MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

Homeopathy is a deeply puzzling subject for many observers. Perhaps it gets a little easier to understand, if we consider the three main perspectives on homeopathy. For the purpose of this post, I take the liberty of exaggerating, almost caricaturizing, these perspectives in order to contrast them as clearly as possible.

THE SCEPTICS’ PERSPECTIVE

Sceptics take a brief look at the two main assumptions which underpin homeopathy (like cures like and potentiation/dilution/water memory) and henceforward are convinced that homeopathic remedies are pure placebos. Homeopathy flies in the face of science; if homeopathy is right, several laws of nature must be wrong, they love to point out. As this is most unlikely, they reject homeopathy outright, usually even without looking in any detail at what homeopaths consider to be evidence in support of their trade. If sceptics are forced to consider a positive study of homeopathy, they know before they have seen it that its results are wrong – due to an error caused by chance, faulty study design or fabrication. The sceptics’ conclusion on homeopathy: it is a placebo-therapy, no doubt about it; and further investment into research is a waste of scarce resources which must be stopped.

THE BELIEVERS’ PERSPECTIVE

The believers in homeopathy know from experience that homeopathy works. They therefore feel that they have no choice but to reject almost every word the sceptics might tell them. They cling on to the gospel of Hahnemann and elaborate on the modern but vague theories that might support the theoretical assumptions of homeopathy. They point to positive clinical trials and outcome studies, to 200 years of experience, and to the endorsement of homeopathy by VIPs. When confronted with the weaknesses of their arguments, they find even weaker ones, such as ‘much of conventional medicine is also not based on good evidence, and the mechanism of action of many mainstream drugs is also not fully understood’. Alternatively, they employ the phoniest argument of them all: ‘even if it works via a placebo effect, it still helps patients and therefore is a useful therapy’. When even this fails, they tend to resort to ad hominem attacks against their opponents. The believers’ conclusion on homeopathy: it is unquestionably a valuable type of therapy regardless of what anyone else might say; research is merely needed to confirm their belief.

THE PERSPECTIVE OF THE ADVOCATES OF EVIDENCE-BASED MEDICINE (EBM)

The perspective of EBM-advocates is pragmatic; they simply say: “show me the evidence!” If the majority of the most reliable clinical trials of homeopathic remedies (or anything else) suggests an effect beyond placebo, they conclude that they are effective. If that is not the case, they doubt the effectiveness. If the evidence is highly contradictory or incomplete, they are likely to advocate more rigorous research. Advocates of EBM are usually not all that concerned by the lack of plausibility of the interventions they evaluate. If it works, it works, they think – and if a plausible mechanism is currently not available, it might be found in due course. The advocates of EBM have no preconceived ideas about homeopathy. Their conclusion on homeopathy goes exactly where the available best evidence leads them.

COMMENT

The arguments and counter-arguments originating from the various perspectives would surely continue for another 200 years – unless, of course, two of the three perspectives merge and arrive at the same or very similar conclusions. And this is precisely what has now happened. As I have pointed out in a recent post, the most thorough and independent evaluation of homeopathy according to rigorous EBM-standards has concluded that “the evidence from research in humans does not show that homeopathy is effective for treating the range of health conditions considered.”

In other words, two of the three principal perspectives have now drawn conclusions which are virtually identical: there is a consensus between the EBM-advocates and the sceptics. This isolates the believers and renders their position no longer tenable. If we furthermore consider that the believers are heavily burdened with obvious conflicts of interest, while the other two groups are by definition much more independent and objective, it appears more and more as though homeopathy is fast degenerating into a cult characterised by the unquestioning commitment and unconditional submission of its members who are too heavily brain-washed to realize that their fervour has isolated them from the rational sections of society. And a cult is hardly what we need in heath care, I should think.

It seems to me therefore that these intriguing developments might finally end the error that homeopathy represented for nearly 200 years.

Progress at last?

11 Responses to Three perspectives on homeopathy, and the end of an error

  • Dr Ernst –

    I will confess that, due to my science an medical background, I initially belonged to the “sceptic” group. I then did my due diligence and read up extensively on the subject and landed firmly in the EBM category.

    We can only hope that this “debate” can be settled at last. As you and countless others have pointed out, there is absolutely no credible, reproducible evidence that homeopathy has any therapeutic effect for any condition. Unfortunately it seems the true believers in homeopathy can and will never be convinced by evidence and science as they immediately discount anything that doesn’t fit their view.

    “For those who believe, no proof is necessary. For those who don’t believe, no proof is possible.” – Stuart Chase

  • Thanks for the article. I see a lot of cognitive dissonance from the ”true believers” who understand the current significance of EBM and therefore claim that homeopathy is ”evidence-based”, while at the same time claiming that ”science just hasn’t found the mechanism yet”. I’ve read a lot of published studies in homeopathy that superficially appear scientific, but are really either case reports or poorly-performed lab work with data, graphs and p-values.

  • I’m not sure that I recognise that much difference between the skeptics’ and the EBM position.

    It is accepted in EBM that extraordinary claims require extraordinary proofs. Bayesian logic is commonly employed: if the prior probability that a hypothesis is true is very low, the evidence required to make it probable that the hypotheses is true would have to be very strong.

    In the case of homeopathy this would mean taking a more critical view of studies that appear to show homeopathy to be effective. It is so unlikely, that the study would have to be very powerful; a P value of 0.05 would be inadequate.

    I’m not quite sure that the homeopath believers will easily change their views. The anecdotal evidence, which they subconsciously cherry-pick, will not allow them to accept that they could be wrong. And homeopathy IS effective in one sense. Any GP will know of Balint’s work, and the influence of “the doctor as drug”. I know from being a GP, and from observing homeopathic consultations, that the things patients want to tell you about (but which are of very little use in reaching the right diagnosis and treatment) are the very things that homeopaths are keen to know. A doctor who takes great interest in what you want to tell him or her is likely to provide a much stronger placebo effect than one who is keen to move you on to what is actually useful.

  • “the evidence from research in humans does not show that homeopathy is effective for treating the range of health conditions considered.”

    No, they will pick up the goalposts and say that treating explicit conditions is not what homeopathy is about, that it war really meant to improve the general health and wellbeing.

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