Three weeks ago I attended a public lecture entitled Medicine and Homeopathy.
The latest from Melbourne University Health Initiative, the lineup included homeopath Isaac Golden and chiropractor Simon Floreani to present the argument for homeopathy. Public health physician and medical activist Dr. Ken Harvey and GP Dr. Stephen Basser, one of Australia’s most accomplished critics and analysts of alternatives to medicine, held the fort for medicine.
All but Stephen Basser feature in this video examining claims made by Isaac Golden about homeoprophylaxis. I was confident Golden would pull off a pleasant well meaning presence and equally confident Floreani would flounder and fall. As it turned out he never arrived, leaving Golden to retrace the tired old footsteps he’s been doing for years all by himself.
There’s a few things that I found novel. Golden was quick to label the Cuban homeopathic immunisation study (see video above) as “an intervention”, not a trial. This in one swipe silenced many a prepared question including my own over how the “immunised” demographic returned to levels of Leptospirosis infection similar to those found elsewhere in Cuba (non “immunised”). The “intervention”, which is quoted by homeopaths as hard evidence of efficacy is often criticised for poor methodology, lacking a control group and inexplicably failing to randomise subjects.
So by renaming it an “intervention” Golden could proclaim to have “evidence” and dismiss questions raised about its veracity being flawed due to poor trial practice. Throughout the “intervention” paper the rest of Cuba (RC) is presented where and how a control would normally be presented in a trial. Defenders of the caper point to RC as a quasi-control when it suits the need to convey comparative difference. Thus, Isaac has invented a nifty escape clause from defending poor methodology.
Another point (in fact an inexcusable failing) was Golden’s inability to address what is at once one of the least complex problems, but perhaps the most important. The entire Cuban scam is not Hahnemannian homeopathy. By no means am I the first to note this. It’s more of what I call Supercalifragilistichomeoprophylaxis.
During the evening Isaac Golden made much of remaining true to Samuel Hahnemann’s Law of Similars and Law of Infinitesimals. The Law of Similars is sometimes known as “like cures like” and states that a mother tincture should be made from a substance which produces symptoms similar to that produced by the disease.
Yet in the Cuban study they used four dead – completely inactive – strains of Leptospira bacteria to make the mother tincture. The paper refers to “highly-diluted strains of inactivated leptospiras”. However the paper title is, Large-scale application of highly-diluted bacteria for Leptospirosis epidemic control. Plainly that is misleading in itself.
So I pointed out to Isaac that in view of his insistence upon the law of similars, and noting that the Cuban mother tincture didn’t contain a substance that could produce any symptom like those experienced with leptospirosis (the bacteria were always dead), he had a problem. Confident, he responded that no, it’s not like a traditional vaccine.
Another audience member ran it by him again. Isaac was confused. Ken Harvey explained the problem also. Then I spelled out the obvious. Without the Law of Similars, there’s no Law of Infinitesimals. But he didn’t hear. Clearly stumped, his mind was cranking over. Eventually he produced the claim that the dead bacteria still had the “energy shape” or “energy signature” and were thus still viable. Quickly he turned and selected another questioner.
I was delighted. Isaac Golden had just told me an “energy shape” could produce similar symptoms to live bacteria. But even better, he’d made it up on the spot. After earlier signing his name to the Law of Similars, he then denied its necessity. I still wanted to press the point as this excuse couldn’t explain the “blood, puss, discharge, urine, flesh, causal organisms…”, and other organic goo used in highly dilute nosodes.
No Law of Infinitesimals either with no Similars. We never really made it to discuss that point. But I already had my answer in that he had no answer. For the record, the beaker for the most dilute agent was washed out 9,999 times. On the 10,000th refill it was called a homeopathic immunising agent. That’s not highly diluted – that’s washed away. The less potent (less dilute) was washed out 199 times.
It was Supercalifragilistichomeoprophylaxis if ever I’d seen it. Remember dear reader a nosode is a homeopathic dose. Golden had earlier used the term. Its definition – in this case – demands “causal organisms”. Energy shape just didn’t make it. The audience member who helped Isaac understand wrote, “Get out of jail free” on his notepad and slid it my way. I had to agree. We know homeopaths make it up as they go along, but it was really nice to be there to see that actually happen.
It was truly a Golden moment.
Other points deserve a mention. Already referring patients to conventional doctors, Isaac came across as keen to extend conventional connections and is striving to make something of a research base. He does not entertain the “us and them” combative mindset of the Monika Milka’s and anti-vaxxer types we know and love, and appeared genuinely keen to reciprocate with bilateral trials. One concern was his allusion to conspiracies, when it was pointed out that if efficacy was truly and constantly demonstrable that widespread use and marketing would already be apparent.
One couldn’t miss however that the totality of discourse and questioning was biased toward examining the claims made by Isaac. He did after all kick off by stressing he heals the “entire person”. This means mental, physical, personal, spiritual and probably “quantumal” for all I know. This was “natural medicine” to Isaac. Getting the human healing abilities to function on these levels.
We were promised lots of evidence but regrettably a few excuses related to third parties were raised. Aside from the Cuban standard, Isaac brought in the Swiss “study”. Written by pro-complementary medicine interests for governmental review and favouring popular demand it was a poor choice as the material is known to be highly selective in favour of homeopathy. Isaac appealed to popularity and use as equating to efficacy a number of times.
Dr. Stephen Basser’s deconstruction of why homeopathy is so widely used, sought after and applied by medical professionals was excellent. It highlighted the factors outside of efficacy that drive uptake and continued use of demonstrably non efficacious options. Patient request or demand, choice of placebo, doctors’ role in monitoring complex patients, marketing, what it’s actually used for and the context of these figures.
I’ve noted here before how chiropractors boast how many Aussies per day use chiropractic – after signing them into treatment contracts. Purchasing 100 doses of a homeopathic preparation doesn’t support it being entirely used. Nor do uptake figures represent clearly articulated failures – and dissatisfaction. What is regular? What is novel or first time? And so on. In short there is no association between popularity and efficacy. Or between demand and documented efficacy.
Ken harvey brought up the point I’d have guessed most would have asked at question time. Golden claims to have completed his PhD successfully in homeopathic immunisation. In Golden’s abstract we read:
The effectiveness of the program could not be established with statistical certainty given the limited sample size and the low probability of acquiring an infectious disease.
This didn’t stop Golden from then claiming:
However, a possible level of effectiveness of 90.3% was identified subject to specified limitations. Further research to confirm the effectiveness of the program is justified.
Despite defending the semantics on the night, it’s clear this air guitar of a PhD has only mused over a possibility.
One thing agreed on at the beginning was to not discuss the mechanisms of homeopathy. In other words, to avoid raising the fact it is physically impossible. This did allow the discussion to move forward. In essence, Golden was awarded a huge concession with respect to reality. Something of a microcosm of the larger homeopathic industry perhaps.
All up it was an interesting night given that no new evidence popped up to support homeopathy. Like many homeopaths Isaac really believes in it.
He just needs to conclude that ones belief is not truth.