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.