Which is witch?

My Yahoo! column from yesterday.


“Homoeopathy is witchcraft”. Those words, spoken by Tom Dolphin of the British Medical Association, garnered a few headlines in the UK, and many more in India. We rarely favour ‘less is more’ ideas, but make an exception for homoeopathy which, though born in Germany two centuries ago, has been conferred a kind of honorary Indian citizenship,.
Reactions to Tom Dolphin’s statement were predictably apoplectic. The Delhi Board of Homoeopathic System of Medicine discerned a "sinister design to malign homoeopathy". Thankfully, apoplexy is treatable through preparations of opium, mercury and belladonna.
Dolphin’s denunciation had come at a conference of junior doctors, which concluded with the resolution:
"This Meeting believes that, given the complete lack of valid scientific evidence of benefit:
(i) homoeopathy should no longer be funded by the NHS; and
(ii) no UK training post should include a placement in homoeopathy."
The Press Trust of India gave it a different spin: “Describing homoeopathy as "witchcraft", BMA, a body of junior doctors in Britain early this week voted overwhelmingly to seek a blanket ban on the practice of the alternative medicine.” (the link was here, but has been taken down for some reason).
Blanket ban on the practice? Where did the writer get that from? All the BMA had demanded was that homoeopathic treatment cease being funded by taxpayers’ money. Private treatment was left entirely outside the resolution’s ambit. Moreover, BMA is not an association of junior doctors and said nothing, as an organisation, about witchcraft. In PTI’s defence, it describes itself as ‘India’s premier news agency’, not ‘India’s most accurate news agency’. The Times of India, criticising the ‘ban’, also picked up on the witchcraft theme: “Now, these medical practitioners are certainly entitled to their views. But their associating homeopathy with "witchcraft" is rather unfortunate. That's not the kind of language expected of men of science. More so, since it amounts to insulting the intelligence of countless people who opt for homeopathic treatment.” It might be argued, using the same logic, that the Times of India has insulted the intelligence of countless people who opt for witchcraft. But that is apparently allowable.
Such controversies relating to homoeopathy aren’t new. In 2005, The Lancet published results of a meta-analysis (a study of studies) which found no strong evidence of homoeopathic treatment being more effective than a placebo. India’s then Health Minister, Anbumani Ramadoss expressed dismay at the findings. “This is a serious issue”, he said, “because India is the largest user of homeopathy. We will counter this with scientific data.” Five years later, there’s no sign of any such data emerging from government research institutes.
Unlike Dr. Ramadoss, there are those who feel homoeopathy requires no scientific validation at all. Pratik Kanjilal, in a Hindustan Times column, argues that the discipline’s nature leaves it impervious to analysis: “Homoeopathy’s benefits are unproven because they can’t be tested by the method of science. Even the most diligently designed double-blind experiment must fail on one significant count. Science requires a valid experiment to be replicable. If Aconite 30 cures the sinusitis of Andy West of Tintagel, it must identically cure Judy North of Inverness. However, homoeopaths go by clusters of symptoms rather than the names of diseases. And, rejecting the egalitarianism of mainstream medicine, they believe that Andy and Judy are different people and should be treated differently. How do you design an experiment to accommodate that difference?”
Kanjilal’s proposition is, I’m afraid, misguided. A double-blind trial is perfectly capable of accommodating individualised treatment. All the trial does is create two groups of people, one that receives medication, and another that is given a ‘placebo’, a formulation that looks exactly like the medication, but has no effect besides the psychological. Neither doctors nor subjects know who is getting the treatment and who the placebo. That key is held by a third party. At the end of the trial, the progress of the two groups is compared. While the framework of such experiments must be replicable, there’s no need for details to be identical across trials, or across patients within each trial.
Kanjilal’s second mistake is to confuse scientific skepticism with philosophical skepticism. Upholding the word ‘maybe’ as an antidote to dogma, Kanjilal writes, “… witch-hunts against unexplained phenomena like homoeopathy look positively medieval. I look forward to the day when a healthy agnosticism replaces our scientific fundamentalisms.” Science, though, is not about agnosticism. It is not satisfied with ‘maybe’. Science comes tied with the idea that there is a definable difference between rationality and irrationality; that there exist universally applicable laws; that certain things are truer than others; that, while we may not have a standard for absolute truth, there are statements which are demonstrably false. “The sun revolves around the earth”, is one such statement. Scientific skepticism resides in the desire to investigate unexplained phenomena in order to find natural elucidations through rigorous observation, deduction and experiment.
Philosophical skepticism, on the other hand, questions the grounds for the validity of all knowledge, including scientific knowledge. For many philosophical skeptics, the sentence, ‘A solar eclipse is caused by the moon partially or fully covering the sun’, possesses no greater truth value than the sentence, ‘A solar eclipse is caused by Rahu swallowing the sun.’ By mixing up scientific and philosophical skepticism, those holding positions contravening scientific consensus often portray themselves as fighters against an entrenched, dogmatic establishment. Science takes the place of the Church, and science deniers adopt the role of Galileo. I’ve found this tendency common in debates over issues like evolution and global warming, where large sections of the public disagree with the conclusions of scientists.
Returning to the narrower subject of this column, namely the issue of homoeopathy, I use for myself a term Pratik Kanjilal would applaud: agnostic. Like most Indians, I have family members who regularly take homoeopathic medication, and I’ve consulted homoeopaths myself. In my experience, the system sometimes appears to have an effect, particularly with respect to allergies. It’s certainly preferrable to witchcraft: no homoeopath has recommended the sacrifice of a first-born or anything along those lines. It’s just been sweet pills and powders, hopefully non-steroidal. But I also know of people who’ve suffered by choosing homoeopathy (usually because it is painless and cheap), though conventional medicine offered a cure. A horrible example of this was the case of an Indian couple convicted of manslaughter in Australia for failing properly to treat their baby daughter’s eczema. The father, a homoeopath himself, handled the case while the daughter’s skin began to crack and ooze. When he felt he couldn’t do any more, he flew her to India for further homoeopathic evaluation. After she died in great pain, he told police: "Conventional medicine would have prolonged her life ... with more misery. It's not going to cure her and that's what I strongly believe."
That is what true dogma sounds like.

The column can be found here on Yahoo!