Friday, 14 September 2012

Good Medicine: Homeopathy

It was an intentional overdose. To prove a point I poured about 30 tiny tablets into my mouth and crunched them down. Because scientifically, I do not believe that these homeopathic pills have any active ingredient.⇑

Today, homeopathy is medicine’s whipping boy, repeatedly and systematically beaten to the ground. Yet despite explaining that the tablets are just placebos, homeopathy always gets up to take another beating. Some homeopathy is funded by the NHS, through general practice, and in the few homeopathic hospitals. This fact enrages the growling commissars of evidenced based medicine who want homeopathy purged from the NHS.⇑

So does homeopathy work? This depends what you measure. Does it cure infection, degenerative conditions, and cancer? It most certainly does not. And if any such claims are made they must be vigorously denounced. But homeopathy is most commonly used for medically unexplained symptoms in patients dismissed as neurotic; the so called “worried well.” These patients have passed from specialist to specialist, enduring repeated invasive and needless negative investigations. Or homeopathy is used in addition to, but not instead of, conventional treatments.

The homeopathic doctors I know are caring people, disillusioned with the crudeness of conventional medicine, not your typical aggressive alpha medical type. They are not in the pay of big pharma, whose drugs potentially kill 100 000 people a year in the United States alone.1 They listen, spend time, and offer some explanation for the unexplainable—and their patients like them. The effect of homeopathy is the positive effect of a therapeutic relationship that is reassuring, accepting, and supportive. Society should never underestimate the healing effect of a kind word or the value of a holistic approach. These consultations genuinely improve wellbeing. Homeopathic pills are placebos, but the placebo response is great, maybe even as high as 80%.

There is no hard evidence for homeopathy. But likewise the more you understand of research evidence the more you understand it is mere modern marketing quackery. There may be some dangerous homeopathic charlatans, but there are plenty in mainstream medicine too. We need to accept that patients will still use homeopathy, and having access to it through the NHS means it is regulated and safe. As for the cost to the NHS, this is roughly the same as a single week of antidepressants, medications that are little better than placebo. Modern medicine has real capacity to do harm but often minimal good; homeopathy has minimal capacity to do harm but real capacity to do good. Homeopathy is an easy target; we would be better to focus on the failings of conventional medicine. Homeopathy is bad science but good medicine.

10 comments:

  1. Oh dear! This article will cause Ben Goldacre and other bad scientists to come out from under. Of course, Ernst & Colquhoon will perform their usual comic duet.

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  2. Is it really possible for Ben Goldacre to double as a bad scientist and a good doctor?

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  3. Des said,

    "So does homeopathy work? Does it cure infection, degenerative conditions, and cancer? It most certainly does not ... These consultations genuinely improve wellbeing. Homeopathic pills are placebos, but the placebo response is great, maybe even as high as 80%."

    Many farmers say homeopathy can cure mastitis. How does the placebo response work in cows?

    ReplyDelete
    Replies
    1. It works on the farmers, silly.

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    2. Don't be a silly billy! It's the cows that have the mastitis, not the farmers.

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    3. Sigh....
      It does not work on the cows but the farmers think it does.

      (Sorry about the word "farmers" - I did try and keep the sentence to words of one syllable to aid your comprehension. Futile, I know. And who mentioned goats?)

      Delete
  4. I suppose that if this is a blog about "all the bad things medicine does", then it might mention the fact that NHS doctors, who are bound by their ethical standards and practice in accordance with the GMC guidelines, have a duty not to lie to their patients or mislead them by prescribing placebos.

    That would indeed be a "bad thing".

    ReplyDelete
  5. Hello

    I disagree. I don't think prescribing placebos, any of them, is a good idea. The reason is that you can give your patients false expectatitions, because the 'placebo effect' is usually only present in a 20-30% of people who participate in a clinical trial. That means you have a 70% of posibilities to not improve health in your patients, and that damages your relationship with them. But the most important reason is that homeopathic drugs are more, more expensive than a sugar tablet. I consider repulsive all the marketing and benefits of Boiron enterprise by this way, all this by the money of everyone. So I think this practices must be avoided. We need, in every country, more regulation about these alternative medicines. To give real information about the efficacy of this drugs, and, if necessary, to obligate to put this information on every packing of this drugs. Patients must know the true of every they take.

    Just sorry if I made some grammatical mistakes. I don't speak English, but I'm learing.

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