Oh, no, not again.
Respectful Insolence⢠has been invaded over the last few days by a particularly idiotic and clueless homeopath named Sunil Sharma, who’s infested the comments of a post about how U.K. homeopaths are complaining about all of us mean skeptics who have the temerity to point out the mind-numbingly obvious about homeopathy, namely that it is based on magical thinking, goes against huge swaths of well-understood science and thus would require some very compelling evidence indeed to be worth being taken seriously by scientists (evidence that homeopaths have been thus far unable to produce). It also relies on phenomena (the “memory of water,” for instance) that do not have any basis in reality. I haven’t really engaged Sharma much, mainly because (1) you, my readers are doing an excellent job dealing with his whining, refusal to provide any actual evidence, special pleading that homeopathy can’t be tested by “allopathic” science, and broadsides against “conventional medicine” and (2) I’m too busy using my allotted blogging time to create new content to be bothered with such trivialities.
Sharma does, however, remind me of another homeopath, a particularly clueless one, who once similarly infested the comments of this blog several months ago (albeit with a better command of English), someone who was most displeased when I did a facetious post in which I explicitly likened homeopathy to magic and humorously (I hope) invoked the fictional comic book Sorcerer Supreme Doctor Strange using a “homeopathic” enchantment. I’m referring, of course, to Dana Ullman, whose long-winded comments after a couple of my posts on homeopathy have become legend for their lists of meaningless references that supposedly “prove” homeopathy combined with numerous logical fallacies and an incredible persistence, not to mention an amazing imperviousness to science and reason.
You probably know where this is going.
Sadly, thanks to Steve Novella, I’ve learned that Ullman’s back, and he’s badder than ever (and not in a good way) with an article entitled How Scientific Is Modern Medicine? Given how well Steve has deconstructed Ullman’s blather, I was almost tempted to let this cup pass. Almost. Unfortunately, because I feel a bit responsible for apparently inspiring Ullman to run amok on the JREF discussion boards, I also feel an obligation to dive into the muck that is Ullman’s prose again. Besides, just because another blogger, even one whom I respect, has taken on a topic never stopped me before.
I actually did know about Dana Ullman’s book, The Homeopathic Revolution: Why Famous People and Cultural Heroes Choose Homeopathy, which came out a few months ago. I even knew that Ullman was going around claiming that all sorts of famous historical figures used homeopathy and apparently loved it and that Ullman’s claims were being credulously parroted by some of the more credulous homeopaths out there. In essence, Ullman’s book looks like one big exercise in argumentum ad populum, chock full of anecdotes. (And we all know that the plural of “anecdote” is not “data,” particularly when most of Ullman’s anecdotes date back to the 19th century.) Indeed, if you were to believe Ullman, you’d think that pretty much every major literary figure in the 19th century was a die-hard true believer in homeopathy, for whatever that’s worth, which is not much even if true. Moreover, as Le Canard Noir has documented for Ullman’s claims about how much stock Charles Darwin put in homeopathy, Ullman doesn’t tell the whole story, leaving out rather important bits of information that color Darwin’s relationship with homeopathy in a way different than the picture that Ullman paints does. Ullman also leaves out why homeopathy may have seemed reasonable 150 years ago but, thanks to the advancement of medical science, is now known to be utterly ridiculous.
I was half-tempted to write Ullman and see if he’d send me a review copy, but then I decided that I had better things to do with my time than to subject my brain to such rot. Besides, the two chapters that I could view online were more than enough to make me realize it would be a waste of my time. Even so, I just couldn’t leave Ullman’s downright silly condemnation of modern medicine as “unscientific” (apparently an excerpt from his book) pass unchallenged. His start is not auspicious:
Conventional medicine adherents have consistently asserted that its methods are scientifically verified, and they have ridiculed other methods that are suggested to have therapeutic or curative effects. In fact, conventional physicians have consistently worked to disallow competitors, even viciously attacking those in their own profession who have questioned conventional treatments or provided alternative modalities.
And yet, strangely enough, whatever has been in vogue in conventional medicine in one decade has been declared ineffective, dangerous, and sometimes barbaric in the ensuing decades. Surprisingly, despite this pattern in history, proponents and defenders of “scientific medicine” tend to have little or no humility, continually asserting that today’s cure is truly effective.
The good news about conventional medicine and one of its remarkable features for which it should be honored is its history of consistently and repeatedly disproving its own treatments. The fact that only a handful of conventional drugs have survived thirty or more years is strong testament to the fact that conventional medicine is honorable enough to acknowledge its mistakes.
Recognize it? It’s the “science has been wrong before” gambit applied to medicine, with a bit of faux “praise” for medicine’s willingness to challenge its own therapies, just to twist the knife a bit. Of course, Ullman’s knife is so dull that it couldn’t even breach a single cell layer of the epidermis on a baby’s bottom, but he apparently thinks that his critique is devastating. It’s not. For one thing, Ullman is apparently clueless about just how many drugs we use today that have been around for decades or even longer. Aspirin and digoxin come to mind as examples that have been around many decades. Even good old-fashioned penicillin is still useful for some infections, as are streptomycin, clindamycin, and first generation cephalosporins. For cancer we still use drugs like methotrexate, 5-fluoruracil, and cyclophosphamide, all of which have been around for decades and all of which are still effective against specific cancers. Also, in his contempt for the way that new therapies in scientific medicine frequently supplant old therapies over time Ullman conveniently neglects to mention that the reason this happens is because the new therapies are usually better in some way, either less toxic, more effective, or cheaper. True, there are a fair number of blind alleys that scientific medicine goes down from time to time. It’s also true that medicine can be prone to fads in treatments and that sometimes therapies are adopted before they are truly evidence-based (physicians are human too, and they like to offer their patients the newest and what they think to be the best), but if you look at the progress of medicine overall medicine in 2007 is clearly more effective than medicine in 1907 and medicine in 1907 was clearly more effective than medicine in 1807, which was Hahnemann’s time. Yes, it may take a lot longer than we would like. (Sometimes it even requires a generational change to occur.) Yes, it may be messy to watch. But it does happen, and the trajectory of modern medicine is slowly, relentlessly upward. Just think about it: Would you want to use medical therapies that haven’t changed since 1807? 1907? Hell, I wouldn’t want to use medical therapies that are more than a decade old and, for some diseases and conditions, that are more than a couple of years old.
This constant change and evolution are in marked contrast to homeopathy, which hasn’t changed appreciably in 200 years. It has made no new discoveries, and homeopaths practice now in much the same way that they did in Hahnemann’s time, with the exception that many homeopaths also practice various other “alternative” therapies, particularly herbalism. Now, as 200 years ago, homeopaths postulate that diluting “like cures like” based on no evidence. Now, as 200 years ago, homeopaths postulate that diluting a remedy beyond the point where a single molecule remains with ritualized shaking “succussion” at each dilution, actually makes the remedy more potent. The only real innovation ever made to Hahnemann’s ideas was the concept of the “memory” of water, an innovation necessitated by the realization later in the 19th century that homeopathic dilution diluted remedies until no molecule remained, a fact appreciated even in 1842 by Oliver Wendell Holmes. Well, that and more recent ludicrous attempts to invoke quantum theory to explain how homeopathy “works.” It should be pointed out once again that the reason homeopathy seemed to do better than conventional medicine two centuries ago was because medicine was very primitive and was all too often worse than the disease, involving the use of purgatives, heavy metals, and various other nasty remedies. Many treatments of the time involved cadmium, antimony, and even mercury. By comparison the placebo that is homeopathy didn’t look bad at all.
Not surprisingly, Ullman seems to have a bug up his butt about a couple of other aspects of modern medicine. Like many alternative medicine fans, he can’t resist a little conspiracy-mongering about Big Pharma, which, with its lackeys in the AMA, is apparently dedicated to ruthlessly stamping out “alternatives” like homeopathy:
Yes, a gorilla is in the house, but anyone who refers to him as a gorilla is usually called a quack or a crank. This gorilla was not born yesterday; he has been growing for generations. A part of his self-defense propensities is to eliminate competing forces, whether the other side seeks cooperation or not. Any competitive force is frequently and soundly attacked. The history of homeopathy shows this side of medicine, for from 1860 to the early twentieth century, the AMA had a consultation clause in its code of ethics that members were not allowed to consult with a medical doctor who practiced homeopathy and weren’t even allowed to treat a homeopath’s patients. At a time in medical history when doctors bloodlet their patients to death and regularly prescribed mercury and various caustic agents to sick people, the only action that the AMA considered reprehensible and actionable was the “crime” of consulting with a homeopath.
[…]
This King Kong, however, is not a monster to everyone. In fact, this big gorilla is wonderfully generous to executives, to large sales and marketing forces, to supportive politicians , and to the media from whom he buys substantial amounts of advertising (and thus, an incredible amount of positive media coverage). And this gorilla is wonderfully generous to stockholders.While it may seem inappropriate to criticize profits, it is important and appropriate to do so when profits are unbelievably excessive, when long-term efficacy hasn’t stood the test of time, and when common use of more than one drug at a time is rarely if ever scientifically tested for efficacy.
Naturally, it never occurs to Ullman that maybe–just maybe–the reason medical societies don’t like homeopathy is because they recognize it for the quackery that it is. True, there may have been some element of not wanting the competition in the past, but I don’t consider it to be wrong not to want competition that has no basis in science and no compelling clinical evidence that it does anything more than a placebo. That’s just good patient care and advocacy. Moreover, it’s a stretch to invoke real problems with big pharma and the profit motive as the reason why big pharma and the AMA supposedly want to suppress homeopathy, because homeopathy and other alternative medical therapies have become big business. They don’t rise to near the level of profitability as the pharmaceutical industry–yet. But then they also don’t involve anywhere near the level of risk that the pharmaceutical industry involves, given that enormous costs of developing a drug, getting it past the regulatory gauntlet, and bringing it to market that can take a decade and nearly a billion dollars per drug. Yes, big pharma can be a bad actor at times in pursuit of profits, but it’s also produced life saving drugs that make people’s lives better. It also recognizes a profit center when it sees it, which is why big pharma is increasingly diving into the supplement business. I predict that it won’t be long before it starts making homeopathic remedies as well.
If you’re still with me this far, you can see that Ullman’s arguments are weak at best and risible at worst. But perhaps the worst of the lot is this:
Modern medicine uses the double-blind and placebo-controlled trial as the gold standard by which effectiveness of a treatment is determined. On the surface, this scientific method is very reasonable. However, serious problems in these studies are widely acknowledged by academics but remain unknown to the general public. Fundamental questions about the meaning of the word “efficacy” are rarely, if ever, raised.
For instance, just because a drug treatment seems to eliminate a specific symptom doesn’t necessarily mean that it is “effective.” In fact, getting rid of a specific symptom can be the bad news. Aspirin may lower your fever, but physiologists recognize that fever is an important defense of the body in its efforts to fight infection. Painkilling drugs may eliminate the acute pain in the short term, but because these drugs do not influence the underlying cause of the discomfort, they do not really heal the person, and worse, they can lead to physical and psychological dependency, addiction, tolerance, and increased heart disease. Sleep-inducing drugs may lead you to fall asleep, but they do not lead to refreshed sleep, and these drugs ultimately tend to aggravate the cycle of insomnia and fatigue. Uncertainty remains for the long-term safety and efficacy of many modern drugs for common ailments, despite the high hopes and sincere expectations from the medical community and the rest of us for greater certainty.
“Fundamental questions about the meaning of the word ‘efficacy’ are rarely, if ever raised”? “Rarely, if ever”? What planet is Ullman living on? Trying to figure out what represents efficacy for each disease is a major concern of clinical trial design. In my area of cancer, for instance, it’s debated endlessly whether overall survival, disease-free survival, or response rates are appropriate clinical measures of efficacy. We discuss quality of life issues and whether the complications of therapy are worse than the disease. The same is true in surgery. The only reason Ullman could say something so astoundingly, jaw-droppingly, breathtakingly ignorant is because he is astoundingly, jaw-droppingly, breathtakingly ignorant of how clinical trials work. In the end, Ullman’s whine is nothing more than a case of special pleading. Because homeopathy can’t demonstrate efficacy in randomized, double blind clinical trials (RCTs), he has to attack the methodology of these trials. RCTs may have problems when it comes to interpretation and application to clinical practice, but not being adequate to the task of testing the efficacy of homeopathy is not one of them, nor is being inferior to the retrospective trials most prone to bias and confounding factors, which are, not surprisingly, the type of trial beloved of homeopaths. In the end, Ullman can do no better than claiming that scientists rig clinical trials. While this may happen, the solution to such problems is more transparency and better science, not replacing science with pseudoscience like homeopathy, nor do the deficiencies of scientific medicine or the expense of American health care relative to indicators of health mean that homeopathy could do any better. Certainly, Ullman can’t present any evidence that it could.
Finally, Ullman can’t resist retreating not only into special pleading but into postmodernism:
History also tends to portray those who lose a war and who represent a minority point of view as having less than positive attributes. For instance, those physicians practicing medicine differently than the orthodox medical practice might be called cranks, crackpots, and quacks. Such name-calling is a wonderfully clever way to trivialize potentially valuable contributions, whether or not one understands what these contributions really are.
Besides name-calling, practitioners of the conventional and dominating paradigm often spin facts to make the strong and solid features of a minority practice into something strange and weird. The fact that homeopaths use smaller doses than used in orthodox medicine has been portrayed as homeopathy using “wimpy” doses that theoretically could not have any physiological effect. Accusations that homeopathic medicines could not possibly have any effect are made without knowledge, experience, or humility, and such accusations simply become evidence of the accuser’s unscientific attitude and his or her ignorance of the diverse body of basic scientific work on the effects of nanodoses of certain substances in specific situations.
In other words, science is just another narrative by the “victors” (of course the real reason why homeopathy lost the battle never occurs to Ullman) and we medical scientists are all just microfascists for insisting on evidence from well-designed experiments and clinical trials before accepting therapy as efficacious. Either that, or we’re just arrogant jerks. Even if that were true, it wouldn’t invalidate science. I have to wonder if Dana Ullman knows Dave Holmes, he of the “microfascist” fame. He’s starting to sound like Holmes.
In the end, Ullman retreats to the same tactics that all pseudoscientists use: straw men arguments about science (in this case, medical science) that would decimate the fields of Kansas to construct; argumentum ad populum; special pleading, and, when all else fails, postmodernist bullshit. He has to. He has no choice, because when it comes to scientific evidence, he’s got nothing.
