MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

The BMJ is my favourite medical journal by far; I think it is full of good science as well as entertaining to read, and I look forward to finding it in my letter box every Friday. It is thus hard for me to criticise the BMJ, and this is not made easier by the fact that I am the author of one of the two pieces in question. However, the current ‘HEAD TO HEAD’ entitled ‘SHOULD DOCTORS RECOMMEND HOMEOPATHY’ does, in my view, not mark the finest hour of this journal. Let me explain why.

The first question that arises is whether homeopathy is a good subject for such a debate. As several commentators have pointed out, it is not – the debate has long been closed; to serious scientists and many doctors, homeopathy tends to be a subject that is nothing more than an odd, obsolete triviality that does not even deserve a mention in the BMJ or any other serious publication. In a way, this notion has almost been proven wrong by the high level of interest the subject quickly generated. So, I will not dwell on this point any longer.

The second issue that arises just from nothing more than merely reading the title of the debate is that the question posed is imprecise. ‘Homeopathy’ is too broad a term for a focussed discussion; it includes amongst other phenomena empathetic encounters, remedies with material doses of highly active ingredients (e.g. Arsenic D1) and remedies that contain absolutely nothing at all (any ‘potency’ beyond C12). In my piece, I tried to make it clear that I speak mostly about ultra-molecular dilutions. This is less obvious in Peter Fisher’s article, and there is doubtlessly a lot of confusion in the debate as well as the comments that follow.

The two articles had to be written without either author knowing the text of the other. Consequently the issues raised by one author were not necessarily addressed by the other. This is somewhat frustrating, as it fails to clarify issues that could easily have been dealt with. In a previous post, I have already explained that the peer-review process of the two articles was seriously flawed. It failed to correct the many misleading statements in Fisher’s piece, as Alan Henness has pointed out in his response both in the BMJ and on this blog. In fact, reading Fisher’s article, I fail to find a single passage that is not factually wrong or highly misleading (the accompanying podcast is even worse, in my view). To me it is obvious that the debate about homeopathy cannot advance, if one side continues to behave in this fashion.

Homeopaths are very adept at recruiting ‘grass roots’ for public relation activities. We know this from various previous experiences. It was therefore predictable that this would swiftly get organised also in this instance. I happen to know from more than one source that there was a highly active campaign by homeopaths trying to persuade their supporters to post responses on the BMJ site and to vote on the BMJ straw poll (scientists, by contrast, know that such polls are silly gadgets and tend to view homeopathy as a triviality that is not worth the effort). In this way, they try to generate the impression that the majority of the public stands firmly behind homeopathy and want doctors to recommend it. It does not need too much to realise that popularity is not a measure of efficacy. Homeopaths, however, tend to relish logical fallacies and therefore will rejoice at such nonsense and celebrate it as their very own victory.

So, was this ‘HEAD TO HEAD’ a mistake? Should I have refused to participate? With hindsight, perhaps. My main reason for accepting was that, had I declined the offer, someone else would have written the piece (there are plenty of excellent scientists who could do an excellent job at this). As sure as hell, that person would subsequently gotten attacked for not ever having researched and/or practiced homeopathy (in the podcast, Fisher even tried to undermine my authority by pointing out that 1) I have not worked as a clinician for decades and 2) I have no NHS contract). I think I may be one of the few critics of homeopathy who cannot possibly be accused of not knowing enough about homeopathy to discuss the subject.

My hope is that, because the BMJ is such an excellent journal, the two articles will survive the current hoo-hah and some people will read them carefully, look up and study the references, analyse all this critically and weigh the arguments responsibly. Then they must be able to discern the fiction from the facts. And in this case, perhaps it was worth it after all.

57 Responses to BMJ: Should doctors recommend homeopathy? Was it worth it?

  • I’m not quite such a fan of the BMJ. I tend to collect them in a pile until I move house. I have a tower of over one meter tall. Despite this, I was surprised and disappointed at the lack of fact checking they had done. I would have hoped a newspaper would have done better, although the probably wouldn’t. The BMJ is supposed to be a journal and should have done much better. That was more like you’d expect from Heat or Cosmopolitan

      • Professor Robert Hahn is quoted in the independent as saying” “I’ve never seen a science writer who was so obviously biased as Edzard Ernst.” .He is an independent assessor of scientific fact and researcher of 30 years standing. Henness phoned him to challenge the quote and got a flea in his ear. Your house of cards is terminated.

        • @Joe
          Is this supposed to make some sort of sense to the reader?

        • Professor Robert Hahn is quoted in the independent as saying” “I’ve never seen a science writer who was so obviously biased as Edzard Ernst.” .

          It seems that this individual is unable to distinguish between “bias” and “conclusion”. Not everyone possesses the brain power necessary to make that distinction. It does not make his claim correct.

          Also, taking his opinion, that of an outsider, above that of an insider who has studied these issues for most of his professional life is the common error most climate change denialists make when they take the opinion of economists and religionists over that of the climate scientists who have devoted their careers to studying it.

          That does not mean that outsiders cannot have valid insights. It does mean, however, that they are not to be released from the obligation of providing evidence for their claims. I am unaware of Hahn doing that, and as a consequence, his opinion is about as valid as that of a drunk in some bar who claims that Elvis is alive.

        • Would that be the homeopathy endorser, Robert Hahn?

          ‘Henness phoned him to challenge the quote and got a flea in his ear.’

          Whose version is that? Who has granted you permission to reveal details of a telephone conversation you were not party to? Easy, such activity, when you don’t provide your full name, eh? ‘House of cards… ‘? That’s your credibility shot, right there.

          • I bet my last shirt that the telephone conversation never took place.

          • Edzard said:

            I bet my last shirt that the telephone conversation never took place.

            Your shirt is perfectly safe.

          • https://www.karger.com/Article/Pdf/355916

            Conclusion

            Clinical trials of homeopathic remedies show that they are most often superior to placebo.

            Researchers claiming the opposite rely on extensive invalidation of studies, adoption of virtual data, or on inappropriate statistical methods.

            Further work with meta-analyses should abandon the concept of summarizing all available clinical trials and focus on the effects of homeopathy versus placebo or other treatments in specific diseases
            or groups of diseases.

            One way to reduce future emotional-driven distortion of evidence by investigators and skeptics would be to separate the evidence-seeking process from the formulation of clinical guidelines more clearly.

            Note
            The author has never practiced, received, or studied homeopathy, but has worked in clinical medicine and performed traditional medical research in anesthesiology and surgery for the past 30 years.

            Disclosure Statement
            There was no financial support, thus there is no conflict of interest
            concerning this paper.

            Professor Hahn spoke about his private telephone conversation.

          • ‘his private telephone conversation’ ???
            it never took place!
            who is telling porkies here?

          • The author has never practiced, received, or studied homeopathy, but has worked in clinical medicine and performed traditional medical research in anesthesiology and surgery for the past 30 years.

            And this utter lack of experience and knowledge qualifies him to say homeopathy is not bollocks. I see.

            Putting that aside, if this individual claims that homeopathy works, and is a doctor, would he not be utterly unethical, a moral monster, if he did not apply this fantastic healing system himself? Please do explain. I’d love to see how this could be consistent.

          • This is getting hilarious!

            Anyway, Hahn said:

            Future meta-analyses should focus on the use of homeopathy in specific diseases or groups of diseases

            What progress has been made by homeopathy enthusiasts on this in recent years?

          • Bart B. Van Bockstaele said:

            And this utter lack of experience and knowledge qualifies him to say homeopathy is not bollocks. I see.

            I thought it was essential to be one of yer actual homeopaths to pronounce on homeopathy?

          • Alan Henness said:

            I thought it was essential to be one of yer actual homeopaths to pronounce on homeopathy?

            I have the impression that this Hahn character disagrees. He seems to think that the combination of non-involvement and utter ignorance makes him eminently qualified to pass judgement. It reminds me of Jim Hacker, but I don’t think even he would go that far.

        • I am flabbergasted!
           
          A renowned director of medical research with well over 300 publications on anesthesia and intensive care and 16 graduated PhD students under his mentorship, who has been leading a life on the side, blogging and writing about spiritualism, and alternative medicine and now ventures on a public crusade for resurrecting the failing realm of homeopathy!?! Unbelievable!
           
          I was unaware of this person before, even if I have lived and worked in Sweden for decades.
          I have spent the evening looking up his net-track and at his blog at roberthahn.nu (in Swedish).
          I will try to summarise some first impressions:
           
          Hahn is evidently deeply religious and there is the usual, unmistakably narcissistic aura over his writings and sayings. He is religiously confident that there is more to this world than what can be measured and sensed. In effect, he seems to believe that homeopathy (as well as alternative medical methods in general) must work because there are people who say they have experienced it and denying the possibility is akin to heresy (not his wording but the essence of his writing).
          He has, along with his wife, authored at least three books on spiritual matters with titles such as (my translations) “Clear replies from the spiritual world” and “Connections of souls”.
          He has a serious issue with skeptics and goes on at length about how they are dishonest bluffers[sic] who willfully cherry-pick and misinterpret evidence to fit their preconceived beliefs.
          He feels that desperate patients should generally be allowed the chance that alternative methods may offer.
          He believes firmly in former-life memories, including his own, which he claims he has found verification for in an ancient Italian parchment.
          His main arguments for homeopathy are Claus Linde’s meta analyses and the sheer number of homeopathic research that he firmly believes shows it being superior to placebo, a fact that (in his opinion) shows it has a biological effect. Shang’s work from 2005 he dismisses as seriously flawed.
          He also points to individual research like this as credible proof of the biologic effect of remedies.

          He somewhat surprisingly denies recommending homeopathy despite being convinced of its effect and maintains that he wants better, more problem oriented and disease specific studies to clarify its applicability. (my interpretation)
           
          If it weren’t for his track record of genuine, acknowledged medical research and him being a renowned authority in a genuine, scientific medical field, this man would be an ordinary, religiously devout quack.

          What strikes me as perhaps telling of a consequence of his “exoscientific” activity, is that Hahn, who holds the position of research director at a large city trauma and emergency hospital is an “adjungerad professor”, which is (usually) a part time, time limited, externally financed professorial position, while any Swedish medical doctor with his very extensive formal merits would very likely hold a full professorship at an academic institution.

          • Yawn, You guys just dongeddit do ya
            You have every right to your opinions
            So does everybody else
            We all even have the right to be wrong, or leftout, or lonely, or flabbergasted, or whatever

          • Joe,
            Of course folks have ‘rights to opinions’ – but that is not what this thread is about.
            This thread is about a BMJ piece asking ‘Should doctors recommend homeopathy’.

            Peter Fisher says ‘yes’ – and wants to see CAM ‘integrated’ with conventional care – and in the NHS where he works, and for which tax payers pay.

            That is why the answer should be ‘no’ – unless and until NICE reports on the cost benefit to the NHS of using homeopathic remedies.

            Opinions on meta-physics don’t count when my tax dollar is being used to pay for remedies without plausible evidence of them resulting in benefits greater than could be achieved from placebos.

          • Professor Hahn has forgotten more about scientific methodology than all you ‘skeptics’ will ever learn…dummkopfs the lot of you with your attempts at character assassination as your knee-jerk response to criticism…..lovely, unpredictable and really useful in a debate……. you ARE not guaranteed to lose, not guaranteed to have already lost… your Maginot line isn’t severely outflanked…your end is not nigh
            Oh..and it’s tax paying patients who want homeopathic medicine on the NHS.. you appear not to hear what the vox populi is expressing and Bjorn is certainly not a UK tax payer so really should keep his nose out
            Anyone paying their tax dollar can butt out too
            Homeopathic medicine is more effective than placebo and to rational minds the evidence is not only plausibe, but highly so, unlike the easily decipherable zealous prejudiced boring repetitive shit you ‘skeptics’ spout out

          • if you say so…

          • Joe, this might help: http://www.simillimum.com/education/little-library/homoeopathic-philosophy/ddh/article.php.

            “Kent taught that will and understanding compose the inner aspects of the human psyche. On this basis he said that love and hate were the deepest of human emotions and central aspects of case taking. This is similar to the philosophy of Empedocles who wrote that love and hate were the powers responsible for the interaction of the five homœomeries. When one loses their willpower and understanding they are subject to delusions about the nature of reality that lead to misplaced attachments and aversions. This makes delusion, loves and hates central concerns in homœopathic psychology.

            Delusions and dreams are very revealing of the psychological states produced by homœopathic provings because they are controlled directly by the unconscious. The images seen in delusions, hallucinations and dreams carry archetypal information in the form of symbols. For example, the Three Witch Drugs are Belladonna, Hyoscyamus and Stramonium. These Solanaceae family remedies share many similar symptoms yet each has a unique remedy picture.”

            Might be worth a try (proving).

            Best wishes.

          • Oh..and it’s tax paying patients who want homeopathic medicine on the NHS.. you appear not to hear what the vox populi is expressing and Bjorn is certainly not a UK tax payer so really should keep his nose out

            It is also tax-paying patients who call marijuana “medicine”, even though nothing particularly impressively beneficial about it has ever been shown to be reliably true, that is, if you ignore the waiting lines of once-enthusiastic potheads, begging to be let in the overloaded detox clinics and be cured of their addictions of this wonderful product “They” don’t want us to know about.
            It is also tax-paying patients who claim that vaccines are a vicious government conspiracy to make us all autistic.
            It is also tax-paying patients who were demanding “liberation therapy”.
            It is also tax-paying patients who are injecting themselves with industrial silicone.
            In other words, just because a patient pays taxes does not seem to be a sufficient reason for a patient to be particularly knowledgeable.

          • AD HOMINEM ^^^^

        • You have commited “appeal to the authority” fallacy, which does not really work, especially when the other side has no idea who you are referring to.

          • … and argumentum ad populum, argumentum ad ignorantiam, copious ad hominem and tu quoque.

            ‘Homeopathic medicine is more effective than placebo and to rational minds the evidence is not only plausibe, but highly so, unlike the easily decipherable zealous prejudiced boring repetitive shit you ‘skeptics’ spout out’ [sic]

            Right. So, tell us ‘Jo(k)e’, if you’re so convinced of it, is there anything homeopathy cannot treat/cure?

          • You are so not fuckwit dummkopfs….everyone cured by medicine is cured. Homeopathic medical drugs help in other circumstances….d””oh…..and so they do.
            Your appeal to fallacious medicine is authoritatively hilarious. Medics know they cannot cure everybody…ditto homeopathy……you have no idea….go refer to a dictionary..or join a modern version of the Spanish inquisition….so sorry…you are a member of one already. The self righteous will inherit …..what was it. ….do let me know when you get it…holdin my breath…….

          • Hmm, reads like a plot in the process of going missing; and/or a good Friday night out; and the Godwin card being thrown?

            Oh, ‘Homeopathic medical drugs’ is an oxymoron, no?

          • You are so not fuckwit dummkopfs…

            Spoken like a true intellectual. With refined arguments like that, who needs research?

          • ‘…who needs research’?
            Or should that have been ‘…restraint’?

  • ‘I think I may be one of the few critics of homeopathy who cannot possibly be accused of not knowing enough about homeopathy to discuss the subject.’

    Nevertheless, there’s one or two that repeatedly try so on various comment threads.

  • In fact, reading Fisher’s article, I fail to find a single passage that is not factually wrong or highly misleading (the accompanying podcast is even worse, in my view). To me it is obvious that the debate about homeopathy cannot advance, if one side continues to behave in this fashion.

    This is precisely why I continue to doubt the claim that quacks believe what they are telling their victims. Fisher and his ilk are the Bernie Madoffs and Benny Hinns of the medical world. They are ruthless charlatans. They behave the way they do because they want to extract easy profit from hapless victims. Their ethics are those of the sociopath who fails to understand that harming others for personal gain, to the point of risking their lives, is not halal.

    To me, they are premeditating murderers. Not because they intend to kill, but because they intentionally are not letting potential death stand in their way of profit. I may just be able to accept, provisionally (without credible evidence, which does not seem to be forthcoming) that people like “Dr.” Charlene Werner or “Dr.” Robert O. Young do not fully comprehend the revolting depth of what they are doing, but – in my opinion – people like Peter Fisher, or Dr. Oz or Deepak Chopra are not entitled to this type of leniency. While exceptional brilliance may not be required to become a doctor, some detectable level of intelligence does most definitely seem to be a requirement. It defies imagination beyond acceptable limits to declare these people too stupid to understand or even merely know what they are doing.

    • I have to disagree with you here; these people are blinded by faith and deluded by fiction, in my experience. they are, however, not murderers.

      • The point I have made in ‘BMJ Responses’ to this piece is germane.
        Namely, that ‘homeopathy’ should have been defined and that the beneficial effects of TLC – as a result of a constructive therapeutic relationship with an empathic practitioner, auto-hyptnotism and response expectances, placebo effects if you will (which I style ‘type I effects’) – should be differentiated from any beneficial effect which might reasonably be attributed to the homeopathic remedy itself (which I style ‘type II effects’).

        Sorry Ernst, but IMHO you should not have contributed until this basic clarification had been established.

        I do not know of any patients killed by Dr Fisher and regard such allegations as intemperate at best.
        But neither do I know whether he sincerely holds the views he expresses, is deluded, is a quack, or even a fraud. How is anyone to tell?

        The GMC has yet to determine whether doctors who promote homeopathy are fit to practice, and to date NICE has declied to respond to calls from the BMA for it to review and report on the cost-benefit to the NHS of homeopathic remedies.

        The BMJ piece at least keeps the issue in the public domain. We who care that patients suffering enough from maladies to seek professional help are properly advised as to their options should demand that If placebos are being used, that is what patients must be told. Failure to do so is unethical.

        Surely even the most dedicated apologist for homeopathic remedies should obtain fully informed consent from a patient and advise them at the very least:

        “I am going to prescribe for you a remedy which I believe will assist your suffering. I must advise you that use of this remedy is controversial, the majority of medical doctors believe its effects, if any, are psychological and best thought of as ‘placebo effects’ and part of a health system reliant on faith – but I believe otherwise and make my recommendation to you accordingly.”

        The fact that such integrity is not demonstrated by homeopaths add to suspicions of quackery and fraud.

        • how is anyone to tell?
          I know him well since about 2 decades. my impression is that he does believe (most of) what he says. even if my intuition were wrong, there is such a thing a ‘the benefit of the doubt’. let’s not start calling fools ‘murderers’ !!!

          • Hang on!
            “I believe Dr X is sincere in his beliefs (even though they are bizarre and irrational) on the grounds that I’ve known him a long time and my ‘intuition’ tells me.”
            ‘Impression, Intuition’?
            That is the very ground on which homeopaths declare their beliefs are based and which surely most readers of this blog feel should be set aside.

            Any chance of a more evidence based opinion?
            If not, is it not high time that the GMC determined whether or not doctors who use or promote homeopathic remedies are truly acting in the best interests of their patients, or are failing to properly inform them and obtain fully informed consent, and if so whether they are fit to practice? Note ‘remedies’. It is not controversial that care from an empathic practitioner is beneficial.

            If we cannot determine whether homeopaths are sincere, quacks or frauds – on what basis is the default position: ‘sincere’?

          • I have no way of telling whether my intuition is correct, and I do not apologise for using my intuition for judging people’s sincerity because I do not have an objective measure for that. I believe this is different from judging the efficacy of a medical intervention by intuition.
            I would like the GMC and NICE to look into homeopaths and homeopathy. however, I have been told repeatedly by people ‘in the know’ that this will not happen because of Charles Windsor blocking such moves. but to make it clear: not acting in the best interests of patients is also done by utterly sincere doctors. these are 2 different issues.

          • But ‘Tu quoque’ is a logical fallacy.
            Let’s just stick to what, prima facie, is the most egregious example of doctors prescribing, even directly selling, remedies to patients for which there simply is no evidence of benefit beyond which placebos would not reasonably be expected to have an effect – and which, on the basis of current understanding of nature, cannot possibly have an effect.

            I too have been told HRH would not like these issues inquired into.
            But is that so?
            Has anyone asked HRH to coperate with a GMC/NICE inquiry?
            If not, why not?
            If NICE reported there were benefits for the NHS from taking homeopathic remedies, we would all want to take them – and HRH would achieve his heart’s desire.
            Why would he not want that?

          • because he is not that stupid?

          • That is the very ground on which homeopaths declare their beliefs are based and which surely most readers of this blog feel should be set aside.

            The conclusion must then be to suspend judgement until the evidence is in. But what do we do in the meantime? These people are causing unnameable harm, and it is unreasonable to let them continue unchallenged.

            Either they have (far) below-average intelligence, they are frauds or they are delusional. In the first case, they need nannies. In the second case, they belong in prison. In the third case, they need psychiatrists and nurses. Question: do we have enough psychiatrists and nurses to handle such a workload?

            Maybe, we are looking at the problem from the wrong side. What matters is not how sincere they are, but how wrong they are and how much harm they do in comparison to how much good they do.

            In all cases, they should be prevented from harming people. I think the law gives us that possibility, but since it is almost never applied, where does that leave their victims?

          • I agree with you on this one: sincerity renders a quack not less but more dangerous.

          • because he is not that stupid?

            Would that then not be an indication that there is some type of intention-to-harm in his royal head?

          • or he could be naively bonkers

          • or he could be naively bonkers

            [laff]
            Is that a medical opinion, doctor?
            [/laff]

      • I have to disagree with you here; these people are blinded by faith and deluded by fiction, in my experience. they are, however, not murderers.

        If I am wrong, then I am. You have told me that before, and I did not forget about that. In fact, it made me reconsider my opinion about part of “A scientist in Wonderland”, which I thought was highly comical, but which I then thought was actually more grim than funny. I guess I need to hear this a few times more, i.e. I need more convincing. Possibly. I guess I’ll know when I have been convinced [giggle]. Sorry for being so hard headed!

    • I’ve watched a few of the YouTube videos in which Peter Fisher holds forth on his homeopathic beliefs. The man is a classic piece of self-delusion, cherry picking vague glimmers of supportive light shed by equally deluded individuals and spreading his ridiculous message with the same credibility as an American TV evangelist.
       
      Bart, if you want to call homeopaths murderers that’s your right, but what they do is not premeditated in the English meaning of the word. I doubt that Dr. Fisher is bright enough to premeditate anything. He has chosen his role in life, like many others (including lots of medical doctors), on the badly mistaken assumption that what he experiences must be true. This is the fallacy that underpins all irrational thought. We don’t have alternative engineering, alternative aviation or alternative basket weaving, because the scientific evidence supporting these fields is self evident; there are no seemingly contrary experiences to explain. But the minute we turn to anything that directly involves humans — medicine, religion and so on — the sharp edges of evidence and reason becomes blunted by the grossly unreliable eye of psychology.
       
      Edzard: with hindsight perhaps it might have been better to have avoided the BMJ experience. A debate managed on the terms of a third party is always a risk, and debates where reason opposes belief never seem to turn out well for the side of reason. Richard Dawkins has consistently advised against debate with creationists on the grounds that doing so suggests there is something valid to debate. Mind you, he doesn’t always seem to stick to that point of view!
       
      The whole BMJ debacle, with regiments of homeopaths now turning up in droves to offer mind-bogglingly idiotic responses to the debate on line increasingly reminds me of the image wonderfully created in a different context by Scott D. Weitzenhoffer: it’s all ‘rather like trying to play chess with a pigeon; it knocks the pieces over, craps on the board, and flies back to its flock to claim victory.’

      • FrankO, thanks for that. I called them killers in the (distant) past. I think that there can be little doubt about that, since (accelerated) death is clearly sometimes the inevitable outcome of quackery. I started to call them murderers and premeditated murderers, because they seem to persist in their dangerous practices even if/when they should have known that this was all but the guaranteed outcome. Maybe it is the Belgian streak in me, where the taxman calls you a fraud and treats you accordingly if for some reason he cannot find your tax return after you sent it in, or maybe it is a reaction to the dark motives these people often indict the medical world of.

        I doubt that Dr. Fisher is bright enough to premeditate anything.

        I think this may be where the correctness/falsehood of my statement hinges on. My own experience at med school was not a good one, and as a result, I am highly suspicious of what doctors say. However, even though I have sometimes said it, I have a very hard time to believe that it is possible to become a doctor without some level of intelligence. Maybe that conviction is wrong.

        I remember that, after he had asked, Richard Dawkins was told that Francis Collins truly believes all the miraculous nonsense in the Bible and the resurrection. His reaction to that was that if that was true, he respect Francis Collins even less. My thoughts at the time were that I have a hard time accepting that someone who reaches his level of achievement in life (I think he was actually more of an administrator on the genome project than an actual scientist, but still) can be so unintelligent … unless I accept the idea that this type of belief is a mental/psychiatric condition. Again, assumptions, assumptions…

        As Prof. Ernst says:

        In fact, reading Fisher’s article, I fail to find a single passage that is not factually wrong or highly misleading (the accompanying podcast is even worse, in my view). To me it is obvious that the debate about homeopathy cannot advance, if one side continues to behave in this fashion.

        and as you say:

        I doubt that Dr. Fisher is bright enough to premeditate anything.

        The conclusion, I think, must be that this one side *will* continue to behave in this way because they lack the neurological equipment to even consider looking at the evidence, let alone weigh it against their own assumptions or coming to the conclusion that factually and demonstrably wrong assumptions are indeed wrong.

        If that is so, my premeditation assumptions are obviously as wrong as wrong can be. As a result, I think I have to join you in your idea that debating Peter Fisher is wrong. He is not worth debating with. After all, we don’t tend to hold discussions with woolly bears or cockroaches either, and I gave up discussing probability theory with my hamsters a long time ago ^_^.

        As for chess, that’s how I play it when I can’t weasel out of it. Except I don’t claim victory. I enthusiastically admit defeat and congratulate the other side. They seem to like that. I am a good, even enthusiastic, game loser. I love it. It makes the other side so happy, and I am not losing anything worth having anyway, except time.

        • @Bart

          I have a very hard time to believe that it is possible to become a doctor without some level of intelligence.

          Intelligence is one of those curious imponderables, outside the context of tests that purport to measure it. A person can be highly intelligent and still sincerely believe ridiculous things. But one datum worth mentioning in this context is that Dr Fisher, aged 65, is a near-contemporary of mine, and I come from a period in the UK where people who went to medical school were not necessarily of the highest intellectual calibre.
           
          I am not a clinician myself, but have spent my research career working constantly alongside medically qualified people. When I went to university in the mid-1960s, the medics and the engineers were universally regarded as the ‘dumb’ sets of students. I know plenty of medical colleagues who entered medical schools with the barest minimum of high school qualifications; today they are sometimes people in senior positions.
           
          This situation continued through the 1960s into the early 1970s, at which point an improved medical career structure, among other factors, changed the situation completely. For the past 40 years or so, only students with the highest secondary qualifications gain admission to medical schools. And this makes it hard for younger people even to believe there ever was a different situation.
           
          Of course, I don’t know anything about Dr Fisher’s ‘A’ level results and I don’t seek to impugn him even by association with these comments; I’m merely reminding anyone who reads this that there was a low period some 50 years ago when medical school entry was not the popular choice it is now, with the resulting consequences.
           
          One thing many clinicians tend not to be good at is laboratory research: they just don’t have the experience. When I watch Peter Fisher on YouTube commenting on results of studies in vitro that he claims support his point of view I am confident he is a poor scholar of laboratory research. Apart from the cherry picking (e.g. one study confirming the so-called ‘Benveniste Effect’ trumps the several that show it to be a non-phenomenon), he thinks that studies showing differential RNA expression between homeopathically treated and control-treated cells indicates a positive effect for ultra-high dilutions. Sadly, such studies (I’ve looked at one or two) are done by people who don’t realize how vulnerable they are to all sorts of experimental and analytical artefacts. In my own research group, people have sometimes complained when I have made them repeat an interesting experimental finding fully blinded as to which sample they are testing and analysing. They come to realize it’s a great way to save yourself from fooling yourself, which I believe is what Richard Feynmann claimed science is all about!

          • FrankO,

            Unfortunately, you bring back unpleasant memories. My time at med school in Ghent is about a decade after Fisher’s. I was so happy. After years of getting mediocre education, slogging through uninteresting classes by teachers who – for the most part – were just talking parrots with little interest and less intelligence, I would now finally learn some things worth learning with open-minded people who were interested in science. It didn’t turn out that way. I think I had watched Cosmos with a bit too much naiveté.

            I had been told a lot of conspiracy nonsense about doctors before then, which was not confirmed, but I certainly have experienced my part of corruption reality which was an important part of my decision to leave (even if “decision” sounds more volitional than it perhaps should). The general impressions I came away with were not good, and I am being charitable. That’s not even taking into account that almost none of the students in my year turned out to be genuinely interested in the field. Making money seemed to be by far the number one reason for starting medical studies. My confidence in doctors has always remained very low.

            Nevertheless, I have (I like to think) never lost perspective. Just because an uneducated overworked waiter/waitress short-changes me in a restaurant is not a very good reason to reject mathematics and just because my opinion of doctors is low – is not a very good reason to think quacks are better.

            In spite of everything, the results of medical science are impressive, perhaps not always so much in day-to-day experience, but when we look back about how things once were, it is undeniable, I think. I also have certainly met a few doctors over the decades that I think did honour to their field, I will never forget Aline Vandevelde, my professor of anatomy. She was no professor at the time, and because she was a woman, and genuinely interested in her field, she was not particularly popular among those in power at Ghent university. However, she taught me the importance of evidence and critical thinking as no one has, and she is one of my heroes.

            It seems to be a matter of probabilities. The likelihood of getting a cure is higher with doctors than it is with alternologists, and I like to think that this is – for all intents and purposes – a demonstrated reality.

            On the other hand, lack of intelligence, combined with the desire of making more money than Mother Theresa, seems to conveniently explain, or allow for, the fact that so many doctors are turning to the dark side and giving people diagnoses of diseases they don’t have and selling them pills and liquors that don’t work with a promise of some type of eternal health/youth/life. Maybe it is the combination that makes them do it. An utter lack of intelligence to prevent the ethical considerations that the desire to take people’s money would raise.

  • William “Silly Billy” Alderson is the gift that keeps on giving. Medicine for the 21st Century? Apart from not being medicine, and coming from the 18th Century…

  • I have read many comments of the kind “modern medicine (whatever it means) has long ago acknowledged homeopathy”, so people should know that it is not the case, allthough when almost everybody else keeps silent, one oponent may have an opposite effect. So maybe the supporters have become even more convinced, but there is also “why bother” group, members of which need to learn that their attitude might have been wrong. And as soon as they wil start speaking against homeopathy, then who knows…

  • This thread seems to have wandered quite a long way from the question asked in the original article. As someone who pays taxes in the UK and therefore has a direct interest in what is allowed on the NHS, I am alarmed that the BMJ can even think of raising this question. The proportion of local health authorities which fund homeopathy has declined sharply in recent years, and I’m glad to say that even my own area – one of the worst in the country in terms of general provision and hospital standards – will not fund it. Discussing it at national level in the journal read by most practitioners is only going to make it more likely that there will be an increase in demand for it.

    I believe that doctors who recommend homeopathy should not be allowed to practise in the UK as doctors – they should have to choose whether they want to be in medicine or in homeopathy. Presumably it is either the shortage of qualified medical practitioners or sheer cowardice on the part of the relevant authorities which is letting the present situation continue.

    I appreciate the point made that each author had to write a piece without knowing what the other would say, with the obvious shortcomings in coverage etc. This seems to be a popular method for magazines and other publications to fill space at the moment. As a fashion, it will eventually go away. I see it in other publications and rarely gain anything meaningful from the page, mainly because the articles are written ‘blind’ so do not really make contact with one another in terms of coverage or the arguments they put forward.

    • I endorse Mr Barton’s views.
      This was not a ‘debate’, as neither ‘side’ knew what the other would claim.
      There has been a serious attempt to gerrymander the ‘survey’ of opinion which ran with the ‘Head to Head’ piece.
      Homeopaths have rallied to say ‘yes’ – but they would, wouldn’t they!
      Most conventional doctors couldn’t be bothered to answer. It’s beneath our dignity.

      Shoddy journalism – the Editor of BMJ has been told!
      Meanwhile, the Chairman of the BMA Council is due to meet the ‘president of the Faculty of Homeopathy’ to discuss concerns that down for discussion at this year’s BMA Representative Meeting (Liverpool 22-26 June) was a motion calling for homeopaths to be ‘regulated by the Magic Circle and not the GMC’.

      Medically qualified homeopaths have complained this motion (though it was not debated) showed ‘disrespect to homeopaths’!

      I have complained that the motion showed disrespect for members of the Magic Circle!
      We are expected to be honest and have the integrity of acknowledging we are creating illusions and being deceptive through natural skills, for the purposes of entertainment.
      Magicians who seriously claim ‘special powers’ or that they can engage ‘quantum fields’; ‘energies; ‘innate intellegence’ are rightly derided and thought unethical – members of TMC have no wish to take non-entertainment advantage of the vulnerable and gullible, and are certainly not expected to use their skills for fraudulent purposes.

      I would like to discuss whether ‘doctors who recommend homeopathy should not be allowed to practise in the UK as doctors – they should have to choose whether they want to be in medicine or in homeopathy.’ further with L. Barton, or anyone else – if you would kindly contact me off-blog : Rich@rdRawlins.demon.co.uk.
      Thank you,

      Dr Richard Rawlins FRCS
      Member of the Magic Circle
      Consultant Charlatan and Specialist in the Care of the Gullible

  • Hello Edzard,

    i saw you last night at the Winchester Discovery centre, and was impressed.
    And so arrived as your website. All initially looks as organised and impressive as I expected.

    Especially the blog rules !

    Except they are not being applied. Why is your science, beautiful logic and teaching falling into a black hole of blame, insults, fatuous comments and non-sequiturs? This thread (I can only stomach the one) is acutely disappointing.

    Please consider a return to your usual high standards – especially here.
    (PS: I accept you are covering a huge field, – if it were my decision I would red pencil most of it – less is more.)

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