MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

As promised in the last post, I will try to briefly address the issues which make me uncomfortable about the quotes by Anthony Campbell. Readers will recall that Campbell, an ex-director of what was arguably the most influential homeopathic hospital in the world and a long-time editor of the journal HOMEOPATHY, freely admitted that homeopathy was unproven and its effects were most likely not due to any specific properties of the homeopathic remedies [which are, in fact, pure placebos] but largely rely on non-specific effects.

I agree with much that Campbell wrote but I disagree with one particular implication of his conclusions:Homeopathy has not been proved to work but neither has it been conclusively disproven….” and “…it is impossible to say categorically that all the remedies are without objective effect…”

This is an argument, we hear from proponents of alternative medicine with unfailing regularity:MY TREATMENT MAY NOT BE SUPPORTED BY GOOD SCIENCE [BECAUSE GOOD SCIENCE IS EXPENSIVE, AND WE CANNOT AFFORD IT] BUT IT HAS NOT BEEN DISPROVEN EITHER – AND, AS LONG AS IT IS NOT DISPROVEN, NOBODY SHOULD STOP US USING IT”

Campbell does not explicitly draw this latter conclusion but he certainly implies it. In his book, he explains that, even though homeopathic remedies probably are placebos, homeopathy does a lot of good through the placebo effect and through its spiritual aspects. And that is, in his view, sufficient reason to employ it for healing the sick. The very last sentence of his book reads: “Love it or loathe it, homeopathy is here to stay”

So the implication is there: alternative therapies can be as bizarre, nonsensical, implausible, unscientific or idiotic as they like, if we scientists cannot disprove them, they must be legitimate for general use. But there are, of course, two obvious errors in this line of reasoning:

  1. Why on earth should scientists waste their time and resources on testing notions which are clearly bonkers? It is hard to imagine research that is less fruitful than such an endeavour.
  2. Disproving homeopathy [or similarly ridiculous treatments] is a near impossibility. Proving a negative is rarely feasible in science.

In the best interest of patients, responsible health care has to follow an entirely different logic: we must consider any treatment to be unproven, while it is not supported with reasonably sound evidence for effectiveness; and in clinical routine, we employ mostly such treatments which are backed by sound evidence, and we avoid those that are unproven. In other words, whether homeopathy or any other medicine is unproven or disproven is of little practical consequence: we try not to use either category.

While I applaud Campbell’s candid judgement regarding the lack of effectiveness of homeopathic remedies, I feel the need to finish his conclusion for him giving it a dramatically different meaning: Homeopathy has not been proved to work but neither has it been conclusively disproven; this means that, until new evidence unambiguously demonstrates otherwise, we should classify homeopathy as ineffective – and this, of course, applies not just to homeopathy but to ALL unproven interventions.

8 Responses to Homeopathy: benefit of the doubt or doubt of the benefit?

  • Thank you for your review of my book.

    May I reply to something in your follow-up comment? You say that I think
    that “homeopathy does a lot of good through the placebo effect and
    through its spiritual aspects.” I do mention the widespread notion in
    alternative medicine circles that treatments should address the
    “spiritual” aspect of patients, but that is not a view I share. My own
    position is best described as metaphysical naturalism, which means that
    I don’t look to find any transcendental or “spiritual” realm beyond what
    we can perceive.

  • Interesting comment, although I would like to submit that the distinction is likely largely irrelevant. Just how genuine medications/treatments work, is not always (entirely) known, and consequently, views may differ, but properly conducted proper tests will show that the medication has a specific and measurable effect, in which case it may be used if considered safe enough, or not, in which case it won’t.

    Whatever one’s ‘position’ is, may be relevant in orienting research into the mechanisms of a medication/treatment’s effect. That is not unimportant, obviously, but only if there is an effect to begin with.

    In that sense, a representative of Boiron in Canada made the interesting observation that Boiron doesn’t conduct many trials because their customers don’t ask for them. How do they know that their products work or have no side-effects if they don’t conduct trials?

    Of course, they are mostly explicitly exempt from the obligation of conducting such trials, so they have the law on their side, but is it not remarkable that they hardly ever conduct/publish proper trials at all? Yes, the law allows them to forgo trials, but I am not aware of any country where they are *forbidden* from conducting them. Why not? Would it not be a great demonstration of their self-claimed genuine concern for patients if they conducted proper trials in spite of this remarkable exemption?

    To the best of my knowledge, the only disease/disorder homoeopathy is shown to help with, heal and even cure is FWD (not to be confused with piriformis syndrome). The effect is real, demonstrable and very specific, regardless of one’s position on how it works.

    Another important and – I think – underestimated effect of homoeopathy is that it could help slowing down the increase of costs to the health system. After all, by wooing customers who are eager to show off all their abbreviations, homoeopaths are freeing up real doctors to treat genuine patients with real diseases. The bad thing is that this effect may be largely undone, by aggravating real conditions in genuine patients because of treatment postponement.

    Maybe, if homoeopaths would be more honest, there would be a place for them in the body of medicine. It could go something like this: You know, Mr/Mrs Patient, we find nothing physically wrong with you, and our psychiatrists are not available right now. You might want to consult with one of our friendly and caring homoeoquacks. Their administrations have not been demonstrated to have any positive effects other than a vague and unreliable placebo effect, but it could be just enough to make you feel better, in case watching Walt Disney’s Pinocchio does not work.

    Another thing that fascinates me is how homoeopaths can claim that their ‘remedies’ have no undesirable effects. I would be highly interested in seeing studies that demonstrate that the ubiquitous lactose in homoeopathic granules does not lead to the same consequences as lactose in milk or cheese. Oeuf corse, we would still have to keep an eye open for lactose-induced obesity due to overconsumption of homoeopathics, but given the price of these things, that might prove to be a very minor problem.

  • As long as we live in societies that permit–indeed, encourage–religious freedom, we will be stuck with those who also believe fervently in various pseudo-scientific medical practices. How is believing in homeopathy different from believing in gods?

  • I completely agree with Irene. There is, to the best of my knowledge, no difference whatsoever between believing in a deity and belief in quackery. The part I am struggling with is with how fight them. It seems obvious that bans have little or no effect, probably even an effect opposite to the one intended.

    My current position is that quackery, religion, psychic (dis)services, recreational drugs, climbing Mount Everest and other phenomena should all be treated the same way, i.e. they should be inaccessible to children, advertising them in any way, shape or form should be strictly forbidden, except for neutral and subdued availability announcements at the point of sale, and heavy penalties (jail terms, or something similarly disruptive) should be exacted for any transgressions. This should be accompanied by science-based information (not propaganda) campaigns in the media and science-based education in schools. All products and literature should carry warnings and references to more science-based information.

    Freedom of expression is too valuable to curtail it for any reason. However, when anyone presenting herself/himself as an expert makes any claims that when acted upon are likely to affect a person’s health, physical or mental, must be able to show he/she has done her/his due diligence, and admit –in no uncertain terms– that her/his position is not supported by evidence, if that is indeed the case. A Quack Miranda warning (this product is not *intended* to…) won’t do.

    In other words, quacks and the like must be held to the same standards as anybody else. No exceptions. Adults should be free to harm themselves if they so choose, but they should do so in full possession of the facts, not just what some quack, psychic or other pope fantasises for them.

    • Why limit the “quack miranda” to advertising? I would love to see jail terms or something similarly disruptive in place for medical professionals who claim expertise outside of their scope. For instance, an MD making claims about Chinese medicine or any other Traditional Medicine practice, without understanding the system (science) they are talking about, should be held accountable. And vice versa.

      Thinking that there is only “one true science” is akin to religious fundamentalism.

      • Well said jm.

      • I am of course trembling with fear over being sued for my libellous and unsolicited interference with a business[sic], which is outside the scope of my profession (really?) and governed by a science, known only to a select few, which is alternative and different than the science that so well explains the reality that I and most of my fellow human beings live in.
        Or maybe it would be interesting to have to go to court and defend reality? I think I would have a winning case.

        This blogpost is about Homeopathy.
        Perhaps I am, as a member of that other, less powerfully endowed profession (“allopathy”) not qualified to question the mysterious memory properties of shaken water, but as I have sworn a solemn oath to care for people, maybe it can be considered somewhat inside my scope to be interested in more means of improving their health?
        There are many things we physicians cannot do so no one would be more thrilled than me to be able to use more and better medicines. There is only one obstacle. We are obliged to know that the means and medications that we use have at least a theoretically credible explanation of how they work. Otherwise we would not be honest to our clients.
        Can the “system (science)” that you (jm) say that you have knowledge of and which ( if I got this right) governs the nature of the alternative (is that synonymous with eastern?) “Traditional Medicine practice” explain how medicinal (or is the correct word healing?) properties are propagated via serial dilution and shaking and then evaporation in sugar pills? I would love to learn just that if nothing else of the other fantastic healing sciences.
        (I already read all the Indian papers with pictures of ice crystals and I know all about the flawed experiments of Benveniste and the (according to himself) curious, self-published article of Luc Montagnier, which (according to himself) does not support a homeopathic effect. All this fails to explain the medicinal properties of shaken, diluted and evaporated water.

        Please tell me where I can learn this alternative magic!

        • You should look up the definition of science. People have come up with many ways to systematically organize the body and its processes. But if you think there’s only “One True Way”…that would be akin to fundamentalism.

          You lost me with the rest of your post – I have no idea what point you’re trying to make. You end it with “Please tell me where I can learn this alternative magic!”. You’re on your own there – I don’t know anything about magic. But you seem to have a genuine interest, as you’ve posted many times about magic. Good luck with your search.

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