Is Homeopathic Medicine the “Enemy of Reason”?

Homeopathy has been the target of criticism by skeptical scientists and physicians throughout its history. One has just been broadcast in The Enemies of Reason, a two-part British TV documentary about New-Age and alternative medical practices.

But this critical view of alternative medicine by a prominent scientist, shown in the video below, suffers from major flaws which I will comment on in this post.

The Enemies of Reason

The second episode of The Enemies of Reason, conceived and presented by Richard Dawkins (the prominent biologist who has gained a worldwide following as a defender of science and reason), is a blistering attack on alternative medicine.

Dawkins views the rise of alternative medicine as an abandonment of rationality in favor of the superstition that preceded the Enlightenment and the Scientific Age. Having in the first episode extolled the virtues of scientific over anti-scientific practices such as astrology, in the second episode Dawkins begins with faith healing and swiftly moves on to homeopathy as though it were their direct descendant:

Is homeopathic medicine the “Enemy of Reason”?

The following is my critical commentary on this episode and especially on Dawkins’ perspective on homeopathy. This is an expansion on a comment I wrote in a prominent skeptical blog, where I responded to an uncritically favorable review of the episode.

Dawkins’ arguments are naive

Dawkins views the worlds of conventional and alternative medicine in black-and-white: alternative medicine is unproven medicine, and as soon as a treatment is proven to work it becomes conventional medicine (or simply, medicine). Never mind that the clinical methods of homeopathy or Chinese medicine require years of concentrated study to master, or that these and other systems use specialized diagnostic systems and criteria of clinical improvement that do not even exist in conventional medicine.

Dawkins’ explanations for the efficacy of alternative treatments are standard fare, reducing all claims of efficacy to the placebo effect. To quote: “It’s all about attentive doctors listening to the patient.” In other words, homeopaths are successful because they are especially attentive to their patients and generous with their time. Never mind that doctors have the full right to engage with their patients as much as homeopaths do, and that homeopaths are attentive because they have to be: conventional physicians wouldn’t have use for a long appointment, because conventional diagnosis is based on a much narrower set of data than homeopathic diagnosis.

Yet another reason for the success of alternative practitioners, Dawkins claims without a shred of evidence, is that they are perceived as figures of authority in an era that has tired of traditional authority figures. Never mind that conventional medicine remains a colossal, authoritative institution, and that most people turn to alternative medicine due to dissatisfaction with conventional treatment rather than a distrust of conventional medicine.

Dawkins’ arguments are simplistic

Dawkins presents alternative medicine in a stereotyped fashion, as though it were a homogeneous entity like conventional medicine. But the reality is that there are countless practices in alternative medicine, ranging from ones based on conventional science (e.g., nutrition) to many that are not medical but are explicitly religious ceremonies adapted through market pressure for healing purposes, in detachment from their original ritualistic context.

Dawkins is at his best when picking on easy targets

When dealing with faith healers who present wacky theories about the universe Dawkins is flawless, instructive, and entertaining (in the best sense of the word): there is no doubt that a lot of what is grouped under alternative medicine is based on placebo, is often performed by practitioners who are poorly trained even in their own disciplines (let alone in scientific thought and medicine), and that some alternative practitioners are malicious in their intent.

Dawkins is at his weakest when picking on homeopathy

When faced not with random faith healers but with more serious, level-minded exponents such as Peter Fisher (homeopathic physician to Queen Elizabeth II and clinical director of the Royal London Homoeopathic Hospital), Dawkins fails seriously to engage with their perspective which is fully aware of science, its triumphs, and its failings. Dawkins is therefore at his weakest when dealing with homeopathy:

  • In Dawkins’ brief allusion to Samuel Hahnemann, the latter is made to look like a faith healer instead of the polymathic scientist that he was. Hahnemann was not only a physician who railed against the superstitious practices of his day, but a leading-edge chemist and an early advocate of experimental method (such that it was in his day) in medicine. But even if Hahnemann were dead-wrong about homeopathy, to suggest that he was irrational or not a scientist is ridiculous. After all, Newton had a lifelong fascination with theology more wacky than homeopathy ever will be, yet no scientist is bothered by this.
  • Dawkins blatantly omits the fact that homeopathic dilutions undergo a specific process of shaking (‘succussion’) that could produce some “memory-of-water” effect. While this description is speculative and metaphorical (as no one has yet explained scientifically how homeopathic information might be stored in water), describing the preparation process of homeopathic remedies as based on dilution alone is factually incorrect and leaves out a crucial step, as dilution alone (without succussion) produces homeopathically inactive remedies that are truly no better than placebo.
  • Dawkins misrepresents the one scientific study that he quotes as a comprehensive “meta-analysis of meta-analyses.” (A meta-analysis is a review of clinical studies, so the claim here is that the study is a review of reviews of clinical studies). In fact, the study he refers to is a methodologically suspect comparison of an a tiny subset of clinical trials (not meta-analyses) of conventional medicine with an unidentified subset of trials (not meta-analyses) of homeopathy, coupled with conclusions that didn’t follow from the in-part positive evidence. Many serious criticisms of this study have been published, including this one by Peter Fisher, yet Dawkins has chosen to adopt the trial’s conclusions uncritically.
  • At the same time, Dawkins fails to alert the viewer about truly comprehensive meta-analyses, some of which (e.g. this one) conclude that there is a modest evidential basis for the reality of the homeopathic effect sufficient to consider the phenomenon a possible anomaly vis-à-vis current scientific understanding.
  • Peter Fisher is himself of a skeptical mindset, admits to doubt, and has performed research to address his concerns. He admits that he will not be swayed by evidence in the sense of abandoning his clinical practice, but doesn’t claim blind belief in the reality of homeopathy above placebo and against experimental evidence, and continues in his research efforts accordingly. Dawkins fails to engage with this position, which combines concern for patients over-and-above scientific ideals (which Fisher nevertheless upholds) with rational skepticism identical to his own.

Let’s be skeptical of the skeptics

Dawkins’ critique is ultimately one-sided because his underlying belief is that, no matter how imperfect, modern medicine is fundamentally on good ground and therefore its imperfections are something we just have to live with, whereas the same faults in alternative practices are damning. This is, for example, why he bemoans the profit motive and poor evidential basis of alternative medicine without addressing the same concerns vis-à-vis conventional medicine.

Most significantly, Dawkins’ association of alternative medicine with irrationality is unsupported by fact. Scores of people no less rational that Dawkins submit to alternative treatments out of real despair arising from incurable conditions, and they frequently persist in their rational-skeptical world-view even after being helped (i.e., remaining agnostic about the explanation for their improvement).

I therefore do not agree with Dawkins’ overall concern that alternative medicine represents an abandonment of rationality, rather than a legitimate adjunct to conventional medicine, which it is rational to pursue, at least once conventional methods have been exhausted.

Ultimately, I would expect Dawkins to be consistent in his argumentation and to evade the charge of hypocrisy by providing:

  1. evidence (rather than anecdote) that people who submit to alternative practices are less rational than those who don’t;
  2. evidence that reduced interest in science is harmful (and in what way) to modern society;
  3. evidence that the modern world was built on reason alone and not also on patently theological elements of Western tradition;
  4. above all, an explanation of what exactly he means when he uses the word “evidence” in multiple contexts throughout the program, as though one could produce a randomized, placebo-controlled trial on demand and automatically obtain “fact” at the other end. Ah, if only the world were this simple!

Update: I discovered this account by Rupert Sheldrake, a biologist whose revolutionary ideas may offer the key to understanding how homeopathy works, of an interview that took place between him and Dawkins during the filming of Enemies of Reason. Sheldrake reports that Dawkins quit filming as soon as he brought up the issue of available evidence (in this case in favor of telepathy) that he had himself produced, thus exposing the refusal of even the best scientists to be swayed by evidence that conflicts with their pre-existing beliefs.

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