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E-letters: Electronic letters published:
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milgrom and the nazi story
- edzard ernst (19 February 2008)
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Weak Quantum Theory isn't that weak
- Daniel Chrastina (13 February 2008)
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Response to Simon Bates: part 2. Schrödinger's silence
- Lionel R Milgrom (27 December 2007)
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Response to Simon Baker: part 1. levelling the playing field
- Lionel R Milgrom (27 December 2007)
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Response to Daniel Chrastina
- Lionel R Milgrom (27 December 2007)
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Re: A placebo effect is not efficacy
- Peter J Flegg (27 December 2007)
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Re: Homeopathy and hubris
- Simon J Baker (27 December 2007)
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A further response to Lionel Milgrom
- Simon Gates (16 November 2007)
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Homeopathy, hubris, and the Third Reich
- Lionel R Milgrom (6 November 2007)
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Re: Response to Simon Baker
- Daniel Chrastina (6 November 2007)
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A placebo effect is not efficacy
- Austin C Elliott (6 November 2007)
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WQT confirmed as only metaphor. But the mathematical criticisms have not been addressed.
- Simon J Baker (6 November 2007)
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Response to Simon Baker
- Lionel R Milgrom (24 June 2007)
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Re: Entanglement in the homeopathic process: response to Simon Gates
- Simon J Baker (24 June 2007)
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Entanglement in the homeopathic process: response to Simon Gates
- Lionel R Milgrom (21 June 2007)
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"Entanglement" in RCTs of homeopathy
- Simon Gates (19 June 2007)
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Ability to kill elevates homeopathy to drug status
- M. Sue Benford (19 June 2007)
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edzard ernst, professor 25 victoria park road,exeter,ex2 4nt
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Mr Milgrom's comments on my BJCP ariticle about homeopathy mentioning the "nazi experiments" are seriously misleading. Here are a few facts to put the record straight: 1)I have a longstanding interest in the role of the medical profession in the nazi autrosities and published many articles on this subject. Had milgrom googled"edzard ernst/nazi" before his ill-conceived deliberations, he might have seen my article in an entirely different light. To make me look like some neo-nazi freak is demonstrably wrong. 2)I have also published articles about the third reich investigations into homeopathy since more than 10 years,including in the journal of homeopathy. To ask "why now" merely discloses the ignorance of Mr. milgrom. 3)From all we know about these investigations,they were done to the highest standards of ethics and science. To compare them to concentration camp experiments is totally inappropriate. As they were ethical research performed by the leading scientists of that time,it is not wrong to refer to them today - or does Milgrom want to ignore all the science that happened in germany between 1933 and 1945? I ask myself why milgrom and other homeopathic evangelists seem so upset by my mentioning this research. Would they have reacted the same if the results had been positive? Conflict of Interest:None declared |
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Daniel Chrastina, Postdoctoral researcher L-NESS, Politecnico di Milano, 22100 Como, Italy
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The e-letter includes mathematical equations that are not viewable on this page. To read the letter, please visit this link. | |||
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Lionel R Milgrom, scientist, writer, homeopath Ainsworths Pharmacy, 36 New Cavendish Street, London W1G 8UF, & The Homeopathic Research Institute
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My original posting [1], seems to have raised a few hackles. Simon Bates suggests I "respond to the substantive and substantial criticisms that have been levelled at (my) scheme before adding yet more courses of brickwork to its fantastical upper storeys" etc, etc: all in good time. First, let us examine what was said concerning the Haidvogl et al data [2]. Dr Austin states that a "central tenet of evidence-based medicine" (EBM) is that "Doctors should not use drugs to treat illnesses where there is clear evidence that the drugs offer no benefit." First, as in part 1, and with reference to homeopathy, I dispute the meaning and value of such evidence; but then I would, wouldn't I! More importantly, however, and from the point of view of patient safety, how does Austin account for the clear evidence that throughout the NHS, drugs are prescribed which actually do harm and sometimes kill [3]? Is there an explanation of that in terms of EBM [4], I wonder? Or is the medical establishment so enthral to the pharmaceutical industry, it has forgotten that the primary effect on the health of populations has been improvements in sanitation and public health measures, not the ministrations of the drug companies [5, 6]? Then Austin asserts that all the Heidvogl data demonstrates is that the homeopathic remedy acts as an "efficient placebo" Given its current pejorative status, this phrase is perhaps oxy-moronic. Or, could it be that what Austin has really stumbled upon is that the placebo effect is the least understood and arguably one of the most powerful of therapeutic modalities [7]: perhaps something worth funding and researching? Of course not! There would be no money in it! There is however, plenty of money to be made out inventing diseases [8] and then providing the 'necessary' drugs for them, which doubtless will pass every EBM test with flying colours. As for Bates 'poorly designed' criticism of the Haidvogl et al study, I would refer him back to my previous comments in Part 1 of this reply, and the work of Holmes et al [4]. But, as he would no doubt say I am, "Just adding more courses of brickwork". Dr Chrastina makes what appear to be some good points (and I thank him for picking up on the typo I missed concerning Planck's constant). However, I did find one or two of them puzzling. For example, the comment "All truth, even scientific truth is relative, not absolute" was made in the spirit of questioning the dictatorial primacy of evidence-based discourse over other knowledge discourses in healthcare systems [4]. So why de-contextualise it into a palpably false logical proposition about absolutes? The question is rhetorical. But it raises a more general point: can there be any truth without our knowledge of it (other than in hindsight)? It seems to me the two are inextricably bound up in and with each other, and that all that hindsight does is to re-write history in terms of a pre-existing narrative, e.g., classical determinism. This leads on to Chrastina's next point. Can one conclude that there is an underlying reality free of our observation of it? This really is at the nub of the ontological issues arising out of quantum theory. I too am aware of the work of Prof Zeilinger's group [9]. So, Chrastina will know that information or knowledge of a system can have a more fundamental meaning than a system's objective reality; or, to put it more starkly, we can only concern ourselves with what can be known about a system, not its objective reality, 'in itself'[10]. Thus, the well-known paradoxes of quantum theory are resolved by taking the quantum state of a system as a representation of our knowledge about it, not its presumed objective 'reality in itself'. Chrastina will also be aware that several hundred years prior to the quantum era, Kant came to similar conclusions about the nature of reality and things 'in themselves'[11]. So I am not denying 'underlying realit'. I am merely questioning its separation from our observation of it, which the term 'underlying' implies. Chrastina also points out that wave function collapse does not generally mean the wave function reduces to zero. While in my scheme this would be true of the 'wave-functions' describing patient, practitioner, and remedy, it appears that the PPR entangled-state wave function does indeed for all intents and purposes disappear. Moving on to Weak Quantum Theory [12], it is interesting that both Chrastina and Bates quote the scurrilous web-site of that magician and arch-hater and baiter of homeopathy James Randi [13] as the source for their conclusion there is no justification for WQT's application to areas outside of orthodox quantum theory. This is quite simply, wrong: the paper [12] quite clearly cites two areas to which WQT is usefully applied; demonstrating the dangers of dependence on un-peer-reviewed Internet material. WQT is motivated precisely by the attempt to find a formal framework for addressing the concepts of complementarity and entanglement, in more general contexts than orthodox quantum physics. Among many examples for complementary relations in the literature, the authors of WQT chose two case studies to demonstrate its applicability: a), complementary types of dynamical descriptions of physical systems, and b) the relation between conscious and unconscious processes in psychoanalytic and psycho- therapeutic settings. Because it has a minimal set of axioms, orthodox quantum theory can be recovered from WQT by adding other axioms and restrictions, e.g., Planck's constant. Thus WQT is a more general version of orthodox quantum theory. However, the two examples illustrate that the amount of generalisation is flexible depending how the situation can be formalised in terms of non-commuting operators; far less generalisation being required for a) compared to b). Clearly, such generalisations would have implications for what the term 'wave-function' means. But, as in orthodox quantum theory, the wave function is still related to a set of observables. However, such sets of observables might not necessarily be amenable to the precise physical measurements physicists are used to making. At the end of the paper, the authors discuss WQT's planned use in describing cognitive processes [14]. This is part of an on-going and increasing research effort analysing conditions for, [14, 15] and applications of, the concept of quantum entanglement to macro-physical systems, e.g., to living organisms [16, 17], in understanding correlated brain functioning [18, 19], and, of course, extensions into medicine and CAM [20-23]. This is a by no means an exhaustive list and all are very much 'works in progress' but doubtless, they will be dismissed simply as the ramblings of 'quantum mystics'[24]. In the mean time, Chrastina I am sure is quite capable of deciding for himself whether quantum entanglement as used in these various contexts, is model, analogy, or metaphor. This brings me again to wave-function collapse. Chrastina is, of course correct in orthodox quantum theoretical terms, concerning the length and time of decoherent wave-function collapse of the huge numbers of particles in a human being. However, the wave functions of orthodox quantum theory represent quantifiably measurable observables of physical particles. This is not what the 'wave-functions' in PPR entanglement or WQT [21] represent (re the comments above concerning WQT). They represent more qualitative and subjective observables; in this case those concerned with the patient's signs and symptoms. For example, the 'wave-function' for the patient is related to the observed secondary symptom picture of the patient. Similarly, the 'wave-function' for the remedy is related to the observed changes in secondary symptoms that brings this about. As the 'wave-functions' of PPR entanglement are so different from those of orthodox quantum theory, then it is reasonable to imagine that they will have different properties of 'coherence' and 'decoherence' to physical quantum particles. What they at the moment it is far too early to say. Though clearly not a quantitative approach like orthodox quantum theory, PPR entanglement has enabled certain insights into the natures of the Vital Force [25] (a concept with holistic significance in CAM: its nearest equivalent in conventional medicine is the homeostatic immune system) and homeopathic remedies [26]; and makes some tentative predictions concerning how homeopathy/CAMs and conventional medicine might be unified [27]. It also sheds light on why double-blind randomised- controlled trials of homeopathy provide at best equivocal results on EBM- defined efficacy, and illustrates by way of analogy with the double-slit experiment of orthodox QT, a working illustration of entanglement between verum and placebo groups during homeopathic provings. Now, just because these ideas are qualitative not quantitative, and are repugnant to Bates et al, does not mean they have "neither explanatory nor predictive powers". Consequently, I shall not be informing my colleagues not to take my ideas at face value, though they will know it is still a work very much in progress. And while my scheme might well be a metaphor, to compare it with Little Red Riding Hood is at best disingenuous; for the latter is not a metaphor for childhood development: it is a fairy tale; which, I have no doubt, is what Bates and Chrastina really think of PPR entanglement. So, I shall entertain them both further by adding yet another metaphorical 'brick in the wall' In fact, I have their comments to thank for this:- A patient enters the practitioner's 'space'and for a time, becomes during the consultation 'isolated' from the surrounding environment. This produces a "kind of 'quantum superposition' or 'coherence' between patient, practitioner, and therapy (in the case of homeopathy, this would be the remedy). When this state interacts with the outside world after the consultation, it gradually undergoes 'decoherence'(i.e., collapse of the quantum superposition), possibly to a state of cure. Though still to be formalised, this idea does emphasise the importance of isolation from the external environment (the consultation) in order for coherence and decoherence to bring about the possibility of cure. From this, we could perhaps predict that increasing the quantity and quality of time patient and doctor spend together in conventional medical practice, might help to improve the chances of a positive outcome. It was Erwin Schrödinger, one of the fathers of quantum theory, who said, "The scientific picture of the real world around me is very deficient. It gives me a lot of factual information, puts all our experience in a magnificent consistent order, but it is ghastly silent about all and sundry that is really dear to our heart; that really matters to us." [28] Continuing the project of generalising quantum theory into macroscopic areas 'dear to our hearts' like medicine and health, might just conceivably help lift that silence a little [29, 30]. References 1. Milgrom LR. Journeys in the country of the blind: entanglement theory and the effects of blinding on trials of homeopathy and homeopathic provings. eCAM 2007;4(1):7-16. 2. Haidvogl M, Riley DS, Heger M et al. Homeopathic and conventional treatment for acute respiratory and ear complaints; a comparative study on outcome in the primary care setting. BMC Comp Alt med. 2007;7:7. 3. Leigh E. A safer place for patients: learning to improve patient safety: 51st report of session 2005-06 report, together with formal minutes, oral, and written evidence. House of Commons papers 831 2005-06, TSO (The Stationery Office). 6th July 2006. 4. Holmes D, Murray SJ, Perron A, Rail G. Deconstructing the evidence-based discourse in health sciences: truth, power, and fascism Int J Evid Based Healthc 2006;4:180-186. 5. Dubos R. Mirage of Health: Utopian Progress and Biological Change. Anchor Books, New York, 1959. 6. Illich I. Medical Nemesis. Bantam, New York, 1976. 7. See Peters D (ed). Understanding the Placebo Effect in Complementary Medicine: Theory, Practice, and Research. Churchill- Livingstone, London, 2001. 8. Moynihan R and Henry D (eds). A Collection of Articles on Disease Mongering. Public Library of Science: Medicine. http://collections.plos.org/plosmedicine/diseasemongering-2006.php. Accessed 7th November 2007. 9. S. Gröblacher, T. Paterek, R. Kaltenbaek, C. Brukner, M. Zukowski, M. Aspelmeyer, et al. Nature 2007;446, 871. 10. Zeilinger A. Quantum teleportation and the nature of reality, 2004: http://www.btgjapan.org/catalysts/anton.html. Accessed 6th November 2007. 11. Kant I (translated by Smith NK, Caygill H.) Critique of Pure Reason. Basingstoke UK: Palgrave-Macmillan; 2003. 12. Atmanspacher H, Römer H, and Walach H. Entanglement in physics and beyond. Found Phys 2002;32:379. 13. http://forums.randi.org/showthread.php?t=24036 (2004). 14. Gernert D. Towards a closed description of observation processes. Biosystems 2000;54:165-180. 15. Gernert D. Conditions for entanglement. Frontier Perspectives 2005;14(2):8-13. 16. Conrad M, Home D, and Josephson BD. Beyond quantum theory: a realist psycho-biological interpretation of quantum theory. In: Microphysical Reality and Quantum Formalism, 1. van der Merwe A, Selleri F,, and Tarozzi G (eds), Kluwer Publishers, Dordrecht 1988, pp285-293. 17. Josephson BD and Pallikari-Viras F. Biological utilisation of quantum non-locality. Found Phys 1991;21:197-207. 18. Grinberg-Zylberbaum J, Delaflor M, Attle L, and Goswami A. The Einstein-Podolsky-Rosen paradox in the brain: the transferred potential. Physics Essays 1994;7:422-428. 19. Wackermann J. Dyadic correlations between brain functional states: present facts and future perspectives. Mind and Matter 2004;2:105-122. 20. Schmid GB. Much ado about entanglement: a novel approach to test non-local communication via violation of'local realism' Forsch Komplementarmed Klass Naturheilkd 2005;12:214-222. 21. Walach H. Generalised entanglement: a new theoretical model for understanding the effects of complementary an alternative medicine. J Altern Complement Med 2005;11:549-559. 22. Hankey A. Are we close to a theory of energy medicine? J Altern Complement Med 2004;10:83-87. 23. Hankey A. A 'Maddox' effect? A reason to adopt time series protocols in tests of homeopathic remedies. J Altern Complement Med 2005;11:759-761. 24. Water in biology. http://waterinbiology.blogspot.com/2007_08_01.archive.html accessed on November 2nd 2007. 25. Milgrom LR. Patient-practitioner-remedy entanglement: part 7. A gyroscopic metaphor for the vital force and its use to illustrate some of the empirical laws of homeopathy. Forsch Komplementarmed Klass Naturheilkd 2004;11:212-223. 26. LR Milgrom. Patient-practitioner-remedy (PPR) entanglement, Part 9: 'Torque' like action of the homeopathic remedy. J Altern Complement Med 2006;12:915-929. 27. LR Milgrom. Patient-practitioner-remedy (PPR) entanglement, Part 10: toward a unified theory of homeopathy and conventional medicine J Altern Complement Med 2007;13:759- 770. 28. Schrödinger E in Quantum Questions, Wilbur K (ed), New Science Library, Boulder, Colorado, 1984, p81. 29. Nadeau R and Kafatos M. The Non-Local Universe: The New Physics and Matters of the Mind. Oxford University Press, Oxford UK, 1999. 30. Goswami A, Reed RE, and Goswami M. The Self-Aware Universe: How Consciousness Creates the Material World. Penguin-Putnam, New York 1995. Conflict of Interest:None declared |
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Lionel R Milgrom, scientist, writer, homeopath Ainsworths Pharmacy & The Homeopathic Research Institute
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Simon Bates says my comments are "Snide ad hominem" and accuses me of "playing the man and not the ball". This rather quaint sporting analogy reveals just how seriously he and other sceptics take their so-called 'debate' with homeopathy. But if it is a sport, a) it is not conducted on anything like a level playing field, and b) the anti-homeopathy 'bench' play full-contact grid-iron American football, not the far gentler English pursuit of spherical objects. And rather like those diving practitioners of 'the beautiful game' methinks Simon Bates protesteth too much. Perhaps a visit to one of the many sceptical web-sites might demonstrate for him the real meaning of 'snide.' After all, homeopathy/CAM practitioners are considered fair game, to be shown 'quack'or 'charlatan' red cards and sent off for playing 'unscientifically': the many millions around the world who have and still do benefit from these therapies, are given yellow cards for feeble-mindedness and/or self-delusion, and warned not to invade the pitch with their silly beliefs in 'phoney' remedies [1]. Some sport where the opposing team supplies the balls, referees, linesmen, and goal-posts: but not content with blatantly rigging the game, a concerted campaign is then launched to rid the NHS of its homeopathy/CAM services, including the withdrawal of state funding from its five homeopathic hospitals [2]. Would that my 'snide ad hominem' comments were that potent! From outside the box, they could score hospital closures and deny those who use them their freedom of therapeutic choice, to which the current UK government is committed. So, let's consider the rules. The branding of homeopathy/CAMs as unscientific rests on the assumption that the double-blind randomised controlled trial (DBRCT) is the best research tool with which to investigate any therapy. Either a therapy works (i.e., is better than placebo), or it doesn't: arguments or appeals to linesmen, referees, or third umpires are useless. But the DBRCT provides at best, only equivocal evidence of homeopathy's efficacy; some trials proving positive, while others return negative results. At which point, the anti-homeopaths are off the bench and screaming at the ref who immediately blows his whistle. It's a goal! Regardless of their source [3], only the negative trial data are taken as 'goals.' Positive trials data are either hand-ball, off-side, over the line, after the whistle, any excuse for them to be disallowed so that homeopathy can be broadcast to the world as having lost yet another the match, i.e., it doesn't work. But around the world, millions of people have been watching a different game: somehow, regardless of inconclusive DBRCTs, and the supporters of the anti-homeopathy team telling them they are deluded, they continue to benefit from homeopathy. For them, homeopathy has won the game. The opposing team brush this aside, convinced those millions watching a different game were also watching a different channel. So what's going on? The assumption here is that the DBRCT is the best research tool with which to investigate any therapy, because it is supposed to provide incontrovertible scientific evidence of efficacy. It is the cornerstone of Evidence-based Medicine (EBM) [4]. But let us for a moment examine this assumed supremacy [5]. In so doing, I shall be drawing on the work of Holmes et al on the deconstruction of evidence-based discourse in the health sciences [6]. When the Cochrane database was set up, it redefined acceptable healthcare research as that based on the DBRCT. All other research (i.e., approximately 98% of the healthcare literature) was deemed scientifically imperfect [7], regardless of the fact that across the board, healthcare professionals possess 'discreet bodies of knowledge' some of which are virtually impossible to test via the DBRCT. The authority of institutional medicine is rarely challenged, and once it adopted the DBRCT as what Foucault would call the 'regime of truth'[8], or paradigm, it became the 'gold standard' for all evidence-based knowledge healthcare. Anything that cannot be reduced to some form of DBRCT testing is deemed of lesser or no value. This essentially is what Simon Baker is doing with the Haidvogl paper he mentions. Thus, EBM suppresses pluralism in the health sciences and marginalises or attempts to destroy other forms of knowledge or knowing. This is what Holmes et al refer to as 'fascism' in the health sciences [6] and it is the 'game plan' which defines the level of the playing field on which homeopathy/CAMs are expected to 'perform'. In my previous posting [9], I described how the DBRCT has built-in, an implicit assumption which imposes on any therapeutic procedure a linearly deterministic separation of therapy from context. It has been demonstrated [10] and explained [11] how this essentially arithmetic convenience seriously interferes with homeopathy/CAMs therapeutic effects. Naturally, this will be rejected out of hand. What is conveniently forgotten is that no therapeutic modality, conventional medicine included, is ever practiced blind in real life. They all begin with an interaction between two beings, each with their own hopes, fears, expectations, understandings, and idiosyncrasies. This cannot be factored out simply by adopting an arithmetic convenience which conveniently separates therapy from context (though the reduction in contact time between patient and practitioner within the NHS might go some way to achieving this). So, there is no such thing as a truly random population sample for an DBRCT. The real problem here, of course, isn't so much homeopathy's equivocal performance in DBRCTs, but convincing a highly sceptical scientific community that a substance diluted out of existence can still exert an effect, viz the memory of water. Recent research data from materials science and elsewhere does indeed suggest water might be able to retain a memory of things once in solution but diluted and succussed out of existence [12-14]. The challenge to the EBM movement is to realise that its almost fanatical parochialism and exclusion of other knowledge discourses are ultimately damaging not only to the healthcare sciences but also to the patients they are meant to serve. This is highly unlikely to happen in the case of homeopathy until it can be demonstrated that I shall address other points concerning my 'scheme'and Weak Quantum Theory in a later posting. References 1. See Nick Cohen. The cranks who swear by citronella. The Observer, Sunday, October 28th 2007. http://www.guardian.co.uk/commentisfree/story/0,,2200815,00.html. Accessed on 30th October 2007. 2. Baum M, Ashcroft F, Berry C, Born G, Black J, Colquhoun D, Dawson P, Ernst E, Garrow J, Peters K, Rose L, Tallis R. Use of 'Alternative Medicine' in the NHS. The Times, 19th May 2006. 3. Ernst E. The truth about homeopathy. Br J Clin Pharmacol, doi:10,1111/j.1365- 2125.2007.03007x. 4. Sackett D. Evidence-Based Medicine: How to Practice and Teach EBM. Churchill- Livingstone, New York, 2000. 5. Derrida J. Speech and Phenomena and Other Essays on Husserl's Theory of Signs. Northwestern University Press, Evanston IL, USA, 1973. 6. Holmes D, Murray SJ, Perron A, Rail G. Deconstructing the evidence-based discourse in health sciences: truth, power, and fascism Int J Evid Based Healthc 2006;4:180-186. 7. Traynor M. The oil crisis, risk, and evidence-based practice. Nurs Inq 2002;9:162-9. 8. Foucault M. The Birth of the Clinic: An Archaeology of Medical Perception. Random House, New York, 1973. 9. Milgrom LR. Homeopathy, hubris, and the Third Reich, published as an e-letter in Evidence- Based Complementary and Alternative Medicine, 6th November 2007. http://ecam.oxfordjournals.org:80/cgi/eletters/4/1/7#91 10. Weatherley-Jones E, Thompson EA, Thomas KJ. The placebo-controlled trial as a test of complementrary and alternative medicine: observations from research experience and individualised homeopathic treatment. Homeopathy 2004;93:186-9. 11. Milgrom LR. Are randomised controlled trials (RCTs) redundant for testing the efficacy of homeopathy? A critique of RCT methodology based on entanglement theory. J Altern Complement Med 2005; 11: 831・38, and references therein. 12. a; Samal S, Geckler RE Unexpected solute aggregation in water on dilution. Chem Commun 2001;21:2224-5: b; Rey L. Thermoluminescence of ultra-high dilutions of lithium chloride and sodium chloride. Physica A 2003;323:67-74: c; Elia V, Niccoli M. New physico-chemical properties of extremely diluted aqueous solutions. J. Thermal Anal Calorimetry 2004; 75: 815 and references therein. 13. See Chaplin M. Water structure and behaviour. Regularly updated online document www.lsbu.ac.uk/water/. Accessed October 30th 2007. 14. Roy R, Tiller WA, Bell I, Hoover MR. The structure of liquid water; novel insights from materials research; potential relevance for homeopathy. Mat Res Innovat 2005;9:559-576. Conflict of Interest:None declared |
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Lionel R Milgrom, scientist, writer, homeopath Ainsworths Pharmacy, 36 New Cavendish Street, London W1G 8UF, & The Homeopathy Research Institute.
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In his critique of my original posting [1], Daniel Chrastina says, "....in the author's formalism there appears to be the misconception that when a wavefunction collapses, it becomes zero. This is not generally the case: it becomes the eigenstate which corresponds to the eigenvalue of the operator which has been measured and leads to the collapse." Chrastina is right: there only appears to be a misconception. I refer him to the concept of illustrating quantum entangled states topologically in terms of knots [2]. Thus, the Greenberger-Horne-Zeilinger (GHZ) quantum state [3], which I use as a metaphor for PPR entanglement, is an entanglement of three particles. If an act of measurement on one particle of the system is performed (collapsing its wave function), it is removed from the three-way link. Depending upon which axis of the system this act of measurement is performed, then one of two things can happen:- a) measurement along the z axis allows the system to be illustrated as a Borromean (knot) quantum state, which means when any one wave function is collapsed the remaining system can be factorised, so that the whole entangled state disappears - "United we stand; divided we fall" [4]. b) measurement along the x axis however, means that the system is illustrated by the (3,3) torus link or Hopf knot: whichever wave function is collapsed the system remains entangled. In describing the effect of trials on homeopathic remedies in terms of the breaking of three-way PPR entanglement by 'removing' the practitioner from the PPR entangled state, I am employing the Borromean knot analogy. Therefore there is no misconception as Chrastina suggests. References [1] Milgrom LR. Journeys in the country of the blind: entanglement and the effects of blinding on trials of homeopathy and homeopathic provings. eCAM 2007;4:7-16. [2] Aravind PK. `Borromean entanglement of the GHZ state', in Quantum Potentiality, Entanglement and Passion-at-a-Distance: Essays for Abner Shimony, eds. R. S. Cohen, M. Horne and J. Stachel, Kluwer, Dordrecht, 1997, pp53-59. [3] Greenberger DM, Horne MA, Shimony A, and Zeilinger A. Bell's theorem without inequalities. Am J Phys 1990;58:1131-1143. [4] Aczel AD. Entanglement: the greatest mystery in physics. John Wiley and Sons, Chichester, United Kingdom, 2003, pp 232-233. Conflict of Interest:None declared |
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Peter J Flegg, Consultant Physician Blackpool, UK
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It would be gratifying if Lionel Milgrom would see fit to respond to the very pertinent point raised by both Simon Baker and Austin Elliot; namely that a demonstration that homeopathy is "not inferior" to what comprises totally useless conventional therapy for minor, self-limiting ailments is hardly a resounding endorsement of homeopathy's effectiveness. Many CAM trials are bedevilled by the problem of what I term the "ineffective comparator". This leads to inappropriate conclusions about efficacy and claims of successful outcomes for remedies that are no better than placebo. Milgrom clearly puts great weight on the study by Haidvogel et al, claiming it is a "positive trial for homeopathy". As a clinician, I am used to seeing published trials in the biomedical journals that have clearly defined endpoints displaying clinically significant outcomes for serious medical conditions. I doubt a trial of a new therapy that showed non-inferiority to conventional therapy for sore throats would even see the light of day, and even if it did no doctor in his right mind would dare tout it as a positive demonstration of the therapy's effectiveness. If only those conducting homeopathy trials could come up with results showing superiority (or even equivalence) to conventional therapies for conditions like leukaemia, thyrotoxicosis or AIDS, then I might sit up and take notice. Conflict of Interest:None declared |
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Simon J Baker, Veterinary Surgeon House and Jackson Veterinary Surgeons, Blackmore, Essex. CM4 0LE
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I'm afraid in Dr Milgrom once again attempts to muddy the waters on the subject of testing homeopathic remedies. He says, " the DBRCT isn't always appropriate for investigating conventional medicine either". That is true. But homeopathy is not one of those exceptions no matter how much its advocates try to hide behind his specious reasoning. I think we can all concede that the homeopathic consultation is a complex human interaction. However, if that interaction is unaffected by the substitution of sugar-blanks for their alleged remedies then the name of that interaction is "counselling" not "homeopathy". The DBRCT is only asked to tell us whether the little pills have any inherent efficacy. That is all we want it to do. That it is all we need it to do. And that it has done. Homeopathy's little pills have precisely the same inherent effect as any other sugar pill to which therapeutic or magical powers have never been ascribed. I think the time has come for homeopaths to start dealing in a more professional manner with the finding that their pills have zero worth. The rest of medicine can cope when one of its traditional modes of treatment is shown to lack utility. Why can they not do the same? Medicine changes. We search for the wheat amongst the chaff and move on. Homeopathy is frozen in its time-warp, kept there by practitioners who have become emotionally wedded to its pleasing fictions. Conflict of Interest:I remain merely a veterinary surgeon |
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Simon Gates, Principal Research Fellow Warwick Clinical Trials Unit, University of Warwick, CV4 7AL
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Lionel Milgrom's detailed response to my earlier comments contains a number of errors and misconceptions. My main criticism of Milgrom's hypothesis is that it is superfluous. There is absolutely no scientific reason for disbelieving the results of randomised controlled trials (RCTs) of homeopathy; nothing in the way the treatment is delivered or its proposed mode of action would invalidate the RCT methodology. The only reason for constructing the whole "entanglement" hypothesis is a refusal to accept the failure of existing RCTs to support homeopathy. It amounts to no more than special pleading for exempting the results of homeopathy trials from our usual standards of scientific evidence. RCTs are the most reliable way of evaluating healthcare interventions. That is not a matter of my own faith or opinion, but a matter of scientific fact. Random allocation of patients' to treatments and blinding of all parties to the treatment received are the best ways we know of eliminating the biases that otherwise make the results unreliable. RCTs may not be perfect, but they are pretty good, and the best tool we have. Milgrom's assertion that "the reputation of the DBRCT has become somewhat tarnished of late" is simply wrong, certainly among mainstream statisticians, clinicians and epidemiologists. Moreover, seeking to discredit RCTs as a means of evaluating homeopathy is futile unless a better method can be suggested; and by "better"in this context I mean less open to bias than an RCT. No such method has been suggested. And of course even if it were true that RCTs cannot evaluate homeopathy, that would not make homeopathy effective, merely untestable. The paper by Haidvogel et al [1] that Milgrom quotes as "One of the latest positive trials of homeopathy"is no such thing. It is not even a randomised trial, but a non-randomised cohort study. It found no difference at all between the homeopathically and conventionally treated groups; hardly a ringing endorsement of homeopathy, especially when you consider that without any randomisation, there was almost certainly a large difference between the groups in their attitude to homeopathic treatment. Indeed, the authors say as much: "the majority of patients in the homeopathic group had a strong treatment preference" In a non- randomised study, to reduce bias it is necessary to control statistically for differences in the composition of the homeopathically and conventionally treated groups, because any differences in outcome may be caused by differences between the groups being compared. This is straightforward for differences in factors like age or sex but virtually impossible for factors like treatment preferences. This underlines the importance of randomisation for evaluating treatments; in a randomised study, patients・treatment preferences would be balanced between the groups, and any differences in outcomes could be confidently ascribed to their different treatments. Milgrom complains of an "Essentially biased conventional scientific community." I believe (and this is a personal opinion) that this is not correct. The majority of clinicians and scientists have no particular antipathy to homeopathy, and have no personal stake in discrediting it. Their conclusions about its effects are based on looking at the evidence, using the same standards of proof that we demand from other forms of treatment. [1] Haidvogl M, Riley DS, Heger M, Brie S, Jong M, Fischer M, Lewith GT, Jansen G, Thurneysen AE. Homeopathic and conventional treatment for acute respiratory and ear complaints: A comparative study on outcome in the primary care setting. BMC Complementary and Alternative Medicine 2007, 7:7 Conflict of Interest:None declared |
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Lionel R Milgrom, BSc, MSc, PhD, CChem, FRSC, LCH, MARH Imperial College London
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Homeopaths might be forgiven for thinking Christmas has come early. Edzard Ernst (the UK's first and only professor of complementary and alternative medicine and sceptic of homeopathy) has recently published a brace of papers, the first suggesting, "... low potency homeopathic remedies (preparations that contain pharmacologically active molecules) may generate clinical effects." Before homeopaths take to the streets in celebration however, Ernst's second paper (2) delivers a decidedly Scroogian "Bah! Humbug!"suggesting further research on high-potency homeopathic remedies is no longer necessary: apparently, more than enough evidence suggests their effects are no better than placebo. No doubt wishing to strengthen his case, Ernst concludes his paper "The truth about homeopathy" by referring to 'lost'research trials undertaken by the pro-homeopathy Nazi leadership that were so "Wholly and disastrously negative" they have been deliberately covered up by German homeopaths ever since. One might expect Ernst's scholarship to be thorough (though the thought of a consciously perpetrated 62-year-old cover up seems to come straight out of a Dan Brown novel, and is a little difficult to swallow). One should however, question its motivation. Why bring up the Third Reich's involvement with homeopathy now? After all, it isn't as if conventional medicine's hands are squeaky clean: it has benefited from the results of Nazi human experimentation in the concentration camps (e.g., the Luftwaffe's experiments on the treatment of ypothermia).(3,4) Nazi skeletons continue to skulk inconveniently in many cupboards. But in order to support his claim that, "The vast majority of those (trials) that are rigorous conclude that homeopathic medicines fail to generate clinical effects that are different from those of placebo", Ernst appears to call upon and condone methodological acceptability for 'lost' Nazi homeopathic research. And this when many in conventional medical circles, still struggle with the ethics of uncritically utilising data obtained via the Third Reich's unspeakable cruelty.(5) Admittedly, it may be hard to imagine how homeopathic research could approach Nazi levels of bestiality: the image of quaking human victims being forced to swallow sugar pills would be Pythonesque were it not so grotesque. Still, invoking the Third Reich in support of an anti-evidential context for homeopathy, leaves Ernst open to the charge of crass disingenuity, and that is putting it mildly: but he continues. "The vast majority of those (reviews) that are rigorous conclude that homeopathic medicines fail to generate clinical effects that are different from those of placebo."(2) Of the three meagre citations listed to support this assertion, two refer to his own papers, while the third cites the by-now (in)famous and methodologically deeply flawed Lancet paper of 2005 by Shang et al.(6) Apart from appearing to ignore somewhat hubristically the work of others in the field, Ernst remains strangely deaf to the damning criticisms of the Lancet review made by many scientists of at least equal calibre and competence.(7) Could any of this be connected with Ernst's unshakeable belief in the primacy of evidence gained solely from the results of double-blind randomised-controlled trials (DBRCTs)? And if so, is that belief always justified? Not necessarily. For the DBRCT makes the implicit assumption that a therapeutic intervention and the context in which it is given (in homeopathy, the remedy and the consultation respectively) can be considered in complete isolation from one another. Of course, this fits neatly into the biomedical paradigm and its assertion of a purely molecular basis to disease. Problems arise however, immediately it is realised the DBRCT's separation of therapy and context is at best, an arithmetic convenience allowing measurements to be made, statistics to be gathered, and inferences to be drawn.(8) Patient individuality (long accepted in homeopathy/CAMs, but largely ignored by conventional bio-medicine) subtly correlates therapy with context; a correlation that can be so disturbed by the DBRCT's blinding methodology, the therapeutic effect could be destroyed.(9) Over time, this means DBRCTs of homeopathy/CAMs can at best deliver only equivocal results and reductions in effect sizes. The DBRCT is not so much a 'gold-standard' of research quality; more a clunking iron fist. It can be similarly argued the DBRCT isn't always appropriate for investigating conventional medicine either:(10) for in real-life circumstances, no therapeutic intervention is ever practiced according to the strictures of the DBRCT. Its blindness (methodological and sometimes deliberate) to certain drugs' toxic side-effects might help explain the dangers posed by some recent high-profile pharmaceuticals, e.g., seroxat, vioxx, statins etc. As if to underline the depths of this crisis, the UK's House of Commons Public Accounts Committee concluded recently that at least 2.68 million people were harmed during 2006 by conventional medical intervention, representing a staggering 4.5% of the UK population.(11) Yet, Professor Ernst and others continue to warn of the 'dangers'posed by homeopathy and CAMs, regardless of the millions around the world who benefit from them. "First: do no harm!"Perhaps the by-now audible sound of Hippocrates turning in his grave has led to the growing challenge to evidence-based medicine (EBM; the edifice being constructed on DBRCTs) coming even from within conventional medicine itself.(12) Given the comments made earlier concerning Nazi medical research, it is indeed ironic that the ideological zeal with which the tenets of EBM are being applied has been likened by some to a form of fascism.(13) A more humane and cost-effective approach might be to concentrate less on the EBM 'party'line and increase patient choice and safety by ensuring CAM therapies like homeopathy are, as on the Indian sub-continent, properly integrated into primary healthcare, and fully available to those who want it. Patients are not stupid and are quite capable of making informed decisions concerning their choice of therapy. Perhaps Professor Ernst should remember this, and that unlike the Third Reich, no-one has a monopoly on truth. For all healing of whatever persuasion begins with two consenting beings, which means that every health practitioner works hard and sincerely towards the same goal: the best that can be done for and with our patients. Lionel R Milgrom, BSc, MSc, PhD, CChem, FRSC, LCH, MARH. Imperial College London References 1. Ernst E. Homeopathy for cancer? Current Oncology 2007;14:128-130. 2. Ernst E. The truth about homeopathy. Br J Clin Pharmacol, doi:10,1111/j.1365-2125.2007.03007x. 3. Bogod D. The Nazi hypothermia experiments: forbidden data? Anasthesia 2004;59:1155. 4. Fernandez JP. Rapid active external warming in accidental hypothermia. J Amer Med Assoc 1970;212:153-6. 5. Garfield E. Remembering the Holocaust, parts 1 & 2. Essays of an information scientist. 1986;8:254- 75 6. Shang A, Huwiler-M・tener K, Nartey L, Juni P, Dorig S, Sterne LA, et al. Are the clinical effects of homeopathy placebo effects? Comparative study of placebo-controlled trials of homeopathy and allopathy. Lancet 2005;366:726-732. 7. See papers by various authors in The Homeopathy Debate. J Altern Comp Med 2005:11:779-785. 8. Weatherley-Jones E, Thompson EA, Thomas KJ. The placebo- controlled trial as a test of complementrary and alternative medicine: observations from research experience and individualised homeopathic treatment. Homeopathy 2004;93:186-9. 9. Milgrom LR. Are randomised controlled trials (RCTs) redundant for testing the efficacy of homeopathy? A critique of RCT methodology based on entanglement theory. J Altern Complement Med 2005; 11: 831・38, and references therein. 10. MHRA Final Report. Investigation into adverse incidents during clinical trials of TGN 1412. 25th May 2006. 11. Leigh E. A safer place for patients: learning to improve patient safety: 51st report of session 2005-06 report, together with formal minutes, oral, and written evidence. House of Commons papers 831 2005-06, TSO (The Stationery Office). 6th July 2006. 12. Goodman NW. Who will challenge evidence-based medicine? J R Physicians 1999;33:249-251. 13. Holmes D, Murray SJ, Perron A, Rail G. Deconstructing the evidence-based discourse in health sciences: truth, power, and fascism Int J Evid Based Healthc 2006;4:180-186. Conflict of Interest:None declared |
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Daniel Chrastina, Postdoctoral researcher L-NESS, Politecnico di Milano, 22100 Como, Italy
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Lionel R. Milgrom is correct that his recent article [1] contains the word “metaphor” many times. However, it also contains the terms “model” and “analogy” and these words have much stronger meanings. In the abstract he writes of “a kind of quantum superposition between the remedy and placebo“ - are we to take this as a metaphor, or to assume that the author means that there really is a quantum superposition? Assuming an interpretation where this is meant metaphorically, the explanation is confusing, unhelpful and misleading to those readers who are not specialists in physics. Also, without specifying exactly what is intended literally and what is intended as metaphor it is not possible to evaluate the information content of the hypothesis. How much of a physicist's understanding of quantum mechanical phenomena could be transferred to homeopathic phenomena? However, assuming a stronger interpretation, the author is quite definitely wrong. Coherence over such large macroscopic states containing so many interacting particles persists only for tiny fractions of a second [2,3]. The author mentions superfluid and superconducting states but these exist at very low temperatures, below about -271°C for superfluid helium [4] and -233°C for superconducting magnesium diboride. These states are characterized by an “energy gap,” meaning that the system is unable to dissipate any energy smaller than a certain critical amount, so at low temperatures interactions are actually suppressed. In a conventional superconductor the coherence length (over which two electrons form a so-called “Cooper pair”) is only about 1 micrometre [5]. The paper [6] which the author cites in his eLetter in response to Gates seems to mainly discuss the role of Einstein-Podolsky-Rosen-type thought experiments in interpretations of quantum mechanics [7,8,9]. This does not seem to be relevant to his statement that “the phenomenon of quantum entanglement is actually not limited by the size of the system being considered.” Entanglement is currently demonstrated in systems of just a few particles - for example, Vandersypen et. al. [10] managed to demonstrate a decoherence-limited quantum computation using seven nuclear spins, which are relatively robust. So the time and length scales over which quantum mechanical states exist at room temperature are much shorter than those which relate to human experience, especially considering the huge numbers of interacting particles in a human being (or a homeopathic preparation, for that matter). There is a third possibility: that “a kind of quantum superposition” refers not to a kind of superposition as understood within quantum theory, but to a superposition within “a kind of” quantum theory, namely the “Weak Quantum Theory” [11] which the author cites. This paper, which contains at least one fundamental error by referring to photons as spin-1/2 particles (they are spin-1), seems to be motivated by a desire to generalize complementarity and/or entanglement to such concepts as the “relationship between conscious and unconcious processes” or “between mind and matter” (this latter obviously being predicated on Cartesian dualism [12]). There is absolutely no justification given for the applicability of Weak Quantum Theory to such things [13]. The author's main point is that a blinded randomized trial is “analogous” to the double-slit experiment, in which knowledge of which slit a particle went through destroys the interference pattern [14,15]. While this analogy should probably not be taken very seriously for the reasons give above, in the author's formalism there appears to be the misconception that when a wavefunction collapses, it becomes zero. This is not generally the case: it becomes the eigenstate which corresponds to the eigenvalue of the operator which has been measured and lead to the collapse. In fact the “collapse of the wavefunction” is a simplification of how classical reality emerges via interactions between simple quantum mechanical systems and (quantum mechanical) measurement apparatus [16,17]. As for the author's statement that, “all truth, even scientific truth, is relative not absolute,” he is confusing the truth with our knowledge of it, and in doing so he is asserting an absolute truth [18]. Recent results which go against hidden variable theory [8] may demonstrate that the underlying reality is quantum mechanical and counterintuitive, but there is still an underlying reality. Finally, the author writes energy / time for the dimensions of Planck's constant, which are energy × time [19].
Conflict of Interest:None declared |
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Austin C Elliott, University Science Lecturer University of Manchester
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Lionel Milgrom concludes his rather rambling defence of his quantum entanglement theory against Simon Gates・criticisms by repeating two of the standard sleights-of-hand of those defending complementary therapies that trials show to be simple placebos. One is to say that the treatment (for instance homeopathy) was "not inferior to conventional treatment" when all this actually shows is that both treatments were equally ineffective as for instance using either homeopathy or antibiotics to "treat" self-limiting upper respiratory tract viral infections. His second point is "Adverse drug reactions occurred more frequently in... the conventional medical group." This is entirely expected for the use of agents which have actual biological effects, as opposed to no effects. The study he quotes thus supports the idea that doctors should not use drugs to treat illnesses where there is clear evidence that the drugs offer no benefit ・a central tenet of evidence-based medicine. The study does not offer any evidence that giving the patients a homeopathic remedy is effective ・it merely shows, once again, that it is an efficient placebo. Medicines, whether mainstream, herbal or homeopathic, should have a place in therapeutic practice if they can demonstrate clear efficacy beyond placebo in properly-constructed RCTs - as Edzard Ernst, among others, has repeatedly argued. If remedies cannot do this, they have no place. All the quantum entanglement in the world cannot tiptoe around this basic point. Conflict of Interest:Biomedical scientist |
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Simon J Baker, veterinary surgeon House and Jackson Veterinary Surgeons, Blackmore, Essex. CM4 0LE
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I am pleased that Dr. Milgrom has reasserted the fact that his sequence of papers describing a quantum theory of homeopathy is to be taken only as metaphor. The story of Little Red Riding Hood is similarly a metaphor of childhood development, but I would not refer to it as a guide to managing neuroendocrine problems in adolescents. Perhaps Dr Milgrom could make it clearer to those who believe in homeopathy that his ideas of quantum theory have neither explanatory nor predictive powers and should not be taken at face value. On the subject of the mathematics involved, I make it a rule not to respond to snide ad hominem. Playing the man not the ball is only an occasionally effective tactic and never if it is too blatant. Suffice to say that perhaps Dr Milgrom should consider that the flaws in his theory are not so profound as to require especially advanced mathematical training to identify and also to remember that, in building an argument derived from mathematics, it requires only a few, or even one, serious flaw to utterly undermine the entire edifice. I would repeat my suggestion that he find an opportunity to respond to the substantive and substantial criticisms that have been levelled at his scheme before adding yet more courses of brickwork to its fantastical upper storeys. As an aside, for those unfamiliar with this material, some more criticism of "Weak Quantum Theory" is covered at this discussion page, http:// forums.randi.org/showthread.php?t=24036. To actually review some clinical evidence rather than wild theoretical speculation, since this is the stated intent of this forum of exchange, it is perhaps germane to note that while trying to absolve homeopathy from the robust scrutiny of controlled trials Dr Milgrom was nonetheless happy to report a poorly designed study where the results suit his agenda. However, in the paper of Haidvogl M [sic] et al, http://www.biomedcentral.com/ 1472-6882/7/7, even the authors acknowledge that "The major limitation of the present study is that patients were not assigned randomly to their treatment group. The majority of patients in the homeopathic group had a strong treatment preference and consequently, they were not willing to be randomized." As Dr Milgrom avowed, it is a mistake not "to tackle the primary source literature in any meaningful fashion". Thus we see that, far from being a fair comparator group, the homeopathic cohort contained exactly those patients temperamentally most inclined to believe in the efficacy of homeopathy. Under those circumstances, for homeopathy to be no worse than conventional treatment for a range of trivial, self-limiting conditions, where the conventional therapy is often of questionable curative benefit, is in itself remarkable. We cannot tell by how much the reported improvements in that group should be discounted, but perhaps, "homeopathy, no worse than useless" turns out to be an over-generous summary. On the other hand, the fact that giving sugar pills or shaken water did not impede recovery from self-limiting conditions is not perhaps a surprising finding. Conflict of Interest:still a veterinary surgeon |
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Lionel R Milgrom, Visiting scientist Imperial College London SW7 2AZ
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As with Simon Gates, so with Simon Baker. If his reading of my papers had been in anyway more detailed, perhaps he might have have noticed that the word 'metaphor' repeatedly appears in them. Cheap jibes about a more generalised version of quantum theory called Weak Quantum Theory being therefore intellectually 'weak' simply demonstrate that Baker hasn't really bothered to tackle the primary source literature in any meaningful fashion, unless of course he combines mathematical erudition with his veternary skills. Somehow, I doubt it. Baker's is now the second letter to eCAM that attempts to dismiss mine and others' ideas, using shallow rhetoric based on a palpable lack of understanding of and any real engagement with the material. If this is going to be representative of the standard of argument that is to appear in eCAM concerning this topic, then I fear it is in danger of descending to the level of abuse commonly found on the Internet on so-called 'quackbusting' web-sites. I shall therefore not bother to reprise arguments I have already used in my response to Gates. Conflict of Interest:I wish to change my declaration of competing interests. I am interested in both science and homeopathy: therefore, there is a conflict! |
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Simon J Baker, veterinary surgeon House and Jackson Veterinary Surgeons, Blackmore, Essex. CM4 0LE
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It is a truly curious migration that, having initially published his ideas of quantum theory as applied to homeopathy as mere metaphor ("Patient- practitioner-remedy (PPR) entanglement. Part 1: a qualitative, non-local metaphor for homeopathy based on quantum theory." Milgrom LR. Homeopathy. 2002 Oct;91(4):239-48), we seem now to have reached a position in which the author requires us to accept these ideas as literal descriptions of the processes involved. It certainly seems to serve the advocates of homeopathy to deploy Milgrom's ideas as established facts rather than as over-extended metaphors (http://www.hpathy.com/research/ hankey-principle.asp). It should not be forgotten that in the third of the sequence of papers on this subject we were told ""there is no constant like Planck's constant (h) in WQT [Weak Quantum Theory]" ("Patient朴ractitioner睦emedy (PPR) entanglement. Part 3. Refining the quantum metaphor for homeopathy" LR Milgrom Homeopathy (2003) 92, 152160). To be frank, if one wishes to bend quantum ideas sufficently out of shape so as to provide a narrative for homeopathy then so be it, but at the same time one has moved resolutely from science into the realm of literature. There has been considerable commentary on this concerted abuse of basic quantum theory, e.g. http://shpalman.livejournal.com/2016.html, motivated by concern at the degree to which the principles of quantum mechanics are distorted and misapplied to achieve the purpose of providing a cover for homeopathy's rational deficiencies. "Weak" quantum theory? Indeed it is. What is more, this is a redundant exercise, there is no mystery to the homeopathic process. Coincidental recoveries, mistaken or misleading representation of outcomes and possibly a little dash of placebo effect are all we need. Sadly this does not suit the believers. Conflict of Interest:veterinary surgeon |
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Lionel R Milgrom, Visiting scientist Imperial College London NW2 3ES
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Simon Gates' blanket rejection of the hypothesis (not theory) I put forward (Milgrom LR. eCAM 2007;4:7-16) regarding entanglement in the homeopathic process is framed in the usual pejorative tones one finds these days among sceptics of homeopathy. However, he is correct on several points. First, I agree completely with his self-assessment concerning his ignorance of quantum physics. Whether a physicist was included among the peer-reviewers of my paper I could not possibly say. However, for his information, I continually run my ideas passed highly competent quantum physicists (including a Nobel Laureate), so he should have no qualms concerning at the very least, their plausibility. I would also remind Gates (as I continually have to remind myself) that neither of us has a monopoly on the understanding or indeed, misunderstanding of quantum theory. For, in the words of the late great Professor Richard Feynman, "Anyone who thinks they have understood quantum theory has probably got it wrong." In this respect, I think I defer to Feynman rather than Gates. Second, I would agree that the theories I have 'borrowed' from physics do indeed describe the behaviour of subatomic particles, as they do atoms and molecules. However, it might interest Gates to learn that the phenomenon of quantum entanglement is actually NOT limited by the size of the system being considered (See Landau LJ. Let Math Phys 1987;14:33-40). For example, under certain circumstances, macroscopic systems may well exhibit similar properties to microscopic quantum systems, e.g., coherence and entanglement, as has repeatedly been observed and recognised with low- temperature superconductors and super-fluids (Kleinert H. Gauge Fields in Condensed Matter; Vol 1. Superflow and Vortex Lines. World Scientific, Singapore 1989). But there is a deeper point to be acknowledged here. Orthodox quantum theory's algebraic language is dominated by an incredibly small number called Planck's constant, and it is this that confines observations and measurements to events occurring at the sub-atomic through to the molecular domains (except as noted above). A much more general theory called Weak Quantum Theory (WQT) has been developed over the last five years which systematically relaxes some of orthodox quantum theory's algebraic axioms. This explicitly allows quantum theory's ideas of entanglement to be applied in such 'macroscopic' areas as philosophy, psychology and information dynamics - and into possible explanations of the dynamics of healing (Atmanspacher et al. Found Phys 2002;32:379-406). It will therefore no doubt perturb Gates to learn that I am not alone in promoting the use of quantum theoretical ideas in describing the dynamics of the therapeutic process (see for example, Walach H. J Altern Complement Med 2005;11:549-59; and, Hyland ME. J Altern Complement Med 2003;9:919- 936). Thus, I would have to agree with Gates again that the entanglement hypothesis should apply to areas other than homeopathy. Indeed, if Gates were to carefully re-read my paper, he will see that I concede this point towards the end, where I suggest that other areas of complementary and alternative medicine, especially those involving complex (not 'secret') interaction between patient and practitioner, might well benefit from this treatment. However, Gates is misguided in his belief that physiotherapy and cognitive behavioural therapy (CBT) are complex procedures as they are currently practiced in an RCT setting. For example, what would be a 'placebo' physiotherapy treatment? Also, CBT as practiced in an RCT setting is so prescriptive as to be devoid of any therapeutic relationship between patient and practitioner. He has also misunderstood the proposed entanglement-breaking effects of the RCT procedure. Thus how could patient and practitioner 'know' to get entangled if they are in a trial, as he puts it? My point is that it is the blinding - the loss of knowledge imposed by the RCT procedure - that breaks the patient-practitioner-remedy entangled state. But on a more general point, trying to understand entanglement at the orthodox quantum theoretical level between sub-atomic particles, using 'common sense' notions of local reality and causality, leads to the bizarre (and erroneous) conclusion that they seem to 'know' in advance if they are going to be observed! (see Gribbon J. Q is for Quantum. London: Weidenfeld and Nicholson, 1998). Thus, even for sub-atomic particles, "knowledge" is a dangerous thing, and I suspect Gates' problem with entanglement in the therapeutic process goes deeper into a general misunderstanding of quantum entanglement per se. It might comfort Gates to know that he is not alone in this misapprehension. Even Richard Feynman referred to quantum entanglement and the double-slit experiment that demonstrated it, as the 'central mystery' of quantum mechanics, and it has puzzled generations of physicists. So what about the RCT? Gates' absolute faith that it is 'the most reliable way of evaluating treatments' is at best naive. The notion of determining absolute drug efficacies that are applicable to everyone (one size fits all), is like aspiring to a Platonic ideal. And the RCT can at best only ever be an approximation to truth. But then perhaps if Gates were to consult Kant, Hume, Kuhn, Popper, Russell, and some of the Post- Modernist philosophers, perhaps he would be a little less certain about the primacy of scientific truth. For these philosophers long ago questioned the deterministic certainties of the logical positivist approach adopted by the biosciences, and the whole edifice of Evidence- Based Medicine (of which the RCT is a part) erected upon it. All truth, even scientific truth, is relative not absolute, which is the reason why science progresses. For there is no such thing as unbiased observation free of any sociological or cultural conditioning, even in science and even under the most stringent experimental circumstances (see, for example, Popper K. The Logic of Scientific Discovery. Basic Books, New York, 1959; and, Latour B. Science in Action: How to Follow Scientists and Engineers through Society. Harvard University Press, Cambridge, Mass.1987). Even if RCTs were just about taking a random sample of people off the streets and then exposing them without preparation double blind to remedy or placebo, this arguably might be fairer and more objective than the way they are actually conducted. As it is, people are not inert, inanimate objects to be picked up, probed and tested in the way we study the physical world. In an RCT, test subjects are necessarily exposed to informed consent, ethics, and legal considerations, all sorts of social pressures (e.g., payment for being in the trial), and their own and others' perceptions of expectation and experimental uncertainty built into the procedure, all of which arguably have the effect of skewing the test results. In other words, there really is no such thing as a truly random population sample in an RCT and this must have the effect of reducing their level of objectivity. Finally, Gates accuses homeopaths of not liking the results of RCTs. Oh really! Nothing could be further from the truth. Yes, some RCTs show homeopathy is no better than placebo. But there are just as many that show a positive effect of homeopathic treatment. Actually, because homeopathy does not fit neatly into the logical positivist paradigm, negative trials are given far greater prominence than positive. What homeopaths do not like is the way influential groups pounce on the negative results while ignoring the positive trials, and are then held up to ridicule by an equally biased media. In ending this reply to Gates, I quote from one of the latest positive trials of homeopathy (Hardvogl M et al. BMC Complementary and Alternative Medicine 2007, 7;7 doi:10.1186/1472-6882-7-7) which concludes, "In primary care, homeopathic treatment for acute respiratory and ear complaints was not inferior to conventional treatment". And, "Adverse drug reactions occurred more frequently in adults of the conventional medical group." Surely this points the way forwards to more rational healthcare systems where CAM therapies like homeopathy are available and integrated into primary healthcare, thus increasing patient choice. For they, ultimately are what is important. In the end, no-one has a monopoly on truth, and perhaps in our saner moments, we could all use a little humility and begin to realise that we are working towards the same goal: the best we can do for our patients. Conflict of Interest:None declared |
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Simon Gates, Principal Research Fellow Warwick Medical School Clinical Trials Unit
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Lionel Milgrom's paper is interesting in many ways. However, his idea that "entanglement" may underlie the failure of randomised controlled trials to support homeopathic treatments is at best far-fetched. The theories from physics that he borrows describe the behaviour of subatomic particles, and cannot apply in any meaningful way to macroscopic entities such as patients and practitioners. I wonder if there was a physicist among the peer-reviewers of this paper? I have little knowledge of quantum physics but the opinions of specialists would be interesting. Even if there were any substance to the "entanglement" theory, it is hard to see why it would apply only to homeopathy. Many other therapies that involve complex interaction between therapist and patient, for example, physiotherapy and psychological treatments such as cognitive behavioural therapy, have been evaluated in RCTs. These trials work perfectly well. Is there some secret mechanism by which the practitioner and patient "know" to get entangled if they are in a trial of homeopathy, but not to bother if it's another sort of treatment? RCTs are the most reliable way of evaluating treatments that we know. There is nothing special about homeopathy that makes it immune to studying in randomised trials; the only reason for elaborate theoretical constructs such as this paper is that homeopaths don't like their results. To reject RCT evidence while accepting the results of "Homeopathic provings" which are so open to bias as to be essentially meaningless, seems an absurd position, and underlines the lack of scientific rigour with which homeopaths view the evidence underlying their practice. Conflict of Interest:None declared |
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M. Sue Benford, PHIS, Inc., President and Founder 2408 Sovron Ct., Dublin, OH USA
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Two recent articles in the March 22, 2007 issue of Nature argue against the inclusion of homeopathy in medical schools. In the commentary entitled, "Science degrees without the science," the author states, "Homeopathy is the most obvious delusion because the 'Medicine' contains no medicine: that was obvious to Oliver Wendell Holmes in 1842." As pointed out in the eCAM 2007;4(1)7・6 article by Lionel Milgrom, ". . . homeopathy's detractors argue, homeopathy cannot possibly work because how can nothing do something, i.e. bring about cure?" This oft-cited belief that homeopathy works, if at all, via "Placebo" effect is a prominent argument against the practice of homeopathy. However, recent preliminary evidence, if confirmed, may dispel this viewpoint. It is generally accepted that a drug can be defined by its ability to produce an action via alteration of human or organism biochemistry. One easily-measured action is the drug's lethal dose (LD). Often used in testing prospective pharmaceutical candidates, LD50, is the Lethal Dose of a chemical that is expected to kill 50% of the population that receives it. Few would dispute that the ability of an agent to kill 50% or more of the organisms exposed to it classifies the agent as having a potent action. In two independent controlled studies, conducted at the Forsyth Institute (Boston) and Indiana University's Center for Regenerative Biology and Medicine, an unexpected result was obtained during the testing of two ultra-dilute homeopathic remedies (no actual molecules present) in Xenopus laevis tadpoles. During experiments that increased the dosage added to the tadpoles standard medium (1:10 ratio), all the animals in the experimental groups died. After thoroughly evaluating materials and protocols, the research teams were not able to offer a competing hypothesis as to why all the animals died except that it was due to the action of the two remedies. Xenopus are known to be highly sensitive to environmental signals including various radiations, which are purported to be at the core of homeopathic actions. Although these results are preliminary, they provide evidence suggesting the need to consider reclassifying homeopathics from a "Placebo" state to an actual drug with potent actions. In any case, further study is recommended. Conflict of Interest:Our company created the remedies being tested at the institutions mentioned. |
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