Hard to swallow

August 18th, 2005 by Ben Goldacre in alternative medicine, bad science, bbc, homeopathy, PhDs, doctors, and qualifications, placebo | 4 Comments »

Ben Goldacre
Thursday August 18, 2005
The Guardian

· Pity the sensible alternative therapist, for they are in a unique and impossible position. On the one hand, they want to be scientific, evidence-based and conservative in what they say. On the other, they have to talk up the myths around their treatments, to maintain the placebo effect. In the inevitable friction between these two desires there is much to amuse anyone as picky as, er, me.

· Take Case Notes on Radio 4, covering homeopathy, with Dr Elizabeth Thompson “consultant homeopathic physician, and honorary senior lecturer at the nearby Department of Palliative Medicine at the University of Bristol”. She’s mainstream, and starts off with some jaw-droppingly sensible stuff, which I wholeheartedly endorse: homeopathy does work, but through non-specific effects, the cultural meaning of the process, the therapeutic relationship, it’s not about the pills; and “waiting list trials”, for example, where you compare homeopathic treatment with no treatment, are more meaningful than placebo-controlled trials, and so on. She practically comes out and says it’s about the cultural meaning and placebo effect; you can read the transcript at www.tinyurl.com/7trc7. She even says this: “People have wanted to say homeopathy is like a pharmaceutical compound and it isn’t, it is a complex intervention.”

· Then the interviewer asks: “What would you say to people who go along to their high street pharmacy, where you can buy homeopathic remedies, and they have let’s say hay fever and they pick off a hay fever remedy, I mean presumably that’s not the way it works?” Now this is what we call “the money shot”. A sensible, evidence-based, alternative therapist such as Thompson is in a very difficult position: she doesn’t want to be dumb and say that the pills work, as pills, in isolation: she’s already said they don’t. But she doesn’t want to break ranks and say the pills don’t work. I’m holding my breath. Will she control herself? No. “They might flick through and they might just be spot-on … [but] you’ve got to be very lucky to walk in and just get the right remedy.” They might be lucky? And find the right pill? In a shop?

· So I write, hand on heart, more in sorrow than in anger: these kind of alternative therapists aren’t bad people. It’s like Plato’s Noble Myth: an excellent set of well-meaning but nonsensical ideas, fed to the masses by the learned classes, to maintain a stable society. But their myths and their sweats will always, always, entertain.

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