Scientific Research in Homeopathy – Alex Tournier misleads

The Complementary Medicine Association (CMA), brainspawn of Jayney Goddard – professor of a burned down Nepalese university, recently held a ‘Scientific Research in Homeopathy’ conference.  Mainstream media coverage of this event has been limited with apparently only the Times Higher Education (THE) covering it.  From the THE it seems the conference was used as a springboard to launch a scurrilous and unpleasant attack on Professor Ernst and Dr Singh who have recently written a book ‘Trick or Treatment?‘.  The crime Ernst and Singh have apparently committed is to take an unbiased and clear headed, and in my opinion generous, look at the evidence behind complementary treatments.  Unfortunately for the homeopaths, even given the authors proclivity for charitable interpretations of evidence, homeopathy is left powerless, bereft of any credible supporting evidence, exposed, flaccid and shrunken in the cold gaze of science.  This is perhaps why the homeopaths, impotent with rage, have resorted to unpleasent ad hominem abuse.  As well as this the Scientific Research in Homeopathy conference was perhaps intended as an attempt to rebut the claims of Ernst and Singh by looking under the bed of pseudoscience, on which some homeopaths now rest, for stimulation.  It seems the presentations from the conference have failed to rise to the occasion.

The Quackometer and apgaylard have already examined Lionel Milgrom’s evidence and found it artificially engorged with pufftalk and piffle so this post will take a look at the presentation from Dr Alex Tournier, a (former?) Cancer Research UK funded biophysicist, and an interesting example of how some scientists can apparently believe in things that openly conflict with their research.  This is a relatively common phenomenon in science, for example there are many biologists (although few geneticists) who believe in an interventionist god when the genetic evidence belies any ‘inteligent’ intervention, and Dr Tournier deserves no special opprobrium for his beliefs.  However, as his presentation shows, he indulges in the familiar deceit, misinterpretations and hypocrisy of homeopaths when it comes to evaluating scientific approaches to homeopathy.

Dr Tournier states the aims of his presentation as follows:

• To show that science and homeopathy are indeed compatible

• To present evidence coming from different fields of science

• To present Homeopathy Research Institute

The deceit begins on the fourth slide where Dr Tournier presents scientific research as follows:

Dr Tournier omits the defining characteristic of the scientific method, the hypothesis.  A testable explanation of an observed phenomena.  Science is based on the assumption that a hypothesis must be able to be tested by experimentation.  Theories are collections of hypotheses, forming a coherent whole, that have survived testing by experimentation.  So Dr Tournier’s slide should present a figure somewhat like this:

Only the hypotheses which survive repeated experimentation are incorporated into theories that give us understanding.

After having put his flawed reasoning forward Dr Tournier then presents this statement that further misleads his audience:

“Homeopathy does not work …… because it cannot work”
[This statement] is not scientific, as it is not grounded in observation

The detail that Dr Tournier conveniently misses out in those ellipsis is the very laws, theories underpinned by many successfully tested hypotheses, that govern the behaviour of energy and matter in this universe, not least the theory behind Avogardo’s number that shows that a typical homeopathic dilution will not contain a single molecule of the original ingredient.  Those ellipsis contain the sum total knowledge of human endeavour in the fields of physics, chemistry and biology, all of which does not provide a plausible, testable hypotheses supporting homeopathy, and they are not considered worthy of examination by Dr Tournier.  Instead, dismissed with a glib aside.

On his next slide, titled ‘Science of Homeopathy’ Dr Tournier builds on the deceit practised in his explanation of scientific method:

Hahnemann built homeopathy following a rigorous scientific approach:

• Experimentation

Provings
Clinical experience

• Theories and concepts

Law of similars
Principle of dilution
Concept of the vital force

This is a lie.  Hahnemann existed before the scientific method was properly established as a means of enquiry and his approach was to use personal experience and provings, a notably subjective experience.  His theories are not based on a coherent collection of tested and testable hypotheses but on unsubstantiated conjecture, anecdote and, in the case of vital force, an ancient myth.  This is not science, this is not the scientific method.  Shame on Dr Tournier for equating the rigourous and applied methodology of scientists to the mystic musings of an 18th century German.   As for the theories and concepts, well homeowatch has some excellent criticisms of the Law of similars and dilutions while nobody has been able to demonstrate the existence of the vital force.

Dr Tournier follows this deceit with a misrepresentation of other researches work.  He presents a figure adapted from a paper by Fønnebø et al exploring “the strengths and weaknesses of conventional biomedical research strategies and methods as applied to complementary and alternative medicine (CAM), and to suggest a new research framework for assessing these treatment modalities.”.

As you can see it seems Fønnebø et al see safety as the last concern of the pharmaceutical model of research.  However when you look at the figure from the original paper it looks very different from Dr Tournier’s interpretation.

CAM research

The original paper makes clear that safety considerations are a factor of Phase I, II and III trials rather than an afterthought after the drug is released.  Perhaps Dr Tournier offered his interpretation because it is clear, both from his slide and the original figure, that in CAM safety considerations come AFTER clinical practice.  Very unlike conventional medicine where safety is a concern from the first trial onwards.

He then goes on to claim that there are 5 high quality papers supporting homeopathy based on NMR experiments.  In support of this claim he cites Witt et al (2003), however, a glance at the abstract suggest Dr Tourner is again offering an interpretation of what he would like the paper to say, rather than what it actually says.  According to Dr Tournier high quality is defined as a Score for Assessment of Physical Experiments on Homeopathy (SAPEH) of >6.  According to Witt et al it is defined as >7.  Also the researchers state in their results,

Most publications were of low quality (SAPEH < 6), only 6 were of high quality (SAPEH > 7, including 2 points for adequate controls). These report 3 experiments (1 NMR, 2 black boxes), of which 2 claim specific features for homeopathic remedies, as does the only medium-quality experiment with sufficient controls.

before concluding,

Most physical experiments of homeopathic preparations were performed with inadequate controls or had other serious flaws that prevented any meaningful conclusion.

It seems Dr Tournier is developing quite the habit of misinterpreting data.

His next slide again makes claims about the number of high quality trials using molecular and cellular systems reported by Witt et al (2007) however again a reading of this paper somewhat belies his claims.  Bizarrely the abstract concludes,

Even experiments with a high methodological standard could demonstrate an effect of high potencies. No positive result was stable enough to be reproduced by all investigators. A general adoption of succussed controls, randomization and blinding would strengthen the evidence of future experiments.

It is frankly unbelievable that somebody can claim that results that are not replicable are high quality. If results from a scientific paper are not replicable then that paper can no longer stand as a contribution to the field.  It is bad enough that this is a poor paper but it is even worse that Dr Tournier seeks to exaggerate its findings before his captive audience of largely scientifically illiterate CAM practitioners.

Dr Tournier then goes on to cover animal systems but does not provide references so I cannot check his claims before moving onto the now notorious metaanalyses of human trials.  After the usual inaccurate rubbishing of the most recent and comprehensive meta-analysis by Shang et al., (the one that showed no effect above placebo for homeoapthy), ably dissected by apgaylard with reference to the CMA presentation by Milgrom, he goes on to make the claim that Shang is not classified as a review by UK DARE (Database of Abstracts of Reviews of Effects).  Now DARE makes no claim to be the definitive repository of reviews, merely describing the reviews as having to study

interventions that are clearly health related; interventions that have the potential to affect health; adverse effects; diagnostic and prognostic studies; individual patient data (IPD).

However, since Dr Tournier thinks that reviews in the DARE database are given extra credibility it is worth highlighting what it says about three reviews that Tournier cites favourably, Linde et al (1997), Linde & Melchart (1998) and Cucherat et al (2000).

Linde et al (1997)

Overall this was a rigorously conducted and well-presented systematic review. The research questions, selection criteria for primary studies, quality assessment, and methods of pooling data were explained clearly. The search strategy was thorough, and an estimation of the impact of publication bias was included. Details of the primary studies were tabulated. However, the results should be treated with some caution due to the fact that the trials included in the meta-analysis differed markedly in terms of the participants, interventions and outcomes. In addition, the results of the statistical test for heterogeneity were not reported, although the authors state that this was carried out. The authors’ conclusions are appropriate given the evidence arising from this review.

But remember this is a paper that concluded,

However, we found insufficient evidence from these studies that homeopathy is clearly efficacious for any single clinical condition.

Linde & Melchart (1998)

However, the review was not based on a well-defined question. Neither participants nor outcomes were specified and a broad class of therapies (individualised homeopathy) rather than particular interventions were reviewed. The inclusion criteria were clearly specified but the assumption that a double blind trial involves an unbiased method of allocation is questionable because blinding usually refers to assessment of outcomes rather than allocation concealment. Three different validity assessments were performed; the primary one was mainly based on the study’s inclusion in a journal listed in MEDLINE. This seems an unusual requirement for studies of complimentary medicine, although the authors do mention that 6 journals dealing with complimentary therapies have been included since 1998. The authors recognise the shortcomings of having only one reviewer assess the papers. Less than half the studies are included in the quantitative meta-analysis. Although the trials were grouped by methodological quality, this is likely to be a heterogeneous set of studies: neither the main outcome, participants nor treatment were constant across studies.

Consequently the results of the meta-analysis should be treated with extreme caution. This is acknowledged by the authors.

Cucherat et al (2000)

The authors stated the research question and inclusion and exclusion criteria. The research question was extremely broad. It is possible it was too broad to be addressed in a meta-analysis. The literature search was reasonably thorough and the authors tested for possible publication bias.

The method used to assess the quality of the included studies was not stated, but issues of study and methodological quality were addressed and further analysed in sensitivity analyses. Trials were excluded if the quality was unacceptable. The authors detail the data extraction process, but there is no report on how the articles were selected, or who performed the selection and quality assessment.

The data extraction is reported in tables and discussed in the text of the review. Due to the disparate nature of the included studies, the studies were combined using p values which only state whether the findings of an individual study are statistically or not statistically significant. Clinical evidence of treatment effectiveness cannot be determined from the results of these studies. Further sensitivity analyses were performed to assess the effects of differences in study quality and methodology.

The authors’ conclusions appear to follow from the results, but should be viewed with great caution because of limitations in the quality of the review process.

Ouch.  Looks like Dr Tournier again hasn’t given the full details to his audience.

It seems Dr Tournier seems to have a fatal weakness when it comes to homeopathy, he misinterprets data and makes unsupportable claims.  Precisely the kind of behaviour that will make you persona non grata in scientific circles.  Dr Tournier has published his non homeopathic CRUK funded research in respectable journals, his papers don’t make any unsupportable claims and, although I am not particularly knowledgable about his field of biophysics, seem perfectly decent to me.  Is it the critical peer review process that maintains the credibility of his biophysics papers? Does he approach homeoapthy in a different way than he does biophysics?  I have no idea.  But he does display the fatal weakness of apparently all homeopaths when it comes to scientific support for homeopathy.  I wonder if this is a case of faith meeting reason and prejudice winning out.  In any case this has resulted in a scientist with a respectable record of publication flogging dishonesty to gullible fools and is a sad sight indeed.