(Swans - July 15, 2013) In the not so distant past when scurvy still ravaged sailors across the world, a man named James Lind undertook what would be the world's first controlled clinical trial to determine the cause of this deadly affliction. Through not himself successful in providing a cure-all for scurvy, his pioneering work meant that scurvy was eventually cured, and that modern evidence-based medicine secured a respected place in history. In this way Lind helped to rescue humanity from mystically-inspired doctors who had bled millions of people to death, one famous presidential patient who suffered such a fate being George Washington. Thankfully through such determined (and much-resisted) research Lind paved the way for double-blind clinical trials that now enable medical practitioners to differentiate between substantive medical interventions and the placebo effect. (1)
Although it was only in the 1940s that the first rigorous examination of the placebo effect was undertaken, perhaps the first scientific investigation into this phenomenon was published some years earlier in 1800 by John Haygarth as Of the Imagination as a Cause and as a Cure of Disorders of the Body. Haygarth had correctly concluded that, among other things, key factors that could boost the power of the placebo effect were a doctor's perceived reputation, the cost of the treatment, and its relative novelty. Thus given the evident power of the placebo effect, in the twentieth century scientists developed a clinical trial known as double-blind: which is a trial when "both the patient and the doctor are unaware of whether a placebo or a supposedly active treatment is being administered," such that "the trial results cannot be influenced by the expectation of either." (2)
In spite of clinical advances: "In recent decades homeopathy has become one of the fastest-growing forms of alternative medicine, particularly in Europe." (3) Homeopathy being a well-worn form of magical treatment that maintains that the weaker the treatment the stronger its effect, with a typical 30C homeopathic treatment containing less than one part per million million million million million million million million million of the original substance that is alleged to have some sort of curative function. Such dilution levels mean that the resulting solution -- sold as a homeopathic remedy -- is scientifically-speaking not likely to contain even a single molecule of the original ingredient. It is bad enough that so many people around the world should pay for bottled water to quench their thirst, but for them to then pay for tiny bottles of water to treat serious medical problems is worrying to say the least. Needless to say there are good reasons why large swathes of the public distrust conventional medical interventions, especially given the corporate media's ongoing propaganda offensive against the National Health Service (NHS), and the fact that mainstream medicine is constrained by a capitalist framework that is legally obliged to place corporate profits before public health.
Medical advances made in the nineteenth century certainly helped undermine the legitimacy of all manner of fraudulent therapies, including not least homeopathy. But for a variety of reasons alternative treatments have still undergone unforeseen revivals. So for example, in 1925 against the backdrop of homeopathy's general downward trend, a paper published by an eminent German surgeon called August Bier led to one such revival, a new-found love for water that was closely related to a resurgent interest in Volkish nationalism among the German ruling class, which celebrated attacks on modernity and allowed the Nazis to propagandise about a treatment that they were pleased to note had been invented in Germany. This renewed obsession with homeopathy was quickly incorporated into the Third Reich's Neue Deutsche Heilkunde (New German Medicine), which sought to "combine the best of both modern and traditional medicine," developments which had the active support of homeopathic booster Rudolf Hess, who recognised the utility of the traditional approach as providing a "low-cost solution to meeting the needs of German healthcare." (4)
With the Nazis' propaganda machine keen to supply the definitive proof of homeopathy's effectiveness, a massive research program was then launched in 1937, funded to the tune of hundreds of millions of Reichsmarks. However, the results of the study, which were to be announced in 1939, were never published. Only one researcher from this project has written about this mammoth experiment, and he concluded that: "Nothing positive emerged from these tests... except the fact that it was indisputably established that the views [of homeopaths] were based on wishful thinking." (5)
Either way, despite the lack of evidence that homeopathic treatments ever work, powerful individuals from the ruling class across the world have always been keen to promote its uptake. For example, in Britain King George VI helped ensure that when the NHS was created in 1948, homeopathic hospitals were included under its remit. Likewise in America, Senator Royal Copeland "successfully persuaded his colleagues that the 1938 Federal Food, Drug, and Cosmetic Act should include the Homeopathic Pharmacopoeia of the United States." Furthermore, like China -- which had served as the incubating ground for acupuncture before exporting it to the United States (and beyond) -- India did much the same with homoeopathy, which it re-exported back to the West in the 1970s. Ironically, such alternative medical therapies were "considered by many Westerners to be an exotic, natural, holistic and individualized form of medicine, and an antidote to the corporate medicine being peddled by giant pharmaceutical corporations in Europe and America." (6)
On top of such reactionary trends, homeopathy received a welcome boost from the scientific community in June 1988 when the prestigious scientific journal Nature published an article by a French scientist named Jacques Benveniste that supported homeopathic claims about the efficacy of their regime of water dilutions. Yet given the magical claims being made in the article, John Maddox, the editor of Nature, added a disclaimer saying that Nature was rerunning the experiment to confirm its legitimacy. The only other time that Maddox had made such a statement was when Nature had published a paper (in 1974) by Uri Geller about his mystical spoon-bending powers. When Benveniste's experiment was eventually repeated with external supervision by a team from Nature, they determined that the results of the study showed no evidence to support homoeopathy. (7)
No sooner had one experiment been debunked, another study supporting homeopathy rose from the flames, and in September 1997 the Lancet published a meta-analysis authored by Klaus Linder -- a senior figure at the Munich-based Centre for Complimentary Medicine -- that allegedly proved that homeopathy was effective. In an attempt to answer his numerous critics, Linder published another article two years later that revisited his data, whereupon he admitted that there "was clear evidence that studies with better methodological quality tended to yield less positive results." Thus it was left to later researchers to conduct a meta-analysis that selected "only those trials with large numbers of participants, decent blinding and proper randomization." Their results, which were published in the Lancet in August 2005, determined that homoeopathy was no better than a placebo -- which is after all precisely what it is. (8)
It is often the case that people turn to alternative therapies as a last resort when they have become disillusioned with mainstream medicine. This is entirely understandable, although not necessarily productive; but unfortunately, much like the corporate media, it hasn't helped that alternative practitioners regularly bad-mouth mainstream medicine. Thus "one study found that more than half of all homeopaths approached [in Britain] advised patients against the MMR [measles, mumps, rubella] vaccine for their children, acting irresponsibly on what will quite probably come to be known as the media's MMR hoax." On top of this the Prince of Wales's office joined the fray, which then "tried to have the lead researcher into the matter sacked." (9)
All of this controversy plays straight into the hands of big pharma, which have ably utilized such "brand-building conspiracy theories" (like that arising around MMR) to bolster their immensely profitable involvement in the sale of alternative treatments. Indeed as Ben Goldacre makes clear, "big pharma isn't frightened for its profits because popular opinion turned against MMR: if they have any sense, these companies are relieved that the public is obsessed with MMR, and is thus distracted from the other far more complex and real issues connected with the pharmaceutical business and its inadequate regulation." (10)
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Notes
1. Simon Singh and Edzard Ernst, Trick or Treatment? Alternative Medicine on Trial (Corgi, 2009), p.31, p.37. This book primarily deals with just four alternative therapies (acupuncture, homeopathy, chiropractic therapy, and herbal medicine), for a more detailed referenced study, see Edzard Ernst, Max Pittler, Barbara Wilder and Kate Boddy (eds.), The Desktop Guide to Complimentary Medicine: An Evidence-based Approach (Mosby, 2006). Lind had actually determined that lemon juice could cure scurvy but he had unfortunately suggested that patients be treated with a concentrated juice that had been boiled, which had the effect of destroying the active ingredient, vitamin C. For a summary of the history and criticisms of acupuncture see my article "Acupuncture Revisited." (back)
2. Singh and Ernst, Trick or Treatment?, p.76, p.77, p.87. Haygarth's book that was written largely as a critical investigation of magical treatments being administered by a soon-to-be wealthy physician/quack named Elisha Perkins.
It was then only in the 1940s that the first rigorous examination of the placebo effect was undertaken by an American anaesthetist named Henry K. Beecher.
Here of course one should observe that while the placebo effect can help patients it also can cause severe problems as well. "For example, imagine a patient who feels better because of a placebo response to an otherwise ineffective treatment -- the underlying problem would still persist, and further treatment might still be necessary, but the temporarily improved patient is less likely to seek that treatment." (p.79) Furthermore, despite providing only a pure water placebo, homeopathy does however present a danger to the public when homeopaths replace real doctors: whether this relates to advising people to avoid immunization vaccines (like MMR) or advising them to take homoeopathic preparations to 'protect' oneself from malaria, the results can be catastrophic. (back)
3. Singh and Ernst, Trick or Treatment?, p.117. "The proportion of the French population using homeopathy increased from 16 per cent to 36 per cent between 1982 and 1992, while in Belgium over half the population regularly relies on homeopathic remedies." (p.117) (back)
4. Singh and Ernst, Trick or Treatment?, p.141, p.142. "Before 1935 there weren't too many effective treatments around: we had insulin, liver for iron deficiency anaemia, morphine -- a drug with superficial charm at least -- but in many respects, doctors were fairly useless. Then suddenly, between about 1935 and 1975, science poured out a constant stream of miracles." Ben Goldacre, Bad Science (Forth Estate, 2009), p.104. (back)
5. Singh and Ernst, Trick or Treatment?, p.143. Quoting Dr Fritz Donner, whose conclusions were published posthumously in 1995. (back)
6. Singh and Ernst, Trick or Treatment?, p.144, p.145. The UK-based Faculty of Homeopathy has over 1,400 registered doctors, while India has some 300,000 qualified homeopaths. (p.117) Arguably, homeopathy spread rapidly around India when it first introduced there in 1829, because it was "perceived as being in opposition to the imperialist medicine practised by the British invaders." (p.144) (back)
7. Singh and Ernst, Trick or Treatment?, p.148, p.151. For a comprehensive debunking of homoeopathy see Jay Shelton, Homeopathy: How it Really Works (Prometheus Books, 2003); and for a review of the limited uses and dangers of herbal medicines, see Dan Hurley, Natural Causes: Death, Lies and Politics in America's Vitamin and Herbal Supplement Industry (Broadway Books, 2007). (back)
8. Singh and Ernst, Trick or Treatment?, p.165, p.166 (Linde cited in Singh and Ernst), p.167, p.168. Placebos are of course not given by doctors, however, one should remember that all mainstream medical treatments benefit not only from the medical intervention itself but also from the placebo effect. (back)
9. Goldacre, Bad Science, p.84. "In the realm of their favourite scares, there is a conspicuous over-reliance by newspapers on scientific research that has not been published at all. This is true of almost all of the more recent headline stories on new MMR research, for example. One regularly quoted sources, Dr Arthur Krigsman, has been making widely reported claims for new scientific evidence on MMR since 2002, and has yet to publish his work in an academic journal to this day, six years later. Similarly, the unpublished 'GM potato' claims of Dr Arpad Pusztai that genetically modified potatoes causes cancer in rats resulted in 'Frankenstein food' headlines for a whole year before the research was finally published, and could be read and meaningfully assessed. Contrary to the media speculation, his work did no support the hypothesis that GM is injurious to health (this doesn't mean it's necessarily a good thing -- as we will see later)." Goldacre, Bad Science, p.238.
Ironically now that the MMR hoax has been exposed, "you will see news reporters -- including the BBC -- saying stupid things like 'The research has since been debunked.' Wrong. The research never justified the media's ludicrous over-interpretation. If they had paid attention, the scare would never have even started." (p.299) As Goldacre points out the reason why the MMR story began to gain momentum is "perhaps bound up in the wider desire of some newspapers and personalities simply to attack the government and the health service." (p.300) Leading healthcare privatiser, Tony Blair, encouraged this process by refusing to publicly say whether his children had been given the MMR vaccine. The partner of his wife's New Age guru, Carole Caplin, was a convicted fraudster named Peter Foster, who "helped manage the Blairs' property deals, and he also says that they took Leo [Blair] to a New Age healer, Jack Temple, who offered crystal dowsing, homeopathy, herbalism and neolithic-circle healing in his back garden." (p.303) Whether the Temple connection was true or not, it was well-reported at the time, and one might notes that the Duchess of York wrote the introduction to Temple's book The Healer: The Extraordinary Healing Methods of Jack Temple (p.304). Cheries was also apparently "a regular visitor of Carole's mum, Sylvia Caplin, a spiritual guru." (p.304) Cherie's alternative therapist is Lilias Curtin, who also practises Gem Therapy (p.72). (back)
10. Goldacre, Bad Science, p.337. (back)