When homeopaths fight back

I love it when my fans notice me.

After all, of what use is my having taken so many hours over so many years laying down on a nearly daily basis if my words don’t have an impact? Surely I couldn’t be so egotistical that I’d do it anyway even if my readership was what it was when I first started out and had not increased to the point where I’m the (alleged) force that I’ve become in the medical and skeptical blogosphere, would I?

Wait, on second thought, don’t answer that.

In any case, back in the day I’d write my best snarky skeptical deconstruction of some bit of pseudoscience or another and the target wouldn’t notice, namely because my traffic was so low that the blogger didn’t notice the incoming traffic and Google didn’t pick me up on searches, at least not on the first couple of pages of any search results. As the blog got bigger, though, that happened less and less. In fact, I can pretty much count on most targets of a heapin’ helpin’ of my special brand of Insolence, Respectful or not-so-Respectful, to notice. Most of the time this is a good thing. After all, why wouldn’t I want purveyors of pseudoscience to have a bit of science-based criticism? More importantly, the responses are amusing. On rare occasions they even teach me something.

This is not one of those times.

Way back in March, I took note of a particularly egregious bit of quackademic medicine published in the International Journal of Oncology. True, the IJO is not a top-tier, or even a second-tier, journal, but it is peer-reviewed and in general I never thought of it as a journal that sucked; that is, at least, until March. In contrast to the mediocre journal, the research group that published this study came from one of the two most respected cancer centers in the U.S., namely the M.D. Anderson Cancer Center. Published by Frankel et al and Cytotoxic effects of ultra-diluted remedies on breast cancer cells, the study brought down the righteous wrath (or at least mockery) of Dr. Rachel Dunlop and, of course, yours truly. That’s because this was a study of homeopathy and breast cancer. That’s right, homeopathy and breast cancer. As Dr. Rachie and I pointed out, the study was riddled with methodological flaws that rendered its conclusions completely unsupported. In fact, the study didn’t show what its authors think it showed; in reality what it showed is that alcohol can be toxic to breast cancer cells in solution as certain chemotherapeutic drugs. Well, that, and random noise. Quackademic medicine doesn’t get much quackier than that, and this was right at M.D. Anderson, what should be the heart of science-based medicine in the world of oncology. Meanwhile, homeopaths trumpeted that homepathy killed breast cancer cells and was “non-toxic.”

In the process of applying the clue-by-four of science to the infiltration of quackademic medicine into the hallowed halls of the M.D. Anderson Cancer Center, Dr. Rachie and I appear to have ticked off a writer at a homeopathy website. The writer, Patricia Maché, decided that she would defend homeopathy and try to refute both Dr. Rachie and yours truly. Her editorial, appearing in the September 2010 issue of “online journal of homeopathy” Interhomeopathy, the “international homeopathic Internet journal,” is entitled The never-ending story of Placebo. It’s virtually a textbook case in the logical fallacies, bad arguments, magical thinking, and pseudoscience that homeopaths routinely use ot justify their woo, so much so that I just couldn’t resist having a little fun providing a bit of my own editorializing. I mean, really. How on earth could I resist?

If there’s one reason I was really, really irritated by Frankel et al, is because I knew it would be seized upon by homeopaths because (1) it comes from M.D. Anderson and (2) because it I knew they would point to it as “evidence” that there must be more than placebo effects to homeopathic remedies because allegedly this study “proved” that there were real effects in cell culture due to these remedies when it did no such thing. True to form, Maché goes right for both. But first she has to repeat the same old canards about homeopathy:

There is an increasing pressure on homeopaths to prove that the working of homeopathy is not simply a placebo effect, as is so often asserted by its sceptics. For those who repeatedly witness the rapid, gentle, and lasting effects of adequate homeopathic treatment, especially on those not prone to the effects of placebo (babies, animals, comatose, and … sceptics), there is little need to prove its effectiveness, though there always remains a healthy curiosity towards its working mechanism.

Translation: We don’t need no steekin’ science to tell us that homeopathy works. We believe it because of testimonials and our own misleading personal experience, full of confirmation and observation of regression to the mean. I will give Maché props for having a bit of a sense of humor with that crack about the comatose and skeptics. Of course, reading Maché’s prose would render most skeptics comatose, so full of pseudoscience and logical fallacies is it, but give her her little joke for the moment. Never mind that homeopathy works just as well on babies, animals, and the comatose just as well as it works on skeptics or anyone else; i.e., not at all. It is, after all, water.

After invoking a study on piglets (which I may have to look up), Maché decides to invoke the dreaded breast cancer homeopathy study that Dr. Rachie and I so thoroughly deconstructed and then complain about how mean we awful skeptics were:

The study was met with enthusiasm by the homeopathic community and, unsurprisingly, with derision by the section of the scientific community, which calls itself ‘the sceptics’. Citing a consistent lack of statistics, which is a valid point,* Dr Rachie in her ‘Sceptics’ book of Pooh-Pooh’, (yes, that is its real name!) proceeds to dismiss the whole study and indirectly calls for the heads of the International Journal of Oncology‘s review panel for having allowed this ‘tripe’ to be published.

I find it rather amusing that Maché admits that Dr. Rachie had a vaild point in criticizing the lack of statistics in the paper. Note the asterisk, though. Apparently Maché actually contacted Dr. Frankel, who responded:

The protocol followed the same research protocol done for initial investigation of any chemotherapeutic drug as practiced in any leading cancer research institute, prior to animal studies and clinical trials … The statistical analysis was done on each set of experiments; due to lack of space in the journal we could not have elaborated on all the details, but the results were significant and easily noticeable…

How lame. As Dr. Rachie and I both pointed out, the statistical analysis (or, more properly, the lack thereof) was completely below the minimal standards expected for a paper like this. Let’s put it this way. Both Dr. Rachie and I are researchers. I’m a cancer researcher. I’ve done cell culture studies similar to the studies reported in Frankel et al. I’ve even grown several of the same cell lines that Frankel et al used, in particular MCF-7 and MDA-MB-231 cells, the latter of which are one of the main cell culture models we use in my lab right now. Let me just assure you that I would never, ever publish studies using these cells without proper statistical analysis. Perhaps the most hilarious part of Dr. Frankel’s response was his claim that they didn’t “elaborate on all the details” because of lack of space. That excuse is a load of fetid dingo’s kidneys. The lack of statistics went far beyond skimping on the description of how statistical analyses were done. We’re talking no statistical analysis here. This isn’t just a quibble, either. “Easily noticeable” just doesn’t cut it in scientific studies, particularly in studies this poorly designed. Dr. Rachie was correct to castigate the editors and peer reviewers of IJO for letting this paper pass peer review.

Of most interest to me, Maché didn’t like one thing I said in particular:

Another sceptic, writing under the pen name of Orac, expectedly adds ‘water’ to Dr Rachie’s mill, in a similar tone. There is, however, an interesting sentence in his diatribe: “It tests a remedy so highly implausible as to be safely considered, for all practical intents and purposes, impossible barring some truly extraordinary evidence coming to light, evidence sufficient to overthrow long-established science in multiple disciplines.” (my emphasis)

Five centuries ago, uncannily similar words were addressed by Luther to Copernicus, who had presented his heliocentric theory: “this fool who wishes to reverse the entire science of astronomy.” Isn’t it ironic to find the sceptics caught in the unenviable position of the Church of those times, which relentlessly persecuted anyone who dared oppose its authority and threaten its power, and systematically used brutal repression in lieu of scientific argumentation. Thankfully, times have changed and the flames of the stakes have been replaced by fiery words; Edzard Ernst does not shy away from using the word ‘heretics’ to qualify homeopaths! (see Jan’s column)

Ah, yes. The old accusation of “your science is just another religion” or that “you’re dogmatic and repressing homeopathy,” or, as I like to call it, “Help, help, I’m being repressed!” I also find it amusing that Maché considers the criticism of two skeptics–that’s right, two skeptics–to be the equivalent of being “relentlessly persecuted” and “brutal repression.” Let’s not forget that the Church imprisoned and killed heretics. Now, metaphorically, apparently we’re burning those poor homeopaths at the stake with “fiery words.” What wimps! All Dr. Rachie and I did was to send a few well-aimed barbs the way of Frenkel et al and the IJO. Science is not for the faint of heart. One of the great things about science is that you have to be able to defend your work, as it will be tested and attacked. Unlike what Maché apparently thinks, this is actually a good thing. By being subjected to a “Darwinian” selection through constant testing, scientific ideas either survive or they do not. Frankel et al‘s ideas, clearly, are too fragile to withstand legitimate criticism, and Maché feels the need to jump in and defend it.

As for the claim that we are using “brutal repression” in lieu of science, all I can say is: Project much? After all, homepathy is far more like religion than science. No evidence will sway its adherents. No amount of demonstration of its inherent magical thinking, akin to sympathetic magic and the law of contagion, sways its believers. Homeopathy remains water, no matter how much homeopaths try to claim otherwise or that water has a magical mystical memory that, as Tim Minchin so famously put it, remembers the good bits but forgets all the poo that’s been in it. In any case, both Dr. Rachie and I did a ridiculously detailed scientific review of the paper. Maché cherry picked a couple of criticisms that she thought she could deflect with some handwaving and ignored the copious other substantive scientific criticisms of this misbegotten excuse for a study, a study so bad that I wouldn’t even excuse an undergraduate student who presented experiments and data like this to me.

Finally, let’s get back to Maché’s disdain for my statement, some version of which or other I almost inevitably use whenever the topic of homeopathy comes up, that homeopathy is so highly implausible from a basic science standpoint as to be safely considered, for all practical intents and purposes, impossible, barring some extraordinary evidence coming to light, evidence sufficient to overthrow long-established science in multiple disciplines.” Maché seems to think that’s a statement of dogma, but in reality it is a simple statement of science. Homeopathy is just that improbable. However, even though homeopathy is that improbable, note that I said only for all practical purposes it can be safely considered impossible. That is simply my way of putting the burden of proof where it belongs: On the homeopaths making the incredible claims.

Look at it this way. If homoepaths could produce compelling evidence of the efficacy of homeopathy, then science would be forced to reconsider the huge swaths of evidence that undergird the statement that homeopathy is so incredibly improbable as to be in essence impossible. If, for example, a homeopathic remedy, prepared as homeopaths say it should be prepared, could cure 10 patients in a row with stage IV pancreatic cancer, that would be evidence so compelling that even I would say we should take a look. If homepaths could show that they can reliably differentiate between homeopathic remedies and placebos when blinded to which is which, even I would say we should take a look. If homeopaths could provide compelling evidence for the princple of “like cures like,” which under current science is nothing more than prescientific sympathetic magic, evne I would say that we should take a look and possibly even reconsider.

No homeopath has ever produced such evidence. Instead, they tell us we are too close-minded for expecting a level of evidence that is at least on the same planet, as far as quantity and quality are concerned, as the mountains of evidence supporting the physics, chemistry, and biology that show that homeopathy is impossible.

Is it too much to ask for some evidence on that level? I don’t think so.

But apparently Maché does, as she winds up her screed with a classic ploy of pseudoscience, namely incorrectly shifting the burden of proof to the skeptics, rather than to the homeopathic scientists (and, believe me, any science in the study Maché cites is homeopathic to the point where all science has been diluted away) producing such crappy studies:

Would not it be another pleasant change, however, if instead of ‘pooh-poohing’ works that do not follow the established creed, the sceptics took up the real challenge to answer Dr Frenkel’s research on the scientific ground to which it belongs and reproduce his experiment in their own labs, to either confirm or oppose his findings. Alternatively, they could make the experiment to come to homeopathic practices, observe for a week or a month, and collect the data which they will be able to use to, again, confirm or oppose that which homeopaths experience every working day. Then, and only then, will we have a truly scientific dialogue, where both partners come to the table with facts and figures, with truth as ultimate aim.

Uh, no, Maché. You are the one challenging well-established science. It’s up to you to bring the science to the table if you think you can. Real scientists have better things to do than to chase down the liquid equivalent of fairy dust that homeopaths peddle and try to prove a negative. In fact, I’ll go one further. For there to be a “truly scientific dialogue,” there have to be scientists who have valid science to come to the table. Currently, only one side has the science now, and, I’m sorry Ms. Maché, but it isn’t the homeopaths. All homeopaths have is water, sympathetic magic, and the law of contagion.

Ms. Maché concludes by invoking what I like to call the Galileo Gambit, likening homeopaths to–who else?–Galileo. She even goes so far to ask, “Is it not the desired aim of true science to be forever overthrowing itself?”

Not exactly.

While science is continually changing, it’s far more common for science to build on what has come before. New science tends to replace incomplete understanding with more complete understanding, not complete misunderstanding with understanding. Albert Einstein’s Theory of Relativity didn’t invalidate Newton’s Laws of Motion. Rather, it showed that Newton’s Laws were incomplete at velocities close to the speed of light and could not account for the behavior of matter at such velocities. However, at velocities much lower than the speed of light (which is where we all live), Newton’s laws describe motion with a high degree of accuracy. Thus, Einstein’s theory described motion more completely, reducing Newton’s laws to a special case at lower velocities. Any new theory to replace Einstein’s theory will no doubt do the same, leaving Einstein’s theory as a special case of the new theory.

It’s hard to imagine a theory that would make homeopathy a plausible modality. Perhaps such a theory exists. It’s incredibly unlikely, but not completely impossible. However, because such a theory is so incredibly implausible based on what we currently know about physics and chemistry, if Maché’s homeopaths think that that paradigm is wrong, then it is up to them to prove it through science.

It has been repeated so many times that perhaps it’s become a cliche, but whenever a woo-meister invokes Galileo, I have to retort that to wear the mantle of Galileo it is not enough to claim persecution at the hands of unsympathetic science. You must also be right.

Show me you’re right, homeopaths, using science. Whining about “persecution” does not impress me.