Dreary Pro-Homeopathy Piece and Letter

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

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

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


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

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

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

Dear Letters,

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

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


Dr Ben Goldacre
(Bad Science, The Guardian)

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115 Responses

  1. SpallationFiend said,

    September 12, 2006 at 2:43 pm

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

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

  2. Delster said,

    September 12, 2006 at 4:48 pm

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

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

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

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

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

  3. SpallationFiend said,

    September 12, 2006 at 5:13 pm

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

  4. doctormonkey said,

    September 12, 2006 at 7:57 pm

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

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

    This was supposed to be a short post…

  5. doctormonkey said,

    September 12, 2006 at 7:58 pm


    this one is!

  6. cath having fun said,

    September 13, 2006 at 12:23 am

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

  7. apothecary said,

    September 14, 2006 at 1:50 pm

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

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

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

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

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

    W “I don’t think so”

    CS M “Oh,well that’s a blessing!”

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

    ROFL? Well, perhaps not.

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

  8. Dr Aust said,

    September 14, 2006 at 5:03 pm

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

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

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

  9. doctormonkey said,

    September 14, 2006 at 7:27 pm

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

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

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

  10. Dr Aust said,

    September 14, 2006 at 8:25 pm

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

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

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

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

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

  11. SpallationFiend said,

    September 15, 2006 at 12:58 pm

    But if they refused… what would the doctors do?

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

  12. doctormonkey said,

    September 16, 2006 at 10:04 am

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

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

  13. SpallationFiend said,

    September 16, 2006 at 3:34 pm

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

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

  14. doctormonkey said,

    September 16, 2006 at 10:06 pm

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

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

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

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