Magnificent torrent of canards in parliament from David Tredinnick MP

February 20th, 2008 by Ben Goldacre in africa, bad science, homeopathy | 50 Comments »

David Tredinnick is conservative MP for Bosworth (he was suspended without pay during the cash for questions scandal) and very keen on alternative therapies. Here is a fabulous speech from him in parliament yesterday. As you can see, he talks up the use of homeopathy as a treatment for HIV, malaria, and a whole host of other problems, including TB, urinary infections, diarrhoea, skin eruptions, diabetes, epilepsy, eye infections, intestinal parasites, cancer, and gangrene. He also talks about ill-informed media coverage and a dirty tricks campaign.

I’ve written him a quick email, which I’ve pasted below.

www.theyworkforyou.com/debates/?id=2008-02-19a.323.0

David Tredinnick (Bosworth, Conservative)

It is unusual to start a debate at quarter to two in the morning these days, although a few years ago we were regularly here a lot later. I am pleased to have the opportunity to introduce this important debate about the threat to the homeopathic hospitals. Their very survival may be at stake and I look forward to hearing from the Minister.

This debate comes at a time when support for homeopathy is at an all-time high, including in the House, with one third of Members signing early-day motion 1240 in the last Session, in support of homeopathy. The Government claim to support choice in health care, but as far as homeopathy is concerned, they are reducing choice. It is not commonly known, but homeopathy has always been available on the health service because its founder, Nye Bevan, had a homeopathic doctor and insisted that that was the case.

In the UK we have four homeopathic hospitals, one in Scotland and three in England. I attended the opening of the beautiful new Glasgow homeopathic hospital before devolution, and it now of course comes under the purview of the Scottish Parliament. I understand that that hospital is protected since a successful campaign in 2004, but that is not the case for the three English hospitals—the Royal London, Bristol and Tunbridge Wells homeopathic hospitals.

The three hospitals are fully integrated into the NHS. They all form part of their local NHS trusts and are staffed by statutorily regulated health professionals with additional training in complementary medicine. All receive patient referrals through normal NHS routes. They have some of the highest patient satisfaction ratings in the NHS and the majority of patients report improvements to their lives across a range of chronic conditions. The treatments employed are clinically safe and cost-effective. They often avert multiple referrals and treatments that many patients find ineffective and the cause of side effects. In addition to homeopathy, the hospitals now offer a full range of complementary therapies.

The flagship hospital is the world-renowned Royal London Homeopathic hospital. I have been the chair of the parliamentary integrated health care group and I used to be the treasurer of the all-party parliamentary group for alternative and complementary medicine. For almost all of my 20 years in this place, I have been an officer of one or other group, so I have had a long association with the Royal London and I believe it to be a very valuable asset. It is the largest and best integrated public sector provider of complementary medicine in Europe. It is also part of the University College London Hospitals NHS foundation trust.

The Royal London provides some 25,000 new and follow-up out-patient appointments a year. Until recently, the number of referrals had been steadily increasing. What has gone wrong? Well, eight primary care trusts have withdrawn their contracts from the Royal London in the last 18 months and patient referrals are down by 20 per cent. on the same period last year. There is great uncertainty about the intentions of the host PCT Camden and its neighbour Islington. If they were to withdraw their support or substantially reduce it, the consequences for the hospital would be very serious. The reduction in referrals has meant that parts of the newly developed building—I attended its opening—are now being used for other services. Despite those problems, the hospital is in discussion with the trust about the proposed polyclinic; it is developing integrated care pathways, integrating complementary and conventional approaches; and, as always, it is pioneering this field of health care.

As for the other two hospitals, West Kent PCT is responsible for the Tunbridge Wells hospital and, sadly, it will withdraw its support from April 2008. That decision has been temporarily rescinded pending a legal challenge by patients. I urge the Minister to look closely at what happened at Tunbridge Wells, where the decision was very unwelcome. Bristol homeopathic hospital has also suffered considerable cuts.

So, why is there a problem? The Government claim that they are increasing choice, but the impact from the perspective of a homeopathic hospital is quite different. If the Minister reflects on the White Papers that have been published in recent years, he will see that they all suggest that choice will increase. “The NHS Improvement Plan”, published in 2004, states:

“By 2008, patients referred by their GP will be able to choose any provider able to meet NHS standards and to deliver care at tariff.”

That appears to guarantee the right to choose treatment at the homeopathic hospitals. The December 2003 document, “Building on the Best: Choice, Responsiveness and Equity in the NHS” stated that NHS services should be “more responsive” to patients. The January 2006 document, “Our health, our care, our say” states:

“We will give people a stronger voice”—

so that they can see a service improvement. The 2004 White Paper stated the intention to give the public more informed choices as regards their health. The Government are certainly failing to do that as far as the homeopathic hospitals are concerned.

Another issue is the introduction of evidence-based practice, which tries to specify the way in which professionals or other decision makers should make decisions. Naturally, as its name suggests, it places a greater emphasis on evidence. The practice guide, however, asks for evidence-based design and development decisions to be made after reviewing information from repeated, rigorous data-gathering. That militates against complementary and alternative medicine, where there may not be a huge number of rigorous or repeated databases to work from. There is not a vast quantity of studies and that has been used against complementary medicine as an excuse. The methodology of assessing CAM might also be unfamiliar to primary care trusts. It might also be difficult to record accurately exactly how homeopathy, for example, treats. It is always different for individual patients, and that can be difficult to record. Sometimes, the treatments require a combination of remedies.

My next point is that homeopathy does not fit normal—that is, orthodox—methods of assessment. For example, the scale of prescribing is in reverse so that the weaker the dose, the more powerful or effective it is. That subject has always been hotly disputed by many doctors, but homeopathic treatments have been operating on the reverse scale of prescribing for 200 years. Some of the most powerful—the constitutional remedies—are so diluted that they can hardly be detected. There are similar problems with acupuncture and its acceptance, as some doctors and commissioners do not necessarily believe in meridians. The same issue occurs with herbs that are unknown in this country.

Another simpler explanation of why complementary services, and the homeopathic commission in particular, have been cut recently is that they are the easiest therapy to cut. Just as advertising gets cut when times get hard in business, when the primary care trusts try to balance their budgets under the new devolved arrangements they often go for homeopathy and other complementary therapies as the soft target.

The most important point that I want to make to the Minister is that I believe that we need proper guidelines on commissioning for primary care trusts. I have said as much several times at Health questions. At present there are no proper guidelines, with the result that PCTs have little direction at a time when many are under financial pressure. Indeed, they often cite that financial pressure as one of the main reasons for not commissioning homeopathy.

Also, PCTs claim that there is not enough evidence to support the use of homeopathy. However, the Royal London Homeopathic hospital has conducted more than 130 randomised and controlled trials of homeopathic treatments that show very effective results, so surely it is in the Department’s interests to make sure that those results are publicised to PCTs.

The Smallwood report took a look at the cost-effectiveness of complementary medicine. Smallwood argued strongly that some complementary therapies were more effective and cost-effective than traditional treatments. He also wanted the National Institute for Health and Clinical Excellence to assess their cost-effectiveness, but that has never been done. I hope that the Minister will be able to help with that. I intend to write to the Public Accounts Committee to see whether it will undertake an assessment, and I have had discussions to that effect with
my hon. Friend the Member for Gainsborough (Mr. Leigh), who is that Committee’s Chairman.

Another problem that homeopathic hospitals have had to face is ill informed and hostile media coverage, as well as a dirty tricks campaign. The Minister may recall that in May 2007 some doctors issued a spurious document—printed on official paper, with the NHS logo—claiming that homeopathic services should be decommissioned. The Government have never written to PCTs to refute that document.

I want to allow the Minister time to reply, because the fate of the Royal London Homeopathic hospital is of great concern internationally. I shall illustrate that, and the importance of the treatment, by looking at the results that have been achieved in Africa by homeopaths who have been trained at the hospitals that I have mentioned. Those results are especially instructive, as the homeopaths involved are treating patients with AIDS, HIV or other serious diseases such as malaria, in countries where the problems are very great.

For example, at Kendu bay in Kenya’s Nyanza province, the Abha Light foundation is an organisation that partners mothers and orphans in the rural community who are suffering from AIDS, and it has had great success in returning those people to an active life. There has also been considerable success in the use of the local herb product called neem as a homeopathic medicine. It has produced what has been described as

“a convincing reduction in malaria attacks”

in a highly endemic area.

I shall close with a note about what is happening in Swaziland in southern Africa. I know a homeopath who has worked there well, and I asked her for a description of what was happening in the clinics there. Her letter to me states:

“Seven years ago I introduced Homeopathy to Swaziland, providing a community of 10,000 people with the only health care available to them. In addition I travelled around with a mobile clinic reaching other very remote areas. On an average day I could see up to 50 patients…Five years ago I built a homeopathic clinic…it was so successful that the people wanted to ensure my tenure which ensured their continued treatment on a daily basis.”

The letter goes on to say that other homeopaths were brought in to help, and that the clinic treated patients who came from as much as 300 miles away.

“Aside from the predominant treatment for HIV, TB and malaria, treatment is being given for many other common ailments such as urinary infections, diarrhoea, skin eruptions, diabetes, epilepsy, eye infections, intestinal parasites, treatment from pregnancy to childbirth, to more serious but locally common ailments like cancer, gangrene, toxaemia…and general injuries…In other words the list is endless.”

The letter states that the homeopathic treatments have achieved success rates of close to 100 per cent.

“As a result many lives have been saved, and pain and misery alleviated, in a community which can simply not afford orthodox treatment even if it were available.”

That is a very important issue for developing countries. Homeopathy is so inexpensive that it is available to everyone. When homeopathic services are introduced, they tend to increase in size very quickly. My acquaintance’s letter goes on to say:

“The low cost of the remedies and the relatively short dosage period, together with the positive results of the treatment are responsible for the expansion and ever increasing demand in a Country that is unable to give the majority of the population even the most basic of health care. Therefore, Homeopathy is excellent value and has saved countless lives as well as alleviating the suffering of the countless unemployed, elderly and orphaned in Swaziland.

We will of course continue with our work. At the end of a day, when we simply cannot see any more patients, the remaining untreated patients usually start fighting among each other as to who will be the last to be seen. A true vote of confidence!”

I hope that the Minister can reassure me on guidelines for primary care trusts so that we have more effective commissioning. I hope that he will refute those statements made in the name of his Department and that he will commission NICE to look at the cost-effectiveness of homeopathy in line with the request of the Smallwood report. I look forward to the Minister’s reply.

More worrying than the claims about homeopathy being brilliant for every illness known to mankind is the warm response this speech received from the Labour health person, you can read the rest here.

www.theyworkforyou.com/debates/?id=2008-02-19a.323.0

I should say that I am completely agnostic on the question on homeopathy on the NHS, and I think my position on the merits of placeboes is well known. However what does worry me is misinformation, and the wider issues of what homeopaths themselves do: undermine vaccination campaigns, give foolish advice on serious illnesses, attack medicine, attack individual people, undermine the public’s understanding of evidence, and so on.

I’ve just pinged David a quick email, hopefully I’ll hear back from him.

Hi David,

I was very interested to read your speech on homeopathy in parliament yesterday. I write the science column in the Guardian, if you had any examples of ill informed media coverage on homeopathy, where people get things wrong, I’d be very pleased to write about it, do please send me links or dates I can pull out of the archives?

Also, if there are homeopaths who are unfamiliar with research methodologies but who would like to do some research on their work, and who want to make sure that the research they are doing is a “fair test” – the most important question in any research – then I’d be very happy to help out, and would be very happy to discuss this further. There really is no reason not to do proper research on alt med, and of course there might well be something in some of it.

Sadly, from the complaints of homeopaths about funding, it seems that homeopathy pill companies such as Boiron (£500 million) are not forthcoming with funds.

best wishes,

Ben

Edit:

This has now been covered quite magnificently by the redoubtable Gimpy.


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50 Responses



  1. Dr Rob said,

    February 20, 2008 at 12:43 pm

    How about introducing psychic surgery? That is probably even more cost effective.

    I wonder: is there no limit to the nonsense people will believe, and even travel 300 miles for?

  2. TheImpostor said,

    February 20, 2008 at 12:45 pm

    Well…I’m prepared to believe that, back in the (17-1800s) day, homeopathy was better than most prevailing medical treatments, but since that seemed to consist mainly of cold baths and dosing with enough toxic heavy metals to make Wakefield swoon, then that’s not saying so much. Difference being, ‘orthodox’ medicine has changed considerably in the intervening centuries, whereas homeopathy, well, hasn’t. Personally, I’m as unprepared to have my tax money go to subsidise homeopathy as I would if it was balancing humours, ‘hydrotherapy’, the Electric Bed, or any of those other ‘medical’ practices we haven’t done since we discovered they were bugger-all use.

    And, extensive use of homeopathy in Swaziland, eh? Would that be the same Swaziland that has an average life expectancy of 36? Is the ‘almost 100% success rate’ only counted among people who, to be blunt, don’t snuff it before they attend their follow-up appointment?

  3. misterjohn said,

    February 20, 2008 at 1:09 pm

    Was David Tredinnick a teacher before he became a member of Parliament?

  4. le canard noir said,

    February 20, 2008 at 2:33 pm

    I think a very interesting question to ask would be to Dr Peter Fisher, The Queen’s Homeopath, and Clinical Director of the Royal London Homeopathic Hospital – Does he support David Tredinnick speech?

    Let us remind ourselves what Dr Fisher’s views are on homeopathy and malaria…

    I’m very angry about it because people are going to get malaria – there is absolutely no reason to think that homeopathy works to prevent malaria and you won’t find that in any textbook or journal of homeopathy so people will get malaria, people may even die of malaria if they follow this advice.

    news.bbc.co.uk/1/hi/programmes/newsnight/5178122.stm

  5. trickcyclist said,

    February 20, 2008 at 2:47 pm

    The sad thing about this is that there are parts of his speech that I could go along with, for example:

    “All receive patient referrals through normal NHS routes. They have some of the highest patient satisfaction ratings in the NHS and the majority of patients report improvements to their lives across a range of chronic conditions. The treatments employed are clinically safe and cost-effective. They often avert multiple referrals and treatments that many patients find ineffective and the cause of side effects.”

    There are quite a lot of people out there suffering from chronic symptoms of various sorts, including ‘psycho-somatic’ conditions, who are not well served by traditional medicine. I therefore used to believe that homeopathy could have a role to play in providing safe placeboes and on-going support, and that could prove to be cost-effective in diverting people away from unneccessary consultations and treatments.

    However towards the end of his speech, David Tredinnick succinctly reminds me why I no longer believe this to be the case. As Ben has eloquently argued in the past, homeopaths make claims for their treatment that are simply incredible and not supported by evidence (beware the therapist promising the ‘close to 100%’ success rate), and do down life-saving, effective medical interventions such as vaccines. This seems to me to be especially unwelcome in places such as Swaziland, where people hardly have the benefits of choice and access to other sources of information that we have, and have a much greater burden of life-threatening (and eminently treatable) disease. I feel the behaviour of these people is irresponsible, and we should continue to try to save others from their well-meaning nonsense.

  6. Ben Goldacre said,

    February 20, 2008 at 2:52 pm

    trickcyclist: i couldn’t agree more, there could well be a role for placeboes on the NHS, but the trouble is that homeopaths et al seem to be showing – more and more – that they cannot do that in a safe, collaborative and sensible fashion.

  7. Jamie Horder said,

    February 20, 2008 at 3:11 pm

    What do people familiar with the field make of this claim?

    “The Royal London Homeopathic hospital has conducted more than 130 randomised and controlled trials of homeopathic treatments that show very effective results”

  8. Ben Goldacre said,

    February 20, 2008 at 3:13 pm

    well it’s obviously not true, but it also doesn’t sit very well with his other equally unevidenced assertion that not enough research has been done.

  9. Dudley said,

    February 20, 2008 at 3:24 pm

    The confusion he evinces between homeopathy (doesn’t work), acupuncture (doesn’t work, but for entirely different reasons) and using herbal remedies (one of the cornerstones of all medicine) is a bit lamentable.

  10. Jamie Horder said,

    February 20, 2008 at 4:04 pm

    Ben : Yeah, – and I liked it when he said that he said “homeopathy does not fit normal — that is, orthodox — methods of assessment” and then call in 130 RCTs supporting it. What I was wondering , though, was whether the RLHH had indeed conducted lots of RCTs and, if not, where he got that 130 figure from? Are these highly positive RLHH studies some kind of urban myth in homeopathic circles?

  11. Jamie Horder said,

    February 20, 2008 at 4:12 pm

    Maybe it’s Chris Morris making the next series of Brass Eye. First “Cake”, now homeopathic cures for malaria…

  12. stavros said,

    February 20, 2008 at 4:21 pm

    Dudley:

    good point about the herbs. I myself have come across many people claiming that “oh why are you upset? Herbal remedies are the basis of normal medicine as well”.

    Then again, I have come across people talking about: resonance frequencies, vibrations, life energies, and a whole load of other bull@*%^!

  13. drowned said,

    February 20, 2008 at 4:42 pm

    As a health economist, I get very irritated when people like Tredinnik claim that something is cost-effective when it isn’t even clinically effective. Perhaps you could argue that because they feel better after treatment and this magic water should be barely more expensive than air (I realise it isn’t given how much it has had to be processed), that it might be cost-effective. But taken to its logical end then, that means that you would start prescribing placebos on grounds of cost-effectiveness and I remain unconvinced that giving people placebos under the guise that it is a real treatment is ethical (on a side note, the pacifing of grumpy patients with viral infections like the common cold by giving them antibiotics might have the same effect, but of course this wouldn’t be cost-effective either). To be cost-effective, the treatment has to be clinically effective; only then can we decide if the improvement in health gained is worth the cost.

    I could probably go on about this at some length so I’d better stop here and hope this appears coherent to others. Does anyone remember the episode of MASH where Hawkeye was dishing out sugar pills to everyone and they all felt miraculously better?

  14. Ben Goldacre said,

    February 20, 2008 at 4:54 pm

    haha from my frighteningly well organised notes on placebo:

    www.mashtvseries.com/site/directory/mash-season-6/season-6-episode-24

    there’s another one where he gives placebo to someone to deal with the heat, and they feel better, until he tells him it was placebo and themn he starts complaining again. anyone? video link ideally?

    also one where they use placebo for someone who is anxious about talking to ladies,.

  15. trickcyclist said,

    February 20, 2008 at 4:58 pm

    But drowned, isn’t there an important distinction to be drawn between ‘clinically effective’, and ‘no better than placebo’? Homeopathic pills, almost by definition, are no better than placebo, but that doesn’t stop them being effective remedies, as for some conditions (eg depression, irritable bowel syndrome) the placebo response is very significant. I defer to you as the health economist, but it also seems to me that if you’re ‘treating’ a condition for which conventional medicine isn’t very effective (for example the common cold), diverting people away from more expensive, also ineffective treatments could be cost-effective. It’s just a shame they can’t play nicely with others…

  16. used to be jdc said,

    February 20, 2008 at 5:21 pm

    “It’s just a shame they can’t play nicely with others…”
    It certainly is a shame. It’s also dangerous – Sense About Science and Newsnight highlighted the dangers of homeopathic malaria ‘prophylaxis’ and Ben has written before about homeopathy and AIDS. Gimpy also blogged about homeopathy and AIDS (the SoH and Sherr got dishonourable mentions).
    whatstheharm.net/index.html has a homeopathy category that documents cases where harm has come to those relying solely on homeopathic medicine (includes cases of malaria).

  17. trickcyclist said,

    February 20, 2008 at 5:36 pm

    Used to be jdc, I couldn’t agree more – see my first comment above. I used to think that the anti-medicine stance that these groups take was a quirk, but I now accept that it’s an inevitable part of either their psyche, or their marketing, which rather makes a mockery of the word ‘complementary’.

  18. Ben Goldacre said,

    February 20, 2008 at 5:41 pm

    “I used to think that the anti-medicine stance that these groups take was a quirk, but I now accept that it’s an inevitable part of either their psyche, or their marketing, which rather makes a mockery of the word ‘complementary’.”

    yeah, me too, my views have really changed on homeopathy as a result of this, and i happen to know that a lot of people in interestingly high places have experienced the same. homeopathy’s fine, but the “attack medicine to promote homeopathy” mentality of homeopaths really is a problem for anyone trying to bend backwards and take them seriously. more to come on this i believe. just goes to show the importance of good manners and clear thinking i guess.

  19. gimpyblog said,

    February 20, 2008 at 5:54 pm

    I’m all embarrassed by the link.

    “I used to think that the anti-medicine stance that these groups take was a quirk, but I now accept that it’s an inevitable part of either their psyche, or their marketing, which rather makes a mockery of the word ‘complementary’.”

    yeah, me too, my views have really changed on homeopathy as a result of this, and i happen to know that a lot of people in interestingly high places have experienced the same. homeopathy’s fine, but the “attack medicine to promote homeopathy” mentality of homeopaths really is a problem for anyone trying to bend backwards and take them seriously. more to come on this i believe. just goes to show the importance of good manners and clear thinking i guess.

    I take it you guys have not been studying the Organon. Hahnemann has written, on the subject of disease:

    But if treated with violent allopathic remedies, other diseases will be formed in its place which are more difficult and dangerous to life.

    This anti-medicine stance has always been with homeopathy and always will be. After all, Hahnemann isn’t wrong, is he?

  20. Harlequin said,

    February 20, 2008 at 6:04 pm

    Shame Tredinnick didn’t mention Cuba (highly developed NHS, life expectancy = USA)

    www.cubaheadlines.com/2007/12/14/7702/homeopathy_against_epidemic_hazard.html

    No doubt the homeopaths here will say it’s not ‘homeopathy’, but interesting all the same.

  21. coracle said,

    February 20, 2008 at 8:26 pm

    also one where they use placebo for someone who is anxious about talking to ladies,.

    Oh help, please can I have a placebo for giving presentations. I need that so much.

  22. mrmuz said,

    February 20, 2008 at 9:34 pm

    Hi folks. Newb here. I’ve been reading this site for a little while now and love it to bits but there’s something I’d like to clear up.
    Whenever this comes up it’s mentioned that homeopathic treatments have uses as placebos, but there seems to be some surprise that homeopaths don’t wish to engage with that notion. I can’t tell if that’s our delightful Mr Goldacre and friends having a joke, a tweak of the nose of homeopaths, or not (as I said, I’m new). Surely folks realise that homepaths and homeopathy users are believers in the actual efficacy of the homeopathic method; they believe that it ‘works’ in the sense that a hammer drives a nail and not merely arrives at a result via some circuitous psycho-physiological means that is tantamount to a delusion to the average punter. So to suggest that homeopathy is useful as a placebo is going to be profoundly insulting, accurate or not. You guys know that right?
    I just wanted to clear that up.

  23. BSM said,

    February 20, 2008 at 11:41 pm

    I, for one, am quite grateful to Tredinnick.

    We have had some woos trying to deny that there are homeopaths bothering sick people in Africa and claiming to cure AIDS etc, but here is their pet MP taking careful aim and shooting them in the foot.

  24. stever said,

    February 20, 2008 at 11:59 pm

    massive homeopathy own goal here surely. what a complete berk.

  25. ayupmeduck said,

    February 21, 2008 at 8:54 am

    @mrmuz:

    “So to suggest that homeopathy is useful as a placebo is going to be profoundly insulting, accurate or not. You guys know that right?”

    I dunno really. Certainly it’s not my goal to insult. But in any case it’s difficult to wrap this issue of placebo effect up in cotton wool when discussing with homeopaths, so maybe they are insulted – but what else can you do?

    Some here, including myself, occasional see a role for homeopathy and it’s placebo effect. But it’s a tricky question. It seems to me that the homeopathy placebo efffect can really only work if the homeopath actually believes. If s/he does NOT believe then:

    1) You might not get the full placebo effect.

    2) The homeopath would need to have “tell lies to your patients” as a the core part of their job description.

    I think quite a few of the people here would stop bothering homeopaths, if only they would also stop bothering us with claims on tax payers money, pushing pills to children, dangerous activities (particularly re. HIV, Africa), corrupting science, etc.

    Just my 2c.

  26. woodchopper said,

    February 21, 2008 at 9:23 am

    mrmuz – as the others have posted I have no great desire to insult homeopaths. But on the other hand its very difficult to avoid causing offence if you are saying that someone is completely wrong.

    There is also the added problem that some people incorrectly view the placebo effect as being ‘all in the mind’. So they incorrectly think that you are accusing them of being deluded.

    But sometimes people are wrong. Normally I wouldn’t bother with it. But some homeopaths are taking their beliefs to their logical conclusion and advising people not to take antibiotics, vaccines etc, as its all part of allopathy. That type of wrong really needs to be argued against.

  27. used to be jdc said,

    February 21, 2008 at 10:40 am

    Tredinnick wrote:

    There are similar problems with acupuncture and its acceptance as some doctors and commissioners do not necessarily believe in meridians. The same issue occurs with herbs that are unknown in this country.

    I think it’s interesting that he’s implying that doctors and commissioners are ignorant not just of homeopathic principles – but also of meridians and herbal treatments. He can’t have read the papers on ‘sham’ versus ‘traditional’ acupuncture then. I think the assumption of ignorance is wrong too – of course you can understand something without subscribing to it (as Andrew Taylor pointed out recently in a comment on Blogging the Organon). A “lack of understanding” is often claimed when it is actually a “lack of belief”. There’s something similar in this PDF: www.integrativemedicine.arizona.edu/publications/babel.pdf – apparently, othodox physicians “do not speak the same language” as CAM practitioners and therefore a genuine understanding of CAM is “unachievable”.

  28. le canard noir said,

    February 21, 2008 at 12:06 pm

    mrmuz – The problem is that most people in this world take offense if you suggest that their beliefs are wrong.

    The sceptic, however, takes as a starting point that delusion is remarkably easy to induce in the human mind. We are all deluded to one degree or another about many of our beliefs. The trick is to build up a stock of defenses against that.

    As Richard P Feynman famously said,

    The first principle is that you must not fool yourself – and you are the easiest person to fool. So you have to be very careful about that.

    Non medically qualified homeopaths, without exception, fail to see the importance of this advice. The medically qualified may well be more subtle in their thought. That is an interesting question.

  29. Ambrielle said,

    February 21, 2008 at 12:27 pm

    I see mrmuz’s point: they actually believe in dilution and succussion and provings. Therefore arguing that it may work as a placebo, or ‘it works, but not like they think’, not going to wash. I’ll say it again. This is a religion. It’s like arguing with creationists. They know it’s true because the bible says so. End of story.
    The homeopaths that know it’s a crock are even more invested in maintaining the paradigm: they are in it for the money.

  30. drowned said,

    February 21, 2008 at 2:53 pm

    I’m not sure what this adds to the debate, but this article from The Onion on placebo from a few years ago made me giggle.

    www.theonion.com/content/node/39082

  31. Lafayette said,

    February 21, 2008 at 10:11 pm

    Perhaps I’ve been hanging out on the Scientology Volunteer Ministry sites for too long, but I instantly smell a rat as soon as any example of, shall we say, strange efficacy at a distance is cited. Is it cynical to say that the harder it is to check methodology and results, the more likely it is that the results were positive?

  32. Martin said,

    February 21, 2008 at 11:50 pm

    Drowned:

    The problem with your example is that a), b) and c) don’t have the same outcome. The placebo effect is such that giving the patient advice to rest *and* a magic sugar pill makes the patient feel better than advice alone. For a non-chronic illness like the common cold this may mean that the patient is ready to return to work a day earlier, and/or feels better and works more productively. Therefore, the placebo could be cost-effective.

    On a different note, is anyone else concerned that homeopathic remedies, which rely on repeated dilution with distilled water, are being pushed in Africa? Maybe access to clean water has improved, but there are still areas of sub-Saharan Africa which are at great risk from drought. Using what water they have for making ineffective medicines sounds like double jeopardy. Or is it that the discarded solution is perfectly safe to drink, because it hasn’t undergone enough dilutions?

  33. drowned said,

    February 22, 2008 at 12:52 pm

    Martin:

    I see what you’re saying and of course you’re right that some who get placebo will get better quicker. What I left out was the detail of how the cost-effectiveness assessment would be made which involves trying to balance the cost of the ‘treatment’, the extent of the improvement in the health of the population of people with common colds and whether the taxpayer should asked to pay for that. I wrote a comment about the basic process of how I would try and do the cost-effectiveness analysis to see if the placebo were indeed cost-effective. I could post it if anyone is interested though I thought it might be too long and dull for most to be bothered.

    But as I said before, I don’t think health economists have ever really thought much about the cost-effectiveness of the placebo effect. I’m now starting to wonder if I should scrape together some time to do a proper literature review on this. Any potential co-conspirators out there?

  34. Delster said,

    February 22, 2008 at 1:26 pm

    @ mrmuz

    While i can see your point about them being insulted there are other factors to consider.

    Just from the speech above we get

    “The letter states that the homeopathic treatments have achieved success rates of close to 100 per cent.”

    Ok if that is true then why is it that there are no rigorous evidence based studies to confirm this. Surely if a treatment is that effective then it would be easy to demonstrate. Yet so far we only have trials showing effective treatment at plecebo levels.

    Also, saying that it is effective against HIV / AIDS where, to date, Non-alternative medicine has not been able to come up with a full cure would be of immense interest to all doctors in all countries. If this cure really existed and worked then all doctors would be signing up to learn how to cure it.

    We also get

    “There is not a vast quantity of studies and that has been used against complementary medicine as an excuse.”

    And

    “However, the Royal London Homeopathic hospital has conducted more than 130 randomised and controlled trials of homeopathic treatments that show very effective results”

    I’m fairly sure that with normal medical practice 130 trials would be more than enought to demonstrate effectivness sufficent to convince doctors to start using a treatment method.

    So why are they not using it, simply because any trials that are done in such a way as to produce meaningful figures don’t show that touted level of effectivness.

    I’m not against CAM as such and use plant oils to produce a form of natural deep heat but untill proper evidence is produced i’ll keep going to see my GP thanks very much.

  35. RS said,

    February 22, 2008 at 1:37 pm

    “Good grief. Could it be that somebody paid Trednnick to come up with this nonsense?”

    Maybe not paid – but it may well have all been written for him – I’ve seen briefing documents I’ve written for lobbying purposes repeated verbatim in Hansard (back in my ‘black hat’ days).

  36. Majikthyse said,

    February 22, 2008 at 5:50 pm

    Does anyone else think Tredinnick is guilty of misleading Parliament?

  37. Diotima said,

    February 22, 2008 at 6:43 pm

    I would assume that the test for Tredinnick would were his cardiologist to inform him that the leaky mitral valve which is causing himself so much trouble might well be fixed by a nice non-invasive homeopathic remedy; it’s cost effective too!

  38. mrmuz said,

    February 23, 2008 at 7:07 am

    Thanks for the talk back folks, and links and things. I realise this is a bit off track for this particular entry and is probably best discussed elsewhere, so apologies for that. I feel I should clarify things a bit however.
    Homeopaths being insulted by the what Ben says about placebos is neither here nor there to me. I’m more interested in how such statements are meant. I usually laugh whenever he and others say it (or write it), as it seems like the ultimate sarcastic dismissal. But there’s usually a point where he goes into lengthy and serious discussion on the place of the placebo in medicine and I wonder where the joke ends and the serious stuff begins, or if it’s all a lengthy dose of salt to the wound. It seems obvious to me that Homeopathy followers would take offense at the idea it’s no better than a placebo, and subsequent statements often seem to be saying “But don’t feel bad! Placebos have an important place thanks to the cultural meaning of treatment” and so my question was to ask if the impression I had there was correct.
    I’m starting to realise it’s more complicated than that and these statements I’m refering to are probably both a tweak of the nose to homeopathy believers and serious comment at the same time. I haven’t quite grasped the particular place of homeopathy in England and the NHS, so that’s a bit of a hole in my comprehension. And of course, as was mentioned earlier, if they had solid evidence they need only produce it and there’d be no need to be offended.

  39. Robert Carnegie said,

    February 24, 2008 at 12:46 am

    Suppose we replace homeopathy with ordinary bottled water, you only drink it if you’re ill, kill two birds with one stone…

    And then there’s Lucozade. Does it aid recovery?

    Is TV drama [Mad Men] actually sponsored by any tobacco companies somehow? By all accounts everyone smokes like a chimney and the cigarette advertising message is… otherwise banned, I think. But because it’s in drama it passes.

  40. Robert Carnegie said,

    February 24, 2008 at 1:50 am

    The effectiveness of placebo is an intellectually interesting question, although the actual usefulness of a placebo is controversial – I think the latest I heard was on the lines of “Placebo makes people feel better but doesn’t make people better”. That would make it less significant to me. And what is placebo, anyway? I suppose it’s a message saying that the community or the universe cares about your troubles and has provided a remedy for them. If the placebo is unpleasant (from bitter pill to smear test or having pins stuck in you) then you also feel that by undergoing an ordeal you have earned health. No pain, no gain. In fairy stories and in religion, you’re taught to grasp the nettle – at least if you must. But I have no knowledge, I’m only guessing.

    Nevertheless, I think that a proper use of placebo effect is to design the therapeutic encounter to maximise the extent to which an equivalent message is sent to the patient, not necessarily with deceit involved. Perhaps even giving patients little diaries to write how they feel in every day (or a Q-Link pendant to speak your symptoms into at home, after which you hang it over the sink), or treatment prescription forms in a nice personalised presentation gift card, would be effective. At any rate it’d get your methods talked about. How about it, Ben? Does sending your patients Christmas cards do them good?

  41. mjrobbins said,

    February 25, 2008 at 12:56 am

    Regardless of the homeopathy argument itself, I find it stunning that government policy on health can ever be in the hands of people who clearly have no proper education in medicine :|

  42. carlsamuelsanderson said,

    February 25, 2008 at 8:01 am

    First of all Hi! i havnt written here for a while, secondly can we please look up the word placebo before using it? placebos are inert substances used to appease patients! Homeopathy is not about using placebos. It is about treating mind and body. I think that most of you are forgetting that homeopaths treat symptoms not illnesses, they use drugs (remember the definition of drugs) to make the body induce an immunological reaction.

    Before the concrete discovery of salicylic acid eating bark of willow trees would have been consideres homeopathic, so are you guys all saying that we have discovered all the drugs that possibly exist? I think we are also forgetting the power of the human mind, people can not only make themselves ill but can cure themselves of symptoms with little more than a push in the right direction.

    I imagine that people will try to slate what I have written as words of a psudo-scientist but I assuse you I am a scientist, I just have an open mind. If one of you had a serious illness that modern medicine (the pharmacist) could not cure and homeopathy offered an option you would take it!

  43. dr_dazza said,

    February 25, 2008 at 5:25 pm

    @ carlsamuelsanderson (comment 49)

    “I think that most of you are forgetting that homeopaths treat symptoms not illnesses, they use drugs (remember the definition of drugs) to make the body induce an immunological reaction.”

    But therein lies the whole crux of this problem. Whatever homeopaths are treating symptoms with, it is anything BUT an active drug!

    If they actually used a drug that was anything other than water, we would have less concern.

    Mind you, saying that, I would be very concerned if someone as unqualified as a homeopath started using active drugs….

    “Before the concrete discovery of salicylic acid eating bark of willow trees would have been consideres homeopathic, so are you guys all saying that we have discovered all the drugs that possibly exist?

    Again, the real point is that an active drug was being used, whether we understood the origin of it or not. It never would have been called “homeopathic”.

  44. peningda said,

    February 25, 2008 at 10:38 pm

    “the clinic treated patients who came from as much as 300 miles away.”

    This triggered my bullshit sensor – Swaziland is small. I checked the maps. Swaziland is only 100 miles across! What is means is something like “Some people visiting from Johannesburg also came to the clinic.” Johannesburg is 300 miles from Swaziland. Typical self aggrandising deceptive marketing.

  45. jez.robinson said,

    February 26, 2008 at 4:32 am

    Peningda – you’re right, Swaziland is small. To be honest, its no great surprise that people from Joburg went to the clinic – at a guess, the clinic is in either Mbabane or Manzini (respectively the capital and economic hub) and loads of people I met there were ‘from’ Joburg – i.e. Swazi enconomic migrants who’ve come back to see the relatives. There are scores of minibuses going between Joburg and Swaziland every day – so its hardly a ringing endorsement of the quality of the clinic.

    But I guess its a bit much to expect the MP to know that.

    In any case, just thought I’d write in to comment that not all of Swaziland is shooting in the wind treating HIV/Aids with snake oil – I spent a couple of months there in 2005 doing volunteer work. Yes, there are homeopathy clinics, witch-doctors, pentecostal healers and the like all peddling cures/treatments for HIV – but there is also a network of clinics dispensing ARVs in villages around the country.

    I also sat in on lessons taught from the Swazi national curriculum about HIV/Aids – and it was all, entirely, conventional and rational advice. I marked exams that every primary school pupil in the country sat which asked questions on the correct diet to maintain while taking antiretrovirals and how to make sure that the people around you are following their prescribed medication regime.

    Every now and then I read something along the lines of the MP’s comments and it makes annoys me something proper because people get this image of Swaziland being some tiny little country where they treat Aids with charms and snake oil. Its not quite so simple. I could go on for ages, but its slightly off topic. And its half four in the morning. Ho hum.

    Jez

  46. Rocko said,

    February 26, 2008 at 6:09 pm

    Interesting stuff as ever, Ben. I’d be interested in reading a longer explanation of your POV regarding homeopathy; from what you’ve said above, you seem to accept that for some people it’s worth prescribing purely for the placebo effect.

    Comments probably aren’t the place for it, but it might be worth an article at some point in the future?

  47. Dr Aust said,

    February 27, 2008 at 4:59 pm

    Hmmm. The following questions are subtly different, to my mind.

    “What do we think about giving an SSRI antidepressant under curcumstances where studies have shown that most or even all of its effects may be placebo?”

    and:

    “What do we think about giving a homoeopathic remedy, which demonstrably can have zero biological effect, simply to make use of the placebo effect?

    Compare and contrast. Would make a good one for the medical students, or even the medical ethicists.

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