Self-treating homoeopaths and self-congratulating skeptics (Will Storr’s The Heretics [US: Unpersuadables], Part 2)
Warning: If you follow the Boots on-line advice about homoeopathy, it could kill you.
Storr devotes one of his most interesting chapters to a group of people that I belong to. He does not like them, and gives good reason for this.
He approaches the topic indirectly, through the story of a woman called Gemma Hoefkens. As Gemma tells it, she had malignant tumours in her brain and spine that were no longer responding to treatment, so she saw no point in staying in hospital, and betook herself home. She recovered, against all expectation, with the help of some little pills she was taking. These pills were homoeopathic Causticum (sodium hydroxide, drain cleaner) at such a low dose that, if it were not for impurities, we could be confident  that each pill contained none of the active ingredient whatsoever. Understandably, she attributes her cure to these pills, with unchallengeable conviction, as others in like case might attribute their cure to the intercession of a saint. 14 years on, she is a licensed homoeopath, and has made a video about her experiences.
Homoeopathy is a procedure that cannot possibly work as claimed, because of the facts of physics. It starts with the nonsensical assertion that the cure for a disease is to be found alongside the disease itself. For example, the miasma from lakes (remember this dates back to the eighteenth century) is responsible for the fevers of malaria, but the bark of the willow tree growing by the lake reduces fevers (indeed it does; it contains a substance closely related to aspirin). It proceeds with the grotesque claim that a curative agent is more effective at lower dose. Now it may well be that the effectiveness per mg is greater at lower dosage, so that 20 mg of a drug is less than twice as effective as 10 mg, but you would certainly expect it to be at least equally effective, and probably more. Indeed, dose-effect relationships are one of the ways of testing whether a substance is having any real effect. Finally, homoeopathic remedies are commonly dispensed at what is called C30 concentration. This means that the original curative agent (which as we have seen could be something as bizarre as drain cleaner) is diluted a hundred-fold 30 times. At that rate, not even an ocean-full would have any real hope of containing a single molecule of the original remedy.
Despite its complete lack of scientific credibility, homoeopathy has been a subject of considerable research, which Storr reported on  in 2011. And the results are clear.
In fact, I would have found it very surprising if it did not. By all accounts, UK homoeopathic hospitals are pleasant places to be in. Patients are treated with apparent professionalism by practitioners, many of them with genuine clinical qualifications, who pay attention to them and say that they are treating, not just a disease, but the whole person. At the end, they are prescribed a remedy that the therapist tells them, in all sincerity, has been tailored to their own individual needs. These are the ideal conditions for bringing into play one of the strangest and least understood of all medical phenomena, the placebo effect. Conventional medicine could learn a lot from the homoeopaths.
So do homoeopathic remedies work any better than placebos, dummy pills that never pretend to be anything more than dummy pills, administered under comparable conditions? That is a much more difficult question to answer, especially as it is notoriously difficult to prove a negative. A good study needs to be large enough to produce statistically meaningful results, and must be “double-blind”, meaning that neither the patients, nor the clinicians in contact with them, nor those evaluating each individual patient’s results, know whether the patient has received the “real” treatment or a placebo. Most of the studies that have been conducted on homoeopathy were of poor quality, perhaps because of the small number of suitably qualified researchers with the desire, and the funding, to investigate what seems from the outset to be a lost cause. Pilot studies were regularly not followed up, as one would expect if they failed to yield interesting results. The authoritative Cochrane Reviews has conducted nine metastudies of homoeopathy for various non-threatening conditions (it would obviously be unethical to test it on cancer patients), and report inconsistent but at times weakly positive findings. The consensus seems to be that homoeopathy really does work, but no better than placebo. Just last week, we had an account of the fullest study so far, which looked at 176 studies spread over 68 different health conditions. Excess performance of homoeopathy over placebo plus chance – zero.
This places protesters against homoeopathy in an interesting moral position. On the one hand, homoeopathy competes with more effective treatments for resources. We also know of cases where rejection of conventional treatment in favour of homoeopathy has led to unnecessary deaths, including deaths of children. On the other hand, some patients benefiting from the placebo effect will be left worse off if their faith in the “treatment” is undermined.
After that digression, let me return to Storr’s real subject here, which is not homoeopathy but a group that I actually belong to, Skeptics in the Pub, who meet to discuss, and hear talks about, a range of intellectually interesting topics. Storr says that he is “curious about the Skeptics because, from an outsider’s point of view, their main hobby seems to be not believing in things. Psychics, homoeopathy, chiropractors, ghosts, God…” I think Storr is being rather unfair here; topics recently discussed in my own (Glasgow) group include the effect of prison rates on crime, is talk therapy effective in treating schizophrenia, the origins of life, should we frack (this from a geologist who has made a special study of the topic; the answer is yes, but only if we can generate public confidence in the regulatory procedures), are surveys of happiness meaningful (we had one speaker who said no, a later speaker who said yes), and were women as constrained in Mediaeval Europe as Hollywood would have us believe (probably not). We have critically scrutinised the criminalising of pimps and the shaming of men who use prostitutes, with the help of Belinda Brooks-Gordon, Reader in Psychology and Social Policy at Birkbeck. We have had a talk from Mark Anderson, author of The Geek Manifesto, urging us to agitate for evidence-based policy-making, and we hold hustings before elections. You may notice a certain flavour here; a willingness to bring evidence to bear on complex topics where people have generally made up their minds on woefully inadequate evidence.
But Storr’s main concern was the assembled skeptics’ war on homoeopathy, and why they would bother. He wonders what prompts people to take Gemma’s video, and superpose on it the word “Quack” coming out of her mouth at the beginning of every sentence. Apparently, someone did that. He also wonders at the motivation of those who took part in the “massive homoeopathic overdose” stunt, originally organised by Merseyside Skeptics under the slogan “Homoeopathy, there is nothing in it”, where large numbers of protesters worldwide simultaneously swallowed large numbers of homeopathic Belladonna pills with no effects whatsoever.
He spoke to Colin, a software engineer, who had not actually read any studies on homoeopathy, but said he was fascinated by its absurdity. His friend Dominic described homoeopathy as really silly, and looked forward to taking part in the overdose. To what end? To make people aware of just how silly it is. Had he read any scientific studies of homoeopathy? “Not personally”.
Confession time: neither had I, until I read Storr’s book, which did not stop me from expressing my scorn towards it. Scorn that, as you can see from my earlier comments, is now considerably modified. And yet I strongly applaud the overdose stunt. And I feel a mixture of anger and contempt, not against the users of homoeopathic remedies, nor even the sincere believers who call themselves homoeopaths, but against the companies who manufacture (if that is the correct word) these materials, and the High Street pharmacists like Boots who market them, knowing exactly what they are doing. Now that I have finally gotten around to examining the relevant materials, I am appalled.
If you follow the Boots on-line advice about homoeopathy, it could kill you. In homely language and reassuring comic sans font, it describes homoeopathic medicines as potent, recommends consulting “a qualified homoeopath or medical practitioner” [my emphasis] regarding “long-standing or more serious illness”, and lists what could in fact be symptoms of life-threatening conditions as suitable for do-it-yourself or homoeopath treatment; the list includes nausea and vomiting, exhaustion, headaches, coughs (including coughs accompanied by “a stitching pain in the chest and a bursting headache”), diarrhoea and earache.
As Dominic said, homoeopathy might stop people from seeking appropriate medical advice, although he did not know anyone to whom this had actually happened. Not too surprising really; people who visit homoeopaths and people who protest their silliness are unlikely to be on intimate terms. However, Dominic said he saw it as a consumer protection issue. What else did he do about consumer protection? Well, he subscribed to Which, and things like that. Mark, another visitor to the convention, was primarily interested in evolution, which he described as “incredibly easy to understand” (you may remember from Part 1 that Nathan Lo, evolutionary biologist, said the exact opposite). What evidence had he personally studied? Fossils. Had he actually studied fossils? Not personally, but then had anyone studied God personally?
Storr has to agree that the skeptics are right. They are promoting the results of science. And yet he finds their company depressing, and feels that he is not of their tribe. I know exactly what he means. Storr knows that he is wrong, and, as he says, drawn to the wrong. The sceptics are right; so righteously right, alas, that the ones he spoke to did not even need so much as an on-line search to verify their rightness.
As I write, there is a fierce controversy among sceptical and freethinking organisations in America about whether or not it was right to disinvite a certain speaker from a certain meeting in the wake of a certain tweet (update; he has now been undisinvited). The issues are complex, but this did not stop people on both sides from jumping to conclusions and then displaying selectivity bias, hardening of positions when challenged, animosity towards opponents, ad hominem arguments, emotionally laden non sequiturs, distorted perceptions of fact, appeals to group loyalty, and emotional blackmail, just like everybody else. I find this oddly comforting.
In other chapters, Storr discusses past life regression therapy, yoga breathing as a panacea, rationalist superstar James Randi and his psychic challenge prize (never even applied for, we are told; but Storr’s investigations show otherwise), imaginary diseases, and… and…
But no point in my simply extending this list. Read the book.
1] A cubic meter of water contains roughly 50,000 moles of water, or 50,000 x 6.022 x 10^23 = (near enough) 3 x 10^28 molecules. Dilute to C30, or one in 10^60, and you will have one of the original water molecules in around 3 x 10^31 cubic meters or 3 x 10^22 cubic kilometers. That’s around a hundred trillion times bigger than the Atlantic Ocean.
3] For details, including my own views on the matter, see here
Adapted from an earlier post in 3 Quarks Daily