MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Not long ago, Peter Fisher fired me from the editorial board of ‘his’ journal ‘HOMEOPATHY’. I thought that this was a surprisingly daft move, particularly as we used to have respect for each other and even published together as co-authors (for instance here). But perhaps I should not have been surprised because, already in 2007, he published an important, potentially libellous falsehood about me.

In this article which he published as Dr. Peter Fisher, Homeopath to Her Majesty, the Queen, he wrote: There is a serious threat to the future of the Royal London Homoeopathic Hospital (RLHH), and we need your help…Lurking behind all this is an orchestrated campaign, including the ’13 doctors letter’, the front page lead in The Times of 23 May 2006, Ernst’s leak of the Smallwood report (also front page lead in The Times, August 2005), and the deeply flawed, but much publicised Lancet meta-analysis of Shang et al…

If you have read my memoir, you will know that even the hostile 13-months investigation by my own university did not find me guilty of the ‘leak’. The Times journalist who interviewed me about the Smallwood report already had the document on his desk when we spoke, and I did not disclose any contents of the report to him. But the truth in homeopathy seems often highly diluted.

More recently, Peter Fisher could be heard on UK radio and TV (for instance here) making further claims which, in my view, are false. Specifically, I am thinking of two of his statements which would mislead the public, if they stood uncorrected:

  1. He said that the studies unanimously show that integrating homeopathy into conventional medicine improves outcomes and saves money.
  2. He also claimed that most of the homeopathic remedies available in the high street still contain small amounts of active ingredients.

POINT NUMBER 1

It seems obvious that adding homeopathy with its lengthy, compassionate encounters to conventional care can easily generate positive outcomes. But costs? I don’t see unanimously positive evidence here at all.

Dr Fisher must know the literature on homeopathy very well. Therefore I assume that he is aware of the most up-to-date systematic review of economic evaluations of this subject. Its authors from the ‘School of Health and Related Research’, University of Sheffield concluded that “it is… not possible to draw firm conclusions based on existing economic evaluations of homeopathy“.

Fisher knows and likes to quote Claudia Witt’s work on homeopathy. Why does he not cite this recent paper then?

OBJECTIVES:

The aim of this study was to compare the health care costs for patients using additional homeopathic treatment (homeopathy group) with the costs for those receiving usual care (control group).

METHODS:

Cost data provided by a large German statutory health insurance company were retrospectively analysed from the societal perspective (primary outcome) and from the statutory health insurance perspective. Patients in both groups were matched using a propensity score matching procedure based on socio-demographic variables as well as costs, number of hospital stays and sick leave days in the previous 12 months. Total cumulative costs over 18 months were compared between the groups with an analysis of covariance (adjusted for baseline costs) across diagnoses and for six specific diagnoses (depression, migraine, allergic rhinitis, asthma, atopic dermatitis, and headache).

RESULTS:

Data from 44,550 patients (67.3% females) were available for analysis. From the societal perspective, total costs after 18 months were higher in the homeopathy group (adj. mean: EUR 7,207.72 [95% CI 7,001.14-7,414.29]) than in the control group (EUR 5,857.56 [5,650.98-6,064.13]; p<0.0001) with the largest differences between groups for productivity loss (homeopathy EUR 3,698.00 [3,586.48-3,809.53] vs. control EUR 3,092.84 [2,981.31-3,204.37]) and outpatient care costs (homeopathy EUR 1,088.25 [1,073.90-1,102.59] vs. control EUR 867.87 [853.52-882.21]). Group differences decreased over time. For all diagnoses, costs were higher in the homeopathy group than in the control group, although this difference was not always statistically significant.

CONCLUSION:

Compared with usual care, additional homeopathic treatment was associated with significantly higher costs. These analyses did not confirm previously observed cost savings resulting from the use of homeopathy in the health care system.

To speak about unanimously positive evidence is simply not true! And Fisher, I suspect, must know it.

POINT NUMBER 2

This point is even clearer, I think. The most commonly used homeopathic potency is surely a ’30C’ – it was already Hahnemann’s favourite. A small statistic proves my point: of the 24 products listed on the Nelson site, 21 are ’30C’ and just three are ‘6C’. For Ainsworths, all 33 of their listed standard products are ’30C’. Helios have 70 ’30C’ products and 27 ‘200C’ products

The likelihood that a ’30C’ contains a single molecule of what it says on the bottle is precisely zero. In fact, this applies already to all remedies beyond ’12C’. Fisher knows that, of course, I assume; if not he should not be a homeopath.

MY CONCLUSION OF ALL THIS

I do not take any pleasure in calling anyone a liar – and it is, of course, far from me to use this word in connection with the Queen’s homeopath. Therefore, in the interest of the scientific truth, medical ethics and honesty, I would like to give Dr Fisher the opportunity to comment on the above issues and herewith invite him to correct the three errors/falsehoods/inaccuracies/misunderstandings mentioned above by supplying the evidence for his statements or by withdrawing them. Then we won’t have to call him names which he might feel are hurtful.

40 Responses to Is the Queen’s homeopath telling the truth?

  • It is glib, disingenuous and misleading to claim “homeopathy works” without distinguishing between the undoubted beneficial effects of a patient having a constructive therapeutic relationship with an empathic practitioner, and the effects of homoeopathically prepared (HP) remedies themselves.

    There is no plausible reproducible evidence that HP remedies have any beneficial effect on any pathological process and the NHS should not spend a penny on them.

    If it were to be decided that placebos should be funded by the NHS, what would not be? There are many things which patients might find pleasing. Many patients would appreciate a dose of whisky, a new hairstyle, or tickets for a visit to the gardens of Highgrove House, but could such NHS funded largesse be generally justified and if so, how could it be rationed?

    I am concerned that Dr Fisher may not obtain fully informed consent from patients to have HP remedies. Unless he sets out the fact that conventional medicine has identified no plausible evidence of specific benefit from any HP remedy, and that his recommendations for HP remedies are based on faith not scientific evidence, it is possible the GMC might determine he is unfit to practice.

    I will write to him and ask for a copy of any information sheet/consent form he uses for his patients.

    • “The undoubted beneficial effects of a patient having a constructive therapeutic relationship with an empathic practitioner”

      Thanks for expressing this excellent point so succinctly. I’ve struggled many times to find the right words for explaining why homeopathy, or placebos in general, “work”.

      I personally think there’s room for placebo in mainstream healthcare. Problem then is: homeopathy is a very expensive placebo.

      • “I personally think there’s room for placebo in mainstream healthcare.”

        I strongly disagree with that sentiment. An equal or better outcome could be achieved without need to lie or fleece just by converting NHS waiting rooms into tearooms. Never underestimate the value of a nice cup of tea and a chat.

        • Hmm…I doubt it. In my local hospital waiting areas, you can have Costa coffee, tea, muffins etc. Generally people aren’t interested until after their appointments and they’re rarely interested in chatting unless it’s to moan about the waiting time. People want to talk about their ailment to a practitioner whom they believe can help and to be prescribed a treatment. I presume it’s that faith+ritual that produces the placebo effect in homeopathy.

          I agree homeopathy has no place in the NHS and not just because it’s an expensive placebo but also because of the credibility funding gives to a pre-science cult therapy based on magic.

  • In relation to the recent spate of media coverage, I emailed Dr Fisher to ask why he appeared to be describing this paper http://www.systematicreviewsjournal.com/content/pdf/2046-4053-3-142.pdf as being done by the Robertson Centre for Biostatistics at the University of Glasgow, whereas the first author, corresponding author and project lead was Robert Mathie of the BHA. I am still unclear why he chose to describe the ownership of that study in the way he did.

    Argument from authority always risks being a fallacy, but if one is going to do it, perhaps it is best to make it clear on whose authority a study depends to avoid confusion as to its attribution

    • I’ve read this review and the authors (despite one of them being from the BHA) warn that caution is needed in interpreting their findings. I quote “The low or unclear overall quality of the evidence prompts caution in interpreting the findings.”
      Sadly, this caution was wholly lacking in Dr Fisher’s references to this review on BBC Radio 4’s Today Programme on Friday 13 November.

  • The claims of Fisher on both rado and TV were astonishing.

  • I sometimes find it politic to use the term “mistaken” (in quotes) rather than lying.

  • You mean the man who, with a straight face, told a parliamentary sub-committee (@11:07:15) that:

    “The shaking is important… If you just gently stir it, it doesn’t work”

    ? Go figure.

    • @ Lee Turnpenny

      Thanks for the link, I enjoyed that.
      After 200 years you would have thought they would have learnt how many times you need to shake it.

  • In Richard Dawkin’s TV program “Enemies of reason” he interviews Dr Fischer and he pretty much gives the game away saying in effect that he went into homeopathy as a career move!

  • Dr. Fisher is engaged in the standard tactic of SCAM proponents: he throws out a soundbyte, a memorable and pithy phrase which is not immediately and incontrovertibly wrong, so cannot be countered with a simple “bullshit”, but which is misleading in every important respect. And this trope will be repeated until the rebuttal is well known, and then a new one will be substituted, because that is what *always* happens.

    Like Dullman, leading with memory of water and then switching to Chikramane’s finding of silicates in products prepared in glass, which any competent scientist will know is an expected contaminant.

    Oceania has always been at war with Eastasia.

  • If you buy a homeopathic remedy, how do you know it doesn’t contain the thing it’s supposed to not contain? It might not contain something completely different.

    • Ha!

      Reminds me of this exchange during the House of Lords Science and Technology Committee on 21 February 2007:

      Ms Chatfield: I am Kate Chatfield. I am here to represent the Society of Homeopaths and I am a senior lecturer in homeopathy at the University of Central Lancashire.

      Q538 Lord Broers: I have a simple, technical question about homeopathy and drugs. Is it possible to distinguish between homeopathic drugs after they have been diluted? Is there any means of distinguishing one from the other?

      Ms Chatfield: Only by the label.

  • From all indications, homeopathic preparations in Western countries are destined to become part of murky, offshore underground, where they will inevitably become a highly lucrative business as unregulated, relabeled lactose.

    • Boiron, the world’s largest manufacturer of this rubbish, reported half-year sales of over €275,000,000 in 2015. I think the “murky, offshore underground, where they will inevitably become a highly lucrative business as unregulated, relabeled lactose” horse has well and truly bolted.

  • Point number 2, the chance of 30C containing a molecule is not “precisely” zero, but I know what you mean. Any remedy is certain to contain all sorts of nasty chemicals at about 6C. Finding one molecule in 30C is about the same chance that you, me, Dr Fisher, Prince Charles and the Queen will _each_ be struck by lightning on Christmas Day 2015.

  • You might not get a response from Fisher at the moment: it looks like the RLHIM may have closed his skin clinic. It’s gone from the Integrated medicine page next to his name, it’s no longer in the menu on the left of all pages, the leaflet for it has gone from this list and the page for the clinic itself has been taken down.

    It’s still in Google’s cache . This must have been taken down sometime on Friday.

    • I am sad to hear yet another great public service now only available to those who can pay lots of money.
      Up to this year I believe I have been kept alive and happy by RLHIM. It is no longer available to me on NHS.

  • Aren’t there hundreds of studies comparing homeopathy with placebos in double blind tests? Doesn’t the evidence speak for itself? I just find it daft comparing a placebo with another placebo. What would you hope to achieve!

    Finally. What do you call alternative medicine that has been proven to work? Answer: medicine.

    • We ( my husband and I) seek similar medicine elsewhere but we are not yet secure in knowing it is perfect.
      We pay for it because it is more important to us than the holiday savings or retirement extras. We are retired.

      • Well, you are in luck Janet, at least as far as the remedies go. I can tell you where to get them for free.
        In most countries a glass of water is free. It works even better than the usual homeopathic remedies as it quenches thirst as well.
        If you absolutely want to take your remedies as pills, you can buy the small sugar drops used to decorate cakes with, put them in a jar, drop one drop of water on top of them and let it evaporate. This is how they manufacture the pill type remedies. They take something, for example some onion, sulphur, table salt,a rock or a housefly and grind it up, mix it with alcohol and then put a drop in a vial of water. They then shake that vial vigorously by banging it against something and then take a drop of that and repeat the process with another vial of water and so forth. If the remedy is supposed to be 30C, they have repeated a hundredfold thinning thirty times. This serially multiplied thinning process means there is about as much of the housefly in the water as would correspond to a housefly in a mass of water that reaches from one end of the universe to the other. OK, that’s a lot, but apparently the ghost of the housefly somehow gets potentiated in the water by the banging process. Or that’s what the homeopaths think, even if we have our doubts about it. Then they take a vial of milk sugar (lactose) globules and drop a drop of the shaken water onto it and let it evaporate.
        Here’s the homeo-scientific basis of the housefly remedy I took as an example. Its called Musca Domestica and if you can’t find it you can order it from Helios. You can find many other exciting remedies there, like Microwave, Menses, Measles vaccine, Milky way (I guess that’s the candy) or magnetism (you can chose the south or the north pole). And that’s just a handful of all the goodies found under “M”.

        You actually do not have to drop the water, just think hard that you did. Some homeopaths even produce their remedies by meditation when they do not have the original ingredient at hand. An example can be found here, where a homeopath tells us how she produced a toothache remedy from her imagination by meditating about Hekla lava (Hekla is a volcano in Iceland).

        In Nelson’s remedy factory in the UK, a delegation from the US found that their pill production lines missed every sixth vial of sugar pills so the drop went on the floor. The remedies worked just as well, or at least no one had ever complained. Here’s the letter they sent to Nelson’s. They also noted that the pills at the bottom of the glasses did not receive any of the shaken water. So it does not seem to matter if the remedy is there at all or if it is made out of any starting material.
        It is enough to think the remedy was made from something and Millions (I kid you not) of people have discovered that they do not have to take a homeopathic remedies for anything.
        I, for example have never had to take remedies for anything. If I get some health problem, I just think: Is this something that will go over? And miraculously, it will!
        Of course, If it doesn’t or I think it probably will not be better without medical attention, I just go to the doctor. Simple.

        • @Björn,

          “They then shake that vial vigorously by banging it against something and then take a drop of that and repeat the process with another vial of water and so forth.”

          In various sources, I’ve read that it must be a leather bound bible for succussing the magic potion. I just checked and, apparently, not so. Probably goes to show, homoeopaths make it up as they go.

          • @Frank Collins
             
            From http://www.naturalworldhealing.com/homeopathyenergytheory.htm (italics mine)
            “1. When the vibration was done by pounding the vial containing the dilution against one’s open palm, or against a resilient surface (Hahnemann would use a leather-bound book, often the Bible), then the preparation would evoke a healing response in the patient.
            2. When the vibration was done by pounding the container against a wooden or hard surface then the preparation would not induce a healing response.”
             
            From http://skepchick.org/2008/04/world-homeopathy-awareness-week-day-2-the-succussion/ (italics mine)
            ” …after each dilution, the solution is vigorously shaken against either a leather-bound book or the palm of the hand. Hahnemann liked to whack it to his Bible!
             
            Like you say, this is all over the web (I’ve quoted both a pro- and con- site above). Where did you discover it’s urban legend?

  • They work for me if I just buy the correct remedy in the correct dose, from a pharmacy. I never had better results from seeing a homeopath and disagree it is about the ‘compassionate therapeutic encounter’ – actually having seen at least four homeopaths and deciding I didn’t like them or their beliefs which they seemed to put before what I was actually telling them. I use a brilliant diagnostic homeopathic book instead and have had really good results.
    The theory is that the vibration left in the water, rather than a measurable quantity of the substance, triggers the body’s own immune response without adding to any existing condition, but it worked before I knew that. It hasn’t worked for everything- maybe some things you need a homeopath to go through the stages of treatment, but I have had amazing results for instance with Arsen Alb. I used to get a truly dreadful tummy ache and didn’t know what caused it. The doc would be called out and a drug prescribed. Until I found Arsen Alb, which worked faster and I could keep some in the house. I then learned that I react to broccoli and don’t get the problem any more, but it worked every time and I always keep it for tummy problems such as food poisoning or intolerances should they arise- it works.
    Arnica helps with healing. Studies have shown it, and I always noticed the cream makes visible bruising go more quickly than expected (hard to measure).
    When I need a doctor I go to the doctor. Operations, scans, consultants etc- the hospital. Obviously. This is not an either or but the two things can and should work together alongside osteopathy, acupuncture, etc. The homeopathic hospital may have been able to help me with M.E. which medicine absolutely cannot but it is no longer allowed to offer anything on the NHS.

    • I’d like to add re the idea of ‘placebo’. If placebo is such a thing- and I understand it has been proven ages ago- how come it isn’t happening when I see my doctor? I have high blood pressure. I have tried about 10 different medicines. The majority give me side effects and about two thirds have literally no effect on my bp. If placebo is a thing I ought to react the same to all of the relatively safe substances. Or at least they all ought to work or not work. I have no predisposed idea favouring one over the other, and my doctors haven’t ‘sold’ me one more enthusiastically than others. Luckily I found one that worked for years- though its efficacy has reduced and I struggle to find one now that works and doesn’t have dreadful side effects such as tinnitus and seriously pounding heart. (See , there are reasons people need to look at safer alternatives sometimes) I trust my doctor, like him and he gives me lots of time- great ‘therapeutic compassionate’ care. Why do the medicines not all work equally? Could it be because the medicines are not all the same? No brainer right? Same goes for homeopathy. You can’t claim placebo effect only works in one context.

    • good on you, to know when you need a doctor and when not. I hope you never make a mistake.

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