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today: James Le Fanu in today’s Telegraph says the BMA, who have recently voted for NHS funding for homeopathy to be withdrawn, aren’t listening to patients but are instead locked into a kind of scientific ‘must have evidence’ vacuum.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.