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

My previous post was about the question whether lay-homeopaths can practise homeopathy without breaking their code of ethics. The answer was NO, because they lack most of the skills needed to obtain informed consent.

What about doctor homeopaths?

Can they practice homeopathy ethically?

Doctors are, of course, also obliged to follow their ethical code, and that means they too must obtain informed consent from their patients before starting a therapy. This is, for instance, what the UK General Medical Council tells their members:

You must give patients the information they want or need about:

  1. the diagnosis and prognosis
  2. any uncertainties about the diagnosis or prognosis, including options for further investigations
  3. options for treating or managing the condition, including the option not to treat
  4. the purpose of any proposed investigation or treatment and what it will involve
  5. the potential benefits, risks and burdens, and the likelihood of success, for each option; this should include information, if available, about whether the benefits or risks are affected by which organisation or doctor is chosen to provide care
  6. whether a proposed investigation or treatment is part of a research programme or is an innovative treatment designed specifically for their benefit4 
  7. the people who will be mainly responsible for and involved in their care, what their roles are, and to what extent students may be involved
  8. their right to refuse to take part in teaching or research
  9. their right to seek a second opinion
  10. any bills they will have to pay
  11. any conflicts of interest that you, or your organisation, may have
  12. any treatments that you believe have greater potential benefit for the patient than those you or your organisation can offer.

You should explore these matters with patients, listen to their concerns, ask for and respect their views, and encourage them to ask questions.

You should check whether patients have understood the information they have been given, and whether or not they would like more information before making a decision. You must make it clear that they can change their mind about a decision.

Following the 8 points from my previous post (I am trying to apply the same criteria to both types of homeopaths), a medical homeopath might tell her patient (whose stomach pain turns out to be caused, let’s assume, by a stomach ulcer) roughly this:

  1. The tests show that you are suffering from stomach ulcer.
  2. The natural history of this condition is usually benign, but it needs effective treatment; if not, the problem would become serious.
  3. Conventional medicine has several effective therapeutic options.
  4. I nevertheless propose to treat you with a homeopathic remedy.
  5. There is no good evidence that it will work beyond a placebo effect.
  6. The remedy is harmless, but not giving you an effective treatment might cause considerable harm.
  7. The cost of the consultation is £80, and the remedy will cost you around £15.
  8. I suggest you come again in a week or two; perhaps we need quite a few consultations altogether.

Again, as with the lay-homeopath from my previous post, any sensible patient would walk away without accepting the treatment. This means that our doctor homeopath can only practice homeopathy, if she does not inform her patient about points 5 and 6. In other words, doctors who practice homeopathy cannot obtain adequately informed consent. We have recently seen a real case of this happening and ending in the death of the patient.

Of course, the homeopath might send her patient to a specialist; or she might decide to administer a conventional therapy herself. Either way, she would not be practising homeopathy.

The dilemma is real, yet it is rarely considered. Here is a short passage from our book where we discuss the ethics of alternative medicine in full detail:

Genuine informed consent is unattainable for most CAM modalities. This presents a serious and intractable ethical problem for CAM practitioners. Attempts to square this circle by watering down or redefining the criteria for informed consent are ethically indefensible. The concept of informed consent and its centrality in medical ethics therefore renders most CAM practice unacceptable. Conventional healthcare subscribes to the ethical principle ‘no consent, no treatment’; we are not aware of the existence of any good reasons to excuse CAM from this dictum.

As I said, the ethical practice of homeopathy is a practical impossibility.

Or do you think I got this wrong?

15 Responses to Doctor homeopaths violate fundamental rules of ethics when practising homeopathy

  • The average American is prescribed 13 prescription drugs PER year…and this doesn’t count any of the over-the-counter drugs that their doctors have prescribed or that the patient takes on his/her own. Further, because many of us do not take ANY conventional drugs in most years, someone else is getting my 13 prescription drugs.

    In this light, doctors are being unethical by NOT prescribing homeopathic medicines because they are breaking one of the most important medical guidelines: “First, do no harm.”

    • very funny Dana!
      it amazes me again and again how resilient you seem to be for comprehending event the most basic principles of healthcare [I mean the one of risk versus benefit].

      • Please show me the studies that verify that patients taking, on average, 13 prescription drugs experience more benefit than risk.

        While you’re there, please show us all high quality randomized double-blind and placebo controlled trials on the thousands of surgeries performed regularly. If you cannot do so, then, I assume that you believe that surgery is quackery OR that there OTHER means by which good scientists can evaluate whether there are more benefits than risks other than randomized double-blind and placebo controlled trials.

        For the record, there are lots of studies published in high-impact conventional journals that verify the BENEFITS from homeopathic medicines:

        –Chronic obstructive pulmonary disease: Frass, M, Dielacher, C, Linkesch, M, et al. Influence of potassium dichromate on tracheal secretions in critically ill patients, Chest, March, 2005;127:936-941. The journal, Chest, is the official publication of the American College of Chest Physicians.

        — Hayfever: Reilly D, Taylor M, McSharry C, et al., Is homoeopathy a placebo response? controlled trial of homoeopathic potency, with pollen in hayfever as model,” Lancet, October 18, 1986, ii: 881-6.
        Asthma: Reilly, D, Taylor, M, Beattie, N, et al., “Is Evidence for Homoeopathy Reproducible?” Lancet, December 10, 1994, 344:1601-6.

        — Fibromyalgia: Bell IR, Lewis II DA, Brooks AJ, et al. Improved clinical status in fibromyalgia patients treated with individualized homeopathic remedies versus placebo, Rheumatology. 2004:1111-5. This journal is the official journal of the British Society of Rheumatology.

        –Fibromyalgia: Fisher P, Greenwood A, Huskisson EC, et al., “Effect of Homoeopathic Treatment on Fibrositis (Primary Fibromyalgia),” BMJ, 299(August 5, 1989):365-6.
        Childhood diarrhea: Jacobs, J, Jimenez, LM, Gloyd, SS, Treatment of Acute Childhood Diarrhea with Homeopathic Medicine: A Randomized Double-blind Controlled Study in Nicaragua, Pediatrics, May, 1994,93,5:719-25.

        ADD/ADHD: Frei, H, Everts R, von Ammon K, Kaufmann F, Walther D, Hsu-Schmitz SF, Collenberg M, Fuhrer K, Hassink R, Steinlin M, Thurneysen A. Homeopathic treatment of children with attention deficit hyperactivity disorder: a randomised, double blind, placebo controlled crossover trial. Eur J Pediatr., July 27,2005,164:758-767.

        • oh Dana!
          your old tricks again?
          I have not made a claim for which I need to show you evidence.
          I think most of us know all the studies that you mention.
          some of them are not nearly as rigorous as you seems to think.
          all of them lack independent replication.
          and the thing you like to forget most: the totality of the evidence fails to be positive.

          • But… but… but… Langmuir!!!!

          • The THREE studies by Jacobs had DIFFERENT homeopaths prescribing…and the first trial published in PEDIATRICS is recognized by ALL as being of the highest quality.

            As for LANGMUIR, that study used 3 different type of spectroscopy and found nanoparticles of each of the original SIX (!) medicinal agents…and several others have found similar results, even with HIGHER potencies.

            I love the way skeptics of homeopathy spin mis-information about this trial…published in a high-impact journal published by the American Chemistry Society. Now, anyone who says that there is “nothing” in homeopathic medicines are simply misinformed or are lying (or both). Many skeptics are experts at this…

          • thank you for mentioning LANGMUIR!!!
            such an important one!!!!
            pity that these studies lack independent confirmation;
            pity that the totality of the evidence is still not positive;
            pity that you keep forgetting these points.

          • Dana Ullman said:

            The THREE studies by Jacobs had DIFFERENT homeopaths prescribing…and the first trial published in PEDIATRICS is recognized by ALL as being of the highest quality.

            Do please tell us all about these three trials by Jacobs and exactly who recognises them as being ‘of the highest quality, Dana, and why!

        • They don’t verify any benefit. They fit your preconceived ideas, you wouldn’t have cited them here otherwise. You don’t live in reality if you don’t consider the entire body of evidence.

          Let me give an example of how homeopathy writings usually divert from important details. Take, for example, this text, which is:
          Homeopathic Oscillococcinum® for preventing and treating influenza and influenza-like illness.

          A small excerpt of the text somewhere in the first few paragraphs goes as such:

          How the intervention might work:

          A 200K potency is so dilute that a typical dose is unlikely to contain any molecules of the starting material (Kayne 2006). The use of high dilutions, including ‘ultra-molecular’ dilutions such as 200K, is the reason that homeopathy is sometimes viewed as implausible.

          Nevertheless, there is some evidence from in vitro biological models that ultra-molecular homeopathic dilutions elicit physiological effects. A total of some 1500 experiments have been reported (Clausen 2011). In a systematic review of in vitro biological experiments with ultra-molecular dilutions, 73% showed biological effects; many of the experiments were of high quality (Witt 2007). Seventy-three per cent of replication experiments were positive, though no positive experimental result was stable enough to be reproduced by all research groups.

          The cited paper of [Witt (et al.), 2007] is this and can be found here. Beside the terrifically optimistic result analysis, upon consulting the detailed gathered information, after scoring, which is Table 3 in the document (pp. 131-132) it is clear that 49 out of 67 experiments were positive. However, bypassing the “modified” scoring system termed SAPEH (Score for Assessment of Physical Experiments in Homeopathy… an inside joke, apparently), and taking into account two extremely important aspects, namely randomization and blinding, which, in my frank opinion should be weighed a bit more than some of the other criteria in terms of points, it is painfully obvious that, only 10 experiments were both randomized and blinded.

          It is trivial to count them from the Table and note that, of those 10, 6 were positive and 4 negative. That’s hardly convincing evidence to base a positive conclusion on, with respect to effects of homeopathic preparations in vitro.

        • Dana

          Please show us the high-quality RCTs which demonstrate the benefit of parachutes for people jumping out of aeroplanes.

          Oh. You can’t.

          Why do you think this might be?

          Now go back and think about surgery again.

  • Please could Dana Ullman provide the evidence that supports his claim regarding the average number of drugs prescribed to Americans each year? Could he also clearly distinguish between those given for a fixed or short term to treat a condition (e.g. antibiotics) as opposed to those given for life-long problems (e,g, antihypertensive drugs). As for his ludicrous claims regarding the published evidence for homeopathy, once again he simply embarrasses himself by failing to understand that publication is only one part of deciding whether a treatment has been shown to be effective. Critical appraisal should be a core skill of someone with a Master of Public Health degree, but a skill he has consistently either failed to,demonstrate or has demonstrated that he lacks that skill.
    In the meantime, would some kind person please purchase a box of straws for him, as he clearly needs something to clutch at?

  • Any volunteers for the study of whether appendectomy is helpful for acute appendicitis? Will be double-blind, control group gets the incision only.

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