There was a recent thread about how to respectfully challenge other peoples' efficacy claims about treatments that they thought had helped them, and if this could even be done. Homeopathy came up as an example of a treatment that gets a lot of criticism, and I thought I might try to explain why I think homeopathy should get a lot of criticism here, at least partly in response to requests to challenge people's arguments.
Sorry if this is a bit long-winded.
History of homeopathy, and the theories it's founded upon:
Homeopathy was developed on the basis of the theory that 'like cures like'. It seems that even keen homeopathy supporters would now recognises that this theory is nonsense.
"Homeopathic proving" was conducted to assess what substances led to what symptoms in test subjects. Then 'medicines' were created by greatly diluting these substances in order to reduce side-effects which worsened the symptoms that they were intended to treat.
The intensive dilution (or "potentization") used to create most homeopathic treatments means that it is unlikely that there is even a single molecule of the original active (like cures like) substance in most people's homeopathic medicine. Homeopathy's originator recommended a dilution ration of 1:10 to the power of 60. It's as pure a placebo as one could hope for.
What about quantum mechanics?:
This came up in the previous thread, and I see it come up quite often in attempted defences of homeopathy, so thought that I'd explain why I think that this is a weak point.
There a lot of confusing stuff going on at a quantum level, and I don't pretend to really understand any of it. But that doesn't mean it can be used to justify homeopathic medicine in any meaningful way. It's possible for Holocaust deniers to argue that a modern understanding of time and the probabilistic nature of matter means that the Holocaust may never have 'happened'... or that perhaps someone learnt how to manipulate quantum fluctuations so as to fabricate the 'evidence' of the Nazi holocaust... anything is possible. But if there's no good positive evidence that strange quantum shenanigans lead to homeopathy being an effective treatment for anything (or challenge our understanding of the Holcaust!) what value is there in bringing it up? One might as well just say 'it could be magic'.
The theories may be rubbish, but that doesn't mean it's not still effective:
It's true that the fact that the underlying theories for homeopathy are nonsense doesn't mean that homeopathic medicine cannot be helpful. Maybe homeopaths just got really lucky? A lot of effective medicines have been developed thanks to large doses of luck. In this case, with the specific theories underlying heomeopathy, and the specific ways in which they are nonsense, that does seems extremely unlikely.
Also, the evidence we have indicates that homeopathic medicines don't work.
Here's an eg of a review:
https://theconversation.com/no-evidence-homeopathy-is-effective-nhmrc-review-25368
There will be occaisional studies that show a positive effect (even for a worthless treatment we'd still expect one in twenty rigorous studies to show a significant difference from a placebo group, and there are also a lot of badly designed homeopathy studies out there), but the totality of evidence fails to show positive value for homeopathy, and certainly nothing like the positive effect over placebo that we'd expect if this was a sensible use of resources.
Why have people used it for so long then?:
I don't know, but there are probably lots of different reason, many I'm not aware of. Lots of ineffective treatments get used for a long time and that doesn't provide any evidence of their value.
For a pretty long time a placebo intervention would be better than the blood letting of 'mainstream' medicine. Even until very recently, it doesn't suprise me that the British Royal Family are keen on homeopathy, as they'll otherwise have had the extensive interventions of the leading 'experts' of the day: keen to validate their exciting new theories on an heir to the throne - a placebo will often be better than that.
Also, there is often a social pressure to seek some form of 'treatment' if one suffers from health problems. When suffering from health problems that lack an effective treatment, homeopathy provides a relatively easy way of responding to those social pressures.
Some people just value the 'therapeutic encounter'. Having someone present themselves as an expert committed to helping with ones health problems can be emotionally pleasing, and a reassuring way of shifting concerns to another, even if they are just a quack. When I hear from people who value the UK's CFS centres, they often seem to value them in this way.
What's the harm if it is just placebo?
There is a danger of people not pursuing more useful treatments, although that's less of an issue for CFS it can be a real problem for more committed fans of homeopathy.
Personally, I don't like people making money from the sick with unfounded claims of treatment efficacy. It bugs me. It takes advantage of people's desperation and wastes their resources. If all the money CFS patients had spent on worthless treatments had instead been invested into medical research, then we'd be in a much better position today.
If people endorse quackery like homeopathy then it will partially undermine any complaints they make about the way mainstream medicine has treated them. When their are such problems with how many with CFS have been treated, this can be a real problem.
Also, lots of people in society are aware of all of the problems with homeopathy I've mentioned above. While homeopathy can be used to relieve social pressure to seek treatment, use of homeopathy can also lead to more social problems. For a lot of people out there, if a patient with CFS says "I'm seeing a homeopath" that can be interpreted as meaning "I'm unreasonable and nothing I say about my health can be trusted". I don't think that's fair, but there are a lot of unfair attitudes about CFS already out there, and patients who associate themselves with quackery risk causing further social problems for themselves, often in ways that they are not fully aware of.
There are lots of treatments being promoted with no real evidence base - why pick on homeopathy?
Because it's easy, and I'm ill and lazy.
I do have a concern that homeopathy attracts more criticism than potentially more dangerous forms of 'alternative' medicine just because it is more obviously nonsense than a lot of other things. When I see people posting about some other things on here that sound very dodgy I often have to decide whether or not I want to spend my time investigating and then debating something that looks like dangerous quackery. More recently, I've generally been deciding to leave it (I've been involved in quite a few long discussions about things like this in the past). In an ideal world we'd all be engaging critically with one anothers ideas non-stop, but this is not an ideal world.
Also, in discussions on PR about the problems with claims made about the efficacy of CBT/GET, 'homeopathy' has become a useful shorthand for 'quackery that no-one in mainstream medicine respects', and pointing to similar problems with claims made about the effiacy for CBT/GET and homeopathy can be a useful tactic for challenging those who consider themselves 'skeptics' yet have dismissed concerns about PACE. 'Homeopathy' can be a useful symbol in those sorts of discussions, but it's often done on the assumption that readers are already dismissive of homeopathy, without any explanation being given as to why people should be dismissive.
Because of the way that they're seen as a part of 'mainstream' medicine (this having a considerable impact on how they're promoted to patients) I think that it's more important to criticise the quackery which surrounds CBT and GET than 'alternative' forms of quackery. But that's just my priority for how I want to spen my energy, and it certainly doesn't mean that I think it's okay for those making money from 'alternative' treatments to set themselves lower standards for the evidence required to justify claims of a treatment's efficacy.
Just to be clear: I don't feel any ill-will to other patients who are using homeopathy. I don't feel smug about the fact that they're doing something that I think it ridiculous. I've done lots of things that I now realise were ridiculous, and I'm grateful to the people who pointed out when I was making mistakes. I think that for a healthy intellectual community we all need to be trying to pick apart one anothers' claims and beliefs in the hope of improving ourselves and getting close to the truth. Best wishes to everyone.
edit:
@barbc56 posted this link summarising some of the possible reasons ineffective treatments can seem to work, even though when they're tested in a properly conducted trial the evidence shows that they do not:
