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 This is a transcription of a [[http://​mediasite.uchc.edu/​mediasite41/​Play/​f45177db9279460797ffe70714a3f5611d|video]] of a talk on homeopathy that took place on the premises of the University of Connecticut,​ March 22<​sup>​nd</​sup>,​ 2013. The topic of the talk was //​Homeopathy:​ Great Medicine or Dangerous Pseudoscience?//,​ the opponents were Dr. André Saine and Dr. Steven Novella. This is a transcription of a [[http://​mediasite.uchc.edu/​mediasite41/​Play/​f45177db9279460797ffe70714a3f5611d|video]] of a talk on homeopathy that took place on the premises of the University of Connecticut,​ March 22<​sup>​nd</​sup>,​ 2013. The topic of the talk was //​Homeopathy:​ Great Medicine or Dangerous Pseudoscience?//,​ the opponents were Dr. André Saine and Dr. Steven Novella.
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 +Following the debate they both agreed to ask each other a question monthly, with the obligation that these Q&A will be posted on their mutual websites.
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 +  * [[en:​misc:​talk-saine-novella-question01|Question 1 from Dr. Steven Novella to Dr. André Saine]]
  
 <WRAP center round info 60%> <WRAP center round info 60%>
  Some minor changes to the order of words have occasionally been made to make this transcription grammatically correct and easier to read.  Some minor changes to the order of words have occasionally been made to make this transcription grammatically correct and easier to read.
 </​WRAP>​ </​WRAP>​
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 ===== Introduction ===== ===== Introduction =====
  
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 A question, a single question! It’s not a conclusion, it's not even a part of conclusion, it’s the only single time it is mentioned in the study. The study is this big, I have it in my briefcase, I can show it to you! So, I am surprised that somebody who is science-based,​ a champion of science-based like you, comes with such a deviated conclusion about such an important study. ​ A question, a single question! It’s not a conclusion, it's not even a part of conclusion, it’s the only single time it is mentioned in the study. The study is this big, I have it in my briefcase, I can show it to you! So, I am surprised that somebody who is science-based,​ a champion of science-based like you, comes with such a deviated conclusion about such an important study. ​
  
-First, you cannot compare the Swiss study with the British study. One, it's a government study where they commission scientists. There were 10 scientists on the committee -- three((the number was corrected by the later statement of Dr. Saine)) were homeopaths, there were neurologists,​ there were mathematicians,​ there were specialists of statistics, but there were only three homeopaths. The British study -- three members of the 14 members of the committee sat on the three meetings -- only three of 14 -- and only one of the three voted for the study -- only of the 14 voted for the study. It was rejected by 70 out of 70 members of the parliament -- it was not abided by the government, it was rejected! Why should you call it if the government itself rejects the study! You cannot compare the two studies!+First, you cannot compare the Swiss study with the British study. One, it's a government study where they commission scientists. There were 10 scientists on the committee -- three((the number was corrected by the later statement of Dr. Saine)) were homeopaths, there were neurologists,​ there were mathematicians,​ there were specialists of statistics, but there were only three homeopaths. The British study -- three members of the 14 members of the committee sat on the three meetings -- only three of 14 -- and only one of the three voted for the study -- only of the 14 voted for the study. It was rejected by 70 out of 70 members of the parliament -- it was not abided by the government, it was rejected! Why should you call itif the government itself rejects the study! You cannot compare the two studies!
  
-Observational study -- I would refer you to the New England Journal Of Medicine, it's called -- Randomized, Controlled Trials, Observation Studies and The Hierarchy of Research Designs by John Concato et al, where he said //“the value of observation studies...it'​s important to point that in the hierarchy of research designs, for well-designed observational studies, especially over a long term like this -- six years and eight years --// //__**do not**__// //​systematically overestimate the magnitude of the effects of treatment as compared with those in randomized, controlled trials on the same topic.”// **Do not** overestimate,​ in the long term!+Observational study -- I would refer you to the New England Journal Of Medicine, it's called -- Randomized, Controlled Trials, Observation Studies and The Hierarchy of Research Designs by John Concato et al, where he said //“the value of observation studies...it'​s important to point that in the hierarchy of research designs, for well-designed observational studies, especially over a long term like this -- six years and eight years --// //**do not**// //​systematically overestimate the magnitude of the effects of treatment as compared with those in randomized, controlled trials on the same topic.”// **Do not** overestimate,​ in the long term!
  
 27% dropout over eight years is not much! Actually, it doesn’t say 27% percent dropout, it says there were 73% that did 8 years, maybe some did seven years and some did six years! It's not a dropout! 27% dropout over eight years is not much! Actually, it doesn’t say 27% percent dropout, it says there were 73% that did 8 years, maybe some did seven years and some did six years! It's not a dropout!
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 In terms of stability of the molecules of water-bounded model, skeptics always come with nanoseconds whereas the study shows that the structure of new physical-chemical properties of water that were studied with spectrometry,​ increase with time, it's not nanoseconds -- at 500 days those properties are increased. I could show you the graph of that, but we don't have the time. In terms of stability of the molecules of water-bounded model, skeptics always come with nanoseconds whereas the study shows that the structure of new physical-chemical properties of water that were studied with spectrometry,​ increase with time, it's not nanoseconds -- at 500 days those properties are increased. I could show you the graph of that, but we don't have the time.
  
-You mentioned Cochrane'​s collaboration review on ADHD -- one of the three studies was pure homeopathy -- that was the Swiss study! The other one was done with Sankaran, that's not Hahnemannian homeopathy! You cannot compare homeopathy, which is a very particular way of practicing, with something that is speculative. The two other studies were not homeopathic studies, they don't relate to homeopathy and that's the problem with Ernst who is your main witness -- he does not understand homeopathy! Your main witness is not a homeopath, he is not even trained in homeopathy, even though he claims he took two months of lectures and six months of training -- while in Germany, you need to have two years of study to be able to pass the exam -- he never wrote the exam, but he claimed to be a trained homeopath for almost 20 years!+You mentioned Cochrane'​s collaboration review on ADHD -- one of the three studies was pure homeopathy -- that was the Swiss study! The other one was done with Sankaran, that's not Hahnemannian homeopathy! You cannot compare homeopathy, which is a very particular way of practicing, with something that is speculative. The two other studies were not homeopathic studies, they don't relate to homeopathy and that's the problem with Ernstwho is your main witness -- he does not understand homeopathy! Your main witness is not a homeopath, he is not even trained in homeopathy, even though he claims he took two months of lectures and six months of training -- while in Germany, you need to have two years of study to be able to pass the exam -- he never wrote the exam, but he claimed to be a trained homeopath for almost 20 years!
  
-In terms of Benveniste, it's very interesting that skeptics mention that Benveniste was contradicted by the literature later on and so on, but it's interesting that they don't cite that there were confirmations of the work of Benveniste -- that was confirmed by 17 different experiments over 25 years over multicentre in Europe and is so well-confirmed,​ the study of histamine with basophils, that the book is closed on it. The work of Benveniste is confirmed throughout the literature. I cannot believe that you bring it up! You should review the literature on the particular subject to make sure that you are up-to-date -- this was done in 99, 2000, 2003 and 2009 at the four different studies by independent researchers. Thank you! (Audience clapping)+In terms of Benveniste, it's very interesting that skeptics mention that Benveniste was contradicted by the literature later on and so on, but it's interesting that they don't cite that there were confirmations of the work of Benveniste -- that was confirmed by 17 different experiments over 25 years over multicentre in Europe and is so well-confirmed,​ the study of histamine with basophils, that the book is closed on it. The work of Benveniste is confirmed throughout the literature. I cannot believe that you bring it up! You should review the literature on the particular subject to make sure that you are up-to-date -- this was done in 1999, 2000, 2003 and 2009 at the four different studies by independent researchers. Thank you! (Audience clapping)
  
 ===== Steven Novella, part 2 ===== ===== Steven Novella, part 2 =====
  
-Dr. Novella: Ok, that was a spirited rebuttal! It's important to recognize that I'm not trying to prove that homeopathy doesn'​t work. Proponents of homeopathy have to prove that it does work, that's how science operates. The burden of proof is on somebody who is trying to change the science books who;s trying to show that here is a new phenomenon that exists, it's realIt exists in physics, it has an effect on body and we should be using this as a medicine. Okay, show it to a reasonable threshold of scientific evidence. I never set out to prove it doesn’t work, I am just trying to answer the question -- have the homeopaths met their burden of proof to show that it exists and it does work? And they haven'​t,​ they are so far away from it that it's unbelievable,​ they'​re not even near that threshold of showing that it's real and that it works.+Dr. Novella: Ok, that was a spirited rebuttal! It's important to recognize that I'm not trying to prove that homeopathy doesn'​t work. Proponents of homeopathy have to prove that it does work, that's how science operates. The burden of proof is on somebody who is trying to change the science books who's trying to show that here is a new phenomenon that exists, it's realIt exists in physics, it has an effect on body and we should be using this as a medicine. Okay, show it to a reasonable threshold of scientific evidence. I never set out to prove it doesn’t work, I am just trying to answer the question -- have the homeopaths met their burden of proof to show that it exists and it does work? And they haven'​t,​ they are so far away from itthat it's unbelievable,​ they'​re not even near that threshold of showing that it's real and that it works.
  
-In terms of the Swiss versus the UK study, you'll notice, I didn't bring up the UK or the Swiss study in my slides, I was simply responding to Dr. Saine touting the Swiss study, which was not reliable. I usually don't rely upon governments to tell me about science, first of all, I usually rely upon scientists reviewing scientific literature, that's what I rely upon. And when scientists review the homeopathic literature the bulk of those reviews show that there is insufficient evidence to conclude that homeopathic remedies are more effective than placebos -- that is uncontested,​ that is the conclusion.+In terms of the Swiss versus the UK study, you'll notice, I didn't bring up the UK or the Swiss study in my slides, I was simply responding to Dr. Saine touting the Swiss study, which was not reliable. I usually don't rely upon governments to tell me about science, first of all, I usually rely upon scientists reviewing scientific literature, that's what I rely upon. And when scientists review the homeopathic literaturethe bulk of those reviews show that there is insufficient evidence to conclude that homeopathic remedies are more effective than placebos -- that is uncontested,​ that is the conclusion.
  
-The only thing that is contested is what kind of spin do you put on itdo you say we need to do more research or we can't rule out an effect and it might be reasonable to use this or the uncontrolled studies show that some patients feel better. There are all kinds of spin you can put on it, but there isn’t a single indication for which any specific homeopathic remedy or just homeopathic treatment in general has been shown to have these statistically significant,​ clinically significant effects above and beyond placebos in rigorous trials that stand up to replication. That’s the threshold to accept something is real in medicine and science and it doesn'​t exist for homeopathy. They haven'​t met their burden of proof.+The only thing that is contested is what kind of spin you put on it -- do you say we need to do more research or we can't rule out an effect and it might be reasonable to use this or the uncontrolled studies show that some patients feel better. There are all kinds of spin you can put on it, but there isn’t a single indication for which any specific homeopathic remedy or just homeopathic treatment in general has been shown to have these statistically significant,​ clinically significant effects above and beyond placebos in rigorous trials that stand up to replication. That’s the threshold to accept something is real in medicine and science and it doesn'​t exist for homeopathy. They haven'​t met their burden of proof.
  
 Homeopaths tend to try to make their case with studies that are flawed, preliminary,​ small, weak, that have curious things about them like using the wrong endpoint like 180 days versus 30 days and speculate endlessly about long-term effect. Okay, but this is odd, you have not established any of these things that you are speculating about. If this was not homeopathy, if this was a drug, I would conclude that this doesn'​t work! This would not pass the FDA and shouldn'​t be used in clinical practice based upon this level of evidence. So, that is the position that we take -- that homeopaths have not met their burden of proof and we are not inventing this threshold or these rules or this way of analyzing the data just for homeopathy; this is science-based medicine, this is evidence-based medicine, this is how it gets applied across the board. The gap between skeptics or science-based proponents and those who are convinced that a treatment which isn't in the mainstream, like homeopathy, works, is a deep appreciation of how complicated and how flawed the medical literature and the scientific literature is. Homeopaths tend to try to make their case with studies that are flawed, preliminary,​ small, weak, that have curious things about them like using the wrong endpoint like 180 days versus 30 days and speculate endlessly about long-term effect. Okay, but this is odd, you have not established any of these things that you are speculating about. If this was not homeopathy, if this was a drug, I would conclude that this doesn'​t work! This would not pass the FDA and shouldn'​t be used in clinical practice based upon this level of evidence. So, that is the position that we take -- that homeopaths have not met their burden of proof and we are not inventing this threshold or these rules or this way of analyzing the data just for homeopathy; this is science-based medicine, this is evidence-based medicine, this is how it gets applied across the board. The gap between skeptics or science-based proponents and those who are convinced that a treatment which isn't in the mainstream, like homeopathy, works, is a deep appreciation of how complicated and how flawed the medical literature and the scientific literature is.
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 Let me give you a couple of additional examples: There is a well-established publication bias, a positive bias in the literature; it's called the “file drawer effect”. If you have a positive study you are much more likely to publish it than if you have a negative study. A journal editor is much more likely to publish the positive study than a negative study because it gets them better headlines; it proves their impact factor more -- well established. There are mechanisms for estimating the publication bias -- you could look at what's called “a Funnel plot” -- remember the bell curve I told you about; if you do that, if you plot out where all the results are against the quality of the study, it may appear that all the negative studies that statistically should be there, are missing or they'​re underrepresented! Where are all the negative studies? And we see this all the time, it's because people aren't bothering to publish the negative studies. Well, if you don't do that analysis and you just do a meta-analysis without doing a Funnel plot or any kind of the statistical measure of publication bias, your results will be unreliable. These are lessons that have been learned over the years as we incrementally improve our understanding of the complexity of medical and scientific research. Let me give you a couple of additional examples: There is a well-established publication bias, a positive bias in the literature; it's called the “file drawer effect”. If you have a positive study you are much more likely to publish it than if you have a negative study. A journal editor is much more likely to publish the positive study than a negative study because it gets them better headlines; it proves their impact factor more -- well established. There are mechanisms for estimating the publication bias -- you could look at what's called “a Funnel plot” -- remember the bell curve I told you about; if you do that, if you plot out where all the results are against the quality of the study, it may appear that all the negative studies that statistically should be there, are missing or they'​re underrepresented! Where are all the negative studies? And we see this all the time, it's because people aren't bothering to publish the negative studies. Well, if you don't do that analysis and you just do a meta-analysis without doing a Funnel plot or any kind of the statistical measure of publication bias, your results will be unreliable. These are lessons that have been learned over the years as we incrementally improve our understanding of the complexity of medical and scientific research.
  
-There is also a “//researcher bias//”. Just last year Simmons et al. published a study, a very interesting study, where they made up a hypothesis that they knew to be wrong -- “listening to music about age will make you actually become physically younger”//​.//​ They made an impossible hypothesis and what they demonstrated was that by varying four variables of how you design and conduct research, you can manufacture a statistically significant positive result, most of the time. 60% of the time you can create a positive research from data that we know is negative and these variables are very innocent -- When do you stop collecting data? Which comparisons are you going to make? What statistical analysis are you going to use? Every researcher has to make those decisions when they design and execute a study and they could very innocently, we are not talking about fraud, we are talking about just innocently choose the way of looking at the data and comparisons to make that make their curves look good, make the data look good which means that they'​re picking a signal out of the noise. Researchers do this unconsciously. Even if you are researching something that has zero effect whatsoever you can manufacture positive results 60% of the time just by playing with the variables that all the researchers play with and then differentially publish a positive ones and not the negative ones. So when we look at the literature or any question we expect there to be this massive positive bias both from researcher bias and from publication bias and Dr. Unitus when he looks at the literature and says //“There it is!”// You see the positive bias and the error in the literature ​we you go back at the questions that have already been settled. So how do we know anything that's true in the medical literature? Well, you need really rigorous studies, you need to have large data sets so statistical flukes are ruled out, you need to have a clinically significant effect size, so that you make sure there isn't just some systematic error in the way you're looking at the data and you need to replicate those studies, if the effect is real it will replicate. Effects that are statistical flukes don't replicate. Until we've done multiple replications we have no idea if the effect is real or not, all we know is 'ok, that's interesting,​ this is worth more research'​ -- that's really the only thing we should reasonably conclude based upon that.+There is also a researcher bias. Just last year Simmons et al. published a study, a very interesting study, where they made up a hypothesis that they knew to be wrong -- “listening to music about age will make you actually become physically younger”//​.//​ They made an impossible hypothesis and what they demonstrated was that by varying four variables of how you design and conduct research, you can manufacture a statistically significant positive result, most of the time. 60% of the time you can create a positive research from data that we know is negative and these variables are very innocent -- When do you stop collecting data? Which comparisons are you going to make? What statistical analysis are you going to use? Every researcher has to make those decisions when they design and execute a study and they couldvery innocently, we are not talking about fraud, we are talking about just innocently choose the way of looking at the data and comparisons to makethat make their curves look good, make the data look good which means that they'​re picking a signal out of the noise. Researchers do this unconsciously. Even if you are researching something that has zero effect whatsoeveryou can manufacture positive results 60% of the time just by playing with the variables that all the researchers play with and then differentially publish a positive ones and not the negative ones. So when we look at the literature or any question we expect there to be this massive positive bias both from researcher bias and from publication bias and Dr. Unitus when he looks at the literature and says “There it is!” You see the positive bias and the error in the literature, when you go back at the questions that have already been settled. ​
  
-When you have a phenomenon ​that over decades fails to reach the thresholddoes never seem to replicate high quality ​studies, you begin to wonder why we are still studying thisit doesn'​t ​seem to be real. The research ​is going in circles it'​s ​not getting anywhere.+So, how do we know anything ​that's true in the medical literature? Wellyou need really rigorous ​studies, you need to have large data sets so statistical flukes ​are ruled outyou need to have a clinically significant effect size, so that you make sure there isn'​t ​just some systematic error in the way you're looking at the data and you need to replicate those studies -- if the effect is real it will replicateEffects that are statistical flukes don't replicate. Until we've done multiple replications we have no idea if the effect is real or not, all we know is 'ok, that'​s ​interesting,​ this is worth more research'​ -- that's really the only thing we should reasonably conclude based upon that.
  
-The research of Jacques Benveniste was found to be fraudulent. It was probably due to a research assistant of his who was trying to make her mentor happy by cooking the books, if you will... don't know how conscious it was but when her ability to author the entries in the books was blinded and essentially when the experiments were set up that she couldn'​t cheat, the effect went away. So when you dial up the rigor of the study to remove the potential for bias, potential for fraud and the effect goes away, that’s a pattern we see in something that is not real. The book is not closed on this, this has not been established to the satisfaction of the general scientific community because once you factor out the fraud and the potential for fraud there just isn't anything there that's very compelling. In fact that research assistant may have been present at other labs that replicated the same research, that really wasn't an independent replication if you had the same person involved.+When you have a phenomenon that over decades fails to reach the threshold, does never seem to replicate high quality studies, you begin to wonder why we are still studying this, it doesn'​t seem to be real. The research is going in circles, it's not getting anywhere. 
 + 
 +The research of Jacques Benveniste was found to be fraudulent. It was probably due to a research assistant of his who was trying to make her mentor happy by cooking the books, if you will... don't know how conscious it was but when her ability to author the entries in the books was blinded and essentially when the experiments were set up that she couldn'​t cheat, the effect went away. So when you dial up the rigor of the study to remove the potential for bias, potential for fraud and the effect goes away, that’s a pattern we see in something that is not real. The book is not closed on this, this has not been established to the satisfaction of the general scientific community because once you factor out the fraud and the potential for fraudthere just isn't anything there that's very compelling. In fact that research assistant may have been present at other labs that replicated the same research, that really wasn't an independent replicationif you had the same person involved.
  
 The problem is that often proponents of homeopathy -- and we've seen this with many other pseudo sciences that we investigate -- they prematurely settle upon the conclusion that 'all right, this has been established,​ it's real, let’s move on'. So, no! Wait, wait, wait! It hasn't been established,​ we don't know whether this is real or not, you haven'​t reached that threshold that we generally accept as the threshold for compelling evidence that is probably true. The problem is that often proponents of homeopathy -- and we've seen this with many other pseudo sciences that we investigate -- they prematurely settle upon the conclusion that 'all right, this has been established,​ it's real, let’s move on'. So, no! Wait, wait, wait! It hasn't been established,​ we don't know whether this is real or not, you haven'​t reached that threshold that we generally accept as the threshold for compelling evidence that is probably true.
  
-I never said that observational data was worthless or not useful! Observational data is not just useful for establishing efficacy, we don't use it that way, but you can use it to establish things if have really good, solid evidence that triangulates well, but it has to be put to the context of plausibility and of efficacy trials and when you do that with homeopathy, again, it doesn'​t workIf these historical cases of curing every case of pneumonia etc., if there was any reality to that at all, if it was a tenth to that effect, it should be a trivial matter to establish it in randomized control clinical trials that would be compelling to objective scientists and it hasn't been done. You have to wonder why that is! Thank you! (audience clapping)+I never said that observational data was worthless or not useful! Observational data is just not useful for establishing efficacy, we don't use it that way, but you can use it to establish things if you have really good, solid evidence that triangulates well, but it has to be put to the context of plausibility and of efficacy trials and when you do that with homeopathy, again, it doesn'​t workIf these historical cases of curing every case of pneumonia etc., if there was any reality to that at all, if it was a tenth to that effect, it should be a trivial matter to establish it in randomized control clinical trials that would be compelling to objective scientists and it hasn't been done. You have to wonder why that is! Thank you! (audience clapping)
  
 Dr. Saine: Regarding the Freis study, the ADHD study, you said the group that was the verum was open label -- open label before the trial, double-blind afterwards! Let's be clear about it, so it is a double-blind randomized study, divided in a random way and it was double blind. The Swiss study and HDA is not a government study, it's a government- commissioned study through the scientists! It's probably the highest level of evidence that the government can use to know, for policy! Thank you. (Clapping) Dr. Saine: Regarding the Freis study, the ADHD study, you said the group that was the verum was open label -- open label before the trial, double-blind afterwards! Let's be clear about it, so it is a double-blind randomized study, divided in a random way and it was double blind. The Swiss study and HDA is not a government study, it's a government- commissioned study through the scientists! It's probably the highest level of evidence that the government can use to know, for policy! Thank you. (Clapping)
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 Dr. Novella: According to your own slide, the p value in that code was on the open label data, that's what achieved the p value of .001. But that statistical significance was attached to the open label data, I am just going by your own quote, that was on your own slide...[some reaction from Dr. Saine] then change your slide. Dr. Novella: According to your own slide, the p value in that code was on the open label data, that's what achieved the p value of .001. But that statistical significance was attached to the open label data, I am just going by your own quote, that was on your own slide...[some reaction from Dr. Saine] then change your slide.
  
-The Swiss study was not a scientific study, it was just a review of the evidence by a committee. Again the UK committee found that the evidence was not compelling for homeopathic, maybe I am wrong about the '​witchcraft ​statement', and the last time I read through that it wasn't the conclusionI would be happy to correct myself if that is a mistake... but that's irrelevant because they concluded the homeopathy doesn'​t work, is not plausible, shouldn'​t be used and shouldn'​t be researched. That's what they concluded. But in any case they were basing their conclusion on the data that actually tells us if something works, the best evidence, the most rigorous control evidence. The Swiss acknowledged that didn't support homeopathy'​s efficacy that’s why they emphasized the data, the type of analysis that is uncontrolled and unblinded because that's the realm where placebo effects predominate and... yes, there are placebo effects, the placebo effects contaminate the literature, it's a very complicated phenomenon... I actually have an hour-long lecture just on placebo, because it's very difficult to understand, but the bottom line is, there are nonspecific therapeutic effects and then there is a lot of the statistical illusion, a lot of bias in reporting, etc. So, you have to thoroughly control for placebo before you conclude that the treatment itself has an actual effect and even the Swiss committee that was trying to spin as positive as they could, couldn'​t conclude that the data shows that there is efficacy for homeopathy. Thanks! (audience clapping)+The Swiss study was not a scientific study, it was just a review of the evidence by a committee. Again the UK committee found that the evidence was not compelling for homeopathy, maybe I am wrong about the '​witchcraft' ​statement, and the last time I read through that it wasn't the conclusionI would be happy to correct myself if that is a mistake... but that's irrelevant because they concluded the homeopathy doesn'​t work, is not plausible, shouldn'​t be used and shouldn'​t be researched. That's what they concluded. But in any case they were basing their conclusion on the data that actually tells us if something works, the best evidence, the most rigorous control evidence. The Swiss acknowledged that [it] didn't support homeopathy'​s efficacy that’s why they emphasized the data, the type of analysis that is uncontrolled and unblinded because that's the realm where placebo effects predominate and... yes, there are placebo effects, the placebo effects contaminate the literature, it's a very complicated phenomenon... I actually have an hour-long lecture just on placebo, because it's very difficult to understand, but the bottom line is, there are nonspecific therapeutic effects and then there is a lot of the statistical illusion, a lot of bias in reporting, etc. So, you have to thoroughly control for placebo before you conclude that the treatment itself has an actual effect and even the Swiss committee that was trying to spin as positive as they could, couldn'​t conclude that the data shows that there is efficacy for homeopathy. Thanks! (audience clapping)
  
 ===== Cross-examination ===== ===== Cross-examination =====
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   - Richard Horton, the editor-in-chief of Lancet, said - “//Prof. Ernst seems to have broken every professional code of scientific behavior.”//​ How you, as a man of science, a champion of science-based medicine, can use this man as your main witness to tell you what is homeopathy?   - Richard Horton, the editor-in-chief of Lancet, said - “//Prof. Ernst seems to have broken every professional code of scientific behavior.”//​ How you, as a man of science, a champion of science-based medicine, can use this man as your main witness to tell you what is homeopathy?
  
-Dr. Novella: First of all, I personally know Edgar Ernst, he is a good guy, he is a professor of complementary and alternative medicine, he does have training in Homeopathy, maybe not up to your satisfaction but these are all your //ad hominem// types of points that you are trying to make here... I don't rely upon him, I rely upon the evidence. I could look at the evidence for myself that's where my expertise is! And he is not the only one to do systematic reviews. I can go out of my way and quote somebody other than Ernst in a couple of systematic reviews -- he's not the only one to have done that. Ernst'​s methods are fine. He has published over 1000 papers, he has a team of people -- at least he did before he semi-retired -- that were experts at doing systematic reviews and meta-analysis.+Dr. Novella: First of all, I personally know Edgar Ernst, he is a good guy, he is a professor of complementary and alternative medicine, he does have training in homeopathy, maybe not up to your satisfaction but these are all your //ad hominem// types of points that you are trying to make here... I don't rely upon him, I rely upon the evidence. I could look at the evidence for myself that's where my expertise is! And he is not the only one to do systematic reviews. I can go out of my way and quote somebody other than Ernst in a couple of systematic reviews -- he's not the only one to have done that. Ernst'​s methods are fine. He has published over 1000 papers, he has a team of people -- at least he did before he semi-retired -- that were experts at doing systematic reviews and meta-analysis.
  
 One further point, even if I accept your point that most studies in homeopathy are not good studies of homeopathy because they don't understand it, all you are saying is that literature is not good -- that doesn'​t add up to '​homeopathy works!'​ Again, I am not trying to prove it doesn'​t work, you have to prove it does work and saying the studies aren’t good doesn'​t prove that it works. It just shows you that the studies out there are not very good. But even when you look at the best studies, the most rigorous studies, they never add up to an effect, like the diarrhea studies you pointed out to, they were extremely flawed, when you look at the details. One further point, even if I accept your point that most studies in homeopathy are not good studies of homeopathy because they don't understand it, all you are saying is that literature is not good -- that doesn'​t add up to '​homeopathy works!'​ Again, I am not trying to prove it doesn'​t work, you have to prove it does work and saying the studies aren’t good doesn'​t prove that it works. It just shows you that the studies out there are not very good. But even when you look at the best studies, the most rigorous studies, they never add up to an effect, like the diarrhea studies you pointed out to, they were extremely flawed, when you look at the details.
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 Let me follow up with a research question -- I agree that the homeopathic community doesn’t invest enough in research. If Boiron, for example, invested the same percentage of their profit, which is billions of dollars, into homeopathic research there would be no shortage of funding for it. You have claimed that true homeopathy, the way it should be studied through individualized treatment, not cookie-cutter,​ therefore do you oppose over-the-counter homeopathic remedies which seem to violate the very principle you are using to excuse much of the negative clinical evidence and do you think that homeopathic community is abrogating their moral charge to do proper research in order to support for their own profession? Let me follow up with a research question -- I agree that the homeopathic community doesn’t invest enough in research. If Boiron, for example, invested the same percentage of their profit, which is billions of dollars, into homeopathic research there would be no shortage of funding for it. You have claimed that true homeopathy, the way it should be studied through individualized treatment, not cookie-cutter,​ therefore do you oppose over-the-counter homeopathic remedies which seem to violate the very principle you are using to excuse much of the negative clinical evidence and do you think that homeopathic community is abrogating their moral charge to do proper research in order to support for their own profession?
  
-Dr. Saine: The use of combined remedies and complex remedies is not part of homeopathy, it's not considered homeopathy, so it's a misrepresentation. So, if they say '​homeopathy',​ it's wrong, it should be called ​homeo-therapeutics. That was the rule, it was done in 1930 to establish what was homeopathy versus all the other dry imitations. It's an imitation, but it's not homeopathy. Generally, homeopathy is based on a fundamental principle -- it has to have a proving -- these have no proving, it's not homeopathy, you need to have a proving. You need to take a case -- these are not used to take a case, so it's not homeopathy. And every chance I have, like now, to say, 'it should not be', I say it. I say it to the drug company, 'This is not homeopathy, you understand it, right? Change the name!'+Dr. Saine: The use of combined remedies and complex remedies is not part of homeopathy, it's not considered homeopathy, so it's a misrepresentation. So, if they say '​homeopathy',​ it's wrong, it should be called ​homeotherapeutics. That was the rule, it was done in 1930 to establish what was homeopathy versus all the other dry imitations. It's an imitation, but it's not homeopathy. Generally, homeopathy is based on a fundamental principle -- it has to have a proving -- these have no proving, it's not homeopathy, you need to have a proving. You need to take a case -- these are not used to take a case, so it's not homeopathy. And every chance I have, like now, to say, 'it should not be', I say it. I say it to the drug company, 'This is not homeopathy, you understand it, right? Change the name!'
  
 Another question: you wrote that systematic review shows negative results... you understand that homeopathy is an individualized treatment, correct? Why do you quote systematic reviews when most of the studies in the systematic reviews are not related to homeopathy -- like the Shang study for instance; there were eight studies that were kept at the end, only one was individualized homeopathy, seven were not! So how can anybody call that kind of study or the study of Ernst or Cochrane? Most of the Cochrane collaboration studies were for labor, there was ADHD... none are pure homeopathy, there'​s none! There are some here and there... some studies but in terms of reviews there are none. Why do you keep referring to those? Another question: you wrote that systematic review shows negative results... you understand that homeopathy is an individualized treatment, correct? Why do you quote systematic reviews when most of the studies in the systematic reviews are not related to homeopathy -- like the Shang study for instance; there were eight studies that were kept at the end, only one was individualized homeopathy, seven were not! So how can anybody call that kind of study or the study of Ernst or Cochrane? Most of the Cochrane collaboration studies were for labor, there was ADHD... none are pure homeopathy, there'​s none! There are some here and there... some studies but in terms of reviews there are none. Why do you keep referring to those?
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 Today, I presented research clearly establishing that the process of serial dilutions and succussion used in homeopathy results in durable and measurable changes in the solutions, therefore supporting the plausibility of UMPs and making it clear that homeopathy can be investigated like any other natural phenomena and completely discredit such blatant statement that 'it doesn’t work because it can’t work'. Today, I presented research clearly establishing that the process of serial dilutions and succussion used in homeopathy results in durable and measurable changes in the solutions, therefore supporting the plausibility of UMPs and making it clear that homeopathy can be investigated like any other natural phenomena and completely discredit such blatant statement that 'it doesn’t work because it can’t work'.
  
-I also presented basic research //in vitro// and so on. Skeptics carry a great responsibility as for more than 200 years they have stalled scientific progress in one of the most important branches of human endeavors. I hope this is only the beginning of discussion between homeopaths and skeptics. As I said earlier, true scientists should come to the same conclusion as long as they stick to facts and use sound reasoning.+I also presented basic research //in vitro// and [plant research showing that UMPs can trigger physiological response and finally I have summarized the clinical, observational and epidemiological research showing the efficacy and real world effectiveness of homeopathy. What more will it take for the scientific community to recognize the validity of homeopathy?​ 
 +However, don’t be surprised if skeptics don’t change their view on homeopathy despite the overwhelming evidence in its favor as they are so entrenched in their belief that homeopathy doesn’t work, that it can’t work. 
 + 
 +As Goethe said, "You see only what you know."​ 
 + 
 +They have created, for more than 200 years, a giant strawman, by their flagrant misrepresentation of homeopathy, which greatly invalidates all their arguments.]((Due to time constraint, this part of DrSaine'​s written conclusion was skipped during the debate; with his permission, it was included in this transcription)) 
 + 
 +Skeptics carry a great responsibility as for more than 200 years they have stalled scientific progress in one of the most important branches of human endeavors. I hope this is only the beginning of discussion between homeopaths and skeptics. As I said earlier, true scientists should come to the same conclusion as long as they stick to facts and use sound reasoning.
  
 Skeptics are not going come out of the deep hole they have dug themselves and for humanity -- unless they can be self-critical like true scientists. Thank you, thank you, thank you! (audience clapping) Skeptics are not going come out of the deep hole they have dug themselves and for humanity -- unless they can be self-critical like true scientists. Thank you, thank you, thank you! (audience clapping)
en/misc/talk-saine-novella.1366021636.txt.gz · Last modified: 2013/04/15 10:27 by legatum