“We read the world wrong and say that it deceives us.”
Rabindranath Tagore

The homeophobes (a term coined by Jeanette Winterson in her Guardian article In Defence of Homeopathy this week) really seem to have the bit between their teeth these days. Yesterday’s publication of The Lancet revealed a comment piece penned by none other than Ben Goldacre, which he supplemented by a more emotive piece, A Kind of Magic?, saying much the same thing in the Guardian.

While recognising the utter pointlessness of arguing back – irreconcilable systems of thought can’t be reconciled in each other’s terms but only by a system of higher order, a metatheory that can encompass both (see Unscientific Attachment for more on this) – I felt Goldacre has had things his own way for quite long enough and it was time to send a letter to the Guardian. Whether it’s published or not is another matter, of course, but here it is in any case.

Sirs

In his November 16 Bad Science article A Kind of Magic?, Ben Goldacre writes: “This is all good fun, but my adamant stance, that I absolutely lack any authority, is key: because this is not about one man’s opinion …”

Unfortunately Dr Goldacre seems somewhat deluded on this point. This is very much about one man’s opinion (and a few others like him). He seems very fond of assuming the mantle of ‘science’ and claiming to speak in its name. However, ‘science’ does not speak with one voice – if it did, it wouldn’t be science – and his oft-repeated mantra that homeopathy avoids scientific scrutiny and that there’s no proof for its efficacy is complete nonscience. There are many people within the boundaries of what Dr Goldacre might define as ‘science’ working hard on the subject, and a large number of high quality trials testing the therapy in terms of its principles as well as its remedies have now been published.

So many, in fact, that the 2005 Shang et al meta-analysis which featured in The Lancet’s last attempt to dismiss homeopathy identified 110 which matched their stringent criteria for inclusion. Why that 110 was reduced to 8 unidentified trials in the final analysis still remains to be answered. At the very least this was a violation of transparency which should never have passed peer review. The analysis also failed to make any comparison between the homeopathic and conventional trials it finally selected. Could that be because there was no statistical difference between the two interventions? So if homeopathy is nothing but placebo, and conventional medicine no better, why is the NHS teetering towards bankruptcy because of the amount it has to spend on drugs, which, according to a 2000 study in the Journal of the American Medical Association, are responsible for over 106,000 deaths annually in the US through side effects alone? We should all be on placebo!

Dr Goldacre holds up randomized controlled trials as the gold standard in evidence-based medicine but seems to forget that these are what they are – trials. It’s estimated that up to one fifth of all new prescription drugs may eventually be recalled or produce potentially harmful side effects (JAMA again, 2002). A 20% failure rate is not much of a gold standard. The gold standard for evidence-based medicine is surely “does it work in practice”? There are now several large-scale long-term clinical studies of homeopathy showing that it not only produces outcomes comparable with conventional medicine, but in some cases (a 2005 German study by Witt et al) better. A 2002 literature review by an Italian Advisory Board came to the same conclusion.

His adherence to the dogma that homeopathy’s use of extreme dilutions renders any potential action impossible is mistaking the map for the territory and ” … relies on a quaint old idea from the nineteenth century that the ONLY way that the property of water can be affected or changed is by incorporating foreign molecules. This is the Avogadro-limit high-school level chemistry argument. To a materials scientist this notion is absurd, since the fundamental paradigm of materials-science is that the structure-property relationship is the basic determinant of everything. It is a fact that the structure of water and therefore the informational content of water can be altered in infinite ways.” ?(Prof Rustum Roy PhD, Evan Pugh Professor of the Solid State Emeritus; Professor of Science, Technology and Society Emeritus; Professor of Geochemistry Emeritus, Pennsylvania State University).

Dr Goldacre may not value patient choice, but the interests of evidence-based medicine alone would seem to be demanding that he indulge in a little more scientific study and a little less opinionated prejudice. The research is all there and it would be kind of tragic if a valid and effective therapeutic option were lost to us for no good reason other than that it violates our present consensus conception of how the world works. The core of the scientific method is that if the evidence contradicts the theory then it’s the theory that gets questioned.

Yours etc

“There are two ways to be fooled. One is to believe what isn’t true; the other is to refuse to believe what is true.”
Søren Kierkegaard