The Evidence

Rational Veterinary Medicine:

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Anyone spending time looking at references about homeopathy will very quickly become aware that a relatively small number of papers are presented again and again during debates involving homeopaths as supposed ‘proof’ of its efficacy. These papers (the "usual suspects") crop up with such regular monotony that they have been given a separate section here, although the critiques are found with the main body of citations on the web site.

Mostly these are meta-analyses (i.e. papers which ‘summarise’ lots of other papers to get a broader view than can be obtained from just a single paper) and they are presented and re-presented in so many lists so frequently that they are obviously just being copied and pasted from place to place without anyone actually reading the papers themselves. Because whatever else they do the “usual suspects” do not support homeopathy and it quite frankly beggars belief that anyone could believe they do. As Bandolier says, "If this is the best they can do, why bother?"

Which papers constitute the usual suspects varies slightly but the core ones are:

Boissel et al (1996) and Cucherat et al (2000) (these first two are pretty much the same thing, despite what the homeopaths would have us believe!)
Kleijnen et al (1991)
Linde et al (1997)
Mathie (2003) (this is mentioned occasionally)

On the flip side there is also one or two frequently mentioned papers which are so obviously evidence that homeopathy is ineffective that even homeopaths aren’t able to spin their results (although some do try) in their favour. These ‘bete noirs’ are primarily Shang et al (2005), with Ernst (2002) also being mentioned occasionally. As they don’t say what homeopaths want to hear these papers are roundly denigrated for being unfair, inadequate, unscientific, unhomeopathic and so on and the authors are subject to personal, ad hominem attack. Again, such criticisms have been refuted, but homeopaths prefer to ignore that too, as they ignore refutations of their wildly optimistic claims about the ‘usual suspects’.

I seem to have spent years as a sceptic, optimistically posting and reposting the ideas and opinions you will read in this web site in a wide range of contexts: discussion groups, forum threads, veterinary literature and so forth. On one occasion, many moons ago, I replied to a letter published in the veterinary press from a leading veterinary homeopath and I carefully and painstakingly refuted the claims he was making for some of these papers. Six years later, in a similar discussion on a different forum however he was still posting the same tired old references, apparently not having read a word of what I had written. Such is the nature of the true believer.

It appears impossible for homeopaths to admit that these papers are not what they claim despite the fact that their claims for homeopathy are incredibly weak and garnered around with so many qualifiers and get-out clauses that any positive findings are weaselled away to nothing. These few papers are held up time and again as proof positive that homeopathy work and I’m sure homeopaths have convinced themselves that they are right. Well, they’re not as you will find when you read further on this site.

In reality this is a war of words, not evidence. Homeopaths realise that most people are trusting and will take the word of a plausible sounding advocate, and not look up the references for themselves. By the same token most sceptics should realise that it will never be possible to get homeopaths to understand how science works and why they are so wrong in their beliefs. Nevertheless it is still vital to keep countering their preposterous claims whenever they are made simply in order to make sure that everyone hears both sides of the argument. Not just the sunny, optimistic anything-is-possible type of homeopathic propaganda but the other, true side of the story.

This true picture is inevitably more mundane; in contrast to bogus homeopathic certainties (all cure, no side effects) you have the real world with all its doubts and uncertainties and the scientific process whose main claim to fame is that it is constantly questioning and re-inventing itself. It is perhaps human nature to turn away from such ‘shifting sands’ to the shallow promises of the homeopaths. We all want to believe that what is true today will also be true tomorrow and the next day but unfortunately life isn’t like that; science isn't magic (unlike homeopathy), it is real.

We don’t know everything, as homeopaths are so fond of reminding us, so obviously as new information and fresh facts come along things will change; that’s how things get better, science is self correcting. Proper medical science is only 100 years old at most. We are still learning. That may be unsettling, but we have to be grown up about it. Medical science has given us so many miracles that it is easy to forget what we owe it, even in its infant state. Vaccination, the control of mass epidimics of polio, small pox, cholera and more; increased life expectancy and cures for many disease which even a couple of decades ago would have been death sentences, to name but a few.

Now, with so much misery, deformity and death controlled by technology we take for granted, society is starting to look at the fine detail, the ‘small print’ if you like, we are looking the gift horse in the mouth. ”What about Thalidomide?” is the rallying cry of the modern technophobe. Well, no one is denying there are two sides to medical technology but the answer is to do more research, more work and more education and to get it right next time because we know the massive benefits it can bring.

The answer is most emphatically not to turn to some misty eyed guru who promises everything and delivers nothing. Looking at the evidence might sound mundane, hard work even, it certainly can be tedious. But it is the only way we’ve got to really find out about the world around us and what makes it and us tick. Science allows us to think for ourselves - and that is a very good thing.


Further reading:

Articles dealing with these papers and others can also be found here:

British Veterinary Voodoo society

“What value references” - Letter to the Veterinary Times

David Ramey at ACHS (2000)

Stephen Barret at homeowatch

Edzard Ernst in UK House of Commons Science and Technology Committe evidence check 2 - Homeopathy (p18) - there is also a detailed analysis of other papers in Table 1 (p88) and Table 2 (p90).

Edzard Ernst blog - Prof Ernst was involved in the Cucherat et al 2000 paper himself, and has a lot of useful information about it and the other “usual suspects”!

Articles on homeopaths' selective view of evidence can be found here:

Ben Goldacre on homeopaths' "ambivalent" attitude to evidence: "By pushing their product relentlessly with ... scientific flim-flam, homeopaths undermine the public understanding of what it means to have an evidence base for a treatment".

More from Ben Goldacre on homeopaths' two faced attitude to research "With alternative therapists, when you point out a problem with the evidence, people don't engage with you about it, or read and reference your work. They get into a huff. They refuse to answer calls or email queries. They wave their hands and mutter sciencey words such as "quantum" and "nano". They accuse you of being a paid plant from some big pharma conspiracy. They threaten to sue you..."

The Usual Suspects