“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.

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

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

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.

The widespread confusion of these two (and it is very widespread) doesn’t make
them the same, carl.

Herbal medicine, as David Colquhoun points out regularly, CAN offer a sort of
pharmacology, though in effect one that is 80 yrs out of date and has all sorts
of shortcomings, mainly lack of standardization and minimal evidence base. However, many herbalists (like the homeopaths) would rather
deal in culturally-based mumbo-jumbo and mysticism than in tests and evidence. To see them do this see e.g. here.

“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”.

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!

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?

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.

How much does a homeopath earn? How much does a doctor at any of the NHS homeopathic hospitals earn? I know how much hospital consultants at proper hospitals get paid. I’m not going to get started on NHS consultant contracts…

Certainly more than, say, a nurse practitioner.

Blimey, I’d be happy to earn £10 p/h doing very little other than pretending to listen to middle-class attention seekers and dishing out placebos.

And, of course, self-prescription of placebo is even cheaper…

Flouridation of the water supply is a controversial issue, but I don’t see a problem with water companies putting homeopathic remedies into the water supply. Cost should be neglible. Think of the benefits. If homeopathic remedies have no side effects then giving remedies not targeted at a individual’s illness is not an issue. If it is, then they DO have side-effects – contra-indications ARE the result of side-effects. Etc… Petard, hoisted by.

Once done, there would be no need for homeopathic hospitals. Or any hospitals at all. Or conventional medicine.

Let’s do it now.

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).

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.

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?