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reader comments: homeopathy

17 May 2009. I skimmed through your homeopathic comments and articles. I have acquired a pretty extensive experience of homeopathy over the years, although I am not an expert by any stretch of the imagination. I could go on and on with examples of what I have seen and experienced.

However, I will surmise [summarize?] my observations to this: If homeopathy is strictly a "placebo effect", how is it that it works so well on animals and tiny children? If you truly do have the correct remedy for the occasion, it is quite amazing to see the effects, which are often visible immediately (within a minute or two).

You are free to use my name (omitting my e-mail address please) should you decide to publish this on your website.

Blessings!
Becky

reply: The placebo effect is an expression used to cover a number of factors that have beneficial psychological and physical effects, even though they are known not to be working as direct causes of the effects. Water, for example, is known not to be a significant causal factor in inducing sleep, yet homeopathic sleeping remedies have their satisfied customers. Benzodiazepine, on the other hand, is a psychoactive drug with sedative properties. You can ingest an entire box of homeopathic sleeping pills without concern for any adverse effects because you are not consuming any active chemicals. You cannot ingest an entire bottle of benzodiazepine tabs without risking serious adverse effects, including death.

How can water or a few soothing words ("here, let daddy kiss it and take away the pain") have any effect on pain relief? You don't need to appeal to the "memory of water" or the "psychic transference of healing energy" to understand these common events. As I explain in my article on the placebo effect, there is scientific research that supports the notion that certain rituals can condition a person or an animal to respond in positive, measurable ways by evoking an opiate response, for example. The answer to your question, then, is to be found in understanding classical conditioning and other elements of what we call the placebo effect.

As you say, it is quite amazing to see a child or a dog appear to find relief just minutes after some treatment like homeopathy or acupuncture. Alternative treatments are effective at times, but not for the reasons given by their advocates. There is no evidence of a "memory in water," nor is there evidence that blocked chi causes illness or that sticking needles in special spots unblocks chi and restores health. There is evidence that homeopathic remedies bring relief to some people some of the time. As long as they're not suffering from something like malaria or eczema, a homeopathic remedy will probably do no harm and, in many cases, bring relief by the placebo effect. But in cases of serious illness, homeopathy can be deadly. There is a court case currently going on in Australia involving a homeopath and his wife, who are charged with manslaughter in the death of their nine-month-old daughter, Gloria. The infant had eczema, which they treated solely with homeopathic remedies. She eventually got worse and worse, developed infections, and apparently suffered a painful last few months. The homeopath, Dr. Sam, took the infant to India when he returned there for his brother's wedding. Dr. Sam took Gloria to see a homeopath while in India, who says she had severe itching, was irritable, malnourished, could not bend her legs and spent most of the time crying. He prescribed drops and asked them to return in a month. The Sams are now blaming a pediatrician for their daughter's death, saying he didn't tell them the baby might die if she didn't receive proper medical treatment.

[update: 30 Sept 2009. Thomas Sam, 42, and his wife Manju, 37, were found guilty of manslaughter last June and were jailed this week. Thomas Sam must serve at least six years in jail, with a maximum sentence of eight years, and Manju must serve at least four years in jail, with a maximum of five years and four months.*]

We don't usually think of homeopathy as deadly because most people who go to a homeopath either have nothing seriously wrong with them (meaning nothing that wouldn't heal if they did nothing at all, which, by the way, is also true of many of the people who see scientific-based medical doctors) or they also see a scientific-based doctor for "complementary" treatment. There is the potential for harm only if the patient truly suffers from a serious disease or disorder that scientific-based medicine can cure or alleviate. Most people with serious medical issues don't go to a homeopath. Mrs. Sam, for example, developed gall stones while in India, but she didn't go to a homeopath for relief. She went to a scientific-based hospital.

Anyway, the fact that a homeopathic remedy works quickly, even on children and pets, is not good evidence for the claim that there is something going on besides placebo medicine. It's also possible that the effect perceived by you in a child or a pet is misperceived or misinterpreted. You wouldn't be the first person to perceive a response where there is none or to interpret a response as if it indicated relief when it doesn't.

Becky replies to my reply:

In the case of my puppy, he had parvo. The vet did all that he could, then sent him home with me with little hope that he would survive the illness. I went to work with two remedies to relieve nausea and vomiting, which I administered every 15 minutes through the night until dawn, when he began to be able to drink water and hold it down. I did not clap my hands or do any other thing that would condition him like your article said. The animal was extremely ill, and basically unresponsive during the first 4 hours of administering the medication! Conditioning is the sort of thing you do on a healthy animal!

reply: Conditioning does not have to be done consciously, nor does it have to involve acts like clapping or ringing a bell. The rituals you went through with your dog when it was ill can have a conditioning effect.

Anyway, when I contacted the vet a few days later, he was surprised. He told me that was the first dog he'd seen survive such a bad case of the disease. Homeopathy is the only thing that could have made the difference in him surviving.

reply: If you're honest, you'll admit that there is no way you could know that homeopathy is the only thing that made the difference. Vets and doctors err all the time about whether a pet or person will live or die. Much healing occurs despite the work or the claims of the professional healer. (Another reader puts it a bit more harshly.)

I had another dog that hated to be left alone, and she was terrified to have me go away for long periods of time.

She knew what the suitcase meant, and when I got one out for a plane trip, she climbed inside and would not get out. I gave her another remedy for emotional trauma. She calmed down and behaved normally while I packed my bags. I had my kids continue to administer the drops while I was gone. They told me that although she clearly still missed me and looked for me, at least she did not go off her food and mope like she had done during other trips. This was the first time she had received any homeopathics.

No animal can be conditioned after receiving homeopathy just one time. Remember, she responded with the first treatment of the homeopathic drops.

How in the world could you say this is "conditioning"?

reply: I don't claim your dog responded due to conditioning. I say that conditioning is one factor that is involved in some placebo responses. The rituals of calming talk, giving pills, and other behaviors that you might not even be aware of can affect how an animal or a person responds to a situation. We often assume we know what is the significant causal factor in a process based on our beliefs and wishes, but rarely do we devise tests to try to tease out confounding factors.

To determine whether the homeopathic remedy was a significant factor in your dog's behavior, you would have to do a controlled test. Perform the same rituals, but give her a placebo. Have someone keep track of how much food she eats while you're gone. Etc. etc.

Conditioning is not the same as training. Classical conditioning refers to the process of association made when a stimulus is presented in conjunction with something else.

I am no fan of western medicine. But I also must acknowledge that the efforts of practitioners of that art also have saved my life and the lives of my family members. I also have relatives who have died at the hands of other doctors, whose actions were well within the accepted procedures and practices of their profession.

I carefully choose how I take care of my body, and who works on it. I have found it is folly to place too much trust in anyone to heal, for only God is the author to heal [?].

reply: There's no need to bring God into it. That's a real conversation stopper for me. If you think God is watching over your dog, I don't think we have much more to say to each other about homeopathy and the placebo effect. If God is the only healer, why bother with the homeopathic remedies?

__________

19 May 2009
I call bullshit on Becky, the latest defender of homeopathy to appear in your Reader Comments. She says a vet "did all he could," then sent her parvo pup home to die. I was a veterinary assistant for ten years, and no vet looks over a parvo puppy, administers treatment while the owner waits (it can't be done!), and sends the pup home to die because there's nothing else to be done. What the vet does is tell the client that the pup has almost zero per cent chance of making it without treatment, which will cost several hundred dollars, and ask for a deposit. If the client ponies up, the pup is very aggressively and immediately treated--it must be hospitalized for several days (which most owners prefer to having a suffering puppy spew infectious vomit and blood all over their home anyway). If the client won't pony up, s/he is asked to reconsider, offered a payment plan, and finally told that the kindest thing to do would be to put the animal down. Some few will decide their at-home nursing can fix things better, and these are the few who really take their pups home to die. I have heard of one cheap person who took the pup home and pulled it through with Gatorade. One--and that's hearsay. The only reason to take a parvo puppy home is because you don't care what kind of agony it dies in.

So one of three things is going on here. One, Becky really did choose magic water over medicine because she is cheap. She may even have chosen not to vaccinate her puppy for parvo because she is cheap, a believer in woo woo, or both. (I don't know this, because the parvo vacc is given in a series, and it takes a while for the pup to have full immunity.) If this is the case and the pup lived, I doubt very much that it had parvo. Two, the pup did have parvo, and Becky wants to give the magic water credit so badly that the vet gets none--she's leaving out what "the vet did all he could" really means. It means he placed a catheter, gave fluids, antibiotics and antidiarrheals, and hospitalized the pup for several days to a week. It means he and his staff put a lot of time and effort into washing filthy-smelling bodily fluids off that pup, cleaning its cage many times a day, keeping its IVs untangled and the bags full, and probably checking on it in the middle of the night.

Three, there's the slimmest of chances the pup did have parvo and was lucky enough to pull through w/o treatment under the care of a very stupid, very cruel owner. If that sounded harsh, you've probably never seen a pup with parvo. It is such a nasty disease that if a vet had done all the treatment he could on a parvo pup and it was still sick (which in this case means slowly dying), he would surely have recommended putting the pup down. He would have done this so strongly that I, in all my experience, saw fewer than five people look at their emaciated, feverish, dehydrated, vomiting, blood-shitting, dull-eyed puppy and say "Oh no, I can take care of this myself." It takes a really special person in very special denial to do it. It takes someone who's more concerned about her wallet/proving how great the magic water is than she is with her pet's suffering.

There's some part of this story we're not being told. For the dog's sake, I hope Becky is merely a liar and didn't really put her puppy through that kind of suffering.

Laurel

reply: I haven't had any experience with parvo pups, but I've communicated with many people who truly believe in some pseudoscience or medical delusion. If money enters into the equation, it is usually to hurl some irrelevant comment about the greed of Big Pharma, scientists, or science-based doctors. So, I agree that Becky is probably not telling the whole story, but I'm not so sure that she did what she did because she's a cheapskate.

Another reader commented on parvovirus:

For what it's worth, Wikipedia reports that untreated canine parvovirus has a 91% mortality rate. Homeopathy's Wonderful Mystical Cure might have cured the pup. The pup also could have been one of the lucky 9% (whose odds may have significantly been improved by the treatment the vet did administer).

If I were a betting man, I'd bet on the 9%...

Frank Kastenholz

__________

11 Nov 2003
Subject: Definition in homeopathy article is wrong.

Student, do the research.

The definition of allopathy has nothing to do with balancing the humors.

Roger Barr

reply: According to William T. Jarvis

The term "allopathy" was invented by German physician Samuel Hahnemann (1755-1843). He conjoined allos "opposite" and pathos "suffering" as a referent to harsh medical practices of his era which included bleeding, purging, vomiting and the administration of highly toxic drugs. These practices were based on the ancient Greek humoral theory which attributed disease to an imbalance of four humors (i.e., blood, phlegm, and black and yellow bile) and four bodily conditions (i.e., hot, cold, wet and dry) that corresponded to four elements (earth, air, fire, and water). Physicians following the Hippocratic tradition attempted to balance the humors by treating symptoms with "opposites." For instance, fever (hot) was believed due to excess blood because patients were flush; therefore, balance was sought by blood-letting in order to "cool" the patient.

Thanks anyway, Roger. Maybe if you slap my answer against your leather pouch it will release its spirit energy and become more dynamic for you.


The following exchange took place five years ago, before I revised the homeopathy entry to better express what the evidence shows. I was wrong to refer to homeopathy and homeopathic remedies as "useless" or "ineffective." I should have referred to the practice as "either ineffective or effective  because of placebo and false placebo factors." I should have referred to the homeopathic potions as "inert." I have altered my responses in this exchange to match the changes I've made. I haven't altered the nameless critic's words, however, but keep in mind that the critic was responding to a differently worded entry.

07 Nov 2003
As a subscriber to your Skeptic's Dictionary Newsletter, I share many of your viewpoints. On the subject of homeopathy, however, your skepticism is shallow.

You argue that since homeopathy does not work, it is not worth investigating how it works. What positive evidence is there that it does not work? What are your criteria?

reply: I explain this in the entry:

Before attempting to explain why so many people believe homeopathy works, let me first defend the claim that homeopathic remedies are inert. There have been several reviews of various studies of the effectiveness of homeopathic treatments and not one of these reviews concludes that there is good evidence for any homeopathic remedy (HR) being more effective than placebos. Homeopaths have had over 200 years to demonstrate the special efficacy of their wares and have failed to do so. Sure, there are single studies that have found statistically significant differences between groups treated with an HR and control groups, but none of these have been replicated or they have been marred by methodological faults. Two hundred years and we're still waiting for proof of special efficacy! Having an open mind is one thing; waiting forever for evidence is more akin to wishful thinking.

A review of the reviews of homeopathic studies has been done by Terence Hines (2003: 360-362). He reviewed Taylor et al. (2000), Wagner (1997), Sampson and London (1995), Kleijen, Knipschild, and ter Riet (1991), and Hill and Doyon (1990). More than one hundred studies have failed to come to any definitive positive conclusions about homeopathic potions being effective or any more effective than placebos. Ramey (2000) notes that Homeopathy has been the subject of at least 12 scientific reviews, including meta-analytic studies, published since the mid-1980s....[And] the findings are remarkably consistent:....homeopathic "remedies" ineffective or are not more effective than any other inert substance.

I don't know how I could make my point any clearer: hundreds of studies, same conclusion: remedies are either ineffective or not more effective than placebos.

One of the axioms of homeopathy is that it is tailored to the patient. Thus, if patients A and B are diagnosed with the same bacterial infection, the same homeopath may well prescribe different remedies. This renders problematic the conventional way of testing a drug's efficacy, since strictly speaking, if one were to meet homeopathy on its own ground, then one would have to amass populations of patients like patient A (or B, as the case may be). Conventional science does not generally meet homeopathy on its own ground. This is not helpful.

reply: Let's get one thing straight. There are not two kinds of science, conventional and non-conventional. There is just science. You are either doing it or not.

What you are saying is that control group testing of homeopathic remedies is irrelevant to whether homeopathic remedies are effective. Why should homeopathy be exempt from a fundamental precept of sound science? You're suggesting that homeopathy be allowed to use anecdotes of satisfied customers as evidence homeopathic remedies are effective. But why stop with homeopathy? Why should any other discipline be expected to do controlled studies? There are good reasons science uses controlled studies. The dangers of self-deception should be apparent. The vulnerability to post hoc fallacies like the regressive fallacy should be obvious. How could we ever separate out placebo and false placebo effects, from unique remedy effect  if we did not do controlled studies? You're asking that homeopaths be given a free pass to draw conclusions about their treatments based on their subjective impressions.

Equally it is not helpful that homeopaths have difficulty in articulating how homeopathy works in a manner which is easily comprehended. They may not even know how it works. But not knowing how something works does not entail that it does not work, although it may entail other things.

However, if skepticism is not simply to masquerade as the arrogance of the established view, perhaps the sounder approach is to generate and test new hypotheses about how homeopathy might work and then establish whether these may lead to a reappraisal of whether homeopathy does in fact work. This is the approach taken by Paolo Bellavite and Andrea Signorini in The Emerging Science of Homeopathy: complexity, biodynamics and nanopharmacology (ISBN 1-55643-384-0). Whilst the latter author practises homeopathy, the former is a university professor of pathology. I commend this book to you and, in particular, its spirit of inquiry. It is scientific in a far more noble and profound sense than, I regret to say, the brand of skepticism demonstrated in your article about homeopathy.

Name withheld by request

reply: The need is for hypotheses to explain why homeopathy has so many satisfied customers despite the overwhelming scientific evidence that its remedies are inert and no more than placebos.

A reply to my reply:

Dear Mr. Carroll,

I read your response with interest, as I did your original entry. May I add the following comments:

1. The stance taken by the book I have commended to you is that very few (if any) of the studies undertaken bear the weight of the conclusion that homeopathy works or does not work. This is principally because, as I articulated it using the vernacular, conventional science does not meet homeopathy on its own ground. Homeopathy claims to treat the person, not the 'disease' or 'illness' from which he or she appears to be suffering. I did not (or at least did not intend to) suggest that control group testing should not be applied to homeopathic remedies - merely that the bespoke nature of homeopathy may render this difficult, if not problematic in practice, and not just because of the more significant role of the practitioner. Nor was I suggesting that there are two kinds of science, conventional and non-conventional, although homeopathy would not currently be considered as conventional science, would it? Here you are mobilizing ignoratio elenchi. (Some - not I - might say that you are also being a bit patronizing.)

2. This leads to the interesting question: if control group testing cannot be applied in a manner that meets homeopathy on its own ground, does this lead us to reject the validity of homeopaths' claims, or alternatively does it suggest that a different, possibly more sophisticated approach testing be taken? The latter, I hope you will agree.

3. I must apologize if you took it that I was name-calling. However, I shall repeat the charge that, in the case of homeopathy, your point of view is shallow. You claim that the evidence says 'no'. I disagree. The evidence does not say 'yes' either. Much more research is required. May I suggest that insisting that the evidence says 'no' does not make it so. In your Dictionary, you are covering an extremely (perhaps impossibly) broad shore-line, and I believe that you need to study the subject far more deeply than you have done so far before you come to so categorical a view. You should remain skeptical both ways, instead of forming a judgment on the basis of insufficient knowledge.

4. The weakness of your position is to some extent indicated in the final sentence of your reply to me. I suggest to you that, if there are so many satisfied customers as well as (which you omit to consider) many very highly qualified and intelligent homeopathic practitioners, perhaps this is because something is escaping the filter of 'overwhelming scientific evidence'? What counts as scientific evidence is always evolving. I am advocating a position of humility based upon the premiss that 'the jury is still out'. I am suggesting you do the same. Otherwise your brand of skepticism may appear to some to be arrogance so far as concerns what are ultimately matters of empirical fact, not just instances of fallacious thinking, easily defeated by the toys of deductive logic.

Name withheld by request

reply: Conventional doctors treat persons who suffer from diseases. Homeopaths are not unique in this respect.

As I see it, we are at a standoff. You think the jury is still out. I disagree. (See "Overview of Homeopathic Research" by  Stephen Barrett, M.D.) In part this is due to your notion of "meeting homeopathy on its own ground," a notion I admit I am not sure I understand.

As you note, it is worth studying why homeopathy has so many satisfied customers even though the scientific evidence that its remedies are not inert is negligible. This is a matter for the psychologists. It has been studied and I report on what some, including a practicing homeopath, think is going on. I'm not going to repeat myself here but this is where I think we meet homeopathy on its own ground. We analyze what is going on when a doctor treats a patient with an inert substance with results that satisfy both the doctor and the patient.

I don't claim that there should be no further investigation of homeopathic remedies, but I do think it is very unlikely any remedy of interest will ever be discovered by classical homeopathy. I don't know why you think that the results of over one hundred studies isn't sufficient or why you think more studies are needed. I assume you understand the nature of such studies and that finding statistically significant results in single studies should not be taken as proof of homeopathy any more than finding nothing significant in a single study proves a remedy is useless or ineffective.

In my view, you are not advocating a position of humility but one of stubbornness. The jury is not still out. The verdict is in. The case isn't closed only because the advocates of homeopathy believe on faith. No matter how many studies indicate their remedies are inert and work by placebo effects, they will still hold out hope that the proof is just around the corner. Or they will continue to claim that their stuff is special and not amenable to "conventional" science. Of course, if you bring in the notion that slapping a jar against a leather pouch releases spirit energy and dynamizes a diluted potion, then you truly have gone beyond science into the realm of magic and superstition.

Another reply to my reply:

I think that if we disagree, it is essentially about how one should interpret the results of relatively low-quality research. My feeling is that one should invest in higher-quality research.

What I mean by "meeting homeopathy on its own ground" is incorporating into the design of clinical trials the fact that the remedy prescribed by a homeopath is as much a function of the nature of the patient as a function of the condition from which he is suffering. Homeopathy claims to address the condition indirectly, by enabling the patient to combat it, rather than address the condition directly, as for example by killing off bacteria with antibiotics. This complicates the design of clinical trials considerably, but if you exclude the patient-centric element of the homeopath's modus operandi, then you are not truly testing the claims of homeopathy.

On your final note, you may well call into question whether slapping a jar against a leather pouch has any effect at all, but oddly enough, the following studies indicate that dynamization or potentization does bring about physicochemical changes in high dilutions of homeopathic drugs, as revealed by nuclear magnetic resonance analysis and by infrared spectrophotometic analysis respectively:

Sukul et al. (2000), Altered solution structure of alocholic medium of potentized Nux vomica underles its antalcoholic effect, Br. Hom. J. 89: 73

Barros and Pasteur (1984), Omeopatia, Medecina del Terreno.

Whilst this does not prove any claim that potentization gives the remedy therapeutic effect, it bears out my point that a sceptical attitude requires greater humility.

Name withheld by request

reply: I think you want to test homeopathy, not homeopathic remedies. The verdict is in: homeopathy works it works by placebo effects.

As for physicochemical changes in homeopathic drugs I am reminded of transubstantiation. The bread and wine still taste like bread and wine and have no more powers than do bread and wine, even if their accidents bear no relation to their substance. A diluted substance may change structure at certain temperatures, it may change according to nuclear magnetic resonance analysis and infrared spectrophotometic analysis, but whether it is an effective remedy for any ailment is a completely different issue.

Another reply to my reply:

Given the choice, I should indeed prefer to test homeopathy, not homeopathic remedies, but are you not posing a false dichotomy? You are looking at the subject in terms of whether remedy A cures condition B. Homeopaths see their task as treating patient X with remedy A - and, potentially, patient Y with remedy C - to cure condition B.

Homeopathy, therefore, posits a different system of treating disease. If, in their design, clinical trials do not meet it "on its own ground" - as I loosely call it - then such trials do not serve a scientific purpose in so far as they are not directed to testing the precise terms of the hypothesis being made.

reply: You're right. I'm looking at the subject in terms of whether remedy A cures condition B. I don't see how physicians are any different from homeopaths; they also treat different patients with different remedies for the same ailment.


7 May 2000 
Hi!, I'm an Englishman, married to an Indian and currently staying most of my time in India. As you would expect I am in the midst of all kinds of weird beliefs but none as great as Homeopathy although Astrology runs it close as does Ayurveda' Truly the Land of the Gullible. I want to take a little mild exception to the article on Homeopathy. I quote 

If people want to buy and drink lemonade which some aquatic entrepreneur has called a tonic that can cure warts, boils and cancer, let them. As long as their products aren't dangerous in themselves, and the government isn't using tax dollars to subsidize the fiasco, then let the buyer beware and let the lawyers be quiet.

I have seen a couple of instances during the time I have been here where Homeopathy has killed. Of course I cannot name names. However I point out that where people are gullible enough to believe that Homeopathy can cure them there must be thousands of undocumented cases where people have died because they were not referred to scientific doctors in time.

The products are dangerous in themselves in that they frequently postpone qualified scientific intervention until the condition becomes chronic or terminal.
Roy Eagleton

Chandigarh (U.T.) INDIA.


20 Sep 2000 
Although it is amply clear that homeopathy is bogus, please be aware that, biologically speaking, one molecule per million can be a very effective quantity of a substance. Many biological molecules are present and very active in nanomolar (1/billion) or even picomolar quantity. Drinking an ounce of 1 micromolar nerve gas or plutonium nitrate would make for a very bad day.

What is more important to note is that many homeopathic remedies have zero molecules per dose. It seems essential is that the concentration of the remedy's main ingredient may be much much higher in the ambient air or water.

I use Ca ion concentration as an admittedly slightly off-topic example. Intracellular fluids contain very few free calcium ions; specifically, about one one-thousandth the concentration of Ca in the highest purity water reasonably attainable in a laboratory. Pure water (a practical impossibility) would be made unusable for many studies simply being left unsealed for, say, an hour in a completely still, completely sterile room.

The point being that your one to one bazillion dilution of Goldenrod pollen extract (or whatever) used for hay fever would be fatally adulterated (undiluted?, strengthened?) in the moment you cracked the seal on the bottle. (Especially in fall, when you would be using it, in the South.)

Given the opportunity to discuss homeopathy, I usually use terms such as "one molecule in an Olympic swimming pool." Although folksy, it is technically more accurate.

Thank you for a wonderful resource.
Greg Griffeth
LSU SVM Class of 2004

reply: Thank you for the comments and information. 

homeopathy

 

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