MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

The question why patients turn to homeopathy – or indeed any other disproven treatment – has puzzled many people. There has been a flurry of research into these issues. Here is the abstract of a paper that I find very remarkable and truly fascinating:

Interviews with 100 homeopathic patients in the San Francisco Bay Area show that for the most part the patients are young, white and well-educated, and have white-collar jobs; most had previously tried mainstream medical care and found it unsatisfactory. Among the reasons for their dissatisfaction were instances of negative side effects from medication, lack of nutritional or preventive medical counseling, and lack of health education. Experiences with conventional physicians were almost evenly divided: nearly half of the subjects reported poor experiences, slightly fewer reported good experiences. Three quarters of the patients suffered from chronic illness and about half considered their progress to be good under homeopathic care. The majority were simultaneously involved in other nontraditional health care activities.

If you read the full article, you will see that the authors make further important points:

  • Patients who use alternative treatments are by no means ignorant or unsophisticated.
  • Most of these patients use other treatments in parallel – but they seem to attribute any improvements in their condition to homeopathy.
  • Dissatisfaction with conventional medicine seems the prime motivation to turn to homeopathy. In particular, patients need more time with their clinician and want to share the responsibility for their own health – and these needs are met by homeopaths better than by conventional doctors.
  • Most homeopaths (63%) adhere to Hahnemann’s dictum that homeopathic remedies must never be combined with other treatments. This renders then potentially dangerous in many situations.

At this point you might say BUT WE KNEW ALL THIS BEFORE! True! Why then do I find this paper so remarkable?

It is remarkable mostly because of its publication date: 1978! In fact, it may well be the very first of hundreds of similar surveys that followed in the years since.

The questions I ask myself are these:

  • IF WE KNEW ALL THIS SINCE ALMOST 40 YEARS, WHY HAVE WE NOT DONE MORE ABOUT IT?
  • WHY ARE WE SO UNSUCCESSFUL IN GETTING THE FACTS THROUGH TO OUR PATIENTS?
  • WHY HAVE WE NOT MANAGED TO IMPROVE CONVENTIONAL MEDICINE SUCH THAT PATIENTS STOP CONSULTING QUACKS?
  • WHY ARE WE STILL CONDUCTING SURVEY AFTER SURVEY WHEN THE EMBARRASSING FACTS ARE PLAIN TO SEE?

62 Responses to Why patients choose homeopathy

  • One thing is certain: patients get lots of medically information long before they seek medical help. Because there is lots of sciency information lying around. Some media invite people with medical education to comment activities of quacks as well as of real medicine, however, owners/journalists need to know the difference between science and quackery. Although you do not need just very basic skills to google e.g. details about the dubious past (lost licences) of the great doctor such and such.

  • My suspicion iis that its continued success is partly due to homeopaths managing to *stop* information about homeopathy getting out. I saw a promotional video put out by the US Homeopaths Association, and all they did was complain that mainstream medicine is bad and that people are “more sick than we’ve ever been” etc, but said practically nothign about the core concepts of homeopathy.

    I also think that skeptics sometimes make a mistake of putting too much emphasis on the chemical/mathematical implausibility of the dilutions. It runs straight into the wall of “science can’t explain how it works”. I don’t mean to criticise any individual skeptics with that, just that ultimately many people’s eyes simply glaze over when they start hearing that kind of talk.

    I think it would be better to focus more on the absurdity of the law of similars — it’s easier to comprehend that our physiology is simply not built according to arbitrary logic.

  • The surveys may not date back much beyond 30 years, but the arguments putting down homeopathy most certainly do: and not a single thing has changed since. A comment elsewhere on this blog drew my attention to the marvellous Quackery Unmasked by Dan King, published in 1858, for goodness’ sake! The book is mostly about homeopathy. It’s available electronically via Google Books. It ridicules the law of similars, it ridicules the extreme dilutions, and it suggests why people are so gullible as to believe the nonsense.
     
    I have known some people see the light when the law of similars is explained to them, and others who co-attended a graphic demonstration of homeopathic dilution involving pint beer glasses and an eye dropper. Some will start to doubt when they hear that a leather-bound book works better than a simple hard surface for banging the containers while making the dilutions. But it is never simple to get people who believe in something fervently to take their fingers from their ears and consider they might be foolishly misguided. In a democratic society we just have to accept there will always be people with perverse, untenable opinions; the disgrace is the use of public money to fund such things.
     
    Should anyone be reading this who wants to see an easy-to-read piece that explains patiently why homeopathy is daft, written by someone who has nothing to do directly with this blog, Ben Goldacre’s Guardian article from 2007 takes some beating: http://www.theguardian.com/science/2007/nov/16/sciencenews.g2.

    • A comment elsewhere on this blog drew my attention to the marvellous Quackery Unmasked by Dan King, published in 1858, for goodness’ sake!

      I have downloaded it. I won’t have time to read it this week, but I glanced at a few pages, and it looks like a great book.

      Page 20:
      “A perfect quack is a most obsequious sycophant–his medicines are always exactly what the patient wants. They are never disagreeable, are perfectly safe in all cases, and always certain to cure.”

      Some things don’t seem to change all that quickly in our supposedly fast-changing world.

      • Reminds me about one Russian writer of detective novels who is a strong advocate of traditional medicine – she wrote in the part of her memories devoted to her breast cancer experience that yes, doctors sound terrible with their “Oh, we’ll just cut off the top (our cut out the bottom) and some radiation, some chemistry, some hormones….”. Interestingly, her oncologist did not promise miracles, because cancer had, after all, advanced to stage IV, but explained in details the plan. And did not interpret her cancer as one of very many although it certainly was.

      • You don’t need to read the whole book. As it is about homeopathy, one word should be enough.

  • I saw a promotional video put out by the US Homeopaths Association, and all they did was complain that mainstream medicine is bad and that people are “more sick than we’ve ever been” etc, but said practically nothign about the core concepts of homeopathy.

    If you read Hahnemann’s seminal Organon, you will see that the homeoquacks learned if from the QuackMeister himself. Of course, medicine was still rather firmly entrenched in the Dark Ages at the time, but the point is that Hahnemann seemed to think that dissing those who disagreed with him somehow made his own fantasies more credible.

    I also think that skeptics sometimes make a mistake of putting too much emphasis on the chemical/mathematical implausibility of the dilutions.

    I agree with that. It is the first thought I had when I saw Richard Dawkins’ “The Enemies of Reason”. Sure, it is all true, but I feel skeptics should perhaps keep the high dilution stuff for its entertainment value and concentrate more on the fact that homeoquacks have never been able to bring up convincing evidence that they are anything else than willful swindlers or delusionals.

  • for the most part the patients are young, white and well-educated, and have white-collar jobs

    I don’t believe that for a second. An education that leads people to believe nonsense is not a good education. At best, their education is relevant to their chosen field and utterly irrelevant to the subject of quackery.

  • A little sympathy, please. Look at the sort of ailments that people take to quacks and you’ll find a great many for which medicine often has little to offer, and, all too often too little time: tinnitus, lower back pain, assorted digestive maladies, eczema, TMJ pain. Try suffering from TMJ pain for ten years, finding that none of the seven painkillers you’ve had from your doctor works any better than Smarties, and not being tempted by someone’s claim to be able to help you (yep, that was me). It’s not so much that one is convinced by the tosh, just that the thought of living with a pain for the rest of one’s puff tends to make one liable to clutch at the most hopeless straws. The problem is that claim – unjustified, unethical and dishonest. Criticise the practitioners, try to get legislation in place to stop them making baseless claims, and educate the potential victims.

    • Too little time? For what, practicing medicine? It’s pretty simple and straightforward – if you don’t have enough time to practice medicine, you should not be practicing medicine.

      • Too little time? For what, practicing medicine? It’s pretty simple and straightforward – if you don’t have enough time to practice medicine, you should not be practicing medicine.

        That is indeed an important difference between quacks and doctors. Quacks have as much time as their marks can afford, since they are entertainers who are paid by the hour. Medicine doesn’t work like that in most civilised countries. Doctors are paid to do their best to cure patients and/or improve their quality of life. Not to entertain bored customers.

        • It’s not so much the number of minutes a great many GPs will spend, it’s more the attitude. It comes across as “You know I can’t offer any relief for what you have, so stop asking”. But it would be helpful if they also said “Don’t be tempted by alt med – they leap on any complaint like this knowing you’d be willing to pay to get rid of that pain/noise/allergy, but it’s all garbage”.

          • @Joyce
            Well said!

          • It’s not so much the number of minutes a great many GPs will spend, it’s more the attitude. It comes across as “You know I can’t offer any relief for what you have, so stop asking”.

            I guess an old dinosaur like me has to accept that people don’t like this, but since I grew up in an environment that hardly ever told me anything else, I have a hard time imagining why this would be a reason to run to quacks.

            But it would be helpful if they also said “Don’t be tempted by alt med – they leap on any complaint like this knowing you’d be willing to pay to get rid of that pain/noise/allergy, but it’s all garbage”.

            I seem to remember that many doctors would love nothing more than say exactly that, but that they are afraid of doing so, because they think it would motivate the patient to run to the quacks, which would generally not end favourably for them.

          • Why is it a reason to turn to quacks? Remember you are talking about people perhaps living with chronic pain, which they are told will only get worse, or with maddening tinnitus destroying their enjoyment of music and conversation, recurrent allergic rashes that are itchy and sore, assorted diarrhoea/constipation/digestive troubles making it difficult to eat with friends or eat a good diet. Complaints that are often not life-threatening, often not visible to anyone else, but which are a constant irritant and damage quality of life, even to the point of triggering depression. It isn’t surprising if sometimes people think that they may as well try a quack, they have nothing to lose but some money. I have been dismayed before by people laying too much of the blame on patients: they are suffering and desperate for help. And before you ask, yes, I have most of those things – I seem to specialise in such problems. But I am cynical and scientifically fairly literate, so the first time I heard about homeopathy I just laughed.

          • Remember you are talking about people perhaps living with chronic …

            As so many other people, I have my (un)fair share as well, but when a doctor tells me point-blank there is nothing he/she can do to make my life more comfortable in ways that are not major threats to my health, then I just accept that. I might ask if he/she learned anything new next time I see her/him, I may ask one or more other doctors as well, but while I certainly understand what desperation can do, I have no idea why my doctor’s admission of powerlessness would motivate me to go to a quack, who is essentially guaranteed to show me a colgate smile, tell me all I’d like to hear, demonstrate her/his lack of knowledge to beyond the reasonable doubt and demand I hand over my hard-earned money, with no benefits for me at all, except perhaps for the harsh lesson that a quack is indeed a quack.
            I think it is a very important issue.

        • The typical visit with a mainstream MD amounts to drive-thru medicine. Just enough time get a list of your symptoms and then pick a drug or two, then bring in the next victim/patient/consumer. It’s a system based on disease management and greed. It’s industrialized assembly-line medicine.

          Practitioners who see fewer patients for longer durations, are in my experience less greedy, more patient, more comprehensive, more humane, etc.

          A quote from the writer Chekhov comes to mind:
          “To give serious aid to forty outpatients between morning and dinnertime was physically impossible, which meant, willy-nilly, that it was all a deceit. During the fiscal year twelve thousand outpatients were received, which meant, simply speaking, that twelve thousand people were deceived.”

          • A quote from the writer Chekhov comes to mind:

            Newsflash: This is the year 2015. Anton Chekhov died in 1904. That’s over a century ago.

            You could do better, by the way. Biblical Jesus meek and mild is said to have cured blindness by rubbing his spit in his victims’ eyes.

        • Seems that if you don’t have time to practice medicine, but you’re practicing anyway…you’re a quack. A pretty dangerous one, if you also write prescriptions. Pity there’s no regulatory organization.

          • Pity there’s no regulatory organization.

            In which country is that?

          • I guess I should have said pity there’s no effective regulatory organization or something similar. The MDs that don’t have time but are practicing anyway seem to be quacking away unchecked. So it goes.

          • “Seems that if you don’t have time to practice medicine, but you’re practicing anyway…you’re a quack. A pretty dangerous one, if you also write prescriptions. Pity there’s no regulatory organization.”

            Absolutely right. Like Chekhov said it’s “all a deceit”.

          • Yes jm,
            Who needs any medicine when there is someone who will scrape your skin to cause bruising, and this will cure you all all sorts of ailments?

            It is rich that you label other people as quacks when you are a skin-scraping charlatan.

          • Frank,

            Once again, you seem to be reading whatever you want, rather than what’s actually written. Although, it certainly is amusing to try to figure out how you got to “Who needs any medicine…”

          • “Once again, you seem to be reading whatever you want, rather than what’s actually written.”

            Tu quoque, again! Please jm, some original thought?

  • Our ancestors were made aware of this not 40 years ago, but more than 150 years ago, by:
    Dan King, MD
    https://en.wikisource.org/wiki/Quackery_Unmasked/Chapter_VI

    Oliver Wendell Holmes, Sr.
    https://en.wikisource.org/wiki/Homoeopathy_and_Its_Kindred_Delusions

  • IF WE KNEW ALL THIS SINCE ALMOST 40 YEARS, WHY HAVE WE NOT DONE MORE ABOUT IT?

    Because there are only so many skeptics, and because the democratic process does have its inconveniences.

    WHY ARE WE SO UNSUCCESSFUL IN GETTING THE FACTS THROUGH TO OUR PATIENTS?

    Because they were educated in a culture that despises intellectual endeavours, where schools attach more importance to winning soccer games than interest in the sciences and rational thinking.

    WHY HAVE WE NOT MANAGED TO IMPROVE CONVENTIONAL MEDICINE SUCH THAT PATIENTS STOP CONSULTING QUACKS?

    Because that would make the system so ridiculously expensive that societies would collapse on health care alone. Because doctors are required to be honest. To quote from “Quackery unmasked”:
    All experience shows that mankind are ever more ready to believe pleasant falsehoods than disagreeable truths. Quackery takes advantage of this proclivity, and therefore caters for the universal appetite. A perfect quack is a most obsequious sycophant—his medicines are always exactly what the patient wants. They are never disagreeable, are perfectly safe in all cases, and always certain to cure. These are what every sick man wants, and therefore strives with all his might to believe, and often does come to believe against the strongest evidence and clearest reason.

    WHY ARE WE STILL CONDUCTING SURVEY AFTER SURVEY WHEN THE EMBARRASSING FACTS ARE PLAIN TO SEE?

    Because it is a lot easier to conduct a survey and scream bloody murder than it is to do something about the facts. It is safer too, as Prof. Ernst’s experience demonstrates.

  • “WHY HAVE WE NOT MANAGED TO IMPROVE CONVENTIONAL MEDICINE SUCH THAT PATIENTS STOP CONSULTING QUACKS?”

    Problem is most conventional doctors are quacks.

    All this attacking of homeopathy seems like a red herring. I would wager that part of your strategy is to go after homeopathy and then by association try to incriminate all of so called “alt-med”.

    Isn’t it a bit silly, trying to expose the alleged terrible evils of homeopathy of all things, seemingly benign at worst and at best offering some benefit through placebo or other means not understood, while truly destructive forms of medicine like psychotropic drugs are left out of the “quackery” debates?

    Of course “alt-med” is purely a term of propaganda and has no real meaning. Its use signals that the speaker is attempting to manipulate reality.

    • ROFL! What do you do for an encore?

    • “Of course ‘alt-med’ is purely a term of propaganda and has no real meaning. Its use signals that the speaker is attempting to manipulate reality.”

      Congratulations, you are finally starting to realize that *all* alt-med is nothing other than its proponents attempting to manipulate reality.

      QUOTE
      “By definition”, I begin
      “Alternative Medicine”, I continue
      “Has either not been proved to work,
      Or been proved not to work.
      You know what they call alternative medicine
      That’s been proved to work?
      Medicine.”
      —Tim Minchin, Storm.

  • Can someone direct me to the articles on this site that expose the fraud and quackery in biological psychiatry? Surely there are many.

    • this is a blog about ALTERNATIVE MEDICINE!!!

      • Alt med is a junk term. Meaningless. It’s entirely subjective.

        You have drawn an arbitrary line between what you consider “alt” and what you consider “conventional”, then you attack everything on one side, and give a pass to everything on the other side.

        Please explain how pharmacological psychiatry is not alternative medicine. Is it because it’s practiced by MDs? Because FDA approves the drugs? By just about any other measure that I can think of, it would be on the short list of most insane and fraudulent forms of healthcare, and most definitely “alternative” given that it is not “conventional” in the broadest sense of the word.

        • Adam, if it worries you so much that this blog isn’t covering the subject in which you are most interested, why don’t you start a blog of your own?

          • L . Barton: I’m just using psychiatry as an example, to illustrate the shameless hypocrisy that underlies this entire site.

            Substitute statin drugs, or PPI drugs for reflux, gallbladder removal surgery, ignoring diet and nutrition… just to name few more examples.

            These practices are insane and very much “alternative” to such things as basic nutrition, exercise, sunlight, detoxing, natural medicines, spiritual practice. They are only mainstream because the systems of power have sanctioned them and indoctrinated the masses.

            But psychiatry is such a clear case, that its omission from all of these pseudo-skeptic sites makes crystal clear what is going on. It’s all about ideology and profit.

          • Adam, I think you’ve now gone overboard. Statin drugs work just fine; there are questions about exactly who and how many paeople should be taking them, but that’s a common conundrum in medicine. Efficacy of PPI inhibitors for oesophageal reflux has been fully demonstrated in rigorous clinical trials. I have no idea what you think is wrong with gallbladder removal: there are situations when it’s the only reasonable option. And, for Pete’s sake, which medics ignore diet and nutrition. In the UK for several years they’re almost obsessively considered by doctors.
             
            Basic nutrition and exercise are something we are nagged about to the point of tedium in the UK — maybe things are different in your country. Detoxing?! Please identify which toxins are not eliminated by the liver and kidneys. ‘Natural’ medicines?! Youyou Tu has just been awarded the Nobel prize for discovery and development of artemisinin, an anti-malarial drug she found by studying traditional Chinese medicine. Aspirin, more than half of antibiotics, many of the chemotherapy drugs you seem to despise, even the statins you see as bad things originate from plants and microbes. But that doesn’t mean that everything ‘natural’ is necessarily beneficial or the source of any medical effect. ‘Spiritual practice’: I guess you mean that, for some (credulous?) people, religion or New Age woffle have a soothing effect (psychiatrists could probably explain that better than me).
             
            The reality is that your rants here have become increasingly daft, and suggest you know very little of what you’re ranting about. Like L. Barton says, if all this stuff bothers you so much, why not start your own blog about it.

          • yes, a little half-knowledge is a dangerous thing!

        • Because Adam, unlike “alt-med”, real medicine is subject to scrutiny and review.

          If mistakes (whether treatments, diagnoses, or medicines) are made, there are mechanisms and people who will say it isn’t right and change will occur. Contrast that with homoeopathy where the only change is to introduce implausible explanations of why the totally implausible can work, despite contravening the laws of nature; for example, the memory of water.

          I am sure you will still bang on with your Tu Quoque, without ever appreciating the difference.

        • it would be on the short list of most insane and fraudulent forms of healthcare

          Really? How is it possible then that numberless people who would, in the past, have been locked up in “asylums for the mentally insane”, are now roaming the streets – freely – and taking up jobs?

          Also, this is a blog about alternative medicine. And yes, there is a difference. Medicine is evidence-based. Alternative medicine is not. In order to learn what this means, you could do worse than read what Prof. Ernst has to say. A lot worse.

          • Bart B. Van Bockstaele said: “How is it possible then that numberless people who would, in the past, have been locked up in asylums for the mentally insane, are now roaming the streets – freely – and taking up jobs?”
            —–
            Says who? Seems many of them are living on the street, or are in prison. The literature on long term outcomes shows that psych drugs are actually increasing mental illness. Medicated patients fare the worst, across the board. Read Robert Whitaker’s “Anatomy of an Epidemic”.

            Biological psychiatry pretends to have figured out the organic cause of mental illness. They have not, but through successful marketing and propaganda, people buy their magic pills anyway. Large number of psychiatrists are consummate quacks, pushing drugs that are in some cases hard to distinguish from illegal street drugs, drugs that are known to increase suicidal and homicidal tendencies, drugs that cure nothing, calling these drugs “medicine”, all to treat imaginary diseases.

            Anyone who claims to go after medical quackery and fraud, who does not start with Biological Psychiatry, would seem to be totally lacking in legitimacy.

            It is most assuredly “alt” medicine. Do not be deceived by the white coats, confusing jargon, and the ritual of the prescription.

  • Frank Odds said: “Statin drugs work just fine”
    Such a compelling argument. How could I not be persuaded. Regarding PPIs, WebMD (basically an industry mouthpiece) reported on a study that showed PPI users had 16-21% heart attack risk increase. And yet these drugs are handed out like candy, or sold OTC to anyone. I guess that’s “real medicine”. It’s the dumbest most blunt most crude approach. Just shut off the patient’s stomach acid.

    Frank Collins said: “If mistakes (whether treatments, diagnoses, or medicines) are made, there are mechanisms and people who will say it isn’t right and change will occur.”
    What color is the sky in your world? Here in the real world, there is fraud and corruption. You describe some ideal or fairy tale.

    Also, please define “real medicine”. Be specific. No vague concepts like “science based”.

    • “Here in the real world, there is fraud and corruption.”

      Oh gawd, another conspiracy theorist nutjob. I’m done with you. Generously, I thought you might be sane, but I am clearly wrong. You and jm should hook up; you will keep each other going for years.

      • Frank Collins said: “Oh gawd, another conspiracy theorist nut job.”
        —————————–

        Oh really? Would the former head of the FDA be a legit source on this matter?

        “The FDA protects the big drug companies, and is subsequently rewarded, and using the government’s police powers, they attack those who threaten the big drug companies.  People think that the FDA is protecting them.  It isn’t.  What the FDA is doing, and what the public thinks it is doing are as different as night and day.”
        — Dr. Herbert Ley, Former Commissioner of the U.S. F.D.A.

        This quote, too, is revealing even if not specifically related:

        “We’ll know our disinformation campaign is complete when everything the American public believes is false.”
        – CIA director William Casey, 1981

  • I have yet to see a single response that addresses the obvious hypocrisy in only targeting so called “alt” medicine, as well as arbitrarily limiting the definition of alt to only those practices you despise or wish to discredit.

    Again psychiatry is the perfect example. Telling me to start my own blog sidesteps the issue. Why is it not included here? Nobody will answer because the answer would expose the hypocrisy, no?

    This site masquerades as some sort of public service. But isn’t really just a vehicle for maintaining the status quo, attacking everything else with vitriol?

  • And then there was only the sound of crickets chirping…

    No answer about the free pass for psychiatry, no answer about the definition of “real medicine”, no answer about the arbitrary “alt” categorization.

    Have you prophets of corporate plastic medicine been defeated by some lone knucklehead? Or maybe you all are hard at work on your next attack of the terrible scourge that is homeopathy.

    Or perhaps an article on the quackery of sunlight. After all, it is not FDA approved and cannot be patented.

    • Adam!
      The quackery of sunlight has already been tested (homeopaths call it proving), branded and marketed. You can order it in several varieties. Here for example. They even have one made from British sunlight, a special rarity.

      Your intemperate interrogation regarding what you see as this blog’s shortcomings have already been fully addressed by others.
      See e.g.:
      Edzard on Monday 05 October 2015 at 07:12
      L . Barton on Tuesday 06 October 2015 at 11:04
      Bart B. Van Bockstaele on Wednesday 07 October 2015 at 20:20
      Frank Collins on Thursday 08 October 2015 at 08:15
      Frank Odds on Wednesday 07 October 2015 at 09:32
       
      It seems obvious that you are not here to discuss the matter at hand, that of why patients choose homeopathy, but to indulge your own wide ranging disgruntlement. Continuing to heckle us may make you feel better for the moment but it will not help solve your personal problems and will in the end only deepen your chagrin as you are calling upon yourself nothing but sneers and disparagement with these obsessive, impolite rants.

      • Björn Geir: The particular points I raised above were not answered at all. Sneers and disparagement… yes, instead of substantive debate. Says it all. Go after the messenger instead of the message. My chagrin is not deepening at all. For me it is fun to expose hypocrisy. But thanks for the presumptuous life lesson.

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