I acknowledge that professor Iain Graham has a difficult task before him. He has to come up with some way to defend the practice of his university (Southern Cross University, SCU, in Australia) of teaching pseudoscience as if it were real medicine. This is no easy feat (at least not for the intellectually honest and rigorous).
Universities in Australia have been coming under fire recently for teaching so-called alternative medicine. A group called the Friends of Science in Medicine formed to publicly complain about the slipping science standards represented by the infiltration of medical pseudoscience into universities. Of course, proponents are not backing off voluntarily. They are marshaling all the logical fallacies and distorted facts in their arsenal to defend their profitable nonsense.
Iain Graham's name has cropped up in a few articles defending the teaching of alternative science as if it were real science. He is the Head of School, Health & Human Sciences for SCU. The SCU website offers this description of Professor Graham's responsibilities:
"Iain’s role is to lead the evolution of the School at Southern Cross University, and position it so that the School can meet the major changes, and challenges, expected in the 21st Century."
It forgot to add - "by defending abject nonsense."
In a recent news report on the controversy, after some lip-service to science and evidence, Graham defends his school's teaching of alt med:
"Traditional Chinese medicine and acupuncture use is well documented and plays a major role in China," Professor Graham said. "People going through major surgery use it an alternative to orthodox methods of anesthesia and it is commonplace in gall bladder operations. In Western practice, it is used in orthodox practices in childbirth as a pain relief rather than using an epidural."
The first sentence is not an argument, nor a reference to any kind of science or evidence. TCM and acupuncture are used in China. So what? There are cultural and historical reasons for that, and at most that is an argument from popularity - a common logical fallacy among CAM proponents (regardless, by the way, of the actual popularity of whatever they are defending).
Graham then repeats the fallacy that acupuncture is used as effective anesthesia. This is largely a myth and gross distortion of reality. Kimball Atwood give a thorough discussion here, but let's just say that the efficacy of acupuncture as anesthesia has been greatly exaggerated.
What Graham does not refer to is any actual evidence that acupuncture works for pain (or anything else). "It is used" is not evidence, it is an appeal to tradition and anecdote.
Edzard Ernst has reviewed systematic reviews of acupuncture and found that out of 32 systematic reviews, most were negative. Only five were positive or tentatively positive. This is consistent with the fact that acupuncture is a procedure in search of an indication, hoping to get lucky and playing the odds. Those results are entirely consistent with the null hypothesis - that acupuncture does not work for anything. We would expect a bell curve of positive and negative outcomes, biased toward the positive due to researcher and publication bias. I also take issue with the positive reviews (two of acupuncture for nausea, one for headache). They make no account in their conclusions for publication bias or the scatter of results. They also include a mix of modalities, and do not adequately isolate acupuncture as a variable. Here are the results of the review of acupuncture for chemotherapy incuded nausea:
"Eleven studies (N = 1247) were pooled. Overall, acupuncture-point stimulation of all methods combined reduced the incidence of acute vomiting (RR = 0.82; 95% confidence interval (CI) 0.69 to 0.99; P = 0.04), but not acute or delayed nausea severity compared to control. By modality, stimulation with needles reduced proportion of acute vomiting (RR = 0.74; 95% CI 0.58 to 0.94; P = 0.01), but not acute nausea severity. Electroacupuncture reduced the proportion of acute vomiting (RR = 0.76; 95% CI 0.60 to 0.97; P = 0.02), but manual acupuncture did not; delayed symptoms for acupuncture were not reported. Acupressure reduced mean acute nausea severity (SMD = -0.19; 95% CI -0.37 to -0.01; P = 0.04) but not acute vomiting or delayed symptoms. Noninvasive electrostimulation showed no benefit for any outcome. All trials used concomitant pharmacologic antiemetics, and all, except electroacupuncture trials, used state-of-the-art antiemetics."
The inclusion of "electroacupuncture" contaminates the results. Electrical stimulation is a physiological intervention that has nothing inherently to do with acupuncture or any of the underlying principles or theories of acupuncture and simply introduces a new variable, making the results impossible to interpret.
Also - look at the results. They are all over the place in terms of which outcomes benefited or did not benefit. Point stimulation reduced acute vomiting but not acute or delayed nausea. What does that mean about its effect? There is no pattern to the results. This is consistent with noise. The authors do admit in their conclusion that the clinical relevance of some of the results are unclear.
And this is the best acupuncture can do - a weakly positive review if you ignore important details like consistency of results and homogeneity of intervention (and only three "positive" reviews out of 32 total).
There is a good opportunity here to teach students in the health field about how to read and interpret the medical literature with a critical eye. Instead Graham's comment is - well it seems to be popular in China.
As is usually the case, it gets worse. Graham goes from acupuncture (where at least something physical is happening) to homeopathy (which is the medical equivalent of magic fairy dust):
"Homeopathy has been around as long as the ancient Greeks," Professor Graham said. "It involves giving people a small dose of what it is that's ailing you. In Europe and the US, lots of orthodox practitioners are using it in their practice. The problem with alternative therapies is that they don't get access to research funds in the way that cancer treatments do. Studies are often small and don't lend themselves to standard research trials. It's a very political, emotive, cultural and complex issue. The whole system of health care is a constant learning, querying, questioning process. We teach students the latest evidence based on research published in the best journals and constantly redevelop the knowledge."
The ancient Greeks? Really? I must have been duped by some subtle conspiracy that is trying to deny homeopathy's ancient Greek roots by claiming it was invented out of whole cloth 200 years ago by the German physician Samuel Hahnemann. That's strike one for Graham in the fact-checking department.
Strike two comes in the very next sentence. Homeopathic products (at leas the vast majority of them) do not involve giving a "small dose" of a substance. It involves giving a non-existent dose. Homeopathic products are diluted to the point where there is likely not even a single molecule of active ingredient left. Homeopaths have to argue that water has magical memory for what was diluted previously in it. This memory apparently survives being placed on a sugar pill, evaporating, getting digested and then absorbed into the body - that is some robust memory.
Despite homeopathy's "law of similars", most homeopathic remedies are not, in fact, the hair of the dog but some far-fetched fanciful concept of "illness". It's the hair of the unicorn. Let's take oscillococcinum, for example. Homeopathic dilutions of this substance are given by homeopaths to treat the flu and many other ailments. The problem is, oscillococcinum does not exist. It is a fairy tale itself - the misidentification of air bubbles on slides as if they were pathogens. Homeopathic oscillococcinum is nothing diluted into nothingness (in this case two negatives do not make a positive).
I get the sense that Professor Graham doesn't even know what homeopathy is, yet he feels comfortable defending its inclusion at his university.
He then waves his hands around saying, "It's a very political, emotive, cultural and complex issue." No, actually it isn't. Despite Graham's attempt at misdirection and befuddlement, trying to muddy the waters of legitimate criticism, with homeopathy the issue is quite simple. Homeopathy is made up nonsense. It never had a lick of science behind it. Two centuries of science since Hahnemann invented homeopathy have clearly shown that it is impossible, as far as we can ever say in science. For homeopathy to be true major sections of physics, chemistry, and biology would have to be rewritten. It is the ultimate extraordinary claim.
Graham's dismissal of skepticism on the grounds that homeopathy has not been adequately studied is also factually incorrect. Just go to PubMed and punch in "homeopathy." Plenty of studies come up. Most are not good, but some are well designed. There is also, you will notice, a pretty reliable relationship between how rigorous a study of homeopathy is and how negative the results are. Even when you put plausibility aside and just look at the clinical evidence, homeopathy does not work.
Further, Graham tries the dodge that, "Studies are often small and don't lend themselves to standard research trials." Really? Why is that, exactly? Homeopathic remedies are pills. Pills are really easy to give as placebos. You can even do the whole homeopathic individualization of treatment, just swap out the homeopathic placebos with other placebos and compare the groups. Whenever this is done rigorously - no difference. Homeopathic pills are placebos.
I expect gross misstatements of fact, logical fallacies, bias and distortion in the defense of pseudoscience by true believers. This is true almost by definition. You cannot use sound arguments to defend false positions, so you have to distort the facts or use bad logic. But it is still shocking when it comes from someone high up in the hierarchy of an academic institution. At least Professor Graham has highlighted the problem for all the world to see.
Steven Novella, M.D. is the JREF's Senior Fellow and Director of the JREF’s new Science-Based Medicine project.
Dr. Novella is an academic clinical neurologist at Yale University School of Medicine. He is the president and co-founder of the New England Skeptical Society and the host and producer of the popular weekly science show, The Skeptics’ Guide to the Universe. He also authors the NeuroLogica Blog.