Thursday, 27 September 2007

Dana Ullman MPH gives me some homework

Dana Ullman MPH (the only person I've ever seen put their qualifications on their blogger username) commented on my piece on Alan Bennett's description of alternative therapies here, suggested that I'm confused about what homeopathy is, and gave me some homework to do. I've read Ullman's webpage, and I can tell you that it's a farrago of nonsense, written in superficially scientific language.

I was aware of some of Dana Ullman's work previously. For example, there's an entire thread dedicated to him at JREF, which you can find here. He posted there (under the username James Gully) to write some utter nonsense about famous scientific figures who supposedly used or supported homeopathy. Having had his arse handed to him by several posters on the forum, he accused them of 'intellectual dishonesty' and disappeared. But I hadn't seen this webpage before. It's entitled 'Why homeopathy makes sense and works', but fails to demonstrate either. You can find it here.

Ullman starts off by talking about side effects. He writes "It should be noted that people often incorrectly assume that conventional drugs have 'side effects.' Actually, in purely pharmacological terms, drugs do NOT have side effects; drugs only have 'effects,' and physicians arbitrarily differentiate between those effects that they like as the effects of the drug, while they call those symptoms that they don’t like 'side effects.' This is akin to saying that the effects of a bomb are that it destroys buildings, but its side effects are that it kills people. Needless to say, one cannot truly separate out one effect from the other. The reason that drugs create 'side effects' that are often worse than the original disease is that these drugs tend to suppress the symptoms the sick person is experiencing and push them deeper into the person’s body."

In fact, the distinction between effects and side effects is simply that the effects are desired, and the 'side effects' are not. It's not an arbitrary distinction, and no-one is trying to claim that side-effects are not effects caused by the drug. That's why medicines are tested for safety before they are licensed for sale. The reason why drugs have side effects is that they contain biologically active substances. A good explanation for the lack of side effects with homeopathic remedies is that they do not contain biologically active substances, that is, they don't work.

Ullman describes the principles behind homeopathy. In a section headed 'Determining what a medicine can cure', he writes about homeopathic provings. In a proving, subjects are given a dose of a substance, and their 'symptoms' are recorded. It is then assumed that a small (or nonexistent) dose of the substance will cure the same symptoms. Ullmann calls these provings 'toxicological studies', but it's easy to see that as scientific studies they leave a lot to be desired. It's an exercise in the post hoc ergo propter hoc fallacy, in that it's impossible to know whether the 'symptoms' were caused by the dose because there are no adequate controls.

Ullman then goes on to describe how homeopathic remedies are made, and talks about the power of 'nanodoses'. Firstly, this is a little disingenuous, as it suggests that homeopathic remedies contain very small amounts of an active ingredient, whereas in many cases they contain no active ingredient at all. Perhaps 'nonodose' would be a better term. Ullman describes the process of dilution and 'succussion' (shaking) well enough, but then bizarrely states that "It is inaccurate to say that homeopathic medicines are extremely diluted; they are extremely 'potentized'". It is not inaccurate to say that the medicines are extremely diluted: they are extremely diluted, as Ullman shows when he talks about serial 1:10 or 1:100 dilutions being conducted up to 1,000,000 times (as an aside, how can this easily be done? If I assume one 'potentisation' step can be done in one minute, it would take nearly two years to do 1,000,000 times, assuming I work 24 hours a day). The homeopathic theory is that this dilution and shaking makes the remedy more 'potent'. Apart from being against common sense (which after all can be wrong), this also goes against the dose-response effect well known from pharmacology, i.e. that a greater dose causes a greater effect. In a section headed "Other evidence on the power of nanodoses" Ullmann writes about certain compounds that have biological effects at very low concentrations, or that have very different effects at low concentrations than they do at high concentrations. This is not relevant to homeopathy, where substances are supposed to be biologically active at zero concentration.

Ullman also writes about clinical evidence for homeopathy. One thing about this section is that Ullman seems to misunderstand p values, when he writes that p=0.008 "means that there was a 99.2% chance that this treatment was effective". It means that if you conducted the experiment 1,000 times, you would expect to get a positive result 8 times through chance. It doesn't tell you about biases, poor experimental design, or other problems with the study (there's a useful discussion of some of these things here, here and here). For any of the examples Ullman gives of studies showing benefits for homeopathy, there are several that show the opposite. A recent well-conducted meta-analysis in the Lancet looked at homeopathy versus 'conventional' treatments. It found that the best conducted studies showed no benefit for homeopathic remedies beyond placebo, whereas the conventional treatments did show a benefit beyond placebo. Tellingly, Ullman mentions New Scientist, a popular science magazine that does not publish original research.

In the last paragraph of the 'clinical evidence' section, Ullman mentions 'water memory'. As regular readers of hawk/handsaw will know (hi to all two of you!), a recent issue of the journal Homeopathy was dedicated to this concept. None of the papers in it showed any 'memory' effect relevant to homeopathy, as discussed here, here, here, here, here and here. It's wishful thinking, at best.

For me, there's nothing on Dana Ullman's page that makes me think that homeopathy 'makes sense and works'. Not only that, but I didn't learn anything I didn't already know about homeopathy.

Edit: Here's a link to the Respectful Insolence blog on the COPD study mentioned by Dana Ullman in the comments to this piece.

32 comments:

Shinga said...

The research is impressive, Paul.

However, it occasionally crosses my mind that this open-minded exploration seems to be awfully one-sided and it is unbelievably time-consuming. Plus, we do end up responding to other people's agenda.

Nonetheless, I accept that it has to be done. Maddening.

Paul Wilson said...

Yes, that link is certainly illustrative....

It actually didn't take me too long to write, but it's possible I could have spent that time doing something more productive. Basically I was just annoyed that Ullman posted a drive-by allegation that I'm confused about homeopathy on my blog. I'm less confused about it than most homeopaths, I think.

Dana Ullman, MPH said...

I'm glad that you didn't learn anything new from my article on "Why Homeopathy Makes Sense and Works." That means that you already knew about the study in CHEST (the leading medical journal on respiratory medicine) that shows substantially significant results from a homeopathic medicine in the treatment of people with COPD (chronic obstructive pulmonary disease).
But heck, this study was conducted at a "new age" center called the University of Vienna Hospital.
I'm glad that you already knew this...and that you knew about the "silica hypothesis" that suggests that the silicate fragments that fall off the walls of the glass (6ppm) in the making of a homeopathic medicine. How can you say with a straight face that this would not or could not influence water structure? Is it just a coincidence that silica has a tendency to store and to broadcast information? But once again, you already knew this because you didn't learn anything new.
I’m pleased that you’re already familiar with the newest research from Rustom Roy, PhD, of the material sciences department at Penn State. You know that he’s gotten 18 articles published in a journal called NATURE…and you know about his newest research testing different spectoscropic analysis, he was able to differentiate between two different homeopathic medicines and two different potencies that were beyond Avogardo’s number.
And I’m glad that it is nothing new to you to have a REAL RESPECT for the human body, and along with this respect is the recognition from modern physiology that symptoms are not simply the result of breakdown but are adaptive responses of the body to infection, stress, and/or environmental exposures. Therefore, using conventional drugs that control or suppress this innate adaptive effort of the body is counter-productive to health, even if it provides short-term relief of a symptom.
I’m glad that you knew all this, even though the best scientists have humility on what they don’t know.

Shinga said...

Wow - that's like a pomo riff on "Reasons to be cheerful" by an Ian Drury with no sense of humour.

Except, it's "I'm glad..." with the implied teenaged (NOT - chuckle, chuckle) that is used with impact on The Simpsons but seems to fail so very abysmally in the 'real world' of blogs.

Why is it when commenters stream a list of "I'm glads" they never mean it?

Drive-bys by Ullman - letters from Holford - you know how to make a starburst impact on the blogging scene, eh?

Anonymous said...

Paul - could you format this post to make it clearer which parts are quotes from DUllman, MPH?

Otherwise, good post. It would be good too see some links in DUllman, MPH's critique of it, but I'm not holding my breath.

Cheers,

HJay, SFA

Dana Ullman, MPH said...

Skeptics of homeopath don't seem to like it when I am "glad" at what they have said or "upset" or "angry" or heck, if I simply say anything.

I am pleased that Paul seems to have previously known everything that I had written in my article (that IS what he said), and I thought it was quite humorous one of the people here couldn't figure out what quotes were from my writing and which were Paul's.

Paul...you're sounding like a homeopath. Congrats.

pv said...

Mr Ullman (miles per hour), I believe Paul wrote:
"but I didn't learn anything I didn't already know about homeopathy".
Maybe you need some new homeopathic spectacles to go with your homeopathic reading ability because. You know, if your first language is English and you have more than a passing acquaintance with it, Paul's words don't translate into:
"I am pleased that Paul seems to have previously known everything that I had written in my article".
Not even a nice try!

But what would one expect from an evangelist trying to flog the cult of delusional medicine?

Anonymous said...

DUllman - formatting is not an act of comprehension, it's an act of clarity and aesthetics.

I'm able to spot the phrases that are quoted easy enough, thankyou, because quotation marks are used.

Amazing how simple that was for you to get wrong eh?

HJay

Dana Ullman, MPH said...

If what I wrote in my article provided you with no new information about homeopathy, then, I assume that you already KNEW about ALL of the research referenced and described in that article. Therefore, what is your response to the COPD study, to the silica hypothesis, to Elia's work on the thermodynamics of homeopathic medicines, and to the other clinical and basic sciences studies.

Please stop your personal insults and simply talk about research.

It is amazing the unscientific attitudes that skeptics of homeopathy have. Chutzpah to the max.

Paul Wilson said...

Thanks all for your comments.

Mr. Ullman, for stuff on the Elia and Roy studies, you could have a look at the links I posted towards the end of "Dana Ullman gives me some homework". Briefly, the recent Elia et al. paper in Homeopathy is so poorly organised and written that it's hard to tell what they did. However, they write 'It is important to emphasise that, from the studies so far conducted, we cannot derive reproducible information concerning the influence of the different degrees of homeopathic dilution or the nature of the active principle (solute) on the measured physicochemical parameters'. In other words, they failed to reproduce any of their results. The Rao et al. paper in the same issue of homeopathy, featuring Rustum Roy and his spectroscopy, is possibly the worst paper I have ever read. There's so much about it that I'm not even going to try and summarise here. It's worth checking out the links.

The COPD study you refer to was in Chest, right? The good folk at Respectful Insolence showed that study to be flawed, because the control group contained people with worse symptoms than the treatment group.

http://scienceblogs.com/insolence/2007/07/homeopathy_in_thecringeicu_1.php#more

As for the silica hypothesis, well, it's just that: a hypothesis with no supporting evidence. Again, the links at the end of "Dana Ullman gives me some homework" on 'memory of water' are worth reading.

Now, I've read the website that you posted. Instead of moaning about the 'unscientific attitude' of homeopathy skeptics, I'd invite you to address some of the points made in my piece, and the links within it.

Paul Wilson said...

Hm, not sure how to do links in the comment box. Will post the respectful insolence link as an edit to the original post.

Dana Ullman, MPH said...

I'm impressed that YOU have declared that the Elia paper was "poorly organized," and yet, his work has been published in some of the most respected scientific publications in the world (both general science and chemistry journals). So, why oh why should anyone believe you.

As for the COPD study, Orac is out of his league (again). The minor differences in the two groups does NOT in any way provide any reason for the SUBSTANTIAL (beyond significant) differences in the treatment group (that is, the homeopathic treatment group) and the placebo group. But heck, if YOU or Orac have an axe to grind, you grind away, throw away good research, and then have the chutzpah to think of yourself as a defender of good science. NOT.

As for the link to the embarrassing analysis of the COPD study by Orac, it is:

http://scienceblogs.com/insolence/2007/07/homeopathy_in_thecringeicu_1.php

Skeptics of homeopathy will soon lose whatever respect you think you have by your unscientific and ill-informed assertions about homeopathy.

To learn something about homeopathy, I invite you to read my forthcoming book...for details, go to www.HomeopathicRevolution.com

Good-bye for now...until you do your homework and maintain a more sophisticated scientific attitude.

Anonymous said...

Has he gone yet?
All this fuss over a placebo...

Keep up the good work Paul.
jdc.

Paul Wilson said...

Lordy, what an unpleasant fellow this Dana Ullman MPH is.

Regarding the Elia et al. paper, I would agree there's no particular reason why anyone should believe me. Not because of a spurious argument from authority, but because they should ideally read the paper and decide for themselves. Whether Elia has published loads of papers is irrelevant: it's whether the Homeopathy paper is important. It can be found here. They say they can't reproduce any of their results, so they've failed to show anything at all.

Would have to disagree about the COPD study. The disparity between the treatment and control groups is a source of bias, and the study is flawed.

I don't think I'll bother with the book, thanks all the same. It seems likely that my time could be spent more productively in other ways.

Dana Ullman, MPH said...

Unpleasant? Just because I defend myself, my work, and an important contribution to medicine and science? I guess that you prefer to walk on people without a spine.

My condolences.

And yes, you probably are better if you don't learn anything new and if you follow the blind crowd.

Paul Wilson said...

Now, I don't blame you for wanting to defend your work. I've been quite critical of a webpage that you wrote, and you're obviously entitled to respond. The problem is that you haven't actually responded to any of the points I have made. For me, I think your misunderstanding of p-values is particularly damning. So far, you've posted some stuff about some flawed studies that supposedly support homeopathy. I've tried to explain why they are flawed, or link to pages that explain why they are flawed. You have dismissed these using arguments from authority, without engaging with the actual science. You call the Respectful Insolence critique of the COPD paper 'embarrassing', but again you don't actually engage with the evidence in order to explain why.

Your definition of a 'sophisticated scientific attitude' seems to be to uncritically accept any study, no matter how flawed, that might provide evidence for homeopathy, while failing to engage with any of the evidence that suggests otherwise. Until this changes, this discussion is a waste of everyone's time.

Shinga said...

Fascinating - I think that we are witnessing semantic degradation or drift whereby the phrase "sophisticated scientific attitude" is taking on an antithetical meaning in some quarters.

apgaylard said...

The comment I liked most was: "... Is it just a coincidence that silica has a tendency to store and to broadcast information ..". It seems, and I'd welcome any clarification, that Ullman is refering to "silicon chip" technology? To make a memory device with silicon doping is required. This is the introduction of specific concentraions of specific elements in specific places. This varies the properties of the semiconductor (silicon) so that devices such as diodes and transistors can be made.

Is Ullman really saying that these silica fragments become doped in just the right way to function as memory devices?

The "broadcast" tendency makes even less sense. Yes, you can make a radio using silicon-based transistors, for example. However, you can make radios without silicon. If we five him his accidental transistors, where do the other componants come from?

I could have misunderstood the point? I'd welcome a clarification if this is the case. Just what storage and broadcast tendencies are meant here?

apgaylard said...

Almost forgot this: Integrated circuits ("silcon chips") are made on a substrate of monocrystal silicon wafers with very low defect rates in the crystal structure. To make a memory device you need many thousands of transistors on the same "chip".

Ullman is talking about SILICA fragments. You can't make chips with these!

Paul Wilson said...

Yes, have to admit that I thought the "... Is it just a coincidence that silica has a tendency to store and to broadcast information .." comment was a classic of the genre. Total rubbish.

apgaylard said...

The invocation of Rustrum Roy was quite good too. It's true that he did some work in the past, but his recent form is far from impressive.

Bob Park said recently of an involvement of Roy with the recent "burning saltwater" lunacy (see http://badscience.net/forum/viewtopic.php?t=3078): "He needed a scientist. Instead, he found Rustum Roy, an emeritus chemistry professor at Penn State, who called it "the most remarkable discovery in water science in 100 years." That would include "polywater," which Roy fell for 40 years ago. Roy said that RF weakens chemical bonds, releasing hydrogen which burns.."
(http://bobpark.physics.umd.edu/WN07/wn091407.html).

Park also points out that Roy is "a specialist in holistic medicine and Christian sexuality."
(see http://www.rustumroy.com/)

Now we have a more complete picture of the cited authority. A brilliant man and distinguished academic with a propensity to be taken in by the implausible and impossible.

Paul Wilson said...

Yes, but "he’s gotten 18 articles published in a journal called NATURE", so he can't be wrong, can he?

Would have been interesting to see what the review comments would have been like had he submitted the Homeopathy paper to Nature...

apgaylard said...

argumentum ad verecundiam

Orac said...

"As for the COPD study, Orac is out of his league (again). The minor differences in the two groups does NOT in any way provide any reason for the SUBSTANTIAL (beyond significant) differences in the treatment group (that is, the homeopathic treatment group) and the placebo group. But heck, if YOU or Orac have an axe to grind, you grind away, throw away good research, and then have the chutzpah to think of yourself as a defender of good science. NOT."

Do tell. Please tell me exactly how and why my analysis is incorrect (not to mention that of some of my readers, who went even beyond my discussion) instead of just hand waving and whining. In fact, the difference between the group are more than enough to account for the reported homeopathy "treatment effect."

Paul Wilson said...

Cheers, Orac...

Enquiring minds want to know, what's actually wrong with Orac's critique?

Danny said...

I too would welcome clarification of “... silica has a tendency to store and to broadcast information”.

HCN said...

Dana has replied back at the JREF thread posted above that the request for a the reasons Orac's analysis of the COPD study is flawed is "not worthy of a response".

Personally, I think it is because he has NO response. Or at least one that would be intellectually honest.

He also seems to think that posting comments on blogs and forums are "emails". Go figure.

Still, I have this song now stuck in my head. It starts off as "Brave Sir Robin".

Mojo said...

"...he talks about serial 1:10 or 1:100 dilutions being conducted up to 1,000,000 times (as an aside, how can this easily be done?)"

They have machines for that these days, and a method of diluting called the "Korsakov method" which does away with all that tedious measuring, as it basically involves repeatedly rinsing a single vessel.

See, for example, this page (under "high potencies"):
http://www.helios.co.uk/technical.html

Also see this page for a description of both Hahnermann and Korsakov methods:
http://www.sulisinstruments.com/us/korsakovian.htm

apgaylard said...

BTW it turns out that the "Nature" score for Roy is:
Articles = 0
Letters = 13
Scientific correspondence =1
News and Views =1

With one letter Roy mentions in his bibliography that I can't find:
R. Roy, D. Agrawal, J. Cheng, and S. Gedevanishvili, “Unexpected sintering of powdered metals parts in microwaves”, Nature, 399, 664 (June 17, 1999).

Still, pretty impressive; though none since 1999.

Paul Wilson said...

Yes, and none on spectroscopy of homeopathic preparations...

Thanks to Mojo for the links. Fascinating stuff.

Paul Wilson said...

apgaylard:

Found that paper you were missing via Web of Science. The title is slightly different, and it actually starts on p. 668, but it seems to be the same one.

Here.

Nothing worse than reference geekery, I know, but the way these errors propagate through the literature suggests that people aren't always reading the references they cite. Not news, I suppose.

Paul Wilson said...

This discussion has prompted some musings on the 'argument from authority' fallacy here.