The Ethics of Homeopathy

By Jim McVeagh 22/04/2011 7


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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7 Responses to “The Ethics of Homeopathy”

  • Ben Goldacre in his book wasn’t too keen on acupuncture either. He wrote that studies have shown no difference between real acupuncture (where the needles are placed at the correct points), sham acupuncture (where the needles are stuck in any old how), and just poking people with toothpicks (which don’t pierce the skin).

  • I agree almost completely.

    The one place I diverge is in calling acupuncture a “genuine complementary therapy.”

    The better studies, as documented in Cochrane reviews, show that the results from acupuncture are almost identical to placebo. As a result, any beneficial results from acupuncture would also appear to be due to placebo from the doctor/patient relationship.

    It also appears that acupuncture is not ancient, chinese, nor medicine – see http://www.sciencebasedmedicine.org/?p=10254

  • PC gone mad. Who are you to tell consumers what they want? If people think they want homeopathy, it’s the doctors’ right to offer it. Whether that’s useless or not is besides the question. It’s a question of supply and demand. Otherwise we’ll simply be socialising medicine by stealth.

    • amiba:

      It is not my job to tell consumers (we call them patients) what they want or should pay for. But it IS my job to tell them what is likely to work and what isn’t. I am paid for my professional opinion.

      It is also incumbent on me not to advocate things I either no nothing about or know do not work. The latter is known as quackery. The former is simple dishonesty.

      May I point out that the Nigerian internet scammers are essentially selling the same things as homeopathy (get rich magically as opposed to get well magically) – I don’t hear anyone suggesting that people have a “right” to be scammed financially, so why do they have a “right” to be scammed medically.

  • repton and stuartg:

    I am aware that Cochrane is less than enthusiastic about acupuncture. It is certainly not my first port of call in chronic pain (the only place where there may be some real value). However, the literature is not particularly convincing either way (whereas it seems quite clear that homeopathy is no better than placebo).

    I’m not convinced that the “placebo needles” in some research really fool patients. I’ve seen them in action and I am not convinced that patients cannot tell the difference. The operator can also tell, so these studies are by necessity single-blind.

  • I personally give Acupuncture a lot more room – this is a practice that was once called the Chinese Medical Sciences. The main reasons for this is that the Chinese Scientists were very skeptical and methodological in their approach. Especially in the 16th and 17th century during their own mini-renaissance, though there were earlier very influential thinkers and practitioners too every couple of centuries. If you look at the “classic” texts, actually very little of what is in there is practiced today. Already this is a good sign. Needham’s _Celestial Lancets_ (Cambridge, ~1990 IIRC) is very good for an introduction to this history of skeptical discovery.

    Acupuncture is one of the few “CAM” practices which does have positive results, and the empiricism of the Chinese is surely to credit for it. It is widely employed by the physiotherapy community for instance, and it’s really hard to argue that for local acute afflictions, sticking a needle in, creating a knot of tissue around the tip of it and yanking it doesn’t do something. Stem cells specialize based on the shape of connective tissue around them; the mechanisms for direct tissue stimulation affecting local cellular function are there. Plus, the “channels” correlate very closely to fine detail of the lymphatic system, as shown by radiotracer studies. These channels are the grain of connective tissue; yielding a potential mechanism for the distal effects which may be observed.

    As far as I’m aware there is yet no appropriate mathematical or objective model to describe the diagnostic process; without this it’s hard for me to take studies discrediting them seriously. And unless they reference authoritative works such as Morant’s tome, _L’Acupuncture Chinoise_ (~1955) which translates the 17th century synthesis, Zhenjiu Dacheng, they could simply be testing a straw man. Another good book is _Acupuncture research: strategies for establishing an evidence base_ by MacPherson.

    It may well be that a great deal, perhaps the majority of applications of acupuncture are placebo – but I expect there are some surprises to be found in making this very old field rigorous.

  • Sam Vilain,

    You should be aware then that the Chinese actually banned acupuncture (for a time at least) as it was considered inferior to Western medicine. My impression is that it remained because it held the popular mindshare, not because it was effective or the Chinese medical expertise thought it was effective (they banned it, after all).

    My recollection is that there controlled studies of acupuncture and that these show that it had no effect beyond placebo. I haven’t time to chase it up I’m afraid.