Posted by apgaylard on July 13, 2008
In the second part of my journey through the arid valley of the recent ‘Scientific Research in Homeopathy’ conference under the guidance of the philosophically myopic Lionel Milgrom we’ll see that the philosophical element of his apologia (powerpoint file) is empty, inconsistent, contradictory, inept and misleading.
The other bits are no better either. (Milgrom’s lecture has been skillfully deconstructed on the quackometer by Andy Lewis)
Milgrom claims that it’s time for homeopaths and other CAM advocates to get angry: it seems his anger has blinded him to the weakness of his arguments.
He wishes to characterise those who argue that homeopathy is unsupportable from the perspectives of basic science and clinical trials as, “unscientific; indeed … anti-scientific.”
How does he approach this task? In true CAM style he appeals to selected positive testimonials from some MPs who are in favour of maintaining homeopathy as part of state-funded medicine in the UK. This is no more than a slightly dressed up appeal to misleading authority.
Then he accuses prominent critics of homeopathy as being, “a tad economical with the truth.” This, as we shall see, is deeply ironic. What does he cite as evidence to support this accusation?
He seems most put out that some commentators have said that homeopathy can be dangerous, deadly even, if used for malaria prophylaxis or as a replacement for conventional treatment of life-threatening conditions.
To make the case that this is at all, “economical with the truth” I would have thought that Milgrom would provide evidence of the effectiveness of homeopathy for malaria prophylaxis; or the case for homeopathy as an alternative to conventional treatments of potentially deadly diseases. But no, instead we have a slide headed “The benefits of modern medicine” which provides a one-sided view of the risks associated with modern medicine.
This is a classic non sequitur; just because modern medicine comes with risks it does not follow that homeopathic malaria prophylaxis is not potentially lethal. Neither does it mean that a homeopathic placebo is a safe substitute for conventional treatments of serious illnesses.
It is also clearly intellectually dishonest to discuss the risks of real medicine without reference to its benefits. Nothing in life is risk-free; every potential benefit comes with a risk. This can be a particularly acute dilemma when facing life-threatening illnesses; such as someone with cancer weighing the risks and benefits of surgery or chemotherapy.
In fact, Milgrom is also peddling the Nirvana fallacy; comparing actual real-world treatments with a non-existant utopian solution.
It is also undeniable that medical professionals will make mistakes, sometimes lethal ones. Drugs that have powerful, and beneficial effects, also have the potential for serious side effects. It is also true that hospital acquired infections are a real problem in the UK. Neither are the ethics of the pharmaceutical industry beyond reproach. There are serious issues to debate here; unfortunately Milgrom is unable to offer anything more than cheap rhetoric.
Before moving away from this point it is important to remember that not all homeopaths are happy with homeopathic malaria prophylaxis. Peter Fisher, clinical director of the Royal London Homeopathic Hospital, reportedly told Newsnight “I’m very angry about it because people are going to get malaria – there is absolutely no reason to think that homeopathy works to prevent malaria and you won’t find that in any textbook or journal of homeopathy so people will get malaria, people may even die of malaria if they follow this advice.”
I wonder, is Lionel Milgrom angry with him as well?
In common with many homeopaths, Milgrom also has a problem with vaccination. He cites as part of his argument against genuine pharmacology, “….MMR and the attempts to discredit Dr Andrew Wakefield”.
Wakefield’s work has been so thoroughly discredited that it is not worth commenting beyond the observation that by levelling this charge Milgrom has further discredited his own arguments.
The anti-vaccine rant, i.e. “The vaccination myth?” is essentially a warming over of “The Social Theory” promoted in the UK by Thomas McKeown. This sort of argument has been addressed by more qualified commentators (See Le Fanu (1999) for example). All that I’d like to add are a few straight-forward observations:
Some of the medical interventions made before vaccines were available proved effective – For example the isolation of consumptives in ‘poor law’ infirmaries in England and Wales, from the late-19th century, contributed in the decline of tuberculosis in these countries.
Given that perhaps the bulk of improvements in this regard pre-dated vaccination, why turn our back on the possibility of making further improvements; or are we just to live with certain diseases being unnecessarily endemic?
This type of analysis tends to focus on evidence from the US and Europe. What about the successful use of vaccines to all but eliminate Hib meningitis in young children in Uganda? The global eradication of smallpox? Or the 60% reduction in measles deaths among African children (the WHO are reported to have concluded that, “Vaccination campaigns that began in 2000 have saved the lives of just over 1 million children in the part of Africa south of the Sahara desert.”)
Milgrom is just plain wrong to infer that vaccination has not brought huge benefits to humanity.
Next comes his rant against the meta-analysis of Shang et al. I have already dealt with this at some length. What is interesting is the appalling asymmetry of his sloppy scholarship: when it comes to Shang he focuses on now-irrelevant criticisms that have been answered by the author; in dealing with the purported ‘Memory of Water’ relevant criticisms are ignored and flawed studies are cited with great gusto.
This just demonstrates that Milgrom is happy with experimental observations and clinical trials as long as they confirm his beliefs. The quality of the evidence be damned: it’s the confirmation of prejudice that counts.
Now we come to Milgrom’s tenuous grasp of the philosophy of science.
Here Milgrom accepts the objective of eventually being able to, “explain homeopathy in scientific terms.” In doing so he imlicitly concedes that there is worth in the values and methods of science; he implicitly accepts that worthwhile objective evidence can be extracted from nature via experiment.
Otherwise, why try at all? Why have a conference called ‘Scientific Research in Homeopathy’? Why bother citing all those studies on alleged memory effect in water?
It’s good to remember this because Milgrom goes on to change his mind and mistrust science, its values and methods.
This process starts on this slide when he raises the issue that assumptions made in the scientific process may colour the results obtained. It is important to note that for Milgrom the question never arises when the trials or experiments confirm his beliefs. It’s only nasty, conventional, sceptical science that suffers from philosophical problems. How convenient!
He starts by raising the well-known problem of induction. For those not familiar with induction and its counter-part, deduction – here’s a version of a simple diagram from my undergraduate text on the philosophy of science. [Chalmers (1985)].
Notice how deduction is important in the use and testing of theories: a prediction may be deduced from theory and then tested to see if it is correct. This is a pretty simple illustration of the role of these ideas in science (actaully it’s so simplistic its only use is as an illustration of these two concepts – it doesn’t mention hypotheses or highlight the limitations of induction, for example). Now, here’s Milgrom’s take on the problem of induction.
Milgrom claims that, “Science relies on induction!”. This is untrue. Science arguably does include some inductive processes – the generation of hypotheses comes to mind. These are then tested deductively – its the testing of hypotheses that science relies on to promote robust theories and good choices.
He opines that, “It is widely assumed that science starts with observation which provides a secure basis from which knowledge can be derived via induction.” Well people, even some scientists may assume this – but it’s not the way science actually works. Even my simple figure illustrating the concepts of induction and deduction shows that even an overly simplistic model of science does not leap inductively to knowledge: predictions and explanations are deductions.
Milgrom’s description is simplistic and incomplete. In recent months I’ve been on a bit of a philosophical journey (prompted by a previous outburst from Milgrom). It has become quite evident to me that science is too rich, diverse and complex human endeavour to be forced into simple philosophical boxes. All philosophical descriptions of science are flawed in one way or another. However, philosophy can provide useful insights: but to have any chance of being useful a philosophical system must be more than the one-dimensional caricature that Milgrom provides. Once more he purposefully overlooks the more complex and relevant descriptions provided by the work of philosophers like Lakatos and Kuhn, to construct a trite straw man.
Also the philosophical description of science that we favour (if any) won’t change the outcome of experiments, or clinical trials. These are based on values common to scientists, irrespective of their philosophical leanings -or lack of them.
He also says that, “But David Hume (18th C) argued it is all a matter of CUSTOM or HABIT and that the use of induction cannot be rationally justified at all!” This is to define rationality as being exclusively deductive, which again is too simplistic: who doesn’t expect the sun to rise tomorrow based on their previous experience. This is a rational and useful induction. Induction does have limits and weaknesses, but to deny it is to deny the rationality of experience-based judgements.
When he adds that, “Science doesn’t ‘prove’ or ‘disprove’ anything: the word ‘proof’ should only be used when describing deductive logical operations, like maths.” He is just plain wrong again. It is quite possible to disprove, or falsify. It’s not as straight-forward as Popper made it out to be, but it does happen.
Also, ‘proof’ has more than one meaning. Yes, it can be the deductive proof of mathematics or formal logic. It can also be ‘proof’ of the sort that can put a person behind bars: ‘proof’ based on evidence, reason and the absence of reasonable doubt. It should be clear from the context which meaning is intended, but to limit the word to the application of deductive logic is to deny the richness of the scientific discourse.
As Kuhn (1996) observed, “Debates over theory-choice cannot be cast in a form that fully resembles logical or mathematical proof.” To try to insist that it should is to ask for the impossible.
(As an aside, in case anyone is tempted to see the quote above as a negative commenty on the rationality of science, Kuhn added that, “Nothing about that relatively familiar thesis implies either that there are no good reasons for being persuaded or that those reasons are not ultimately decisive for the group. Nor does it even imply that the reasons for choice are different from those usually listed by philosophers of science: accuracy, simplicity, fruitfulness and the like”.)
The use of the word ‘proof’ to mean a strictly deductive process is certainly not seen among homeopaths and CAM advocates. For instance, homeopaths call their fantasy trials of potential new remedies ‘provings‘. The words “clinically proven” are also seen in the marketing hype for some CAM gizmos.
It would add a veil of respectability to Milgrom’s arguments if they were at the least to apply equally to everyone.
Finally his observation that, “Offering a ‘reward’ to ‘prove’ homeopathy/CAMs work is a just a stunt” is false. The “Ernst-Singh £10,000 Homeopathic Challenge” doesn’t ask for ‘proof’, “We challenge homeopaths to demonstrate that homeopathy is effective by showing that the Cochrane Collaboration has published a review that is strongly and conclusively positive about high dilution homeopathic remedies for any human condition…” So here we have mis-direction from Milgrom.
(Also, Randi’s reward does not even require clinical effectiveness: just proof beyond reasonable doubt that ultra-molecular homeopathic solutions are different from the solvent.)
This is a very naïve commentary on naïve inductivism. Science does not, “work like that”. Part of the motivation for the work of Kuhn, Feyerabend and Lakatos was that they could see that science didn’t work like that – no matter what some scientists claimed.
Kuhn, particularly, based his philosophy on a clearly historical approach – trying to see how scientists had actually worked and continued to work. He was actually a historian of science before he was recognised as a philosopher of science
Popper is indeed famous for propounding the principle of falsification as a solution to the problem of induction, though some commentators suggest that this was not an original contribution. It is certainly a weakness in Popper’s scheme that some theories are born ‘pre-falsified’ – he was at least aware of it.
Others explicitly worked on this problem. For example Lakatos’ philosophical model – the Methodology of Scientific Research Programmes – specifically incorporates a description of how the core hypotheses of a research programme are protected from premature falsification.
So Milgrom raises a red herring; ideas on how to face this issue had been developed by the early 1970s – if he had actually read the works he lists in the published version of this rant he should know that. So he is being disingenuous here: either he knows better and pretends not to, merely to serve his argument; or cites references he’s never read. This goes beyond sloppy scholarship.
Now, this criticism of Ernst is really poor. First, note the source for the quotation: it is not in a philosophical treatise or a learned journal, it’s in a newspaper. Perhaps it’s not fair to treat this as a definitive philosophical position piece. However, the worst is yet to come: Milgrom is being selective to suit his argument. Have a look at the complete quotation carried in The Times.
“I don’t believe in anything that I can’t prove. My only true belief is in science and its ability to sort out belief from fact. Part of my fascination with alternative therapies stems from the fact that some of them have not yet been proved. My job is to establish whether or not they are evidence-based. There is no aspect of belief in this at all. If there is, it gets in the way and becomes a bias. Once you have tested and established your hypothesis, you try to disprove it. If you can’t, you do the test again before you consider believing it. If you find the results contradict your belief, you abandon it – or you’re a fool. This is why I am convinced of the power of placebo. I have done trials with patients who suffer from intractable pain. A portion of them, who were seen by actors pretending to be spiritual healers, improved so significantly that some were able to abandon their wheelchairs. This is this kind of proof I look for before I believe in something.”
Edzard Ernst quoted in “What scientists believe but can’t prove . . .”, The Times, December 24, 2005 (emphasis mine)
In a recent letter published in the pseudo-journal Homeopathy Milgrom used this partial quote to as a proof by example that Ernst -and many other scientists – are naïve inductivists. This is again implied by the way it is used here.
Is Ernst saying that he follows a naïvely inductivist approach to his work? No, in the full published quotation he actually talks about falsification and the abandonment of falsified hypotheses. This is a pretty reasonable explanation of a scientific approach for a lay audience in an informal article.
Is this logical positivism? No; one of the central tenets of the logical positivists was verificationalism – the idea that to be meaningful, a non-analytic sentence has to be empirically verifiable. In essence this is an inductive view and explains, in part, why Popper is credited as being a harsh critic of the logical positivists. As we can clearly see in reality Ernst takes the opposite, falisificationalist, view, “Once you have tested and established your hypothesis, you try to disprove it. If you can’t, you do the test again before you consider believing it.”
Is he talking about proof in the deductive mathematical or logical sense? No, it’s clear from the last sentence that he is talking about judgement based on objective evidence. This kind of proof is similar to the legal, rather than mathematical kind.
Is this unambiguously scientistic? No. Rather than asserting the authority of science over every part of life, Ernst is talking against the backdrop of his work as a scientist.
Would it really matter is he was? No. Because the issues that Milgrom raises are about the application of science within modern medicine, which is a discipline with a scientific core i.e. medical science. This is not about science transgressing the boundaries of myth, religion or magic. It’s about Milgrom and his fellow CAM advocates trying to import quasi-religious belief systems into the domain of science.
The part of the quotation that Milgrom has chosen not to show is revealing. Why would he only use part of this quote? Well, it is the only way he can try to support his argument. This is more than “a tad economical with the truth” and is also a good example of the fallacy of contextomy.
The first bullet point is not necessarily talking about induction. By saying that, “Scientific beliefs stand or fall in the light of this evidence” he could equally well be talking about any of the serious proposals made by philosophers of science during the 20th century. Popperians would agree with the, “or fall” idea; it fits nicely with Lakatos’ concept of progressive and degenerate research programmes; even Kuhn would be happy with this as the basis for theory-choice: “It makes a great deal of sense to ask which of two actual and competing theories fits the facts better.”
So this view is not, “based explicitly in the early 20th C philosophy of logical positivism.” The approach of deciding what is correct based on carefully collected evidence is, as Kuhn noted, one of the defining characteristics of science in general – regardless of the particular philosophical stance taken by the individual scientist.
To argue against the possibility of obtaining objective evidence about the world and making judgements based on it is to argue against science in general and, by the way, all of Milgrom’s own points about any putative ‘Memory of Water’ or sucessful clinical trials of homeopathy.
So, here is the denouement of Milgrom’s thesis. He claims that EBM (or a particular variant of EBM – note now he’s talking about EBM generally) is founded on logical positivism – a debunked philosophical concept – and is therefore flawed; so somehow homeopathy is OK.
What we have seen is that the single example he provides of a ‘logical inductivist’ scientist is based on the dishonest use of a quotation in a newspaper! All he has managed to show is that EBM has values that are consistant with science generally. Any criticisms of the reliance of science on judgements made on observations applies equally to the science he likes – positive clinical trials of homeopathy and measurements that aledgedly show water has a memory.
So by this point Milgrom is done. He has nothing but a tenuous thread of logical fallacies, misconceptions and false evidence. But, of course, he ploughs on regardless.
Now, the statement that, “Developments in the philosophy of science since the 1920s have posed serious challenges to logical positivism” is one of the few things in this presentation that I can agree with. However, we have seen that logical positivism cannot, and has not, be explicitly identified with EBM. So to stretch this to saying that “developments in the philosophy of science” challenge EBM is to simply false.
Here also, Milgrom gets his philosophy totally wrong when he says, “and particularly from Post-Modernists – Foucault, Derrida, Feyerabend, Lakatoé, etc)”
Lakatoé, more usually known as Lakatos (though perhaps an improvement on his earlier attempt: Latakos) was certainly no post-modernist. His lecture on science and pseudoscience is well worth a read and should demonstrate the point very clearly.
Feyerabend was not a post-modernist either, at least during the most influential part of his career when he was a philosopher of science. Some argue that his later works strayed into that school, but that is moot as it is his treatise “Against Method” that Milgrom cites in the published version of this rant. At this time he described his philosophy as anarchist and Dadaist, the latter school can be seen as a, “prelude to postmodernism.”
These may seem like small points, but they illuminate the standard of Milgrom’s scholarship: he either doesn’t bother to read the sources he cites or doesn’t understand them.
The, “recent Post-Modernist deconstruction of EBM discourse” which “compares it to a ‘fascist’ structure for its intolerance of pluralism in healthcare systems” has been dealt with at length by Ben Goldacre. Milgrom seems to keep forgetting that any deconstruction that undermines evidence also undermines any he would cite for the memory of water.
(To assess the credibility of the post-modernist assault on science, I’d direct readers to Sokal & Bricmont’s excellent “Intellectual Impostures“.)
Now Milgrom moves on to undermine the notion of objectivity in observation. A futile aim, as it hurts the evidence that homeopaths love to cite as much as anyone else.
It’s notable again that his reading of the philosophical works he quotes is questionable. In citing Kuhn after his definition of ‘paradigm‘ he makes clear that he’s not read (or remembered) Kuhn’s 1969 Postcript to The Structure of Scientific Revolutions.
His arguments about the social nature of evidence and theory-choice do not reflect Kuhn’s views. Kuhn makes it clear that whilst individuals are subject to social and cultural biases that decisions in science are made at a group level, reducing their impact.
(There’s much more to say about what Kuhn really said. If anyone is interested I explored this in a series of posts, after an invitation from a homeopathy advocate who seemed to lose interest.)
Next Milgrom returns to a familiar theme, “Hence positive results from even the highest standard RCTs in homeopathy will be rejected by those who do not ‘believe’ in the possibility that ultra high dilutions can have an effect. Catch 22!”
Milgrom made a similar assertion in an earlier publication. I was surprised; the best evidence is that the better the standard of the RCT the more negative the conclusion about homeopathy. So I asked, in a letter which appeared in Homeopathy, for the references; his reply ignored the request. This, I think, demonstrates that Milgrom is again indulging in empty rhetoric.
This is nothing more than a faux-Kuhnian position. (To see what Kuhn really said see my previous posts).
Remember that Milgrom started out by claiming that detractors of homeopathy were, “anti-scientific”. By calling science, “a conformist society which represents only the curently accepted paradigm” and embracing post-modern deconstructions of science I’d say that Milgrom is revealed to be “anti-scientific”.
In any case, its clear that he is mis-characterising science.
Science is really a complex, diverse, dynamic, technical, human enterprise. It is undertaken by communities that share a deep commitment to core values and have developed both common (like blinding) and unique tools that accord with these values. The community-based nature of its judgement process diminishes the influence of individual prejudices, cultural and social pressures.
It is a progressive enterprise that is open to change and new ideas, but doesn’t accept them until they have proven their worth. It is conservative in the sense that it holds onto ideas until something better comes along, to avoid chaos and maintain progress.
It bears no real resemblance to Milgrom’s crude and simplistic caricature.
Milgrom’s conclusions are entirely worthless. We have seen that they are based on fallacious reasoning, sloppy scholarship, bias, error and misunderstanding. Also, in any event, homeopathy in particular and CAM in general don’t practise what Milgrom preaches.
To illustrate this, consider Dr Alexander Tournier’s presentation (covered nicely by gimpy), at the same event: “Overview of the current state of the research in Homeopathy”. Here is his slide on the, “Scientific discovery process”.
This is naïve inductivism pure and simple. There is no use of deduction to test hypotheses. Actually, this scheme ignores hypotheses and goes straight to theories! The dotted yellow line seems to infer that homeopathy has not progressed to the point where deductions could be made from their theories.
This slide criticises views that he perceives as not, “grounded in observation”. This is pleading the case for induction. It is also clear that Tournier has no problems with observation, or for that matter the idea of non-deductive proof (See below – ‘provings’).
Perhaps Tournier and Milgrom ought to get together and decide what they believe, before lecturing everyone else.
In fact, to me, it seems like the homeopathic community are on a myopic inductivist quest; building their ‘evidence base’ one poor-quality cherry-picked study at a time.
It’s sad that Milgrom seems so angry. It appears that it has rendered him blind to the need to actually read the philosophers he quotes, take care to be consistant, get aligned with his colleagues, construct his arguments properly, think straight and not be, “economical with the truth” himself.
A F Chalmers (1985), “What is this this called Science”, 2nd ed., Open University Press.
J Le Fanu (1999), “The Rise & Fall of Modern Medicine”, Abacus.
T S Kuhn (1994), “The Structure of Scientific Revolutions”, 3rd. ed., The University of Chicago Press.
A Sokal and J Bricmont (2004) “Intellectual Impostures”, 2nd. ed., Profile Books Ltd.
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