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Head To Head

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

Rapid Response:

Re: Should doctors recommend homeopathy?

Dear Editor

I am grateful for the opportunity to respond to this Head to Head and indebted to the many, many folk who have appraised me of the facts which follow. Facts which can be responded to.

The Swedish researcher Professor Robert Hahn has never practised, received, or studied homeopathy, and has worked in clinical medicine, performed traditional medical research in anaesthetics and surgery for the past 30 years and has a wealth of research methodology experience.

Professor Hahn published a rarely mentioned paper in 2013. "Homeopathy: Meta-analyses of pooled clinical data".[1] The final conclusions are quite stark and bear repeating here:

Clinical trials of homeopathic remedies show that they are most often superior to placebo.

Researchers claiming the opposite rely on extensive invalidation of studies, adoption of virtual data, or on inappropriate statistical methods.

Further work with meta-analyses should abandon the concept of summarizing all available clinical trials and focus on the effects of homeopathy versus placebo or other treatments in specific diseases or groups of diseases.

One way to reduce future emotional-driven distortion of evidence by investigators and skeptics would be to separate the evidence-seeking process from the formulation of clinical guidelines more clearly.

Just such a meta-analysis was carried out by Robert Mathie, et al. last year.[2] The only negative criticisms of the Mathie meta-analysis to date have come from Professor Ernst and his associates.

Homeopathy is controversial and effective.

The fact homeopathic medicines work in the clinical field and patients themselves find benefit from homeopathy and express almost universal appreciation of this medical treatment frustrates the self styled arbiters who have come to call themselves 'skeptics' or even more abstrusely 'the Good Thinking Society'[sic]. Those who have swallowed the aggressive anti-homeopathy PR campaign without question or critical appraisal, who do not work with patients or who survey healthcare from their isolated ivory towers are similarly challenged to recognise the evidence of the cherry-picking of research to suit anti-homeopathic preconceptions. The vigour of homeopathy bashing indicates homeopathic medicine is either considered a threat or ripe for takeover, re-branding and relaunching.

Post marketing surveillance has yet to find it necessary to withdraw a single homeopathic drug in over 200 years of use and their side effect profile is negligible in comparison to ABPI information on other NHS prescribed medical drugs, no matter how much recent comments have tortuously tried to divergently spin this fact.

With regard to Professor Ernst's concern for patients missing out on effective treatments, he makes an important point. However in the opinions of 2 eminent colleagues the evidence base for much of what we take to be 'effective treatment' may be flimsier than his assumptions imply. "The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness."Dr Richard Horton- Editor in Chief of the Lancet. [3]

"It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of the New England Journal of Medicine" Dr. Marcia Angell Editor in Chief of the New England Medical Journal.[4]

One might wonder then, just who is selling 'Snake Oil'?

Dr Mark Porter of the British Medical Association would do well to comment and explain why in 2010 members of the BMA alluded to medical colleagues who utilise homeopathy being witchdoctors? [5]

The GMC is yet to comment.

[1] http://www.karger.com/Article/Pdf/355916
[2] http://www.systematicreviewsjournal.com/content/3/1/142/abstract
[3] http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736%2815%2960696...
[4] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2964337/
[5] http://www.telegraph.co.uk/news/health/alternative-medicine/7728281/Home...

Competing interests: NHS physician using complementary medicine

03 August 2015
Andrew Sikorski
GP
Wadhurst