Wednesday, December 31, 2008

Richard Dawkins and Michael Baum: Homeopaths "Speak With Forked Tongues" And "It Makes You Weep" They Don't Have To Prove That It Works

"I'm obviously against alternative medicine, because to me, alternative, by definition, means it does not work. If it works, we would use it."

-- Michael Baum, Professor Emeritus of Surgery at the University College of London and a breast cancer specialist, in a new alternative medicine documentary with Professor Richard Dawkins, that focuses on homeopathy, for the Digital Journal.

Richard Dawkins,...switches to the main subject of the interview, homeopathy. He mentions that homeopathy uses ultra-diluted substances that are said to become more potent, the more they are diluted, and how -on the face of it- this sounds like plain bonkers. Yet, so many people swear by it on the basis of anecdotal evidence.

Prof. Baum reacts by stating that homeopathy is a system of beliefs into the nature of evidence and anecdotal evidence that is very hard to shift. What is meant by anecdotal evidence?

1. I have a problem
2. I did something
3. The problem went away
4. Therefore, what I did, works

This can be a powerful experience for the individual, and Baum says that a compassionate, caring medical practitioner must now ask the question if this could simply be the normal history of a self-limiting condition(1) that would have got better anyway or if it could be a placebo effect(2). And of course, it is also possible that this anecdote might hint that there is something active that might be worth exploring, for example, if there would be a lot of anecdotal evidence. However, an anecdote in and of itself is not evidence.

Michael Baum gives a nice example. If you would be standing in court to be judged for murder, you would probably prefer this evidence to be somewhat stronger than just anecdotal, circumstantial evidence. He goes on to say that we accept this for the judiciary and that his patients, who are often facing a life sentence (because of breast cancer) also deserve treatments for which the evidence is stronger than mere anecdotal, circumstantial evidence.

Richard Dawkins then asks how he would go about to test the validity of homeopathy. Baum says that the gold standard of testing is the randomized controlled trial. He explains that the homeopaths always advance two objections to that. First, he says, the homeopaths claim that their administrations cannot be patented and that they therefore do not have the money necessary to do these tests.

Baum says this is just not true. The homeopathic industry is hugely profitable and testing their remedies in controlled trials is simply not very expensive, one reason being that these remedies hardly cost anything. He says that a decent trial could be done for about 30,000 British pounds a year and that this is cheap, especially for an industry that makes millions. He goes on saying that he actually advised the Blackie Foundation at the Royal Homeopathic Hospital on how to design and conduct these trials. They refused.

The other argument homeopaths are always advancing is that they individualise their treatments and that therefore, clinical trials are not appropriate for testing their treatments. Baum says that this is a very poor argument, and he gives two reasons. When one buys a homeopathic remedy over the counter, it is not individualized. One asks for a remedy, say for a cold, and goes away with an off-the-shelf product, so there simply is no individualization. "So, "he says, "they speak with forked tongues." The second reason he advances is that modern testing methodology is perfectly able to accommodate for individualized treatments, and he gives an example on how to organize a four-armed trial.

Professor Baum also explains that he is quite upset with the way that alternologists hijack perfectly good words of the English language and pervert them into meanings they do not have. He gives the example of "holistic," and says that alternologists have debased this word by hijacking it without knowing what it means and that while they think that it means "whole" but that, in fact, holism is about the hierarchical organization of the human subject up to and beyond the family unit where at each level the sum is greater than the parts.

Prof. Dawkins and Baum also talk about the wisdom of allocating NHS (the UK National Health Service) money to homeopathy. Baum says that this is currently a minor problem, but that there is a fundamental principle at stake, namely that now, in the UK, there are two standards for medical products. Proper pharmaceuticals are to be tested rigorously and must show their efficacy, while homeopathic products do not have to show that they are effective. "It makes you weep," says professor Baum.

Later on, they talk about what Baum politely calls "post-modern relativism," the idea that everything is but an opinion. I have an opinion, but you have read some other books and you have therefore another opinion and both opinions are equally valid. As a result, we have now alternative medicine, alternative teaching methods, alternative legal advocates, "but," he says "we haven't yet come up with an alternative Boeing 747 pilot".

He links this to the MMR vaccine crisis where people are being told by alternologists and are convinced that there is a conspiracy of the medical establishment and the government that, in order to protect themselves, they were willing to sacrifice countless children to autism. "This is simply a lie," he says, and he adds that even among his closest friends, there are people who are not immunizing their children and that these children are now unprotected as a result.

Baum goes on giving another example of young women backpacking around the world who are taking homeopathic anti-malarials and as a result, are coming back to the UK with malaria.

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