Homeopaths should be held legally responsible for their placebos
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By Paul Rodgers
If it were up to me, magic would work. Much of my teens were spent in an imaginary land full of elves and dwarves, steeped in the lore of Tolkien’s The Lord of the Rings and games such as Dungeons & Dragons. Who could resist the idea that waving a wand or drinking a potion could solve life’s problems?
As an adult, though, I found that magic doesn’t work, and science does. Yet the NHS, an institution that should be a bastion of science, continues to spend millions of pounds a year – for remedies, staff and the upkeep of four specialist hospitals – on homeopathy, a practice with no scientific basis whose origins lie in Renaissance alchemy. At best, homeopathy is an expensive placebo, but in leaching scarce resources from treatments that are effective, and by distracting patients from seeking proper medical care, it causes real harm. That kind-hearted Britons are being encouraged to give money to pay for a group of homeopaths to go to Haiti to treat earthquake victims is scandalous.
Let’s be clear. Homeopathy is not the same as herbalism, which has some scientific merit. Its main principle, that “like-cures-like”, dates back to Paracelsus, a 16th century physician, astrologer and occultist who believed that if you suffered from, say, stomach cramps, the cure should be something that causes stomach cramps. The problem – obviously, you might think – was that this “cure” often made things worse. Two centuries later, Samuel Hahnemann, a German physician, realised that diluting the like-cures-like medicines reduced their toxic effects, though not, he claimed paradoxically, their efficacy.
And so homeopathy was born. Minute doses of the active ingredients are diluted so much that your chance of finding even one atom of it in your pricey sugar pills could be as low as one in a trillion. Exotic explanations for this vary widely, often involving the sort of pseudoscientific gobbledygook that is the stock in trade for Star Trek scriptwriters. One common idea is that water can “remember” which active ingredient used to be present (though apparently it forgets the myriad other contaminants that have been removed). As David Colquhoun, a professor of pharmacology at University College London, put it: “If homeopathy worked, the whole of chemistry and physics would have to be overturned”. Even some of the purveyors of these snake oils don’t have much faith in them. Paul Bennett, the professional standards director at Boots, one of the country’s biggest homeopathic retailers, admitted in November that “I have no evidence before me to suggest that they are efficacious.”
The Commons Science and Technology Select Committee – which reported on 22 February on its investigation into this “alternative therapy” – concluded that public funding for this hocus pocus should be cut. Even research into it should be abandoned as a waste of money. The MPs should go further. Homeopaths should be held legally responsible if they prescribe their placebos for conditions which demand proper medical attention. In Australia, two homeopaths, husband and wife, were jailed last autumn for gross criminal negligence over the death of their nine-month-old baby in 2002. The baby had severe eczema and died of septicaemia after her parents tried to treat her homeopathically. Even the placebo effect doesn’t work on babies.
Homeopaths will counter that they have several centuries worth of experience during which they’ve given their tonics to patients who have subsequently recovered. The flaw here is clear. Just because a treatment precedes a recovery does not mean it caused the recovery. Often patients seek help when their symptoms are worst, when the only way they could change is to get better. The argument that, in a free country, people should be allowed to choose what therapies they take is stronger, but only if patients are told the facts about those nostrums. And once they know that they’re getting a placebo, its effectiveness will mostly crumble. It has also been suggested that homeopathy helps GPs divert chronic time-wasters. Convenient, perhaps, but dishonest; like magic potions, lies have no place in a doctor’s black bag.
Posted on February 25, 2010 at 8:56 pm
Dismissing a medicine becuase you believe its mode of action (e.g.'water memory') is implausible is an irrelevant distraction.
Let's not forget that for decades we thought stomach ulcers were caused by stress, and laughed at the idea that bacteria could be responsible. Now we take it for granted that we can cure such ulcers with a suitable antibiotic, but the discovery was hampered because the mechanism was considered implausible. On that basis the effects of antibiotics are indeed 'magic'!
It is completely irrelevant whether homeopathic pills have any active molecules in them or not - you are making assumptions about their mode of action. The only relevant point is that there is virtually no reliable evidence that they work in controlled trials - which suggests all the reported effects are due to placebo.
However, a recent Cochrane review of 75 trials of seasonal flu vaccine found that there is littel evidece for its benefits above placebo. One of the reviewers, Tom Jefferson (writing in the BMJ) found "In children under 2 years inactivated [flu] vaccines had the same field efficacy as placebo, and in healthy people under 65 vaccination did not affect hospital stay, time off work, or death from influenza and its complications." and was dismayed that there was very little research into adverse events [http://bmjcom.highwire.org/cgi/content/full/333/7574/912]
Are we as ready to demand that seasonal flu vaccine be banned from the NHS because there is no evidence of efficacy?
Few of the 'rational' critics of homeopathy are willing to say so. This smacks of just the double standards that the public suspects is behind this debate. We say 'evidence is needed if we are to spend tax payers money on medicine', but all go quiet when the medicine in question 'ought' to work. Our rationalism about 'mechanism' can lead to such bias.
Many of the medical rationalists do not seem to realise the degree of distortion in the evidence base they rely on. The unhealthily close ties between the pharmaceutical companies, the regulator (MHRA) which is funded by those companies, and the NHS is well documented - read the select committee report 2004/5 [http://www.parliament.the-stationery-office.co.uk/pa/cm200405/cmselect/cmhealth/42/42.pdf] - it's pretty damning.
In the case of 'evidence based medicine' consider statins (for example). There is a huge amount of evidence of manufacturer bias in the trials, widespread duplicitous promotional material and no systematic study of the side effects. recently it comes to light that they increase the risk of diabetes. But we are told they 'still do more good than harm' - a totally unacceptable assertion based on the very dubious nature of the evidence.
Prozac was licensed by the FDA in the usa on the basis of 2 positive trials, despite the fact that 60% of trialsd could not find any benefit above placebo!
For any medicines where the side effects are real you have to show that the total harm done is less than the total benefit. Random controlled trials are only applied to the benefits. The side-effects are never measured precisely - they rely on anecdotes. Hence the benefit to risk ratio is never established. So much for evidence based medicine!
Posted on March 8, 2010 at 12:17 pm
@ Tiffany…sheesh, OW. Nothing like an application of anti-histamines (or, hell, soap) when a bee venom pill will do
@ Everybodyknows…you seem to have stormed in here to wave your hobby-horse about in the manner of a well-worn Truther…you may make a decent point about the placebo effect being more commonplace than suspected, if your facts are correct, but the point stands that if homeopathy is advertised as carrying an active ingredient, it darn better contain that active ingredient, otherwise it's just holy water. Now, I am *very* interested in the effect pharmaceutical companies have upon policy, and to what extent illnesses are industries, so if you have more along those lines I'll be intrigued to hear it.
Posted on March 15, 2010 at 6:02 am
homeopathy has its own methodology & science. trying to understand homeopathy from conventional scientific method is completely illogical.failure of conventional science & medicine to cure multitude of chronic diseases shows that only conventional scientific approach to deal with diseses is not sufficient there is a dire need for an altrenative approach ,an alternative science & homeopathy has filled this vacum & millions of pts have experienced healing effects.only those fields which comply with conventional science are not usefull but there are other sciences also which are equally usefull to humanity. please dont reduce everything to conventional science becoz this world need other alternative sciences too. humanity has vastly different kinds of health related problems & only single approach of conventional science/medicine can not tackle all.
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Posted on February 25, 2010 at 1:11 pm
Thank you for pointing out that homeopathy is not the same as herbalism. I think the two terms are often erroneously used as synonyms.
True story: I was once strung more than 100 times by bees. The woman responsible for my well-being at the time refused to take me to a doctor (she obviously had never watched 'My Girl' with Macaulay Culkin) and instead gave me homeopathic tablets with bee venom to place under my tongue and made me eat honey cake. I survived, but my face swelled to twice its size and I was stratching bee stingers from my scalp for days.