Double blinded homoeopathic trial 'proves' provings

[Yuri Nalyssus]

The journal Homeopathy has published the following paper:

G Dominici, P Bellavite, C di Stanislao, P Gulia and G Pitari; Double-blind, placebo-controlled homeopathic pathogenetic trials: Symptom collection and analysis, Homeopathy (2006) 95, 123–130. The abstract and links to the full paper can be found here: http://tinyurl.com/z3pfc (http://tinyurl.com/z3pfc).

The abstract reads:
Background: Homeopathic pathogenetic trials (provings) are fundamental to homeopathy. Since most of the data from available provings have not been statistically evaluated, it is unclear how specific reported symptoms are and how they differ from those reported by people taking placebo. Method: We combine and analyse data from two different homeopathic pathogenic trials—including 10 and 11 provers, respectively, and both including 30% placebo—to test the null hypothesis that there is no significant difference between the number of symptoms in placebo and verum groups. Results: The principal results were: Placebo reported less symptoms than verum groups. Symptom distribution according to predefined classes (common symptoms increased in intensity and/or duration, cured, old, new and exceptional) was statistically different between placebo and verum group at a high level of significance (Po0.001). Compared to verum, placebo provers reported less new and old but more common (increased in duration or intensity) symptoms. Within repertory categories, other differences were detected. The two groups differ in terms of the duration of each symptom and kinetics of symptoms: most symptoms were more persistent in verum than in placebo groups and verum provers recorded a decreasing number of symptoms with time. Placebo provers did not show such a temporal pattern. Conclusions: If confirmed by other studies these results would demonstrate the nonequivalence between homeopathic medicines in high dilution and placebo and contribute to the improvement of proving methodology and evaluation. Homeopathy(2006) 95, 123–130.
This is just the sort of paper that is trumped by homoeopaths as proof that it works. Reading it, it seems that the trial was properly blinded, and has good confidence intervals and it seems to show that subjects taking the remedy showed more and varied symptoms than those receiving placebo.

Whether or not it is possible to distinguish remedy from placebo is an acid test of homoeopathy so this paper is of particular interest. Can anyone with a knowledge of statistics or who is more familiar with reading research papers than I am say what (if anything) is wrong with this trial, or is it really proof of the validity of homoeopathic provings as the authors claim.

Yuri

[geoman]

Alas, I have no subscription to the worthy journal and am certainly not shelling out 30 bucks for the paper. BUT...

do I understand the term "provers" correctly as "subjects"?; were there only 10 & 11 subjects for each trial? Doesn't seem much, especially to get a 99.9% significance level.

Also I'm not sure how to square "Compared to verum, placebo provers reported ... more common (increased in duration or intensity) symptoms" with "most symptoms were more persistent in verum than in placebo groups". To my non-medical brain, a more persistent symptom would be one which lasted longer.

p.s. Yuri, Freudian slip in saying that "it seems to show that subjects taking the placebo showed more and varied symptoms than those receiving placebo"? :rolleyes:

[Jorghnassen]

Who peer-reviewed this? This is one of the worst abstract I've ever seen. Plus, if placebos reported less symptoms than treatment groups, wouldn't that mean that placebos were more effective than homeopathic treatment? That's just pathetic.

[Mojo]

We combine and analyse data from two different homeopathic pathogenic trials—including 10 and 11 provers, respectively, and both including 30% placeboHaven't read the article yet, but 30% of 21? They gave a placebo to 6.3 of the subjects?

[Mojo]

Plus, if placebos reported less symptoms than treatment groups, wouldn't that mean that placebos were more effective than homeopathic treatment? That's just pathetic.No. In proving tests, the remedy is given to healthy subjects to see what symptoms it causes in them.

The idea is that the remedy can then be used to treat patients suffering from similar symptoms to those that the remedy causes in healthy people (crazy huh?).

[Yuri Nalyssus]

...do I understand the term "provers" correctly as "subjects"?; were there only 10 & 11 subjects for each trial? Doesn't seem much, especially to get a 99.9% significance level.
Yet that's what they claim to achieve, so presumably the difference between the 2 groups must have been very obvious.
p.s. Yuri, Freudian slip in saying that "it seems to show that subjects taking the placebo showed more and varied symptoms than those receiving placebo"? :rolleyes:
Oops, many thanks, mistake now corrected, I have an overdeveloped ridicule centre, obviously it's started to express subconsciously.

Yuri

[Mojo]

Yet that's what they claim to achieve, so presumably the difference between the 2 groups must have been very obvious.
Do they know about the Million Dollar Challenge?

[Kopji]

How about a test where the evaluators apply their statistics to the entire test group, and then precisely identify the placebo group as inferred from their criteria?

[Capsid]

OT: I just noticed your avatar Yuri. I'm not sure I understood that film but I did enjoy it.

[Yuri Nalyssus]

Who peer-reviewed this? This is one of the worst abstract I've ever seen.
As far as I know 'Homeopathy' claims to be a peer reviewed journal but since the 'peers' would be homoeopaths it leaves itself open to accusations of publication bias. Nevertheless the figures apparently speak for themselves. Other trials show no difference between remedies and placebo so what is going on with this one - are the findings true or coincidence or are we only hearing the partial truth about the method?

Yuri

[CFLarsen]

Placebo reported less symptoms than verum groups.
...
Compared to verum, placebo provers reported less new and old but more common (increased in duration or intensity) symptoms. Within repertory categories, other differences were detected. The two groups differ in terms of the duration of each symptom and kinetics of symptoms: most symptoms were more persistent in verum than in placebo groups and verum provers recorded a decreasing number of symptoms with time. Placebo provers did not show such a temporal pattern.

Note the very vague wording. "Most". "Less". "Increased". "Differ". But we don't hear how much it is. We also don't hear what kind of symptoms.

Sniff test.

Reading it, it seems that the trial was properly blinded, and has good confidence intervals and it seems to show that subjects taking the remedy showed more and varied symptoms than those receiving placebo.

Since you read the paper, perhaps you can fill us in on some numbers?

[Yuri Nalyssus]

OT: I just noticed your avatar Yuri. I'm not sure I understood that film but I did enjoy it.
One of studio Ghibli's finest. I put the avatar up a few weeks ago, No-face seemed strangely appropriate; and I do have a tendency to wander around with a blank look on my face saying 'uuh?'.

Yuri

[jon]

My library's apparently paid for electronic access :( and it looks like they allow me to e-mail out a copy. Don't much fancy reading this closely (and my stat's isn't great) if someone wants to PM me, though, I can e-mail out (one) copy. First come first served :)

[Yuri Nalyssus]

Since you read the paper, perhaps you can fill us in on some numbers?
I'll have a go.

Yuri

[Yuri Nalyssus]

Do they know about the Million Dollar Challenge?
I'm sure if asked they would decline on the basis that they wouldn't want to sully themselves with such folderol. (That's what the usual line is I believe)

Yuri

[flume]

They had 11 in the first trial - 3 were placebo. They had 10 in the second trial; 3 were placebo. When they did the analysis they combined the 3 placebo provers in each trial into a group of 6. They said they could do this because they wrere not analyzing specific symptoms.

The placebo provers were picked randomly from the group of 11 or 10.

I have a question - were the same people used as provers for the two tests. I think probably not, because the provers had to have taken no homeopathic remedies for 6 months, so that would mean a 6 month wait between trials. And probably it is implied. But they don't explicitly say they were not.

They do have a table listing symptoms under a long list of different homeopathic categories (e.g. mind (placebo:34 symptoms (31%); etna lava:94 symptoms (25%); hydrogen peroxide:35 symptoms (19%) (percents rounded by me), generals, head, eye, ear,... stomach (P:6(6%); EL:26(6%); HP:16(8%)....through extremities, fever, skin, back.

I think a few hypersensitive or more talkative people in the group provers of the verum remedies could throw the whole thing off (resulting in more symptoms and more interesting symptoms in that group), so that they should have repeated it with the same people who had previously gotten the remedies getting the placebo and vice versa.

[CFLarsen]

I'll have a go.

Yuri
Thanks.

How many people were tested?

[CriticalThanking]

I can't tell from the chart - what were the homeo products used? Etna lava and Hydrogen Peroxide, but in what strength: 30C, 1X, or something in between? Obviously at 1X there is something besides solvent present and there would be some real effects. At 30C, there should be no difference with Placebo. What are they claiming?

CT

[flume]

In the first trial (Etna lava) there were 11 people: 8 proved the etna lava; 3 proved the placebo.
In the second trial of hydrogen peroxide (or whatever their fancy name for it is) there were 10 people. 7 proved the hydrogen peroxide; 3 proved the placebo.

For their analysys they lumped the 3 placebo provers from the two trials, so they had 8 for Etna Lava, 7 for hydrogen peroxide, and 6 for placebo.
(by sex, 5/3. 4/3. 4/2 female/male)
age: EL: mean 41years(30-54); HP: mean 37 yrs (26-48); P:mean 38 yrs (30-45)

[CFLarsen]

In the first trial (Etna lava) there were 11 people: 8 proved the etna lava; 3 proved the placebo.
In the second trial of hydrogen peroxide (or whatever their fancy name for it is) there were 10 people. 7 proved the hydrogen peroxide; 3 proved the placebo.

For their analysys they lumped the 3 placebo provers from the two trials, so they had 8 for Etna Lava, 7 for hydrogen peroxide, and 6 for placebo.
(by sex, 5/3. 4/3. 4/2 female/male)
age: EL: mean 41years(30-54); HP: mean 37 yrs (26-48); P:mean 38 yrs (30-45)

11 people? Two groups, of 8 and 3?

Are you sure??

[Yahzi]

One of studio Ghibli's finest.
My 7 year old neice broke down in tears when the boy turned into a dragon.

I think she had a crush on him, and realized at that moment that he was a river, not a boy.

[tkingdoll]

My 7 year old neice broke down in tears when the boy turned into a dragon.

I think she had a crush on him, and realized at that moment that he was a river, not a boy.

Well he was kinda hot...

Not as hot as Howl though.

[Yuri Nalyssus]

I can't tell from the chart - what were the homeo products used? Etna lava and Hydrogen Peroxide, but in what strength: 30C, 1X, or something in between? Obviously at 1X there is something besides solvent present and there would be some real effects. At 30C, there should be no difference with Placebo. What are they claiming?

I'll attempt a precis.

The authors studied data from 2 provings; symptoms were collected from the two provings, done on a small number of subjects using the same procedure, and were considered together in order to increase the significance of results.

The remedies tested were: 1] potentized Etna Lava, made from lava collected during the August 2000 eruption (volcanoes are known as sources of useful but poorly understood remedies), and 2] potentized H2O2 (hydrogen peroxide, Hydrogenium peroxidatum): (this molecule is a reactive oxygen species (ROS), responsible for tissue injury with consequent disease if not efficiently detoxified; ROS have been implicated in over 50 diseases and in the ageing process (They’d obviously never heard of these people (http://www.cancertutor.com/Cancer/HydrogenPeroxide.html), but that’s another story)). Both remedies were taken in 30CH potency (that’s a dilution of 1 in a hundred done 30 times) three times daily for a maximum of 2 days.

The authors state the design was a “double blind, randomized, multicentric, placebo controlled experimental study”. the trials lasted 2 months each, the 2 groups numbered 11 and 10 provers respectively. In the lava group 8 out of 11 took verum and in the H2O2 group 7 took the verum, the rest took placebo (3 in each group). Participants in the trial were the provers and their supervisers (both blinded and the authors state the verum was indistinguishable from the placebo by sight, smell or taste). The coordinators numbered the preparations and gave them to the supervisors who then distributed them blindly and randomly to the provers. Each prover had kept a diary of symptoms in the lead up to the trial and continued it while taking the test substance. The analyst received the final data from the coordinator and compared the 2 groups receiving verum with the placebo groups which were pooled to increase the statistical power.

In the discussion the authors state “The study has to be considered as preliminary, because of the limited number of subjects, but it could be an important example of proving methodology and evaluation” and later “Distribution of symptoms by predefined classes... showed that placebo and verum provers represent two different groups: the differences cannot be explained by chance alone”.

What they claim is "we have shown a particular difference between placebo and verum in pathogenic homeopathic trials" although they do go on to say more extensive studies are needed.

Re-reading the paper I see the analyst was given the results by the coordinator who was responsible for the labelling of the trial substances, a bit of a weak spot perhaps.

My problem is that it's tempting to just dismiss the whole paper on the grounds that "it can't be right, they must have made some slip up and they're just not telling us". If that were the case though, the same could be said for any paper no matter what the subject. This paper has the appearance (at least to me) of a genuine scientific trial, unlike the many howlers that are passed off as research by homoeos just desparate for positive evidence. As such it is inevitably going to be used as a stick to beat sceptics with and I'd like a few reasons why it shouldn't be taken at face value.

Yuri

[Mojo]

...useful but poorly understood remedies50% ain't bad...

[joller]

As such it is inevitably going to be used as a stick to beat sceptics with and I'd like a few reasons why it shouldn't be taken at face value.
Yuri
Scientific studies need to be repeatable.
get the same remedies that thery've used in similar potencies (as long as they're above avogadro's limit, otherwise it really isn't homeopathy per se), round up some peopletogether (looks like you don't really need that many), and verify the results.
If you get what they get, then .... then I'll ask someone else to confirm it :)
If It still works, and we don't detect some protocol roblems in the meantime, then I'm gonna say:
"Holy smokes, Batman!
Take me to the water, throw me in the river, I'm converted!"

[Zep]

I've just had a quick run through the figures in that table, and it raises some issues for me. Perhaps wiser heads than I can clarify...

1) The numbers in the table did not seem to be derivable from the data provided. Then I realised that it what we were shown was actually a tally of symptoms per category across all subjects. What would have been more useful would have been the per-subject tallies of symptoms. Because with such a small test population, it would take only one or two subjects to cause a severe anomaly in the overall tallies.

2) I calculated the average symptoms per subject from the table data for the placebo and the two verums, and plotted them (sorted lowest to highest to give a nice graph!). The results were very similar rankings - the categories tended to rank in the same order, and with similar proportions to the whole, for all three test products. This would indicate the subjects all recorded proportionally similar counts per categories of symptoms, regardless of the test substance - a trend that needs to be taken into account.

3) I then plotted the symptom categories as a percentage of total symptoms. This was a first basic attempt at normalisation, really. To simplify (and I allow this may be statistically invalid), I summed the two verum sets to give one "total verum" result per category. When plotted per category and compared with the placebo numbers similarly treated, the results appeared by observation to be even more similar, both per category and by absolute value. I would certainly like to see some hard statistical calculations on that side.

4) It is worth noting that over a 60-day period with 21 subjects involved, a total of 674 symptoms were recorded - just under 2 symptoms per day per subject. Given the totally subjective nature and effectively uncontrolled environment for the substances under test, there would need to be at least baseline measurements taken first to establish initial trends. While the report says these were done, they do not seem to be mentioned in the subsequent results. I suspect if baseline measurements were factored in, the results would be even more similar.

As a comment, I note that the Etna lava verum results are parallel to the others in percentage terms, but stand out in absolute terms - almost as if someone had just gone through and multiplied the base data by a constant, or added a singularly suspect data set for one subject... Either that, or the blinding may have broken in some way. Certainly the H2O2 results were almost indistinguishable from placebo. I'd be calling shenanigans on that one...

[Badly Shaved Monkey]

What Zep said.

Also, it is not clear that the 'analyst' was blinded. And, do you know what, I'll bet they weren't, even if the formal protocol says they were.

The group sizes are unbalanced, so even if they were labelled X and Y, the analyst would know that the larger group was verum.

Also, to get P=0.001 from that small number of subjects is unlikely. I'll bet they did their stats on the n of symptom numbers, 674 or whatever. BUT, these data are not independent. As has already been pointed out, uneven distribution of garrulous subjects would bias the results. Technically, this means that there are large correlations among groups of data points that would competely invalidate any stats that assume they are independently sampled.

Also, the abstract completely fails to indicate how many statistical tests were done and whether the analysis was defined before the study. If you take a large pool of data and keep running tests on it you are very likely to create some low p-values.

It's a classic cheat to get something like this published then tuck away in the small print that it is only a 'pilot' or similar. For goodness sake, this wasn't even a new piece of work. This should have been done behind closed doors as a paper exercise that would generate reasonable hypotheses to be tested properly. Instead they have shoved it out for publication where it adds yet one more item to the list of 'proofs' that homeopathy works. Yet again, we have to point out who the 'peers' are.

Also, bear in mind that this 'novel' study was performed on data that had already been shoehorned into shape for publication. Publication bias is likely to be a heavy factor.

Enough "also". It's Classic Bad Science.

Apart from all that it's a brilliant piece of ground-breaking work.

[Yuri Nalyssus]

...it is not clear that the 'analyst' was blinded. And, do you know what, I'll bet they weren't, even if the formal protocol says they were.I can't see anywhere in the paper where it says the analyst was blinded and he/she was supplied with the data by the "coordinator" who was the person who numbered and labelled the original test substances.

The group sizes are unbalanced, so even if they were labelled X and Y, the analyst would know that the larger group was verum.ah hah!!




Also, the abstract completely fails to indicate how many statistical tests were done and whether the analysis was defined before the study. If you take a large pool of data and keep running tests on it you are very likely to create some low p-values.This is the point in the paper I started to get lost:Student t-test was used to compare data means (number of symptoms/prover) between two groups.
When data (symptoms) were distributed into categories (classes) a bivariate tabular analysis was performed and the χ2 test applied.
Confidence interval were analysed when permitted by the amount of data.
Cramer's V coefficient was calculated, when permitted, for the distribution with largest χ2.
The ‘null’ hypothesis assumed homeopathic potencies to be identical to placebo. If this was correct:
the two groups (verum and placebo) should provide a similar number of symptoms/prover;
the two variables (symptoms/classes) and groups (placebo or verum) should be independent, and symptoms distributed into the considered categories in numbers similar to the expected values;
Cramer's V, (a measure of the degree of association between the variables in the bivariate table) should be zero;
the categories of symptoms (physical, mental etc) and the time course of their appearance in the two groups should be similar.
When a statistically significant difference between data was observed by χ2 analysis, further statistical control of homogeneity was performed. The test for homogeneity answers the proposition that several individuals into a population are homogeneous with respect to some characteristic.




The problem for the lay person (ie me and more than likely most homoeos) reading this stuff is that all the stats sound very impressive even though one hasn't the faintest idea what it all means. The difference is whether to seek clarification or to swallow it hook, line and sinker. I know there are similar, larger studies out there including ones done by homoeopaths (http://http:/tinyurl.com/qhzwc)which suggest there is no difference between placebo & remedy but this one left me wondering for a while - starting to see things more clearly now though.

Yuri

[Badly Shaved Monkey]

Yuri, my eyes began to glaze over a little as well!

As far as I can see, though, if they have used chi-squared tests they have been using 'counts' of symptoms entered into the cells of their tables, but each subject potentially contributed numerous counts, which is exactly the lack of independence I suggested. However they collected their data, the only legitimate way to start doing chi-squared tests would be if they turned each subject into a count of 1, e.g. by showing some number or type of symptoms beyond a certain threshold, but of course that criterion would have had to have been predefined before the analysis. Sadly a chi-squared table with such a small number of subjects would be incredibly low-powered.

As is always the case with bad science like this, there is no way you can definitively disprove what they state as their conclusions. The data are simply too poor to make any statement one way or the other and should not have been published. but, take a politically motivated house journal and a scrutiny panel of homeopathic peers and you have a paper and another abstract to circle in the world of woo.

[Zep]

After more fiddling about with Excel...

Taking each category's symptom-count as a percentage of total symptom-count (see my point (3) above), I did a simple correlation coefficient calculation (i.e. Excel's built-in function!) of the two arrays of points. Result? R = 0.8966. And according to the bumph I have managed to unearth from my uni stats course and other places (see below), that means a strong positive correlation between the two data sets.

This suggests again that the test substance has little bearing on the shape of the data. There is merely a tendency for the test subjects to log more of the same symptoms, not any different pattern to the results.

Or put another way: The verums seem to make the provers notice and log a higher count of "normal placebo-type symptoms". Which is a unusual situation in that it indicates the provers knew when they were being given the verum (so they were aware they were supposed to be looking for more symptoms), but not what it was supposed to produce in the way of symptoms (so they logged more of the same). If so, that would clearly indicate a break of blinding, by way of knowing when they were proving a verum, but not what with (or they would have known which new symptoms to "look for").

Comments?

http://sportsci.org/resource/stats/correl.html
http://mathbits.com/MathBits/TISection/Statistics2/correlation.htm
http://www.uwsp.edu/psych/stat/7/correlat.htm

[Badly Shaved Monkey]

With such a small number of subjects it could stll be due to have more imaginative subjects in the verum group because n is too small to allow good randomisation. I mean, in the placebo group we have n=3, twice. You can barely do stats on that.

This is what it all boils down to- n was tny and unbalanced.

[Zep]

With such a small number of subjects it could stll be due to have more imaginative subjects in the verum group because n is too small to allow good randomisation. I mean, in the placebo group we have n=3, twice. You can barely do stats on that.

This is what it all boils down to- n was tny and unbalanced.
All well and good - I agree.

But my discussion was more to do with interesting point that it would appear, even from these tiny set of numbers, that the provers did indeed know WHEN they were being asked to prove a verum and not a placebo, but not what the verum was they were testing. My only reasonable conclusion is that the provers of verum and placebo knew which group they were in beforehand, i.e. nowhere near properly blinded testing.

[Badly Shaved Monkey]

All well and good - I agree.

But my discussion was more to do with interesting point that it would appear, even from these tiny set of numbers, that the provers did indeed know WHEN they were being asked to prove a verum and not a placebo, but not what the verum was they were testing. My only reasonable conclusion is that the provers of verum and placebo knew which group they were in beforehand, i.e. nowhere near properly blinded testing.

You mean they might not have run the trial competently? Oh, say it isn't so. My illusions are all shattered.

[Zep]

You mean they might no have run the trial competently? Oh, say it isn't so. My illusions are all shattered.http://www.istockphoto.com/file_thumbview_approve/502645/2/istockphoto_502645_broken_wine_glass.jpg]

[Jorghnassen]

No. In proving tests, the remedy is given to healthy subjects to see what symptoms it causes in them.

The idea is that the remedy can then be used to treat patients suffering from similar symptoms to those that the remedy causes in healthy people (crazy huh?).

OK... I guess I'll have to dilute my critical thinking skills a few Cs before I can understand the mind of an homeopath.

[Yuri Nalyssus]

OK... I guess I'll have to dilute my critical thinking skills a few Cs before I can understand the mind of an homeopath.Oh yes, because then you would become a super powerful, potentised sceptic [fiendish laughter]

Provings are described in a sceptic site here (http://www.angelfire.com/ult/homeopathysucks/proving.html), with a 'pro' view here (http://www.homeopathy-ecch.org/content/view/24/41/).

The Berlin wall (http://www.biolumanetics.net/tantalus/Cases/BerlinWall.htm) is one of my favourite remedies although the Peregrine falcon (http://www.hominf.org/articles/posheal.htm)comes a close second, just above anti-matter (http://www.hominf.org/posi/posiintr.htm) (what else would you use to treat the effects of a warp core breach). Now you see why this is so much fun!

Yuri

[Dr Adequate]

Hold on.

As I understand it, the point of "proving" a substance is that you give the subject a significant (ie non-homeopathic) dose of some substance and see if it makes him ill.

Well, why shouldn't it?

If they tried "proving", say, LSD against placebo, they'd see a huge difference. Statistically significant? You betcha. But it wouldn't go any way towards proving that sub-molecular dilutions of LSD are a cure for hallucinations.

So if their results were statistically significant, and they don't seem to be, then all they'd have proved is that eating Mount Etna is bad for you.

[Yuri Nalyssus]

Hold on.

As I understand it, the point of "proving" a substance is that you give the subject a significant (ie non-homeopathic) dose of some substance and see if it makes him ill.

Well, why shouldn't it?The trend these days is to use 30 centessimal dilutions for provings. I guess it's safer and saves people from having to eat peregrine falcons and chew bits of the Berlin wall (see above).

Sometimes even more unlikely methods are used such as meditating and dreaming about the remedies for long periods; 2 years according to one group.

Why am I explaining this to a potions professor?

I'm afraid they have an answer for everything.

Yuri

[Zep]

Dr A, the study was using 30C remedies of Etna lava, and hydrogen peroxide as the verums (pl. vera?). That is, they were diluted 1:100 thirty times over.

[Dr Adequate]

So they "prove" the substances by showing that homeopathic doses of them are bad for you?

Er ...

Haven't they just proved that homeopathic medicine makes you ill?

[Badly Shaved Monkey]

Haven't they just proved that homeopathic medicine makes you ill?

Oh, yes. But with their cracked logic, what you need to get you better is more of the same presented in their little magic pills.

[Mojo]

Haven't they just proved that homeopathic medicine makes you ill?Sure, but they'll also tell you it has no side-effects...

:hb:

[Yuri Nalyssus]

Sure, but they'll also tell you it has no side-effects...

:hb:Then they'll accuse you of being stuck in a Newtonian paradigm for not realising this in the first place.

Yuri

[Art Vandelay]

After more fiddling about with Excel...

Taking each category's symptom-count as a percentage of total symptom-count (see my point (3) above), I did a simple correlation coefficient calculation (i.e. Excel's built-in function!) of the two arrays of points. Result? R = 0.8966. And according to the bumph I have managed to unearth from my uni stats course and other places (see below), that means a strong positive correlation between the two data sets.Actually, Excel has a built-in Pearson function as well, which gives you a measure of how significant a correlation is. You do have to know a bit of statistics to know how to apply it, though.

My problem is that it's tempting to just dismiss the whole paper on the grounds that "it can't be right, they must have made some slip up and they're just not telling us". If that were the case though, the same could be said for any paper no matter what the subject. No. If homeopathy works, that would contradict everything that we know about how the world works. Since every homeopathy trial is based on the assumption that we understand how the world works, any trial that "proves" that homeopathy works is invalid. Any such result would merely mean that ONE of our assumptions of how the world works is wrong. It could mean that homeopathy works, but it could also mean that invisible space aliens are screwing around with the result. Frankly, I find the latter more probable.

There is no comparison between homeopathy and, say, drug trials. There is nothing in our understanding of the world that prohibits drugs from working, so a successful drug trial doesn't call into question the validity of the trial.

Science is based on Occam's razor. All a trial does is show that either the claimed effect exists, OR something is wrong with the trial. We then accept whichever explanation requires us to adjust our worldview the least. "This drug works" is a much less difficult claim to accept than "Strictly controlled drug trials are invalid", so we accept the former. But in the case of homeopathy, there is simply no test, no matter how well constructed, for which believing that the test is flawed is more difficult than believing that homeopathy works. If we are going to entertain the notion that trans-Avagadro dilutions can affect the result, why not entertain the notion that some other supernatural effect is at work? "Proving" that homeopathy exists would be like trying to use a pot of gold to prove that leprechauns exist. Once we entertain the notion that leprechauns exist, why not consider the possibility that, in fact, a bunch of elves are merely impersonating leprechauns? Or gremlins? Or hobbits? Pixies? Poltergeists?

And the Randi challenge is yet another point that skeptics can use. If this works, why haven't they claimed the million?

[Zep]

Actually, Excel has a built-in Pearson function as well, which gives you a measure of how significant a correlation is. You do have to know a bit of statistics to know how to apply it, though.Yes, I've highlighted my deficiency. Would you care to take a stab at it? I'll gladly email you my spreadsheet, and besides, I've run out of interest.

No. If homeopathy works, that would contradict everything that we know about how the world works. Since every homeopathy trial is based on the assumption that we understand how the world works, any trial that "proves" that homeopathy works is invalid. Any such result would merely mean that ONE of our assumptions of how the world works is wrong. It could mean that homeopathy works, but it could also mean that invisible space aliens are screwing around with the result. Frankly, I find the latter more probable.

There is no comparison between homeopathy and, say, drug trials. There is nothing in our understanding of the world that prohibits drugs from working, so a successful drug trial doesn't call into question the validity of the trial.

Science is based on Occam's razor. All a trial does is show that either the claimed effect exists, OR something is wrong with the trial. We then accept whichever explanation requires us to adjust our worldview the least. "This drug works" is a much less difficult claim to accept than "Strictly controlled drug trials are invalid", so we accept the former. But in the case of homeopathy, there is simply no test, no matter how well constructed, for which believing that the test is flawed is more difficult than believing that homeopathy works. If we are going to entertain the notion that trans-Avagadro dilutions can affect the result, why not entertain the notion that some other supernatural effect is at work? "Proving" that homeopathy exists would be like trying to use a pot of gold to prove that leprechauns exist. Once we entertain the notion that leprechauns exist, why not consider the possibility that, in fact, a bunch of elves are merely impersonating leprechauns? Or gremlins? Or hobbits? Pixies? Poltergeists?

And the Randi challenge is yet another point that skeptics can use. If this works, why haven't they claimed the million?You are preaching to the converted here. The problem with the homeopaths is that they are converted too...but to a religion, not a philosophy.

[Nucular]

Were the members of the groups tested individually, or in actual separate groups? If the latter, you'd expect major differences between groups, presumably.

For those without a subscription to Homeopathy, there's a sample issue available from January 06 (http://www.sciencedirect.com/science/journal/14754916) (if the link doesn't work, I'll see if I can fix it) which might give a flavour - a few interesting articles, mostly banging on about the Lancet meta-analysis.

One letter from two of the authors of the paper this thread is concerned with, on the subject of 'Homeopathy and Placebo' in the light of the Lancet article, which may or may not shed some light on their conceptualisation of 'placebo':
The placebo ‘action’ is definitely not due to the activity of
the ‘inactive’ substance but to the intrinsic healing
capacities and response of the treated subject. This
response is also the one that is expected to be triggered
by the homeopathic remedy. To successfully discriminate
between the placebo and remedy response it is
important to know the characteristics of the substance
given to the patient and the healing steps of the two
different clinical methods. Assuming that the extremely-
low dose remedy and the endogenous healing
mechanisms interact in a complex way, the final effect
is due to the product of these two factors and any
procedure decreasing the latter may markedly affect
the homeopathic cure, much more than the allopathic
drug effect.
So there you have it - homeopathy is 'placebo but more so', and so has a more complex relationship with placebo than 'orthodox' medicine; and so we need to know the nature of the remedy in order to distinguish it from placebo. Which sounds eerily like a diatribe on why proper blinding isn't for them. Perhaps.

An editorial from that issue is perhaps a bit more honest, titularly speaking at any rate: "Changing Reality".

[MRC_Hans]

Dr. A: Pls try to get to grips with the basic principle of homeopathy: Like cures like. The remedy that produces the same symptoms as the disease supplants and thus removes the disease.

Remember, it was all thought out 200 years ago, when nobody really knew what caused diseases.

As for the trial, there is something rotten in the way they pool the data across individuals. You can't do that till you break the blinding and see who belongs to which group.

Hans

[Crispy Duck]

Surely the next step for the authors is to do a dose-response study on a single verum. Get six subjects each to take placebo, 1X, 1C, 5C, 10C and 30C dilutions of hydrogen peroxide, and plot the number of subjects having each symptom against their dose.

I wonder - what would the homeopaths expect to get? I presume they must expect there to be a minimum around the 5C point? Even a homeopath would surely expect a 1X dilution of H2O2 to cause some fairly significant symptoms, and yet their study shows that 30C H2O2 also causes quite a bit of tummy trouble. Where would they expect the minimum to occur, and why?

For what it's worth, I work in clinical trials reporting, and I can confirm that a subject reporting, say, ten headaches while taking a single drug would only be counted once against the 'headache' category in the summary tables.

[Deetee]

So they "prove" the substances by showing that homeopathic doses of them are bad for you?

Er ...

Haven't they just proved that homeopathic medicine makes you ill?
Well, the antimatter proving elicited the following symptoms:

Death & Evil, anti-life
Anti-Matter
Unfeeling; non-connection
Destruction
Desire to harm
No regret, 'a nugget of pure evil'
Feeling threatened = agression
Dreams: stabbing, needles, teeth
Feeling betrayed, used & abused, enslaved, raped, dirty
Old age & ugliness

Nothing matters, flat, no libido

Aversion to exercise

"What is sex for"

Dreams of toilets & sh1*t

Sexual perversions

Violating Mother Earth.











Quite. You could argue this type of manifestation is not very good for you physically.

What if you are of a personality type that conforms to the symptoms above- do you take a few drops of homeopathic antimatter to make you feel better, or will it just not make you feel more sh1*t?

Or perhaps if you have someone with an exceedingly annoying and jolly personality, you can cure them by slipping some in their coffee?

[Yuri Nalyssus]

No. If homeopathy works, that would contradict everything that we know about how the world works. Since every homeopathy trial is based on the assumption that we understand how the world works, any trial that "proves" that homeopathy works is invalid. Any such result would merely mean that ONE of our assumptions of how the world works is wrong. It could mean that homeopathy works, but it could also mean that invisible space aliens are screwing around with the result. Frankly, I find the latter more probable.

There is no comparison between homeopathy and, say, drug trials. There is nothing in our understanding of the world that prohibits drugs from working, so a successful drug trial doesn't call into question the validity of the trial.

Science is based on Occam's razor. All a trial does is show that either the claimed effect exists, OR something is wrong with the trial. We then accept whichever explanation requires us to adjust our worldview the least. "This drug works" is a much less difficult claim to accept than "Strictly controlled drug trials are invalid", so we accept the former. But in the case of homeopathy, there is simply no test, no matter how well constructed, for which believing that the test is flawed is more difficult than believing that homeopathy works. If we are going to entertain the notion that trans-Avagadro dilutions can affect the result, why not entertain the notion that some other supernatural effect is at work? "Proving" that homeopathy exists would be like trying to use a pot of gold to prove that leprechauns exist. Once we entertain the notion that leprechauns exist, why not consider the possibility that, in fact, a bunch of elves are merely impersonating leprechauns? Or gremlins? Or hobbits? Pixies? Poltergeists?I know about the impossibility of homeopathy and given that and the body of pre-existing research it could be legitimately argued it is pointless to continue to research into homoeopathy. Given that such research continues to be done, however it needs to be looked at carefully. That was the whole point of my starting this thread - I knew full well that the paper's conclusion was almost certain to be false but, not having a grasp of the statistics involved I needed it explained to me where the flaws were (incidentally many thanks to BSM, Zep, CFLarsen et al for their help). That way, when (inevitably) this paper appears as evidence for homoeopathy being effective I will be able to properly counter the findings on the same terms that the paper has used. Simply dismissing the results as bogus because homoeopathy can't possibly works just confirms the suspicion of CAM proponents that sceptics are not prepared to consider confounding evidence. Now I can say I have considered it in some depth and the trial doesn't cut the mustard.

Yuri

[kellyb]

I know about the impossibility of homeopathy and given that and the body of pre-existing research it could be legitimately argued it is pointless to continue to research into homoeopathy. Given that such research continues to be done, however it needs to be looked at carefully. That was the whole point of my starting this thread - I knew full well that the paper's conclusion was almost certain to be false but, not having a grasp of the statistics involved I needed it explained to me where the flaws were (incidentally many thanks to BSM, Zep, CFLarsen et al for their help). That way, when (inevitably) this paper appears as evidence for homoeopathy being effective I will be able to properly counter the findings on the same terms that the paper has used. Simply dismissing the results as bogus because homoeopathy can't possibly works just confirms the suspicion of CAM proponents that sceptics are not prepared to consider confounding evidence. Now I can say I have considered it in some depth and the trial doesn't cut the mustard.

Yuri
Yep. "Observer bias" is a very real phenomenon, and one that evidence based medicine goes to great lengths to avoid nowadays (most of the time).
The burden of proof is now on them to prove that the differences in the size of the "remedy" group to "placebo" group did not unblind the study, or to duplicate the study properly.
There are other flaws, but that's the one I see as the biggest. (Or maybe I just get overwhelmed trying to translate homeopathic terminology into "normal medical" terminology.:o Trying to argue these claims is always a bit like trying to debate with someone speaking Greek).

[Badly Shaved Monkey]

This is where, I think, we head into the tricky territory of Bayesian probabilities and I will get out of my depth very quickly, but essentially, the interpretation of any trial should take into account the 'prior probability' of the hypothesis. For homeopathy, that prior probability is vanishingly low, so to overturn that would take a very strongly statistically significant result. Of course, estimating the prior probability is difficult. In the case of homeopathy it is effectively the same as making Art Vandelay's point: the likelihood of homeopathy being true is so low that one would be correct to reject almost any conceivable trial that came out in favour of it.

This is the position I've been moving towards myself recently. Trialling homeopathy only lends it a spurious credibility. We have too many lines of counter-argument from sources beyond clinical trials. These make trials literally a waste of time and effort that only serves to feed the delusion by appearing to take it seriously.

ETA: see my Sig Line. The second quote from 'Bach/bwv11' is quite accurate but 180-degrees wrong because he has chosen to believe that the truth of homeopathy is unassailable. Here's the quote, in case I change my Sig Line: "IF we operate on the assumption that homeopathic remedies work, then a trial showing they do not work must be flawed"

[kellyb]

Ok. I just went over the chart again, and this time just looked at the % of suffering patients, and I'm not seeing any kind of pattern.
I'm seeing coincidence on both sides.
Sometimes the homeopathy takers are more ill, and equally often the placebo group has an illness.
This is such crappy science I'm kinda at a loss, but I'm not seeing the trends that would even implicate observer bias.

[Mojo]

It's odd, really, that they've chosen to combine the results of provings of two different remedies to attempt to demonstrate that they give a different result from placebo. Since placebo should, if the subjects aren't told what the remedy is but think they've taken something*, give a more or less random spread of symptoms, and the real remedies should, if they actually do produce proving symptoms, produce their specific and different set of symptoms in addition to the placebo symptoms, I would have thought that combining two sets of symptoms would blur the distinction between verum and placebo (if there actually was any ;) ).

I was never much good with statistics; what happens if we look at the results for each verum separately?


*Was this aspect of the study blinded, or were the subjects aware of what remedy was being proved?

[Zep]

It's odd, really, that they've chosen to combine the results of provings of two different remedies to attempt to demonstrate that they give a different result from placebo. Since placebo should, if the subjects aren't told what the remedy is but think they've taken something*, give a more or less random spread of symptoms, and the real remedies should, if they actually do produce proving symptoms, produce their specific and different set of symptoms in addition to the placebo symptoms, I would have thought that combining two sets of symptoms would blur the distinction between verum and placebo (if there actually was any ;) ).

I was never much good with statistics; what happens if we look at the results for each verum separately?


*Was this aspect of the study blinded, or were the subjects aware of what remedy was being proved?
This is exactly the issue I mentioned above - there is a strong suspicion that the blinding...wasn't.

And the answer to your last question is: The etna lava results stand out as lots more of "more of the same", while the H2O2 results are almost indistinguishable from placebo. But that is assuming that the placebo results are similar for both trials (they were separate trials), which we can't tell without the base data. For all we know, the etna lava trial placebo results could be almost identical to the same trial's verum results, but the report-writers just lumped them in with the placebo results of the H2O2 trial to "average the two out" (they make the statistical excuse that a placebo is a placebo is a placebo, so the results must be the same, surely!).

:crazy:

[H'ethetheth]

Oh, yes. But with their cracked logic, what you need to get you better is more of the same presented in their little magic pills.I Didn't realise this, but this must be the weirdest thing I've heard about homeopathy yet.
If you give someone who you've just cured with some homeopathic medicine the same medicine, he would get sick again. This would mean that, as a patient, you would have to keep popping pills until you feel sick again.

I can see where they get their profits.

[MRC_Hans]

I Didn't realise this, but this must be the weirdest thing I've heard about homeopathy yet.
If you give someone who you've just cured with some homeopathic medicine the same medicine, he would get sick again. This would mean that, as a patient, you would have to keep popping pills until you feel sick again.

I can see where they get their profits.No, that is not how it's supposed to work.

I wrote a short article here: http://www.hans-egebo.dk/skeptic/Homeopathy%20article.htm

Perhaps that can clear up the basic concepts.

Hans

[Harlequin]

So they "prove" the substances by showing that homeopathic doses of them are bad for you?

Er ...

Haven't they just proved that homeopathic medicine makes you ill?

I think Dr.A has a good point here. I'm sure it's been discussed before, but this is sort on inconsistent with a major part of the "theory" behind homeopathy.

OK, assuming that "like cures like" and dilution increases potency, you should be able to take real amounts of something, determine what it does to you, and then use potentized amounts to counter those symptoms.

How can they rationalise doing provings with homeopathic doses and not realize that it cannot work unless there really are potential bad side-effects from homeopathics?

Are there really people who say "It's absolutely safe, it will only help you" and also say "Oooh, make sure you go to a real practitioner because if you take the wrong thing you could get sick and die"?

Oh, what am I thinking. Of course there are people like that. I bet they even say it in the same paragraph.

Bleahh.

[MRC_Hans]

I think Dr.A has a good point here. I'm sure it's been discussed before, but this is sort on inconsistent with a major part of the "theory" behind homeopathy.

Not quite, because it is part of homeopathic doctrine that disease is only manifest as symptoms. The remedy does not cause you to be ill, i mimicks the symptom profile of the illnes.

OK, assuming that "like cures like" and dilution increases potency, you should be able to take real amounts of something, determine what it does to you, and then use potentized amounts to counter those symptoms.

Strictly speaking, that is isopathy, however, homeopaths are indeed concerned about remedies antidoting themselves. So, in classical homeopathy, the potency is often increased ('plussed') for each administration. This is usually done by dissolving the remedy in water, giving the container a couple of wacks, then taking the remedy. Yes, that is really what they do.

How can they rationalise doing provings with homeopathic doses and not realize that it cannot work unless there really are potential bad side-effects from homeopathics?

The idea is that the properties of the highly potentized remedies are of a "spiritual" nature (Hahemann's term, but it has never been clear exactly what he means), and that the body somehow seeks out the right effects of the sometimes 1000+ ones listed for the remedy. I have seen homeopaths explain it as a resinance phenomenon.

Obviously, the logic is raher loop-sided here, since if that was the case, you should just mix three or four of the so-called polycrests (remedies with thousands of symptoms in their list) and you would have a catch-all with the body resonancing out whatever it needed. Seems that is to thick, even for homeopaths, however.

Are there really people who say "It's absolutely safe, it will only help you" and also say "Oooh, make sure you go to a real practitioner because if you take the wrong thing you could get sick and die"?

Oh, what am I thinking. Of course there are people like that. I bet they even say it in the same paragraph.

Bleahh.At least, they are quite ambiguous about it, plus their opinions differ. Some blithely claim that homeopathy is harmless, no matter what, others concede that there might be risks involved in vrongly prescribed remedies. At this point, there is usually a unified thrust to change the subject and talk about side-effect in conventional meds, instead ;).

Hans

[H'ethetheth]

No, that is not how it's supposed to work.

I wrote a short article here: http://www.hans-egebo.dk/skeptic/Homeopathy%20article.htm

Perhaps that can clear up the basic concepts.

HansBut if proving works like that, I cannot see a way in which a patient could avoid the sitiuation in which she has to keep taking the remedy until the symptoms persist or, at best, reappear.

That strikes me as a debilitatingly silly notion.

'Plussing' the remedy would only work if the plussed remedy itself does not cause symptoms in healthy people. Do they claim this?

[MRC_Hans]

But if proving works like that, I cannot see a way in which a patient could avoid the sitiuation in which she has to keep taking the remedy until the symptoms persist or, at best, reappear.

That strikes me as a debilitatingly silly notion.

In classical homeopathy, Hahnemann emphasizes the "single dose", that is he gives a dose, and waits for the result. If there is no reaction, he plusses it, and gives a new dose. This continues till there is "aggravation" or the patient "proves" the remedy. If there is no cure, the case is re-taken and a new remedy is found.

Nowadays, few homeopaths really practice classical homeopathy, and some even advocate taking a remedy daily, for life.

'Plussing' the remedy would only work if the plussed remedy itself does not cause symptoms in healthy people. Do they claim this?

No, the idea is that the remedy must gain strength to overcome the disease.

Hans

[H'ethetheth]

In classical homeopathy, Hahnemann emphasizes the "single dose", that is he gives a dose, and waits for the result. If there is no reaction, he plusses it, and gives a new dose. This continues till there is "aggravation" or the patient "proves" the remedy. If there is no cure, the case is re-taken and a new remedy is found.

Nowadays, few homeopaths really practice classical homeopathy, and some even advocate taking a remedy daily, for life.



No, the idea is that the remedy must gain strength to overcome the disease.

HansOkay, much clearer now. Thanks.

[Zep]

The "daily remedy for life" Hans speaks of is called a person's "constitutional" remedy. Another term defined, I hope.

[Paul C. Anagnostopoulos]

Yeah, this doesn't make any sense, even in the nonsensical world of homeopathy.

The idea is that some substance that produces symptoms similar to that of a disease when given full strength to a healthy person, should alleviate the disease when given in homeopathic doses to a sick person. Provings are used to determine the symptoms produced by the full-strength substance.

It makes no sense to use homeopathic dilutions for provings, unless the real theory is:

The idea is that some substance that produces symptoms similar to that of a disease when given in homeopathic doses to a healthy person, should alleviate the disease when given in homeopathic doses to a sick person.

This makes the entire process even more complex, because now you have to worry about exactly how healthy and sick the people are, exactly what the homepathic dilutions need to be, and the fact that you never used the substance at any measurable strength.

~~ Paul

[Paul C. Anagnostopoulos]

Hang on, I may be confused about provings. Don't you prove a substance in order to find out which symptoms it causes, so you can decide which diseases to treat it with? You go into a proving without any biases about which symptoms it will cause, right?

So this study must have looked for a skew in the symptoms reported by the subjects: Certain symptoms that appeared more often than with placebo, so that those symptoms could be called out as the important ones for the particular substances tested. Does the data show that certain symptoms were more common?

~~ Paul

[steenkh]

So this study must have looked for a skew in the symptoms reported by the subjects: Certain symptoms that appeared more often than with placebo, so that those symptoms could be called out as the important ones for the particular substances tested. Does the data show that certain symptoms were more common?
I believe that homoeopaths expect placebo to produce no symptoms at all, so they are essentially looking for any kind of symptoms. It should be very worrying for them to find that the placebo group also developed symptoms, which proves at least that the blinding of the provers was partly effective, and that they were homoeopathy believers. It could also mean that they are lowering the treshold for the symptoms that they are looking for, and essentially report "symptoms" that could have been reported even by healthy people.

In every discussion I have had with homoeopaths, they have decided to ignore the inconvenient fact that placebo causes the same or similar symptoms. They are just happy, if they can spot a difference, even if it can be explained by the small number of test persons or animals that they use.

[Paul C. Anagnostopoulos]

I believe that homoeopaths expect placebo to produce no symptoms at all, so they are essentially looking for any kind of symptoms.
But that's ridiculous. :D The only way controls would have no symptoms at all is if they never got sick, tired, worn out from exercise, psychologically upset, and so forth. But if that never happens, then there is no need for homeopathic remedies at all, or any other medicine for that matter.

~~ Paul

[steenkh]

But that's ridiculous. :D The only way controls would have no symptoms at all is if they never got sick, tired, worn out from exercise, psychologically upset, and so forth. But if that never happens, then there is no need for homeopathic remedies at all, or any other medicine for that matter.
They often regard it as a kind of insult that they have to compare their remedies to placebo, because it implies that homoeopathic remedies might not work. And this comes from their expectation that placebo would not work at all. They would rather not contemplate that placebo could in any way be similar to what they experience with their potions.

[Zep]

It seems to stem from their very incomplete understanding of how testing actually works, and the (very simple to understand) theory behind it. Behind that stands a more basic and frequent common factor - they tend to be uneducated in maths and the sciences generally.

The exceptions to this condition, those who are well-educated but who publish reports like this, tend to have vested interests to pander to (usually in the form of their own job-security).

[MRC_Hans]

The "daily remedy for life" Hans speaks of is called a person's "constitutional" remedy. Another term defined, I hope.Yes, and the "Joe de Livera method" ;).

Joe is someone who has no education in medicine or homeopathy, but thinks he has found a miracle cure for practically everything, which consists of taking Arnica 30C daily. His evidence is that he is over 70 and doing fine. Even many homeopaths laugh at Joe.

Joe, OTOH, takes himself VERY seriously :roll:.

Hans

[Nucular]

They often regard it as a kind of insult that they have to compare their remedies to placebo, because it implies that homoeopathic remedies might not work. And this comes from their expectation that placebo would not work at all. They would rather not contemplate that placebo could in any way be similar to what they experience with their potions.
True for some, I think, but not necessarily all. In the bit I quoted above, which I'll quote again for your viewing pleasure, two of the authors of the study in the OP regard placebo as the body's endogenous healing mechanism, just the same mechanism which is supposed to be more effectively stimulated by homeopathy, implying (they argue) a more complex relationship between homeopathy and placebo. Homeopathy is a morecebo? Ah, neologisms.

But I guess some of the inconsistency comes from the fact that there is much disagreement as to even these basic ideas within homeopathy, something I've ineffectually pointed out elsewhere should mean proper research would help homeopaths sort out these problems, just as research in medicine helps medics sort out proper protocols and mechanisms, assuming the gist of homeopathy was true. But, deaf ears and all that.

The placebo ‘action’ is definitely not due to the activity of
the ‘inactive’ substance but to the intrinsic healing
capacities and response of the treated subject. This
response is also the one that is expected to be triggered
by the homeopathic remedy. To successfully discriminate
between the placebo and remedy response it is
important to know the characteristics of the substance
given to the patient and the healing steps of the two
different clinical methods. Assuming that the extremely-
low dose remedy and the endogenous healing
mechanisms interact in a complex way, the final effect
is due to the product of these two factors and any
procedure decreasing the latter may markedly affect
the homeopathic cure, much more than the allopathic
drug effect.

[Zep]

Nucular, unfortunately you are investing them with too much ability and sense. The reality is that most homeopaths accept these (to us) obvious contradictions as "reality". Their "science" is so because they say it is so - don't expect any logic or reasoning to support it.

They win the argument by means of outright declaration and sticking their fingers in their ears. That's all.

[Badly Shaved Monkey]

removed

No. Homeopathically diluted and thus you have made an extremely strong point.

[Zep]

I've been emailed a copy of the original article by a kind poster here. I believe I can see some issues with what they have done, including what may be a rather obvious and incorrect assumption. My interest in the subject has revived, so let me just write up some stuff then pass it by a few people here for peer-review first.

[brodski]

No. Homeopathically diluted and thus you have made an extremely strong point.
:p

[steenkh]

True for some, I think, but not necessarily all. In the bit I quoted above, which I'll quote again for your viewing pleasure, two of the authors of the study in the OP regard placebo as the body's endogenous healing mechanism, just the same mechanism which is supposed to be more effectively stimulated by homeopathy, implying (they argue) a more complex relationship between homeopathy and placebo. Homeopathy is a morecebo? Ah, neologisms.
You are quite right. Even if they acknowledge placebo as a factor to reckon with, they tend to think that because placebo is so close in effect to their own favorite healing system, it must be because placebo is a powerful healing agent.

In reality, of course, placebo is not the name of a mysterious healing force, but the name of a treament that does nothing. And healings that happen anyway are mostly caused by the natural healing power of the immune system, or the misdiagnosing of either the illness or the cured state!

[Deetee]

So this study must have looked for a skew in the symptoms reported by the subjects: Certain symptoms that appeared more often than with placebo, so that those symptoms could be called out as the important ones for the particular substances tested. Does the data show that certain symptoms were more common?
~~ PaulThe study did categorise symptoms, and all study subjects (who were "volunteers from homeopathy schools or people interested in homeopathy") were trained over a 2 week run in period to recognise what were relevant symptoms.

Symptoms were also categorised as common, previous, cured and exceptional (with an accompanying wishy-washy explanation as to these definitions).

So if someone had a sensation of numbness for a week, then this is effectively counted as 7 symptoms, since symptoms were added up on a day to day basis. The study authors are quite open about the way they double up groups and pool data in this way to "increase the statistical power" - apparently "pooling is permissable when the analyst does not look for the quality of the symptoms or how much placebo symptoms resemble the verum ones"
:eek:

The potential for bias in the collection of this type of data is huge - with only a tiny number of people in each group, all you need is one person who experiences significantly more or less syptoms than their peers to skew the totals quite wildly.

I have no idea if there was any symptom-reporting consistency between the individuals - the paper does not indicate this - in practice in a modern scientific trial any outliers might be excluded from the analysis. But if you have only 3 people in a placebo group, one gets 20 symptoms on day one during his proving, one gets 12 and one gets 4, how do you know whether your outlier is the one with the most symptoms or the least? I cannot see why this "Multicentre" trial recruited such a small number of subjects - if there were 50 people in each group then I would be prepared to accept the statistical significances we are told, but in groups with so few people???

Another interesting phenomenon that the trial shows is that symptoms decline over 1 month to return to baseline. Now I don't know what this means, but isn't it strange that a homeopathic remedy should "lose" its effect in this way?

One quote from the trial discussion:
The group taking verum experienced more ‘‘old symptoms’’ (which had not occurred for at least 1 year) than the placebo groups (particularly for mental symptoms). A possible interpretation of this finding may be that each person, even apparently healthy at the moment of the experiment, has his/her own complex pathobiographic history and the remedy, when effective, has the power to trigger an homeodynamic change in the direction of previous equilibria characterized by old symptoms, which have subsequently disappeared. Such an interpretation is consistent with a complexity theory interpretation of how the body functions and how the homeopathic medicines may work.
These people seem to operate in a parallel scientific universe. Ignoring the fact that their trials seek to elicit rather arbitrary and strangely-defined symptoms, their medical/scientific terminology is also incomprehensible. Admittedly I am not a homeopath, but I have had medical training and I don't know what these guys are on about.

Oh, and finally, this trial did NOT seek approval form the bioethical committee - reason being that trials of homeopathy "are not considered by the Italian National Bioethical Committee." So that's alright then? - any trial in which virtually everyone receiving an "active" component experienced symptoms in my view needs to pass ethics approval. So who peer-reviewed this paper? Homeopaths. Which journal accepted it? Homeopathy.

[Elaedith]

Table 2 shoes both total number of symptoms and number of symptoms per prover. I am assuming that their t test analysis is computed on the mean number of symptoms per prover.

The t test is sensitive to violations of normality and homogeneity with small sample sizes. You would normally expect at least 10 per condition to be robust. Notice that they point out the data shown in Table 3 was normally distributed, although this is somewhat irrelevant because that data was analysed using a non-parametric test. However, the parametric t test was used for the data in Table 2 and they fail to describe the distribution for this data. However, you can see that the standard error is much larger (5.85) for the verum-1 condition that produced the highest number of symptoms, compared with that in the verum-2 (1.05) condition. That would be consistent with one or two participants in the verum-1 condition reporting an unusually high number of symptoms.

[Cynric]

No, that is not how it's supposed to work.

I wrote a short article here: http://www.hans-egebo.dk/skeptic/Homeopathy%20article.htm

Perhaps that can clear up the basic concepts.

Hans

That's a really good article Hans. Thanks for that.