Benefiting from the Atlantic Time Zone, I got to be one of the first to watch CBC Marketplace on Friday night (darn you, Newfoundland!) where they covered the topic of homeopathy. Here are my impressions.
First, I want to praise Marketplace for not offering false balance on the issue. Homeopathy is not something about which there is any serious scientific debate. The evidence is clear that homeopathy is not physiologically/chemically/physically possible, has no defined mechanism of action, and does not work beyond a placebo effect. It would be wonderful if it did work, but it doesn’t.
The show opened with an intrepid band of skeptics who decided to overdose on homeopathy, 10-23 style. After consuming bottles of remedies, they waited. The host cut back to the skeptics periodically through the episode, who stood patiently waiting for something, anything, to happen.
Next came the anecdotes. While countless people use homeopathy for things like colds, headaches, cuts, scrapes, and other self-limiting conditions and have “seen results”, there is no distinction between what was supposedly done by the homeopathic medicine and what would have happened on its own, without the remedy. One woman interviewed even mentioned that homeopathy takes longer to heal ailments than conventional medicine. In other words, homeopathy is like paying to watch your body heal itself.
It seemed clear from some of the short interviews, as well as from comments on the Marketplace website, that many users believe there are actual ingredients, at small amounts, in homeopathy. But unlike herbal medicine, homeopathy is diluted such that most remedies don’t contain a single molecule of the original ingredient. Within alternative medicine, herbal remedies (having a mix of chemical constituents) are the polar opposite of homeopathy (having sugar, shaken water, and nothing else). The lab testing the show commissioned showed this – two different remedies were chemically indistinguishable.
Proponents claim that, however it works, homeopathy is some form of “energy” that science can’t measure. Fine. Set aside the idea that homeopathy “remembers” the original substance, yet forgets the memory of everything else that the water has ever encountered. Is it having an effect on the person taking it? If yes, then the effect is measurable! But when we try to measure it, using rigorous studies that control for biases, homeopathy behaves exactly like what one would predict for sugar pills: it’s as effective as a placebo.
This is where Marketplace got a little sidetracked. They focused a lot on mechanism and not enough on efficacy. Homeopaths love to deflect criticism of mechanism with testimonials about how it “worked for so-and-so”. I wish there had been more focus on the numerous clinical trials that have shown no significant measurable benefit, though they did mention the recent British Evidence Check into Homeopathy, an extensive review that concluded:
The Committee concurred with the Government that the evidence base shows that homeopathy is not efficacious (that is, it does not work beyond the placebo effect) and that explanations for why homeopathy would work are scientifically implausible.
The show also, to its credit, excelled in documenting the actual and potential risks of homeopathy. Advocates love to say “What’s the harm?” or “At least I know there’s nothing harmful in it because it’s diluted”, but there can be a real harm to ignoring proven medical treatments. They talked to one woman who believes her son is vaccinated because she gave him homeopathic “vaccinations”. (A simple blood titre test would tell her otherwise.) The show also pointed to the tragedy of Gloria Thomas, a baby born perfectly healthy who died of septicemia because her parents treated her eczema with homeopathy instead of proven medicine. (The parents were later convicted of manslaughter.) They also spoke to a few homeopaths who alarmingly claimed they could cure cancer and found more Canadian homeopaths making these claims online. Let’s get this straight right now: delaying early stage cancer treatment can absolutely kill people and there is no evidence - none – that homeopathy can cure cancer.
Marketplace also put homeopaths, and the manufacturers of homeopathic medicine, on the spot to prove their products work. They got answers like “[So you can't explain how homeopathy works?] Not exactly, no, I just use it”, “There hasn’t been a lot of demand for clinical studies”, “Perhaps science hasn’t developed to a point where they can detect the medicine”, etc. One homeopath offered to send scientific papers to Marketplace, which they report were never received. This is what homeopaths credit for the supposed miracle that can cure cancer? Gut feelings and excuses for a lack of any credible evidence for the remedies they sell?
An Ontario government spokesman, Josh Tepper, looked clearly uncomfortable defending the decision to regulate the practice of homeopathy. Granted, the government is in a bit of a tough situation: regulated, homeopathy can be potentially monitored to minimize the harms; unregulated, homeopaths seem to have free reign to make claims like cancer cures. Why a practice like homeopathy deserves the government stamp of legitimacy wasn’t answered. Surely there are existing measures in place to stop people from offering fake cancer cures.
Perhaps, when it comes to homeopathy, the decision flows from the actions of Health Canada, the federal authority that has determined that homeopathic medications are “safe and effective”. Failing to question Health Canada on exactly how sugar pills are deemed to have medicinal effects was the biggest omission from the program. It was a major shortcoming to not link the products they tested on the show with Health Canada’s separate approvals of indistinguishable sugar pills. But you can only do so much in a half-hour.
All in all, this was a big win for health skepticism and scientific inquiry. The potential dangers of homeopathy were outlined (false claims of cancer cures, false claims of vaccination, examples of past harm, etc), the problems with the purported mechanism were outlined, the lack of convincing evidence were mentioned (though unfortunately there was too little time to go into detail), and consumer rights issues were brought to the forefront. And the skeptics? The overdose was deemed a success – all lived.
Why bother to take this on? The facts of homeopathy don’t seem well-understood by the general public, which may explain its appeal. Some of the street interviewees looked surprised and a little unhappy when informed that their preferred remedy had nothing in it. Homeopathy has escaped scrutiny in mainstream Canadian media for some time, and this is where the Marketplace episode ultimately succeeded. It refused to accept a medical double standard for consumers. Why should homeopathy be able to make claims to hopeful Canadians without any justifiable evidence? Short answer: they shouldn’t.
You can now watch the full episode online.
Of course, not all viewers of Friday’s Marketplace were pleased with the results. Before the show even aired, homeopathy advocates were in a furor, going so far as to start comment campaigns (site now deleted) among their a priori criticisms. Bryce Wylde even linked to his same old list of homeopathic evidence, including 21 papers which were already demonstrated to lack scientific rigor and to sometimes have nothing to do with homeopathy at all.
Despite these criticisms, curiously, the show noted that almost all spokespersons for homeopathy organizations declined invitations to appear and defend their practice.