On to the goods. Let’s start with the title: “More evidence that alternative medicine boosters don’t really want scientific evaluation of their therapies”:http://oracknows.blogspot.com/2005/12/more-evidence-that-alternative.html. Pretty heady title. Looks like we have a hypothesis here: “Alternative medicine boosters don’t really want scientific evaluation of their therapies.” And, presumably, what Orac presents is “evidence” in favor of this “hypothesis.”
bq. Since the very beginning of this blog, I’ve said that I’d love to see “alternative” medicine treated on equal footing with conventional medicine.
“Bullshit”:http://www.randomjohn.info/wordpress/2005/10/05/straw-men/. He might drop that here and there, but his actions belie his words.
bq. Of course, this doesn’t necessarily mean what alties think it does. When I say “equal footing,” I don’t necessarily mean that alt-med should be treated with equal respect, although that might be the effect in some cases. No, what I mean is that it should be subject to the same standards with regards to efficacy and safety as that conventional medicines must meet before being approved for use and widely used by physicians. To my mind, if alt-med practitioners want to be treated with the same level of respect as conventional physicians and have their methods used more widely, it is only fair that they should have to jump through the same hoops and meet the same standards that conventional physicians and conventional medicines do.
I don’t know about you, but I hear a tinge of envy in these words. At least he says he’s stating an opinion.
bq. Not surprisingly, craving the acceptance and legal status given to conventional physicians by our society, some alt-med practitioners like to claim that they, too, want their remedies to be investigated scientifically, to have them tested in the same way that conventional drugs are tested. True, they often add a boatload of caveats, such as complaints that they’re too busy treating patients to do clinical trials or research, that they can’t get funding for their work (a much smaller problem since the National Center for Complementary and Alternative Medicine started handing out big grants to alties), or that drug companies aren’t interested in studying their remedies because they can’t make a profit off of them (never mind that supplement companies seem to do quite well selling them). Some of them are sincere, but I’ve always suspected that most of them would really prefer that science be kept away from their treatments.
Well, I can’t speak to what Orac may suspect or not, but I personally suspect he wouldn’t know a sincere alt-med practitioner if one bit him on the ass. But let’s break this down a little bit more.
bq. Not surprisingly, craving the acceptance and legal status given to conventional physicians by our society, some alt-med practitioners like to claim that they, too, want their remedies to be investigated scientifically.
This is known as “mind-reading”:http://ucsfhr.ucsf.edu/assist/articles/info.html?x=1059 (scroll down), and really indicates to me that Orac isn’t going to even give scientific studies showing noninferiority of an alternative therapy a fair shake (or the advocates of these therapies). He could surprise me.
bq. True, they often add a boatload of caveats, such as complaints that they’re too busy treating patients to do clinical trials or research, that they can’t get funding for their work (a much smaller problem since the National Center for Complementary and Alternative Medicine started handing out big grants to alties), or that drug companies aren’t interested in studying their remedies because they can’t make a profit off of them (never mind that supplement companies seem to do quite well selling them).
So what? What’s the point here? Do _all_ alt-med practitioners make these claims? How about some data to back this up?
BTW, let’s look at that last point. Many promising conventional therapies get stuck in drug development because funding runs out. And controversial medications, such as Plan B, get rejected for political reasons despite scientific demonstrations of safety and efficacy. While a lot of science goes into drug development, the decisions about what is safe and not safe are not always scientific.
Finally, however, Orac gives us something concrete to work with: an article about Edzard Ernst of Exeter University, who denounced homeopathy as “ineffective.” This man, who is “after [Orac's] own heart,” was hired to “bring scientific rigor to the study of alternative medicine.” Ok, fine. Sticking with the article, we find the following:
bq. ‘Homeopathic remedies don’t work,’ he told The Observer. ‘Study after study has shown it is simply the purest form of placebo. You may as well take a glass of water than a homeopathic medicine.’
Ok, I’m a biostatistician, so I think I can comment on what a study would look like to show that “[homeopathy] is simply the purest form of placebo.” That study would measure the biomarkers of the placebo response in whatever condition is being treated, and compare them to the biomarkers of the homeopathic response. If there is statistical equivalence, then we can conclude that homeopathy is simply the “purest form of placebo.” Has this study been run?
Ok, maybe not, but “??The Lancet??”:http://www.thelancet.com/ agrees with Dr. Ernst, and published a bold metaanalysis and editorial in its Aug 25, 2005 issue declaring “The End of Homeopathy.” As you might expect, this metaanalysis is not without its own “criticism and flaws”:http://altmedicine.about.com/od/alternativemedicinebasics/a/lancet_homeopat.htm (more detailed “criticism here”:http://www.hpathy.com/research/bhatia-lancet-homeopathy.asp, along with some cheerleading of homeopaths).
As an aside, I find it interesting that in the case of “Barrett vs. King Bio”:http://www.healthfreedomlaw.com/Welcome%20Major%20News.htm#King%20Bio the court said the following:
bq. NCAHF presented no evidence that King Bioâ€™s products were not safe and effective, relying instead on a general attack on homeopathy, made by witnesses who had _no knowledge of, or experience with_, King Bioâ€™s products, and who were found to be _biased and unworthy of credibility_. (emphasis mine)
Hmmmâ€¦that makes me wonder about the experience of the authors of the article and editorial with regards to the practice of homeopathy (and not just going to the store and buying a pill).
So, we finally get another piece of concrete data here:
Ernst, then a professor of rehabilitation medicine in Vienna, took the job to bring scientific rigour to the study of alternative medicines, an approach that has made him a highly controversial figure in the field. An example is provided by Ernst’s study of arnica, given as a standard homeopathic treatment for bruising.
‘We arranged for patients after surgery to be given arnica or a placebo,’ he said. ‘They didn’t know which they were getting. It made no difference. They got better at the same rate, whether they got arnica or the placebo. And arnica is a classic homeopathic remedy. It doesn’t work, however.’
Cool! Something we can address specifically! From Dr. Bhatia’s “response”:http://www.hpathy.com/research/bhatia-lancet-homeopathy.asp to ??The Lancet??’s “End of Homeopathy”:
bq. â€¦ why do you suggest â€˜Arnicaâ€™ for every injury? Again this is a misconception. Arnica will only work if the symptom picture that arises after injury matches that of Arnica. Otherwise some other remedy like Rhus-tox, Ruta, Symphytum, Calc-flour, Aconite, Bellis-p, Calendula, Camphora, Causticum, Cicuta, Conium, Hammamelis, Hypericum, Ledum, Plantago, Pulsatilla, Staph etc may come into play. There are actually more than 217 homeopathic remedies listed for injuries! Still, it is true that homeopaths often suggest arnica in cases of injuries but then conscientious homeopaths also know that in large number of cases such a prescription does not work. This does not show that anything is wrong with the system or the law. It just reflects the personal deficiency of a homeopath.
So the study Ernst cites indicates that people who reflexively reach for arnica for every bruise or scrape isn’t going to get good results, which homeopaths agree with.
Let’s examine a couple of these statements a little more closely:
bq. “They got better at the same rate, whether they got arnica or the placebo. And arnica is a classic homeopathic remedy. It doesn’t work, however.”
What did he mean they ‘got better at the same rate’? Did he do a “log-rank test”:http://www.graphpad.com/www/book/compsurv.htm on time-to-get-better curves? Did he run a _t_-test on times to get better? Inquiring minds want to know! What was the _p_-value? 0.045, 0.5, 0.9? Were there any outliers? How were these treated in the analysis?
How do we know these results are not “confirmation bias”:http://skepdic.com/confirmbias.html. (Boy, my hands feel dirty just linking to that site. But I freely expose my own bias here.)
bq. [Orac comments] Of course, the real surprise would have been if Dr. Ernst had found actual evidence that homeopathy did anything at all.
Again, I ask â€¦ how are you not engaging in confirmation bias?
bq. Dr. Ernst is correct; homeopathy is no more better than drinking a glass of water because it is no more than drinking a glass of water.
Do you have any data to back up this claim? Oh wait, here comes an assertion:
bq. After all, homeopathy uses successive dilutions of the “active ingredient” to levels where there may not even be a single molecule of it in the specimen.
And now I ask you, how does this make a homeopathic remedy ineffective (at least in the dilutions where this is true)? To quote “Dr. Rustum Roy”:http://rustumroy.com:
bq. Among other topics, the Lancet challenges the plausibility of homeopathic effects given that homeopathic remedies are often administered in dilutions in excess of Avogadro’s number. Dr. Rustum Roy, Ph.D. distinguished material scientist from Penn State University commented that the chemistry argument made in this study and by conventional medicine in general is false science. “The underpinning of the editorial content of the Lancet as it relates to homeopathy 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” (quote in the commentary of “Dr. Bhatia’s response to ??The Lancet?? article”:http://www.hpathy.com/research/bhatia-lancet-homeopathy.asp)
While this commentary doesn’t necessarily _prove_ that homeopathic remedies work in high dilutions, it does call into the question the assertion (opinion, not a fact) that homeopathy is “no more than drinking a glass of water.” So yeah, let see some proof.
bq. Nevertheless, Ernst insists that he is a supporter of complementary medicines. (some list of positive statements, etc.)
This must mean that he’s not really after “[Orac's] own heart”:
bq. I’d agree with him about some of the herbal remedies (although St. John’s Wort has not lived up to initial studies) and hypnotherapy, but I’m a bit less convinced about acupuncture. Certainly, at least one of Dr. Ernst’s own studies showed it to be no better than sham treatment.
Ok, Orac, for an academic surgeon and researcher, you sure are making one whopper of a stupid statement here. Let’s think about this: _one_ study questions the effectiveness of acupuncture treatment after a _stroke_ (yet does name one area where it helps, with somewhat strong evidence with a _p_-value of 0.02), and Orac says that “[acupuncture] is no better than sham treatment.” No mention of any other therapeutic areas such as pain control, labor and delivery, hypertension, anything. “Here’s”:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16376183&query_hl=3&itool=pubmed_docsum a positive article to balance the negative one. Repeat after me: _confirmation bias_.
bq. Dr. Ernst has also exposed some of the antivaccination bias in alt-med circles:
So, let’s see what the antivax bias is:
bq. Ernst’s opponents also claim some of his research methods are unethical. Once, a colleague pretended to be a pregnant mother and asked homeopaths and chiropractors if she should give the MMR vaccine to her child. Most said no. Ernst published a paper on these findings.
Vaccination may have been the _subject_ is this particular article, but the thesis of the paragraph is that “Ernst’s opponents also claim some of his research methods are unethical.” This has nothing to do with vaccination. Yet, Orac does a “PubMed”:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed search and goes off on an antivaccination tangent, which I don’t care to address right now. But we eventually get back from the aside to find:
bq. Personally, I don’t see how it is “unethical” to test whether homeopaths and chiropractors are giving out harmful medical advice.
So, without context, Orac states that it’s ethical research to send someone out under false pretenses to find out what medical advice certain practitioners give and then write it up for ??Vaccine?? journal. And he then categorically labels the practitioners’ purported claims as “harmful medical advice.” No mention of what the faux pregnant woman said exactly to the practitioners, whether leading language was used, whether proper survey sampling methods were used, anything. I don’t see how this _is_ ethical. It certainly isn’t good quantitative science. Oh wait, Orac agrees:
bq. To me, it’s no different than investigative journalism.
So then we get to this tortured statement:
bq. No doubt, studies like this are among the reasons that Dr. Ernst is probably quite correct when he observes, “I think my peers would prefer someone who didn’t rock the boat.”
No doubt, statements like this are among the reasons I am probably quite correct when I observe, “Orac has done a sloppy job writing this blog entry.”
Snark aside, this statement paints a whole class of people (alt-med practitioners) with a broad brush stroke. An alternative hypothesis is that the class of alt-med practitioners can be broken down, if one finds it convenient to do so, into the following categories:
* those who primarily want to do their practice and help patients, and who rely primarily on clinical experience but don’t worry too much one way or the other about the scientific literature
* those who are evil and just want to make money, without regard to human life
* those who primarily want to scientifically prove a chosen therapy
* those who primarily want to avoid rigorous investigation of a chosen therapy
bq. [on "I think my peers would prefer someone who didn't rock the boat."] Of course they would, because, far more often than not, scientific scrutiny of alternative medicine remedies reveals that they do not do what CAM(Complementary and Alternative Medicine) practitioners claim that they do.
Let’s break this down. We’re getting back into mind reading again, and we’re back to unsupported general assertions again. But then we get into a weird twist:
bq. When they do, often they become part of conventional medicine, which is as it should be.
Let’s play with this. To paraphrase: “It should be the case that if scientific scrutiny of alternative medicine remedies reveals that that they do what CAM(Complementary and Alternative Medicine) practitioners claim they do, then they become part of conventional medicine.” Let’s examine the “contrapositive”:http://aux.planetmath.org/cache/objects/891/l2h/ of the ifâ€¦thenâ€¦ part of the statement (leaving the value judgment in place): “It should be the case that if alternative medicine remedies do not become part of conventional medicine, then scientific scrutiny of them does not reveal that they do what CAM(Complementary and Alternative Medicine) claim they do.” (Contrapositive statements are logically equivalent to the original statement.)
Call me paranoid, but this sounds like Orac wants to assimilate a tiny portion of alt-med and eliminate the rest of it. Or at least that’s what his statement implies, and I’ve seen little evidence against it.
bq. Whatever the result, we need researchers willing to examine these therapies scientifically to identify the ones that have therapeutic value and discard the ones that do not.
My advice to Orac is, if he’s serious about this statement, to disassociate from the “Ratbags”:http://www.ratbags.com and the “Quackwatchers”:http://www.quackwatchers.com, because Stephen Barrett has indicated “little interest”:http://www.healthfreedomlaw.com/Welcome%20Major%20News.htm#King%20Bio in doing actual research, only filing frivolous libel lawsuits against alt-med practitioners.