Tuesday, June 1, 2010

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!

24 comments:

seana said...

For some reason this makes me think of a scene I read long ago in George Eliot's Middlemarch, or maybe just about that scene, as I probably wouldn't have dwelt on it long, where people talk about the latest medical cures and treatments amongst themselves. No one actually has studied medicine but they all have very convinced opinions on what works and what doesn't. Most of us think we know things, when in truth we only believe them, having given ourselves over to one authority or another. That doesn't mean these authorities are all equal in wisdom but that doesn't seem to play a large part in who we decide to believe.

By the way, I do hope the Wiccan community here in Santa Cruz doesn't get wind of your characterization of witchcraft, by the way, because they are not going to like it one bit. But don't worry--I won't tell them

Girish Shahane said...

Yes, I thought of putting in a bit about the Wiccans around the Times of India comment, then decided against it.
We do hear of people sacrificing children to relieve curses here in India, so I wasn't making that up.

seana said...

I didn't say they didn't sacrifice children here, but if they do it's probably in a very loving and environmentally friendly way.

I was once riding on a bus and got in a talk with an older man who claimed to have been very involved in voodoo and witchcraft in his native, probably Caribbean country. He had since become a Jehovah's Witness and was involved in some custody battle for his daughter, and his inlaws were all witches and warlocks. He said, remember, when you get married, you're marrying the family too. Wise advice, even if they aren't involved in witchcraft.

adrian mckinty said...

Girish

You might like this video of The Amazing Randi taking a lethal overdose of homeopathic sleeping medication.

Girish Shahane said...

And you believe him after what he did at the start?
Actually, here's something I didn't mention in my article: as a kid, I'd pop my grandmother's homoeopathic pills all the time. I'm not even sure what they were for, but they don't appear to have had any more effect on me than those sleeping pills.

Girish Shahane said...

And actually, left to myself, I wouldn't be agnostic about homoeopathy any more than I am about God. The explanation for how it works is frankly ridiculous. But, although the meta-analysis found no statistically significant difference between placebo and medication, there WAS a tiny (albeit statistically insignificant) difference in favour of homoeopathy. Of the trials looked at, a significant number attributed small benign influences to the medication. I'm more or less convinced that must be because of some bias that crept into the testing, but am prepared to wait a few more years for more comprehensive tests to come out.

seana said...

So here's the ethical question. Let's say that homeopathy is claptrap. I have no idea, but let's just say it is. By publicising it as such, are you working against the placebo effect that some people do derive from it?

Basically, I don't really want my last vestiges of the power to believe in cures taken from me, in case they just happen to save my life.

Girish Shahane said...

Seana, people who believe, and there are plenty of those at least in India, aren't affected in the least by anything I write.

seana said...

Can't be sure about that, though, can you?

DS said...

Homeopathy is witchcraft, sounds a typically dismissive and wryly humourous and v British thorough rejection of a "science" that cannot back its claims by scientific trials. So faith is what sustains homeopathy.So why should that be funded by taxpayers money? In total agreement with Dolphin in the outcome of his statement if not his headline grabbing statement itself. Has he done trials to prove it is witchcraft? :)

I know of paediatrician friends here, sound doctors trained in allopathy, who have thrown up their hands and sent kids esp off to homeopathy for their allergies. And they have heard of some favourable responses. Also heard of stories of people having tested homeopathic tablets they were prescribed only to find out they were steroids. An even faster acting overall "placebo"!! To each his own as long as we aren't being taxed for what we don't believe in.

Paromita said...

Homoeopathy is used by millions of people around the world. I do agree that the mere use of a system of medicine donot validate its scientificity. Controversy revolving around homoeopathy is the ultra diluted dose of a homoeopathic medicine, and the question of placebo effect in patients. Homoeopathic “waters” really do have identical chemical compositions .But, compositions are not an end in itself the first law of material science is: “Properties are controlled mainly by structure, not by composition” this is not my statement- this is said by Dr Rustom Roy ,Prof, Material Sciences, Pennsylvania state university,Elia etal and Rey, Scientists at Pennstate University have similar opinion. The second point can be combated based on a scientific paper (Med Sci Monit, 2005; 11(12):SR27-31) who highlight that CCT technology cannot be applied to homoeopathy and it is biased to conclude on this basis -The list of the honest Endeavour’s done by Government research organization will follow soon.

Dr Paromita Goswami
New Delhi.

Girish Shahane said...

"The list of the honest Endeavour’s done by Government research organization will follow soon."

You'll pardon me if I don't hold my breath.

Paromita Goswami said...

I will just give an example -a collaborative research study done by the Government research institute in collaboration with School of tropical medicine (Kolkata) the study - Effect of homoeopathic medicines on Japanese encephalitis virus infection on chorioallantoic membrane and suckling mice-The homoeopathic medicine particularly Belladonna 3c,6c,30c,200c were found to diminish JE virus infection by inhibiting the pock formation it was also revealed in a In vivo study that that the mean survival rate of Suckling mice in the group in which mother mice were treated with Belladonna 200 for 7 days was 86.63% against the control group with 49.32%.A paper on this was presented by principal investigator at 25th Clinical Virology Symposium in April 2009 at Florida USA.An International Seminar on recent advances of Homoeopathy was held in Kolkata on Feb 19-21 Feb 2010 at Kolkata where scientists from various disciplines presented their papers on Evidence based homoeopathy.

Girish Shahane said...

Has this paper been published in a peer reviewed journal? I'd love to have the reference.

Paromita Goswami said...

This is an ongoing research project. The papers can be published only at completion. But, the acceptance of this paper at an international symposium necessitates a stringent quality control which this paper sufficed. I have intimated the concerned research organization and will also wait for their feedback.

I.J.SWAMY said...

Homoeopathy REALLY works. Works by SUGGESTION .Homoeo medicine HYPNOTIZES the receipient that he/she is CURED..To help such CURE Homoeopaths use philosophy .They spend hours to question the patients and decide the small sugar pill after PROLONGED discussion and DEEP thought.

Dr. Ajit R. Jadhav said...

Homeopathy didn't work when I myself tried. But it did work for a few people, some very close personal friends. I don't think I have good reasons to question the kind of rigour of observations that they exercised, at least in this matter.

This second-hand experience is apart from those (admittedly rare) documented cases of homeopathy showing its efficacy(in both good and bad ways) with animals and infants.

It would take a series of full articles about the nature of homeopathy and of its theorization as taught to the homeopathic doctors, and also about the intellectual quality of most of its practitioners. Currently I have no time; just jotting a few points.

Objections beginning with Avogadro's number are logically weak, even if on a somewhat correct track. Atoms/ions indeed are structural entities, but you cannot say that the process of identifying structure stop at a particular scale of observation and with a particular way of making those observations. Indeed, structural features have been observed to exist at as fine a scale as we have been experimentally able to go.

More important here: there can be other kind of structural features that aren't observed only by "zooming in" (though this can be necessary or helpful) but rather, in a way, also simultaneously by "zooming out," by understanding the fine, perhaps spatially gradual, changes in the longer-range correlations or interactions between the water or sugar powder body.

Fine changes like these can perhaps play a critical ("chaos"-theoretic) influence on the biochemical processes of organisms (the latter being considered as "complex" systems). There is a fine mathematical physics hidden behind that almost hippy terminology of "chaos," "complex," "nonlinear," etc.

BTW, in talking about longer range correlations in water/matter, I was not specifically suggesting quantum entanglement (I don't think it even exists in the form usually suggested), but just indicating longer range interactions in general. ("Clusters" proposed by some homeopathy researchers provide but one example, but aren't necessarily the thing.)

Clinical evidence is not a bad thing---our ancestors had hardly anything more than that. Analytical explanation sharpens and expands the efficacy. This does not mean that in its absence, clinical evidence is to be thrown out.

Double-blind testing protocol, in the form usually practised, isn't suited to test homeopathic claims. The objection is not to the "double-blind" aspect of it, but to the form of the practise. It should be possible to evolve protocols better suited to test something like homeopathy. To my knowledge, this has not been undertaken.

By and large, homeopathic practitioners in India have poor intellectualization skills, and as such, though I don't consider homeopathy a witchcraft, in general, it would be my third choice---after allopathy and (the better part of) Ayurveda.

This comment has become big enough that I might post it as a separate post at my blog!

--Ajit

[E&OE]

Shashi Shekhar said...

I will like to quote a study The entitled “Homoeopathic drugs Natrum sulphuricum and Carcinosin prevent azodye-induced hepatocarcinogenesis in mice” was undertaken by AR khudabukhsh (Kalyani University, West Bengal) to examine whether Carcinosin 200 could provide additional ameliorative effect, if used intermittently with Natrum sulph 30 against hepatocarcinogenesis induced by chronic feeding of p-dimethylaminoazobenzene (p-DAB) and Phenobarbital (PB) in mice (Mus musculus). Mice were randomly divided into seven groups normal untreated; normal+succussed alcohol; p-DAB(0.06%)+PB(0.05%); p-DAB+PB+succussed alcohol; p-DAB+PB+Nat sulph–30; p-DAB+PB+Car-200, and p-DAB+PB+Nat sulph30+Car-200. They were sacrificed at 30, 60, 90, 120 days for assessment of genotoxicity through cytogenetical end-points like chromosome aberrations, micronuclei, mitotic index and sperm head anomaly and cytotoxicity through assay of widely accepted bio-markers and patho-physiological parameters. Additionally, electron microscopic studies and gelatin zymograpy for matrix metalloproteinases (MMPs) were conducted in liver at 90 and 120 days. Results showed that administration of Natrum sulph 30 alone and in combination with Car -200 reduced the liver tumors with positive ultra-structural changes and in MMPs expression, genotoxic parameters, and other biochemical parameters. Thus intermittent use of Car-200 along with Nat sulph-30 yielded additional benefit against genotoxicity, cytotoxicity, hepatotoxicity and oxidative stress induced by carcinogens during hepatocarcinogenesis. This article was published in the journal (Indian journal of Biochemistry and Bio-physics, Vol 46, August 2009, Page 307-318)

Anonymous said...

The placebo effect as you are saying also does not have sufficient evidence, many of the research papers say.

Moreover you may have placebo effect in adults but in infants and young children, when a single dose of homeopathic medicine (aptly diluted) cures asthma or hyper-reactive airway disease, will you like to call it as placebo effect? Just curious!

Girish Shahane said...

Paromita, best of luck getting the paper published. Shashi, I read your paper on the Net, thanks for the reference. I'd be very interested in knowing anytime there's an attempt at indepepndent verification of the findings.

Love Care said...

Try in TEN cases of Abscessed TOOTH
following combination of medicines.
1.Anacardium 200
2.Kreosotum 200
3.Merc sol 200
4.Staphysagria 200
Give 4 drops 4 times 4 hourly, then report cures.

http://www.google.co.in/images?hl=en&q=abscessed+tooth&rlz=1R2SHCN_en&um=1&ie=UTF-8&source=univ&ei=ibgVTIvRDc-yrAeI7ZyWCA&sa=X&oi=image_result_group&ct=title&resnum=4&ved=0CD8QsAQwAw

Paromita Goswami said...

Hello girish in case if you this check I feel very pleased to inform you that the paper whose abstract i quoted has been recently published in American Journal of Infectious Diseases 6(2): 24-28, 2010

Girish Shahane said...

Congratulations, Paromita! And thanks for keeping me up to date, I'll certainly try to look up the paper.

Anonymous said...

>Congratulations, Paromita! And >thanks for keeping me up to date, >I'll certainly try to look up the >paper.

@Girish

did u check out paromita's paper...
awaiting ur views on that.