A thought provoking piece about the attacks on homeopathy by Dr Lionel Milgrom
A short foreword by Robert Verkerk, executive and scientific director, ANH-Intl
Lionel and I have both been speakers at the last two Scientific Research in Homeopathy conferences, the last one being held in London on 27th March 2010. Lionel has also recently joined ANH-Intl’s expert committee. For me, Lionel’s intellect, political savvy and deeply questioning mind stand out among those who practice forms of medicine that are not well supported by the establishment. In Lionel’s case, his preferred modality is homeopathy—and there’s no doubt, especially in the UK, that this modality has come under massive fire from a small but noisy assemblage of orthodox medicine and bio-medical aficionados. From that perspective, Lionel knows a thing or two about being on the receiving end of the heat. But perhaps it’s Lionel’s roots in mainstream science—chemistry in particular—that make his commentary on what is really going on over the attacks against alternative medicine, and more specifically homeopathy, so relevant. In short, Lionel is sounding an important warning about the distortion of the scientific process by a small number of highly vocal and influential individuals who, it would seem, have chosen, at least in relation to their attacks on alternative medicine, to adopt remarkably unscientific approaches. Lionel calls this developing trend the ‘New Fundamentalism’ (albeit, simply a virulent form of ‘scientism’, which of course, should be differentiated from science itself).
We urge you to prepare an herbal tea or other beverage of your choice, kick back for a few minutes and read what Lionel has to say. You might find yourself agreeing with everything he writes, but I know there will be some readers who won’t. Either way, it’s worth thinking why there is so much disagreement—and I believe that Lionel’s approach goes some way to help clarify some of the underlying reasons for this. We are reminded, during the journey Lionel takes us on, that some forms of science are more of an art than a rigorously objective method. Like religion, science it seems is also steeped in different belief systems, some of which conflict intensely with one another.
For those of us who are protagonists of ‘alternative medicine’, I hope that Lionel’s feature might help offer some new insights about the challenges we face. It might also help you to better communicate to others some of the underlying processes at work. Only with a deep understanding of what’s really going on can we work together to help transition the political, medical, scientific, social and regulatory systems in such a way that affords future generations a more appropriate, a more effective and a more sustainable and biocompatible system of healthcare.
Beware scientism’s onward march!
By Lionel Milgrom PhD
Introducing some concepts
First it is necessary to make a clear distinction between science and scientism. The former might be defined as a continuing effort to increase human knowledge and understanding through observation (with the important proviso that in spite of its more outlandish proposals, post-modernism still serves to warn that objectivity in observation is always conditioned by expectations and past experiences; regardless of the ‘rigour’ of the science). Scientism, on the other hand,  is the totally unscientific belief that:-
· Only scientific knowledge is real knowledge:
· There is no rational, objective form of inquiry that is not a branch of science:
· Science is the absolute and only justifiable access to truth.
Significantly, no sign of post-modernism’s warning being heeded here. Indeed, supporters of scientism (which has its roots in materialistic logical positivism  and naïve inductivism  - both of which are seriously limited interpretations of science)  see it as their bounden duty to do away with most, if not all, metaphysical, mythological, philosophical, sociological (in any non-reductive sense), and religious claims to knowledge, as their truths cannot be apprehended by the scientific method. And precisely because scientism’s supporters are so jealous of what they believe is their monopoly on truth (especially as exemplified by the science of the day: science too has its fashions), they represent a form of dogmatic intolerance bordering on fundamentalism; even fascism. As neurophysiologist and Nobel Laureate Sir John Eccles once so eloquently put it, “Arrogance is one of the worst diseases of scientists and it gives rise to statements of authority and finality which are expressed usually in fields that are completely beyond the scientific competence of the dogmatist. It is important to realise that dogmatism has now become a disease of scientists rather than of theologians."We shall soon see how ominously prescient were these words.
Who are the New Fundamentalists?
To be sure, there aren’t many scientists who would wish to see themselves cast in such a light. Indeed, the present scientistic clamour emanates from a small but highly voluble group of mainly bio-medically-oriented scientists and media ‘communicators’. In the UK, they include so-called sceptics Professors Michael Baum, Edzard Ernst, David Colquhoun and Richard Dawkins, science writers Simon Singh and Ben Goldacre, the pro-science campaigning organisation Sense About Science (of which Singh is a trustee, and whose backers openly include pharmaceutical companies, The Lancet medical journal and The Guardian newspaper).  They also include Westminster ‘villagers’ Evan Harris MP (Lib Dem spokesperson for science) and Lord Dick Taverne, the Chair of Sense About Science.
Best described by British geneticist Professor Steve Jones as part of a, “….broad church full of narrow minds trained to know even more about even less.”,  one of the main objects of their scientistic ire is complementary and alternative medicine (CAM), particularly homeopathy. When it comes to these subjects, the above collection of individuals proves beyond a shadow of doubt that the biomedical sciences have more than their fair share of narrow, scientistic, one track minds.
But make no mistake: this is not some dry exercise in academic mud-slinging. In the United Kingdom, scientism is on the march, attempting to crush beneath its positivist boot the public’s right to complementary and alternative medical therapies such as homeopathy, free on Britain’s National Health Service. This more militant form of scientism that attempts to impinge directly on the public’s healthcare choices (supported by globalised concerns such as the pharmaceutical industry and the media), I have termed the New Fundamentalism. 
Baum and Ernst preach across the pond
A good example of what might be considered the New Fundamentalist’s ‘catechism’ may be found in a recent comment in the American Journal of Medicine by Professors Baum and Ernst entitled ‘Should we maintain an open mind about homeopathy?’.  I have singled out this particular article because its authors exemplify so well the arrogance, ignorance, and self-contradictions mentioned previously in the quote from Sir John Eccles. Thus, quite early on in their article, Baum and Ernst refer to manipulative physical therapies as “some of the more plausible aspects of alternative medicine”, in direct contradiction to Ernst’s own published stance on chiropractic. 
Dr. Edzard Ernst
Baum and Ernst then describe homeopathy as “….among the worst examples of faith-based medicine that gathers shrill support of celebrities and other powerful lobbies in place of a genuine and humble wish to explore the limits of our knowledge using the scientific method ….”.  Apart from astounding hypocrisy (the pharmaceutical industry constitutes one of the most powerful lobbying organisations on the planet), Baum and Ernst repeatedly cite the 2005 Lancet meta-analysis by Shang et al  as the ‘genuine and humble wish to explore the limits of our knowledge…’, etc. They put this analysis forward as conclusive ‘proof’ that homeopathy is no more than placebo. Nothing could be further from the truth. In fact, this paper was severely criticised on methodological grounds by several independent authors, [11-14] and contains significant scientific flaws. [15, 16] Not only does it lack any literature citations (a fundamental academic gaff that makes one wonder why the paper was passed fit for publication in the first place), the Shang et al meta-analysis violates even the Lancet’s own strict guidelines on methodological and publication transparency. 
Professor Michael Baum
More importantly, Baum and Ernst neglect the conventional medical and scientific literature on one of homeopathy’s core tenets, i.e., hormesis. This is a biphasic dose response to an environmental agent, e.g., toxin, drug, remedial agent, etc, characterised by a low-dose stimulation or beneficial effect, and a high-dose inhibitory or toxic effect.  It is a concept with a long history in medicine, precisely because of its association with a core tenet of homeopathic practice, namely the potency of the minimum dose. Nevertheless, as Calabrese has pointed out, “….the hormetic dose-response is far more common and fundamental than the dose-response models…. used in toxicology and risk assessment.... Acceptance of the possibility of hormesis has the potential to profoundly affect the practice of toxicology and risk assessment….” 
In addition, there are high quality laboratory studies which suggest infinitesimal dilutions prepared in the homeopathic manner (of serial dilution and agitation), may well exert biological effects. [20-23] Indeed most recently, very low doses of cytokines IL-12 and IFN-γ were reported by Gariboldi et al  to be much more effective in a mouse asthma model when the cytokines had been prior subjected to what these authors describe as ‘sequential kinetic activation’; in other words, homeopathic serial dilution and agitation (interestingly, this paper was only passed fit for publication once all words referring to homeopathy had been excised from the original manuscript. So much for scientific ‘objectivity’….)
The scientific evidence shows that homeopathy works
Nevertheless, Baum and Ernst continuously assert the results of homeopathic prescribing lack efficacy beyond a placebo response.  Closer examination of this claim reveals that it is based on just two systematic reviews, both by Ernst: [25, 26] as if his are the only well-designed high-quality studies, and that those of others [21, 22, 24, 27-29] considered by many to be of at least equally high quality, should be discounted. But vaunting hubris aside, Baum and Ernst are just plain wrong: by end of 2009, 142 RCTs of homeopathy had been published in peer-reviewed journals. In terms of statistically significant results, 74 of these trials were able to draw firm conclusions; 63 were positive (patients given a homeopathic medicine improved significantly more than the comparison group given either an inactive placebo or established conventional treatment), and 11 were negative (no significant difference was seen between the action of the homeopathic medicine and the comparison group). 
Baum and Ernst then go on to suggest that the scientific validity of homeopathy must exist in some ‘parallel universe’, because if correct, it would mean that “much of physics, chemistry, and pharmacology must be incorrect.”  Meanwhile, in Baum and Ernst’s universe of gold standards and systematic reviews, all is not well with evidence-based medicine (EBM) and its experimental ‘grand inquisitor’, the randomised controlled trial (RCT).
As mentioned earlier, much of Baum and Ernst’s ire against homeopathy/CAM stems from their unquestioning logical positivist mindset. [2-4] For understanding how guns, rockets, and washing machines, etc, work this might appear to be perfectly adequate. When applied to medicine (as much an art as it is a science) and the therapeutic encounter however, it effectively downgrades or ignores other no less important but less scientifically defined forms of evidence.
How relevant is “Evidenced-Based Medicine (EBM)”?
The result is that clinical decisions are now supposed to be based solely on the scientific evidence (which incidentally was never the intention of those who originally formulated the principles of Evidence-Based Medicine (EBM)).  The irony here is that if such a draconian approach was to be enforced throughout the whole of medicine, nearly half of all its current procedures would have to be halted until their effectiveness had finally been ‘proven’,  and much time, money and effort wasted in the process.
Ultimately, it could well turn out to be a double-edged sword. Trials of one of the biggest selling drugs—Prozac—recently found it to be no better than placebo.  Interestingly one does not hear Baum and Ernst campaigning for the removal of Prozac, as they do for homeopathy/CAM. Fortunately, their scientific ‘fundamentalism’ is not shared by all in medicine. Thus, top UK cancer clinician Karol Sikora (around 60% of whose patients use some form of CAM as adjuvant therapies) roundly excoriated attempts by what he calls ‘inexperienced’, ‘armchair physicians’, to tell him how to do his job, while at the same time excoriating their attempts to rid the NHS of its CAM services as ‘Stalinist’. 
Questioning medicine’s gold standard: the randomised controlled trial
Sir Michael Rawlins
Even Sir Michael Rawlins (Chair of the UK’s National Institute for Clinical Excellence and no great friend of homeopathy) in his 2008 Harveian Oration,  warned: “RCTs, long regarded as the ‘gold standard’ of evidence, have been put on an undeserved pedestal. Their appearance at the top of hierarchies of evidence is inappropriate; and hierarchies are illusory tools for assessing evidence. They should be replaced by a diversity of approaches that involve analysing the totality of the evidence base.” Indeed, this merely echoes one of the founders of EBM David Sackett’s earlier concern that EBM might be in danger of turning into an evidence ‘mono-culture’, where an ‘ideal’ scientifically-determined efficacy would subsume other no less important forms of evidence, to the detriment of patient and clinician concerns.  That a decade later, voices in the nursing profession were being raised concerning EBM’s intolerance of therapeutic pluralism in healthcare systems,  suggests Sackett’s early warning went unheeded.
But perhaps the most damning demolition of the kind of scientistic fundamentalism expressed by Baum, Ernst and others over-impinging on clinical practice, was provided seven years ago by Smith and Pell.  Their slightly tongue-in-cheek paper on the use of parachutes ‘to prevent death and major trauma related to gravitational challenge’ (i.e., falling) makes the point rather well by concluding, “As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of EBM have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of EBM organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.” Perhaps Baum and Ernst might care to volunteer for such a trial….?
Memory of Water: a mechanism for homeopathic effectiveness?
In fact, many conventional medical procedures are well known to lack scientific evidence;  fraud in biomedical and pharmacological research is rife and has been exposed, [38, 39] while clear evidence exists for the harm that can result from routine conventional medical practice and prescribing. [40, 41] It would have been to their credit had Baum and Ernst campaigned for an open mind to the shortcomings of conventional biomedicine. Instead, they assert that “The true sceptic…takes pride in closed mindedness when presented with absurd assertions that contravene the laws of thermodynamics….”.  No doubt this is a reference to the Memory of Water hypothesis as a possible biophysical explanation for the efficacy of remedies prepared by the method of serial dilution and succussion as in homeopathy.
Though the Memory of Water hypothesis has yet to provide definitive evidence supporting the tenets of homeopathic medicine,  it is factually incorrect to assume that it contravenes basic scientific principles. There is a growing body of evidence  from chemistry, [43-46] physics, [47, 48] and materials science,  which suggests the properties of water may well depend on its dilution history.  The question then is how?
Considering the Memory of Water (MoW) as an emergent property of bulk liquid water (i.e., the whole is greater than the sum of its individual molecular parts) defies explanation in terms of high-school chemistry, or the notion that water molecules move completely randomly in relation to one another. Certainly, the ability of water molecules to affect each other over long ranges via dynamic switching of hydrogen bonds may be crucially important here, as would be weaker intermolecular interactions, known as van de Waals forces.  From this dynamic interplay of molecular forces could arise coherent supra-molecular behaviour, (i.e., involving large numbers of water molecules) that the equilibrium laws of thermodynamics one learns at school, and the known short life-time of hydrogen bonding in aqueous solutions,  cannot explain.
To understand MoW requires a knowledge of systems operating far from chemical equilibrium, as described by Professor Ilya Prigogine’s Nobel Prize-winning work on non-equilibrium thermodynamics in near-chaotic chemical reactions, and importantly, as exists in all living organisms.  Here, it has been suggested that quantum points of local instability may act as dynamic ‘attractors’ of the whole macroscopic system, leading to long-range coherent supra-molecular behaviour. 
More than 20 years ago, Italian physicists del Guidice et al  advanced a theoretical mechanism for MoW which modelled the effects of homeopathic serial dilution and agitation in terms of the continued formation and dissolution of such dynamic supra-molecular structures.  These so-called ‘coherent domains’ are calculated to be thermodynamically more stable than a totally random collection of water molecules, and remain (hence the ‘memory effect’) long after all traces of the original dissolved substance have been removed. Indeed, a recent paper authored by Professor Luc Montagnier (winner of the Nobel Prize for Medicine, for his discovery of the HIV virus) has demonstrated memory effects in aqueous DNA solutions that depend on interactions with the background electromagnetic field.  Consequently, MoW is not only plausible, it contravenes no known (except by Baum and Ernst) scientific laws and principles.
But Baum and Ernst’s general ignorance of areas outside their level of competence runs deeper and is far more simplistic than MoW. The same could be said for their understanding of science’s history. For example, they say, “Homeopathic principles are bold conjectures. There has been no spectacular corroboration of any of its founding principles. An example of the spectacular corroboration of a bold conjecture is that the planet Pluto was predicted by observing minor discrepancies in the orbit of its neighbouring planet Neptune, and its discovery was counted as a spectacular corroboration of a bold conjecture….” And later on, “….homeopaths remind us of Galileo’s battle with the dogma of his day and how in the fullness of time this heretic was proven right….”
Astronomy, bold conjecture, dogma of the day, and science
With this, Baum and Ernst demonstrate how little they know about astronomy or celestial mechanics. It was the earlier discovery of Neptune (not Pluto) which was corroboration of a bold conjecture that, based on Newton’s Laws of Motion, discrepancies in the orbit of Uranus could be explained by another large planet further out from the Sun. The discovery of Pluto actually was a fluke, seeing as the now-known mass of this dwarf planet is far too small to have any gravitational affect on Neptune’s orbital behaviour.
A far better example that Baum and Ernst could have picked would have been Einstein’s prediction of anomalies in the orbital behaviour of Mercury as spectacular corroboration of his own bold conjecture; namely, general relativity, one of the pillars of 20th century physics. This ultimately pointed out the inadequacies of the classical view of the universe to which misguidedly, Baum and Ernst both still appear to cling.
And Galileo? His ‘battle with the dogma of his day’ was not as Baum and Ernst suggest. Galileo insisted on proposing heliocentricity not as a theory, but as a truth for which at the time there was no proof, and chose instead to argue scripture not science with those who believed and promoted a fundamentalist interpretation of the Bible. In this respect, Galileo was not playing the role of some heretical proto-scientific hero: he was being arrogant and stupid, arguably delaying uptake of a new idea by creating unnecessary resistance in those that might have been more sympathetic had he not appeared to be attacking their own self-interested power base. In this respect, Baum and Ernst’s absurd attitude of closed mindedness to homeopathy, and casting themselves as ‘defenders’ of science against a presumed rising tide of irrationality, resembles that of the Inquisition.
Of course, everything happens for a reason. No matter how dogmatically idiotic and contrary to the real spirit of scientific enquiry the New Fundamentalism and those who promulgate it truly are, it serves a purpose beyond dry academic discourse. The pharmaceutical industry is having a hard time lately. A combination of plummeting profits (because many block-buster drugs are coming off patent and there are few to replace them); successful class actions over drug side-effects costing Big Pharma billions; substantiated claims of cheating and plagiarism in drugs trials, etc, are stoking the public’s growing distrust of the pharmaceutical industry. In addition, increasing interest in and use of health alternatives (e.g., homeopathy, CAM) by millions across the world all adds up to the pharmaceutical industry feeling itself threatened. And it will do everything in its considerable economic and political power to fight back. Against this background, the New Fundamentalism and those pushing its agenda may be seen simply as witless cats’ paws of globalised corporatism.
What’s really going on….
So what is The New Fundamentalism? It is an insidious ‘crypto-fascist’ brew of scientism, globalised corporatism, and (ironically, originally left-wing) militant materialistic nihilism which denies humanity has any inner metaphysical reality. Thus, it reduces human beings to biochemical mechanisms, from which it is but a short step to regarding humans as nothing other than biologically-determined economic units. This suits globalised conglomerates very well which, via their encroaching control over individual governments, would no doubt wish to see representative democracy reduced to the irrelevance of some inane reality game show. (With apologies to Juvenal) Rememdium, panem et circenses.
We have of course, been here before, and indeed, history does not disappoint. Inspired by the work of the German philosopher Jürgen Habermas, Prof Martin Ryder of Colorado State University warns of the dangers of unbridled scientism encroaching into public policy. “.….Policy can be informed by science, and the best policies take into account the best available scientific reasoning. Law makers are prudent to keep an ear open to science while resisting the rhetoric of the science ‘industry’ in formulating policy. It is the role of science to serve the primary interests of the polity. But government in a free society is not obliged to serve the interests of science (my italics)…. positivism and scientism move in where the discourse of science lacks self-reflection and where the spokesmen of science exempt themselves from public scrutiny.”
Here in the UK, the signs are not good. The Government’s Science and Technology Committee recently recommended homeopathy should no longer be made available on the NHS: the Government has yet to respond (a looming general election occupying most politicians’ minds just now). Also, Simon Singh can breathe easier after his day in court with the chiropractors (who considered themselves libelled by him: after several judgements in their favour, Singh won on appeal, and the chiropractors have pushed back from the table and called it a night).
More importantly, the onward march of scientism has been evidenced by the huge sums given away to pharmaceutical companies for an unnecessary flu vaccine (the Government are trying to claw back some of that money), and an interesting spate of resignations from the Government’s Advisory Council on the Misuse of Drugs (ACMD).  It appears the scientists involved not only expect (quite reasonably) their advice to be listened to, but acted upon as if science should be the only consideration. It would be fascinating to observe these scientists trying to explain to bereaved parents how the illegal substances that killed or maimed their children are less harmful than alcohol or tobacco.
While it is no doubt time society grew up and took a more considered and mature attitude towards drugs, the idea that in a democratic society, science should be the only arbiter of political decision making on such issues, is dangerously scientistic and would set us on a path Jürgen Habermas knew only too well.  For he grew up in one of the world’s first attempts at engineering a society along scientistic lines: it was called Nazi Germany….
About the author
Lionel Milgrom has been in practice as a professional homeopath (LCH, MARH, RHom) for over a decade. He has also had a parallel career as a research scientist for well over 30 years, with over 70 academic papers published in leading chemistry journals (BSc, MSc, PhD, CChem, FRSC). He was the founder and first CEO of an anti-cancer bio-tech spin-out company in 2001. Lionel also writes and comments about science and been a sometime broadcaster on the subject.
Combining these talents, he has spent the last 8 years developing new ideas about the therapeutic process, based on the discourse of quantum entanglement. Lionel is a keen observer and critic of the current debate around homeopathy/CAMs, coining the phrase ‘New Fundamentalism’ to describe the mind-set of those currently waging a campaign to see homeopathy and CAM axed from Britain’s National Health Service (NHS). He has published peer-reviewed papers in CAM journals and written many articles in CAM magazines on these subjects.
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