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

Guest post by Richard Rawlins

Ever since its inception, Homeopathy has struggled to establish principled medical ethics amongst its practitioners. For sure, Samuel Hahnemann was good doctor who achieved much by denying his patients the bleeding, emetics, expectorants, laxatives and poly-pharmacy conventional at the turn of the nineteenth century. But he then lost his way in spiritism and vitalism, devised a system of care which could not, and did not, provide any benefit beyond placebo responses, and inveigled many colleagues to share his delusion. Many derided him.

As medicine in all developed countries became better regulated, so the associated ethics became better focussed. “First do no harm” is common to all systems, but in the UK, the four ‘A’s of avoiding adultery with a patient, alcohol whilst in a clinical situation, advertising, and association formed the next domain. ‘Association’ meant having a professional medical relationship with anyone not also a GMC registrant. Times, and standards have changed, but quackery, charlatanism and health care fraud has always been unethical. The problem for society has been the GMC’s reluctance to take any action against its registrants who lack integrity, promote quackery, or seek to defraud. The general response has been “we only act on complaints by a patient, health authority or fellow registrant – and complaints have to be specific.”

So it is that about 400 registrants of the GMC continue practising homeopathy with impunity. Sir Simon Stevens has now all but banned homeopathy from the NHS, but a medically qualified practitioner, in the private sector can do as they please, no matter how vulnerable and gullible the patient.

Doctors are of course required to obtain fully informed consent to treatment, and that should mean advising patients that homeopathic remedies are but placebos. Many patients so treated will declare they “feel better” and are content – but in practice, no explanation is offered to patients attending homeopaths. A classic charlatonnade (a charade promulgated by a charlatan).

But perhaps the vicissitudes of Covid-19 is exposing the hypocrisy of the GMC’s position, and might yet enable some redress for patients seeking redress for unethical medically qualified homeopathic attention.

The Guardian and Sunday Times of 22nd March 2020 reported that Dr Mark Ali allegedly made £1.7M profit in one week from selling kits to test for COVID -19.

“The GMC said no doctor should try to ‘profit from the fear and uncertainly caused by the pandemic…We would be concerned to learn that doctors are exploiting patient’s vulnerability or lack of medical knowledge, in order to profit from fear and uncertainty…’ “

The rationale for that fear is surely irrelevant – any health practice which takes advantage of the patient’s vulnerability or lack of medical knowledge is unethical. Simple.

“We also expect doctors… not to offer or recommend tests that are unproven, clinically unverified or otherwise unreliable.”

This is in the context of the serious issues of SARS-CoV-2 (the name of the corona virus which causes the illness COVID-19) – but it is helpful that the GMC’s ethical principles have been clearly stated.

May we take it the GMC will be equally as stringent with their registrants (doctors) who take advantage of the patient’s vulnerability or lack of medical knowledge, and recommend tests such as homeopathic provings “that are unproven, clinically unverified or otherwise unreliable.”?

And if not, why not?

All homeopathic remedy prescriptions are ‘tests’: “Take this, see how you go, I’ll adjust if needed…”. The German word pruefung used by Hahnemann (meaning ‘testing’ or ‘examination’) has been translated into English as ‘proving’. But the word for ‘to prove’ is beweisen, and that is not the word Hahnemann used. The use of ‘proving’ in English implies merit which is not deserved. All part of the delusion.

Clearly, any doctor who recommends homeopathic remedies, but does not explain the conventional view of the remedy, lacks integrity and is unethical – by definition. If the doctor is GMC registered (which a ‘doctor’ does not have to be – e.g., dentists are not) – they should be subject to sanction by the GMC. The GMC should do its duty to protect the public, and not wait for a crisis to stir them into action.

Sadly, if practitioners are not GMC registered, caveat emptor.

23 Responses to Ethical homeopathy

  • Very insightful post, thank you.
    You make an intriguing point about quackery’s de facto ‘test’ role. The dependence of altmed on subjective, personal experience – ‘it works for her/him, try it and see if it works for you’ – is deeply unethical.
    We are already hearing accounts of individuals dosing themselves with anti-malarial medicines, and then declaring publicly that it has helped them avoid or recover from covid-19. This has been quite visible, partly because it has contributed to problems with the supply of these medicines. But one wonders: to what extent in social media, individuals’ accounts of their ‘successful’ personal ‘tests’ of homeopathy (etc) are circulating? Impossible to know – but to the extent that it’s happening (as surely it must be), harm is certainly being done.

    • Thank you Kevin.
      And that is the problem with SCAMs/camistry – the harm is insidious:
      Warping the mindset of those involved, detaching them from reality, powering up the Dunning Kreuger effect, giving scope to those who are complacent about their ethical responsibilities to act with integrity, or even conspire to take advantage of the gullible and vulnerable.

      ‘Alternative medicine’ is for alternative people.

      All we ask is for is the evidence on which practitioners base their opinions and advice.
      Implausible ‘evidence’; “It seems to me…”; “I just know…”:
      The red flags of a quack.
      Really rather nasty.

      I have the same opinion of crooks doing the three card monte or ‘Find the Lady’ card scam and swindle for other than entertainment purposes – as I can do!
      But health is not entertainment.

  • Since the unspeakable claim that homeopathy has no effect beyond the placebo effect has been proven to be wrong in this apodictic statement (homeopathy has exactly the “same bad” evidence as the so-called scientific medicine),

    https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2753.2007.00886.x

    all conclusions drawn from this which lead to an exclusion of of Homeopathy from CAM medicine (and discrediting to be understood as quackery) can only be explained by the uncertainty regarding the limited possibilities of conventional medicine concerning viral deseases (but in the IUC-unit thank god possibly life-saving ).
    “Little good data is available for the great flu epidemic in 1918, which was thought to have claimed just over 20 million lives worldwide. Statistics compiled by the American professor of materia-medica, Dewey, shows that the mortality rate in patients treated by homeopaths was relatively low. A study in Ohio on 24,000 patients who received conventional care showed a mortality rate of 28%. The mortality rate of the homeopathic patients was between 0.01 and 1.05% depending on the region.”
    If you think that in this threatening situation you still have to fight against ANY (!) POSSIBLE (!) ADDITIONAL (1) HELP (!), and can afford not to TRY EYERY OPPORTUNITY, you can only be classified as fogged by fear or suicidal. According to Darwin, it is not the intellectuals who survive, but the pragmatic and reasonable ones and those who are able to learn from the past! Good luck anyway for all of you!

      • “suggesting” for me personal seems more reasonable (see Darwin) than just waiting…..

      • I suspect, from the source cited and the usual use to which apologists for homeopathy put figures like this, that he also doesn’t appreciate the difference between a RCT and a systematic review.

    • Because of the “same bad evidence”, look at this:
      https://blog.psiram.com/2011/09/wieviel-medizin-ist-evidenzbasiert/

      When considering the epidemic, you are subject to the same misconception that guides you in individual cases: the post-hoc ergo-propter-hoc fallacy. One cannot simply assume, whether in an individual case or in the fight against an epidemic outbreak, that what happened “before” causes a particular “after”.

      Even the Leipzig cholera epidemic during Hahnemann’s lifetime is often cited as a “success” of homeopathic therapy. In fact, Hahnemann avoided forbidding his patients to drink and kept to hygiene – in contrast to the “allopaths” of the time. Thus it is obvious that homeopathic remedies most probably did not contribute to the higher survival rates of Hahnemann’s patients.

      And with trying out every possibility, that is also one of those things, even an ethical one. The patient will always have a tendency for that, that’s for sure. But he himself will hardly be able to decide with the necessary rationality whether he is not possibly doing himself further harm by trying out X. For a responsible physician, trying out every potentially conceivable possibility does not seem to me to be an ethically justifiable category. To tolerate things that are subjectively good for the patient in the case of an unfavorable prognosis is something completely different.

      Ceterum censeo in any case (unspeakable!): Homeopathy hasn’t any effect above placebo!

    • @Dr. Heinrich Hümmer

      I suggest for COVID-19 a cure I have found very effective for many other diseases. Precisely at midnight the patient must stand on one leg and repeat the phrase “Wacky-wacky-wacky” eleven times. (Why eleven times, I don’t know, but 10 and 12 don’t seem to work as effectively.)

      I look forward to your arguments why we can afford not to include my Wacky-wacky treatment as possibly beneficial for patients suffering from COVID-19. FYI, I agree that we can’t afford not to TRY EVERY OPPORTUNITY and I don’t think I’m fogged by fear or suicidal.

    • @hh: my son has taken to saying: “people are just so stupid”. Typically I correct him that clearly not every person is stupid and for him to utter such a phrase suggests that he doesn’t put himself in that camp. That being said after he read your blog entry he reiterated “people are just so stupid”. I suspect he’s on the mark this time.

  • In order to be able to use placebos sensibly, the administers themselves must be aware that they are placebos (an absolute prerequisite for “informed consent”). However, most homeopaths assume that homeopathy does not (only) have a placebo effect, but strongly advocate the use of specifically effective drug therapy.

    If one adds to this the “public reputation” of homeopathy, the widespread assumption that it is an effective drug therapy, one comes to the conclusion that no “informed consent” is possible in such a constellation. The distortions of perception on the part of both therapists and patients are simply too great.

    From which it follows that homeopathic treatment is systemically (!) unethical. In this respect it becomes a victim of its own so false reputation. And this in turn should be reason enough for the medical associations to take a “systemic” stand against homeopathy and not to retreat to the “nihil non nocere” in individual cases.

    Apart from the fact that the “nihil non nocere” is no longer contained in the Geneva vow in this form – for reasons. Unlike in ancient times, today the risks and benefits of a therapy can be weighed up and the “nihil non nocere” must also be given a different status from case to case.

  • The German word pruefung used by Hahnemann (meaning ‘testing’ or ‘examination’) has been translated into English as ‘proving’. But the word for ‘to prove’ is beweisen, and that is not the word Hahnemann used. The use of ‘proving’ in English implies merit which is not deserved.

    I am not a German speaker, but I suspect that the original translation was accurate. The verb “to prove” in English means to test or try out. These days it is more commonly understood to mean demonstrating or showing something to be the case, but the original meaning is still used:

    “The proof of the pudding is in the eating”
    “It proved to be true”
    “Nitro-proofed” (usually engraved on shotguns)
    “Alcohol 70 degrees proof” (here the test is to mix the solution with gunpowder – if it can still be ignited then the alcohol content is 100 degrees proof).

    A homeopathic proving is surely another example of this correct English usage.

    That is very different, of course, from being correct physiologically. The same distinction can be found in mathematics:

    O! O! another stroke! that makes the third.
    He stabs me to the heart against my wish.

    If that be so, thy state of health is poor;
    But thine arithmetic is quite correct.

    (A E Housman)

    • Julian and Steve: I agree “to prove” derives from probare and can mean “to test” (probably!), but homeopaths use the term with abandom in a more contemporary sense impling that the proof is indeed in the pudding – that the case is proven – has been tested and can be regarded as ‘true’.

      It is this use of ‘prooving’ to which I object.
      There is no reason the term ‘test’ or ‘experiment’ could not be used (in English), but look at the homeopathic articles, websites and commentators – they all suggest there has been or is ‘proof’ in the sense of veracity.
      They intend their audience to be misled.
      Why else use ‘proving’, ‘proof’?

      That usage lacks integrity and is unethical. QED. IMHO.

  • One small point, Richard: The words “proof/prove” still have a similar “test” usage in English. Bread-makers “prove” the dough, distillers may state the degree “proof” of their distillates (my favourite gin is 100 proof (50% ABV).

    • Julian and Steve:
      I agree “to prove” derives from probare and can mean “to test” (probably!), but homeopaths use the term with abandom in a more contemporary sense impling that the proof is indeed in the pudding – that the case is proven – has been tested and can be regarded as ‘true’.

      It is this use of ‘proving’ to which I object.
      A phony proof.
      There is no reason the term ‘test’ or ‘experiment’ could not be used (in English), but look at the homeopathic articles, websites and commentators – they all suggest there has been or is ‘proof’ in the sense of veracity.
      They intend their audience to be misled.
      Why else use ‘proving’, ‘proof’?

      That usage lacks integrity and is unethical. QED. IMHO.

      • a more contemporary sense impling that the proof is indeed in the pudding

        Sorry to be pedantic, but the meaning of this saying is that you can’t know the quality or effectiveness of something until you have tried it out. You test a pudding by eating it.

        • If you know the pudding to be cow dung, and the look and smell reinforces your suspicion, then why try it?

          Or, to be closer to the matter at hand, let’s say the proverbial pudding looks, smells and comes from the tap like water, then why expect it to be more than water? Why expect shaken water soaked sugar pills to be anything more than… that?

          Everything about homeopathy and its so called remedies tells us it is make-believe medicine. You can try it but you do not need to. If you try it and whatever ails you happens to get better, then you are just plain stupid if you think it was the homeoremedy that did the trick, just because it came before the change and some homeopathist says it.

  • I think it is DANGEROUSLY UNETHICAL to withhold ANY (!) POTENTIALLY (!) EFFECTIVE ADDITIONAL (!) therapy from a purely dogmatic stubbornness, especially under the given dramatic circumstances.
    This from a practical therapist und not from theorizing cynicism!
    People in the homeopathic clinics in New York 1918 did not ask, if their survival was evident!

    • “it is DANGEROUSLY UNETHICAL to withhold ANY (!) POTENTIALLY (!) EFFECTIVE ADDITIONAL (!) therapy from a purely dogmatic stubbornness”
      TRUE!
      BUT:
      1) Homeopathy is not potentially effective
      2) and the reasons to withhold it are neither dogmatic nor stubborn

    • Homeopathy never was, is or will be a potentially effective additional therapy. Three additional exclamation points will not change that either.

  • Here-here Richard. Totally agree with the article.

    The GMC should sharply distinguish its registered doctors from non-registered practitioners on the question of homeopathy. GMC doctors should tell patients that homeopathic “medicine” is not medicine. Homeopathy is a contradiction of basic science. Homeopathy is nonsense. GMC doctors who refuse to spell out these basic facts to their patients should not be GMC doctors.

    • Mmm. That didn’t look right and isn’t right.

      Should be “hear hear”.

    • Thank you Leigh.
      That’s all I ask.
      The GMC will not (and cannot) ban homeopathy, or stop doctors from fairy wrangling or searching for unicorn dung to add to their remedies – but it has set standards of integrity when it comes to obtaining informed consent, and should stringently require its registrants to apply them.

      And ‘informed consent’ requires a patient to be told all information reasonably relevant to assist their decision making.
      The advice that the former CMO Dame Sally Davies described homeopathy as “rubbish” and that the CEO of the NHS has all but banned the use of homeopathic remedies in the NHS on the grounds of lack of demonstrable efficacy, should be conveyed to the patient.
      If the patient disregards conventional opinion, so be it.

      NHS doctors can still use homeopathic remedies if the psychological state of the patient is such that denial of treatment they are already receiving would cause significant psychological trauma.
      Post Withdrawal Stress Disorder – PWSD.
      Or perhaps ‘Potential WSD’ is more accurate – as we would not want any particularly sensitive and distressed patient established on a homeopathic regime to suffer by withdrawing.
      Denying remedies to demanding new patients is a different matter.

  • unicorn dung

    Marketing opportunity for the cynically unethical here! A bit of pretentious Latinisation (in order to disguise what it actually is), allied to outlandish and unverifiable claims that have never been specifically falsified, and there are fortunes to be made from marketing Stercus Monocerotis.

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