homeopathy
The ‘Deutsche Apotheker Zeitung’, a paper for German pharmacists, rarely is the most humorous of publications. However, recently they reported on a battle between the EU and the European producers of homeopathic remedies – a battle over mercury which has, I think, hints of Monty Python and the Flying Circus.
The EU already has strict regulations on the use of mercury, for obvious reasons, they apply particularly to medicines. The law in this area is now 8 years old and is about to be replaced by a new one which is even stricter. A draft has been recently published here.
The new law would prohibit all mercury in medicinal products, except for some used in dentistry. For the homeopathic and anthroposophic manufacturers, this is not good news because they have many remedies on the market that have the word ‘mercury’ on the label. Consequently, they fear that the sale of these products might be impeded or even become impossible in the EU.
„Quecksilber und Quecksilberverbindungen stellen für manche homöopathische und andere traditionelle Arzneimittel einen unverzichtbaren Bestandteil dar“ (Mercury and mercury compounds are an essential ingredient of some homeopathic and other traditional medicines) .. “Es steht keine Quecksilber-freie Alternative zur Verfügung, die als aktiver Bestandteil in der Therapie mit homöopathischen oder anderen traditionellen Arzneimitteln verwendet werden könnte“ (There is no mercury-free alternative that could be used in these medications”) wrote the Dachverband der Arzneimittelhersteller im Bereich der Selbstmedikation (AESGP) (a lobby group of the homeopathic manufacturers) in a comment adding that „Diese Produkte sind seit Dekaden auf dem europäischen Markt und gehören zum Arzneimittel-Werkzeugkoffer” (these products are on the market since decades and belong to the medical tool-kit)… and that these products contain merely tiny amounts of mercury – even the largest manufacturers of these remedies only require a few milligrams for their production.
The plea of the manufacturers therefore is for an exemption from the new law which would allow the trade of mercury-containing remedies in future. They even have the support of some health politicians; for instance Peter Liese CDU favours an exemption for homeopathic medicines. The next meeting of the EU committee on public health will vote on the matter.
Personally, I can imagine the following dialogue between the EU officials (EU) and the lobbyists of the homeopathic industry (LOHI):
EU: We are very sorry but, because of the toxicity of mercury, we will not allow any of it in medicines.
LOHI: But we have always used it and nobody has come to harm.
EU: We don’t know that, and we have to be strict.
LOHI: We appreciate your concern, but we use only very, very tiny amounts; they cannot cause harm.
EU: The law is the law!
LOHI: Actually, the vast majority of our products are so dilute that they do not contain a single molecule of the ingredient on the bottle.
EU: That’s interesting! In this case, they are not medicines and we will have to ban them.
LOHI: NO, no, no – you don’t understand. We potentise our medicines; this means that the ingredient that they no longer contain gets more and more powerful.
EU: Are you sure?
LOHI: Absolutely!
EU: In this case, we will ban not just your mercury products but all your phony remedies. Because either science is right and they are fraudulent, or you are correct and they are dangerous.
If you are free on 17 – 19 November, why not pop over to Vienna and attend the European Congress for Homeopathy? The programme looks exciting (and full of humour); here are eight of my favourite lectures:
- R G Hahn ‘Homeopathy from a scientific and sceptic point of view’
- L Ellinger ‘Homeopathy as a replacement of antibiotics and in epidemics’
- T Farrington ‘Homeopathic treatment of farm animals’
- M M Montoya ‘Evidence based medicine in veterinary homeopathy’
- S Kruse ‘Homeopathy in neonatology’
- J Wurster ‘Homeopathic treatment and healing of cancer’
- P Knafl ‘The homeopathic treatment of cancer in cats and dogs’
- E Scherr ‘The homeopathic treatment of cancer in horses’
Other presenters at this meeting include two members of my ALT MED HALL OF FAME: Dr Fisher and Prof Frass. Their contributions alone would make the journey to Vienna a memorable event, I am sure.
And why are the presentations selected above amongst my favourites?
I am glad you asked! Here are some of my reasons:
- Prof Hahn as been mentioned on this blog before. He published what some homeopaths consider a biting criticism of one of my papers. I find his arguments utterly bonkers and I tried to explain this here. In the comments section of this post, one commentator wrote: “Dr. Hahn has an interesting take on the relationship of reason and science. Perhaps the best illustration of his confused views is illustrated in a comment-dialog (in english) following a blog post by Michael Eriksson, a Swedish computer scientist living in Germany. There, the two exchange views on this matter: https://michaeleriksson.wordpress.com/2011/01/16/science-and-reason/
The following quote from Dr. Hahn’s comments in this thread I find illustrative:The question is – should we believe in scientific data or should we believe is them only if you can accept them by reason? I claim that you should trust the data, in particular if “reason” is provided by a complete outsider. The risk is very great that reason provided by an outsider is completely wrong.
Dr. Hahn reveals his denial of homeopathy’s implausibility and motivates this view by rejecting reason itself. He seems to be totally blind to the meaning of the term “reason” and presumably therefore blind to his own lack of it.
As I said, quite a curious case. Perhaps a variant of the Nobel disease?”END OF QUOTE
These considerations render the title of Hahn’s lecture more than a little humorous, in my view.
- Homeopathy as a preplacement of antibiotics could to be a special type of very dark humour. If anyone really did implement such a strategy, there would be millions of fatalities worldwide within just a few months.
- Homeopathy for animals has also been debated on this blog before. The long and short of it is that there is no good evidence that it works.
- What follows for ‘evidence-based veterinary homeopathy is simple: it is a contradiction in terms.
- Homeopathy for children is not much different; in fact, it is worse: arguably, this is child abuse.
- The last there of my selected lectures are all on cancer, a subject that we too on this blog are familiar with (see here, here, here, here and here, for instance). Where does the homeopathic obsession with cancer cone from? Have homeopaths somehow decided that, as they are so very useless at curing trivial conditions, they must now go for the life-threatening diseases?
In any case, this conference promises to be a hilarious event – full of comedy gold, hubris, and wishful thinking. I think it’s a ‘must event’ for sceptics – so hurry and book soon!
The Subject of the German ‘Heilpraktiker’ has recently been the topic of one of my blog-posts. In Germany, it has been a taboo for decades, but now the ‘Frankfurter Allgemeine Zeitung’ (FAZ) have courageously addressed the problem. In today’s article, the FAZ reports that, Josef Hecken, the chair of the an organisation called ‘Selbstverwaltung im Gesundheitswesen’ (self-administration in healthcare), demands that “health-insurers should be forbidden to pay for treatments that are not supported by evidence.” Hecken, is also the chair of the Gemeinsamen Bundesausschusses, an umbrella organisation of doctors, insurers and hospitals which determines which services are paid for and which not. He stated that even paying for homeopathy out of your own pocket when treating diseases like cancer must be forbidden and stressed that “this is not about well-being but human lives.”
Hecken’s views are partly supported by Rudolf Henke, the chair of both a German doctor’s union and of the Marburger Bund, a union of hospitals: “the regulations regarding the Heilpraktiker have to be re-considered entirely… I do not believe it to be acceptable that Heilpraktiker are able to treat cancer patients.”
These remarks relate to the deaths that recently occurred in a clinic led by a Heilpraktiker. About two thirds of all German health insurers seem to pay for consultations with a Heilpraktiker. Vis a vis the fact that most of their treatments are not evidence-based, this situation seems intolerable and deeply unethical.
Hecken’s stance seems clear, rational and, in view of the popularity of homeopathy in Germany, even courageous: “The government should charge the ‘Gemeinsamen Bundesausschuss’ or another organisation with the task of conducting a meta-analysis on the evidence of homeopathy and then draw the appropriate conclusions… We have reached a point where we need a public discussion, and I am prepared to take the flack.”
On the website of THE CENTRE FOR HOMEOPATHIC EDUCATION (CHE), an organisation which claims to operate ‘in partnership with’ the MIDDLESEX UNIVERSITY LONDON, we find the most amazing promotion of quackery. Under the title of ’10 Top Homeopathic Remedies for your First Aid Kit’ they state that “we wanted to give you some top tips to put together your own remedy kit to use in first-aid situations for yourself, friends and family.”
Yes, you did read correctly: apparently, the Middlesex University is supporting a homeopathic ‘first aid’ kit. You find this unbelievable? You are not alone!
The remedies they recommend would be ideal in the 30c potency for everyday use, they claim. Here are a few of the high-lighted remedies, together with their ‘indications’:
ACONITE This remedy is great for shock…
ARNICA This is the classic remedy for trauma… The typical arnica patient will tell you that they’re fine and avoid attention, but may well still be in shock…
ARSENICUM This is your go-to remedy for food-poisoning…
BELLADONNA …This is a great remedy for fever, sunstroke, and for a skin condition such as boils.
HEPAR SULPH Very painful and infected wounds and abscesses respond well to this remedy.
RHUS TOX …used to treat skin rashes like chicken pox and shingles.
There are many more remedies to choose from, but hopefully this will give you a good little starter kit. Also it is possible to buy a comprehensive homeopathic first-aid kit from any of the reputable homeopathic suppliers. These kits will come with instructions on how to use the remedies too.
END OF 1st QUOTE
The CHE run all sorts of courses. It’s a shame that we all missed the recent lecture Evidence based homeopathy – with Dana Ullman. But if you are in London, you might want to attend on 7/9/2016 entitled Homeopathy, Detox and Cancer – with Dr Robin Murphy ND. It will cover subjects like these:
- The Cancer Diseases – the cancer disease is an umbrella term for a range of conditions which primarily affects the cells and immune system first.There are many causes of this condition such as emotional shocks, toxins, drugs, trauma, radiation and severe stress, etc. In some cases the cause is genetic or not known. Aging is another factor in the development and treatment of the cancer diseases.
- Homeopathic remedies: Cancer remedies, cancer pains, chemotherapy and radiation side effects, socks, trauma, sleep, surgery, remedies for prevention and recovery.
- Detox therapy: Detox principles and methods, heavy metals, chemo drugs, radiation, chemicals, etc. Detox diet, superfoods, herbal tonics and natural remedies.
END OF 2nd QUOTE
Yes, not just first aid but also cancer! This is sensational (or is the term scandalous better suited?) ! Cancer, they claim, can be caused by emotional shock (they do seem to like this term!) and there are homeopathic cancer remedies (the English cancer act prohibits claims, I think). This course must be a bargain at just £30! Perhaps some London sceptics should attend?
It would be ever so easy to make fun at this – but let’s try to keep a straight face because, in fact, this is not funny at all. It seems clear to me that it would be possible to kill quite a few emergency patients following the instructions of the homeopathic first aid kit, and one would most likely hasten the death of many cancer patients following Murphy’s cancer course.
Why is the Middlesex University a ‘partner’ in such monstrosities? Presumably they get some money for it, and officials would probably claim that their ‘partnership’ does not amount to an endorsement of such dangerous quackery (interestingly, when I searched their site for ‘homeopathy’, I got “no results found”). Yet they must be aware that they are lending credibility to indefensible charlatanry and thereby risking their own reputation.
If I were the Vice Chancellor of Middlesex, I would quickly sever all links to THE CENTRE FOR HOMEOPATHIC EDUCATION and publish an apology for having been involved in such mind-boggling quackery.
Dengue is a viral infection spread by mosquitoes; it is common in many parts of the world. The symptoms include fever, headache, muscle/joint pain and a red rash. The infection is usually mild and lasts about a week. In rare cases it can be more serious and even life threatening. There’s no specific treatment – except for homeopathy; at least this is what many homeopaths want us to believe.
And, of course, we don’t want to listen to just any odd homeopath, we want true experts to tell us the truth – for instance, experts like Dr. R.K. Manchanda, Deputy Director(Homoeopathy), Directorate of ISM & Homoeopathy, Govt. of NCT of Delhi and Dr. Surinder Verma, Assistant Director (Homoeopathy), Directorate of ISM & Homoeopathy, Govt. of NCT of Delhi. They authored an article which states the following:
There are about 25 homoeopathic drugs available for the treatment of dengue fever. These are Aconite., Arnica, Arsenic-alb., Arum-tri., Baptisia., Belladonna., Bryonia., Cantharis., China officinalis Colocynthis., Eupatorium perfoliatum., Ferrum metallicum., Gelsemium., Hamamelis., Ipecac., Lachesis, Merc-sol, Nux vomica., Podophyllum., Rhus toxicodendron., Rhus-venenata., Sanicula., Secale cornutum and Sul-acidum. These drugs had been successfully used by various homeopaths across the globe for its treatment and management. In 1996 during the epidemic of dengue in Delhi Eupatorium perfoliatum was found most effective.
Sadly, the article does not provide any evidence. A quick Medline search located one (!) single trial on the subject. Here is the abstract:
A double-blind, placebo-controlled randomized trial of a homeopathic combination medication for dengue fever was carried out in municipal health clinics in Honduras. Sixty patients who met the case definition of dengue (fever plus two ancillary symptoms) were randomized to receive the homeopathic medication or placebo for 1 week, along with standard conventional analgesic treatment for dengue. The results showed no difference in outcomes between the two groups, including the number of days of fever and pain as well as analgesic use and complication rates. Only three subjects had laboratory confirmed dengue. An interesting sinusoidal curve in reported pain scores was seen in the verum group that might suggest a homeopathic aggravation or a proving. The small sample size makes conclusions difficult, but the results of this study do not suggest that this combination homeopathic remedy is effective for the symptoms that are characteristic of dengue fever.
This is a 2007 study by a well-known US homeopath. Its results fail to confirm that homeopathy is effective for Dengue. So, surely the homeopathic community has since stopped claiming that homeopathy is an option for this infection!
No, you guessed correctly, they continue claiming that homeopathy works for Dengue. Currently, there are about half a million websites doing exactly that. An example is this article published YESTERDAY (!):
Alopathy is no more the only solution for Dengue these days. Especially in a place like Bengaluru where doctors and medicines are both expensive, residents have now turned to a cheaper and an effective alternative-Homeopathy to combat Dengue.People have been milling Homeopathy clinics and hospitals for an antidote. Dr Sudhir Babu of Javaji Advanced Homeopathy said, “People ask for some cure to keep the disease at bay. We do in fact have medicines to help build immunity against the ailment.”The dosage is for four or five days and is taken daily. Homeopathy has now become a trusted alternative in the field of medicine, especially because of its easy acceptibility among children and adults. According to a survey by IMRB, 100% people know about this form of medicine and 92% perceive it as a reputed form of treatment. The medicines that are administered depending on the symmptoms of Dengue Fever are Aconitum Napellus, Arsenicum Album, Belladonna, Bryonia Alba, Cantharis, Cinchona Officinalis, Eupatorium Perfoliatum, Gelsemium, Ipecacuanha, Nux Vomica, Rhus Toxicodendron and Rhus Venenata.
What I found particularly impressive here is the way popularity has been used to replace evidence. This, I think, begs several questions:
- How long will homeopaths continue treating self-limiting conditions to claim success based no nothing but their natural history?
- How long will they continue to lie to the public?
- How long will they refuse to learn from the evidence?
- How long will they ignore even the most fundamental rules of medical ethics?
- How long will we let them get away with all this?
When a leading paper like the FRANKFURTER ALLGEMEINE ZEITUNG (FAZ) publishes in its science pages (!!!) a long article on homeopathy, this is bound to raise some eyebrows, particularly when the article in question was written by the chair of the German Association of Homeopaths (Deutscher Zentralverein homöopathischer Ärzte) and turns out to be a completely one-sided and misleading white-wash of homeopathy. The article (entitled DIE ZEIT DES GEGENEINANDERS IST VORBEI which roughly translates into THE DAYS OF FIGHTING ARE OVER) is in German, of course, so I will translate the conclusions for you here:
The critics [of homeopathy] … view the current insights of conventional pharmacology as some type of dogma. For them it is unthinkable that a high potency can cause a self-regulatory and thus healing effect on a sick person. Homeopathic doctors are in their eyes “liars”. Based on this single argument, the critics affirm further that therefore no positive studies can exist which prove the efficacy of homeopathy beyond placebo. After all, high potencies “contain nothing”. The big success of homeopathy is a sore point for them, because efficacious high potencies contradict their seemingly rational-materialistic world view. Research into homeopathy should be stopped, the critics say. This tune is played unisono today by critics who formerly claimed that homeopaths block the research into their therapy. The fact is: homeopathic doctors are today in favour of research, even with their own funds, whenever possible. Critics meanwhile demand a ban.
In the final analysis, homeopathic doctors do not want a fight but a co-operation of the methods. Homeopathy creates new therapeutic options for the management of acute to serious chronic diseases. In this, homeopathy is self-evidently not a panacea: the physician decides with every patient individually, whether homeopathy is to be employed as an alternative, as an adjunct, or not at all. Conventional diagnostic techniques are always part of the therapy.
END OF QUOTE
[For those readers who read German, here is the German original:Die Kritiker … betrachten die heutigen Erkenntnisse der konventionellen Pharmakologie als eine Art Dogma. Für sie ist es undenkbar, dass eine Hochpotenz einen selbstregulativen und damit heilenden Effekt bei einem kranken Menschen auslösen kann. Homöopathische Ärzte sind in ihren Augen “Lügner”. Von diesem einen Argument ausgehend, wird dann weiter behauptet, dass es deshalb gar keine positiven Studien geben könne, die eine Wirksamkeit der Homöopathie über einen Placebo-Effekt hinaus belegen. Schließlich sei in Hochpotenzen “nichts drin”. Der große Erfolg der Homöopathie ist ihnen ein Dorn im Auge, weil wirksame Hochpotenzen ihrem vermeintlich rational-materialistischen Weltbild widersprechen. Die Erforschung der Homöopathie solle gestoppt werden, heißt es. Unisono wird diese Melodie von Kritikern heute gespielt, von ebenjenen Kritikern, die früher behaupteten, die homöopathischen Ärzte sperrten sich gegen die Erforschung ihrer Heilmethode. Fakt ist: Heute setzen sich homöopathische Ärzte für die Forschung ein, auch mit eigenen Mitteln, soweit es ihnen möglich ist. Kritiker fordern mittlerweile das Verbot.
Letztlich geht es homöopathischen Ärzten allerdings nicht um ein Gegeneinander, sondern um ein Miteinander der Methoden. Durch die Homöopathie entstehen neue Therapieoptionen bei der Behandlung von akuten bis hin zu schweren chronischen Erkrankungen. Dabei ist die ärztliche Homöopathie selbstverständlich kein Allheilmittel: Bei jedem erkrankten Patienten entscheidet der Arzt individuell, ob er die Homöopathie alternativ oder ergänzend zur konventionellen Medizin einsetzt – oder eben gar nicht. Die konventionelle Diagnostik ist stets Teil der Behandlung.]
While translating this short text, I had to smile; here are some of the reasons why:
- ‘conventional pharmacology’ is a funny term; do homeopaths think that there also is an unconventional pharmacology?
- ‘dogma’… who is dogmatic, conventional medicine which changes almost every month, or homeopathy which has remained essentially unchanged since 200 years?
- ‘liars’ – yes, that’s a correct term for people who use untruths for promoting their business!
- ‘Based on this single argument’… oh, I know quite a few more!
- ‘doctors are today in favour of research’ – I have recently blogged about the research activity of homeopaths.
- ‘co-operation of the methods’ – I have also blogged repeatedly about the dangerous nonsense of ‘integrative medicine’ and called it ‘one of the most colossal deceptions of healthcare today’. Hahnemann would have ex-communicated the author for this suggestion, he called homeopaths who combined the two methods ‘traitors’!!!
- ‘new therapeutic options’… neither new nor therapeutic, I would counter; to be accepted as ‘therapeutic’, one would need a solid proof of efficacy.
- ’employed as an alternative’ – would this be ethical?
- ‘Conventional diagnostic techniques are always part of the therapy’… really? I was taught that diagnosis and treatment are two separate things.
There were many comments by readers of the FAZ. Their vast majority expressed bewilderment at the idea that the chair of the German Association of Homeopaths has been given such a platform to dangerously mislead the public. I have to say that I fully agree with this view: the promotion of bogus treatments can only be a disservice to public health.
This is a post that I wanted to write for a while (I had done something similar on acupuncture moths ago); but I had to wait, and wait, and wait…until finally there were the awaited 100 Medline listed articles on homeopathy with a publication date of 2016. It took until the beginning of August to reach the 100 mark. To put this into perspective with other areas of alternative medicine, let me give you the figures for 3 other therapies:
- there are currently 1 413 articles from 2016 on herbal medicine;
- 875 on acupuncture;
- and 256 on chiropractic.
And to give you a flavour of the research activity in some areas of conventional medicine:
- there are currently almost 100 000 articles from 2016 on surgery;
- 1 410 on statins;
- and 33 033 on psychotherapy.
This suggests quite strongly, I think, that the research activity in homeopathy is relatively low (to put it mildly).
So, what do the first 100 Medline articles on homeopathy cover? Here are some of the findings of my mini-survey:
- there were 4 RCTs;
- 3 systematic reviews;
- 8 papers on observational-type data (case series, observational studies etc.);
- 9 animal studies;
- 14 other pre-clinical or basic research studies;
- 1 pilot study;
- 14 investigations of the quality of homeopathic preparations;
- 15 surveys;
- 2 investigations into the adverse effects of homeopathic treatments;
- 49 other papers (e. g. comments, opinion pieces, letters, perspective articles, editorials).
I should mention that, because I assessed 100 papers, the above numbers can be read both as absolute as well as percentage figures.
How should we interpret my findings?
As with my previous evaluation, I must caution not to draw generalizable conclusions from them. What follows should therefore be taken with a pinch of salt (or two):
- The research activity into homeopathy is currently very subdued.
- Arguably the main research question of efficacy does not seem to concern researchers of homeopathy all that much.
- There is an almost irritating abundance of papers that are data-free and thrive on opinion (my category of ‘other papers’).
- Given all this, I find it hard to imagine that this area of investigation is going to generate much relevant new knowledge or clinical progress.
Yes, I admit it: over the years, I had formed a vague impression that homeopaths lack humour. Certainly, many comments on this blog seemed to confirm the notion. But now I changed my mind: some homeopaths are intensely funny.
Yesterday, I found a tweet which read: “NCH and homeopathy to be highlighted at the 2016 American Public Health Association’s conference in Denver”. The tweet provided a link which took me to an abstract authored by Alison Teitelbaum from the US National Center for Homeopathy (on their website, this organization tell us that they “inform legislators and work to secure homeopathy’s place in the U.S health care system while working to ensure that homeopathy is accurately represented in the media”).
The abstract in question summarized a presentation for the up-coming APHA-meeting in Denver. It is so hilariously comical that I simply have to share it with you (for those readers are homeopaths, I have added [in square brackets] a few footnotes explaining the humorous side of it):
Background: Over the last 25 years there has been a marked increase in consumer demand for information about complimentary [1] and alternative medicine, including homeopathy. Anecdotal data [2] suggest that homeopathic consumers are very satisfied with homeopathic medicines, and use them to treat acute, self-limiting conditions, however very little data exists in the published literature examining either topic [3]. Therefore, the purpose of this project was to evaluate homeopathic consumers’ use and satisfaction with homeopathic medicines.
Methods: Survey of nearly 20,000 consumers [4] who had purchased at least 1 over-the-counter (OTC) homeopathic medicine in the past 2 years.
Results: [5] More than 95% of respondents indicated they were very or extremely satisfied with the most recent OTC homeopathic medicine they had purchased and used [6]. More than 96% of respondents indicated they were very or extremely satisfied with the results of OTC homeopathic medicines that they had used in general [7]. Over 98% of respondents reported that they were very likely to purchase OTC homeopathic medicines again in the future [8]. More than 97% of respondents indicated that they were very likely to recommend homeopathic medicines to others [9]. Finally, more than 80% of respondents indicated using OTC homeopathic medicines for acute, self-limiting conditions, such as aches and pains; cold and flu symptoms; and digestive upset [10].
Conclusion: These results support anecdotal evidence [11] that homeopathic consumers are satisfied with OTC homeopathic medicines [12], and are using them to treat acute, self-limiting conditions [13]. Additional research is needed to further explore the use of OTC homeopathic medicine in the US for trends, access, and overall awareness about homeopathy [14].
[1] complimentary medicine = healthcare that costs nothing; complementary medicine = healthcare that complements real medicine; homeopathy should belong to the former category because it contains nothing. [2] please note how ‘anecdotal data’ becomes ‘anecdotal evidence’ by the time we reach the conclusion; little does the author know that THE PLURAL OF ANECDOTE IS NOT ‘DATA’ BUT ‘ANECDOTES’!!! [3] this statement implies that the author cannot cope with a Medline search, because there are plenty of articles on this subject. [4] ‘nearly 20 000’ perfectly reflects the scientific rigor of this project (is it really too demanding to provide the exact figure?) [5] how come we do not learn anything about the response rate of this survey (did ‘nearly’ everyone reply? or did ‘nearly’ everyone not reply?)? [6] considering that only homeopathy-fans were included, this figure should be 100%! [7] considering that only homeopathy-fans were included, this figure should be 100%! [8] considering that only homeopathy-fans were included, this figure should be 100%! [9] considering that only homeopathy-fans were included, this figure should be 100%! [10] ‘more than 80%’ of an unknown rate of responders is about as much as a tin of peas. But I am nevertheless relieved that the majority used placebos merely for self-limiting conditions; the 20% who might have used it for life-threatening conditions are probably all dead – sad! [11] see footnote number 2 [12] this is like doing a survey in a hamburger joint concluding that all consumers love to eat hamburgers. [13] except, of course, the unknown percentage of non-responders who might all be dead. [14] I would re-phrase this last sentence as follows: MORE SUCH PRESENTATIONS ARE NEEDED TO PROVIDE COMIC RELIEF TO OTHERWISE DRY AND BORING MEETINGS ON PUBLIC HEALTH.Informed consent is a basic ethical principle and a precondition for any medical or surgical procedure (e. g. a therapeutic intervention or a diagnostic test). Essentially, there are 4 facets of informed consent:
- the patient must have decision-making capacity,
- the patient’s decision must be free from coercion or manipulation,
- all relevant information must be disclosed to the patient,
- the patient must not merely be told but must understand what he/she has been told.
It seems to me that points 1, 2 and 4 are more or less the same in alternative as in conventional medicine. Point 3, however, has fundamentally different implications in the two types of healthcare.
What is meant by ‘all relevant information’? There seems to be general agreement that this should include the following elements:
- the indication,
- the nature of the procedure,
- its potential benefits,
- its risks,
- other options for the proposed procedure, including the option of doing nothing at all.
If we carefully consider these 5 elements of ‘all relevant information’, we soon realise why there might be profound differences between alternative and conventional medicine. These differences relate not so much to the nature of the procedures but to the competence of the clinicians.
At medical school, doctors-to-be learn the necessary facts that should enable them to adequately deal with the 5 elements listed above. (This does not necessarily mean that, in conventional medical or surgical practice, informed consent is always optimal. But there is little doubt that, in theory, it could be optimal.)
By contrast, alternative practitioners have not normally been to medical school and will have gone through an entirely different type of training. Therefore, the question arises whether – even in theory – they are able to transmit to their patients all essential information as outlined above.
Let’s try to address this question by looking at concrete cases: a patient with frequent headaches consults an alternative practitioner for help. For the sake of argument, the practitioner could be:
- a chiropractor,
- an acupuncturist,
- a homeopath,
- a naturopath,
- a traditional herbalist.
Are these alternative practitioners able to convey all the relevant information to their patient before starting their respective treatments?
THE CHIROPRACTOR
- Can he provide full information on the indication? In all likelihood he would treat the headache as though it was caused by a spinal subluxation. If our patient were suffering from a brain tumour, for instance, this might dangerously delay the diagnosis.
- Can he explain the nature of the procedure? Yes.
- Can he explain its potential benefits? He is likely to have a too optimistic view on this.
- Can he explain its risks? Many chiropractors deny any risk of spinal manipulation.
- Can he provide details about the other options for the proposed procedure, including the option of doing nothing at all? Probably yes for cervicogenic headache. No for most other differential diagnoses.
THE TRADITIONAL ACUPUNCTURIST
- Can he provide full information on the indication? The patient might be treated for an assumed ‘energy blockage’; other diagnoses might not be given adequate consideration.
- Can he explain the nature of the procedure? Yes.
- Can he explain its potential benefits? He is likely to have a too optimistic view on this.
- Can he explain its risks? Perhaps.
- Can he provide details about the other options for the proposed procedure, including the option of doing nothing at all? No
THE CLASSICAL HOMEOPATH
- Can he provide full information on the indication? No, for a classical homeopath, the totality of the symptoms is the only valid diagnosis.
- Can he explain the nature of the procedure? Yes.
- Can he explain its potential benefits? Doubtful.
- Can he explain its risks? Doubtful.
- Can he provide details about the other options for the proposed procedure, including the option of doing nothing at all? No.
THE NATUROPATH
- Can he provide full information on the indication? Doubtful.
- Can he explain the nature of the procedure? Yes.
- Can he explain its potential benefits? He is likely to have a too optimistic view on this.
- Can he explain its risks? Doubtful.
- Can he provide details about the other options for the proposed procedure, including the option of doing nothing at all? No.
THE TRADITIONAL HERBALIST
- Can he provide full information on the indication? No.
- Can he explain the nature of the procedure? Yes.
- Can he explain its potential benefits? He is likely to have a too optimistic view on this.
- Can he explain its risks? He is likely to have a too optimistic view on this.
- Can he provide details about the other options for the proposed procedure, including the option of doing nothing at all? No.
The answers provided above are based on my experience of more than 20 years with alternative practitioners; I am aware of the degree of simplification required to give short, succinct replies. The answers are, of course, assumptions as well as generalisations. There may well be individual practitioners who would do better (or worse) than the fictitious average I had in mind when answering the questions. Moreover, one would expect important national differences.
If my experience-based assumptions are not totally incorrect, their implications could be most significant. In essence they suggest that, in alternative medicine, fully informed consent can rarely, if ever, be provided. In turn, this means that the current practice of alternative medicine cannot be in line with the most fundamental requirements of medical ethics.
There is very little research on any of these issues, and thus hardly any reliable evidence. Therefore, this post is simply meant as a deliberately provocative essay to stimulate debate – debate which, in my view, is urgently required.
The UK petition to ban homeopathy for animals has so far achieved well over 3 000 signatures. Remarkably, it also prompted a reaction from the Faculty of Homeopathy which I reproduce here in full:
Response to petition calling on the RCVS to ban homeopathy
Homeopathy has a long history of being used successfully in veterinary practice for both domestic and farm animals. The EU recommends its use in its regulations on organic farms and is funding research into veterinary homeopathy as a way of reducing antibiotic use in livestock. It is nonsense to suggest that responsible pet owners and farmers are unable to distinguish between effective and ineffective medicines; they continue to use homeopathy because they see its benefits.
Membership of the Faculty of Homeopathy (VetMFHom) is bestowed on qualified veterinary surgeons who have completed a minimum of three years study of homeopathy and after a rigorous examination procedure. It differentiates the qualified veterinary homeopath from an unlicensed healer.
In a statement, the Royal College of Veterinary Surgeons said “… homeopathy is currently accepted by society and recognised by UK medicines legislation, and does not, in itself, cause harm to animals”. Before going on to say it could see no justification for banning veterinary surgeons from practising homeopathy.
In an age when antibiotic resistance is such an important issue, veterinary surgeons and farmers who have found they can limit the use of these drugs by using homeopathy should be applauded and not attacked.
Peter Gregory BVSc MRCVS VetFFHom
Veterinary Dean, Faculty of Homeopathy
Such sentiments resonate with those of the UK’s most influential supporter of homeopathy, Prince Charles. Speaking at a global leaders summit on antimicrobial resistance, Prince Charles recently warned that Britain faced a “potentially disastrous scenario” because of the “overuse and abuse” of antibiotics. The Prince explained that he had switched to organic farming on his estates because of the growing threat from antibiotic resistance and now treats his cattle with homeopathic remedies rather than conventional medication. “As some of you may be aware, this issue has been a long-standing and acute concern to me,” he told delegates from 20 countries at The Royal Society in London. “I have enormous sympathy for those engaged in the vital task of ensuring that, as the world population continues to increase unsustainably and travel becomes easier, antibiotics retain their availability to overcome disease… It must be incredibly frustrating to witness the fact that antibiotics have too often simply acted as a substitute for basic hygiene, or as it would seem, a way of placating a patient who has a viral infection or who actually needs little more than patience to allow a minor bacterial infection to resolve itself.”
It seems that both Prince Charles and Peter Gregory believe that homeopathy can be employed to reduce the use of antibiotics in animals. So, let’s analyse this hypothesis a little closer.
The way I see it, the belief must be based on one of two assumptions:
- Homeopathic remedies are effective in treating or preventing bacterial infections.
- If farmers administer homeopathic remedies to their life-stock, they are less likely to administer unnecessary antibiotics.
Assumption No 1 can be rejected without much further debate; there is no evidence whatsoever that homeopathic remedies have antibiotic efficacy. In fact, the consensus today is that highly diluted homeopathic remedies are pure placebos.
Assumption No 2, however, might be more plausible and therefore deserves further scrutiny. If we do not tell the farmers nor the vets that homeopathic remedies are placebos, if, in other words, we mislead them to think they are efficacious medicines, they might give them to their animals instead of antibiotics. Consequently, the usage of antibiotics in animals would decrease. This strategy sounds plausible but, on second thought, it has many serious drawbacks:
- The truth has a high value in itself which we would disregard at our peril.
- One might not be able to keep the truth from the farmers and even less able to hide it from vets.
- If we mislead farmers and vets, we must also mislead the rest of the population; this means lots of people might start using homeopathic placebos even for serious conditions.
- Misleading farmers, vets and the rest of the population is clearly unethical.
- Misleading farmers and vets in this way might not be necessary; if there is abuse of antibiotics in farming, we ought to tackle this phenomenon directly.
- Misleading farmers and vets might be dangerous for at least two reasons: firstly, animals who truly need antibiotics would not receive adequate treatment; secondly, farmers and vets might eventually become convinced that homeopathy is efficacious and would therefore use it in all sorts of situations, even for serious diseases of humans.
Whichever way I twist and turn the assumption No 2, I fail to arrive at anything remotely sensible. But this leaves me with a huge problem: I would have to conclude that both the Veterinary Dean, Faculty of Homeopathy and the heir to the throne are bonkers… and, surely, this cannot be right either!!!
