Portside

Well, it’s over.

I’m referring to the two day hearing held by the FDA in Bethesda seeking public comment regarding how it should modernize its regulation of homeopathic products. Actually, as I discussed before (as did Jann Bellamy over at my favorite other blog, Science-Based Medicine), in fact it’s arguable wither there is currently much, if any, actual regulation of homeopathic remedies. Oh, sure, sometimes when a foolish company or true believer tries to market something as unremittingly dangerous as a homeopathic asthma nasal spray, the FDA takes notices. However, for the most part, the FDA turns a blind eye to homeopathic products because back in the 1930s, an update to the law authorizing the FDA to regulate food, drugs, and cosmetics defined anything that is listed in the Homeopathic Pharmacopoeia of the United States (HPUS) as a drug. Unfortunately, for whatever historical reason, the FDA seems to have interpreted that part of the law, at least for the last few decades, as meaning that anything in the HPUS is automatically FDA approved and that manufacturers of products within the HPUS don’t have to demonstrate efficacy and safety of their products.

For whatever reason, about a month ago the FDA announced that it was looking to update its regulation of homeopathic remedies; not surprisingly, that led to quite a bit of consternation among homeopaths, with reactions ranging from dismay to outright fear mongering that the jack-booted thugs from the FDA were coming to take away your homeopathic remedies and this had to be resisted, because, you know, FREEDOM! (Or “health freedom,” anyway.) No wonder the vast majority of those testifying were either homeopaths, manufacturers of homeopathic remedies, or supporters of alternative medicine. Left to stem the tide. For instance, representing the side of science and reason was Michael DeDora of the Center for Inquiry, along with a few others. For instance, I was happy to see that Adriane Fugh-Berman, a pharmacology professor at Georgetown University Medical Center, came down solidly on the side of science, as related by this article in the Washington Examiner:

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A key part of the hearing was whether the products are effective.

“The evidence for homeopathy’s effectiveness is between scant and nil,” said Adriane Fugh-Berman, a pharmacology professor at Georgetown University Medical Center at the meeting.

Fugh-Berman cited a recent effort by Australian researchers to pore through more than 170 studies on homeopathic medicines. The researchers concluded there is no reliable evidence homeopathy is effective.

A supporter of homeopathy shot back that the Australia study was “poorly done” and doesn’t take into account specific treatments or conditions and do analyses of those treatments.

Same as it ever was. I had been concerned that Fugh-Berman might be wishy-washy given her history of being somewhat sympathy towards alternative medicine and her antipathy to big pharma, but she wasn’t. Good on her. Neither was Luana Colloca, a placebo researcher from the University of Maryland Baltimore, who discussed placebo effects and characterized homeopathy as placebo.

De Dora was even more blunt:

Proponents of homeopathy will suggest that there are studies which show homeopathy is effective. It is true you can find studies that suggest homeopathy has brought about a positive result. Yet these studies have found only a placebo effect, and significantly do not and cannot explain if and how homeopathy has treated the illness. Further, these studies must be seen within the broader context of hundreds of studies that have found homeopathy ineffective.

Of course, this all makes sense: by its own definition, homeopathy cannot work. Its centuries-old pseudoscientific principles sit at complete odds with our modern understanding of biology, chemistry, and physics — the bodies of accepted scientific knowledge that form the basis of modern medicine.

Again, we need not spend much time on this, as the federal government is well aware of the scientific evidence against homeopathy. As the National Center for Complementary and Integrative Medicine states on its website:

There is little evidence to support homeopathy as an effective treatment for any specific condition.

All of which is true. He then went on to answer the question “What’s the harm?” and to present proposals for how the FDA should regulate homeopathy going forward.

Links to the text of all the testimony submitted can be found here. Unfortunately, I couldn’t watch the live streaming video coverage because I’m at a cancer research meeting right now and I’d have had to miss the meeting to do it. (Watching it at the convention center—or even parts of it—was not an option because the wifi here sucked so badly that just checking e-mail and Twitter was a teeth-grinding exercise in futility, and the convention center seemed to blunt cellular Internet connectivity to the point where it was little better.) Last night, though, taking advantage of the fast Internet in my hotel, just for yucks I perused some of the testimony of the various homeopathy advocates, including naturopaths (of course!), homeopaths, homeopathic pharmacists (the jokes write themselves on this one!), and homeopathy advocates. One, Bruce Shelton, characterized homeopathy as “critical to his success in helping patients” and that he has never experienced safety or quality issues, the latter of which seems like an extraordinary claim given that Shelton claimed over 20,000 patient visits. Confirmation bias, anyone?

In any case, the homeopathy supporters who testified didn’t say anything that any skeptic who pays attention to homeopathy (like me) hasn’t heard a million times before. At least the skeptics did discuss exactly what homeopathy was and why its principles are so ridiculous.

Which brings me to an observation about the news coverage that a reader named Andrey Pavlov sent me in response to an NPR report on this review. It starts with an anecdote about a homeopath named Anthony Aurigemma practicing in Bethesda (!), MD. He’s an MD who became disillusioned with medicine and switched to homeopathy, a truly depressing conversion to contemplate, one I’ve never understood because a physician should have enough basic science knowledge to understand why homeopathy can’t work other than as placebo. Be that as it may, and despite my good bud Steve Novella being quoted in the article, this reader noted a problem, which he describes as why news stories so seldom seem to describe exactly what homeopathy is. This particular NPR story does, but a lot of others don’t. Even in stating what homeopathy is, it doesn’t really explain why homeopathy is so utterly ridiculous; rather, the explanation was couched in the annoying “tell both sides” trope so common in reporting of pseudoscience by letting Aurigemma explain:

“We believe that there is a memory left in the solution. You might call it a memory. You might call it energy,” Aurigemma says. “Each substance in nature has a certain set of characteristics. And when a patient comes who matches the physical, mental and emotional symptoms that a remedy produces — that medicine may heal the person’s problem.”

Critics say those ideas are nonsense, and that study after study has failed to find any evidence that homeopathy works.

No, science itself says the ideas behind homeopathy are nonsense. Critics of homeopathy cite that science to show why the ideas behind homeopathy are nonsense. I’ve explained why more times than I can remember. Other medical skeptics have explained why so many times they can’t remember. In fact, I consider knowing why homeopathy is The One Quackery To Rule Them All (with the possible exception of reiki and “energy medicine,” which vie with homeopathy for the title) and being able to explain it a test of whether one is actually a skeptic in terms of medical quackery.

I’m not the only one who’s noticed, apparently. For example, Jerry Coyne noted:

Reader Howie Neufeld sent me a note about two CBS television segments I missed (readers can assume I miss every show except for “60 Minutes” and the NBC Evening News):

This morning CBS News had Dr. Holly Phillips (internist) discuss homeopathy. When the anchor asked her if it was pseudoscience, she sidestepped the question, referring mainly to the lack of FDA regulation of such remedies. Having taught about homeopathy (I consider it junk, not pseudoscience) for years, I was extremely disappointed in her lackluster and inadequate responses. She should have debunked it totally, as she had a national audience. Instead, she caved in to the herbal drug industry.

Howie was right; CBS abnegated its responsibility here in refusing to say that homeopathy is not only ineffective, but dangerous in drawing sick people away from science-based treatment.

Here’s the segment:

And the screenshot featured at the beginning of this article illustrates my point almost better than I can explain it. Anyone here who knows anything about homeopathy knows what an epic fail CBS medical correspondent Dr. Holly Phillips’ description of homeopathy was in this segment. Truly, one wonders if she has clue one what homeopathy really is!

Andrey ends up asking:

Why is it that we are allowing the discussion to be framed from a “health freedom” and “regulatory” perspective instead of just saying what homeopathy is at every single chance available?

An excellent question. Clearly Dr. Phillips either had zero clue what homeopathy really is and how utterly pseudoscientific it is, or she didn’t care.

I’ve related the tale before about how even medical students and residents whom I teach have no idea what homeopathy really is. Whenever the topic comes up (which isn’t that frequently, but over the years I’ve accumulated quite a few discussions) and I ask the trainee what homeopathy is, he will answer that it’s some sort of herbal medicine. Heck, its not just trainees. It’s attending physicians and senior scientists, too, who don’t know what homeopathy is.

So I tell them.

I tell them the two main “laws” of homeopathy, the first being “like cures like.” That one will sometimes cause some amusement, because there really is not scientific justification for concluding as a general principle that to treat a symptom you need to use something that causes that symptom in healthy subjects. Next, I’ll explain the law of infinitesimals, specifically how homeopaths believe that diluting a substance—with vigorous shaking between dilutions, of course, to “potentize” it—makes the remedy stronger. Of course, it’s not just that. It’s that diluting a remedy away to non-existence makes it stronger, dilutions of 30C or greater, which is a 10^-60 dilution, or more than 1036-fold greater than Avogadro’s number, are commonly used by homeopaths. When I tell the students or residents this, not infrequently their jaws drop, and they respond, “Really? You’re kidding. That can’t be. That’s ridiculous!”

Minds blown.

I then explain how homeopaths believe in the “memory of water” as the mechanism by which this effect supposedly occurs.

More minds blown.

This brings me back to Andrey’s point, which is a valid one. Part of the reason that homeopaths and their apologists so easily get away with making appeals to anecdotal evidence and framing the pseudodebate in terms of regulation and health freedom is that there is so little understanding among politicians and the public just how utterly nonsensical homeopathy is. It’s magical thinking. Actually, as I’ve argued before, it’s sympathetic magic. My favorite example to make this point is compare homeopathy to the principles of sympathetic magic. For instance, homeopathy’s law of similars (“like cures like”) is uncannily similar to Sir James George Frazer’s Law of Similarity as described in The Golden Bough (1922) as one of the implicit principles of magic. In addition, the concept that water can somehow retain the imprint of substances with which it’s been in contact, which really underlies the belief among homeopaths that remedies diluted to nonexistence (basically anything diluted more than around 12 C–14C or 15C, to be safe) can have biological effects, is very much like the Law of Contagion. Given that it’s been a while since I’ve written about this, now seems a good time to invite you again to read the following passage from The Golden Bough and tell me that it doesn’t sound almost exactly like homeopathy:

If we analyse the principles of thought on which magic is based, they will probably be found to resolve themselves into two: first, that like produces like, or that an effect resembles its cause; and, second, that things which have once been in contact with each other continue to act on each other at a distance after the physical contact has been severed. The former principle may be called the Law of Similarity, the latter the Law of Contact or Contagion. From the first of these principles, namely the Law of Similarity, the magician infers that he can produce any effect he desires merely by imitating it: from the second he infers that whatever he does to a material object will affect equally the person with whom the object was once in contact, whether it formed part of his body or not. Charms based on the Law of Similarity may be called Homoeopathic or Imitative Magic. Charms based on the Law of Contact or Contagion may be called Contagious Magic.

See what I mean? These passages would not be out of place in a textbook of homeopathy, with the word “magic” replaced with various vitalistic mumbo-jumbo to “explain” how homeopathy “works.” A later passage by Sir Frazer actually provides an excellent criticism of the two pillars of homeopathy:

Homoeopathic magic is founded on the association of ideas by similarity: contagious magic is founded on the association of ideas by contiguity. Homoeopathic magic commits the mistake of assuming that things which resemble each other are the same: contagious magic commits the mistake of assuming that things which have once been in contact with each other are always in contact. But in practice the two branches are often combined; or, to be more exact, while homoeopathic or imitative magic may be practised by itself, contagious magic will generally be found to involve an application of the homoeopathic or imitative principle.

Of course, homeopaths make exactly these mistakes, assuming as a general rule based on no science that to counter or control a symptom requires a substance that can cause the symptom and assuming that, just because the water used to dilute homeopathic remedies was once in contact with the homeopathic remedy (and the water from the later dilutions were in contact with the water that was originally in contact with the original homeopathic remedy and so on to many, many powers of 10), that the homeopathic remedy is somehow still in mystical contact with the original substance.

Finally, if I want to blow minds to the point of skepticism, I’ll talk about homeopathic provings, homeopathic plutonium, and, of course, homeopathic antimatter. Oh, and homeopathic Saturn light, which was made by exposing powdered milk sugar to a powerful telescope while it was focused on Saturn. The homeopath then made a 3C dilution, which means there was actually some milk powder left. The results were described thusly:

The trituration process began with lots of giggling and silliness; and throughout there was talk of getting high, stories about getting high. Senses were distorted. One prover kept seeing smoke rise from the milk sugar as she ground and scraped.

“Drugs come into the mainstream… truckers used speed to stay awake. Ecstasy was first used for marriage counseling.”

“I’m feeling really high… spacey.”

Provers were laughing until the tears came. “You guys are ripped.” “I feel like I smoked.” “Sound is distorted as if I’m high…” “Do you remember the first time you smoked?”

There were a number of other symptoms reported, including itching, headache, watery eyes, and others.

The homeopath’s conclusion? She concluded that the sorts of behavior and symptoms observed were consistent with what, from an astrological standpoint, Saturn stood for, the structure of the body, the bones, especially the spine, knees and teeth. Apparently Saturn is also connected to old age and maturity as well as the cycles of time and aging, while the goat aspect of Saturn is connected to “robust sexual expression.” This led the homeopath to conclude:

From a homeopathic point of view, both the physical symptoms that appeared and the content of the discussion during the proving suggest that this remedy might be effective for accident-related trauma, bone and nerve damage. The Titan-like quality of strength, survival and endurance seems connected; perhaps an ability to survive disasters is part of this remedy. This remedy may also be effective for allergies, in light of all the itching that occurred.

If you’re not satisfied with the ridiculousness of homeopathic provings, take a look at this sampling, which includes Jupiter rays, helium (that must have been fun), Yellow Box Fish, placenta, and the common loon, for which the jokes write themselves.

A huge part of the problem with science and medicine reporting in this country (and the world) can be demonstrated with a simple reference to homeopathy. Homeopathy is, as Steve Novella characterized it, an “excellent example of the purest form of pseudoscience,” and as I, more blunt that Steve, like to call it, “The One Quackery To Rule Them All.” Failing to make that clear in media coverage of homeopathy lets advocates of homeopathic quackery to label skeptics as “homeopathic naysayers” and claim that the current FDA regulatory framework for homeopathic products is working just fine.

Of course they would say that. As currently formulated, FDA regulation (or, more properly the lack thereof), lets homeopathic “pharmacies” sell whatever they want with minimal oversight, and few know or care enough about it to force change. This FDA reevaluation of its regulatory framework for homeopathic remedies is the first glint of light in ages that could lead to actual reform. However, with news coverage like that of CBS and even NPR, it’s going to be difficult to build a consensus to regulate homeopathic remedies the same way other drugs are regulated or at least to stop homeopaths from making scientifically unsupported claims about what their treatments do.

It is, after all, just water (or ethanol, or whatever an individual remedy is diluted with). You’d never know that from the news coverage though, or at the very least all you’d get is a hint of that. Therein lies the problem.