Nancy Malik shows us how NOT to conduct a poll on homeopathy

For those not aware “Dr” Nancy Malik is one of the more prevalent Internet homeopaths, happily promoting the anti-science quackery we know as homeopathy. She attracted the attention of skeptics with a very long (and now defunct) Google Knol which supposedly contained hundreds of peer reviewed articles which provided evidence for the efficacy of homeopathy. Despite pretty much every link being scrutinized and rubbished by the wonderful Xtal Dave, Malik has moved the list to her new blog, amusingly entitled “Science-based Homeopathy” (a contradiction in terms if ever there was one).

Malik has come up with a poll about medicine, presumably in an attempt to gather evidence on the popularity of homeopathy. However, as I type this it’s not looking too good for homeopathy.

As you can see, conventional medicine is currently surging way ahead of all the alternatives to medicine. Ironically, if Malik wanted to set this poll up to get the result she wanted, she’s done pretty much the opposite of what she should have done in all cases. Let’s have a look at some ways to knobble a poll, and where she’s gone wrong.

1. Ask a leading question to point the responder towards the answer you want them to give

Malik asks “Which medicine you prefer when fall ill”. Apart from the embarrassingly bad use of English, it doesn’t steer people towards homeopathy. For example, a lot of quacks say things along the lines of “if you’ve tried everything else, why not try homeopathy?”, so why doesn’t Malik’s question attempt to represent that?

2. Place the answer you want people to give at the top

The answer presented first will obviously be the one that the respondent looks at first, so if you want a certain answer to come out on top, put it before all the others! Malik fails here by putting ‘conventional’ first, the answer that she presumably does not want people to pick.

3. Present the options you do not want people to pick in an unfavourable light

As mentioned above, Malik uses the term ‘conventional’ medicine. Alternatively, you could term it “evidence based” or “science based” medicine (which both sound good), but if you were a devious homeopath set out to discredit it you could call it something else. Homeopaths often like to call conventional medicine “allopathic” (treating like with non-like), as if it was some sort of polar opposite to homeopathy. You can also confuse people who don’t know what ‘allopathic’ is by doing this, something that Malik fails to do.

4. Split the vote of the options that you don’t want people to pick

A simple tactic, splitting the vote involves presenting more options than necessary for those that you don’t like. For example, say that you were out with friends and you wanted to get a cup of coffee, whereas your friends fancied a pint of beer. If you were to vote on where to go, you could present one coffee house and six or seven pubs. That way, everyone who wants a beer will vote for different pubs, but those who want a coffee will all vote for the same coffee shop, increasing the proportion of the ‘coffee’ votes.

So, for Malik’s poll, she could have quite easily presented all the non-evidence based practices as one option, perhaps calling it “alternative and complementary therapies”, and split up ‘conventional’ into several options, but once again this was not done. Another fail!

Taking all that into consideration, here is how I would have presented Malik’s poll if I was looking for a result that favours homeopathy:

“Which form of medicine would you prefer to use?”

  • Complementary and alternative therapies
  • Allopathy
  • Pharmaceuticals
  • High street drugs

With this poll, I’ve tried to apply the rules mentioned above to get a result in favour of homeopathy. For a start, I’ve rephrased the question to ask people what they would prefer to use, rather than what they actually do use. Who wouldn’t prefer to use lovely natural plants and gentle sugar pills? Second, I’ve placed the CAM option at the top to give it the most prevalence. I’ve also avoided using the term ‘homeopathy’ altogether, instead lumping all the alt med guff into “Complementary and alternative therapies”. That sounds nice doesn’t it? On the other hand, for conventional medicine I’ve tried to split the vote by using the terms “allopathy” (hoping that people won’t know what it is and therefore not check it), pharmaceuticals (scary big pharma) and “high street drugs” (no one likes the sound of “drugs”, especially when in close proximity to the word “street”).

Perhaps Nancy could use this for her second poll?

Anyway, I suggest you vote in Nancy’s poll before she takes it down!

Presenting the Dana Ullman Button!

Strangely for a skeptic blog, I’ve yet to write anything about one Dana Ullman. In case you haven’t come across him before, Dana is a homeopath whose misleading, catty and disingenuous remarks in defence of his profession on Twitter and various blogs are legendary. Such exchanges inspired Kimball Atwood over at Science Based Medicine to coin the Dulll-Man law:

In any discussion involving science or medicine, being Dana Ullman loses you the argument immediately…and gets you laughed out of the room.

Now you may think that’s a tad unfair, but believe me if you get into a conversation with Dana Ullman his contempt for both science and general discussion etiquette will either make you laugh or fly into a blind rage. I do miss my Twitter exchanges with the D’Ullman, but sadly he’s blocked me!

Anyway, as an extension to the Dull-Man law (and a test of my programming skills) I’ve come up with a little toy which you can use to automatically react to any piece of writing by Dana Ullman. Here is what I recommend. Open up his Twitter page, and every time you read a tweet, make sure you’ve got your sound turned up and click on the button below:

If you want to put this button on your site, you should (touch wood) be able to copy the HTML code below and paste it into your site:


Homeopathy on the NHS in Liverpool: thriving or moribund?

Water dropJust what is the current state of NHS provision in Liverpool, birthplace of the 10:23 campaign against homeopathy and my current residence? As a skeptic and ardent 10:23 swallower, I was very happy to learn from Andy Lewis on Quackometer that the Liverpool Homeopathic Hospital has closed. This seemed to happen without any fanfare from the NHS or wailing from homeopathy sympathisers. In fact, the British Homeopathic Association appeared to simply remove the name of the hospital from it’s own website. If you’re interested, you can see that both Liverpool and the Tunbridge Wells Homeopathic Hospital were listed on the same page in 2009.

So far, so good. No NHS Homeopathic Hospital in Liverpool, homeopathy in retreat. However, a short while later I learned from the Faculty of Homeopathy that NHS homeopathy was in fact “thriving” in Liverpool:

A new clinic is now providing homeopathic treatment to NHS patients in Liverpool. The Liverpool Medical Homeopathy Service (LMHS) operates from the Old Swan Health Centre in Old Swan and is staffed by medically trained homeopaths. Patients can gain NHS access to the service through a letter of referral from their GP.

Liverpool PCT is commissioning the new service from the LMHS which is a Community Interest Company, a limited company created to provide a service for the benefit of the community and not purely for private advantage. The setting up of the clinic also highlights the new approach to commissioning NHS services being adopted as part of the government’s NHS reforms.

The rest of the article quotes the Clinical Director at LMHS, one Dr Hugh Nielsen, who trots out the usual argument from antiquity and the ‘patient satisfaction’ red herring. I remember Dr. Hugh Nielsen BA MA BM BCh MRCP FFHom (not sure which one of those bachelors, masters, memberships and fellowships allow him to be called Dr) from the NHS Wirral consultation on homeopathy, so it’s not at all surprising that he’s trying to continue the tradition of treating people with sugar pills!

As you might expect, I was rather perturbed by this. I wanted to find out more. I could find very little information about the new service on the internet, so I thought I’d have a go at writing a Freedom of Information request to my local PCT. This is what I asked for:

I have read that the Liverpool PCT now commissions homeopathic services from the Liverpool Medical Homeopathy Service (LMHS) based at the Old Swan Health Centre. Is this true, and if so how much money is being spent on it?

The yesterday, I was glad to see that my request had been answered:

I can confirm that there is a homeopathy service based at Old Swan called the Liverpool Medical Homeopathy Service (LMHS). The service operates under any qualified provider arrangements. This means that no level of income or activity is guaranteed. Payment to the Provider is based on the number of patients attending the service who are referred by their GP. Referral into the service is only via primary care. The service commenced 1st November 2011; to date we have not received a request for payment from the provider.

Now, I’m no expect on healthcare provision and I’d appreciate some more insights, but I found this reply intriguing. Firstly, it’s plain confirmation that the LMHS service does indeed exist, but it’s NHS funding is based solely on the number of people referred to it. The reply is dated December 29th 2011 and the service commenced on November 1st 2011, and as of yet the LMHS has not requested any payment from the PCT. Am I wrong to think that no payments = no patients? Homeopathy thriving in Liverpool, indeed.

EU funding homeopathy for cows

Euro cowThe #ten23 hashtag on Twitter is currently full of homeopathy skeptics currently up in arms over a Daily Mail article claiming that the EU are to spend 2 million euro on researching the use of homeopathy in livestock farming. However, rather than being another piece of Mail right-wing euro-bashing, it is in fact true.

Fernando Frias kindly furnished me with a copy of the AGRI commission’s latest budget ammendments, and it’s right there on page 35:

Pilot project — Coordinate resesarch (sic) on the use of homeopathy and phytotherapy in livestock farming

Calls upon the Commission to set up a pilot project to coordinate research on the use of homeopathy and
phytotherapy in livestock farming, in line with the motion for a resolution on antibiotic resistance in
which Parliament called for the use of antibiotics in livestock farming to be reduced and for alternative
methods to be used; such methods include the use of homeopathy and phytotherapy; the pilot project
should involve the collection of data as to what research projects in the field of homeopathy and
phytotherapy have already been set up by the various Member States’ universities and higher education
institutions, and what findings they have made; the pilot project should also investigate whether, and in
what framework, the universities involved cooperate.

Pilot project within the meaning of Article 49(6) of Council Regulation (EC, Euratom) No 1605/2002 of
25 June 2002 on the Financial Regulation applicable to the general budget of the European Communities
(OJ L 248, 16.9.2002, p. 1).

The amendment is justified:

Antibiotic resistance is a growing problem in the EU and worldwide. One problem is the use of antibiotics in
livestock farming. That is why research on alternative methods has to be moved forward, for example
homeopathy and phytotherapy.

A quick glance at the accompanying table confirms that the amendment will cost a cool 2 million euro. It has been tabled by the MEPs Ulrike Rodust and Luis Manuel Capoulas Santos, who are both members of the left wing group of Progressive Alliance of Socialists and Democrats.

It may seem to be a noble idea, to investigate the possibility of reducing the amount of antibiotics given to livestock. So what are the problems here? First off, as myself and the 10:23 campaign have tried to make clear, homeopathy simply doesn’t work beyond placebo. It’s been around for over 200 years, and really doesn’t require any more research into it’s efficacy as far as I’m concerned. Secondly, there is the issue of ethics. If you treat livestock with homeopathy/placebo instead of antibiotics you are denying the livestock a proven treatment, which can lead to the animals suffering for no good reason. Finally of course, there is the issue of cost. 2 million euro is a lot of money to waste, regardless of the state of the global economy.

I think I’ve made myself clear on where I stand here, but I really have to address one other point that cropped up in the Mail article:

Animals cannot benefit from the placebo effect because they won’t realise they have been given the treatment, say critics.

The idea that animals cannot experience the placebo effect is total nonsense, for two reasons. Animals can respond to attention, the placebo effect isn’t just about taking pills. Also, it isn’t the farm animal that judges whether they are benefiting from a treatment, it’s the farmer. The farmer is very much open to a kind of ‘secondary’ placebo effect, where he or she believes that their animals are getting better because they have seen them treated. Hopefully that’s that silly notion put to bed!


Homeopathy back on the NHS on the Wirral?

Boots homeopathy

Homeopathy, soon available on the NHS on the Wirral?

A few months ago, the Wirral Primary Care Trust (PCT) made the extremely reasonable decision to cease funding for homeopathy. This was done at a meeting of the Professional Executive Committee (PEC), which followed a public consultation (which I attended). John Cook of Northwest Friends of Homeopathy presented the case for homeopathy in both the public consultation and the PEC meeting, whilst Michael Marshall from the Merseyside Skeptics Society provided a voice for those who want their NHS to provide treatments based on good evidence. The PEC considered the evidence, and voted to scrap funding for homeopathy.

I thought that would be the end of it. However, Jo Brodie reports that this is not the case. Pauline Lomas, a cancer survivor and apparent fan of many ‘alternative therapies’ out there, instructed her solicitors Leigh Day & Co to challenge the Wirral PCT’s decision to hold it’s drug and therapy commissioning meetings in private. According to the Leigh Day & Co website (who illustrate the case with a bottle of vitamins), the action “would not have been possible without funding from the Legal Services Commission”, which as far as I’m aware means that they were able to access legal aid for this case.

So what will this mean for NHS funding of homeopathy on the Wirral? My guess is that there will be another commissioning meeting, held in public, where the homeopathy sympathisers will once again show up to bombard members of the PEC with their anecdotes. The science will not change, the evidence in support of homeopathy will be no better. I see no reason why the PCT will change their minds, they have essentially been caught out on a technicality. I imagine it’s cheaper to do this than to enter a legal battle with the solicitors.

Personally, the only aspect of the decision to stop funding for homeopathy that I have any sympathy for is the amount of notice given of the public consultation. However, that didn’t stop a room full of homeopathy sympathisers from filling two rooms at the PCT to tell the PEC their anecdotes. Needless to say, anecdotes don’t cut it as scientific evidence, so any other public consultation will just be a repeat and a pretty fruitless exercise. Having said that, it is good that the NHS is engaging with it’s patients, and I for one will be looking forward to being able to have my say again. I’m more concerned about Legal Aid being used to challenge a decision by a PCT to stop funding a pseudoscience. Another case of the law being used to defend quackery, as in the Simon Singh case?

A preview of the results of the homeopathy survey

Water dropYou may remember that last month some homeopaths posted a somewhat mysterious survey up on, possibly in an attempt to get some sympathetic data. Of course, skeptics picked up on this and crashed the survey. I had a feeling that this would cause the homeopaths to abandon the survey (which is now closed), so I decided to register for myself and copy it. I promised to release the results this month.

Before I continue, I should say that are pretty cheeky monkeys! You can look at the first 100 responses of a survey for free, but anything more than that costs money. Not a prohibitively large amount of money mind, but enough. Also, as I type this there are currently 864 responses, I’d love to see it hit 1,000 soon! So, in the meantime I thought I’d look at data from the first 100 responses.

Not surprisingly, the data from these first 100 responses has a distinctively skeptical flavour. Bear in mind that this is a survey, so the most you can take from it is a measure of public opinion and not scientific conclusions! Let’s take a look at the questions and answers.

1. Do you know what Homeopathy is?

An overwhelming 96% of respondents answered this question with “yes”. This at least shows that people answering the questions think they know what they are talking about!

2. If you had a health concern, would you consider supplementing conventional medicine with alternative medicine such as Homeopathy?

I suppose this is the question that tells you what people really think of homeopathy and 93.9% answered this with “no” (one person skipped the question). So, at the early stages of the survey, I think it’s pretty save to say that the majority of respondents were not homeopathy sympathisers!

3. Have you ever taken a Homeopathic Remedy?

Now is where it gets a little interesting. 47.4% of people responded “yes”. Perhaps these people took homeopathy at a 10:23 event? Maybe they tried homeopathy and found it to be ineffective?

4. Qualified Homeopaths are no longer permitted to explain how Homeopathy works or offer any evidence on their websites because of a ruling by the Advertising Standards Agency. Do you think Homeopaths should be allowed to explain how Homeopathy works?

This is a fairly bizarre question, because the overwhelming scientific consensus is that homeopathy does not work, so how can you explain a phenomenon that isn’t present in the first place? Surprisingly (and bear in mind how many people said that they would not consider taking homeopathy as a complementary medicine) 43% of respondents answered “yes”. Fortunately, this is the first question where people are allowed to expand on their answers, and these answers reveal some interesting logic.

I think they should be required to explain how it is supposed to work and how stupid it is.

Actually, I thoroughly enjoy watching homeopaths try to explain how homeopathy works. You can’t invent that kind of comedy.

Yes because once you know you realise you should just take a sugar pill but make sure that someone else gives it to you telling you it will make you better. Will work just as well.

These answers seem to be suggesting that homeopaths should be allowed to try and explain how homeopathy works so that their patients can judge how silly it is. I’m not sure that I agree with that! Others argued on a freedom of speech level:

If homeopathy is going to exist, its practitioners should be able to explain it. Censoring information isn’t a way to effect worthwhile change — and as it is in every health food store where vitamins can’t list the conditions they treat, people will step in and tell you. This is a really terrible idea if the point is to help consumers understand their options.

5. Qualified Homeopaths are no longer allowed to state which medical conditions they treat. If you visited a Homeopaths website, would you find it useful or not useful to know which conditions they can treat?

This is in a similar vein to the last question. The science says that homeopaths can’t treat anything (unless you count the placebo effect), yet 33% of respondents said that it would be useful to know which conditions homeopaths can treat. A few people wanted the homeopaths to be honest:

They can treat the diseases which can be treated with placebos. If they said that, at least pacients would know they are not supposed to try to get rid of their cancer with Homeopathy, for example

I would find it very useful, if homeopaths would have to state, what they really can treat. According to a lot of scientific research it’s just nothing, and that has to be stated!

Since the answer is nothing, they should state that.

It would be nice to see a homeopath’s website where you click on “Conditions which can be treated with homeopathy” and get a blank page!

6. Qualified Homeopaths are no longer allowed to give testimonials from genuine patients if those patients want to state that their health has improved as a result of homeopathy. (Testimonials means comments only from verifiable, genuine patients) Do you think testimonials giving details of improvement from genuine patients should be not allowed or allowed?

The premise of this question goes against the mantra of “the plural of anecdote is not data”. Personal anecdotes are not evidence of efficacy, and the results so far reflect this position, with 82.5% of respondents saying that homeopaths should not be allowed to give patient testimonials.

7. Why do you think Homeopaths are being treated in this way?

The final question, and most of the responses are along skeptical lines:

Because they are charlatans and the public needs to be protected

Because they are quacks. At best making money from the gullible, at worst preventing effective medical treatment of illness.

Homeopaths are treated this way because homeopathy is a pseudoscience, which should not be depicted as an alternative to actual medicine.

However, towards the end of the responses a few answers from homeopathy sympathisers crept in:

Big Pharma wants to eliminate competition.

And my favourite logical fallacy-laden answer:

In a nutshell, homeopathy is a gentle, effective and increasingly popular healing model, that poses a threat to the profits of pharmaceutical companies, who have gained the support of the media (James Murdoch on GSK’s board of governors) to push their attack on homeopathy in the hope of undermining competition. Why do the skeptics not get up in arms about the number of people treated on the NHS for negative reactions to conventional drug treatments, or the fact that meta-analysis of anti-depressants show they are no better than placebo?

As these two answers were towards the end of the first 100 responses, I have an inkling that news of the survey reached homeopathy sympathisers and that the numbers will be very different once all the responses are taken into consideration. Like I say, I’m hoping to get 1,000 responses before closing the survey, and I will make the results available on request. Please spread the word!

Take the survey

A Homeopathy Survey and a Skeptic Version

Water dropPoor homeopaths, they aren’t feeling too well as of late. The ASA has given them an ultimatum to sort their websites out and the 10:23 campaign thwarted their “Let People Choose” campaign by pre-empting it with their own “Let People Choose” website, dispelling the fallacy of allowing homeopathy on the NHS as a matter of consumer choice.

So now, they have set up a public SurveyMonkey survey on homeopathy, most probably in an effort to get data to support their position. However, because it’s an open survey, various skeptics have filled it in, telling the homeopaths what they need to hear and even attempting to correct some of their fallacious questions. Given their track record of abandoning projects when it becomes clear they are not going their way (“Let People Choose” is an obvious example), I wouldn’t be surprised if the survey disappears and the homeopaths attempt to quietly sweep it under the rug. Therefore, I’ve decided to set up my own SurveyMonkey account, and I’ve pretty much duplicated their survey. I invite everyone (including skeptics and homeopaths) to fill in my version of the survey, and I will release the results in early August. Whereas all the clever skeptical comments entered into their survey will doubtless be thrown into the ether, I will preserve the comments in my version for posterity!

Rubbish Homeopathy Cartoons

Big hat-tip to Alan Henness (via @RachelOfTheNorf) for this one. He tweeted a page on homeopathy site that contains some truly atrocious cartoons, possibly even worse than those by Mike Adams of The ‘cartoonist’ in question is Alan V. Schmukler, a homeopath with a drawing style which I can only compare to a 5 year old let loose on MS Paint. Here’s a taster:

The above cartoon appeals to the fallacy that you have to try homeopathy to judge it’s efficacy, which is total bullshit. You don’t have to experience something to make a judgement on it. As an extreme example, would you need to murder someone to prove to yourself that murder is wrong?

I’ve ploughed my way through all of these cartoons, and what struck me was that the cartoons don’t just deal with homeopathy and all the logical fallacies associated with it, they also branch of into “big pharma” conspiracies and anti-vaccinationist propaganda. Here’s a classic post hoc fallacy:

That certainly doesn’t do anything to support the idea that homeopathy is a credible science, as opposed to a fantasy that belongs in the realm of conspiracy nuts. I could go on, but I think I’ve given the general picture of these woeful comics. I’ll show one more, because it has a little dig at the 10:23 campaign. The people in the cartoon might even be the hosts of the Skeptics With a K podcast. Check out the comic sans!

It’s World Homeopathy Awareness Week!

The week of April 10th-16th sees the World Homeopathy Awareness Organization hold it’s World Homeopathy Awareness Week, so I thought I’d do my bit. People need to be aware that homeopathy doesn’t work, as various systematic reviews of it have shown. Not only that, it couldn’t possibly work, as homeopathic ‘remedies’ above 12C contain no active ingredient. Any benefits that people see from homeopathy can usually be easily explained by the placebo effect or regression to the mean. It can even kill if used in place of conventional medicine. So please, support World Homeopathy Awareness Week by being aware of homeopathy, and don’t use it.

Lib Dem councillor promoting homeopathy and ear candling in Manchester

This Saturday morning (April 2nd) sees a Holistic Health Fair come to the Levenshulme Inspire Centre in south Manchester. A variety of bunkum will be on show, including reiki, ear candling, and of course, homeopathy.

Homeopathy needs no introduction from myself (I’ve already given my take on it here) but I’ve not mentioned reiki or ear candling before. Reiki is a form of alternative medicine that is literally hand-waving. Reiki practitioners use the palms of their hands to transfer healing energy (ki) onto their patients, supposedly. Needless to say, a 2008 systematic review from Edzard Ernst concluded that “the evidence is insufficient to suggest that reiki is an effective treatment for any condition”.

Ear candling

What's wrong with this picture?

So, onto ear candling. This really is one of those alternative ‘treatments’ that defies belief. During an ear candling treatment, the patient lies on their side and a hollow candle is placed vertically over their ear canal. The candle is then lit and allowed to burn. At the end of the treatment, the patient is shown the contents of the burnt out candle so they can see how many ‘impurities’ have been removed from their ear. Unsurprisingly, these impurities are just residue from the candle itself! The practise of ear candling is pretty dangerous too, the hot wax can drip into the patient’s ear and cause damage. There is also the issue of the name. One manufacturer in particular, Biosun, refers to them as “Hopi” ear candles. It won’t surprise you to hear that there is no evidence that the Hopi tribe (who can be found in Arizona) have ever used ear candles.

Anyway, it’s bad enough that this event exists in the first place, but what makes it even worse is the fact that it is being plugged by local Liberal Democrat councillor Simon Ashley. I’ve been a long-term supporter of the Lib Dems, so it’s sad to hear that there is a non-skeptical “it worked for me” woo merchant amongst their midst.

As far as I’m aware it’s free, so if you intend to go you can reply on their facebook page. Sadly I can’t make it, not because I can’t be bothered to get up and get to Manchester for 10am on a Saturday, but because it clashes with the return to 6 music of Adam and Joe (yay!).

EDIT: Hat-top to @janisbennion