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In memoriam: Dr Peter Fisher

I 've just received the sad news of the death of Dr Peter Fisher in a cycling accident in High Holborn, near The Royal London Hospital for Integrated Medicine, where he had been a leading clinician for many years.

Peter was a good friend and colleague in my years at the hospital, where he was consultant physician and Director of Research, as well as Editor-in-Chief of the journal Homeopathy. He was a convinced homeopath but always took an evidence-based approach to the subject; for example, he criticised opposition to vaccination on the part of some homeopaths as unscientific (and contrary to homeopathic principle).. Nevertheless he was largely responsible for changing the name of the hospital from The Royal London Homeopathic Hospital to its present form in 2010. This was a wise move which reflected the fact that the hospital now offers a range of complementary treatments, always in the wider context of modern clinical medicine.

Peter's death will be an irreplaceable loss to British homeopathy.

Water companies use dowsing to find leaks

Today's Daily Mirror reports that an engineer working for the Severn Trent water company used dowsing to search for a leak at a property. The property owners' daughter, who is studying for a Ph.D in evolutionary biology at Oxford University, contacted the water company; they confirmed that some of their engineers practise dowsing and they have no objection. She then wrote to other water companies and found that nine of them used dowsing.

Dowsing is generally regarded as pseudo-science. Wikipedia lists a number of scientific studies of the practice that have been conducted since the early twentieth century; they have almost uniformly found the results were no better than chance.

A number of homeopaths use dowsing, usually with a pendulum, to choose their medicines. In the 1980s, when I was a physician at The Royal London Homeopathic Hospital (now The Royal London Hospital for Integrated Medicine), I contacted a dowsers' society to ask if their members were willing to take part in a trial to see if they could distinguish real homeopathic medicines from placebos. They agreed to do this and I started to set up the trial, but unfortunately they then backed out.

Homeopathy - a celebrity's endorsement or not?

The Faculty of Homeopathy is drawing the attention of supporters to "an excellent article" in The Mail Online.

This link takes you to a page where the actress Michelle Collins, who has appeared in East Enders and Coronation Street, describes how she gave up conventional medicine and moved to homeopathy to help her anxiety and depression. This was successful and she now feels much better.

But what is odd about this recommendation by the Faculty is that the article has an inset with a "Expert View" by Dr Ellie Cannon, who says that she does not reommend homeopathy to her patients because more than 150 trials have failed to show that it works.

Homeopathy’s dilution theory – that water ‘remembers’ the active ingredients it comes into contact with – is implausible. If it were true, water would also remember other substances – bacteria, animal waste or the test-tube the remedy was made in.

So how do I explain the positive effects some people experience? Michelle had crucial time and input from a therapist who listened to her worries. It helped her develop a positive mental attitude about coping with her anxiety. I believe it is this that has led to the improvement in her condition.

The placebo effect is real and powerful. So even though the pills are inert, treatment will ease the symptoms of stress. That is why taking a remedy before a show helps to control the panic. But the pill itself could just as well be a sugar lump.

Given the traumatic times Michelle has had, it is so important that she has found something that works for her. But as a general solution for others it would not work.

I think that Dr Collins gets it exactly right here. Homeopathy is best regarded as a form of psychotherapy. Please see my book Homeopathy in Perspective.

Psychotherapy today uses many different theories but it originated with Freud and psychoanalysis. The psychiatrist Anthony Storr was sceptical about much psychoanalytic theory but nevertheless thought that psychoanalysis could have beneficial effects on patients.
. . .
Much or all of homeopathic theory may be mistaken, and the remedies themselves may have little objective efficacy or even none at all, but patients often get better nevertheless. To say that this is due to the placebo effect is to beg the question, because we have only hazy notions about how placebos work anyway. For many patients, especially those whose symptoms really arise from their life situation, merely stating their problems verbally is sometimes enough to put them in a new light and to suggest the direction to look for a solution. In such cases the therapist is merely a sounding board; indeed, even a computer will do as a listener for some people. Many others do need a human individual to interact with, however.

So is the therapist no more than a sympathetic friend? No; this is where the theory comes in. It often doesn’t matter much what a therapist’s theoretical beliefs are (provided they are not actually dangerous, of course); their function in many cases is not to be “right” but to provide a framework to keep the discussion in focus.

Michelle's endorsement illustrates this extremely well.

Scepticism, homeopathy, and the Swiss Government report

For some reason the fact that the Swiss Government had produced a favourable report on homeopathy had escaped my notice until today, but when I learnt of it I looked it up on the net. This brought me to the Quackometer site, which has a discussion of the report called The Swizz report on homeopathy.

Well, of course, you'd expect the Quackometer to be critical of a report that supports homeopathy, but fortunately their piece contains some quotations from the Swiss article which help us to make up our own minds..

The current thinking and research of mainstream medicine are influenced mainly by Newton’s mechanistic and strictly causal-analytical physics (classical reductionist biomedical model), which ignores the more complex phenomena of nature, the organism’s systemic correlations, its life processes and overall regulation, and life as a whole, as well as qualitative experiences and the phenomena of spiritual science.

This passage is a complete give-away, particularly the reference to spiritual science. This will no doubt puzzle many readers, but anyone who knows anything about Anthroposophy, the so-called "Spiritual Science" founded by the philosopher and mystic Rudolf Steiner in the first half of the twentieth century, will recognise the term at once. It seems certain that Anthroposophical influences helped to shape the authors' conclusions.

So Newton is outmoded and a waste of time but science is not a total washout, it seems. Further on, predictably, we are told that homeopathy is supported by quantum physics.

Modern physics with its theory of relativity and quantum physics has long overtaken Newtonian mechanics and is paving the way for an understanding of the homeopathic mechanism of action.

Since few of us who are not trained physicists have any deep understanding of quantum mechanics or relativity we mostly have to rely on non-mathematical descriptions of these things written for readers like us. Some of these are very good, but physicists assure us that verbal accounts cannot give an in-depth understanding of the matter. Quantum mechanics is often invoked to explain the action of highly dilute homeopathic medicines. Often, I think, this amounts to little more than asserting that quantum mechanics and homeopathy are both mysterious, so they ought work in the same way. Moreover, if science can tolerate the paradoxes of quantum mechanics, why baulk at homeopathy?

Just to round off, I should point out that we even get the long-discredited idea of the vital force.

The vital force, just as vitality in general, cannot be measured and quantified by science, but it exists as a phenomenon.

I admit I haven't read the whole of this (long) report and perhaps some parts of it are better. But at least it seems clear that its authors are hostile to the values of the Enlightenment, which is enough to move it a long way down my reading list.

Homeopathy in the NHS

The Science and Technology Committee of the House of Commons concluded in February that homeopathy is a placebo treatment that should no longer be provided by the NHS, mainly because it entailed deception of patients which could do damage to the doctor-patient relationship. In its official response, published on 26 July, the government said: "... we do not believe that this risk amounts to a risk to patient trust, nor do we believe that the risk is sufficient enough for the Department to take the unusual step of removing PCTs' flexibility to make their own decisions."

Whatever one may think about the government's view (which seems to me to be a first-class example of buck-passing), "sufficient enough" is an absurd pleonasm.

Is homeopathy witchcraft?

According to Dr Tom Dolphin, deputy chairman of the junior doctors' committee of the BMA, homeopathy is witchcraft and should not be offered as a treatment by the NHS. This view was apparently overwhelmingly endorsed by a vote at the annual conference of junior doctors, according to The Telegraph. Clearly homeopathy is going to be increasingly under attack in the present straitened financial circumstances of the NHS.

Witchcraft seems a little harsh. Homeopathic remedies may have no effect beyond that of a placebo but that is not the whole story. A homeopathic consultation is typically lengthy (an hour or more), and during that time the patient discusses his or her situation in a structured environment. The homeopath is not asking questions at random but is constructing a therapeutic context that has meaning for the patient, and many people find this to be valuable. it may help them to see their problems in a new light.

This is very similar to what happens in counselling. The theories used by counsellors may have little or no validity but many patients nevertheless find the experience valuable. I think that homeopathy can best be thought of as a form of psychotherapy. If you like to call this witchcraft, so be it; but in many traditional societies "witchdoctors" provide an important psychotherapeutic service for their clients.

There are many similarities between homeopathy and psychoanalysis. Both have been denounced as lacking a scientific basis. Both were invented by doctors (Hahnemann, Freud) but were taken up mainly by practitioners without a medical training. And both elicit extreme loyalty among their adherents.

Homeopathy sceptics' demonstration

On 30 January over 300 homeopathic sceptics will publicly swallow a bottleful of homeopathic tablets to demonstrate that they suffer no ill effects. This reminds me of an experience many years ago: a casualty officer rang the Royal London Homeopathic Hospital to say that a child had been brought in having swallowed a lot of homeopathic tablets. Should she wash out the child's stomach? I was able to reassure her that there was no need to do anything. So what should she do? "Nothing,", I said, though in retrospect I wish I'd told her to warn the mother to be more careful with her prescription medicines in future because another time she might not be so lucky.

The demonstration to be staged next Saturday will be good theatre, I suppose, but it won't do much to clarify the issues. My book Homeopathy in Perspective gives plenty of information for anyone who really wants to know about the subject.

Homeopathy doesn't prevent malaria

Homeopathy is in the news again today. An undercover survey has produced ten homeopaths who advised people that they could take homeopathic medicines as an alternative to conventional antimalarial prophylaxis. Dr Peter Fisher at The Royal London Homeopathic Hospital pointed out that there was no evidence for such claims and that they made no sense in homeopathic theory, but it seems unlikely that such denials will undo the harm that has been done by the irresponsible claims already made.

When I was at the hospital I quite often had to explain to patients that there was no homeopathic alternative to conventional immunisation against such diseases as whooping cough, measles, or rubella. Irresponsible claims to the contrary were quite common at that time.

Homeopathy and the Quantum

If you read the journal Homeopathy with any regularity you will have seen a series of articles by LR Milgrom and others advancing theories about how homeopathy may work by quantum entanglement. Milgrom himself stated that this was supposed to be a metaphor, but others seem to have taken it more literally as an explanation for what may be going on.

Although no one has a fully satisfactory theory about how homeopathic medicines might work, the general assumption has been that they do so thanks to some property of the medicines themselves. Theories of this kind treat homeopathic medicines as approximately equivalent to conventional drugs, although no doubt working in a different way.

There has however always been a tendency for some enthusiasts to seek for more esoteric explanations, and in recent years these have sometimes invoked quantum mechanics for the purpose. For some, part of the appeal of these ideas is that they seem to allow homeopathy to get away from linear thinking and conventional pharmacology.

An important notion here is that of quantum non-locality. Quantum entanglement refers to a strange phenomenon whereby the properties of a particle pair can be instantaneously related even if they are at opposite ends of the universe. This is certainly a lot more mysterious than homeopathy but it is mainstream science, fully accepted within conventional physics.

Applying this idea to homeopathy, the authors of these recent papers have postulated a network of relationships involving the patient, the homeopathic medicine, the prescriber, and even the manufacturer of the medicine. Many combinations are possible and the field for speculation is wide open.

One difficulty, of course, is that particle physics is concerned with the very small and it is unclear whether quantum non-locality can be applied to the world of patients and medicines. As the Editor of Homeopathy, Peter Fisher, remarked in the journal in January 2003, quantum non-locality has been invoked in other contentious areas, such as distant healing and parapsychology. He thinks, I'm sure correctly, that many homeopaths would be uneasy to find their form of therapy placed alongside these things. Fisher returned to the subject in another editorial in October 2004, pointing out that the apparent efficacy of self-prescribed homeopathic medicines seems to pose difficulties for
theories of this kind.

I have myself always noted a similarity between homeopathy and parapsychology. Both have a long history; both are largely rejected by mainstream science although supported by a small number of scientifically trained enthusiasts; both have tried to provide evidence for the validity of their claims by means of scientific research, which has not been universally recognized as valid; both are bedevilled by a lack of plausible theory to explain how they might work.

Although the authors who have taken part in the recent debate in the journal have favoured different versions of the quantum non-locality idea, all do at least agree that there is something to be explained. That is, they all think that homeopathy has real effects over and beyond the placebo response.

It has to be said, however, that this has not been conclusively demonstrated to the satisfaction of everyone. In another editorial in April 2003, E. Ernst gave it as his opinion that, in spite of all the research to date, we still are unable to say with any certainty that homeopathy is more than a placebo. If he is right, there is little point in pursuing complex and probably unverifiable speculations about how it is supposed to work.

Homeopathic research will never be decisive

Yesterday's BBC Horizon programme was on cold fusion, which most people thought was a dead duck after widespread failure to replicate the original claims by Ponds and Fleischmann. (Even Fleischmann, it appears, now accepts that these claims were mistaken.) However, Dr Rusi Taleyarkhan at Oak Ridge National Laboratory has recently revived cold fusion using a different technique based on sonoluminescence. His research has been published in the leading US science journal, although not everyone in the field accepts his claims. Horizon set out to replicate his work and see if in fact neutrons were being generated. The attempt failed. Horizon asked Taleyarkhan to comment; he said that the failure was due to not following his technique sufficiently accurately.

All this is oddly reminiscent of the claims and counter-claims that have dogged other contentious research such as that into homeopathic dilutions. Homeopaths claim that the highly dilute solutions they use (so highly dilute that there should be no molecules of the original substance left) reveal astonishing properties of water. The late Jacques Beneviste published research on this question in Nature and the consequent furore largely put paid to his scientific career. However, research on homeopathic dilutions still continues and positive results continue to be claimed.

One big difference between homeopathy and cold fusion is the amount of attention they receive. If cold fusion were ever shown to work the results would be enormously significant. We would have a cheap pollution-free and inexhaustible source of energy for ever. Homeopathy, in contrast, is very small beer. So while cold fusion attracts millions of dollars of funding and is focused on by research groups all over the world, homeopathic research has to be carried out on the proverbial shoe string. As a result, I doubt if a consensus about it will ever be reached.

In fact, Horizon did do their own research on homeopathy last year and, as in the present case, they reached a negative conclusion. Predictably, this did not have more than a minor effect on homeopaths, who simply dismissed the research as flawed, for much the same reasons as Taleyarkhan.