Time Out, London
November 16-23 2005
I feel a bit mean, since you’re all having so much fun here, but let me quickly point out a couple of things about homeopathy. First, it doesn’t work. Second, it’s old fashioned and paternalistic. And third, that’s what they say about us: how weird is that?
We’ll do them in order. Stick with me here: at least if you disagree, you’ll disagree with a whole lot more panache by the end. So how do we know homeopathy doesn’t work? By the modern miracle of “counting”. There’s no voodoo here: you take 100 people on homeopathic pills, and 100 people on placebo sugar pills, and you count up how many people get better in each group. The answer is, people on placebo do just as well as people on homeopathic pills. You can’t argue with that fact. You can try and argue around it, but the people in these studies are all individuals: are you denying the reality of their experiences?
Occasionally, yes, you hear about a clinical trial which has found that homeopathy did perform better than placebo. But if you take the figures from all these little trials, and add them all up, and do one big count, you find, again, that homeopathy is no better than placebo. This is called a “meta-analysis”. There have been lots of them. No wriggling. It’s just counting, and if you doubt the methods, or the references, then come to www.badscience.net, and we’ll all happily talk you through it. Nothing is hidden here.
But it’s more complicated than that. What is a placebo? It’s not just a sugar pill: a placebo is about much more than that. Placebo is about expectation, and the cultural meaning of the treatment. Green sugar pills are a more effective treatment for anxiety than red sugar pills. Weird. Why? Your guess is, well, almost as good as mine: and my guess is, it’s because of the cultural meaning of the colours “green” and “red”.
The experiments are endless. Salt-water injections are a more effective placebo treatment than white sugar pills â€“ not because there’s anything especially useful about salt water injections, but because the ceremony of performing an injection is a much more invasive, authoritative and dramatic thing to do to someone.
It gets much better. An experiment in the 1950s found that a placebo operation for angina was just as effective as the real one. I read the academic article again today. In the discussion section, do they say: “Woah, placebo operations work, how weird is that?” No. Because nobody ever notices how completely weird the placebo effect really is.
Branding, of course, is the key with your little white sugar pills. Marketing, after all, is engineered cultural meaning. So a four-way comparison, of sugar pills and aspirin, in either unbranded aspirin tubs or mocked up Disprin brand packaging, showed that brand-name packaging kills pain. The huge wealth of cultural background material – the adverts, the word-of-mouth endorsement, the childhood experiences â€“ everything that the packaging plays on, it’s all part of the pill.
So sneery rationalists, who buy generic, unbranded tablets like aspirin and ibuprofen instead of Disprin or Nurofen: they’re wrong too. It’s perfectly rational to believe that expensive Nurofen is more effective than cheap unbranded ibuprofen, even if they’ve both got the same active ingredient – but only, in a perverse turn, if that’s what you believe.
And this is the key also to alternative medicine: homeopathy is a “complex intervention”, rich in cultural meaning, drawing on attractive contemporary ideas like individualism, patient empowerment, and personalised healthcare, not to mention word of mouth. More importantly, all alternative therapies also offer something missing from modern medicine: the “containment” of symptoms, with understanding and certainty.
A transparent modern medic will say: “I can’t be exactly sure what the cause for your problem is. This treatment might make it better, but, well, it might not.” Nice. “Oh, and it also might have these side effects.” Thanks. Sometimes we even finish off with: “What do you think?”
Enter the alternative therapist: they understand your problems, whatever they are; they’re privately employed, so they have all the time you need; and they have an answer. In fact, they can give you an attractively complicated, wilfully obscure, authoritative explanation for whatever is going on in your body. Energy, chakras, some fictitious and chemical sounding dietary deficiency, whatever you’re buying, they’re selling. They maintain the power imbalance, in their therapeutic relationship with you, because they play up their exclusive access to arcane knowledge, and their authority.
If that’s not old-fashioned medical paternalism, I don’t know what is. Sure, it feels like it works, they’re bigging up the placebo with all the authority and technical flammery they can muster. It’s positively Victorian. Doctors don’t do that any more, but it seems it was popular: there’s a demand, a need, a gap in the market. You know how people sometimes say “doctors should give homeopathy to their patients”? Well we can’t, because to do that, we’d have to lie to our patients. No thanks.
So spend your money. If you want interventions that might work (damn right they have side effects, this is potent stuff) then come to us. But if you prefer your treatment served with extra lies, expense, reassurance, and paternalism: then you’ll be needing a time machine, or an alternative therapist.