Alternative medicine is riddled with a multitude of serious ethical problems. In our recent book, we made an attempt to look at them systematically and critically (I am not aware of anyone having done this before). Essentially, we arrive at the conclusion that, for many types of alternative medicine, it is not possible to practise them according to fundamental demands of healthcare.
Homeopathy is one of them. I recently had a look at the CODE OF ETHICS of the UK Society of Homeopaths (last updated 2015). There I almost instantly stumbled over perhaps the most significant hurdle of practising homeopathy ethically. Here is what the SoH demands of its members:
1) To ensure that the patient is always able to make informed choices with regard to their healthcare, registered and student clinical members must give full and clear information about their services when commencing homeopathic treatment. This will include written information about the nature of the treatment, charges, availability for advice, confidentiality and security of records.
2) To ensure that the patient or their authorised representative is able to give valid consent with regard to healthcare, registered and student clinical members must give clear and sufficient information about the nature of homeopathic treatment, its scope and its limitations, before treatment begins and as appropriate during treatment…
The SoH is absolutely correct, full, sufficient and clear information before commencing treatment and consent to that treatment are two preconditions for any type of healthcare. However, the SoH is a bit shy about explaining what ‘full information’ must entail. As I have mentioned before, full and sufficient information must include:
- the diagnosis,
- its natural history,
- the most effective treatment options available,
- the proposed therapy,
- its effectiveness,
- its risks,
- its cost,
- a rough treatment plan.
So, let’s imagine a patient who suffers from stomach pains consulting his homeopath. Following the above 8 points, here is what she would need to tell him:
- I don’t know what your diagnosis is; I am not medically trained.
- I therefore can tell you nothing about its natural history.
- And nothing about the most effective treatment for your condition.
- I nevertheless propose to treat you with a homeopathic remedy.
- There is no good evidence that it will work beyond a placebo effect.
- The remedy is harmless, but not giving you an effective treatment might, of course, cause considerable harm.
- The cost of the consultation is £80, and the remedy will cost you around £15.
- I suggest you come again in a week or two; perhaps we need quite a few consultations altogether.
After hearing this, almost any patient would get up, thank the homeopath for the full information and look for a clinician who is able to offer an effective therapy. In other words, the SoH is inhibiting its members from practising homeopathy (alright, they don’t spell it out in such clear terms, but that is what full and sufficient information amounts to).
Why do they do that?
Because they have to!
Not supplying full and sufficient information would simply be unethical. And unethical healthcare cannot be tolerated.
It gets better or worse, depending on your prespective. Compliance with the Code of Ethics is a contractual requirement. The SoH’s Code of Ethics and Practice makes explicit mention of NOS –
“1.16 Practise in accordance with the Core Criteria for Homeopathic Practice and the Complementary and Natural Healthcare National Occupational Standards for Homeopathy.”
The National Occupational Standards make for very dull reading but can be found here http://www.hcpf.org.uk/wp-content/uploads/2016/03/NOS-Homeopathy-2012.pdf but there are some gems in there.
I know it is futile to tell Professor Ernst this as he has not managed to get this point for the entire duration that he has engaged in his critical assessments of homeopathy: the difference between ‘homeopath’ and medical doctor, and homeopath and homeopath pretending to be as if a medical doctor (‘clinical homeopathy’, ‘practical homeopathy’).
Professor Ernst has done a lot of work that highlights the lack of evidence of clinical homeopathy, but, as yet, has not even begun to critically assess homeopathy.
Any ‘homeopath’ that claims to provide specific treatments for particular medical conditions is not a homeopath, they should be a medical doctor. Now why is this so difficult for Professor Ernst to understand?
Indeed. Homeopaths are not interested in medical conditions, only in symptoms.
…and homeopathy doesn’t treat them either…
So if a patient has a large benign lump on their neck that means they are unable to move their neck the full normal range and they feel embarrassment, I assume the lump is the condition and the impaired range and embarrassment the symptoms. How would homeopathy seek to deal with these symptoms?
Everything would be so much simpler if homeopathy – all homeopathy – admitted that they base everything on the preconcieved ideas of their founder and that homeopathy is a scientific practice in the same way as religion. We could all stop spending time discussing the science-base and conclude that homeopathy has no ethical role to play in medicine. But somehow Greg, it seems all homeopaths works to protray the practice under a science-based shimmer – the nostrums are produced under GLP, papers in purportedly scientific journals are counted, and grants to performed warped clinical studies are applied for…
Just as we are often critisized for not knowing “true” homeopathy I still haven’t found a homeopath that is even willing to learn what science-based medicine or public health is about – so your argument Greg falls flat. I do hope you take the discussion to where it is best placed – within the homeopathic community! As long as the fundamental point – that homeopaths guess their treatments based on unsubstantiated ideas of disease as well as quality of remedies – you do not have a leg to stand on by shifting the blame to those who by your standards practice a flawed art of homeopathy. The difference between science-litteracy and homeopathy-litteracy is that the former is valid even outside the specific field of treating the ails of fellow humans subcommunities.
P-i-E, I have worked with pharmacists and they are knowledgeable people. Most of the ones I worked with had an interest in homeopathy (a curiosity rather than a belief, although one of them opened a full scale homeopathic dispensary within the pharmacy).
I’m not being offhand or ‘shifting blame’ to ‘flawed homeopathy’, as I can see that the critics don’t know homeopathy, and i can also see that some of those who practice/profess homeopathy have not studied the original writings of Hahnemann and Kent. It is not possible to be knowledgeable of the writings of these people, and write the nonsense that is written.
For many people for follow ‘homeopathy’, all they know is: ‘similia similibus curentur’, and hence no need to waste more time reading more! Just get going with it! This approach is complete nonsense, I’m sorry to say.
As for your comment on ‘science based medicine’: the majority of people who have medical illnesses need to use ‘scientific medicine’ to manage their condition; unfortunately, many of them go to homeopaths after years of being sick and hope to obtain relief or cure(!); and sadly this is not possible to give.
Sorry, P-i-E, your analysis is mistaken.
How do you know that “many of them go to homeopaths…….” – what is your evidence?
Stephen Hicks: Is that all you have for a response?
‘Many’ of the patients that go to A Homeopath have been sick for years. As far as I know, 99% of people don’t go paying £80 plus £15 (for remedies), if they are well so PRESUMABLY they are sick.
Your thinking ‘many’ is in terms of the total population of sick people, an incorrect inference. ‘Many’ of the total sick population never get to see a homeopath. It cannot be ‘many’ in the context that you mean it.
If you have anything regarding the actual debate: medicine’s failure to appropriate ‘homeopathy’ within clinical practice, please write it here. The writing is already on the wall though: but it is a failure that has not stopped Dana and Edzard from continuing to pretend that the debate is still ‘on’.
How much fun is this site Stephen?: ‘a LOT’.
There are well known voids in modern medicine’s ability to make everyone happy. Medicine steadily progresses towards narrowing them.
The correct question to ask is:
People may go to homeopaths but are they really helped? Where is the evidence for that?
What evidence is there for homeopathy being able to fill these voids with anything more than temporary soothing?
Sorry Greg – I don’t understand your ripost. There is no, absolutely no science-base in the writings of either Hahnemann nor Kent (yes – I’ve read them both), and if your argument that Ernst “not even begun to critically assess homeopathy” isn’t to be construed as an argument against “clinical” och “practical homeoepathy” – how should it be interpreted?
Greg – you used the term “many” – you define it otherwise your post is meaningless.
‘Many’: many millions of human beings have been poisoned by conventional medicine treatment of self-resolving ailments. They have literally had the poison shoved in their mouths.
Gosh darnit, Greg, I’ve had several conventional prescriptions from doctors over the years, but never anyone to offer literally to shove the poison in my mouth. Why am I not getting the proper service from the NHS?! Is this why I am not among the millions of dead you mention? I note also that pharmacists never seem to employ literal poison shovers, either. They just sell the poisons and leave you to swallow them on your own.
But now I think about it… On a few occasions I have had conventional doctors literally shove poisons directly into my veins. Maybe you should focus on injections to support your ‘literal’ points. Come to think of it, why don’t homeopaths inject their medicines? Is it because water’s not isotonic with blood?
Are homeopaths healthcare or disease care practitioners?
Speaking of poison…
Arsenic toxicity from homeopathic treatment.
Happens every day, unfortunately, and nobody keeps count…
please, do some research!
and much more, but those who have individual approach
Sorry Damir – we really do have different approaches to research…