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Homeopathy: Ben Goldacre, Hans Schrauder and… The Buzzer

The recent damning conclusions from the House of Commons Evidence Check on homeopathy, calling for NHS funding for the prescribing of homeopathic remedies to be stopped, has thrown homeopathy into the news again. And, of course, the media spotlight carries with it the utterly idiotic approach of bringing “both sides” of the argument as though, in every argument, the two sides have equal intellectual weight supporting them.

Yes, that’s right, the newsroom debates between (usually very blunt) reasoned thought and very earnestly delivered and plausible-sounding but ultimately misleading soundbites from advocates of homeopathy have started appearing.

The idiocy of the media’s insistence that they bring “both sides of the argument” and act as though they are the final arbiter between the two sides becomes more apparent when you stop and recall that, actually, the scientists themselves have already done that job for them. It’s easy to forget in this circus that scientists who appear on television for comment, such as Evan Harris MP, David Colquhoun and Ben Goldacre, actually have no a priori reason for dismissing homeopathy without looking at the evidence first. They have in fact already acted as an arbiter in an argument between a party who says “we believe homeopathy is great” and a party who says “we believe homeopathy is rubbish”, looked at the evidence, and arrived at their conclusion. That their conclusion is more in favour of one side than the other does not alter the fact that they have already acted as arbiter in the case.

And then in steps the media. The fact that the scientist in their studio has already studied the evidence and drawn their conclusions goes out of the window. No, now the scientist is merely “one side of the debate”. It is now the news anchor, behind their desk, who is the referee, throwing one side’s statements to the other without any thought to whether or not those statements merit any support. It should be noted here that the homeopathy advocate’s role remains completely unchanged.

Here are a couple of examples from the BBC this week. Firstly, David Colquhoun’s face-off with Charlotte Mendes da Costa. In the lottery that is the 5 minute newsroom debate, Colquhoun came off rather well. Very few of Mendes da Costa’s waffly generalisms about cherry-picked studies or how her patients liked being given homeopathy were allowed to go unchallenged. The quote about “some people might want Chanel No. 5 on the NHS” was a corker. I suspect it will remain in the arsenal of quick, punchy arguments against homeopathy for some time to come.

However, coming off less well in the lottery was Ben Goldacre, in his “debate” with Hans Schrauder, Vice-Chairman of the Homeopathic Medical Association (HMA). Schrauder unleashed a veritable Gish Gallop of half-truths, non-sequiturs, irrelevances and very earnestly-delivered cobblers and there was very little that Goldacre could do about it, completely unhelped by the news-anchor who sadly couldn’t have spotted a fallacy if it fell on her.

It occurred to me how wonderfully useful it would be if you could have a little buzzer that went off every time a dodgy logical step, misleading statement or unsubstantiated claim was uttered. And then it occurred to me that with the power of a youtube downloader, some simple video editing software and a quick visit to findsounds.com, that this idea could become a reality. So I set to work redressing the balance. The result is posted at the top of this page. Largely, I think The Buzzer speaks for itself, but here are some notes about some specific interjections:

(1:52) Hans Schrauder said: “I certainly wouldn’t be making any claims to be curing cancer with homeopathy”. I buzzed here, not because I think that Hans Schrauder personally has made any claims to cure cancer with homeopathy, but a google search of the Homeopathic Medical Association’s web-site (recalling that Hans Schrauder is Vice-Chair of the HMA) certainly reveals some evidence that the Association has made assertions regarding “prevention” of and “recovery” from cancer, as well as “management” of cancer. While the pages now yield server errors rather than anything substantive, there are certainly traces of evidence that the HMA may have made unsubstantiated claims on the treatment of cancer, at least in the past anyway. Here is a screenshot of that Google search, in case those pages “disappear” from Google’s cache some time in the future (taken 2 March 2010):

Googling "cancer" on "the-hma.org"

Googling "cancer" on "the-hma.org"

One of those traces points to an “International Cancer Congress” that took place in Badenweiler last year, featuring Indian homeopath A.U. Ramakrishnan. The review of the congress is somewhat disturbing. Ramakrishnan’s method featured in the teaching materials from the Westminster University BSc course in homeopathy, as obtained under the Freedom of Information Act by David Colquhoun. As Colquhoun explains, these lecture notes recommend specific treatments for a named disease. So, while there is no reason to doubt that Hans Schrauder personally would not make any claims to cure cancer with homeopathy, that position would appear not to be representative of the homeopathic profession as a whole, and may not even be representative of the views of the Association of which Schrauder is Vice-Chair.

(2:10) The “we treat the person, not the specific complaint” gambit gets trotted out. Again. As though doctors don’t take account of a patient’s history, other conditions, other medication, personal characteristics, etc. when making an evidence-based decision. Schrauder is quite right that in many cases, the body heals itself, but when it does, it has nothing to do with the homeopathy whatsoever. He is not right, however, to suggest that “we do it all the time”. There are many diseases from which the body doesn’t recover by itself, and a proper medical intervention is necessary, with any delays being fatal. When I was 11, I contracted meningococcal septicaemia. I only survived because it was spotted and diagnosed almost immediately by my GP, who then had me rushed straight to hospital. It terrifies me to think what might have happened had that diagnosis been delayed by being taken to a homeopath first.

(3:40) “There is evidence to show that homeopathy works” – this is a partial truth, but what it fails to say is that this evidence is flawed. Systematic reviews of all the evidence have repeatedly shown that the most rigorous trials with the most participants and the fairest methodology show no difference between homeopathy and a placebo, and that the only evidence that comes out in favour of homeopathy is in small trials, with inadequate controls, and poor methodology that are almost bound to come up with a “positive” result regardless of what they were testing and whether or not it worked, simply because they don’t produce fair tests.

(4:05) Randomised Controlled Trials (RCTs) are not the only studies that form the evidence upon which modern public health is based, but they do form the best evidence. No RCTs have been conducted to demonstrate the link between smoking and lung cancer, for example. This is because to conduct an RCT on this association, you would have to ask a group of people assigned at random to take up smoking, which is clearly unethical. The link thus relies on evidence from cohort studies instead.

Homeopathy, on the other hand, is in fact perfectly suited to testing by RCTs. In fact, oddly, much of the evidence that Schrauder (and Mendes da Costa, for that matter) refer to is… yup, you’ve guessed it, RCTs. Flawed, badly designed, inadequate RCTs, but RCTs nonetheless.

(6:40) The placebo effect in animals, as Ben Goldacre tries to point out before being told off by the news-anchor, actually has good evidence supporting it. In any case, even if the placebo effect weren’t present in animals, there are plenty of other explanations for why animals get better after being seen by a homeopath without jumping to the conclusion that “homeopathy works”. The one that sticks out like a sore thumb is regression to the mean, or, in other words, they would have got better anyway. Besides, in an argument about whether homeopathy should be available on the NHS, which treats humans, why is it of any relevance at all whether or not homeopathy “works” on animals?

(7:30) I really don’t think I need to point out what’s wrong with this statement: “I think you’re only misleading patients if you believe that homeopathic remedies are placebos, and we earnestly believe they are not, they are active medicines”. Self-belief in one’s talents may be fine for sportsmen, actors, musicians and the like, but as the sole evidence base for a method of health-care? No.

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