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16 November, 2007

Some hope for understanding

Ben Goldacre has republished two articles at Bad Science today.  One, for the Lancet, is a wonderfully clear and concise summary of why homeopathy is and is not of genuine use, with both risks and benefits. However, without wishing to patronise, I suspect its phrasing could be misinterpreted by those unfamiliar with key concepts of scientific methodology and statistics.
The other article, for the Guardian, is a rewrite of the same piece for a less-specialist audience, incorporating a very accessible explanation of those key concepts.

Both are very well worth reading, especially by supporters of homeopathy, who should at the very least accept the suitability of careful self-reflection.

Unfortunately, as a commenter at Bad Science suggests, that open consideration mightn't be possible, not necessarily due to vindictiveness or over-defensiveness, but because of an inability of anti-scientists to comprehend the value of scientific methodology:

The point I twigged after a while was that she cared not in the slightest about evidence. In fact she treated the whole issue of evidence as some sort of underhanded sophistry on the part of “the establishment”. I think this is at the heart of the whole issue. We have managed to arrive at a point in our development as a species where large numbers of people actively prefer the irrational to the rational. Those of us educated in science or any evidence based discipline simply do not have the ability to understand that position, at least I know that I don’t.
I don’t think its is about insulting intelligence per se. Maybe it is about different types of intelligence. My dinner companion was certainly not stupid in her contributions to the conference or in lots of other ways. She just had a very specific approach to this subject. If I had not made the remark about quantum physics I would never have had any reason to question her intelligence.
As I said a few days ago, I, er, believe that mass-media have some responsibility in this, in devaluing specialist research by presenting everything as, at best, a debate between equals, and encouraging the idea that any reader/viewer's opinion on a topic is just as valid as any expert's evidence.

Comments

i don't have a problem with the subset of "alternative" medicine which essentially acts as a cultural framework for triggering the placebo effect. eg the rather nice studies recently which showed profound benefits from randomly used acupuncture needles.

however i DO have a problem with the self-appointed priests of the homeopathic industry/"alternative" medicine industry. they are motivated, like most UK doctors, by a need for status rather than a genuine drive to pursue their nominal purpose: to help the patient. as such, they cloud and obfuscate and insist on bandwagon assertions, rather than looking at evidence. the same syndrome is highly prevalent in conventional medicine, to be clear.

so, go: homeopathy, but bin homeopathists.
same principle with religion and politics and law, tellingly.


interestingly, if muddlingly, some research noted in new scientist last year actually suggests homeopathy could have a valid scientific basis. a chap studying the quantum level behaviour of water (a VERY strange chemical) accidentally discovered that after being exposed to various chemicals and then re-purified, water behaved differently, persisting in behaviour it had acquired during the exposure. fully replicable but neither he nor the replicators could explain it, other than suggesting the known changes in micro-clumping structures (can't remember the actual terms they used) persist and that these have real macro-level "chemical" effects. fascinating stuff.

Posted by Saltation at November 21, 2007 11:39 AM

"i don't have a problem with the subset of "alternative" medicine which essentially acts as a cultural framework for triggering the placebo effect. eg the rather nice studies recently which showed profound benefits from randomly used acupuncture needles."

To be fair, nor does Ben G., who counts the placebo effect as valid and valuable, and has cited the same acupuncture study.

"however i DO have a problem with the self-appointed priests of the homeopathic industry/"alternative" medicine industry. they are motivated, like most UK doctors, by a need for status rather than a genuine drive to pursue their nominal purpose: to help the patient."

My sister is an orthopaedic registrar. I don't disagree with you. ;)

"as such, they cloud and obfuscate and insist on bandwagon assertions, rather than looking at evidence. the same syndrome is highly prevalent in conventional medicine, to be clear."

Maybe in stereotypical 'big pharma' marketing, but I'd question the assertion that it's routine in conventional (aka evidence-based!) medicine.

"interestingly, if muddlingly, some research noted in new scientist last year actually suggests homeopathy could have a valid scientific basis."

Wonderful. I'd entirely welcome that, and confidently suggest Ben G. would agree. We'd both have a caveat, of course:
The researcher would need to prove his/her claims, by reproducable means, then publish a peer-reviewed paper in a recognised, independent academic journal (not a popular science magazine). That's where homeopathy research tends to hit problems: proof.

Posted by NRT at November 21, 2007 04:57 PM

yeah, that's the exciting thing -- apparently it WAS replicated. and it was first published in a real journal, and that's how new scientist picked up on it.

i personally disbelieve the bulk of the general homeopathy blurb. but the whole concept and practice of vaccination relies on the training of one human feedback system to include a new trigger pattern. and there are any number of suggestions of other feedback systems we just don't properly understand/perceive yet. (eg, the 3-repetition which magically magnitudinally increases the strength and accuracy of remembrance was discovered a few years ago to be down to an overlooked GLIAL chemical behaviour -- yes, that "90% of your brain is unused" stuff that is still taught in unis as being mere framework for neurons)

and these feedback mechanisms generally don't need a huge volume of input, merely a new type of input.

so i'm cautiously intrigued/excited by the idea that homeopathyish insertions of new pattens to the mechanism but safe patterns for the rest of the body, could be used to trigger wholesale internal changes, driven by and taking advantage of the body's own existing adaptive "mechanisms". just like vaccinations today.

> > "as such, they cloud and obfuscate and insist on bandwagon assertions, rather than looking at evidence. the same syndrome is highly prevalent in conventional medicine, to be clear."
> Maybe in stereotypical 'big pharma' marketing, but I'd question the assertion that it's routine in conventional (aka evidence-based!) medicine.

ahhhh... here we have a "lovely" example of two entirely different concepts being unfortunately described, or rather referenced, with the same words.


brief but relevant digression: i personally distinguish between 3 key attitudes to a task/goal (inclusive of the awareness of the distinction):
• scientist
• engineer
• technician.
the technician uses the toolbox the way he was taught ; the engineer understands the toolbox and the goals, and uses that understanding to choose the appropriate tool from the toolbox for each task to best achieve the goal ; the scientist strives to improve the toolbox, and usually does so by seeking a better understanding of how things REALLY work.

(in a coding context, perhaps: object, coder, language designer) (cook, chef, chemist) (thug, general, diplomat) (normal, clever, pointy-end)

((mum, ramsay, blumenthal))

although you would ideally want all Professionals to be "engineers" in this framework, in practice the overwhelming bulk are focussed on other things and are merely "technicians" in their nominal job. (the realisation of this is one of the key loss-of-youthful-vim events in one's life)


in this context but now getting back to the topic at hand, i was thinking/intending the normal practitioners/"technicians", but you were thinking/reading "scientists"/researchers.

at the pointy end, i agree with you.

but i was thinking more about the whole UK medical corpus, which is overwhelmingly practitioners. "medicine as she is wrote".

or perhaps rather, "medicine as she is rote".

( In this sense, it's a much fairer comparison than Goldacre's since he juxtaposes dedicated pointy-end specialist researchers supported by a huge and culture-wide infrastructure, with tiny unfunded bodies of unsupported nonconformist practitioners wearing multiple hats (i'm being charitable at both ends here). )

i have been only horrified by the uk medical profession. the combination of arrogance, baseless assertion, incompetence/wilful inaction, and self-righteousness displayed by near every GP, nurse, and consultant is far superior to all but the most psychotically obsessed of the "alternative therapists" here. they bleat standard "facts" (discarded as obsolete in most other countries decades ago) with religious righteousness, regardless of the consequences for others. mention to a practitioner that "high blood cholesterol" (inaccurate in and of itself) is primarily caused by sugar, for example, rather than by eating cholesterol or fat, and see what happens. i was present at a royal society lecture where the president of the rs put a rocket up the nobel committee for their parasitic incompetence in not giving the speaker a nobel prize already (seriously. shocked silence across the vast pallmall room.), and said speaker then described not only the process and practice of his outstanding discovery about the actual mechanism driving high blood pressure (failure of the inner epithelium of arteries to produce sufficient NO to regulate the default behaviour of arteries to muscularly close solid), but also how the BMA expressly told him to fcuk off because he was denying "facts".
i could go on...
i too often do...
i am again...

suffice to say that every characteristic of the homeopathism subculture that goldacre derides is represented in spades in conventional medicineism. worryingly, that comprises a VASTLY larger number of people. and more worryingly, comprises people in key and mandatory "gatekeeper" positions.


here's an amusing but enlightening way of looking at it. the homeopathismists, in seeking to sculpt community perception to suit their goals, are the left wing of medicine, struggling against the right wing, the conventionalismists. and both sides, as always, in every demesne, are using the same weapons. and, as always, in every demesne, for the same non-demesne goals. "four legs, good. two legs, BETTER."

Posted by Saltation at November 22, 2007 02:11 AM

"or perhaps rather, "medicine as she is rote"."

Ah. Right. Yes, we were talking at cross purposes!

Posted by NRT at November 22, 2007 11:08 AM

Dont be too quick to dismiss all alternative medicine. Science and medicine have a vital place but there is more to life and health than this, the whole spiritual aspect of humanity should not be overlooked.

Posted by colin at December 3, 2007 08:55 AM

Well, yes, we've already mentioned the placebo/psychosomatic effect. And that's not being dismissive – I fully accept that treatment works best if people believe it works.

I don't think many people would casually dismiss all alternative medicine. Though a lot of it is meaningless 'woo', there may well be genuine worthwhile effects. However, the precondition for acceptance is that alternative therapists must prove all their claims, point-by-point, in scientific terms. Empty belief (on the part of the practitioner) is never acceptable.

What people do in private is no business of mine, but no, I wouldn't say that spirituality has a place in mainstream/commercial medicine, just as religion has no valid place in public life.

Posted by NRT at December 3, 2007 10:57 AM
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