I was delighted this Monday when my fellow Yahoo! columnist Girish Shahane took on homeopathy in his column ‘Sugar Pills and Skepticism’. It needed to be done, but while I found myself agreeing with much of his piece, I was disappointed by the last paragraph, in which Girish said that he uses homeopathy occasionally, and that it sometimes seemed “to have an effect, particularly with respect to allergies.” This is a fairly common view among many people, who admit that while homeopathy has no scientific foundation, ‘it seems to work’. For many of my friends, this puts homeopathy in the category of things that conventional science can’t explain yet, rather than those that have no scientific basis at all.
I used homeopathy for a few years when I was much younger. I believed then that it worked on me. I still have much fondness for my erstwhile homeopath, who I believe to be neither a fraud nor a fool. And some people close to me still pop sugar pills when they are ill. Yet, I now believe that homeopathy is no less ridiculous than astrology or numerology, and no more scientific than them. I’ve travelled the entire arc of belief when it comes to homeopathy, from an automatic, peer-influenced faith to skepticism to unbelief and contempt—and that is the subject of my column today: why so many people believe in homeopathy even though it is, to put it plainly, nonsense.
I won’t do a detailed debunking of homeopathy here. For that, I refer you to books like Ben Goldacre’s Bad Science and Simon Singh & Edzard Ernst’s Trick or Treatment, as well as this classic talk by James Randi. To summarise, the methodology of homeopathy makes no sense whatsoever, and scientific trials, when carried out with proper rigour, have shown homeopathic medicine to be no better than placebo, the standard for judging the efficacy of any new medicine.
The most bizarre thing about its methodology is the composition of the medicine itself. In homeopathic medicine, the substance being used to treat a patient has to be so diluted that there is generally not a chance that a single molecule of the substance remains in the medicine a patient is taking. In Randi’s video, for example, he displays a homeopathic sleeping aid that contains, as its active ingredient, caffeine. (Homeopaths believe that the substances that cause a particular condition should be used to treat it. Go figure.) The dilution of the caffeine in the medicine: “10 to the power of 1500.”
Randi asked the maths writer Martin Gardner if there was a way of explaining to the layman how much that really was. Gardner explained, “That’s equivalent to taking one grain of rice, crushing it to a powder, dissolving it in a sphere of water the size of the solar system, with the sun at the centre and the orbit of Pluto at the outside, and then repeating that process 2 million times.”
In Bad Science, Goldacre offers another analogy: “Imagine a sphere of water with a diameter of 150 million kilometers (the distance from the earth to the sun). It takes light eight minutes to travel that distance. Picture a sphere of water that size, with one molecule of a substance in it: that’s a 30c dilution.”
By these standards, there are so many impurities in regular drinking water that we are probably being treated for every major disease anyway.
Leave aside methodology. Maybe modern science hasn’t advanced enough, and we just don’t get it. Methodology would not matter if homeopathy actually worked. The standard test in medicine for seeing whether a treatment works is a double-blind placebo-controlled test. In this, patients are randomly divided into two groups, one of which is given the treatment being tested, and the other is given placebo—such as pills that look like real ones, but are actually inert. Neither the patients nor the doctors know which group is getting the treatment and which the placebo (that’s why it’s ‘double-blind’), thus eliminating psychological biases on their part. The mere belief that they are being treated often helps patients, so the true test for a treatment is if it can do better than placebo.
Homeopathy has failed such trials consistently. (Bad Science covers this subject in some depth, and also explains why some of the trials homeopaths claim have been successful have had methodological flaws, and suchlike.) There was a time when I wanted to believe the damn thing worked—but there is no evidence of it.
That brings us back to belief. Why do so many immensely smart people around us believe that homeopathy works if it does not? Surely they can’t all be deluded?
One reason why homeopathy seems to work on so many people is the aforementioned placebo effect. This is a remarkably powerful phenomenon, one that medical scientists are still studying with wonder. In Bad Science, Goldacre wrote about Henry Beecher, an American anaesthetist who operated on a soldier with “horrific injuries” during World War 2, using salt water instead of morphine, which was not available. It worked. Similar stories abound through the history of medicine, and the placebo effect is an established part of medical science. If you believe you are taking medicine, that belief itself might help you get better, and you will naturally ascribe the recovery to the medicine you took. This is why, for any medicine to get the approval of the scientific establishment, it has to be shown to be better than placebo—otherwise what’s the point?
There is also a phenomenon called regression to the mean which comes into play. Many diseases or physical conditions have a natural cycle—they get worse, and then they get better, quite on their own. This can be true of backaches, migraines, common colds, stomach upsets, practically anything non-major. If you take homeopathy during the course of this, and you get better, you might well ascribe causation where there is only correlation, and assume the medicine did it. As Simon Singh puts it, you may take homeopathy for a cold or a bruise, and “recover after just seven days instead of taking a whole week.” And there you go, you’re a lifetime fan of Phos 1M right there. (This is known as the Regressive Fallacy.)
I suspect this was one reason homeopathy became popular in the first place. Back in the 19th century, conventional medicine was in its infancy, and as Goldacre wrote in his book, “mainstream medicine consisted of blood-letting, purging and various other ineffective and dangerous evils, when new treatments were conjured up out of thin air by arbitrary authority figures who called themselves ‘doctors’, often with little evidence to support them.”
Indeed, seeing a doctor or visiting a hospital probably increased your chances of dying. Atul Gawande, in his book Better, tells us in another context that in the mid-19th century, at the hospital in Vienna where the doctor Ignac Semmelweis worked, 20% of the mothers who delivered babies in hospitals died. The corresponding figure for mothers who delivered at home: 1%. The culprit: infections carried by doctors who did not wash their hands. (Semmelweis tried to reform the system and was sacked.) This, then, was the state of mainstream medicine when homeopathy began gaining in popularity. In contrast, homeopathy was harmless, would not make you worse or give you an infection and kill you, and if you recovered in the natural course of things, you would give it the credit and tell all your friends about it. The growth of the system, I say with intended irony, was viral.
When it comes to any kind of belief, the confirmation bias comes into play. If we use homeopathy, we do so because we are inclined to believe in it, and our ego gets tied up with that belief. After that, we ignore all evidence that it doesn’t work, and every time we pop a few sugar pills and get better, we give homeopathy the credit. Also, the fact that so many other believers exist reinforces our own belief, for all these people surely can’t be wrong.
In a way, belief in homeopathy is similar to religious belief. (Yes, I’m an atheist as well.) I don’t berate my religious friends for their beliefs, because even though they might be wrong, there is often comfort in that kind of wrongness, especially when dealing with issues of mortality and insignificance. Similarly, if someone I know wants to pop homeopathic pills for a stomach ache or a common cold, I’ll let them be, both because of the power of the placebo effect, and because they’re likely to get better on their own anyway. (Also, I’d rather see them taking sugar pills than, say, antibiotics for something so trivial.)
But just as religious belief can be taken too far, so can homeopathic faith. When people treat serious ailments with sugar pills instead of proper medicine, matters get problematic – especially if they force such treatment on others, such as the Aussie homeopathy lecturer Girish wrote about and I’d blogged about once, who killed his daughter by insisting that her eczema be treated with homeopathy alone. That demonstrates that while blind faith may have its consolations, it can be lethal when taken too far. If only it could be given a homeopathic dilution.
Previously on Viewfinder