Saturday, 28 November 2009

Quacking Up

Ben Goldacre writes:

This week the parliamentary science and technology committee looked into the the funding of homeopathy on the NHS and the evidence behind the decision of the MHRA, which regulates medicines, to allow homeopathy sugar pill labels to make medical claims without evidence of efficacy.

There were comedy highlights, as you might expect from any serious inquiry into an industry where sugar pills have healing powers conferred upon them by being shaken with one drop of the ingredient which has been diluted so extremely that it equates to one molecule of the substance in a sphere of water whose diameter is roughly the distance from the Earth to the sun.

The man from Boots said he had no evidence that homeopathy pills worked, but he sold them because people wanted to buy them. The man from the pill manufacturers' association said negative trials about homeopathy were often small, with an average of 65 people, and "all statisticians" agreed you need 500 people for a proper trial. Not only is it untrue that you necessarily need this many people; he then cited, in his favour, a positive homeopathy trial with just 25 patients in it.

The best moment was Dr Peter Fisher from the (NHS-funded) Royal London Homeopathic hospital explaining that homeopathic sugar pills have physical side-effects – so they must be powerful.

Can a sugar pill have a side-effect? Interestingly, a paper published in the journal Pain next month looks at just this issue. It found every single placebo-controlled trial ever conducted on a migraine drug, and looked at the side-effects reported by the people in the control group, who received a dummy "placebo" sugar pill instead of the real drug. Not only were these side-effects common, they were also similar to those of whatever drug the patients thought they might be receiving.

This is nothing new. A study in 2006 sat 75 people in front of a rotating drum to make them feel nauseous, and gave them a placebo sugar pill: 25 were told it was a drug that would make the nausea worse. It did get worse, and they also exhibited more gastric tachyarrhythmia, the abnormal stomach activity that frequently accompanies nausea.

A paper in 2004 took 600 patients from three different specialist drug allergy clinics and gave them either the drug that was causing their adverse reactions, or a dummy pill with no ingredients: 27% of the patients experienced side-effects such as itching, malaise and headache from the placebo dummy pill.

And a classic paper from 1987 looked at the impact of listing side-effects on the treatment consent form. This was a large trial comparing aspirin against placebo, conducted in three different centres. In two, the form outlined various gastrointestinal side-effects, and in these centres there was a sixfold rise in the number of people reporting such symptoms and dropping out of the trial. This is the amazing world of the nocebo effect, where negative expectations can induce unpleasant symptoms, in the absence of a physical cause.

And in any case, it doesn't help homeopaths: In 2003 Professor Edzard Ernst conducted a systematic review, finding every homeopathy trial that reported side-effects. There was no significant difference in the rates of side-effects between patients given placebo and those given homeopathic remedies.

The world of the homeopath is reductionist, one-dimensional, and built on the power of the pill: it cannot accommodate the fascinating reality of connections between mind and body which have been elucidated by science.

The next time you find yourself trapped at dinner next to some bore who's decided in middle age that they have secret mystical healing powers, while they earnestly explain how their crass efforts at selling sugar pills represent a meaningful political stand against the crimes of big pharma, just think: some lucky person, somewhere in the world, is sat next to a nocebo researcher.

How can there be any such thing as “complementary medicine” or “alternative medicine”? If it works, then it is just medicine. And it does work, doesn’t it?

The current popularity of these things is, like so much else, the result of our culture’s having moved away from the uniquely Christian rejection of humanity’s otherwise universal concepts of eternalism (that the universe has always existed and always will), animism (that the universe is a living thing, an animal), pantheism (that the universe is itself the ultimate reality, God), cyclicism (that everything which happens has already happened in exactly the same form, and will happen again in exactly the same form, an infinite number of times) and astrology (that events on earth are controlled by the movements of celestial bodies).

Science cannot prove that these closely interrelated things are not the case; it simply has to presuppose their falseness, first established in thirteenth-century Paris when their Aristotelian expression was condemned at the Sorbonne specifically by ecclesial authority, and specifically by reference to the Biblical Revelation.

This is why science as we now understand the term never originated anywhere other than in Mediaeval Europe. And it is why science did not last, or flower as it might have done, in the Islamic world: whereas Christianity sees the rationally investigable order in the universe as reflecting and expressing the rationality of the Creator, the Qur’an repeatedly depicts the will of Allah as capricious.

By turning away from ecclesial authority’s articulation and protection of the Biblical Revelation, and by turning away from the Biblical Revelation itself, the civilisation that these things called into being has turned away from science and towards eternalism, animism, pantheism, cyclicism and astrology, to the extent that a few years ago a Doctorate of Science was awarded to François Mitterand’s astrologer by, of all institutions, the Sorbonne.

And eternalism, animism, pantheism, cyclicism and astrology, inseparable from each other, underlie, among so very much else, each and every form of “alternative medicine” or “complementary medicine”, contradictions in terms that these are.


  1. "cyclicism (that everything which happens has already happened in exactly the same form, and will happen again in exactly the same form, an infinite number of times)"

    I'm becoming increasingly convinced of this one.

  2. Your recurring comment may be an example of it.

  3. David,
    Clearly you've never experienced a health problem that mainstream medicine couldn't help. Your close-minded attitude is a reflection of your limited life experience. For those of us who've been to Mayo Clinic without success, we're thankful there are hundreds of therapies that have been proven safe and effective for decades, hundreds,even thousands of years. Is it placebo effect? Maybe the placebo effect is simply a term to describe the body's own healing mechanism. Whatever it is, I'm glad there are ways to use it otherwise I'd still be suffering and in pain at the hands of medical doctors.

  4. "hundreds of therapies that have been proven safe and effective for decades, hundreds,even thousands of years"

    The active ingredient will be identifiable scientifically. That may not yet have happened. But it will be possible.