Homeopathy is a favourite kickabout of sceptical writers and bloggers (eg Science based medicine; some Bad Science blogs although only those with homeopathy in the title or extract are listed so many relevant posts are missing; Skepdude). Ben Goldacre of badscience.net writes about the weird and wonderful practice of homeopathy in Bad Science (see standard preamble). Goldacre discusses the open goal of dilution at some length and supplies a brief overview of provings.
Homeopaths run their own version of drug trials with provings. However, rather than scrupulous recruitment, careful screening, well-controlled conditions, there is a rather more Blue Peter approach to these tests. In a rather charming ritual that calls upon the great tradition of self-experimenters, a group of volunteers (varies in number, it can be 1-30), take frequent doses of the remedy that is undergoing proving, over the course of two or more days. At specified times of the day, the volunteers journalled the mental, physical, emotional sensations and dreams that they experienced not only during this assessment but perhaps for several months afterwards. The collection of responses was compiled into the drug picture – and this informed therapeutic recommendations and prescribing.
All of which seems a little homegrown but essentially harmless in itself for that period in history. Apparently, however, some contemporaries had a less charitable perspective on the justification for some aspects of provings. James Young Simpson provides a wry footnote about the provings. Hahnemann was insistent that his medicines should be tested on both men and women to ascertain any differences “in reference to the sexual system”. The London Medical Gazette remarked that proving records contained revelations and language of “astounding impurity”. Dr Bushnan noted Hahnemann’s influence and wrote: “we have to thank this law for the abominable and filthy character of many of the homoeopathic writings”.
It is possibly little wonder that some homeopaths find modern trials for drugs or other interventions to be a tad dull, boring and grey by contrast or even inimical to evaluating the value of homeopathy. Holly Day is studying:
the development of homoeopathic proving techniques in the light of historical, social and cultural influences. In essence, the aim is to identify the reasons and circumstances prompting contemporary variances in proving procedures. Emphasis is placed upon the rationale underlying individual approaches, whilst also situating beliefs within particular research philosophies.
Rather miserably for homeopaths who enjoy this high-engagement and somewhat colourful way of appraising their remedies, it seems that there are moves to formalise the proving procedures and make them more quantitative than qualitative.[1]
The most recent review of proving studies indicated that provings are generally of poor methodological quality. Methods to improve the quality and scientific rigour are needed to critically assess the clinical basis of homeopathy. This article describes a methodology using a symptom diary with a selection of predefined remedy specific symptoms (proving questionnaire). The proving questionnaire was developed as an alternative to the traditional qualitative proving methods in an attempt to provide a quantitative method that could rigorously validate the original provings.
I haven’t seen the original paper so it is possible that the authors discuss the possibility that it might not be possible to validate the provings for therapeutic purposes (however, as one of the authors seems to practise as a homeopath, perhaps not). Maybe this is a rigorous examination of how homeopathy might be subjected to a robust examination, or maybe it’s just an attempt to tell followers of the cargo cult how they might improve the shape of their earphones.(a)
Notes
(a) Feynman, R. Caltech commencement address given in 1974.
I think the educational and psychological studies I mentioned are examples of what I would like to call cargo cult science. In the South Seas there is a cargo cult of people. During the war they saw airplanes land with lots of good materials, and they want the same thing to happen now. So they’ve arranged to imitate things like runways, to put fires along the sides of the runways, to make a wooden hut for a man to sit in, with two wooden pieces on his head like headphones and bars of bamboo sticking out like antennas–he’s the controller–and they wait for the airplanes to land. They’re doing everything right. The form is perfect. It looks exactly the way it looked before. But it doesn’t work. No airplanes land. So I call these things cargo cult science, because they follow all the apparent precepts and forms of scientific investigation, but they’re missing something essential, because the planes don’t land.
Now it behooves me, of course, to tell you what they’re missing. But it would be just about as difficult to explain to the South Sea Islanders how they have to arrange things so that they get some wealth in their system. It is not something simple like telling them how to improve the shapes of the earphones.
References
[1] Brien S, Lewith G. Assessing homeopathic proving using questionnaire methodology: consideration and implications for future studies. Forsch Komplementarmed Klass Naturheilkd. 2005 Jun;12(3):152-8.
Tags: Bad Science, Ben Goldacre, CAM, complementary and alternative medicine, homeopathy, proving
