My favorite term to describe homeopathy is The One Quackery To Rule Them All. The reason for that, of course, is obvious to anyone who knows anything about homeopathy. Basically, homeopathy is based on two principles, neither of which is rooted in science, but rather vitalism and magic. That is why I was quite shocked to see this Tweet the other day about talks about homeopathy given by Peter Fisher and Iris Bell at my alma mater, the University of Michigan:
Homeopathy research presented at University of Michigan: https://t.co/BCv9XABmWL
— Kathleen Slonager (@Homeopath_Kat) July 24, 2018
Which led me to this Facebook post:
I love how this post includes a stock photo of a scientist in a lab in front of a large instrument, all in order to imply that homeopathy is scientific. It’s not. As was the case when I discovered that the Department of Family Medicine at U. of M. had embraced Rudolf Steiner’s incredibly quacky philosophy of medicine, anthroposophic medicine, I most definitely do not love that somehow the American Institute of Homeopathy hosting Peter Fisher, who is a famous physician and homeopath in the UK because he’s the Queen’s physician and homeopath and very prominent in British homeopathy, given his positions at the Royal London Hospital for Integrated Medicine (which used to be the Royal London Homeopathic Hospital). Nor do I love that, included in this session was Iris Bell, a believer in homeopathy based at Andrew Weil‘s integrative medicine program at the University of Arizona. I also have to wonder what, exactly, it was that the American Institute of Homeopathy hosted, given that the YouTube video shows both Peter Fisher and Iris Bell giving their talks by teleconference. There was no travel expense. Maybe there were honoraria. Maybe the American Institute of Homeopathy paid for lunch, given that this sounded like a lunchtime lecture. (Near the end of the two talks, both of which ran long, it’s mentioned that a lot of the physicians attending had to leave to get to their afternoon clinics by 1 PM.) Who knows?
Homeopathy: The One Quackery To Rule Them All
Before I discuss the horror of seeing committed believers and practitioners of homeopathy giving a talk for the Department of Family Medicine at the University of Michigan, my alma mater, I feel obliged to explain briefly why, in case there are any newbies who don’t know what homeopathy is. Basically, homeopathy was invented by a German physician Samuel Hahnemann in 1796 (as described by Peter Fisher in the talk itself). The first law of homeopathy is the Law of Similars, which states that you treat a symptom using something that causes that symptom. Of course, there is no physiologic, biochemical, or medical basis for such a principle, and in fact what the first law of homeopathy resembles more than anything else is, as I alluded to above, the principles of sympathetic magic, specifically Sir James George Frazer’s Law of Similarity as described in The Golden Bough (1922) as one of the implicit principles of sympathetic magic.
The second “law” of homeopathy, the Law of Infinitesimals, is even more ridiculous and pseudoscientific (or even mystical). This law states that homeopathic remedies become stronger with dilution. Actually, the process of making a homeopathic remedy involves serial dilution, usually 1:100. The mother tincture (or original compound) is diluted 1:100 and then shaken vigorously (succussed), the succussion step being claimed to be necessary to “potentize” the remedy. After that, it’s diluted again in the same way. Each 1:100 dilution is designated by “C,” such that a 6C dilution equals six 1:100 dilutions. The problem comes with the higher dilutions. For instance, a 12C solution is on the order of a 10-24 dilution ((10-2)12 = 10-24). Many homeopathic remedies are on the order of 30C, which is a 10-60 dilution, or more than 1036-fold greater than Avogadro’s number. Some homeopathic remedies go up to 100C or more, or 10-200. Here’s a hint: The number of atoms in the known universe is estimated to be around 1078 to 1082. The math just doesn’t work, and remedies over around 12C are basically water. “Lesser” dilutions contain so little remedy that it’s highly unlikely that they have a pharmacological effect.
First up, the Queen’s homeopath
The funny thing is that Peter Fisher describes these two laws in detail and admits quite freely that, thanks to Avogadro’s number, a homeopathic dilution greater than 12C (or 23X) is highly unlikely to contain even a single molecule of starting material left. Then, however, he goes on to say on more than one occasion variations of, “The fact that there is no starting substance present doesn’t mean there is nothing present” or “Do not confuse that [the lack of starting material after serial dilutions” with ‘nothing is present.'” When I heard that, I had a feeling I knew where the talks were going to go, but I’m getting a head of myself here. First, let’s link to the video, which you are welcome to watch in its one hour, one minute quack glory if you so desire, but I do have to discuss its “high”—or should I say “low”—points.
So here’s the video:
The first 36 minutes or so of this woo-fest at the University of Michigan is Peter Fisher, and the remainder of the video is Iris Bell. Let’s dig in.
Since I already mentioned that Fisher described the invention of homeopathy by Samuel Hahnemann and how homeopathic remedies are made; so I’ll skip over those. He did, however, start by listing the topics he wanted to address:
- Homeopathy is much misunderstood
- Who uses homeopathy?
- Comparative and cost effectiveness research
- Systematic reviews and meta-analyses
- Biological models of high dilutions response
- Physical chemistry research
That’s a heck of a lot to pack into what presumably was supposed to be a 30 minute talk! Of course, given that the talk is about homeopathy, I was seriously tempted to make any of a number of homeopathy jokes about the brevity of the talks. I restrained myself. I will give him credit for defending vaccination, but will also point out that he’s deluding himself if he thinks that homeopathy is not antivaccine or that homeopaths don’t claim that homeopathy can substitute for vaccinations. Homeopathic nosodes, anyone?
Given the utter implausibility of homeopathy based on chemistry, physics, and biology, Fisher spent an awful lot of time on topics #2 and #3, who uses homeopathy and comparative and cost effectiveness research. This allowed him to cherry pick multiple uncontrolled studies. Before he does that, though, he invokes hormesis as the principle that allows “ultralow” concentrations of molecules to have biological effects. Basically, hormesis is a term to describe how some compounds can have nonlinear dose-response curves. He used examples of chlordane against crickets, showing graphs where very low concentrations of this pesticide induce greater weight gain in young crickets before the curve turns south and increasing doses cause slower weight gain and ultimately weight loss and death.
I once discussed hormesis in the context of radiation after the Fukushima nuclear spill after an earthquake and tsunami that devastated northern Japan. Basically, Ann Coulter and the usual suspects who try to downplay environmental catastrophes were trying to argue that Fukushima wasn’t a big deal because a little (or even more than a little) radiation is actually good for you based on—you guessed it—hormesis. Let’s just say that she cherry picked her studies and exaggerated hormesis, while misrepresenting the reasons for the model used by regulatory agencies with the relatively self-explanatory name of the linear no-threshold (LNT) model, which describes a model in which any radiation is a hazard in a linear fashion. As I pointed out, at very low doses, it’s hard to distinguish between an LNT model and hormesis, and the radiation levels at Fukushima were above any reasonable estimate where hormesis might be possible. (As an aside, just the other night I watched the episode of the Netflix series Dark Tourist in which David Farrier visits Fukushima, which is now deserted because of radiation, and is forced to cut his tour short because radiation readings were much higher than advertised and higher than what was deemed safe.) Let’s just say that Fisher, like Coulter, oversold hormesis as being a near-universal phenomenon (it’s not). Let’s just also say that, given that there is no starting material left in most homeopathic remedies, invoking hormesis as a basis of homeopathy is—shall we say?—completely irrelevant.
Observational studies and bad systematic reviews and meta-analyses
As for the observational papers, holy hell! He started going through several observational, uncontrolled studies. One showed that homeopathy use is most prevalent in France (10% of the population) and might be higher in India. Given what I’ve learned recently about the popularity of homeopathy in France, I was not surprised. He also noted that in the US, only 2.1% of the population has used homeopathy in the last year, but that homeopathy use was associated with high levels of education, female sex, a “healthy lifestyle,” and multiple complementary therapies. He noted a study from France, which compared conventional family practices versus homeopathic family practitioners, versus “mixed” (practices where homeopathy was integrated). The claimed finding was that homeopathy use was associated with less use of nonsteroidal anti-inflammatory drugs, less use of antibiotics, less use of psychotropic drugs, and that it cost 20% less. He cited another study from Germany that claimed better results with homeopathy for the same cost. Another study cited by Fisher of “homeopathy in the real world” claimed to show that the use of homeopathy could avert the use of antibiotics for acute otitis media. Of course, given that antibiotics are not always necessary for acute otitis media and in some cases “watchful waiting” plus treatment of symptoms are appropriate, it would take a randomized controlled trial to tell whether homeopathy is doing anything, and this wasn’t it. The same could be said of a study cited by Fisher that purported to show that homeopathy could decrease antibiotic use in acute upper respiratory infection. (Most URIs don’t require antibiotics.) I also couldn’t help but note that a lot of these studies were old, too. The otitis media study is from 2001, for instance.
Interestingly, Fisher also cited the Swiss Health Technology Assessment from 2012. This is, as Jan Willem Nienhuys put it, a case of “homeopathic optimism” and, as Edzard Ernst puts it, a report that only homeopaths take seriously any more. Fisher also cites a database supposedly at this URL: https://www.carstens-stiftung.de/core-hom, where, he claims, as of May 2018 there were 1,210 clinical trials of homeopathy, of which . I clicked on that link and got a 404 page not found error. Maybe it will be there for you by the time this post publishes. Be that as it may, I can’t help but point out that Edzard Ernst had a look at this database three years ago and was less than impressed:
In the podcast that accompanies the articles Fisher insists that, on this database, there are well over 300 RCT, and I had to admit that this was new to me. Keen to learn more, I registered with the database and had a look. What I found startled me. True, the database does claim that almost 500 RCTs are available, but just a very superficial scrutiny of these studies reveals that
- some are not truly randomised,
- some are not even clinical trials,
- the list includes dual publications, re-analyses of already published studies as well as aborted trials,
- many have never been peer-reviewed,
- many are not double-blind,
- many are not placebo controlled,
- the majority are of poor methodological quality.
Fisher also cites a meta-analysis by Mathie et al from 2014 that claimed (hilariously) that not only is homeopathy effective, but the effect size increases with better-designed studies, which is the exact opposite of what we would expect for any treatment, conventional or alternative, because that’s how it goes. Initial, less rigorous trials often yield more impressive results, which often “decline” in later, more rigorous trials. That raised my eyebrow right away. Fortunately, again, Edzard Ernst is familiar with this nonsense and has discussed the Mathie meta-analysis in detail. Basically, he’s noted that this meta-analysis somehow managed to omit “the two most rigorous studies which happen to be negative.” More specifically:
It is not an overall meta-analysis but merely evaluates the subset of those trials that employed individualised homeopathy. Crucially, it omits the two most rigorous studies which happen to be negative. Its conclusions are as follows: ‘Medicines prescribed in individualised homeopathy may have small, specific treatment effects. Findings are consistent with sub-group data available in a previous ‘global’ systematic review. The low or unclear overall quality of the evidence prompts caution in interpreting the findings. New high-quality RCT research is necessary to enable more decisive interpretation.’
And, looking at other meta-analyses by homeopaths:
MY CONCLUSIONS FROM ALL THIS:
- Some systematic reviews and meta-analyses do indeed suggest that the trial data are positive. However, they all caution that such a result might be false-positive.
- None of these papers provide anything near a proof for the effectiveness of homeopathy.
- Homeopathy has not been shown to be more than a placebo therapy.
- To issue statements to the contrary is dishonest.
Let’s just say that misleading by meta-analysis is a common tactic of homeopaths. Sadly, faculty at the University of Michigan were unable to pick up on this.
Fisher finished rushing through a bunch of the usual suspect studies for mechanisms. I couldn’t help but laugh uproariously when he spent some time claiming that the studies in mast cell degranulation by Jacques Benveniste were good evidence of a biological effect of homeopathic remedies. Benveniste’s work was fatally flawed and shown to be nonsense by James Randi himself. Basically, Randi and the team of referees asked Benveniste to repeat the experiment, but went to extraordinary lengths to make sure that the people carrying out the experiments didn’t know what groups were the control groups and which groups were the ultradilute samples. Under these conditions, Benveniste’s results were not replicable. Basically, Randi showed how critical proper blinding was to experiments involving homeopathy. Fisher also blew through a few other papers, which I might have to look into if I get the time, but they all looked to suffer from similar issues.
Iris Bell: Nanoparticles prove homeopathy!
Enter Iris Bell. Bell, as you might know, is a physician and homeopath (and emeritus professor at the University of Arizona) whom I first noticed ten years ago when I noticed that she had gotten a grant to study homeopathy from the National Center for Complementary and Alternative Medicine (NCCAM), now known as the National Center for Complementary and Integrative Health (NCCIH) and from her debate appearance in 2007 at the University of Connecticut. She’s clearly unhappy with skeptics, because she declares right at the outset, “Skeptics keep saying, “There’s nothing there, so this is ridiculous.'” Why, yes. Yes we do. Then she goes to a straw man, claiming we say, “If you have a positive finding, so what? It’s an accident.” Actually, our arguments about Bayesian considerations are quite a bit more nuanced than that. But whatever.
Her response is to say her argument is a striking set of data that “allow you to put together a potential model for how this all works. The emphasis is that you’re going to find, truly, structures in the material that generate signals that have been demontratied that will then trigger nonlinear responses in the organism, a complex adaptive system that is self-organized and actually has self-similarity (?) at certain levels.” Her overview of the “healing process” is as follows”
Pick correct remedy for diseased organism and organ, which leads to a self-amplified adaptive response across the networks, which leads to healing and a healthier organism. She emphasizes that skeptics misunderstand homeopathy because homeopathic remedies are “not acting like a drug,” but are rather “acting like a signal that tells the body that it can heal” (whatever that means).
Here’s where Bell gets into what I knew was coming from the beginning, when Fisher said that just because homeopathic remedies don’t contain any original remedy doesn’t mean that there isn’t something there. Yes, we’re talking nanoparticles, baby! Not only are nanoparticles the One True Cause Of Disease in some alternative medicine, they’re also the cure because they make homeopathy work! It’s one of the favorite “explanations” for homeopathy out there other than the “memory of water” and it’s just as plausible and convincing (as in not at all plausible). I remember when I first heard of this gambit back in 2010 when I encountered a paper published by homeopaths in India that confused what were almost certainly heavy metal nanoparticle contaminants from the manufacturing process for particles arising de novo as a result of the succussion (shaking) between each dilution step. I later heard about how homeopaths were invoking silica nanoparticles as “proof” that homeopathic remedies were not just water. Of course, as I put it at the time, I wonder where silica nanoparticles could come from, if in fact they have actually been detected in homeopathic remedies. It couldn’t have anything to do with the fact that most homeopathic dilutions are made in glass vials, could it? Perish the thought! In fact, hilariously, I discussed that study in the context of discussing a paper by—you guessed it!—Iris Bell herself!
I think I’ll quote myself here, as what I said then perfectly applies to what Iris Bell said in her talk at the University of Michigan:
According to Bell, all that grinding and succussion generates nanoparticles, and these nanoparticles do things. All sorts of things. Magical things. Like homeopathy things. They can even emit electrical signals! Oh, wait. The paper Bell cites to justify that claim is the infamous paper by Nobel Laureate Luc Montagnier, who, unfortunately, appears to have fallen prey to the Nobel Disease and become a crank. Indeed, that particular paper was roundly criticized (including, of course, by me) for its poor methodology and conclusions not supported by its data, and these days Montagnier is subjecting autistic children to long term antibiotic treatment and appearing at quack conferences like Autism One, along with women who think that giving autistic children bleach enemas is a good way to treat autism. In other words, as sad as it makes me to say it, Montagnier is no longer a good scientist, and I wouldn’t trust anything he publishes these days any more than I trust what Dana Ullman publishes—or, for that matter, Iris Bell.
Of course, in this talk, it’s not just silicates from the glass, but she even mentions how homeopaths use natural cork stoppers and speculates how cork might adsorb to the nanoparticles. Her explanation for how nanoparticles “get there” is epically hilarious:
Basically, it’s a whole lot of handwaving involving the lactose that is sometimes in ground up homeopathic remedies before they are placed in a water/ethanol solution to be diluted, combined with shaking, nanobubbles, interactions between nanobubbles on the surface of the glass with entrapped air bubbles and the formation of a layer of nanoparticles on the surface of the remedy. It’s all utter nonsense, as I’m sure any physicist, chemist, or materials scientist will be happy to back me up about.
Oh, and she cites Luc Montagnier’s claim of electrical signals from homeopathically prepared E. coli. That’s when she jumped the shark, even for a homeopath, although she did also invoke quantum entanglement, as all good defenders of quackery do. She even points out that silicates are used as adjuvants in some vaccines, which, as far as I can tell, is not exactly true, although they are being studied for that use. Maybe she was referring to aluminum adjuvants, which do form particles. In any case, she used that to try to make a connection between these nanoparticles and stimulation of the immune system because, of course she did. I also can’t help but point out that many of her slides showed no consistent dose-response curves, which tells a skeptic that what’s being seen is either noise or bias in the experiments, but is convenient to someone like Bell, who can invoke “nonlinear” dose-response curves, no matter how implausible.
Bell, too, had to rush through her last few slides, which left a couple of minutes for questions. To be honest, I was very disappointed. Not a single skeptical question was asked, and the last question let Bell go on about how she wants to find collaborators who have model systems she’s interested in and ultimately use “big data” to answer how homeopathy works.
Quackademic medicine at the University of Michigan
As I’ve mentioned before, back when I attended the University of Michigan in the late 1980s, U. of M. was really hardcore about science, so much so that it was viewed as seriously old-school. No new (at the time) organ system approach for us! During the first two years, ever four weeks, like clockwork, we’d have what was called a concurrent examination, which basically meant that we were tested (with multiple choice tests, of course!) on every subject on the same morning. At the time I was there, the medical curriculum for the first two years had been fairly constant for quite some time, with a heaping helpin’ of anatomy, histology, biochemistry, and physiology in the first year and the second year packed full of pharmacology, pathology, and neurosciences. Nowhere to be found in the curriculum was anything resembling “energy medicine” or anything that wasn’t science-based! Of course, back in the 1980s, the infiltration of quackademic medicine (the mingling of quackery with academic medicine) into medical schools and academic medical centers hadn’t really begun in earnest yet, although the rumblings of what is now called “complementary and alternative medicine” (CAM) and, more frequently these days, “integrative medicine” (IM) were starting to be heard in East Coast and West Coast schools.
How low U. of M. has fallen, at least the Department of Family Medicine, which is riddled with “integrative medicine” quackery, up to and including a willingness to be credulous to homeopathy. I also can’t help but note that the department has at least one naturopath on its faculty, Suzanna Zick, who is co-director of the integrative medicine program in the department. We’ve met her before, both doing an acupressure study and being part of the team who developed the Society for Integrative Oncology’s breast cancer guidelines. (She was SIO President from 2015-2016.)
It saddens me that even one department in the medical school that trained me has drunk deeply from the quackademic medicine firehose. I only reassure myself by telling myself that the department of surgery there is relatively free of this nonsense, as is (most) of the rest of the medical center. I only hope it doesn’t metastasize from the Department of Family Medicine.anthroposophic medicine’s assertion of relationships between the various bodies (physical, etheric, etc.) and astronomical bodies is far more akin to astrology than science. Would that it were only homeopathy U. of M. were teaching and practicing!