Homeopaths Without Borders practice exploitation not humanitarianismBMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f5448 (Published 17 September 2013) Cite this as: BMJ 2013;347:f5448
All rapid responses
T. H. Huxley summed it up perfectly: "The great tragedy of Science — the slaying of a beautiful hypothesis by an ugly fact"
It would be lovely if there was a safe, gentle, effective cure for all diseases that had no side effects and relied on a universal model of disease that could be expressed as simply as "like cures like".
Sadly, the reality is a lot messier.
On the other hand, it is probably just as well that homeopathy does not work as advertised. Homeopaths claim to stimulate the immune system; as one who has suffered from autoimmune diseases, I am profoundly glad that this is not true - or every glass of water would be a major gamble!
Competing interests: No competing interests
David Shaw expresses opinions that are trenchant or tendentious, depending on whether one denies or supports the effectiveness of homeopathy.
There is no point in trying to change his mind.
Denialism, of the roundness of the earth, of evolution, of the usefulness of homeopathy, has always been around us.
The mindset and psychological mechanisms that enable people to go on denying the increasing evidence for the cause of global warming have recently been reviewed in fascinating detail. (1)
No matter how much evidence accumulates for the nature of global warming, or for the effectiveness of homeopathy,(2), denialism resists any change of view.
Medical homeopaths accept that colleagues find it difficult to incorporate the practice of homeopathy within the scientific paradigm that we take for granted in our professional and every day lives.
So do we.
But we see, with life long astonishment, the effect it can have on our patients.
And their pets and farm animals.
We are sceptics to our bone marrow, but not dismissive and contemptuous of what seems to make no sense, at first sight.
We are tired of talk of placebos.
Any half decent doctor should have used the placebo effect twenty times before lunch.
We would rejoice at the chance to share our homeopathic experiences with colleagues, to give them the opportunity to increase the satisfaction of their professional lives, and to benefit their patients.
In return, much abuse, name calling, and accusations of unprofessional behavior.
And an unwillingness to meet and converse, on the one hand; on the other, an unwillingness to carry those accusations to their logical and dutiful conclusion.
Shaw’s ‘Personal View’ is very personal.
A collection of opinions and assertions about people he likely has never met nor observed in action, people whose motivation and behaviour he dismisses with distaste.
Many pages would be needed to disentangle the value judgements and non sequiters which bind his piece together.
Where is there any indication of the experience and knowledge to support his opinions ?
One assertion, central to his attack on Homeopaths without Borders, is that “ people affected by massive earthquakes cannot benefit from homeopathy any more than people living safely in London.”
Is this based on his experience ?
I have no connection with Homeopaths without Borders, and have not been to Haiti, but did spend four winter months, as a volunteer with Medecins du Monde, in the mountains of Northern Pakistan, immediately after the massive earthquakes and landslides of late 2005.(3)
The severely injured were moved to hospital, or died , within a short time. The vast majority of people that we saw in the IDP camps, and in ‘unofficial’ camps in the mountains, did not have life threatening physical diseases. Many had ‘whole body pain’ and musculoskeletal problems, compounded by suppressed or overt grief/separation/loss/trauma reactions, in the absence of any psychiatric service to help them.
We prescribed many antibiotics, far too many, loads of paracetamol, and gallons of benzyl benzoate.
At the time ,and in retrospect, many people would have been much better served by homeopathic remedies, which work so well for musculoskeletal pain, for emotional trauma, and it’s physical effects.
The pharmacy store contained enough injectable antibiotics to treat an Asian pandemic, and boxes piled high, of ‘donated’ drugs, near their ‘use by’ dates.
My experience suggests that the people of Haiti may have enjoyed more relief from homeopathy than Shaw could ever imagine.
Shaw , with no medical nor homeopathic experience, and with little apparent inclination to enquire from those with some insight into such situations, has an opposite opinion.
So be it.
Shaw’s remarks seem to suggest that people in developing countries are obliged to choose between what he regards as useless homeopathic remedies, and more effective conventional medicines.
That situation rarely arises in Africa, where homeopaths are very few and far between. Where it does occur, interesting things happen.
Quite recently, visiting a very remote Masai village, with a small clinic and resident nurse, funded by an NGO, we were asked to replace the absent nurse for a morning clinic.
Many mothers and babies, not seriously unwell, but curious to consult the visitors, were given some few homeopathic tablets. Our local translator told us that most were a little disgruntled to be given a few small white tablets, instead of the variety of larger coloured capsules that they usually received.
A look at the clinic day book confirmed that multiple prescriptions were the norm.
The nurse had little choice, or patients would travel to the nearest government clinic, for more generous supplies.
This is not what we were taught to expect on the excellent London DTM&H course, but outside of the few academic centres, and certainly beyond the metalled roads , such experiences are commonplace.
The vogue for ‘syndromic management’, in recent decades, may be partly to blame.
The implications of such inappropriate conventional prescribing would be a good subject for Shaw to address, and it might help him to understand some of the complicated cultural, and therapeutic issues that surround the prescription of any sort of medication.
Shaw mentions Kenya, and writes about the training of local homeopaths.
In recent years it has been my good fortune to practice and teach homeopathy, and basic medical sciences, in two subsaharan countries.
Contrary to Shaw’s assertion that “ homeopathy is not real health care“ my conscience is clear that my tiny contribution may help, not hinder, the skeletal health systems and local people in those poor, often undoctored areas.
My NHS appraisers agree, when we discuss these issues on an annual basis.
It is clear, from his assertions, that Shaw regards homeopaths, like me, as deceivers and exploiters of students and patients.
As a professional ethicist, he surely has a duty to report me to the GMC ?
In the past year, at least six of your responders, who have accused homeopaths of unethical conduct, of lying to, and deceiving patients, have not acted on my suggestion that they should refer me, an avowed homeopath, to the GMC.
Given their accusations, they are obliged to do so.
What explains their reluctance, and what explains your reluctance, dear editorial team, you who facilitate, not moderate, their accusations. ( Shaw’s piece was ‘ not commissioned; not externally peer reviewed.’)
Where do you see your professional duties, in safeguarding patients, and in not bringing the profession into disrepute ?
Perhaps we should be told ?
1 Engaging with Climate Change. Psychoanalytic and Interdisciplinary perspectives.
Ed. Sally Wintrobe. Routledge.
Competing interests: About a dozen working visits to developing countries since 2006. Self funded, except for 4months with MdM in NWFP. Free accommodation in Botswana, Kenya and Lesotho. In conventional and homeopathic roles. No income from homeopathy, no money,fees, ever accepted from patients in UK or abroad.
Dr. Thompson demands "balance". This is fallacious.
In medical science, as in all science, any compromise between a correct statement and an incorrect statement is an incorrect statement.
Science has a complete explanation for all the observations seen in respect of homeopathy; this explanation is also consilient with other scientific findings.
Homeopaths offer an incomplete explanation which is in serious conflict with other areas of science, including some of the most robustly tested knowledge we have. This explanation invokes principles presented as laws, but which are without foundation in fact. For example, there is no "law of similars". Like does not cure like, as a general rule, let alone as a sole basis for cure.
The thing that rally baffles me is that a medical doctor can believe in both medicine and homeopathy. This is a bit like believing in evolution during the week and young earth creationism on Sundays! I'd be interested to hear how the medically trained homeopaths reconcile medicine with a belief system that was defined at its outset and at all times since by its opposition to, antagonism towards, and exclusivity from medicine.
Competing interests: No competing interests
Dr Andrew Sikorski misunderstands the intellectual position of sceptics. They are the very reverse of `arrogant', as they simply ask for evidence. Should they be castigated for publicly stating that the evidence for homeopathy is poor?
Dr Elizabeth Thompson cherry-picks the evidence. Any competent researcher will hear alarm bells at the term `sub-group analysis'. She also ignores the matter of trial quality, which is inversely related to effect sizes for homeopathy (1).
Both contributors need to understand the difference between evidence and opinion. Balancing an argument based on evidence, with an opinion based on imagination, is no balance at all.
Critical thinking is essential for all professions, and especially for medicine. I thought it was taught in medical schools.
1. Linde K, Scholz M, Ramirez G, Clausius N, Melchart D, Jonas WB. Impact of study quality on outcome in placebo-controlled trials of homeopathy. J Clin Epidemiol. 1999 Jul;52(7):631-6.
Competing interests: I have worked for 35 years on clinical trials for medicines.
If the homeopaths are asking for financial support, perhaps they would find donations of purses or bags that once contained money acceptable.
Competing interests: No competing interests
I refer to Dr Andrew Sikorsk's rapid response.
"The author ignores the fact of wide use of homeopathy alongside standard medical practice throughout Europe where Homeopathy is recognised as being effective and regarded as a useful part of standard, recognised healthcare."
Please state which European countries have wide use of homeopathy alongside standard medical practice. Please also state which countries have national health care systems that support/subsidise/provide homeopathic care.
For the benefit of concrete example, I consider the term "wide use" as involving more than 30% of standard medical practice which also include homeopathy. I also consider the phrase "throughout Europe" to involve at least 50% of European countries (in EU that means 14 out of 28 countries)
I consider the core practice unique to homeopathy to involve remedies prepared by repeatedly diluting a chosen substance in alcohol or distilled water, followed by forceful striking on an elastic body, the dilution usually continues well past the point where no molecules of the original substance remains.[Modified from wikipedia]
"It is indeed quite clearly wrong to use homeopathy instead of standard care, yet when used alongside standard care, or where there is no standard care the benefits to suffering patients are to be lauded rather than upbraided in a biased and ill-informed sensationalist and sanctimonious manner."
I do not understand your stance on why you consider it wrong to use homeopathy INSTEAD of standard care, if you believe homeopathy works as well as standard care. I also do not understand the assertion that homeopathy should be used where there is no standard care since the patients will be lead to believe that should not try to seek standard care as they are getting homeopathic care.
Please educate me.
Competing interests: I do not believe that homeopathy works and there is no robust evidence to proof it works either.
The response of the homeopath to this article is regrettable. To deride the article as an arrogant attempt to dictate what is best by narrow minded scientists is typical of their defensive posture when their activities are exposed to any light.
I think it is valid to question the activities of any group in a disaster zone - and yes we do need to look for what is 'best' in any scenario - it is our duty.
All valid trials (but not the weakly designed ones touted by homeopaths) show that homeopathy is placebo. And that's fine. But;
1) be honest about that, please
2) don't use it in acute scenarios, and do not describe it as life saving when it cannot be.
To defend homeopathy on the basis purely that some patients like it is misleading as to the nature of the placebo effect. People like rituals, and the placebo effect is powerful, but it does not fix a broken leg, a ruptured spleen and infectious diseases to name but a few.
Competing interests: No competing interests
I am writing this letter at midnight, having foolishly taken the BMJ to bed with me to catch up on all matters medical. Reading David Shaw’s opinion piece ‘Homeopathy is not humanitarianism’ has left me too angry to sleep; not so much angry with him but with Fiona Godlee who has repeatedly let these opinion pieces go out without any recourse to a balanced debate. A clear problem in the way David Shaw sets out his argument that the clinical use of homeopathy is unethical (either here or abroad) is the fact that he is so convinced there is no evidence for the biological and clinical effects of homeopathic medicines. He, like so many others, entranced with the likes of Simon Singh and Edzard Ernst and the advertising mantra they have used, believes that there is no evidence for homeopathy. Undeniably, they have won the media battle but what about the battle for truth?
Such a culture of contempt for homeopathy now exists that when I speak to colleagues they imagine I am lying about the evidence, and they rarely take the trouble to look at the basic research and trial data themselves, so impressed are they by the bright young things of medical journalism. Consider these few examples: just one strand of basic research demonstrates the influence of homeopathic dilutions of thyroxine on the metamorphosis in frogs;1 there is evidence for a clinical effect of homeopathic medicine in improving diarrhoea in children in Nicaragua;2 subgroup analyses of homeopathy for upper respiratory tract infections in children shows odds ratios suggesting that the clinical effect is more than a placebo effect.3 This lack of curiosity for researching non-pharmaceutical approaches is a paradox in the face of the acknowledged consequences of the highly invasive interventionist model of healthcare prevailing in the western world. We have almost forgotten that self-regulation and the promotion of self-healing are possible.
These are important issues when attempting to move towards a model of sustainable healthcare both here and in developing countries which lack resources, and in situations of natural disaster where biomedical aid is scarce – situations in which Homeopathie Sans Frontiers offers relief.
Suggesting that the use of homeopathy is unethical is an unwarranted and insulting accusation to someone like myself – an NHS consultant delivering much-needed care every day to many patients trapped in the despair of a range of illnesses, often multi-morbidity, and failed or at least disappointed by conventional medicine.
I would like to suggest to Dr Godlee that if, in future, she decides to give space to the detractors of homeopathy, then those of us who actually have extensive clinical and research experience of the use of homeopathy should be offered the opportunity to reply in the pages of the journal. Or is a genuine debate about homeopathy something the BMJ wants to avoid?
Dr Elizabeth Thompson, DMOxon, MBBS, MRCP, FFHom Lead Clinician/Consultant Homeopathic Physician and Honorary Senior Lecturer in Palliative Medicine
Bristol Homeopathic Hospital at South Bristol Community Hospital
University Hospitals Bristol NHS Foundation Trust
Hengrove Promenade Bristol , BS14 0DE
1.Endler P, Thieves K, Reich C, Matthiessen P, Bonamin L, Scherr C, Baumgartner S. Repetitions of fundamental research models for homeopathically prepared dilutions beyond 10-23: a bibliometric study (2010). Homeopathy; 99: 25–36.
2.Jacobs J, Jimenez LM, Gloyds SS, Gale JL, Crothers D (1994). Treatment of acute childhood diarrhea with homeopathic medicine; a randomized clinical trial in Nicaragua. Pediatrics; 93: 719–725.
3.Shang A, Huwiler-Muntener K, Nartey L, Juntherapiesi P, Dorig S, Sterne JA, Pewsner D, Egger M (2005). Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet; 366: 726–732.
Competing interests: No competing interests
Having noted the comments from an engineer and pilot, I side with the pilot as having greater understanding of the needs of a person, whilst the products of engineering are of use BY a person. Mr Chapman is associated with groups of fanatical anti-homeopath bloggers, self-termed 'skeptics' (Nightingale Collaboration, Sense about Science) who arrogantly 'know best' what patients should receive and similarly what doctors should do. The author ignores the fact of wide use of homeopathy alongside standard medical practice throughout Europe where Homeopathy is recognised as being effective and regarded as a useful part of standard, recognised healthcare. It is indeed quite clearly wrong to use homeopathy instead of standard care, yet when used alongside standard care, or where there is no standard care the benefits to suffering patients are to be lauded rather than upbraided in a biased and ill-informed sensationalist and sanctimonious manner. Many doctors are trained in both conventional and complementary therapies and work for the benefit of their patients. It is curious how their views and clinical experience are air-brushed out of the medical literature.
Competing interests: NHS GP and Homeopath/ acupuncture practitioner
RJ Herrmann is wrong when he says that homeopathy only suffered setbacks when the AMA took against it; he's also wrong about their motivation for doing so and I think this stems from a false impression among homeopathists as to the origin of the animosity between medicine and homeopathy.
Homeopathy's popularity declined steadily during the 19th Century as the field of medical science developed and the practice of medicine became less like witchcraft. One of the earliest critiques of homeopathy was published in 1840 (Oliver Wendell Holmes Sr., Homoeopathy And Its Kindred Delusions), seven years before the AMA was even founded.
The AMA was (and largely remains) opposed to all superstitious practices; the defining characteristic that separate medicine from the various pre-scientific traditions is the exercise of medical science to examine and improve practice and I do think that a certain impatience grew up with those who clung to outdated beliefs in the face of this. Homeopathy, by contrast, has not developed at all, presumably because it lacks any mechanism for systematic objective inquiry - any application of honest science shows, as apostate homeopath Professor Edzard Ernst has pointed out many times, that the core doctrines are wrong.
It was Hahnemann himself who consciously and deliberately defined homeopathy as being apart from, and an enemy of, medicine; he savaged doctors who practised both as committing "treason against divine homoeopathy". This attitude of enmity towards medicine remains endemic in homeopathy today despite the fact that the practice of medicine has changed beyond all recognition. Homeopaths are typically supportive even towards practices with mutually exclusive philosophies, such as acupuncture, reiki, chiropractic and even naturopathy, which is "allopathic" by any meaningful definition - "my enemy's enemy is my friend" it seems.
But the medicine Hahnemann despised no longer exists, and hasn't existed almost since the time of his death. It is a completely different creature to medicine as we know it. It's not even obvious to me that evidence based medicine can justly be said to be descended from "heroic medicine", any commonality of individuals seems to me to be largely accidental as heroic medicine was entirely discarded really quite early.
The resurgence in the latter part of the 20th Century of fanciful notions such as homeopathy seems to me to be ironic: it is a consequence of the emergence of the "worried well" as a dominant factor in healthcare, which is, of course, a side effect of the success of evidence based medicine. Thanks to medicine we are much less likely to die of infectious diseases, childbirth and trauma - we live longer, with inevitable consequences for a body evolved to live to what is now only middle age.
At the same time medicine has become more honest. Sir Lancelot Spratt was a dying breed even in the postwar years, these days the informed patient is welcome and evidence is openly discussed. Peddlers of "woo" exploit this while dismissing as "bias" the findings from precisely the same kind of science, that their treatments are worthless or even harmless.
A recent cartoon summed this up beautifully: two desks, with signs offering "unpleasant truths" and "comforting lies". The former has nobody in line, the latter a long queue.
So we have a situation where the Advertising Standards Authority appears to be the only body with the guts to tell it like it is. Homeopaths, reiki practitioners, crystal healers and others have been told that their advertisements are not "legal, decent, honest and truthful" because they make claims to cure disease, and their reaction seems to be to assert a "different truth" - a parallel universe, perhaps, in which the laws of physics are profoundly different.
It is this kind of advertising, and these claims, that delude people into thinking that homeopathy works and that taking quackery to a disaster zone is "humanitarian".
We must give such views short shrift. Messing about with quack nostrums that have no credible evidence is a harmless bit of nonsense for the worried well, but is a pressing public health risk when real illness is involved, and a monstrous fraud on the vulnerable when it's taken to disaster areas where critical thinking is unlikely to be top of the list for people suffering injury, disease and hardship.
If homeopaths want to be tolerated they need to stick to the agreed fudge of only pretending to cure minor self-limiting ailments. Stray into cancer, vaccination, serious disease or disaster areas and they cease to be an ignorable sideshow: they may attract attention they do not want.
Competing interests: No competing interests