Complementary Medicine, Homeopathy and The Queen.

As we all look forward to the Jubilee weekend, it was heartening to read in the Daily Mail that Her Majesty Queen Elizabeth II is a big fan of alternative medicine and homeopathy.

The article states that the Queen is never far from ‘60 vials of homeopathic medicines, carried in a special leather case, without which she won’t travel anywhere.’ She even treated one of her beloved corgis with a homeopathic remedy. So clearly the Queen also believes in veterinary homeopathy.

Although the Queen has tactfully refrained from entering into the rather distasteful ongoing argument about NHS homeopathy – it is well documented that the Royal Family has patronized homeopathy and appointed an official Royal homeopathic physician since the mid- 19th century.

So:

  • the present Coalition Government is protective of the people’s access to NHS homeopathy;
  • the previous Labour administration felt much the same about it;
  • and now the Daily Mail reports that the Head of State uses homeopathy on herself and her pets.

I wonder why.

On behalf of all doctors, homeopaths, veterinary surgeons and responsible practitioners and patients of whole person orientated medicine, I would like to wish Her Majesty and all her family and pets a very happy Jubilee and many, many more healthy years.

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Comments

Yeh, Long Live Homeopathy!

Thanks for this Dr Kaplan.

If I understand you correctly, your argument for the NHS funding of homeopathy (etc.) is based more in libertarian values of democracy, than ‘scientismic’ values of efficacy. Assuming you extend these democratic values to the rest of your politics (it seems to me libertarianism has to be universal), why would you care two hoots about the health beliefs of an unelected head of state and her family? And regardless of the place of monarchy in 21st century Britain, why should the health views/practices of this particular family be vaguely interesting or influential? I’m sure there’s plenty of celebrities who endorse this stuff, why choose them as a third of your political argument for homeopathy?

Thanks

Adzcliff

It’s great that our Royalty are so keen on unconventional healing.

I am reminded of Charles II who believed that his mere touch could cure people of tuberculosis.

So powerful was the King’s touch that you could even be cured by touching a coin that had once been touched by the King. How homeopathic is that?

http://www.sciencemuseum.org.uk/broughttolife/techniques/kingsevil.aspx

Wrong. I for one am not looking forward to the Jubilee. It is irrelevant to modern life, as is the entire concept of monarchy. Why I should be impressed by the choices and opinions of an unqualified person who has never studied any science, and whose position in society results from a disputed genealogy, is beyond me. As appeals to authority go, this just about sums up the desperation to which homeopaths have to resort.

Dear Adzcliffe,
Yes these are valid questions which I will address:

Re: ‘Scientismic’ values of efficacy and democracy: I mostly agree with what you have assumed here, although I would substitute ‘scientismic methods of evaluating efficacy’. But yes scientism must never be allowed to trump democracy and so far in this country it has not.

Re: health views of the head of state: Well she is the head of state and it seems that the people want it to be just that way. If the people want a monarchy, they should get it and have it and believe me, a referendum would establish their preference for this unequivocally. So it’s worthy of note that the Labour Party, the Coalition and the head of state ALL support homeopathy.

Re: Celebrities: actually most celebrities appear to be against homeopathy (eg Stephen Fry, Tim MInchin and many others). This appearance is because when celebrities such as Jeanette Winterson write something in praise of homeopathy, they are bludgeoned ad hominem by the media especially The Guardian (legitimate as they are a private concern) and the BBC (absolutely disingenuous because they are funded by a poll tax so the 6 million or so people who support homeopathy deserve representation for their license fee).

I agree it’s great because many people rightly think that there is a reason that the Royals choose homeopathy when obviously they can have the choice of the very best doctors in the land.

Dear Les,
The Queen is the Head of State whether you approve or not. Therefore her views, the views of the Coalition Government and the views of the previous Labour administration are of importance in this country. So if we ask which of these views supports the people’s right to homeopathy, the answere is unequivocal: ALL OF THE ABOVE.

Not very homeopathic at all.

Thanks for this quick flurry of responses Dr Kaplan.

You may be right that the UK populace ‘would’ choose a monarchy given the opportunity, but that’s just it, they’ve never had had the opportunity (nothing democratic about that).

As for your criticism of ‘scientismic methods of evaluating efficacy’, correct me if I’m wrong, but wasn’t it you who cited a ‘major study’ to highlight the ‘outrageous’ ‘less-than-evidence-based’ over-prescribing of anti-depressants in mild-moderate depression? What’s to stop the committed psychiatric prescriber accusing you of ‘scientism’, and using the growing popularity of SSRIs as a democratic argument for their continued use in mild-moderate depression? Surely you’re not in the ‘I know better than you what’s good for you! Brigade’? It seems to me, as we discussed earlier, it’s only ‘democracy’ and ‘scientism’ when the evidence is against you?

As it goes, you won’t find any anti-monarchy sentiments here – I’m largely indifferent but probably a tad sentimental – but I do find it bizarre that the health whims of this particular family are an argument for anything?? If the tide turned, I’d take it you’d feel challenged politically and intellectually by Will and Kate’s new passion for science, scepticism and critical thinking? Would it be “…I’d best shift my view as they are the heads of state after all” or “…why the hell should I be persuaded anything those two say, how many homeopathy patients have they actually met??”

Cheers for now.

Adzcliff

Dear Adzcliffe,
I think you misunderstand my position. I am not against SSRIs because of their disappointing meta-analysis. I still think GPs should feel free to prescribe them if they wish. What I chose to expose was the disingenuous reaction of many homeopathic detractors to the two meta-analyses (Shang – homeopathy and Kirsch – SSRIs) The anti-homeopaths used Shang to trash homeopathy (NHS budget for medicines – £10) and pretty much ignore the SSRI one (NHS budget £232m) Thus when people to choose to IGNORE the latter but use the former to attack homeopathy PARTICULARLY ON THE BASIS of being a ‘waste of taxpayers’ money’, I point out the blatant hypocrisy and call for a level playing field for ALL interventions on the NHS.
As to Will and Kate: They have plenty of time to learn, become wiser and grow up before they occupy thrones. There is an heir-in-waiting between them and the Queen and guess what? He also supports homeopathy.

Thanks Dr Kaplan

That’s an interesting position. You believe that anti-depressants are ‘outrageously’ over-prescribed, ‘less than evidence-based’, and lament that psychiatrists are still doing nothing about their growing popularity (perhaps even the opposite), whilst also believing that GPs should be free to prescribe them if they wish? Does that extend to GPs being able to prescribe whatever they like for whatever they like – evidence based or not?? Surely there’s some cognitive dissonance in there somewhere…

Going back to Dr Trossel – mentioned by me in a previous blog – here was ‘alternative’ medic practicing out of Holland, treating MS sufferers with expensive, unproven, bovine stem-cell treatments. Despite seeming sincere and compassionate, having some positive anecdotal evidence, and a good customer-base, the GMC have prevented him from practicing in the UK, and he now faces legal action from disgruntled customers. As far as I’m aware, no one from the alternative health lobby rallied around him, and he remains unable to practice his preferred therapy. Would I be right to assume that you’d see this as a miscarriage of justice?

http://www.bbc.co.uk/news/health-11425435

Fair play to you for hosting these discussions out in the open though; I know lesser bloggers who’ll carefully censor when things don’t go their way.

Adzcliff

Dr. Stapf, a german introduced homeopathy in UK in 1820 by curing Adelaide who later become a queen.
The British Royal Family has been under homeopathic care since then and there has always been a Royal Homeopathic Doctor. The post is currently held by Dr. Peter Fisher.

If a skeptic was to say that the exact same logic and quality of evidence should not be applied to the SSRI meta-study but should be applied to homeopathy, it would not only be hypocrisy but completely illogical. Have you any evidence that this is taking place? In fact the effectiveness/non-effectiveness of SSRIs has nothing to do with the effectiveness of homeopathy. Linking the two is just a piece of misdirection, common among homeopaths, to avert the gaze from the glaring absence of evidence of effectiveness for their own modality.

As for a ‘level playing field for all interventions’, this is complete nonsense. Certain modalities are effective and others are not. How do we know this? By the application of science and accumulation of evidence. That evidence which is so lacking for homeopathy. Presumably this lack is why homeopaths have to use the appeal to authority, appeal to popularity and many other fallacious arguments.

I guess what I’m saying (amongst the verbiage) is I don’t understand how you reconcile your statements that SSRIs are ‘outrageously’ over-prescribed, but that clinicians should be free to (over-)prescribe them if they wish?

Adzcliffe, I don’t think you get what homeopathy is at all.
If you treat MS (a specific disease) with a specific treatment (Trossels treatment) then you can test that treatment for that disease. Homeopathy does not work like this. You need to spend considerable time with a patient in order to match them and their symptoms to a homeopathic remedy. It’s not medicine for conditions, it’s medicine for condition’s specific and particular manifestation in a patint.

GPs do prescribe many things that don’t have an evidence base behind them. Many meds in chemists have no evidence basis – just like the SSRIs. But yes, if a GP talks to a patient, reassures and prescribes an SSRI (a licensed drug), then yes s/he should ‘be allowed’ to do it.

Of course anybody can speak here. I only occasionally block posts with obscenities or open insults.

Thanks for the detail Nancy.
So it’s coming up for 200 years of Royal support of homeopathy.

The comparison between SSRIs and homeopathy is based on the following:
SSRIs and homeopathy were both exposed to major meta-analyses. The Shang meta-analysis of homeopathy is controversial (accusations of cherry picking etc.) but is not positive for showing homeopathy to be effective over and above placebo. The Kirsch meta-analysis is only slightly controversial among psychiatrists (accusations that the researchers are obsessed with placebo effect) and pretty much shows SSRIs to be no better than placebo in mild and moderate depression and even controversial in many cases of severe depression.

The comparison is not between these meta-nalyses but in the general REACTION to these statistics. The Shang meta-analysis was used by a gang of rabid anti-homeopathic activists to try to bully parliament to outlaw NHS homeopathy. (Thankfully democracy stood its ground) The Kirsch meta-analysis was used to ‘advise’ GPs to be more judicious about prescribing SSRIs. Result: SSRI’s have soared in prescription SINCE Kirsch et al.

Why is a call for a level playing field for all interventions on the NHS nonsense? What I mean by a ‘level playing field’ is a LEVEL OF EVIDENCE that ALL prospective interventions must pass. It’s either low (trusting in GPs) or high (turning GPs slightly into automatons) BUT it cannot be high evidence needed for homeopathy (presumably because of its alleged ‘implausibility’) and low evidence for SSRIs (presumably because most psychiatric medications have poor evidence behind them but psychiatry very much wants to remain part of mainstream medicine)

I really hope this clarifies my comparison.

‘Presumably this lack is why homeopaths have to use the appeal to authority, appeal to popularity and many other fallacious arguments.’

In the words of Mr John McEnroe: ” You cannot be serious!”

Homeopaths appealing to AUTHORITY?? Where and when? It is the utterly authoritarian detractors of homeopathy that tried to bully Government into banning NHS homeopathy. They appealed to Government to listen to their ‘authoritative’ I KNOW BETTER THAN YOU WHAT’S GOOD FOR YOU view of medicine and ban NHS homeopathy whether the people agree or not.

‘Appeal to popularity’ What does this mean. Perhaps politicians shouldn’t appeal to popularity. Perhaps what is popular should not count for anything? Perhaps one small group of suitably scientifically trained ‘authorities’ should decide what the people should get in education, medicine food etc. Actually perhaps just one very clever, scientifically trained man will suffice: Please step forward
Joseph Stalin.

Thanks again Dr Kaplan

“I don’t think you get what homeopathy is at all. If you treat MS (a specific disease) with a specific treatment (Trossels treatment) then you can test that treatment for that disease. Homeopathy does not work like this.”

With respect, this isn’t about comparing bovine stem-cell treatments with homeopathy. This is about your ethical stance on a clinician being prevented from practicing his preferred ‘alternative’ bovine stem-cell therapy on as many MS patients he can get to believe in it? Would this an intrusion of the “I know better than you what’s good for you! Brigade?”

Ta.

Adzcliff

Okay Adzcliffe, There is a tricky issue here with MS. First of all everybody agrees it is very difficult to treat with anything so it’s not an issue of effective mainstream treatment being discarded in favour of alternatives. However when expensive (and the cost and financial aspects are important) are touted for a specific treatment of a specific disease, then issues of exploitation can be raised. However if for example a doctor thinks that eating a healthy diet (with some supplements such as fish oils high in DHA – just for example) and learning deep relaxation often helps MS especially when combined with monitoring the patient carefully with regards to stress and lifestyle (and I am not saying that I advocate this) then that hypothetical GP should be ‘allowed’ to try to help his patient in this way – even sans evidence for this whole person orientated approach – because whole person approaches are difficult to assess with RCTs.
The way this applies to homeopaths: Most homeopaths earn a very modest living from homeopathy. They have been trained to be excellent listeners and spend long times with their patients empathising and trying to work out which homeopathic medicine best suits their patient. Their time is not valued like accountants and lawyers and they are generally highly educated, empathic but lowly paid professionals. Their treatments obviously work. The only question (and this debate is all about this question) is: Is the clinical effect due to an inherent action of the homeopathic remedy or is the patient getting better because of ‘suggestion’ power of being listened to carefully by a professional who necessarily believes

    that the medicine s/he is trying to match to the whole patient, has an inherent effect over and above the placebo effect? If s/he did not believe this, then they would be fraudulent and would also be able to see a patient every 6 minute dishing out ‘sugar pills’ with confidence. But homeopathic doctors and lay homeopaths DO believe their medicines work independent of suggestion. They have done for 200 years in the face of much of the same criticism they face today. What has changed are merely three things:
    1. The critics of homeopathy (and all things non-scientifically ‘proven’) have become more aggressive, vocal and media savvy.
    2. The swing from libertarian to more authoritarian politics in the UK.
    3. There has been in the UK a sad move away from that most precious of British characteristics – tolerance.
    A pity.

Okay.

1. Expense: It sounds like you’re suggesting that Dr Trossel may have been unethical because his alternative treatments were expensive. The cheaper his unproven bovine stem-cell therapies became, the more ethical they became (there’s a point where such therapies tip from unethical into ethical). In other words, you should be allowed to treat anything with anything, as long as it’s inexpensive to the consumer (and/or doesn’t make the therapist rich).

2. Clinician sincerity. Dr Trossel wasn’t practising fraudulently, as he ‘believed’ his unproven bovine stem-cell therapies were medicinal. Likewise, his clients were open-minded to their efficacy – irrespective of his part in their belief – and it was their right to be treated in this way. So it’s not just about clinicians’ evidence or training, it’s also about their ‘beliefs’, regardless of whether their application is identical. In example, it would be fraudulent for an enlightened evidence-based chiropractor to manipulate the spine of a child for ear infections, but acceptable for the evidence-blind or indifferent chiropractor next door to administer the very same therapy? Likewise, the moderately depressed patient who collects their SSRI repeat prescriptions from different locums, has probably, at some point, been the victim of fraud.

I thinking I’m beginning to understand you, but I’m afraid I bring myself to agree…

Thanks anyway.

Adzcliff

Hmmm,
Not sure we are on the same wavelength here. There is a big difference between ‘pseudoscience’ and whole person orientated medicine (of which homeopathy is an example). What Trossel was doing was not whole person medicine, but a type of ‘scientific’ medicine that was not justified by scientific data but would be amenable to straightforward RCTs. It also has grave ethical considerations as to where the stem cells came from etc.
The doctor’s belief system is important. If a doctor believes that many of his patients can benefit from stress management techniques such as Autogenic Training and AT is safe and generally good for the whole person and often good for particular problems, he should feel free to use it. If a doctor feels that patients who go through the structured sensitive time consuming process of an homeopathic history and then receive a very safe medicine based on that history prescribed by a fully accountable doctor, then of course that should be ‘allowed’.
When there is big money concerned or animal rights or safety issues, things are different. But perhaps that is just a personal opinion.
Homeopathy is safe and it works and it exploits nobody. Just examine the fees homeopaths charge per hour compared to specialist doctors! They are not fraudulent. They do not ‘pray on the vulnerable’. The only thing that is in dispute is HOW homeopathy works and the very worst accusation that can be made is that ‘it’s all in the consultation’. And doctors that accuse us of that, should learn from us rather than condescendingly and patronisingly continue this pathetic authoritarian witch hunt on homeopathy.
Also citing cases like Trossel are less than helpful or appropriate. There are plenty of crooks and sharp practising individuals in conventional medicine – we all know that. Crooks are crooks. Honest doctors are honest doctors. And most homeopaths (doctors or not) are philanthropic decent human beings who are prepared to listen carefully to the details of people’s symptoms in the context of the story of their lives, relationships, hopes and disappointments. I know that because I (unlike the scientismic authoritarian

    ‘I know better than you what’s good for you!’ Brigade

who mostly have no idea what the structured process of a homeopathic interview involves.

Those who think that results of homeopathy are all due to the consultation, instead of pathetically denigrating homeopathy (which 6 million people in the UK want and many millions would not choose to have banned because they don’t belong to the arrogant ‘Brigade’), should study the way homeopaths converse with their patients carefully. Very carefully indeed.

Thanks Dr Kaplan

It seems to me that you’re making a distinction between what’s acceptable in ‘whole person’ medicine and what’s acceptable in symptom-focussed ‘science’ based medicine. Personally I don’t think Trossel was being scientific in the slightest, but was trusting his clinical experience. I also don’t feel the need to seperate ‘whole person’ and more symptom-focussed approaches – for me it’s just about what works, when and why.

However, I’m absolutely with you that homeopathy’s proven safety sets it apart from Trossel’s alternative therapy of unproven safety (although not proven unsafety). However, I am quite happy to sit him alongside chiropractors who manipulate children’s spines for colic, asthma, ear-infections etc. After all, when we see through the narrative of an unscrupulous medical doctor lucratively exploiting vulnerable patients to his own ends, this just becomes a self-deluded clinician making a good living from unevidence-based ‘alternative’ medicine of unproven efficacy and safety. I’d argue this probably describes the bulk of ‘paediatric’ chiropractors. From your arguments above, I think you’d have to be quite imaginative not to agree.

(To make the naturopathic analogy, I’m not sure how a cow’s stem cells are any less natural than, say, an Echinacea plant? In terms of the animal rights dimension, I’m reminded that some homeopathic dilutions use animal products?)

Ta.

Adzcliff

It’s worrying that Prince Philip has been taken ill, but what I can’t understand is why the Duke of Edinburgh wasn’t treated by the Queen’s homeopathic physician, Dr Dixon. Wouldn’t that have been easier and safer?

Hi Adzcliff,
I’m not sure about the ‘self-deluded’ description. Would you call the tens of thousands of GPs who use SSRI anti-depressants on patients with mild and moderate depression, self-deluded?
And yes homeopaths do use animal products in homeopathic potency but this has always been with ‘full animal rights clearance’. You would be hard pressed to find anyone who objects to homeopathy on those grounds.

No it’s not worrying. I’m sure he is receiving good treatment and if he wants homeopathic supplementation, there is a Royal homeopathic physician, Dr Peter Fisher, whom he could call upon at any time if he wishes.

Ah! My mistake – I thought his name was Dixon.

Adzcliff,

I am unaware of the Trossel case to which you refer, but I note that you seem to be suggesting that it is somehow unethical for a chiropractor to treat a child for colic, asthma or ear infections. My ex wife is a chiropractor. She does not treat many children but her attitude on this question is to point out that many things such as asthma have stress at their root and that spinal manipulation is a way of relieving musculo-skeletal tension and thence stress – so, why not? Why not treat stress in either its causes or its manifestations; and why should doing so be unethical?

As Brian will tell you, a good part of the homeopathic consultation is a thorough taking-of-the-history and the eventual prescription takes account of this history, so homeopathy also treats causes of stress (or shock, or trauma, or life changing event) as an essential part of the treatment. This, surely, is the great beauty of “whole person medicine”.

Hi David, The people who argue against homeopathy have not the slightest concept of what ‘whole person medicine’ is. They think it is ‘waffle’, ‘ cognitive dissonance’, ‘self-delusion’, ‘fraud’, ‘lying to patients’ etc. etc. I have pointed them in the direction of philosopher doctors such as Jaspers and my mentor, E.K.Ledermann (http://www.wholepersonmedicine.co.uk/introd.htm) – but to no avail. None of them has the slightest inkling of how a ‘whole person philosophy’ can underpin a medical approach. They know what they know while straitjacketed into the mechanistic and deterministic paradigm of the universe they hold so dear. They are also self-righteous, condescending and patronising towards anybody ignorant enough to disagree with their ‘I know better than you what’s good for you approach’ which is rooted in the scientismic overview many are hardly aware of dominating everything they say. There is nothing I can do to change them and their views. My defence has primarily been in the realm of politics, democracy, liberty and authoritarianism. When they try to lobby Westminster, it is necessary to provide an opposing voice. Otherwise – if you will forgive an agricultural reference – we are all heading for Animal Farm.

Brian,

You are quite right – the phrase and all that it implies just slipped out without thinking. In my mind I had the picture of a calf that had diarrhoea: why did she have diarrhoea? Was it something to do with her being a first calf for her young and slightly immature mother, who did not have a lot of milk and who was initially frightened that her calf approached her back end from which so much trauma had recently occurred? The calf was effectively abandonned for a while until we could get to her and bottle feed. This too was problematic and calf refused the bottle and started to go downhill fairly quickly. In the end (amongst other things) the fear, grief and so on was part of the picture which prescribed Phos and which brought her back from the brink within twelve hours. She started feeding from the bottle like a good’un within four or five hours and never looked back.

It was an interesting case which involved her also getting pneumonia and bloody stools. Conventional treatment of antibiotics and re-hydration worked but only for the short term, thereafter she did not show signs of proper recovery and so started the downhill journey starting with loss of interest and that vital spark, which you see in an animal’s eyes when it wants to fight, and yet disappears so quietly when it is giving up. Tulip (as she became) was one of my real success stories and is a classic case of conventional medicine killing the bug (pneumonia) but nothing further. So often we find that the healing process needs to be kick started by something else; and in this case it was Phosphorous 200c administered several times in rapid succession in the first couple of hours after treatment commenced. It is such a joy when an animal perks up within hours of treatment, when otherwise the end is almost in sight.

And, yes I know your frustration at the obduracy of the skeptic camp. In itself, that quality alone is suitable for psychological study; but sadly whilst such study may yield understanding, I fear it will not give us a cure. Ideological polemic such as we face is not given to moderation, even in the face of overwhelming evidence, until the whole edifice collapses like the Berlin Wall. To paraphrase Orwell: “Under EBM, all evidence is equal, but some is more equal than others.”

But, all is not yet lost. CAM in its various forms is fighting back, research is progressing and being published and more and more GPs and hospital specialists are beginning to appreciate the limitations of some forms of conventional medicine and starting to acknowledge and refer to other practitioners, because the patient says x or y treatment helped in addition to the mainstream stuff. That kind of response is difficult to deny for any clinician, whose responsibility lies with the individual patient – not with some artificially elevated ideology. When it is the patient who is sitting in front of you, looking for help and wanting answers, where few are to be had (because we just don’t know) then what kind of stoney-hearted doctor is going to tell a patient that everything else in the “market” is woo, when they have a patient who is absolutely determined to leave no treatment option unturned? The determination of many patients, and the results that determination have acheived, has caused many a doctor to reconsider their views of all things CAM.

Cheers,

David.

Dear David,
Thanks very much for your wise and encouraging words.
Brian

David

Sorry to be so blunt on this, but are you really saying that because your wife ‘thinks’ asthma is a stress disorder, and ‘thinks’ spinal manipulation is a treatment for stress, then ‘why not’ manipulate the spine of a child?? This is absolutely my point: Dr Trossel ‘thought’ bovine stem cells were a safe treatment for MS – am I to assume you’d extend your ‘why not’ sentiment to his practice as well?

Adzcliff

Sorry Dr Kaplan, on the ‘self-deluded’ issue: yes, I have reason to believe that anyone who prescribes SSRIs for mild-moderate depression believing them to be medicinal – perhaps believing that their ‘clinical experience’ trumps gold-standard RCT evidence – is self-deluded. I suggest it’s up to them to show why/how the evidence is wrong. However, there may be those who (rightly or wrongly) prescribe in full of awareness of the evidence, in which case, we’re not necessarily talking about self-delusion. I suggest it may even be compassionate to talk about Dr Trossel and certain ‘paediatric’ chiropractors in terms of self-delusion; to practice these alternative techniques on human beings in full awareness of the unknowns could lead us somewhere far murkier…

Adzcliffe,
Yes there are some murky areas in health care and they exist in both orthodox and alternative medicine. As the BMJ’s Clinical Evidence clearly shows, MUCH of orthodox medicine is hardly evidenced at all. Let us be clear about this discussion: It is an acceptable political position to demand a certain level of evidence for any intervention used on the NHS. It is not my position because some things are very hard to back up with the type of evidence scientists and scientismists prefer and demand respectively – eg psychoanalysis. However it is a reasonable position to take. What is unreasonable and disingenuous is to have double standards of evidence depending on what one feels about the ‘plausibility’ of an intervention. Thus it is deeply disingenuous imo to call for a ban on NHS homeopathy exclusively* without setting a standard of evidence for ANY intervention pitching to be included on the NHS. That, and just that, is my main point and has been for quite some time.

* esp. when you can only get NHS homeopathy if you are referred by your GP to another NHS doctor using homeopathy. THAT is all the protection the public needs, thank you very much indeed!

Adzcliff,

It seems to me that, like every other skeptic I have read, you are looking for absolute certainty before a homeopath or any other clinician, can legitimately use their craft upon a patient. If this impression is correct, then forgive me for pointing out that you will find no such level of certainty in any area of the biological sciences (including medicine), climate and weather sciences, economics, politics and very many other areas of human activity or study.

If we restrict the conversation to medicine, there are two reasons why this is so: the first can be seen in the summary of current knowledge of Evidence Based Medicine highlighted by Brian in his link. The second can be understood if we look at the mathematics which is employed in medicine, which is statistics. Statistics by its very definition is about probability, and so even in a study which reaches <5% significance levels, we still have a 1 in 20 chance that the conclusion is wrong.

If you don't believe me or Brian about the shortcomings of EBM, then try reading "Over-Diagnosed – Making people sick in the pursuit of health", by H Gilbert Welch. In a very similar vein, Margaret McCartney is very good; and likewise both of James Penston's books ("Fiction and Fantasy in Medical Research", and "Stat.Conn") are required reading.

The shortcomings of frequentist statistics are widely debated, especially on William Briggs' blog, as well as in Introduction to Bayesian Statistics by William Bolstad. If you think that the Bayesian stuff still does not answer all the questions (it doesn't) then google Complexity Theory and see where that leads you. As well as Brian's reference above to the philosophical aspects of holism you will find yet more critique, in the complexity stuff, of the reductionist stance that you are taking. On the other hand if you are of a more philosophical bent, you could try dipping into "Science's First Mistake – Delusions in Pursuit of Theory" by Ian Angell and Dionysios Demetis, whilst waiting for your cocoa to cool.

If you want to see some of the difficulties that an otherwise well run large scale, multi centre RCT can get into, I recommend you read:
http://www.bmj.com/content/344/bmj.e2758 and its 2010 protocol: http://www.trialsjournal.com/content/11/1/105 and when you have done that, you should answer the question: "Does physical exercise relieve the symptoms of depression, and if so, what kind of exercise is best?" If you find the answer to that question from this paper, then let us all know because there are a large number of psychiatrists/psychologists/GPs out there who would like to know. This paper is a well run trial but which sadly has failed to answer the question that it never quite got around to asking. The editor of the BMJ or the referees should have picked this up, but didn't.

If you need your critical appraisal skills brushing up, you could do a lot worse than to do the one day course run by the College of Medicine on the subject. One of your skeptical colleagues already has, and has blessed it with faint praise. Alternatively, if you feel the need to understand more fully the difficulties of running a full blown RCT, then the 4 day course at Keele is good and run by a bunch of enthusiastic physios. Better still, why not design and run your own RCT and find out first hand just how tricky it is to get it all up together and publishable.

You could also try reading some of the many books on EBM processes, systematic reviews and so on. There you will discover that in order to overcome each of the successive difficulties the principles of EBM gets the researcher into, there are ever more intricate solutions and sub-processes designed to meet the difficulties. The thing gets more and more complex; and further and further away from the thing which started it all in the first place – the actual experience of the participant in the trial with the intervention or its control.

And it is the experience of the individual patient that GPs like Brian, or me as a livestock farmer, that really, really matters. Oh, I know, I know. You can summarise that experience as a single data point on a graph. You can mingle it with others and find their means, standard deviations, standard errors, confidence limits and the rest. You can torture the data by log transformation and reciprocals to get a non-normal distribution to look like a normal distribution and so justify a 't' test. You can take lots of other trials and weight and add and then average them out in a forest plot. And finally you can invert it, pervert it and then stuff it into a funnel plot and ask it to tell you if there is something you have missed, by making the critical assumption that the data are once again random and normally distributed. If you want an explanation as to why there are so many statisticians in medical science then you need look no further than these delicate and multifarious edifices that they have erected.

But none of this, absolutely none of this, is any substitute for the experience of the clinician who is facing an expectant, sometimes frightened and depressed patient, but who nevertheless is wanting answers and help. That is a grievous responsibility – and I have to say in passing that it is a responsibility that few, if any, of the skeptics who spend their time sniping from the sidelines, are willing or qualified to take. They want the power to control those who actually have to do the work and take responsibility for it. In this sense the skeptics display a particularly unpleasant brand of moral and intellectual cowardice.

The clinician's experience is continously informed by the experiences, not of one, but of many patients; who respond favourably or unfavourably to the recommendations of that clinician, who in turn is informed by his knowledge of the patient, training, observations/examination, consultation with his colleagues and sometimes even by the construct that we call EBM.

But there are no certainties in any of this.

So, Adzcliff, if you cannot understand that stress and life's knocks and kickings are reponsible for a good deal of dis-ease (or at the very least, for making many conditions worse), and neither can you understand that treatment by acupuncture, or homeopathy, or counselling or musculo-skeletal manipulation, or even by pharmaceutical drugs can actually help the manifestation of stress and thence reduce the impact of disease then I do not believe you should be commenting upon any aspect of medicine.

If you are still determined that certainty has all the answers and that a linear reductionist view is all that is needed, then I urge you to take up engineering instead. For that is the only applied science that I am aware of that will give you any real measure of certainty.

Now it is late and my glass of vintage cider is nearly empty, so I bid you all a very good night.

David.

Good night sweet prince of whole organism medicine!

Thanks for all that David. Interesting that instead of answering my fairly simple and direct question, you issued me a lesson in solipsism and a reading list?? In response, I suggest you read a quick definition of the ‘Tu quoque’ fallacy.

So, in answer to my earlier question:

“…are you really saying that because your wife ‘thinks’ asthma is a stress disorder, and ‘thinks’ spinal manipulation is a treatment for stress, then ‘why not’ manipulate the spine of a child??”

Your answer is simply ‘yes’. And I’m also to assume, that because Dr Trossel ‘thought’ bovine stem-cell injections are a safe treatment for MS (his clinical experience told him so) you’d support his right to practice in the UK.

You may also be with the affronted medical establishment who rejected Florence Nightingale’s thorough statistical analyses that good hygiene and sanitation was a more effective health intervention than anything the medical profession could offer ill and wounded soldiers at the time.

Medic: “But none of this [Nurse Nightingale], absolutely none of this, is any substitute for the experience of the clinician who is facing an expectant, sometimes frightened and depressed patient, but who nevertheless is wanting answers and help.”

Adzcliff,

There are no logical fallacies in the position that both Brian and I take in pointing out that the evidence base for Evidence Based Medicine is patchy at best and in other places weak and sometimes downright non-existent. That EBM is, in many cases, failing to live up to expectations is self-evident and increasingly recognised across the medical professions. That does not mean however that the evidence that it does provide is entirely useless, because it is not.

Neither are there fallacies or hypocrisies in our pointing out that the skeptics such as yourself are asking for a different, and largely unachievable, standard of “proof” for homeopathy and the like.

Both Brian and myself have therefore come to this debate, and remain in it, with “clean hands”. So your invocation of the term tu quoque must be applied to yourself.

I have absolutely no difficulty at all with patients with conditions which are stress related, or exacerbated by stress (such as asthma), being treated by chiropractors, osteopaths or physiotherapists, provided that all other medical constraints are taken into consideration. This is something that all of these professions do as a matter of course, because all of them have undergone long and arduous medical training.

That stress is a large component of many diseases is self-evident and there is no “think” about it.

I do not know the details of the Trossel case and so will not comment upon him directly, except to say that attempting to treat a serious disease like MS with methods or substances for which there is no evidence at all, is clearly ethically unsound. There may also be ethical issues in using patients as experimental subjects without their explicit consent.

Your final hyperbolic extrapolation is absurd. I have not argued that there is no need for evidence. I have said that there are no certainties in the evidence to hand.

I hope that clears up your misunderstandings.

David.

In my fourth paragraph above, the last sentence should read: “This (all other medicial constraints being taken into consideration) is something that all of these professions……”

My apologies for the ambiguity.

David.

Monarchy is not Democracy and democracy is not exploiting human ignorance under the proclaimed virtue of Freedom of Expression, draped under a Veil of clever manipulative hypocrisy. Monarchy is symbolic representation of a people’s own faith in nobility,virtue and order, whose flow of power and authority into various branches of department of working people sustains their daily lives and suggests the direction to look forward to. Even if money is wanting to maintain all materially defined standards of living,the richness of contentment leading to a joyful social living outruns the many economic ‘depressions’ of drummed up democratic virtues which many nations presently are ailing under. If professional authority of medicine should give way by democratic means to support the Divine Graced life, which the nobility of monarchy accepts as a sacrament by all means available to human beings whom they represent and maintain unto themselves as well as common laity,let Homeopathy be also suggested under the care (as opposed to scare)of dearness beneficial to the life of Prince Phillip.

Thanks David for a clear and logical summary of this discussion. Of course the detractors of homeopathy and whole person medicine are guilty of an almost comical exposition of Freud’s concept of projection. They accuse homeopaths of being anecdotal and then bring up obscure cases of strange doctors using strange treatments to bolster their case for authoritarian and scientismic regulation – but only for homeopathy and CAM. They have no answer to your (and my) point that they do not recommend their draconian, authoritarian, condescending and patronizing regulations across the board for ALL NHS therapeutic interventions – only for NHS homeopathy. Their political position is an embarrassing disgrace. The Labour Party doesn’t support it and nor does the Coalition or the Queen. Still they continue their ignoble fight apparently on behalf of people too stupid to think and choose for themselves. Thankfully democracy has stood firm against this threat but nothing is secure. After all it was only 20 thousand Bolsheviks who won the Russian Revolution and paved the way for the mass-murdering Oriental despot, Stalin and one of the cruellest empires ever. The price of liberty is indeed eternal vigilance. There is much more than just NHS homeopathy at stake here.

I always enjoy the reflections of Sastry.M, who views things from a very different angle to me, but whose conclusions are rich in observations of the human and medical condition. Thank you.

Brian,

You are South African by birth and upbringing. I have spent but a mere two years in Nigeria in the early ’80s. Shortly after I left, the country plunged into yet another military coup and dictatorship. It seems that we have both seen first hand what happens when events shake democracy to the point whereby the rule of law goes into freefall. Very few people who have been born and brought up in this country have any real comprehension as to the fragility of the conditions which we take for granted in the UK.

The events which shaped our modern constitutional monarchy were signed on a piece of parchment in a field nearly 800 years by King John. And, since then, this country has undergone relatively little in the way of internal strife and violence. It is true that there have been ups and downs from time to time – even a brief flirtation which republicanism – but the wholesale slaughter and genocide which has affected many other countries has not happened here since the Magna Carta was signed. As usual with a profoundly lucky people, we do not know our own good fortune.

And so you are spot on in pointing out the threat, its origins, and the vigilance we need to keep it at bay.

As always, your very good health,

David.

Not having studied psychology at all, I had to look up your reference to Freudian projection. Wikipedia says: “Psychological projection or projection bias is a psychological defense mechanism where a person subconsciously denies his or her own attributes, thoughts, and emotions, which are then ascribed to the outside world, usually to other people. Thus, projection involves imagining or projecting the belief that others originate those feelings.[1]”

Outwardly, this fits the bill nicely. But my caveat is that I do not believe that our skeptical friends are doing this subconsciously. I think their tactics are absolutely and consciously deliberate; and are intended to be divisive, disruptive, time wasting and damaging.

As to what their motives are, and who gains what from the exercise is another question for another day. What is certain is that if they win, the patient (and ultimately, medical science) will suffer.

David

David, have you just re-buffed my allegation of tu quoque by quoting it back at me? Classic!

Assuming this wasn’t purely for comedic value, I’ll try to answer why I think you’re wrong. I acknowledge that ‘EBM’ isn’t as perfect or bias-free as I and many others would like (don’t forget, I’m with Dr Kaplan – if slightly less outraged – that SSRIs are worryingly over-prescribed). I have shared my appreciation with you of critical writers such as John Ioannidis, and wish for so-called ‘EBM’ to become more ‘EB’. Now I also extend this stance towards CAM, where, through no fault of mine, evidence is scarce (much more so, than in EBM). You on the other hand, from what I can make out, prefer to mis-represent my position: creating a false-hypocrisy by pointing out the (obvious) limitations to what science can ‘know’, and that conventional medicine isn’t perfect either. You may be right on this, but to use this as an argument for CAM would be ‘tu quoque’: CAM is ethical/unethical, effective/ineffective regardless of what’s going on in ‘EBM’ – unless you know otherwise.

It’s also interesting that you’ve chosen to negatively caricature my position (fallacy: Straw Man argument) as a certainty-seeker – I have never said or implied anything of the sort – but now you ‘know’ that stress is ‘self-evidently’ a large component of many diseases. Well I agree – who are you arguing with here (fallacy: moving the goal posts)? However, what little I know about asthma, suggests this condition is far more about allergy, genetics and environment than it is about stress. Do you also ‘know’ that spinal manipulation is a treatment for stress? If so, how do you ‘know’ this?

You then allude to the training of chiropractors, osteopaths and physios as an indicator of safety and efficacy in their practice. Well Dr Trossel was exceptionally well-trained, is this a good avertisement for Bovine Stem-Cell injections? Florence Nightingale’s medical colleagues were well trained – should this have been enough to silence her ‘scientismic’ skepticism? Reiki healers are relatively well-trained, but their theories violate the laws of thermo-dynamics?? The fallacy I’m referring to here is, of course, the argument from authority.

You then go on to say that “Dr Trossel’s attempts to] treat a serious disease like MS with methods or substances for which there is no evidence at all, is clearly ethically unsound. There may also be ethical issues in using patients as experimental subjects without their explicit consent.” Well Dr Kaplan will debate with you the value and achievability of ‘informed consent’ – I won’t – but this is a contradiction of your earlier point. Dr Trossel propped up his wishful-thinking through his ‘clinical experience’ and anecdotal evidence. It’s you – not me – who said that statistical evidence is no replacement for clinical experience; I disagree, I believe good statistical evidence occasionally requires us to question our clinical experience, not the other way round.

And Dr Kaplan, why would you not want to show some humility to Dr Trossel’s position (“strange doctors using strange treatments”)? Okay he and his clients didn’t share your health beliefs, but I thought you were about pluralism and libertarianism? Some of us feel the same way about some of your health beliefs, but resist saying so so directly. Don’t forget, as far as we know, his treatments could still be safer that chiropractic.

Thanks.

Adzcliff

Yes, mostly that is true but there is some projection in the mix of their approach.

Adzcliff,

Re:”CAM is ethical/unethical, effective/ineffective regardless of what’s going on in ‘EBM’ – unless you know otherwise.”
Okay then, so agree with me THERE SHOULD BE ONE STANDARD OF EBM for all therapeutic interventions on the NHS:
Yes or No, Adzciff.?

Re: Weird/strange treatments, pluralism and libertarianism: In a way i do think people should be able to see any doctor or therapist they want and other people should be able
to say what they want about these doctors/therapists. Deliberate exploitation of patients is not acceptable though but if a doctor is fully qualified and accountable there is no way I think he should be straitjacketed into becoming a dispensing robot governed by what Big Pharma considers ‘scientific medicine’.

It’s difficult for the ‘skeptics’ to understand what whole person medicine is at all. It requires a paradigm shift of which they are completely incapable. They would like the ‘debate’ to be restricted to their scientismic, deterministic and mechanistic view of the universe and I simply will not play ball exclusively in that arena.

Adzcliff,

After reading your entry on 8th June at 11.56, I came to the suspicion that Adzcliff is a sock puppet for someone like Andy Lewis and that you were deliberately trying to wind me up.

You accused me of solipsism, tu quoque and (in your words) ‘caricatured’ my position in order (reductio ab absurdam) to “prove” that I think that proper medical evidence is a waste of time.

Your response of 4.41 today is to go back again over the same ground; and we are then set to go round and round this one in circles until one of us falls dead with exhaustion.

So before I answer your points in detail, I want to know if you are genuine or not.

What is your real name?

What is your training in medical science?

What is your day-job?

Why do you feel it necessary to hide behind a pseudonym?

You know who I am. You know what I do for a living. You know that I use homeopathy on my animals; and you know that I have a deeper than average interest in the mechanisms of EBM.

You also know who Dr Brian Kaplan is. You know his profession, his qualifications and what he actually does as a clinician. Neither of us are hiding behind any sort of anonymity. But you are.

So come on Adzcliff, don’t be shy. Tell us who you really are.

Okay Dr Kaplan, if you’re saying that your knowledge and skills transcend the known laws of physics, then you are indeed in an unfalsifiable and impenetrable intellectual position. I might be attracted to this worldview myself, but I’d be too worried that I was making things up or fooling myself.

However, you do ask an excellent (if surprising) question”

“Okay then, so agree with me THERE SHOULD BE ONE STANDARD OF EBM for all therapeutic interventions on the NHS:
Yes or No, Adzciff.?”

Yes!

I believe all manufacturers of medicinal products should have to register and publish all their research. They should also have to evidence safety and efficacy before a treatment can be badged a ‘medicine’, ‘remedy’ or ‘treatment’ etc. (This is as much about trading standards as it is public health. Do you believe in trading standards – this is quite anti-libertarian?)

If the prescription/administration of that medicinal product is usually accompanied by a skilled and thorough consultation (e.g. homeopathic, psychiatric, herbal), then you should have to prove efficacy and safety over and above said consultation.

If the treatment is rooted more in physical or psychological intervention, then I believe there should be a requirement to evidence safety and efficacy.

I believe the NHS should limit their finite financial resources to treatments of proven efficacy and safety (or at least taking into account the law of double effect).

I think you’ll agree, what I am describing is a level playing field, so you may need to adjust how you’re describing my position.

As for the amateur psychology, it reminds me of the school yard trick of accusing the class homophobes of homosexuality (no doubt some were, but we knew we didn’t know that).

Thanks

Adzcliff

P.S. I also think people should be able to subject their body and mind to whatever the hell they like in their pursuit of health and well-being. However, I disagree with you that the public are always able to discern for themselves what’s in their health best interests. The public are made up of individuals, all of whom have different skills and needs. I’m vulnerable to exploitation regarding home-improvements, and in some respects, upkeep of our vehicles. Less so financially (but not entirely), and less so still on health related matters. My friends’ and families’ skills are distributed differently; and, yes, some would struggle to discern what’s in theirs’ and their dependents’ health best-interests. Many would take it on trust that the therapist they’re talking to or hearing about is safe and effective; just as I would be talking to an electrician or plumber. This is why I think regulation should be at the point of delivery, and unevidenced-based ‘treatments’ should be badged and sold as such…

Adzcliff, I congratulate you on agreeing that there should be one standard of entry to qualify for NHS admission. This separates you from homeopathy’s disingenuous critics who want NHS homeopathy disqualified (because its ‘implausibility’ offends their scientism and statism imo) while having no interest and nothing to say about huge NHS expenses on things like SSRIs which lack requisite evidence but are massively lobbied for by Big Pharma.

I also agree that people should have access to the level of evidence for anything – but on the whole they don’t. For example there are many products to put in your ears for wax removal. Do you know which products work better than others? Do any of these products have better evidence of efficacy than plain water or cooking olive oil and how do those two compare against each other? Do you know the answer, Adzcliff? People should be allowed to choose anyway – whether they know the evidence or not.

A lot of this discussion is about statism vs libertarianism but my opponents (largely statists) really dislike it being looked at that way.

Re: “If the prescription/administration of that medicinal product is usually accompanied by a skilled and thorough consultation (e.g. homeopathic, psychiatric, herbal), then you should have to prove efficacy and safety over and above said consultation” While this is correct from a deterministic point of view do you see how from a humanitarian point of view this comment denigrates and disrespects the therapeutic power of such consultations? This is why I’ve said many times of the Bristol outcome study of homeopathy: If

    detractors say the results are from the sympatico consultations, then they should study those consultations very carefully and keep an outcome study going over several years because there is obviously much to learn from it. On the other hand you cannot consult like that unless you believe in the inherent power of homeopathic remedies. Of course David and veterinary homeopaths have seen homeopathy acting on cows, horses and goats, so they may come to their own conclusions about these things.

    I do not think my ‘knowledge and skills transcend the known laws of physics’ I refer you to the work of the physicist, Fritjof Capra: Here is a brief blurb on the Turning Point:

    The Turning Point: First published in 1982, and subtitled Science, Society, and the Rising Culture, the book explains perceived scientific and economic crises. It begins by outlining and tracing the history of science and economics, highlighting the flaws in the Cartesian, Newtonian, and reductionist paradigms. It explains how such viewpoints have grown inadequate for modern technology and ecology needs, then argues that science needs to develop the concepts and insights of holism and systems theory to solve society’s complex problems.

Hahahahaha! David, you have just articulated what I have long felt! Some detractors do comment under their real names on this blog and I certainly have more respect for those that do. It seems gutless to write strong opinions under a pseudonym but reminds me of a bridge joke.

An irate husband publicly chastises his wife after she (as his partner in a game of bridge) trumps his ace and completely destroys the hand.

Furious wife: ‘Well how would YOU have played that hand then?’
Irate husband: ‘Under an assumed name’.

But seriously your points are good. I think because the pseudonyms will continue to be used everywhere, I cannot ignore them. However I think I should have a maximum number of words in which to reply to these faceless commentators. Life is too short to waste conversing with people too (choose an adjective) to speak under their real names. Thank you for pushing me in this direction.

Okay David, re. anonymity. I do respect those of you/us who use their real names, and recognise you probably have the moral high-ground here. My reasons for remaining anonymous are purely that I’ve tried publishing under my real name in the past, and find it nerve-racking (that someone will take offence at my skepticism, locate me and/or my employer, and create unnecessary aggro for all of us). If free-speech creates problems for the likes of eminent employees such as Prof. Edzard Ernst and Prof. David Colquhoun, then lowly old me would stand no chance. If at some stage I feel more secure in my free-speech, you will be some of the first to know. But as I say, think you may well have the moral high-ground here.

So having declined to answer your first question (for now), and answered your fourth, here’s 2 and 3:

2. What is your training in medical science?

3. What is your day-job?

Irrelevant. My posts don’t rely on any appeal to authority. My arguments are either good or they’re not; nothing about my work or education effects this in the slightest.

Dr.David Eyles- Thanks! The excellent service you are doing to remedy the maladies of mute animals by means of medicinal therapeutics which is based on Homeopathic philosophy, whose conceptual truth and cognitive application encompass all highly evolved creatures on Earth, is in itself a well established EBM as an intellectual product of highest evolved human beings.
Only human beings, by virtue of uniquely evolved faculties of mental acumen, are always aware of Nescience which is viewed with a sense of inadequacy and which is sought to be dispelled by many means of ‘quest’ for knowledge.
While the faculties of mind are capable of transcending all limitations of subtly perceived concepts, the descent into practical applications in the physical world should constrain to phenomenally defined Space-Time limitations. Thus necessitates a ‘definition’ for anything that should ‘conform’ to a given physical application. Viewed from this angle , our own physical bodies conform to all definitions of physical world in a rationally observable manner. The integrated subtle mind –gross body individual personalities, however, behave conforming to the subtle and responding to the stimuli of gross in a variety of manner. To find a rational means of interpretation and methods of working , the broad conceptual awareness of Science is evolved, based upon both subtle cognitive as well as gross empirical means of definitive evidence built around by highly evolved human faculties.
At the turn of 18th-entering 19’th Century the zeitgeist of scientific awareness gripped the imagination of many pioneering people dedicated to various faculties of scientific learning and technological innovations. Among them we find a meticulously trained classical school physician Dr. Samuel Hahnemann, whose genuine application of medical practice at hospitals left in his pioneering soul gripped with contemporary time spirit a sense of great inadequacy and horror, unbecoming of values for human applications This led him to a quest into the past regarding his subject profession and rewarded his spirit with a reawakening stimulus of an old principle ‘similia similibus’ leading up to the new school Homeopathy as an alternate medical profession.
When we speak EBM we have to first reckon with Evidence and Basis before proceeding further for Medical application. At the time Dr.Hahnemann human imagination was still restricted necessarily to some means of mechanical compliance for transfer of any physically directed action. This was dispelled by the observation of H.C Oersted in an experiment of teaching electrical conduction to students when the needle of a compass lying in proximity to a copper wire deflected instantly whenever its both ends are electrically polarized. Thus established an evidence of ‘action at a distance’ based on first human observation and later ‘scientifically’ rationalized. We human beings develop science as a means of rational verification of phenomenal occurrences within the detectable sensitivities of our direct primary perceptions and extend further augmented by high sensitivity scientific instruments. All these manipulations, however, cannot supplant the extent of human ingenuity and dispel the ever existing sense of ‘wanting’ for further perfection. Indeed, with the advent of founding new medical school of Homeopathy the nature of psycho-somatic relationship was well established first by the new and latter accepted by the old classical. Hence its success even as a veterinary medicine at the hands of Dr.Eyels, whose Homeopathic spirit of application is lifted from down south by Dr.Brian up north into the British Isles and defended with the courage of Witwatersrand.

Shame about that Adzcliff. I am surprised that you feel so insecure. You seem such a polite and well mannered sort of chap. Not the sort of person who would say anything offensive to anyone. But then perhaps, in the form of your alter ego, you did rather bring all those problems upon yourself didn’t you?

In the interests of brevity, I may not have made myself entirely clear re: tu quoque. My understanding of this phrase is based upon my understanding of common and equity law, and it goes like this:

Jones and Smith are neighbours on an ordinary suburban housing estate. They have a common boundary fence to both their front and back gardens. Smith decides to renew the front fence and in so doing, moves the fence line into Jones’ garden by a foot or so, thus pinching a bit of Jones’ land. Jones protests, but Smith refuses to move the fence, so Jones instructs his solicitors.

In his defence, Smith states that the previous year, Jones built a garden shed in his back garden and in so doing built part of it upon Smith’s land.

This counter-accusation is the ‘tu quoque’ defence. In other words it is a “you too” or tit-for-tat defence. Note that Smith has not denied his tresspass, he is using Jones’ earlier incursion as justification. However, his defence is still precarious, because the court could still decide that despite Jones’ provocation the previous year and his hypocrisy now, Smith should have dealt with Jones when he built the shed. Two wrongs do not make a right. The precise facts of the case will decide which way this defence goes.

On the other hand, If Jones can show that he did not build his shed upon Smith’s land, perhaps by reference to deeds, measurements and so on, then there is no hypocrisy on Jones’ part in protesting at Smith’s behaviour. Jones has come to court with a clean conscience – with “clean hands”. Smith’s tu quoque defence fails; and Jones’ case is upheld.

I stated quite clearly in my comment at 10.24 on 9th June above that there is no inconsistency or hypocrisy in my position. That is: I have come to the debate with clean hands. Therefore your defence and counter-accusation of tu quoque falls at the first fence.

At this point, I was going to go into the way in which EBM is unlikely to fulfill your apparent ambition to get it to the point where medical products are specified and tested, as if they were an engineering component, and thence can be regulated under trade descriptions. But I am not going to bother, because I do not think that wasting my time in this way is anything anything more than an entertaining diversion for you.

And yes Adzcliff, it does matter what you do for a living; because if, for instance, you are a journalist then that puts a different complexion on why you are engaging with homeopathy on Brian’s blog. If you are a journalist with strong connections to aggressively anti complementary medicine organisations such as Sense About Science or the Nightingale Collaboration, then that makes it even more important that we know who you are.

You see, the Leveson Inquiry and recent examples of plagiarism have tended to confirm the public’s impression that all journalists are as duplicitous, manipulative and cynical as these recent high profile cases involving what is actually a very small minority of that profession. It is fair to say that journalists’ reputation has reached a nadir in the eyes of the public, on a par with the most distrusted profession of all – politicians. There is a widespread view that journalists will do anything to enhance their own careers, regardless as to who or what they damage or destroy in the process.

And so when you describe yourself as “lowly old me”, forgive me Adzcliff, but I cannot dismiss the possibility that you are dissembling. In particular, I cannot help wondering why you have thrown the Trossel case into the debate. Are you on a fishing trip? Are you using this as bait to get Brian to say something that you can subsequently use against him in an article or a book? Is this an exercise in entrapment?

And finally Simon (you don’t mind if I call you Simon, do you?) you have accused me of tu quoque (a variety of ad hominem), moving the goalposts, solipsism, and have wilfully misinterpreted what I have said. Goodness gracious me Simon, you have expended the entire Nightingale arsenal of pejorative epithets within a few lines. May I suggest that if you are going to play chess, you learn to move one piece at a time?

Regards,

David

Always worries me when people hide behind funny names, very sinister and not really honest. Agent provocateur (not the naughty knickers) comes to mind.

Is that the honest Les Rose in the blog who acused me falsely of academic fraud and wasted 2 years of University and NHS time and money only to discover that he had misled us (you see I am polite) about the outcome of his personal participation in a clinical trial of acupuncture. Well what is the point of debate with people who cannot be honest about their names and their complaints about others. What a bunch of …… reputable scientists…..I think? Is Les a real medical scientist like the rest of you and of course Simon/Adzcliff..

Yes indeed George, It’s strange how the anonymous commentator on the internet suddenly became completely acceptable. I guess there was always the odd letter from ‘Disgrunteld of Tunbridge Wells’ but the difference was that this was always considered a little cowardlyj and generally satirized. In defence of Adzcliff, I would say that he has apologised for anonymity which is something that most boneheaded, anonymous ‘internet activitists’ would never dream of. And don’t forget the 50 centers – the mercenary typists hired by various nefarious groups.

Hi David

Tu quoque: yes, as I understand it, this literaly means ‘you too’. I evoked it when I spotted you were trying to undermine my position that CAM isn’t evidence-based enough, by pointing out EBM isn’t perfect either. This is a fallacy as, even if you were to expose me as a hypocrite (I don’t think you have), this says nothing about the ethics and efficacy of CAM.

I’m not a journalist (??). But even if I were, I’m assuming you stand by what you’re saying, and are debating me on the basis of my words. (Frankly, I’m occasionally embarrassed by how poorly I’m able to articulate my point, so am genuinely baffled by why anyone would think I’m a journalist??)

I think you’re probably write to criticise me for hiding behind a pseudonym, but find it very draconian of you to actively try and deny me that right. If Dr Kaplan wishes to ban pseudonymous comments on his blog, then I hope he would say so, and I would have to rethink how and if I comment. ‘Lowly old me’ really is a fair description – I apologise for the anti-climax if/when it comes.

As for bringing up the Trossel case: it struck me that I wasn’t clear why his case was so patently clear-cut regarding his unethical ‘alternative’ claims/practices, whereas other ‘alternative’ claims/practices seem to be less so . It seems we all sense intuitively that Trossel is a rogue, perhaps even criminal, but struggle to articulate this without leaving some CAM vulnerable too. I presented it as a novel analogy or thought-experiment. It seems to me that this case is indeed a bit of a curve-ball, but I, unlike some people here, like curve-balls, and enjoy having to change my mind to accommodate them.

I sense that you feel I have been impolite. If I have, then I apologise (this is rarely my intention, but I do have regrettable lapses), but if you’re confusing impolite with being rigorous or relentless, then I stand by my approach. I’m sorry I can’t take your beliefs on trust, but that is the nature of skepticism…

Adzcliff

Oh, and David, I think you’ll find you’re wrong to accuse me of ad hominem. To point out the logical flaws in someone’s argument is the very opposite of ad hominem. Me identifying a tu quoque in your argument is no more an ad hominem that your charge of ad hominem in mine.

Over and out.

Brian – I am afraid I feel you misrepresent the critics of homeopathy in insisting they want some sort of ‘double standards of evidence’.

Tell me this.

If my little boy rushes in from the garden and says there is a dog in the bushes, I might go out and see the bush rustling as if there is a large animal in there. I conclude in all likelihood there is a dog in the bush.

On a second occasion, my boy rushes in and says there is a tiger in the bush. Again, I see the bush rustling as if there is a large animal in there.

If I am to be consistent in how I treat evidence, should I conclude there is a tiger in the garden?

Andy,
I’m afraid the point of your dog, tiger and bush story is lost on me. I’ll read a few Aesop’s Fables to try to understand the metaphor. The critics of NHS homeopathy do not ‘want’ double standards, they apply double standards all the time. They should simply state the LEVEL OF EVIDENCE (say according to BMJ Clinical Evidence standards) they think should be required for ANY medical intervention to be included on the NHS. Then this level of evidence can be debated. I repeat: It matters little how homeopathy works – only that the people that vote for a Government think it works. 6 million do and many millions of other people who don’t choose it for themselves would want it on the NHS because they have a characteristic known to be British but by no means in all Britons. It is called tolerance.

Dr Kaplan,

It’s not a hard problem. Would you conclude there is a tiger in the garden? Yes/No?

I have a sneaking suspicion that the point of my question is entirely clear to you.

Andy,

1. Okay, I would not conclude that there is a tiger in the garden.
2. I have no idea what this story (an Andy’s Fable?) means or illustrates.
3. Your ‘sneaking suspicion’ has everything to do with you and nothing to do with me.

Given that the same levels of evidence exist both for the tiger and the dog, in what way is a double standard being applied to the evidence?

Sorry Andy, I just don’t get this dog/tiger/evidence thing at all – whatever your ‘sneaking suspicions’.

The answer is obvious – one claim is plausible – the other is not plausible. The levels of evidence require to accept a hypothesis will depend on the prior probability of the claim being true.

This is how people work in everyday life. We call people who accept extraordinary claims without lots evidence ‘gullible’.

In science too, this common sense view of the world is formalised by Bayesian inference. Any new piece of evidence has to be put into context of all the other evidence and knowledge we had before.

For example, recently, the claim that neutrinos could travel faster than light was accepted with extreme scepticism. It ran counter to well established results in physics. Despite the experiment being high quality with all aspects of it being checked and rechecked by teams all over the world, you would struggle to find a credible physicist who changed their mind about neutrino velocities. It was always more likely that there had been a mistake or artifact somewhere than the result being sound. Bayes rule tells us this and how to assimilate the new result.

Most new drugs go through years, if not decades, of preclinical studies to build up plausibility – test tube result, animal results and so on. Good plausibility does not mean that the drug will work, but when you do the clinical trials, the prior plausibility gives confidence in any trial results. EBM suffers from the (somewhat hidden) assumption that prior probability is constant for all hypotheses. Thus, say, a p-value of 0.05 is good enough to accept significance. But for most alt med, this is not true. Prior probability is low or even non-existant.

And this is where the real double standard lies. Homeopaths want scientists to accept their results without regard for the prior probability being extremely low. In doing so, they are wanting to overturn a constant, robust and rational approach to evidence.

Indeed, much lower than there being a tiger in my garden. Tigers are real. You can imagine scenarios in which this might be true. But homeopathy is not just implausibly, it contradicts what we know about physics and chemisty and biology. It is like my little boy rushing in and telling me there are fairies and gnomes in the garden.

I write this because your representation of homeopathy critics ‘wanting a double standard’ is not true and unhelpful in the debate. Indeed, the exact opposite is true. Homeopaths want shortcuts to acceptance.

Given that you do not believe a tiger is in the garden, do you still stand by your claim that,

“What is unreasonable and disingenuous is to have double standards of evidence depending on what one feels about the ‘plausibility’ of an intervention.”

Yes of course I do. If the people want homeopathy after listening to the incredible publicity given to its aggressive detractors by the like of the Guardian and BBC – they should get it on the NHS from qualified doctors. The fact that hundreds of millions of people in the world (and esp. India as I have pointed out) have valued homeopathy for 200 years is enough ‘plausibility’ for me in regard to NHS recognition but clearly not enough for the Disciples of Scientism and the I Know Better Than You What’s Good For You Brigade. That’s my point Andy and you know it and have known it for some time. The people can elect a Christian Democratic Party (if they want to) no matter what Evan Harris says about religion and they are entitled to NHS homeopathy whatever you say about dogs, tigers, gardens, implausibility etc. The point is simple. Scientists are entitled to their opinion. Homeopaths are entitled to their opinion. Scientismists are entitled to their opinion. Authoritarians are entitled to their opinion. But in the end the voice of the people is what should decide what happens on a state funded NHS. And please don’t bring up the incredibly patronising issue of ‘informed consent’. My views on that have been expressed many times

So, you get around the problem by claiming that homeopathy is plausible because people have ‘valued it’.

Do the same principles of plausibility apply to astrology, blood letting, lucky rabbits feet and voodoo.

I do not believe that folk beliefs correlate well with plausibility. Do you?

This is getting boring. People ‘believe’ in the Royal Family which must be an anathema to ethical scientismists. And the Royal Family rightly continues to exist because the people want it to.
The End.

By “boring”, do you mean, “I’ve lost”?

Perhaps to get back to the original point of your blog post, when Prince Philip was taken ill during the Jubilee, did she use her “60 vials of homeopathic medicines, carried in a special leather case, without which she won’t travel anywhere” or was Philip rushed to hospital?

I’m not sure, as I was in the States at the time.

No.

For what purpose then are the 60 vials?

This is the sort of rubbish, detractors of NHS homeopathy have to resort to. It implies that homeopathy is a failure because it ‘apparently’ purports to be a complete alternative to orthodox medicne – which it never has.

Best treatment for appendicitis: Surgery
Best treatment for syphilis: Penicillin
Best treatment for bone fractures: Orthopaedic surgery
Best treatment for Irritable Bowel Syndrome: Holistic approach including homeopathy, stress management and dietary changes.
Best treatment for acute urinary obstruction: Catheterization.
Best treatment for Depression: Unknown, possibly long term therapeutic relationship (not easy to prove with RCTs) but definitely not SSRI antidepressants (NHS budget £232million)
Best treatment for RSTD: (Refractory Scientismic Thinking Disorder) No known treatment

To be used to treat appropriate medical problems whose symptom picture matches the symptom picture of the homeopathic remedies in the 60 phials. In conjunction with conventional medicine if necessary of course. The Queen also believes in conventional medicine – as well as homeopathy. As did her mother with whom she appears to share longevity.
Long live the Queen!

There is nothing in the rules of homeopathy that I can see that places specific limitations on where it can be used.

Indeed, Prince Philip had an infection from what I understand. Homeopaths claim that homeopathy is superior to mainstream treatments in such cases. Indeed, some even claim antibiotics are the cause of illness.

What was it about Philip’s illness the precluded homeopathy?

Dr Kaplan, you said,

“It implies that homeopathy is a failure because it ‘apparently’ purports to be a complete alternative to orthodox medicne – which it never has.”

I am not so sure,

http://qako.me/MGWbtA

Well NHS homeopathic doctors do not think it is and NHS homeopathy is my chosen arena for this debate.

I have no idea. I am not his doctor and do not have access to his case notes.

Can you point me to any document that describes the scope of ‘NHS Homeopathy’ and how it is different from ‘Homeopathy’?

And, you are a private doctor no? Do you do NHS work?

Yes I do.

Go here: http://www.facultyofhomeopathy.org/about_us/about_homeopathy.html

Last paragraph reads:
Homeopathy doesn’t interfere with conventional medicine and should be seen as a complementary treatment, not as an alternative. In fact, homeopathic and conventional treatments can work very well alongside each other. This approach also gives patients more treatment choices.

The Faculty of Homeopathy which represents doctors using homeopathy is pretty clear about this. Okay Andy? Or any other tricks, dogs or tigers up your sleeve?

All scientific evidence is compiled based upon plausible concepts,interpretations of theoretical logic and practical experimental verifications, with consistent results accrued when conducted under similar procedures and conditions.
Science concerns only human beings as a product of mind-intellectual prowess, but in itself is NOT an all knowable web of compendium. What I seek to impress in my above comment is that while human being are capable of rational scientific explanation of many phenomenal observations, they concerning themselves are plagued by the difficulty of exercising the right choice between what was definitively known and what is sought to be known. This is because the phenomenal physical world is mostly conformal to definitively known choice by commonsense as well further supported by scientific knowledge. The reverse,alas,is not true as the historical events since AD2000 as displayed over all communicative media which baffled even the best experts of concerned scientific disciplines-events such as the falling Towers of Ny and threats of WMD’s etc.
Can I venture to seek some explanations, with due apology to the distraction from subject under discussion, how Homeopathy stayed with the NHS given the human choice between science and commonsense?

As we have already seen, homeopaths see homeopathy as a ‘complete system of medicine’ and indeed it was founded on deeply hostile attitudes to mainstream medicine. It is very easy to find these views expressed today.

Why have ‘NHS Homepopaths’ unilaterally decided that it is only a complementary medicine? What role does this complementary aspect have? If mainstream treatments are doing the curing, pain relief, symptom alleviation etc, what is homeopathy doing that is complementary to that?

And can you be specific how a ‘complementary medicine’can “give patients more choices”? Surely choices have to be between alternatives?

Andy, I’m sorry but we have covered most of this before. There is a limit to how much time I can devote to answering your questions. If you would like to debate this with me live in public, on the radio, on the beaches or in your backyard, that is another story. But this conversation is becoming a bit inane and has veered off the subject of my post.

You see, I think the Faculties statement is a meaningless platitude. It looks nice, but cannot bear scrutiny. If it could, you would answer. Instead, you choose to get bored again.

‘cannot bear scrutiny’ What nonsense!

Please go on then and address my question.

The Faculty’s (sic) statement is completely true. It’s how I was educated by them and they have been consistent in their espousal of that view for over 30 years in my direct experience.

Now let me ask YOU a question.

Do you receive any financial support whatsoever or any form of sponsorship for writing your blog OR being a ‘skeptic activist’ of any kind?

No need to be embarrassed if you are. The wikipedia entry for Sense About Science shows what they receive from various pharmaceutical companies and with this in the public domain, Tracey Brown had no problem testifying to the parliamentary S&T sub committee – which as you know I feel has been deeply discredited and whose recommendations have been rejected by two Governments. However if you do not receive ANY sponsorship for your contribution to the ‘skeptics cause’ this is a good place to be unequivocal about it. I only ask because you seem to have endless time to engage in debating these things with me on my blog and I don’t know what exactly you are trying to achieve. If your aim is to discredit me in any way, then the best place to attempt to do that would be in public debate.

I answered your question about me working on the NHS now please give a YES or NO answer to my question about whether you receive ANY financial compensation for writing your blog and/or general work on behalf of the so-called skeptics.

Well, there is a rather obvious attempt to deflect the questioning and try the ‘shill gambit’.

So, let’s get this out of the way – the answer is no.

Can you answer a similar question?

Do you gain financially from your advocacy of homeopathy or its practice?

Back to the questions then,

If homeopathy is “complementary” how have ‘NHS homeopaths’ come to a different view from the majority of homeopaths? If mainstream treatments are doing the curing, pain relief, symptom alleviation etc, what is homeopathy doing that is complementary to that?

Okay good. Answer to your question is also no.
In answer to your question about how homeopathy is complementary to conventional medicine I say the following:
1. I am amazed you didn’t know this obvious fact about homeopathy – esp. NHS homeopathy.
2. Conventional medicine is very far from being able to treat many conditions. In these situations, a whole person orientated approach such as homeopathy is useful.
3. Some people don’t like the side effects of the drugs they are on and seek more wholesome alternatives.
4. NB: Most NHS homeopathic referrals are precisely for conditions that have failed to respond to conventional treatment from GPs. Didn’t you know that, Andy? I am surprised.

You did not answer my bolded question. I answered yours.

1. You may be amazed, but I would like to know your answer.

2. That is true. Is homeopathy able to treat those conditions that medicine cannot?

3. Hang on. The Faculty says, “Homeopathy doesn’t interfere with conventional medicine and should be seen as a omplementary treatment, not as an alternative.”

You are saying it is an alternative?

Which is true?

4. Yes. I know that homeopathic referrals are TEETH. That does not mean homeopathy works – or ethical.

I would really like your response to point 3 please.

Andy, I can’t take much more of this so this answer will be the last you get. You have strayed from the theme of the post so this discussion is not appropriate anyway.
Point 3: It is both complementary and alternative. It can act alongside conventional medicine in arthritis for example of if the patient really dislikes the SEs of NSAIDs it may be able to act as an ‘alternative’ to NSAIDs. That’s why CAM stands for Comp. and Alternative medicine. What homeopathy certainly is NOT – is an alternative system of medicine to conventional medicine. I totally value much of conventional medicine and much of alternative medicine and have no problem in using them as complements to each other.

The End (of this correspondence)

Debating with Andy Lewis and the skeptics is a useless activity, they are stuck in this aristotelian idea that all is black or white: what is black cannot be black, what is black cannot be white.
they define what constitute evidence, and everything else is rejected. no point arguing with people like this, you will get nowhere.the dissatisfaction with treatment in the NHS is low, the satisfaction of patients with alternative medicine is consistently very high; does that tell anything to Lewis and is skeptic friend? no
I find the whole argument rather boring and repetitive: Lewis and his mates are forever against anything that they do not approve of, and there arrogance and aggressive attitude has no limits.
Their arguments are negative and repetitive, there is really no point entering nto any open and creative discussion with them, you might as well try to convince Bashar al-Assad or Kim Jong-un of the benefit of democracy.

Hi Nadine,
You are corrrect of course. However I don’t reply to their comments in order to convince them of anything other than I am well able to answer
their questions which are aimed at discrediting CAM. They have no idea of what whole person medicine is and are not interested in finding out. It must be sad constantly looking to disparage something while having nothing really to espouse oneself. I almost feel sorry for them.

here is a quote about sientism that you will appreciate: ““Scientism” is a term that has been applied to Western science’s tendency to consider itself as the only valid way of describing reality and acquiring knowledge. Far from objective science, it is riddled with a self-imposed form of materialistic and mechanistic bias. When it inappropriately and clumsily attempts to impose its restricted worldview upon domains where it has no business meddling, it can no longer be considered legitimate science that is practiced with an awareness of its boundaries. It instead begins to resemble an ideology not unlike a religious form of evangelism. Again, it is more than a bit ironic when conventional medicine attempts to belittle some alternative therapies as “faith-based.”
and hte link to his author: http://drsundardas.wordpress.com/2012/04/03/is-medicine-becoming-a-new-religion-part-1-2/

and just in case you do not find part 2, here it is:
Like any good faith, the church of medicine stands on the authority of its sacred texts. The randomized double-blinded placebo-controlled trial is the gold standard that assures the purity of church doctrine. The sacred studies are the only source of true knowledge; all other forms of knowledge are held to be inferior. Upholders of the faith frequently quote from the sacred texts in order to disprove and discredit heretical viewpoints.
looking at Andy Lewis as a high priest is an interesting and somewhat amusing idea

I am afraid, Doctor Kaplan, that you are an Heretic; if Lewis and al had their way, you would probably be burnt at the stake, but probably included in a Randomised Controlled trial to prove that this method actually cure heresy

Thanks Nadine,
For the excellent definition of Scientism – not the image of me being burnt at the stake. Yes, many of these people have much more in common with the worst parts of religion than they think.

Wasn’t going to wade in again, but it is just such sloppy thinking.

Which bit of homeopathy and its claims does science have “no business meddling”?

Not my quote. Ask Dr Sunderdas. But I certainly think scientismists, if they want to meddle in politics, should form their own party rather than try smuggle in their intolerant views through the back door. I’ve already nominated Evan Harris as a possible leader of the new Party of Scientism. You could be shadow minister of propaganda, Edzard Ernst shadow minister of health and so on. Organisations such as The Nightingale Association should think about this seriously. C’mon Andy how can you stomach all this non-scientific garbage being believed in all over the place such as religion, faith, astrology, homeopathy and CAM? We desperately need a complete Maoist style cultural revolution and you guys are the ones to deliver it. People may not appreciate having scientistic views forced upon them at the start but they will appreciate it eventually because as we all know: The ends justify the means. People who ‘believe’ in things not fully explained by modern science, need to be disciplined and laws need to be made to deal with them. The wise must educate the stupid and free them from their deluded belief system. If the ballot box won’t work, well then, why not try relentless propaganda. Suggested motto for the Party of Scientism: Democracy Sucks! Science Rules!

Let’s try again.

In your opinion, which bit of homeopathy and its claims does science have “no business meddling”?

I tried to dend a post, it didi not work, so here it is again:
1984 is getting closer than you think, if scientism has its way, your freedom of thinking will be soon under threat. Here is a hint of what is coming to us: http://www.asa.org.uk/ASA-action/Adjudications/2012/6/Healing-on-the-Streets_Bath/SHP_ADJ_158433.aspx
I am sure Andy Lewis will be all for it, as for you Dr Kaplan, if the burning at the stake is not coming back, I am pretty sure that the re-education camp will be your fate (you will be initiated to the joy of critical thinking, where critical is the important bit, and thinking is slightly forgotten)

Hi Nadine,
Thanks for the good news! I agree with you. Freedom is slowly being eroded and those that know better than us what is good for us are working very hard to restrict the rest of us. I actually think that some of these people believe that what they are doing is actually good for society – bizarre as that may seem. Others represent vested interests of course. But the Nanny State is getting more powerful every day. Now and then a politician stands up for freedom and liberty but most just put their heads in the trough and do what they deem to be in their own interest. Governments support homeopathy because they know a significant amount of the people do and it is not in the interest of any government to allow scientism to trump democracy. It is also immoral of course. We may not get to the full 1984 situtation though. Things can turn around and I do hope that that very British policy of moderation continues to prevail here.

Andy,
You dont’ give up easily do you? :-) I do answer your questions because you are generally polite and they help me refine my own medical and political philosophy – even though you are good at straying from the point of the post! First of all I don’t see why I should own the phrase ‘no business meddling in’ at all because it was not me that used it. However I’ll tell you where science becomes scientism and is therefore an intolerable threat to democracy and what is left of liberty in our society.

Let us return specifically for this purpose to the Bristol Outcome Study. This study of 23 000 homeopathic OPD appointments shows that the overwhelming number of patients were either ‘very satisfied’ or ‘satisfied’ even several years after the treatment. Now we must bear in mind that patients referred by GPs to homeopathic clinics have already generally tried conventional medicine and not been ‘satisfied’ so this is a rather refractory group of patients.

What critics, detractors and scientismists say about this study:
1. It’s useless because it didn’t use double blind controls.
2. All the results could have been due to placebo or definitely were due to the placebo effect.
3. It is ‘discredited’ because of 1 and 2.
4. This clinic (and all other NHS clinics) should therefore be shut down because this study certainly doesn’t support them staying open.

What homeopaths and supporter say of this study:
1. It shows that patients with refractory conditions attending homeopathic clinics such as this – are subjectively incredibly satisfied with the results.
2. It shows that patients going through the homeopathic process and being seen by doctors who totally believe in that process and the medicines, do very very well.

NOW: from a political point of view and in direct answer to your question:

    Authoritarian scientismists: End NHS homeopathy and close down clinics like this as they are a waste of taxpayers’ money. Using ‘placebo’ like this is unethical, a waste of money and should only be done with ‘informed consent’ and certainly not at the taxpayer’s expense.

    Libertarians say: Of course such a clinic must stay open however homeopathy works. Libertarians who have studied homeopathy think that it should remain open because homeopathy works. Libertarians who are skeptical about homeopathy also support it staying open because they are happy to see others benefit from going to a clinic – no matter how they think those results have been achieved. They also believe that the argument about ‘informed consent’ is nonsense because ‘informed consent’ is almost impossible to define and will differ significantly according to who gives it. For example, mentioning this study to patients is a form of informed consent but so is referring them to your blog or recommending they read popular ant-CAM books by well-known authoritarian, scientismic statists, some of whom are even medically trained.

    I have nothing against science but everything against scientism. You may never fully understand this Andy and have shown this lack of comprehension before where you suggested that I would see a whole lot of stuff you wrote as scientism and not science – but I did not. A true scientist would recommend that the Bristol Homeopathic NHS Clinic stays open at all costs because there is clearly something very, very important for science to learn from so many people claiming they are better. Even longer term trials could be done. RCTs could also be done. But to call for it to close is pernicious meddling by scientismists When scientists call for authoritarian statist action like this, they become scientismists and I totally oppose them – not only to protect homeopathy but to protect liberty and democracy in our society.

    Thank you for asking this question. I enjoyed answering it.

I am not sure you have answered my question again. I asked, “which bit of homeopathy and its claims does science have “no business meddling?”

Nadine wrote about science “impose its restricted worldview upon domains where it has no business meddling”. But neither of you have mentioned any intrinsic aspect of homeopathy that can lie outside the domain of science.

What you, Dr Kaplan, appear to object to, is people taking policy positions based on their understanding of the science, when you disagree with them. In other words, it looks like ‘scientism’ is just a label you apply to opponents of your position.

Using science and evidence in policy is of course a ‘good thing’. And I agree, that science should never be the overriding determinant in policy. But you misrepresent your opponents positions to make it look like they are being clumsy in their application of evidence – a straw man – and then call you label them scientismists and authoritarian.

Your depiction of the position of people like myself is ridden with misrepresentations. Perhaps I can expose a few of them…

cont…

So, you bring up the Spence (Bristol) study and characterise its critics in certain ways. Let’s take that apart.

1) You claim critics think “It’s useless because it didn’t use double blind controls.”. Well, it depends what type of conclusions you want to draw from the study. If you want to understand if people were satisfied with their treatment at the clinic, then the survey might tell you something. If you want to use it to show that homeopathy treatment is effective, then the study is useless. The reasons for this are very straightforward and uncontroversial.

2) You claim critics say “All the results could have been due to placebo or definitely were due to the placebo effect.”

Not true.

The Spence study looked at many conditions that are self-limiting in their nature, childhood ailments, menopause, etc. After 7 years, we can expect improvements in health anyway. For example, the biggest group was for childhood eczema. Any natural progression in this group could account for large numbers of ‘improvements’.

50.7% of patients reported they were ‘better’ ot ‘much better’. This does not take into account the people who died, dropped out, survey non-responders. This sort of result, given the type of conditions, is entirely consistent with homeopathy offering no specific effects. And the style of survey (no controls) means that we cannot know if it had an effect. The survey adds no evidence to support the idea that homeopathy is effective.

3) You claim “It is ‘discredited’ because of 1 and 2.”

Not true. Homeopaths discredit themselves by trying to use Spence to justify claims that the survey cannot answer.

4) You claim “This clinic (and all other NHS clinics) should therefore be shut down because this study certainly doesn’t support them staying open.”

Until such time as homeopathy can provide evidence that it is not pseudoscientific claptrap, then, yes, the NHS should not be wasting money on it.

But you then shout “But look at all the satisfied people!” and infer that they are satisfied because homeopathy works. I am sure you would agree that medicine that produces ‘satisfied’ patients may not be the same as effective medicine. It is easy for a doctor to satisfy a patient – give them false reassurances, claim a treatment is possible when none exists, give them nice wards, waiting rooms, friendly staff. And patients can be most unsatisfied with effective medicine – painful operations, unwanted advice(“stop smoking, exercise more etc).

You claim I should be saying “the Bristol Homeopathic NHS Clinic stays open at all costs because there is clearly something very, very important for science to learn from so many people claiming they are better.”

This is absurd. The totality of evidence and an understanding of basic science, tells us homeopathy is an inert treatment. The Spence study adds nothing tothis as explained. We can understand the results purely from the study design and types of conditions surveyed. There is nothing ‘very very important’ in Spence that justifies anything.

If you can articulate how the Spence study does suggest something and how we can discount the inadequacies of the study design and how we would expect a significant fraction of patients to have got better anyway, then you may be onto something.

But you will not be able to.

Andy, Yes I will be and am able to – but obviously never to your satisfaction. No point in flogging a dead horse. We obviously operate in very different paradigms. I am a doctor and you are not. I really believe homeopathy works and have seen it work. You don’t and haven’t etc. etc. Your remark about ‘false assurances’ is so wrong that I cannot take the time to refute it except to say that hundreds of thousands of homeopaths know that you are wrong and nobody gives ‘false’ assurances. Even Edzard Ernst accepts that homeopathic doctors believe that homeopathic remedies are active (but ‘should know better’) No point in taking it any further as you seem to suggest. But the real difference that can be debated is your authoritarian politics vs. my libertarian politics. THAT subject can indeed be discussed.
Here is an interesting ‘did you know’ for this discussion.
I heard on Radio 4 (Start the week) today that 80% of the Chinese politburo are scientists. When I heard this a lot of things became clear for me and one was: Heaven help us and human rights in the UK if that happens to our parliament. Ulitmately a government should be of the people, for the people and by the people. Otherwise we all hit The Road to Serfdom

Brian – you missed my point entirely. I was merely making the point about how you can easily create ‘customer satisfaction’ in medicine. And that satisfaction is not a proxy for effectiveness.

And I too believe most homeopaths believe they are not giving false assurances. That also does not mean they are not.

And there is nothing in my politics that I believe is ‘authoritarian’. I merely suggest that there ought to be standards for evidence and a scientific rationale in what the tax payer finds in the NHS. And that touting studies such as Spence does not provide this.

You have not addressed any of mu substantive points in my argument. Merely pulled the authority card out of your pocket and huffed a bit.

It is why I think any public debate with you would be a waste of time. If you cannot debate the substantive points here, why would you do it in a live setting?

Andy,
You have got to be joking.
Yes? :-)

Forgive me for failing to address your ‘substantive’ (nice choice for a self-applied adjective) points. I thought I had. However the hypocrisy of the accusation is jaw-dropping. How about you talking about the subject of the post for once? Instead you veer off into the same stuff we have debated before ad nauseam. I have clearly stated that my main issues here are liberty and democracy and respect for the people – no matter how stupid, in need of ‘informed consent’, ‘vulnerable’ and apparently best cared for by a nanny state you and the other self-appointed detractors of NHS homeopathy think they may be.

One advantage of a public debate is that there you would be called on to stay on the main subject of the debate. Another would be that it would be the audience who would judge which one of us is making the more ‘substantive points’.

You know absolutely nothing about whole person medicine, the philosophy of holism as applied to medicine (and how it requires a different way of assessing clinical results) and refused to read the work of E.K.Ledermann (perhaps the clearest exponent of modern medicine and philosophy) when I recommended his work to you.

I now see you also know very little about liberty and totalitarianism. I could recommend you read Hayek’s classic, The Road to Serfdom but of course you know what you know and don’t need to look at that either. Good for you. From now on I’ll post only comments directly relating to the subject of my post. If your objective has been to waste my time, congratulations – you have been successful to some degree. But as I’ve said, you have also helped me clarify my own views on medical politics. But I see the law of diminishing returns in action now and will react accordingly.

you just have to go to various skeptic websites to see the high level of intolerance; some of the comments made by skeptics would not be out of place in the most right wing political organisations.
In fact comments they disagree with are met with scorn, and their author subjected to aggressive attacks, derision, etc.
Their way of thinking is similar to the medieval inquisition, or the soviet system where those who disagree with the party are enemies of the party, and therefore an enemy of the state.
This is why, I think the new popularity of scientism and its quasi-religious and evangelical fervor could eventually lead us to a 1984 scenario

Nadine,
I know what you are thinking and there is a movement a little in that direction which is disappointing in a country known for its qualities of moderation and tolerance. However scientism is not that ‘popular’. Just because its proponents are vocal, aggressive and media-savvy, we should not assume it is ‘popular’. People trust their instinct and know that most CAM practitioners are decent, well-intentioned, sensitive people. Many also recognise that CAM’s detractors are hardly the kindest or most altruistic of people and correctly identify something authoritarian and condescending about them. When they are open about their politics – they suffer huge setbacks. The case of the Evan Harris (a doctor and ex-MP) losing his seat in parliament purely due to his scientismic views on a number of subjects is a an excellent illustrative example of this process in action. But yes, the trend is somewhat worrying but we have a long way to go before we enter the Orwellian nightmare scenario.

Brian -I believe all my posts are in response to topics that others have brought up in order to defend their position. That the debate then leads to positions you find uncomfortable is not my fault.

And I have read your guru references on “whole person medicine”. It’s just a deflection technique of you to avoid putting this in your own words.(“Go and read someone else”).

The referencesare so full of nonsense that they do not add to the debate

Just one comment before I say that this isn’t on the subject of the post: I will let others decide who is ‘full of nonsense’.

On that note, we agree.

And that brings us full circle to the main message of this post. Hurrah for that!

‘Others’ such as The Labour Party, The Coalition Government and of course The Queen agree with me.
That is all I was saying in my Jubilee post but you managed to veer away from this point as usual.

A bunch of vocal, aggressive and media savvy ‘detractors’ agree with you. That is clear too but not the main point of my post. They are entitled to their opinion (as the above are) but when this bunch argue for legislation based on scientism, I oppose them politically because I am a libertarian (in the J.S.Mill sense of the word) and have little time for the I know better than you what’s good for you Brigade whether such people base their patronising politics on religion, Marxism, scientism, statism or astrology.

Except what you say is not true. We have been over this and you keep repeating the same misleading statements.

You said, “the present Coalition Government is protective of the people’s access to NHS homeopathy;”

Only this month in Parliament,

http://www.publications.parliament.uk/pa/ld201213/ldhansrd/text/120611w0002.htm

To ask Her Majesty’s Government what is their policy towards the use of homeopathic medicines in the National Health Service.[HL396]

Response:

The department does not maintain a position on any particular complementary or alternative therapies including homeopathy. It is the responsibility of local National Health Service organisations to make decisions on the commissioning and funding of such treatments, taking account of issues to do with safety,

Its very tiring.

Exactly!

The statist recommendations of Tracey Brown, Edzard Ernst, Evan Harris & co to remove the possibility of NHS GPs and local health authorities referring patients to NHS homeopathic clinics were all kicked into touch by the Coalition government and the previous Labour government said that it would be illiberal to ban NHS homeopathy. Only people like you and a few others think that NHS GPs cannot be trusted to decide whether patients should be sent to NHS hospitals or not. In one way that’s the difference between me and you. I trust Britain’s GPs more than you do. Patients cannot get NHS homeopathy unless referred to NHS homeopathic clinics by their GPs. That’s good enough for me but apparently not you – who although not a doctor, would seek to thwart rather than dissuade GPs in this regard.

For me, It should be left only to NHS GPs and not to lay people on NHS local health ‘authorities’. But at least the suggested draconian, illiberal, anti-democratic, authoritarian, patronising, nanny-state, scientismic suggestions to remove all NHS homeopathy by diktat from Westminster was stamped on by two successive governments. The British are meant to be good losers, but if you can see the Government’s response to the S&T committee as a win for the detractors of NHS homeopathy, then please let me know where you get your rose-tinted glasses from.

No need for rose tinted classes. The report from Science and Technology Evidence Check on homeopathy is having the desired effect.

That’s a moot point. But ALL its recommendations were rejected by the Government so politically it had no influence at all.

As I have said before, I am happy for you to believe that.

Ask the lay homeopaths how they are feeling right now.

There is no belief involved. The Government rejected all their recommendations. QED.

We’ve been over this. That is a misrepresentation.

The Goverment’s position can be summed up in Para 8.

We agree with many of the Committee’s conclusions and
recommendations. However, our continued position on the use of homeopathy within the NHS is that the local NHS and clinicians, rather than Whitehall, are best placed to make decisions on what treatment is appropriate for their patients – including complementary or alternative treatments such as homeopathy – and provide accordingly for those treatments.

So, whilst the government wanted to wash its hands, the local NHS is quietly dismantling NHS homeopathy,using the report as its justification.

Other authorities are also using the report to back up their positions.

So, I am happy for you to think it was a victory. Meanwhile, homeopathy is struggling to get commissioned, cannot advertise openly with the ASA breathing down their neck, and with the MHRA consolidating regulations that are most unfavourable to them.

Exactly. I agree with the Government that

      doctors

rather than people like you, scientismists and of course the ‘I know better than you what’s good for you’ Brigade

are best placed to make decisions about

    their own patients.

And yes you may well be right; the UK may be slipping towards a much more authoritarian, nanny state, ’1984-like’, over-regulated surveilance society at this time in history. So if that makes you happy – good for you.

I think the skeptics live in the magical world of Alice in Wonderland:
“”I’ll be judge, I’ll be jury,” said cunning old Fury.
“I’ll try the whole cause, and condemn you to death.”

Does that ring a bell?

Sure does Nadine! Oh for a white rabbit. Or a white light. Or any form of enlightenment in these darkening times.

Funny.

But isn’t Dr Kaplan calling for doctors to be judge and jury? I am calling for the evidence to settle the matter.

I find the fashionable emphasis on critical thinking that Lewis and Al tend to bring forward as their “raison d’etre” and why they are always right, amusing when the underlying method of “hyper-critical thinking is always present: This method is generally a suspicious analysis of dependent and insignificant details related to a topic, to repel an opposing theory, even though the evidence brought by the latter is far from negligible.
The hyper-critical method is difficult to counter, to the extent that it is launching a large number of sweeping assertions (and quick to make), which require work to be verified.
Add to this a 2 valued logic and you have the boringly repeatitive argument of the skeptics

Democracy is in your rearview mirror, serfs.

Still, I liked her music.

Ouch!

Re: ‘boring repetition’:

“The most brilliant propagandist technique will yield no success unless one fundamental principle is borne in mind constantly – it must confine itself to a few points and repeat them over and over” (Josef Goebbels)

Andy, At last we reach the crux of the matter!

Should accountable doctors be judge and jury of how their own patients are treated? Am I being naive, horribly controversial and anti-Statist, if I say YES?

Trials have been done (not enough). Meta-analyses have been done (with controversial interpretation of them). Outcome studies have been done (some deride, some applaud)

Now who is to decide whether a patient can benefit from being sent to an NHS homeopathic clinic?

a) Clinicians such as the patient’s own NHS GP who might have known them and their family and situation for years and maybe decades?
b) Scientists of the Scientismic persuasion
c) The non-medically qualified I KNOW BETTER THAN YOU WHAT’S GOOD FOR YOU BRIGADE Non-medical, patronising, condescending, statist propagandists who believe their views should be forced on the people.
d) The medically-qualified I KNOW BETTER THAN YOU WHAT’S GOOD FOR YOU BRIGADE Medically-trained, patronising, condescending, statist propagandists who believe their views should be forced on the people.
e) BIG PHARMA

Forgive me for being so naive fo putting a circle around

    answer a.

I know it’s not a very scientific answer because obviously many GPs are so naive/stupid/gullible/impressionable that even a non-medically trained person such as yourself knows better than they know what is good for most of their own patients.

Andy, your comment: “But isn’t Dr Kaplan calling for doctors to be judge and jury? I am calling for the evidence to settle the matter.”
at least the doctors use their clinical experience to make the decisions, they do not try to reduce patient to a mathematical algorithm or a statistic as it would happen if you had your way: your Evidence Based Medicine is mostly statistical evidence, or in other words a probability within set criteria, to me it constitute good information, but lack one dimension that only the expert bring into account, your line of reasoning is constantly distorted by the fact that your speciality is maths, not medicine, and you constantly demonstrate the lack of this dimension; I would happily use your knowledge to help my daughter with the math GCSE, but if I want, say my bronchitis to be treated, I prefer to go to the doc; he may choose to give me steroids, antibiotic, an homeopathgic medicine or do nothing, but I would trust more his judgement than your stats.
The 2 valued logic that you and your skeptic friends try to apply systematically to the subject of alternative medicine simply does not work

Nadine – doctors’ clinical experience is not infallible. There may be some who completely fail to understand how they can be misled into thinking a patient’s improvements was due to their intervention. Homeopathy is the systematic practice of this error.

Not all doctors are scientists. They are trained technicians. And no matter whether you view your patient as a ‘mathematical algorithm’ or a ‘holistic whole person’ an ineffective treatment is still just that – ineffective.

A doctor who ignores statistical evidence is incompetent. Your incompetent view of mathematics does not change that.

And there you have it Nadine: In the condescending eyes of a scientismist, doctors are merely ‘trained technicians’. In that Andy says very little about medicine, but everything about himself. My instinct is that I know a lot more about statistics and calculus than he knows about human beings and medicine.
No matter that the great William Osler described medicine as an ‘art based upon science’. It’s no go whole person medicine. It’s no go liberty. It’s no go democracy and you know what it’s no go a conversation with me because he is so straitjacketed into the scientismic paradigm, that it really is impossible for him to understand whole person medicine.

Here is an epitaph of a doctor who was a little more than a ‘trained technician’. Homeopathic doctors will understand it easily. In fact most doctors will relate to it but for scientismists who think of doctors as ‘trained technicians’ it could be somewhat ‘challenging’.


“To cure sometimes, to relieve often, to comfort always”
Epitaph of an Athenian Doctor, AD 2

So Brian, you see how dangerous the reasoning of the skeptic is, doctors are not infallible, but they get it right most of the time, when people are reduced to statistical results of RCTs, if you do not fit the statistical model you are wrong (and you probably die) One of the constant claims of the skeptics, is that homeopathy is dangerous: even if there are a few idiots among the homeopaths who think they can cure absolutely everything with homeopathy, there are some idiots among the skeptics who thinks that a human being can be reduced to some kind of algorithm; I find the skeptics far more dangerous than a few idiots among the homeopaths. I may be incompetent in maths (so What?) but i know that human being will never fit in statistical models such as RCTs.
The problem with people like Andy, he means well but he simply does not see the flaw in the system he is proposing.
I guess my idea of hell could be a world ruled by mathematicians.

Thanks Nadine, I concur.

Nadine – Incompetence in maths,so what? The so what is that you have no idea how statistics can be applied to medicine and yet you feel happy to dismiss such an approach. I think Dunning-Kruger applies here.

Brian – yes, medicine may well be an art based upon a science. The trick is not to dismiss the science bit. You then end up with homeopathy – an art based on gobbledygook.

It is such a shame that we sceptics lost the political battle with the House of Commons Select Committee report on homeopathy.

It has had no impact.

http://qako.me/LNo6EK

Yes, you did lose the battle in the Houses of Parliament despite the wise and scientismic counsel of Ben Goldacre, Professor Edzard Ernst and Tracey Brown. The Government rejected ALL their recommendations. Do you dispute this? This is a FACT and it precipitated a fuming letter by Michael Baum to The Lancet (culminating with ‘Shame on you minister!’) soon after he had called for the debate to be brought into the realm of ‘polite disputation’ in the American Journal of Medicine. The Government’s decision certainly displeased the detractors of NHS homeopathy. That they have got the ‘impartial’ BBC and a host of regulators to make life difficult for homeopaths – in spite of the Government’s view on the matter- is another issue altogether. I don’t support Stasi-like enforcement of authoritarian regulations whether I agree with them or not. You do. That’s the difference between us and let’s just leave it at that. Enjoy your evenings.

Dunning-Kruger yourself! you feel you are so superior because you have a degree in maths, and therefore the fact that you have no competence in medicine is insignificant.I may have no idea how statistics are applied to medicine, but you seem to have no idea how medicine is applied to people.
Your stats seem to contradict themselves a bit too often in the various meta-analysis and systematic revues that are published.

Given that it is quite clear that it is now illegal to trade in and dispense the vast majority of homeopathic remedies, do you intend to abide by the law? What will this mean for your practice?

As I’ve said, Andy,
I’ve had enough of this ‘discussion’. I’ve had enough of your veering off the subject to the same stuff you always talk about.

I will meet you in debate anywhere in public. A neutral audience might shed some light on who is making sense here.

And by the way, yes, I intend to abide by the law on medicine and homeopathy as stated by the Government. And the Government has been quite clear about NHS homeopathy as I’ve mentioned many times. Or perhaps you think that the Government expects NHS homeopathic doctors to practise homeopathy without prescribing homeopathic medicines? Or the public should be ‘allowed’ to take homeopathic medicines but nobody is allowed to buy them or sell them? Yes, that must be it. That’s what Mike O’Brien and Ann Milton said in parliament wasn’t it? Or was it at the Mad Hatter’s Teaparty? Or maybe you just misunderstood something and need to read both Mike O’Brien’s and Ann Milton’s response to the S&T Committee’s horrendous report in which they both rejected
ALL the anti-homeopathic recommendations made by this discredited S&T Committee
whose report was only signed by a small minority of its constituent members.

I go with the views of the Labour Party, the Coalition Government and the Queen. The Government is still the maker of laws in this country when I last checked so I guess if I am guided by what they say in parliament I am abiding by the law. Thank you for allowing me to quote the Government to legitimise the use of homeopathy in my own practice. Thoughtful of you.

Hey Andy,

Do you think the Gaussian distribution is valid? Fat tail events in medicine are a bit of a sticky problem. Do you have a better model for addressing probabilities that are not classically Gaussian at all?
I believe Gauss oversimplified (and Mandelbrot over-reached).

Even if you tried to reduce clinical medicine to an algorithm, the multiple algorithms of co-morbidities are very difficult (and often impossible) to model and implement….and these situations are very common. This is where non-mathematical types of judgement are most valued. I would nail you in a debate on this and several other issues related to a dialectic, where math and medicine are pressure-tested for concordance.
Brian has strong backup (and is a superior chess player), so careful if you take any calculated bets with him ;^)

Ruth

I have a feeling that this is the most intelligent comment ever posted on my site. Thanks Ruth!

Ruth – Yawn. You would nail me in a debate? Ho hum.

The fact that medical phenomena may not demonstrate normal distrubutions does not allow you to jump to ‘non-mathematical types of judgement’.

The problem for homeopathy is very simple. It cannot demonstrate, in well controlled trials, any deviation from the distribution of outcomes seen with a comparable placebo treatment.

No amount of hand-waving about gaussian distributions can get you out of that fix.

Oh, and Brian – you tell me off for ‘veering off the subject’, then someone jumps in waving their arms around about statistical distributions without being in any way specific or coherent and you claim their comment is ‘intelligent’.

Perhaps, you think long words are a sign of intelligence. Uncharacteristically, I can think of no long words at the moment, except for ‘wheelbarrow’.

You should be grateful to Ruth! She is a biotechnician and a mathematician. More importantly, she is also addressing you personally and your limitations in applying maths to medicine in any way productive or helpful way.

Why don’t you try to contribute something to pure mathematics – a subject whose beauty is undeniable rather than making your rather ugly remarks about medical doctors with whom you disagree?

I’m quite interested in the search for the curve or formula that predicts the sequence of prime numbers. Know anything about it. Let’s chat…

Ruth has made no specific criticism. Just handwaving side swipes suggesting my approach to maths does not take into account deviations from normal distributions. Utter nonsense.

If Ruth would care to expand on what she means, with examples, then we can chat.

Andy,
I am very interested in prime numbers. In particular I refer to the search for a formula or ‘curve’ that will predict the sequence of prime numbers.
I have spend some time thinking about these enigmatic numbers and discussed them with many a mathematician including one who is totally preoccupied with prime numbers. Love to hear from you on this subject.

Good for you.

Yes it is good for me. I think the prime numbers are a fascinating subject and met some good mathematicians through chess. Top chess players and top mathematicians often have in common: absolute genius; eccentricity and inability to find meaningful work.

What’s your view on this? And prime numbers?

Andy,

Do you really have a degree in Maths? Your comments on Bayesian statistics lead me to believe that you haven’t a clue, but of course, I could be wrong…….

What on earth has any of this got to do with the price of fish?

Andy you surprise me! I thought that you of all people would be highly tolerant of people who deliberately digress from the main point of the discussion and move on to what they want to talk about.

David,
I’m keen to hear what Andy has to say about prime numbers.

I am fascinated by them. For example, although 1023 is a prime number for the detractors of homeopathy (esp. Michael Marshall who has named his pathetic anti-homeopathic campaign 10:23), 1023 is not in fact a prime number even though it looks a little like one. It is however divisible by 11.

Brian,

I too would be fascinated to see Andy engaged in a debate about prime numbers. He seems to have such authority when he writes about homeopathy and what is and what is not acceptable evidence, or methods of gathering evidence, that I am increasingly riveted by this exchange.

But what also fascinates me are his references to Bayesian methods.

So, Andy,

In your post at 12.40 pm on 12 June above: what exactly do you mean by “plausibility” in a Bayesian prior. And also, how does significance testing, as in P<0.05, relate to Bayesian methods?

Cheers,

David.

Dr Kaplan. It was not me who initiated the discussion on Gaussian distributions. Ruth did. I challenged hew to be specific. She has declined to respond. She obviously believes this is somehow important fore the topic in hand but has declined to say how. I am calling her bluff.

David – please feel free to point out where I ‘haven’t a clue’ over what I have said on the important role of prior probabilities in assessing evidence.

No it wasn’t, but you are very adept at essaying the segway from the topic of my posts to mathematical analysis of trials and meta-analyses. Your comments show (in my opinion) that:
- you know nothing about clinical medicine and what it takes to be a doctor
- you have little respect for liberty and democracy and favour authoritarian rules and regulations esp when they support your mechanistic and deterministic view of life
- you have some knowledge of mathematics

Your knowledge of mathematics is now being questioned by other commentators on my blog, so please be courteous enough to supply them with answers to their questions.

David. Our posts cross.

Well, let’s start off with p-values. They are a measure of the probability of observing the results of an experiment if the null hypothesis was true. A small p-value then tells us that either the null hypothesis was false or we have seen a rare event. However, if your prior probability of seeing that experimental result was low then you would be misguided in accepting the null hypothesis to be false without using a Bayesian approach to assessing the posterior probability.

Now, of course, in reality assessing what the prior probability of something like homeopathy being true is not trivial. One has to be a somewhat descriptive of it since you cannot easily assign probabilities to the event that all of physics and chemistry turns out to be wrong. That does not mean we should of course abandon such thinking in evaluating homeopathy. One may not be able to easily assign the prior probability of there being a tiger (or a unicorn) in the garden, but only fools would assume it was the same as there being a dog in the garden.

Brian -a trivial search of this page will show Ruth initiated the discussion on Guassian distributions.

If I brought up mathematics it was to show that you were incorrect in your assertions that, “What is unreasonable and disingenuous is to have double standards of evidence depending on what one feels about the ‘plausibility’ of an intervention.”

I do not believe you have conceded that point. You merely switched track to try to assert that homeopathy was plausible. Even if it was, your statement about plausibility would still be wrong.

Happy to talk about plausibility of homeopathy, but at least concede the point on assessing evidence.

I do find we go round in circles discussing homeopathy because homeopaths will never concede a point. Tactic is to move the goalposts like saying argument is about plausibility of homeopathy not about double standards of assessing evidence. You then accuse me of going off topic.

Yes we go around in circles alright but not for the reason you say. Patients who go through the homeopathic process get better however you and I think that homeopathy works. The Bristol study shows this and at the very least any humane person would call on it to stay open so that the patients with refractory conditions, 70 – 80% of whom are very satisfied with result can continue to be helped.

No point in going around in circles. There are those who agree with me and those who agree with you. I’m happy for patients to visit an NHS clinic where the satisfaction rate is so high and they have been referred there by their NHS GP. You are not. That is the difference between us. The reason for this imo is that your politics are authoritarian, condescending, patronising, illiberal and generally insulting to the people and mine are in line with liberty in the John Stuart Mill sense of the word.

Good grief Brian.

Which bit of this is hard or difficult to understand:

1) The Bristol study included lots of people with self-limiting conditions.
2) Over the years, people will get better anyway even without treatment.
3) The study also did not take into account drop-outs, deaths,non-responders.
4) Any quoted figure is therefore entirely ambiguous.
5) Using this study to suggest homeopath is effective could be misleading.

Which point is wrong and why?

It’s a zombie debate. The arguments get an axe right through them, and they just keep on walking.

And I am dismayed at how often you resort to asserting that I am some sort of illiberal authoritarian.

You do this once again to deflect from my argument: that you are spreading misinformation.

I am more than happy for people to make their own choices. I am not happy about people in positions of authority making those choices meaningless by the promulgation of misinformation.

Will I have to repeat myself on that point?

Enough of this. A live audience could decide who is obfuscating and who is making sense.

Misinformation? The propoganda mission against homeopathy and CAM is an absolute disgrace of a misinformation scandal. With society facing huge problems such as an increased death rate for the millions on benzodiazepine soma-like drugs that numb people to life, you and your ‘colleagues’ choose to devote your time to trashing people who spend hours listening to and caring for others and using homeopathy to help them. And you accuse me of misinformation! What a joke. The whole debate has to be seen in the following contexts.

1. Much of conventional medicine does not

    have the type of evidence you and your friends demand of homeopathy. That is WHY the campaign against NHS homeopathy is vile and disingenuous though you are to be commended for giving so much time to it for no financial reward whatsoever – as you have assured me.
    2. Homeopathy works – however you and I think it works. Your arguments against the Bristol study are risible. Those patients had difficult-to-treat conditions that conventional medicine had failed with.
    3. In a democracy the people are entitled to homeopathy or Christian democracy or a liberal democracy. I respect that. You do not.
    4. Everybody has heard the propaganda against homeopathy but people like you are not happy for patients to see fully accountable NHS homeopathic doctors – even when those patients have been referred to those clinics by their own GPs!

    I take from this that You, mathematician but non-doctor, Andy Lewis, thinks he knows what is better for patients than their own GPs!

    So please forgive my lack of respect for your opinions on medicine and medical politics and tell me what you know about prime numbers please.

So, as a GP then, what would you expect the outcome to be of six years of following a child with eczema? Would you expect some natural progression towards improvement? What about menopause? Or childhood asthma? Do people with ME/CFS not improve spontaneously? As you are the doctor, please enlighten us as to how we can attribute improvements to homeopathy and not natural progression?

The Bristol study skewed results by arbitrarily only counting assessments on the last visit. How would you expect the last visit scores to compare with first visit scores for self-limiting conditions? Or for people also undergoing conventional treatments? Again, your insights would be invaluable.

Instead of debating the merits of the treatments, you rail against me for suggesting that you might be making misleading statements in using the Spence report to support homeopathy.

Happy for others to judge that.

Yes, that’s why I propose a live debate in front of a neutral audience. This is a waste of time. I would prefer to talk to you about a field in which you have some knowledge so let’s talk about prime numbers please.

Are you going to respond to the points I make re Spence?

If you cannot do it here, cannot see how a live debate would make it more likely you would address substantive points put to you.

You use Bristol/Spence to justify your stance, but refuse to engage on it.

We have fully engaged in it and I’m tired of arguing with you exclusively within your narrow-minded, mechanistic, deterministic paradigm in which you also feel free to make authoritarian, illiberal remarks. Sorry.

Which of my statements was “exclusively within your narrow-minded, mechanistic, deterministic paradigm”

Was it asking you if children with eczema might see improvements as they grow up. Or menopause being self-limiting? Or not taking these things into account might give misleading results in an observational study?

Please let me know how I am being stuck in my “deterministic paradigm”?

Yes you are not only ‘stuck’ in a mechanistic paradigm; your are utterly straitjacketed by it.

You know nothing about whole person medicine or the philosophy of holism and have little interest in learning because I’ve recommended E.K.Ledermann and Smuts to you and you rejected them as ‘my gurus’. I am a teacher but have little interest in educating a reluctant student in these matters.

I could talk about how eczema can get worse as well as better.
I could talk about how bringing up menopause (well-known to be self-limiting) is a disingenuous example to bolster your ‘argument’.
I could talk about how you never address my point that patients of NHS homeopathic clinics tend to be suffering from refractory conditions.
I could repeat that you are illiberal and authoritarian because you think you know better than patients’ GPs what’s better for their patients!
I could say that you are disingenuous in saying that I am spreading misinformation when I clearly do believe homeopathy works as do every homeopathic doctor and homeopath I personally have ever met. Why don’t you go and accuse Archbishop Rowan Williams, or Rabbi Jonathan Sacks or The Pope of the crime of ‘misinformation’? Surely they do not have the requisite evidence to say the things they say. It is utterly despicable to accuse people of misinformation when they clearly believe what they are saying. This tactic is used relentlessly by you and your colleagues and I will apply the usual adjectives to it: authoritarian; snide; propagandist; nanny-statish, illiberal and ugly.

I could talk about how a live neutral audience could decide who is making ‘substantive’ points

I could talk about all these things but would prefer to talk to you about prime numbers because I really enjoy talking to people who are educated in the field in which they have strong opinions. So if your next remark is about prime numbers, I will respond. Otherwise this is a complete waste of time.

You call me disingenuous.

Have you even read the Spence paper you keep quoting?

I bring up the conditions it measured.

The biggest group (448) was childhood eczema.
There were 195 childhood asthma cases and 152 women with menopausal issues.

With such conditions, on average, would you expect improvements. How would that likely skew the results?

I don’t believe E.K.Ledermann has the answers to those questions, does he?

Patients do well having consulted homeopathic doctors. QED.

Patients do well on psychotherapy but try to prove that to a scientismist!

I feel I have addressed many of your points but you never address mine about: accountable NHS homeopathic doctors; patients being sent to them by their GPs; patient choice; holistic philosophy; authoritarianism and political philosophy. Perhaps you feel the same way about me and so it would be civilised to let this ‘discussion’ go now. A neutral audience could decide which one of us is making better points but you seem more than reluctant to do that.
When in an earlier remark you referred to doctors as ‘trained technicians’ (sic) I should really have terminated this ‘conversation’ then. I’m not sure how I got sucked into a discussion with someone capable of making a remark like that. There is hardly a doctor in the world who would agree with that definition of himself or herself. It is indeed a comment that reeks of scientism and disrespect for my profession and I should have terminated this conversation then.

Brian,

It’s no good expecting Andy to respond to your interest in prime numbers, because he is no mathematician. His entry at 3.32 pm today is pure b——t. His sentence commencing “They are a measure….” is nonsense. I think I know what he means but it’s not worth the effort to respond. The rest of it appears to make two cardinal errors.

The first is that he seems to be making some sort of bastardised hybrid between frequentist and Bayesian statistics by suggesting that p-values are used for formulating the Baysian prior. P-values are not used in Bayesian stats.

His second is that he assumes that formation of the Bayesian prior requires a complete understanding of physics and chemistry in order to formulate the prior. This again is nonsense.

To formulate a Bayesian prior I may, for example, conduct a triple blind randomised controlled trial upon my sheep to determine the distress levels of lambs tail-docked with rubber rings, using a placebo as control and homeopathy as verum. Let us say that I expect a 30% improvement (or reduction) in the distress for homeopathy (because I have run a pilot study for instance), it is that assumption that forms my prior (if I am using Bayesian rather than frequentist stats). The data from the experiment forms the posterior and if that is roughly in agreement with my prior, then that is fine. That posterior goes on to inform my prior for the next experiment.

And that’s just the stats. One of his objections to the Bristol study is that it only measured the response of the patients at the end of their experience in the unit. That is, the study measured the outcome. Andy says that they should also have measured the starting point. Well, that’s one way of doing it. Studies which measure the before and after treatment are termed longitudinal and are sadly very rare in the medical papers that I have read. I am guessing, but I would think that 95 – 98% of all RCTs in the literature are cross-sectional, i.e. they measure the response to the intervention at only one point in time and that is at the end of the treatment. The Bristol study just followed the norm.

Secondly, his other main assumption which I really take exception to is his idea that all childhood eczema and asthma are self limiting. They are not. Many go on to suffer from these conditions for the rest of their lives.

This whole debate has been fascinating in terms of what we have learned about the methods of a few so-called skeptics. So you are to be congratulated for tolerating it for so long.

David. I don’t think you either read my comments, the Bristol paper, or understand how you might establish a prior probability for your sheep homeopathic experiment.

You have essentially straw-manned me. I said nothing about p-values “are used for formulating the Baysian prior”. Quite the opposite.

And your idea that you can form a prior from a pilot study is absurd in the case of homeopathy, because any attempt to do so has to chain back to the fact that homeopathy is absurd and no meaningfully finite prior could be established. Basing your prior on a half-cocked pilot study is the route to self-deception. In maninstream medicine, a prior based on a pilot might be formable, but that is because of the hidden assumption in mainstream EBM that plausibility can be considered a constant for all interventions. (Based on the assumption that researchers will not research implausible bonkers ideas). With CAM, that assumption is out of the window,

As for the Bristol study, one of its central weaknesses was it asked patients to recall how they felt on first presentation and then compare that with now at some arbitrary point in the future. The scope for recall bias in that is huge -although I doubt Dr Kaplan will comment on this because he never answered my question if he read the paper.

If the Bristol paper ‘followed the norm’ then it followed flawed methodology.

As for childhood eczema and asthma being self-limiting. Remember, we are talking about averages here. Yes, some suffer into adulthood. But what would you expect your baseline to look like?

David,

Thanks for that. Your discussion with Andy on maths looks interesting :-)

My discussion with Andy is now at an end and I think I understand why. First I should say that as a commentator on my blog he has generally been courteous which is why the conversation has continued for so long. He is not a doctor and thus some of the things he says are much more forgivable than what emerges from the mouths of people like Edzard Ernst who has a medical degree and practised medicine in the past. The conversation I had with Andy is a lot more civilised than the one I had with Ernst on his awful, anti-CAM and homeopathy blog on PULSE where you can actually see him lose his temper as he splurges out with multiple exclamation marks.

I think Andy Lewis’s objective was to ‘expose’ me in some way with his logical-sounding questions but imo he merely exposed his own bias and inability to make the paradigmatic shift necessary to understand or appreciate whole person medicine. This requires a little explanation:

Dr E.K. Ledermann and other others have attempted to explain the philosophy of holism which was first mentioned by Jan Smuts in the 1920s. In fact Wikipedia is quite strong on this so I’ll just paste in the first 2 paragraphs and we can then refer to them. (italics are mine)

(From Wikipedia)
Holism (from ὂλος holos, a Greek word meaning all, whole, entire, total), is the idea that natural systems (physical, biological, chemical, social, economic, mental, linguistic, etc.) and their properties, should be viewed as wholes, not as collections of parts. This often includes the view that systems somehow function as wholes and that their functioning cannot be fully understood solely in terms of their component parts.
The term holism was coined in 1926 by Jan Smuts. Reductionism is sometimes seen as the opposite of holism. Reductionism in science says that a complex system can be explained by reduction to its fundamental parts. For example, the processes of biology are reducible to chemistry and the laws of chemistry are explained by physics.’

Andy Lewis’s opinion on medicine is essentially reductionist and also mechanistic and deterministic. HIs description of doctors at ‘trained technicians’ (sic) is as clear an espousal of this that you will find anywhere. However he is fully entitled to that opinion as his starting point but not to insist on my starting at that point. This is essentially why my discussion is over with him. Unconsciously he is insisting that the discussion we have is on his terms and although CAM can be looked at in his paradigm, it really needs also to be examined within the paradigm of holism, as E.K. Ledermann makes absolutely clear in his erudite Philosophy and Medicine (1970). I’ve pointed this out to Andy but of course he sees no reason to read a book such as this – because for him the only paradigm is his paradigm, which I see as reductionist, mechanistic and deterministic. This is not done consciously. I think Andy really believes that his mechanistic paradigm is the only one that makes any sense at all to any sane/rational person.

However, and this really is the crux of my point:

Andy Lewis has no evidence whatsoever to prove that his starting point (reductionist paradigm) in understanding CAM is any more correct/valid/real than my starting point (holistic paradigm)

Politically we differ significantly too: He would like laws to protect people (presumably without his scientific knowledge) against homeopaths and practitioners of CAM. I find this condescending and patronising and representative of authoritarian politics rather than my more liberal (in the way J.S.Mill used the word) politics. I also absolutely fear a parliament dominated by scientists. There is one in the world already; the Chinese poliburo comprises 80% scientists but many liberals in the rest of the world are rather dismayed at the country’s human rights record and would not want to see that here. Of course we cannot prove a causal relationship between the high % of scientists in government and the human rights record but their co-existence does make me nervous and I would prefer people like Ann Milton (health minister) and Mike O’Brien (ex Labour health minister) making decisions about the NHS than people like Andy Lewis or Evan Harris. In fact the latter is a superb example of where democracy trumped scientism. Harris, a very scientismic politician in my opinion – lost his seat as an MP in the House of Commons (in spite of standing in a safe Lib-Dem seat in an election ‘galvinised’ by a LIbdem revival because of Nick Clegg’s performance on TV!) precisely because his strong scientismic (imo) views were not to the taste of his would-be constituents. I’m sure people like Andy Lewis might see that result as very unfortunate and perhaps ‘stupid’ but it was democracy in action.

Democracy did not allow itself to be trumped by scientism and thus all the anti-homeopathic, draconian legislation supported by Ernst, Goldacre, Tracey Brown, Evan Harris etc. was REJECTED by both Labour and Coalition health ministers. Andy makes the point that the report of that committee has been used to damage homeopathy and regrettably and undemocratically it has – but in the form of ‘backdoor legislation’, regulatory bodies etc. Not the sort of ‘democracy’ I approve of.

Finally looking at politics, homeopathy and the NHS: You can only get NHS homeopathy if your GP refers you to an NHS homeopathic clinic. That’s good enough for me but not for Andy Lewis and the other detractors of homeopathy who sought legislation to thwart rather than dissuade GPs from doing this. The Government did not like this part of the report and thought that local authorities (I don’t agree) and GPs (I agree strongly) were best placed to decide what was best for their own patients! Is that really so controversial?

From this I conclude:
I trust Britain’s General Practitioners a lot more than Andy Lewis and his fellow non-medical and medical detractors of homeopathy do.

Notice how he never addresses this point to which he obviously has no answer. He is welcome of course to reply to this long comment but I will not answer any more questions from him unless they relate specifically to the main point of my post.

If your argument that I am looking at this problem from some flawed philosophical standpoint had any merit, I would of course concede.

But you have not made that case. Merely asserted it.

I intervened in this discussion on two main points.

The first, obviously facetiously, was to mock the idea that because the Queen uses homeopathy, then homeopathy has merit.

It does not matter whether you take a reductionist or holistic standpoint, this is still a logical fallacy.

Secondly, I came in to challenge your assertion that it is unreasonable and disingenuous is to have double standards of evidence depending on what one feels about the ‘plausibility’ of an intervention.

Again, you have failed to show how my philosophical standpoint has any bearing on the correctness or otherwise of this assertion.

It is my belief you merely use this philosophical position as a gambit. To undermine the possibility of actually having a reasoned discussion and so protect your own worldview from scrutiny.

The philosopher Stephen Law describes this sort of argument – escaping into unexaminable philosophical standpoints – as one of the ways people get trapped in intellectual black holes.

I suggest you are well and truly beyond the event horizon of that intellectual black hole and no escape is possible.

Brian,

Firstly, apologies for me allowing the real world to impinge upon blogging and for my delay in getting back to you. Having read and then re-read the entire post, I think it may be time to sum it up as best I can.

Firstly, your points about the holistic approach to medicine are well made. In my own way, having read a little of complexity theory, I feel that there may well be a time when science and philosophy come together and converge on this very point. You and Sastry are leading where science will follow.

Secondly, I have spent some time trying to make sense of this entire post; starting as it did with a perfectly innocuous comment about the Royal Family’s interest in homeopathy. The post then proceded very quickly into an aggressive dismissal of your views on the subject from one or two well known so-called “skeptics”. I use skeptics in inverted commas to differentiate the word from “sceptics” who are a different kind of person altogether. The debate quickly became what can only be described as an interrogation.

Whilst I realise that you feel that Andy and Adzcliff have been courteous – and so they have – that does not diminish the nature of what they are actually doing or attempting to do. If anyone is in any doubt at all as to the intimidating nature of an interrogation, then I recommend that they read Arthur Koestler’s political novel “Darkness at Noon”. It is set in 1930s Soviet Russia during the Stalinist purges, but is based to a large extent upon Koestler’s own first hand experience of being interrogated during the Spanish Civil War.

In the book, Rubashov is an Old Guard party member and senior apparatchik who is arrested and interrogated by an old comrade and intellectual equal, Ivanov, and the more rustic but relentless Gletkin. There is no abuse or physical violence, just the steady grinding down of a blameless man into signing a “confession” of his counter-revolutionary activities, which are of course, completely fabricated. Eventually Rubashov gives in, signs the confession and is executed. This novel is Koestler’s legacy to our modern world and acts as a chilling reminder as to the realities under a totalitarian regime.

The methods that Andy and Adzcliff have used in this post are revealing. Firstly they give us a fairly clear idea as to the tactics used by the skeptics whenever interacting with homeopaths or other CAM practitioners. Secondly, they have given us, inadvertantly, a pretty clear idea as to the level of ignorance of the interrogators themselves.

After the ritual initial-beating-in-the-cell by the thugs/heavies such as Les Rose and Acleron; their real starting position is to take a trivial and misleading example (Adzcliff’s citing of the Trossel case; Andy’s tiger in the garden) in order to elicit replies so that a pseudo-logical cross-examination can take place. None of this involves any use whatsoever of medical or other scientific evidence. It is purely conducted to see if the respondent can be trapped into an incriminating position or something which can be used against them, either by logical or moral contradiction. As you demonstrated, the best answer to this is ridicule.

During the detail of the exchanges, the skeptics resort to any accusation they can to disrupt the position taken by the respondent. These usually amount to accusations of “straw man arguments”, “ad hominem attacks”, Adzcliff’s variant upon the latter of “tu quoque”, “moving the goalposts” and finally, perhaps the best one of all: Andy’s suggestion that the Dunning-Kruger effect applies to Nadine. These accusations have the effect of diverting the debate away from the weaknesses of the accuser’s argument and means that the respondent has to waste time answering it; it also means that the respondent’s position cannot be consolidated as the argument and counter-argument flows to and fro in ever increasing confusion. They are a pre-emptive tactic, thrown in early in order to prevent the respondent using them as a defence. Invariably, their use by the accuser is to cover for the accusers’ own hypocrisy.

Another tactic is the use of constant repetition of the same question. This is extremely intimidating even if expressed politely. Andy used this technique recently in (I think) a Guardian CiF exchange with Nancy Malik, as well as this post. No-one reading that exchange could be left in any doubt that it was intended to be extremely aggressive. Andy obviously fancies himself as a latter-day Paxman, but actually, that technique owes everything to the most vicious of interrogations, including torture.

An important point to note is that the underlying theme is predicated upon the accused having to provide proof of their innocence. The accusers sit back and continually demand more and more “evidence”. Even if that evidence is forthcoming, it is dismissed as somehow irrelevant. Remember, this is an interrogation – not a scientific debate.

A last technique worth mentioning is Andy’s ability to resort to the most breathtaking levels of patronising arrogance. I am undecided whether this is deliberate or whether it is a product of his own Dunning-Kruger effect (Wiki gives the following: “The Dunning–Kruger effect is a cognitive bias in which unskilled individuals suffer from illusory superiority, mistakenly rating their ability much higher than average. This bias is attributed to a metacognitive inability of the unskilled to recognize their mistakes.”). Given the conclusions I have reached about his abilities, I suspect the latter.

All these techniques of interrogation are intended to frighten, intimidate and ultimately to close debate, information and research into homeopathy and other forms of CAM. Period. Whatever protestations Andy and others may make to the contrary, it is apparent that their aim is to shut down patient choice.

This brings me to what we have learnt about our accusers in this exchange.

When tables are turned and the accusers are themselves questioned, they get angry. Attempts to engage them in discussions where their alleged authority will be subjected to close examination, are rebuffed. You have done it, I have attempted it and Ruth has done it exquisitely, but each time they refuse to engage in the same game that they expect us to play on their terms. Andy claims to be bored, Adzcliff resorts to “I make no appeals to authority”. In other words, they do not know anything about the subject under discussion. They do not have qualifications or experience in medicine, science or mathematics and that is why they refuse to debate on our terms. All they have is a regression to their immutable central dogma which is that homeopathy does not work. Everything else, in their world and in their arguments, stems from that one statement. Every time Andy, for example, is challenged he resorts to that same statement. It is a tenet of unchanging and (for him) unchallengable political belief and has nothing to do with evidence, or science, or the healing of sick people.

Which finally brings me to conclude that this is not an argument about which kind of medicine is suitable for which people in what circumstances. It is, as you have so often pointed out, a political argument based around whether or not people in a free and tolerant society are entitled to choose for themselves what sort a of medicine, or combination of medicines, they should have. Furthermore, it is about whether they should have access to that medicine without harrassment from other vested interests.

So, will the skeptics win the argument? I think that they will not. Just look at blogs where people have taken the courage to enter a post which says that they used homeopathy (or chiropractic, or acupuncture or whatever) and it worked for them. And then just look at the number of replies that they get from the Andy Lewis’s of this world: decrying their choice, denigrating their conclusions, telling them that they do not know what actually made them get better. Look at the hatred, the bile and splenetic arrogance of those responses. And ask yourself “Are the skeptics not actually shooting themselves in the foot here?”

Evan Harris did not lose his MP’s seat because he is a Lib Dem (the Lib Dems did OK in the last election); he lost his seat because of his own strident, dictatorial arrogance – exactly the same qualities which so many skeptics exhibit with such nauseating regularity. In the end, people vote with their feet and their own bodies and are far more intelligent and discerning than the skeptics ever give them credit for. Your best advert, Brian, is word of mouth.

As ever,

Best wishes,

David.

Dear David,
Thank you so much for reading this whole discussion again and taking the time to assimilate it once more and then to come to the considered and magnificent summary you have submitted here.
Of course I was aware of the less-than-benign motives of these people all the time but you have dissected and exposed their strategy and tactics sublimely.

“Whatever protestations Andy and others may make to the contrary, it is apparent that their aim is to shut down patient choice. This brings me to what we have learnt about our accusers in this exchange. When tables are turned and the accusers are themselves questioned, they get angry. Attempts to engage them in discussions where their alleged authority will be subjected to close examination, are rebuffed. You have done it, I have attempted it and Ruth has done it exquisitely, but each time they refuse to engage in the same game that they expect us to play on their terms.”

Exactly!

This explains why:

1. They hate talking about this on a political level and insist on the context being utterly scientismic and only within the realms of scientism and evidentialism and certainly not liberalism!
2. Andy Lewis has persistently declined my invitations to take him on in a live debate on NHS homeopathy. Imo he fears that the political case I will make will not be easily answerable. (As Even Harris found to his cost!) and so he tries to push the argument into maths, trials, plausibility etc while keeping it away from simple patient choice which may well be based on subjectivity as well as objectivity. A neutral audience would be free to vote on any basis they wanted and that does not suit the scientismists and evidentialists.
3. And yes, there comes a point where medical knowledge and experience are essential in such a debate and Andy Lewis simply does not have that.

Skepticism has a long, long history and there have certainly been better exponents of it than Andy Lewis and Adzcliff. They sought to expose me in some way but I always knew they would simply expose themselves. It took someone to show this graphically by dispassionately and accurately holding up a mirror to their ‘philosophy’, strategy and tactics. Thank you very much for doing this.

What is of course supremely ironic in David’s post is that everything he accuses me of doing to divert attention from the central arguments, he himself does in his post.

It’s all an attempt to argue about arguments rather than address the fundamental weaknesses in the case for homeopathy.

Well done.

Brian,

It was, of course, a pleasure. But I had to worry at it like a dog with a bone for a while. A couple of things niggled me and I couldn’t quite place them in context. But then I re-read Koestler for the second time, after a gap of thirty years or so, and then things dropped into place. It seems almost as if their tactics have been resurrected straight from the Stalinist 1930s.

A less robust character than you might have folded at the pressure from these people, so you deserve credit for continually standing up to them in the way that you do. And it is important that you carry on mining this political seam, because everyone else is fretting about the evidence thing and that is slow to bear fruit. It will come eventually and a good deal of my interest is in helping that come about in my very small way. But the political case for choice in medical care is unanswerable by these perishers and that is why they spend so much time skirting around it.

So, all strength to your elbow and keep it up. We learn a little more each time. And if ever I am in London, we must find time to blow the froth off a pint together.

As ever,

David.

David,
Thanks for the effort and support. You are absolutely right. They cannot bear discussing homeopathy and CAM in terms of libertarian vs. authoritarian politics. You are quite right to bring up Stalin and the worst of the Soviet era. A forensic examination of all my online ‘debates’ with the like of Adzcliff, Andy Lewis, Les Rose, David Colquhoun and Edzard Ernst reveal this very clearly. My posts have focused on the political dimensions of this debate and they persistently try to segway into the paradigm of their exclusively mechanistic, deterministic, evidentialist view of medicine and patronising, condescending, nanny-state-supporting, ‘I know better than you what’s good for you!’ political position if you can call such a position ‘political’ at all. It does indeed bear comparison to ultra-authoritarian regimes such as the USSR and the present politburo in China.

My position on this subject is indeed political as are most of my posts. The ‘central argument’ is political no matter how many Adzcliffs and Andy Lewises try to segway into their version of science and of course their scientism. The ‘I know better than you what’s good for you!’ Brigade don’t like that title nor do they like being called the Disciples of Scientism. But of course their ideology IS scientism and they are indeed political in every sense of the word. It comes as no surprise that my libertarian politics are irritating to them and they are loathe indeed to enter the political realm when ‘debating’ with me here. No wonder when we see what happened to Evan Harris when he presented his (imo) intolerant and scientismic views to the electorate!

It is worth noting that the skeptics, for years have concentrated all their efforts against the paranormal, and so called parapsychology; to their own admission, that got them absolutely nowhere: studies in the US shows that their years of campaigning did absolutely nothing to change people’s beliefs in for example telepathy, ghosts, afterlife etc.
A change of tactic was necessary, and they decided on a concerted attack on homeopathy and by extension to alternative medicine in general.
Their attacks are much more aggressive, with a high level of intolerance.
Let’s hope that they are as effective with homeopathy as they were with the paranormal.

Once again, this is not about libertarian vs. authoritarian politics. I have been quite clear on my stance that people are free to chose what they like. How many time should I say this before you accept it?

This debate is about information vs.misinformation. And indeed,that the truth,or otherwise, of what you claim, is the thing that you cannot bear discussing and always try to turn into some cartoon political debate.

Nadine,
That is most interesting and totally believable. However the ‘skeptics’ are very tenacious. Just look at Andy Lewis’s last comment on this post. He says:
‘Once again, this is not about libertarian vs. authoritarian politics.’ But he forgets one thing: This is my website and my blog and the subject of this post and most of the others IS essentially about libertarian and authoritarian politics in relation to NHS homeopathy. He is of course welcome to write whatever he wants on his rather dark blog but to tell me what the discussion is on my blog – well that is where one would use the word chutzpah pejoratively. This blog refers to The Queen, The Labour Party and The Coalition Government in relation to their attitude towards homeopathy which happens to be: They either support and use homeopathy or think that it should be available on the NHS for patients whose GPs think they will benefit from it. I’m not obliged to discuss anything other than this with Andy Lewis or anyone else. I choose the subject for my blog; he chooses the subject for his. Who can say fairer than that?

Andy: read the posts and the skeptic comments on your own blog: it is all about “getting rid of all those evil scammers”
“educating people in the right way of thinking” etc
most of the comments by some of your best mate posting regular commnents on your blog would not be out of place on a national front website.
When you say that you respect people right to choose, you become a denialist of your own rethoric.

Nadine,
Is ‘educating people in the right way of thinking’ a direct quote? That sounds something from The Ministry of Truth in 1984 or Pol Pot. Needless to say, my recommendation to read Hayek’s The Road to Serfdom fell on deaf ears.
Maybe my dubbing of these people as the I KNOW BETTER THAN YOU WHAT’S GOOD FOR YOU BRIGADE is a gross understatement!

Nadine- I do not believe (the vats majority) of homeopaths are ‘scammers’, no matter whatever anyone else may comment on my blog.However, I do believe that homeopaths are mistaken and that their subsequent actions are indeed indistinguishable from a scam.

Yes, Brian, you are free to write about what you choose. I a, merely suggesting their are holes in your libertarian argument as soon as you consider whether a doctor might be misleading a patient.

If you agree that there ought to be checks and balances on doctors who systematically mislead patients, then the discussion has to inevitably turn to whether homeopathy is effective or not.

But that is territory you do not want to go into because you feel safer having a shallow political argument. And so you label me as somehow being “scientismic” or something and distort my arguments.

That is how you survive – not by winning, but denying the arguments.

This comment has been published but will not be answered because it fails to address the subject of the post. It is the policy of the author of this blog to answer only the first of any comments deemed to be in this rubrik. Subsequent comments by the same commentator that veer off the point or are obviously tangental to it, will not be published.

Careful Brian and watch your head. There appear to be high speed goalposts whizzing around.

Is the above post a slippery slope to an Orwellian ‘ministry of relevance’? Not that it matters, as I assume this won’t be published anyway…

Andy, you are such an hypocrite, most of the people posting on your blog are your skeptic friends, some of them attend various skeptic meeting with you. So you say you do not believe that the vast majority of homeopath are scammers, but you spend a large amount of your time ruthlessly “debunking” them.
Either you are a complete idiot who fail to see the implications of what you propose and the totalitarian comments of your friends who support your blog, or you are exactly what we can see: a determined authoritarian supporter of a regime where people’s freedom of choice and even freedom of thinking would be severely curtailed.

If Andy wants to respond to this, I will publish. However, I personally will not answer any questions he or anybody else has which are unrelated to the subject of the post.

Oh dear. Having already deleted my previous post, it seems that off-topic posts by critics of CAM-skepticism get a free pass, and after that only what the ministry permits in response. This is getting more Orwellian by the minute…

Nadine – many people comment on my blog with a wide range of views. Even people supportive of homeopathy. I think it is good to see a wide range of opinions and views and rarely block comments unless people are libelous or personally abusive.

Having a wide range of views allows myself and others to be challenged and have our opinions tested. If my arguments are weak, they will be exposed. That is a good intellectual discipline. Only those who fear scrutiny of their beliefs are quick to censor dissenting views.

A recent sceptics meeting I went to was in Dartington Hall, Totnes. I debated so-called ‘integrated medicine’ with a prominent proponent from the College of Medicine. I think it would be fair to say, most people in the room were supporters of alternative medicine. People were free to argue their points and make their cases. Some went wildly off topic and tried to claim there was a conspiracy of supermarkets to poison us. But it is important to hear such views, even if they are a little wacky.

Once again, I am not proposing a ban on homeopathy, no matter how much you fantasise that I am. At the very least, such a ban would be impractical. And I am quite happy for adults to have the right to accept or decline any treatments. However, once again, I do speak out against misinformation. That is what I do. If people are challenged about what they are hearing and asked to consider that it might not be true what homeopaths claim, then I hope that most people will go away being better able to make a more informed choice.

I would call that a libertarian position. But some others would prefer that I do not speak. That I shut up. That I am silenced. Is that a libertarian position?

Not at all Adzcliff. Feel free to discuss off-topic issues with other commentators, just don’t expect me to respond to questions and comments that imo have nothing to do with the subject of my posts.

Thanks for that Dr Kaplan. Actually I think you were being true to your word that “…comments by the same commentator that veer off the point or are obviously tangental to it, will not be published.” Good to see my posts re-appear though, as I do genuinely think this would be a dodgy manoeuvre by someone who relies so heavily on Orwellian metaphor.

Ta.

Nadine,
I’ve been thinking about that horrific quotation you cite: “educating people in the right way of thinking”.
I think this sums up the ‘skeptics’ position’. But we must always know that “educating people in the right way of thinking” will not be successful so that it quickly become punish people for the wrong way of thinking. This happened in the USSR, E.Germany, Cambodia, Burma, China etc and certainly should never happen in a moderate country like the UK. Still we are definitely moving in the wrong direction. Skeptics KNOW that their views will always be rejected at the ballot box. Government health ministers – whatever their personal views on homeopathy – have more respect for the will of the people (and their own position) no matter which party they come from. This is what the skeptics cannot stand so they seek to force changes by appealing to regulatory bodies, advertising standards authorities etc. (As if all advertisements for conventional OTC drugs are never guilty of misinformation!) Their political methods are all well away from the ballot box and are clearly an insult to democracy. Even people who dislike homeopathy but treasure democracy should oppose this vile, anti-democratic, condescending, patronizing and dirty attack on homeopathy and CAM.

If this was a blog about financial services, would you be condemning critics of pay day loans, payment protection insurance, dodgy pensions and store cards for suggesting people thing differently about money? Would you be condemning poeple who urged tighter controls on such products? Or better education about how money works? Or would you insist it is people’s democratic right to buy useless or dangerous financial services products?

Serious question.

Serious indeed. What about casinos? Do the public need to be protected from them? Do the public need to be educated about how the % against them will always beat the gambler? On to alcohol? Legislation needed there too? Ban casinos, alcohol, drain cleaner because the public are so naive and need a nanny state? I think not.

The debate between the two of us Andy is simple: It is political. You simply believe in a much more authoritarian state than me. There are many issues and examples we can each bring to the table. However what is clear and what has been expressed in this post is:

1. The Government Minister (despite whatever her or her partys’s personal view is) think that GPs and local authorities are best placed to make decisions regarding NHS homeopathy. QED
2. The previous Labour Minister felt the same. QED
3. The Head of State obviously supports NHS homeopathy, uses it, gave a Royal title to a homeopathic hospital and a Royal warrant to a homeopathic chemist and retains a Royal homeopathic doctor.

The ‘skeptics’ took their case to Parliament and sought to change the law. But in this respect they LOST. So they try to change it by going through the back door which has become available because the UK straitjacketed itself into Weimar Republic style regulations in recent decades. The fact is that you cannot accept the Government’s view that it is up to NHS GPs and local authorities. I don’t fully accept it either. It should ONLY be up to NHS GPs not ‘local authorities’ sans medical qualifications and sans relationships with the actual cases in hand.

The skeptics also KNOW they cannot get anywhere at the ballot box either. So they try to change things using the nanny state ‘apparatus’ – even though the State does not agree with them in terms of legislation.

I know that it’s hard for you to accept that people ‘irrationally’ believe in homeopathy. I know it’s hard for you to accept the quite obvious fact that patients who see medically qualified homeopathic doctors do well and there is no risk to them doing so. People who ‘irrationally’ believe in a divinity must be very annoying to you too. Surely you should be seeking legislation against all churches, mosques, syanagogues, temples who receive a penny of Government money for their upkeep?

From a political point of view:
IF we had to ask the public the following two questions in a referendum:

1. Do you think that all openly religious persons should be barred from being elected to the House of Commons because it is dangerous to have ‘irrational’ thinkers in parliament ?
2. Do you think that medically qualified doctors using CAM/homeopathy should be employed by the NHS as long as patients request homeopathy/CAM and their GPs are happy to refer them for it.

Answer to 1: A massive majority would vote NO
Answer to 2: At least a significant minority would vote YES. Might even be a majority because not all people who don’t want homeopathy for themselves want to deny it on the NHS for those that do want it.

You might not like it Andy. You may think it’s irrational. But to me it’s very precious and it’s called democracy.

Please ensure all questions relate to the post which is about the attitude of the Queen and 2 successive government to NHS homeopathy (and the result of the 2010 General election result in the seat of Abingdon and West Oxford because it related directly to my arguments about democracy.

You are dodging the point Dr Kaplan.

With my financial services analogue, do you think it is right there should be compliance rules for FS companies that force them to demonstrate a product would be right (effective) for a customer and that they must not must not mis-sell? Do you think it is rigfht that campaigners should highlight the risk of things like pay-day loans as questionable FS product? Or do you think that is somehow anti-democratic.

If you accept the need for FS regulation and that people have a right to discuss and highlight the ineffectiveness or shortcomings of certain products, what is the essential difference between this FS analogy and homeopathy and medicine?

You may try to characterise me as much as you like as being somehow anti-democratic. It does not wash. My answers to that are clear and above. Your refusal to test your ideas about liberty and homeopathy speak volumes. They cannot stand the slightest scrutiny. You always seek to dodge so that you do not have to address the evidence question.

If I am wrong, answer my question above and explain why FS regulation is a good thing, but medicines not.

Andy,

I am dodging nothing. Generally I am against over-regulation. I don’t choose to get into the specifics of the ethics of selling financial products because I prefer to stay within the realm of a subject I know something about – namely medicine. I used gambling before as an example of ‘miss-seliing’. Have you seen the ads for Lotto? Surely they should tell you that buying a lottery ticket is about the worst possible investment you can make. But I don’t want to talk about gambling or financial products because they are not my field.

So let’s keep this to medicine and particularly medical politics. And we should never forget the 800 pound gorilla in the room of our discussion: The ethics of how many conventional medicines are sold to the public. For example what is your opinion of TV advertisements for conventional medicines such as painkillers and antacids? Are they being missold? Does the multi-million dollar breakthrough called angioplasty really work? What about most prescriptions of anti-deperssants. Proof please. And if not – stringent regulation? As I’ve said for years the game played by anti-CAM people is to give the impression all of conventional medicine is ‘evidence based’ That will be the day.

    Once again unto the Pieman!

That this nasty campaign selectively against NHS homeopathy (and the tiny portion of NHS money involved) and CAM can go continue its ugly course while not answering huge questions applying to the above examples of highly questionable ‘conventional medicine’ is a sick joke.

We all have different views about what and what should not be regulated and particularly over-regulated. Those who favour a nanny state think:
* people need loads of regulations to protect themselves from their own stupidity and naivety (eg patients of homeopathic doctors)
* fortune tellers should have signs saying ‘For entertainment only’ just in case a person a lot stupider than say you Andy Lewis thought there was incontravertible evidence behind fortune telling.
and so on.

You are good at getting me to make comments here but in the end Andy, dear fellow, you know that we are simply lightyears apart – politically speaking. There is no point in having a PM Question Time debate like this. Sooner or later our case has to be put to some sort of vote.That is why I have proposed a live debate – say in front of 2nd year medical students – who would tend to favour your mechanistic and deterministic philosophy. After all you are the man who dubbed doctors ‘trained technicians’. And I will never let you forget that because that quote says everything about you and a lot about why people having this debate really should be medically trained – as Ruth hinted in her comments here.

And one more thing said Columbo. You have real chutzpah to demand an answer to your digressional questions. How about you answering my question.

Is it true that I trust Britain’s GPs more than you do?

I say I do because you would seek to thwart them rather than dissuade them form referring patients for NHS homeopathy.

Anyway this could go on for ever. The challenge to a live debate has been made. Let’s see what others think of us instead of having a rather inane slanging match like this because internet chess is more fun for me than this ‘debate’.

Correct me if I’m wrong, but aren’t casinos advertised as places to ‘gamble’ – meaning any financial transactions that take place within are, by definition, a ‘gamble’. Hence the need for a ‘gambling’ license, as opposed to an FSA license? And as for the lotto, well that’s a ‘lottery’. I’d be very skeptical of a financial product that described itself as a ‘lottery’ – in fact I’d assume it was a deliberate warning against said product? I’m not sure bunching casinos/lotto and financial services together works in this context: one is a financially-risky leisure activity, the other claims to sell good financial advice and products, but anyway…

I’d agree if you wrote claims in italics in your last line.

Once again -dodge the question and change the subject. You are very transparent Dr Kaplan. The reason you dodge it is because you are bound to accept that a level of regulation of financial services products is required to protect people from hard-to-understand products where banks are keen to sell as many as possible without obligations to show the products do what they claim.

And if you accept that, then you have a hard case saying medicine should be different and so your appeals to ‘democracy’ fail.

So, its wriggle, wriggle, wriggle, divert, smokescreen, whine.

And to answer your question. I trust Britain’s GPs enormously – with the exception of a few that believe sugar pills can have magical healing properties. I trust GP’s, but am not uncritical of a fringe few who believe nonsense. As you might expect in any community or profession.

Good point, I would’ve used italics if I knew how. I think ‘claims’ is the sticking factor here.

Ta.

So you Andy Lewis (sans even MBBS) is the one who can say which NHS can be trusted and which ones not. Good for you.

On ‘misinformation’: There are clearly two types of misinformation – deliberate and ‘inadvertent’.

Homeopathic doctors totally believe in the inherent value of their medicines and there is quite a lot of objective evidence that the homeopathic process (ie seeing homeopathic doctors) can make people feel better. So what you are accusing homeopaths of is clearly ‘inadvertent misinformation’ because I and every homeopathic doctor I have met believe in the therapeutic effect of homeopathic medicines.

Deliberate misinformation is a another matter altogether and people may well be doing this when selling financial products. I don’t know because it’s not my field but yes a government may need to introduce regulations to prevent deliberate misinformation.

As for inadvertent misinformation: (which is what you are accusing homeopathic doctors and CAM practitioners of) this is very widespread and I would list the following as major purveyors of inadvertent misinformation.

All the media, including all TV channels and all newspapers. Most TV advertisements – ads for ‘orthodox medications’ are so obviously misinforming that it’s a joke.

So Andy perhaps you want a world free of any form of inadvertent misinformation and that anything said to the public must have ROCK SOLID EVIDENCE behind it. This amounts to a philosophy of evidentialism which can become political evidentialism. However the main parties in this country would not dare adopt purist political evidentialism as their primary political philosophy. Instead they may choose to listen to the VOTERS who may ‘irrationally’ believe in a divinity based not on evidence at all but on a sensus divinitatis.

Thus a noble route for the evidentialists would be to form their own political party as I’ve suggested but based on the ‘Evan Harris Experience’ I don’t think they will. I think they will continue to push for ‘legislation by stealth’ in an increasingly nanny state because clearly they believe the people cannot be trusted to choose for themselves. That’s why when Nadine said that your blog is full of commentators saying things like people needing to be taught ‘correct thinking’ sent a chill down my spine. ‘Taught correct thinking’ soon becomes ‘punished for incorrect thinking’ and this is the way people in many countries have been forced on to The Road to Serfdom as Hayek has eloquently pointed out. (notice return to main theme of post – Medical politics)

First of all, I do not see it useful on the whole to try to distinguish between inadvertent misinformation and deliberate misinformation. I believe most homeopaths are honestly mistaken, but I cannot supply evidence for that. I have no window into their souls.

The banks analogy helps here. It is quite possible to see much of the retail mis-selling as being due to complexity, ignorance and incompetent management controls rather than deliberate malfeasance. (Investment banking, another matter.)

So, yes – what matters is not intent, but whether misinformation is being given.

The Advertising Standards Authority are quite clear about how adverisers should not misinform the public -they require advertisers to hold appropriate evidence to be able to substantiate their claims and will call people out if they do not.

Adding an -ism to the end of a word does not make is a bad thing. Asking for evidence to substantiate claims is prudence, not bad philosophy.

You could only accuse me of evidentialism if somehow you could demonstrate it was pragmatic to hold a belief in homeopathy, with the hope of beneficial outcomes, is spite of there being evidence to the contrary.

But then, paradoxically, we would both be respecting the evidence, but taking different consequential paths. Nevertheless, you would still not escape the requirement of justifying your pragmatic approach to holding your belief against the evidence.

No matter what -isms you want to append to your critics viewpoints, you cannot escape the requirement that you address the evidence. Even in your libertarian world-view, to deny the evidence is still an abdication of thoughtful practice. You may see the evidence, decide you want to practice homeopathy anyway, because you believe in some greater benefit. You have not got yourself off the evidential hook, but at least you might be starting on a coherent and rational path.

What is worrying about your viewpoint, is your need to aggressively dismiss the idea that it is legitimate to look at the science and evidence to see what it says. You name-call all such attempts as ‘scientism’ or now ‘evidencialism’.

I suspect most homeopathic doctors are in that position. At least, I have seen none really engage with the evidence and then decide that practically it still has merit.

And that is one of the reasons that I would not trust a doctor who prescribed homeopathy. And yes, I do feel qualified to make that judgement. I would not trust a mechanic who told me to put lucky dice in my windscreen as a safety device, even though I know nothing about car mechanics. Same, I would not trust a doctor who told me to take magic sugar pills for their health benefits.

Andy,

Of course we will need to agree to disagree here about regulations. What you need to concede though (returning to the subject of this post!) is that two successive Governments have stated that NHS homeopathy should be available to the public because they (the public) value it. I understand and empathise that this is not the sort of Government you approve of but unfortunately for you, it has been supported by both sides of the house because we still have a semblance of liberal democracy in this country.

Face it Andy. You guys gave the Government and parliament your best shot. You wheeled out Ben Goldacre, Tracey Brown, Evan Harris and unbelievably Edzard Ernst (supposedly a ‘professor’ of CAM) to testify against NHS homeopathy and availability of homeopathic medicines.

BUT

The Government rejected all the recommendations of the above S&T Committee.

AND YET

This discredited committee’s report (discredited in my opinion and in the opinion of politicians in both Houses of Parliament mainly because it was signed by only three of more than a dozen constituent members) has been used (disingenuously imo) by a small but very vocal and very aggressive group of people to try and stop the practice of homeopathy in this country. They refuse to accept the official view of two successive Governments and now try to influence a number of unelected quangos to try to force their views undemocratically on the public. To behave like this is to treat democracy with contempt – so please forgive me for trying to defend what is left of liberal democracy in the UK.

An excellent article on CAM and conventional medicine published by an Australian professor this month ends with this:

“In the spirit and tradition of science, if there is a disagreement, let it be resolved in the crucible of public discourse. We do not need intellectual vigilantes patrolling the corridors of our institutions looking for theories or ideas with which they disagree to drive them out from our midst”

I agree with this and the thrust of the whole piece entirely and you can read the full article here. Do you think you personally qualify as the sort of ‘intellectual vigilante’ he is referring to here?

In Conclusion:

This ‘debate’ between the two of us had been going around in circles for far too long. It resembles a version of Question Time sans chairman, sans probing questions from other parties (eg audience members) sans audience and particularly sans vote. It’s high time we heard what others think of the arguments that have been made here. I have challenged you to a live debate in front of as neutral audience we can find or a debate on the radio to this end.


The gauntlet has been thrown down.

My contribution to the debate: my beautiful 9 year old dog has just been cured of cluster epilepsy (very serious version of it) through homoepathic intervention which lasted for one year of treatment. The leading veterinary hospital he attends could only control it, using drugs, which he needed alot of, so that his life quality was very impaired. Now, I have a list of the infections he was treated for (with all those “placebo drops”) and which the conventional tests did not pick up. They included borrelia in the nervous system. He is free of all them now. Vikki.

Thank you for that Vikki. The successful use of homeopathy on animals (including the Royal corgis) has always been a hugely persuasive factor in persuading many that homeopathic remedies work over and above the placebo effect.

In what possible sense are you being a responsible health care provider in encouraging an obviously delusional person that they can manage their dog’s serious condition with sugar pills?

Oh, and while you are at it. In what sense do your ideas of libertarianism apply to the best interests of this poor animal?

Hi Brian,
To me there has never been any doubt that the practitioner patient relationship could have anything significant to do with positive responses in non psychological cases. Given the short consultation times that we Indian homeopaths are accustomed to, I think there would be patients “dissatisfied” with consultation, yet showing excellent responses to remedies, when correctly chosen. No doubt at all.

Sorry but I have no intention to answer questions like these anymore. Please refer to my comments about the history of our discussion and my challenge to debate NHS homeopathy with you in front of a live audience who could ask us questions and even vote on the issue.

Just to be clear: I do respond to comments about the subject of my posts. I do not feel obliged to suffer a hostile cross examination of my philosophy of medicine. Andy Lewis’s last comment accusing me of ‘encouraging an obviously delusional person that they can manage their dog’s serious condi’tion with sugar pills’ Now I am absolutely certain this relates to Vikki’s dog and not the Queens corgis which are mentioned in the post. I feel sure that Andy would not use the word ‘delusional’ to describe the Head of State and the Head of the Church of England.

No. I would. I was talking about the Queen.

Obviously batshit delusional about homeopathy.

I am glad that society is sufficiently ‘progressive’ to allow you to say that sort of thing instead having your head removed at the Tower of London.

Fact: Aprox 5 billion people in the world (about 80% of the world population) are religious.
Are they ALL ‘batshit delusional’ ?

Should they be allowed to VOTE?

Guess not hey Andy. Surely the world should be run exclusively by a few highly intelligent, scientismic, anti-democratic, authoritarian, mechanistic, deterministic, evidentialist, quango-loving, non-delusional people. Like yourself for instance?

The rest of us ‘delusionals’ can hit the Road to Serfdom. It’s all we deserve.

You see Brian. I have no interest in taking part in a pantomime debate. You are not s serious player in the discussion.

The reason is that it is quite obvious, that at the heart of the debate is the question of efficacy of homeopathy and the evidence and rationale for that.

You try to hide behind a silly appeal to democracy and liberty. But it quickly falls apart. The anecdote above clearly demonstrates that. Either the dog was miraculously cured, or the owner is delusional and not acting in the best interests of the animal. And with animals, your appeals to freedom of choice fall on very tricky moral ground. Are you willing to stick with your concept of ‘democracy’ and allow owners to potentially mistreat animals?

The only ethical approach here it to look carefully at whether it is rational to treat this dog in this way given the evidence.

But you run away as soon as the need to look at the evidence arises. And as such, you renounce any sort of moral position.

Your commitment to homeopathy is far more important than the potential suffering of this animal.

Re: ‘You are not s serious player in the discussion.’ (sic)
If that’s true, then why have you wasted a s s s s serious amount of your time writing often highly verbose comments on my blog?
I say: Let others decide who is making a better case here, but I do empathise that such an idea is utterly incompatible with the way of thinking of the anti-democratic I Know Better Than You What’s Good For You Brigade

I am interested in how you think. That is all.

To Andy Lewis:

“Either the dog was miraculously cured, or the owner is delusional and not acting in the best interests of the animal.” – SO you would rather believe in miracles than in homeopathy? Now we know a little bit about how you think.
Thanks!

No. The homeopathy would be a miracle. Happy to accept the owner is delusional.

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I am possibly wading into waters here behond my depth. I shall atest also that as much as i tried i did not get through all of the comments displayed above.

“200 years of royal support for Homeopathy” ?.. As far as i know according to a 1324 statue (charter) the Queen also owns all the sturgeon, whales and dolphins in UK waters, and can then only assume she has supported ‘ownership’ of various sea species for well over 600 years?. It means nothing really does it in real terms (unless i guess yo are a member of the sturgeon liberation front).

Being the cynic that i am (although i prefer to call it ‘life experience supported pragmatism) i shall dare suggest the next scenario.

The Queens ‘support’ for Homeopathy is pretty quantifiable by the fact then when she (and other memebers of the royal family) appear to be ill in any kind of way that could suggest it could get more serious go to mainstream hospitals and consult mainstream physicians and take take mainstream scientism tested drugs. As did happen when the Duke was ill several times last year.

I am sure the Queen would happily call for her Homeopath when she has abit of a cough, or abit of a rash.. but what actually happens if that cough starts to sound abit more like a chest infection.. or god forbid tuberculosis? .. i suspect she would shove homeopathy to one side pretty quick and gets herself to hospital. And odd as it seems i doubt very much whether her highly homoepathic trained and devout homeopath would say “no no, that is quite alright Mam, i am pretty sure i have the tools to help remedy you of this, i will take responsibilty for you health”. Nope i suspects he keeps his head down and allows her to carry on into hospital, because of cause ‘that was her dicission’ at the end of the day. :o ) And i also strongly suspect the whole Homeopathic community collectively breaths a very big sigh of relief.

Also as a side note on quantifying ‘support’; the Queen ‘supports’ (is patron of) over 620 charities and organisations. Thats quite alot. Many many of them are science based health and medicine organisations and charities. Yet non relate (far as i can see) to anything homeopathic.

Dear Simon,
A few facts:
1. The Queen absolutely uses homeopathy on a regular basis and this has been a tradition in the Royal Family for several generations.
2. The Queen’s ‘homeopath’ is actually a fully qualified medical doctor and specialist in Internal Medicine (ie consultant physician) as well as being trained in homeopathy. Thus he is well qualified to choose what is best for any given clinical situation.

You seem to be under the impression that it is an ‘either or’ situation of homeopathy versus conventional medicine. This is simply not the case. Physicians such as myself and Peter Fisher (the Queen’s homeopathic doctor) are always prepared to use conventional medicine or homeopathy or whatever we consider most appropriate for any given clinical situation. I would have thought that this is clear from my website in general. Homeopathy is a therapeutic tool that has its place in medicine as do drugs, surgery, talking therapies, physical therapies etc.

[...] -   Homoeopathy is considered to be one of the safest form of treatment and commonly used by the Royals. The remedies are aimed at improving the  body’s own healing [...]

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