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RE: Homeopathy: Just water?

in #science4 years ago

While I am skeptical of homeopathy, I appreciate the subtly of your argument. I do wonder though, at what point is there enough evidence that homeopathy is ineffective? Is your claim falsifiable and under what conditions?

I enjoyed your post and included it in today’s #philosophy-review
https://steemit.com/philosophy/@aaanderson/the-philosophy-review-12-4-2016

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Let's see. I guess there are two main claims that I'm making here. The first is that the argument that "it's just water and therefore doesn't do anything more than tap water" is based on a fallacy of composition. That argument is never going to be logical, so anyone arguing against the benefits of homeopathy should take that into account, if they want to argue logically.

@baerdric has pointed out some valid criticisms of one of the papers I mentioned, such as self-reporting, and they're definitely not unique to that paper. What I have noticed in some of the studies, even ones which show a positive effect, is that they tend to be applying exactly the same remedy to many patients. Generally that's not what homeopaths do - they provide individualised treatment after asking many questions, taking an interest in the patient. What I'd propose would be a study where you have at least three groups:

  1. A group treated by homeopaths with high patient ratings, given homeopathic remedies
  2. A group treated by homeopaths with high patient ratings, given a placebo (of a similar level of complexity to the homeopathic remedy)
  3. A group treated by GPs, given a placebo

In a broader sense, we already know that homeopathy "works" - that people receive some benefit from it. If they didn't, they wouldn't be spending so much money on it worldwide. Anybody claiming that "homeopathy doesn't work, case closed, no more questions to ask" really has a low/confused view of humans, a lack of understanding of economics, or a lack of curiosity necessary for scientific enquiry.

Part of the question is: is this benefit because of the medicine, or because of the way homeopaths talk to people compared to GPs, or some other part of the homeopathic process? Without including the third group, we can say whether the medicine is effective, but we can't say whether homeopathy is effective - which is obviously the more important question. If homeopaths talk to people in a way that helps them to heal, then those techniques could later be taught to GPs.

Of course, such a study would be rather impractical, because it would have to be a study which was not specific to a disease, as the diagnoses of the homeopaths could vary from one another, and from the GPs, and from any pre-screening for illnesses. In that case, it makes it very difficult to maintain objective measures of health, except in a very large and well-funded study.

Edit: On second thought, it might not be so impractical. Here's a relevant quote:

"They're used to the western evidence model where everyone has the same condition, everyone has the same treatment, and that's the criteria they judged the quality of a trial by, which doesn't work for homeopathy because that's exactly the opposite to how homeopathy prescribes in practice," says Cope.

"We take a hundred people with headaches and they each get a different medicine or different prescribing technique depending on their individual circumstances so that does make it very difficult for folks like the NHMRC."

However, Glasziou says while that might be a reasonable claim, it is also a testable one. He cites a trial that was done of Chinese herbal medicine, which compared personalised treatment and standard treatment with placebo for the treatment of irritable bowel syndrome.

The other thing is, if it turns out that homeopaths do make people feel better without actually providing any health benefit, that should be taken into account too. Good customer service should be part of good medicine, as medicine is customer service.

Thanks for the mention and for the question. You got my brain ticking.

Great follow up, and it sounds like a reasonable route for testing. The personalized aspect is a challenge, but i like the concept of comparing personalized vs standard treatment first, then moving on to specific treatments when personalized shows efficacy.

Outside of clinical trials though, i see a lot of practical issues that could arise. Perhaps your homeopath is highly rated but not a good fit for you, for example. The could be the case with a GP as well, but at least with treatment algorithms, you're almost ensured a minimum level of effective treatment.

That's mostly a practical concern, but potentially a hurdle for trials. How to test the match between homeopath and patient? Maybe a rubric for this exists in the psychiatric world?

This is a relevant study that I just found: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3093927/ but I think the measurement (DAS-28) is a subjective one, relying on the patient to report which joints are tender. Their conclusion is that the consultation process helps the patient heal, but not the remedy.

I guess for now, the only way would be old-fashioned trial and error, finding a homeopath that suits you. Maybe some personality tests like Myer-Briggs could be useful, but there is skepticism and questions around those as well.

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