Smart Bombs

Homeopathic remedies such as essence of crop circle and ‘F sharp minor’ may sound daft but they have a vital role to play in modern medicine

The post was written by Michael Brooks, the author of 13 things that don’t make sense. which has chapters such as “Most of the universe is missing”, and “Methane from Martians”. The book looks like an interesting popular science book. I haven’t read it myself though. Mr Brooks wades straight in with

Should homeopathy be available on the NHS? Absolutely – it’s possibly the safest, most ethical and most effective placebo there is.

So homeopathy is safe, ethical, and an effective placebo? Homeopathic remedies are certainly safe in themselves – they could hardly be otherwise, seeing as there is not a molecule of the original substance in them; they have no biochemical effect at all. However, there is plenty of evidence that homeopaths suggest their treatments are preferable to proven medicine, thereby encouraging patients to choose their placebo instead. Ethical, well is it ethical to deceive your patients; to claim that they are receiving an effective treatment when they are not? We’ll come back to this. I agree with his third statement – homeopathy is certainly an effective placebo, but it’s nothing more than that.

Where money is truly wasted is in trying to find evidence that homeopathy works.

I would certainly agree with the vast majority of scientists who say that homeopathy is almost certainly no more effective than placebo. But there are two qualifications I should make about that statement – and they make all the difference. The first qualification is that the claim homeopathy doesn’t work is a prejudice, not a scientifically proven fact. The second qualification is much more important. I don’t actually know what “no more effective than placebo” means. And neither does anyone else.

All of the evidence shows that homeopathy performs no better than placebo. How is the conclusion that it therefore doesn’t work a prejudice? And the statement “no more effective than placebo” is pretty straightforward; one group of patients is given an inert sugar pill, another group is given the treatment to be tested. If the second group shows the same rate of improvement as the first, then the treatment is ”no more effective than placebo”. Everyone working in medical trials knows what that statement means.

In fact, the phrase’s negative connotations are undeserved. Let’s not forget that placebos are medically useful, and doctors know it.

Of course. No-one is denying that placebo has an important role to play in medicine; just that homeopathy doesn’t have any effect more than that; it doesn’t do what the homeopaths claim it does.

In 2003, a survey found that 48% of Danish GPs use what they regarded as a placebo intervention …  half of US physicians admit to regularly prescribing placebo – usually vitamins or analgesics …  Giving a placebo is not the same as doing nothing, which means that sometimes prescribing a placebo is better than doing nothing.

Doctors are well aware of how and when it is appropriate to prescribe a placebo. My opinion is that it should be avoided as much as possible, as we should be avoiding the old fashioned paternal approach that you don’t need to understand what the doctor is trating you with. However, when doctors prescribe placebo, they are not subscribing to the mystical mumbo jumbo, anti-science agenda of the homeopaths.

Using placebos effectively is difficult, however. Regulations governing cost and evidence-based prescribing prevent a pharmacy from dispensing something recognised as a placebo … With homeopathy, that problem is side-stepped. Homeopaths tend to believe in what they are doing, so there’s no deception

The problem is that if doctors refer to homeopaths, they are lending credibility to a system that is complete nonsense. You might as well refer patients to witch doctors, as they probably “tend to believe in what they are doing” too. Feel free to make use of the placebo effect, but the NHS shouldn’t be endorsing homeopathy as a whole in order to do so.  Stolen from the comments on the article: “allowing homeopaths to continue to work their ‘magic’ privately while also giving them legitimacy within the NHS, is a very dangerous game.” It’s also worth noting that the placebo effect is only useful in minor, self-limiting conditions. That is, it will help with conditions that will probably get better anyway, but will not have any benefit for serious conditions like AIDS &c. Bearing in mind that many homeopaths believe that their magic pills can help with more serious diseases, referring people to a homeopath could well lead to them not seeking proper medical attention for something serious. Homeopaths should be kept as far away from the NHS as possible!