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The BMJ is a prestigious medical journal, which just goes to show that prestigious journals can sometimes make awful decisions. They recently published a pro vs con article on homeopathy. Peter Fisher dragged out the current repertoire of pro-homeopathy tropes, while Edzard Ernst did a fine job of summarizing why homeopathy is nonsense.

I also think the article is an excellent example of the difference between evidence-based medicine and science-based medicine. While EBM is led by a misguided notion of “scientific equipoise” or fairness, SBM endeavors to use all scientific knowledge to make the best judgments we can about treatments.

An SBM approach to homeopathy leads only to scathing condemnation, because it is among the purest of pseudosciences.

Ineffective treatments call for desperate measures

Fisher tries desperately to rescue the 200 year old pre-scientific notions of homeopathy, but only reveals the intellectual bankruptcy of that profession. He writes:

Homeopathy is part of a family of toxicological and pharmacological phenomena that are attracting growing interest, characterised by secondary, reverse, or paradoxical reactions to drugs or toxins as a function of dose or time or both. These include hormesis (the paradoxical, stimulatory, or beneficial effect of low doses of toxins), paradoxical pharmacology, and rebound effects.

No, it isn’t. Putting aside the legitimacy of hormesis and the question of whether or not this is clinically significant, these results depend on molecules of active ingredient doing something physiological in the body. Homeopathic potions cannot operate this way – therefore this is a false analogy.

As Ernst points out, most homeopathic preparations are diluted to the point that they do not contain any active ingredients. They are pure water.

Fisher has to further rescue his false analogy by claiming:

…basic physical research shows that the homeopathic manufacturing process changes the structure of the diluent, including the formation of nanoparticles of silica and gas.

He is playing the game of using one dubious science to support another dubious science. The existence of nanoparticles has not been established. He can only refer to a few preliminary studies of dubious quality without adequate independent replication to show that the phenomenon is real. These are the N-rays of homeopathy.

Further, there is no evidence that these dubious nanoparticles can be biologically active.

Further still, as I have pointed out before, transient anomalous phenomena of water are not a plausible explanation for a homeopathic potion. For this to be true, these miraculous nanoparticles would have to have amazing specificity – if they are to encode all of the various types of specific properties required for all the various claimed homeopathic products to work.

But even worse, they would have to maintain their properties even when placed on a sugar pill, stored in a bottle, then consumed, digested in the stomach, absorbed through the intestines, and travel through the liver and through the blood to whatever their destination is.

So, we have a questionable phenomenon (nanoparticles) that probably don’t exist that would have to have fantastical properties that defy sober speculation about how they could possibly work – and Fisher think this provides a plausible mechanism for homeopathy.

Homeopathy is magic with good PR

Let us also consider the principle of like-cures-like, which results in many fanciful starting ingredients to be diluted out of existence. There is no plausible connection between duck liver and the flu. The fact that a substance causes certain symptoms has no plausible connection to an unrelated disease process that causes superficially similar symptoms, while accounting for the patient’s personality.

This principle of homeopathy is as magical and completely devoid of evidence as astrology.

Clinical deceptions

Fisher then moves onto the clinical evidence, which he butchers. What he reveals is the astonishingly low threshold of evidence that true-believers use to support their wild theories.

In order for scientific evidence to establish convincingly that a new natural phenomenon exists we need repeatable results with a reasonable signal-to-noise ratio with adequately rigorous study design. We never get this with homeopathy.

What we get are positive results from poorly designed studies, or results that can only be produced by a particular lab, or razor thin effect sizes that look suspiciously like p-hacking – but never anything convincing.

There is a very simple and elegant explanation for this – homeopathy is bunk.

Fisher and other homeopaths, however, want to use low grade clinical evidence, like “comparative effectiveness research,” which is not controlled and not designed to test efficacy.

In essence they have built a house of cards of the weakest and worst forms of evidence possible in order to support an incredibly fantastical claim.

What are the odds that a crank physician from 200 years ago hit upon so many revolutionary ideas simultaneously, shaking the very foundations of our scientific understanding of physics, chemistry and biology, and that validation of these revolutionary ideas can only be acquired by the weakest forms of evidence, most easy to manipulate, and if you squint just right in the proper light?

It seems far more likely that homeopathy is just water, and people have a tendency to be fooled by placebo effects – something which is already very well established.

Conclusion: BMJ should be ashamed

The BMJ frankly should be ashamed of themselves. The only proper response of the scientific community to homeopathy is ridicule and outrage. It is outrageous that anyone takes homeopathy seriously. The scientific community should be united in condemning this pernicious form of pseudoscience and trying to rid humanity of this nonsense once and for all.

Giving a forum to a homeopathy apologist like Fisher, as if there is something legitimate to debate, is harmful. It legitimizes pseudoscience.