Free Bad Science by Ben Goldacre Page B

what research is missing, on whom, how, measuring what, and why you want to do it, but the hand-waving, superficially open-minded call for “more research” is meaningless and unhelpful.
    There have been more than a hundred randomized placebo-controlled trials of homeopathy, and the time has come to stop. Homeopathy pills work no better than placebo pills; we know that much. But there is room for more interesting research. People do experience that homeopathy is positive for them, but the action is likely to be in the whole process of going to see a homeopath, of being listened to, having some kind of explanation for your symptoms, and all the other collateral benefits of old-fashioned, paternalistic, reassuring medicine. (Oh, and regression to the mean.)
    So we should measure that, and here is the final superb lesson in evidence-based medicine that homeopathy can teach us: sometimes you need to be imaginative about what kinds of research you do, compromise, and be driven by the questions that need answering, rather than by the tools available to you.
    It is very common for researchers to research the things that interest them, in all areas of medicine, but they can be interested in quite different things from patients. One study actually thought to ask people with osteoarthritis of the knee what kind of research they wanted to be carried out, and the responses were fascinating: they wanted rigorous real-world evaluations of the benefits from physiotherapy and surgery, from educational and coping strategy interventions, and other pragmatic things. They didn’t want yet another trial comparing one pill with another or with placebo.
    In the case of homeopathy, similarly, homeopaths want to believe that the power is in the pill, rather than in the whole process of going to visit a homeopath, having a chat, and so on. It is crucially important to their professional identity. But I believe that going to see a homeopath is probably a helpful intervention, in some cases, for some people, even if the pills are just placebos. I think patients would agree, and I think it would be an interesting thing to measure. It would be easy, and you would do something called a pragmatic waiting list–controlled trial.
    You take two hundred patients, say, all suitable for homeopathic treatment, currently in a doctor’s clinic, and all willing to be referred on for homeopathy, then split them randomly into two groups of one hundred. One group gets treated by a homeopath as normal, pills, consultation, smoke, and voodoo, on top of whatever other treatment they are having, same as in the real world. The other group just sits on the homeopathy waiting list, so they get “treatment as usual,” whether that is “neglect,” “family doctor treatment,” or whatever, but they get no homeopathy. Then you measure outcomes and compare who gets better the most.
    You could argue that it would be a trivial positive finding, and that it’s obvious the homeopathy group would do better; but it’s the only piece of research really waiting to be done. This is a “pragmatic trial.” The groups aren’t blinded, but they couldn’t possibly be in this kind of trial, and sometimes we have to accept compromises in experimental methodology. It would be a legitimate use of public money (or perhaps money from Boiron, the homeopathic pill company valued at five hundred million dollars), but there’s nothing to stop homeopaths from just cracking on and doing it for themselves, because despite the homeopaths’ fantasies, born out of a lack of knowledge, that research is difficult, magical, and expensive, in fact, such a trial would be very cheap to conduct.
    But it’s not really money that’s missing from the alternative therapy research community working with the ideas of this billion-dollar industry; it’s knowledge of evidence-based medicine and expertise in how to do a trial. Their literature and debates drip with ignorance and vitriolic anger at anyone