A misguided defense of The One Quackery To Rule Them All

Homeopathy is what I like to call The One Quackery To Rule Them All. Depending upon my mood, I’ll use more or less of J.R.R. Tolkien’s famous poem about the One Ring from The Lord of the Rings, but the point is usually made. Homeopathy is major quackery.

And it is, too. On the off chance that there’s a newbie reading this who hasn’t been a regular reader of this blog or other skeptical blogs and doesn’t know what homeopathy is. (Regulars can skip this paragraph if they wish, but I wouldn’t. It’s entertaining.) Basically, homeopathy is a system of magical medicine thought up over 200 years ago by a guy named Samuel Hahnemann. Basically, Hahnemann came up with two main concepts. The first is “like cures like,” which in practice meant that Hahnemann advocated using substances that caused the symptoms in healthy individuals in order to treat those same symptoms. Of course, there’s no real scientific rationale for this principle, but Hahnemann went even further off the deep end by further proposing that those remedies had to be diluted and that serial dilutions (with vigorous shaking, or succussion between each dilution step—homeopaths will tell us that this is essential) and that the potency of the remedy would increase with increasing dilutions. Of course, this alone is totally ridiculous based on some very basic principles of chemistry and pharmacology, but violating principles of chemistry and pharmacology isn’t enough for homeopaths. Oh, no, they have to violate the laws of physics by diluting their starting remedies to nonexistence. For example, a 1C homeopathic dilution is a 1:100 dilution, and a typical homeopathic dilution is 30 C, which equals 10030, or 1060. There’s just one problem. Avagadro’s number (the number of molecules in a mole) is 6.023 x 1023, or, just for the sake of ease, around 1 x 1024 rounded up. That means that a 30C homeopathic dilution is roughly 1036-fold more than Avagadro’s number. That means that the odds of even a single molecule of remedy being left after a 30C dilution is infinitesimal. In fact, any dilution greater than around 12C is unlikely to have more than one molecule of starting remedy in it, and even “weaker” homeopathic dilutions (less than 12C, which means they have more starting remedy in them) tend to fall into concentration ranges so dilute that even they’re unlikely to do anything.

In other words, homeopathy is nonsense, pure pseudoscience. What does that make homeopaths? I think you know the answer to that. They’re quacks. What else would you call practitioners of The One Quackery To Rule Them All?

Apparently, a general practitioner in Glasgow named Des Spence agrees that homeopathy is nonsense, so much so that he even said so in an editorial in the BMJ. Unfortunately, somehow he still manages to entitle his editorial (which he’s published on his very own blog as well), Good Medicine: Homeopathy. In it, as he states clearly and bluntly that homeopathic remedies don’t have any remedy in them (for presumably the same reason I just explained above). Unfortunately, he doesn’t just stop there. Unfortunately, what he writes makes me wonder what Fiona Godlee and the editors of the BMJ were thinking when they allowed this drivel to appear in the same pages that Brian Deer’s fantastic deconstruction of Andrew Wakefield’s antivaccine pseudoscience and scientific fraud appeared:

It was an intentional overdose. To prove a point I poured about 30 tiny tablets into my mouth and crunched them down. Because scientifically, I do not believe that these homeopathic pills have any active ingredient.⇑

Today, homeopathy is medicine’s whipping boy, repeatedly and systematically beaten to the ground. Yet despite explaining that the tablets are just placebos, homeopathy always gets up to take another beating. Some homeopathy is funded by the NHS, through general practice, and in the few homeopathic hospitals. This fact enrages the growling commissars of evidenced based medicine who want homeopathy purged from the NHS.

The “growling commissars of evidence-based medicine”? Is Dr. Spence for real? At least, with that one phrase alone, Dr. Spence has made it very clear what he thinks of science- and evidence-based medicine; he has utter contempt for it and those who try to promote it and who point out that homeopathy is quackery because, well, if there is a quackery more quacky than homeopathy, I’m hard-pressed to think of it right now. Yes, Dr. Spence. Homeopathy is medicine’s whipping boy for a reason. Actually, it’s medicine’s whipping boy for many reasons, not the least of which because, for homeopathy to work, more than one law of physics and chemistry would have to be proven to be not just wrong but spectacularly wrong. Now, normally, although it’s high implausible that we could have gotten the laws of physics that fantastically wrong, I suppose that, strictly speaking, it’s not impossible. However, to demonstrate that so much science supported by so many decades of careful experimentation and observations from multiple scientific disciplines would require more than some equivocal clinical trials whose results are entirely consistent with homeopathy being nothing more than placebo. Apparently Dr. Spence agrees that homeopathy is quackery but doesn’t agree with the conclusion that follows from that premise, namely that homeopathy shouldn’t be used and homeopaths are quacks:

So does homeopathy work? This depends what you measure. Does it cure infection, degenerative conditions, and cancer? It most certainly does not. And if any such claims are made they must be vigorously denounced. But homeopathy is most commonly used for medically unexplained symptoms in patients dismissed as neurotic; the so called “worried well.” These patients have passed from specialist to specialist, enduring repeated invasive and needless negative investigations. Or homeopathy is used in addition to, but not instead of, conventional treatments.

Let this sink in. Dr. Spence has just said that he thinks it’s acceptable to give something to patients and tell them that it will help them when it certainly will not. Homeopathic remedies are, after all, nothing more than water or whatever solvent is used to dilute the original remedy into nonexistence. (Sometimes ethanol is used.) Dr. Spence knows that. Dr. Spence agrees that that’s what homeopathy is. That’s why what I find even more disturbing is the level of contempt for the “worried well” that Dr. Spence’s post about homeopaths demonstrates. Oh, sure, he isn’t open about it. He disguises it quite well as compassion. But in reality what he is doing is saying, in essence, “I know homeopathy is quackery. I know there’s nothing to it. But homeopaths are such caring people and these worried well are so hard to deal with. Might as well give them water disguised as real medicine, all packed up into little sugar pills, tell them it will cure what ails them, and maybe things will be OK.” The subtext is, of course, that it will also get the “worried well” out of the doctor’s hair.

Of course, Dr. Spence would strenuously disagree with my characterization of his viewpoint, namely that he is advocating lying to patients and implying that what homeopaths do is good even though they are quacks because they seem so very, very caring, but that’s what he’s doing, and he’s deluding himself if he thinks otherwise. To him apparently it’s all good because medicine is controlled by big pharma pushing drugs and homeopaths aren’t. In fact, Dr. Spence makes an explicit argument for placebo medicine, but then he completely overestimates placebo responses, claiming that they might be as high as 80%, which is much higher than any estimate of placebo responses, even for subjective measures, that I have seen. But that’s OK to Dr. Spence. He doesn’t mind, because:

The homeopathic doctors I know are caring people, disillusioned with the crudeness of conventional medicine, not your typical aggressive alpha medical type. They are not in the pay of big pharma, whose drugs potentially kill 100 000 people a year in the United States alone.1 They listen, spend time, and offer some explanation for the unexplainable—and their patients like them. The effect of homeopathy is the positive effect of a therapeutic relationship that is reassuring, accepting, and supportive. Society should never underestimate the healing effect of a kind word or the value of a holistic approach.

This may surprise you, but in one aspect I agree with Dr. Spence. No, I don’t agree with him regarding the oft-cited and exaggerated estimate that drugs kill 100,000 people a year in the US. I am, however, relieved that he didn’t trot out Gary Null’s estimate of 780,000 deaths per year, which, if it were true, would make iatrogenic deaths the number one cause of death in the U.S. by far at approximately one-third of all yearly deaths. (I’m thankful for small favors in that.) No, I don’t agree that “conventional” medicine is “crude.” If you want crude, actually, you should go for homeopathy. It is, after all, incredibly crude in that it uses long-discredited methods thought up over 200 years ago, long before doctors even accepted the germ theory of disease. Back in those days, bloodletting was still considered a science-based treatment. So was purging with toxic metals, and diseases were thought to be due to either an imbalance of humors or the influence of miasmas. Indeed, back then, homeopathy looked good to some because doing nothing was better than the medicine of the time. Medicine has progressed a lot in 200 years, though. These days, giving patients water, patting them on the head an saying that everything will be OK is no longer acceptable. In fact, the only thing that is shocking is how long the paternalistic attitude that it’s OK to tell patients that something will work in order to get them to believe that it will (even though it’s obvious that it won’t) is OK. This sort of paternalism held out until the 1960s, 1970s, and even 1980s. Fortunately, however, this paternalism no longer holds sway, at least not as much as it used to, and it’s continuing to weaken. Be that as it may, I agree with Dr. Spence that the therapeutic relationship with a patient is important. I just don’t agree that it’s acceptable to lie to a patient or to feed him nonsense (whether I myself believe it or not) in the service of that relationship. Doing so poisons the relationship with unrealistic expectations.

Sadly, doctors like Dr. Spence don’t understand that. Their version of the “therapeutic relationship” is not a relationship in which the health practitioner must tell patients the truth, even when it’s an unpleasant truth. Oh, no. His version demands that the practitioner either believe nonsense and pseudoscience and communicate that belief to patients, all in the name of the “therapeutic relationship that is reassuring, accepting, and supportive,” or that he lie to the patient. Take your pick. Either way, it equates the “therapeutic relationship” to the power of the physician, though the awesome power of his presence alone, to invoke placebo responses. Think I’m exaggerating? Think I’m invoking a straw man? Think again. Take a look at Dr. Spence’s last paragraph. Not only is it a a complete false dichotomy, but it’s an insult to the intelligence and dedication of any physician who supports science-based medicine:

There is no hard evidence for homeopathy. But likewise the more you understand of research evidence the more you understand it is mere modern marketing quackery. There may be some dangerous homeopathic charlatans, but there are plenty in mainstream medicine too. We need to accept that patients will still use homeopathy, and having access to it through the NHS means it is regulated and safe. As for the cost to the NHS, this is roughly the same as a single week of antidepressants,2 3 medications that are little better than placebo.4 Modern medicine has real capacity to do harm but often minimal good; homeopathy has minimal capacity to do harm but real capacity to do good. Homeopathy is an easy target; we would be better to focus on the failings of conventional medicine. Homeopathy is bad science but good medicine.

As a medical researcher myself, I have a simple message for Dr. Spence in response to his apparent belief that research evidence is “modern marketing quackery.” That response is: Screw you, Dr. Spence. You know nothing. You demonstrate it in the false dichotomy between science, which has its shortcomings but is responsible for an incredible increase in life expectancy and decrease in suffering, and homeopathy, which Dr. Spence equates to scientific medicine, even though it’s pure quackery. But to him it’s all good because homeopaths care so very, very much, apparently.

Dr. Spence may not realize it, but he’s just advocated lying to patients, foisting what he knows to be pseudoscience on them, all because it’s cheaper, because the people doing the foisting are allegedly so caring, and because he thinks placebo medicine is acceptable. I do not, and I think Dr. Spence is an idiot.