20 Apr, 12 | by Iain Brassington
Some very strange papers have just appeared in Bioethics regarding homeopathy. Not so long ago, the journal published a paper by Kevin Smith that advanced the claim that homeopathy is not only ineffective, but ethically problematic. The position taken was that homeopathy “ought to be actively rejected by healthcare professionals”, and that it is in fact ethically unacceptable, not least because of concerns about it reducing the likelihood that people would seek effective healthcare, and wasting resources. The analysis is overtly utilitarian, but I don’t see any particular reason why a non-utilitarian theory wouldn’t come to essentially the same conclusions about using homeopathy, especially by public bodies. (For example, there seems to be a reasonable justice-based claim that could be made on behalf of taxpayers, that it’s wrong to spend their money on stuff that lacks an evidence base: it should either be redirected to stuff that has evidence in its favour, or refunded. This doesn’t have to be utilitarian in flavour.)
But while I have no particular dispute with Smith’s paper, neither do I have any dispute with homeopaths getting a right to reply in the same journal. They should have this right. Papers could be wrong or need refining, and disinterested argument is a good way to correct errors.
Still: scientifically speaking, homeopaths have their work cut out. And without the science, the ethics is going to be tricky. Several scientists throughout the blogosphere provide sterling service in debunking the claims put by homeopaths – David Colquhoun, Xtal Dave, David Gorski, and even some who aren’t called David, like Edzard Ernst. Martin Robbins’ column in The Guardian a couple of days ago does a lovely job of showing that even homeopaths aren’t particularly good at defending homeopathy. From what I can tell, the commentaries and replies to Smith’s paper published in Bioethics (here, here, here, and here) would not trouble any of these commentators for too long. But I’m not a scientist, and so I’ll leave the scientific arguments to those better qualified – though if the apparently serious use of the phrase “the energy field of the patient as a whole” in Moskowitz’ paper isn’t a drop-dead cert for crankiness, I don’t know what is. Orac has been fast off the mark with a fisking of all four commentaries here, and Smith himself gets a right to respond here.
I am, though, pretty good when it comes to poor arguments more generally; and there’s some astonishingly poor stuff on show here. Take, for example, a couple of textbook blunders in Irene Sebastian’s paper.
First, she points out that Luc Montaignier has supported the idea that homeopathy isn’t quackery – and he has a Nobel prize for having identified HIV. But so what? The fact that he’s a respectable virologist doesn’t show that he’s an authority on all science: it doesn’t even show that everything he says about virology is right. Given that chemistry and physics are not branches of virology, why should virological expertise imply expertise here? There’s nothing but an argument to authority here – made worse by the absence of any reason to suppose that the notional “authority” is an authority on the subject after all (and, IIRC, Montaignier’s comments were greeted with no small amount of derision by the scientific community: see here for a blogospheric takedown.)
Her next advocate is Gandhi. Seriously.
Given that most users of homeopathic medicines are in fact also proponents, a conservative estimate of the number of people Dr. Smith has labeled “unethical” is 200 million. Mahatma Gandhi, one of the great moral visionaries of the 20th century and a strong proponent of homeopathic medicine, is also “unethical” according to Dr. Smith’s logic.
It’s hard to know where to start with that. Whatever you think about Gandhi as a moral visionary, it’s hard to deny that his biggest influence was in, er, politics. So quite why his endorsement of homeopathy’s effectiveness should be taken seriously is anyone’s guess – unless you happen to think either than he was incapable of error, or that his support for something is enough to change the fabric of reality. (Maybe homeopaths do believe that. They believe that water has a memory, after all.) Besides: Smith’s claim is not that homeopaths are (necessarily) bad people: it’s that there is a moral problem associated with the use of homeopathy. That’s a very important difference to keep in mind. The most that he’s saying is that people who push homeopathy do something impermissible if either (a) they’re unaware of its ineffectiveness, because you ought to know whether something is effective before you push it, or (b) they are aware of its ineffectiveness, but push it anyway. To the extent that someone is guilty of one of these, and to that extent alone, their endorsement of homeopathy makes them morally questionable.
Nor can you use the support of someone you admire to demonstrate the permissibility of an action, any more than you can use the support of someone you dislike to show the impermissibility of another. The argumentum ad Gandhium here is just as fallacious as the argumentum ad Hitlerum in other contexts, and for exactly the same reason. Things aren’t a bad idea because Hitler endorsed them (Hitler endorsed shoes, but they’re OK); if they’re a bad idea, Hitler’s endorsement is irrelevant. Similarly, things aren’t a good idea because Gandhi endorsed them, and nor is his endorsement evidence in their favour.
Milgrom and Chatfield’s paper advances an even stranger argument: that Smith (and, by extension, other people opposed to homeopathy) are scientistic. This isn’t true, as far as I can tell. But even if it were, what’s the problem? For Milgrom and Chatfield, the problem is that,
[t]aken to the extreme, scientism defaults to Internet-fueled inquisitorial intolerance which, supported by certain academics, sections of the media, and (usually anonymous) blog sites, systematically vilifies anything considered ‘unscientific’, e.g. the campaign to undemocratically rid Britain’s NHS of its homeopathy/CAM facilities.
Two things here. First, science is not a matter of tolerance, and nor should it be. Reality is not tolerant. Things are either true or false. If you’re claiming that illnesses can be cured by any treatment, the onus is on you to prove it. If you can’t prove it, and if the mechanism by which the cure is supposed to work is massively improbable (and you can’t say satisfactorily how that might work), then you don’t get the same platform as things that can be proven, and the mechanism of which is scrutable. Noone gets special treatment. (For sure, a treatment not working is not the death-knell: if there’s good reason to suppose that it could work based on what we already know, then that’s an invitation to refine the treatment, and to learn something about why it doesn’t in this case. But homeopathy cannot claim to be plausible by the standards of what we know, so it stands or falls according to its results.)
Second, the appeal to democracy is specious. So what if people want homeopathy? They also frequently want antibiotics to treat their cold. The NHS should not provide that, either. Just as science isn’t a matter for tolerance, neither is it a matter for democracy.
I could go on, but this is already long. I might return to other aspects of the papers in future.
For the time being, though, a question. Should the responses have been published, given their problems? Well, merely coming to the defence of homeopathy isn’t sufficient to veto publication; such papers should get their day in the sun. I am slightly more worried, though, by the fact that the authors themselves thought their responses worth publishing. I don’t think that any of them has done great favours for the intellectual reputation of homeopathy.