Dreary Pro-Homeopathy Piece and Letter

September 4th, 2006 by Ben Goldacre in bad science, homeopathy | 115 Comments »

The usual tedious stuff in this 1000 word pro-CAM piece in the Guardian today: “CAM is good because medicine is bad”, “CAM is not researched because it doesn’t have big money” (in fact there are plenty of incompetent CAM trials, a bad trial costs as much to perform as a good one), “some authority figures say CAM is good”, and no attempt to address any criticisms except to complain that they are persecutory.

The whining and rhetoric I can cope with; an ignorance about evidence based medicine, so profound that she can’t even get the most basic terminology correct, is fine too (she refers to “random controlled trials” which means nothing, I presume she means “randomised controlled trials”); but she seems to allude to a trial that does not exist, and that is the thing, as usual, that I find most offensive.

society.guardian.co.uk/health/comment/0,,1864592,00.html


“Ironically, one of the few areas that a large-scale trial has been done is the area that started this current row. Homeopathic medicine is indeed controversial, as in order for a homeopath to treat a patient, the person’s individual symptoms have to be taken into account in order to make an individualised prescription. This means that homeopathy does not perform exceptionally well in random controlled trials – where one group of people are all given the same medicine and another group are given a placebo.

“When homeopathic trials are based upon individualised prescriptions we see a very different picture. At the end of 2005, the results of a large six-year study of 6,500 patients at Bristol Homeopathic Hospital reported 75% improvement in their health.”

I whacked this over to letters@guardian.co.uk in a spare moment, don’t know if they’ll use it.

Dear Letters,

Alongside the usual attacks on the medical profession which are characteristic of alternative therapists’ brand building – thalidomide pops up from 1957, I see – Nicola Sturzaker attempts to recruit scientific evidence in support of her arguments. Firstly she suggests that placebo controlled trials of homeopathy are flawed because all patients are given the same homeopathic treatment and this is not how homeopaths work. There is no reason not to simply substitute a placebo sugar pill, in a study, for whatever individualised sugar pill a homeopath prescribes, and if these trials are not done enough for homeopaths then homeopaths themselves should simply do them, just as orthopaedic surgeons assess their different ways of managing fractures.

More seriously, she then says that “when homeopathic trials are based upon individualised prescriptions we see a very different picture” and references some work to support this, quoting various figures from it. I found the study she quotes, and it is not actually a trial at all, it was simply a survey in a homeopathy clinic, where they asked the patients who came back if they felt any better. A pleasant enough exercise, but there was no placebo, and no control group at all, nothing was compared with anything: this was very simply and clearly not a trial. It is this level of ignorance about the most basic concepts in evidence based medicine which makes the debate with alternative therapists so fabulously circular.

Yours

Dr Ben Goldacre
(Bad Science, The Guardian)


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115 Responses



  1. superburger said,

    September 4, 2006 at 4:36 pm

    i just vented my spleen over breakfast, though i sent it to the society editor. Do they print letters there?

    Nicola Sturzacker’s recent article, regarding the changes in licensing for homeopathic remedies fails to address the fact that homeopathy simply does not work any better than placebo.

    Indeed, your paper’s own science correspondent Dr Goldacre pointed out, in a Badscience column at the end of 2005, that a comprehensive study by the Cochrane Library had demonstrated that homeopathic treatments are nothing more than placebo.

    If homeopathic concepts were correct, then a rewriting of every single work on chemistry, biochemistry, pharmacology and physiology, written since about 1800, would be required.

    Today we have a situation where taxpayers money is being diverted from clinical treatments which are expensive but effective e.g. Herceptin, in favour of a disproven remedy, a relic from history.

    If the self-indulgent rich wish to spend their own money on such alternative treatments then so be it, but it is immoral to deny those who rely on the NHS the latest drugs, whilst we continue to fund homeopathy from finite public funds.

    Sturzacker’s defence of this discredited practise consists of the usual diatribe against the medical profession. She points out that physicians sometimes make mistakes and misdiagnoses. This is true. Medicine is still conducted by all too fallible human beings. However, the medical profession is regulated by statute, with the aim of preventing repeated mistakes. Compare this to the largely unregulated alternative medicine market.

    Those who watched the recent Newsnight report on the activities of homeopaths, some of whom claimed to be ‘Fellows of the Society of Homeopaths’ will have seen how these unlicensed quacks advise that people travelling to malarial regions of Africa stop taking the prophylactics prescribed by their GP in favour of unproven homeopathic remedies to ‘remove malria shaped hole’s in one’s energy.’ So much of Sturvacker’s definition of homeopathy as ‘complimentary’ to regular medical practise.

    To defend homeopathy based on ‘millions of years of human history’ is foolish. Firstly, H Sapiens the primate species to which we all belong has only been in existence for 200,000 or so years. I find it remarkable that someone claiming to be trained in the science of anatomy is unaware of this fact.

    Secondly, homeopathy was invented around 1807, giving it just short of 200 years of history. It has since been discredited by such advances as Pasteur’s germ theory of disease and Avogadro’s concept of the chemical mole.Medicine has moved on, and it is time that Sturzacker accepts this and stops defending in indefensible.

  2. simongates said,

    September 4, 2006 at 4:39 pm

    Some bits of Nicola’s article are quite accurate, and I quote shamelessly selectively for comic effect: “…the complementary sector as nothing more than a bunch of white witches and charlatans.”

  3. coracle said,

    September 4, 2006 at 4:59 pm

    Nice one, that article really pissed me off. Utter crap from start to finish.

  4. superburger said,

    September 4, 2006 at 5:22 pm

    she’s used the same sentence twice in her previous article on chiroparactic

    society.guardian.co.uk/health/story/0,,1738047,00.html

    “learning anatomy to the same degree as doctors as well as studying physiology, the respiratory system, cardiovascular system,”

    society.guardian.co.uk/health/comment/0,,1864592,00.html?gusrc=rss&feed=1

    learning anatomy to the same degree as doctors, as well as studying physiology, the respiratory system, the cardiovascular system, pharmacology

    knowing as much sa a physician about anatomy does not make you as qualified as doctor is to diagnose and treat disease.

    Does the guardian pay freelancers a per line / per word fee? ‘Cos using the same words twice is surely cheating……

  5. 1729 said,

    September 4, 2006 at 5:42 pm

    Hey Dr. Ben,

    Been enjoying the site for a while now, particularly pleased to have Irrationality by Stuart Sutherland drawn to my attention in one of the forums. His words,

    “To establish that a rule is likely to be true, one must try to prove it false, but this is just what people don’t do.”

    springs to mind reading that article.

  6. Ben Goldacre said,

    September 4, 2006 at 6:52 pm

    art students learn quite a lot of anatomy too, they used to come in to dissection and do the cadavers.

  7. MostlySunny said,

    September 4, 2006 at 6:53 pm

    ” If you want clinical evidence – how about millions of years of human history?”

    oh dear. the fact that people died in massive numbers of things like colds, cuts and childbrith means nothing then…

  8. Ben Goldacre said,

    September 4, 2006 at 7:12 pm

    heh. although i would have to agree with her that millions of years of people often getting better by themselves really does shed light on how alternative therapies work.

  9. doctormonkey said,

    September 4, 2006 at 7:41 pm

    Two quick points and then a rant…

    a) how can the Guardian print this woman’s drivel? (see below in rant for more details)

    b) well done Ben (and others) for challenging this

    Rant: this osteopath claims to train for as long as a doctor, I must protest this – having just reviewed the General Osteopathic Council website they train for 4-5 years but then there appears to be no requirement for or provision of postgraduate training. I and Ben and many others have not only spent 4-6 years at medical school but must then spend a further 5 years minimum before we can call ourselves specialists or GPs so NO they are not necessarily as well trained as doctors (although some may well be).

    To further pick apart her article:

    She attacks Michael Baum who I think I saw on BBC TV and who pointed out that as a surgeon he was not threatened by homeopathy etc as they do not attempt to sort out the type of surgical problems he deals with (I believe breast cancer) and that he had been chosen by homeopaths (I can’t remember which august body but one of them) for this perceived neutrality.

    She then attacks conventional medicine for not being perfect, I have never come across anyone who claims it is and most people I have come across when they make a mistake are at pains to learn from it and try to stop colleagues from making the same mistake.

    She alludes to an earlier “attack” on spinal manipulation which she wrote her other article on as an excuse to attack the medical profession.

    I am surprised she can claim that osteopaths and chiropractors learn as much anatomy etc as doctors as to the best of my knowledge the levels of these subjects taught at medical schools seems to vary quite bit (from personal experience).

    What she fails to mention when she comments on an osteopath’s assessment of a patient is the stage where they recognise the limits of their knowledge/ability and refer to/back to the doctor/GP: this appears to be a common failure among CAM “professionals” and a worrying one, most doctors and other scientists are only too aware of their own limitations and when and where to look for help.

    It is interesting that her attacks on the evidence base of medicine and its practice are thalidomide and herceptin, thalidomide is old news and prompted a massive reorganisation and tightening of the rules and herceptin appears to me to have been pushed by drugs companies/politicians with no doctors I have heard supporting this rushed move before there is any real body of evidence for benefit and quite a bit on risks.

    I agree with other commentators to her article, it is at most millenia (hundreds maybe) of human history, populated by early death and suffering from now easily treatable and in some cases erradicated diseases (cured and erradicated by CONVENTIONAL medicine), maybe CAM will allow us to weed out the gullible from the gene pool?

    I have never understood why a homeopathic trial cannot simply be homeopath sees patient, makes diagnosis or whatever, prescribes medication, makes up medication or otherwise obtains it, passes it to study controller who randomly either gives medication or placebo, then study patient outcome? Any answers PLEASE

    If much of the benefits of CAM if not all are from placebo effect of attention, maybe money better spent on the few where the special intervention works and the rest of the money spent on counsellors?

    The final point I would like to make, in defence of conventional medicine and Prof Edzard Ernst in particular, is that there is a new book on CAM and the evidence bases and a summary in a trade rag (Pulse, 24/08/2006 p30-32) gives a list of conditions demonstrated to benefit from accupuncture, a treatment that seems to have as bizarre an underlying theory as homeopathy! Why do they not mention this as a triumph of the CAM? For the record, I have not checked on the research basis for this but if “they” hate Prof Ernst and he says this is so, maybe it is?

    Sorry for the length of the rant.

    By the way, Ben, do you want more of us to write to the Editor of the Grauniad about such things or should we confine rants to message boards/forums like this?

  10. cath having fun said,

    September 4, 2006 at 7:41 pm

    Ms Sturzaker exploits her osteopath qualifications and her ‘touchy-feely’ ability to find ‘cysts and tumours’ missed by ‘careless-but-wrongly-trusted’ medical professionals as proof-positive of her ability to write on a subject about which she clearly knows little. But her naive drivel provides further evidence that our future HM-in-waiting has it completely wrong about bringing complementary medicines into mainstream medicine at the current time. Ms Sturzaker brings to the debate the musings of the typical Guardian reader, not the views of a health care professional as the current definition refers.
    If she were really the latter, by now she could be facing a formal disciplinary action as I for one would complain about her not only for recommending treatment of no proven benefit, but for misleading her clients by justifying her naive musings on a subject about which she clearly knows little about with the old chestnut, ‘ trust me, I’m an osteopath’.
    and although i am a dietitian rather than a physiotherapist, my physiotherapist colleagues i know would take issue with her statement ‘the new rules on homeopathic treatment are a small step in the direction of bringing complementary medicines into the mainstream – a journey already made by physiotherapists’
    Ms Sturzaker, physiotherapists are light years away from the fumblings of chiropracters, although I know of several who trust osteopaths enough to recommend clients try their approach. But to compare your status akin to a physiotherapist is just plain delusional.
    Physiotherapists remain ‘complementary’ to medicine, just as they have done – along with most of the other 12 healthcare professions – since 1980. Consider my profession as a dietitian also ‘complementary’ if you like to conventional medicine (and yes, we also occasionally pick up health cues missed by medics, but therein lies the benefits of NHS team work). But the difference between us and osteopaths – or our alternative nutters (aka nutritional therapists, ‘leading clinical nutritionists’) remain that we work ‘complementary’ within the NHS and private framework to provide the holistic service considered the Holy Grail of healthcare management, whereas Ms Sturzaker remains outside it……. bleating that the conventional approach fails to take her and her ilk seriously. Her article justifies such rebuttal.

  11. Ben Goldacre said,

    September 4, 2006 at 7:49 pm

    “By the way, Ben, do you want more of us to write to the Editor of the Grauniad about such things or should we confine rants to message boards/forums like this?”

    i have no desire to be the cheerleader of a letter writing campaign. i do think it’s pretty funny though. if the crop continues to be so good i reckon i might do a roundup of foolish homeopathy story commentaries this week, there’ve been some great debates on radio and telly too, with respected homeopaths properly going for it and outright denying the very existence of inconvenient trials and meta-analyses. Genius.

  12. Skeptico said,

    September 4, 2006 at 9:09 pm

    Great letter Ben. If they don’t publish it you could always make it the subject of your next Bad Science column.

    Incidentally I wrote about it here: skeptico.blogs.com/skeptico/2006/09/homeopathy_guar.html

  13. steve said,

    September 4, 2006 at 10:41 pm

    “Osteopaths and chiropractors (the areas I am most familiar with) train for four or five years, learning anatomy to the same degree as doctors, as well as studying physiology, the respiratory system, the cardiovascular system, pharmacology and pathology, among others, which all help in our diagnostic triage – we are becoming more and more often the first port of call for many patients”

    Wow! They study pharmacology? But how much – it must be less than doctors, otherwise the article would have said that they study pharmacology to the same degree as doctors. And seeing as doctors don’t actually learn that much pharmacology, that must mean that osteopaths and chiropractors study virtually no pharmacology. Which is fairly obvious, as it only requires a basic familarity with pharmacology to realise that homeopathy just cannot work.

  14. lammtron said,

    September 5, 2006 at 12:33 am

    From the article I’m not convinced of the rigourous level of training osteopaths go through and its just awful journalism to boot . She also seems to lump all of CAM together as being equally effective, so now I’m in a bit of dilemma- I’ve got a headache from wading through all the drivel in her artcle but I don’t want to take any nasty ibuprofen since it’ll invariably mess with my chakras, so whats the CAM cure? Cranial osteopathy, a healing crystal, eliminating wheat and dairy, trepanning……?

  15. JohnD said,

    September 5, 2006 at 1:11 am

    Ben, Superburger, anyone thinking of writing to The Editor,
    200 words? About an item in the paper, esp ‘Society’? No chance.
    They’ll only print letters as long as that about events.
    Pithy, witty, that’s what the Guardian likes.

    GIve them credit, they’ve replaced the awful, fluttery author of their “Wellbeing” weekend supplement page (I used to read it for the adrenaline rush) with Max Pittler of the The Peninsular School of Medicine, Exeter, Department of Complementary Medicine. At least he and Prof Ernst know very well what an RCT is.

    John

  16. Mithent said,

    September 5, 2006 at 1:53 am

    How highly trained any CAM practioners may or may not be in any field is rather irrelevant to whether the treatment they offer actually works, anyway!

  17. Symball said,

    September 5, 2006 at 10:14 am

    Perhaps an Ig nobel award might help, I have nominated the MHRA for their allowing homeopathy labels to include treatments- apparently you can even nominate whole countries so south africa’s AIDS treatments should also be included!

  18. coracle said,

    September 5, 2006 at 10:28 am

    I just checked the letters web page on the Guardian site, I assume from that they declined to publish?

  19. simongates said,

    September 5, 2006 at 11:28 am

    It’s a bit ironic that the publication that brought us Bad Science also brings us stuff like Nicola Sturzaker’s article. I’ve written to the Guardian too so we’ll see if that gets published anywhere.

    A couple of aditional points: her ignorance extends to human evolution as well as evidence based medicine. There are not “millions of years of human history” – anatomically modern humans have only been around for 160,000 years or so.

    And how much training in physiology anhd pharmacology does your average homeopath have? And if they have any, do they have to have it erased from their brains before starting to practise their art, which has no mecahnistic basis known to science?

  20. kim said,

    September 5, 2006 at 11:30 am

    Steve, you said that “it only requires a basic familarity with pharmacology to realise that homeopathy just cannot work.” And yet there are GPs around who are prescribing homoeopathic remedies to their patients. Does this mean that some GPs don’t have a basic familiarity with pharmacology? I only ask.

  21. Ephiny said,

    September 5, 2006 at 12:15 pm

    Maybe it’s a way for the GPs to get away with giving useless sugar pills to placate their hypochondriac patients who actually have nothing wrong with them that requires real treatment?

    I should hope all GPs do have at least a basic familiarity with pharmacology! But maybe some of them also ‘believe’ in homeopathy. It does seem to be an almost religious faith for some people, and maybe that can override what they should rationally know to be true?

  22. Tessa K said,

    September 5, 2006 at 12:50 pm

    If CAM is so good, how come people who still live in ‘primitive’ societies have such high infant mortality rates, live shorter lives and die from diseases that are easily treatable in the West? They use ‘natural’ remedies because that is all they have, not because they are better.

    Of course some ‘natural’ remedies work, because they have the same chemical components as Western medicine, but if I have a headache, I’d rather get a pill from the chemist than a bit of twig with an unknown active dose, potentially adulterated by mould, bird poo etc.

    If only GPs would learn to be a bit more touchy-feely, a lot of people wouldn’t feel the need for CAM. And if only people realised that we are all walking chemical factories, they might not be so suspicious about ‘chemical’ medicine.

  23. coracle said,

    September 5, 2006 at 12:57 pm

    There’s a nice readers rebuttal here: here

  24. kim said,

    September 5, 2006 at 1:02 pm

    That’s Superburger – well done, Superburger!

  25. Ben Goldacre said,

    September 5, 2006 at 1:15 pm

    fly moves superburger, you are totally kung fu.

  26. Dr Aust said,

    September 5, 2006 at 1:39 pm

    Kim wrote:

    “Steve, you said that “it only requires a basic familarity with pharmacology to realise that homeopathy just cannot work.” And yet there are GPs around who are prescribing homoeopathic remedies to their patients. Does this mean that some GPs don’t have a basic familiarity with pharmacology? I only ask

    The snide answer here, coming from one of my more cynical GP friends, runs:
    “Imaginary remedies seem to work quite well for patients with imaginary diseases”

    I suspect most GPs don’t PRESCRIBE homeopathy, but maintain a fairly neutral attitude to their patients using it – we are talking mostly supermarket homeopathic remedies rather than consulting a homeopath. The GP probably rationalises it as “If my patient wants to feel they are taking some action to try to help manage their condition, why disillusion them / tell them it is hopeless etc etc.”

    My other half (a hospital doctor) has a careful form of words for patients who report the typical vague malaise/”off-colour”/fatigue-y symptoms, usually untreatable by conventional medicine, and who then mention taking homeopathic remedies. She says:

    “Well, it’s not regarded by doctors as having any medical effect, but some people have said that this helped them”.

    I do know medics and scientists who think this is terrible and misleading because it tends to legitimize the homeo-stuff, but a response like this can be argued to (i) be accurate and (ii) preserve the “therapeutic relationship” between the doctor and the patient.

  27. kim said,

    September 5, 2006 at 1:57 pm

    No, I’m sure most GPs don’t prescribe homoeopathy, but there are a few who do.

    My point, really, is that I get slightly fed up by the assumption on this board that doctors are saintly people, who behave completely rationally at all times, and whose only problem is that they are bothered by silly people with imaginary illnesses.

    While there are no doubt a few who match this description (Dr Ben, natch), there are an awful lot of doctors out there who are quite dreadful and simply don’t have a clue.

    I have plenty of stories I could bore you with, but surely you must have come across instances yourself, either from your own experience, or that of friends or relatives, of doctors who have missed the symptoms of a major illness or come up with a completely wrong diagnosis. If not, then you’re a damn lucky fellow.

  28. 1729 said,

    September 5, 2006 at 2:07 pm

    How long does it take to kill a bad meme?

  29. Mojo said,

    September 5, 2006 at 2:43 pm

    “My point, really, is that I get slightly fed up by the assumption on this board that doctors are saintly people, who behave completely rationally at all times, and whose only problem is that they are bothered by silly people with imaginary illnesses.

    While there are no doubt a few who match this description (Dr Ben, natch), there are an awful lot of doctors out there who are quite dreadful and simply don’t have a clue.

    I have plenty of stories I could bore you with, but surely you must have come across instances yourself, either from your own experience, or that of friends or relatives, of doctors who have missed the symptoms of a major illness or come up with a completely wrong diagnosis. If not, then you’re a damn lucky fellow.”

    Nice strawman (and one that Sturzaker used in her article). Nobody suggests that doctors are infallible. But if diagnosis and treatment is based on evidence rather than wishful thinking, at least there is a chance of detecting and correcting mistakes, and of weeding out ineffective treatments.

  30. kim said,

    September 5, 2006 at 2:59 pm

    Not really a strawman, though. A strawman is one, surely, that doesn’t exist. Lousy doctors do exist. I’m not defending homeopathy (I don’t think it works), but I dislike the assumption that doctors, by virtue of their qualifications, are somehow above criticism. The thing is, you say “if diagnosis and treatment is based on evidence rather than wishful thinking…” but a lot of the time it isn’t based on evidence. It’s based on “I don’t know what’s wrong with this patient and I wish they’d go away.”

  31. Dr Aust said,

    September 5, 2006 at 3:08 pm

    Agreed, Mojo – as long as medicine is based on evidence then misdiagnosis / poor care can hopefully be corrected by going to a different doctor.

    Kim – I wouldn’t claim they are all great. I have been teaching medical students for 20 yrs, and have taught a good few I would have nightmares about meeting on the other end of the stethoscope. I have also been a patient of good doctors (at least as I saw it) and significantly not-so-good ones. Plus they are not always good at all aspects of their job – like the stereotypes of surgeons with hands that are brilliant holding a scalpel but a profound inability to talk to their patients.

    From living with a doctor, and knowing a load of others, I would say that medicine is a hard job to do well, and very wearing, physically and emotionally, for the practioner. The harder they work to do it right, the more it takes out of them. Human nature being what it is, there will always be some who are going through the motions, as well as some who are not all that good. What we are saying here on the Badscience threads is usually that “Going to the Darkside”, crying ” A plague on them” and embracing homeopathy and the like, is not a sensible reaction and certainly not a solution.

  32. smacks said,

    September 5, 2006 at 3:22 pm

    I would rather see a bad doctor with effective tools at his or her disposal than a good osteopath with tools that have little or no evidence base.
    They may not be everybody’s perfect solution but the increased heavy handed guidance of the PCTs and Health boards in the UK mean that GPs increasingly have protocols to follow for particular patients, especially in terms of prescribing cost effective drugs with a proven evidence base.

    ( You could argue that the drugs with the widest evidence base are likely to be promoted by the biggest companies however- this does not mean that these drugs are not effective- just that there may be equally effective agents that exist that are marketed by smaller companies who just do not have the capital to invest in a big multicentred RCT, just like some of the alternative companies,but that’s a different debate)

    This means that you are very likely to receive a standardised treatment – the same if you are in Plymouth or Glasgow.

    Also, Osteopaths are much less likely to see many of the socially and economically deprived patients that many inner city GPs will have to see, with substance abuse and other problems which very may well mask or alter symptoms of disease and illness.

    Many patients require a holistic tailored approach but they need effective molecules to treat them once a diagnosis has been made

    I find it hard to believe that people are trying to compare the professions.

  33. Symball said,

    September 5, 2006 at 3:22 pm

    Kim- my take on this is that I would rather have a bad doctor who is going to get it right 50% of the time than a good homeopathist who will never make a real difference. Of course we would like infallible doctors but as long as we keep trying to improve the system I will take fallible ones over snake-oil every day.

    And any doctor recommending homeopathy, even with such woolly terms, should be disciplined by the BMA. A doctor has a position of trust and recommending expensive sugar pills is an abuse of that trust. It doesn’t matter if they have tried to be circumspect they are an authority figure and should not lend that to a quack treatment like homeopathy.

    A lot of people feel they should get the treatment they want from the NHS- It is there to give you the treatment that you need.

  34. Mojo said,

    September 5, 2006 at 3:24 pm

    “Not really a strawman, though. A strawman is one, surely, that doesn’t exist. Lousy doctors do exist. I’m not defending homeopathy (I don’t think it works), but I dislike the assumption that doctors, by virtue of their qualifications, are somehow above criticism.”

    If it isn’t a strawman, you will have no difficulty naming a few people who have stated that doctors are, by virtue of their qualifications, above criticism.

  35. Ben Goldacre said,

    September 5, 2006 at 3:34 pm

    “If it isn’t a strawman, you will have no difficulty naming a few people who have stated that doctors are, by virtue of their qualifications, above criticism.”

    heh:

    freesound.iua.upf.edu/samplesViewSingle.php?id=22331

  36. Dr Aust said,

    September 5, 2006 at 3:59 pm

    Symball wrote: “And any doctor recommending homeopathy, even with such woolly terms, should be disciplined by the BMA. A doctor has a position of trust and recommending expensive sugar pills is an abuse of that trust.”

    The doctors don’t RECOMMEND homeopathy – none that I’ve ever met, anyway. It is more that the PATIENTS want to try it and should the doctor tell them not to. (They’ll probably do it anyway). But it is more complicated than that.

    The typical scenario (recounted to me by several hospital doctor / GP friends) runs:

    Patient has symptoms of “not feeling right”, fatigue, indigestion, feels shaky, defeated, mid-life crisis etc etc. Doctor investigates, finds nothing, concludes patient is not totally happy with their job / life (well, who is?). Recommends all the evidence-based things, healthier diet, exercise, gives “lifestyle advice”, suggests more holidays, outside interests, breaks during working day, etc etc.

    Patient: responds “But I’m so tired all the time I couldn’t possibly….”

    Some time later patient returns saying: “I was talking to …. and s/he said… Red Kooyong ginseng… felt loads better…so much that s/he started hiking again was able to walk up Snowdon …Thought I would try it….. is that OK medically, doctor?”

    Doctor thinks:

    Hmm, potential “transforming moment” here, they may improve if they feel they can take some “positive action”….so…. if they believe the thingummy powder might work, think placebo effect…. and that might help them persuade themself to do the evidence-based things I’ve suggested, break the negative circle… so what can it hurt? What’s important is to get them to do something… Cue:

    “Well, it’s not regarded by us doctors as having any medical effect, but some people have said that this helped them”.

    There is also the aspect that the doctor does not want to “alienate” the patient by saying “what??! Load of rubbish, don’t waste your time”. This argument also turns up with (e.g.) cough medicine for kids with coughs. There is no evidence suggesting it makes them get better quicker. So on EBM grounds, no cough medicine shouod ne doled out ever.

    BUT… GPs surveyed a while back often said that if distressed parents clearly WANTED their kid to have cough medicine, and BELIEVED it would make a difference, they would prescribe it… because it couldn’t do any harm, and because keeping a good relationship with their patients was more important than “enforcing” EBM.

    This “balance” in turn, would be different if there was a more signficant medical or public health reason NOT to prescribe, rather than just “it doesn’t help”- e.g. not giving antibiotics for things that don’t need them as it might encourage drug resistant bacteria. So the prediction would be that a GP would be more likely to resist pressure to hand out antibiotics than pressure to hand out harmless cough medicine.

  37. 1729 said,

    September 5, 2006 at 4:35 pm

    I’m probably heading way off topic, but I was trying to think of how to address Kim’s point in terms of logic and if one had no access to evidence and the only anecdotal experience (as I have no real knowledge myself of medicine.)
    If one takes the view that not all doctors are bad, there must therefore be less bad doctors than there are doctors in total. At this point some numbers would be handy, but perhaps it’s not going too far too suggest that if there were more bad than good everyone would seek alternative treatments. This would suggest that on probability alone, it’s better to see a proper doctor than a quack even if one has had a bad experience previously. Just don’t see the same one.

    I haven’t thought about that hard enough to be sure it that this isn’t simply a plausible argument. I’ve only ever been able to prove something properly in Maths, the rest is just a question of what degree of tolerance of proof is considered satifactory (for irrational human beings.)

  38. spectator said,

    September 5, 2006 at 4:36 pm

    Pro-CAM arguments provoke the same despair in me as reading about how Bush and Blair are said to have worshipped together. You can’t argue with blind faith. Am I alone?

  39. smacks said,

    September 5, 2006 at 4:56 pm

    I agree with Dr Aust
    Although some complemetary medicine can have harmful interactions with prescribed and OTC medicine, in most patients, the only harm it will do is to their bank balance.
    But if they feel that they are empowered: I hate corporate speak but if they ‘take ownership’ of the problem and the solution, they will invest more in getting better.

    A lot of CAM is as effective as placebo- or that is what we must assume until proper evidence is provided.
    However, placebo itself is a wonder drug- upto 60% effective when treating depression in trials versus prozac like drugs and even around 30% effective in reducing blood pressure in some hypertension studies.
    The patients state of mind and attitude towards the treatment has a major impact on the subsequent success of that treatment. That is how CAM has become such a multimillion pound business. Oh yeah,and blind faith.

  40. kim said,

    September 5, 2006 at 7:03 pm

    Well, an interesting range of comments.

    Let me try and make myself clear. I don’t believe homoeopathy works. Like most people here, I don’t think it makes any kind of scientific sense. I would much sooner go to a GP than to a homoepath. Actually, I just wouldn’t bother going to a homoeopath at all.

    But I dislike the assumption that GPs, by virtue of having a scientific training, therefore behave rationally and sensibly. A minority of GPs do, for example, believe in homoeopathy – they don’t just say things like “if it works for you, then use it,” they actively prescribe homoeopathic remedies, or they refer patients to the homoeopathic hospital (part of the NHS, incidentally, so they’re not terribly likely to be disciplined by the BMA). And they can get things very badly wrong.

    I suppose the comments that have provoked me are ones on the lines of doctors getting fed up with people who have imaginary ailments, and only people with imaginary ailments going to homoeopaths etc. Why not consider the other option, namely that the person has something wrong with them but the GP genuinely doesn’t know what it is? The trouble is doctors rarely admit to not knowing what is wrong with someone and would prefer to say it’s imaginary or mutter something about stress than admit to not knowing. Thus are people driven into the arms of CAM practitioners.

  41. Mojo said,

    September 6, 2006 at 6:01 am

    “But I dislike the assumption that GPs, by virtue of having a scientific training, therefore behave rationally and sensibly.”

    Who assumes this?

  42. superburger said,

    September 6, 2006 at 11:34 am

    cool, fame at last.

    Was my letter in the actual paper or just online? I am currently at my grandmother’s house and the old dear put the paper for recycling, very environmentally friendly i am sure. But the collection was today and jet lag ensured I slept through it all.

    I would like a copy – feel free to pm me through the message boards. All costs covered natuarlly (and organicaly too!)

  43. Andrew Clegg said,

    September 6, 2006 at 12:45 pm

    Ephiny said: “Maybe it’s a way for the GPs to get away with giving useless sugar pills to placate their hypochondriac patients who actually have nothing wrong with them that requires real treatment?”

    I remember a particularly interesting MD column in Private Eye once, the only time I can remember when he’s written about alternative medicine — the gist of it was, it’s all a load of rubbish, but absolutely vital to the NHS for getting untreatable malingerers out of doctor’s waiting rooms. In fact, he suggested the NHS would collapse without it…

    PS superburger, well done, didn’t see the paper yesterday so I don’t know if it’s in actual print or not.

    Now we know who you are, get back to the recording studio ;-)

    Andrew.

  44. Mojo said,

    September 6, 2006 at 1:32 pm

    superburger said, “Was my letter in the actual paper or just online?”

    I haven’t seen it on the main letter page. It was in the “society” section, which (I think) only publishes in paper form on Wednesdays. There’s no sign of it or the article you were replying to in today’s issue, as far as I can see, but the original story is mentioned on the front page of the “society” section as being available in the online version

  45. icarus said,

    September 6, 2006 at 1:56 pm

    Something from a few months back:

    J Allergy Clin Immunol. 2006 May;117(5):1054-62 – Systematic review of complementary and alternative medicine for rhinitis and asthma

    Makes a good short read, reviews various trials – and concludes a general lack of standards in CAM trials – no real news, but those with access can enjoy the fact that money was spent on demonstating it yet again!

  46. detly said,

    September 6, 2006 at 3:49 pm

    “Fabulously circular.”

    I love it.

  47. smacks said,

    September 6, 2006 at 5:14 pm

    I reckon we are missing the point here- many homeopathic remedies ARE effective and share many similarities with patented molecules marketed by the pharma industry- it’s just the evidence is not there because no-one has invested in it.

    (St Johns Wort, for instance alters the levels of neurotransmitters at the synapse or nerve ending just like the older and newer antidpressive agents but you don’t need a prescription to consume it. Although it has more robust data than most CAM, it is still patchy and people buy it online and in ‘health shops’ and don’t have a clue about safe, effective doses).

    If patients have access to the evidence for homeopathic remedies, they can make informed choices- although I guess that not everybody would be capable of interpretting the data correctly.

    However, even if they could make sense of the CAM evidence, they would not have the evidence for the prescription medicines to compare it to as most of that data does not lie in the public domain and is reserved (by the Pharma industry) for healthcare professionals.

    (Even if the evidence is there, it must be noted that a pharma company has an obvious interest in proving effectiveness- patient selection, competitor drug selection and doses, duration of trial: these criteria all have the power to alter the results of a trial quite significantly. Most doctors can see through the ‘spin’ however.)

    There is also a backlash by many doctors against the current trend for EBM or nothing.
    It is logical that if there is more positive evidence for 1 agent versus another, then you are more likely to prescribe that in general for your patients. But when you have a patient in front of you who for various reasons, cannot tolerate a certain drug or in who it is contra-indicated, then you may have very powerful rationale for using the drug with less evidence in general, in THAT particular patient.

    This is starting to sound like the CAM claims, but medicine has always been tailored to patients, based on gender, race, age and now diabetic status. Soon, as has been heralded for decades (more emperors clothes, anybody?) gene therapy and other gene specific targetted agents will make medicine very much a bespoke package.

    So maybe one of us may find a relatively unproven ‘homeopathic therapy’ more useful than a Pharma industry alternative supported by a wide body of evidence, or maybe we won’ t get sick in the first place.

  48. Dr Aust said,

    September 6, 2006 at 7:01 pm

    I think you mean “HERBAL therapy”, Smacks – homeopathic means something different, specifically “diluted and diluted and diluted and diluted again and again until there is nothing there but water” – not one molecule of pharmacologically-active anything. Hence the reason homeopathy in particular gets us mainstreamers so grouchy.

    For HERBAL medicines, the problem is typically not enough well-conducted trials.
    Herbal remedies ARE testable in standard trial designs (just like pharmaceutical products)and HAVE been tested – St J’s Wort being probably the best example. However, there IS a difficulty in that different companies’ products are probably not strictly comparable. In Germany, incidentally, you are probably more likely to get prescribed ST J’s W by your DOCTOR (that’s medically qualified doctor) for mild depression than you are to be given a pharmaceutical antidepressant.

    …BUT….

    Once you reach that point, is the stuff CAM? As several of the big-league commentators have observed, once it has been clearly shown to work it ceases to be a “complementary therapy” and just becomes “a therapy”.

    PS On “What is CAM and what isn’t”, it always makes me laugh when I see a piece in the health/lifestyle pages headlined “CAM cured my back pain” and it turns out the “CAM” was them paying a CAM type to tell them to get up and start moving about. This would be the same advice the doctor would have given them, but there they might have interpreted it as “they said they couldn’t really help and just gave me more painkillers”. Sometimes it’s all in the eye of the beholder.

  49. pv said,

    September 6, 2006 at 11:38 pm

    “many homeopathic remedies ARE effective”

    Er… no they aren’t. Not a single one of them, and here’s why:
    www.acahf.org.au/articles/homeopathy1.htm

    I think, Smacks, you are falling into the same trap that causes many people to think there is something medicinally valid about homeopathy. As Dr Aust has pointed out, homoeopathy and herbal medicine are entirely different things and not related at all.
    On the “alternative” front,
    As for “alternative” or “complementary” medicine – there is no such thing. If it works it’s medicine, and if it doesn’t work it isn’t medicine. If it works it can be tested and demonstrated. The only serious, properly controlled tests ever conducted on homeopathic “remedies” (none of which by the way ever contain anything more active than water or lactose) all conclude that it has no more medicinal value than a placebo (in other words, it’s as effective as wishful thinking). The fact that Prince Charles or any other famous but equally gullible celebrity endorses homeopathy doesn’t change anything. If HRH Prince Charles decided the Earth was flat no doubt some other lunatics could be found to agree. However, the Earth would still be flat, and homeopathy would still be a fraudulent billion dollar industry

  50. Mojo said,

    September 7, 2006 at 12:02 am

    pv said, “The only serious, properly controlled tests ever conducted on homeopathic “remedies” (none of which by the way ever contain anything more active than water or lactose)…”

    Actually, this is only the case for potentcies of 12c/24x and higher. In some of the lower potencies used there will be minute amounts of the mother tincture present. Just not enough to have any actual effect.

    And this doesn’t alter the fact that the whole “like cures like” thing is nonsense…

  51. doctormonkey said,

    September 7, 2006 at 12:06 am

    Wikipedia gave 2 definitions of CAM –

    Richard Dawkins is quoted as saying “alternative medicine is defined as that set of practices which cannot be tested, refuse to be tested, or consistently fail tests. If a healing technique is demonstrated to have curative properties in properly controlled double-blind trials, it ceases to be alternative. It simply…becomes medicine.” He also states that “There is no alternative medicine. There is only medicine that works and medicine that doesn’t work.” and they give references.

    They acknowledge that the more commonly held (by scientist et al) definition is “a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine” and they quote Prof Ernst (surely one of the most quoted/abused/used academics since the 1940s physicists?!) as holding to a similar definition as he attempts to pin them down with a little science to see which appear to work and which not.

    It is all in the first few bits of the website at en.wikipedia.org/wiki/Complementary_medicine

    it is also worth looking at the site about homeopathy giving some history and some arguments against etc

    personally i think one definition is too soft and the other is really just an excuse to start an argument (Ben is not the only one from North/West London although some of us leave!)

  52. smacks said,

    September 7, 2006 at 9:02 am

    Like the man in the orthopaedic shoes, I stand corrected.

    I was unaware that homeopathy is such a diluted form of medicine. That makes a lot of the previous stuff I wrote make little sense.

    What strikes me most about this fact is that the actual placebo effect must be severely diminished too if the patients have made an informed choice to take something that is so diluted or that they know is little more than sugar and water.

    I also agree that once a product has been tested to RCT standards then by definition, it does then become a medicine and not a alternative or complemenary preperation.

    The earth isn’t flat?

  53. zakmundo said,

    September 7, 2006 at 11:02 am

    are there any forums where we can find the mirror image to this : a bunch of homeopaths (users, dispensers and believers) happily chattering away? Would like to be a fly on their wall if nothing else.

  54. Mojo said,

    September 7, 2006 at 11:09 am

    You could try:

    www.hpathy.com/homeopathyforums/default.asp
    www.otherhealth.com/

  55. apothecary said,

    September 7, 2006 at 12:27 pm

    Great stuff, this. Two points:

    A – I do believe that some herbal remedies have some effect (I’m not saying if I’d prefer to take, say fluoxetine or St John’s Wort if I were depressed, that would depend on lots of things). I also believe that for some MSK conditions, manipulation and exercise can help a lot. But of course, all alternative med is lumped together with homeoopathy and bach flower remedies being equated with extract of Digitalis purpurea for the dropsy (which is effective, if less than ideal as a crude extract of uncertain strength than in good pharmaceuitcal format, and also carries risks as well as potential benefits)

    B – the homeopathy bunch always squirm on the RCT arguement. They say that homeopathic remedies have to be individualised, so you can’t do an RCT. But they also say that you can use eg Arnica for all bruises etc (and other examples). So the RCT-isn’t-appropriate arguement doesn’t seem to stand up. And I find it deeply embarassing that some pharmacists sell such snake oil.

    Both come back to the fundamental problem, which is that lots of people wouldn’t know a scientific arguement if it came up and bit them on the bottom. CP Snow’s two cultures!

  56. pv said,

    September 7, 2006 at 1:42 pm

    “And I find it deeply embarassing that some pharmacists sell such snake oil.”

    Boots the Chemist?

  57. zakmundo said,

    September 7, 2006 at 1:55 pm

    so much for this : www.hpathy.com/homeopathyforums/default.asp

    I couldn’t get in to the discussion forum for ‘Professionals & Practitoners’ (are they separate people?) because it is….”A closed forum for professional homeopaths. To join this forum, send email to webmaster with your full name, qualification, experience, address & phone no.”

  58. David Mingay said,

    September 7, 2006 at 1:58 pm

    Mojo – thank you for the hpathy.com forum link. In one of the threads, a homeopath claims that homeopathy can cure some guy’s wife’s aversion to giving him oral sex (although it may take years of expensive therapy). The question is: what should she do with the dose – spit or swallow?

  59. MostlySunny said,

    September 7, 2006 at 2:12 pm

    I had a quick look round too – there are a few posters on there looking to mix it up a bit I think – but WHAT a bunch of self-important so-and-so’s! The one woman actually QUESTIONED why a person had taken anti-biotics instead of homeopathic treatment! Scary and dangerous.

  60. zakmundo said,

    September 7, 2006 at 2:12 pm

    so I read threads like this

    www.otherhealth.com/showthread.php?t=2018

    Is a fantastic exercise in delusion looking at why homeopathic treatments fail.

    And is deeply scary. These people are still at the levels of crystal balls and pyramids.

  61. Ben Goldacre said,

    September 7, 2006 at 2:14 pm

    no takers so far for my offer

    www.hpathy.com/homeopathyforums/forum_posts.asp?TID=4741&PN=1

  62. MostlySunny said,

    September 7, 2006 at 2:43 pm

    but where’s the fun in THAT! Boring old science mucking up perfectly good fairy tales.

  63. Mojo said,

    September 7, 2006 at 2:51 pm

    Wow!

    www.otherhealth.com/showthread.php?t=2018

    “What would you say were the reasons why such a high percentage of cases that are posted on this website end in disappointment, confusion and failure?

    Would you consider any of those reasons to be (in no particular order):

    *Inadequate education?

    *Practical inexperience on the part of the homoeopath?

    *Insufficient information on which to base a prescription?

    *An over-reliance on keynote symptoms which is supposed to substitute for the fact that you can’t actually see and hear and touch the patient?

    *Attempting to prescribe in acute situations in isolation when you know nothing about the chronic state of the patient?

    *Unrealistic expectations of the person seeking treatment from an unidentified stranger over the internet?

    *The homoeopath’s ego motivations?

    *Ego competitiveness between homoeopaths and their preferred methods?

    *A lack of accountability in following up cases to see if they actually were ever resolved?

    Anything else?”

    Yes: IT DOESN’T WORK!!!

  64. coracle said,

    September 7, 2006 at 3:03 pm

    pv,

    arabian vesion of the shop coming soon, Boots the al-chemist.

  65. Mojo said,

    September 7, 2006 at 3:10 pm

    Here’s one of my favourites from those:

    www.hpathy.com/homeopathyforums/forum_posts.asp?TID=2557&PN=1

  66. David Mingay said,

    September 7, 2006 at 3:24 pm

    Or, given that we’re talking about fairy tales, Puss in Boots the Chemist.

  67. wilksie said,

    September 7, 2006 at 3:50 pm

    Wandered in to my local Boots today and there are big signs hanging from the ceiling over each aisle – painkillers, travel medicine, ….complimentary medicine. I had a lot of fun pointing out to the pharmacist that I wouldn’t trust their advice on complementary meds if they couldn’t even spell the word.
    (I know, doesn’t take much to make me happy).

  68. zakmundo said,

    September 7, 2006 at 4:02 pm

    Mojo : well well what a great read

    ….www.hpathy.com/homeopathyforums/forum_posts.asp?TID=2557&PN=1

    after a spectacular my-first-breaking-the-atom explanation, a breathless poster responds

    “Not being very much informed on the subject of nuclear physics and following my own peculiar logic, my thoughts on the subject coincide.

    Which points out another subject, and that is, somehow we are all connected with a collective “brain” for want of a better understanding term.”

    well yes of course. And then from the dizzying intellectual heights a poster marked as a ‘professional’ writes :

    “Hence I always say that the so called modern science is far behind to explain homeopathy.”

    Now, where’s my amber crystal gone?

  69. MostlySunny said,

    September 7, 2006 at 4:06 pm

    Mojo – that exchange was unreal – I’m not terribly good at science but wasn’t she suggesting that she could accomplish by the mere shaking of her special mixing jar what scientists can only achieve using a particle collider underneath Switzerland or somewhere?

  70. Dr Aust said,

    September 7, 2006 at 4:17 pm

    Zakmundo wrote: “Mojo : well well what a great read”

    Agreed. Made me laugh out loud at least three times. I love the idea that shaking the homeopathic tube produces a nuclear reaction to generate the “remedy memory”.

    Felt a bit sorry for Danish Hans, the voice of (kind of) reality.

    As several people have already commented, reading this does re-iterate why a truly convinced “homeo-believer” cannot be unconvinced. You would need cult-buster style “deprogramming” to even try. Remember: homeopathy is, in effect, a RELIGION. Not a form of medicine. And “Believers” are (typically) not susceptible to argument about what they believe.

    …What we do need to do is keep educating people in the ranks of the undecided/not all that informed about WHAT homeopathy really is, and WHY it is therefore utterly baseless.

  71. zakmundo said,

    September 7, 2006 at 5:03 pm

    “cult-buster style “deprogramming

    love it.

    The underlying problem with this belief system is that it self-solves. Ignore the placebo effect and most people will just get better. Homeopathy works.

    And if some poor soul is chronically ill and conventional meds don’t work, or merely provide pain management, then this provides a “modern understanding isn’t complete” argument.

    I like the homeopathy as cult idea. It also suggests that the appropriate response is pity and patience, not scorn and anger.

  72. Dave M said,

    September 7, 2006 at 5:08 pm

    Dr Aust said “…What we do need to do is keep educating people in the ranks of the undecided/not all that informed about WHAT homeopathy really is, and WHY it is therefore utterly baseless”

    I think this is a really important point. Doing a quick survey of my friends the other day I was amazed how many made a similar mistake to smacks (post 47) confusing homeopathy with herbal remedies and other CAM stuff. When I explained the process their stance tended to go from ‘There might be something in it…’ to ‘Obviously that is rubbish…’

  73. doctormonkey said,

    September 7, 2006 at 6:47 pm

    had an intersting encounter today that may be relevant:

    background – I am a junior doctor in a GP surgery as a placement on a training rotation

    encounter – a (apparently good and well respected by his peers) locum GP turned out to be a homeopath, I explained I was sceptical and he gave me what his interpretation of the science behind it is and when I commented on some of the other, more extreme, aspects, like writing the cure on a piece of paper and homeopathic “vaccinations” he agreed that it is magic/rubbish; he was also sceptical about non-medically/lay homeopaths as they lack the training to spot emergencies (his example is a headache cure that is supposed to cure a headache that doctors would want to have scanned in hours as it may be a sub-arrachnoid [brain] haemorrhage!)

    comment – I think that the point he makes is that homeopathy does cover a broad spectrum of believers or users and some may not be as bad as others

    personal comment – I still think it is all on a par with fairy dust, magic and good placebo effect

    PS can we invite some homeopaths to the site for discussions or would it get too ugly too quickly

  74. Ben Goldacre said,

    September 7, 2006 at 7:08 pm

    there are plenty of very sensible homeopathic doctors who speak clearly to the evidence and they are a joy to behold, but they are also a tiny minority, possibly a minority of one in peter fisher, i guess there are a couple of other people i’ve come across serendipitously. the rest are a disgrace, especially the way they muddy the water by cherry picking experimental evidence. once they’ve had it pointed out to them once, it becomes deliberate, and that’s v v bad behaviour in my book.

    PS can we invite some homeopaths to the site for discussions or would it get too ugly too quickly

    all are welcome and we’ve had a few, but they tend to get a bit boring and bonkers pretty quickly, writing long ranting posts, derailing other peoples discussions, making it all about them, and missing a lot of basic background that everyone else has already covered. also they tend to copy and paste huge rambles from elsewhere, or long lists of research citations without any critical appraisal or even much explanation, and then expect people to go and read them all, and then when people do, they turn out not to exist, or not to say what they said they say, or to be ludicrously flawed, or overwhelmingly contradicted elsewhere, etc etc.

    that said they are great fun, especially in the forum

    www.badscience.net/forum

  75. Mojo said,

    September 7, 2006 at 7:32 pm

    doctormonkey said, “encounter – a (apparently good and well respected by his peers) locum GP turned out to be a homeopath, I explained I was sceptical and he gave me what his interpretation of the science behind it is…”

    Could you briefly give us his interpretation? Where does he stand on “like cures like” and “vital force”, for example?

    “…and when I commented on some of the other, more extreme, aspects, like writing the cure on a piece of paper and homeopathic “vaccinations” he agreed that it is magic/rubbish; he was also sceptical about non-medically/lay homeopaths as they lack the training to spot emergencies (his example is a headache cure that is supposed to cure a headache that doctors would want to have scanned in hours as it may be a sub-arrachnoid [brain] haemorrhage!)”

    While the fact that he’s well enough trained to spot emergencies may conceivably save lives if he refers patients for appropriate treatment, it doesn’t affect the nature of homoeopathy. A homoeopathic remedy prescribed by a qualified doctor will be no more effective than one prescribed by Dr. Goldacre’s late cat.

  76. Ben Goldacre said,

    September 7, 2006 at 7:40 pm

    A homoeopathic remedy prescribed by a qualified doctor will be no more effective than one prescribed by Dr. Goldacre’s late cat.

    i disagree. my dead cat’s bedside manner is completely rubbish.

  77. John Coffin said,

    September 7, 2006 at 8:22 pm

    Those famous ‘bad doctors’ that quacks constantly invoke are ‘bad’ because they are personally unskilled or corrupt.

    All Homeopaths, no matter how honest or skilled, are ‘bad,’ as they are commited to a system which is based on wrong principles and sustained by denial and rationalization.

    “In 1835 a public challenge was offered to the best-known Homeopathic physician in Paris to select any ten substances asserted to produce the most striking effects; to prepare them himself; to choose one by lot without knowing which of them he had taken, and try it upon himself or an intelligent and devoted Homeopathist, and, waiting his own time, to come forward and tell what substance had been employed. The challenge was at first accepted, but the acceptance retracted before the time of trial arrived.”

    Oliver Wendell Holmes
    Homeopathy and Its Kindred Delusions, 1842

    Well, 171 years later and we’re still waiting.

  78. doctormonkey said,

    September 7, 2006 at 8:31 pm

    Many thank for the comment on the comment Mojo,

    I did not ask about “like cures like” (I should have done) and the impression I got was that he felt that there was a chemical basis to the therapy and so did not explore “vital force”

    Reflecting on the patients I saw today I am not sure how many I treated with the pills I gave them and how many were treated by me trying to be sympathetic and helpful; in some cases they got both and there it really gets murky. There is a school of thought I have come across called “doctor as drug” but I feel that we have moved away from a god-like position (eg I will give you this pill, it will make you better) and more towards a negotiation (eg I would like to give you this pill to treat X, it may not agree with you, you may get any from a long list of side effects, what do you think?) of course homeopathic stuff can’t have any side effects as it doesn’t have ANY effects!

    One of my own arguments against homeopathy is its lack of safety as in focusing on symtoms and their alleviation a lay homeopath may miss underlying serious disease (eg cough may be cancer or TB not just a life style problem)

    I must say that my girlfriend’s (alive) cat would probably have the same autistic-type bedside manner as most orthopods (awful-pods)

    on another note, I am not very experienced at posting and am finding they get a little long and have rather dense paragraphs – any advice? (briefly so as not to derail the theme of the comments)

  79. Dr Aust said,

    September 7, 2006 at 9:51 pm

    - doctor monkey

    Don’t worry about the post lengths. If you’ve got something useful to say, people will still read. And as a few particularly bonkers examples over on the badscience forums amply demonstrate, you are currently a long way short of what we call “loser-length”.

    One suggestion sometimes made about Alt Therapists that goes to some of your comments is compulsory state registration and thus compulsory qualifications – so that a homeopath would have to learn the basic “conventional” view of how the body works, and of disease, as well as their “specialty” . The system in some continental countries (e.g. Germany) is similar to this, I think. The idea then is that the alternativist should know that someone who comes to them with chest pains a few hrs after falling off a motorbike needs to be sent to A&E, rather than given dilute tincture of homeopathic whatever. Another way of looking at this is that under these regulatory systems homeopaths are supposed to stick to treating chronic non life-threatening conditions in people who have already been checked out by conventional physicians. If they don’t stick to this they get “struck off” and can’t work. Of course, in the UK there is no regulation of “therapists” at all.

    The downside of this kind of system, voiced by people like Prof David Colquhoun

    www.ucl.ac.uk/Pharmacology/dc-bits/quack.html

    – is that it would grant them a spurious legitimacy.

    Reading what most of the (non-medical) homeopaths appear to believe about their business and how it works, I find it hard to imagine any of them being able to tolerate haivng to learn conventional mechanism / causality based science. But it actually does happen in some places.

    BTW, re “doctor as drug”, think one basis of this that lives on in the modern “frame of reference” is that sympathy, help and REASSURANCE coming from someone with training / knowledge / experience is valuable. If a patient comes with minor symptoms but worried they are something nasty, and you can reassure them, you have helped – but the helping depends on your “medical status” The same reassurance – “I’m sure it’s nothing serious” coming from the man / woman next door does not have the same value – or effect (placebo or otherwise).

  80. doctormonkey said,

    September 7, 2006 at 11:11 pm

    I will strive to avoid “loser-length”.

    Possibly sadly chiropractic and osteopathy are both rgulated by the goverment as are doctors, dentists, nurses, physio’s etc by the GCC and GOsC – yet they are still CAM and the evidence for their benefits (certainly for some of the things they claim) is pretty dodgy.

    I wonder how medics who do CAM can cope with the dichotomy (I think this is the right word) of the CAM philosophy underlying one side of their training and the conventional science behind the other. It seems similar to children being taught intelligent design and evolution.

    Many thanks for the reassurance that reassurance is an acceptable part of medical care. The emphasis on patient empowerment has, I think, reduced the physician to the point where I feel bad if I deliberately just ressure someone, almost in case they then get run over by a bus and feel I am to blame becuase pre-bus I said they were OK.

    On the other hand, I sometimes want to be able to get out of having a long talk to a patient to persuade them to take something and be able to order them to and be obeyed, especially if there is nothing wrong with them and it is nothing more than a placebo!

  81. Mojo said,

    September 8, 2006 at 12:11 am

    doctormonkey said, “…the impression I got was that he felt that there was a chemical basis to the therapy …”

    Did he give any details of this “chemical basis”? I’m sure we’d be interested to hear about it.

  82. Mojo said,

    September 8, 2006 at 12:19 am

    “on another note, I am not very experienced at posting and am finding they get a little long and have rather dense paragraphs – any advice? (briefly so as not to derail the theme of the comments) ”

    Pop over to the forum, anf let yourself go!

    badscience.net/forum/

  83. SpallationFiend said,

    September 8, 2006 at 9:42 am

    Mojo – that exchange was unreal – I’m not terribly good at science but wasn’t she suggesting that she could accomplish by the mere shaking of her special mixing jar what scientists can only achieve using a particle collider underneath Switzerland or somewhere?

    Actually we do that here in sunny Oxfordshire. I wish someone off that board could’ve told us we could create a neutron spallation source so easily; it would’ve saved us our £13million a year electricity bill.

  84. JQH said,

    September 8, 2006 at 12:53 pm

    Maybe somebody should point out that if their remedy was being blasted with neutrons it would become radioactive?

    Might do it myself if I can be arsed registering.

  85. spectator said,

    September 8, 2006 at 2:53 pm

    Doctormonkey (post 80) – doctors coping with a dichotomy. They don’t cope with the dichotomy, they merely experience severe cognitive dissonance. Leon Festinger could have used your example to illustrate his theories…

  86. The Reverend AG said,

    September 8, 2006 at 3:07 pm

    Pardon my ignorance.. I must ask this question:

    Wouldn’t breaking nuetrons free of the nucleus release large amounts of energy? If it were possible to do so by shaking a jar, wouldn’t the jar and her hand be incinerated by the energy expenditure?

  87. Mojo said,

    September 8, 2006 at 3:17 pm

    Not only can homoeopathy cure all ills, it can also solve all our energy problems!

  88. The Reverend AG said,

    September 8, 2006 at 3:31 pm

    I think I finally understand why Coke fizzes when you shake it. It’s all those damned free neutrons trying to get out.

  89. SpallationFiend said,

    September 8, 2006 at 4:16 pm

    Wouldn’t breaking nuetrons free of the nucleus release large amounts of energy? If it were possible to do so by shaking a jar, wouldn’t the jar and her hand be incinerated by the energy expenditure?

    Oh god yes, loads.
    Would be very impressive to watch though.

    From a distance.

    Wearing boron carbide armour.

  90. MostlySunny said,

    September 8, 2006 at 5:48 pm

    Let’s book some beam time!

  91. doctormonkey said,

    September 8, 2006 at 6:56 pm

    Essentially, the GP/homeopath’s theory was that water and alcohol (which apparently is the solvent of choice for homeopathy rather than H2O) have complex low powered interactions between the hydrogen ions in them and it is through manipulation of these that it may have some effects on a quantum level.

    There was a recent New Scientist article on this which my sister’s boyfriend sent me at www.newscientist.com/article/mg19025461.200-water-the-quantum-elixir.html

    On reflection it seems a little odd to talk about such interactions having a memory as it must be a product of the molecules interacting with each other and by definition (I understand) in a fluid the molecules will mill around like NorthWest Londoners at a party with a glass of chardonay in their hand so these bonds are being constantly made and broken, removing the option of a memory.

    While I am not a chemist or physicist it sounds like bullsh*t, looks like bullsh*t and smells like bullsh*t to me so I am happy to diagnose bullsh*t! But there it is for interest.

    I must caveat that I may have misinterpreted him, I was more interested in trying to remember my chemistry/biology as he compared the process to the folding of enzymes but I was not sold as they are very complex molecules and alcohol and water are very simple so it is not a case of them behaving the same.

    I would like it if a homeopath managed to truely release some neutrons in banging a bottle of water or alcohol as the explosion might be impressive, if there was any of the area destroyed left to write it up in a peer review journal! But there would be issues with replicability!

  92. Junkmonkey said,

    September 8, 2006 at 8:31 pm

    Doctormonkey Said:

    “I would like it if a homeopath managed to truely release some neutrons in banging a bottle of water or alcohol as the explosion might be impressive, if there was any of the area destroyed left to write it up in a peer review journal! But there would be issues with replicability!”

    If this was possible surely the US Military with all it’s vast research budget dedicated to finding new and interestingly cheap ways of killing vast numbers of people would have come up with a working model by now. Or maybe that’s what the recent flap about taking liquids on board planes was all about; Al Qaeda has discovered how to make Homeopathic bombs!

  93. The Reverend AG said,

    September 8, 2006 at 9:11 pm

    “Al Qaeda has discovered how to make Homeopathic bombs!”

    Haha.

    If I were one of these homeopaths, my main concern would be situations where I am jumping/bouncing up and down. It could trigger world war 3.

  94. doctormonkey said,

    September 8, 2006 at 10:03 pm

    homeopathic war? virtually no fighting but lots of death, sounds like nuclear war, which is always good but have we wandered off topic? although this is fun!

  95. SpallationFiend said,

    September 8, 2006 at 11:35 pm

    Then of course we can drop the placebo bomb; an empty shell which does nothing, but causes thousands of impressionable enemies to drop dead.

  96. doctormonkey said,

    September 9, 2006 at 12:22 am

    genius comment

  97. Dr Aust said,

    September 9, 2006 at 12:02 pm

    SpallationFiend:

    You rule – I’m with drM – a top piece of black humour.

    Check out also the gags on this thread, including the “homeopathic parachute”:

    badscience.net/forum/viewtopic.php?t=585

    In fact, perhaps we should have an “Alt Med jokes” page on the Bad Science Wiki? How about it Ben?

    And maybe also a page for the the most scientifically deranged psuedo-sciency neutron bombardment claims by homeopaths as to how homeopathy “works”?

  98. Pish-Tush! said,

    September 9, 2006 at 4:01 pm

    Did anyone say homeopathy has no side effects? Reading the claims sends my blood pressure up.
    I wonder whether the ‘empty’ plinth in Trafalgar square is it still there and was it actually a homeopathic statue of Hahnemann?
    It’s amazing how eager people are to believe this stuff; I work for a QA lab for a ‘Big Pharma’ company and some of the BScs there argue for it!

  99. Camp Freddie said,

    September 11, 2006 at 1:52 pm

    DoctorMonkey, you’re right about all that water/alcohol interaction crap. It’s just the usual hydrogen bond stuff.
    It’s great for keeping water and alcohol in liquid form at room temperature, but the whole point is that the bonds are temporary and that once broken, the water goes back to having a standard O-H covalent bond with no memory of any prvious interactions.

  100. wotsisnameinlondon said,

    September 12, 2006 at 2:09 pm

    Only 75% of patients showed an improvement in their health. Is that all.

    If you go to a hospital ,even a homeopathic hospital, then it is fairly certain that you feel there is something wrong with you. If you do go to a homeopathic hospital it is highly unlikely that you will be there for urgent trauma surgery or other invasive treatment (actually, I quite like the idea of a homeopathic ER. It would make a great TV series. It falls in with other great ideas such as the Salvation Airforce). It is more likely that you will be prescribed pills to make you feel better.

    To confess that 25% of patients do not feel better after six years treatment is not a very good advertisment for homeopathy. I wonder what are the equivalent results for real medicine?

  101. SpallationFiend said,

    September 12, 2006 at 2:43 pm

    Indeed, especially as these were all people pre-disposed towards homeopathy and should be text-book placebo cases, as I think Ben has noted before.
    The fact that 25% didn’t “feel better” probably means that they were either more ill then they could convince themselves out of (poor sods), or they weren’t all that gullible in the first place.

    Either way, it’s still bollocks.
    I mean, what is going on? After all the scientific progress the human race has made over the last 100 years, why does such a large subset of society feel obliged to regress us back down the developmental ladder? FFS.

  102. Delster said,

    September 12, 2006 at 4:48 pm

    surprisingly i feel i have to defend CAM here (osteopaths in this case) to get back to subject for a moment.

    I was once referred to one following an extended period mostly spent on my back due to an accident. Improvement was very rapid and pain relief immense.

    However this was for a purely mechanical problem as the human body is not adapted to spending life in bed for months at a time esp following impacts bad enough to smash bones up.

    I don;t really view Osteopaths as CAM. They are effective for mechanical problems where manipulation of the muscles and bones will physically re-allign the body to it’s proper posture.

    I’d not go to see them over a medical condition though. horses for courses etc….

  103. SpallationFiend said,

    September 12, 2006 at 5:13 pm

    I’m not that hostile to osteopaths and chiropractors in general because hey, I like a back rub as much as the next guy; however I do take issue with someone who’ll say they can treat my flu by apparently trying to twist my head off.
    But then there are two very distinct communities in the field (particularly with chiropractic):
    Those who try to alleviate joint and muscle pain by some kind of bodily manipulation, and the other kind who don’t believe in diseases, bleat on about bodily energies and are very safely in the sphere of quackery.
    Any warranted credit to the former is very much marred by the latter.

  104. doctormonkey said,

    September 12, 2006 at 7:57 pm

    My take on osteopathy/chiropractic is they are at least part CAM not because they don’t work (I haven’t and can’t be bothered to look up how good the evidence for them is) but that they don’t seem to be any better than conventional physio etc and they DO have some dodgy origins that they don’t seem to have divorced from but do keep quieter about.

    I must admit much of my info comes from a bried read through of the osteopathy and chiropractic entries in wikipedia and then glancing at their GMC equivalent websites. The difference between their origins and ours (as a GMC registered physician) is that I do not treat people based upon the principles of Galen or Hippocrites, I have new reasons they work, if they work at all (eg St John’s Wort – magic or neurochemistry? or poppy juice, because its from opium poppies or because I gathered them at midnight and have prayed over them?).

    This was supposed to be a short post…

  105. doctormonkey said,

    September 12, 2006 at 7:58 pm

    damn

    this one is!

  106. cath having fun said,

    September 13, 2006 at 12:23 am

    zakmundo at #53
    why would you want to be a ‘fly on the wall’ of homeopathic practitioners discussions.
    by definition there’d be ‘nothing’ to discuss
    Avogadro’s rules!

  107. apothecary said,

    September 14, 2006 at 1:50 pm

    Re DrAust’ s comment above (97) re CAM jokes:

    Woman to Christian Science minister: “I’m worried about my husband, he’s very poorly”

    CS M “No, no, you should say that he is under the impression that he’s very poorly”

    A few weeks go by, and CS M sees W again

    CS M “Now, why so downcast? How is your husband these days, is he still under the impression that he is unwell?”

    W “I don’t think so”

    CS M “Oh,well that’s a blessing!”

    W “Not really sir, you see, now he’s under the impression that he’s dead”

    ROFL? Well, perhaps not.

    Should also say that Christian Science bears as much similarity to Christianity as it does to Science (IMVHO).

  108. Dr Aust said,

    September 14, 2006 at 5:03 pm

    Of course, in the late 19th century and early 20th century, Christian Scientists in the US were quite HEALTHY compared to the greater population, presumably feeding their sense that they were right in the way they look at “health and the mind” and “healing through prayer”.

    The explanation is presumably that Christian Science as a church always had fairly wealthy demographics – i.e. Christian Scientists were less likely to be poor. Because of this they were healthier, since the connections between wealth/class and health were no doubt even more marked in the 19th century than in the late 20th, especially in the absence of cures for things like epidemic infectious diseases.

    Nowadays Christian Scientists, not surprisingly in view of their tendency to eschew conventional medicine, seem to do less well heath-wise than the average. See Wikipedia for details.

  109. doctormonkey said,

    September 14, 2006 at 7:27 pm

    could we use “true” Christian Scientists as the ultimate control group?

    are there any who, when really ill, don’t turn to conventional medicine, albeit sometimes too late?

    is it not child abuse (having briefly read the wikipedia article) for them to insist that their children be treated exclusively by Christian Science if many decide that for them it is not enough?

  110. Dr Aust said,

    September 14, 2006 at 8:25 pm

    “are there any who, when really ill, don’t turn to conventional medicine, albeit sometimes too late?”

    Interestingly, it apparently cuts both ways – i.e. some people turn to Christian Science when conventional medicine has told them there is nothing more it can do for them.

    “is it not child abuse (having briefly read the wikipedia article) for them to insist that their children be treated exclusively by Christian Science if many decide that for them it is not enough?”

    An interesting ethical dilemma, certainly. To set it up in a slightly loaded way: Suppose one imagines a child with a life-threatening but treatable illness (say a childhood cancer) and devout Christian Scientist parents. As I read the Wikipedia entry, a proportion of Christian Scientists would probably accept the treatment under these circumstances. BUt if they refused… what would the doctors do?

    Especially in the case of a very young child (no chance of having a view of their own), I would have thought the doctors would be applying for court orders.

  111. SpallationFiend said,

    September 15, 2006 at 12:58 pm

    But if they refused… what would the doctors do?

    Over here, the doctors would contact social services, who would most likely run an assessment on the situation and apply for a protection order if the child is seen to be in danger of serious harm whilst in it’s parents care; which of course it would be. It would then be decided by a court, but we’re not in the habit of letting children die due to a parents’ ignorance in this country.
    Assuming competance on the local authorities part of course.

  112. doctormonkey said,

    September 16, 2006 at 10:04 am

    It is worth saying that these sorts of ethical dilemmas (sorry about spelling, I can’t) were frequently raised as part of my (recent) medical training and so at least doctors involved can be hoped to have an awareness of such issues.

    The problem could be with a lack of presentation to services that can recognise there is a problem for a child. Potentially a child could be kept as a “zero” by a religious group, never presented to any form of authority (born at home, never registered…) and so no authority would know to keep an eye on such a child.

  113. SpallationFiend said,

    September 16, 2006 at 3:34 pm

    Ah, this is the problem, and even if the child IS registered, someone still has to bring the issue to the attention of the authorities; be it a doctor like in our example, or a friend/neighbour if they know a child is being abused. Far too many people will remain silent for fear of disrupting a family, however.
    The missus is a childcare solicitor for local government, and she informs me that the medical personnel at hospitals are sometimes less then well-versed in the procedures to follow when cases like this occur. Was it a significant part of your training?

    We’ve strolled from the beaten path a bit, haven’t we? Had to look up what we’re commenting on.

  114. doctormonkey said,

    September 16, 2006 at 10:06 pm

    I know its a bit of a wander… but never mind!

    A lot of the training is on recognising the lack of depth of knowledge we have and that there is always someone to call (normally a senior paediatrician) for advice about such things so it is not that we are all experts, we just know when to refer to one, as we do with illness (eg patient too sick for ward, go to ITU, patient too young for normal doctor, go to paeds…)

    I was working in A&E and called them once and they were very nice about it

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