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Mike’s thesis is essentially: Silly skeptics, it’s impossible to OD on homeopathy!

1. “Notice that they never consume their own medicines in large doses? Chemotherapy? Statin drugs? Blood thinners? They wouldn’t dare drink those.

Of course we wouldn’t. Steven Novella rightly points out that, though Mike thinks he’s being clever here, he’s actually demonstrating a lack of understanding for what the 10:23 campaign is about by using a straw man. Mike later issues a challenge for skeptics to drink their favourite medicines while he drinks homeopathy. Since no one will agree to that for the reasons explained above, he can claim some sort of victory — hence his smugness. But no one is saying that drugs aren’t harmful.

The difference between medicine and poison is in the dose. The vitamins and herbs promoted by the CAM industry are just as potentially harmful as any pharmaceutical drug, given enough of it. Would Adams be willing to OD on the vitamins or herbal remedies that he sells?

Even Adams’ favorite panacea, vitamin D, is toxic if you take enough of it (just ask Gary Null). Notice how skeptics don’t consume those either, because that is not the point they’re making.

The point of these demonstrations is that homeopathy has nothing in it, has no measurable physiological effects, and does not do what is advertised on the package.

2. “Homeopathy, you see, isn’t a drug. It’s not a chemical.” Well, he’s got that right. “You know the drugs are kicking in when you start getting worse. Toxicity and conventional medicine go hand in hand.” [emphasis his]

Here I have to wonder if Adams knows any people with diabetes, AIDS, or any other illness that used to mean a death sentence before the significant medical advances of the 20th century that we now take for granted. So far he seems to be a firm believer in the false dichotomy that drugs are bad and natural products are good, regardless of what’s in them or how they’re used (as we know, natural products can have biologically active substances and effectively act as impure drugs – but leave it to Adams not to get bogged down with details). There is nothing to support the assertion that conventional medicine is nothing but toxic symptom-inducers.

3-11. “But homeopathy isn’t a chemical. It’s a resonance. A vibration, or a harmony. It’s the restructuring of water to resonate with the particular energy of a plant or substance. We can get into the physics of it in a subsequent article, but for now it’s easy to recognize that even from a conventional physics point of view, liquid water has tremendous energy, and it’s constantly in motion, not just at the molecular level but also at the level of its subatomic particles and so-called “orbiting electrons” which aren’t even orbiting in the first place. Electrons are vibrations and not physical objects.” [emphasis his]

This is Star Trek-like technobabble – lots of sciency words

if something — anything — has an effect, then that effect is measurable by definition. Either something works or it doesn’t, regardless of mechanism. In any case, I’d like to see the well-documented series of research that conclusively proves this supposed mechanism. Actually, I’d like to see any credible research at all. I know what the answer will be to that: science can’t detect this yet. Well if you agree with that statement, reader, ask yourself this: then how does Adams know? Where did he get this information? Without evidence, he is guessing, and what is that really worth?

13. “But getting back to water and vibrations, which isn’t magic but rather vibrational physics, you can’t overdose on a harmony. If you have one violin playing a note in your room, and you add ten more violins — or a hundred more — it’s all still the same harmony (with all its complex higher frequencies, too). There’s no toxicity to it.” [emphasis his]

Homeopathy has standard dosing regimes (they’re all the same), but there is no “dose” to speak of: the ingredients have usually been diluted out to nothing. But Adams is also saying that homeopathy doesn’t work by dose at all, it works by the properties of “resonance” and “vibration”. Then why any dosing regimen? To maintain the resonance? How is this resonance measured? How long does the “resonance” last? Why does it wear off? Why does he think televisions can inactivate homeopathy? (I think I might know the answer to that last one, as electronic interference is a handy excuse for inefficacy.)

“These skeptics just want to kill themselves… and they wouldn’t mind taking a few of you along with them, too. Hence their promotion of vaccines, pharmaceuticals, chemotherapy and water fluoridation. We’ll title the video, “SKEPTICS COMMIT MASS SUICIDE BY DRINKING PHARMACEUTICALS AS IF THEY WERE KOOL-AID.” Jonestown, anyone?”

“Do you notice the irony here? The only medicines they’re willing to consume in large doses in public are homeopathic remedies! They won’t dare consume large quantities of the medicines they all say YOU should be taking! (The pharma drugs.)” [emphasis his]

what Adams seems to have missed is that the skeptics have no intention of killing themselves, so his bizarre claims that the 10:23 participants are psychopathic, self-loathing, and suicidal makes not even a little bit of sense. Skeptics know they aren’t going to die with these demonstrations, because homeopathy has no active ingredients and no evidence of efficacy.

The inventor of homeopathy himself, Samuel Hahnemann believed that excessive doses of homeopathy could be harmful (see sections 275 and 276 of his Organon). Homeopaths are pros at retconning their own field to fit in with Hahnemann’s original ideas (inventing new mechanisms, such as water memory and resonance, in the face of germ theory). So how does Adams reconcile this claim?

While certainly not as big as the ($820B) pharmaceutical industry, $85B is still an awful lot of money, and it’s hard to imagine it not being enough to carve out a research budget from. Yet research isn’t done by entire industries, but by one tier of the value chain — the companies that manufacture and distribute the products.  If they’re not big enough to fund the type of research skeptics are looking for, it won’t be done, so let’s consider some of the bigger players before we make that call.

French giant Boiron (EPA:BOI) is by far the largest distributor of natural health products in Canada – they’re responsible for nearly 4000 (15%) of the 26,000 products approved by Health Canada’s Natural Health Products Directorate. They’re also one of largest natural health products companies globally, with 2010 revenues of €520M ($700M CAD) – a size achieved not just through the success of killer products like Oscillococcinum, but also through acquisitions. In recent years, the company has acquired both its main French rival Dolisos (giving them 90% of the French homeopathy market) and the largest homeopathy company in Belgium, Unda. So this is a big company that’s prepared to spend money to get even bigger. What about spending some of that money on research?  Well ostensibly it’s a priority: “Since 2005, we have devoted a growing level of resources to develop research,” they proclaim in the opening pages of their latest annual report, citing 70 in-progress research projects. Yet the numbers tell a different story – €4.2M in R&D expenditures in 2009, just 0.8% of revenues.

To put that in perspective, consider that in the same year, GlaxoSmithKline spent 14% of its revenues on R&D, Pfizer spent 15%, and Merck spent a whopping 21%.

But if Boiron’s not spending like pharma on research, there’s one line item where they do go toe to toe: Marketing. The company spent €114M – a full 21% of revenues on marketing in 2009. By contrast, GSK, Pfizer and Merck reported 33%, 29%, and 30% of revenues respectively on their “Selling, General, and Administrative” (SG&A) line – which includes not just sales & marketing expenses, but also executive salaries, support staff, legal, rent, utilities, and other overhead costs. Once those are subtracted out, it’s likely that Boiron spends at least as much of its revenues on marketing as Big Pharma.

Even then Gardner was bemoaning that some beliefs never seem to go out of vogue, as he recalled an H. L. Mencken quip from the 1920s: "Heave an egg out of a Pullman window, and you will hit a Fundamentalist almost anywhere in the U.S. today." Gardner cautions that when religious superstition should be on the wane, it is easy "to forget that thousands of high school teachers of biology, in many of our southern states, are still afraid to teach the theory of evolution for fear of losing their jobs." Today creationism has spread northward and mutated into the oxymoronic form of "creation science."

the differences between science and pseudoscience. On the one extreme we have ideas that are most certainly false, "such as the dianetic view that a one-day-old embryo can make sound recordings of its mother's conversation." In the borderlands between the two "are theories advanced as working hypotheses, but highly debatable because of the lack of sufficient data." Of these Gardner selects a most propitious propitious example: "the theory that the universe is expanding." That theory would now fall at the other extreme end of the spectrum, where lie "theories al- most certainly true, such as the belief that the Earth is round or that men and beasts are distant cousins."

How can we tell if someone is a scientific crank? Gardner offers this advice: (1) "First and most important of these traits is that cranks work in almost total isolation from their colleagues." Cranks typically do not understand how the scientific process operates—that they need to try out their ideas on colleagues, attend conferences and publish their hypotheses in peer-reviewed journals before announcing to the world their startling discovery. Of course, when you explain this to them they say that their ideas are too radical for the conservative scientific establishment to accept.

(2) "A second characteristic of the pseudo-scientist, which greatly strengthens his isolation, is a tendency toward paranoia," which manifests itself in several ways: (1) He considers himself a genius. (2) He regards his colleagues, without exception, as ignorant blockheads....(3) He believes himself unjustly persecuted and discriminated against. The recognized societies refuse to let him lecture. The journals reject his papers and either ignore his books or assign them to "enemies" for review. It is all part of a dastardly plot. It never occurs to the crank that this opposition may be due to error in his work....(4) He has strong compulsions to focus his attacks on the greatest scientists and the best-established theories. When Newton was the outstanding name in physics, eccentric works in that science were violently anti-Newton. Today, with Einstein the father-symbol of authority, a crank theory of physics is likely to attack Einstein....(5) He often has a tendency to write in a complex jargon, in many cases making use of terms and phrases he himself has coined.

"If the present trend continues," Gardner concludes, "we can expect a wide variety of these men, with theories yet unimaginable, to put in their appearance in the years immediately ahead. They will write impressive books, give inspiring lectures, organize exciting cults. They may achieve a following of one—or one million. In any case, it will be well for ourselves and for society if we are on our guard against them."

Medical science, when it works well, tends to progress from basic science, to small pilot studies, to larger randomized studies, and then–only then–to those big, rigorous, insanely expensive randomized, double-blind, placebo-controlled trials. Dr. Spector mentions hierarchies of evidence, but he seems to fall into a false dichotomy, namely that if it’s not Level I evidence, it’s crap. The problem is, as Mark pointed out, in medicine we often don’t have Level I evidence for many questions. Indeed, for some questions, we will never have Level I evidence. Clinical medicine involves making decisions in the midst of uncertainty, sometimes extreme uncertainty.

Dr. Spector then proceeds to paint a picture of reckless physicians proceeding on crappy studies to pump women full of hormones. Actually, it was more than a bit more complicated on than that. That was the time when I was in my medical training, and I remember the discussions we had regarding the strength (or lack thereof) of the epidemiological data and the lack of good RCTs looking at HRT. I also remember that nothing works as well to relieve menopausal symptoms as HRT, an observation we have been reminded of again since 2003, which is the year when the first big study came out implicating HRT in increasing the risk of breast cancer (more later).

I found a rather fascinating editorial in the New England Journal of Medicine from more than 20 years ago that discussed the state of the evidence back then with regard to estrogen and breast cancer: Evidence that estrogen increases the risk of breast cancer has been surprisingly difficult to obtain. Clinical and epidemiologic studies and studies in animals strongly suggest that endogenous estrogen plays a part in causing breast cancer. If so, exogenous estrogen should be a potent promoter of breast cancer. Although more than 20 case–control and prospective studies of the relation of breast cancer and noncontraceptive estrogen use have failed to demonstrate the expected association, relatively few women in these studies used estrogen for extended periods. Studies of the use of diethylstilbestrol and oral contraceptives suggest that a long exposure or latency may be necessary to show any association between hormone use and breast cancer. In the Swedish study, only six years of follow-up was needed to demonstrate an increased risk of breast cancer with the postmenopausal use of estradiol. It should be noted, however, that half the women in the subgroup that provided detailed data on the duration of hormone use had taken estrogen for many years before their base-line prescription status was defined. The duration of estrogen exposure in these women before the diagnosis of breast cancer was probably seriously underestimated; a short latency cannot be attributed to estradiol on the basis of these data. Other recent studies of the use of noncontraceptive estrogen suggest a slightly increased risk of breast cancer after 15 to 20 years’ use.

even now, the evidence is conflicting regarding HRT and breast cancer, with the preponderance of evidence suggesting that mixed HRT (estrogen and progestin) significantly increases the risk of breast cancer, while estrogen-alone HRT very well might not increase the risk of breast cancer at all or (more likely) only very little. Indeed, I was just at a conference all day Saturday where data demonstrating this very point were discussed by one of the speakers. None of this stops Dr. Spector from categorically labeling estrogen as a “carcinogen that causes breast cancers that kill women.” Maybe. Maybe not. It’s actually not that clear. The problem, of course, is that, consistent with the first primary reports of WHI results, the preponderance of evidence finding health risks due to HRT have indicted the combined progestin/estrogen combinations as unsafe.