Should doctors recommend homeopathy?
BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h3735 (Published 14 July 2015) Cite this as: BMJ 2015;351:h3735
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Dr Lewis demonstrates his sharp scientific and unassailable scrutiny by quoting a highly amusing comic you tube clip made by professional comedian entertainers as the last word on homeopathically prepared NHS prescribable therapeutic medications. We should all pack our bags and exit the debate forthwith.
Perhaps our psychiatrically challenged medical student colleagues mentioned in the media recently would do better by drinking more of that homeopathic lager?
Competing interests: No competing interests
Nothing I say would have the slightest effect on William Alderson's nor Noel Thomas' conviction that homoepathy works, despite the patent lack of RCT evidence at the level required by NICE.
But hey, why worry ? Go with the flow and lighten up !
Liam Farrell both said it better -
http://www.bmj.com/content/340/bmj.c2492
And Mitchell and Webb have demonstrated the overwhelming case for lifesaving homeopathy in A&E -
Competing interests: No competing interests
Because he believes that it is not effective and not credible, L Sam Lewis proposes: 'Let homoeopathy remain a choice, but please, NOT at NHS or taxpayer expense.'
Patients and practitioners have made the point again and again here that homeopathy has provided real benefits. The only response has been to call such first-hand testimony 'anecdotal'. On the other hand, the results of an experimental conventional medical treatment on a single patient can make headline news with no cries of 'anecdotal evidence'. Why is a single conventional medical case study acceptable, but any number of homeopathic case studies are not?
Patients and practitioners have pointed out that use of homeopathy is safe, and there has been no evidence to contradict this. The only argument has been based an extremely poorly researched paper puffed up into a website.
Patients and practitioners have pointed out that homeopathy is often cheaper than the conventional medical drugs, and has been found to help patients when those drugs have failed, as in the study at Bristol Homeopathic Hospital.[1] They have also pointed out that the cost of drug failures dwarfs that of homeopathy in the NHS, so the financial argument is clearly a blind. Any real concern about wasted money would focus on those expenses.
The vast majority of those paying for the NHS will use only the tiniest fraction of its services, so should they have the right to decide that all the other services which they have not used should not be funded by them, even though others have benefited from those services? This would destroy the whole rationale of a health service.
In 2009 H:MC21 published a survey of Primary Care Trusts which found that only 14.3% of those surveyed had any evidence that those making decisions about access to homeopathy have professional knowledge of the principles and practice of homeopathy. Even then they could only say that some of these people had some knowledge.[2] I very much doubt that Care Commissioning Groups are any better informed or any more conscientious about making sure that they receive advice about homeopathy from appropriately qualified people.
Competent medical decisions depend on knowledge, but those opposed to homeopathy seem determined to stifle all attempts to gain knowledge. This is bad medicine and bad science, and doctors should ask why the campaign is being pursued so relentlessly.
References
[1] Spence DS, Thompson EA, Barron SJ, ‘Homeopathic Treatment for Chronic Disease: A 6-Year, University-Hospital Outpatient Observational Study’, Journal of Alternative and Complementary Medicine, 2005, 11:793-798.
[2] William Alderson, 'Report of a Pilot Survey of PCTs and Their Provision of Homeopathy' (Stoke Ferry: Homeopathy: Medicine for the 21st Century, 2009) at http://www.hmc21.org/#/pct-survey/4535660289
Competing interests: No competing interests
Homeopaths will be grateful to Sam Lewis for his acknowledgement that we do no harm.
Those homeopaths who are are old enough, and were privileged to sit at the feet of sensitive and enquiring psychiatrists in days gone by, in therapeutic community settings, in Balint groups and in one-to-one consultations, need no reminding of the value of listening and dialogue.
Such communication is not a medical prerogative that comes with our degree. The sharing and listening that was part of the social cement, holding communities together, may have been a better guarantor of individual happiness than a sackful of citalopram.
Individual caring has diminished, with the fragmentation of communities and family networks, as our prescriptions for chemical replacements have increased.
A thousand thanks are due to those who still fulfill those listening roles.
Sensitive listeners will register the myriad life experiences retailed to them as they might the many multi coloured pieces of a jig saw puzzle spread out on a table before them. Putting the pieces together, discovering that some are missing, may yet produce a message or a picture which gives the subject transient catharsis and relief, but no more.
Psychoanalysis may last for years. Those lucky enough to find an NHS counsellor are allowed a dozen sessions at most. Results are not impressive.
Listening and words of support and guidance are important, but not always enough.
Homeopaths are fortunate to use a method of remedy selection that may enable them to choose a remedy (one of thousands) that fits with the the idiosyncrasies, the oddities, as well as the banal characteristics of the person’s personality and symptoms.
The hidden meaning of the completed jigsaw is revealed.
The method of remedy selection, helped by modern software, is much less tedious than older homeopaths remember, collating the clinical experiences of centuries of effective homeopathy.
Those of us, who have decades of experience at the NHS coal face, and who have as much scepticism as haemoglobin, in our bloodstream, are regularly astonished at the results we get.
Sam Lewis does not wish us to listen at length, and prescribe, at NHS expense.
One or two hours spent detailing the life of an ‘ADHD’ child may seem a lot. But if it enables child and family to live happier, less constrained, and drug free lives, is it not a tiny investment to improve the years ahead? How many visits to GP, CAMHS, and how many repeat scripts, will be avoided?
GP homeopaths who know their patients well are often able to prescribe within the ten minute appointment schedule.
General Practice is in crisis, we are told. Set about with guidelines, awaiting ambush by NICE, every morning surgery has a patient or two when the beleaguered homeopathic practitioner rejoices at the possibility of real change.
Why retire early when such satisfaction and opportunities beckon every day?
Michael Chelk (1) wrote of the dramatic relief that Arsenicum album gives to dysentery sufferers in Africa. I know of a recent case of a ten day history of infective dysentery and ‘no pathogens’ on stool culture in which the overnight response was dramatic to a few submolecular doses of that remedy.
A coincidence, of course. Like all the similar experiences of homeopaths world wide. (1)
Will Sam Lewis please explain why homeopaths are so prone to these amazing, very regular, coincidences, which just keep happening ?
They certainly make the practice of homeopathy a source of great satisfaction to doctor and patient, as well as some small saving to the tax payer.
1 Michael L Chelk http://www.bmj.com/content/351/bmj.h3735/rr-116
Competing interests: Peripatetic homeopath.
You make the reasonable surmise that homoeopathy is entirely harmless, and homeopaths appear not to have been responsible for deaths..
I would agree.
But there are hundreds of thousands of well-meaning people in Britain, who listen attentively, sympathetically and supportively to people in distress, over a glass of water ( or cup of tea, glass of wine, juice, or pint of beer ). I would say they were as effective, and a lot more credible. What's more, they do it from human kindness, and charge nothing, except perhaps, for the drinks !
Let homoeopathy remain a choice, but please, NOT at NHS or taxpayer expense.
Competing interests: No competing interests
Neither the Nightingale Foundation, nor Prof Ernst, nor his two co-authors, nor any journalists have answered my simple questions.
Almost four weeks have gone by.
I conclude that no medical homoeopath in England has killed any patient he (she) may have treated .
What a safe mode of treatment in the hands of a medically qualified homoeopath practising in England.
Competing interests: Still seeking precise answers to precise questions
Is it in any way curiously stimulating for this 'head to head' to have had over 6,600 visits to the podcast, 5,127 votes cast in the week long online poll (of which 62% were in favour of doctors recommending homeopathy) and to have attracted 100 rapid responses?
Is it not time for a wider awareness of Homeopathic Medicine in our profession, if only for the associated educational benefits of improving non-specific therapeutic aspects of doctor-patient encounters, let alone the awareness of and engagement with issues Dr Chelk has elucidated in his recent comments?
How can it not be time for a weekly column by a doctor homeopath in The BMJ?
Competing interests: NHS Physician incorporating complementary therapies
Although Professor Ernst believes that homoeopathy has no effect he still claims that it does harm because it precludes the use of some effective therapy. This presumably means the use of pharmaceutical drugs or surgery. It is a mistake, however, to assume that because they are different therapies people must use one or the other. Many people use both and many only turn to homoeopathy when conventional medicine has failed or its side-effects have become intolerable.
He also assumes that the conventional treatment he prefers is always safe and effective. As RCTs funded by pharmaceutical companies are four times more likely to be favourable than others the evidence for these drugs must be regarded as unreliable and BMJ Evidence calculates that the proportion of standard interventions supported by good evidence is only 12%. Add to this the use of untested polypharmacy, off-label prescribing, the prescription of drugs for life after short term trials, the use of untested vaccines and heart surgery that is no better than placebo and it is clear that Ernst is comparing homoeopathy with a perfect conventional system which does not exist.
In making this claim Ernst disregards the numerous side-effects (including death) which affect those treated with conventional medicine. His claim will also mean that conventional pharmaceutical medicine is the only therapy permissible and no other system may be used. Besides homoeopathy he rules out acupuncture, herbal medicine, ayurveda, Chinese traditional medicine, osteopathy and any other medical system there may be. This may be welcome to those who practice conventional medicine or who manufacture drugs but it will stifle the progress of medicine, prevent the development of new treatments and remove our freedom of choice. It is contrary to public policy that any one system of medicine should be able to impose itself and ban all others. There is no evidence that homoeopathy does harm. It was conventional medicine that gave us thalidomide, vioxx and lethal blood transfusions and it is conventional medicine that does harm to patients.
Ernst should allow patients the freedom to choose what treatment they wish to have. He may not agree with their choice but that does not entitle him to impose his own preferences on others.
Ernst continues his attack on homoeopathy by arguing that the cost of homoeopathy on the NHS should be spent elsewhere. The sums involved, £3m-£5m in a budget of £113 billion, are no more than 0.004%. This is trivial and considering the demand for homoeopathic treatment it is hopelessly inadequate. As a homoeopathic remedy for one month will cost around £30 while drugs may cost several thousands it is clear that the NHS must be incurring high additional costs by failing to use homoeopathy. There are many other costs that Ernst could criticise - the cost of unused surgical facilities, the cost of temporary nursing staff, the ever-increasing cost of drugs, the £116m cost of biscuits, cakes and pizza prescriptions (excluding handling charges around £20 per item) and, above all, the annual cost of medical negligence which has now reached £26.1 billion, 23.1% of the annual budget. If the NHS reduced this by a mere 5% it would save £1.3 billion, 260 times the cost of the homoeopathic services provided and would save patients some of the pain and distress they suffer now. If Ernst were genuinely concerned with NHS costs he would address some of these issues but his only concern seems to be to find an argument with which to attack homoeopathy.
Competing interests: No competing interests
Professor Ernst tells us that homoeopathic dilutions are "typically far too dilute" to contain molecules of any medicinal substance and cannot therefore be effective. He describes the homoeopathic system as "implausible" and says that it "flies in the face of science.....unless our understanding of the laws of nature is incorrect". Ernst presents the traditional argument against homoeopathy which has been put forward since 1850. The argument, however, is flawed.
The first problem is the low dilutions. The lowest homoeopathic dilution in use is the 1x which contains 10% of some medicinal substance and plenty of molecules. Other low potencies include the 6c which is commonly used and others going up to the level of 12c. Ernst muddies the waters by referring to "typical" dilutions and then rejects all dilutions, high and low, on the grounds that homoeopathic dilutions contain no molecules. There is no logic in that and the argument is invalid. Ernst is aware that low dilutions are used. He should explain how he came to use an argument that is invalid and say what grounds, if any, he has for rejecting low dilutions.
As regards high dilutions Ernst assumes that the absence of medicinal molecules will mean that they cannot have any effect. No evidence is provided to establish this and he has overlooked the findings of materials science. This shows that the properties of a dilution may be changed in two ways, by the addition of molecules, as Ernst is aware, or by any change in the molecular structure of the diluent. This falsifies Ernst's assumption that change can only happen if molecules are present. It can also be due to a change in the molecular structure even when molecules are not present and the method of preparing homoeopathic medication, serial dilution with succussion, could well have this effect.
There is also the phenomenon of epitaxy, known to materials science, by which one substance can transmit information to another without the transfer of matter, The effect of this does not last as long as the long term effects of homoeopathic dilutions but it conclusively disproves Ernst's assumption that molecules must be present. Here again his assumption is falsified by the relevant science. (See 'The Structure of Liquid Water; Novel Insights from Materials Research; Potential Relevance to Homeopathy' by Roy R et al. at http://ccrhindia.org/ijrh/3(2)/1).
I do not recognise Ernst's belief in immutable laws of nature because science never reaches finality. If science is the systematic pursuit of knowledge how can it stand still? Bertrand Russell said " Nothing in science is immune from further discoveries." (The Scientific Outlook, 55). Even the law of gravity was amended by Einstein. What grounds does Ernst have for assuming that the unspecified laws he refers to will not also be developed over time? Is he just describing his own views as the laws of nature?
Although he claims to speak for science Ernst begins with an illogical argument, rejects low dilutions without giving any reason, and gives no evidence to support his ideas about molecules and the laws of nature. He gives us nothing more than personal opinions which carry no weight in a scientific debate. He has only one argument against homoeopathy based on his assumption about molecules and when this fails he has no other grounds for opposing it.
I think that personal experience is more to the point than dubious theories about molecules. Over the years I have had cholera in West Africa five times. It is a very nasty infection beginning suddenly with total physical collapse, vomiting, profuse sweating, freezing cold and violent diarrhoea. For this I take homoeopathic ars alb 30c which starts to take effect within fifteen minutes. This stops the initial attack in an hour or so and restores strength afterwards in two or three days. I take no other medication. I also find that one tablet of ars 200c will stop acute diarrhoea in thirty minutes Diarrhoea is also a dangerous condition in the tropics and causes many thousands of deaths. If Ernst believes these remedies are inert he is clearly wrong. It is a pity that his theories about molecules should prevent people from benefitting from effective treatment and he should consider the harm done by his campaign against homoeopathy in depriving people of treatment which could save so many lives.
When the issue is a conflict between a priori assumptions and experience Galileo's comment is relevant - "Among the safe ways to pursue truth is the putting of experience ahead of any reasoning we being sure that any fallacy must reside in the latter as it is not possible that sensible experience is contrary to truth." (S Drake. Galileo at Work, 408-9).
Competing interests: No competing interests
Re: Should doctors recommend homeopathy?
With respect, L Sam Lewis appears to conflate a sympathetic listening ear (accompanied by an appropriate beverage) with homeopathic treatment. But there is a fundamental difference: the homeopathic treatment includes a little pill, and there lies the cogent point. The efficacy of homeopathy is reliant upon a good, engaged Homeopath to prescribe the correct remedy for the presenting condition. Edzard Ernst expounds that this efficacy can only be the result of consultation, expectation and placebo. May I be permitted to give my perspective as a homeopathic user?
40 years ago it was suggested that I saw a Homeopath for a condition that was not responding to orthodox treatment. I had no knowledge of homeopathy and didn't know what a placebo was, therefore, there was no expectation. Indeed, the GP Homeopath was very to the point (so not much of a consultation or listening ear experience) but the remedy worked. If it hadn't I would not be writing this. Contrary to the views of those that denigrate homeopathy, I would not waste my money on fallacious remedies. This may be viewed as anecdotal by the anti-homeopathy lobby, but it is my experience and, therefore, valid. 40 years of raising a family with homeopathy had been largely successful - granted it had been at my own expense, but worthwhile. There are many people who could be writing this experience : we use homeopathy because it works. I have consulted seven Homeopaths during this time : some were also GPs, others were either Lay or had a pharmaceutical background. Without exception, none has told me not to vaccinate my children (Peter Fisher made this point in the debate, but still it is thrown into the mix at every opportunity).
Another recurring accusation is that Homeopaths are in the profession to singularly make great amounts of money. Again, 40 years' experience shows me that the opposite is true: I have often been told " hope I don't see you too soon then I know the prescribed remedy has worked". There are very many like me with similar experiences. I live in a democracy, pay taxes, I am not a burden on the NHS and fail to comprehend why homeopathy creates such a backlash. Homeopathy was an integral part of the NHS at its inception; the sensible way forward is for it to remain an option within the NHS, as, in my humble opinion, it is cost effective, despite the not insignificant campaign by the anti homeopathy groups to have it removed from the NHS.
In conclusion, there is too much diverse information: tidbits here and there, RCTs - that fail to tell the complete story - empirical evidence seekers, anti homeopathy lobby's opinion, science, counter science and so forth: it is a minefield of misinformation. And then there are those whose experiences tell the true story: could it possibly be that accounts of these experiences be the next step forward in this polarised debate.................one lives in hope? However, having just read L Sam Lewis's post trivialising this debate to a low of comedic scenario, maybe not.
Competing interests: No competing interests