King Charles’s doctor: If homeopathy helps patients, what’s the problem?

THE TIMES recently published an interview with (my ex-friend) Michael Dixon, a person who has featured regularly on this blog. Here is a short passage relevant to our many discussions about homeopathy:

“Can I say on the record I’ve never studied homeopathy,” he says. “I’ve never even offered homeopathy. What I have done is said that if patients feel they’ve benefited from homeopathy, what’s the problem?”

The problem, scientists would argue, is that homeopathy undermines trust in real, evidence-based medicine. Homeopathic remedies are made by diluting active ingredients in water, often so that none of the original substance remains. Homeopathy has been banned on the NHS since 2017, because it is “at best a placebo”.

For Dixon, however, this “trench warfare” divide between alternative and conventional medicine is too binary. Even if something is scientifically impossible, as long as it helps his patients that is all that matters, Dixon says. “Many years ago, a Christian faith healer started seeing some of my patients. She made a lot of them better. I didn’t care a damn if it’s placebo — they got better,” he says.

While he thinks homeopathy can serve a purpose on the NHS, he draws a line at the “madness of some of the more wayward complementary practitioners” who will argue for using homeopathy to vaccinate children. “I would always advocate against anyone going for complementary medicine if there’s good evidence-based conventional medicine.”

Apart from

• the hilarious implication that a faith healer is NOT  a “wayward practitioner”,
• the fact that, as far as I know, nobody ever claimed that Dixon studied homeopathy,
• the fact that Dixon does not understand what, according to scientists, the problems with homeopathy are,

his statements seem very empathetic at first glance.

Dixon’s key argument – if patients feel they’ve benefited from homeopathy, why not prescribe it – is an often-voiced notion. But that does not make it correct!

A physician’s duty is not primarily to please the patient. His/her duty foremost is to behave responsibly and to treat patients in the most effective way. And this includes, in a case where the patient feels to have benefitted from a useless or dangerous treatment, to inform the patient about the current best evidence. To me, this is obvious, to others, including Dixon, it seems not. Let me therefore ask you, the reader of these lines: what is the right way to act as a GP?

SCENARIO DIXON

Patient wants a treatment that is far from optimal and claims to have experienced benefit from it. The GP feels this is enough reason to prescribe it, despite plenty of evidence that shows the treatment in question has at best a placebo effect. Thus the doctor agrees to his/her patient taking homeopathy.

SCENARIO ERNST

Patient wants a treatment that is far from optimal and claims to have experienced benefit from it. The doctor takes some time to explain the the therapy is not effective and that, for the patient’s condition, there are treatments that would be better suited. The patient reluctantly agrees and the doctor prescribes a therapy that is backed by sound evidence (in case the patient resists, he/she is invited to see another doctor).

I admit that risking to lose a patient to another colleague is not an attractive prospect, particularly if the patient happens to be your King. But nobody ever said that medicine was easy – and it certainly is not a supermarket were customers can pick and choose as they please.

What do you think?