alternative medicine

Running down the hallways naked

Steven Novella was recently on the Dr. Oz show. He had been fairly critical of Oz earlier this month on the Skeptic’s Guide to the Universe podcast, so I was surprised to see him invited. Novella’s post-mortem is here. It’s a great read.

Jay Novella said something that keeps cracking me up on that podcast, though, and I’d like to share it with those who aren’t SGU addicts like me. Here it is:

“[Oz] is like the classic rock star guy who just got into the good band and he’s all happy and enthusiastic and he’s getting up early to practice his riffs…and then you zoom out and zoom back in…about six months later and he’s doing coke, he’s running up and down the hallways naked, Jack Daniels every night…”

And you can just see Oz running up and down the halls with a big check signed by Oprah Winfrey. What a load of nonsense this man is peddling.

Homeopathy: placebos with bowties

I know a surprising number of people who think homeopathy actually works. Every time I begin asking, “But do you know how it works?” I realize we aren’t speaking about homeopathy but about herbal remedies. Actual ingredients, that is. Homeopathy, properly understood, is a perfect lack of active ingredients. There’s nothing in it but a fancy sounding name and a placebo with a bowtie.

Some of you will grumble, but you haven’t tried homeopathy! I have, and I can tell you it works. And that’s enough for me. And I will grumble back, the plural of anecdote is not data.

Allow me to pass the mic to Ben Goldacre, who writes the Bad Science column at the Guardian (in one of that newspaper’s more noble journalistic endeavors). His writing is as clear as sunlight poking through the London fog.

Homeopathic remedies are made by taking an ingredient, such as arsenic, and diluting it down so far that there is not a single molecule left in the dose that you get. The ingredients are selected on the basis of like cures like, so that a substance that causes sweating at normal doses, for example, would be used to treat sweating.

Many people confuse homeopathy with herbalism and do not realise just how far homeopathic remedies are diluted. The typical dilution is called “30C”: this means that the original substance has been diluted by 1 drop in 100, 30 times. On the Society of Homeopaths site, in their “What is homeopathy?” section, they say that “30C contains less than 1 part per million of the original substance.”

They’ve since apparently deleted these embarrassing numbers, preferring the ambiguous “highly diluted substances” and a long list of celebrity homeopathy users like Jude Law and Tina Turner. Some celebrities use cocaine, too.

This is an understatement: a 30C homeopathic preparation is a dilution of 1 in 100^30 [to the 30th power], or rather 1 in 10^60 [to the 60th power], which means a 1 followed by 60 zeroes, or – let’s be absolutely clear – a dilution of 1 in 1,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000, 000,000,000,000,000.

That’s an awful lot of zeroes.

To phrase that in the Society of Homeopaths’ terms, we should say: “30C contains less than one part per million million million million million million million million million million of the original substance.”

Wait. One, two, three, four…

At a homeopathic dilution of 100C, which they sell routinely, and which homeopaths claim is even more powerful than 30C, the treating substance is diluted by more than the total number of atoms in the universe. Homeopathy was invented before we knew what atoms were, or how many there are, or how big they are. It has not changed its belief system in light of this information.

Did you get that last point? It doesn’t matter what science discovers about reality, the homeopaths prefer their crackpot dogma instead. This makes homeopathy irrational, akin to voodoo, astrology and flat-earth creationism.

If you “believe” in homeopathy – a locution which should set the alarm bells ringing in your head – you might be upset with me for having made such a brash comparison. Voodoo? I don’t stick little pins into dolls, thank you very much! Astrology? Yeah, like I think the position of Venus in the sixth house and Mars in the ascendant makes me snappy! Go get a haircut, bozo. And I will cite Oliver Wendell Holmes (with homage to Simon Singh and Edzard Ernst):

“Truth is tough. It will not break, like a bubble, at a touch; nay, you may kick it about all day, like a football, and it will be round and full at evening.”

So try kicking homeopathy around a bit and see if it, too, is round and full at the end of the day.

Weird Medicine

Feeling funky yet?

I began to wonder what was really going on when my own family began telling me of their positive experiences with alternative medicine. The first lesson I learned was not to ask too many questions. As a result I only began asking more.

To be fair, I once flirted with alternative treatments myself. I’ve always suffered severe allergies and hay fever. Some years ago in New York, a colleague suggested I visit her acupuncturist in Chinatown. “He did miracles for my back,” she said. Desperate for anything that worked (or might) I made an appointment at his office on Canal Street.

I went only twice. Perhaps deep down I was just a skeptical 26-year-old. I recall the quick tap of an index finger and the needles sinking into the skin of my face. I felt less pain than constant pressure, especially when the needles were twisted in. I now know they were supposed to touch a meridian, which channels the Ch’i, or life force. The needles were then hooked up to what appeared to be a Ham radio. The doctor left me there for almost an hour. When I walked out into the street I was convinced I felt better. Then again, I had just shelled out $50 and my face hurt.

But my allergies didn’t dwindle. True, I didn’t complete the treatment, leaving me to wonder what if…

Having just finished reading Simon Singh and Edzard Ernst’s Trick or Treatment? Alternative Medicine on Trial I can safely say I’m glad I never returned to Canal Street for anything more than a cheap meal. Singh and Ernst studied scientific evidence culled from many trials, discarded the results from unreliable ones, and provide a useful overview of what works and what doesn’t.

They concentrate on the four “respectable” alternative treatments: acupuncture, chiropractic therapy, homeopathy and herbal medicine. An appendix deals briefly with the borderlands of alternative medicine: crystal therapy, ear candles, Reiki, Feng Shui.

When faced with rigorous testing, none of the four major therapies appear to be anything more than a placebo. That means whatever’s “working” is pretty much wishful thinking coupled with a wish to feel that your money, time and trust have been well-invested.

This should come as no surprise based on the founding principles of chiropractic (“innate energy”), acupuncture (Ch’i, meridians) and homeopathy (“memory” water). Herbal remedies fared slightly better, but the authors warn strongly against misuse and fraudulent marketing. They conclude that there’s really no such thing as “alternative medicine.” Either something works, in which case it is “medicine;” or it doesn’t, in which case it isn’t.

There are surprises on almost every page. Most homeopathic remedies don’t contain a molecule of their original substance. Frequently, they’re watered down millions of times, intended to make them even more potent! They are said to retain the “memory” of the original tincture, often made from soaking a root or leaf in a vial of water. When they reach the market, they’re often just pure water with a hefty price tag.

Acupuncture had been pretty much discredited in China until Chairman Mao decided it would be a great way to revive national “tradition.” The authors quote him as saying, “Even though we should promote Chinese medicine, I personally do not believe in it. I don’t take Chinese medicine.”

Now back to my family. My mother believes she has been cured of her lifelong allergies through a treatment called Nambudripad Allergy Elimination Technique, or NAET. This involves holding small glass vials of “essences” to which one is allergic — things like chocolate and nuts in her case — while a therapist does acupuncture on the patient. When I asked my mother how it worked, she shrugged and said, “How do I know? It just does.”

Further questioning prompted her to phone the therapist. “Hello, Fran? My son would like to ask you a few questions about allergy treatment. He thinks you’re a witchdoctor.” Then she passed me the phone.

Our conversation lasted for a few minutes. Fran enthusiastically explained how NAET is supposed to work. She more than once dropped big-sounding words like “energy” and “mind-body.” “But how do you know this stuff really works?” I pressed. “Listen,” she said confidently, “I could cure your mother’s allergies over the phone.”

That was it for me. My mother was the helpless victim of an alternative therapy guru. Her belief in the efficacy of prayer was already a bone in my throat. Now NAET and acupuncture. What was next, 2012?

When I voiced my skepticism to my sister — herself a part-time believer in alternative therapy — she rightly pointed out that the glass vials were probably just a placebo. It was the acupuncture that really did the trick.

That last word was telling.

Published in The American

Don’t Get Scammed

I spent most of the last week reading Simon Singh and Edzard Ernst’s Trick or Treatment: Alternative Medicine on Trial. Besides being written in clear, understandable English – always a plus – the book is full of information that might save you from getting scammed. Because this – the issue of whether placebos count as valid treatment aside – is what’s at stake with most alternative medicine.

In fact, the term “alternative medicine” is an oxymoron. It’s like saying “right” is “alternative left,” or that there is “science” and “alternative science.” There is science and pseudoscience. When a new remedy or treatment is proven to work, it stops being alternative and becomes medicine. Alternative medicine is akin to quackery. As Robert Todd Carroll of Skepdic puts it:

What quackery lacks in scientific study it sometimes makes up for by prescribing generous portions of caring—sometime sincere but often counterfeit—and overdoses of false hope.

Worst of all, most have us have probably been scammed at least once by such practioners as chiropractors, herbalists, acupuncturists, reflexologists, not to mention the really wacky stuff like threapeautic touch, Reiki and crystal therapy. Punch any of these into Skepdic and read up on them before shelling out.

Of course, you may not want to know what skeptics have to say about a treatment you’ve been using. Let’s say you’ve been having acupuncture regularly for years. You’re convinced it works. Why are you going to listen to some shmo like Robert Todd Carroll or Simon Singh tell you that you’re just buying extravagant placebos? Well, that’s what the trials tell us. None of your favorite alternative treatments – underline none – have proven to be anything more than placebos after having undergone rigorous testing. When you reflect on the voodoo-like nature of most of them, involving catchy concept-words like “energy”, “mind-body”and “spirit,” this should come as no surprise.

Some, however, will argue that quackery is an acceptable method of healing the sick. Why take away hope? The counter-argument is that lying to patients undermines the trust on which the doctor-patient relationship is based. And it opens the door to charlatans of every stripe. Like Kevin Trudeau. Allowing for “ethical quackery” would erase whatever distinction we make between concepts such as “truth” and “falsehood”, rendering them meaningless. After all, why bother developing and testing real medicine when all we need are sugar pills with fancy names? Why bother getting a medical degree when we could all become faith healers or homeopaths simply by hanging a sign over our door or on our website? Unless we are able to admit that there is a real and worthwhile difference between selling a product known to work and a simple placebo, we might as well send our children to witchdoctors and our elderly parents to the bloodletter.

Here are a few websites to help you out: Quackwatch, Bad Science and, of course, Skepdic. There’s a lot of information out there, but it would be prudent to find out what actual scientists and doctors have to say before paying for a treatment based on some mythical Oriental tradition which probably never even existed.

Now Reading: Trick or Treatment?

Fearless, intelligent and remorselessly rational, the authors exemplify the same Enlightenment spirit of criticism that animated The Lancet in its early days. One by one, they go through the most influential alternative therapies (acupuncture, homeopathy, chiropractic and herbal medicines) and subject them to scientific scrutiny. In each case, they ask what is the evidence base for saying that a given therapy “works”? Acupuncture, homeopathy and chiropractic all come out badly. Singh and Ernst build a compelling case that these therapies are at worst positively dangerous – chiropractic neck manipulation can result in injury or death – and at best, are more or less useless. For example, tests done in Germany have shown that “real” acupuncture works no better in easing migraines than sham acupuncture, a random application of wrongly positioned needles, working as a placebo.