Homeopathy: witch hunting or waste of money

etc, etc.

I am getting quite bored of the homeopathy debate. It should have moved on a bit, really. So here is the state of play today: James Le Fanu in today’s Telegraph says the BMA, who have recently voted for NHS funding for homeopathy to be withdrawn, aren’t listening to patients but are instead locked into a kind of scientific ‘must have evidence’ vacuum. Martin Robbins in the Guardian is calling for a debate about whether or not the knowing use of placebos – which is what he says homeopathy is – can be used ethically.

Sorry, but you are both missing the point. The point is not that we need a placebo tablet, and it is certainly not about ignoring what patients say works for them. The missing link is what placebo actually means: caring effects. We can get good caring effects when we spend time listening, when we follow people up carefully and consistently, when we take longer appointments, when we explain properly and usefully what the problems are and what might help. There is evidence for this: we know that using such ‘caring effects’ makes people better, faster, and for longer.

Using a ‘placebo tablet’ isn’t necessary to get ‘caring effects’. There is no need to mislead or to confound people with promises about tablets that aren’t based in evidence.

The problem is that the NHS is geared (still) towards easily measured targets and outcomes. It is not geared to help the vocationally motivated doctors and nurses who want to ‘care’. Ethical, placebo-like ‘caring effects’ are there for the taking, but the real question is how best to do this in an NHS that finds it easy to overlook the importance of them.

7 Responses to “Homeopathy: witch hunting or waste of money”

  1. Northern Doctor July 6, 2010 at 8:55 am #

    Absolutely spot on Margaret. It’s a massive issue with skeptics that they think handing over a little sugar pill has some magical effect and they don’t apply the same rigour to examination of placebo as they do to stuff like homeopathy.

    It’s everything around it that does the job – your ‘caring effects’ that matter. We need a system that values them.

  2. Michael Power July 6, 2010 at 9:58 am #

    Margaret

    You are spot on in your comments.

    Both conventional science-based medicine and complementary and alternative medicine (CAM) have a blind spot in their visual field which is centered over the concept of caring. Empathy, the key component of caring is a taboo word, even for people who promote values-based medicine (1). This is strange, given that most people would want their healthcare provider to aim “to cure sometimes, to relieve often, and to comfort always” (2). The NHS is good at curing disease and relieving symptoms whenever this is possible. It is not so good at caring, as an anecdote in a recent issue of the Lancet illustrates (3).

    Even CAM therapies focus exclusively on the delivery mechanisms (needles, pillules, aromas, …) of their therapies. The results is that they cannot entertain the possibility that caring and empathy provide the placebo effects they misinterpret as specific effects.

    Caring and empathy cannot be professionalized or commercialized. They are thus very difficult to implement and manage in services such as the NHS. This is a challenge that should be tackled, not shied away from.

    References:
    (1) Petrova M, Dale J, Fulford BK. Values-based practice in primary care: easing the tensions between individual values, ethical principles and best evidence. Br J Gen Pract. 2006 Sep;56(530):703-9
    (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1876638/)

    (2) Russell, I. Jon. Consoler Toujours -To Comfort Always. Journal of Musculoskeletal Pain, Vol. 8(3) 2000
    (http://www.cfids-cab.org/cfs-inform/Ptsd/editorial.russell00.txt)

    (3) Horton R. Offline: Just take a seat and they’ll call you. The Lancet, Volume 376, Issue 9734, Page 12, 3 July 2010
    (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61037-9/fulltext)

  3. Graham Jagger July 6, 2010 at 10:55 am #

    I am a GP who uses homeopathy often when a number of conventional medications and therapies have not worked (despite spending time in discussion about their place in treatment, action, and hopeful effects). I don’t get a special ‘Homeopathic Caring Effect’ glint in my eye which switches on the PLACEBO. It is an insult to insinuate that those caring doctors (some of whom may have voted to ban homeopathy from the NHS) and who use conventional medical approaches only, are deficient in the ‘caring effect’.

  4. Margaret McCartney
    margaretmccartney July 6, 2010 at 9:50 pm #

    thankyou: the Horton piece is very interesting because it echos with my own experience of certain hospital receptionists who seem to think patients merely interrupt their own conversation.

    Dr Jagger, I agree. I don’t think doctors who don’t use homeopathy are necessarily deficient in ‘caring effects’. I’m trying to say something quite different.

  5. Northern Doctor July 7, 2010 at 8:51 am #

    @Dr Jagger
    I didn’t read this piece in this way at all. It emphasises that all doctors use the ‘caring effects’ but we need to value and foster them. Arguments about varieties of placebo, whether they are the homeopathy flavour or sugar-pill flavor, are a distraction and, as Margaret has so succinctly put it, miss this vitally important point.

  6. Dr No July 8, 2010 at 7:03 pm #

    A very interesting post, much of which I agree with. But I am not sure the placebo effect is really just part of the caring effect: I suspect it has its own existence. Too much to post here as a comment – see:

    The Ultimate Quack Remedy

  7. Margaret McCartney
    margaretmccartney July 8, 2010 at 9:33 pm #

    thanks for these. A while ago I interviewed an intelligent and obviously very caring homeopath for an article about alternative medicine. We were discussing placebo, and his belief that there really was something in the water. I suggested a trial where two groups had identical treatment in the consulting room, ie long ‘homeopathic history’ taking, etc, etc, and the homeopath and the patient were blinded as to whether the treatment was “real” or not. He said he didn’t think this – where the full laying on of hands consultation was complete as part of the trial – had ever been done, and then said that it wouldn’ t matter what it showed because he knew that the homeopathic remedy itself worked.
    I’m still recovering from that insight.

Leave a Reply