MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Lots of people are puzzled how healthcare professionals – some with sound medical training – can become convinced homeopaths. Having done part of this journey myself, I think I know one possible answer to this question. So, let me try to explain it to you in the form of a ‘story’ of a young doctor who goes through this development. As you may have guessed, some elements of this story are autobiographical but others are entirely fictional.

Here is the story:

After he had finished medical school, our young and enthusiastic doctor wanted nothing more than to help and assist needy patients. A chain of coincidences made him take a post in a homeopathic hospital where he worked as a junior clinician alongside 10 experienced homeopaths. What he saw impressed him: despite of what he had learnt at med school, homeopathy seemed to work quite well: patients with all sorts of symptoms improved. This was not his or anybody else’s imagination, it was an undeniable fact.

As his confidence and his ability to think clearly grew, the young physician began to wonder nevertheless: were his patients’ improvements really due to the homeopathic remedies, or were these outcomes caused by the kind and compassionate care he and the other staff provided?

To cut a long story short, when he left the hospital to establish his own practice, he certainly knew how to prescribe homeopathics but he was not what one might call a convinced homeopath. He decided to employ homeopathy in parallel with conventional medicine and it turned out that he made less and less use of homeopathy as the months went by.

One day, a young women consulted him; she had been unsuccessfully trying to have a baby for two years and was now getting very frustrated, even depressed, with her childlessness. All tests on her and her husband had not revealed any abnormalities. A friend had told her that homeopathy might help, and see had therefore made this appointment to consult a doctor who had trained as a homeopath.

Our young physician was not convinced that he could help his patient but, in the end, he was persuaded to give it a try. As he had been taught by his fellow homeopaths, he conducted a full homeopathic history to find the optimal remedy for his patient, gave her an individualised prescription and explained that any effect might take a while. The patient was delighted that someone had given her so much time, felt well-cared for by her homeopaths, and seemed full of optimism.

Months passed and she returned for several further consultations. But sadly she failed to become pregnant. About a year later, when everyone involved had all but given up hope, her periods stopped and the test confirmed: she was expecting!

Everyone was surprised, not least our doctor. This outcome, he reasoned, could not possibly be due to placebo, or the good therapeutic relationship he had been able to establish with his patient. Perhaps it was just a coincidence?

In the small town where they lived, news spread quickly that he was able to treat infertility with homeopathy. Several other women with the same problem liked the idea of having an effective yet risk-free therapy for their infertility problem. The doctor thus treated several infertile women, about 10, during the next months. Amazingly most of them got pregnant within a year or so. The doctor was baffled, such a series of pregnancies could not be a coincidence, he reasoned.

Naturally, the cases that were talked about were the women who had become pregnant. And naturally, these were the patients our doctor liked to remember. Slowly he became convinced that he was indeed able to treat infertility homeopathically – so much so that he published a case series in a homeopathic journal about his successes.

In a way, he had hoped that, perhaps, someone would challenge him and explain where he had gone wrong. But the article was greeted nationally with much applause by his fellow homeopaths, and he was even invited to speak at several conferences. In short, within a few years, he made himself a name for his ability to help infertile women.

Patients now travelled from across the country to see him, and some even came from abroad. Our physician had become a minor celebrity in the realm of homeopathy. He also, one has to admit, had started to make very good money; most of his patients were private patients. Life was good. It almost goes without saying that all his former doubts about the effectiveness of homeopathic remedies gradually vanished into thin air.

Whenever now someone challenged his findings with arguments like ‘homeopathics are just placebos’, he surprised himself by getting quite angry. How do they dare doubt my data, he thought. The babies are there, to deny their existence means calling me a liar!

OUR DOCTOR HAD BECOME AN EVANGELICALLY CONVINCED HOMEOPATH, AND NO RATIONAL ARGUMENT COULD DISSUADE HIM.

And what arguments might that be? Isn’t he entirely correct? Can dozens of pregnancies be the result of a placebo effect, the therapeutic relationship or coincidence?

The answer is NO! The babies are real, very real.

But there are other, even simpler and much more plausible explanations for our doctor’s apparent success rate: otherwise healthy women who don’t get pregnant within months of trying do very often succeed eventually, even without any treatment whatsoever. Our doctor struck lucky when this happened a few times after the first patient had consulted him. Had he prescribed non-homeopathic placebos, his success rate would have been exactly the same.

As a clinician, it is all too easy and extremely tempting not to adequately rationalise such ‘success’. If the ‘success’ then happens repeatedly, one can be in danger of becoming deluded, and then one almost automatically ‘forgets’ one’s failures. Over time, this confirmation bias will create an entirely false impression and often even a deeply felt conviction.

I am sure that this sort of thing happens often, very often. And it happens not just to homeopaths. It happens to all types of quacks. And, I am afraid, it also happens to many conventional doctors.

This is how ineffective treatments survive for often very long periods. This is how blood-letting survived for centuries. This is how millions of patients get harmed following the advice of their trusted physicians to employ a useless or even dangerous therapy.

HOW CAN THIS SORT OF THING BE STOPPED?

The answer to this most important question is very simple: health care professionals need to systematically learn critical thinking early on in their education. The answer may be simple but its realisation is unfortunately not.

Even today, courses in critical thinking are rarely part of the medical curriculum. In my view, they would be as important as anatomy, physiology or any of the other core subjects in medicine.

9 Responses to The making of a homeopath

  • I agree, but who is to teach?
    Philosophers, psychologists, physiologists, learned clinicians (who are not very good), sceptical scientists – all the above?
    The French study philosophy in secondary school (and are therefore familiar with the CT basics), but they use homeopathy uncritically!
    And it is near impossible to fit anything else into a secondary or university curriculum.
    What will give way to make room?

    So, Edzard’s proposal should be supported 100%, but the practicalities are daunting.

  • Really great article!

    Once when I worked at a summer camp for handicapped children, there was a kid whose parents insisted on exclusively homeopathic treatments. He got sick and got a fever, and I gave him his homeopathic pills and took him to a doctor, who wanted to give him medication to reduce the fever. I said the parents insisted on only homeopathy. The doctor said “That doesn’t work — come back tomorrow we’ll check again.” The child’s fever (thankfully) had gone the next day, and doctor said “Hmm, maybe there is something in it.”

    This shows that the doctor’s first priority was to do what was best for the patient, ans was prepared to do anything that works. When homeopaths say that we don’t know how asprin or analgesics work, this actually demonstrates that the medical profession is not dogmatically opposed to doing what works. It is only when one looks more closely that it becomes clear that how kind of scenario that Dr Ernst describes above, can come about — good intentions all the way down.

    But it should really also be obvious to such doctors just how quickly it turns dangerous. Google “homeopathic contraceptive”, for example, (perhaps a possible next step for the career of the exemplary doctor), and one finds this:

    http://abchomeopathy.com/forum2.php/58092/

    “My wife age 33 gave birth to a healthy baby boy March ’05. After a week of the delivery she suffered seizures and a MRI scan revealed 5 clots in her brain (diagnosed as Cerebral Vein Thrombosis). She was put on blood thinners and anti-fit medicines and has, by the grace of god, almost recovered to normal.
    The Dr. has advised her not to conceive in the near future as this can be dangerous for my wife and medicines can be harmful for the fetus. Due to blood clotting all hormonal contraceptives are dangerous. This leaves us with few alternatives and a constant fear of pregnancy.
    Was wondering if Homeopathy might have some sort of alternative method of contraception.”

    None of the homeopaths who respond warn the man that his wife is in imminent and grave danger if they try it. It goes without saying that no one even suggests the idea that such a case would be a perfect test case for a homeopathic remedy — with willing and fully informed subjects, of course, with no health problems. Instead homeopaths routinely use their clients for human experiments of the kind the Nazis tried and found to be useless.

    (Sorry for ranting!)

  • Your story reminds me of something I had just read on Prof Colquhoun’s latest article on his blog, which I hope he won’t mind me copying here:

    One is reminded, once again, of the definition of clinical experience: “Making the same mistakes with increasing confidence over an impressive number of years.” (from A Sceptic’s Medical Dictionary by Michael O’Donnell. A Sceptic’s Medical Dictionary BMJ publishing, 1997).

  • I agree it would be better if all concerned were to learn and employ sound thinking.

    It would be helpful if critics of homeopathy would engage critical thinking instead of repeating the various propaganda mantras put out uncritically by “skeptic” websites – such as homeopathy “is just placebo”, since that is far from proven (and seems extremely unlikely).

    It would be helpful if critics of homeopathy would engage even a smigeon of critical thinking when looking at a slew of negative SRs which just happen to have placed the bar to put homeopathy in the worst possible light. Playing to the gallery – in journals suspected to possess antagonistic bias.

    Remember, “To conclude that homeopathy lacks clinical effect, more than 90% of the available clinical trials had to be disregarded. Alternatively, flawed statistical methods had to be applied”, Prof R.G. Hahn “Homeopathy: meta-analyses of pooled clinical data” 2013 Oct 17 http://www.ncbi.nlm.nih.gov/pubmed/24200828 . He was quite critical of your work, I recall.

    It would be helpful to apply better “good thinking” to the nature, very existence and origins of any noisy propaganda campaign that depends on armchair critics, journalists and publicists rather than involved practitioners, and yet discounts the personal experiences of the only true arbiters, the people who count, the individual cured patients. A clear thinker would be more inclined to dismiss the views of hobby critics who have never seriously studied the subject matter, but instead are well versed in disinformation techniques and power plays

    It would be interesting to consider why so many of these propagandists are so totally uncritical of the dominant regime in medicine, even relying on a ‘perfect world fallacy’ (bordering on racketeering) to bolster their arguments that the conventional is always faultlessly superior (where’s the harm?). Not even 50% of conventional medicine has good evidence base (13%, is it, according to BMA?), and pharmaceuticals are known to be problematic for thousands (if one counts consequent deaths as problematic), yet these uncritical critics spend their time attempting to remove choices from people who already know they have benefit from homeopathy.

    It would be helpful if all were to apply critical thinking to any assertion that the 200-year-old hypothesis by lawyer Avogadro cannot be challenged in “science” (argumentum ad verecundiam et sine ratione experimentum), when there have been a stream of results showing it does not hold.

    And to the proposition that succussion is irrelevant. And to the unfounded yet conventional proposition that only substantive material doses may affect an organism. (I find a rant can cheer me up immensely.) And to the consideration that the best medicine may concern the terrain rather than the apparent vector. And so on, and so on.

    And, good Heavens, it would be useful if homeopaths and all complementary therapists could and would apply some critical thinking to the way they record and present outcomes, and how a good case can be made.

    It would be helpful if everyone would apply critical thinking to statements claiming there are no positive trials of homeopathy, or that homeopathy has never cured anyone.

    It would be helpful if everyone would apply more critical thinking to the classification of evidence, rather than slavishly (and conveniently) choosing to believe that size is quality, and to the view that the RCT reigns supreme, however inappropriately designed. A past president of NICE and even the founders of EBM would disagree. (Recall Sir Michael Rawlins, Harveian Oration 2008, DeTestimonio: “randomised controlled trials (RCTs), long regarded as the ‘gold standard’ of evidence, have been put on an undeserved pedestal”. Now, that’s critical thinking. )

    It would be helpful if everyone, including retired professors of complementary medicine (I wanted to put “failed professors of complementary medicine”, but I shouldn’t) would devote some critical thinking time to discovering the methodological biases in approaches to analysis which disfavour certain therapies, and to a more thorough consideration of where meta-analyses can be deeply misleading (not rocket science).

    To that end, it would be helpful if critics of holistic therapies in general were to think critically and deeply about the design and the mathematics of analysis of RCTs, when the current convention is liable to produce misleading results underestimating the effect of the homeopathic approach, and can be shown even to mimic regression to mean when an approach is canonically true.

    Yes, a good rant can be therapeutic, but is useless if the giver of rant is a hopelessly misguided pseudo-skeptic, reliant on false authority, reliant upon apriorism, reliant upon false information and false analysis, using circular cites, steeped in confirmation bias and prey to Dunning–Kruger effect.

    So I have to be careful I do not do the same.

  • The answer to this most important question is very simple: health care professionals need to systematically learn critical thinking early on in their education.

    I strongly disagree: we should be teaching everyone critical thinking skills early on in their education, from primary school onwards. In particular, I think secondary school science education has a lot to answer for, teaching students that science is a Mastermind contest, of rote question and rote answer to determine the winner, not a self-empowering tool for exploring and understanding our world. Newton did not coin F=ma as a robotic exercise in punching in numbers to get numbers out, but as a simple self-contained statement: “This is how one part of our world works.” The language may not be English, but its intent should be clear nonetheless.

    To understand science, one must realize what motivated humanity to invent and apply it in the first place. Science is not an abstract set of numbers and facts, it is a human story of human endeavor, and everything else grows out of that. So here’s one way to do it: have science classes teach the history of science as its overarching framework, say 25% of the course, and fit all the practical work and math into that.

    Such an approach would not only address the much needed Why and How, but also make the subject as a whole far more accessible and (hopefully) engaging to those students who don’t possess a natural flare for math but do take an interest in the humanities. Teach new minds what an utter bastard Newton was, and of the hilarious stushies kicked up by Mad Madge. Teach them what the ancient Greeks and early Islam ever did for us. Science is all about humans and human frailties; why pretend otherwise? The whole point is to face up to and accept our own fallibility, and figure out ways to keep it from making total fools of ourselves, and you don’t do that by memorizing equations.

    The math then becomes less about punching rote numbers into rote equations to generate rote answers, and more about appreciating how the equations themselves are elegant concise descriptions of how the numerous parts of the universe fit together all around us. And the explosions and collisions and unspeakable bits of sticky stuff are still explosions and collisions and unspeakable bits of sticky stuff, which honestly never get old. (Especially when you can manage to combine all three.)

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