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Rapid response to:

Head To Head

Should doctors recommend homeopathy?

BMJ 2015; 351 doi: (Published 14 July 2015) Cite this as: BMJ 2015;351:h3735

Rapid Response:

Re: Should doctors recommend homeopathy? No, and this is why

I thank the BMJ for allowing this very interesting debate to take place. It concerns fundamental questions in medicine.
The arguments of the homeopathy proponents seemed to me unclear, confused, and making a rather inaccurate account of the facts. Also, the homeopathies believers demonstrate a rather worrying ignorance of the role of science in medicine and of some essential medical concerns .
In the history, beliefs and superstition usually fill the gap of ignorance when reliable knowledge is not available in important matters such as climate hazards that make harvest uncertain and health matters, for instance.

Although the history of conventional medicine has started with rather fanciful practices such as bloodletting, the trend, over centuries, was to put more rationality and more science in it. This has been made possible by relying less and less on crude subjective individual perceived effectiveness of medical proceedings or drugs and more and more on replicable trials based on methodological rigorous statistical methods .
The idea that a drug “works” is not such a simple one as the homeopathies supporters seem to believe. And that is a fundamental question for every physician. The perceived effectiveness is the final result of a complex process and the perceived effectiveness can result from many factors as are the natural evolution of a disease or condition, supporting the placebo effect by contextual factors , or from unknown factors or, last but not least from the specific effect of a drug. The aim of the scientific procedure is to separate the specific effect of a drug from other factors and to quantify it.
There are precise rules for that, which are or should be applied in the final stage of the marketing authorization process.
When the methodological process is respected this offers a guarantee of reliable knowledge and information about the chances a drug has to have a specific effect. Much more reliable, anyway, that the one based on individual opinions and perceptions.
That Is why, in medicine, “primary evidence”, is not the patient experience as stated by William Anderson but well conducted trials.
The problem, thus, is not to “put aside bias based on the alleged implausibility of homeopathy”, as stated by P Fisher, because the question of plausibility is an important one in medicine and in science. And , above all, even then, the essential concernremains to prove an homeopathic drug has a specific effect that can be distinguished from the placebo effect. Ie what is required for any other non homeopathic drug.
The evidence put forward by P Fisher doesn’t seem very compelling in this respect. Allan Hennes has responded to it and shown the facts about evidence have been reported by P Fisher in a misleading and incomplete manner
Guy Chapman has listed a sort of minimal requirements list in order to consider some sort of specific effect of any homeopathic drug These requirements have never been fulfilled .
We can also discuss the other arguments of homeopathy supporters.
1 Homeopathic drugs can’t be assessed like conventional drugs because their effect depends on the set of symptoms, of the personality of the patient and some other factors.
That seems to be a good definition of a placebo effect that can’t not be linked with any specific drug, or diagnostic. If the confidence in a positive outcome can’t be put on the drug, where else is it to be put on? Maybe on the ability of the homeopath to choose the good homeopathic treatment? That seems rather hazardous, doesn’t it? And if the confidence has to be entirely put on the ability of the homeopath, it clearly makes the patient more and more dependent upon his homeopath.
2 The homeopathy is cheap.
It depends. If you consider It is just sugar and water, and even including some rare nanoparticules which specific effect on the medical condition can’t be proven, they are rather expensive. If you consider too they have never undergone the whole marketing authorization and expensive process, you can doubt. In France, one of the biggest consumers of homeopathy, 700 million euros are spent and reimbursed for homeopathic drugs every year.
3 The homeopathy allows reduction in conventional drugs consumption.
Even Peter Fisher , recognizes that this is not true. France and Germay, the biggest consumers of homeopathy, are also among the five biggest consumers of conventional drugs.
In conclusion, why wouldn’t I recommend homeopathy?
Because homeopathy makes medicine go backwards and not forward.
Because the definition of homeopathic benefits are so vague and large that legitimizing homeopathy would necessarily result and contribute to increasing medication of the whole life
Because if I recommend homeopathic I should recommend, on the same obscure grounds , magnetizers and all the forms of alternative medicines.
Because it could legitimize the idea than conventional medicine proceedings could easily be replaced by some homeopathic remedies and thus put patients at risk.
Because I hold an ethic position that is not promising to the patient an effectiveness of any drug that has never been proved.
Because I believe patients have to become more autonomous and not more dependant on doctors.
Because I believe high quality information promotes better reasoning that is most fit to promote healthier and safer behaviors.

Even though, we can’t ignore that an important part of outcomes in medicine are driven by what we will call psychological factors, often not rationale ones, that have to be dealt with because they can translate in placebo positive effects for the patient. That is a great gap to fill in medicine, but I would rather it to be filled in a more ethic and scientific manner that it is dealt with by homeopathic alternative medicine.

Competing interests: No competing interests

19 July 2015
Prenventive medicine for children
Lyon, France