Say I give a homeopathic remedy to a patient who complains of, among other things, rheumatoid arthritis. Her rheumatoid symptoms improve over six weeks. Can I really say that the remedy caused this improvement?
What if she’s had rheumatoid arthritis for many years and had tried conventional treatments and some other alternative healing modalities without much effect, but felt better after taking a homeopathic remedy?
What if, in addition to the rheumatoid symptoms, after taking the remedy she also had improvement with some other problematic but non-pathological things, such as that she was less bothered by something that used to cause her stress, and that a disturbing recurring dream changed?
What if she took the remedy and felt better for a time, then started to worsen again and took the remedy again and improved a second time?
What if after those six weeks her rheumatoid arthritis symptoms were gone altogether, requiring no more remedies or conventional medications? (Not the kind of result you get from a placebo effect, although I’m open to the possibility.)
I’m not intending to put this out there as evidence for homeopathy. I understand that this is hypothetical and anecdotal. (And for the record, I’m not saying all my patients have this kind of result either.) I am saying, what if you experienced this? Would that not convince you personally that homeopathy “works?” What level of personal evidence do I need to have before it’s not just my “belief?”
Now what if I observe similar kinds of things on a regular basis?
And then what if other homeopaths tell me they have similar experiences?
The next question is how much of this “anecdotal evidence” do I need to accumulate before it raises to the level of scientific evidence? I could try to create a randomized double-blind controlled trial to “prove” this. But every patient might get a different remedy. Some might not need the repetition, and some might need more. The levels of improvement would vary. And the other “symptoms” of each patient that improved would be different in each patient. It would not be a successful “Remedy X is effective in reducing rheumatoid arthritis symptoms” kind of study. It would have to be: “homeopathic treatment in general produces a general improvement in health that causes a significant number of patients with rheumatoid arthritis to experience improvement.”
Apart from the epistemic questions, there is also a practical question here for homeopaths: how many “clues” do we need before we feel positive that the remedy has worked for a patient. Sometimes it’s overwhelmingly obvious. But when I only have the first two “what if”s I listed above, I remain skeptical. Many of my patients are doing other things for their health as well as homeopathy. For me, it’s mainly the “pattern shift” and “improvement on repetition” clues that make me feel sure. Only truly holistic influences cause the pattern shift, in my experience. And the repetitive effect is just rational—more evidence increases certainty.
However, I should point out, with a patient my goal is not to prove myself right or accumulate data. The goal is the health of the patient. If the patient is better and I'm not trying to decide whether to change to a different remedy or not, the certainty factor is just a note in the case. Just a reminder that the questions I'm asking in this blog are secondary…
Comments:
“Many of my patients are doing other things for their health as well as homeopathy.”
So how do you know that these “other things” aren’t responsible for your patients’ recovery?
That’s what I said. I have to rule those things out as best I can. And I can usually but certainly not always make the distinction.
By the way, I do see actual placebo effect. Sometimes I also believe it was the “interview effect,” not the remedy. When I suspect those, sometimes I repeat the remedy to try to get confirmation and sometime I say, “That didn’t work. What next?”
But back to my question… How much of this kind of evidence is required?
I can’t do a clinical trial of one. And I might do general trials, but I can’t realistically do a RDBCT on “remedy X will cure exactly Y” with homeopathy, or any holistic modality. Even if a trial were done that let me know there is a good chance of success using homeopathy with some condition, it wouldn’t help me evaluate the sitution with a sinlge patient who took one particular remedy.
So how can I ever know, if anecdotal evidence doesn’t count?
I think you have hit the nail on the head. There is no amount of eveidence like this that can answer a question like ‘does it work’. You can never rule out that there are significant confounding factors at play.
“I have to rule those things out as best I can. And I can usually but certainly not always make the distinction.”
Yes but *how*? If somebody has conventional treatment and homeopathy, what method do you use to determine whether their recovery is due to the former or the latter? Especially given that some other patients with similar conditions are able to recover using only conventional treatment.
Thus my claim that reductionistic science can become too disconnected from real life.
Would you also claim that someone who observes animal behavior in the wild isn’t doing science, unless they bring the animals into a controlled environment?
I believe that there is a difference between not having confounding factors and being able to compensate for those factors. In other words, if I have known “noise” signals, I may be able to filter them out. Or if my signal is strong enough, the confounding factors will be small in comparison.
Some comments about my method are in the original post. When only a single symptom improved, I don’t know. But I have a list of other information to consider. But how much and what kind of other information do I need?
Keep in mind that for a single case I’m only asking how much evidence you would need as a person involved in that case. I’m not talking about general “proof” of homeopathy there.
That’s not my experience. While it’s possible that the conventional treatment finally kicked in after years, that is usually unlikely. And besides, in many cases the patient isn’t taking the conventional treatment any more because it was ineffective.
So are you saying that it would be sufficient evidence if the patient wasn’t taking any other medications or treatments?
Removing confounding factors usually straightforward. The biggest problems in medicine are observer bias. Blinding subjects and researchers does a pretty good job of getting rid of those problems.
One major problem with anecdotal evidence is that it selects only the stories which seemed to demonstrate the effectiveness of homeopathy. Random things do happen to people, they get better, they get worse, other factors in their life change.
Consider another imaginary anecdote:
A patient comes to you who complains of, among other things, rheumatoid arthritis. You do your interview thing and give her a remedy, she comes back with no real improvements so you adjust her treatment again. After a few such interviews the patient misses an appointment and you never hear of her again.
Does this kind of thing happen in your practice? Is this anecdotal evidence of the inefficacy of homeopathy or were you just unable to find the right treatment?
You will notice apparent successes all the time because they are what give you job satisfaction. The missed appointments and not quite right remedies will fade into the background of the work a day world.
But if you could repeatedly show that patients presenting with arthritis go into remission soon after you start treatment, then get worse again when a placebo is substituted for the remedy, then get better again when the correct treatment is given, then yes that would be compelling evidence.
Yes, but once the healing process begins, giving placebo would not prove anything. Remember, it is not the remedy- it is the person’s own body that has been stimulated by the remedy to heal itself. That is why all sort of things begin to change and even OTHER conditions will begin to heal after homeopathic treatment. Emotional and mental things shift as well.
I agree that with an allopathic/mechanistic view of the body, this is hard to understand, and may be hard to prove using the received scientific method.
My experience with my homeopath is that it is a journey. He has even told me that he will have treated someone over let’s say six months, and then they disappear. Five years later, he gets a call for a new appointment- they show up saying they have been well since that one remedy, and now it was time for a tune up. And some don’t give it the time it requires and move on.
My journey has been 26 years....
Headaches, allergies, workaholism,bad marriage,bladder infections,low energy,bursitis, excema,anxiety attacks, menopausal symptoms, two pregnancies ( one at age 43!)- all have been healed or assisted by this homeopathic journey.
Hey, I have been a “light” user of the conventional health care system- I am healthy at age 55, take no medication ( the last antibiotics were 26 years ago, my medicine cabinet is quite empty).
Let’s celebrate this amazing thing called homeopathy, and let’s try to help others understand it’s very gently yet profound influence on our health.
-GG
The placebo effect may be one part of the process in treating some patients, and if this helps then it’s not such a bad thing! But how can that be the case when treating babies and animals? They aren’t aware of what they’ve been given or even why, yet many homeopaths have experienced excellent results despite this.
I recently attended Peter Chappell’s seminar in London. He says there are hospital records of epidemic diseases cured by homeopathy, showing homeopathy to be ten times more successful than conventional medicine at the time the results were documented. These results can be found in ‘The Bradford Logic of Figures’. There are of course many other records indicating homeopathy to be more successful than conventional medicine in treating epidemic diseases. Peter has had amazing results with his treatment of AIDS in Africa and India, and surely it is the results that count, not evidence of how it works when dealing with people.
Homeopathy is an energy based system of medicine, and this is where it differs from conventional medicine which works on a chemical level. So how can we measure the efficacy of homeopathy as compared to conventional medicine, when they are in fact like chalk and cheese, and two very different methods of treatment!
Selling remedies in chemists to members of the public who do not understand the philosophy or principles of homeopathy is another way of turning people off. They may have tried to self-prescribe to no effect as they aren’t aware of what needs to be taken into account when prescribing a remedy.
Homeopathy being a taboo subject is a good sign; bringing awareness to it is just what is needed in this day and age, and hopefully in a short time, science will have the means to prove that it does actually work.
Sarah Keays:
If it does work in animals then that is an excellent system to run a test on. I understood, though, that homeopathy was a holistic therapy for which you need to interview a patient about many aspects of their life. How do you personalise a medicine to an animal you can’t interview? How would you manage to treat an entire flock or heard of seperate animals? My farmer friend says cows all have different personalities. Do homeopaths secretly just consider the symptoms of their patients? Would you, for example, really prescribe different remedies to two patients with gamy knees, one of whom has trouble sleeping but a great sex life and the other who sleeps like a log but has lost their libido? If so then how could this be extended to animals?
I’d also like to know what you mean by “Energy Medicine”? The word “energy” means several very specific and sometimes subtle things to me and that gets in the way of understanding what you mean by the word.
Most evidence of efficacy in animals is more anecdotal evidence from pet owners. There is anecdotal evidence from vets that pet owners believe homeopathic treatments are helping whilst their pet continues to deteriorate. How can we decide which of these two sets of anecdotes provide a more accurate picture of the situation?
Ok where is Peter Chapels evidence? Setting aside the ethical issues of testing unproven therapies in third world countries, permanent remission of AIDs would be compelling evidence for the efficay of homeopathy. Where is the careful documentation of cases, the follow up one year, five years and ten years on, to confirm remission is real and permanent? Where is the evidence that levels of HIV virus in the blood stream is falls below detectable levels in his patients?
If he isn’t collecting this data then he is either risking the lives of his patients because he won’t realise at the earliest possible juncture that his medicine is ineffective or he is risking the lives of everyone else in Africa by not collecting the kind of evidence that will convince the rest of us to support the extension of an effective cheap therapy to the rest of the continent.
As an aside; when someone says something like “ten times more effective”. You should ask your self: What does he mean? What was measured? Which situations were compared to give this result? There are many kinds of statistical slight of hand that can return impressive but misleading numbers. Often people aren’t trying to mislead but miss represent the data because statistics is tricky! That’s why you must always check someone’s reasoning ESPECIALY WHEN YOU AGREE WITH THEM!
GaleG:
I’m afraid if you say you can not PROVE* it then you yourself do not KNOW it.
Also; Johns interesting hypothetical anecdote suggests removing the homeopathic treatment precipitates a return of arthritis. Is he wrong? How do you guys decide which of you is correct when you disagree?
*By prove I mean demonstrate a phenomena in a number of different experiments robustly (means the experiment can be modified slightly without changing the outcome) and repeatedly (means the experiment can be repeated by different people and get very similar results). You have had 200 years! Get on with it!
I’d like to try to bring this back to my original question and not argue specific claims here.
By the way, I will be talking about “energy medicine” in the next couple of posts. And I’ll try to at least partially address the question about individualising treatment to animals when I write about what natural healing means after that.
For the record, Derek, I do agree with you about questioning the reasoning of people you agree with. I certainly don’t agree with every claim made about either homeopathy or conventional medicine, even if the source seems good to me.
That isn’t quite right. It’s more accurate to say that healing starts and goes for a while and sometimes needs another push (or several). But the ideal is to get the person’s body to heal itself and then they don’t need further treatment, as GaleG said.
Yes, there are dosing methods that involve repetition, and switching to placebo might stop improvement, but if there is a full return of symptoms, that would likely mean that the remedy was only palliative, not curative. It might be useful in a experiment to prove homeopathy to skeptics, though, but I’d prefer a test with better intentions.
Anyhow, regarding what I said in my original post, when I give a remedy and the patient is better for some time, then their symptoms come back a bit and I repeat the remedy and then they improve again, I usually feel very confident that the remedy has “worked,” as you put it.
Another part of what I was trying to say above is that I look at many factors in evaluating remedy response. Certain factors mean more than others and simple improvement as described in the first item in my post leaves me in doubt. By the way, this simple improvement is usually as far as conventional trials go. This is the difference between holistic and allopathic—they have different ideas of what improvement means.
By the way, I do not believe that it is hard to show that homeopathy is not just placebo using conventional scientific testing. The problem is that we are making what amounts to an extraordinary claim as far as scientists are concerned, and so the climb to scientific acceptance is much, much longer and more difficult.
On the other hand, once we get beyond the “does it really work” question, it’s gets much more complicated: works for who, when, and what does “improvement” mean?
I love it! It’s a nicer image than “like apples and oranges.”
So here is where I was coming from with this post:
1. Science says that homeopaths are making an extraordinary claim and don’t have the extraordinary proof to back it up; therefore it’s a belief or a delusion.
(Yes, I realize that’s not how some of you might put it.)
2. Homeopaths like me say that it is our frequent experience that homeopathy works. (Not like having a vision or making a prediction, but a cause and effect situation.)
My question: What if you were on the other side? Despite your philosophy of science, how much of an experience would you have to have (#2) before it counts for you. I understand that greater scientific evidence is a bigger question. How does my hypothetical situation above fare?
Yes, it does. All I can say is that when I look at all my patients, even the “missing” ones, my successful cases far outnumber the ones where there was only a minor result or no result. I don’t offer this a proof, only to say that the “selective memory” argument might work with for domestic use of homeopathic remedies, but it is counter to what I experience in my practice.
You have no idea. No idea. The difficult cases occupy much, much more of my thought and time.
By the way, I do audit my practice on a regular basis (thank you, Miranda) and call some “missing” patients for feedback. Usually they didn’t get a satisfactory result, but occasionally I do find someone who actually was better and didn’t see any point in coming to see me and didn’t communicate that when they cancelled the appointment.
“My question: What if you were on the other side? Despite your philosophy of science, how much of an experience would you have to have (#2) before it counts for you.”
I fear that you really don’t get it. To a rational mind, it absolutely doesn’t matter how much of a personal experience one has if objective testing demonstrates that ‘experience’ to be an illusion.
There is absolutely no amount of ‘experience’ which could persuade me because I don’t base my understanding of the world solely on my experience. I base my understanding of the world on people with a great deal of existing knowledge and critical reasoning poking bits of the world with sticks and accurately measuring how much it squeaks. That’s what could persuade me.
Anecdotal evidence does not become data just because it’s an anecdote about oneself.
John; thank you for your replies, I am enjoying this. Challenging ones ideas against someone with a very different world view is invigorating.
I would like to deal with #2
I am afraid my answer is slightly paradoxical. In my experience, my experience is unreliable. I have watched magicians do impossible things. I have read into my data what I expected to see and done further work on that basis with messy results. I have been certain, given my experience, that tweaking one little factor in an experiment will improve the quality of my data and ended up, several tweaks later with worse quality data than I started with.
So no amount of direct experience would convince me that it works any more than any amount of watching the same conjuring trick would convince me that it was real magic.
What I require is a different kind of experience: A Demonstration that if you do one thing; give a remedy, you get a different out come than if you do a different thing; give a sugar pill.
In response to Derik, I would like to add that homeopathic vets work by asking the owner of the animal how the animal is, ie if their appetite is affected, what differences they have noticed from the norm etc. Likewise when treating a baby, the mother will tell you the symptoms as far as she knows, including any aetiological factors and changes in behaviour and this is how a prescription is usually made.
Peter Chappell is trying to raise funds for research into his methods of treating AIDS in Africa; Until he has sufficient funds to do this, he recommends homeopaths use a scoring system (Karnofsky score) to evaluate the progress of their patients. This is an effective way of evaluating cases. As for the ethical issues surrounding the treatment of AIDS in Africa, you need only to read books such as ‘the Truth about HIV’ by Phillip Day (Credence Publications) to see that there are many questions to be raised about ethics where the pharmaceutical industry is concerned.
The European Council for Classical Homeopathy also have a good resource of cases treated successfully with homeopathy.
AS for misleading information, I’d like to refer you to the following link: http://freetochoosehealth.wordpress.com/.
Energy - other words or phrases used to describe this, Ki or vital force etc. Acupuncturists, cranial sacral therapists, reiki practitioners work along the same lines, releasing energy blockages in order for the Ki or vitality to flow harmoniously resulting in better health.
Gale G, I myself have not had 200 years to get on with it, but seeing as we collectively are under immense pressure to do so, some of us are making huge efforts in this vein, Peter Chappell being a good example!
I have an idea!
I am inspired by your statement:
You have made a “specific prediction”
that you get a particular pattern shift in the response you get from patients. Tell me about it. Is it ailment independent? Does it always happen? Would it be something that could only happen if you gave the right remedy and not if you gave the wrong remedy or a placebo?
We can do things with patterns you know, it could form the basis of a hypothesis test you would buy into. You’d need to talk to a real statistion though because these things are really involved and I couldn’t swear to getting it right. I could probably give you some idea about how they work though.
Sarah:
So far as I can tell Peter hasn’t ever published anything in either of the journals Homeopathy or eCAM. In addition he has never published in any of the journals searchable by web of science or pubmed on the topic of AIDS. Why no preliminary data? Or even a letter? If he had enough data to give a presentation he must have enough to publish. How will he get funding if he can’t point to peer reviewed papers?
You must understand that this makes him look like a charlatan. In the absence of such publications I am forced to assume that his failure to put any data into the public domain is because it does not stand up to scrutiny.
If you can point me at anything he has published I will look at it.
Homeopathy will have to stand or fall on its own merits. I couldn’t pass over the issue of testing homeopathy in the third world in silence but I don’t want to get bogged down in it. I am also not concerned to defend every allopathic remedy. Cough mixture may or may not be toxic, it has no impact on the question of the efficacy of homeopathy.
You haven’t answered my question about energy by giving me other names for it. Would “vim and vigour and get up and go” be another equally valid if less mystical sounding term? I will wait for Johns up coming and hopefully more enlightening post on the subject.
Derik
Peter Chappell has published a book called ‘The Second Simillimum.. A Disease Specific Complement to Individual Treatment’. I’ll let John handle the energy issue, thanks John!
You are right. That’s one reason I started this blog: to try to figure out how to talk about all of this.
Ah, the sticking point. I disagree that objective testing has ever shown any such thing. I don’t believe that is a rational interpretation of the existing science, weak as it is. To me that claim is your ‘illusion.’
I really liked what laughingmysocksoff had to say about hitting your thumb with a hammer:
“You could happily admit to the possibility of being wrong about any of your beliefs about why you missed the nail and hit your thumb. But you wouldn’t be prepared to say you were wrong that you hit your thumb. That would be ludicrous.”
Here’s another example:
Let’s say that I’m living in the French countryside in 1802 and I witness a meteorite fall from the sky and land in my field. I go out there and find a large stone in middle of a crater that was not there before. But the French Academy of Sciences had declared that year that stones do not fall from space, in response to some recently published evidence in England. Do I believe myself or the scientists? Could such a large stone have formed in the clouds somehow? That is less plausable than the alternative. What am I to think?
In the real story, a meteor shower a year later proved French scientists wrong. I claim that sooner or later there will be enough overwhelming evidence for homeopathy. (Although “proving” that homeopathy is not just placebo only opens Pandora’s Box.) In any case, whether you believe that day will come or not, what am I to do in the meantime with this (metaphorical) meteorite that is right in front of me but that some other people tell me is a kind of delusion?
(Thanks to Kenneth Salls for the example.)
Homeopaths try to match the symptom pattern in the patient to the symptom pattern that is known about a remedy. If the patterns don’t match, there is a minor or no effect. That description skips over a number of important points, such as chronic vs. acute, but that’s the core of it. Does a pattern shift always happen? No. But in the best cases there is general improvement, i.e. change in many of the patient’s issues. That’s what it means to be holistic. But what I’m referring to as a “pattern shift” is more patient than remedy dependent, although the two are related since we are talking about like cures like.
Testing that clinically is impractical to say the least. That’s a topic for later as well. But an interesting test was discussed here.
I followed your link.
I think I’m a bit confused. Is it central to homeopathy that 30C remedies will produce the symptoms in a “prover” that they experience in a “proving”? Or is it the opposite symptoms?
“You could happily admit to the possibility of being wrong about any of your beliefs about why you missed the nail and hit your thumb. But you wouldn’t be prepared to say you were wrong that you hit your thumb. That would be ludicrous.”
You know when you thought you hit your thumb with a hammer? Well, we were secretly videoing you and if you watch closely you can see that you actually missed your thumb. But at that moment we jabbed a sharp spike up from under the table into your thumb and you associated the pain with the hammer even though you missed your thumb.
Or…
That small scar on the back of your head is where we inserted a small implant into your brain which enables us to activate the pain sensation relating to your thumb at will.
Or…
The audience here in the studio and at home saw me hypnotising you and implanting the suggestion that on the third tap of the nail you would feel a sharp pain in your thumb, even if the hammer missed you completely.
There we are - off the top of my head, three ways to make somebody think they’ve hit their thumb with a hammer when they haven’t.
If we live in the “evil genus” universe where the creator is just messing with us, all bets are off anyhow. Maybe we’re just part of the lab experiment of some greater being. Or maybe there is a great conspiracy out there implanting devices in the brains of homeopaths, or sending trick patients to homeopaths just to fool us or test us. It seems far more likely that there is some force of nature at work here that science doesn’t understand yet.
Also, as a person taking homeopathic remedies, I’ve experienced immediate reactions that I would never have expected, i.e. not the placebo effect. And I experienced this before I studied homeopathy and knew what to expect. (I’ve been surprised afterwards as well!) There were no magicians as guests in my home at the time. If it was just me alone perhaps I could speculate that my wife had hypnotized me or was slipping something into my food and drink.
Anyhow, we’re going around in a circle. For you, there is no level of personal experience that would convince you to doubt what some scientists who you trust have told you were the results of clinical trials.
I’m moving on…
Well said John. I think M Simpson has some paranoid delusions about homeopaths. We do not set out to learn homeopathy for four years in order to foil our patients into believing it works when it doesn’t.
I myself have taken part in a proving and this is the biggest proof I felt I had for KNOWING that homeopathy works in ways that cannot yet be fully understood by rational science. I wonder if some honest sceptics would be prepared to take part in a proving? Randomly selected, healthy individuals (mentally, physically and emotionally)who genuinely want to know what homeopathy is. Just a thought, but probably an impossible task.
The choice of a 30C was so that there would be absolutely no molecules of the original substance left, i.e. only the so-called memory effect would be involved in the experiment.
I missed how opposite symptoms came in to the discussion, but provers experience both an initial effect and a secondary oppositive effect.
A note about provings: Not everybody who takes a remedy experiences a change, and some have more of an effect, some less. Usually there is at least something in all provers, but it can be subtle. Homeopathic remedies have a quality that is like resonance.
Resonance is a very powerful and measurable phenomena, it can tear bridges down, it is the basis of the nuclear magnetic resonance technique.
I’ve noticed a worrying pattern here. You repeatedly seem to say something definite about some immediate and compelling phenomena. Then I get all excited and start thinking or all kinds of things that I would predict if you where right and all kinds of experiment I could do to test them. I have designed three different sets of experiments in the last few days. But every time I ask for clarification about particular phenomena it suddenly slips from an immediate and obvious experience like a thumb hit by a hammer or a stone falling out of the sky and becomes a subtle effect, always different, not something that could be relied upon to happen all the time.
How can you trust your experience of such ephemeral things?
I am going to disappear for a bit. But I will be interested to read your energy medicine piece. Please try not to use any jargon from quantum theory, I studied quantum chemistry and statistical thermodynamics during my chemistry masters and I have never understood what any of you lot mean by the words you use. A useful guide for such things is writing for an intelligent 14 year old! Let us all understand what you mean.
I said that is has some qualities like resonance. I’m not saying it is resonant.
I have also studied some quantum physics and I can assure you that I will be taking a much different path.
I apologize if I’m giving the impression of something easily measurable. It’s not. (See my next post. Then I’ll quickly move on to my take on the “energy medicine” business.)
The point that I’m trying to make is that while I don’t have such experiences every time, I do encounter on a regular basis what I consider to be incontrovertible evidence. I find the “unknown force of nature at work in homeopathic remedies” possibility much, much, much more likely than the “some hidden magician is messing with my mind” hypothesis.
But it remains anecdotal. My opinion is that science will eventually get beyond what I consider to be a philosophical issue of materialism and accept that homeopathy works, but in the meantime all I have is my experience and the experience of many others like me. I’m less concerned with convincing skeptics with anecdotal evidence than figuring out how to talk about it. I understand the skepticism, I really do, and yet I’m not willing to deny what has been my direct cause and effect experience.
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