Homeopathy and Skepticism

Articles on the debate between skeptics and supporters of homeopathy about whether homeopathy it a real form of medicine or quackery.

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.

Skepticism About Homeopathy: Can’t We Just Ignore the Skeptics?

Homeopathy is the bad boy of healing systems. Over 200 years after its inception it continues to generate controversy, and being skeptical about homeopathy is far more popular than simply accepting it as is.

It is not surprising, therefore, that possibly the most popular article on this blog has been Is Homeopathic Medicine the “Enemy of Reason”?, where I offered an example of the media’s sensationalization of the alleged scientific implausibility and irrationality of homeopathy.

Why be skeptical about homeopathy in a homeopathic blog?

There are four main reasons for being interested in the skeptical perspective on homeopathy:

  1. Perhaps the skeptics will turn out to be correct: homeopathy is all a big lie, and I shouldn’t be wasting my life and your time.
  2. More soberly, engaging with the skeptical arguments against homeopathy helps one in developing a balanced, well-reasoned perspective on the subject: while skeptics are not likely to sway me and those of you who have experienced homeopathy’s benefits away from it, I think it is important for each of us to avoid accepting homeopathy uncritically, either.
  3. Not least because I am convinced that homeopathy is real, I believe that entering this debate encourages a deeper assessment of the adequacy of the current scientific paradigm or world-view in explaining (i.e., incorporating rather than rejecting as unreal) the many known yet unexplained phenomena of which we have knowledge. This will, in turn, lead to a more inclusive future paradigm that has yet to be articulated fully.
  4. Homeopathy is under a constant battle for public opinion. In this battle homeopaths are outnumbered by the mainstream scientific and medical communities and their media outlets, which allocate significant resources toward defending the official world-view to which they pledge allegiance. Gains and losses in this battle roughly translate into gains and losses in the success of homeopathy in reaching a wide population and thereby fulfilling its potential for bettering humanity.

Of these the last one is of most concern to the homeopathic community: Because of the influence of media on public opinion and on regulatory bodies, homeopaths must engage with their skeptical critics rather than hope to survive in isolation from such worldly troubles.

Trial by media

Most of the public debate on homeopathy is stimulated by media reports that favor a skeptical view of homeopathy, most often based on complete ignorance of the subject matter. As a result of such negative media coverage, many people who know nothing of homeopathy (and very little of the foundations of modern science) hold a critical view of it.

The people who inform the media range from clueless journalists to professional skeptics who are rarely clueless but often disingenuous in their skepticism. The list of such skeptics includes academics such as Michael Shermer, Richard Wiseman and Richard Dawkins, magicians such as James Randi, and physicians such as Stephen Barrett and Ben Goldacre.

Some of these skeptics are high-level or world-class scientists in their domain (Richard Dawkins is a leading evolutionary biologist). Others are media figures who achieved fame prior to becoming professional skeptics (James Randi won fame during his early career as a professional magician appearing on television), and others yet have garnered attention thanks to their journalistic rather than their primary professional pursuit (Ben Goldacre is a physician who writes a weekly skeptical column for England’s Guardian newspaper).

While in some cases skeptics are professionally suited to their task (e.g., James Randi regularly applies his magician skills to the debunking of fraudulent claims by reproducing the phenomenon under investigation) all skeptics are limited in their ability to evaluate phenomena in which they are not themselves expert.

To bypass this limitation, for example in the case of a non-homeopath skeptic investigating homeopathy, skeptics apply standard criteria of evidence to questionable phenomena, whereby they determine whether a phenomenon is real by whether or not it passes a test that they devise based on their understanding of what constitutes evidence for or against the phenomenon in question. Consequently they engage in “armchair skepticism” rather than sincerely encountering the field or belief they are criticizing.

At best, armchair skepticism is a shortcut to the truth: it allows the skeptic to sift through most bogus claims and distill most true claims without needing to spend an inordinate amount of time on each. But frequently armchair skepticism is inadequate, because its superficial approach cannot penetrate into phenomena that cannot easily be distilled into black and white.

And as should well know by now, I regard homeopathy as a phenomenon, field of medicine, and set of beliefs that is anything but black-and-white!

Skeptics exert a powerful influence on regulatory bodies

Debates on homeopathy usually take place in remove from clinical reality, often between scientists and physicians who have little or no inside knowledge of the practice of homeopathy (whether they are in favor or against it).

Yet it is such debates that influence government policies worldwide as well the general public which these governments serve, and therefore determine to what extent homeopathy is simply allowed to be, encouraged to flourish, or actively suppressed.

At present, the homeopathic profession is functioning and often thriving in many places worldwide, outside of official legislative frameworks such as governmental regulation. Indeed, its rate of growth is among the highest of all forms of natural medicine.

But homeopathy could be in a much better state if it were to be the recipient of outside financial resources rather than self-supported. Furthermore, certain legislative moves could hamper its present level of activity, even crippling the profession as it was crippled following the 1910 publication of the Flexner Report which led to the standardization of medical education in the US, to the benefit of modern medicine and detriment of naturopathy and homeopathy (both of which had been highly evolved, growing professions until then).

What are the main issues in the homeopathy debate?

In upcoming articles on this topic I will be answering the following questions which represent the main issues in the ongoing ‘homeopathy debate’:

  1. What are the main skeptical arguments against homeopathy?
  2. What are the proper responses to these arguments?
  3. What scientific research is there in support of homeopathy?
  4. What other data are admissible as evidence for homeopathy?
  5. What conclusions should be drawn (by homeopaths, patients, scientists, and regulatory bodies) from these research findings?
  6. Can homeopathy be explained within the context of the current scientific paradigm?
  7. If not, what world-view could incorporate modern science and medicine, homeopathy, and other unexplained phenomena without mutual conflict?

I believe that this debate has been ongoing for the entire duration of the existence of homeopathy because it brings up fundamental questions about the nature of reality that have remained unanswered by modern science. Besides the remarkable clinical results of homeopathic treatment, it is for this reason that I find homeopathy fascinating: it is a portal to a deeper reality that we are only now beginning to understand.

Debating the Availability of Publicly Funded Homeopathic Treatment

In the recent article on skepticism about homeopathy we saw how we cannot ignore skeptical media reports because of their powerful influence on the acceptance of homeopathy in society. Well, if we cannot ignore them then let’s debate them!

In today’s article I present a video of a recent debate between physician and homeopath Peter Fisher, clinical director of the Royal London Homoeopathic Hospital (the same one who appears in Dawkins’ The Enemies of Reason) and Ben Goldacre, a physician and skeptical columnist for England’s Guardian newspaper.

The importance of debates such as this is that they influence not only the public but also regulatory bodies that rely on self-appointed experts on both sides of the debate in crafting their policies. In some cases their regulatory decisions exert a significant influence on the state of homeopathy locally and internationally.

Availability of publicly funded homeopathic treatment in the UK

Should homeopathy be available under publicly funded medical programs such as Britain’s NHS (National Health Service)?

Recently there has been a movement afoot to eliminate all UK government spending on homeopathy, after many decades of limited but significant support.

Thanks to the Royal family’s use of homeopathy over the past few generations, there happen to be four government-funded homeopathic hospitals in the UK, where patients can access a combination of conventional and homeopathic treatment along with other alternative services. These hospitals are now under risk of closure due to discontinuation of their government funding. (Incidentally, if you ever experienced the benefits of homeopathy you may sign the “‎Homeopathy Worked for Me‎” online petition which has been organized in response to this troublesome state of affairs — both UK and international residents may sign.)

By learning about this particular debate we can better understand the dynamics between supporters and opponents of homeopathy, and the social consequences of their interaction, wherever in the world these debates might take place.

The video’s total length is 1h33m, of which the following sections are relevant to us:

  1. 6m-26m: Peter Fisher (pro-homeopathy) retells some cases of ‘bad science’ that argue that homeopathy has no effect followed by ‘good science’ that shows that homeopathy has an effect.
  2. 30m-50m: Ben Goldacre (anti-homeopathy) presents the basic principles of skepticism, engages in “armchair skepticism” by declining directly to challenge any of Fisher’s positive evidence.
  3. 1h1m-1h30m: Audience debate, in which several interesting comments in favor of homeopathy are made (the audience in this case is made up mostly of supporters of homeopathy).

The present episode serves as an illustration of the ongoing dialogue between supporters and opponents of homeopathy.

Relevance to other countries

Legislative trends in certain countries often have worldwide implications. If homeopathy were to take a step backward in the UK then it might have less of a chance of being supported elsewhere in the near future, regardless of positive clinical outcomes and patient satisfaction.

Even detractors of homeopathy will admit that the homeopathic hospitals offer a valuable service to the community by striving to maximize patient choice through a broad selection of conventional and complementary treatments: external referrals from ordinary physicians are their main source of patients, and surveys show high patient satisfaction and positive clinical outcomes.

But despite this they consider any expenditure on homeopathy unjustified given, as they claim, its scientific implausibility and lack of demonstrated efficacy in randomized, placebo-controlled trials. In other words, they see any expenditure on unproven therapies as unjustified in principle.

So we see that the fact that there is demand for homeopathy and that homeopathic treatment likely saves health-care resources (by diverting patients away from more costly conventional care) is not enough for ensuring its ongoing, unhindered development. The debate on the status of homeopathy is thus a debate on the extent to which mainstream scientific opinion should determine which treatment choices we pursue.

It is difficult for skeptics to forbid everyone from pursuing homeopathic and other alternative treatments. But it is possible for them to make it more difficult and costly than it could otherwise be, and thereby to prevent from many people from experiencing the benefits of alternative medicine.

Further reading

You may explore the current UK situation in greater detail by following the links below. For a more general view of a typical debate on the scientific status of homeopathy see the lengthy discussion between myself and several defenders of Ben Goldacre’s position as mentioned below.

  1. Open letter calling for a boycott on homeopathy (see also the comments that follow it), written by a group of UK physicians and academics headed by Edzard Ernst (a physician who investigates alternative medicine), demanding that NHS support for homeopathy be stopped.
  2. Peter Fisher’s reply to the above letter.
  3. A recent editorial titled Benefits and Risks of Homoeopathy published in The Lancet (a British medical journal of worldwide influence) by Ben Goldacre, followed by a discussion between myself and Ben and several of his supporters on his site Bad Science. This discussion offers a lively illustration of how such debates are typically not resolved, because each side views the raw evidence through the lens of pre-existing assumptions.
  4. A more recent article about funding cuts for homeopathic services that are already taking place in the UK.

Again, please sign the online petition in support of government-funded homeopathy if you have experienced its benefits and wish to voice your support of it in the UK and beyond.

Have your say below: Should homeopathic treatment generally be funded by the taxpayer or financed privately?