Rational Veterinary Medicine

If there is nothing to homeopathy then why waste so much effort in denouncing it, why not just ignore it?

The problem with this is that homeopathy is deeply unscientific. This isn't just some ivory tower, philosophical position but it is fundamental to what belief in medicine, science and the real world is about. Homeopathy cannot be proved objectively to work, the very best evidence that homeopaths is flawed and weak. This means, for a start, there can be no way of doing quality control; how can it be properly determined for example that the remedy in the bottle is the same as what the label says when even homeopaths themselves can't tell the difference. Drug companies get this wrong from time to time, why not homeopathic pharmacies? Here’s an interesting anecdote: some time ago I spoke to a representative from a company who sold herbal and homeopathic remedies in the veterinary market. I was told that on one occasion, when an owner wanted a remedy to dry up her bitch’s milk after weaning, the company had accidentally sent her a remedy which was designed to increase milk production instead. When the company realised their mistake after a week or so they phoned the owner to apologise only to be told, before they could get a word out, that the remedy had been highly effective and the bitch had stopped lactating!  Such is the power of the human mind to convince itself of what it wants to believe.

A more important point though is that if the use of one modality which cannot be confirmed to work is accepted, where does that take us? There are some aspects of homeopathy which are so far fetched that even other homeopaths have their doubts - creating a remedy by writing the name on a piece of paper and leaving it next to a glass of water which then becomes magically potentised, using remedies based on the planet Venus, the moon or anti-matter for example. There are other, even more far fetched ‘therapies’ out there which people swear by and have anecdotes to support their use but no scientific proof (the ‘Tesla energy shield’ is one of my favourites).  The point is, if we believe homeopathy with all its contradictions and impossibilities how can we tell the difference between that and the other supposedly even more far fetched things? Should we believe David Icke when he tells us that the colour purple will protect us from the evil reptiles who rule the world or Uri Geller when he says his spoon bending powers come from the planet Hoova, or psychic surgeons who claim to be able to remove internal tumours from conscious patients without pain or leaving a wound? Should we believe it when we’re told that by drinking the poison we will be taken up into the flying saucer and on to salvation as happened at San Diego?

Not every far fetched “cure” is as harmless as homeopathy is either - intra-venous hydrogen peroxide, intra-venous or oral urine, laetril, megadoses of vitamins and some herbal remedies have all been associated with adverse (or occasionally fatal) effects but again, those that use them claim they work brilliantly and have loads of anecdotes to support their continued use.

This isn’t sarcasm or ridicule, it is a serious point. These other things are genuinely no less unlikely to the disinterested observer than homeopathy itself.  If something can’t be proved (or disproved) objectively then all that remains is taking someone at their word.

Sceptics just can’t bring themselves to believe in homeopathy because deep down they fear that perhaps there is something there.

That is an argument that is particularly unreasonable because it reduces a sceptic’s genuinely held and carefully considered position on the subject to one purely of a miserly vested interest in the status quo. But why on Earth would anyone be afraid of something that was as effective as homeopathy is claimed to be? It would be a wonderful new weapon in the armoury if it did even half of what was claimed - curing cancer, AIDS, arthritis and heart failure, protecting against malaria, terrorist attacks and rabies. If homeopathy was finally proven scientifically any true sceptic would rejoice at the news and would embrace it whole heartedly as a genuinely world changing system of medicine. The problem is though, that little word “if”.

There are thousands of cases which have responded to homeopathy and it is too simplistic to say that these patients and clinicians are deluded and the rest of the population is sane.

Well, deluded is not the opposite of ‘sane’ and no one is insane just by virtue of believing in homeopathy, but many people are mistaken - there’s a big difference. The trouble is that everyone and anyone is prone to subjective errors - that doesn’t make them mad or bad (though it does occasionally make them dangerous to know!) it just means they’re human. That is why the scientific process has come to be, it is a way of taking unintended cognitive bias or prejudice (the ‘will to believe’) out of the equation, and that applies as much to conventional drugs and treatments as to homeopathy and other alternative medical belief systems.

Some conditions have lasted weeks, months or even years, yet a change is seen within a short period of having taken a homeopathic remedy. This is too unlikely to be simply a coincidence.

Many would say this is the absolute nub of the fundamental difference in views on this subject. To the homeopathic believer the unlikely nature of the improvement means it must be caused by the remedy but to the critical thinker the massively greater unlikleyhood of the remedy being effective means that almost any coincidence, spontaneous resolution or whatever is more likely than the possibility that the remedy could have been effective. The scientific way requires belief only in an extremely unlikely coincidence, and we know they happen, people win the lottery afterall. The way of the homeopathic believer, on the other hand, requires that most of what the whole of science knows about the nature of disease and the workings of the body as well as the chemistry and physics of water, sugar and alcohol molecules, quantum particles and energy is totally wrong. This is the “brute mystery” that Sehon et al (2006) refer to in their paper concerning the Simplicity Principle. The most economical explanation is that something other than homeopathy has produced the change as we don't have to re-write the entire of science to accommodate it.

How can you criticise homeopathy if you haven’t studied it? How can you say it doesn’t work if you haven’t tried it?

All too often this criticism is code for “Only someone who agrees from the outset that homeopathy is effective is qualified to judge the discipline”.

This argument is often heard when discussing theology as a means of countering arguments put forward by non-believers and in homeopathy it is used in exactly the same way, betraying homeopathy’s real appeal which is that of a belief system rather than a rational system of medicine. The intent of course is a sweeping negation of any of the arguments of non-homeopaths with which a homeopath may dislike, thus avoiding the need for further debate involving actual issues.  When looked at closely though this argument fails for the very reason that its proponents believe it to be so unassailable.

Anyone who uses homeopathy, particularly on animals, who have no say in the matter, or who has gone further and spent time and money learning about the discipline, its history, internal rules, the minutae of dilutions, potencies, sucussions and provings; how classical Hannemanian homeopathy relates to modern day practice, the teachings of Kent and Hering and so forth will have very good reason to not only believe in homoeopathy but to argue its case most firmly. Such investment represents a heavy commitment, both materially and in terms of self interest and ‘face’, or self belief. Additionally, during the process an initiate will have made the acquaintance of like minded tutors and colleagues who will have an expectation that they will remain loyal to the peer group. Consequently a volte-face with subsequent renouncement of homeopathy is most unlikely in one who has seriously tried or studied it to any depth, not because of the quality of the evidence but because of personal commitment, peer pressure and dogmatic belief.

Homeopathic believers, when employing this objection to criticism forget that homeopathy can be investigated in more than just one way. There is an assumption by believers that anyone who studies the subject must be doing so in order to gain a sort of “personal fulfillment” by learning how to apply homeopathy, having already made the decision that to do so is worthwhile. In many cases students may have had a negative experience of conventional medicine and its practitioners, or some positive experience of homeopathy at a crucial point in their life which has nudged them on to a certain path but for whatever reason they are already inclined to be positive and accepting rather than neutral or independent. They are learning, not so much about the validity of homeopathy, which point has for them already been passed, but about its internal details and workings.

Homeopathy can also be studied, however not from the point of view of an initiate seeking enlightenment but with a desire to learn more about the evidence behind it. Why, for instance are homeopathic journals full of positive reports but mainstream publictions are not? Why are most conventional scientists unconvinced about its merits - is this simply widespread prejudice or could it be that homeopathy really doesn’t stand up to close scrutiny? The only way to get proper answers to these and other questions is from a position of disinterest. It can be strongly argued that, far from its own practitioners being the best qualified to critique homeopathy, they are actually the least likely of all to offer an impartial view of the subject. It is only a neutral observer, with no vested interest in what the final results prove, who is best placed to see what is both good and bad about homeopathy, to offer a “warts and all” view.

While looking into the merits or otherwise of homeopathy it is important to assume from the outset that practitioners on both sides of the debate, conventional and homeopathic, do what they do for genuine reasons and believe they are acting in the best interests of their patients. It is obvious then that practitioners who have studied homeopathy as critical outsiders and found it lacking would be most unlikely to use it. Particularly in groups incapable of giving informed consent such use would be highly unethical in their eyes. Hence the argument that only insiders can judge is further invalidated as not only are homeopathic practitioners the least likely to be critical of their discipline but anyone who has found it lacking is most unlikely to be a practitioner.

When all is said and done, if you want to know the relative merits of Quebracho over Argentum or what psora, sycosis and syphillus are and how they relate to tuberculinism then you need to speak to a homeopath. If, on the other hand you want to take a step back and look at the wider picture - the science and the ethics, then you need to talk to an ‘outsider’, an independent observer, only that way will you be able to think for yourself about the subject.

Scientists are too closed minded to admit that homeopathy works.

This is simply not true. While individual scientists might have differing views on the subject science as a whole has carried out a great deal of objective research on homeopathy and the consensus is that it doesn't work. The acclaim that would go with discovering homeopathy was effective and the resulting implications in every other branch of science would see the scientist who finally proved it given so many Nobel prizes he or she wouldn't know what to do with them, not to mention the financial rewards that would follow. There is a massive incentive for scientists to try to prove the effectiveness of homeopathy, the fact that no one has yet done so suggests strongly that homeopathy is unlikely ever to be so proven.

Conventional medicines have hundreds of side effects, homoeopathy is completely safe, surely its use must be justified. What about thalidomide?

This is simply a ‘tu quoque’ argument and basically boils down to “well your medicine is bad too so that means we’re equal”. Such an argument is patently false. Conventional medicines have real, often very powerful effects, in some cases those effects are beneficial, in others less so but they are employed according to an informed risk-benefit calculation based on real world facts, proven through scientific testing. In some cases seriously, even terminally-ill people are treated with conventional medications - palliation, pain relief and symptomatic treatments are used in patients who sadly will eventually succumb to their illness. As long as homeopathy is mainly employed for minor, self limiting conditions such as hay fever, sprains and bruising, this is going to massively skew the figures and give the appearence that more people die while on conventional medications than while on homeopathy. It is interesting to note that when homeopathy and other types of alternative medicine is used for serious conditions people do start dying however. The only thing that limits this type of mortality is what seems to be an innate mechanism within all but the most extreme homeopaths which determines that, whatever their rhetoric about how wonderful homeopathy is and how it can cure all the world’s ills, when actually asked to treat real diseases they will always find a reason not to - the patient’s ‘miasma’ is wrong, conventional medicines have “antidoted” the remedy, science-based medication or surgery (even years in the past) has “suppressed” the disease which has now become chronic. For this reason homeopathy has been described as not so much a system of medicine as a list of excuses.

Another point to consider is that conventional medications have a formal, well regulated system for reporting problems which highlights problems with drugs allowing corrective action to be undertaken. To use the Thalidomide example that system is how the problems with Thalidomide were discovered in the 1960's - suspected adverse reactions were reported and the medical establishment was able to build up a case for banning its use in pregnancy. The same can be said for other drugs which have had problems - even in cases where drug companies have tried to suppress data and pretend that there is not a problem eventually the establishment, the system of reporting and of checks and balances, has highlighted the problem and resulted in a ban or change of use. Interestingly, through careful research, Thalidomide is now starting to be used once again in medicine as a promising treatment for certain types of cancer. Homeopathy has no such system of checks and balances, there is no formal mechanism for the reporting of suspect adverse reactions; how can there be in a modality which claims that everything a conventional practitioner would call an adverse reaction is simply an "aggravation" and actually a sign that the remedy is working? If there were problems with homeopathic remedies, if there was, say a homeopathic thalidomide, we wouldn't have a clue about it.

Regardles however of the incidence of morbidity and mortality in people under treatment with real drugs, even if conventional medicine was as bad and dangerous as some homeopaths would have us believe (it isn’t) this still in no way justifies the treatment of any medical disorder by means of inert sugar tablets.

Look - here’s a paper with perfect methodology, a double blinded, randomised placebo controlled trial which confirms that homeopathy works and it has a 95% confidence interval.  Surely this must convince the sceptics!

OK, so such a paper doesn’t actually exist, even homeopathic trials with claimed confidence intervals of 95% or stronger have always got some major flaw or another. The question is though would such a paper, if it existed, conclisively prove homeopathy? The answer is unfortunately no, it wouldn’t!

To properly assess a novel treatment like homeopathy the entire body of evidence must be considered, not just one or two isolated papers. In fact, although a confidence interval of 95% sounds impressive what it means is there is a 1 in 20 chance of the results being purely due to chance. So if you’ve got hundreds of papers which suggest that homeopathy is ineffective and only one or two ‘outliers’ which suggest that it is, those outlier results would rightly be treated with considerable scepticism.

Many of conventional medicine's most effective therapies have never needed to go anywhere near a DBRPCT to prove their efficacy of course. Insulin treatment for diabetes mellitus, defibrillation in the case of cardiac arrest and fluid therapy in the case of shock to name but a few all have effects so powerful that to test them against an inert dummy treatment would be so downright murderous as to be beyond consideration. It is a constant source of puzzlement to those sceptical of homeopathy that the supposedly miraculous effects seen by individual practitioners in the privacy of the consulting room completely vanish when put to the test.

Farmers using homeopathy are hard nosed businessmen and wouldn’t use it if it was a waste of time.

Indeed, farmers are business-men (and occasionally even -women), they may even be expert farmers but that doesn’t make them the best at assessing whether or not an intervention has worked, particularly where their own stock is concerned. They are just as likely as anyone else to be taken in by a charlatan with a good line in patter whether it’s a feed salesman selling them thousands of pounds of useless additives or a homeopathic vet selling them the false dream of an effective treatment which is free from side effects and doesn’t have any requirement for the witholding of meat, milk or eggs from sale during treatment which is the case with real drugs.

After that I’m afraid that farmers are just as likely to fall prey to all the cognitive errors that you, I and everyone else is prone to - assuming that an improvement following treatment must be due to treatment as opposed to spontaneous or coincidental resolution, convincing themselves that a condition has improved when it hasn’t, ignoring other factors which may have helped with a cure and so on.

Furthermore, in the past some extremely knowledgeable people have been convinced that treatments which are now discredited have worked - bleeding was used by eminent doctors who convinced themselves that it was highly effective, phrenology had a very large following and there are still vets today who mourn the passing of the firing of horses. All those modalities have been shown to be useless. Homeopathy is simply a more benign example of the same sort of thing.

But we don't even know why mainstream drugs work, why pick on homeopathy - what about anaesthetics!

This particular argument runs along the lines that since, allegedly, we don’t know how many conventional drugs work we should basically cut homeopathy some slack and give it the benefit of the doubt. A favourite example is anaesthetics with claims that we have no idea how they work and no information as to their safety or cost-effectiveness, the implication being that if anaesthetics (which obviously do work) have no known mechanism of action then homeopathy also must work even though it also has no known mechanism of action.

This is another tu quoque argument – flawed and designed to mislead. There are several problems with it, not least of which is that even if we really did have no idea how pharmaceutical drugs worked it still wouldn't mean it was ok to go on using homeopathy. We don't have to worry about that though because not only is this argument illogical, it is based on a falsehood, presumably put about in the hope that lay readers won’t bother to check the far-fetched claims being made in the defence of homeopathy.

In fact we have a very good idea of how pharmaceuticals work, including anaesthetics. Take Alfaxan (alfaxalone) for example, a popular veterinary anaesthetic agent. Alfaxalone binds to specific binding sites on the gamma animo butyric acid (GABA) sub-type A receptors on the cells of the Central Nervous System. GABA is a major inhibitory neurotransmitter. When GABA binds to the GABA-A receptors this results in opening of chloride channels into the cells and an influx of chloride ions, resulting in hyperpolarisation of the cells and inhibition of neural impulse transmission. Alfaxalone enhances the effects of GABA at the GABA-A receptors, so causing greater inhibition of neural impulse transmission and, thereby, unconsciousness. This information, along with safety and cost information is widely available in textbooks and via the internet. Why anyone would want to pretend we don't know how anaesthetics work when it is so clear we do is a mystery, but possibly reflects the limited grasp medical and veterinary homeopaths have of proper medicine.

Even if we didn’t know exactly how anaesthetics and other pharmaceuticals worked we do know they have recognised, analysable, physical content. We know exactly what they are. Their mode of action, even where not known precisely, will involve a number of pre-existing mechanisms, all firmly grounded in the known facts of neurology, physiology and biochemistry. All pharmaceuticals, including anaesthetics, follow predictible, rational patterns – if I dilute an anaesthetic it will have a reduced effect, if I use a stronger concentration it will have a more profound effect. And anaesthetics actually work. If I get the dose correct and use the proper delivery route my patients will go to sleep – every single time.

The rational basis of real drugs means if someone makes the claim that a particular pharmaceutical doesn’t work, or has unacceptible consequences that claim can be investigate using proven scientific principles and, depending on the results, the drug will either be withdrawn from use or have its safety profile enhanced. To take extreme examples of both – thalidomide was withdrawn from use in the middle of the 20th century after investigation showed it was causing an unacceptible level of deformities in new-born babies whereas claims the MMR vaccine caused autism in children were discovered to be without foundation once the research was carried out, consequently now the MMR vaccine is one of the safest, most widely researched drugs on the market.

Homeopathy on the other hand has no rational basis and no content other than sugar or water, its ‘mode of action’ is a pure fiction. Infact several pure fictions, depending on what you believe – quantum, nano-bubbles, spallation, cavitation, the life-force etc… You’ll find a different ‘mode of action’ at every website you care to visit on the subject. Unlike real drugs, homeopathy follows no rational or predictable pattern – behind the closed doors of the consulting room it is reported to have profound effects yet when looked at objectively those effects vanish to the margins of statistical significance. When homeopathy declines to perform when tested by science homeopaths, instead of upping the ante and doing better research, simply make excuses; the energy has been ‘antidoted’ by pretty much any substance you care to mention, or it’s being tested by people who don’t ‘understand’, or it’s the ‘wrong type’ of homeopathy – not individualised, or isopathy – or we’re looking at the ‘wrong results’. Yet all those excuses go out of the window if the results look even vaguely like they support the idea homeopathy works. Homeopaths’ view of a well-conducted trial is one that proves, not tests homeopathy.

Finally, with homeopathy if you dilute it, it supposedly gets stronger, not weaker. And no theory of homeopathy’s ‘mode of action’ has ever managed to explain that one. Why homeopathy should get more quantum activity, nano-particles, energy signatures, micro-clusters or whatever the more dilute it is, remains a total mystery, even to the most imaginitive of those practitioners and multi-national corporations who profit by it.

Homeopathy is a different way of knowing and works perfectly well within its own frame of reference – it cannot be judged by science.

This ‘everything is subjective’ line is a well worn trope heard from many practitioners of CAVM – how can science ‘prove itself’, much less disprove anything which operates oustide its purview? Such commentators though want it both ways as we will see.

The point hinges on the very philosophy of science itself and disingenuous homeopaths as well as well-meaning but naïve scientists will suggest that any scientific argument against homeopathy is, at its root, prejudice. Homeopathy, it is claimed, is merely one of many ways of looking at the world and understanding it. As such, although different from science, it is deserving of equal respect. Good scientists, critics say, recognise this and should always have doubt. Well, that last point is certainly true, but it doesn’t mean doubt can be filled in with any old far-fetched nonsense which springs to mind.

To be clear, the core philosophy of science has little to do with the way medical trials are conducted or the usefulness evidence-based medicine. Certainly, medicine employs scientific tools – the double blind placebo controlled trial, confidence intervals, metanalyses and so forth but medicine (and by extension EBM) is no more a science than engineering is, both use science but that does not make them science; they are technologies.

One of the best illustrations of scientific principles is simply if something is going to claim scientific credentials then those credentials must be able to be tested by science. That’s it really, nothing more – 'Put up or shut up' in other words. Science isn't even about finding answers, being far more concerned with asking questions.

Philosophers of a post-modern bent (and possibly a few who like to sound clever!) will argue science is just 'another way of knowing' and that all healing (and other) modalities are equal but different. While this makes for interesting debate it is meaningless in practical terms in the real world. We know much of how the universe works. Consequently we know if a culture believes it is possible for humans to fly unaided while it might be polite of us not to directly contradict or otherwise disrespect members of that particular culture, even a homeopath would be ill advised to take politeness so far as to step out of a high window on their say-so. You can't have one set of facts, or truths for one group and a different set for another.

Critics are regularly castigated by its adherents for describing homeopathy as unscientific. Quite the opposite we are told, loudly and with vigour, homeopathy does indeed work by scientific principles (inevitably quantum physics as a rule), non-homeopaths are just too feeble-minded to see it. Yet, when the paucity of their ‘scientific’ evidence is pointed out to them, instead of doing the scientific thing by upping the ante and performing better tests homeopaths instead accuse critics of prejudice and bigotry while at the same time doing a volte face and hiding behind the skirts of New-Age philosophising. From this refuge they will claim they’ve changed their mind and actually homeopathy can't be tested by science afterall (that is until the next poorly performed trial comes along which claims even the smallest of effects from homeopathy, at which point all the mental gymnastics and philosophical navel-gazing get quietly shelved!). This really is wanting to have one’s cake and eat it, but that isn't how science works.

Homeopathy craves all the kudos and credibility science brings but will not accept the scientific process and the discipline that comes with it – mainly the discipline of discarding cherished beliefs in the face of contradictory evidence. It is homeopaths who are attempting to prove homeopathy by science, not scientists. If they were content to present themselves as practitioners of a mystic, unexplainable and untestable philosophy this whole debate would have a very different tone.

What follows is a selection of plausible sounding arguments often put forward in favour of homeopathy. Many of them have a convincing ring and are to be found in a variety of homeopathic web sites and books, many of the questions below are direct quotes from such material.

They are sometimes put forward by people who should know better and who rightly wouldn’t accept such arguments if used to try to convince them that a conventional drug was safe or effective.

When looked at in a little detail however they are found to be inadequate. All they do is confuse the issues and cloud the real argument, generating a lot of heat, and diverting any discussion away from the key question of reliable evidence.

Nevertheless they still continue to be put forward, despite their highly questionable logic, often in the belief that they offer decisive reasons for the continued use of homeopathy.


Index:

  1. The establishment is conspiring to suppress the truth about homeopathy. [Link to RationalVetmed.net blog post]
  2. If there is nothing to homeopathy then why waste so much effort in denouncing it, why not just ignore it?
  3. Sceptics just can’t bring themselves to believe in homeopathy because deep down they fear that perhaps there is something there.
  4. There are thousands of cases which have responded to homeopathy and it is too simplistic to say that these patients and clinicians are deluded and the rest of the population is sane.
  5. Some conditions have lasted weeks, months or even years, yet a change is seen within a short period of having taken a homeopathic remedy. This is too unlikely to be simply a coincidence.
  6. How can you criticise homeopathy if you haven’t studied it? How can you say it doesn’t work if you haven’t tried it?
  7. Scientists are too closed minded to admit that homeopathy works.
  8. Conventional medicines have hundreds of side effects, homoeopathy is completely safe, surely its use must be justified.  What about thalidomide?
  9. Look - here’s a paper with perfect methodology, a double blinded, randomised placebo controlled trial which confirms that homeopathy works and it has a 95% confidence interval.  Surely this must convince the sceptics!
  10. Farmers using homeopathy are hard nosed businessmen and wouldn’t use it if it was a waste of time.
  11. But we don't even know why mainstream drugs work, why pick on homeopathy - what about anaesthetics!   
  12. Homeopathy is a different way of knowing and works perfectly well within its own frame of reference – it cannot be judged by science.