Skepticism

I’m going to a homeopath

No, I haven’t lost my mind – rather that I’ve become convinced that while millions of people can be wrong, that simple dismissal isn’t enough to explain the attraction of homeopathy. We know it works for certain values of ‘works’, because of the placebo effect, which isn’t particularly well understood yet but understood enough to acknowledge it exists. The jury is somewhat out on whether or not it’s ethical to exploit the placebo effect, but regardless, it’s not going away. Homeopathy probably works because the patient feels better simply for having done something, has little actually wrong with them in the first place (at least, little medically wrong), and because the patient is lavished in attention. Who doesn’t like attention? Myself, I love attention, no surprises there, and I also suffer from something that medical doctors call TATT (Tired All The Time). I’m tired all the time because I work ridiculously long hours and hardly ever take a day off. It’s not a medical problem, it’s a lifestyle one, but I’d like to have my cake and eat it. I think that makes me an ideal candidate for homeopathy.

In addition, I already take SSRIs. This is controversial, but there is good evidence that they are little more than placebo. They contain little active ingredient, and work no better than placebo for mild to moderate depression in clinical trials. Added to that, I felt better the very next morning after taking the first one, which is far too soon for a chemical effect. It was a placebo effect. I am aware of this and yet still take them, because they work. Replace ‘SRRI’ with ‘homeopathy’ and you have a familiar argument.

So, what seems clear here is that the placebo effect is mighty, and in many cases works even when the patient is aware of it. SSRIs are prescribed without any placebo warning, as is homeopathy. There are interesting dilemmas here. Being a willing participant in placebo myself, I think investigating homeopathy first hand to see why so many people swear by it will be a very useful exercise. How else can I continue to protest it in good conscience? My problem with homeopathy is that it doesn’t work as claimed. If it was sold as a placebo, with full patient education about its lack of content and no nonsense about water memory, I couldn’t rightly object to it, as long as patients were very clear about what it works for, when, and why. But I read a lot about what homeopaths claim without any personal insight into the process at all. I’m off to remedy that, excuse the pun. I’ll report back, no doubt with horror, but at least with some first-hand experience of the thing I’m protesting. Wish me lu…good health!

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92 Comments

  1. Interesting idea – I think with all the willingness and rush to point and laugh at homeopathy (something I’m 100% guilty of, I’ll hold my hands up), I’m not aware of anyone from the skeptical side of things who’s really gone out of their way to see how people do buy into it, and what the attraction really is. We’ve all got to the ‘it doesn’t work, and is scientifically nonsensical, etc etc etc’ point and largely stopped there. But I agree – to fully understand the way people can fall for it, it’s important someone puts their neck on the (admittedly incredibly diluted) line.

    I’d be careful though – if they do manage to convert you, Rebecca might force you to give back your skepchick ring and hand in your keys to skepchick mansion.

  2. The chances of conversion are zero, I like to think. I find homeopathy unethical, annoying, distasteful and in many cases downright dangerous. However, I have often lost my temper at people/groups who condemn movies or games with religious or violent content without having seen them. Often the defence is “I don’t need to see it to know it’s wrong” or “I’ve had the content described to me and I object to it”, etc. I always get mad at such defences. It is not acceptable to me to condemn something that a lot of people get something out of without experiencing it. I don’t like to condemn a movie, game or book without seeing, playing or reading it. I might say that in principle it sounds wrong, or that I refuse to have an informed opinion so any opinion I do have carries less weight, but there is no doubt that a genuinely informed opinion has to include experiencing the thing one is condemning. I don’t need to visit a homeopath to know that homeopathy is scientifically invalid, just like I don’t need to see a murder to know that murder is wrong, but I do need to see a homeopath to back up my suspicion that it’s ethically wrong to exploit the placebo effect, particularly given that I already happily take what is in all likelihood a placebo. I may come away from the homeopath having had a really fantastic experience – in which case, I’ll have a very different approach to how I go up against homeopathy.

    Knowledge is power and ammo. If we do want homeopathy to go the fuck away, then having first-hand experience will give very useful insight into what psychology we’re up against.

  3. Whilst I wouldn’t wish to give it any credence, I don’t have a problem with fools being exploited, after all, they’d be exploited by someone, so why not a homeopath.
    “A fool and his money are soon parted” – Thomas Tusser

    Funny how we’re warned about scam e-mails from Nigeria, and yet no action is taken against people who sell little bottles of water. What will it take before the scam is realised, a death or two?

  4. “The jury is somewhat out on whether or not it’s ethical to exploit the placebo effect […]”

    Is it? I don’t really think so. In fact, I think that it’s more or less universally acknowledged that the Placebo effect contributes (sometimes significantly) to the patient’s well-being, and that this is a good thing.

    Furthermore, there’s some research going on to explore the effect, try to understand it and use it more effectively.

    What *is* objected to, on the other hand, is the deliberate (or, in the case of homoeopaths, sometimes gullible and non-deliberate) deception of the patient to create a placebo effect.

    Wouldn’t it be preferable to maintain an honest relationship with the patient and still have the benefits of self-healing via placebo?

  5. Would be interesting to see the whole process, and how it compares with a visit to a GP in terms of the environment, the stuff on the wall, the clothes that people wear, the magazines in the waiting room…

    I reckon that my GP could improve patients trust in his diagnosis if he pretended that I wasn’t the 20th person with pretty much the same issues he’d seen that day, and that he wasn’t following a very short and well worn descision tree.

    Better still, perhaps he should wear a pair of half moon spectacles, and before pronouncing the verdict, he’d reach up from the top shelf of a bookcase behind him, blow off some dust, and then turn to a page, nod assuredly, and then print off the prescription.

  6. Good for you. I think more skeptics should see homeopaths. And actively engage them in conversation, and free open dialogue. And talk to them about the science behind it. Homeopaths have stood behind their remedies, resisting most recent attempts to apply clinical science to them. If Mohamed won’t go to the mountain…

    I’ve said before that the placebo effect is still an effect. But beyond that, the power of alternative medicine is not in the science, but in the failure of the bureaucracy of conventional medicine. In the US, there are still millions of people without insurance, and the bill that’s currently grasping and striving its way through congress is nothing more than a tiny insignificant step in the right direction. And Canada has universal health care payed for by the government, but we’re still only a little better off. A family doctor visit can have a waiting list weeks or months long in some cases, and if you go to the ER, you’re still looking at a wait of several hours for minor conditions, depending on your province and region.

    In that environment, it’s no surprise that people go to their pharmacist, or look at OTC treatments before even bringing their doctor in on it. And if there’s an ‘alternative’ treatment, they’re likely to just shrug and go for it rather than think about the science behind it.

    The placebo effect is less likely to work on skeptics. Some of us might be able to suspend disbelief long enough to get by, but not much longer. But on the general public, its more pronounced. When you see it their way, it might be easier to understand why they buy into it so easily, even if they know the science is shaky.

  7. It’s a good idea. I must say that I think a little research together with imagination will result in a high probability prediction of the process itself. I’m looking forward to hearing how your BS meter responds when they tell you why it’s going to work.

    To some extent, the practice of attending a homeopath is subject to caveat emptor as far as I’m concerned. I have no strong feelings about it. Visiting a homeopath proabably can render a sense of well being. Especially if the homeopath is good with people.

    Years ago, when I began a training career, I was taught how to demonstrate the effectivness of good quality questioning technique in a selling situation by role playing a doctor/patient scenario. Ask enough “pertinent” questions and whatever you say the resulting “solution” is becomes very persuasive.

    I intend to ridicule this therapist type aspect in a video parody one of these days.

    I don’t agree that the placebo effect is less likely to work on skeptics. Once a glimmer of belief appears there is a chance that the intellect will begin trying to understand it and before you know it….

    The Boots campaign as begun with the open letter from the Merseyside Skeptics, and as continued by the skeptical community as a whole is about trust in a high street store, and founded on the principle they are more than just a shop. As far as I know they do not offer to counselling aspect of homeopathy. They just offer the stuff for sale, for dogmatically commercial reasons.

    They have no reason to sell it, except for the profit, as the “customer demand” could be fulfilled by other stores.

    There is a cultural aspect to the acceptance of homeopathy by institutions. Boots, the government, the Royal Family, the woman on the high street. The only way we can address that is to get people talking about it.

    Why should we care?

    Because the bloody scientists are being ignored yet again, and the sick people are still buying expensive sugar.

    We don’t like that.

    Andy
    Merseyside Skeptics Society
    10:23

  8. @Tracy King: Well, I’d imagine. Given a sugar pill that we didn’t know was a sugar pill, it might do what we’re told it will do. But given a sugar pill that we’re told will have a placebo effect… I don’t know. It’d be interesting to test, anyway.

    I tend to stay away from stuff I now doesn’t work these days. But there are times…

    My wife gave me a lavender pouch a few years ago as a treatment for something. I don’t remember. Nausea, insomnia, whatever I had at the time, or whatever Wiccans think lavender does. Did I believe it? Not really. Did it work? kinda.

  9. @Tracy King : I think you may need to go to more than one to get an accurate “bullshit prescription” sample. I would bet a pound in old English money that you will get wildly contrasting diagnoses for each one you visit. Maybe this is not practically or fiscally possible, either way I await the resulting report with baited breath. Going by the contradictions we just witessed in the Home Office question sessions this and last week in the UK, there seems little chance of any consistency with your prognosis. Mind you they are grouping for an offensive so could have already been on the grape vine to each other to avoid such a situation arising. I doubt it though. Good luck and kudos to you for your gesture. A genuinly positive step forward.

  10. @Peregrine: There was a study on this a while back, it’s reported in Bad Science. My understanding is that patients still experienced a placebo effect even when aware of what they were taking. And as I say, in my own case with the SSRIs, that was certainly true. I knew full well it could only be psychological, but I still felt better immediately.

  11. @Tracy King: I agree – in my eyes it’d be arrogant to think that skeptics were immune to the placebo effect purely because we know it exists and are expecting it.

    I do sometimes wonder if skeptics are more susceptible to a degree of nocebo effect, though. Purely my own experience, but knowing the amount of subjectivity involved in pain relief always seems to make paracetamols work pretty poorly on me – even though I’m 90% sure it’s down to my own over-awareness and over-sensitivity to the notion of a placebo effect, I still rarely notice any relief from pain after paracetamols and other weak pain killers. Still, that may just be me!

  12. @Tracy King: As I say, my personal experience with SSRIs says that in the case of this skeptic, that’s not the case.

    ———-

    This is correlation. You took the SSRIs, and you felt better the next morning. It’s entirely possible that some other mechanism is at work here, hormonal, seasonal, cognitive, nutritional, biochemical. You’re falling into a post-hoc fallacy here, assigning your increased sense of well being to the placebo effect of the SSRIs when in fact there could be a completely different mechanism at work.

  13. I didn’t say we were immune. I speculated that we’d be less likely to be affected. Obviously, we’re as susceptible to the placebo effect as anyone else, but we can still ‘let’ it work if we want or need it to. I’ve been known to suspend disbelief on occasion, and I’d do it again if necessary.

    If we were given a sugar pill, and told it was a sleeping pill, it would probably have a pronounced placebo effect, just like anyone else. But if we were given a sugar pill, told it was just a placebo, and that it would help us sleep… we’d probably do whatever we wanted or needed at the time. If we had insomnia, we’d probably go to sleep, wake up, and say “wow, that was some placebo effect”. If we wanted to prove that sugar pills had no effect, we’d be awake all night. I’d wager, anyway.

    Hell, I don’t know. I could be wrong. It’s been known to happen.

  14. I’m wondering if any studies have been done which control for the _knowledge_ (or lack of) that the treatment being received is a placebo.

    While I also think it is unethical to knowingly give a placebo while claiming efficacy through hokey pseudo-science, I wonder if any placebo control treatments would continue to work after knowing that it’s “all in your head”, so to speak.

  15. This is the first time i have ever heard of ssri’s being little more effective then placebo.I will have to bring that up with my doctor. My own personal experience with prozac is mixed. I honestly prefer not to take it, and hate that i have to. But, i take it for the other people in my life.

    When I started taking it I didn’t notice any change at all, it took my family and school to point it out to me. I take it not for depression, but for the rapid explosive mood swings that manifests from my own adhd. Whenever I stop taking it, I am good for about a month. Then, something happens and i seem to be unable to control my anger/sadness/unreasonableness around other people. It then usually takes a few weeks back on the stuff before I start not exploding at people again. Unlike Tracy, it takes weeks for me to start to feel the effects of my medication.

    The one thing I believe most emphatically is not a placebo is the death of the sex drive caused by prozac. That is the only outward sign I can personally attest to being true.

  16. The placebo effect is NOT an effect on the patient’s well-being. It encompasses a collection of factors that confound how data about a treatment’s effectiveness is collected. As such, it’s wholly wrong to talk about a placebo “working.” A placebo is, by definition, that which does not work.

    People may have positive things to say about homeopathy, but that isn’t because homeopathy in any way “worked” for them (except, as noted, when the only problem is anxiety over inaction).

  17. @sethmanapio: Yes, that is possible, but the positive feeling kicked in immediately and stayed kicked in, and my GP was not at all surprised, she’d prescribed four days worth to see if I felt better, but she was unaware that I’m more knowledgeable than the average patient and knew full well four days couldn’t have an effect above placebo. But it is common practice to prescribe a short dose, I expect in part that’s to help diagnose the severity of the depression.

  18. @Merseyskeptic: Yes, the over-the-counter sales are an entirely different kettle of fish, and I can’t think of any justification for them at all. Boots is entitled to sell them, but the customer is entitled to know the truth, and that part of the transaction appears to be missing. There is no consultation, the customer is simply over-paying for a bottle of nothing.

  19. @Tracy King: If a particular medication takes a week to gain an effective dose in your system and another period of time to asses the effectiveness than I’d say your GP is doing her patients a disservice and acting in an irresponsible manner; not to mention asking her patients to be credulous partners. And don’t forget that the more you pay for a sugar pill the more likely you’ll be convinced it works!

  20. I am so glad that you posted this right now, especially with the mention of SSRIs. I’ve also had a really good experience with them in the past, but that was before I knew of the clinical research that showed that it fared little better than placebo. In recent discussion of my anxiety issues with my family, it was suggested that I try them again, but I refused, assuming that I’ve somehow “ruined” myself from being helped if it is more placebo than anything else. So, I’m glad to hear that there may be more to the story than than!

    I don’t know, I’ll probably try something cheaper and more non-committal, like meditation, which also has a history of helping me not freak the hell out. So I can totally see why you’d experiment with something like homeopathy, even knowing that it IS just water. You have the advantage of knowing the science before you get into it, so you won’t get suckered. But the attention-lavishing could be nice. We eagerly await your report!

  21. @Merseyskeptic: Unsurprisingly, I agree with you Andy, but that’s to be expected really! 10:23, I agree.

    I would only add that I’d still think it important that people are fully aware of the reality of homeopathy to avoid them taking sugar pills for something very serious – while there’s no harm as such in someone using homeopathy to treat Chronic Fatigue Syndrome or other medically unexplained symptoms where no viable and reliable medical alternative exists, the problem often is that homeopaths can be guilty of taking the legitimacy afforded to them by the acceptance of their sugar pills for these diagnoses, and abusing that legitimacy where it comes to real diseases and illnesses that real medicine can deal with.

    Unfortunately, it’s this abuse of legitimacy where we start to see the real harm – homeopathic solutions for malaria, swine flu, AIDS. Hell, tragically, we’ve seen even eczema can be a killer when left to homeopathy alone. I guess that’s where my strong-ish views on visiting homeopaths come in, really.

  22. Incidentally, I’ve been on SSRIs for 8 months now, 10mg for six months increased to 20mg for the past two months. More than long enough for them to have had any chemical effect. They’re not meant to be long-term, just long enough to get through the whole marriage separation/moving away from family and friends to Scary London thing. They work, but I’m aware that they don’t work any better than placebo, so I’m very interested to know if an actual placebo would work as well. However, that is certainly not the point of the homeopathy visit, I have no intention of coming of SSRIs and even less intention of swapping them for sugar pills. Depression is not something to fuck with. One of the things I’m curious about is whether or not the homeopath will suggest I come off the prescribed medication. Will be a very interesting conversation if she/he does!

    I am currently trying to decide whether to record the episode, not because I’d put it online (I wouldn’t), but because I’d have a proper record to refer back to when writing my report for you guys. Memory is a shitty thing to rely on, but taping someone without their knowledge is shittier, I think.

  23. @Tracy King: Why not tape them WITH their knowledge? If you just ask them if they’d mind if you taped the consultation so you could be sure you didn’t misremember any of their advice, they might well be OK with that, and you’d be being entirely honest about it, too.

  24. @Tracy King: From my reading it appears clear that placebo’s don’t in fact work at all for anything. They can create a perception of efficacy for a circumstance that is either self resolving on its own or of such a vague nature that no real efficacy is in fact quantifiable. I’ll try and find the article I read this in. If memory serves I think it was Steve Novella or David Gorski who was the author. And do you think the actual patient visit to the homeopath will be tantamount to giving them credibility?

  25. I love the idea of taking this approach, actually going along yourself to try and understand the experience. The part that really troubles me is the idea of having to cross their palm with silver. While I suspect most homeopaths are true believers, rather than con artists, I still find the profession maddeningly unethical.

    Are you planning on going in deep under cover (in which case, you have to say your name in Crystal) or are you planning to be upfront on your position on the matter?

  26. @Nicole: I don’t know, I’ll probably try something cheaper and more non-committal, like meditation, which also has a history of helping me not freak the hell out.

    ——

    And has the side benefit of being (if we’re talking about mindfullness meditation here) clinically proven to actually help with anxiety and depression, instead of either only working as a placebo or possibly increasing your risk of suicide.

  27. I have a blog post about the physiology behind the placebo effect.

    http://daedalus2u.blogspot.com/2007/04/placebo-and-nocebo-effects.html

    SSRIs can have prompt effects. When I first took an SSRI, I noticed positive effect on my mood in ~15 minutes, so did my brother who I talked with by phone (without prompting). I had taken other antidepressants before which had taken weeks to have an effect, so I wasn’t expecting any prompt effect.

    Placebos work well on depression because depression is a symptom of low NO. “Stress” lowers basal NO levels, the more stress, the lower the NO level gets. When it gets very low, it induces the near death delusional state, the “runner’s high”, where one gets a burst of energy and you feel like you can run for ever. You can’t run forever. The feeling that you can is a delusion, a very powerful delusion that your body induces so that you can run until you drop dead from exhaustion. Being able to run until you drop dead from exhaustion is a very valuable survival feature, a feature that helps when you are running from a bear. Being caught and dropping dead from exhaustion are “the same” from an evolutionary perspective, so evolution has configured physiology to minimize the sum of deaths from both causes.

    The near death metabolic state has to be euphoric if you are to be able to run while your muscles are dying from necrosis due to ischemia. If a euphoric state could be entered easily, organisms would, and would risk death needlessly. There must be an aversive state between the state “at rest” and the near death metabolic state. That intermediate aversive state is depression. Stimulants trigger the near death metabolic state too, that is why they cause euphoria. That is also why people who abuse stimulants see their health degrade. That “burst of energy” doesn’t come from reserve emergency source of energy, your body doesn’t have such things. Where that energy comes from is from turning off normal “housekeeping” pathways, cell repair, damaged protein disposal, healing, growth, and reproduction. If you turn those off, there is more ATP available to run from a bear. But those pathways have to be turned back on, or you will drop dead from exhaustion. That is the evolved trade-off your body is balancing, death from being caught by the bear or death from turning off all cell repair.

    How you feel is not a reliable measure of how your physiology is doing. People on stimulants can feel great while their bodies are self-destructing. Pain and fatigue are very important and useful signals that your body uses to tell you when you are exceeding prudent limits and causing irreversible damage. That is why exercising after using stimulants or pain killers is so dangerous. It is very easy to over do it and injure yourself because you have disabled the normal safeties (pain and fatigue).

  28. @Tracy King:
    As your intentions are clear and your actions borne out of honest curiosity and for the sake of balance, I can’t see how anybody should be reticent to allow you to record and thus relay and exact and accurate version of how your conversations go. It is also in the Homeopaths interest to put themselves across in a good light, after all. My gut says ask ’em if you can record right off the bat and tell them why, ie for study and analysis as well as diagnosis. If this fails many times it says something in its self. The honest approach would seem to be the obvious one to me. As you clearly are not just in there to cause mischief, and its obvious you have an open mind plus relevant experience with placebo and an actual “condition” in being permanently knackered……………an honest approach would deserve an honest response.

  29. Note on depression: my understanding is that exercise has been shown to be as effective as anti-depressants for mild to moderate depression. I use Wii Fit, not as often as I should because I’m Ms Busypants, but I always feel better afterwards. I am sure that daily exercise is an excellent way to manage depression. I’m also a big fan of therapy but of course that can be expensive.

  30. This sounds like an interesting science experiment. I agree with the notion if you are going to criticize something/someone, you should know as much as possible.

    As for exercise being anti-depressant – I have a lot of anecdotal experience on that and there have been some studies. It does help to increase endorphins in the brain which can help with mild depression. It has always worked for me and others of which I am aware. Beats sitting around and navel gazing.

  31. @OnlyCheryl: Thanks Cheryl. I don’t see it as an experiment, in that I’m not testing anything, I’m merely attempting to experience something, but I am absolutely convinced that if I’m to continue on my current path of trying to put homeopaths out of business, it would be disingenuous to have never even met one, let alone experienced what it is I’m trying to stop.

    There are lines to be drawn, for sure. One can’t really argue that lawmakers should try heroin before outlawing it, because heroin is addictive and potentially harmful, but in this case there are zero risks to me. I know homeopathy is bollocks, I know what homeopath literature claims and why I disagree with it, but what I don’t know is what homeopathy patients actually go through. I’ve read vague accounts of the process, and I’ve read many many anecdotes supporting it, but I’ve never experienced any medical treatment other than the NHS, which is built for speed, and there must be very good reasons why those who support it do so avidly.

    If I can isolate what’s good about homeopathy, I will certainly know better how to go about persuading the public that it’s not OK for the NHS to invest in it. It’s a major issue in the UK at the moment, and one where skeptics can make an impact. We can’t be prepared enough, as far as I’m concerned.

    The BBC breakfast show had an interview with a homeopath, a medical doctor who was also a woo. For ‘balance’, they had a female journalist who didn’t know what homeopathy was, had never been to one, and said she would rather take an aspirin as she knew it would work. It was very shoddy journalism, but also very shoddy of her to agree to debate something she had no knowledge of. I am not a scientist, and can’t attack homeopathy from scientific authority. I am a communicator by trade, so I can only attack it by using my communication skills. It is imperative that to have a full understanding of how to communicate about homeopathy effectively, I experience it.

    I will be able to say that I’ve tried it, that it was good or bad for reasons X,Y,Z, and that (hopefully) I know more about what sort of psychology we’re dealing with from both the patient and the homeopath’s perspective.

    As someone mentioned earlier, the only downside is I do have to fork out some cash and a homeopath with profit. Not loads, £50 or thereabouts, but paying for the treatment is part of the experience. I want to know if it feels like value for money, if the value part continues into the treatment or if just the consultation is enough, if knowing that you’re paying for someone’s time has a similar feeling to therapy (of which I have a lot of experience), etc. These things will go a long way to explaining why homeopathy is so popular despite it being sugar water.

  32. Have fun! I can’t wait to read the report.

    On a whim I once went to a Reiki healer because my grandfather had gone for his arthritis and I was curious. It was some old lady in a trailer park (all jokes aside though, her trailer was nice!)

    What wasn’t nice was when she read my palm and told me I was part of an alien race from the Pleiadese that are tall with blue eyes and blond hair (I’m 5’4 and you can see my user pic). She also told me she talked to a gray alien in one of the vortexes in Sedona, AZ.

    Needless to say I never returned and I convinced my grandfather this might not be such a good idea.

  33. My understanding is that the placebo effect still works when you’re aware you’re taking a placebo, but it works better the more you believe in it. That’s why I agree with the position in Trick or Treatment. If we’re going to start recommending placebos, then in order to get the best out of them, we’d have to lie about it. There’d need to be a conspiracy of silence so that the truth never got out. And particularly in time when people are losing their trust in science, I think that level of lying can’t be justified.

    That’s also why I think it’s ethical to try and drive homeopathy out of business without ever trying it. I’ve researched the subject. I know the science behind it is implausible and the clinical studies show it’s just a placebo. I don’t need to be one who has been lied to in order to stand against the lies.

  34. @Salo: You might think it’s ethical to try and drive homeopaths out of business without experiencing it, but do you think you have the right tools to do it? I don’t necessarily think it’s unethical to not have experienced it (I’m still trying to figure that out), but I certainly believe that I’ll be better-equipped. Only this morning I wrote a lengthy emailing giving tips to a group who are working against homeopathy, and whilst writing it I was aware that I have limited understanding of the driving force behind the patient group, and therefore limited ability to formulate tools and tactics. So it’s very much a personal choice for me, and I’m certainly not saying that all skeptics should experience the thing they condemn, but I think on balance it’s a good thing for me to do. Those who don’t want to do it can read the experiences of a Skeptic At the Homeopaths, if they want to, and those who seek my advice on how to counter homeopathy through the media and other communication methods will know that my opinion is informed from all angles (the scientific as well as the personal/emotional).

    Homeopaths use pseudoscience, bullshit explanations to legitimise their wares enough to pull patients in, but that can’t be what keeps the patients. There is a huge emotional and psychological component to the treatment that I don’t think I’m addressing adequately. My arsenal at the moment is physics and mockery – homeopathy can’t work in the way claimed, and when you examine the claims they are worthly of ridicule. I’d like more ammo than that, because the homeopaths and their patients, I suspect, don’t give a damn about the science, and the public are not far behind. So what WILL they give a damn about?

  35. @sethmanapio: I didn’t realize there were actually clinical studies in this matter, especially positive ones! Will have to look into that. My experience has been spotty, usually campus funded “stress reduction” sessions around finals times, and a Zen Buddhist monastery in Pennsylvania… no joke. (They kept most of the spiritualism out of it, so it was genuinely relaxing. And then served us tea!)

  36. @Tracy King: “I’m also a big fan of therapy but of course that can be expensive.”

    And it’s really hard to find one that you click well with.

    @Surly Nymph: “What wasn’t nice was when she read my palm and told me I was part of an alien race from the Pleiadese…”

    Hey! I met another one of your people when I was visiting Roswell. He didn’t take it too kindly when we pointed out that the Pleiades was too young of a star cluster to have formed planets capable of supporting life.

  37. @Tracy King:
    You definitely make a good point. I’m a scientist (or science grad student, at least), and I fall in the same traps that many scientists fall in. I know I have objective truth on my side and the truth should be enough. But you’re right, a fair presentation of the data just isn’t effective to many believers. Going to a homeopath with a real intent to let yourself be helped could be a useful way to understand why the practice is so popular. I can certainly respect the decision even if I couldn’t bring myself to try it.

    My major interest is actually creationism, and I’ve been trying hard to understand the religious mindset, but I just don’t get it. It’s really frustrating. It seems like your desire to understand the mindset behind homeopathy isn’t that different. I hope you have more success than I’ve had.

  38. Two things:

    If the anti-depressant you are taking is not having a meaningful impact on your mood after 8 months, switch to a different anti-depressant. I have been on three, and only one was truly effective at stabilizing my mood. One of them could just have well been a sugar pill, and the other was somewhere between the two.

    My understanding is that the placebo effect works because the subject believes that they are taking an effective medication, and their mind creates the relief they expect the drug to provide. If the subject knows they are taking something with no medical effects, then there is no expectation that they will feel any different because of the placebo.

    If that is not correct, and knowingly taking a placebo can still result in an effect, then you should be able to make yourself feel better by simply telling yourself that a glass of water, or your morning coffee, or the air you happen to be breathing has beneficial medical effects, and obtain a benefit from that, without having to shell out any dough to a homeopath (or to your pharmacist for your SSRI’s).

    Good luck with your trip to the homeopath, but even after reading your post and the comments, I can’t understand why you are doing it.

  39. @Salo: I expect what will actually happen is I’ll lose my temper if they say something dangerous (for example trying to persuade me off the SSRIs), or won’t be able to resist asking questions about how it works and then not being able to resist disagreeing. Or, it may not be what I expect at all!

    I will start with one and see how that goes, it may be prudent to see a few different homeopaths as I expect they vary in knowledge and beliefs. At this stage I haven’t decided whether or not to actually take anything prescribed to me, I’ll play it by ear. It entirely depends how much I get out of the consultation. I also don’t want to spend too much money, there are limits on my curiosity.

  40. Whilst I understand that you are not experimenting you are in effect investigating the experience in order to better argue against it. Given your underlying position on the matter won’t it be difficult to evaluate the experience and any outcome given your bias? I would find it very hard to put aside my attitude to Homeopathy which at best is expensively misleading but at its worst downright sickeningly dangerous:

    A colleague of mine told me recently that her uncle was advised by a Homeopath to use homeopathy and come off his insulin! He apparently did this against his doctors advice and unsurprisingly died. I don’t know whether he was misled or used the Homeopath’s claims to justify his own wish to try without his insulin – either way, very sad.

    You said you felt better just a day after taking your SSRIs – could that also have been the reassuring chat with your doctor as much as the tablets themselves? This is one way in which those practicing ‘alternative therapies’ win their fans I think. Their clients are given a lot of personal time, reassurance and attention and often some pretty sensible lifestyle advice too. If prescribed homeopathic/sugar pills for depression and told to also try exercise etc then it would be difficult for the patient to judge what had been helpful and they might therefore attribute it to the pills but in the same way a visit to the GP might yield medicine and similar advice with a similarly difficult to quantify outcome.

    I think I’d have great difficulty assessing the ‘treatment’ with my inner monologue picking at everything said and done. So I wish you luck and look forward to your write up with interest.

  41. @Shell: “Whilst I understand that you are not experimenting you are in effect investigating the experience in order to better argue against it. Given your underlying position on the matter won’t it be difficult to evaluate the experience and any outcome given your bias?”

    I am not worried about that, I’m an investigative journalist in this scenario rather than a scientist, if that helps to make it clearer how I’ll be dealing with it. I will go in with plenty of biases, and come out with plenty of information, but of course if I didn’t have those biases I may well have a different experience. Nothing I can do about that. The point is not to figure out what to do with my experience on a personal level (I will do nothing with it, I have no intention of using homeopathy as medication instead of SSRIs and have already said that I’m going in with ‘always tired’ as my symptom, so there won’t be any outcome other than them prescribing something that I may or may not take), the point is to have the experience so I can better understand what approach to take when combating support for homeopathy. All I need to do is keep my temper in the consultation. That’s why I most likely need to visit more than one. As said in an earlier comment, some are worse than others. My biggest dilemma at this stage is deciding how much knowledge and bias to reveal, or whether to play dumb.

    I was recently given a tour of the Scientology headquarters in London and played dumb the whole time, but I am fairly sure the girl saw through me anyway, she was very cagey. But how do I know they’re not like that anyway? I don’t.

    So yes, my biases will influence the consultation, but I will have to manage that as best as I can, either by telling the homeopath that I am researching, or by playing dumb. I might try both approaches with two different homeopaths.

    I’m very concious that things aren’t always as we believe them to be. Homeopathy patients get a lot out of it, so something is going on that’s worth looking into. I have friends doing the Alpha Course for much the same reason. They have no intention of becoming Christians, but do want to know what goes on behind the closed doors to better understand the mindset of Christians. In my case, I want to understand the mindset of homeopathy patients and in doing so, help to find a way of reasoning with them that doesn’t invoke ‘PHYSICS SAYS NO!’, because that doesn’t work.

  42. @daedalus2u:

    SSRIs can have prompt effects. When I first took an SSRI, I noticed positive effect on my mood in ~15 minutes, so did my brother who I talked with by phone (without prompting). I had taken other antidepressants before which had taken weeks to have an effect, so I wasn’t expecting any prompt effect.

    I had the same experience here, Daedalus2u. I had several doctors tell me that this was impossible and that I was experiencing a placebo effect. I assure you it is real. I suppose the withdrawal symptoms are a placebo effect as well – right? When pressed they all admit that some people are more sensitive than others and that the published “time for therapuetic effect” is just an average. It is not unprecedented for the human body to react quickly tp foreign substances. I am allergic to fish. The reaction is quick (within minutes), but mild. Other people eat boatloads and are perfectly fine.

    BCT

  43. I tried homeopathic ear drops one time to (attempt to) fix an ear infection. At the time, I had no idea what homeopathic meant, but I was still pretty skeptical about it.

    I wound up with a sticky ear. Felt kinda nice when I first put the drops in, but I’m sure cold water would’ve done the same thing.

  44. @ Salo,

    I’m just an old chemist and teacher who’s trying to keep ID out of public school science classes.

    The attached talk by Dr Andy Thomson tells us how our needs as helpless infants uses the same parts of the brain as our thoughts about the mythology of religion:

    http://www.youtube.com/watch?v=1iMmvu9eMrg

    I hope it helps your quest.
    I just worry about Tracy’s quest as any other father worries about his daughter when it’s time for them to fly by themselves. Stay strong and healthy, Tracy.

  45. I am a physician who not only treats patients with mental illness, but I have taught classes on it ( from a primary care perspective ).

    That said I find this is a dangerous post to be placed on a skeptical site. There is no controversy regarding SSRIs in the medical community. This is a straw man argument! They absolutely ( as many double blinded, randomized studies have suggested ) work better than placebos, though of course there is a normal curve of efficacy. Modern day psychiatry owes a great deal of gratitude to this class of drugs. They are safer than the class they essentially replaced ( tricyclic antidepressants) and thus a better choice for those who suffer from depression. Sometimes doses must be pushed into a higher range before efficacy can be reached. Sometimes a cocktail of two or more meds may be needed for the most difficult cases. Also, counseling has an additive effect for many who have depression. Finally, if several SSRIs have been tried without success, the diagnosis needs to be readdressed. Sometimes the actual diagnosis may be a form of bipolar disease ( there are several types and subtypes, some of which are very subtle). Treatment of bipolar would then be the proper choice of therapy. These are not perfect drugs. This is difficult to treat at times. A multifactorial approach sometimes is needed. But homeopathy is not one of factors.

    I’m truly disappointed that this has been posted. It gives credence to that which has none, it dismisses that which does. This should not be posted in a science driven forum.

  46. @Marsh: …while there’s no harm as such in someone using homeopathy to treat Chronic Fatigue Syndrome or other medically unexplained symptoms where no viable and reliable medical alternative exists…

    At the risk of derailing the conversation, Marsh, I must disagree with you here. As someone with CFS, I see far too many fellow patients who have this mindset. The truth is that many symptoms of CFS do have viable and reliable medical alternatives, but doctors so often blow off all symptoms as “just the CFS” that patients are forced into seeking out quackery to solve their problems.

    For example, one of the hallmark problems of CFS is unrefreshing sleep. I have read many stories of patients turning to all kinds of useless and often expensive “alternative” therapies for this. In my case, the doctor who diagnosed me insisted on seeing an old sleep study of mine that no one had ever followed up on. From this he determined an entirely new course of sleep meds than the ones I had been on for years, and it made a very positive improvement.

    The notion that “oh, it’s just CFS, it doesn’t matter what you do for it” is unhelpful at best and dangerous at worst for patients who don’t think critically or do their due diligence into science-based treatments that may help. That said, of course there are many problems with this illness and similar ones that aren’t helped by such treatments, in which case an informed venture into placebo analgesics may be called for — but the operating word is “informed.”

  47. Being tired all the time can be a symptom of depression. Maybe you should see a doctor about it instead of fooling around with what you already know to be woo. You wanna try homeopathy for yourself? Fine, chug half a gallon of it and when it has no effect you can say you tested it. But don’t delay seeking real treatment if something’s actually wrong.

  48. I completely agree with halincoh. SSRIs are extremely valuable antidepressants. When SSRIs were introduced the suicide rate went down. When the black-box warning was put on some of them and prescriptions went down, the suicide rate went up.

    Much of the anti-anti-depressant spiin is from Scientologists.

  49. The black box was specific for adolescents. On the one hand, I sorta liked that black box as it encouraged us to get the young people to counseling. On the other hand, people who needed pharmaceutical treatment were delayed in getting that treatment. Now, as the dust has settled, treating the patient completely and fully in the order best suited for the patient seems to be the rule again.

  50. @ZenMonkey: Ah, that’ll be my non-medical background showing through there – apologies! I only happened to use CFS as an example because I recently organised a Skeptics in the Pub here in Liverpool where a specialist on CFS came to speak about it, and the quackery surrounding it. His opinion, at least as put forward to a room of interested amateurs, was similar to what I expressed above. Apologies if I sounded dismissive of a genuine medical complaint I don’t know loads about, I was just trying to express the ‘using homeopathy won’t kill people who’s illnesses won’t kill them, but homeopaths don’t just stick to illnesses that won’t kill people’ kinda argument, if that makes sense!

  51. I think some people have really dramatically misunderstood my post and my intentions. Perhaps I wasn’t clear enough.

    Let me clarify:

    #1 I am not going to a homeopath because I suffer from depression. My depression, which is managed very well with SSRIs, is not an issue. I mentioned it because there is very good evidence which shows SSRIs work no better than placebo for mild to moderate depression. In my own case I experienced a placebo effect immediately. This is comparable to the justifications for homeopathy, which may explain why homeopathy patients swear by it.

    #2 I explained that I am tired all the time (as many many people are) BECAUSE I WORK ALL THE TIME. Figure it out people. This is the sort of thing that bogs down NHS doctors and gives homeopaths their trade. I work all the time, therefore I am highly productive, therefore being tired is not only likely to be caused by the fact that I overwork, it’s also not an issue because I am not substituting activity for sleep. It is precisely “non-issues” like this that drive people who feel “a bit not right” to seek medical advice where none is needed. Therefore it makes me the perfect patient for homeopathy because THERE IS NOTHING MEDICALLY WRONG WITH ME. See?

    #3 I am not going to a homeopath as some sort of science experiment. I am not a scientist. I am a communicator and writer. I am going for the experience, much like you might go and see a crappy movie (I saw 2012 at the weekend, I enjoyed despite it being implausible crap) or something less entertainment-driven like climbing a mountain.

    #4 I will use the experience to better inform my communication plans when combatting homeopathy, which I am called upon to do regularly. Understanding the mindset of the patient is essential in communicating with the patient. It is not enough to simply tell people they are wrong, in the same way I haven’t stopped taking SSRIs even though I know that exercise or a sugar pill has been proven to have the same effect. I posted a link to the meta-analysis, which I believe is one of several, in an earlier comment.

    I hope that clears things up.

  52. @halincoh: Thanks for the information. I know medical doctors who disagree with you and are extremely reluctant to prescribe SSRIs for mild to moderate depression. I described it as controversial, though, not from a medical science standpoint (the meta-study seems conclusive to me), but from my readers’ point of view, as I was aware than many posters would disagree with the study. As I have said many times already in this thread, they work very well for me and did so from the first day I took them, but I have read the meta-study which shows they are no more effective than placebo, and I am very comfortable in knowing that were they sugar pills, they’d likely have the same effect. I take them anyway. I would argue, and indeed am arguing, that this is much the same mentality as homeopath patients when presented with the ‘science says they can’t work’ argument that skeptics are fond of using.

    Homeopathy is not going away. It doesn’t matter what the science shows, as homeopaths (including some GPs) and many of their patients are not fighting the battle on the same ground. Science is irrelevant to them. They are interested in experience. Therefore, as someone on ‘the front line’, if you will, I am also interested in the experience. Otherwise I can’t effectively communicate, on the same ground that homeopaths and their patients already occupy, why they shouldn’t use it.

    I’d be interested to hear your commentary on the meta-study I linked to in an earlier post. That aside, the SSRIs are a side-issue, would you like to comment on homeopathy and why people swear by it despite it being no better than placebo? That is what my post is about.

  53. @Marsh: No worries. You didn’t sound dismissive at all, actually. “Medically unexplained symptoms” is perfectly accurate for some of what’s wrong with us. And that must have been an interesting talk; there certainly is a lot of quackery surrounding CFS, for the very reason I mentioned, that patients are led to believe “medically unexplained” means “medically untreatable.”

  54. the number one homeopathic medicine lab is in London! I remember reading about it recently. The thing is the author was trying to figure out if homeopathy works, or why. I think it would be well worth a visit. He was horrified that ANYTHING can be made into a homeopathic medication, including a musical note. Yes, they make MUSIC into medicine. They give tours, and are rather ashamed of some of their “medicines” but said it’s not up to them to say “no” to anything. Very interesting… homeopathy seems to want to be a medicine, yet can’t quite shake the over the top woo it is wedded to. A lot of homeopathic practicioners deplore the over the top woo elements. Still, it’s rather like “well that’s NUTS but I swear this works”. Let’s see how complicated the treatment is. I know our local homeopathic doctors make the treatment so complex (“and three drops 4 times a day and wake up at 2 am to take 10 drops…”) that most of the homeopathic patients I know blame the failure of the treatment on themselves (“you know I was skipping that 2 am thing.. it’s me, I messed up”)

    sigh…

  55. oh yeah and I have suffered from Social Anxiety, the inability to talk in groups or be comfortable in social situations. Paxil does the trick. My doctor pointed out that some meds do better for certain symptoms. She said many doctors are too “lazy” or “overworked” to really investigate the differences in the medications. As she told me “it’s more than the same medication with a different name!” People that say me at TAM1 (and few remember me) and then say me a t TAM2 could point out the HUGE difference in my social behavior. TAM1, I needed to have my husband by my side at all times in a group. TAM2, parrrtayyy! It wasn’t for depression, but the need to have a doctor that tailors your treatment to your actual specific symptoms is important. Just a side note to give a few meds a pat on the back.

  56. @ Tracy

    My major point is you have created a straw man. There is no controversy. As Dr Novella so emphatically states ( and yes I am pulling an argument from authority here ) one must look at the evidence as a whole. One can always cherry pick data to support an opinion and one can always find supporters for outlying opinion. The consensus opinion is not in doubt. And meta-analysys great data AT ALL. As far as mild depression goes, yes, sometimes all that is needed is talk therapy.

    And regarding the placebo effect, as a grad student, before med school, I did a ton of research on this effect. I LOVE the placebo effect. As a physician, I am a walking , talking, living, breathing placebo effect. Of course there is a placebo effect in medicine. But our jobs are to be BETTER than, significantly BETTER than the placebo effect. Hopefully your response to the med has been better than placebo as well.

    My best to you and your journey Tracy. But burn the straw man, my pretty … or I’ll get your little dog too. :)

  57. Marsh, CFS is quite real and is difficult to treat. I see it as a state of low nitric oxide which shifts the number of mitochondria to a level where there is no excess ATP production capacity. This results in a severe limit to how much aerobic work can be done. If you don’t have enough mitochondria to make enough ATP, your muscles can’t consume ATP and generate work. This leads to a complete inability to produce work at a certain rate. It has nothing to do with motivation, it is purely physiological.

    The reason CFS is difficult to treat is because there is no generally recognized way to increase nitric oxide levels. I know of only 2 ways, meditation (which not everyone can do), and the bacteria I am working with (which I think is the best way, but that is not generally recognized yet). A write-up of how NO is involved with CFS is here.

    http://www.chronicfatiguetreatments.com/wordpress/treatments/chronic-fatigue-syndrome-nitric-oxide/

  58. @kittynh: If you look up Hahanemann labs in the US, they actually offer a homeopathic treatment of “Berlin Wall”! you can get it at 6c (crunchy!) 12c, 30c, 200c and ….wait for it…. 50m! That’s like 50c but with thousands instead of hundreds. Someone do the math please!

  59. I’m intrigued by this post. Not the homeopath quest, but the depression.

    Richard Wilson (“Don’t Get Fooled Again – A Sceptic’s Handbook”) points out the most people over estimate their abilities. People who correctly estimate their abilities are more likely to be depressive (doing this from memory – not scientific!!) So as I’d guess (my logical jump is here) that skeptics are more likely to be of the type to estimate their own abilities correctly – are they also more prone to depression.

    I don’t want to hi-jack this thread, so if you want come on over to http://williamsatirejr.blogspot.com/
    discuss, if anyone is interested…

  60. @William Satire: I know loads of skeptics with depression, it is very interesting. That’s also why I made a point of saying that the placebo research would be controversial, I expected some resistance to it as it potentially affects a fair few of us. That’s not to say anyone should stop taking their meds just because of some meta-analysis, I’d be horrified if anyone thought I was suggesting that and I myself have every intention of staying on them. Just because placebos have been demonstrated to work as well for mild to moderate depression, it doesn’t mean it’s a good idea to stop taking the SSRIs. I did feel it necessary to explain why I need to know more about the homeopathic consultation process, and the comparison with SSRIs was a useful one.

    In his recent SitP talk, Prof Edzard Ernst said that Prozac (not the SSRI I take) has very little active ingredient, where St John’s Wort does, and yet one is considered ‘real’ medicince where the other is considered ‘alternative’. He was making the point that the lines are blurry and the definitions aren’t always useful, and that’s partly what I’m trying to get across here. We dismiss homeopathy, and rightly so, because of it’s silly magical claims, but there are other huge mechanisms at work that can’t be addressed by ‘science says no’ and we’re not going to get anywhere if we don’t try to understand them. All I can do, as a non-scientist, is go and get first-hand experience.

  61. @William Satire: Strangely enough, I was having this exact ‘are skeptics more prone to depression than your average bear’ conversation just last night. From my own (anecdotal, wildly unscientific and entirely bullshit stats-wise) experiences/observations, it seems a reasonable assertion that depression (in differing degrees) seems more common in skeptics than in other groups of people I tend to encounter.

    That’s not to say, I’ll stress, that we skeptics are a depressive bunch, so please don’t let that put anyone off coming to Liverpool Skeptics in the Pub if you’re ever in town…!

  62. @Marsh – I’m an ex-pat scouser living in London. I hope to one day attend – but ironically my geneology makes it less likely because of all the family/friend commitments when I do get back every so often! I’d like to be an honourary member, though! Feel free to visit my blog and let me know what you think. The odd bit of childish scouse humour.

    @TracyKing – very interesting indeed! A subject worthy of much study, I think. I wish you all the best.

  63. “Just because placebos have been demonstrated to work as well for mild to moderate depression”

    Grrrrr … the BRUNT of the evidence says this is not true. (Mild maybe – moderate no.)
    You really should stop presenting this.

    Though I have no idea what Prof Ernst actually said that day( or why ), when Prozac and St John’s Wort are analyzed ( and they have been ) it’s the opposite that’s true! I do not know if he has a present agenda , but it sounds like he might have. Prozac comes in many mg. The most frequently used dose is about 20 mg, but up to 60 mg are used in practice. Though please do not quote me, for this is only from memory, St John’s Wort , in standard dosing suggestions, would be something like 5 mg … and THAT is a placebo effect! Recent studies have demonstrated that St John’s Wort simply does not work. And that is why one is “alternative!!!”

  64. Let me say again that I agree with halincoh, and that claims of the equivalence of antidepressants with placebos must be treated with skepticism too; with enormously great skepticism because the consequences are life-and-death. In 1995 the 11th leading cause of death (32,637) was from suicide, 1.3%.

    A study where some people received “the same” benefit from a placebo as some people received from a particular antidepressant does not show that antidepressants are equal to placebos.

    It is wrong for someone who is not up on the literature of antidepressants to claim they are equivalent to placebos. It is wrong when Tom Cruise makes the claim, it is just as wrong when Tracy King or Prof Edzard Ernst makes the claim.

    I think that skeptics do tend to have greater depression because they tend to have lower NO levels. They have lower NO levels because they are more on the ASD spectrum, and so have a relatively stronger “theory of reality” than people less on the ASD spectrum (who have a stronger “theory of mind).

  65. @halincoh: I will present it as long as I have the evidence for it, which I have linked to, although there are also other studies which show the same thing (the earliest I’ve seen was 2002) and as long as respected scientists like Prof Ernst tell me it is so. If you would like to present counter-evidence then I’d be happy to read it. Your say-so isn’t enough though.

  66. One last comment from me on this: perhaps the confusion regarding therapeutic effectiveness is the difference between no response, response, and remission. Most studies define response as a 50% reduction on a HAM D scale (http://healthnet.umassmed.edu/mhealth/HAMD.pdf). Remission is a often defined as an absence of essentially all symptoms on a HAM D , but it may be more complicated than that. (http://ajp.psychiatryonline.org/cgi/content/full/163/1/148).

    Remission ( about 1/3 of patients in studies attain this ) is obviously a more difficult objective than response ( about 2/3 of patients in studies attain this ). But that doesn’t mean that a response is not important to the clinician or to the patient. It simply conveys the difficulty in treating patients with mental illness, primarily because we are trying to objectively define both the disease entity and the treatment of a very subjective disease.

    But in order to be considered a response the therapy must decrease symptoms by 50%. I think therein might lie the problem with some of the statements about placebo and antidepressants.

    Ok … the only way I will comment further on this is through facillated communication. I promise.

  67. @halincoh: Maybe we should put our heads together and do a future post clarifying all this at some point. It seems like there is a huge amount to discuss about it, and as depression does seem to be common in skepticism, we could get a very interesting thread going. Not that this one isn’t interesting, but it’s mostly about homeopathy.

    Facilitated communication with a gorilla, please.

  68. @Tracy King: I hear that if an infinite number of gorillas facilitated-communicated an infinite number of monkeys at an infinite number of typewriters, they’ll eventually write the complete set of scripts to the planet of the apes films.

  69. @daedalus2u: The reason CFS is difficult to treat is because there is no generally recognized way to increase nitric oxide levels.

    You have an interesting hypothesis going there, but you don’t address the fact that there are so many different etiologies of ME/CFS as well as so many different ways the illness presents itself — some people have solely neurological symptoms; others present with the full range of post-viral symptoms. Also, I don’t see a discussion of the upregulated immune system.

    These are some of the many reasons CFS is difficult to treat, not because of a failure of people to adopt your hypothesis, which while a good read and certainly may contribute to the problems of CFS, is by your own admission an engineering and not a clinical standpoint.

  70. ZenMonkey, low NO is the final common pathway in CFS. Yes, there are many different presentations because NO phsyiology is very complex, highly compled, non-linear and involved in at least hundreds of different pathways (if not thousands).

    The immune system is down-regulated by NO. NO inhibits NFkB, the “respiratory burst” lowers the local NO level and locally “turns on” the immune system. Low NO potentiates mast cell degranulation too.

  71. If all you have is your hypothesis on a website, then I don’t see where you’re qualified to state that your idea is “the reason” why CFS is difficult to treat. That statement requires a lot of qualification from you, like “in my opinion” and “although there is no medical literature on this whatsoever.”

  72. My “qualifications” come from having read and understood the CFS and nitric oxide literature and then having thought deeply about how they are connected. If you have not done so, then you are not “qualified” to understand my “qualifications” in this matter.

    My argument isn’t from my “authority”, my argument is from facts in the literature strung together with logic. If you can find fault either with the facts I am using, or with the logic I have used to reach conclusions, I would be happy to hear about it.

    The fundamental problem of CFS is insufficient aerobic ATP production. ATP is produced aerobically only by mitochondria. Mitochondria biogenesis is regulated by NO; insufficient NO leads to insufficient mitochondria. Insufficient mitochondria lead to insufficient ATP which leads to exercise intolerance as is observed in CFS.

    This is a website on skepticism. You are entitled to be a skeptic about my assertions and about everything else too. A skeptic only argues from facts and logic, not from authority or personal incredulity.

  73. You have misunderstood the word “qualification” as I used it, but I’m done trying to explain this to you. Get back to me when there’s corroboration. “Reading and thinking” are not enough to claim you’ve come up with “the problem” and “the answer.” I’m quite surprised you don’t see this since theoretically you are a skeptic and understand how science works. By proclaiming that you have the answers with no support whatsoever, you’re only adding to the quack problem that people with CFS constantly face.

  74. I am a skeptic and I do know how science works. I have not proclaimed I have the answer with no support whatsoever. My claim may have no support that you understand, but those are not the same things.

    Reading and thinking is all that Einstein did. I am not claiming to be Einstein, but there is a tremendous amount of data in the literature, far more data than one could hope to gather by oneself. Why is reading and understanding other people’s data insufficient?

    No, I am not contributing to the quack problem with CFS. CFS is quite susceptible to the placebo effect because the placebo effect raises NO levels and it is low NO that causes CFS. That is one of the things that differentiates disorders that are caused by low NO, they tend to be particularly sensitive to the placebo effect.

    You might try eating a lot of green leafy vegetables. They have a lot of nitrate in them, that does raise NO/NOx status. It doesn’t have the same effect as what I am doing, but it does help because there is so much cross-talk in NO/NOx pathways. I wish you well. I am sorry that the quacks have so poisoned the atmosphere that when real breakthroughs happen they are so difficult for people to recognize.

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