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Want to Help Save 34 Billion a Year in Health Care Costs? Be a Skeptic

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Are unregenerate skeptics unfairly bashing homeopathy? Well, as George Orwell has written, clear thinking requires proper attention to language. I read with great enjoyment articles like Gary Hart's clarification of the word liberal (pertaining to a free people) and its proper antonym, totalitarianism. James Zogby has done his readers a similar service with his posts.

That's why I am puzzled to find, in these same pages, the distain for a similarly liberating and enlightening word: skeptic. I am referring to the articles by Dana Ullman touting the efficacy of homeopathic medicine (the idea that finding a substance that produces a symptom and then diluting it into non-existence is an effective treatment for that symptom) (1).

This idea is both highly implausible prima facie, and violates what we know about chemistry and physics (If you're one of those people who think, "Hey, the laws of chemistry and physics are for other people, you need read no further). He rails again and again about how closed-minded and pernicious skeptics are ignoring "the evidence." Does he make his case? I think not. Who am I to question a self-proclaimed "expert on homeopathy?" Well, I am an expert on B.S -- a teacher of persuasion, an authority on sham arguments. Let's remove the sham arguments from Mr. Ullman's case and see what's left.

But first, let's reclaim the meaning of the word skeptic. A skeptic is a person who proportions his/her belief to the evidence. Of course, a properly skeptical person does not accept just any "evidence" that matches his/her preconceptions and ignores the rest; evidence must pass certain tests of verity and must be verifiable independently and abundantly. No evidence, no belief. A bit of information that goes against the rest and is not properly verified, no good (think cold fusion). Cherry-picking positive evidence and ignoring the rest? No belief plus the stink eye. That's why the Nigerian yellowcake letter was "evidence" of the Iraq's intentions only to the already convinced. If skepticism is good in the political realm, why not in terms of health?

Let's start with the low hanging fruit. The article begins with the statement, "Numerous surveys over the past 150 plus years have confirmed that people who seek homeopathic treatment tend to be considerably more educated than those who don't." I'd dismiss this as simple ingratiation of the faithful (any good salesman will compliment you on your "good taste," especially when you're buying something ghastly), but he goes on to cite 12 more times that users of homeopathy are of "higher socioeconomic status," "upper class" and have "a high[er] level of education" than non-users. This connection must be there to prove something, but what? Could it be that if smart people (and oddly, people of high social status) believe it, it's more likely to be true? I showed this argument to my not-yet -highly-educated freshman class and they got it in one. Correlation is not causation. Maybe the upper class and well educated have more discretionary income to spend indiscriminately; you don't see many low wage workers blowing their paychecks on feng shui either. What about, "England's Royal Family has been homeopathy's strongest advocates. . ." Well, only when you're looking for a good tailor is Prince Charles an authority.

But it's so popular! A wag on this blog easily nails this argumentum ad populum, saying that cigarette smoking is popular in Europe, too. As Richard Kammann has remarked, "Contrary to the where-there's-smoke theory, [no pun intended] the number of people believing an idea is not much evidence for its truth value."(2) Next case.

"Skeptics of homeopathy insist that homeopathic medicines do not work, but have difficulty explaining how so many people use and rely on this system of medicine to treat themselves for so many acute and chronic diseases; and a very large number of these people do not have to use anything else." No, not at all; it's very easily explained. This is called the fallacy of subjective (or personal) validation, the "I tried it and it worked" argument. This argument has no more force than the ones above, although many people believe that it does (3). By this very low standard everything works, because people themselves are very poor judges of the efficacy of treatment. First, people generally get better without treatment; are they good judges of the speed of their recovery? No. Of course there's the placebo effect. And people do many things when they are sick, like taking proven drugs with their homeopathic ones, change their diet, rest, etc. Which factors aided recovery? They don't know.

Chronic conditions, by definition, have no decisive medical cure, and vary in their severity over time. Take a nostrum when the symptoms are at their worst, and the most probable outcome is that your symptoms will decline. Post hoc, ergo propter hoc. It apparently "works" for the afflicted as long as they believe it does. One of my students told me that, as I child, she once had a pain in her side. Her mother concluded that someone had given her the "evil eye" (a skeptic, no doubt). The mother rubbed an egg along the affected area to remove the curse. Did it work? Of course it did; the mother allayed her fears and exerted illusory control over a capricious world, and the child's pain eventually went away. Before you scoff, consider that eggs are much cheaper than homeopathy, and nutritious too (if ingested rather than applied topically).

A doctor's clinical testimony is no better, the "I gave it to my patients and they say that it helped them" argument (4). As Michael Shermer likes to say, "anecdotes are not evidence and a thousand anecdotes are no better than one."(5) Bad evidence doesn't get better as it accumulates. As Kammann has said, "Unfortunately it is not the quantity of evidence that makes an idea correct, but the quality of the evidence."(6)

What about the claim that, "a very large number of people do not have to use anything else." I assume that he's speaking about India where "100 million people depend on it solely on this form of medical care." This is a clear bit of sophistry; it's not that they need no other care, they have no other care, and Ullman admits that India's health outcomes are not good, but only in footnote. Reading the article he references does not dispel skepticism. It states:

Apart from the growing pool of doctors trained in homeopathy, the therapy's appeal is also due to the failure of the Indian public-health system which is ill equipped to serve the country's vast population. According to the UN Development Programme, India has just 48 physicians per 100,000 people. The poor provision means that people turn to the private sector, both modern and homeopathic, which is lightly regulated. (7)

This article also includes the heartwarming story of a homeopath who took a poor farmer's money (he sold his tractor to pay for the treatment) in turn for " a cure for AIDS." It did not go well. Is it ringing endorsements like these that skeptics are powerless to challenge?

What about the overall claim, "homeopathic medicine is the leading 'alternative' treatment used by physicians in Europe. . ." Wherever Ullman makes this claim directly there is no citation, and when there is a citation, the author(s) cited are not enthusiasts. For example, Ullman proclaims, "A survey of departments of obstetrics in hospitals in the state of North Rhine-Wesphalia, Germany, found that acupuncture and homeopathic medicine were the two most commonly used CAM practices." But why? Let's read the article: "Homeopathy was mostly administered by midwives alone (>90 percent) and rarely by obstetricians."(8) Why do physicians condone this practice? "The data showed that the principle motivation for using CAM methods was the midwives' belief in its effectiveness followed by demands from patients."(9) In reviewing the evidence, these authors conclude, "there is little evidence that the CAM methods offered in obstetrics departments in Germany and delivered mainly by midwives are beneficial."(10) They then wonder, "Why do German midwives use CAM therapies with virtually no or very low levels of evidence? Why do physicians, who have primary responsibility for the patient's medical care, allow midwives to use such therapies?"(11) Why indeed? Are these the believers in the miracles of homeopathy? Doctors' number one alternative?

Or how about, "A survey of patients in Germany with chronic lymphocytic leukemia found that 44 percent had used alternative treatments." The authors' conclusion? Better education, not CAM: "Rational evidence-based medical information about the effects and risks of CAM use should be made available. ... "(12) Or how about this one, "The use of homeopathy and CAM in Germany by people with other chronic disease is also high, as was observed in a survey of German's [sic] with multiple sclerosis." What do the authors say? "In the light of the increasing number of highly effective pharmacological treatments available today, the frequent use of CAM by patients with MS is worrying." (13) They elaborate:

It appears that patients trust unproven promises and treatments offered by various therapists and healers, in most cases without any scientific evidence, more than our scientifically proven therapies, which have been subject to thorough clinical testing before being accredited. (14)

Are these more converts? With boosters like these, who needs skeptics. Show me a physician who prescribes homeopathic remedies rather than proven scientific ones for a treatable condition and I'll show you an MD about to lose his/her license. At least one already has, but not before a needless death. (15)

We now come to the sham argument of last resort, the ad hominem fallacy. Yes, it's very popular with TV screamers (FOX "opinion" shows would be dead air without it), but it's still a fallacy, and one of the basest. It goes like this: if you can't address your interlocutor's argument, then shift the burden of proof and accuse him/her of bad character or nefarious intent. Thus, the original argument is lost in the scuffle, and your adversary is somehow on the back foot defending himself. Sometimes Mr. Ullman's use of ad hominem is rather tame; for example, "Because of homeopathy's impressive and growing popularity in Europe, this alternative treatment poses a significant threat to conventional medicine, which may explain why there are ongoing efforts to attack it (and homeopaths) using devious and ethically questionable means." Possibly, but this is irrelevant to the claim that homeopathy has any merit. Maybe MDs are jealous, or maybe they are concerned that patients may delay or avoid legitimate treatments and suffer the consequences, impossible to say. People make good arguments for many reasons, and Hitler was a vegetarian. Address the argument, not the motive.

But it gets worse. Apparently, "there is a very active group of skeptics, with significant big pharma funding, who work vigorously to attack this system of natural medicine." These skeptics "are a mixture of former or present libertarians, Marxists and Trotskyists." My lord, they're everywhere, waiting to suppress the truth, these skeptics, and they're commies too! What have these 'bolshi bomb-throwers' been up to? They convinced the House of Commons Science and Technology Committee to hold a hearing and write a report with the very reasonable title, "Evidence Check 2: Homeopathy."(16) But wait, isn't this what Mr. Ullman keeps saying that skeptics refuse to do, read the evidence and evaluate it dispassionately? Without addressing anything in the report, Mr. Ullman calls the committee a "kangaroo court" and assets that, "Any rational person should and must be very suspicious of this 'report'" (scare quotes in the original). Why not address the arguments in the report rather than merely bad-mouth those involved? This is like a dog whistle to a sham argument spotter; people tend to abuse others in inverse proportion to the strength of their own case.

And that's just what we find. The committee's inquiry and report could not have been more reasonable, thorough, even-handed, or damning to the credibility of homeopathy. Their goal was simple: since the British government provides homeopathic remedies through the National Health Service and licenses them through the Medical and Healthcare Products Regulatory Agency, they ask, on what evidence are these polices based? In pursuing this question, they find homeopathy's mode of action (how it is supposed to work) lacking. That is, the notion of similars (like cures like) confuses symptoms with the underlying cause of disease and the law of infinitesimals (extreme dilution of the active ingredient increases its effects) often produces products where not one molecule of the original ingredient remains.

Although homeopaths maintain that the ingredient, although no longer present, has left its impression on the remaining medium, the committee is, of course, skeptical. "The notion that water could hold imprints of solutions previously dissolved in it is so far removed from current scientific understanding that, as Professor David Colquhoun, Professor of Pharmacy at UCL put it: "If homeopathy worked the whole of chemistry and physics would have to be overturned."(17) But what about the clinical studies? They turn to these next and conclude that, aside from the cherry-picking of homeopaths, "the systematic reviews and meta-analyses [of clinical trials] conclusively demonstrate that homeopathic products perform no better than placebos."(18) They express the worry that if homeopathy continues to be supported by the NHS, the public will assume they are an effective alternative. As to the issue of patient choice, they conclude that choice should be an informed choice, and therefore the placebo nature of homeopathy should be part of that choice (among other recommendations).

What's left of homeopathy with the sham arguments removed? As the law of infinitesimals would predict, nothing.

References

Newsday reports that Americans spend $33.9 billion annually on complementary and alternative (CAM) medicine. Of this figure $3 billion is spent on homeopathy. Marilyn Marchione and Michael Strobe, "$34B Spent on Unconventional Care," Newsday, 31 July 2009.

(1) Dana Ullman, "Homeopathic Medicine: Europe's #1 Alternative for Doctors. Huffington Post <http:www.huffingtonpost.com/dana-ullman/homeopathic-medicine-euro_b_402490.html>

(2) David Marks and Richard Kammann, The Psychology of the Psychic. (Buffalo, NY: Prometheus, 1980), 156.

(3) Theodore Schick, Jr. and Lewis Vaughn, How to Think About Weird Things, 3rd ed. (Boston, MA: McGraw Hill, 2002), 213-220.

(4) Schick and Vaughn, 220-227.

(5) Michael Shermer, Why People Believe Weird Things, (New York: Henry Holt, 2002), 48.

(6) Marks and Kammann, 194.

(7) Raekha Prasad, "Homeopathy Booming in India" The Lancet, vol. 370, no 9600 (2007): 1680.

(8) Karsten Munstedt, Anja Brenken, and Matthias Kalder, "Clinical Indications and Perceived Effectiveness of Complementary and Alternative Medicine in Departments of Obstetrics in Germany: A Questionnaire Study" European Journal of Obstetrics & Gynecology and Reproductive Biology, 146 (2009), 51.

(9) Munstedt, Brenken, and Kalder, 52.

(10) Munstedt, Brenken, and Kalder, 53.

(11) Munstedt, Brenken, and Kalder, 53.

(12) M. Henzel, M. Zoz, and A.D. Ho, "Complementary and Alternative Medicine in Patients with Chronic Lymphocytic Leukemia," Support Care Cancer (2008), May 6.

(13) S. Schwarz, C. Knorr, H. Geiger, and P. Flachenecker, "Complementary and Alternative Medicine for Multiple Sclerosis," Multiple Sclerosis, 14 (2008): 1113.

(14) Schwarz, et al., 1117.

(15) Stephen Barrett, MD, "Homeopathic 'True Believer' Loses Medical License" HomeoWatch 3 July 2010 <http:www. Homeowatch.org/reg/metzler.html>

(16) House of Commons Science and Technology Committee, "Evidence Check 2: Homeopathy (Fourth Report of Session 2009-10, February 2010)
http://www.publications.parliament.uk/pa/cm200910/cmselect/cmsctech/45/45.pdf

(17) House of Commons Science and Technology Committee, 17.

(18) House of Commons Science and Technology Committee, 19.