-Caveat Lector-
Dave Hartley
http://www.Asheville-Computer.com/dave
interesting article (admission?) about the limits of
modern science in understanding those things that fall outside of the
confines of current understanding and acceptability. All the more
interesting for its mention of Homeopathy, however brief, from a
publication entitled "The Scientist".
--------------------
Volume 12, #18
The Scientist
September 14, 1998
From Placebo to Homeopathy: The Fear of the
Irrational
Author: Dimitri Viza
Date: September 14, 1998
Today's biomedical science oscillates between rigorous approaches,
with rational attitudes, and irrationality or incoherence. Thus,
in the era of molecular biology, psychoanalysis thrives and
represents a multimillion-dollar annual business, whereas other
such "nonmaterialistic" disciplines as homeopathy, acupuncture,
or hypnosis are a priori and uncritically rejected by hard science.
Indeed, the temptation is to reject anything without a molecular
explanation--better to deny a fact than get mixed up with a fluke.
But if reason has partially freed us from medieval beliefs, it is
now proving to be self-destructive (F. Schiller, Clinical
Medicine, 19:81-6, 1984). For when facts are rejected as
unreasonable in the name of reason, we are adopting the
same superstitious approach to reality as people did in the
Middle Ages.
The placebo effect is a perfect illustration of scientific
exorcism of a disturbing fact (W.A. Brown, Scientific American,
Jan. 1998, pages 68-73). Although its existence has been
established beyond doubt, all efforts are directed not toward
studying its mechanisms, but to subtracting its interference.
To satisfy statisticians and referees, constraints have become
more stringent and ethics are bent--as are coherence and
logic--so that one is justified in wondering whether randomized
clinical trials, necessary for producing placebo-free data, are
not "the worst kind of epidemiology," deliberately ignoring the
individual patient's welfare in the name of science (B.G.
Charlton, Nature Medicine, 1:1101-2, 1995). For when a physician
knows that treatments are not equivalent, ethics require that the
superior treatment be recommended. Only when equipoise is
reached--a state of genuine uncertainty regarding the
comparative therapeutic merits--can randomized clinical trials be
acceptable.
If, for a number of patients, an inert substance with nil toxicity
produces the same beneficial results as a toxic pharmaceutical
compound, logic would require that the phenomenon be thoroughly
investigated for the patients' benefit, and for its potential to
reduce medical costs. However, because of the implicit
psychological mechanisms underlying the effect, placebo has
maintained and reinforced its dubious reputation, thus impeding
further research.
Hence, the real placebo paradox, which illustrates the
schizophrenic paranoia of today's medicine: since placebo
equates in the minds of many to a psychosomatic, i.e., unreal
illness, administering it is synonymous with medical
deception and unscientific maneuvering, even if the patient's
pathology improves. Modern medical logic would rather that
treatments were inefficacious than incomprehensible. And yet, for
economic, ethical, and purely scientific reasons (especially in
an era when certain effects of the immaterial soul can be pinned
down to a secretory activity of the brain), the placebo effect
warrants further investigation, as does homeopathy, a
controversial practice plagued by the same type of ostracism.
In France, for instance, where homeopathic drugs are used by
one-third of the population and paid for by national
health insurance, their cost represents only 1 percent of
that of conventional drugs. Whether observed clinical
improvements are illusory or due to placebo effect, the
results satisfy the vast majority of patients and physicians
who use these compounds, even if it is shocking for well-thinking
scientists to accept that high dilutions of chemicals can display
activity, as the homeopathy theory claims. In an era when
over-medication threatens the basis of health policies, the
rationale for encouraging the fashion for innocuous, low-cost,
and yet effective medicines is evident. Nonetheless, it would
be more intellectually satisfying and morally acceptable to know
whether a homeopathic prescription is handed out because of its
placebo power or its direct effect on the biochemistry of the
organism.
Nobody seems to be interested in exploiting homeopathy as a placebo
tool, or in funding bona fide research that should prove
(or disprove) the underlying theory. Here, again, the
attitudes of the proponents and opponents of the hypothesis evoke
religious wars, irrationality, and intellectual dishonesty.
Yet, several clinical studies suggest genuine effects
(K. Linde et al., Lancet, 350:824-5, 1997). But the debate being
a passionate one, it will probably never come to a head, every
side determined to debunk and ridicule the opponent's position
before even considering the evidence.
Interestingly, the a priori rejection of "impossible" facts does
not only concern fringe disciplines and nonmaterialistic phenomena.
It can also strike at once-respectable hard data. One of today's
most salient examples is that of transfer factor, an immunomodulator
long lauded for producing extraordinary clinical results within the
realm of cell-mediated immunity (D. Viza, Biotherapy, 9:17-26, 1996).
In the 1990s, it became a non-grata research topic, because its
molecular structure could not be elucidated. Forty years' research,
which has generated more than 1,000 clinical and laboratory reports,
seems to have been wasted because we are still determined to ignore
writer George Santayana's warning: "Those who forget the past are
destined always to repeat it."
At the turn of the century, one can but hope that scientists will
one day cease to compete with priests and politicians in their race
for certainty, and accept at last, as philosopher Karl Popper
contends, that, unlike psychoanalysts, their fate is always to
be wrong. Scientific arrogance might then subside, making science
healthier, and also--most important for some--more productive.
Dimitri Viza is director of the Immunobiology Laboratory at the
Faculte de Medecine des Saints-Peres in Paris.
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