It was a borderline decision for me whether it was worth getting out of bed early to sit in on the House of Commons Science and Technology sub-Committee’s ‘evidence check’ on homeopathy yesterday and since the whole thing would soon be available online, I have to wonder why I bothered. That’s not to say I didn’t enjoy witnessing the reassuring predictability of the top drawer defenders of homeopathy such as Dr Peter Fisher and Robert Wilson who, as it turns out, are no better at defending the indefensible than any of the common or garden homeoquacks and punters who keep themselves busy spreading their crap all over the web.
Much has already been made of the admission by Paul Bennett, Professional Standards Director at Boots, which stocks homeopathy and other quack remedies aplenty. Responding to a question from the Chair, Phil Willis MP, on whether homeopathic remedies work better than placebo, he said,
I have no evidence to suggest that they are efficacious and we look very much for the evidence to support that so I am unable to give a yes or no answer to that question.
“It could go down as a Boot in Mouth moment” says the Daily Mail, which compares Bennett’s admission to that of Gerald Ratner, who in 1991 described the items sold in his chain of jewellery shops as “total crap”. They went out of business soon afterwards.
Paul Bennett can’t be a complete moron. He must have anticipated the question but perhaps not the emphatic directness with which it was put and which he found himself unable to dodge. In a split second he decided to come clean and quite right too, even if he does end up losing his job over it.
Although Dr Evan Harris did ask him if he had no qualms about selling stuff he didn’t believe in (the answer was ‘no’ in case, you’re wondering), Bennett got off pretty lightly, all things considered. Nobody mentioned the Boots Learning Store website, which promotes homeopathic remedies as if they are indeed efficacious and to be taken seriously.
The Learning Store website makes much of what it calls “the philosophy that like cures like” and gives a few examples of homeopathic ingredients and what they might treat. Take belladonna, for example. The wiki article on belladonna tells us that, “the symptoms of belladonna poisoning include dilated pupils, sensitivity to light, blurred vision, tachycardia, loss of balance, staggering, headache, rash, flushing, dry mouth and throat, slurred speech, urinary retention, constipation, confusion, hallucinations, delirium, and convulsions.” So which of those does belladonna treat homeopathically, according to Boots?
Why, acne, of course! If you’re wondering what the connection between belladonna and acne is and how treating one with the other fits the ‘like cures like’ idea, you are not alone. But we should take comfort in the thought that the question does at least occur to us and we don’t just take it as gospel, unlike the unsuspecting customers of Boots. And we shouldn’t perhaps be surprised that the ‘evidence’ that satisfies the likes of a director of a chain of shops is simply that a large number of customers think they work. “It’s a question for consumer choice,” he said. “They are licensed medicinal products, therefore we believe it’s right to make them available.” Fair enough. I hope Paul keeps his job.
That ‘it works for them’ is, of course, the overriding consideration of all defenders of homeopathy and one that Robert Wilson, Chairman of the British Association of Homeopathy Manufacturers, seemed unable to get past. His own answer to the question of whether it works beyond placebo was that in France and Germany, homeopathy is a “400 million euro business.”
“So is prostitution,” Phil Willis helpfully pointed out.
Asked for cast-iron evidence that homeopathy works, Robert Wilson claimed to have many trials showing a “strong efficaciousness” for homeopathy. Asked, not unreasonably, by Phil Willis why he hadn’t told Boots about all this evidence, Wilson protested that he had indeed told them, though as the high pressure interrogation continued he amended his answer to saying that Paul Bennett, “hasn’t asked us specifically about the efficaciousness of homeopathic medicines.”
Blimey! That’s a bit remiss of Boots isn’t it? And to think that Paul Bennett had only two minutes earlier, claimed to “look very much for the evidence”, when he hasn’t even asked for it! The hearing was already taking on the character of a comedy farce when Wilson delievered his coup de grâce:
You’ve got to ask, if these medicines didn’t work beyond the placebo effect, why do people keep buying them?
Exactly what all the homeopaths in the room were thinking, no doubt. Phil Willis, however, was unimpressed. “That wasn’t a serious point was it?” he said. (I love how on the video Edzard Ernst can be seen smiling broadly at this point. I think we all were.)
Of course it was a serious point, as far as Robert Wilson was concerned. In common with the bloke who sells them, all that really matters to the bloke who makes them is that customers want them. Evidence, shmevidence, as they say. In fairness, on being pressed, Robert Wilson did name one product — Arnica — for which, he claimed there is a very large, new trial showing a positive result. It was lead by Claudia Witt in Berlin but, alas, I am unable to find it (any help in tracking it down would be appreciated). Professor Jane Lawrence, Chief Scientific Adviser of the Royal Pharmaceutical Society, hadn’t seen it either, adding that she had recently reviewed all the evidence and believes there is no scientific or clinical evidence that supports the use of homeopathy.
It was excrutiating to listen to Robert Wilson pontificate about whether trial results were “statistically significant”, when it was obvious he didn’t have a clue what he was talking about. On and on he gibbered about the importance of sample size, at one point making the ludicrous assertion that “any sample size of less than 500 is not going to be statistically relevant”. In trying to educate him, Dr Evan Harris needed all the patience of a kindergarten teacher. “Whether a sample size is statistically significant depends on the frequency of the outcome you’re measuring,” Evans said gently, before trying to pin Wilson down to accepting that the best way to consider the evidence is to look at the totality of it and especially systematic reviews from which flawed trials have been excluded, rather than cherry-picking individual trials — a point that had been made early on by Ben Goldacre.
Wilson wasn’t having any of it however. Rather than concede what must have seemed a very elementary point to everyone listening (apart from the homeoquacks), he just gave further vent to his obsession with sample size, even though this was totally irrelevant in the context. I wonder if Paul Bennett learned any lessons about how to prevaricate, fudge issues and dodge questions he doesn’t like by listening to this maestro.
On the whole, I did enjoy the hearing. Ben Goldacre, Edzard Ernst and Tracey Brown (Sense about Science) all made useful contributions, as did the mild-mannered Dr James Thallon of the West Kent NHS, which took the heroic decision to close down the Tunbridge Wells homeopathic hospital a couple of years back. But the star of the show for me was Evan Harris who, in a most engaging wide-eyed and innocent manner, did his best to draw the quacks on some of the most unhinged aspects of homeopathy.
“Do you think homeopathic provings represent good evidence of effectiveness?” he asked Robert Wilson. (The short answer was “no” but, predictably, he went all round the houses with it.) “Why does the water retain the memory of the homeopathic ingredient and not the memory of all the poo that’s been it?” He addressed this one to Dr Peter Fisher, who’d obviously been asked the same question many times and had his answer off pat. Use highly purified doubly-distilled and de-ionised water in the first place — apparently if it’s that pure it will have forgotten about the poo but will remember any subsequently added ingredient provided the mixture is shaken properly.
“I would have thought it would have less memory if it was shaken,” said Evan, keeping a straight face. But leaving the water alone or just stirring it has been investigated and “it doesn’t induce the same structural effects,” responded Fisher, just as earnestly. Evan asked him how much the shaking was needed but Fisher could see where he was heading and side-stepped neatly saying something about research being in its early stages. It seems Dr Fisher has discounted all the painstaking research done by Samuel Hahnemann himself 200 years ago and which is faithfully reproduced by the homeopathy manufacturers of the 21st century. Let’s have a reminder:
…one grain of this powder is dissolved in 500 drops of a mixture of one part of alcohol and four parts of distilled water, of which one drop is put in a vial. To this are added 100 drops of pure alcohol and given one hundred strong succussions with the hand against a hard but elastic body.
Oh for crying out loud! How did we ever get to the stage that we need to have an HOC sub-Committee consider whether this lunacy should be part of our National Health Service or not? Enough already.