THE MEMORY OF WATER UNDER THE BRIDGE?

Dear Editor:

After analyzing the poor quality of the ar-guments against homeopathy in the biomed-ical press, Vickers (2000a) asks us to accept aparticularly threadbare example. “Extraordi-nary claims require extraordinary evidence” iseven institutionalized as a “requirement,” ap-parently on the presumption that homeopa-thy’s effects are too slight to be differentiatedfrom placebo unless trials involve many thou-sands of participants. Just how constructive ause of a tiny budget this would be can be as-sessed by remembering the existing random-ized small trials where individualized orknowledgeably applied formulaic homeopathywas not merely better than placebo, but equiv-alent or superior to conventional treatments(for example Tarne et al., 1998; Van Erp andBrands, 1996; Weiser and Strösser; 1998).Strangely, Vickers (2000b) now claims that peo-ple who object to double standards, ad hoc sta-tistical manipulation, and obscurantism in theevaluation of homeopathy consign themselvesto an intellectual ghetto—even though they callfor independent replication of the same posi-tive high-quality trials that were the stimulusfor his review (Dean, 1998).

In a journal that is a home for debate aboutparadigm and policy, as well as practice, Vick-ers would like to deflect attention from the con-nection between homeopathy’s status andfunding and its historical treatment by a mo-nopolistic and barely scientific medical estab-lishment—one that created a rigid “them” and“us,” and threatened professional suicide forthose who practiced or researched homeopa-thy. This Cartesian failure to respect the his-torical dimension behind the present predica-ments leads inevitably to the argument thatreplication of physical tests to distinguishhomeopathic dilutions from controls is simplya matter of pure science. If it is, we are stillowed a convincing explanation of why an en-tire field of therapeutically relevant inquiryinto conventional low-dose effects has been os-tracized for half a century (Calabrese and Bald-win, 1999) and why skeptics can publish their

own replications (P 5 0.0027) of earlier peer-re-viewed and replicated work on serial agitateddilutions, as if it were a falsification (Davenas,et al., 1988; Hirst, et al. 1993).

All this goes to show that the invitation tovigorous scientific debate that is held up for ad-miration might be more plausible if there werea serious chance of its taking place—if by vigoris meant the open-minded inquiry and deepthought that genuinely, and therefore pluralis-tic, evidence-based health care demands andthat patients deserve. Nearly 200 years ago,J.C.A. Heinroth (1825), the professor of psy-chological medicine at Leipzig University, Ger-many, prefaced his all-out attack on homeopa-thy by stating that he was unconcerned withclinical evidence—solely with theoretical ob-jections. Today, at the end of a decade whenthe goal of evidence-based health care has beenwidely accepted, Heinroth’s attitude is stillprevalent when homeopathy is the frame. Thecontinual accusations of homeopathic fraud, orinsignificance when fraud is no longer tenable,simply echo Heinroth and are reminiscent ofthe inhabitants of Swift’s airborne island of La-puta: scientists who, Gulliver found, were“very bad Reasoners, and vehemently given toOpposition.”

REFERENCES

Calabrese E, Baldwin L. The marginalization of hormesis.Toxicol Pathol 1999;27(2):187– 194.

Davenas E, Beauvais F, Amara J, et al. Human basophildegranulation triggered by very dilute antiserumagainst IgE. Nature 1988;333:816– 818.

Dean M. Out of step with the Lancet homeopathy meta-analysis: More objections than objectivity? J Alt Com-plement Med 1998;4(4):389– 398.

Heinroth JCA. Anti-Organon, oder das Irrige der Hahne-mannischen Lehre im Organon der Heilkunst. Leipzig,1825.

Hirst SJ, Hayes NA, Burridge J, Pearce FL, Foreman JC.Human basophil degranulation is not triggered by verydilute antiserum against IgE. Nature 1993;366:525– 527.

Tarne PP, Runnebaum B, Roebruck P, Monga B, GerhardI. Homeopathy vs conventional therapy for female in-fertility. Archives Gynecol Obstet 1998;261(supp l.1):193–195.

Van Erp V, Brands M. Homeopathic treatment of malariain Ghana: Open study and clinical trial. Br Homeo-pathic J 1996;85:66– 70.

LETTERS TO THE EDITOR 301

LETTERS TO THE EDITOR302

Vickers AJ. Homeopathy: Analysis of a scientific debate.J Alt Complement Med 2000a;6(1):50– 58.

Vickers AJ. The lure of the ghetto. J Altern ComplementMed 2000b;6(4):300.

Weiser M, Strösser WKP. Homeopathic vs conventionaltreatment of vertigo: A randomized double-blind con-trolled clinical study. Arch Otolaryngol: Head NeckSurg 1998;124:879– 885.

Michael Emmans Dean, H.M.D., M.H.M.A.Department of Health Sciences and

Clinical EvaluationUniversity of York

HeslingtonYork, YO10 5DDUnited Kingdom

A LAST WORD FROM THE ORIGINAL AUTHOR

Dear Editor:

In response to Dean’s (2000a, 2000b) discus-sion of Descartes, Heinroth, Swift, Leibniz andHume; and Jonas’ (2000) discussion of the so-ciology of belief, I would like to return to myoriginal paper (Vickers, 2000). No, I am not try-ing “to deflect attention from the connectionbetween homeopathy’s status . . . and its his-torical treatment” (Dean, 2000b) and, no, I donot take “on trust [science’s] self-proclaimedrole of reality’s gatekeeper” (Dean, 2000a). Fur-thermore, I am not offering a “methodologicalsolution to a debate about belief” (Jonas, 2000).This is because I was writing about what I waswriting about, and not about something else.

The purpose of my article was to examine thedebate about clinical research in homeopathy,expose flawed arguments, and air some of themore valuable points. The point of the paper isto improve clinical research in homeopathy. I

care about this because I have conducted andpublished such research. Contrary to the im-plications of Dean and Jonas, I did not suggestthat improved clinical research would “solve”the debate about homeopathy; neither did Iclaim that scientific appraisal was the only im-portant way of looking at homeopathy or ar-gue that a different type of analysis of homeo-pathic research could not possibly tell usanything of sociologic interest.

Dean’s complaints about the “monopolisticand barely scientific medical establishment”and Jonas’ more positive suggestions aboutnew avenues of research both have their place.But when “playing the game” of clinical re-search, let’s concentrate on the game at handand play it as hard and as well as we can. Somemight believe that clinical research in home-opathy is beyond improvement, that no rea-sonable scientist could deny that homeopathicefficacy has been demonstrated, and that, to in-terpret clinical trials, only clinical-trial evidenceis required. For others, the conclusions of myoriginal paper—that researchers should pay at-tention to publication bias and strength of ev-idence—will be of value.

REFERENCES

Dean ME. Commentary on Vickers. J Altern ComplementMed 2000a;6(1):57– 59.

Dean ME. The memory of water under the bridge? [inLetters to the Editor] J Altern Complement Med2000b;6(4):301 –302.

Jonas WB. The homoeopathy debate. J Altern Comple-ment Med 2000;6(3):213– 215.

Vickers AJ. Clinical trials of homoeopathy and placebo:Analysis of a scientific debate. J Altern ComplemenMed 2000;6(1):49– 56.

Andrew J. Vickers, Ph.D.Royal London Homoeopathic Hospital

E-mail: Vickersa@mskcc.org

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