The Green Party and homeopathy
One criticism that has often been levelled at the Green Party is that they are anti-science. It's my understanding that they are aware of that criticism and are keen to embrace a more scientific mindset, so I was very interested to listen to James O'Malley's interview with the new Green Party leader, Natalie Bennett, on today's Pod Delusion.
Sadly, I think they may have a way to go before they can shake off the anti-science reputation.
One of the questions James asked in this context was about Natalie's attitudes to homeopathy. Homeopathy is, as we all know, scientific nonsense, and yet the Green Party have form for supporting it: the Greens' only MP, Caroline Lucas, has supported a parliamentary Early Day Motion praising homeopathy (although to be fair, she did later withdraw her signature).
So I was pleased when, in response to James's question about homeopathy, Natalie started by saying that she realised that homeopathy was scientific nonsense (and yes, she did use the exact words "scientific nonsense"). However, after that, her scientific credentials started to go downhill. She then said that she felt that perhaps it still had a "very small and limited place" in the NHS, by virtue of its placebo effect.
Now, I'm not completely unsympathetic to the idea of using homeopathy for its placebo effect, as I've argued before (although oddly, no homeopath has ever agreed with me on this point as far as I know). However, there are 2 problems with this approach. The first is an ethical one: what does the clinician who uses homeopathy say to the patient? Either the clinician has to admit that it is a placebo, which may nullify the placebo effect, or has to pretend that it is an active treatment, which is dishonest and, to my mind at least, crosses an important line in medical ethics. This is not necessarily an insoluble problem, but it is certainly a tricky one. Interestingly, placebos have been found effective even when patients are told they are placebos in one study, although I'm not convinced that the explanation given to the patients in that study was completely honest.
Natalie did not suggest a solution to this ethical problem, although to be fair she wasn't asked about it in this interview, which had to cover many other topics as well. Natalie, if you're reading this, I would be really interested in your views on this ethical question via the comments form below.
The second problem is that using treatments in the NHS that have been found to be no more effective than placebo in numerous randomised controlled trials sets a bad precedent for the way in which the NHS respects scientific evidence. James did ask her directly about this problem. Her reply is worth reproducing in full:
for some conditions, and the problem is of course that medical trials are almost invariably funded by the pharmaceutical industry so these trials are never done, for some types of conditions and some circumstances, if you did a double-blind trial of homeopathy, because of the placebo effect, you might get a 30 or 40% cure or substantial improvement in condition rate, you might get better results than you get for lots of medicines, for certain kinds of conditions, but no-one's done those tests, and what you would be testing is placebo. But there's a problem and science needs to think a lot more about how we can take advantage of the placebo effect, because it's very powerful
Now, on one level, she's right: the placebo effect is very powerful, and we would indeed do well to learn how to make better use of it. However, the claim that double-blind trials of homeopathy are never done is rather odd. First, it's wildly and hopelessly untrue. A meta-analysis published in 1997 found 89 double-blind trials of homeopathy, and I dare say many more have been done since then. For Natalie to express opinions on homeopathy when she is apparently so completely unfamiliar with the literature is worrying.
But those trials were placebo controlled trials. Perhaps Natalie meant that there were no double-blind trials testing homeopathy against an ineffective treatment that isn't a placebo, so that the specific placebo effect of homeopathy could be investigated. Well, by definition, that's impossible. Either you test homeopathy against some sort of inert substance, in which case it's a placebo controlled trial such as those that have been done many times before, or you test it against no treatment, in which case it cannot be a double-blind trial, and would have little scientific validity.
In addition, the idea that you might get better results than for lots of medicines seems hard to justify. Conventional medicines benefit from the placebo effect too. True, it's possible that a conventional medicine might be actively harmful and perform worse than placebo, but something would have gone seriously wrong if such a drug were ever to be licensed.
There are some serious misconceptions in there, and for me, that reply provides pretty good evidence that the Green Party have a long way to go before they lose their anti-science reputation.
The placebo effect is not well defined in conversation, or by homeopaths. In a double blind clinical trial, the placebo arm may well show 40-50% improvement, it is wrong to extend this to the term placebo effect. Most of this improvement is due to self correcting conditions. There have been very few trials carried out to compare placebo and absolutely nothing. These do not show the levels of effect for placebo that Miss Bennett is talking about.
This was a pathetic performance.
Note that she believes that homeopathy might have value for its "placebo effect" when all other treatments for a serious diseases have proved fruitless. Since UK homeopathy is not about treating terminal cancer patients (at least I hope it's not), this is a pointless position.
And of course the notion that the placebo effect of homeopathy should be tested against... a placebo (?) seems to show her to be totally scientifically illiterate and lacking even in common sense (we won't speak to the fact that real medicine also has the same placebo effect, with the added benefit of maybe doing something).
Plus, she wants to do away with coffee and tea in the UK!
The Green Party's non-science stance on homeopathy, Organic food and other forms of alternative 'medicine' is the only reason I won't vote for them. I'm sure this is true of many other would-be Green voters. Not only that, it strongly undermines their position on other issues in which the science is in total accord with the Green Party, such as global warming and the need for renewable energy.
Thanks for this post, Adam.
I have also posted on homeopathy: http://peterenglish.blogspot.co.uk/2011/08/do-homeopaths-and-other-cam.html
Like (I think) you and Natalie Bennett, I think that homeopathy may be effective at harnessing the placebo effect.
I share your concerns about the anti-science stance of the Green Party - though I'm more concerned about their anti-GM stance than (if Ms Bennett's line is widely held within the party) their stance on homeopathy.
But who else is there? The labour party lost all credibility when they were in power, starting off the privatisation of the NHS; the tories finished it off for them; and the lib-dems didn't have to support the Health and Social Care Bill (it wasn't in the coalition agreement after all) but voluntarily chose to do so...
Residents Associations sound like a great idea; but in practice they are usually ultra-conservative.
So, unless the National Health Action party can get itself together and field a candidate in my area, who else can I vote for? The Green Party might end up being the least worst alternative.
It's curious that you wrote so many words based on the interview with the new Green Party leader but failed to quote her when she said (about 18 minutes in):
>> "I absolutely do not believe homeopathy works as they describe it. I think it is scientific nonsense. However, what I do believe in is the placebo effect."
It's pretty clear the interviewer has an agenda to paint the Green Party as anti-science "hippies" - he even uses that word in the weasely, "I don't want to use the word 'hippy', but...".
After Bennett explains that the placebo effect is very powerful, he responds "Interesting. Interesting. Our audience are going to love that!", as though she had just said "I believe in fairies."
He then asks Bennett "why not have someone waving their magic hands over them?" thereby demonstrating he failed to understand the preceding explanation about placebo, to which she replies:
> "I want it to all be based on science."
What we have with this leading interview is an intellectually lazy person with a very narrow grasp of science who already believed the Green Party are "anti-science" - most likely because they oppose (for very solid scientific reasons) his *belief* in GMO agriculture and nuclear energy.
Paul, did you actually read my post? I ask because you say I failed to quote Bennett when she said homeopathy was scientific nonsense. Read my 4th paragraph again.
Also, Bennett may want things to be based on science, but her answers show that she really doesn't understand the science. Again, read my post and you'll see that that's explained.
Apologies, I did miss that little snippet 'hidden' in amongst other text. So now I'm puzzling why you did not quote her in full and give it the same prominence of a proper quote as you did the quote about medical trials.
However, you then make a common mistake of assuming that her opinion must be wrong simply because you hold a different opinion:
>> "after that, her scientific credentials started to go downhill. She then said that she felt that perhaps it still had a “very small and limited place” in the NHS, by virtue of its placebo effect."
In fact, it is your "scientific credentials" going downhill if you are denying that placebo effect is very real, and potentially very valuable in treatment of patients.
>> "her answers show that she really doesn’t understand the science."
Stating that does not make it so, and you have failed to offer any evidence that anything she has said is scientifically false. The best seems to be some confusion about what she is saying with regard clinical trials.
Basically, Green Party policy is to follow the best scientific clinical evidence. They don't have the closed mind attitude that many 'internet science warriors' have the moment "alternative" or "holistic" is mentioned.
OK Paul, before you post your next comment on my post, you really do need to read it. For one thing, I don't deny that the placebo effect is real. The bit where I talk about the placebo effect is "hidden" in the paragraph following the verbatim quote. I'm guessing you missed that as well.
If you read that same paragraph, you'll also find the bit where I point out precisely what she said that was scientifically false.
No, Adam, I read it. But you are not being specific and clear. You are just making vague accusations that Bennett doesn't understand the science and you do - without evidence for either.
And trying to work out your point is not easy when you contradict yourself from one sentence to the next:
>> "...her scientific credentials started to go downhill. She then said that she felt that perhaps it still had a “very small and limited place” in the NHS, by virtue of its placebo effect."
>> "Now, I’m not completely unsympathetic to the idea of using homeopathy for its placebo effect..."
So, Bennett's scientific credentials go "downhill" for suggesting homeopathy might be used for its placebo effect, but not yours when you do exactly the same.
You then raise two possible objections: ethical and efficacy. Given that Bennett and Green Party policy is saying "let doctors and best clinical advice decide" then your objections are moot.
It seems you believe your coup de grace is applied in the paragraph containing:
>> "Perhaps Natalie meant that..."
You're not sure what she meant, you make an assumption and then decide she is wrong based on that assumption. The only thing this convinces me of is that you had decided on a guilty verdict without regard to facts.
Finally, you reveal your naivete and lack of knowledge with this:
>> "...it’s possible that a conventional medicine might be actively harmful and perform worse than placebo, but something would have gone seriously wrong if such a drug were ever to be licensed."
To understand why that is such a naive belief, I suggest reading http://www.badscience.net/
You're entitled to your opinion Paul. I think I've already made my points pretty clearly, but if you choose not to accept them, that's up to you.
I have countered your points, Adam, and you have ignored the arguments and evidence presented. Your blog post and your response in the comments appears to be driven by ideology and not science.
P.S. The current Tory health minister actually believes homeopathy works: http://www.guardian.co.uk/commentisfree/poll/2012/sep/04/do-you-believe-in-homeopathy-jeremy-hunt
So which is the anti-science party?!
The discussants in this thread seem to have taken it as a proven fact that there is a placebo effect. However, much of what is taken to be a placebo effect may be just regression to the mean. To show that placebos have an effect (to the standard we commonly require for other treatments) would require a three-armed trial: nothing, drug, placebo to drug. Such trials are fairly rare but some reviews of them have been carried out. A good starting point is this reference:
"Kienle, G. S. and H. Kiene (1997). "The powerful placebo effect: fact or fiction?" Journal of Clinical Epidemiology 50(12): 1311-1318.
In 1955, Henry K. Beecher published the classic work entitled "The Powerful Placebo." Since that time, 40 years ago, the placebo effect has been considered a scientific fact. Beecher was the first scientist to quantify the placebo effect. He claimed that in 15 trials with different diseases, 35% of 1082 patients were satisfactorily relieved by a placebo alone. This publication is still the most frequently cited placebo reference. Recently Beecher's article was reanalyzed with surprising results: In contrast to his claim, no evidence was found of any placebo effect in any of the studies cited by him. There were many other factors that could account for the reported improvements in patients in these trials, but most likely there was no placebo effect whatsoever. False impressions of placebo effects can be produced in various ways. Spontaneous improvement, fluctuation of symptoms, regression to the mean, additional treatment, conditional switching of placebo treatment, scaling bias, irrelevant response variables, answers of politeness, experimental subordination, conditioned answers, neurotic or psychotic misjudgment, psychosomatic phenomena, misquotation, etc. These factors are still prevalent in modern placebo literature. The placebo topic seems to invite sloppy methodological thinking. Therefore awareness of Beecher's mistakes and misinterpretations is essential for an appropriate interpretation of current placebo literature."
Stephen
My declaration of interest is here
http://www.senns.demon.co.uk/Declaration_Interest.htm