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Yes, it’s that most boring of non-medicine topics, homeopathy, again.  At lunchtime on Thursday I got a call from a Times journallst, Fay Schopen, to ask if I could do 500 words on the Science and Technology Committee’s Evidence Check report on homeopathy. Bang goes another evening.  The (im)balance was provided by Sara Eames, President of the Faculty of Homeopathy.  As always the media insist on treating the matter as though it were an even argument.  It’s not.  The version I bashed out was three times the length they wanted, and it was skilfully pruned to length by Fay Schopen for the published version.  Here is the original. longer, version, for what it’s worth.

Should the NHS fund homeopathy?

Eames
DC

The problem with parliament is that there aren’t enough doctors in the House.  Or at least there are too many people who seem not to be able to make a critical distinction between what you’d like to be true and what actually is true (no, I’m not talking about Iraq but about something far less important). Perhaps the prime example is David Tredinnick (Cons. Bosworth) who claimed £700 on expenses for his efforts to link astrology and alternative medicine.

Luckily there are a few MPs who are not convinced that healthcare depends on the phase of the moon, and most of them are on the parliamentary Science and Technology Committee (STC).  That committee has been conducting ‘evidence checks’ in an effort to find out the extent to which government policy is based on good evidence.  Last Monday they published Evidence Check 2: Homeopathy.  The report restores ones faith in reason.  It concluded that there is no reason to think homeopathic pills have more effect than a placebo, therefore they should not be paid for by the NHS, and neither was more research justified. The report also criticised the Medicines and Health Regulatory Authority (MHRA) for allowing misleading labelling of homeopathic pills, and the Department of Health for failing the take notice of evidence.

Let’s get one thing straight. Homeopathy is very simple indeed.  The medicine (in dilutions beyond 12C) contains no medicine. Zero, zilch, nothing. That’s why it is a placebo.  Arnica 30C contains not a single molecule of Arnica.  It is like selling strawberry jam that has never seen a strawberry.  Yet Trading Standards officers can do nothing about this gross mislabelling because loopholes in the law allow advocates of magic medicine to get away with it.  It also involves the preposterous idea that the more you dilute a remedy the stronger it gets.  If you want to get drunk quickly, put a drop of whisky in the Atlantic Ocean and take a drop.  It is nothing sort of surreal that the matter is still being discussed after 200 years.

How did these absurd ideas ever take hold?  Around 1800, when homeopathy started, conventional medicine barely existed, and giving nothing was better than being bled and poisoned.  Bleeding patients had been standard medicine for hundreds of years in 1800 despite the fact that it killed people.  It went on so long because it depended on anecdotes, clinical authority and wishful thinking.  These are still the forms of evidence favoured by homeopaths, but real medicine has changed entirely now whereas homeopathy has remained stuck in 1800.

The problem is that homeopaths routinely misrepresent the evidence (if they didn’t they’d be out of business).  The report says

”We regret that advocates of homeopathy, including in their submissions to our inquiry, choose to rely on, and promulgate, selective approaches to the treatment of the evidence base”.

The Society of Homeopaths has the nerve to offer you “An overview of positive homeopathy research”. They quite blatantly omit the very much stronger negative evidence.  The only word for that is dishonesty. 

A favourite with homeopaths is a 2005 study in which 6544 consecutive patients were asked how they felt after homeopathic treatment and 50% said they felt better or much better.  That seems a surprisingly small proportion given that most of them would have been treated for minor self-limiting conditions, but we’ll never know because there was no comparison group at all.  As evidence, this is utterly worthless,

Two other defences are commonly offered by homeopaths.  One is patient choice.  The other is that it doesn’t really matter if it’s a placebo if it makes you happy.  Choice is fine as long as it’s informed choice.  If the homeopath said “these pills contain nothing, but you might feel better after taking them anyway”, that would be fine.  But homeopaths never say that.  In any case to deceive the patient into thinking they are being offered real medicine when they are not poses deep ethical problems, and the Department of Health has refused to grasp that nettle.  You might as well say that Chanel No 5 should be available on the NHS because it makes some people feel better.  At the moment we are in the absurd position in which a doctor is not supposed to give placebo knowingly and honestly, but can refer patient to a homeopath for a dishonest placebo.  The fact that the homeopath may genuinely believe in the magic is not a sufficient excuse. 
 
If homeopaths limited themselves to minor self-limiting conditions, they wouldn’t do too much harm.  But non-medical homeopaths (the vast majority, in the Society of Homeopaths) mostly have no idea of their limitations.  They believe they can prevent and treat treat malaria, AIDS, cholera, yellow fever, even cancer..  At this point homeopathy ceases to be a harmless joke but becomes more like culpable homicide. 

Recently two homeopaths in Australia were jailed for manslaughter after their own daughter died for want of proper treatment.  That is the sort of thing that happens you put your faith in magic medicine,

Homeopathy is on a par with talking to trees. No decent health service should pay for it.

Follow-up

Goldacre has lovely piece in the Guardian.

Homeopathy doesn’t work. But are the claims for other medicines any better?

Drug ads that don’t back up their claims show how dumb doctors can be about evidence and how lax regulation has become

After the Commons science and technology committee report this week, and the stupidity of “we bring you both sides” media coverage, you are bored with homeopathy. So am I, but it gives a simple window into the wider disasters in medicine.

He sounds as bored with homeopathy as I am. He points out that while 100% of claims made by homeopaths’ advertisements are untrue, it is also the case that 30 – 60% of advertisements by Big Pharma can’t be justified by evidence. Once again we see the similarity between the alternative industry and the regular industry (though the former still comes out worse).

Michael Grayer (2 march 2010) , at nontoxic.org.uk has some trenchant comments about what the mainstream media call “balance”. What constitutes balanced coverage worries me too, and gave rise to a complaint to the BBC recently.

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11 Responses to Homeopathy (sigh) again, in The Times

  • I found myself debating with Sara Eames on Radio 5 about a year ago. When pressed, she said there was RCT evidence for homeopathy in menopausal hot flushes. I looked up the citation she sent me. The paper was full of methodological errrors, especially on the statistics, and it was not even written so that anyone could really understand what they did.

    Of course, listeners would have accepted what she said and would not be able to assess the evidence, as I did. The S&T Committee has done them the great service of assessing the evidence for them, but still the homeopaths carry on regardless, misquoting, misinterpreting, and misleading. It is quite beyond me how anyone with a medical degree can do this, and lack the intelligence to realise what they are doing.

  • I can understand why you are getting tired of homeopathy: I wonder whether you think there will ever come a day when it is unnecessary to write about it?

    I am puzzled by homeopaths and others who believe in this sort of nonsense. It truly seems that some people see the world in a very different way and genuinely believe that it is a valid way of viewing it. I am beginning to think that this is some sort of personality type which is immune to education or reasoning or explanation. Perhaps such people will always be with us.

    On the other hand, it is very hard to believe that someone could make the sort of blatant out-of context quotes which are sometimes made, oblivious to what he or she is doing.

    Apparently Sam Harris has recently been involved in an fMRI study looking at what is going on in the brain when people “believe” different propositions. It would be interesting to put some homeopaths under such scrutiny and see whether there is any evidence for self-deception going on.

  • @GDP

    “I can understand why you are getting tired of homeopathy: I wonder whether you think there will ever come a day when it is unnecessary to write about it?”

    Actually I think that day might be in sight. Homeopathy has already vanished from most universities (not quite all), one hospital has closed and commissioning has fallen. Once it is out of universities and the health service, false advertising is stopped, and homeopaths who kill people are charged with manslaughter, then I can shut up. A lot of High Street quacks, who do no harm, and lighten the wallets of the gullible, don’t really worry me all.

  • Extra concise and entertaining, really feels (in my mind at least) like the case against homeopathy is concluded. The sun is setting on the matter.

    Thanks for the enjoyable read DC!

    P.S. – Do you think people like “cream for my swollen horse” Kayte Bridge on the comments of the Times article are paid to publish their anecdotes in such places? Somewhat like the chinese online propaganda army.. scaled way down.
    What I like is when they occaisionally develop their argument, like replacing the placebo effect with observer bias for the anecdotal false positive. Why concern yourself with such ideas within an anecdote?
    Better to go to Azkaban for a dragon than an egg, as Hagrid would say, ehm.

  • Would it be worth complaining to the GMC about medical doctors who and make misleading, or just downright false, statements about homeopathy in the media? Has the GMC ever investigated such a case?

  • @gordonw
    Good point. It has happened in the UK, In 2008 Marisa Viegas was struck off the medical register by the GMC for inappropriate use of ‘alternative’ treatments, as described here.

    But somebody has to die before anything happens. I haven’t heard of a GP getting into trouble for prescribing belladonna 30C, as happened to a friend who lives in Edinburgh. On the contrary, the indignant letters that followed that episode, the GP was backed by the NHS authorities.

    Scotland, very sad to say, seems to be slipping back into the medical dark ages. It seems they intend to ignore the recommendations in the Sci Tech report.

  • I particularly liked that both writers cited the Bristol Customer Satisfaction Survey, Eames as evidence for homoeopathy and DC as an example of worthless evidence.

  • I too an bored with homeopahty – edifying as it was to read your latest article on the subject, David.

    Acupuncture is far more interesting!

  • No, conventional medicine is far more interesting.
    Just looking at the data on adverse reactions for PPIs (those acid lowering drugs that every man and his dog is on).
    Hip fracture OR 1.44 (95%CI 1.30-1.59)
    JAMA 2004 292 2112
    C. difficile OR 2.9 (95% CI 2.4-3.4)
    JAMA 2005 294 2959
    CAP OR 1.89 (95%CI 1.36-2.82)
    MJA 2009 190 114-16

    Don’t get me on NSAIDs or SSRIs or most of the BNF come to think of it. Though these are the reasons they are probably on a PPI.
    Homeopathy sucks but conventional medicine kills.

  • @toots

    Yes I agree that acupuncture is far more interesting. There has been a lot of research, much of it quite good, The upshot is that it is unlikely to be anything more than a theatrical placebo. Its “principles” are as bizarre as those of homeopathy, and are thoroughly disproved. Yet despite all this, acupuncture seems to have a public image that is somewhat better than other sorts of alternative medicine. That is interesting, but baffling.

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