The Ethics of Homeopathy
Dr Shaun Holt is no stranger to controversy, having last year laid into the Chiropractors. Now he, along with a number of other researchers, have written a letter to the New Zealand Medical Journal saying:
“Practicing homeopathy or endorsing it by referring patients is not consistent with the ethical or regulatory requirements of practising medicine”
This is unlikely to endear him to the many hundreds of GPs who use, or advocate the use of, homeopathic remedies! It certainly annoyed Susanna Shelton, co-president of the New Zealand Council of Homeopaths, who claims “homeopathy had been safely practised around the world for 200 years”. However, Shaun was not talking about the “safety” of homeopathy, but about the utility of it. If it does not work, it’s safety is a moot issue.
Shaun’s point is that it could be considered unethical to advocate a treatment that has no evidence backing it’s usefulness, particularly in the light of the Medical Council’s latest directive on alternative therapies which clearly states:
“Doctors must inform patients on the nature of alternative treatments they offered, the extent to which they were consistent with conventional theories of medicine, whether they had the support of the majority of doctors, and their likely effectiveness according to peer-reviewed medical publications.”
Unfortunately for proponents of homeopathy, a recent review of all the Cochrane evidenced-based reviews on homeopathy was less than enthusiastic. The article (found here) concludes:
“The most reliable evidence — that produced by Cochrane reviews — fails to demonstrate that homeopathic medicines have effects beyond placebo.”
Indeed, a quick trip through some of the latest issues of reputable journals such as Homeopathy, Journal of Alternative and Complementary Medicine and Evidenced Based Complementary and Alternative Medicine, reveals much waffle and little in the way of real science. Even the odd randomised trials are usually poorly done and use very small numbers of patients. The larger, better done trials invariably fail to show significant results. All in all, it is hard not to draw the conclusion that homeopathy is dependent chiefly upon the placebo effect.
Readers of this blog will know that I have a soft spot for the placebo effect. I believe it can be a very useful tool in medicine, provided that the doctor/patient relationship is robust enough to survive the eventual discovery that the medication is question is bogus. However, the basic problem with homeopathy is that it is all bogus and the placebo effect cannot be used blindly with every patient but has to be used sparingly and carefully when appropriate. I therefore tend to agree with Shaun that it is difficult to approve of the wholesale use of homeopathy in a doctor’s practice.
Homeopathy is not a harmless thing that slightly flakey patients go for
”Supporters of homeopathy usually point out that it is harmless and relatively cheap and that it does have anecdotal benefits, though it is usually uncertain whether these benefits are derived from the holistic and detailed manner of the consultation or the “medicine” itself. Unfortunately, homeopathy has a number of undesirable effects that far outweigh its nebulous gains.
- There is a substantial risk that patients may not seek conventional care in life or limb threatening situations. Shaun makes this very point in the Herald article. The situation is made more dangerous by the fact that homeopathy practitioners have a distinct aversion to “allopathic” medicine and tend to avoid referring back to conventional doctors.
- Scarce resources are wasted on homeopathy. While the first point is well-known, it is not really appreciated that valuable resources are being wasted in terms of doctor’s time, patient’s money and manufacturing equipment, to name a few. This is not as acute a problem in New Zealand (where few public health resources are spent on homeopathy) as it is in the US, where there are entire hospitals and clinics dedicated to the subject.
- Support for science-based medicine is weakened. It is quite likely that some commentators will get quite hot under the collar telling me all the faults of conventional medicine. Some of these criticisms may be justified but a great many will be based on an antipathy toward scientific medicine that is wholly unjustified. The vaccine debate would be an excellent example of this effect, but homeopathy provides good fodder for some of the more flakey responses to medicine.
- Support for genuine complementary therapies may be weakened. There are some alternative therapies such as acupuncture and meditation, that produce verifiable, evidence-based results. Yet these therapies run the risk of being dismissed by doctors and patients being bombarded by ludicrous claims from myriad other complimentary “therapies”, including Homeopathy. (source: Smith K. Against Homeopathy – A Utilitarian Perspective. Bioethics – epub)
The conclusion is therefore inescapable that homeopathy is not a harmless thing that slightly flakey patients go for. It is not a valid therapeutic modality that doctors can use. It is a deeply anti-scientific subject of dubious merit that subtly undermines every that medicine stands for. Doctors who use it should seriously consider the ethics of their stance.
PS: You can find a poster size version of the wonderfully rude graphic right here.
Related posts:
- Unethical Ethics Have you ever noticed how the word unethical seems to...
- Lactose Intolerant The recent stunt by the New Zealand Skeptics Society might...
- The Ethics of Resuscitation There is a fairly long discussion on Do Not Resuscitate...
- Newsflash! Advertisers Lie! Yes, I know it is almost impossible to fathom such...
- Immaterial Ethics A fascinating insight into the mind of an unredeemed marxist...
36 Comments
Leave A ReplyOne Trackback/Ping
- Homeopathy – practical remedies to address it? | Code for Life — [...] See also the comments on his original [...]
Apr 22 11 2:14 am
If water has a memory then homeopathy is full of excreted antibiotics.
Mandeno Musings´s last [type] ..New law supposedly protects some and threatens the rest of us
Apr 22 11 7:43 am
Acupuncture is no better than placebo either
http://www.ncbi.nlm.nih.gov/pubmed/16420542
http://www.badscience.net/2007/09/acupuncture-and-back-pain-some-interesting-background-references/
…
Cheers
Apr 22 11 10:04 am
It is certainly pretty useless for back pain. There is some evidence that it is useful for neurogenic and chronic pain, but it is hard to separate out the placebo effect when studying it. Using acupuncture for anything except pain would appear to be descending into the realms of pure quackery.
Apr 22 11 9:38 am
Not surprisingly….I agree with your post! Cheers. Shaun
Apr 22 11 10:16 am
Decades ago the standing medical joke was that doctors had patients that they sent off to the chemist with a prescription that had “aot” scrawled in there somewhere.. standing for “any old thing”.
Myth or not, it seems some modern docs and patients have found their own version of aot.
JC
Apr 22 11 11:21 am
A friend of mine who is involved with the Green Party and who is ardently pro-scientific method and anti-homeopathy posted a mainstream media story about this on his Facebook.
What was scary about it was that two candidates of the Greens came out in support of homeopathy. I decided to have a looksie at their health policy and while it doesn’t mention homeopathy specifically it does mention alternative medicines — BUT ONLY WHERE THERE IS EVIDENCE FOR THEIR EFFICACY.
I wonder if these candidates said that they don’t agree with the Greens policy when they put their names forward as candidates. I also wonder if they thought about the damage it might do to their own and the Greens credibility to publicly endorse quackery.
Apr 22 11 11:21 am
You commented on the evidence – but not the science behind homeopathy.
To accept that homeopathy works or could work is to believe in magical effects outside the laws of physics and chemistry. It turns any idea of a dose / response relationship on its head. Because in homeopathy, the weaker (more dilute) the ‘remedy’, the stronger the alleged effect.
You neglected to mention that the alleged ‘active’ ingredient in a homepathic remedy has been so diluted, that there is negligible probability of even one molecule of the ‘active’ ingredient remaining. Therefore water has to retain ‘a memory’ of the original ingredient without retaining any ‘memory’ of all the less desirable substances that have ever been dissolved or suspended within it.
The evidence for the tooth fairy is stronger than that for homeopathy. Real money gets left under pillows of children young enough to believe in fairy tales.
Apr 22 11 3:38 pm
I didn’t comment on the science behind homeopathy because there IS no science behind it. Even the “memory of water” idea is desperately vague and does not even begin to explain the various claims made for homeopathy.
The most obvious objection to the “memory” idea is the one hinted at in the graphic. Why does the molecule that you are diluting retain its imprint, but no other molecule of contaminant? Clearly, the idea is absurd.
Another objection to the “theory” (there is no actual coherent theory behind homeopathy) is that even the water molecules with “memory”, if they exist, would be too few to make any difference to physiological processes.
The final objection is, of course, that there is no reason at all why a dilute version of something should have the opposing effect. Dilution merely weakens effect, not reverses it.
Apr 23 11 12:36 am
Always interesting to hear MacD go off about homeopathy every once and a while- and as always he takes the time to canvas opinion on the issue from both sides so thoroughly(!)
Perhaps the opinions of a Nobel-prize-winning scientist, Dr Luc Montagnier (who discovered the AIDS virus, and who is also founder and president of the World Foundation for AIDS Research and Prevention) in support of homeopathy may provide some food for thought…
http://www.naturalnews.com/031210_Luc_Montagnier_Homeopathy.html
Apr 23 11 12:52 am
One day I’m going to make a list of all the nutty things Nobel laureates have believed (HIV denialism, racism, refrigerator mothers, vitC as a cure-all… it’s quite the list)
Apr 23 11 12:24 pm
Ah, yes. The fallacy of appealing to authority. Despite his undoubted genius in the field of virology, Dr. Montagnier is, of course, no more qualified to give an opinion on homeopathy than I.
As David points out, Nobel prize winners have a long history of flaky pronouncements on subjects outside of their immediate area of expertise. They get quoted by the media and by the internet sites because people make the mistake of thinking that the Nobel prize confers some sort of authority upon you. This is, of course, complete nonsense.
Apr 24 11 4:54 pm
I’m not surprised that you’re being dismissive of the work (ie actual published research, rather than just a ‘flaky pronouncement’) of one of the world’s great scientific minds.
For a start, it is a given that he is operating outside of his field of expertise – in case you haven’t noticed, the work he is doing now is in a field that doesn’t even exist yet. There is no-one who could say that they do actually have expertise in that field- so you’ve got better things to do than put some actual thought into this debate?
Anyone who attempts to research anything to do with this issue will by definition always be operating outside their field of expertise – but who would be more suited to applying the process of scientific enquiry to a nascent field of medical or scientific endeavour than a recipient of a Nobel Prize in Medicine who has already made one of the world’s greatest medical discoveries? Need I labour this point any further.
Apr 24 11 5:56 pm
Actually, no-one is dismissive of Montagnier’s work on the properties of water. The demonstration that water retains the “shape” of a molecule and thus speeds up protein folding is indeed breakthrough science. Unfortunately, as I have said several times above, that is a long way from forming a theoretical basis for homeopathy. For homeopathy to have a theoretical basis one would have to demonstrate that this “shape retention” actually has significant biological effects in the manner in which homeopathic preparations are prepared not simply demonstrating that water memory speeds up protein folding. This is a much bigger ask and it certainly does not help that, as soon as a trial of homeopathic medicine is done in a rigorous, scientific fashion, the “effects” of homeopathy disappear into the placebo effect.
Understand that, for homeopathy to work, not only would all the water have to retain the shape of the active ingredient, but that retained shape would, somehow, have to become more biologically “powerful” the more dilute it becomes and then have a predictable biological effect. Unfortunately for homeopathy, absolutely everything we know about cell physiology tells us that this is purest nonsense.
Apr 24 11 6:52 pm
I must say that it is confusing that Dr Luc can state that homeopaths have exactly the right idea about these properties of water, and that his research confirms this, while you don’t seem to find that his work has any implications for our understanding of homeopathy at all. I wonder whose opinion I shall believe.
At least we can now agree that Dr Luc has rebutted your statements that the “memory of water” idea was desperately vague and with no scientific basis.
And why don’t we examine this unnecessary profession of homeopathy in light of the current level of iatrogenic deaths occuring in NZ annually. We don’t necessarily know this, but we can guess since death from prescription medicine is likely to be somewhere between the 4th and the leading cause of death for your average US citizen.
MacD, how many NZers are suffering a severe adverse reaction or even death every minute from prescription medicine in NZ? I’m hardly overstating the incidence of this as you well know. When I like to discuss how useless and harmful homeopathy is, you can understand that I want to establish a bit of proper context and perspective first you understand.
Apr 22 11 12:28 pm
I’ve just spent the last 3 days arguing on a blog with sciency people who think that because it’s BS it should be banned.
My position remains that if people are going to homeopaths, and the homeopaths are honest about the lack of scientific backing, the dealings between the customer and the homeopath is their business and not something the state or the medical and science communities need to poke their nose into.
Apr 22 11 1:26 pm
It shouldn’t be banned – if people are desperate to throw them money away that’s sad but none of my business. But the “honest about the lack of scientific backing” is the bit that matters, most homeopaths just aren’t honest about this (the best you’ll get it “Science is yet to catch up to homeopathy, but it works because this guy got better after taking it”)
I do think their should be tighter controls around the ‘therapeutic claims’ health practitioners can make – ‘assists the bodies normal blah blah’ might be true, but it’s usually meaningless.
david winter´s last [type] ..Conserving Don Merton’s achievements
Apr 22 11 9:15 pm
Well, there are laws against false and misleading advertising, and the consumers guarantees act and fair trading act can also be used against dishonest traders.
Apr 22 11 3:43 pm
I have no desire to ban homeopathy. However, I would like to see doctors stop giving this quackery any form of credence as it merely exacerbates ignorance. People are at liberty to waste their money in any way they choose, though the consumption of valuable medical resources in the name of flummery does stick in my craw.
It is my experience that most homeopathics are the very opposite of honest about the scientific “basis” of their product.
Apr 22 11 5:00 pm
Most would subscribe to this approach. However, conventional medicine is not squeaky clean either. For example, prescribing antibiotics for chronic prostatitis, where no bacterial cause can be established, then when they don’t work, prescribe them again for a longer period. There is no scientific backing for this approach, just the feeling that sometimes some people get better after such treatment. I can’t see the difference.
Apr 22 11 11:29 pm
There is plenty of stuff we do in medicine that is somewhat dubious evidence-wise. That is a long way from having an entire discipline founded on something that has appears to have no basis in reality.
Apr 22 11 10:32 pm
I have read of homeopathy described as ‘the air guitar of medicine’.
Apr 22 11 11:23 pm
I like that! Indeed it is.
Apr 23 11 8:11 am
Hey! I’ve just worked out that the film Kungfu Panda is all about homeopathy! There are no secret ingredients! It’s all about believing in yourself and your body!
Apr 23 11 12:13 pm
And using your little finger to crush the life out of your opposition…
Or not.
Apr 23 11 11:16 am
MacDoctor,
A very comprehensive argument against homeopathy, nicely done.
Andrew W,
” the homeopaths are honest about the lack of scientific backing, the dealings between the customer and the homeopath is their business”
The problem is that most homeopaths are not honest about the lack of scientific backing. Read any homeopathic website and you will most probably find claims that hoemopathy is supported by “quantum theory”, or you will see appeals to authority such as referring to Luc Montagnier’s paper or other papers which “support” homeopathy (though carefully reading of such paper’s typically does not support it).
In many cases I don’t think homeopaths are being deliberately dishonest, instead I think many of them only have a limited grasp of what science is all about.
” there are laws against false and misleading advertising, and the consumers guarantees act and fair trading act can also be used against dishonest traders.”
I can’t remember why but most homeopaths seem to be able to dodge these acts – I suspect this is because of the rather cautious way the describe what they can do, for example, when treatments do not work they often claim that they have not yet found the one which “matches” their client.
I’m not in favour of banning homeopathy either – I think education and challenging homeopaths to show how their art “works” is far better.
Apr 23 11 12:00 pm
Michael, an interesting comment in which you raise reasonable points which you then successfully refute leaving me nothing to say.
Apr 23 11 8:16 pm
I think homeopathy is fairly well summed up by Mitchell and Webb: http://www.youtube.com/watch?v=HMGIbOGu8q0
I particularly like how a homeopathic lager is 2 drops of beer in a glass of water
Apr 23 11 10:38 pm
I particularly like the part when he uses dilute essence of Ford Mondeo to treat trauma. If only it were that easy…
Apr 23 11 10:06 pm
“I’m not in favour of banning homeopathy either – I think education and challenging homeopaths to show how their art “works” is far better.”
Agreed, but we should apply the same criteria to ALL medical practitioners. Ever ask a GP or specialist how a a particular drug works, or why that specific one has been prescribed? Most are not proficient at answering such queries from a patient, they just ACCEPT that a certain drug is the thing to prescribe for a certain condition. One would hope that the science is there, but how good is it? If a certain drug company claims their new drug is the best treatment for a particular ailment, how many GPs are willing, or even able, to investigate the science? I suggest most just accept such claims at face value…not too different from the homeopaths, really.
Apr 23 11 10:36 pm
You have a very simplistic view of medicine, Rod. While no GP would be expected to know the finer details of all the medication s/he prescribes, I would expect any GP to at least know if the treatment was evidenced-based. It may be that the GP would get that knowledge from specialists that he uses or from experts in the field at conferences or in review articles in journals, rather than do the research him/herself, but very few GPs would simply take the word of the drug rep.
By the time a drug rep gets to present a new drug, the chances are that the GP has heard about the drug and the clinical trials around it on several occasions. S/he may even have discussed using it with consultants in that field. It would be pretty rare that anyone would consider using a new drug on the say-so of only a rep. Doctors are a generally conservative bunch.
This is not to say that none of our treatments are faddish or founded on dubious evidence. Of course there are such things. But that is a far cry from the complete dearth of evidence that homeopathy is anything more than placebo.
Apr 23 11 11:10 pm
I guess I do have a rather simplistic view, largely brought about by the fact that medicine seems in recent times to be intent on reducing itself to simply another consumer service. I read the local newspapers, and amongst the “infomercials” for car servicing and the likes, are those for skin clinics, sports medicine clinic, etc. “Come to us for better, more effective treatment”. Also, I firmly believe a patient is entitled to an explanation of a doctor’s findings, the treatment offered, and the expected outcome, rather than the hasty scribbling of a prescription and a single sentence response. Getting information from some (most?) GPs is like extracting teeth. I have no belief in homeopathy, colour therapy, bach flowers, and all that stuff out there, but can see that frustration with conventional medicine (or at least with many of the practitioners of it) is the reason why many people seek alternatives.
Apr 24 11 12:34 am
I hear you. Time constraints often make the average consultation rather less than satisfactory. Having said that, it is my experience that patients don’t want to know most of the science behind the treatment.
Apr 24 11 10:18 pm
If they don’t want to know, fine. If they ask however, they should get answers, at least to the best of the practitioner’s ability.
Apr 24 11 10:37 pm
Johnnieboy: At least we can now agree that Dr Luc has rebutted your statements that the “memory of water” idea was desperately vague and with no scientific basis.
Not really. What I actually said was “Even the “memory of water” idea is desperately vague and does not even begin to explain the various claims made for homeopathy.” With regards to homeopathy this is precisely true. There is no explanation how the memory effect of water is not effected by contamination, no explanation of how it may be, contrary to all the physics we know, enhanced by serial dilution with water which (presumably) has other memories and no explanation of how, when this water enters into a human body, this one, fantastically diluted “memory” manages to makes its way past all the other molecules in the body, yet retain this one “memory”.
Can you not see that this is a quantum leap away from water retaining a memory of a folded protein right next to the spot were the protein is created?
Dr. Montagnier is fully entitled to engage in fanciful speculation as to the implications of his discovery. This does not mean he has proposed a valid scientific theory, nor “proved” homeopathy to be true.
By the way. suggesting that conventional medicine can cause iatrogenic problems (which is, sadly, very true) in no way supports any argument for the veracity of homeopathy. Suggest you read through Matthew Flannagan’s excellent Friday Fallacy series as you seem to have a problem with fallacious argument. Pay particular notice to the one on “Tu Quoque”.
Apr 25 11 12:53 am
Regarding my obvious Tu Quoque, you mention that safety is a moot point where there is no proven efficacy, but later make the inference there that you consider homeopathy to be dangerous to patient health in certain cases. I am making that counter-argument that where we find 1 incident per year in one profession, and 10,000 from the other, then perhaps we have more important issues to discuss than scare-mongering over that 1 incident (especially where there is not even one anecdoctal report of that 1 incident in NZ).
As for there being no scientific evidence that homeopathy has an effect that is greater than placebo, the only way to address that is to open up that whole debacle again where The UK Science & Technology Committee made it their mission to discredit the 120 placebo controlled trials that the UK Homeopathic Association put forward as showing that the effects of homeopathic treatment were greater than placebo (this was true in 44% of these RCTs, with 48% being statistically non-conclusive, and 8% showing negative effects).
The conclusions of the UK S&T Committee start at point #65 here: http://www.publications.parliament.uk/pa/cm200910/cmselect/cmsctech/45/4504.htm#a15
& the response of the UK Homeopathic Association to this is here:
http://www.britishhomeopathic.org/media_centre/news/st_part2.html
The government later basically ignored the recommendations of the UK S&T Committee, largely due to the large backlash from the public that would arise
Apr 25 11 9:03 am
I’m clearly not going to convince you of anything, am I, Johnnieboy? The UK S&T committee came to exactly the same conclusions as I. There is no plausible scientific theory behind homeopathy and the trials fail to demonstrate anything beyond placebo effect. As usual, the homeopathy society cite selected trials to try and make themselves look good. What they fail to acknowledge is that, as the power of a trial increases, so the “effect” of homeopathic remedies disappears into placebo effects. When this happens in medicine, the drug is discarded as ineffective.
Comparing side-effect events against homeopathy “side effects” is meaningless if homeopathic medicines have no effect.
Note that most homeopaths do little harm and people often feel better after seeing them. This is not the issue. If people wish to spend good money seeing homeopaths, then so be it. The issue is that conventional medicine should not be giving homeopathy credence. We should not be using homeopathic medicines in our practices, nor should we be referring patients to them.