Clinical Review ABC of complementary medicine

Homoeopathy

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7217.1115 (Published 23 October 1999) Cite this as: BMJ 1999;319:1115

Re: BMJ Debates Homeopathy: 1990s or 1840s?

· A response to Peter Morrel

Debate of the 1840s is revisited
“EDITORVickers and Zollman's article on homoeopathy was a balanced account
of homoeopathic medicine.”

I disagree

“ However, the ensuing dialogue between medicine and "evil quackery"
shows some parallels with that in the 1840s.
In both cases, the engagement has been vigorous and hostile; alternative
medical systems were booming then, just as they are today.
The pressure of public popularity is driving the worldwide growth of
alternative medicine.
Clearly patients who turn to alternative medicine are unhappy with some
aspect of conventional treatment, and they should reveal their motives to
their doctors.
Unless their disappointments are addressed, more patients will inevitably
flock to such therapists.

Holistic treatments may offer slender hope to patients, but they seem
to prefer hopes to drugs and surgery.”

True. I think there are many complex reasons for this. I think we
have a very strong need to make sense of our lives, to have stories that
are plausible, so that the frightening random element is diminished.

Science based medicine is rightly cautious about supplying these.
Quacks are fountains of them, Implicit and explicit.

Our bodies are a great vulnerability, but we feel strongly that we
are not merely bodies. This illusion of dualism is a very natural and very
strong one: For centuries it was believed that physical deformity was a
manifestation of moral deformity. Why else would God have made some people
deformed? Although I haven’t heard this one from a quack recently their
rationale is routed in similarly cosy parallels.

Thinking scientifically is likely to lead (perhaps unconsciously) to
some unpalatable truths, (come to think of it they hang in the air of
every hospital.): Life is short, arbitrary painful and pointless. The
good are unlikely to be rewarded.
Alternative medicine by contrast paints a view of life in which health and
happiness are the only natural consequences of being oneself, its just a
question of finding ones true self and restoring the balance with some
expensive tincture.
Is it ludicrous to suggest that people see their healers instead of going
to church?

“Many people refer to the unproved efficacy of homoeopathy and the
"ludicrous" nature of its minimum doses.
The usual argument is that because "it cannot work" therefore "it does not
work."

If I am not mistaken many aspects of anaesthesia were a complete
mystery until very recently; it didn’t stop it being a very useful tool
and very central to conventional medicine.

“Were homeopathy to prove an effective therapy, it would be
irrational for any legitimate medical practitioner to ignore or fail to
employ it.
Given the apparent lack of adverse effects from high dilution homeopathic
remedies, such a therapy should be readily embraced if it were effective.

Indeed, open-mindedness is one of the hallmarks of science and the
rapid assimilation of new therapies and technologies has been a consistent
characteristic of scientific medicine. In fact, studies have shown that
practitioners of mainstream medicine are less dogmatic than those of its
alternatives.
To quote the late Dr. Carl Sagan, "...at the heart of science is an
essential balance between two seemingly contradictory attitudes -- an
openness to new ideas, no matter how bizarre or counterintuitive, and the
most ruthlessly sceptical scrutiny of all ideas, old and new. This is how
deep truths are winnowed from deep nonsense."68 From "Homeopathy and
science a closer look"
David W. Ramey, DVM*
Mahlon Wagner, PhD^
Robert H. Imrie, DVM`
Victor Stenger, PhD#

“In the 1840s, Sir John Forbes, physician to Queen Victoria's
household, called "the infinitesimal doses" of homoeopathy "an outrage to
human reason."

Its successes were written off as "self limiting diseases."

But as patients know, few diseases improve when left alone.”

I disagree, though it’s certainly true that we like to feel we are
doing something other than suffering passively.

“ Thus, to claim that homoeopathy works because patients "would get
better anyway" does not square with human experience:”

Human experience is full of its own illusions; we often see what we
are looking for.

“ if doing nothing for self limiting diseases is the reason that
homoeopathy works, then why should anyone bother giving any drugs at all?”

Perhaps very often no drugs would be a good idea.

“It is doubtful that patients would pay high fees for treatments of
no value.”

Is it? Some people do yogic flying, others collect avant-garde art,
Chinese women had their feet bound. There is no end to the diversity of
culture. Can culture stand a vacuum? It would be very odd if bogus
therapies did not exist. Imagine a bogus therapy that has all the
qualities to survive and flourish and ask yourself how it differs from
homeopathy? A: not much if at all.

“The argument that they are rich and desperate (or stupid) enough not
to know whether a treatment works seems unconvincing.

Vickers and Zollman state that there is a lack of "evidence that
homoeopathy is clearly efficacious for any single condition."
How does one define "evidence" when homoeopaths deny the existence of
single conditions?”

Is this really a very robust strategy?

“ Trials of homoeopathy have been disappointing, but the weight of
anecdotal evidence must count for something.”

I was Ill (fill in the details) the doctors and specialist could not
help me but the homeopath, asking strange questions and finding my
constitutional type has cured me and now I can do x again which I couldn’t
do before."

This story is:

A: easier to tell than a more complex one

B: more likely to be told and repeated than a similar one with no
positive ending.

We may have a culturally embedded need to tell this or similar story.
Homeopathy is a process for generating these anecdotes.

“In the 1850s it was widely predicted that "medical fads" such as
homoeopathy would fizzle out in a few years.
That they have failed to do so either indicates that they do work or
stands as a testament to human credulity.”

The latter. Homeopathy does not stand alone in having fooled people,
although its products seem to enjoy a peculiar privilege in that they make
outrageous and unsubstantiated claims whilst having no active ingredient.
Any natural common sense view of fair trade is being violated. In matters
of health surely consumers have an even greater than normal right to
protection.

“The growing demand for these treatments is a central and
uncomfortable reality which medicine must face up to.”

Sad but true

Stephen Park

PS, I have no commercial or professional interest in this subject. I
am genuinely curious and therefore never satisfied by mumbo jumbo.
(Homeopathy is an endless source of this stuff). Where is the nitty-
gritty?
Homeopathy is an enormous industry precariously balanced on a stupid
falsehood. The prognosis is not good. Any careful reading of these
exchanges reveals that insiders in this vain and silly enterprise actually
carry this conclusion with them, a gene that must not be let out at any
time.
I was going to write a book on this subject but I’ve been beaten to it. I
can thoroughly recommend: Homeopathy What are we Swallowing? By Steven
Ransom. Credence publications. ISBN0-953512-2-1

I think I will work instead on a pamphlet, which might be entitled
”How to give up being a homeopath without feeling gullible and foolish”
there only one problem , I simply don’t know where to begin.

pps. Closed minds? In my experience an open mind would preclude
anyone from a career in alternative medicine.

Competing interests: No competing interests

04 June 2000
Stephen park
non medical lay person
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