Wednesday, August 17, 2016

Deconstructing Homeopathy Propaganda


The definition of “propaganda,” like so many things, is a bit fuzzy. The dictionary definition is: “information, especially of a biased or misleading nature, used to promote or publicize a particular political cause or point of view.” There is no sharp demarcation line, however.

Speech occurs on a spectrum from obsessively objective, fair, balanced, and scholarly at one end to deliberately deceptive and manipulative propaganda at the other. Most speech is somewhere in the middle. We are all coming from a certain narrative, one which we believe is valid and important, and often speech is meant to be persuasive.

Persuasive speech promoting a point of view or certain conclusion is fine – it does not necessarily deserve the label of propaganda. The fuzzy line gets crossed, however, the more logic and evidence are compromised for the sake of the narrative.

Homeopathy Propaganda

I was recently sent a particular piece of pro-homeopathy propaganda, from a website whose very name is highly biased and misleading, What Doctors Won’t Tell You.  The name implies that the medical profession is hiding information from their patients and the public for some nefarious purpose, but the plucky band of rebels who run this website will give you this secret information.

This, of course, is utter nonsense. It’s just another narrative from which to promote the usual array of snake oil and dubious treatments. (Yes, those are emotional terms meant to persuade, but they are also entirely fair and accurate.)

The article in question is a defense of homeopathy, which is the poster-child for unscientific medicine. Homeopathy is a 200 year old approach to treatment that is based entirely in pseudoscience and pre-scientific superstition. It has no legitimate defense, and so defending it requires distortion and misinformation. They begin:

Ever since the birth of the National Health Service in 1948, homeopathy has been an integral part of the medical care offered by GPs and hospital doctors. Costing a tiny fraction of the NHS’s overall drug bill—£4 million out of £113 billion last year—homeopathic remedies have offered any NHS doctor who cared to do extra training a clinical alternative to the monoculture of pharmaceutical drugs. Some 400 doctors who took the training now offer homeopathy in addition to standard medical care.

But this option is now under threat, largely as a result of a decade-long propaganda campaign mounted by a small band of British ‘sceptics’ who have lobbied the UK government to ‘blacklist’ homeopathic remedies.

The facts here are accurate, but the characterization of pharmceutical drugs as a “monoculture” is nonsense. It is not even clear what this means, but “monoculture” is a common criticism of modern agriculture, and the target audience is already primed to have a negative association with it. How are the thousands of different drugs with different mechanisms of action a monoculture and why aren’t the more limited homeopathic options a monoculture?

The second paragraph is pure distortion. The implication is that a small band of “sceptics” (with scare quotes) are waging an unfair propaganda campaign against the public’s choice to use homeopathy.

Homeopathy is under threat because decades of research shows that it does not work. Skeptics have simply been pointing out that homeopathy lacks any scientific plausibility and the clinical evidence is consistent with lack of efficacy. The editors of WDDTY are blaming the messengers.

It is technically accurate to use the term “blacklist” because the NHS does blacklist treatments that it deems worthless that it will not pay for, but they miss the point that skeptics simply do not think the government should use taxpayer money to pay for demonstrably worthless treatments. They are not lobbying to make homeopathy illegal for private use.

Next the editors phrase the debate over homeopathy as nothing but a turf war (they are referring here to the Evidence Check: Homeopathy report):

Interestingly, the Committee’s most vitriolic opponents of homeopathy were MPs with a background in conventional medicine. Indeed, from the very beginning, there’s been a turf war between two opposing medical systems: the pharmaceutical doctors and the homeopathic doctors.

No – the war is between science and pseudoscience. Notice how they characterize mainstream medicine as “pharmaceutical doctors.” Doctors, of course, use many treatment modalities including pharmacology, nutrition, surgery, physical therapy, lifestyle interventions, and in fact any intervention that is adequately science-based.

The committee did a full investigation of homeopathy, looking at all the evidence, and giving homeopaths an opportunity to defend themselves, and they correctly concluded that homeopathy is witchcraft. So again, they attack the messengers with ad hominem attacks.

After accurately reporting the main criticism of homeopathy, that extreme dilutions lack scientific plausibility, they respond:

This kind of invective means it’s a dialogue of the deaf, says Noel Thomas, a GP in South Wales. “Opponents make much of the ‘consistent failure to demonstrate effect beyond placebo’ when trials of homeopathy are studied; this is untrue. It is depressing to see the interests of patients being threatened by a small posse of poorly informed and discourteous critics, who mix a little science with denigration and abuse,” he says.

“Only a very few critics confine themselves to what they regard as scientific principles—people who believe that science knows everything about everything, and nothing remains to be explained—scientific ‘fundamentalists’, perhaps.”

This is the cry of all quacks, charlatans, cranks, and pseudoscientists. I have heard this literally hundreds of times in many contexts. I will get to the one factual claim below, that it is untrue that homeopathy consistently fails clinical trials (it does). Thomas is claiming that scientists who oppose homeopathy are threatening the interests of patients. This is the opposite of the truth. They are defending the interests of patients from charlatans who want to use magical potions as if they were valid remedies.

Critics are also not poorly informed. Just here at SBM we have a vast library of articles delving deeply into the claims and evidence regarding homeopathy. Further, correctly characterizing pseudoscience as pseudoscience is not “discourteous.”

I find that to be a very common strategy. The pattern is this: say something completely outrageous that should offend the sensibilities of anyone who is reasonably scientifically literate. When they respond with a fair but sharply critical condemnation of the outrageous pseudoscience, then attack them with accusations of being discourteous, having an agenda, or (for the bit more sophisticated) being guilty of “scientism.”

Again, this is focusing on the messenger in a desperate attempt to distract from the facts.

The editors double down:

“Dr Thomas has put his finger on the nub of the issue. The war is not about evidence, but scientific ideology. Because homeopathic medicines often contain not a single molecule of an active ingredient, opponents mock them as an affront to rationality—and indeed, a threat to the whole of science. Hence the hostility from lobbying organizations such as the self-styled Sense About Science and The Good Thinking Society (a name eerily close to Orwell’s dystopian “Ministry of Truth”), whose attacks echo those of the medieval Vatican against Galileo: it cannot be true, so it’s not.”

Ah, the Galileo Gambit – there is no more certain sign of pseudoscience than comparing oneself to the great astronomer. The difference, of course, is this – the medieval Vatican based their beliefs on rigid religious dogma. The modern scientific community bases their tentative conclusions on an ongoing campaign of careful scientific investigation. See the difference?

They recast an utter lack of scientific plausibility as nothing but ideology. That demonstrates that they have no idea what science is (or are motivated to deny it).

It is also very telling that they think “The Good Thinking Society” is the equivalent of “The Ministry of Truth.” “Good Thinking” is about following a valid process. “Truth” with a capital “T” is about enforcing a rigid conclusion.

This is exactly why it is useful to examine such propaganda from proponents of nonsense – it exposes their flaws. It says much more about them than the actual targets of their commentary.

Also very telling is their response to the valid accusation that homeopathy lacks scientific plausibility. They do not respond with a counter argument of how it can be plausible, but instead just make an appeal to anecdote.

GPs who prescribe homeopathy acknowledge that their medicines’ mode of action is difficult to explain scientifically, but they cannot deny the often startling evidence of their own eyes.

Andrew Sikorski, a GP in a group practice in East Sussex, tells of a powerful experience at the end of his NHS homeopathic training in the 1990s. “I was a locum in ENT surgery at a hospital in Winchester when I was called late one night to see a male patient who arrived as an emergency with an advanced case of quinsy [a rare complication of tonsillitis]. His throat was almost completely blocked by a large abscess, and he could barely swallow his own saliva. He was very ill, with a high temperature and rapid pulse. The GP had prescribed a week of oral antibiotics, which clearly had failed.

“The correct emergency treatment was intravenous antibiotics and lancing of the abscess. However, I happened to have a first-aid homeopathic kit in my white coat pocket. To my barely tutored eye, the patient’s presentation indicated the homeopathic medicine Belladonna—fortunately part of the kit.

“With the consent of the patient and his partner, I popped a Belladonna pill into his mouth before going off to prepare the intravenous drip. I returned a few minutes later and was astounded to see the patient sipping water and talking freely. Both his pulse and temperature had reverted to near-normal and, on examination, there was no abscess whatever—just a red flush in the area of the right tonsil where the abscess had been. That extraordinarily rapid and complete response was well-nigh miraculous: no conventional treatment could have achieved anything like it.”

Homeopathy’s mode of action is not “difficult to explain,” it is as close to impossible as we can get in science. This is what we call a “non-trivial problem,” but they just brush it off.

As I said above, the manner in which they argue tells us a great deal about their flaws. I also find this to be a common pattern – pseudoscientist often use impressive anecdotes to defend their beliefs, and they seem to think that the more dramatic the anecdote the more convincing it is. This, however, is the opposite of reality – the overly dramatic anecdote is simply more unbelievable.

I mean, wow. One sugar pill that had a drop of water that used to contain belladonna placed on it cured an abscess in minutes. I have no idea what actually happened to this patient, that is precisely why anecdotes are worthless, but am confident that the sugar pill had nothing to do with it (unless the mere act of swallowing a pill helped to burst the abscess that was on the verge of bursting anyway).

Think about the chain of implausibility here. First, why belladonna? That is an alkaloid toxin with anticholinergic properties. How would this, or the opposite of this, treat an abscess? I wonder what would have happened if he gave homeopathic Arnica instead.

Of course, the belladonna is not present in the pill, it was diluted out of existence. Homeopaths claim that the water remembers the “essence” of the belladonna. But then how is that memory transferred to the sugar pill? Do both water and sucrose have the same magical ability to encode chemical information? Once consumed, how is that essence then transferred to the body (surviving digestion and absorption and transport through the blood), and how does is interact with the target tissue?

How did this magical essence of belladonna lance and drain an abscess and treat a serious infection in a few minutes? The fact that the editors of WDDTY were impressed by this anecdote, and feel it is an adequate and compelling response to the accusation that homeopathy lacks plausibility, speaks volumes.

Of course, if homeopathic remedies were even a fraction as effective as this, it would be a trivial matter to demonstrate such powerful effects in clinical trials. Why, then, have clinical trials failed to show that homeopathy works for anything?

When confronted with this fact, as the WDDTY editors do here with further worthless anecdotes, is they appeal to the lowest grade of evidence – uncontrolled clinical observations. They essentially argue that, “It works for me.” This is an extremely naive position that fails to understand the history of medical knowledge. Uncontrolled observations lead to biased and often false conclusion. Carefully controlled observations are more reliable. Beware of anyone dismissing better evidence in favor of less reliable evidence.

Their response to this valid point – “Well, mainstream medicine lacks evidence, too.” Again, a tired canard.

But over the past decade, conventional medicine itself has come under fire for having an equally poor evidence base. The first high-level critic was Dr Marcia Angell, formerly editor of the prestigious New England Journal of Medicine who, in 2005, made the astonishing claim: “It is simply not possible to believe much of the clinical evidence that is published”.3 Two years later, the BMJ agreed, publishing a survey showing that only 15 per cent of NHS treatments were definitely “beneficial” and 22 per cent “likely to be beneficial”, leaving the vast majority to be of “unknown effectiveness” or “likely to be ineffective”.4

This is highly misleading. Of course, there are problems with the rigorousness of evidence in mainstream medicine. We dedicate many pages here to detailing those problems and possible remedies. The editors, however, are guilty of false equivalency.

Homeopathy is 100% pseudoscience. Mainstream medicine is largely science-based, but has some quality control issues that need to be worked out. These are not the same.

Further, they are cherry picking one unscientific survey regarding mainstream medicine. A more thorough review of such evidence demonstrates that about 80% of mainstream medicine interventions are reasonably evidence-based (compared to 0% of homeopathic treatments).

The rest of the editorial is just doubling down on the same fallacious points we already discussed. The editors appeal to the “memory of water” claim, that homeopathic water has electromagnetic energy or nanoparticles that carry the memory of the treatment. They reference a few terrible studies that have already been thoroughly debunked.

They further try to cherry pick positive studies or bogus reviews, and appeal to the lowest grade of evidence that is uncontrolled.


Nothing has changed in the world of homeopathy. There is not possible mechanism of action of homeopathic position, which represent a chain of dramatic implausibility. In order for Hahnemann to have been right he would have to have won the scientific lottery not just once but a dozen times, stumbling upon multiple entirely new principles of nature. Further, these principles would all have to be of such a nature that they have eluded scientific investigation for the last two centuries.

Further still, there would have to be something about homeopathy that causes it not to work under carefully controlled observing conditions, and only work when observing conditions are loose enough to allow for placebo effects and random quirky results.

Of course the far simpler explanation to this dizzying chain of extreme implausibility is that homeopathy does not work. We don’t have to invent new physics, chemistry, and biology to accommodate homeopathy’s mercurial effects. We can simply recognize placebo effects and naked self-deception when we see it staring us in the face.

Deconstructing Homeopathy Propaganda Steven Novella

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