Thursday, 14 July 2016

Do not ban homoeopathy in the name of Science

The BBC reports on a petition to ban homoeopathy for pets, which is already singed by a 1000 British vets. The justification for this is that homoeopathy does not work. The vet who started the petition said: "It's been shown that homeopathy doesn't work, so it probably shouldn't be offered any more even if it is offered with good intentions."

Classical homoeopathy naturally does not work. It works with strong dilutions, some are actually so strongly diluted that you can show that most bottles do not contain anything.

Furthermore, homoeopathy is taken as pills or drops. This means that you can make a double blind randomized trail. You randomly give half the people the "medicine" and half a fake medicine (placebo). The patient and doctor both do not know who got what (double blind). At the end you analyse whether there was a difference between the medicine and the placebo. If you pass this trial, your medicine works, no matter how it was made, whether is was conventional or homoeopathic. Also for many traditional medicines it is not known (well) how they work, but the double-blind randomized trail shows that it does. Classical homoeopathic medicine has failed this foundational test.

However, that homoeopathy does not work is not sufficient reason to ban it. It also does no harm and in doubt we should always chose the side of freedom. Government action is there to fix important wrongs, not for stuff that just makes us uncomfortable.

Just sleep

Even if it does not work, homoeopathy may still do some good. Also placebos work. Patients heal faster with a placebo than without treatment. Medical science should work much more on how to optimize the placebo effect. The number of times a day you take the pill, its colour, taste, size, ...

In The Netherlands doctors often tell their patients to simply go home, sleep and if the symptoms do not go away come back in a week. I like that, I am Dutch. Isn't it a relief when the doctor tells you it is not something serious and you should just go to bed? Sounds fine to me.

Foreigners mostly hate it. If they do not get a pill they do not feel taken seriously and they can even get quite aggressive. I would not be surprised if their anger leads to an anti-placebo effect. Why not give them something homoeopathic? That is better than unnecessary medicine, which may do harm, and lot better than over-prescribing on antibiotics.

Homoeopathy or classical homoeopathy?

The vet in the BBC article gives the impression he really believes in homoeopathy. That could be problematic. I would avoid such doctors because they clearly do not understand how to evaluate evidence. But a doctor who pragmatically prescribes it in case someone should just go to bed would be fine.

It could also be that the medicines this vet prescribes are not classical homoeopathy, but herbal medicine, which is often marketed as homoeopathic. Those could naturally work, many conventional medicines come from substances that were used in traditional cures in healing traditions from all over the world. The active ingredient of aspirin famously comes from willow bark.

That is why I do not like intolerance directed against traditional medicine; we should study it, see if it works, try to understand why it works, how to reduce side effects and how to improve their effectiveness. In many cases we do not have clear evidence against it, like we have for classical homoeopathy, and even if the "explanation" of how the cures work makes no sense we should keep an open mind that the actual treatment does bring benefits.

If a "homoeopathic" herbal medicine would pass the double blind trial, you could sell it as a normal medicine if it works better than existing medicines. Thus for me it is a bad sign when a pill is marketed as homoeopathic. Although, I do not know whether it is true, but I once heard an ironic story about a pill that went through all the tests and was approved as conventional medicine, but then the marketing department decided it was better to sell it as a herbal cure.

Science and politics

There is a parallel to the climate debate. Science can tell you some of the consequences of continued fossil fuel use. Science can tell you classical homoeopathy does not work. Science cannot tell society how to respond to climate change. Science cannot tell whether we should ban homoeopathy.

As a citizen I feel we should transition to renewable energy. As a citizen I feel we can be tolerant towards homoeopathy.

[UPDATE, Oct 2016. Apparently it can be legal in the USA to take your kid to a faith healer rather than the doctor in case of serious illnesses. Even when the kid dies as a result. That is where my understanding ends. If a kid (or for this post a pet) has a serious illness, you should go to a real doctor or face the consequences of the law.


Related reading

BBC News, Science & Environment: Vets: Ban the use of homeopathy in animals

Steven Novella, MD, academic clinical neurologist at Yale University School of Medicine and president and co-founder of the New England Skeptical Society want to ban homoeopathy for pets: Should We Ban Homeopathy for Animals?

Quark Soup by David Appell: The Homeopathic Patient :-)

* Top photo: Cats by Abdullah AlBargan, used with a Creative Commons Attribution-NoDerivs 2.0 Generic (CC BY-ND 2.0) license.
* Middle photo: Cat, MacDuff the cat by Kevin Dooley, used with a Creative Commons Attribution 2.0 Generic (CC BY 2.0) license.
* This post was a wonderful excuse to finally write a popular post with cute cat photos.


hvwaldow said...

Victor, thanks for the nice post. I agree 100% with the facts you present, but have a different conclusion.

Regarding the "ban": Of course everybody should be free to take herself or give to her animals small amounts of sugar, water or ethanol. The concern they raise is about "animal welfare". In other words, they belive animals unnecessarily suffer because of incompetent vets. So please improve vet education and control and don't fight at the sidelines.

The problem I have with homeopathy:

1. It poses as a "scientific method". That is just wrong and is related to

2. The public education problem. People in our highly developed societies with complicated problems should be able to discern between questionable claims and reliable facts of importance that were established at great cost and are the fruit of one of the most successful millenia old traditions we have. Belief that homeopathy works despite we know for sure that it doesn't, belive that global warming doesn't occur, belief that vaccinations are a hoax, ... have at least one common root, and that is ignorance with regard to science and distrust in expertise. That is a general problem with ramnifications for current politics and for the long-term fate of our societies.

I have otherwise intelligent and sane friends who, when their kids have a health problem, google it and self-medicate with homeopathic pills. That is just scary. They don't trust the medic. Yes it's sometimes hard to find a good one, but how can you prefer to follow uneducated hearsay instead of searching a medic you trust who studied that stuff for 10 years?

I agree that homeopathy might be a way to harness the power of the placebo effect. But that would entail to keep the patients stupid and lie to them in their own interest. Not sure how that could be ethically implemented.

Also yes, there are many "traditional" methods that work. But if you tolerate homeopathy and argue for these methods you have lost my support (because of lacking trust in your motives and faculty of discrimination). It is about the tedious never ending effort to actually figure it out and fight intellelctual laziness.

Same with climate change: It is certainly right and justified to call attention to all sources of uncertainty inherent in model results. But if this is coming from someone who, in the same breath, claims to know that ECS=1 and mentions in passing that CO2 is "plant food", there is no basis for discussing anything.

The last point is that when you have a social health insurance, you will pay for charlatans if homeopathy is accepted practice. That is of course a politcal battle, people who believe in Hahnemann have the same right to fight it as I have. But my preference is clear.

Have a nice summer!

Victor Venema said...

That is the nice think about the weather, politics and digestion. You can talk about it your entire life because there is no truth there, just opinions. (And the reason I like science.)

Are there really people who think that homoeopathy is accepted by science? They may disagree with science, but I think they know it is not accepted. It is not called alternative medicine for nothing.

The biggest problem of your friends is the googling symptoms part. A really bad idea. That is why I prefer people going to a vet/doctor who does homoeopathy over going to a healer who only does homoeopathy. Theoretically the latter would be better because it makes the distinction between science and homoeopathy clearer, but a good diagnosis is important.

"if you tolerate homeopathy and argue for these methods you have lost my support"

What do you mean with "argue for"? Not advocating banning it, using it yourself, telling other people they should use it. Very different cases.

People are allowed to do stupid things. Many large institutions are based on that and I also do it all the time. As long as it does not hurt others, we will have to tolerate that. In case of vaccines and climate change there is real harm (to others). In case of most health problems people should just go to bed and afterwards move more, take more time for themselves and eat real food. If someone really has a health problem, they should get a real treatment.

I liked the vet example because it avoids the insurance issue. That is a complicated discussion. Because the alternative to homoeopathy would often be some pill, which has real costs, can do real damages and might need treatment for the problems it causes, I expect that a health plan that includes some alternative medicine is likely cheaper. In Germany at least there is so much over-prescription. Science-based doctors who prescribe antibiotics, which only work for bacteria, for viral infection, for example. I would not use these alternatives myself, but the lower costs could be worth it.

But even if it were cheaper, I really hate to pay for charlatans. So that is a hard choice.

I am not sure you have to lie to people for the placebo effect to work. It might work better, but I think it still works when the patient knows it is a placebo. (My hunch would be that it is nice to know that you do not have something serious, that reduces the stress and is good for healing.)

Have a nice summer too.

hvwaldow said...

but a good diagnosis is important

You are aware that pure homeopaths do not do diagnosis at all? Treatment is entirely derived from symptoms. There is no "understanding what is happening" part in that system. It is "coming up with a description of symptoms" and then looking up the proper type of medicine in the holy book. Yes, I avoid medics that do hybrid "classic" and homeopathic practice like the plague. Esotericists with antibiotics.

What do you mean with "argue for"? Not advocating banning it, using it yourself, telling other people they should use it. Very different cases.

To make that clear: I think there is an under-appreciation of many "alternative" methods that work or might well work. Its also under-researched. And "classic" medicin has its own bullshit problems - lacking actual new active substances the industry constantly comes up with same old substance + menthol - pills, doubles the price and bribes the docs to prescribe them.

Its about really trying to figure it out. Arguing (or not) that homeopathy works, should be used more, should become an accepted method, is a litmus test for me in that regard.

And yes, homeopaths themselves claim that their method is "scientific" and that the "simile principle" is some sort of proven natural law. And they do so quite sophisticatedly, look at this for example:

I am sure you can see the parallels to the publications of the more sophisticated fossil fuel lobbyists regarding global warming.

Victor Venema said...

Yes, I am aware that pure homoeopaths do not do diagnosis at all. You must have misread my complicated construction above. That was why I argued that it was better that a doctor or vet does it. Then they can limit it to cases where the patient does not have anything serious.

I would love to avoid them, but my current doctor also does bio resonance. A good reason to always check that the treatment I get is the standard one for my diagnosis. She is a nice person and actually listens when you speak, which is also important. She knows I am a scientist and never suggested anything esoteric.

Funny brochure. It document also states on the first page that in the name of science, homoeopathy has no justification to exist.

No problem to study alternative medicine at a university, but when a scientist argues against a randomized trail, they are not doing real science. That homoeopathy is personalised is no reason not to make a randomized trail. You can still give half of these people a personalised homoeopathic pill and that other half a placebo with also nothing in it.

The scientists in the brochure are rather sad, but I do not come away with the impression that science supports homoeopathy. You can also not expect them to say homoeopathy does not work. Why not just compare it to any company trying to put its product in a good light. Apple?

hvwaldow said...

Then they can limit it to cases where the patient does not have anything serious.

Well ok. But if they believe the Hahnemann "law" that reflects on their qualification to properly handle antibiotics. If not and they consciously use placebos, ok, I guess.

It document also states on the first page that in the name of science, homoeopathy has no justification to exist.

Yes and next to it: "Wissenschaftlich belegt ist dagegen, dass die Homöopathie heilen kann."

The scientists in the brochure are rather sad, but I do not come away with the impression that science supports homoeopathy.

But you must admit that people without a sci eduction most likely will - and that makes me angry.

:). Ok. But the phones work, kind of.

Anyway, I wish you all the health, no matter how you gain and maintain it.

izen said...

It might be tempting to see this attempt to ban homeopathy use by Vets as a typical example of the English sentimentality over animals, compared to people. Another symptom of a society where more money if given to animal protection charities than child protection charities.

I think there may be an ethical justification, or at least reason, for this. Animals, pets etc are seen as lacking autonomy. they are unable to choose their treatment, it is imposed by their owners.

Sentient agents are can hurt themselves by bad choices, but it is less acceptable if they hurt an innocent creature. (unless it is their child apparently)
The UK health service still provides Homeopathic treatment if requested, estimates put the cost to the taxpayer at around £4m. But then cost should be low for a treatment that requires no expensive investigation and uses almost pure water as its treatment.

That is the real problem with homeopathy, - follow the money. Conventional medicine may have its flaws, but it largely conforms to a set of tests and methods that can credibly determine whether it works. Big Pharma may try and bend those rules and manipulate the methods, but that is within a scientific context of research and testing.
Homeopathy claims that it can evade all that scientific validation because it uses a 'system' that is independent and untestable, and apparently undetectable, by science. But still expects to get paid for providing it.
Do not ban Homeopathy in the name of science. Ban it because it is commercial fraud and make it a crimminal offence to charge for Homeopathic treatment!


Victor Venema said...

I would not call practising homoeopathy a fraud. The people get what they ask for. I do not understand why, but they do not want conventional medicine.

It would be fraud to have a book on climate change written by Anthony Watts and then put real science in it.

Marco said...

"It also does no harm"

It *does* do harm, primarily when used to 'treat' a real disease. It comes down to *not* treating the disease.

diessoli said...

You bring up the 'no-harm' argument, one of the most frequently heard justifications by people who know that Homeopathy is just placebo medicine. There are multiple documented cases of kids needlessly dying because their parents refused to seek medical treatment and instead used alternative modalities.

"The people get what they ask for. "
Are you sure about that? I would have thought what people ask for is a drug that deals with their illness and has no or minimal side-effects.
What they get with homeopathic remedies is the later + a lottery ticket.

I am not sure that Homeopathy should be banned (after all we don't ban Astrology), but health insurers should not pay for it, scientifically trained doctors should not prescribe it and pharmacies should not stock it.

(Just few weeks ago I was in a pharmacy and overheard the pharmacists talking to a client how she can take the globuli together with that other since they go well together. It was all I could do not to blurt out that 'of course they go together, it's just sugar'.)


Victor Venema said...

Marco: "It *does* do harm, primarily when used to 'treat' a real disease. It comes down to *not* treating the disease"

That is why I personally prefer real doctors and vets prescribing homoeopathic pills. That way the diagnosis is more likely to be right and real diseases treated. If they do this wrong, you can sue them.

diessoli: "There are multiple documented cases of kids needlessly dying because their parents refused to seek medical treatment and instead used alternative modalities."

How would banning vets and doctors from prescribing homoeopathic medicine cure the stupidity of these parents?

diessoli said...

"How would banning vets and doctors from prescribing homoeopathic medicine cure the stupidity of these parents? "

I didn't say it would.
What I wanted to point out that the often heard argument (which you raise at least twice) that Homeopathy does not harm is not valid.

EliRabett said...

Victor, you need to read about Krebiozin.

People die from quackery. Now animals have the same chance.

Victor Venema said...

People die by cars, guns and ladders.

EliRabett said...

Cars, guns and ladders are regulated (well not so much in the US on the guns) to insure safety. An unsafe car, gun, or ladder is not available for purchase.

Victor Venema said...

An unsafe car, gun, or ladder is not available for purchase?

Car and guns kill enormous amounts of people. Medical errors of conventional doctors are one of the main causes of death of people in hospitals.

At least in Germany homoeopathy is also regulated. I am sure they make sure that there is nothing in those pills, salts and drops. (I must admit that I do not understand why that makes it better.)

That was, however, not my implicit argument. I had expected not to have to make it explicit for a professorial bunny. You have to look at the all over benefits and you need to have pretty strong evidence of a net problem before you use the coercive power of the state :) to ban something.

Just a few anecdotes won't do. Even good statistics on the number of people who died would not be enough, as the example of medical errors illustrates. One would need to show clear evidence that without homoeopathy likely less people would die. If you have that, I am happy to consider changing my mind.

I understand the emotional response to homoeopathy. I would also not use it myself. But that is not enough reason. That would be comparable to the Republican laws to give themselves the right to discriminate because they do not like certain groups. I am a liberal and like freedom and am not such a fan of big government as those Republicans are.

EliRabett said...

In case you thought Eli was joking about ladders

Safety standards for cars are even more detailed

Cars and ladders that don't meet these standards cannot be sold.

OK, guns are another issue

EliRabett said...

rconnor said...

I think many commenters are missing (or twisting) Victor's point. The point that I take from Victor's post, and he can correct me if I'm wrong, is that where no serious medical treatment is required, homoeopathy may provide the patient with more of placebo effect than "just go home and gets some rest" will, and won't do any more harm. So while homoeopathy should obviously not be prescribed when serious medical treatment is required, it may be unnecessarily stringent to ban it altogether.

Other posters seem to be responding with, "but when serious medical treatment is required, homeopathy can be very dangerous". Of course it is and no where has Victor disagreed with that.

The question isn't should homoeopathy be allowed in all circumstances or not, it's should homoeopathy be banned in all circumstances or not.

Now I'd be more than happy to say "good riddance" to homeopathy altogether but I think Victor makes an interesting point. I'm not sure I fully agree with it but I'm also not sure I can make a compelling case otherwise. So thanks for an interesting perspective Victor.

Victor Venema said...

Thanks, rconnor. Sounds like a fair summary of my point. Maybe I should have made a better effort to keep it that short.

Tenney Naumer said...

As someone who lived in The Netherlands (1978-1986), I would like to mention that during that time (and hopefully things have changed) when women went to doctors with abdominal complaints, they were often sent home with pain killers, or told it was just "stress." Many died from cervical cancer. While in The Netherlands, I myself received a Class 3 PAP smear result. My MD congratulated me! I demanded to see another doctor, and upon informing her of my DES history, she said, "Oh, we don't believe that here." I had to fly back to my tiny small town in the Midwest and have pre-cancerous cells removed by cryosurgery in the doctor's office. Later, having been referred to a cancer specialist in Amsterdam, the specialist informed me that they did not yet have cryosurgical instruments fine enough to have performed the same non-invasive procedure.

Here's the thing Victor. Most people don't go to the doctor until they feel pretty damned sick for a while. (My own mother used to say, "If you're still sick in six weeks, I'll take you to the doctor.")

I just don't think it is something to take so lightly.

Victor Venema said...

Happy to hear the doctors helped you well in the US. One should not be blind to the other side, the danger of doing too much. Medical errors is a frighteningly large cause of death, the more procedures, the more this will happen.