The 10:23 campaign against homeopathy raises a question: given that homeopathy doesn’t work, why is there such strong demand for it? A new paper by Werner Troesken (ungated draft pdf) sheds some interesting light on this.
He studies not homeopathy but US patent medicines in the 19th century. Despite being practically useless, these enjoyed spectacular long-run growth - Professor Troesken estimates that spending on them grew 22 times faster than US GDP between 1810 and 1939. Why?
The answer, he says, is that demand for them was inelastic with respect to failure - people kept buying them even though they didn’t work. This was because the medicines offered enormous consumer surplus; the products were cheap, but the benefits they offered were huge; there’s an analogy here with Pascal’s wager. As a result, when a product failed to work, consumers downgraded the probability that patent medicines generally would work, but still saw a positive expected gain from buying them; the small chance of a big improvement in one’s health is worth paying for.
What’s more, there were several things that stopped consumers learning that the entire industry was useless:
1. Many of the products contained morphine or alcohol, so even though the medicine didn’t make the patient better, it made him feel better for a while. In this regard, patent medicines were superior to homeopathy - and possibly better than at least cheap placebos.
2. Consumers of failed products didn’t tell others of their bad experience. Few people told their colleagues that their Nobby Stiles were as bad as ever.
3. There were countless new products coming onto the market, so someone who had tried many medicines could hope that the new one would finally do the trick. This is, however, not the whole story; several patent medicines had a long product life.
4. Companies spent a fortune on advertising. Hadacol, for example, sponsored concerts by superstars such as Hank Williams and Carmen Miranda. This had the effect of excluding superior but honest products. What chance does “a 20% chance of making you a bit better” have against “most efficacious in every case”?
And on top of all this, the very fact that the medicines failed meant that there remained a huge market for cures. “Patent medicines proliferated and flourished not despite their dubious medicinal qualities, but because of them” says Professor Troesken.
The story here is a wider one than quack remedies. The moral of this story is that a form of Gresham’s law might apply quite widely. We can put this alongside Marko Tervio’s paper on the market for “talent“. Both show that, far from weeding out bad products, a free market can allow them to thrive. I guess the markets in music or newspaper columnists vindicate this view.
I say this not (just!) to knock neoliberal economics, but rather to suggest that markets operate in some more interesting ways than Econ 101 would have us believe.
He studies not homeopathy but US patent medicines in the 19th century. Despite being practically useless, these enjoyed spectacular long-run growth - Professor Troesken estimates that spending on them grew 22 times faster than US GDP between 1810 and 1939. Why?
The answer, he says, is that demand for them was inelastic with respect to failure - people kept buying them even though they didn’t work. This was because the medicines offered enormous consumer surplus; the products were cheap, but the benefits they offered were huge; there’s an analogy here with Pascal’s wager. As a result, when a product failed to work, consumers downgraded the probability that patent medicines generally would work, but still saw a positive expected gain from buying them; the small chance of a big improvement in one’s health is worth paying for.
What’s more, there were several things that stopped consumers learning that the entire industry was useless:
1. Many of the products contained morphine or alcohol, so even though the medicine didn’t make the patient better, it made him feel better for a while. In this regard, patent medicines were superior to homeopathy - and possibly better than at least cheap placebos.
2. Consumers of failed products didn’t tell others of their bad experience. Few people told their colleagues that their Nobby Stiles were as bad as ever.
3. There were countless new products coming onto the market, so someone who had tried many medicines could hope that the new one would finally do the trick. This is, however, not the whole story; several patent medicines had a long product life.
4. Companies spent a fortune on advertising. Hadacol, for example, sponsored concerts by superstars such as Hank Williams and Carmen Miranda. This had the effect of excluding superior but honest products. What chance does “a 20% chance of making you a bit better” have against “most efficacious in every case”?
And on top of all this, the very fact that the medicines failed meant that there remained a huge market for cures. “Patent medicines proliferated and flourished not despite their dubious medicinal qualities, but because of them” says Professor Troesken.
The story here is a wider one than quack remedies. The moral of this story is that a form of Gresham’s law might apply quite widely. We can put this alongside Marko Tervio’s paper on the market for “talent“. Both show that, far from weeding out bad products, a free market can allow them to thrive. I guess the markets in music or newspaper columnists vindicate this view.
I say this not (just!) to knock neoliberal economics, but rather to suggest that markets operate in some more interesting ways than Econ 101 would have us believe.
"Both show that, far from weeding out bad products, a free market can allow them to thrive."
Yes, but this is a bit misleading. There's a concerted, tax payer-funded, DHS-driven, attempt to spread the use of quack medicine in the NHS.
It's not so much that the free market allows quackery to thrive, though it does, but more that people are drawn to quackery and it will appear and flourish under any system that consists of people. That is, under any system at all.
Posted by: Peter Risdon | February 04, 2010 at 05:31 PM
Coincidental to see this this morning. I'm married to a homoeopath but rarely take remedies (or any other medicines, being generally very well). I took one last night - admittedly not for malaria - and woke up feeling wonderful. The problem was completely gone. My first words were: "Why is Ben Goldacre such an idiot?"
Over the years, I have personally experienced a number of such over-night cures and seen quite a few homoeopathic 'miracles' performed. It's funny that, no matter how dramatic these effects may be, they will never be more than 'anecdotal'. No matter how much evidence exists in favour of the above-placebo effect of homoeopathy - and, contrary to the claims of increasingly vocal campaigners, the evidence is substantial - it will not be accepted by those whose prior philosophical committment to scientism leads them to begin with the conclusion "it *can't* work, therefore it *doesn't*" and then develop their thinking from there.
The rise and rise of pseudo-scepticism would be funny if it's intellectual and social consequences were not so dire.
Posted by: Aidan | February 05, 2010 at 10:22 AM
"No matter how much evidence exists in favour of the above-placebo effect of homoeopathy..."
Would you consider adding some links to such evidence?
Posted by: Peter Risdon | February 05, 2010 at 11:24 AM
1. The main reason for the succes of homeopathy and other of the so called alternative therapies is the practice of medicine as it is today. Many people, after some experience with its practices and results, simply runs away from it.
Not long ago, I saw the presenter of a BBC program asking to a charlatan, and with the usual smirk, how many patients with cancer had he cured. I wonder if he has ever asked the same question to a doctor.
2. I enjoy your links very much and just not today. Do you know of any double blind test for chemotherapy? If so, I would be very thankful. If not, let's think why.
Posted by: ortega | February 05, 2010 at 01:59 PM
I didn't include links because I didn't want to insult anyone's intelligence by implying that they might not be able to research the subject for themselves and draw their own conclusions. As with every other subject, you have to sift the sources, identify ideological biases, etc.
The fury over homoeopathy appears primarily ideological. In the field of medicine, allopathy has been virtually deified, a massive cognitive blindspot having been allowed to occlude its serious failings. When some of these failings cannot but be acknowledged, they are invariably viewed almost entirely benignly.
Personally, I consider allopaths to be world-leaders in the mechanical aspects of human health; when it comes to surgical procedures or setting broken bones, I would trust allopathic practitioners above all others to fix the problem. For non-mechanical issues, I would avoid them like the plague.
A few links:
http://www.medicalnewstoday.com/articles/129436.php
http://www.britishhomeopathic.org/research/the_evidence_for_homeopathy.html
http://www.docstoc.com/docs/23234110/Classical-Homeopathy-Evidence-from-scientific-literature-meta
http://www.britishhomeopathic.org/research/the_evidence_for_homeopathy.html
http://hpathy.com/homeopathy-scientific-research/scientific-research-in-homeopathy-to-prove-or-to-improve/
Posted by: Aidan | February 05, 2010 at 11:16 PM
Adrian
You should read this http://www.guardian.co.uk/science/blog/2010/feb/04/homeopathic-association-evidence-commons-committee
Posted by: Dnotice | February 07, 2010 at 05:41 PM
I think the lessons of quack medicine sales may be applicable to the beauty industry. Except that some products do what we want them to - until we're encouraged to want more visible results. Today's mascaras wars are typical.
Posted by: Bialik | February 07, 2010 at 11:23 PM
Dnotice
I did read the article. It certainly makes short work of the BHA; if they did indeed behave as claimed, it is quite indefensible. What a club to place in the hands of the anti-homoeopathy crusaders! Personally, I would have hoped they could manage some minimum standards with regard to truth and proper representation of findings. Homoeopathy is not reducible to this institution, however.
I then read through the comments that followed, painful though it was. You'll notice that, in my original comment, I referred to 'scientism' and 'pseudo-scepticism'? You can see this in action everywhere these days: true believers rallying under the banner of something they call 'Science' (actually, philosophical materialism), their eyes lit with the justified certainty of knowledge as they crusade against error and zealously persecute the unbelievers. Was any faith ever more complete than theirs?
Homoeopathy provokes fury because it contradicts the basic tenets of philosophical materialism. A material effect from a non-material cause - nothing could invite more rage from those who know the true nature of things. Scientism simply will not stand for it; it alone has a monopoly upon the word 'quack' and it is not afraid to use it loudly and repeatedly.
Due to a large gap between scientistic orthodoxy and truth, many homoeopaths either deliberately conceal or do not reveal the real nature of their remedies. They are well aware that the material trace of the substance is long gone. For a materialist, this revelation is all they need to know about homoeopathy to dismiss it out of hand.
For me, the present campaign against homoeopathy is just a symbol, one among many, of what is happening on a wider scale. If the standards for harm (physical, social, moral, intellectual, financial) that are being brought to bear upon homoeopathy were to be applied even-handedly and, indeed, universally, it is allopathy that would be shot to pieces in seconds. [Allopathy - brought to you by scientism.]
Posted by: Aidan | February 08, 2010 at 08:29 PM
I've used homeopathy for a dozen years with wonderful success in treating serious, chronic illnesses such as neuropathy, acute illnesses like bronchitis, injuries and the pain and swelling from dental work. My experience with conventional medicine is that, in general, it does not heal but does cause its own pathologies. My friends and family have seen what homeopathy has done for me and tried it themselves. They were impressed with the results and told their friends who told their friends.......
The attacks on this healing system of medicine show only one thing: that these people's hidden motives and agendas (financial and ideological)don't serve the best interests of the people they are trying to influence.
Posted by: Christy Redd | February 10, 2010 at 03:19 PM
I am still using Homeopathic medicines and I am comfortable with it. I still think that Homeopathy is one of the best ways for treatment of diseases but it requires a bit more research.
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