9 DIALOGUE ON THE VITAL FORCE
9.6 Analysis of professional experiential data on theme of vital force
analysis of homeopathy trials (9.6.1). I describe this as sceptics’ discourse. In response to this I play with the idea that sceptics’ discourse is participating in a paradigm shift (9.6.2).
Reflection October 2008: I struggle not to reproduce what I perceive as polarised relations with biomedicine in homeopathy discourse. Predictably, a sense of ‘wanting to be taken seriously’ surfaced early on in research supervision. Years later I experienced this tension gradually increasing as a scientific critique of homeopathy gained credence. It was helpful to learn from another practitioner researcher that “polarization is an abstraction from reality, since it does not take into account the complexity and fluidity of human experience” (Lees, 2008, p.5).
9.6.1 Deconstructing the ‘sceptics’ discourse’
In the Context chapter 4 we considered the publication of the most recent meta-analysis on homeopathy trials (Shang et al., 2005) as more significant to homeopaths as a media event than contributing to the evidence base. Given that the review has been criticised for lack of rigor and transparency (Frass et al., 2006, Rutten and Ludtke, 2008), and excluded from Cochrane Library database of Abstracts of Reviews of Effects, it is surprising that The Lancet editorial welcomed the results so stridently as “The end of homeopathy” (Horton, 2005). This editorial was picked up by the national newspapers and the coverage contributed to an emerging media and web based sceptics’ discourse. Self-appointed experts, demonstrating little or no understanding of homeopathic treatment, claimed speak on behalf of medicine or science, presented homeopathy’s claims to therapeutic effect as reducible to placebo, homeopaths as deceiving their patients and funding for research in homeopathy as unjustified. I explore the vitality of this discourse through analysis of three media texts:- The Lancet editorial (Horton, 2005), a national newspaper report (Frith, 2006) on the editorial and an article (McCarthy, 2005) in the same issue of The Lancet.
‘The end of homeopathy’ or is it?
The Lancet editorial (Horton, 2005) opens in an authoritative tone launching a series of negative comments about homeopathy. The editorial is set within a political context of debates over provision of CAM within the NHS. Supporting references to other systematic reviews and meta- analyses are notably absent, and the sources used are weak and ill-defined. Reference to ‘150 years of unfavourable findings’ draws attention to the longevity of homeopathy rather than to the vague illusion of ‘unfavourable’. The report of the Parliamentary Select Committee on Science and Technology (House of Lords, 2000), is a general reference to CAM treatment rather than specifically to homeopathy. Comments on withdrawal of funding for homeopathic treatment by the study’s sponsor, a Swiss health insurance company, are misleading. The Shang meta- analysis forms part of an evaluation programme of effectiveness and cost-effectiveness for the inclusion of complementary therapy treatments in its insurance scheme. Neither the The Lancet editorial nor the Shang et al. paper mention criticism by the evaluation programme management in 2003 of Shang’s methods and conclusions. Reports of the evaluation programme present a different view, that homeopathic treatment is more economical, patients experienced greater improvement, reduced side effects and reduced hospitalisation as compared to conventional treatment (Rutten, 2006).
What emerges between the lines is that the continued public demand for CAM and homeopathy is at least in part a response to biomedicine’s failure to meet patients’ needs. This is recognised by the editor in his advice to doctors to improve their ‘personalised care’. Homeopathy patients and users are viewed as a ‘threat to conventional care’. The editorial ends with a moralistic address instructing doctors to cease ‘a politically correct laissez-faire attitude’ and to advise their patients against homeopathic treatment. An explanation as to how a poorly reported meta- analysis can deny patient choice is not absent.
How is the debate constructed in the national newspapers?
An article in The Independent entitled ‘‘Effects of homeopathy ‘are all in the mind’’ (Frith, 2006). is used as an example of coverage in national newspapers. Use of inverted commas in the title suggests an ambivalent attitude towards the The Lancet editor’s comments. An ambivalent tone is established in the first line with the reference to ‘no real health benefits’. Drawing on the Cartesian divide of mind-body, imagined effectiveness is demarcated from real, presumably physical, changes. There is a shift in attitude part way through the text signalling divergent opinions, “there is room for both”. Consumer power begins to emerge with reference to royal patronage, CAM practitioners outnumbering GPs and the millions of pounds spent each year on CAM treatments. Critics are described as scathing and suspicious, and unfavourably compared with the old fashioned image of a family GP who “embraces alternative therapies”.
Conspiracy theories? The making of a controversy to obfuscate other issues?
By examining the context in which the editorial appeared, we can identify other factors at play. This issue of The Lancet also featured a short piece on a leaked draft of the forthcoming, to my knowledge still unpublished World Health Organisation (WHO) report on homeopathy: “Critics slam draft WHO report on homeopathy” (McCarthy, 2005). There have been suggestions (Rutten, 2006) that the editor’s vociferous argument against homeopathy was designed to create a diversion from WHO’s findings that
“the majority’ of peer-reviewed scientific papers published over the last 40 years ‘have demonstrated that homeopathy is superior to placebo in placebo-controlled trials and is equivalent to conventional medicines in the treatment of illnesses, in both humans and animals.”
(McCarthy, 2005, p.705).
Conflicting interests between WHO and the British medical establishment are visible. The WHO draft report sets the use of both complementary and traditional forms of healing within an international context and thus opens wider perspectives. The costs of drugs places the Western medicine beyond the reach of many people in the world and traditional forms of healthcare are mainstream. As a relatively recent Western invention, through the work of 19th century Christian missions, homeopathy plays an essential role in healthcare in subcontinents such as India and South America.
Setting these texts within the context of sceptics’ discourse
The media reporting of the Shang meta-analysis participates in a wider discourse of scientific scepticism. Whilst scepticism is an essential feature of the scientific method, it can lose its criticality and veer towards dogmatism. This discourse is distinctly different from philosophical scepticism that questions our ability to make knowledge claims. Scientific scepticism is promoted through the activities of Sense about Science, websites (www.skeptic.org.uk, www.skeptic.com), publications by the Committee for Skeptical Inquiry and Skeptical Inquirer, and social media networks. These sites have organised campaigns against Bachelor of Science degrees in CAM (Colquhoun, 2007) and mass complaints to the Advertising Standards Authority about homeopath’s websites (Burchill, 2011). Journalism distorts science discourse by over- interpreting the results and constructing polarised debates. Science journalists have achieved
the status as experts and their influence is visible in the House of Commons Science and Technology Select Committee evidence check on homeopathy (2010).
The sceptical discourse questions the veracity of knowledge claims that are perceived to lack rational justification through empirical or reproducible evidence. It venerates scientific truths, and distorts the role of scientific method as supporting the status quo in science rather than in disproving theories. Whilst the scientific method is the best method so far to find out from a realist standpoint about how the natural world works, the sceptics discourse loses sight of the fact that science is not about belief, as current theories and models are always provisional until better explanations are generated. Sceptics’ discourse represents itself as ‘myth-busting’ but is itself promoting a myth of salvation through science. From a feminist standpoint, I find emphasis on rational argument problematic. Rationality can be viewed as a male construct (Johnson et al., 2000), relying on abstract values of autonomy, domination and mastery. Knowledge is always subject to the limitations of understanding through the human mind. Whilst designating certain practices as pre-scientific and irrational, the discourse itself does not embrace current scientific thinking that perceives the natural world as far more complex than previously anticipated. Mathematical physicist and philosopher North Whitehead expresses the sense of how scientific inquiry can become trapped within orthodoxies:
“The Universe is vast. Nothing is more curious than the self-satisfied dogmatism with which mankind at each period of its history cherishes the delusion of the finality of its existing modes of knowledge. Sceptics and believers are all alike. At this moment scientists and sceptics are the leading dogmatists. Advance in detail is admitted: fundamental novelty is barred. This dogmatic common sense is the death of philosophical adventure, The Universe is vast.” (1948 cited (Dossey, 2000) p1737)
We are currently witnessing a fundamental rupture of scientific understanding as research is contradicting Einstein’s Theory of Relativity by suggesting that sub-atomic particles can travel fractionally faster than the speed of light. Given that this has radical implications for our understanding of time, questions about the activity of high dilutions appear quite plausible by comparison.
There is a sense that professional homeopaths do not have a voice that is acknowledged in the public sphere (Couldry, 2010). Spokespersons tend to be medical homeopaths speaking with the legitimacy conferred by the prefix doctor. I recognise that professional homeopathy discourse does not demonstrate reflexivity or critical thinking, but campaigns to censor homeopaths’ websites is an example of how homeopaths’ voices are being stifled (Burchill, 2011). I embrace the criticisms levelled at homeopaths as creating an impetus for positive change and as an opportunity to deepen and strengthen our understanding of what we do and why, on our own terms. The formation (October 2010) of an international campaigning body ‘One Vision, One Voice’, represents an attempt to fill the absence of an articulate voice to represent homeopaths in the public arena.
9.6.2 Is homeopathy participating in a ‘paradigm shift’?
Let us take a provocative stance here – the popularity of homeopathy and other CAM practices challenges dominant ways of thinking. To make sense of our experiences, our perceptions are shaped by specific ways of thinking or belief systems. Whilst we may hold contradictory or conflicting beliefs, our sense of self is constituted through these beliefs so it can be very threatening to have our belief system challenged. Drawing on a Kuhnian notion of paradigm shifts (Kuhn, 1970), it could be argued that the
Newtonian-Cartesian paradigm, that has dominated Western scientific and philosophical thought since the 18th century, is beginning to be undermined. Quantum- relativistic physics is part of the formation of a new paradigm (Capra, 1982, Grof, 1984) within which vitalist ideas may play a role.
Kuhn’s model offers a way of conceptualising the interaction between vitalism and scientific discourse. This model must be used with caution, as the emphasis on a linear and rational notion of progress, implicit in modernism, is incongruent with the framing of this inquiry. Also Kuhn’s use of the term ‘paradigm’ is ambiguous (Gutting, 1980). Kuhn elaborates a ‘life cycle’ of science practice, where a particular cognitive framework and set of values and beliefs dominate practice, and over time gradually a new framework begins to articulate a different perspective until a ‘paradigm crisis’ occurs. Initially advocates of this new framework are marginalised by the old vested interests, but gradually they gain a critical mass and begin to undermine the old framework. Ultimately the latter collapses and the new framework becomes dominant.
So are CAM researchers participating in a paradigmatic shift? Certainly if we are at the vanguard of change, we are experiencing fierce attacks from the establishment. Peters (2005) proposes “21st century vitalism” informed
by research into self-organisation, homeostasis, subtle energy and embodied consciousness. He proposes 21st century holistic healthcare based on a model of entanglement between the biochemical, biomechanical and psycho-social aspects of self-organisation. The term entanglement is from the vocabulary of quantum mechanics, and we will meet this concept again when we consider explanatory models for homeopathy in the Dialogue on Potentisation chapter 12.
Reflection on what would it feel like to be in a paradigm shift: Homeopathy appears to be singled out from other CAM practices for condemnation. It feels like our presence, (medical and professional homeopaths alike), our patients’ preferences, and our two hundred year history offend certain individuals, who use the media and institutional positions to denounce us. Our difference from biomedicine is presented as grounds for ceasing all NHS provision and further research. Yet there are shared values with biomedicine, such as patient choice and engagement, reducing the use of antibiotics and anti-depressants. Are the two related? Is homeopathy criticised by certain groups precisely because we offer another trajectory? We are caught in two counter forces. The Kuhnian model suggests that we should not be passive, but forge ahead in changing the political climate.