Posts Tagged Placebo

The Ethics of Homeopathy Jim McVeagh Apr 22


Dr Shaun Holt is no stranger to controversy, having last year laid into the Chiropractors. Now he, along with a number of other researchers, have written a letter to the New Zealand Medical Journal saying:

Practicing homeopathy or endorsing it by referring patients is not consistent with the ethical or regulatory requirements of practising medicine

This is unlikely to endear him to the many hundreds of GPs who use, or advocate the use of, homeopathic remedies! It certainly annoyed Susanna Shelton, co-president of the New Zealand Council of Homeopaths, who claims “homeopathy had been safely practised around the world for 200 years”. However, Shaun was not talking about the “safety” of homeopathy, but about the utility of it. If it does not work, it’s safety is a moot issue.

Shaun’s point is that it could be considered unethical to advocate a treatment that has no evidence backing it’s usefulness, particularly in the light of the Medical Council’s latest directive on alternative therapies which clearly states:

Doctors must inform patients on the nature of alternative treatments they offered, the extent to which they were consistent with conventional theories of medicine, whether they had the support of the majority of doctors, and their likely effectiveness according to peer-reviewed medical publications.

Unfortunately for proponents of homeopathy, a recent review of all the Cochrane evidenced-based reviews on homeopathy was less than enthusiastic. The article (found here) concludes:

The most reliable evidence – that produced by Cochrane reviews – fails to demonstrate that homeopathic medicines have effects beyond placebo.

Indeed, a quick trip through some of the latest issues of reputable journals such as Homeopathy, Journal of Alternative and Complementary Medicine and Evidenced Based Complementary and Alternative Medicine, reveals much waffle and little in the way of real science. Even the odd randomised trials are usually poorly done and use very small numbers of patients. The larger, better done trials invariably fail to show significant results. All in all, it is hard not to draw the conclusion that homeopathy is dependent chiefly upon the placebo effect.

Readers of this blog will know that I have a soft spot for the placebo effect. I believe it can be a very useful tool in medicine, provided that the doctor/patient relationship is robust enough to survive the eventual discovery that the medication is question is bogus. However, the basic problem with homeopathy is that it is all bogus and the placebo effect cannot be used blindly with every patient but has to be used sparingly and carefully when appropriate. I therefore tend to agree with Shaun that it is difficult to approve of the wholesale use of homeopathy in a doctor’s practice.

Supporters of homeopathy usually point out that it is harmless and relatively cheap and that it does have anecdotal benefits, though it is usually uncertain whether these benefits are derived from the holistic and detailed manner of the consultation or the “medicine” itself. Unfortunately, homeopathy has a number of undesirable effects that far outweigh its nebulous gains.

  • There is a substantial risk that patients may not seek conventional care in life or limb threatening situations. Shaun makes this very point in the Herald article. The situation is made more dangerous by the fact that homeopathy practitioners have a distinct aversion to “allopathic” medicine and tend to avoid referring back to conventional doctors.
  • Scarce resources are wasted on homeopathy. While the first point is well-known, it is not really appreciated that valuable resources are being wasted in terms of doctor’s time, patient’s money and manufacturing equipment, to name a few. This is not as acute a problem in New Zealand (where few public health resources are spent on homeopathy) as it is in the US, where there are entire hospitals and clinics dedicated to the subject.
  • Support for science-based medicine is weakened. It is quite likely that some commentators will get quite hot under the collar telling me all the faults of conventional medicine. Some of these criticisms may be justified but a great many will be based on an antipathy toward scientific medicine that is wholly unjustified. The vaccine debate would be an excellent example of this effect, but homeopathy provides good fodder for some of the more flakey responses to medicine.
  • Support for genuine complementary therapies may be weakened. There are some alternative therapies such as acupuncture and meditation, that produce verifiable, evidence-based results. Yet these therapies run the risk of being dismissed by doctors and patients being bombarded by ludicrous claims from myriad other complimentary “therapies”, including Homeopathy. (source: Smith K. Against Homeopathy – A Utilitarian Perspective. Bioethics – epub)

The conclusion is therefore inescapable that homeopathy is not a harmless thing that slightly flakey patients go for. It is not a valid therapeutic modality that doctors can use. It is a deeply anti-scientific subject of dubious merit that subtly undermines every that medicine stands for. Doctors who use it should seriously consider the ethics of their stance.

PS: You can find a poster size version of the wonderfully rude graphic right here.


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