I am very pleased to publish my blog’s first guest post. A reader contacted me a little while ago to see if I would take a look at an essay he had written debunking some of the nonsense that What Doctors Don’t Tell You had written about homeopathy, and although I don’t generally do guest posts, I thought that his piece would be useful to others as an exercise in spotting false information, a rebuke of WDDTY, and a reference for the flaws in many arguments in favor of homeopathy. Therefore, I offered to post it here. Enjoy.

I want to explain the problems with an article found in What Doctors Don’t Tell You (WDDTY) titled “The doctors’ case for homeopathy.” This piece is full of misinformation, and it serves as an ideal case study of what I’ve observed to be WDDTY’s typical behavior. Here’s the full list of problems I found with the article, which I will elaborate on below:

• Cherry picking throughout
• Making arguments that WDDTY itself admits are invalid
• Huge over-reliance on anecdotes
• Outright lies
• Referencing bad data/bad science
• Straw man fallacies
• Deceitful rhetoric, ad hominems, and hyperbole
• Missing references (that is, unsubstantiated claims)
• Non sequiturs coupled with hypocrisy
• Massive internal contradictions
• Misrepresenting information and quotes from trusted sources

…but all written in a manner that at first appears to be balanced, transparent, and thorough. It is none.

What follows should serve as:

1. A clear demonstration that the evidence WDDTY provides in favor of homeopathy is unreliable or wrong
2. A thorough indictment of WDDTY
3. A cursory lesson in recognising dishonest or fallacious arguments
4. A cursory lesson in good scientific practice, and good scientific writing

Let’s take a look at each of the problems:

 

Making arguments that WDDTY itself admits are invalid

The broad pattern of the article is:

1. Make a lengthy argument
2. Swiftly concede that the argument made is invalid
3. Move on to another (or, even, repeat the same) bad lengthy argument
4. Back to step 2.

Most of the article’s content is rendered useless by these two admissions alone:

• “Such stories can be dismissed as examples of a particularly dramatic placebo effect or even coincidence”
• “of course, the fact that pharmaceutical medicine has a poor evidence base doesn’t necessarily make a stronger case for homeopathy.”

With these two remarks the writers have dismissed most of their own arguments. But they know full well that readers will ingest the broad points they’ve made, and gloss over the admissions of their worthlessness. In fact, the subtle admission only makes them (falsely) appear so much more reasonable and balanced. Clever.

This article also claims that scientific studies are thoroughly unreliable, before trying to make a case for homeopathy, using… scientific studies! It’s a neat example of the kind of shameless cherry picking that WDDTY repeatedly uses.

 

Overreliance on anecdotes

“GPs who prescribe homeopathy acknowledge that their medicines’ mode of action is difficult to explain scientifically, but they cannot deny the often startling evidence of their own eyes.”

Yes, we can deny the evidence of our own eyes. We have to question such evidence, because we know how susceptible it is to (conscious or unconscious) bias, error and misinterpretation. Anyone who’s read Daniel Kahneman’s “Thinking, Fast and Slow” will know that our own interpretations of our own limited experiences are unreliable. This is why we perform blinded, randomized, controlled trials. The “evidence of our own eyes” regarding homeopathy is perfectly well explained by proven phenomena: the placebo effect, external confounders, and regression to the mean (a phenomenon whose named absence in a lengthy article pretending to be balanced about homeopathy is notable). WDDTY’s assertion here shows just how happy the magazine is to accept completely unreliable information — anecdotes — so long as it supports WDDTY’s position.

Remember, the anecdotes that make up most of this article “can be dismissed as examples of a particularly dramatic placebo effect or even coincidence”. So including them was just dishonest.

“…but they’re not uncommon.”

It’s true that anecdotes are not uncommon. They’re everywhere, and in support of anything you can name. Commonality of a belief doesn’t make it any more true.

 

Outright lies

Sadly, this is where WDDTY comes into its own.

“from the very beginning, there’s been a turf war between two opposing medical systems: the pharmaceutical doctors and the homeopathic doctors.”

There are no such things as “pharmaceutical doctors.” GPs use an extensive array of different treatments (including no treatment); some of those treatments are drugs. (Those same doctors would embrace homeopathic treatments if only the evidence supported them.) The obsessively black-and-white approach that WDDTY takes is insidious and only makes its advocates look simple.

“[In Europe] studies have shown that primary-care practices offering homeopathy have better patient outcomes than pharma-only practices, and often at lower cost.”

To repeat: there are no “pharma-only practices”.

“the monoculture of pharmaceutical drugs”

To repeat: there is no “monoculture of pharmaceutical drugs”.

“In 2010, [the British] Science and Technology Committee report recommended … banning any further homeopathic research”

Here’s what the report actually said:

“We would challenge Professor Harper’s comment that research funding should be directed towards exploring theories that are not scientifically plausible. Research funding is limited and highly competitive. The Government should continue its policy of funding the highest quality applications for important scientific research determined on the basis of peer review.” Then: “We recommend that the Government Chief Scientific Adviser and Professor Harper, Chief Scientist at the DH, get together to see if they can reach an agreed position on the question of whether there is any merit in research funding being directed towards the claimed modes of action of homeopathy.” Also: “There has been enough testing of homeopathy and plenty of evidence showing that it is not efficacious. Competition for research funding is fierce and we cannot see how further research on the efficacy of homeopathy is justified in the face of competing priorities. It is also unethical to enter patients into trials to answer questions that have been settled already.”

In the entire 275-page report, there is absolutely no mention of a research “ban”. WDDTY has taken the report’s clear, balanced and rational recommendation — to direct what limited funding is available towards new research that has at least a chance of yielding positive results — and turned it into “banning any further homeopathic research”: not just spin, but a complete lie.

(By the way, the report is a very good read for anyone sincerely interested in a clear, fair and logical analysis of homeopathy in the UK)

“It is depressing to see the interests of patients being threatened by a small posse of poorly informed and discourteous critics, who mix a little science with denigration and abuse”

The interests of patients are benefited, not threatened, by people highlighting that a popular treatment is ineffective. It’s no “small posse” of people who recognize the failure of homeopathy, and they’re not “poorly informed” – it’s practically the entire community of scientific and medical experts. And they don’t use “a little science” – they refer to the overwhelming consensus of the best available evidence.

WDDTY then claims that studies on animals and even plants have shown homeopathy treatments working better than placebos.

“All of this non-human evidence inherently rules out the dismissive ‘placebo-effect’ explanation.” / “homeopathic remedies have repeatedly been shown to have measurable effects on non-human biological systems, which inherently rules out the placebo effect”

No, it doesn’t. There are plenty of reasons to believe that placebo effects are in evidence in animals; not least that the effects of treatments are recorded by placebo-susceptible humans.

As for plants, this is arguably the low point of the article: WDDTY’s single stated reason to believe homeopathy benefits plants is a study in which 26 out of 30 homeopathic products failed; then when the test was repeated, three of the four remaining homeopathic products failed as well (in one of the preparations, the disease even got worse). And the single successful treatment (with “a small to medium effect size”)? A product for which the study’s authors state, “the exact composition … is not known” – in fact, it appears not to actually be homeopathic at all (a homeopathic version of that same product was one of the 29 that failed). WDDTY fails to mention any of these truths (as well as failing to mention that the journal the study is published in is notoriously shoddy). Citing this as favourable evidence is called p-hacking, and it’s notoriously deceitful (un)scientific behaviour.

To be as clear as possible: the data from this study suggest that homeopathy doesn’t work on plants, and WDDTY has used it (and as its sole reference) to claim that homeopathy does work on plants. It’s clear that WDDTY’s researchers are either completely incompetent or thoroughly dishonest, both to reference this journal and to misconstrue the information within it. Is this demonstrably dreadful magazine really a source that anyone would want to refer to or rely on?

“The war is not about evidence”.

The “war” – such as it is – is all about evidence. The evidence overwhelmingly shows that homeopathic remedies are nothing but placebos – if you’re prepared to look at all of the evidence, and separate the reliable evidence from the unreliable, rather than just referencing the (bad) studies that (do or can be spun to) support homeopathy.

“Because homeopathic medicines often contain not a single molecule of an active ingredient, opponents mock them as an affront to rationality—and indeed, a threat to the whole of science.”

Homeopathy isn’t “a threat to the whole of science” – the whole of science is a threat to homeopathy. If the evidence supported homeopathy, science would evolve to accommodate it. The evidence does not support homeopathy.(Here, for curiosity, is a non-exhaustive list of occasions when the scientific consensus moved on because of new evidence)

“Opponents make much of the ‘consistent failure to demonstrate effect beyond placebo’ when trials of homeopathy are studied; this is untrue.”

It only appears untrue if you accept poor evidence from bad studies, ignore good studies, and pretend anomalies are less statistically likely in good studies than they are. Which is to say, the claim that it’s untrue is itself fundamentally dishonest.

“However, after 70 years of being part of the NHS, homeopathy now faces extinction.”

Come on, no it doesn’t. Homeopathy is a booming business. (I admit this is speculation – I’ve found it extremely hard to come by reliable data on revenue or use of homeopathy; but I see no evidence that homeopathy is facing “extinction” or anything close to it. Boiron alone made a profit of €73.9 million in 2015)

“Clearly, both homeopathy and conventional medicine are on a par with each other when it comes to evidence-based medicine”

See the “bad data” section below for detail on why this is a lie.

“the NHS needs more homeopathy, say Britain’s 400 GPs who currently prescribe it.”

In this article, four – not 400 – GPs are quoted appearing to support homeopathy. As you’ll see in the “unsubstantiated claims” section below, GP referrals for homeopathy are “almost always at the patient’s request rather than as the result of a clinical decision”. It’s yet another outright lie to claim that “Britain’s 400 GPs who currently prescribe it [say] the NHS needs more homeopathy.”

This is WDDTY’s USP: helping people who believe in things disproven by science to convince themselves that they’re actually in good company, and that experts, evidence and science support their beliefs. In reality it’s lie after lie after lie.

“such stories [are] not uncommon”

It seems they are uncommon, since in a 3,700-word piece, WDDTY has only managed to find four GPs apparently prepared to tell such stories. (We know now that that’s because most of the 400 GPs WDDTY mentions probably don’t have such stories at all – they are, in fact, uncommon.) On top of this, I’m giving WDDTY the benefit of the doubt and assuming that the quotes from GPs are real; as you’ll see in the footnote at the end of this document, WDDTY is perfectly happy to make up quotes to support the most despicable lies.

“homeopathy—with its zero side-effects and arguably adequate reliability”

A serious examination shows that, despite trying really hard to do so, this article completely fails to demonstrate that homeopathic remedies have “arguably adequate reliability.” Indeed, the fact that the writers have to resort to the lies, misinterpretations, ad hominems and fallacies that they do suggests (correctly, as it happens) that there isn’t any good evidence that homeopathy has even arguably adequate reliability.

 

Referencing bad data/bad science

“An analysis of the responses to the homeopathic medicines revealed…”

The audit cited here (Tom Robinson in 2006) bears little resemblance to a scientific study. There’s no control, no placebo, no blinding. It’s not a study at all, just another series of anecdotes.

“Only 3 per cent of his [homeopathy] patients found their condition worsened following treatment”

Pointing out that ineffective remedies don’t usually make things worse is redundant. It’s not a point in favor of homeopathy.

“[Critics’] attacks echo those of the medieval Vatican against Galileo: it cannot be true, so it’s not.”

“It cannot be true, so it’s not” is a perfectly sound argument. It was wrong in the case of Galileo (if anyone even said it to him) because “it cannot be true” was a false claim. In the case of homeopathy: it cannot be true. So it’s not. (Also, and far more significantly: when it’s tested, it’s shown not to be true.)

By the way, the “Galileo Gambit” is a famous (and famously bad) debating technique.

“[Homeopathy’s] ultra-low doses are prepared by ‘serial dilution’ in water—adding a drop of the original medicine to 100 drops of water … homeopaths not only say such extreme dilutions work, but actually work better than the original medicine.”

Even WDDTY’s own writers appear not to have understood the basic theory of homeopathy. There is no “original medicine” to be diluted; only a substance that causes similar symptoms to those the patient is suffering.

“By the end of 2014, homeopathy had been tested in 104 RCTs for 61 different medical conditions: 41 per cent were positive; 5 per cent were negative; and 54 per cent were inconclusive. This track record is strikingly similar to conventional medicine’s. A 2007 analysis of a “large random sample” of RCTs of conventional treatments revealed that 44 per cent were ‘likely to be beneficial’, 7 per cent were ‘likely to be harmful’ and 49 per cent were inconclusive”

This statement about homeopathy studies is not, however, from a proper scientific review. It’s a claim from the Faculty of Homeopathy. WDDTY is comparing a peer-reviewed paper in the prestigious Journal of Evaluation in Clinical Practice to a dubious claim from the Faculty of Homeopathy. Putting the two in the same space and trying to draw a comparison is amateurish. Luckily the Lancet has performed a fair, direct comparison. Homeopathy came out worse.

Indeed, when serious meta-analyses are performed, it’s shown that “there are no health conditions for which there is reliable evidence that homeopathy is effective.”

Most of the studies WDDTY references appear to be any of:

1. not scientific studies at all, just more anecdotes
2. lacking controls, lacking blinding, lacking placebos
3. performed on worthlessly small sample sizes
4. published in poor quality journals – or even not published in a journal at all
5. demonstrating different (sometimes opposite!) results to the results WDDTY claims.

As ever, they’re all cherry picked to support WDDTY’s position, ignoring the bigger picture: that the results of hundreds of studies – the vast majority of good studies – overwhelmingly show homeopathy doesn’t work.

And a word about animal studies: animal studies, like case reports and case series (and like anecdotes), are first steps. They’re dipping your toes in the water to see if it’s warm. You use their results to determine whether further, human studies are worth running (and safe to do so). To reference an animal study with positive results when human studies have already shown negative results is thoroughly dishonest (just as referencing individual studies when there are meta-analyses demonstrating the opposite results is dishonest). It’s cherry picking, again. WDDTY’s writers are either incompetent not to know this, or dishonest to ignore it.

More on the hierarchy of scientific evidence can be found here.

 

Straw man fallacies

“Only a very few critics confine themselves to what they regard as scientific principles—people who believe that science knows everything about everything, and nothing remains to be explained—scientific ‘fundamentalists’, perhaps.”

There is literally nobody in existence “who believes that science knows everything about everything, and nothing remains to be explained”. The threat of “scientific fundamentalism” continues to be massively overstated. Pretending that the people highlighting homeopathy’s flaws are simple-minded “fundamentalists” is a cheap straw man. See the rhetoric section below for more on WDDTY’s attempt to paint a childish caricature of its opponents.

 

Deceitful rhetoric, ad hominems, and hyperbole

WDDTY pretty shameless in their use of absurdly melodramatic language (some of these are quotes that WDDTY simply features, but quotes that they fail to challenge):

• “propaganda campaign”
• “The Good Thinking Society (a name eerily close to Orwell’s dystopian “Ministry of Truth”)”
• “attacks echo those of the medieval Vatican”
• “tide of hostility”
• “vitriolic opponents”
• “the supposedly respectable British Medical Journal”
• “that arch-critic of homeopathy”
• “a small posse of poorly informed and discourteous critics”
• “scientific ‘fundamentalists’”

This shouldn’t be necessary in a serious scientific publication that can rely on the strength of its arguments. But when you strip out the misinformation, this childish rhetoric is all WDDTY has left. Of course, painting a paranoid picture of people who don’t share your beliefs as one-dimensional, conspiratorial villains makes it far easier to dismiss those people and the valid points they make.

 

Missing references (that is, unsubstantiated claims)

This is just bad practice: another reason to steer clear of the magazine (which on its Facebook page calls itself a journal; another lie):

• “Homeopathic medicines appear particularly effective at the extremes of age…”
• “Many GPs prescribe antibiotics for such conditions”
• “[In Europe] studies have shown that primary-care practices offering homeopathy have better patient outcomes than pharma-only practices”
• “One area where homeopathy has scientifically proved more effective than conventional drugs is with upper respiratory tract infections like flu, coughs, colds and sore throats.”
• “an appropriate homeopathic remedy, now shown to be effective according to ‘outcome studies’”
• “Britain’s 400 GPs who currently prescribe [homeopathy]”

I sought out the source of that final statistic, that 400 GPs (that’s all but 99.3% of them, by the way) currently prescribe homeopathy. The stat turned out to be yet another unsubstantiated claim from the Faculty of Homeopathy. Along my journey, I discovered that “a review carried out by West Kent NHS Primary Care Trust in 2007 found that [a referral for homeopathy] was almost always at the patient’s request rather than as the result of a clinical decision” (quote taken from Wikipedia; not the source, as the link was broken at time of writing). Even WDDTY’s attempts at appeal-to-authority fallacies are failures.

 

Non sequiturs coupled with hypocrisy and massive internal contradictions

“But over the past decade, conventional medicine itself has come under fire for having an equally poor evidence base…”

Conventional medicine allegedly having a poor evidence base is not an argument in favour of homeopathy (as the article itself admits moments later, thus demonstrating that this section was a waste of everyone’s time – except, again, for those people who will soak up the points presented and ignore the admission that they’re irrelevant). Ironically, WDDTY uses this section to suggest that scientific studies are practically worthless, then goes on to reference a load of scientific studies in homeopathy’s favor (two typical behaviors of proponents of flawed arguments: claiming evidence is unreliable except when it appears to be favorable; and trying to deflect attention to the flaws of others in order to avoid scrutiny of itself).

“Why should homeopathy be singled out?” asks Dr Kaplan. “To use evidence-based medicine to attack homeopathy exclusively and call for legislation against it, while huge swathes of conventional medicine lack evidence, is rather strange behaviour,” he says. “Double standards? That would be putting it euphemistically.””

Sure, if other treatments lack evidence, we should be acting against them too (and in many cases, we do, in contradiction of Kaplan’s lie that homeopathy is “exclusively” “attacked”). That’s not a reason to give homeopathy a free pass. Homeopathy gets so much attention focused on it because it’s so prominent. It gets attention focused on it because of all these anecdotes!

 

Misrepresenting information and quotes

“As a result, says Horton, “much of the scientific literature, perhaps half, may simply be untrue”.”

Logic of Science has addressed misuse of this quote specifically. Ironically the kind of papers that Horton suggests are “simply untrue” are the very ones that WDDTY repeatedly references. The unreliability of scientific papers is the very reason we strip out bad data using meta-analyses and systematic reviews – which are the very evidence that WDDTY is careful to ignore.

“That view is shared by the late Professor David Sackett, widely regarded as one of the fathers of clinical epidemiology: “Evidence-based medicine is not restricted to RCTs and meta-analyses,” he wrote 20 years ago. “It involves tracking down the best external evidence with which to answer our clinical questions.””

The best evidence. Not poor evidence cherry picked because it appears to support a position. And when the best evidence is RCTs and meta-analyses, we pay attention to them, rather than ignoring them in favor of poor quality studies and anecdotes. See my earlier link on hierarchy of evidence.

“Who said this? Ironically, no less a figure than that arch-critic of homeopathy, Edzard Ernst.”

(Interestingly in a related piece Ernst suggests that for some problems Acupuncture, Aromatherapy and Hypnosis can do more good than harm. Homeopathy isn’t on the list.)

These quotes are from people whom WDDTY vilifies when they disagree; but the magazine is happy to quote them when their words do (or can be spun to) support their position. Cherry picking. It’s cheap and dishonest and a mark of the gutter press.

 

The truth at last

“Opponents of homeopathy claim [outcome] studies are worthless as they cannot exclude either the placebo effect or the fact that many conditions are ‘self-limiting’—in time, patients get better anyway. The only way to establish whether homeopathy really works, they say, is through randomized controlled trials (RCTs) testing a homeopathic pill against an identical-looking placebo. According to British pressure group Sense About Science, “over 150 clinical trials have failed to show that homeopathy works. Some small-scale studies have yielded positive results, but this is due to poor methodologies or random effects.””

At last, WDDTY speaks the truth (broadly, with some exaggerated turns of phrase thrown in). These 90 words are just about the only content of any real value in the whole article.

 

Conclusion

In this article, WDDTY admits (correctly) that anecdotes don’t constitute good evidence, but spends most of its word count using anecdotes to back up its claims. It claims (falsely) that scientific studies are unreliable, then tries to back up its claims using scientific studies. The studies it does reference are awful. Sometimes those studies even draw the very opposite conclusions to that which WDDTY claims. WDDTY highlights an (alleged) poor evidence base for modern medicine in defense of homeopathy, then admits that an (alleged) poor evidence base for modern medicine does not constitute a defence of homeopathy. It entirely ignores the best available evidence, because that evidence doesn’t suit WDDTY’s argument — indeed, the best available evidence shows WDDTY’s position to be wrong. Finally, WDDTY makes a series of claims that are outright lies, a further series of claims that are unsubstantiated, and a series of suggestions that are childish, hyperbolic and absurd.

WDDTY doesn’t exist to tell the truth. It exists to tell its readers what they want to hear, and pretends to have evidence to back it up. With the deepest irony, I paraphrase their own accusation: “it’s not about evidence, but ideology.”

WDDTY’s staff are very good writers, who know how to cherry pick any apparent evidence that suits them (and omit that which doesn’t), dress it up to appear more reliable and balanced than it is – or even to make claims that it doesn’t really suggest at all – and throw in some incendiary hyperbole to excite its readers. I wish I could say the writers at WDDTY are just incompetent – but the high quality of their writing, and the fact that they admit their arguments are invalid and publish them anyway, suggests to me that the lies that fill their magazine are quite intentional. It doesn’t really matter — either way, it’s a thoroughly unreliable source.

There’s no global media conspiracy: if something in the media is important and true, you should almost always be able to find it cited by a credible source. If your best or only source is What Doctors Don’t Tell You (or Joseph Mercola, or Green Med Info, or Andrew Wakefield, or Natural News, all of whom use similar tactics), it’s not because those people and publications are beacons of truth trailblazing in a world of media corruption and deceit; it’s almost certainly because they’re wrong. And time after time, when their claims are scrutinized, they’re shown to be exactly that: wrong.

For a demonstrably rubbish article like this, WDDTY deserves to be avoided. When they publish vile, dangerous lies about the safety and effectiveness of lifesaving interventions like vaccines and cancer treatments (which they do, using the same cheap tricks that I’ve demonstrated above)*, anyone should be embarrassed and ashamed to have anything to do with them.

 

*Here’s one example. WDDTY, Jan 2013: “Chemotherapy isn’t only useless against cancer–it even encourages the tumour to grow, researchers have discovered… They say that chemotherapy is ‘completely worthless’ and that cancer sufferers would do better by avoiding the drugs altogether.”

The “completely worthless” quote is a fiction; the paper doesn’t recommend avoiding chemotherapy drugs; and when a skeptical reader subsequently contacted the paper’s authors for comment, they said: “The paper says nothing of the sort… Our study has been misquoted and misinterpreted – I believe on purpose…”