Tom Salinsky

I recently invited my father to an exchange of views about homeopathy – me from the point of view of an ethusiastic skeptic, eagerly slashing down falsehood and flummery wherever I find it; he from the point of view of a physician with decades of experience actually helping people to get better. Here is the first of our exchanges…

TOM

As I understand it, you think that NHS should continue to provide homeopathic remedies under some circumstance, and you are surprised at the strength of my feeling that they should not. Through this exchange of emails, I hope to better understand your position (since you speak from experience of treating patients, which I can’t) and to get you to better understand mine.

I imagine there is quite a lot of common ground between us, so before we get to the fun of the debate, here are some statements I think we can both agree with.

–          Homeopathy doesn’t work. Reviewing the evidence base as a whole reveals that homeopathy works no better than placebo. While a number of studies do exist which apparently show a more significant effect, these are always smaller studies often with methodological flaws. The better the study, the smaller the effect. This finding is confirmed by the Cochrane Collaboration and the recent Select Committee report.

–          Homeopathy couldn’t possibly work. The notions that “like cures like” and that “dilution increases potency” are pre-scientific magical thinking. Many homeopathic remedies are so diluted that it is literally true that not a single molecule of the original substance can possibly remain. How the water used for the dilution “remembers” the substance (and none of the other substances it had previously been in contact with) is a mystery which homeopaths avoid tackling.

–          Evidence-based medicine is, in general, a good thing. Especially within a cash-strapped NHS, treatments should be provided to patients on the basis of the best evidence available, not on a patient’s demand, nor a physician’s whim, nor in order prop up a discredited theory.

Assuming that we agree on these three points, it seems that you wish to make an exception to the evidence-based rule for homeopathy. Is that right? If so, here are the questions that next spring to mind.

1. Under what circumstances do you think it is appropriate for the NHS to provide homeopathic remedies? What are the possible negative consequences of doing this under these circumstances (if any)?
2. Do you feel the same way about chiropractic, reflexology, acupuncture, iridology, reiki (to name a few)? Are some of these interventions more worthwhile than others in your opinion? Are they all equally beneficial placebos or are some more worthy of public funding than others?
3. Are you concerned about the drop-off in vaccinations which has taken place in the UK and the USA recently? Do you see any connection between this and people’s fondness for alternative medicine?

JOHN

I think the first thing I’d like to say is that when considering the possible beneficial or harmful effects of any form of  treatment, I like to include not just the intrinsic chemical power of the substance prescribed, but the whole context of treatment.

The so-called placebo effect also includes the  treatment environment, the way the doctor approaches the patient, her kindness and consideration,  her ability to listen and to accept people’s distress. The faith of both doctor and patient in the theory, the method, the procedures, and in the personal relationship are all important too.  Every form of medical practice has its own philosophy, incuding evidence based medicine, which, by the way is not always as reproducible in an an ordinary community setting as it is under strict experimental conditions.  Even EBM  in most cases only offers a probability of a cure or improvement: a significant proprtion of those treated will not benefit at all. Some will be harmed.

You and I don’t believe that homeopathic remedies can have any chemical effect as such. But this is not chemotherapy. These patients are not being treated with agents that can kill cancer cells or eliminate antibodies. The patients who attend homeopathic practitioners and the homeopathic hospitals are suffering from chronic diseases for which conventional chemical medicine or surgery can do no more. The treatment is not and should not be a substitute for ‘proper’ medicine.  At the London Homeopathic hospital, where all the clinical staff are medically qualified, they examine people in the usual way and advise anyone who needs conventional treatment to go and get it.  The homeopathic treatment process  (including the empty tablets) has the effect of making patients feel better and feel cared for. It gives them some hope. The placebo effect can be incredibly powerful and can certainly  relieve pain and other symptoms such as nausea, giddiness, anorexia etc.

Are the remedies expensive?  No, compared with modern drugs, often unscrupulously promoted by pharmaceutical companies and overprescribed by doctors, they are cheap. Unlike most conventional drugs there is no risk of  serious adverse effects. The London Homeopathic Hospital has just had a fairly expensive refit. It looks beautiful, calm, tranquil and peaceful. It would be a pleasure to go there for treatment.  OK they don’t cure any cancers or kill any bacteria. But a large part of medical practice is about helping people to cope with  chronic illnesses that can’t (yet) be cured or with distressing symptoms that are not even understood.

There has always been a need for some sort of magic and mystery in medicine, going back to the ancient shamans. This has not gone away, despite the acievements of scientific medicine. If some patients are helped to feel better by what we see as pseudoscience, why should we be outraged? It doesn’t mean that we are denying the validity of science itself.

I think the money is well spent!   And, by the way, I have no  personal interest to declare.

Finally in answer to your last three points:

1) I have argued above that the remedies should be seen in the context of the treatment as a whole and the kind of ill-health for which homeopathic treatment is suited.

2) I think a similar case can be made for the other complementary therapies but I dont think any of these are publicly funded at present. I think some treatment ‘stories’  will  help some patients  but not others and there is no reason why those whom conventional medicine still cannot help adequately should not explore them. It’s important, if you have a chronic illness, to have a plan, to keep trying.

3) I think the drop-off in immunisations has been largely due to Dr Wakefield, a thoroughly conventional medical researcher who got carried away and did a lot of harm. I don’t think homeopathy has anything to do with refusing vaccines of proven effectiveness.