The Merseyside Skeptics Society have produced the following open letter which I re-publish below in full:
An Open Letter to Alliance Boots
However, in evidence given recently to the Commons Science and Technology Committee, you admitted that you do not believe homeopathy to be efficacious. Despite this, homeopathic products are offered for sale in Boots pharmacies – many of them bearing the trusted Boots brand.
Not only is this two-hundred-year-old pseudo-therapy implausible, it is scientifically absurd. The purported mechanisms of action fly in the face of our understanding of chemistry, physics, pharmacology and physiology. As you are aware, the best and most rigorous scientific research concludes that homeopathy offers no therapeutic effect beyond placebo, but you continue to sell these products regardless because “customers believe they work”. Is this the standard you set for yourselves?
The majority of people do not have the time or inclination to check whether the scientific literature supports the claims of efficacy made by products such as homeopathy. We trust brands such as Boots to check the facts for us, to provide sound medical advice that is in our interest and supply only those products with a demonstrable medical benefit.
We don’t expect to find products on the shelf at our local pharmacy which do not work.
Not only are these products ineffective, they can also be dangerous. Patients may delay seeking proper medical assistance because they believe homeopathy can treat their condition. Until recently, the Boots website even went so far as to tell patients that “after taking a homeopathic medicine your symptoms may become slightly worse,” and that this is “a sign that the body’s natural energies have started to counteract the illness”. Advice such as this directly encourages patients to wait before seeking real medical attention, even when their condition deteriorates.
We call upon Boots to withdraw all homeopathic products from your shelves. You should not be involved in the sale of ineffective products, because your customers trust you to do what is right for their health. Surely you agree that your commitment to excellent patient care is better served by supplying only those products whose claims can be substantiated by rigorous scientific research? Or do you really believe that Boots should be in the business of selling placebos to the sick and the injured?
The support lent by Boots to this quack therapy contributes directly to its acceptance as a valid medical treatment by the British public, acceptance it does not warrant and support it does not deserve. Please do the right thing, and remove this bogus therapy from your shelves.
Yours sincerely,
Merseyside Skeptics Society
However, in evidence given recently to the Commons Science and Technology Committee, you admitted that you do not believe homeopathy to be efficacious.
You state about the Boots representative that
This is not strictly true, as the representative said
You also state that
This is actually not true.
1. The theory of treating like with like is not implausible. It accords with the understanding of homeostasis as a physiological phenomenon, and the significance of homeostatic reactions to medical treatments can easily be seen in the rebound effect, for example.
2. The theory was developed by applying the scientific method. It was based on a combination of thorough academic research, observation of actual events, theorising and testing of the proposed theory. When the theory failed to match with reality it was re-examined and further research and experimentation led to further articulation of the theory. The power of this approach was such that Hahnemann identified cholera infection as being a result of micro-organisms 60 years before Koch observed the bacteria, and incorporated this into the theory of homeopathy. He also maintained that these organisms evolved some 30 years before Darwin published On the Origin of Species.
3. The medicines used by homeopathy may involve material doses. What defines a medicine as homeopathic is the relationship of the totality of the symptoms it can cause to the totality of the symptoms of the individual being treated.
4. The pharmacological action of chemicals at cellular level is unpredictable. They can stimulate or inhibit cellular functions depending on a multitude of factors, including concentrations inside and outside of the cell, frequency of presentation to receptors, and so on. At a more gross level, the contradictory effects resulting from differences in concentration are referred to as hormesis.
5. The mechanism by which potentised remedies work cannot be explained by the application of chemistry, and Hahnemann (himself a chemist) specifically stated that it cannot.
6. Physics has no problem in theory with the idea that the process of potentisation effects changes in the state of the medicines. It is well know that water molecules, for example, have a polarity which leads to some very curious observations. The combination of water and alcohol is also proving to have unusual properties.
7. Researchers have established that potentised substances produce different reactions from the same substances merely diluted. This is not a theoretical issue, but one of fact based on multi-centre and replicated studies. This means that dilution + succussion ≠ dilution and so any discussion of dilution in this context is largely redundant, except in so far as it relates to the question of increasing the signal to noise ratio of the potentised substance.
You state that
This depends on whose version of events you pay attention to, and on what occasion they are presenting their version of events. Ben Goldacre, for example, has stated in Bad Science that:
but he has also stated to a Commons Committee that:
When opponents of homeopathy are so unreliable in the “information” they provide to the public, one has to question the validity of their position.
There is also the question of the way randomised controlled trials (RCTs) of homeopathic treatment are conducted. If they are not performed in a manner consistent with the whole theoretical framework of homeopathy, then they will necessarily produce confusing results. Indeed some RCTs have ended up testing a placebo against a placebo as a result of failing to take this into account. To understand whether a trial is truly testing homeopathic treatment, one needs to understand the process and its theoretical constraints, and it is not sufficient to apply the rules used by orthodox pharmacology. The huge discrepancy between the results of RCTs and those of outcome studies is indicative of the failure to use appropriate protocols in the RCTs.
There is also an assumption made that RCTs are sufficient in themselves to prove whether a treatment works or not. Those making this assumption usually claim that this is the basis of evidence based medicine (EBM). This assumption is wrong, and it is counter to the stated definition of EBM, which recognises that both trials and experience of treatment use in clinical practice are needed, and that neither source of evidence is sufficient alone. It should also be noted that EBM is based entirely on the comparison of bodies of evidence, and that theory does not form a part of the process. The reason for this is that EBM is an attempt to reach valid conclusions in the absence of a science of medicine.
RCTs are also limited in what evidence they can provide. They can predict harmful effects because these are general, and only the rate of harm is affected by the individuality of the patient. RCTs cannot predict curative effects without a definition of effectiveness which is (a) scientifically well-founded and (b) takes into account the individuality of patients’ responses. Such a definition of effectiveness does not exist in orthodox pharmacology. RCTs cannot, therefore, scientifically test effectiveness.
The insufficiency of RCTs is shown by the number of medicines which have to be withdrawn when their use in clinical practice reveals the extent of their side effects. Pharmaceuticals tested by use of RCTs have also led to an £8.2bn annual drugs bill in the NHS requiring a further £2bn to be spent annually on dealing with the adverse effects of those drugs when prescribed. To use RCTs as a final arbiter in assessing the effectiveness of homeopathic treatments is a fallacious and unscientific approach.
I have not provided references here, but fully referenced works on which these comments are based can be found in Halloween Science at:
http://www.homeopathyworkedforme.org/#/halloween-science/4533482584
and H:MC21’s submission to the Commons Science and Technology Committee at:
http://www.publications.parliament.uk/pa/cm200910/cmselect/cmsctech/memo/homeopathy/ucm3302.htm