Friday, January 22, 2010

Distinction: Homeopathy vs. Herbal Supplements

Several people have pointed out correctly that I've conflated herbal remedies with homeopathy. Homeopathy is still categorically bunk, all of it. Herbal medicine is the use of natural products to benefit health, and sometimes works, but most of the time is the result of a misunderstanding of the importance of "naturalness", whatever that is. There are some herbal medicines that work, and we know this because they've been reproducibly tested and shown results (note that echinacea is not one of them). Indeed many modern medicines got their start or were inspired by natural cures.

Certainly I'm not the only person who's conflated the two, and I think the reason is that, at least in the mind of the public, promoters of homeopathy and herbal medicine share similar values, which I will summarize here. I invite any homeopaths or naturopaths who run across this post to give us more information in the comments.

Apparent Value #1: different standards should apply to homeopathy and herbal medicine than to allopathic pharmaceuticals. Let me be very clear: if I could reliably show that depression, cancer and malaria could be cured by a readily available root preparation, I would be ecstatic. Note the operative phrase reliably show. Some Chinese herb cures schizophrenia? Great! Let's get it into a study and subject it to ruthless scrutiny, as is already done (rightfully so!) to allopathic pharmaceuticals. Apparently, for some people, asking for verification is an affront to decency, and it's easier to believe that healthcare professionals are either stupid, or want to hurt their patients. In the run up to the 10:23 event, skeptics have been hearing the usual whines about respecting others' beliefs and leaving people alone to make their choices. If you want to put your own health in the hands of a charlatan, that's up to you. But if you are that charlatan, then shame on you, and more shame on you still if you're a parent depriving your children of real medical care. Remember what we call alternative medicine that's been proven to work: "medicine".

Apparent Value #2: Natural things are good for you. Unnatural things are bad for you. The problem here is that there is no coherent meaning of natural and unnatural. There is no "vital force" unique to living things, and that's not some New Atheist talking point, that's basic chemistry from the 1840s. Here are some examples to think about.

a) Imagine you have two bowls. One contains synthetic omega-3 fish oil. Another contains the exact same mix of fish oils, except these were isolated from an actual salmon and purified. I blindfold you, move the bowls around, and un-blindfold you. What method can you use to tell which one is the natural one? There's no way to tell, because there's no difference. (True story: one person solved this by telling me that because I had such negative energy, the un-natural-ness would contaminate both bowls, so of course you couldn't tell them apart.)

b) Wheat, corn, and citrus fruit have all existed as human-bioengineered crops for millennia. In what way are these natural?

c) Curare and botox protein are both natural. In what way are these good for you?

The most harmful effect of this superstitious attitude about "naturalness" is the total lack of regulation of herbal remedies, which can and do still hurt people. (Remember kava?) The FDA was created precisely to regulate the snake oil salesmen selling flavored ethylene glycol (antifreeze) syrup as medicine, and the kids who took it subsequently dying from liver damage. Today the snake oil salesmen are back with a different pitch, and it's time to regulate them all under the same standards before more people get hurt.

Apparent Value #3: Making money from medicine is immoral, unless it's homeopathic or herbal medicine. I don't know about homeopathy but herbal supplements are a big industry in the U.S. - if you ever landed at LAX, you may have noticed the high-rise with the big green Herbalife sign on it, and they don't give you high-rises in LA for free (that's your gingko biloba money keeping the lights on). There's even a Federally-funded institute (which so far hasn't found much, which pissed off the industry lobbyists and the Congresspeople they own). If making money from medicine is cause for suspicion, then the herbalists and homeopaths are right up there with the best.

If you run across this post and think these incoherent values are mis-represented straw-men, please correct me in the comment section. It's difficult to figure out exactly what the foundational principles of these medical philosophies are because whenever we ask questions, it's considered offensive and disrespectful. Please do leave comments with further information; please don't waste your time with a paragraph about how ignorant we all are and how I'm oppressing the truth while somehow in the process missing an opportunity to spread that truth. It's oddly like creationism that way.

I'll end with a list of questions - difficult but serious, not sarcastic questions - that I have about homeopathy. Homeopaths: that skeptics have these questions shows that we take your philosophy more seriously than you do. When we make decisions in life, we all have some bar we set to determine what's true and what's not, and when we're dealing with human life and suffering, that bar goes up considerably.

- Say I have a full bottle of homeopathic medicine. I use half of it. If I refill, why isn't it twice as strong? Why couldn't I continue this process indefinitely for infinitely strong medicine?

- Say I have a homeopathic headache remedy. Say I also have ibuprofen. Wouldn't a combined approach work better, i.e. I wash down the ibuprofen with the homeopathic solution?

- A common criticism of homeopathy is that the water somehow remembers the desired ingredient, but forgets something very undesirable at far higher dilutions (for example, human waste). To the best of your knowledge, what's the science behind this?

- Physicians are happy to treat their patients any way they can get results, and yet homeopathy is not taught in medical schools. Why not?

- Yes or no: is homeopathy different than placebo?

- It seems much more difficult to show efficacy in studies of homeopathic remedies. Why would this be the case?

- It seems that homeopathy could benefit greatly by improving mainstream medical acceptance through controlled clinical studies, and yet the perception is that homeopaths are reluctant to do so. Why is this? (The reluctance and/or the perception.)

- Does homeopathy work with any solvent? For example, with ethanol or benzene? If not limited to liquid water, what about alloys - does the aluminum in a soda can remember being next to other elements when it was in the ground as bauxite ore? If the effect extends to other phases of water, isn't all water vapor in the air contiguous? In general, are there experiments ongoing to determine the exact nature of the homeopathic dilution effect?

- Is it possible to create and bottle homeopathic medicine with an automated process; if not, why not?

- What about faith-healing? How would you as a homeopath devise a test to measure whether a televangelist or a pharmaceutical had better cancer-cure rates?


Philippe said...

Michael I cant help but think the problem lies in the ability and or willingness to reason. Therefore your effort to spark debate through reason cannot achieve anything.

People who can understand, will agree with you. People who cannot understand, will not agree with you no matter what both parties write.

This issue is one of many that points to an overall lack of scientific thinking in the overall public that needs to be address from a process point of view; we need to teach people how to think instead of debating or ridiculing them on a specific issue.

Michael Caton said...

There's no doubt that reasoning with people can be an uphill battle, and that we need a more critically-thinking public. But humans are social organisms, and sometimes seeing a bunch of people do something is more persuasive than hearing from one person. There are also lots of people who keep their thoughts to themselves because they don't even know like-minded people exist. Consequently a show of solidarity by skeptics not only will be fun, it'll also help us grow. But you're right, I don't expect that many people's minds to change directly as a result of this event.

TGP said...

In my experience, the best weapon against homeopathy is a clear explanation of what the homeopathic process is.

My wife used to buy oscillococcinum for colds or whatever. It had been recommended as an alternative or natural preventative medicine. Nobody ever explained homeopathy to her. I'd venture that most people who buy the stuff think it's just some kind of natural medicine.

One Wikipedia article later and we got some extra space in the medicine cabinet.

Michael Caton said...

Excellent. Like many things, the lack of critical thinking sneaks under the door because "my mother/best friend/etc. told me about it, and they wouldn't steer me wrong", and it seems like that's what happened to your lady. To illustrate this, I can attest (bluntly) from personal experienc that otherwise extremely rational people from East Asian countries can do a 180 when it comes to pseudomedicines recommended by parents or talk show hosts.