If we believe homeopaths, we might get the impression that homeopathy is firmly established in mainstream health care. “They would say that, wouldn’t they?” To convince skeptics, we might want to have a bit more than wishful thinking.
We have just published a systematic review in order to instill some evidence into this debate. Our aim was to evaluate all the data from recent surveys of GPs and assess their involvement with and attitudes towards homeopathy. We searched 7 electronic databases to identify all relevant articles. Data extraction was conducted by three independent reviewers. Thirteen surveys met the inclusion criteria. Their findings suggest that less than 10% of GPs treated patients with homeopathy; referral rates varied hugely and ranged from 4.6% to 73%.
Two surveys also assessed GPs’ endorsement of homeopathy; they suggested that less than 15% of GPs were endorsing homeopathy. One survey asked about GPs’ personal usage of homeopathy and reported less than 10% had used this form of therapy on themselves.
Three surveys investigated adverse events (AEs) from homeopathic treatments. One was solely focussed on AEs which were classified as “serious” (either life threatening or likely to cause disability or sever morbidity) or non-serious. In total, 21 “indirect” serious AEs were reported (e.g., stopping medication, refusing immunisation, refusing cancer treatment, delaying diagnosis). Another survey found that 14% of GPs reported AEs following homeopathic treatment within a year. Other authors reported that the discontinuation of conventional asthma treatment in favour of a homeopathic remedy had led to cardiovascular arrest.
These data shed a much more sober light on the use of homeopathy in the UK. They fail to show that homeopathy is well-accepted by British GPs. More importantly perhaps they disclose serious problems with the use of homeopathy.
34 Responses to Homeopathy: how well accepted is it really?
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Professor Ernst wrote: “…[GP] referral rates varied hugely and ranged from 4.6% to 73%”
Even then, that could be highly misleading. For example, research carried out during 2007 for a consultation about funding of the Tunbridge Wells Homeopathic Hospital found that although 52% of GP practices in West Kent referred patients to homoeopaths, less than 1% of the patients in those practices were referred, and referral was almost always at the patient’s request rather than as a result of a clinical decision.
http://web.archive.org/web/20080422063051/http://www.westkentpct.nhs.uk/EasySiteWeb/GatewayLink.aspx?alId=11159
good point!
i entirely agree.
So what? Those figures are fine with me. Just leave those GPs who do want to make such referrals alone. But the ‘sceptics’ can never do this because they think the ‘stupid’ people are being ‘duped’ in some way. Either that or they cannot stand the fact that people derive benefit and succour from homeopathy – however it works.
Ever read Democracy in America by de Toqueville? He explains how a great evil can emerge even in democracies. He calls it the ‘tyranny of the majority’. The way the ‘sceptics’ try to bully the significant minority of people and doctors who want to use and prescribe homeopathy is a perfect example of what de Toqueville argued against and the combination of what you have previously written about homeopathy and the stats you describe above show, illustrate just how prescient de Toqueville was.
so, do you propose health care by popular vote?
i have to say that i prefer heath care that orientates itself on reliable evidence.
I could derive much succour from a diet consisting of mainly fries, burgers, steaks, eggs, bacon, and sausages. A GP would (hopefully) be deemed wholly incompetent if he/she referred me to a practitioner who promotes the Atkins Nutritional Approach (aka the Atkins Diet).
I find seat belts uncomfortable. If a GP recommended I visit a car dealership specialising in old cars that are exempt from compulsory seat belts, then I strongly suggest that the GP would be an incompetent clown. If the same GP, instead, referred me to a homeopath who will dilute a seat belt to, say, 30C potency, then he/she is still an incompetent clown; irrespective of whether or not the placebo effect from the resulting sugar pills would alleviate my discomfort.
Evils can indeed emerge in democracies, but your argument is a non sequitur. Science is not a democratic process, it is an evidence-based self-correcting process, which is immune to both authoritarian and public opinions. The only reason that I’m allowed to state, in public, that the Earth revolves around the Sun is because science did not bow down to authority and public opinion.
Currently (in many countries) we are free to choose between evidence-based healthcare and quackery. I will invoke the slippery slope informal fallacy to make a counterpoint to your comment… Let’s allow civil engineers to accommodate a significant minority of public opinion, and let’s suppose that this public opinion is to have some bridges made out of fluorescent plastic because the wonderful colours would make the local community feel better than staring at boring concrete. Great! But, not so great when the plastic fails after a few years and lives are lost due to its failure. This would be a very slippery downhill slope for both civil engineering and the human race.
I sincerely hope that you, Brian, would vociferously object if a local civil engineer referred your council committee to an ‘alternative’ civil engineer whom uses non-scientific methods for the design and construction of a new project just because a significant minority prefer fluorescent plastic, or whatever. There is no such thing as efficacious ‘alternative engineering’ and there is no such thing as efficacious ‘alternative medicine’ — the efficacious versions have the unequivocal terms: engineering and medicine.
As I understand it, skeptics put a great deal of personal time and effort into reducing human suffering and saving lives. If this sometimes results in an apparent restriction of freedom then so be it. Those who refuse to learn critical thinking skills will sometimes/often be offended.
Evils emerge in democracies because the majority of the electorate do not make the time and effort (or do not know how) to determine which candidate is the most rational thinker. Indeed, election campaigns rely on the emotive force of rhetoric, not on evidence, and certainly not on the profound logic underpinning deductive arguments.
We interfere all the time with the freedom to exploit others. Fraud is illegal. It’s not clear why medical fraud such as homeopathy should be treated differently.
I like your comment Pete628 and agree with it – the homeopath’s answer to your bridge analogy though would be that they don’t believe that the “alternative fluorescent plastic” is inferior to concrete or just appealing on a surface level. Most honestly believe it is effective. It mostly comes down to your points about lack of critical thinking skills, various biases, and misunderstandings about how science works (with a pinch of magical thinking thrown in for good measure).
These discussions seem very philosophical! As an ordinary person who occasionally might need medicine, the key question that matters is the simple one: does homoeopathy work? Is it yes, or no, or is it that we don’t yet know enough to say one way or the other? I’d be interested to hear from both sides.
the simple answer is no, it does not work. what might give the impression that it does are effects not related to the remedy, such as placebo, regression to the mean, natural history etc.
I’m not quite clear about the difference between something working and something ‘giving the impression that it works’. Is it possible to make your statement more precise? For instance, in relation to the reference to a placebo, are you saying that in various situations when people take homoeopathic treament, it does in some cases help them, but that the help is not due to the model that the homoeopaths have but rather it is due to the placebo effect?
if you get better after a cold, it could have been the remedy you took or it could have happened by itself [natural history of the disease]. there are several phenomena that can give the impression that a treatment was effective, while, in fact, it did nothing at all.
Many thanks for your reply, and what you say is of course quite true, but what I was really trying to get clear in my mind was the difference between four possibilities that emerge from the issues that you have been raising:
(1) That homoeopathy does not work
(2) That homoeopathy does work, but not in the way that its practitioners think it does and why it works is as yet not clear
(3) That homoeopathy does work, and such efficacy as it has can be accounted for by the placebo effect
(4) That homeopathy does work in the way its practitioners maintain
I’m mentioning 4 for the sake of completeness, and what I am not clear about from what you say is whether your conclusions are along the lines of 1, 2 or 3.
homeopathic remedies are placebos and do not work beyond placebo.
homeopathic consultations may work via the effects of an empathetic therapeutic encounter.
Many thanks for the reply, which is appreciated.
And just to be precise, would you say that your position is a mixture of 2 and 3, namely:
Homoeopathic remedies work but not in the way that their practitioners think, but rather through the placebo effect, with the actual placebo possibly being the tablet but also possibly being the therapeutic encounter with the practitioner. The placebo effect sets an upper limit for the scale of effectiveness of homoeopathic remedies.
I get the impression that you want to change my meaning ever so slightly. what I wrote is quite clear and I prefer to stick to my original statement.
Howie, I would like you to read the following articles because I think they may answer some of your questions:
http://skeptoid.com/episodes/4151
http://skepdic.com/essays/evaluatingexperience.html
No, I most certainly am not interested in trying to change your meaning, I’m trying – as I said previously – to make your position precise, particularly from the point of view of the patient. The average person, when trying to make a decision about whether or not to take a possible remedy, often asks the single question: does it work? And that was the question I gave you: Is it yes, or no, or is it that we don’t yet know enough to say one way or the other? If I read you correctly, you are saying: yes, it does work, but we don’t know why – but because my whole purpose is analytical, with the aim of better understanding, I want to check this with you direct.
no, I think you are confusing my meaning which is entirely clear.
anyway, if someone asks me this simplistic question DOES IT WORK? i’d say NO. but explain that things are just a little more complex.
Dear professor,
About the placebo effect; when a patiënt does not heal with regular medicine but he does with
alternative medicine; why – in case of a cure – is this placebo effect so much greater with the last method.
While one would expect that all the investigations, apparatus and the scientific impact of the medicine
would have a much greater placebo effect then just a few globes or needles.
One mentions here and there an “empathetic encounter” with the practionar as an explanation for the “alternative placebo effect but one also hears frequently
that concerning patiënts found their GP of specialist very agreable and they took a lot of time for them.
So this “empathy” is not exclusive.
One would expect also that a patiënt would be far more impressed by a professor of internal medicine then someone
with the doubtful burden of quackery.
Thank you for your reply, which is appreciated, and I should say that if there is any confusion, my aim is to assist you in removing it, as I hope I’ve been making clear. Just to explain the background to my questions, I have a particular interest in the philosophy of science and have been looking for some time into the question of language, and the degree of precision with which it is used in the discussion of scientific issues.
I have been interested to study your writing, as you work in a field where scientific investigation and public discussion meet. In doing so, I’ve come across some differing formulations of your views. For instance, on the question ‘Does homoeopathy work?’ you have two earlier statements which both seem to say a ‘yes’:
“I still think homoeopathy works, the question is: why? After years of research, I think the answer now is conclusive. It works because of a very long empathetic consultation. It’s a powerful placebo effect.” (New Scientist, 20 August 2011)
“[A]s a clinician almost 30 years ago, I was impressed with the results achieved by homoeopathy. Many of my patients seemed to improve dramatically after receiving homoeopathic treatment. How was this possible?” (Guardian, 3 April 2012)
But the tenor of other statements seems to be along the lines of a ‘no’, as indeed you have stated in the present discussion:
“the simple answer is no, it does not work. what might give the impression that it does are effects not related to the remedy, such as placebo, regression to the mean, natural history etc.” (here, 19 May)
Hence my further questioning. As mentioned, this key question, ‘Does homoeopathy work?’, is one which many members of the public do ask, particularly in situations of illness for themselves or a member of their family, so I think it’s important that science can give them an answer.
interesting!
I have to admit that precision of the (English) language is perhaps not my forte; after all, it is my second language. nevertheless, I try to express myself clearly and accurately, and I do try to address the public.
and there are other factors, such as time and context, which complicate this matter at times.
the quotes you cited back to me are probably not prime examples of precision but they are, as far as I can tell, not contradictory either. what I try to express that homeopathy works via something unrelated to homeopathy; so it works, while at the same time, it doesn’t. this concept seems difficult to grasp for lay people and I am probably a bit clumsy at expressing it. but there you are – things are neither back or white, nor are they simple.
with your interest in the philosophy of science, you probably also have an interest in the meaning and meaningfulness of questions. in my view DOES HOMEOPATHY WORK? is not a meaningful question. the consumer asks it alright, but we have to provide answers that dissect the question in something meaningful and answerable, I think.
Howie
All treatments need to be examined as having distinct elements. Generally, there are specific and non-specific effects from any treatment. For homeopathy, the specific elements of it are the effects that are only due to the sugar pills themselves and nothing else. The non-specific effects are everything else that surrounds that including the therapeutic encounter with the practitioner, the environment, the confidence and manner of the practitioner, the length of the encounter, the attention the practitioner pays to the client, the beliefs of the client, etc, etc, etc. There is clear evidence that any therapeutic encounter can have very beneficial (placebo) effects, but these are simply to do with that encounter and have nothing to do directly with any specific effects of the treatment itself. Indeed, there are non-specific effects from a consultation with your GP whether or not he/she prescribes anything. These can add to the overall beneficial effects of a treatment.
Even for homeopathy, there is evidence that the non-specific effects can be beneficial in some circumstances [1], particularly if the condition was amenable to placebo effects, and if so, you could say that homeopathy ‘worked’. However, this says nothing about the effectiveness of the sugar pills and the evidence is clear that they have no specific effects whatsoever. In that sense, homeopathy doesn’t work at all. It depends entirely on the context of the word ‘homeopathy’.
1 Brien, Sarah, Laurie Lachance, Phil Prescott, Clare McDermott, and George Lewith. 2011. “Homeopathy Has Clinical Benefits in Rheumatoid Arthritis Patients That Are Attributable to the Consultation Process but Not the Homeopathic Remedy: a Randomized Controlled Clinical Trial.” Rheumatology (Oxford, England) 50 (6) (June): 1070–1082. doi:10.1093/rheumatology/keq234.
Yes, I agree with you both, and many thanks for these very helpful replies. I do agree that the form of the question has to be tackled. To the person asking it, who may be ill or be concerned for an ill member of the family, the question as to whether or not a possible remedy ‘works’ is straightforward, but indeed in the present context of providing an explanation there is an element of ambiguity that has to be tackled.
I think that it is important to be able to give an answer in a ‘yes’ or a ‘no’ form, since the person who is ill needs to know that. I have been trying to think of a more precise way to phrase the question, for instance, ‘Will this proposed therapy help me to get better?’ to which the answer might be: ‘Yes, but not in the way that its proponents claim’, but this is only a first attempt and I will need to sleep on it!
I think that the key is the way in which the use of words and perception of their meaning is coloured by the particular experience of the individual.
Thus in regard to the perception of any therapy, the individual with the illness is focused mostly on the outcome; he or she simply wants to get better. The therapist is focused on the process and its detail, making sure that all the various points are covered. Those of us who are observing, with an interest in the science, are more concerned with the question why? – and our particular focus is on the concepts and methodology of the therapy. In each case the perception and usage of words will differ, depending on the individual perspective.
It’s a bit analogous to the example quoted by Wittgenstein to explain why a word is not a fixed concept with a single thread running through it, but rather a family of usages, each related to its neighbours but not necessaarily to all of the rest. (“Someone says to me: ‘Show the children a game.’ I teach them gaming with dice, and the other says ‘I didn’t mean that sort of game.’ “)
So indeed, the question ‘Does homoeopathy work?’ cannot be answered with precision, since the word ‘work’ has different meanings for different perspectives.
But since the question is such an important one, science has to try to find a reply. Could I say something like: “If you mean, can homoeopathy help, the answer is yes, in some circumstances, but we have to make the caveat that its effect may well be through something totally different from what its proponents believe. That being so, there are various areas of uncertainty, where what may succeed in one situation may not do so in another situation that on the surface looks very similar.”
I should say that I’m not trying to put words into anybody’s mouth, just trying to explore with my own words the implications of some of these language issues.
I am travelling for the next three days but when I am back I would be glad to speak further with you both, if you wouldn’t mind, as I do believe that these issues of language are important to investigate.
DOES HOMEOPATHY WORK?
you are right about the various meanings of WORK. but, what complicates the matter further is HOMEOPATHY. it consists of the remedy (actually thousands of different remedies) and the therapeutic encounter. the former is a placebo, the latter not.
I think what is abundantly clear is that homeopathy does not work for the vast array of conditions claimed by homeopaths. Whilst that includes things like the common cold and bruising, which are minor, self-limiting conditions, there are frequent claims made for malaria prevention, HIV/AIDS and other serious medical conditions. Even if the therapeutic encounter makes a client feel a little bit better, it is clear that the sugar pills can have no therapeutic effect on these serious conditions.
yes, that is an important differentiation. empathy may help the patient to feel better but it can do very little to pathologies that might threaten the patient’s life.
It looks like the capacity to change pathology is the ultimate criterium of curing potential and i think you are wright.
However, changing the pathology is also for regular medicine (RM) a dubious result. Besides surgery and tissue destroying radiation or chemo, in general internal diseases i.c. arthritis the pathology is hardly changing ( or with methotrexate the pathology shifts to hematological-gastrointestinal or hepatic etc. ) and for example in hypertension or asthma medicine has to be taken on and on and pathology over the years is getiing worse.
I was always fond of biochemistry during my study. In the clinic however the dogma of contrarity did rise a dispappointment in chronic cases where medicine have to be repeated for years and years. There is no cure. Or even spontaneous as with placebo’s.
The regular medicine (RM) became great after discovery of micro-organisms and antibiotics, it was corn on the mill of the contrariety doctrine. The infectious diseases stand model for the method of RM were a a group of symptoms have a real “cause” that can be “beaten”. Nevertheless we see a lot of cases were patients remain ever sick after infections which are sufficiently treated with antibiotics. An explanation might be that toxins spread in the tissues already before antibiotics come into play. (Or that antibiotics are not sufficient in case of virus.)
Do you have a special opinion about RM cases which have “never been better since” a flu or Pfeiffer became chronic ?
Does predisposition play the main role ?
In the context of “pathology that might threaten life”; that chronicity is yet a kind of threatening life can not be denied.
Does RM have an answer to this kind pathology that i am not aware of ?
true, we do not have the answer to many questions and conditions. but it is better, I think, to admit this fact than to pretend the answers are available.
Apologies, I had planned to come back much sooner but have had heavy pressure of work. I wonder how close the following would be to my understanding of my original question? I’m putting it in my own words:
Some critics of homoeopathy do accept that in certain situations it can help a patient. They emphasise that the way in which any help occurs is definitely not due to any of the mechanisms advanced by homoeopaths, but rather that is purely a manifestation of the placebo effect. They say that the placebo effect comes into play through the consultation with the homoeopath, rather than through taking the homoeopathic tablets.
That’s about as close as I can get but if anyone can change any of the wording to improve it, I’ll be glad to hear.
Howie Firth said:
It depends on your audience, but I don’t think that makes the distinction clear enough. Many homeopathists would jump on your first sentence and immediately claim that you were saying that homeopathy works/helps/is effective and will completely miss the subtlety in what you are saying: that you are differentiating between specific and non-specific effects. In general, many homeopathists I’ve argued with (and there have been many!) seem to be completely incapable of critical thinking and argumentation and logical fallacies are anathema to them. With them, you have to be completely clear and unequivocal in what you say.
There is also the problem that it’s not just placebo effects (plural!) that explain why some believe homeopathy seems to work: there are a number of far more palusible reasons and this article gives a good account of them: Social and judgmental biases that make inert treatments seem to work by Barry L. Beyerstein.
Thanks for these comments Alan, and I take your point the dangers of selective quoting out of context. This indeed emphasises the need to continually seek greater precision in language. But we have to have a starting-point with the facts of what is actually being said, and my aim here is to see if it is possible to make these precise, so that some of the potential for misquoting can be reduced. I do think that my summary is pretty accurate, but if there are any specific words or phrases that can be improved, I would be glad to hear. As I hope I have shown, sometimes some simple phrasing can make a difference, for instance with the replacement of the word ‘works’ by the phrase ‘can help a patient’.
Thanks too for the link to the article about the paradoxical propensity for intelligent people to think illogically. I hadn’t seen it before and it is most interesting and highlights a problem which I believe is on a much wider scale than the question of unorthodox medical techniques. It can also be found in places which one would think would be highly resistant to it. To give one example – far away from the current context of medicine – much of the confusion that has plagued the interpretation of quantum theory for several decades can be traced back to a lack of discipline in the thinking of some of those in the field. The research of the late Professor Mara Beller has opened up some quite unexpected insights. Here’s a link to one of her papers.
That’s just one example, in what would have been thought to be a stronghold of objective and disciplined thought, and over the years I have come across more. I think that these various examples of human foibles affecting the thinking of intelligent people underlines the need for a greater emphasis in education at just about every level of philosophy per se and philosophy of science in particular.
I’m sorry but it seems my comment will be a couple of years late. Nevertheless I shall make it any just in case someone may read it. Homeopathy exists and is respected by people in most countries in the world because for the past several hundred years because they find comfort in it, i.e. it works. Why, is important to scientists and competitors but not so much to users.
The remedy that I can vouch for is arnica montana. On several occasions I used it immediately after mashing a finger or toe, to the extent that the nail broke, and it prevented pain, swelling, temperature and bruising. I have also found relief in several other remedies. Read your history, the AMA was formed in 1846 for the sole purpose eliminating by law homeopathic practice because they were getting most of the business! The work of the practitioner is not easy becase one must not only select the best remedy but also the best potency and know the detailed habits of the patient. That is something not easy in a 15 minute appointment with a 90 day follow up. Dilution was mentioned, and belittled, but nothing about succussion which is now believed to create electrical energy. What we don’t understand we deny!
@Evan P Cundiff
You might usefully spend some more time reading other articles on this blog; then you might realise that your unverified and unverifiable anecdote is irrelevant. As is the rest of your comment.