| ABSTRACT
Though in use for over 200 years, and still benefiting millions
of people worldwide today, homeopathy is currently under continuous
attacks for being “unscientific.” The reasons for this
can be understood in terms of what might be called a “New
Fundamentalism,” emanating particularly but not exclusively
from within biomedicine, and supported in some sections of the media.
Possible reasons for this are discussed. New Fundamentalism’s
hallmarks include the denial of evidence for the efficacy of any
therapeutic modality that cannot be consistently “proven”
using double-blind, randomized controlled trials. It excludes explanations
of homeopathy’s efficacy; ignores, excoriates, or considers
current research data supporting those explanations incomprehensible,
particularly from outside biomedicine: it is also not averse to
using experimental bias, hearsay, and innuendo in order to discredit
homeopathy. Thus, New Fundamentalism is itself unscientific. This
may have consequences in the future for how practitioners, researchers,
and patients of homeopathy/complementary and alternative medicine
engage and negotiate with primary health care systems.
INTRODUCTION
Acts of terrorism aside, in a pluralistic society intolerance
can work far more insidiously on an intellectual
level, by stifling and ultimately removing access to alternative
forms of knowledge. For example, the evidence-based
discourse that some think has “colonized” much of contemporary
conventional medicine1 could be said to be based
on a “naïve inductivist” scientific paradigm2,3
(i.e., that
purely objective observations can be made that lead to irrefutable
facts: that generalizations can be induced from
these facts; and that scientific laws and theories result from
these inductions) that ideologically excludes alternative
therapies (such as homeopathy), and their discourses. The
discourse of evidence-based medicine (EBM) has recently
been compared to a “fascist” structure for its active
intolerance
of pluralism in health care systems.1 As such, overzealous
interpretation of the principles of EBM could be said to
promote an attitude that demeans and attempts to disempower
practitioners and patients of homeopathy/complementary
and alternative medicines (CAMs), ultimately seeking
to deprive millions of people of these therapeutic choices
because they are considered “unscientific.” The uglier
side
of this attitude is displayed on internet websites virtually on
a daily basis.
An examination of such skeptical Web sites reveals a high
level of emotive subjectivity directed against CAMs, particularly
homeopathy. Given the warnings these sites display,
about not tolerating offensive language, it is remarkable
that what can only described as abuse masquerading as
debate is allowed onto a widely used communication
medium: easier, perhaps, to ignore these Web sites, and go
about one’s business. Unfortunately, that would be to bury
one’s head in the sand, for it is now appearing in mainstream
literature.
Take, for example, the respected and influential U.K.
Sunday newspaper, The Observer. One of its columnists,
Nick Cohen (ironically, a popular scourge of political correctness
in what is essentially a left-wing newspaper) recently
had this to say:3,4 “Yet dismissing homeopathy as quackery
given by and for the feeble-minded is surprisingly
hard. Anti-elitism dominates our society and many feel uncomfortable
saying that the six million people who take alternative
medicines are foolish—to put the case against them
at its kindest. They sincerely believe in phony remedies and
sincerity trumps sense in modern culture.” And, “(homeopathy’s)
effects can be positively deadly,” a sentiment repeated
recently in The Lancet.5,6
All this ignores conventional medicine’s own highly
questionable safety record, something that has recently come
under scrutiny from the UK’s House of Commons Public
Accounts Committee. Thus, it concluded that in 2006 alone
and including fatalities, at least 2.68 million people were
harmed by conventional medical intervention: that represents a staggering
4.5% of the U.K. population.7
Clearly, homeopathy is being deliberately misrepresented
when it is referred to as “deadly,” but is now considered
fair
game; to be lambasted and lumped together with religion
and creationism, etc.: a point of view that uncritically condones
a procrustean version of scientific rationality. From
whence does it spring?
THE NEW FUNDAMENTALISM
In the United Kingdom, attacks on homeopathy/CAM as non valid therapeutic
procedures emanate mainly from individuals such as Edzard Ernst
(oddly, the United Kingdom’s first professor of CAM at the
University of Exeter), Oxford academic and author Richard Dawkins,
pharmacologist David Colquhoun, and some emeritus medical professors
and doctors (including oncologist Michael Baum, and gerontologist
and philosopher Raymond Tallis) who recently wrote to the Times
newspaper urging health authorities to stop supporting “unproven”
therapies like homeopathy/ CAMs.8 As well as the recently
formed organization, Sense About Science, they and those like them
around the world, I call the “New Fundamentalists.”
It is perhaps only fair to say at this point that not all scientists
who value the essentially scientific principles behind EBM are “New
Fundamentalists”; equally, not all those who defend homeopathy/CAMs
do so within a spirit of scientific inquiry.
New Fundamentalists tend to represent themselves as the
last bastions of reason, against a perceived tide of irrational
belief in, among other things, “quack” medicines. Their
certainty that all the evidence indicates homeopathy doesn’t
work and, in fact, is positively deadly, leads them to ignore
or condemn out of hand anything that contradicts their beliefs.
And behind them, like some eminence gris, is the financial reach
of the globalized pharmaceutical industry.
In the United Kingdom, the New Fundamentalists’ raison d’être
is to ensure the total exclusion from the National
Health Service of all what they consider to be “quack”
therapies, and to bring about the closure of the five state-funded
homeopathic hospitals, regardless of the many who have and
continue to benefit from them.8 Subsequently, there have indeed
been reductions in NHS referrals to homeopathy, and the Royal London
Homeopathic Hospital in the United
Kingdom, is currently under threat of closure.
Though no more than a clash of paradigms, and in the
history of science nothing new, what marks the present attacks on
homeopathy/CAMs as different is that we now live
in an age of easily accessible mass communication. And the
New Fundamentalists are helped in propagating their
“quack-busting” message by many in the media, some of
whom share their beliefs.
SCIENCE, EDUCATION, AND DETERMINISM
Journalism was not always specialized. So any journalist
interested in the subject or commissioned to do so, wrote
about science. For, the fact is, a good investigative reporter
can usually turn their hands to anything and write balanced,
entertaining copy. But over the last couple of decades this
situation has changed.
Increasingly, one finds ex-science graduates and post
graduates, many with a biomedical sciences training, as journalists
and writers.9 Either they became bored with the practice of science
and sought something new, or they could not
find long-term gainful employment in their chosen disciplines (I
exclude here career scientists who write in order to
popularize their subject).
Some universities now offer postgraduate conversion
courses in science communication. In addition, scientists have
realized their subjects are perhaps not as well understood as
they would like by the general public who, through their taxes,
pay for state-sponsored scientific research. This has led to a
growing “industry” in the public understanding of science.
There is nothing wrong with that per se. Ideally in any democratic
society, the public should be well informed and able
to engage with the big scientific and ethical questions of the
day (e.g., climate change and stem-cell research). Then
through the democratic process they can have their input into
political debate concerning the choices that need to be made.
Education has a vital role to play here, but in the last 20
years, there has been serious dumbing-down of school science curricula,
and evidence that in the developed world,
children are increasingly being turned off from science.10
This may be partly due to fears of real hands-on and engaging curiosity-driven
experience—chemistry experiments
in particular, can be dangerous, and parents litigious—and
that perhaps in their early teens, children tend to be more
interested in other things (including each other) than science.
There are also the effects on education of what some consider is
a Post-Modernist anti-elitism,4–6 part of whose
agenda has been to deconstruct the assumed supremacy of
scientific “truth” over other forms of discourse.11–14
New
Fundamentalists might argue this attitude is at least partly
to blame for the current disenchantment with science in the
developed world. Thus, instead of being humanity’s crowning
achievement or indeed its “savior,” as science was perceived
to be back in the 1950s, it could be argued that science has become
a slave to the military–industrial complex,
globalized (e.g., pharmaceutical) profit, and a corporate arrogance
that, for example, regards genes as nothing more
than sets of privatizable molecular “Lego®” bricks.
Between
boredom, raging hormones, and Post-Modernism, is it any
wonder the kids are turned off from science?
So, there is a felt need for more and better science communication
and qualified communicators. However, in a media age where sound-bites
rule, science has to compete for
time and space in a crowded and increasingly commercialized media
marketplace. Inevitably, this leads to oversimplification of complex
scientific issues. Thus, though perhaps a readily accessible and
media-friendly version of
science, the New Fundamentalists’ naïve inductivism2,3
had
its limitations pointed out in the 1950s by Karl Popper,15
not to mention being undermined by Post-Modernism11–14
and other philosophical movements.
In all this, it is perhaps easily forgotten that science is not
a homogeneous entity, and that its separate disciplines do
not all share the same intellectual depth and rigor. For example,
compare the largely “belt and braces” empirical approach
of biomedicine (which in an accident and emergency
setting saves lives, but is not so effective in treating chronic
conditions), with the intellectual subtlety and sophistication
of quantum physics. Through concepts such as nonlocality
and entanglement, the latter offers a worldview profoundly
at odds with the determinism embedded in Western culture
since the Enlightenment.
The consequences of the quantum worldview—that there
is a subtle, indissoluble link between observer and observed,
such that the universe cannot always be considered objectively separate
from us—is an ontological and for some, disturbing conundrum
even within the academic teaching of
the subject.16 It is simply referred to as “quantum weirdness,”17
a telling phrase indicating how difficult the quantum world view
is to understand within the confines of deterministic Western thinking.
Yet this subtle connection
between observer and observed has long been recognized in
the social, anthropological, and psychologic sciences.18 It
could well be that it has a much more important role to play
in the healing process than is currently admitted to in conventional
medicine: Certainly it is beginning to inform nondeterministic explanations
and interpretations of how homeopathy/CAMs might work.19
TRIALS, TRIBULATIONS, AND THE MEMORY OF WATER
The combination of New Fundamentalism with some science writers’
natural desire to inform and educate the public can provoke in them
a crusading zeal to rid the world of
unreason, thoughtless belief, and anything that cannot readily be
proved and explained by “black and white” deterministic
science (e.g., homeopathy/CAMs). Unfortunately, such an attitude
does not accommodate “gray” very well, so
it defaults to black in order to establish “the truth.”
Take, for example, that “gold standard” of research
quality, the double-blind, randomized controlled trial (DBRCT).
Against placebo, it provides at best only equivocal evidence
of homeopathy’s efficacy, with some trials proving positive,
while others return negative results. To a New Fundamentalist, such
inconclusiveness is intolerable (especially because homeopathy appears
to contradict the biomolecular
paradigm of conventional medicine); the negative trial data
are taken as “true,” positive trial data are discounted,
and so
homeopathy is considered as being no better than placebo
(i.e., it does not work). Yet around the world, millions of
people have benefited, and continue to benefit from homeopathy.
This is usually discounted as mass delusion, the
workings of the placebo effect, or self-hypnosis.
The assumption here is that the DBRCT is the best research tool
with which to establish the evidence base of any
therapy. Indeed, it could be argued that the DBRCT is predicated
more on Popperian principles of falsifiability than on
naïve inductivism. However, deconstructing the DBRCT’s
rationale reveals that it imposes on any therapeutic procedure an
implicit and simplistic division of therapy from context. This turns
out to be nothing more than an arithmetic
convenience that allows the measurements made, statistics
gathered, and inferences drawn from a trial ultimately to
have significance within a deterministic framework.
It has been demonstrated20 and explained (by analogy
with quantum theory’s notion of wave-function collapse during
observation)21 that this separation can seriously interfere with
homeopathy/CAMs’ therapeutic effects. However,
such an explanation of the inconclusiveness of DBRCTs of
homeopathy/CAMs has recently been dismissed by New
Fundamentalists as “quantum mysticism.”22
What tends to be forgotten by those who promote an
overzealous adherence to the DBRCT as the “gold standard”
for testing any therapy’s efficacy is that no therapeutic
modality, conventional medicine included, is ever practiced
in real life according to the DBRCT’s procedural separation
of therapy and context. As a result, the evidence-based
movement’s increasing hold on the health sciences is now
being challenged (even from within conventional medicine),
for its exclusion of alternative therapeutic discourses.1,18
Explanations of how homeopathic remedies might work
(e.g., the Memory of Water effect)23 are similarly discounted,24,25
regardless of mounting evidence suggesting
that memory effects may indeed exist.26–31 They can be explained
in materials science terms, as homeopathy’s succussive dilution
process inducing observable alterations to
the dynamic supramolecular structure of liquid water.29–32
Yet, cancer physician Stephen Sagar, for example, has dismissed
the Memory of Water hypothesis as a “belief in undetected
sub atomic [my italics] fields.”24,25 Far from delivering
the intended coup de grace to the Memory of Water
and homeopathy, the use of the term “subatomic” might
be
seen as inappropriate when describing what is in essence current
research in molecular physics, materials science, and
chemistry.
This attitude could partly explain why there is so little published
research on how cellular water memory effects
might lead to cure of the whole patient:33 it would require
much closer collaboration and understanding between biomedical and
physical scientists than currently exists, assuming it ever were
to achieve proper levels of funding.
INNUENDOES AND BAD SCIENCE
Besides ignoring or not understanding the latest research,
New Fundamentalists can sometimes employ insinuation
and innuendo in order to discredit homeopathy. For example, Ernst
reported recently that trials of homeopathy performed by the Nazis
(which had been considered “lost”)
were so “wholly and devastatingly negative,” German
homeopaths have covered it up ever since.34,35
Apart from the ethical problems involved in quoting uncritically
the results of Nazi research (especially because
conventional medicine is well known to have benefited from
the Nazis’ medical “experiments”),36–38
Ernst’s source material has proved to be highly suspect.39–42
At best, Ernst
might be considered to be acting unethically and unscientifically
by endorsing essentially 60-year-old hearsay as a
condemnation of homeopathy.
Although exposing every case like this is no doubt
necessary (if only to bolster morale!), ultimately this is a reactive
strategy and does not advance the cause of homeopathy/CAMs very
far. Just like the sound-bite or the attention-grabbing headline,
it is the initial impression that
sticks, not the more complex retraction buried in the back
pages that appears months later.
Perhaps the most famous case of this in point is the by-
now (in)famous 2005 Lancet “meta-analysis” by Shang
et
al.43 This managed to conclude that homeopathy is no better than
placebo, even though it patently failed to meet any
of the generally accepted standards and criteria (e.g., transparency)44
for such meta-analyses, some of which the Lancet
itself had laid down.45
This Lancet meta-analysis appeared during that peculiar
late-summer news “quiet time” in the UK media cycle
known as the “silly season.” As a result, the media
descended en masse on this putative “end of homeopathy”
story.46 It is perhaps not surprising that the fact that The
Lancet meta-analysis was totally debunked in the literature
a few months later by many reputable researchers and scientists47–50
went totally unnoticed by the media.
THE “JOYS” OF HERDING CATS
So, we are left with the dilemma of how to address proactively
the New Fundamentalism. Obviously, research on efficacy and possible
modes of action of homeopathy/CAMs
must continue to be prosecuted, published, and promoted.
However, it is unlikely in the near term to command the media’s
attention in the way New Fundamentalists can. Nevertheless, debating
with them should continue because,
though a thankless task, it keeps these issues alive and before
the public, however one-sided (through media exposure) the debate
may appear at times.
First things first, however: There is the problem of achieving
unity among the various CAM professions, which is a
vital prerequisite for any concerted action. This is not trivial,
homeopathy being a case in point.
From Hahnemann to the present day, its history has been
one of such factionalism, herding cats might seem a more
tempting prospect than getting homeopaths to agree. Apart
from homeopathy in the UK apparently having been overtaken by a
particularly narrow-minded form of political
correctness, the profession itself is fragmented. There are
medical homeopaths, classical homeopaths, polypharmacists, homotoxicologists,
etc., all with their associated professional organizations, and
all incapable of agreeing on a
unified way forward. For example, after over 6 years of increasingly
bad-tempered negotiations, homeopathic organizations in the UK finally
gave up trying to achieve the modicum of unity necessary for them
to combine under a single
register. This would have given them at least some modicum of regulatory
transparency.
The message of disunity and unprofessionalism this sends
out, especially to government, plays directly into the hands
of the New Fundamentalists and makes it easier for them to
isolate and target the CAM professions one at a time. Homeopaths
as a group have simply got to wake up and learn to
unite among themselves, and with other CAM disciplines.
There are, however, some encouraging signs going forward.
First, the UK is currently in the throes of modernizing its
much-admired National Health Service (NHS). Policymakers have realized
there is an explosion of interest in CAM
both from within and outside the NHS. So, like CAM, primary health
care is increasingly being seen as inherently
holistic, patient-centered, and multiprofessional.51 Add to
this that CAMs are low-tech and low-cost, and policymakers see them
as resonating with the central themes of government health policy.
These include a proactively health-
oriented NHS and informed patient choice of relevant CAM
options, as well as conventional health care: in other words,
central government policy is moving more toward a model
where patients “own” their health and health care.
So, bypassing the New Fundamentalists’ insistence on a
narrowly defined deterministic evidence base for homeopathy/CAMs,
what the policymakers are really after in order
to properly integrate them into primary health care are (1)
evidence of cost-effectiveness; (2) many real-life working
examples of CAM therapies in action; (3) proper regulation
of CAMs; and (4) good clinical governance. Homeopaths
and homeopathic organizations need to urgently take note,
especially of points 3 and 4.
Second, and again in the United Kingdom, homeopaths are
becoming increasingly impatient with the institutionalized
torpor of their professional organizations in the face of continued
attacks in the media and literature. An organization has
been formed called “Homeopathy: Medicine for the 21st Century”
or HMC21, which is asking satisfied patients to sign a
declaration saying homeopathy has worked for them.52 In the
very short time since its inception, and with no publicity except
a Web site, HMC21 has already gathered thousands of
signatures worldwide, and sent a wake-up call to the UK
homeopathic community. Ultimately they hope to harvest a
quarter of a million signatures by the middle of 2008, and so
achieve the critical mass needed to bring public opinion to
bear on the problems of saving homeopathy in the NHS, and
the state-funded hospitals that provide it. This has been mirrored
politically in the UK’s House of Commons recently,
where over 200 MPs across all parties signed an Early Day
Motion to debate the future of the Royal London Homeopathic Hospital,
despite being targeted by skeptics.53
CONCLUSIONS
The continuous attacks on homeopathy/CAMs for being
“unscientific,” emanating from an informal combination
of
largely biomedically oriented scientists and sections of the
media (collectively termed the New Fundamentalists), are
themselves unscientific.
Regardless of their lack of compliance to a narrowly
defined version of evidence-based discourse, homeopathy/
CAMs are used successfully on a regular basis by millions
around the world. In the UK, there will be increasing opportunities
for homeopathy/CAMs to make significant contributions to primary
health care within a modernizing, more
holistic NHS, if they can provide evidence of cost-effectiveness,
real-life efficacy, proper regulation, and good clinical governance.
One can only hope it is not too late for the homeopathy/CAM community
to unite; for public opinion to be galvanized; and for their combined
might to be brought to bear
on government and NHS Trusts in order to retain their homeopathy/CAM
services. It would be the best possible critique
of the New Fundamentalists, and would mark, not as they
hope “the end of homeopathy” but as Winston Churchill
once said in a different context and a different century, “the
end of the beginning.”54
ACKNOWLEDGMENTS
In preparing this paper, the author gratefully acknowledges the
help of Suse Moebius, R.S.Hom., and Ms. Jane
Wilkinson, Senior Research Fellow at the University of
Westminster.
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