Providers have much to gain from homoeopathy being accepted

EDITOR—Debates generated by the lack of evidence of benefit of screening for breast and prostate cancer are similar to the argument for lack of effectiveness of homoeopathy. How does one show a lack of benefit in the face of wishful thinking by both customers and providers, particularly when the providers have a financial interest in a positive outcome? And, as an anaesthetist and non-user of any of these services, why should I care?

The answer is given by Feder and Katz, who point out that patients can be referred to homoeopathic specialists in the NHS or general practitioners who prescribe homoeopathically.1 Consumers of these resources should have a duty to show a benefit from any consultations or treatments provided, and the fundholders should have a duty to withhold funds in the absence of such evidence. If the customers then wish to purchase treatment that is not beneficial they will of course be free to do so and the homoeopaths, iridologists, colonic irrigationists, and the rest can flourish.

As the editorial points out, meta-analysis of results of trials of homoeopathic treatments suggest benefit greater than placebo in some cases, but this can easily be discounted by publication bias. Statistically, some trials of homoeopathic treatments will show some benefit even when the real effect of the treatment is zero, and these are the trials that are most likely to be published.

Homoeopaths argue that their treatments are not amenable to statistical analysis in the same way as conventional medicine is, in part because most trials of homoeopathic medicines do not individualise treatment. I can give an example from my own practice: anaesthesia for coronary artery surgery. In this, treatment is tailored to individuals, whose coronary anatomy is unique, yet statistical analysis shows an aggregate beneficial effect from treatment. This is how …