All bow before the mighty power of the nocebo effect

November 28th, 2009 by Ben Goldacre in homeopathy, placebo | 70 Comments »

Ben Goldacre, Saturday 28 November 2009, The Guardian

This week the parliamentary science and technology select committee looked into the evidence behind the MHRA’s decision to allow homeopathy sugar pill labels to make medical claims without evidence of efficacy, and the funding of homeopathy on the NHS. There were some comedy highlights, as you might expect from any serious enquiry into an industry where sugar pills have healing powers conferred upon them by being shaken with one drop of the ingredient which has been diluted, so extremely, that it equates to one molecule of the substance in a sphere of water whose diameter is roughly the distance from the earth to the sun.

The man from Boots said he had no evidence that homeopathy pills worked, but he sold them because people wanted to buy them. The man from the pill manufacturers association said negative trials about homeopathy were often small, with an average of 65 people in them, and “all statisticians” agree that you need 500 people for a proper trial. Not only is this untrue (it depends on the effect size, if you claimed your pill cured an incurable condition in every single case, then a dozen patients would be too many): he then joyfully careered on to cite, in his favour, a positive homeopathy trial with just 25 patients in it.

But the best moment was Dr Peter Fisher from the Royal London Homeopathic Hospital (funded by the NHS) explaining that homeopathic sugar pills do actually have physical side effects: so they must be powerful.

Can a sugar pill have a side effect? Interestingly, a paper published in the journal Pain next month looks at just this issue. They found every single placebo-controlled trial ever conducted on a migraine drug, and looked at the side effects reported by the people in the control group, who received a dummy “placebo” sugar pill instead of the real drug. Not only were these side effects common, they were also similar to the side effects of whatever drug the patients thought they might be getting: patients getting placebo instead of anticonvulsants, for example, reported memory difficulties, sleepiness, and loss of appetite, while patients getting placebo instead of painkillers got digestive problems, which themselves are commonly caused by painkillers.

This is nothing new. A study in 2006 sat 75 people in front of a rotating drum to make them feel nauseous, and gave them a placebo sugar pill. 25 were told it was a drug that would make the nausea worse: their nausea was worse, and they also exhibited more gastric tachyarrhythmia, the abnormal stomach activity that frequently accompanies nausea.

A paper in 2004 took 600 patients from 3 different specialist drug allergy clinics and gave them either the drug that was causing their adverse reactions, or a dummy pill with no ingredients: 27% of the patients experienced side effects such as itching, malaise and headache from the placebo dummy pill.

And a classic paper from 1987 looked at the impact of listing side effects on the form which patients sign to give consent to treatment. This was a large placebo-controlled trial comparing aspirin against placebo, conducted in three different centres. In two of them, the consent form contained a statement outling various gastrointestinal side effects, and in these centres there was a sixfold increase in the number of people reporting such symptoms and dropping out of the trial, compared with the one centre that did not list such side effects in the form.

This is the amazing world of the nocebo effect, where negative expectations can induce unpleasant symptoms, in the absence of a physical cause. And in any case, it doesn’t help homeopaths: in 2003 Professor Edzard Ernst conducted a systematic review, finding every single homeopathy trial that reported side effects. This systematic search found, in total, 50 episodes of side effects in patients treated with placebo and 63 to patients treated with homoeopathically diluted remedies, with no statistically significant difference in the rates of side effects between the two groups.

The world of the homeopath is reductionist, one-dimensional, and built on the power of the pill: it cannot accommodate the fascinating reality of connections between mind and body which have been elucidated by science. The next time you find yourself trapped at dinner next to some bore who’s decided in middle age that they have secret mystical healing powers, while they earnestly explain how their crass efforts at selling sugar pills represent a meaningful political stand against the crimes of big pharma, just think: some lucky person, somewhere in the world, is sat next to a nocebo researcher.


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70 Responses



  1. FelixO said,

    November 28, 2009 at 1:07 am

    It struck me as strange that as the homeopaths were calling again and again for more trials, supported with government money to prop up their business none of the science proponents pointed out that in the USA the NCCAM has spent 1 Billion Dollars investigating all forms of CAM without having proved effectiveness for any “alternative” method.

    www.quackwatch.org/01QuackeryRelatedTopics/nccam.html
    www.sciencebasedmedicine.org/?p=36

  2. Crabbadon said,

    November 28, 2009 at 1:08 am

    And what a horrible thought. Someone whose job consists of tricking people into hurting themselves… Ah, but in the name of science, of course.

  3. confuseddave said,

    November 28, 2009 at 8:53 am

    Crabbadon:

    Well… Someone who’s job it is to pay people to experience discomfort which – by definition – they are informed of before starting, and are legally allowed to opt out of at any point.

    Sounds pretty fun to me.

  4. thepoisongarden said,

    November 28, 2009 at 9:24 am

    The example I always quote is the trial reported by Petro and Ellenberger in 1981 involving the use of THC extracted from Cannabis sativa to relieve spasticity in MS. The subjects were all told that the medicine might have psychoactive effects. It was a tiny trial, only 9 patients, but it was double blind. One patient on THC and one on placebo reported feeling ‘high’ after taking their medication.

    (Cannabis in Medical Practice Edited by Mary Lynn Mathre, McFarland & co 1997, page 115.)

  5. asobala said,

    November 28, 2009 at 11:01 am

    There’s a journal called Pain. woot woot.

  6. natsils24 said,

    November 28, 2009 at 11:09 am

    Ah Ben, another nail you have hit on the head. I have always loved the fact that the NHS funds a homeopathic hospital when the science behind it is obviously so woo-hoo! I am about to experience a week of complementary medicine lectures as part of my final year of medicine and as such I am re-reading alot of systematic reviews today hoping having some actual scientific knowledge will help combat against the woo I am about to experience.

    The placebo effect and the nocebo effect are both fascinating and highly complex. If you look under any drug entry in the BNF there will usually be a huge number of side-effects listed. The difference being that for the majority of drugs there is a good evidence base showing their effectiveness, where is that for homeopathic remedies?

    Please google the London Homeopathic Hospital and read their pharmacy page, I don’t think I have laughed that much in a long time.

  7. njdowrick said,

    November 28, 2009 at 11:17 am

    The real pills and the placebo pills must look pretty similar, right? So maybe there’s a simple unified explanation for both the placebo and the nocebo effects – the pills simply get mixed up! Has this ever been checked?

  8. huey said,

    November 28, 2009 at 11:25 am

    I was infuriated by the bbc homeopathy clip Ben linked to (on the miniblog) where is the balance? the non homeopathy woman didnt have a clue – at one point she said she wasnt sure about taking something that ‘took a long time to work’ and ‘only had like 1% of the active ingredient’ This just spreads ignorance, its almost like deliberate obfuscation.

    Rage!!

  9. natsils24 said,

    November 28, 2009 at 11:28 am

    @ njdowrick – if they were conducting a well-designed double blind randomly controlled trial there would be almost no chance at all (if not just no chance) that these pills could just simply get mixed up! Because that would completely invalidate everything.

  10. apothecary said,

    November 28, 2009 at 1:14 pm

    @njdowrick – I’m a pharmacist and in a previous job I oversaw the pharmacy aspects of clinical trials. I can see it’s logically possible, but I can assure you, the procedures and checking involved make the chance of this actually happening vanishingly small.

    BTW – I’d like to mention another, less well known, potential bias in trials, even double blind RCTs: unconcealed allocation. Forgive me if esteemed badsciencers are already well aware of it, but basically, if researchers know which treatment a particular trial participant is likely to get *before* he/she is actually entered into the trial, they can consciously or unconsciously skew the recruitment and this can overestimate the benefits of the trial intervention by up to 40%. This is different from blinding and the CONSORT authors explain it better than I can here – see www.consort-statement.org/index.aspx?o=1026 (apologies if I haven’t embedded the hyperlink very well). It would be interesting to know how many trials of homoeopathy ensured that allocation was concealed, yet this is easy to incorporate into trial design. With a little ingenuity there’s no methodological reason why one can’t conduct a high quality, well designed, RCT on homoeopathy, and even maintain the aspects of the homoeopathic consultation which adherents say is so important.

  11. adamk said,

    November 28, 2009 at 1:59 pm

    A common problem that crops up with the nocebo effect , is that when prescribing a new drug to a patient , the clinician is duty bound to describe the possible side effects. Having told the patient what side effects are possible , some patients will experience these side effects through nocebo , rather than through a genuine adverse reaction. Often it is possible to predict beforehand who will experience a nocebo/side effect.

  12. phayes said,

    November 28, 2009 at 2:36 pm

    “With a little ingenuity there’s no methodological reason why one can’t conduct a high quality, well designed, RCT on homoeopathy”

    There are, however, compelling reasons why one *shouldn’t* conduct one. The spectacle of homeopath pseudoscientists arguing with scientists proper over a body of meaningless non-evidence which the latter group have encouraged the former to collect is ugly indeed.

  13. njdowrick said,

    November 28, 2009 at 3:35 pm

    #9 and #10: Thank you. I didn’t seriously expect that pill mixing would be likely to happen, but it was worth asking the question! My mind is now at rest.

  14. Diversity said,

    November 28, 2009 at 4:39 pm

    There are three problems here.
    - how to push the quacks out of the market,
    - how to reduce the nocebo effect to a minimum in clinical practice,
    - this blog needs proper finance.

    I propose that Dr. Ben’s Individualised Elexir be marketed. The patient who feels need of it will fill up a quite detailed questinnaire and present it to the local chemist. The chemist will scan the questionnaire for any signs of any thing serious. It anything possibly serious is spotted, the chemist will tell the patient to go to the doctor. If not, the chemist will enter the questionnaire in her computer and print out the elexir recipe which corresponds to the questinnaire answers. The chemist will then make up the individual recipe from Dr. Ben’s kit.

    The kit will comprise a large numer of bottles. The chemist will take between 1 and 5 drops from the indicated bottles for that patient, dilute with lightly sugared water quant. suf., and print out a special label for Dr Ben’s Elixir ‘prepared and compounded uniquely for (patient’s name)’. The label will tell the patient four things – dosage, ‘Good for all (patient’s name)’s symptoms, but will not cure any disease’, ‘A unique property of Dr Ben’s Elixir is that it has absolutely no undesirable effects on anyone.’, and ‘If any symptoms persist after taking Dr. Ben’s, you must go and see your doctor straightaway’.

    Each bottle in the kit will contain a very weak solution of a different harmless substance. Every recipe will contain some of Dr Ben’s Saturated Elixir. The substance in that bottle will be the product of Dr Ben’s inspiration; but a pot of tea prepared by his inspired hands and diluted in 10,000 gallons of water will do.

    Kits wll be supplied to chemists at cost. Printing out a label will automatically forward 25% of the chemist’s margin to this blog’s account.

    Dr Ben’s Elixir should compete effectively against every one of the quack pills and potions on the market; minimse nocebo effects from anything not actually prescribed; fund this blog, and do absolutely no harm.

  15. JQH said,

    November 28, 2009 at 5:58 pm

    Hang on, Dr Fisher says that homeopathic nostrums have side-effects? I thought the homs always claimed that their sugar pills had no side effects?

    On the nocebo effect: MrsH is a nurse in a GP sugury & she tells me that if the tabloid press carry a vaccination scare-story, there will ber an upsurge in patients claiming to have the side effects described i the scare-story. I knew reading the Daily Mail was bad for my blood pressure but now it appears it causes other health problems!

  16. skyesteve said,

    November 28, 2009 at 6:07 pm

    I do think it’s right that homoeopathy should have to live by the same rules as conventional medicine and because it can’t prove it’s more than placebo then the NHS shouldn’t pay for it and it should be ditched. However, I don’t think those of us who work in or believe in conventional healthcare should get too smug just yet.
    We have seen numerous “best things since sliced bread…all the evidence shows that” ideas go up in smoke – HRT anyone? The NHS still funds things in conventional healthcare for which the evidence is often flimsy.
    It still carries out tens of thousands of knee arthroscopies every year at no small cost despite mounting evidence that in many cases the procedure may no better than placebo.
    The NHS spends perhaps hundreds of millions of taxpayers’ pounds on antidepressants each year despite mounting evidence that in many cases they may be no better than St Johns’s Wort and both may be no better than placebo plus/minus a bit of cognitive behaviour therapy.
    We still see mild opiates like dihydrocodeine prescribed in large amounts despite me being unaware of any good, large-scale, RCTs showing that they are more effective that paracetamol or placebo (can anyone enlighten me?).
    We’ve seen beta blockers relegated from numero uno antihypertensives to a poor fourth on the list.
    I could go on but I think I’ve made the point. It’s fun to laugh at squirming homoeopaths but we also must avoid our own complacency.

  17. MrNick said,

    November 28, 2009 at 6:44 pm

    @huey:8
    OMG the BBC clip is just atrocious.

    The sceptical journalist is totally clueless wtf was she doing there? Why not soneone with a clue?

    How do doctors get sucked into this nonsense? I think that would be a very interesting field of study.

    @natsils24:6
    This is an NHS hospital? Unbelievable.
    I particularly liked:
    Electronic gadgetry, mobile telephones, radiation emitting equipment can affect the remedies hence; the remedies should be stored away from such equipment if possible.

    Nick

  18. Sili said,

    November 28, 2009 at 6:58 pm

    Every bit of medication I’ve ever taken has had a slip included that listed the sideeffects (in order of likelihood).

    If homoeopathy – dog forbid – is to be regulated, let’s hope someone remembers to insist that such slips be included for the make believe remedies too. It’ll be even more fun when someone goes on to sue the homoeopsychopaths for the adverse effects they’ve suffered, that were not listed on the slip. In fact, I’m pretty sure taking homoeopathic remedies during, before or after pregnancy is a leading cause of autism.

    Of course, I’d prefer that any regulation of homoeopathy just holds it to the same standard as the rest of the pharmaceutical market: double blind tests against the currently best practise (notice that trials against placebo are not done in cases where an existing treatment exists that has been tested against placebo – efficacy is transitive (or should be, at least)).

  19. erenard said,

    November 28, 2009 at 8:01 pm

    I’m no connaisseur of homeopathy [and would never take such tack] but it’s evidently possible to do randomized studies. Let’s agree that such products do no more harm than NICE approved drugs that also don’t help prevent the disease they are prescribed for. Moreover homeopathic pills may have, or have, a placebo benefit. Moreover, I don’t think they are used for cancer, Alzheimer’s or heart disease [correct me if I am wrong].

    THREE AstraZeneca studies with a total of 55,000 patient-years of ‘proper’ randomization regarding the NICE sanctioned rosuvastatin, Crestor, had a dismal result, repeat dismal result. Summary:
    www.health-heart.org/JUPITER_Table_3_Outcomes.gif [start here]
    Other statins: www.health-heart.org/cholesterol.htm

    These drugs are prescribed to prevent heart disease but the deaths are the same. In some, at the cost of $880,000, they prevent a [non fatal] heart attack while 470 people swallow the drug for a year believing it may prevent such event. It only costs ~$550,000 to prevent one non life saving angioplasty or bypass in 300 people on the drug. That is 10-20 times the cost of the operations themselves and, trust me, in British £’s they are no more cost effective.

    The harm done: the calcification of the artery and heart valves continues AT THE SAME RATE on statins while patients are lulled into the false sense of security that cholesterol is no longer [if ever it was] a risk factor. That is doing harm FIRST since there are VERY effective cheap ways to avoid such cardiac ‘events’, which is not the topic.

    Compared with the urgency to do trials in homeopathy, the reexamination of the NICE dictated statin business is urgent. Gold fish vs sharks; pimples vs melanoma.

  20. pls2917 said,

    November 29, 2009 at 3:16 am

    @apothecary:10
    Regarding unconcealed allocation: your link mentions that the way to avoid this is through centralized randomization via automated phone or web system. The references in the CONSORT article appear to be all 10 years old or more. The IVRS/IWRS systems have become mainstream since then.

  21. PsyPro said,

    November 29, 2009 at 3:27 am

    What “nocebo” effect? You need an effect before you can give it a name, and all the referenced results are either a placebo effect, or no effect at all. A result exceeding a no-treatment control in the direction of the expected results of treatment is a placebo effect, not a nocebo effect. So, suggesting that by ingesting an (inert) pill one will experience all sorts negative outcomes (“side-effects”) is a PLACEBO condition. And, if it results in an increase in those outcomes relative to those not so informed or treated, then we have a PLACEBO effect. The mere appearance of those outcomes in any condition is not ANY effect at all, unless different from that in some other condition.

    A nocebo effect, to the extent it has any meaning at all, would be to have negative consequences on being in a treatment (but not) condition where one was informed that one was NOT to be treated, and those negative consequences were the OPPOSITE of what was the case in those informed that they were being treated (but not). For example, where, upon being informed that one was NOT to be treated for hypertension, one’s blood pressure *rose* (not just was higher than—that would just be the untreated control) relative to those in the placebo condition.

    That said, there is a mechanism for a nocebo effect: compensatory conditioned responses in the central nervous system, but such responses seem to be tied to *placebo* conditions (e.g., presentation of a saline bolus in the conditions that would normally signal a bolus of morphine).

  22. PsyPro said,

    November 29, 2009 at 3:47 am

    As for even placebo effects with homeopathy, what evidence is there? Are there *any* properly controlled experiments demonstrating such effects? First, as homeopathic “remedies” are what we would normally call the placebo condition, just what is meant? Note, comparing a homeopathic treatment to some other alleged treatment is NOT the proper experiment. To demonstrate a placebo effect (which is true for non-homeopathic treatments, as well), you need a non-treatment control, and there are damn few of those in the medical literature. Indeed, ironically, and surprisingly to many, there is not, in medicine, a lot of evidence of a placebo effect, despite the widespread use of placebo control conditions, and claims that “x is just a placebo effect”. Indeed, it is mostly in experimental psychology that we find any firm evidence of what some would call a placebo effect, and it appears to have little to do with “belief” (i.e., rats evince convincing placebo effects, and it is hard to communicate “belief” to a rat), and everything to do with evolutionarily-based immune responses and healing (including social) processes.

  23. iantanner said,

    November 29, 2009 at 4:55 am

    Where do sugar pills come from (ie they’re presumably not Mint Imperials!)? Can Doctors prescribe them and, either actually or hypothetically, how ethical is that? Could they become addictive?

  24. natsils24 said,

    November 29, 2009 at 11:13 am

    @skyesteve – I get the point that you are making, drugs and treatments in conventional medicine do go in and out of fashion, I think a perfect example is how beta-blockers could never be prescribed for a heart failure patient, now we know they reduce mortality.

    However I think that although the evidence we base some of our treatment decisions on is flimsy that misses the crucial point. In conventional medicine we keep doing trials to compromise more of an evidence base and that is why treatments change over time. This just does not happen to even a fraction of the same percent in homeopathy, if at all. If homeopathy worked surely homeopaths would be lining up to do trials, getting published all over the place so they could back up their claims. But this just doesn’t happen.

    @ Mr Nick – yeap, funded for by the NHS. Its brilliant reading isn’t it?! One of my favourite quotes on the subject from a couple of years ago… “I find it appalling that the National Health Service should be funding a therapy like homeopathy that is utterly bogus.” Michael Baum of University College London, who was in a group of doctors and scientists in the UK urging the NHS to stop funding alternative medicine.

  25. HypnoSynthesis said,

    November 29, 2009 at 2:59 pm

    Research on hypnosis provides an interesting source of information about nocebo effects. When given standardised hypnotic scripts, mild, transient side-effects are relatively common such as nausea, anxiety, feelings of disorientation, and even headaches.

    In experiments using control groups who simply sit for twenty minutes with their eyes shut, in silence, without being hypnotised or told anything unusual, a surprising number of mildly unpleasant side-effects are reported even by the controls. T.X. Barber reported one of these studies in Hypnosis: A Scientific Perspective (1969) which found that of 50 controls who merely sat in silence with their eyes closed, the following % reported feeling certain potentially unpleasant side-effects,

    Changes in equilibrium. (66%)
    Experimenter’s voice seemed either very close or very far. (34%)
    Feelings of unreality. (26%)
    Alterations in (felt) size of body or body parts. (36%)
    Changes in experienced temperature (feeling very hot or very cold). (34%)
    “Disappearance” of body or body parts. (4%)

    In other words, weird sensations, and unpleasant reactions, seem to occur very easily even in control groups, perhaps as the result merely of introspection and some vague expectation that an experiment is taking place.

  26. E@L said,

    November 29, 2009 at 3:37 pm

    I took a placebo and I turned into a newt!

    I only got better with homeopathy!

  27. MrNick said,

    November 29, 2009 at 8:27 pm

    @HypnoSynthesis
    Very interesting. It surprises me that it is possible to get reliable results at all considering how much is going on in the head.

    It’s a long time since I read the Discworld books with Granny Weatherwax but if I remember correctly most of what she did was headology and not magic at all. Belief and expectation have a huge effect.

    Nick

  28. emen said,

    November 29, 2009 at 8:54 pm

    adamk #11

    “Often it is possible to predict beforehand who will experience a nocebo/side effect.”

    I’d really like to know how.

  29. emen said,

    November 29, 2009 at 9:39 pm

    Ben says,
    “But the best moment was Dr Peter Fisher from the Royal London Homeopathic Hospital (funded by the NHS) explaining that homeopathic sugar pills do actually have physical side effects: so they must be powerful.”

    What is even funnier is that Peter Fisher says it in the context of patients taking homeopathic remedies to PREVENT FLU.

    Putting aside the exciting fact that using homoepathy to PREVENT anything contradicts their first principle, you can’t treat anything with homeopathy before you have any symptoms.

    But homeopaths DO say that the pills can have side effects. I have argued with homeopaths enough in my life to have heard the following claims:

    1. If you have chosen the right remedy, it is quite normal for your symptoms to get worse before your problem starts to improve. In fact, “it is a very good sign”.

    2. Some homeopaths say that if you are taking the wrong remedy, simply nothing will happen. But some say that the wrong remedy will trigger the symptoms that it really is for.

    So if you have a cough that gets better if you drink cold water, but you get the remedy that is for the (entirely different) coughs that get better if somebody gives you a hug, in won’t cure your cough, but it will give you an EXTRA cough on top of your existing cough, the type that goes away if somebody gives you a hug.

    3. Homeopaths also often say that it is not safe to take remedies for longer periods (for more than 2 weeks, let’s say), again because it will provoke the symptoms that the remedy is originally for. (Therefore some very holistic homeopaths recommend “constitutional remedies” for chronic problems, and symptomatic remedies for acute conditions only. A constitutional remedy is your own special holistic remedy, one that will heal everything that you have. You can be a “Nux Vomica” type for example, and when you start taking nux vomica, all your health problems, past or present will leave your body in a special holistic order, and should you get the symptoms of these illnesses, it means the remedy is beautifully kicking in.)

    4. Also, ask any homeopath whether it is safe to take a remedy in potency C200 every day for weeks. The answer will probably will be no, because that potency is too strong.

    5. Some homeopaths will say it is not safe to take more than one homeopathic remedy at a time because they will interact. So you can’t take something for your headache and something else for your hayfever at the same time.

    And so on.

    Of course, there is no evidence that sugar pills will have physical harmful effects, but they can make you feel worse if that is your expectation after your consultation with a homeopath. But more importantly, if you attribute the worsening of your condition to the homeopathic sugar pills kicking in, you might be putting yourself at risk by not seeing a doctor instead.

  30. Sam the Centipede said,

    November 29, 2009 at 10:38 pm

    Anti-homeopaths (sensible people!) do bang on and on about placebo and nocebo effects and sometimes even make the assertion that “there is nothing to homeopathy beyond the placebo effect”. This is simply not correct.

    Homeopathy has several other ways of being effective:
    (1) mendacity: don’t underestimate this, a practitioner can say “you look much better” when you’re actually worse – there is anecdotal evidence for this from the unethical world of veterinary homeopathy (unethical because the animals can’t consent to being mis-treated);
    (2) only counting successes – it worked for A, B and C, ignoring the fact that it didn’t for D to Z;
    (3) natural healing, where the patient gets better anyway irrespective of the quack’s attention or his/her treatments (that’s not a placebo effect because there is no effect);
    (4) use of anecdotal evidence rather than real evidence.

    I thought it interesting that nobody picked up on the idiotic claim from the guy from the British Shaken Water and Sugar Pill Manufacturers Association that their baby teething “remedies” must be effective because they sold a lot and babies couldn’t exhibit a placebo effect. Well, I think they can. And certainly their mothers can, who are probably the ones assessing the symptoms.

  31. adamk said,

    November 30, 2009 at 12:58 pm

    @emen

    It seems to me that often the more suggestible patients are the people to experience side effects/nocebo (how can one tell the difference?).

    I wonder if this is the effect that medical practicing homeopaths see? Presumably only some of their patients are given homeopathy , and are probably selected on the basis that they are more likely to respond. Perhaps a likeliness to respond is equivalent to a higher degree of suggestibility , and a greater susceptibility to the placebo effect.
    Thats all speculation though!

  32. MarkRyan said,

    November 30, 2009 at 1:56 pm

    I also watched the BBC breakfast item on homeopathy, I was suprised that the journalist selected to speak against the hoeopathic ‘doctor’ admitted to not knowing anything about homeopathy. Does this represent the state of balanced debate on our national broadcaster? Or was it, as I suspect, just another lazy attempt at discussing a highly complex problem by dragging the first two people you can find in front of a camera.

    Come on BBC, you can do better than that.

  33. sciencerocks said,

    November 30, 2009 at 2:25 pm

    One of the things that really makes me mad about the present government (although I suspect the Tories would be no better) is that it is happy to waste money on homeopathy and support irrational homeopathic claims, but we (in audiology) are told that they want to scrap the current four-year BSc Audiology training programme for audiologists (that delivers competent audiologists) in favour of a new generic three-year programme (that won’t deliver competent audiologists) whilst completely ignoring professional bodies along the way.

    So the same government that spends millions (ish) on setting up a new degree in 2002ish now plans to scrap it and spend more money on a new programme that won’t work whilst urinating money up the proverbial wall on homeopathy. Bonkers!

    If you are as incensed by this as me, perhaps you might consider lending your support (especially those of you who were affected by the DH’s modernising medical careers mess): petitions.number10.gov.uk/Audiology-BSc/

  34. el-stuarto said,

    November 30, 2009 at 2:58 pm

    AdamK’s note about consenting for treatment promoting the nocebo effect is not just applicable for medical treatments but for surgical operations too.

    Because of the nature of an operation it is important to get written (signed) consent in the majority of cases, which usually means having it explained to you in no uncertain terms that you may go on to have significant pain and disability post op,particularly in orthopaedics, where I work.

    Consenting is a double edged sword, what we stand to gain in not being sued, we probably lose out in nocebo complications, and lets not forget that nocebo complications can lead to investigations and treatments of their own, which may carry their own risk of morbidity.

  35. adamk said,

    November 30, 2009 at 6:08 pm

    @el-stuarto
    maybe we need consent for gaining consent
    “what you are about to hear may damage your health”

  36. Jbags said,

    December 1, 2009 at 2:59 am

    Reading that same pharmacy page on the homeopathic hospital website as natsils24 brought up and emen commented on, I was just staggered to read the sentence:

    ” In some cases symptoms may appear to become worse after starting the remedy. This is usually a good sign ”

    Surely this is immensely irresponsible? If you have an ailment, and you take sugar pills, and your ailment gets worse, that’s ok! its supposed to happen. don’t go and see your doctor, wait for the pills to work properly!

    Even if they have a disclaimer afterwards, saying if symptoms persist see your GP, the fact they have that first sentence in there at all has to be damaging in the way it affects people’s behaviour. For the person who has a ‘bit of a cough’ and starts taking sugar pills, and bears this in mind as the cough gets worse, they will be at home clutching a bottle of sugar pills while potentially nurturing a severe case of bronchitis or worse.

    Its examples like this that steer me away from a tolerant stance of homeopathy (its ok as long as people pay for it and they’re told to see their GP), to outright opposition on grounds that its impossible to stop something like this doing harm.

  37. natsils24 said,

    December 1, 2009 at 12:24 pm

    @ Jbags

    I personally love that pharmacy page, nearly spat out some water over my laptop laughing at it. What really makes me mad however is that if homeopathy is as amazing as they say it is there would be well conducted RCTs showing evidence for its effectiveness and they would be shouting this from the roof tops. And they would have their remedies (I will not call it medicine) regulated by the MHRA.

    This is why I have such a low tolerance for homeopathy, I read the evidence and am enquiring enough to try to read widely around topics. But luckily I am a medical student so I have this opportunity and have been taught how to evaluate evidence. People with chronic conditions that have very inadequate medical therapies can’t always do this and these are the people I feel for.

    Plus I am happy that the paracetamol I carry in my handbag can exist next to my mobile phone, I can’t afford to invest in another bag to separate them!!

  38. elvisionary said,

    December 1, 2009 at 12:33 pm

    The BBC’s sloppiness highlights a really important issue. Homeopathy and other quackery flourish in the vacuum created by ignorance – it’s not that people are being wilfully stupid or reckless about the consequence, it’s just that they don’t really understand the issues and don’t have any particular desire to learn about them.

    I’m a bit ashamed to say I know this from experience. I’m not a scientist or a medic of any kind. A few years ago my daughter was suffering badly from eczema, which was not responding to the range of conventional treatments we tried, some of which seemed to be exacerbating the problem. My wife was talking to a well-meaning neighbour (media type!), who said that his daughter had had the same problem, they’d tried everything, until finally they went to a homeopath, after which it cleared up in weeks. This was a fairly typical example of the anecdotal success story that homeopaths can easily use in marketing their wares through word of mouth, but we decided to give it a go. At the time I was ignorant about homeopathy – I was probably aware that there was no proof of its effectiveness, but to parents who would try anything to relieve their daughter’s suffering, that might not be a good enough argument not to do it. If I had known more about homeopathy, I would have objected violently to paying some fluffy idiot good money to give my daughter some sugar and water.

    So homeopathy should in theory be an easy target – not only is its effectiveness beyond the placebo effect unproven, it is also palpably absurd, and no rational person would expect it to be fully effective. There is far more reason for a rational individual to “give it a go” with other unproven remedies than with homeopathy – at least some “ancient chinese remedies” might actually have an active ingredient that could have an effect, which could in theory one day be proven to be more effective than a placebo. Homeopaths can’t even realistically rely on that possibility – no-one in their right mind would even expect it to work!

    But most people don’t even know how ridiculous homeopathy is. So the challenge is: how do we fill that ignorance gap? I think scientists need to be honest about the fact that they’re not always effective at expressing things in ways that make sense to the wider population. And sometimes the tone taken by scientists can actually be counter-productive and turn people off. How can we translate this into English, and get through to people who have no desire to engage on these kinds of issues on a daily basis? Comedy sketches like the brilliant “Homeopathic A&E” by Mitchell & Webb can help – humour is a great way of pricking people’s pretensions – but equally it probably wouldn’t have made much sense to those who didn’t know what homeopathy was in the first place.

    Oh well, enough of that – I’m off to have a pint of homeopathic lager. Strong stuff!

  39. elvisionary said,

    December 1, 2009 at 2:10 pm

    Was reflecting on Psypro’s point about whether it’s really a nocebo, or just another placebo. I suppose what we’re really talking about here is a placebo side-effect. But either way, I did wonder about research on side-effects: if a piece of shoddy research shows a link between a treatment and a side-effect, is it self-fulfilling that this side-effect will forever be associated with the treatment?

    How do you ever establish that there is no side-effect, when this effect (whether you call it nocebo or something else) will be seen in all trials as a direct result of the patients (on both sides of the trial) being told of the potential side-effect.

    If the results showed statistically similar levels of side-effect on both sides (real drug and placebo), that might make you suspect that the side-effect was not a direct consequence of the treatment – but the trial would not have been designed for this purpose, and this would not prove that there was no side-effect. Presumably the only way to prove the absence of a side-effect would be the ethically questionable approach of having a control group who had not been told about the side-effect. In the end, won’t this just turn out to be too difficult, with the result that the non-side-effect would never actually be challenged?

  40. Jessica said,

    December 1, 2009 at 2:54 pm

    I program, and report out, the raw data from clinical trials for a living. Once a study is de-randomized I am often surprised at how often the adverse event datasets contain more of the subjects on placebo than on the study drug. This often happens even when the study isn’t 50/50, but placebo subjects are far fewer than the treated subjects. This in turn probably indicates that a small percentage of the adverse events reported on the study drug are also placebo.

    Now, if there was a way of tracking the pharmacokinetics of a placebo (bloodsugar?), _that_ would be interesting. Would placebo prone subjects flush out a traceable, but inactive, compound with well known pharmacokinetics (and what would that compound be) differently from their own baseline, if they were told at second administration that it should be all flushed out within less, or more, than the expected flushout? My uneducated guess is no.

    Kind Regards,
    Jessica

  41. MarkRyan said,

    December 1, 2009 at 3:42 pm

    haha! see below re: the BBC coverage of this story – a more balanced debate followed the next day after a load of complaints

    “Thank you very much for your email. This interview was from BBC Breakfast News. We discussed the quality of the debate at the time and agreed that it was not as rounded as it should have been. Therefore, Breakfast took the subject on again the following day in an attempt to explore the science more fully. This was represented on the BBC News Website here: news.bbc.co.uk/1/hi/health/8384040.stm.
    Carley Bowman
    Assistant Editor
    BBC News “

  42. mikewhit said,

    December 1, 2009 at 3:53 pm

    There continues to be confusion between homoeopathic and herbal medicine in the population.

    Called into the M56 Chester services recently, asked if they had any travel sickness tablets (for my wife).
    The guy pointed behind the counter and said, “We’ve only got these herbal ones” – picked up the box: “homoeopathic travel sickness treatment”.
    My Bad Science-reading kids said I should have bought them and tried them on the wife for any effect !

    Also the other week when Boots said it would continue to sell homoeopathic stuff, the Daily Express article mentioned St.John’s Wort among other herbals on sale at Boots, as well as the homoeopathic stuff.

  43. skyesteve said,

    December 1, 2009 at 4:25 pm

    I think possibly what is needed to really deal with the homoeopathy issue is a good, full-blooded court case where someone sues an NHS homoeopathy establishment and part of the case is the need for the homoeopaths to prove that their treatment does “what it says on the tin”. A good legal judgement which says that there is no proof that homoeopathy does what it says would be reasonable grounds once and for all for ensuring that valuable NHS resources are not being wasted on sugar pills.

  44. Jbags said,

    December 2, 2009 at 1:29 am

    @natsils24

    I agree, its patients with chronic illnesses that medicine provides inadequately for, who are in a tough position. My brother had persistent eczema throughout his childhood, and once medicine had run its course and not solved the issue our mum (despite starting her career as a nurse) threw quackery at it, including homeopathy. Of course it didn’t do anything, and years later his skin cleared up on its own; but I can see why patients turn to homoepathy in this instance. Doesn’t make it right, or worthwhile, there’s just clearly a mechanism for sustaining the practice.

    I’m glad that even as a child I had no time for homeopathy, as an asthmatic it could have been far more life threatening to replace my salbutamol inhaler with a sugar pill. I bet if I was suckered, went around armed with sugar pills, had an asthma attack, died, an investigative homeopathist would have a look and go “theeere’s the problem! he kept the pills in the same pocket as his mobile! homeopathy does work, he just used it incorrectly!”

    @Mark Ryan

    good to see a better debate than that travesty they thought they could get away with first time round. Interesting that its the GP speaking sense and the Academic spouting bollocks. Government 1 University of Southampton 0!

  45. T.J. Crowder said,

    December 2, 2009 at 10:33 am

    @Psypro: “nocebo” is just the term used for the placebo effect when it manifests an undesireable, rather than desireable, outcome. This is just like “side-effect”. Drugs don’t have side-effects, they have *effects*. Some of the effects are the ones we want, some of them aren’t. We call the latter “side-effects”. Similarly, if someone experiences a negative effect as the result of suggestion rather than medicine, we call it the “nocebo” effect. A positive effect similarly induced is a placebo. No great conspiracy, just terminology.

  46. Jellyman said,

    December 3, 2009 at 1:39 pm

    I may just be being dense but a cannot understand this statement “one drop of the ingredient which has been diluted, so extremely, that it equates to one molecule of the substance in a sphere of water whose diameter is roughly the distance from the earth to the sun.” i’m not familiar with the manufacturing process of homeopathic pills but it stikes me that to dilute something to this degree you would need a “sphere of water whose diameter is roughly the distance from the earth to the sun” to place the one molecule in. However i am clearly no pharmacist, can anyone explain?

  47. mikewhit said,

    December 3, 2009 at 6:51 pm

    @Jellyman:
    no, you just follow the homoeopathic instructions.

    IIRC,
    Take 1 drop (1 cubic mm ?) of your ‘stuff’, stick it in 100 cubic cm of water, stir well.
    Dilution = 1/1000 / 100 = 1e-5 (one over a hundred thousand)

    Now do the same again with a drop of the result,
    Dilution = 1e-10

    Same again.
    Dilution = 1e-20

    Since (Avogadro) we know that one molecular weight of a substance in grams (of which our initial drop probably contained say 1/100) contains roughly 6e23 (6 times (10 to the 23)) molecules, you can see that with the dilutions above we are getting down to only a few molecules in our dilutions already.

    Can’t remember how far homoeopaths go, but the point being made by the ‘interplanetary sphere of water’ is that at homoeopathic dilutions, there is no actual substance molecule present unless you had a vast amount of the ‘diluted solution’.

    Like saying you’d have to put in 14 million lottery tickets to be certain of winning – you’d have to have that much ‘solution’, at the homoeopathic dilution, to ‘ensure’ you got one molecule of the substance.

  48. mikewhit said,

    December 3, 2009 at 6:54 pm

    Oops, sorry. The dilutions should have been:
    1e-5
    1e-10
    1e-15

    going down by 100,000 each time.

  49. The Placebo said,

    December 3, 2009 at 8:33 pm

    So a placebo can have a side effect, and you regard homeopathic remedies as placebo. But one thing you seem to have overlooked is that people buying homeopathic remedies do not think they are buying placebos and therefore will not have your placebo side effects. Of course, words such as sugar pill are very easy to use, and words can be used very selectively to make whatever point you want. but put some logic into arguments where you criticise others for lack of logic and your own arguments fall over, tripping on the basis of not being able to come up with anything better than name calling.

  50. skyesteve said,

    December 3, 2009 at 10:23 pm

    Placebo – you seem mis-understand the concept of placebo in this context.
    If a homoeopath says this or that remedy will make you feel better and someone else gives you something they know to be no more than a lump of sugar and tells you that you will feel better and there’s no objective and repeatably demonstrable difference between the benefits of what the homoeopath offers and the lump of sugar then that is placebo. In addition, if I spent an hour with someone listening to all their woes then charged them £60 for the privelege and offered them a bottle of pills or powders to help them I guarantee they’d feel better for it.
    But, in a way, that’s not the point. Homoeopaths want to have their cake and eat it. If individual people want to spend their own money on something that may or may not be no better than a “sugar pill” in the hope that it will make them feel better then that is their business.
    But when the NHS pays for treatment which does not stand up to the same scrutiny as conventional drug therapy then that is everyone’s business because every tax payer is subsidising it.
    If homoeopaths want the NHS to fund homoeopathic treatment then they have to live by the same rules. It’s no use them saying that it’s unfair to judge homoeopathic “remedies” by the same randomised, double-blind, controlled trials which are used to evaluate conventional drugs.
    To most rational people the MRHA’s decision and the funding of homoeopathy by the cash-strapped NHS is just preposterous.
    And before you say that I don’t know what I’m talking about I studied homoeopathy through the (NHS) Glasgow Homoeopathic Hospital for over three years and still think it’s mince – smoke, mirrors and a huge dose of charismatic “healing” (as I say, nothing wrong in that if you want to pay for it but don’t expect the taxpayer to do so) .

  51. The Placebo said,

    December 3, 2009 at 11:18 pm

    The common interpretation of placebo is that it is something which is taken in a trial where someone thinks they are getting something which will have an effect although it is known it will not, to compare it with something which is expected to have an effect. My point was that a homeopathic remedy is not nothing, and is taken by someone on that basis.

    As a taxpayer, I should have the option to treatment from the NHS of my choice, especially if that choice is cheaper than the alternative. Maybe the Homeopathic remedy producers should charge the same as the pharmaceutical companies for their output. Then they could afford to do trials and produce statistics which support them as the pharma companies do. There are examples in this thread of drugs which are proved to not work, but are very expensive to the NHS. Why does that happen. Post 19 points out the costs for rosuvastatin – higher than the total spent by the NHS on homeopathic remedies according to evidence put to the parliamentary committee last week.

    Is it really a problem to spend less than 0.00625% of the NHS drugs bill on something that recipients of that spend feel benefits them?

  52. Jbags said,

    December 4, 2009 at 1:33 am

    @51 Placebo

    I’m not quite following your posts, you seem to criticize commenters for saying off-the-shelf homeopathy will have a placebo effect.

    It has been shown that homeopathy’s -only- benefit is throught the placebo effect. In the case of homeopathy from a pharmacist’s shelf, the person buying the remedy expects it to work, so they pay the money, then go through the daily ritual of taking the pill. Because they think it will work, it can have a positive effect via the placebo effect. You don’t have to be in a trial to witness a placebo, there doesn’t have to be a control.

    It is perfectly accurate to use the term placebo in this case, it is also perfectly accurate to use the term sugar pill, since the placebo is the mechanism and the sugar pill is the vehicle.

    I’m sorry to challenge you, but I’m afraid you’re wrong on your second point in #51. As a taxpayer, you shouldn’t have access to your treatment of choice through the NHS. You should have access to proven treatments as tested by experts and regulated by the government. Fine, you want homeopathy on the NHS and you don’t think its unreasonable, but what about the person who wants to be treated by a witchdoctor, should the NHS employ a “Redbridge PCT Witchdoctor”? What about palm reading, or tarot reading as preventative measures? What about prayer healing, should the NHS employ a hundred strong force available 24 hours a day to pray for people who want to be treated through the power of prayer?

    I understand if you have a firm belief in homeopathy, then these examples will sound absurd, but I’m afraid there’s no better proof for homeopathy than there is for any of these methods. When you are ill, you go to the GP (the trained physician) so that he or she can prescribe the best treatment, whatever that may be.

    Your last paragraph raises an interesting point, if the placebo effect can be shown to be effective in the treatment of patients, should the NHS fund the placebo effect? Again, although interesting, I’m afraid this is a no. I heartily recommend you watch the parliamentary science and technology committee hearing on homeopathy, found here:

    www.parliamentlive.tv/Main/Player.aspx?meetingId=5221

    Where NHS funding of the placebo effect is one of the (many) points raised. This is the same link as given in Ben’s post of the 25th Nov.

    Prescribing a placebo is fundamentally dishonest, patients should not be given (and made to pay for via prescription costs) something that is -known not to work-. This is a potential can of worms, so much can go wrong with starting to prescribe medicines that aren’t medicines (see homeopathic malarial prophylaxis).

    I’d rather spend that 5/80,000 of the NHS’ drugs bill on more actual drugs that actually work. But even if that weren’t an option, I would rather spend that much on sending antiretrovirals and vitamin supplements to the third world, rather than spending it on homeopathy for UK citizens. Then at least someone is getting some real help (beyond placebo) from that money.

  53. skyesteve said,

    December 4, 2009 at 9:47 am

    @Jbags – here’s some alternative (or is that complimentary?) views on homoeopathy on the NHS and how to manage it!

    www.thedailymash.co.uk/news/health/ten-in-ten-homeopathic-prescriptions-contain-mistakes-200912032281/

    www.thedailymash.co.uk/news/health/complementary-therapists-to-be-regulated-by-witch-doctor-200901201522/

  54. The Placebo said,

    December 4, 2009 at 11:47 am

    A final post from me, as there seems little point in discussing things rationally with people who have already made their minds up about something which brings a great benefit to many people just because it doesn’t have “scientific” proof. Life isn’t all about science, humans aren’t ruled by science. What people feel is far more important than what a scientist can measure. I guess all those seeking scientific proof don’t believe in love, and only see it as a placebo.

    But in terms of cost, 0.00625% of the NHS drugs spent on something that does have a real effect on how people feel as opposed to on another drug which would then require further drugs to counter the side effects seems pretty reasonable. In a democracy we, the public, should have a say. Those who have financial interests currently rule, and that is wrong. So what if 0.00625% is spent on something doctors don’t understand. I don’t understand why the NHS spend that much on lots of things which produce no noticeable benefit to those the NHS exists to serve, not even as a placebo.

    And, for the record, I am not a great believer in homeopathy. But I do know that it can work for some people for some ailments. Who cares if scientists can’t prove it, people feel different. Love rules!

  55. Jellyman said,

    December 4, 2009 at 11:58 am

    Thanks mikewhit thats a wonderful explanation. How incredible that these sugar pill lottery tickets cure cancer. Isn’t science fascinating!

  56. Jbags said,

    December 4, 2009 at 1:40 pm

    @Skysteve

    Those are absolute genius, I’d never seen that site before and its cracking. The one about the witch doctor made me laugh a great deal, I got very odd looks from people in the office!

    @The Placebo

    In response to your final post, I would just like to clear up one thing. I’m not ‘fundamentalist’ in my scientific beliefs, I don’t want to force everyone to share my beliefs. I honestly don’t mind if people would rather see a homeopath than their GP, or get a tarot reading or see a witchdoctor (I worked in Uganda for a while, and they are still very popular there, even where proven conventional medicine is available). I’m fine with people going to see a homeopath, and finding themselves lighter of wallet, and feeling happier; its not my bag, but I defend the rights of people to see homeopaths if that is what they so desire.

    When this gets into a less happy situation for me, is public funding. Why do you insist the taxpayer funds homeopathy? Why can’t we just leave it as a private practice? The problem here is that the government has to be responsible about how it spends its money. The health service has a limited budget, and it has to justify every penny it spends. You cannot medically justify spending public money on alternative medicine, that being: things that have not been proven to work, or things that have been proven not to work . Here, homeopathy falls into both categories (with the caveat “beyond the placebo effect). Ok, homeopathy is not the particular torch that you carry, but surely you can see that you need to have an evidence base on something you wish to spend public money on? some reason to actually spend the money? I don’t think I am alone in thinking that the benefit from a treatment whose only effect is that of a placebo, does not give a good enough reason for the health service to spend money on it.

    No indeed, humans are not ruled by science, but I do hope (perhaps in vain) it does crop up in the functioning of the government. We, and the world around us, is described by science, and that’s the point. Via the scientific method we find out about the world, and find a way to describe its wonder and its awe. I am sad that you feel one cannot be a scientist and be in awe of love, and all the wonder of human experience. I have had endless debates with my dad about this (he lives in Australia selling coloured phials of water which are meant to enhance our ‘energies’), and I just cannot seem to get the point across that scientific outlook on the world enhances my experience through greater understanding. I see beauty in a succinct mathematical proof in the same way I see beauty in that brilliant new nature doc ‘Life’ (narrated by the most awesome Sir David Attenborough). The fact I believe the biological mechanism for the experience of emotion in the brain can be fully observed and described by medical science does nothing to belittle my wonder of the highs of love, or the life-affirming blackness of tragedy (not oximoronic I believe). My dad and many others like him prefer to believe that turning our backs on observation (and the scientific method), we become enlightened and start contemplating proper ideas (none of which can ever be tested, proven, or otherwise engaged with).

    I find this tragically naive, because in essence my dad, and all the others like him, have effectively confined their experience and beliefs to human imagination. What I can’t seem to communicate is that there are things in the universe that so utterly blow the mind, they are beyond any man made idea, theology or ‘alternative philosophy’. See Dr Phil Plait’s Bad Astronomy blog for example, and check out the stunning images of our solar system, our galaxy and even further afield. There is so much more out there than human imagination and the ‘rule of emotion’. This is pure intropsection, when if we just looked outside of what people imagine, and into the wonders of the physical universe; whether its subatomic breakthroughs at CERN, the 2.5 billion pixel image of our galaxy from the spitzer telescope, or the discovery and documentation of HIV resistant genetic mutations in humans, I am constantly in awe of the world around me, and have science and scientists to thank for it.

    I feel so indebted to the generations of academics and scientists, whose millions of man-hours of work allow me to experience the world like no previous generation has, that yes I do resent it when people like my dad would rather talk about a plastic phial of coloured water with “infinium” written across it in silver ink.

    To drag this back to topic, this then applies to all complementary medicines, none of which work beyond the placebo effect. People are drawn in by quirks of human imagination (from horoscopes, to homeopathy, to reflexology, to kinesiology), and decide to wilfully ignore proven science… it saddens me. But like I said, I will defend the ability of these people to undergo this treatment if they wish (although not at the expense of conventional medical treatment), I do not want to rid the world of homeopaths or people who believe in it. I just want to keep the restricted public health budget spent on medicines which actually work beyond placebo.

    If you would like to see a homeopath that’s fine, I just resent footing (part of) the bill.

  57. adamk said,

    December 4, 2009 at 1:50 pm

    @placebo
    Please don’t think you are being picked on , but you are right , most people posting on this site already have a firm and similair opinion about homeopathy , and when someone comes along who says something different , it makes things more interesting. After all you can’t really have a debate if everybody agrees.

    Why not try to discuss things rationally? Reason and logical thinking is what , I believe , set humans apart from the rest of the animals.

    I think you may misunderstand the placebo effect. Any treatment can have a placebo effect – it requires the person taking it to believe it to have an effect. For example – morphine , a well known and proven to be effective pain killer , will have an associated placebo effect , if the person taking it believes it to work.

    New substances , in order to become prescribable medications have to be shown (in trials and tests) to work OVER AND ABOVE the placebo effect. Now , there are problems with how some of these trials and tests are performed , or reported – see Ben’s latest post – but on the whole every drug has to go through fairly rigorous investigation before it comes available for doctors to prescribe.

    The trouble with homeopathy , is that , though it should be fairly easy to set up good quality trials , there is NO GOOD EVIDENCE that it works OVER AND ABOVE the placebo effect.

    So , homeopathy medication works about as much as one would expect a sugar pill to work. This makes sense – by diluting a substance a million million million times (if not more) and then adding this to a sugar pill ( the method by which these medications are prepared) then what have you got? A sugar pill.

    What about your argument that if it makes people feel better , why not? This argument has more merit.

    I think the trouble with this , over and above the seeming unfairness of rigorous rules for proper medication (which I don’t think anybody objects to) and the complete lack of rules for homeopathic remedies , boils down to a question of money. The NHS has limited funds. we could spend money on developing money which works (ie has a placebo effect and a proven additional effect). ie medication that would make MORE people feel MORE BENEFIT , than homeopathic medication. More bangs for the buck.

    Then there is the problem of homeopathy being used for more serious condtions , in the place of traditional medication (the most notorious is against malaria – where I’m afraid placebo effect will not stop you dying).

    Then there is the problem of the NHS officialy sanctioning a product with no proof it works more than the placebo effect , endorsed by poor reasoning and faulty logic.

    Your last paragraph – ‘Who cares if scientists can’t prove it, people feel different’ – they can prove it ,people DO feel different but NO MORE than the placebo effect , and that is the point.

  58. bodenca said,

    December 4, 2009 at 9:12 pm

    Sorry but …
    1. As the chapter in Ben’s book amply illustrates, you do not have to believe in anything for the placebo effect to work.
    2. It is the attitude “Who cares if scientists can’t prove it, people feel different” that sometimes leaves people to die in agony from easily medically preventable causes, supposedly “happily”. I call that homicide.

  59. Rat Bag said,

    December 11, 2009 at 12:27 pm

    “…to make them feel nauseous…”

    Sorry. Realize (Yep, ‘Merican) this is not a substantive contribution to the discussion … but I am afraid that you have awoken one of my pet peeves.

    Nauseous: causing or able to cause nausea.

    I recognize (there’s that annoying zed again) that there is a growing use of “nauseous” for “nauseated,” further, it seems probable that this usage will become primary.

    At times this brightens my day – think of taking the medical history of a 350 pound woman with bright red inch-long fake fingernails and purple dyed hair telling one that she is nauseous – but more often one is left reflecting upon the loss of yet another word to ignorance.

  60. Windows 7 Professional said,

    December 21, 2009 at 8:34 am

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  61. cloudyskies said,

    March 31, 2010 at 2:45 am

    About placebos…

    Have you seen this Ben?
    gw.innocentive.com/ar/challenge/9188486

  62. MiniMoose said,

    May 5, 2010 at 2:35 am

    One good thing stuff like homeopathy can bring us. Think about all the money that goes into treating patients with no real disease (I see this all the time in neurological ward here in norway). There’s a LOT of money being spent on these people. Some aware that they’re faking symptoms and others not aware (yes it gets complicated).

    My point being…if these people go to a homeopath and gets healed, well, that’s a good thing financially for everyone. Mind you, I wouldn’t go to one, because I find it insulting to even my mediocre intelligence, but there are positive sides to this. I hate a quack, but if a quack can heal a ducky…I’m all for it ;)

  63. arml said,

    May 24, 2010 at 8:46 am

    Sorry if I’m being slow, but has everyone spotted the result of the committee’s enquiry?
    Victory thanks to Dr Ben et al: www.parliament.uk/business/committees/committees-archive/science-technology/s-t-homeopathy-inquiry/

  64. simonb said,

    May 25, 2010 at 3:13 pm

    OK…i have read the book and have a reasonable grasp of the placebo effect. I have always thought it was a complete con but I have one area that I cannot find an argument against in discussion with supporters of homeopathy.

    In the early nineties I worked for a farming company dealing with dairy farmers. One farmer swore by homeopathic remedies for treating mastitis (he was an early organic convert) how exactly does the placebo effect work in dairy cattle?

    would be extremely grateful for a concise (if possible ) explanation.
    many thanks
    Simon

  65. smedley said,

    July 18, 2010 at 5:24 pm

    You’re not as alone as you thought: xkcd.com/765/

    Enjoy lots of it

  66. kevinbradshaw said,

    July 26, 2010 at 5:16 pm

    I’ve written a short blog post interpreting homeopathy through the quote “Science advances most when its predictions prove wrong” (Don E Wilhelms from To A Rocky Moon: A Geologist’s History of Lunar Exploration).

    “Scientists are opposed to homeopathy, not because they are scared of it or paid off by Big-Pharma, but because it doesn’t work. It is a lie, it confuses people, and makes them believe weird and dangerous things.”

    Read the full post here.

    Thank you :)
    Kev

  67. phoenix6 said,

    September 15, 2010 at 12:23 pm

    It is stereotyping to call someone who uses homeopathy as some middle aged person who thinks they have mystical powers. The very reason I have started using homeopathy I’d because of all the awful dangerous side effects of sonmany western medicines. My homeopath is a trained qualified doctor who knows both sides and I trust him with my life. I would be interested to know why if these remedies are nocebo then why do some remedies react badly with warfarin and also why remedies work so well with children and animals.. Surely you would not expect any effect whatsoever either way?
    A friend

  68. phoenix6 said,

    September 15, 2010 at 12:28 pm

    I would also like to add that a good friend of mine who is a scientist told me that there is nothing in it for drugs companies to find anything positive from homeopathy. I guess by that she means no money in it.

  69. Greg Shal said,

    December 11, 2010 at 8:06 pm

    If there is one thing that annoys most people with mouth ulcers, it’s the fact that they have very little options for a cure. If you are interested in what canker sore treatment is available, check them out here: hubpages.com/hub/Canker_Sore_Treatment

  70. dandare70 said,

    February 24, 2011 at 5:15 pm

    I have CFS/M.E. and find myself reacting to just about any medication I have ever tried to take, including nutritional supplements and once I recall trying some homeopathic tablets which I reacted to badly. I no longer believe in homeopathy thanks to informed sites such as this but I still react to all the medications I try.

    If I am experiencing or have experienced a nocebo effect does anyone have any advice on how I ocould approach this matter?

    Regards.

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