Randomised controlled trials for homoeopathyBMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7354.41 (Published 06 July 2002) Cite this as: BMJ 2002;325:41
Providers have much to gain from homoeopathy being accepted
- Michael Foley, consultant anaesthetist (firstname.lastname@example.org)
- James Cook University Hospital, Middlesbrough TS4 3BW
- St Vincent's Hospital, Fitzroy, Victoria 3065, Australia
- Glasgow Homoeopathic Hospital, Glasgow G12 0XQ
- Australian Vaccination Network Inc, PO Box 177, Bangalow NSW 2479, Australia
- Glasgow Homoeopathic Hospital, Glasgow G12 OXQ
- Complementary Medicine Research Unit, Mail Point OPH, Royal South Hants Hospital, Southampton SO14 0YG
- Department of Psychology, University of Plymouth, Plymouth PL4 8AA
- Respiratory, Cell and Molecular Biology Division, Mailpoint 810, Southampton General Hospital, Southampton SO16 6YD
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 …