pruned for length?!
The same issue also contained an article by Mike Nelson critisising Mr. Rogers for himself revealing details the RSPCA had insisted were sub judice, and questioning the rationale for referring the Chris Day case to the RCVS after he had been acquitted in Court. He makes a reasonable point, but we do wonder how any welfare organisation is supposed to protect animals from the neglect of being treated by content-free medicines if the judiciary and even the RCVS appear to accede to the assertion that homoeopathy is acceptable practice. If the RSPCA's move makes the College look a little bit more closely at what is actually being done to animals in the name of this so-called "natural" medicine, then some good may indeed come of it all.
The first letter of September (not reproduced here) was in fact from the Enforcement branch of the Veterinary Medicines Directorate, reminding us all of our responsibilities in respect of medicines legislation, particularly import restrictions. We can't help wondering how selling shaken-up water with therapeutic claims squares with the requirement to "meet certain minimum standards of quality, safety and efficacy".
This week it was three to one to the good guys.
[Volume 33, no. 33, 1st September 2003, pages 2-3.]
'Craft has no rational basis'Dear Editor, Having debated homoeopaths on Internet forums and in these pages during the last several months, as an alternarive to actually getting a life, I note that the defences always fall into two rough categories: an appeal to the historical authority of the system and personal experience. Neither is capable of providing verifiable, objective and reproducible evidence. The fact that the homoeopaths themselves cannot see this failing does not excuse the rest of us from acting in the knowledge that their craft has no rational basis. Francis Hunter's plea (11th August issue) that "treatments will either stand or fall depending on how successful they are" is typical of the kind of superficial reasoning employed to defend homoeopathy as just another equally valid system of medicine. Unless it subjects itself to proper scrutiny, success cannot be judged. It is not that all conventional medicine has been so scrutinised, but those areas that have been can demonstrate efficacy, whereas homoeopathy simply never does. So while I cannot defend every dot and comma of conventional medicine, I am happy to completely reject homoeopathy as having failed when put to the proper test. To return to the unreliable evidence of anecdote for a moment, I really would recommend reading homoeopathic case histories with the eye of the sceptic and asking whether the homoeopaths' personal experiences would be any different if homoeopathy did nothing (I have saved an excellent one about a sick squirrel that is especially illustrative and this can be e-mailed on request). To lift a quote from a homoeopath, "homoeotherapeutics is so forgiving that we can, in chronic diseases, keep trying to find the correct remedy or keep zig-zagging cases toward cure", i.e. you can pretty much excuse any outcome. I accept that cases treated by conventional medicine can have this property, but not often, and we do have the backing of 200 years' scientific understanding in medicine to extend our practice into unusual cases. In the absence of any objective evidence to the contrary, I shall stick to my view that homoeopathy's use as a system of medicine is the same as that of Nero's fiddle as a fire extinguisher. Yours faithfully, SIMON J. BAKER, MA, VetMB, PhD, MRCVS, |
Since it was becoming clear that the RCVS Registrar had no intention of stepping in personally to correct the false claims first introduced to this correspondence by Mr. Saxton, the Voodoo Society once more intervened to make her point for her, using the more recent repetition of the fallacy by Mr. Rogers of the RSPCA. The full details behind this letter are included on another page.
[Volume 33, no. 33, 1st September 2003, page 3.]
Homoeopathy not recognised by RCVSDear Editor, The letter from Hamish Rogers of the RSPCA contains a serious error of fact which needs correction. In his penultimate paragraph, he says homoeopathy is a discipline recognised by the Royal College. This is incorrect. Homoeopathy is not recognised by the College but those who compile the Register of Veterinary Surgeons were unwise enough to put the list of homoeopaths on the same page as conventional specialists. This is not going to happen in the new Register and those responsible for the homoeopathy website have been told to remove their erroneous claim of recognition and specialist status by the registrar of the College. Yours faithfully, GEORGE W. TRIBE, BVM&S, MPhil, DLAS, CBiol, FIBioI, FRCVS, |
Mr. Allport also thinks we're vicious. Wasn't that "vitriolic" last month? Ah well, we can't please all of the people all of the time....
[Volume 33, no. 33, 1st September 2003, page 3.]
Holistic approach 'should be the norm'Dear Editor, The letter (11th August issue) from my erstwhile colleague Mike Jessop contained a great deal I agree with. Developing a holistic approach is indeed hugely beneficial- if only more members of our profession would adopt it. Unfortunately, modern veterinary medicine appears to be heading in the opposite direction of reductionism and compartmentalisation. However, I don't feel the holistic approach "belongs" to any particular branch of medicine - it should be the norm whatever therapy is being used. I also agree that homoeopaths develop a real enthusiasm for this method of treatment. I would not go so far as to call it an "almost religious zeal", this is a rather pejorative description. I qualified as a vet 30 years ago with a great enthusiasm for joining the profession, and have kept that enthusiasm ever since, whatever therapies I have employed. For any vet to lose such enthusiasm would be a great pity. Learning new therapies or techniques, or specialising in a particular field, helps to maintain that enthusiasm. Mike himself specialises in tortoises, for which he shows great enthusiasm and zeal (though I guess business must be "slow"!). At least Mike took the trouble to find out something about homoeopathy, although he is the only vet I have ever met who, on attending courses and trying out homoeopathy, was negative about the results. It's a little sad that, as far as I recall, he never mentioned on joining my practice or during his time as my assistant that he had any reservations regarding homoeopathy, but the passage of time may have affected my memory. It may well be that - as, according to Mike, no amount of evidence against homoeopathy is going to sway homoeopaths from accepting the value of homoeopathy - equally no amount of evidence for homoeopathy is going to sway anti-homoeopaths towards accepting the value of homoeopathy. It seems views will remain entrenched. I don't demand that colleagues stop using conventional, allopathic treatments, even though I think they are often mistaken. Equally, I believe I should have the right to practise the therapy I do, having gone through a rigorous training and examination in the subject, unhindered by the vicious comments of some members of our profession. Yours faithfully, RICHARD ALLPORT, BVetMed, VetMFHom, MRCVS, |
It's certainly magnanimous of him not to demand that the rest of us all stop using the medicine we were taught at college - generally referred to as 'evidence-based' rather than 'allopathic' these days though, we have to insist. He hasn't been reading his Veterinary Times too carefully though. A very similar letter to Mr. Jessop's was published some months before all this began, from a lady colleague who ascribed her temporary dalliance with homoeopathy to early lack of confidence and feelings of inadequacy, and commented that as she grew more experienced and more confident with treatments which actually worked she had to resort to homoeopathy less and less, until she eventually abandoned it as a pointless delusion. Unfortunately we neglected to save that issue. If anyone still has a copy, we would be very pleased to hear from them.
In fact we would accept evidence for homoeopathy very readily. Any one situation where a self-evident physiological effect could be demonstrated would do. Any takers?
Perhaps the correspondence is "going round in circles", but it was arguably time for a summary, and we do like Mr. Taylor's style.
[Volume 33, no. 33, 1st September 2003, page 3.]
'Dogged defence of the indefensible'Dear Editor, One has to admire the sheer tenacity and almost religious zeal of the recent spate of letters from believers in homoeopathy. The number of ways that the indefensible is doggedly defended seems almost unlimited. The lack of any sort of evidence showing homoeopathy to be effective has no bearing whatsoever on their adherence to the faith and neither apparently does the type of case that opened the whole debate, that of the multiple deaths of pups supposedly protected by nosodes. As people prepared to accept anecdotal evidence as proof of their stock in trade homoeopaths are pretty selective about which anecdotes they choose to believe. Evidence being non-existent we have instead had references to a higher power; the suggestion that, regardless of ethics or medical training, we should treat our patients however our clients dictate (even when those clients are misguided); a hint that maybe homoeopathy is magic after all but so what and the argument that homoeopathy is above the need to show proper evidence, unlike real medicine and every other type of technology and science you care to mention. We have had ad nauseam the argument that only those who practice homoeopathy should be qualified to judge it. Mr Hoare has tried to convince us that homoeopathy must work because vaccines work and you can use vaseline to treat dry skin and last but not least we musn't forget good old quantum physics, the final, shameless refuge of every pseudoscience and quack therapy from ESP and crystal healing to telepathy and spoon bending. The only thing this argument tells us is that quantum homoeopaths clearly don't know their quarks from their elbows. The latest incisive argument seems to be smug complacency. Francis Hunter is trying to convince himself that homoeopaths have nothing to worry about after all; they've already got the whole thing sewn up and everything is fine because, guess what, medical homoeopaths and the NHS can be just as deluded as veterinary homoeopaths - well that's OK then, isn't it? So still no need for any of that pesky evidence, why let mere facts get in the way of a good thing (the phrase "whistling in the dark" comes to mind here). How very generous he is in allowing that he isn't decrying conventional medicine and on occasion may even recommend it. His final heartfelt plea for us all to pull together for a group hug almost moved me to tears. OK, I'm convinced; just as soon as he can answer my little "bicker" and tell me how water can cure cancer I'll be "grown-up" and even "joined-up" along with everyone else. Oh no, I'm filling up again. Quick, pass the Oscillococcinum someone. Yours faithfully, NIALL T. TAYLOR, BVM&S, MRCVS,
|
A new combatant entered the field the following week on the side of right and reason. He seemed concerned about boring the audience, but we feel that this distinction is reserved for the letter which followed his.
[Volume 33, no. 34, 8th September 2003, page 2.]
Homoeopathy: 'huge benefit from trials'Dear Editor, At the risk of boring everyone to death, I would like to contribute to the debate on homoeopathy. My point is very simple: if it really works, prove it. It would not be expensive to organise a peer-reviewed double-blind trial of homoeopathy conducted by conventional scientists and to be published in JSAP. I cannot understand why this has not been done yet, as the consequent benefits to the cause of homoeopathy would be huge. Inevitably, one suspects that the homoeopaths know that it will not stand up to this scrutiny and hence avoid it. Like a previous correspondent, I would recommend the late John Diamond's book Snake Oil and especially his analogy of counting chairs. Veterinary surgeons practising conventional medicine should be proud rather than ashamed. It is conventional medicine and surgery which has enabled humanity to make huge strides in treating both human and animal disease, not homoeopathy. Conventional medicine is based on fact, not belief. When homoeopathy is proven to the same criteria, I too will believe, but then it will have become conventional medicine! Yours faithfully, NICK MYERSCOUGH, BVetMed, MRCVS, |
Well, Mr. Myerscough, that's what we thought we were talking about in the 'tutorial' letter near the beginning of the thread, when we called for "trials carried out by non-believers". However, what we got was Mr. Hoare's invitation to get involved in a 'proving' instead - something which has not yet been concluded to anyone's satisfaction.
Next, another of those letters which just brings out the worst in the Voodoo Society, we fear.
[Volume 33, no. 34, 8th September 2003, page 2.]
Medical discipline based on valid preceptsDear Editor, Morag Kerr is quite correct to imply that Mr Hoare will not be able to win the "Million-Dollar Paranormal Challenge". That is because, to quote the letter in Veterinary Times (25th August issue), that challenge is concerned with "any paranormal, supernatural, or occult power or event". Homoeopathy, contrary to some opinions, is none of these. It is a medical discipline based on valid precepts, and backed by both sound scientific confirmation and around 200 years of clinical confirmation. "Supernatural" or "occult" implies not being capable of rational explanation by the natural laws of this world, with perhaps some religious overtones. Could it be that the real reason for the formation of the Voodoo Society is in fact to win the prize? "Paranormal" implies beyond the normal, yet for millions of people the reality of homoeopathy is within their normal everyday experience as either patients, clients, or professionally trained objective healers. Morag Kerr may be happy agreeing that the Horizon programme was a conclusive piece of high quality scientific research, superior in every way to the repetitions of Madeleine Ellis' experiment that have taken place in independent and conventional universities across Europe. But then there appear in the published letters to be some very individualistic criteria in a number of fields. There is the distinct impression from a previous letter that the definition of a "respectable immunologist" is one who does not believe in homoeopathy, and in the current letter there is clearly an unwillingness to envisage any progress in pharmacological thinking beyond the model that was taught circa 1976. In fact, the inability to encompass new ideas seems to be a feature of many of the critics of homoeopathy within both the veterinary and medical worlds. It is instructive to realise that in the scientific disciplines beyond medicine, such as theoretical physics, molecular biology, and quantum physics/mechanics, there is no difficulty in accepting the precepts of homoeopathy as being in accord with their current thinking and practice. But much of medical thinking remains stuck in the time warp of Newtonian physics, and wedded to the sacred cow of the double blind trial. Much of Newton's work is, of course, still valid today and indeed parts of it are integral to any explanation of homoeopathy. But I am sure he would have been the first to decry any suggestion that it was the ultimate pronouncement on any subject. I would also remind Dr Kerr that 'O' level chemistry represents a very early stage in scientific education, and some of what is taught at that stage is adapted even as early as 'A' level. Mr Hoare draws attention to the limitations of the random controlled trial in the same issue as Morag Kerr's letter so I will not belabour that point. Suffice it to say that its infallibility is being currently questioned in research circles and other techniques developed to improve on it. However, the remark concerning the Exeter work invites comment since it is quoted as an integral part of Dr Kerr's case. Here we have a team led by a man who, judging from his published works, has an incomplete understanding of homoeopathic principles, and whose efforts have also drawn criticism for their RCT methodology and statistical analysis. It must be acknowledged that we all have a tendency to rely on those references that suit our position, but it must be remembered that there is always another side to any question. I have not had any response to my offer in a previous letter to provide relevant references to anyone who is interested. Is this a question of "don't confuse me with facts - my mind's made up"? Yours faithfully, JOHN G. G. SAXTON, BVetMed, VetFFHom, CertIAVH, MRCVS, |
It's a pity Mr. Saxton didn't bother to find out for himself about the JREF Challenge before putting pen to paper. They've been trying to get homoeopaths to put up (or shut up) for years - homoeopathy is most certainly considered to be eligible for the prize. If the Voodoo Society actually believed it could win that money, we'd be over there applying before you could say "similia similibus". Funny how reluctant the homoeopaths are to go for it. Surely they can't doubt their ability to demonstrate the truth of their claims?
We'd like to hear about all these respectable replications of Professor Ennis's experiment. However, since Mr. Saxton doesn't even seem to have realised that I made a typing error in her name when I originally submitted my letter (and a request to Veterinary Times the following day to fix this wasn't heeded), and has simply reproduced the typo exactly, we're not convinced he actually has much familiarity with the field. He seems to have looked up my date of graduation - oooh, 1976, what a long time ago! However, he's obviously unaware that I did my postgraduate work partly in the Department of Veterinary Pharmacology at Glasgow University, being awarded my PhD for this in 1986 (maybe that's still antediluvian to one of Mr. Saxton's vintage - 1964 as it happens), and by the way, one does have to discover something new before they actually award that degree, unlike the VetFFHom and CertIAVH, which he seems to have decided to claim after all - why not, everyone else does it.
We've already covered the point about the RDBPCT being inappropriate for testing anything which has a self-evident effect. We'll only mention that Dr. Edzard Ernst is Professor of Complementary Medicine at Exeter University, and is one of the few people in this field to be doing work of a quality which is appropriate for publication in mainstream journals as Thorax and the British Journal of Clinical Pharmacology. Of course he's being critisied by homoeopaths who can only get published in Homeopathy and Hahnemannian Gleanings! He should be proud.
As an aside, we'd still like to know about the "sound scientific confirmation" and so on of radionics and "pranamonics", on which Mr. Saxton has published at least one paper.
"Don't confuse me with facts - my mind's made up." You have to laugh. Especially in view of the beginning of the first letter of the following week....
[Volume 33, no. 35, 15th September 2003, page 2.]
An issue of beliefsDear Editor, It appears I have to spell it out again: "No amount of placebo-controlled double-blind crossover trials is going to convince me that the effects of homoeopathy which I observe daily in practice are a delusion." Your correspondents continue to misrepresent these words for obvious reasons. May I add that it is a matter of great interest to me that while some trials do show a positive effect for homoeopathy, others do not. Sometimes it is obvious why this has resulted, such as lack of individualisation, or selecting an inappropriate remedy for the condition under investigation; at other times it is not. Unfortunately, such is the controversy around homoeopathy that many trials seem to set out specifically to prove that homoeopathy does not work. This is counterbalanced by those which attempt to prove that it does work. Unfortunately, this is hardly an objective scientific framework, especially for investigation of a system of medicine which appears to operate on such a subtle level. As Churchill said, "There are lies, damned lies and statistics." So I prefer to believe my own eyes and clinical judgement. It is, of course, precisely because "O" level chemistry cannot explain homoeopathy that researchers are investigating other areas of science in attempts to understand this intriguing phenomenon. L. R. Milgrom (of the Department of Chemistry at the Imperial College of Science, Technology and Medicine), for instance, proposes a non-local metaphor for homoeopathy, based on quantum physics, in which the potentised medicine, the patient and the practitioner are seen as forming "a non-local therapeutically entangled triad, qualitatively described in terms of the transactional interpretation of quantum mechanics".1, 2 This is the sort of research which may well help us to understand what might otherwise be deemed "magic". Significantly, this research is performed in an attempt to understand why homoeopathy works in the clinical situation, not whether it works. Personally, I have no objection to Ms Kerr [that's "Dr. Kerr" to you] referring to homoeopathy as magic, if that is her belief, but I am intrigued that she finds investigation of what she considers to be paranormal so abhorrent that she feels the need to purge it from our profession. In addition I fail to understand how attempting to discredit homoeopathy will benefit our profession as a whole. Let us consider what might happen if the Royal College were to follow the wishes of this minority and to put homoeopathy outside the veterinary profession: the burgeoning number of animal owners who seek homoeopathic medicine will be free to obtain this service from lay homoeopaths, homoeopathic doctors and anyone who wishes to set themselves up as animal therapists. They will practise without making a diagnosis, as this would still be an offence under the Veterinary Surgeons Act. The Royal College would have no control whatsoever. It seems to me that this would be a "no win" situation - the veterinary profession would suffer, the client would suffer, and most importantly, the patient would suffer. That being so, I have yet again to conclude that there is an issue here somewhere about belief systems. For what it's worth, my belief is that it is unscientific and archaic to dismiss that which we cannot understand as "paranormal" or "magic" and, for whatever the reason, to attempt to suppress it. Conventional aerodynamics cannot yet explain why a bumble bee can fly; perhaps they are all magicians, perhaps it is a delusion, or perhaps there is something about the phenomenon we do not yet understand. Either way, I suggest we leave them alone and keep on searching. If we could look down a microscope and see what there is in a potentised medicine, I suspect we would be having a different discussion, but as Nietzche said, "If I were to shake a tree with my hands, it would not move - but the wind, which we cannot see, can bend the tree. It is the invisible things that twist and torment us most." I'm off now to discuss Heisenberg's Uncertainty Principle with the fairies at the bottom af my garden. Yours faithfully, PETER GREGORY, BVSc, VetMFHom, MRCVS, References
|
We rather tend to suspect that, if all were revealed, it is exactly 5% of the trials of homoeopathy which show a positive effect. There are of course good statistical reasons for this. Another 5% almost certainly show a negative effect, but very few of these see the light of day. The really funny bit about this letter is that its two references are two of the ones we omitted from our list on 25th August for reasons of space, and instead referred readers to the links on this web site. The others were Dr. Milgrom's third tedious offering in his series (which Mr. Gregory doesn't seem to have caught up with yet, we can hardly say we blame him), and another rather similar one by a Dr. Weingärtner - also perhaps rather recent for Mr Gregory's reading programme. We're intrigued by his definition of "research". If 17-page fantasies that perhaps homoeopathy works macroscopically something like quantum mechanics appears to work at the sub-atomic level, with NOT ONE SINGLE EXPERIMENTAL FACT TO SUPPORT THEM count as research, I obviously wasted some of the best years of my life! Of course this is all geared to explaining how homoeopathy works. The premise that it works is already taken as read, based on such irrefutable facts as that patients often come back for more, and the method hasn't died even after 200 years!
Once again we have the horrible prospect of animals being treated with water by lay witchdoctors instead of being treated with water by veterinary witchdoctors being used to try to retain control of this unprofessional but undoubtedly lucrative activity, and of course, "there are more things in heaven and earth, Horatio...." However, we hate to spoil a good rant, but science worked out quite some time ago exactly how a bumble bee can fly.
We're not quite sure what the next correspondent was getting at, but in the interests of completeness we include the letter in its entirety.
[Volume 33, no. 35, 15th September 2003, page 2.]
New name suggestedDear Editor, Just a thought. Would the correct terminology for someone who does not subscribe to alternative medicine be a "homoeophobe?" Yours faithfully, NEIL STODDARD, BVetMed, MRCVS, |
We do know what the next letter is driving at, but....
[Volume 33, no. 36, 22nd September 2003, page 26.]
Absence of references doesn't help causeDear Editor, In response to John Saxton's letter, clearly many readers are interested and perhaps he should include and publish a list of references in his letter. It is bizarre and possibly telling how many times proponents of homoeopathy mention validated research, without providing any details of it! Yours faithfully, MARK GOODMAN, BVM&S, MRCVS, |
.... for goodness sake, Mr. Goodman, don't encourage them! It's always the same list, starring Kleijnen, Linde and Reilly, and Mr. Hoare pretty much covered it all last April!
And of course, he got what he asked for. Kleijnen, Linde and Reilly, and a few more of the usual suspects.
[Volume 33, no. 38, 6th October 2003, page 22.]
Homoeopathy: a lack of understandingDear Editor, May I take a little more space in your publication to reply to some of the recent correspondence. The opponents of homoeopathy seem to be poorly informed about homoeopathy. They do not understand its principles and base their opposition on a belief, that belief being that "it couldn't possibly work". Mr Goodman should start his reading with the meta-analyses conducted by Kleijnen,1 Boissel2 and Linde3. He could then go on to Reilly,4 Albertini5 and Benre.6 The meta-analyses can obviously lead on to more references should he wish to look deeper into the subject. It would, of course, help if he had read The Organon7 beforehand. Much of the opposition is based on a misunderstanding of the term homoeopathy, and an inability to register the difference between a principle, a mechanism and an example. Dr Kerr's opposition to homoeopathy appears to be based on an inability to believe that highly diluted Hahnemannean solutions can affect a mammal's physiology and psychology. She insists that over the last 200 years hundreds of provers, thousands of doctors and millions of patients have all suffered from a delusion. As I wrote in an earlier letter, the way to see if a 30cH medicine can affect a body is to take it. This she resolutely refuses to do because she already knows that it won't affect her. Had she bothered to contact either myself or Mr Johnson, she would have found out that we would love to have her help and advice in setting up a proving that would satisfy both parties regarding methodology, blinding, numbers, control groups and any other factor that interests her. The offer is still open. I must, however, decline her challenge to me on grounds that are quite sensible when homoeopathic theory is taken into account. The materia medica of a medicine is the summation of the results of provings, toxicology and successful, cured cases. This means that the results of any one prover should be within the ambit of the materia medica of that medicine. It does not follow, though, that any one prover will provide symptoms that are actually diagnostic of that medicine. A simple analogy would be the division of a 1,200-piece jigsaw puzzle of a well-known picture into 12 random collections of 100 pieces and allowing 10 people to each take a collection. Together they could make a good guess as to what the picture was, although individually each would be unlikely to recognise the whole picture. To Mr Myerscough, I would like to point out that conventional scientists tend to set up trials that are invalid from a homoeopathic point of view, and to reject those conducted by homoeopaths simply because they ought not to have worked. The proof that it works lies in the provings. It should not be forgotten that Hahnemann was the first person to attempt to establish the action of a drug8 and that "blinded trials", both single and double, are a very recent innovation. I find Mr Baker's claim that conventional medicine has 200 years of scientific understanding rather over the top. A homoeopath would find a much wider range of medicines readily available for him to use, and that his materia medica and repertory had been greatly expanded. I doubt very much if a doctor from 1820 would be able to find the medicines that he needed, nor would he find a cupping bowl and fleam. Indeed, it is unlikely that any doctor practising before 1940 would be able to cope today without extensive retraining. I also find it interesting that when acupuncture was introduced into Europe in the 1930s it was laughed at. It was still being laughed at by the medical establishment in the 70s. It was not until "neuropeptides" were discovered in the 1980s that the endorphins, released when certain acupuncture points are needled, could be identified. That enabled acupuncture to become respectable. It is not yet fully respectable because endorphins alone cannot account for all the recorded effects attributed to acupuncture. Finally, may I say to Mr Taylor that if he is feeling nauseous he would be better off taking Ipecacuhana than Oscillococcinum.8, 9 Yours faithfully, JOHN HOARE, BVSc, MRCVS, VetFHom,
|
Perhaps Mr. Hoare might like to consider that we understand homoeopathy only too well, and that we've read quite as much as we care to of the references he's so fond of quoting? (Oh, all right - we haven't looked at Hahnemannian Gleanings, sorry.) And that (apparently unlike him) we've also read the detailed, scholarly critiques of these works which reveal the deep deficiencies and statistical flaws. With particular reference to the arnica stuff, he might like to peruse this meta-analysis. Oh, but we forgot - Mr. Saxton has dismissed its author as "having an incomplete understanding of homoeopathic principles". Well, that's that then.
In fact only three of the papers cited appeared in mainstream refereed journals, and it's worth looking at their conclusions.
Kleijnen - "At the moment the evidence of clinical trials is positive but not sufficient to draw definitive conclusions because most trials are of low methodological quality and because of the unknown role of publication bias."
Linde - "The results of our meta-analysis are not compatible with the hypothesis that the clinical effects of homeopathy are completely due to placebo. However, we found insufficient evidence from these studies that homeopathy is clearly efficacious for any single clinical condition."
Reilly - "Is the reproducibility of evidence in favour of homoeopathy proof of its activity or proof of the clinical trial's capacity to produce false-positive results?"
In addition, we think that the Boissel et al. (1996) report Mr. Hoare mentions must be essentially the same as:
CUCHERAT, M., HAUGH, M. C., GOOCH, M. & BOISSEL, J. P. (2000) Evidence of clinical efficacy of homeopathy. A meta-analysis of clinical trials. HMRAG. Homeopathic Medicines Research Advisory Group. Eur. J. Clin. Pharmacol. 56, 27-33.
This abstract states - "There is some evidence that homeopathic treatments are more effective than placebo; however, the strength of this evidence is low because of the low methodological quality of the trials. Studies of high methodological quality were more likely to be negative than the lower quality studies."
If these are Mr. Hoare's best shots, we can't say we're impressed. In fact the last quote has actually hit the nail on the head. It's simply not valid to throw every study into a pool and aggregate the results regardless, and it has been shown by a number of commentators that when proper account is taken of quality of study, there is in fact nothing there above placebo effect.
His excuse for declining the challenge was certainly one we hadn't thought of, but it's a pretty feeble wriggle. We hadn't realised that he needed ten people to identify the remedy, but if that's what it takes, then just do it that way! Perhaps this would mean that the prize would have to be divided among the group, but £63,500 each is still worth having, and for that we'd certainly join in! However, our simplified test appeared in the same issue, and perhaps he could manage it on his own if he only has to distinguish a known remedy from a sham.
It was probably inevitable that Mr. Hoare would also think that acupuncture is scientifically legitimate. We're afraid not (see for example Thoresen, 2003). Endorphin release was at one stage suggested as a possible mode of action, but this turned out not to be the case. In fact, now that sham trials have been devised and conducted, it has become apparent that there's nothing there but a fairly pronounced placebo effect.
Ah, it was about time for another example of the favourite homoeopathy letter, the miracle cure....
[Volume 33, no. 38, 6th October 2003, pages 22-23.]
It is a medicine in its own right...Dear Editor, I have been watching the recent correspondence on the pros and cons of homoeopathy with interest. I have been using homoeopathy on select cases for 20 years and now, having sold my main practice where I did both orthodox and alternative practice, I just take referrals for homoeopathy and acupuncture. At the same time I have nearly completed a four-year training in human homoeopathy. Most of the veterinary cases that I use homoeopathy on are referred cases where orthodox treatment is not working. I have a good enough success rate even in these cases to make me want to carry on treating animals this way, otherwise I would have given up years ago! I have a case I would like to relate which shows how effectively homoeopathy can work. The patient was a two-year-old Weimaraner dog which had behavioural problems. The history was that the owner rescued Weimaraners and re-homed them. She had taken in this dog a year ago and it was the first one she felt she could not re-home due to its restless behaviour and the fact it appeared untrainable. She was a good trainer but homoeopathy was its last chance as the alternative to euthanasia. The dog was very restless in the surgery and kept coming up asking for attention and then causing chaos; I could see her problem. For behavioural consultations it is better to see them off the lead so we can see how they react. A full homoeopathic consultation of an hour and a half was carried out, after which I felt this dog was very similar to a hyperactive child. The remedy given was three doses of a homoeopathic medicine given at 12 hourly intervals. She rang me up 48 hours later to tell me that the dog was a changed character; it was no longer hyperactive and was now quite trainable. She was amazed, as I was, that the homoeopathy should work so quickly. It did pass through my mind that the dog was ill! However, she came back three weeks later and the dog was still better. In fact it was so relaxed that it lay down flat on the surgery floor throughout the consultation. The dog is now well-behaved and trainable. She can now re-home him. So there is nothing in those little white tablets? Instead of arguing about homoeopathy, let us put our efforts into a way of explaining why it does work. It may not work every time as we may not have the right remedy. In homoeopathy, to get the right remedy we need to know about what the patient is feeling and how he may have reacted to any stresses in his life as well as the physical ailment he may have at the time; needless to say this can be difficult to find out as we can only go on what the owner tells us, which makes our task more difficult than in the human field. Homoeopathy is a medicine in its own right, the study of which is never ending. It is a useful form of treatment in behavioural problems, phobias, skin and respiratory conditions, cystitis, gingivitis, hyperthyroidism in cats, head-shaking and COPD in horses, to name but a few conditions that it can treat effectively. Before too long I am sure we will explain how it does work; in the meantime, I will carry on making animals better, which is why I entered the profession in the first place. Yours faithfully, TRIXIE WILLIAMS, BVSc, MRCVS, |
Yes, we know, you're so convinced that "it works" that you see no need to prove this to anyone else's satisfaction. However, although we've encountered other miracle cures where the dilution of the remedy wasn't specified, this one is a first in apparently believing that the identity of the remedy isn't worth mentioning. Yes, there really is nothing in these little white tablets - nothing but lactose, anyway.
All right, let's try this one more time.
[Volume 33, no. 38, 6th October 2003, page 24.]
Randi Challenge is still onDear Editor, Let's get this straight. Eligibility for the James Randi Million Dollar Challenge doesn't depend on the claimant's belief that his abilities are paranormal. The vital point is that those who administer the Challenge define the ability as paranormal. Homoeopathy is explicitly included, and indeed the terms were restated only a few weeks ago. "Can the applicant differentiate between homeopathic and non-homeopathic materials?" The list of suggested methods includes "biological (in vivo)". (www.randi.org/jr/082203.html) It seems my earlier suggestion was unnecessarily complicated. There's no need to identify different or unknown homoeopathic remedies. Simply choose one remedy, any one you like, and demonstrate that you can reliably distinguish it from a sham (the native carrier material). That's the crunch, isn't it? The science we rely on declares that there's nothing in the homoeopathic preparation which isn't in the sham. Homoeopathy, irrespective of any theories as to mechanism of action, declares that the homoeopathic preparation has very definite in vivo effects. Who's right? Can this be tested? Focussing on patients and trying to show measurable clinical improvement is fraught with difficulty. The entire system lacks one single situation where self-evident effects can be reliably produced - in itself a serious indictment. Single dramatic "cures" never seem to be repeatable, and clinical trials flounder amid mutual accusations of flawed design and misapplied statistics. The argument deadlocks at "I believe it works in my clinic" vs. "I believe you're kidding yourself". In contrast the 'proving' effect, which is fundamental to homoeopathic theory and practice, should be perfectly amenable to objective testing just as Mr. Hoare suggested. "Like cures like" relies absolutely on the alleged ability of these solute-free preparations to produce significant, recognisable symptoms in healthy individuals, as we're constantly assured. It seems simple enough. Any experienced homoeopath should be able to tell quite easily, using himself as a subject, whether he is taking the homoeopathic preparation or a sham. If this is true, and can be shown to be true, I'm a convert. Sign me up for the next training course. But if it can be shown to be true, the Randi Challenge is also in the bag. In fact, isn't it a bit odd that somebody hasn't picked it up already? Human nature doesn't often turn up its nose at an easy £600,000 plus. Even if the money is irrelevant, what about the publicity value? Winning that prize for homoeopathy would stun the critics dead in their tracks. The system and its proponents would be resoundingly vindicated. The world would be at your feet. But still, nobody seems to want to try. Mr. Gregory would do well to remind himself of the definition of the word 'metaphor', and to take note that Dr. Milgrom's three very long and very boring papers contain no research data, but merely describe fanciful speculations. However, if there's any substance at all to this quantum mechanical para-magical flummery, this simple, objective test should be a walkover. If no homoeopath will even step forward to attempt it, how can anyone justify treating sick animals on this basis? In what way does claiming therapeutic properties for the stuff, and declaring that one routinely uses it in preference to licensed medicines, not qualify as professional misconduct? This is a very serious point, and one which our professional regulators ought to examine very carefully. Yours faithfully, MORAG KERR, BVMS, BSc, PhD, CBiol, FIBiol, MRCVS, |
Mr. Myerscough may imagine that everyone is bored senseless by all this, but he's obviously still reading, and so are we.... He can certainly look after himself, anyway.
[Volume 33, no. 40, 20th October 2003, page 24.]
Homoeopathy: where does the problem lie?Dear Editor, I will again take the liberty of boring everyone to death! In reply to John Hoare, his statement that "conventional scientists tend to set up trials that are invalid from a homoeopathic point of view" is exactly the point I was trying to make. Homoeopaths will not accept conventional testing because homoeopathy fails these tests. Most conventional scientists would conclude that the problem lay with the medicines, not with the tests. Why do we have to accept medicines that do not conform to the same standards demanded of conventional medicine? Beats me! NICK MYERSCOUGH, BVetMed, MRCVS, |
Well perhaps this next trial is also "invalid from a homoeopathic point of view." However, it will be interesting to find out exactly why.
[Volume 33, no. 41, 27th October 2003, page 10.]
Homoeopathy: the million dollar challengeDear Editor, I'm immensely flattered that Mr. Hoare would "love" to have my help in designing a protocol to test his claims regarding homoeopathic provings. However, every time I think I've got my brain round this very odd theory, he tells me that no, I just don't understand the subject. In fact, I'm only concerned to know whether he can indeed distinguish a 30C homoeopathic preparation of his own choice from a sham. How he does it would undoubtedly be interesting, but I certainly wouldn't want to restrict his protocol in any way. So, how about this?
It would be wise to take independent statistical advice on this, but I imagine that 18 correct out of 20 trials (p<0.001) would impress pretty much anybody. This might be quite a prolonged exercise, depending on how long it takes Mr. Hoare to make up his mind each time, but in a sense that doesn't matter. So long as the preparation, storage and dispensing of the materials are carried out with scrupulous honesty and the record of what has been dispensed each time is completely secret, there's no need at all to supervise the actual testing. I imagine Mr. Hoare intends to set up some sort of "proving", using either himself (to return to his own analogy, surely even one person can tell whether he's been given a random 10% of a jigsaw of the Mona Lisa, or of a blank canvas), or as large a group of volunteers as he requires. The people involved can confer all they like, consult whatever literature or expert sources they like, and take as long as they like. Nothing is forbidden - NMR spectroscopy, or X-ray diffraction, or dowsing; ask NASA, or Porton Down, or Russell Grant; even give it to selected patients if that is deemed appropriate. What could be fairer than that? Of course, a trial along these lines would certainly be acceptable as a protocol for a preliminary test for the JREF Million Dollar Prize. I see no point whatsoever in going to all this trouble unless it is an official attempt at the prize. I would therefore urge Mr. Hoare to look at www.randi.org/research/index.html, read through the rules at www.randi.org/research/challenge.html (these look perfectly fair to me), and get his application in. The JREF will then provide advice on the final details of the protocol, including how to ensure that the critical steps are adequately secure, and what level of performance should be accepted as a statistically valid demonstration of the claimed ability. I think this is a straightforward and fair protocol to test Mr. Hoare's claim. I would be very happy to help him refine it further to meet the requirements of the JREF, to approach academic colleagues who might be mutually acceptable as unbiassed guardians of the preparation, dispensing and recording steps, and even to be one of his proving group if he really wants me - though if I were him, I'd stick to experienced homoeopaths who understand what's going on and know what they're looking for. I look forward to hearing from him. However, I do hope that any deficiencies in my outline approach will be met by suggestions as to how these might be overcome, rather than being used as excuses for declining the challenge altogether. A million dollars, remember? Fame, adulation and complete vindication! Homoeopathy elevated to its rightful status as the medicine of the future! If he can do it, of course. Yours faithfully, MORAG KERR, BVMS, BSc, PhD, CBiol, FIBiol, MRCVS, |
It seems as if Mr. Hoare isn't the only homoeopath who thinks this is possible. A medical colleague of his has just made an extremely similar suggestion to the Guardian's Bad Science correspondent. We imagine Dr. Goldacre has also heard of the JREF Challenge - better hurry up, Mr. Hoare, before Mr. Ebrahimi gets there first!
back to Home Page | on to next page of letters