Homeopathy: Mere Placebo or Great Medicine?
POST-DEBATE QUESTIONS AND ANSWERS TO DR. JOE SCHWARCZ
A Debate held at McGill University on November 27, 2012
between Drs. André Saine and Joe Schwarcz
B) Questions from Dr. André Saine to Dr. Joe Schwarcz:
The answers to this series of questions will be found at the end after the last question.
QUESTION 1: When you were asked during the debate a question from the public regarding the placebo effect, "If homeopathic substances are purely psychological placebos, do you think the evidence that they can work in animals and plants has any weight?," you discussed the case of pets. It is well known that the placebo effect in animals is negligible, but you explained that perception can be biased in a pet’s owner. Now, please explain the role of the placebo effect in the numerous, measurable results obtained experimentally and clinically with homeopathy on measurable aspects, in: in vitro experimentations, experimentations with plants, farm animals (where the owner’s perception does not play a role, such as infertility, stillbirth, weight gain or helmintiasis), infants (again regarding measurable changes in the infants as opposed to qualitative changes), the unconscious persons, and the insane persons?
» Dr. Joe Schwarz’ answers
QUESTION 2: You said in the debate, "I think I’m pretty up to date on science. I’m pretty up to date on the literature. I’ve read all of those papers about the nanoparticles. They have absolutely nothing to do with homeopathy. They have to do with some anomalous findings and some solutions. Virtually all of them have been explained, whether or not its particles dissolving from the glass, or whether it’s an overgrowth of bacteria that were inadvertently introduced. I mean, there are explanations there." Can you be more precise on the problems encountered in the experiments published in Langmuir by Chikramane et al.(1) in 2012 and their cause? In fact, I presented their evidence that there were nanoparticles of starting materials in ultra-molecular preparations (UMPs). How can the presence of these nanoparticles in these UMPs be irrelevant? Are you aware of studies showing the properties often unexpected of nanoparticles?(2, 3, 4, 5, 6, 7) Are you aware that the homeopathic preparation process of trituration followed by dilution and succussion is in fact an inexpensive, top down way of manufacturing highly reactive nanoparticles from the original bulk materials?
» Dr. Joe Schwarz’ answers
QUESTION 3: If you are really concerned about patients being injured and duped, then why don’t you place an equal energy into warning people about the dangers of allopathic medicine that by the most conservative estimates say are responsible for at least 10,000 deaths a year in Canada? You do not seem interested in warning the public against cough and cold medicines for children that resulted in many deaths with no proven efficacy? What about polypharmacy which results in many deaths but is extremely common in conventional medicine?
» Dr. Joe Schwarz’ answers
QUESTION 4: It is interesting to note that since the middle of the nineteenth century neither you nor any other skeptic have ever commented with an in-depth analysis on the extraordinary results obtained by homeopathy in epidemics, namely a consistent and extremely low mortality rate. For instance, it is very well documented that the mortality of cholera remained consistent at about 50% until rehydration was introduced in the 1960’s, and this was regardless of the type of treatment provided or even in the absence of treatment. In the debate, I reported one of many hundreds of similar occurrences, namely, the results obtained by two homeopaths in Cincinnati who had published their daily records in the local press during the 1849 cholera epidemic. In total, they treated 2,646 cases with 35 deaths, or a mortality rate of 1.32%, despite seeing 60-70 cases that were in a deep stage of collapse. After the epidemic, they were accused by a skeptic of having falsified their records. A public commission was set up to inquire the matter, which was chaired by Alphonso Taft who would later become Secretary of War under President Grant and whose son became the 27th President of the United States. In the end, the commission confirmed that the results reported by the two homeopathic physicians were absolutely correct down to every single case reported during the epidemic. In your dismissal of the efficacy of homeopathy, can you please explain your complete silence on the overall extraordinary, consistent and predictable results obtained by homeopathy in epidemics, which I briefly addressed in the debate and have been greatly authenticated by a number of reputable medical historians?
» Dr. Joe Schwarz’ answers
QUESTION 5: It is astonishing to note that a "man of science" would consider the Shang et al. 2005 meta-analysis published in the Lancet the "definitive meta-analysis(8)" —notwithstanding the fact that major flaws have been underlined by a large number of scientists(9 to 23) —if only for the fact that six of the eight large studies used in the final analysis were not following the rule of individualization, which is fundamental to homeopathy. Do you still think that this meta-study, which is composed of a majority of studies that violate this fundamental principle, can be used as proof against homeopathy? How do you explain that the accompanying editorial of the Lancet(24) was able to come up to such radical conclusions, despite the fact that the study didn’t even adhere to the QUORUM guidelines for meta-analyses(25), and that the body of scientific evidence on homeopathy extends much beyond the limitations of the Shang et al. meta-analysis?
» Dr. Joe Schwarz’ answers
QUESTION 6: In the debate, you said of Professor Rustum Roy of Penn State University, "Rustum Roy, who was referred to, is not highly regarded in the scientific community. He is one of those outliers. And there are many such." On what basis do you base your opinion that Professor Roy is not highly regarded in the scientific community? Are you aware that in 2003 the ISI (Phila) rated his lab the #1 in the world on the basis of highly cited scholars(26) and that he has published over 1,000 papers in peer-review journals? Which ones of his results are therefore not trustworthy? How do you decide whether a scientific article published in a peer-reviewed journal is trustworthy, such as the one of Roy in Materials Science(27) in 2005 or the one of Chikramane in Langmuir(28) in 2012?
» Dr. Joe Schwarz’ answers
QUESTION 7: You wrote, "Dr. Edzard Ernst, one of the world’s foremost experts on homeopathy ..."(29) Yet, Edzard Ernst, a known skeptic of alternative medicine, who has authored at least five systematic reviews and meta-analyses on homeopathy, and who has been portraying himself professionally as a trained homeopath(30) —which would be illegal in Germany for a practicing physician to falsely use this title—even to the point of stressing this point in November 2009 before the British House of Commons, "Many years ago, I have worked as a homeopath and therefore understand the concepts of homeopathy(31)," has denied in an interview published in April 2010 ever having completed any course in homeopathy(32). Further, Richard Horton, the editor in chief of the Lancet, said, "Professor Ernst seems to have broken every professional code of scientific behaviour(33)." How is it that, as a professional quackbuster(34), you are unaware of this delusion and you were still claiming in June 2012 that Ernst has credibility in the scientific world as an expert on homeopathy?
To suggest that Edzard Ernst has no credibility is pure folly. His writings are all thoroughly documented. He never claimed to be a homeopath ( why would anyone who isn't one do that? Hardly a badge of honour). He just claimed to have worked in a homeopathic hospital where he was exposed to all the tenets of homeopathy. In any case what does whether he was a homeopath or not have to do with anything? Let the facts speak.
» Dr. Joe Schwarz’ answers
QUESTION 8: I am curious to know which research papers I presented in this debate on homeopathy represent "a plundering of science," and can you please explain on what basis they don’t abide by the strictest scientific method?
» Dr. Joe Schwarz’ answers
QUESTION 9: You said in the debate, "And Hahnemann was aware of this and he experimented on himself. He wanted to know: What was the right dose to give to his patients? So, he kept taking bigger and bigger doses to see what would happen. And he took these doses and, eventually, he developed a fever, much like he saw in his malaria patients and then came to the conclusion that a substance that—in a healthy person—causes a certain disease can cure a sick person who has those symptoms. … Remember that Hahnemann started with the whole notion of taking cinchona in larger and larger doses to trigger the symptoms of malaria. That’s the foot upon which homeopathy stands originally. Has anyone ever tried to replicate that? Yes. In 1991, German Professor Wolfgang Hopff did the experiment, started to take cinchona bark in bigger and bigger doses and never got a fever; he never got the malaria symptoms. So we don’t know what happened in the case of Hahnemann. Maybe he was unlucky. He was taking the cinchona doses and he got the flu at the same time. And that’s what caused the fever." It is interesting to note, first, that Hahnemann never reported wanting "to know: What was the right dose to give to his patients?," but instead clearly stated that he wanted to know the principle underlying the effectiveness of cinchona bark in malaria; second, that he never reported having taken increasing doses, but instead took the same dose twice a day; third, that he never reported having had developed a fever or the "peculiar chilly shivering rigor" of malaria during his proving of cinchona bark tincture(35) ; and fourth, that fever is a very common symptom of acute cinchonism(36) , quinine "also has a mild antipyretic effect(37) ," and that every single one of the eight most recent cases of acute cinchonism that I could find in the scientific literature had developed a fever.(38 to 44) Can you please provide primary source references documenting your version of Hahnemann’s proving of cinchona bark and why are you referring to a Professor Hopff’s experimentation(45) when the scientific literature is extremely clear on this point, namely, that fever is a very common occurrence of acute cinchonism?
» Dr. Joe Schwarz’ answers
QUESTION 10: On what basis do you claim that homeopathy is chemically and biologically implausible?
» Dr. Joe Schwarz’ answers
QUESTION 11: I have been treating this 10 year-old girl with cystic fibrosis for more than two years. Since the inception of homeopathic treatment in September 2010, the child hasn’t needed to use antibiotics once, which is unbelievable to the mother who is a medical researcher. I asked her what would she say to Joe Schwarcz if he would tell you, "The recovery of your child is all related to the placebo effect." She said, "We live with this disease daily. He doesn’t know what he is talking about. The remedies change the person. No [allopathic] medicaments can change the person. They only treat the symptoms, not the person. N. changed from bottom up completely. She is a perfect girl now. She has no symptoms whatsoever. Since early childhood she had had a rebellious temperament. If ever she begins to relapse I just give her another dose of the remedy and she becomes cooperative again. Since homeopathic treatment she has been falling asleep at bedtime within 15 minutes, while before it took a minimum of 45 minutes. She is stronger emotionally. She used to be obsessive, now she has a balance personality. She used to regularly have nightmares. They have been gone with the remedies. If there are any signs of a relapse I just redose her and everything improves as a whole again. When I initiated treatment with you, N. had nausea daily, had a very poor appetite, regurgitated her food everyday, had chronic diarrhea with abdominal cramping, had mal-absorption and was at the limit of malnutrition. She had not grown in three years. Within one year she was at 25 percentile for weight and now, she is normal. Not once has she required antibiotics since beginning homeopathy. Her nose had been constantly blocked since eleven months old until we began homeopathic treatment. She has not had a blocked nose in two years. Anyone explaining that this prolonged, continuous recovery of health in a patient with a genetic disease is due to the placebo effect doesn’t know what they are talking about." Would you recommend this mother to abandon homeopathic treatment under my care and just give her daughter any randomly chosen remedy sold for homeopathic purposes she can find at the pharmacy, as it would be much cheaper and it "should do just as well"? Or, if you really believe that the health recovery of this child was due to the mother’s enthusiasm (who incidentally consulted me very reluctantly despite having been referred by a senior colleague medical researcher who had had prior experience with homeopathy) or the child’s faith in homeopathy (most time she takes the homeopathic remedy without particularly knowing it, as she is taking it with her enzymes), can you please scientifically support the claim that there exists such a phenomenon as the long-term placebo effect with an overall health recovery, including changes of personality, temperament, sleep pattern, digestion, susceptibility to infections, etc., in patients with serious, obstinate, continuously progressing, genetic diseases such as cystic fibrosis? If you would respond that this case is an exception and it was "cherry-picked" among all my cases, I would ask you how do you know that such a recovery of health is not what people should expect under genuine homeopathy?
If Andre claims to have cured a patient of cystic fibrosis with homeopathy he should submit the data to a reputable journal as a case report. If he can reproduce the cure he should be nominated for a Nobel Prize, or at least a Lasker Award.
» Dr. Joe Schwarz’ answers
QUESTION 12: How much money do you receive every year from your consulting activities to private companies and which companies were involved?
As far as consulting fees, the sum total is $0. My salary comes from McGill.
» Dr. Joe Schwarz’ answers
QUESTION 13: You said in the debate, "A properly controlled, randomized trial. That’s all we ask for in science." I presented during the debate two properly conducted RCTs one by Frass et al. and the other by Frei et al.(46, 47) It is noteworthy that Frass et al. had also found out in another RCT that Kali bichromicum 30 C helped to significantly reduce tracheal secretions (p < 0.0001) and extubation could be performed significantly earlier (p < 0.0001) in critically ill patients in ICU(48). Also, Frei et al. was a replication of the 1997 Lamont RCT with ADHD children that had found statistically significant differences in favor of homeopathy(49). Have these RCTs affected at all your opinion on homeopathy?
» Dr. Joe Schwarz’ answers
QUESTION 14: You also said in the debate, "Well, actually, we ask for more than one properly controlled, randomized trial, because one trial doesn’t mean much, but if we have a selection of properly controlled, randomized trials, yes, I would buy it. You show me what you consider is a properly controlled, randomized trial for a specific condition, where a specific homeopathic remedy cures that condition." Jacobs et al. conducted three RCTs in children with diarrhea and their combined results showed a decrease in the duration of the diarrhea with a p=0.008 and their meta-analysis showed a consistent effect-size difference of p=0.008. These trials, as well as the trials referred to in question 12, should indeed fulfill all your requirements. Will you now buy homeopathy? If not, please explain yourself?
» Dr. Joe Schwarz’ answers
QUESTION 15: You said in the debate, "But this was, of course, not known to Hahnemann, because Avogadro’s and Dalton’s theories were basically just formulated in the middle 1800s about atoms, and Hahnemann knew nothing about that." Can you please document these statements with primary source references in view of the facts that, first, Hahnemann was known to be an accomplished chemist and was very well read; second, Dalton presented his ideas of the atomic theory between 1804 and 1810; and third, Hahnemann referred to the doctrine of the divisibility of matter in 1810(60), said in 1829 that "there must be an end to the thing [divisibility of matter], it cannot go on to infinity(61)," and in 1843 questioned whether "the invisible medicinal force of highly potentized remedies depended on their material atoms(62)" ?
Andre, as one might expect, is not familiar with chemical history. Avogadro's number was named after him, not by him. Hahnemann could not have had any idea about the number of atoms or molecules in a mole.
» Dr. Joe Schwarz’ answers
QUESTION 16: You said in the debate, "So if you look at the meta-analysis and you look at the properly controlled studies, there is nothing there." Please demonstrate the irrelevance of the evidence in the two systematic reviews(63, 64) I presented in the debate?
» Dr. Joe Schwarz’ answers
QUESTION 17: You said in the debate, "And then Hahnemann came to the conclusion—somehow—nobody seems to be able to explain exactly how he came to this conclusion: That less is more, the theory of infinitesimals. That if you dilute your product—your original solution—you make it more potent. Well, one day he made a house call. And he answered this house call in a horse-drawn carriage. And his homeopathic remedy worked extremely well on the patient. And he developed a second aspect of homeopathy, succussion. He believed that the cobblestones had shaken the medication and that potentiated it. So, the two aspects." Can you please give primary source references to document your statements, as according to reliable historical sources your story is a complete fabrication from one end to the other?
» Dr. Joe Schwarz’ answers
QUESTION 18: How different is the case of homeopathy from the many examples in the history of science where experimental results were denied plausibility prior to becoming well accepted?
» Dr. Joe Schwarz’ answers
QUESTION 19: You said in the debate, "Well, this, I think, does not stand up to the rigor of what we call science-based medicine, which has four basic pillars. Of course we rely on peer-review. We do rely on plausibility because we have a large fountain of scientific knowledge upon which we can stand and gaze out at the world and judge to see what makes sense and what doesn’t. And, of course, experience plays a role, as does critical thinking. But, really, the cornerstones are peer review and plausibility." Yet, you state that "most" peer-review articles that come out every day are "mediocre." How do you reconcile these two statements?
» Dr. Joe Schwarz’ answers
QUESTION 20: Your story of Hahnemann’s proving of arsenic is incorrect, as Hahnemann didn’t publish his proving of arsenic trioxide until 1816, which is 26 years after his first experiment with cinchona. The proving was conducted in potencies and not in "increasing doses." It would be interesting to know which "friends and relatives Hahnemann lost along the way" and what actual primary source reference you used, if any, to state that he concluded, "that therefore, in smaller doses this would be a remedy for food poisoning."
» Dr. Joe Schwarz’ answers
QUESTION 21: If you really feel that homeopathic medicines are both placebo and good medicine, then what are your real motives behind the multi-million dollar lawsuit against a homeopathic manufacturer you are part of? Who is paying for your legal fees?
The motive behind the lawsuit is simple. Homeopathic medications are claimed to have active ingredients without any proof that they contain such. Therefore they are mislabeled. The lawsuit is being funded totally by a group of lawyers who initiated it. I had nothing to do with it but of course I do support it because I think all products that make medical claims should be held to the same standards of safety and efficacy. Homeopathic products are getting a free ride.
» Dr. Joe Schwarz’ answers
QUESTION 22: Can you provide any primary source reference that Napoleon was actually treated with homeopathy for pubic lice?
» Dr. Joe Schwarz’ answers
QUESTION 23: When you referred to the paper Benveniste published in Nature in 1988, you omitted to explain the fact that his experiments have since been successfully replicated by four independent laboratories in Europe and that the issue is now closed?(65, 66) Isn’t this, the proof—reproducible evidence that UMPs have biological effects—that you have been asking for? Please explain your criteria for rejecting this body of research?
» Dr. Joe Schwarz’ answers
QUESTION 24: Please consider the following scenario recently related to me by a German colleague: As a young MD, she did an internship with a homeopathic pediatrician. Over the course of several weeks, she observed how one child after another recovered within days under homeopathic treatment from ailments like ear infections, UTI, bronchitis, bronchiolitis, pneumonia, impetigo and other acute diseases. No conventional medication was used, no side effects, no complications. If you were in a position of being a young doctor and watching these effects like she was, would you consider studying homeopathy more deeply?
Questions like #24 are so puerile and smack so strongly of the ignorance of scientific methodology that they don't merit further discussion.
» Dr. Joe Schwarz’ answers
QUESTION 25: On what philosophical or scientific basis, would you say skeptics consider their inexperience coupled with an immovable bias more reliable than the experience of many generations of homeopaths all over the world corroborated with loads of undeniable facts?
» Dr. Joe Schwarz’ answers
QUESTION 26: Since our subject is the wellbeing of our fellow human beings, the outcome of this debate carries a certain amount of responsibility. In light of this responsibility, can you state that you have investigated homeopathy thoroughly and with an open mind, and have found out beyond reasonable doubt that it is nothing else than placebo, despite the many inaccuracies I have pointed out in your statements and the references I gave showing that they are contradicted by more reliable historical sources or recent scientific studies?
» Dr. Joe Schwarz’ answers
QUESTION 27: You wrote, "Choice consumers make is based on scientifically informed opinion. In the case of homeopathy, misinformation can have consequences ranging from a needless waste of money to forgoing more effective treatments(67) ." I agree with you on this very point, and I have pointed out many serious inaccuracies in your statements or writings about homeopathy and referred you to more relevant historical sources or recent scientific research. To what extent, do you and the McGill Office for Science and Society take responsibility for the information you disseminate to the public, when it is contradicted by reliable sources or recent scientific evidence?
As to the final question, we take full responsibility for whatever information we disseminate. The scientific community stands firmly behind the notion that homeopathy is nothing other than an example of the placebo effect. Data can be dredged up to attempt to counter the evidence the same way that Creationists publish all sorts of papers that sound scientific and appear to be so to the uninitiated. But of course Creationism is bogus. How many serious scientists think the Earth is 5700 years old? How many think that homeopathy is more than placebo?
» Dr. Joe Schwarz’ answers
Dr. Joe Schwarz’ answers:
As far as this second set of questions goes, I'm just not willing to devote any more time to this discussion. I think I have already spent far more time discussing homeopathy than the subject deserves. I'm not going to get into it any more for the same reason I don't get into discussion with Creationists or various conspiracy theorists. Furthermore I have essentially answered these questions either in the attached or in previous writings. I will make just a couple of comments though.
I certainly do warn about the dangers of conventional medicine when appropriate and have written extensively on the issue. (incidentally the term "allopathic" was devised as a derogatory term by Hahnemann ) But that is not the question here. The question is whether homeopathy is bogus or not.
Andre is totally unaware that the issues he brings up have been the subject of numerous scientific discussions and that books have been written on them. The claims about cholera and flu and homeopathy have been addressed and the explanation is obvious. "Heroic" treatments were actually harmful while homeopathic ones were just useless. It is true that homeopathic hospitals had better hygiene, but that had nothing to do with the concept of homeopathy.
To suggest that Edzard Ernst has no credibility is pure folly. His writings are all thoroughly documented. He never claimed to be a homeopath ( why would anyone who isn't one do that? Hardly a badge of honour). He just claimed to have worked in a homeopathic hospital where he was exposed to all the tenets of homeopathy. In any case what does whether he was a homeopath or not have to do with anything? Let the facts speak.
If Andre claims to have cured a patient of cystic fibrosis with homeopathy he should submit the data to a reputable journal as a case report. If he can reproduce the cure he should be nominated for a Nobel Prize, or at least a Lasker Award.
As far as consulting fees, the sum total is $0. My salary comes from McGill.
Andre, as one might expect, is not familiar with chemical history. Avogadro's number was named after him, not by him. Hahnemann could not have had any idea about the number of atoms or molecules in a mole.
The motive behind the lawsuit is simple. Homeopathic medications are claimed to have active ingredients without any proof that they contain such. Therefore they are mislabeled. The lawsuit is being funded totally by a group of lawyers who initiated it. I had nothing to do with it but of course I do support it because I think all products that make medical claims should be held to the same standards of safety and efficacy. Homeopathic products are getting a free ride.
Questions like #24 are so puerile and smack so strongly of the ignorance of scientific methodology that they don't merit further discussion.
As to the final question, we take full responsibility for whatever information we disseminate. The scientific community stands firmly behind the notion that homeopathy is nothing other than an example of the placebo effect. Data can be dredged up to attempt to counter the evidence the same way that Creationists publish all sorts of papers that sound scientific and appear to be so to the uninitiated. But of course Creationism is bogus. How many serious scientists think the Earth is 5700 years old? How many think that homeopathy is more than placebo?
Anyway, as I said, this discussion has gone far enough and I do not want to devote more time to it. If Andre would like to publicize his ideas further, there is a way to do it. The lawyers are actually looking for a homeopath to include in the lawsuit, and if Andre desires I could put him in touch with them. He could state his case then in a very public forum and get lots of attention.
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