01 and the universe: Homeopathy

My comrade-in-reason Angela, the Skeptic Detective, alerted me to an anomalous article she picked up on her Skep-dar. On his website named 'Biocura' a Homeopathic "doctor" named Johan Prinsloo (Jnr) has written a lengthy article in which he claims to address the questions and challenges to Homeopathy posed by sceptics.

He's certainly not alone in this attempt, and ordinarily I wouldn't have given the page a second glance, but Angela pointed out that he refers to lil' ol' me in his article, by name. I'm far too arrogant to let that slide, so here begins my response to his article.

(Update 2009-09-03: Since I posted this, Prinsloo has made some non-trivial changes to the text of the page. Luckily I saved a copy of the text as it was when I was composing my response. You can find that here. Google Cache has a copy of it too, that's here.)

He begins the piece with this:

"It is against my principles to debate the validity and efficacy of Homeopathy with ignorants."

Setting aside his attempt to turn an adjective into a noun, thus coining a new term, he then contradicts this assertion by launching into a tirade of no less than 5600 words attempting to do exactly that: debate the validity and efficacy of Homeopathy with "ignorants".

He then defines an "ignorant" as follows:

On this page, reference to the word ignorant shall mean :
Any so-called scientist or "expert" that expresses him/herself on the subject of Homeopathy, it's validity or efficacy, but who -

Is not a qualified Homeopath;

Has not studied Homeopathy to the extent that a Homeopath does;

Has not conducted extensive research on Homeopathy in accordance with the scientific principles of Homeopathy under the supervision of a qualified Homeopath;

Does not possess sufficient experience in the practical application of Homeopathy in a clinical setting;

Who is not registered as a Homeopathic Practitioner in South Africa and / or does not meet the requirements for such registration;

Who is not an expert on applied Homeopathy.(*)With respect to Homeopathy, that is an ignorant in my opinion and someone not worthy of my time.

(*) Howard Stephen Berg, The World's Fastest Reader, defines an expert as "someone who has read at least 25 books on a particular subject".

You see what he's doing here? This is a textbook case of the Argument from Special Pleading. In essence, he is asserting that only somebody with special knowledge (knowledge that he, himself, just happens to possess) is qualified to engage in any sort of meaningful discussion on the topic of Homeopathy. He seems to be of the opinion that this will allow him to summarily dismiss the arguments of anyone who does not already possess it as being worthless.

(Before we go any further: isn't it interesting that he excludes any and all Homeopaths who are not South African? What's that about?)

Let's play a game. Let's take his definition and see if we can apply it to another situation. I hereby coin a new term, I shall call it "Flarpojip". A Flarpojip is a person who is:

Is not a qualified film and television producer;
Has not studied buses to the extent that a film and television producer does;
Has not conducted extensive research on film and television productions in accordance with the scientific principles of film and television producer under the supervision of a qualified film and television producer;
Does not possess sufficient experience in the practical application of film and television producer in a commercial setting;
Who is not registered as a Film and Television Producer in South Africa and / or does not meet the requirements for such registration;
Who is not an expert on applied film and television production.

By Prinsloo's argument, someone who is a flarpojip can have no valuable positions when it comes to films or television. Just about any film critic you may encounter (like Barry Ronge) shouldn't be paid attention to, and you would be justified in refusing to discuss last night's episode of Lost with any of your friends or family who happen to be flarpojips.

It is interesting, then, that Prinsloo includes in his website a page he calls "Legal Stuff". Is Prinsloo a qualified attorney or advocate? If not, what justification does he use to post anything of a legal nature on his website? Has he even read 25 books on the subject? I doubt it.

Forgive my brief foray into an Argument from Absurdity... but I take it my point is made. It's not necessary to hold any sort of formal qualifications in a subject in order to have valuable and accurate information on it. While I can't guarantee that the information I possess about Homeopathy is either valuable or accurate, I can still present it in the context of an argument, in the interests of the pursuit of an adequately precise approximation of the truth.

And, unfortunately for Prinsloo, since I am the one advocating the Null Hypothesis, the burden of proof falls more heavily on him to substantiate his extraordinary claim: that Homeopathy works.

Let's move onto his argument.

No wait... looks like there's some more logical fallacies first.

Under the section entitled "Allow me to explain", Prinsloo asserts that

"the vast majority of medical practitioners and specialists have good working relationships with the South African Homeopathic fraternity and there exists a healthy mutual respect between the medical professions and the Homeopathic Profession in South Africa."

An interesting claim, to be sure. I'd be interested to see the evidence Prinsloo has to support it. But wait... he doesn't offer any.

Instead he continues his rant against "ingorants", and makes this alarming claim:

"Unfortunately, as with anything else in this world, there is always a small number of self-centred individuals with their own agendas and probably backed by some pharmaceutical company or grouping, that has to infect our healthy source of drinking water with some unwanted pest or virus."

Yikes. I certainly hope he was speaking metaphorically there. The suggestion that there is some sort of Big Pharma conspiracy working to contaminate the water supply is worrying. If he was speaking metaphorically, however, it's only slightly less worrying: it means that despite all the qualifications he claims to possess, Prinsloo can't seem to string together a coherent analogy... at least not one that makes any sense to me.

He then makes references to the three (yes, three) institutions who offer post-graduate courses in Homeopathy in South Africa. He points out that these courses are offered exclusively to medical post-grads... in other words, real doctors.

What he's attempting to do here is called the Argument from Authority. He's trying to ~~usurp~~ borrow an air of legitimacy by demonstrating that these otherwise respectable institutions and medical practitioners have offered some measure of endorsement to the enterprise of Homeopathy. Unfortunately, we can't infer that legitimacy at all. Only three institutions offerring courses seems a little low, and Prinsloo declines to mention any of the so-called medical practitioners by name who he claims support Homeopathy.

So not only was that a fallacious Argument from Authority, but it was a bad attempt at one too.

Okay, on to the actual argument.

No, wait. It seems we're not there yet. In the section titled "The creators of filth" Prinsloo takes some more time to cast scorn upon 'ignorant' experts who appear on television, radio and print media attempting to discredit Homeopathy. It seems that these authorities are not to be listened to, according to Prinsloo.

So let me get this straight: We should be paying attention to the experts who agree with Prinsloo, but not to those who don't. The sole differentiator between them, it seems, is the fact that they either agree with him or not... not on any other professional grounds. Interesting.

Okay, next stop... the argument.

No wait, another delay. First we must stop at the section labelled "But why not?" in which Prinsloo summarises and restates the article so far. Nothing new here. Let's press on to the argument.

So, we're about a third of a way through, and we finally see something that seems to actually be about Homeopathy: the section entitled "Highly Diluted Immeasurable Substances". Hooray!

This is where it starts getting confusing.

Prinsloo asserts that not all Homeopaths advocate the Homeopathic "Law of Infinitessimals", or the dilution of preparations to the point where not a single molecule of active ingredient remains. (Actually he says that "The issue of dilution of Homeopathic substances has NOTHING to do with Homeopathy." That's a pretty blatant falsehood, but I'll generously chalk it up to hyperbole, and give Prinsloo the benefit of the considerable doubt). Again he declines to provide any evidence of this, but luckily I happen to know how to use Google. It seems that there really is an ongoing debate over this amongst Homeopaths. I find this encouraging... it means that not all Homeopaths are quite as insane as I thought. Thanks for enlightening me, Prinsloo!

Perhaps I've misjudged Prinsloo. Maybe he's not a complete idiot.

Oh dear.

"one milligram / 1mg means one part per million(1:1,000,000) of the active ingredient".

Um, no. It seems I have been too generous. One milligram (1mg) of ingredient diluted into 1mg (one milligram) of solution is a ratio of 1:1. It seems that Prinsloo suffers from the same inability to count zeroes as his super-diluting colleagues do.

Prinsloo then gives us a brief, inadequate and inaccurate lesson on Homeopathic dilution codes. The innacuracy stemming from the error I mentioned above. It seems that they don't teach arithmetic at Homeopathy School.

Then he says

"You will find that most Homeopathic medicines on the open market fall within [the range of 1:10 and 1:10 000]. Now where is the "highly diluted", immeasurableness in that?"

Another interesting claim. I wonder what he bases it on. Unfortunately I'll have to continue wondering, as he yet again declines to provide any citation. (I guess since he's the expert, we're just supposed to take his word for it.)

Next stop, the section labelled "Lack of Scientific Research in Homeopathy".

To summarize Prinsloo's argument here, he claims that it is humanly impossible for any given practitioner to possibly read any and all research papers that are published, and that some selection bias is at work. Therefore, when a medical practitioner claims that there is insufficient research into Homeopathy, he is only revealing his own selection bias, in that only Homeopaths would take the time to read the research papers on Homeopathy. (That's a pretty heavy summation... Prinsloo seems to lack the rhetorical sophistication to use terms like "selection bias". Perhaps he prefers to invent new words, like using "ignorant" as a noun, or "murking".)

Surprisingly, this argument is actually logically viable. I quite like it. Or rather, I would like it if it weren't profoundly misinformed. ("profound" is my new favourite word. I wonder if I can turn it into a noun.)

The thing is, we are now living in the 21st century. Research papers and scientific journals are still published on paper, but fewer and fewer people use them that way: because its inefficient. It's far easier and quicker to use a search engine, like Google. That's what I use. Alternatively there are services that archive reputable journals digitally, and make them available to the public online... one such service is PubMed. Any seeker after truth with adequate access would likely use one of these resources before making a claim that research into Homeopathy is infrequent, of poor quality or sparse.

In fact, quite a few seekers after truth have done just that, and guess what they found? That there is a considerable amount of research into Homeopathy. They also found that the trend in this research suggests that the better the study, the smaller the purported effect, and the best studies show that Homeopathic preparations perform no better than placebo.

So, Prinsloo: good argument. But wrong.

Now we get to the good bit. It's good because I'm in it: "The IGNORANTS" (his allcaps, not mine).

Prinsloo starts by making this curious statement:

"The one thing that always catches my attention is the fact that generally the skeptics of Homeopathy also tend to be anti-religion or at least skeptical of religion." (emphasis not mine)

Funny... I've noticed the same thing. Here's my question: so what? He doesn't appear to draw any connection between that observation and whether or not the criticisms we sceptics offer are viable. A poorly executed attempt at Poisoning the Well perhaps? Who knows?

He points to the South African Skeptics forum as being the lair of "another typical bunch of ignorants". For those of you who are not familiar with it, it's pretty much what is claims to be: a web-based forum for South African sceptics. I've posted there from time to time, but I don't participate as often as I'd like to.

First, he cites the post I made about my Homeopathic Suicide Attempt. He offers a very erudite and well-measured evaluation of my argument:

"Quite amusing".

Seriously? That's all you have to say? I thought it was hi-freaking-larious! You don't even want to take the time to address the glaring errors and logical fallacies I employed in those videos? Fine.

Prinsloo then picks on a user called johanvz (with whom I am not acquainted. Johanvz commented on the thread wothout offerring any real criticisms of Homeopathy. I suppose that's why Prinsloo chose him: Prinsloo doesn't seem to like dealing with actual arguments.)

Then... oh then... Prinsloo makes the mistake of setting his sights on the aforementioned Skeptic Detective. Oh dear.

He starts by referring to Angela's jokes about Christianity. Again, so what?

Thankfully, he doesn't stop there. He quotes a comment she made in some or other article he posted online, in which she cites some of the examples in which Homeopathy was shown to be ineffective (specifically James Randi's expose of Jacques Benveniste's flawed research back in 1979).

Prinsloo's rebuttal (paraphrased): "James Randi and Jacques Benveniste are not Homeopaths". Wow. That was awesome. Tell us again how that makes Angela's comment innaccurate? I think I missed that part.

In the next section, "A Few Surprising Facts on Research in Medicine", Prinsloo lists about thirty "facts". He doesn't mention any citation for those "facts", nor does he provide any context on how they relate to his argument. I guess we're just supposed to assume that they support it, and that we should take his word for them.

In the following section, Prinsloo quotes an article from the Royal Society of Medicine which states the (pretty obvious) claim that research papers submitted by teams who recieve funding from the pharmaceutical industry will tend to demonstrate a degree of bias in favour of the intervention being tested. Again, he does so without making any allusions to how (if at all) this study supports his argument or refutes those of "ignorants".

It seems that at this point in the article, Prinsloo has grown as weary of writing as I have of critiquing his babbling. Instead of concluding his position, he finishes off by posting another lengthy article from the Alternative Medicine Digest (a clearly impartial source) ill-informedly (see what I did there? Turned an adjective into an adverb!) dismissing the concepts of "science" and "proof". And again, Prinsloo neglects to demonstrate the relevance of it.

So, what have we learned from all of this?

Well, I learned that the Law of Infinitessimals isn't adhered to by all Homeopaths. I also learned that if his thinking is an incoherent as his writing, it doesn't surprise me at all that "Doctor" Prinsloo has devoted his professional career to the advancement of a nonsense pseudoscience, and the unethical "treatment" of patients with intervetions that have no reasonable support for their efficacy.

Oh, and we learned that you don't have be an expert terminologist in order to be able to make up words.

I've touched on the idea of homeopathy several times in the past, but I thought it might be a good idea to go through a quick description of what it is and why it doesn't work.

What is it?

Homeopathy is an alternative theraputic modality. It was invented by a man named Samuel Hahnemann in the late 18th century, when mainstream medical technology still included things like leeches, bloodletting and trepanning. Hygiene hadn't been invented yet, and imbalances in the Four Humours were thought to be the cause of disease.

At that time, a patient undergoing medical treatment was more likely to die from secondary infections and and side effects from treatment than to recover, so Hahnemann created what he believed to be a gentler alternative: Homeopathy.

Homeopathy is based on two main principles: Similia Similubus Curentur and Dilution. Let's look at each of those separately.

Like Cures Like

Similia Similubus Curentur (or Like Cures Like) is based on a "fight fire with fire" approach to handling disease. An idea not all that dissimilar to the use of vaccinations in modern medicine, but in a much more primitive form. It's primitive because Homeopathy employs this approach reactively and at a symptomatic level, rather than pre-emptively dealing with the cause.

The process begins with a "Proving", in which a healthy patient is given a dose of a particular substance, and is observed to see what symptoms it induces. Once the symptoms have been documented, that substance is then used to treat sick patients who demonstrate that same cluster of symptoms.

For example: caffeine would inhibit the ability to sleep in a healthy patient. So the Homeopath will treat an insomniac (who is already unable to sleep) with caffeine. Or the Homeopath might treat a patient suffering from a fever with chilli, and so on.

On the surface this seems counter intuitive. And that's exactly what it is. There is simply no known mechanism through which this might work. It's simply a ridiculous idea, and Homeopaths would need to present some pretty extraordinary evidence to prove that it works. The problem is that that evidence simply isn't forthcoming.

Dilution

Somehow, Hahnemann got into his head a very strange idea: that the more you dilute a substance, the more potent it becomes.

When we talk about dilutions in the context of Homeopathy, we're not talking about dissolving a teaspoon of sugar in a glass of water. That wouldn't be potent enough! We're talking about dilutions so great that we need superscripts to be able to write the numbers!

For instance, it's not uncommon for us to see Homeopathic remedies available at 200C. This is Homeopathic code for a dilution of 1 part active ingredient to 10^400 parts of water. (10^400 is a number with a 1 in the front and 400 zeroes behind it. I'm not going to type all that out. As far as I know, that number doesn't have a name.)

The problem comes in with a well-understood concept in both chemistry and physics called Avagadro's Constant. Avagadro's Constant tells us that once you get to a solution of 1:10^23 , you only have one molecule of the active ingredient left in the mixture.

So as soon as you get to a solution of 1:10^24, you have a one in ten chance of there being a single molecule in the mixture. 1:10^25 takes that to one in a hundred, and so on. Once you get to 1:10^400, the chances of there being even a single molecule of the active ingredient in the preparation are far too small to even consider.

So what are they selling? Pure water? Yup. Sometimes they'll dilute the substance in something other than water: alcohol or sugar pills, perhaps. But then they're simply selling pure alcohol or just plain sugar pills. In other words, Homeopathic preparations are nothing more than a placebo.

Homeopaths claim that during the dilution process, if they shake the mixture just right, the properties of the active ingredient are somehow passed into the water, through some sort of magical "water memory". If that's true, then surely the water would still hold the properties of every other substance it's ever come into contact with, wouldn't it? All the water we currently drink could just as easily be considered Homeopathic Dinosaur Urine or Homeopathic Primordial Soup.

But Why do People Still Buy It?

This is a very good question. One that could just as easily be asked about any number of other fake medicinal preparations. The answer seems to be a little complicated.

It appears to be as a result of a cluster of known bugs in the human brain:

The placebo effect: since we often can't tell the difference between a sham intervention and real medicine, we sometimes feel better after taking a placebo.
Mistaken causality: the human brain is an extremely sophisticated pattern-recognition engine. It's far too easy for us to assume a causal link between two unrelated instances - the idea that A came before B, therefore A caused B.
Anecdotal evidence: hearing the stories of other people who felt better after taking Homeopathic remedies, we'll tend to believe them, and then confirmation bias comes into play - remembering the stories and experiences that confirm our beliefs, and ignoring or explaining away the ones that don't.

What's the Harm?

Another good question: if people feel better after taking a placebo, why not just let them take it to make themselves feel better?

In general I would agree with that. The problem comes in when people turn to Homeopathic remedies first, and don't seek proper medical care that could save their lives. There is a growing list of such such instances over at whatstheharm.net.