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

An article in yesterday’ Times makes the surprising claim that ‘doctors turn to herbal cures when the drugs don’t work’. As the subject is undoubtedly relevant to this blog and as the Times is a highly respected newspaper, I think this might be important and will therefore comment (in normal print) on the full text of the article (in bold print):

GPs are increasingly dissatisfied with doling out pills that do not work for illnesses with social and emotional roots, and a surprising number of them end up turning to alternative medicine.

What a sentence! I would have thought that GPs have always been ‘dissatisfied’ with treatments that are ineffective. But who says they turn to alternative medicine in ‘surprising numbers’ (our own survey does not confirm the notion)? And what is a ‘surprising number’ anyway (zero would be surprising, in my view)?

Charlotte Mendes da Costa is unusual in being both an NHS GP and a registered homeopath. Her frustration with the conventional approach of matching a medicine to a symptom is growing as doctors increasingly see the limits, and the risks, of such a tactic.

Do we get the impression that THE TIMES does not know that homeopathy is not herbal medicine? Do they know that ‘matching a medicine to a symptom’ is what homeopaths believe they are doing? Real doctors try to find the cause of a symptom and, whenever possible, treat it.

She asks patients with sore throats questions that few other GPs pose: “What side is it? Is it easier to swallow solids or liquids? What time of day is it worst?” Dr Mendes da Costa is trying to find out which homeopathic remedy to prescribe. But when NHS guidance for sore throats aims mainly to convince patients that they will get better on their own, her questions are just as important as her prescription.

This section makes no sense. Sore throats do get better on their own, that’s a fact. And empathy is not a monopoly of homeopaths. But Dr Mendes Da Costa might be somewhat detached from reality; she once promoted the nonsensical notion that “up to the end of 2010, 156 randomised controlled trials (RCTs) in homeopathy had been carried out with 41% reporting positive effects, whereas only 7% have been negative. The remainder were non-conclusive.” (see more on this particular issue here)

“It’s very difficult to disentangle the effect of listening to someone properly, in a non-judgmental way, and taking a real rather than a superficial interest,” she says. “With a sore throat [I was trained] really only to be interested in, ‘Do they need antibiotics or not?’ ”

In this case, she should ask her money back; her medical school seems to have been rubbish in training her adequately.

This week a Lancet series on back pain said that millions of patients were getting treatments that did them no good. A government review is looking into how one in 11 people has come to be on potentially addictive drugs such as tranquillisers, opioid painkillers and antidepressants.

Yes, and how is that an argument for homeopathy? It isn’t! It seems to come from the textbook of fallacies.

And this week a BMJ Open study found that GPs with alternative training prescribed a fifth fewer antibiotics.

That study was akin to showing that butchers sell less vegetables than green-grocers. It provided no argument at all for implying that homeopathy is a valuable therapy.

Doctors seem receptive to alternative approaches: in a poll on its website 70 per cent agreed that doctors should recommend acupuncture to patients in pain. The Faculty of Homeopathy now counts 400 doctors among its 700 healthcare professional members.

Wow! Does the Times journalist know that the ‘Faculty of Homeopathy’ is primarily an organisation for doctor homeopaths? If so, why are these figures anything to write home about? And does the author appreciate that the pole was open not just to doctors but to to anyone (particularly those who were motivated, like acupuncturists)?

This horrifies many academics, who say that there is almost no evidence that complementary therapies work.

It horrifies nobody, I’d say. It puzzles some people, and not just academics. And their claim of a lack of sound evidence is evidence-based.

“It’s a false battle”, says Michael Dixon, a GP who chairs the College of Medicine, which is trying to broaden the focus on treatment to patients’ whole lives. “GPs are practical. If a patient gets better that’s all that matters.”

Here comes the inevitable Dr Dixon (the ‘pyromaniac in a field of straw-men’) with the oldest chestnut in town. But repeating a nonsense endlessly does not render it sensible.

Dr Dixon says there are enormous areas of illness ranging from chronic pain to irritable bowels where few conventional treatments have been shown to be particularly effective, so why not try alternatives with fewer side effects?

Unable to diagnose and treat adequately, let’s all do the next worst thing and apply some outright quackery?!? Logic does not seem to be Dixon’s strong point, does it?

He recommends herbal remedies such as pelargonium — “like a geranium, quite a pretty little flower” — acupressure, and techniques such as self-hypnosis. To those who say these are placebos he replies: so what?

So what indeed! There are over 200 species of pelargonium; only 2 or 3 of them are used in herbal medicine. I don’t suppose Dr Dixon wants to poison us?

“Aromatherapy does work, but only if you believe in it, that’s the way you have to look at it, like a mother kissing knees better.” He continues: “We are healers. That’s what we do as doctors. You can call it theatrical or you can call it a relationship. A lot of patients come in with a metaphor — a headache is actually unhappiness — and the treatment is symbolic.”

It frightens me to know that there are doctors out there who think like this!

What if a patient is seriously ill?

A cancer is a metaphor for what exactly?

As doctors, we have the ethical duty to apply BOTH the science and the art of medicine, BOTH efficacious, evidence-based therapies AND compassion. Can I be so bold as to recommend our book about the ethics of alternative medicine to Dixon?

Such talk makes conventional doctors very nervous. Yet acupuncture illustrates their dilemma. It used to be recommended by the NHS for back pain because patients did improve. Now it is not, after further evidence suggested that patients given placebo “sham acupuncture” did just as well.

No, acupuncture used to be recommended by NICE because there was some evidence; when subsequently more rigorous trials emerged showing that it does NOT work, NICE stopped recommending it. Real medicine develops – it’s only alternative medicine and its proponents that seem to be stuck in the past and resist progress.

Martin Underwood, of the University of Warwick, asks: “So are you going to say, ‘Well, patients get better than they would do otherwise’? Or say it’s all theatrical placebo because it shows no benefit over sham treatment? That’s the question for society.”

Society has long answered it! The answer is called evidence-based medicine. We are not content using quackery for its placebo response; we know that effective treatments do that too, and we want to make progress and improve healthcare of tomorrow.

Although many doctors agree that they need to look at patients more broadly, they insist they do not need to turn to unproven treatments. The magic ingredient, they say, is not an alternative remedy, but time. Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said: “Practices which offer alternative therapies tend to spend longer with patients . . . allowing for more in-depth conversations.”


I am sorry, if this post turned into a bit of a lengthy rant. But it was needed, I think: if there ever was a poorly written, ill focussed, badly researched and badly argued article on alternative medicine, it must be this one.

Did I call the Times a highly respected paper?

I take it back.

22 Responses to ‘Doctors turn to herbal cures when the drugs don’t work’ … THE TIMES is wallowing in nonsense

  • I’m interested in your early comment about the Times being a ‘ highly respected newspaper’.
    By the same kind of people who ‘highly respect’ the Telegraph, for instance, maybe.
    Many others regard these publications now as being a bad joke, whatever ‘respect’ they might have commanded in the past.
    The Telegraph, for instance, is now nothing more than the Mail in long trousers, and it seems to me that both publications are still attempting to ride on their previous reputations.
    As Ben Goldacre has often pointed out, many newspapers farm out their science stories to juniors and incompetents, in a way they wouldn’t dream of doing with, say, football stories.
    As many have pointed out, if it works, we take it on board, and call it ‘medicine’. If it doesn’t work, we call it ‘nonsense’ or, at best, ‘placebo’.

  • It’s a completely unevidenced piece. A vague veiled plug for the private practice of Charlotte Mendes da Costa. Yes, she does work part time as an NHS GP. But the surgery falls under Ealing CCG which has long had a policy against the prescribing of homeopathic and herbal medicines. Analysis suggests that GPs do comply with that policy.

    I do not have the data (need a list of BNF codes of herbal products first) but it is known that the GPs who write the most NHS prescriptions for homeopathy are Anthroposophists. Anthoroposophic medicine also uses various herbal concoctions. It is suspected that GP prescribing of herbal medicines will have seen a similar decline to homeopathic products and that the few GPs who currently prescribe them are Anthroposophists.

    Hopefully NHS England will provide the necessary BNF code list to Ben Goldacre and his colleagues at EBM Data Labs so I can do the analysis!

    OpenPrescribing.net is a wonderful for monitoring GP prescribing practices against local policies…

  • Please don’t be sorry for what you’re concerned might be a “lengthy rant.” I’m not a doctor but the crazy statements you cite have given me a stomach ache. This is a great review of a very troubling and seemingly growing symptom of people losing their minds.

  • Thanks for taking this cheap and nasty piece of CAM propaganda apart line by line.

  • Here we have yet another very busy homeopath taking pressure off the NHS.
    You should all be grateful.

    • JK said: “Here we have yet another very busy homeopath taking pressure off the NHS. You should all be grateful.”

      Thanks JK, I agree 100% Your comment will most likely be the most truthful one posted here.

    • Or rather indulging her hobby on a private practice basis rather devoting that time to being an NHS GP.

      http://www.bedford-park.co.uk/staff

    • We would be grateful for a caring, empathic doctor taking on difficult patients – but does she do so ethically and with integrity?
      Does she obtain fully informed consent before treating them?

      “I am going to prescribe a preparation in which I have faith that you might gain benefit, but ethically I must advise you that the consensus of medical opinion is that such preparations have no effect on any ailment and are placebos at best. Do you consent to treatment on that basis?”

      Gratitude does not extend to endorsing quackery, or misleading patients.

      • Who can argue with that?

        Doctors are expected to base their practice and advice to patients on evidence (EBM).

        Telling people that x medicine treats condition y when there is no evidence for it, is lying.

    • I am sure the grave diggers are also grateful.

  • I don’t know who are making these crazy statements about other therapies like accupuncture is not proven , in fact it is , Blue Cross Blue Shield covers this treatment , chiropractor s also do GREAT work and have proven the worth … Big Pharmacy likes to poison people with toxic so called meds !!
    It’s about time for “other “treatments be allowed into our country … As other countries have much better results for thier patients .
    They use so called alternative means that are not allowed to be utilized in this country … As cash is the deciding factor in this country …
    Most people have little to no idea about thier own bodies and how they work , as well as how sickness and disease effect them , they unfortunately look to these worthless GPs like they are GODs !! So sad for the IGNORANCE
    of people of this country … And the complete DUMB ASS who writes this IGNORANT artical !

  • Mr Powell, you are very wrong. Patients in the UK can use any treatment they like, unless medicines in schedule 4 which require prescription by a registered medical practitioner.

    The question in this blog theme is the bad journalism demonstrated by the Times who reported on what some unethical doctors do. And the parallel theme of people who expect the NHS to pay for their whims.

    And Mr Powell, do please check your spelling.

  • The Times article, written by its Health Editor Chris Smyth, was, IMHO, shoddy journalism.

    Mr Smyth is wrong to imply that an increasing number of GPs are ‘turning to alternative medicine’. The ‘Faculty of Homeopathy’ has had about 400 members for about 15 years, probably mostly the same members.

    Dr da Costa, quoted by Mr Smyth, may well be frustrated, but she is wrong to suggest that is on account of “the conventional (medical) approach of matching a medicine to a symptom.” Conventionally, doctors diagnose and then treat ailments. Improvement of symptoms is a side-effect of treatment, not the principal aim.

    Dr da Costa is wrong to waste time ascertaining “which homeopathic remedy to prescribe”, because it makes no difference whatsoever which homeopathic remedy she prescribes – in terms of activity, they are all identical. As her researches have surely demonstrated to her.

    Dr da Costa is wrong to have understood her training to have been: “Really only to be interested in, ‘Do they need antibiotics or not.’ ” Re-training is indicated.

    Mr Smyth is wrong to suggest the BMJ Open study indicated anything about what doctors recommend about acupuncture. As the name on the tin clearly states – this study was open, and anyone could have contributed – some doctors, but also all the acupuncturists who wished and who were lobbied to do so.

    Doctors may well acquiesce in a patient having acupuncture, but not because they seriously believe the pricking of ‘meridians’ will have any effect, but because a consultation with an ‘acupuncturist’ helps get awkward patients off their hands, and the TLC may be beneficial. Mr Smyth is wrong to suggest such reference constitutes a ‘recommendation’.

    Mr Smyth is wrong to have quoted “Dr Michael Dixon, a GP who chairs the College of Medicine…”, without indicating Dr Dixon is self-appointed and the ‘College’ has been described in the BMJ as a ‘College of Quackery.’

    Mr Smyth is wrong to have quoted Dr Dixon asking: “Given the enormous areas of illness … where few conventional treatments have been shown to be particularly effective, so why not try alternatives…?”, without indicating which these areas of ‘effective treatment’ are, what the evidence for any benefit from their use is, and without pointing out that it is unethical to use ineffective treatments. If they are effective, they will be ‘medicine’. “Why not?” – because such practice is unethical.

    Mr Smyth is wrong to quote Dr Dixon saying: “Aromatherapy does work, but only if you believe in it”, without questioning why ‘belief’ is essential. Such an approach is faith healing.

    Mr Smyth does try to balance his article by quoting reputable doctors, but his motive for writing the article in the first place is obscure. Magic and time, along with auto-hypnosis do provide many patients with pleasurable placebo effects.
    But if patients are not told the consensus of medical opinion, they cannot give informed consent to treatment of any kind. Practitioners who fail to obtain informed consent are quacks. Mr Smyth is wrong not to be more critical of them and their practices.

  • Chris Smyth of The Times is at it again – inviting Michael Dixon to comment on the proposition that GPs are the new clergy.

    https://www.thetimes.co.uk/article/patients-expect-gps-to-heal-their-souls-as-the-church-s-role-declines-7ffhvd0dk

    Quoth Dixon, “We must acknowledge that people have a spiritual level and that’s important both in knowing where they’re coming from and also in terms of a solution…”

    Who exactly is making the proposition? According to Chris Smyth, family doctors themselves are. At least that is how he interprets Alistair Appleby.

    In a new BJGP Open publication Appleby et al. interviewed 19 Scottish GPs to “provide a detailed description of how GPs understand the concept of spirituality and apply this with patients.”

    http://bjgpopen.org/content/early/2018/04/03/bjgpopen18X101469#xref-ref-9-1

    A small bunch of Scottish GPs, provided their disparate thoughts, when prompted, on the subject of spirituality in the surgery. That is it.

    In their paper Appleby et al. state, “Previous research suggests most patients are interested in spiritual discussion…”
    The reference for this is Best M, Butow P, Olver I, (2015), Do patients want doctors to talk about spirituality? A systematic literature review.

    The published paper is behind a paywall but I found a pdf copy of the accepted manuscript with the following two statements about the studies included in their review:

    “Over half the studies (31/54) included patients with life-threatening or chronic diseases”

    “More than half the studies (30/38) addressing this question reported that a majority of patients thought it was appropriate for a doctor to enquire about R/S needs in at least some circumstances”.

    The question being “Do patients want their doctors to ask them about R/S?”
    R/S = religion/spirituality.

    Screened populations included general practice patients, hospital outpatients, acutely ill hospitalized patients, and patients with life-threatening illness.

    This doctors involved in the studied in this review were not primarily GPs. The lead author Megan Best works in palliative care.

    http://search.ror.unisa.edu.au/record/UNISA_ALMA51116769150001831/media/digital/open/9916007410501831/12142953860001831/13142953440001831/pdf

  • Smyth and The Times are presenting a false picture of General Practice in the UK. I don’t call “fake news”. I do call crappy journalism, uncritically and unwittingly publicising a looney fringe.

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