Tag: homeopathy

Is it right to vilify homoeopathy? Sometimes. Often, perhaps. But not always.

In a brilliant article for the Guardian Tim Lott decried the intolerance of people on the left of politics. He complained that people, like him, who raised questions about gender discrimination, Islamism, feeling English or complaining about political correctness, risk unleashing intolerant invective from the “liberal” left.  He was speaking as a Labour loyalist – but I recognise the same issue in the Liberal Democrats. Now let me make my politically incorrect contribution to the genre. It’s about homoeopathy.

Homoeopathy is a branch of alternative medicine developed in the 19th Century. Its theoretical grounding might fairly be called mumbo-jumbo. But it has retained a degree of popularity, and has been available under Britain’s NHS, which supports placebo therapies in some circumstances. It is, however, a popular subject of ridicule, particularly from the liberal left. They condemn its availability on the NHS, and want it to be driven off the face of the earth. This article by Edzard Ernst in today’s Guardian is one of the more temperate ones. It follows some publicity from a recent Australian study showing that there was no scientific foundation for its claims.

Let’s clear the decks a bit. I have no doubt that homoeopathy provides cover for charlatans. And practising homoeopaths are their own worst enemies. They persist in using their outdated mumbo-jumbo explanations. According to Dr Ernst they also cite scientific evidence that is spurious. That goes for David Tredinnick, the Conservative MP who is a public supporter. People that suggest that homoeopathy is an equivalent discipline to modern conventional medicine deserve the ridicule that is heaped on them.

But there is another side to this story. Arguments over the discipline’s scientific basis miss a point that should be understood by everybody. Scientific evidence will only ever get our understanding of the world around us so far. Much knowledge is simply beyond its reach. Homoeopathy may not be an alternative to modern medicine, but it may enter space that modern medicine cannot go.

Conventional medicine it is bound up with the idea that people suffer a series of different ailments, and medicine’s job is to find and test therapies for each of these ailments in turn. These ailments are further described in turns of measurable chemical or biological imbalances. The therapies are likewise usually chemical or biological agents – though other therapies may be admitted so long as they are standardised and repeatable. This line of approach (which I like to call the “magic potion” method of medicine) is extremely powerful. It goes alongside a system of evidence gathering  that allows you to place a tick or cross against each therapy. The standard is whether or not the symptoms are alleviated against an alternative “placebo” treatment which uses chemically inert substances. Through this approach medicine has developed a formidable inventory of magic potions over two centuries and prolonged many, many lives.

But it will take you only so far. Now take two places where homoeopathy might help to provide patients with relief. The first is what might be called “mind over matter”. It has been demonstrated countless times that mental outlook can affect symptoms. This phenomenon accounts for the placebo effect.  Scientists do everything they can to eliminate its effects from their evidence. So if homoeopathy is an effective placebo, the scientific studies wouldn’t show it. This is something Dr Ernst’s article is quite careful to state (“no effect beyond placebo”).  Of course there is danger if a patient is persuaded to use a placebo when something else is more appropriate – but not to treat a patient with a placebo when this might be effective also poses an ethical problem. Or it should. Conventional doctors often use antibiotics to treat viral infections; this is surely a much more questionable practice.

The second way homoeopathy might work is holism. Homoeopathic practitioners should (even if many don’t) look at the patient’s complete circumstances – from  the complete range medical symptoms to anxieties and outlook on life, before selecting a therapy that is individual to that patient. This is another place that scientific method cannot go. It cannot produce the sort of repeatable results that science requires – because everybody is a bit different. That still leaves therapies depending on placebo effects, but it could give that effect extra oomph. One of the causes of disillusion with modern medicine is that patients are treated as disconnected symptoms parcelled out to different specialists, with  obvious things (like what the patient eats in hospital) often neglected. Puzzling symptoms are overlooked to focus on ones more within practitioners’ comfort zones. There is much talk of patient-centred medicine, but remarkably little practice. That may be because building up an appropriate evidence base is impossible.

To my mind that leaves space for an ethical homoeopathist who is no simply trying to peddle expensive but inert magic potions. Modern medicine can’t be beaten in the magic potion business. But when it comes to treating mind and body as part of the same human being and looking more widely on how to advance that human beings health and wellbeing – modern medicine does not look so hot.

 

Is there a case for complementary medicine on the NHS?

Last weekend there was outrage from The Daily Mail that Prince Charles had being lobbying government ministers to give more space for complementary medicine on the NHS. This provoked a piece on the BBC Today programme (at 0833) on Saturday morning. In this UCL’s Professor David Colquhoun made short work of Tory MP David Tredinnick, who was attempting to defend homeopathy, the target of choice of those wanting to drive complementary medicine to the lunatic fringe. Indeed, very few advocates of complementary techniques do a decent job of defending them in public forums, quickly resorting to dodgy mumbo-jumbo and dubious scientific studies. And yet there is a case to be made.

I find it a bit awkward to make this case myself. I have not used such therapies, and nor am I likely to. I am simply in too deep with conventional scientific scepticism to give any credence to their supporting patter – “energy fields”, “life forces”, or homeopathy’s “like cures like”. And without that, I suspect the techniques lose a lot of their impact. However, people I like and respect do use selected complementary techniques, and they have value.

The best way to start a defence of complementary medicine is attack. Conventional, evidence-based medicine has its own weaknesses. The technique depends on breaking health issues down into bite-sized problems, and then testing therapies to treat them using statistical tests against a placebo. Once a therapy passes this test, it then gets rolled out to anybody suffering from the condition concerned. This approach benefits from scientific rigour, and has steadily improved the effectiveness of conventional medicine over the generations. More recently the focus of the technique has been more on finding what works than necessarily why. This makes it less vulnerable to dismissing therapies that do not work in theory (as happened in some spectacular early medical failures in the 19th century over the importance of hygiene and clean water). But it has certain blind spots designed into it.

The first problem concerns placebos. The reason why this is the null hypothesis against which therapies are tested is that placebos have a measurable beneficial effect in many cases. The main scientific sceptical explanation for any benefits of complementary therapies is that it is a placebo effect. A supporter might go further: complementary therapists understand how placebos work better than conventional therapists: it isn’t just a placebo, it’s a top class placebo. But you can’t test a placebo against a placebo. Back in the 1980s a practicing GP told me how one of his favoured techniques was to prescribe harmless sugar pills to his patients, and he claimed great benefits from doing so. Surely if that sort of thing is allowed on the NHS, why can’t other placebo therapies? And the answer isn’t to ban all placebos – though doubtless that is the approach taken by conventional medicine advocates; something tells me that my GP wouldn’t be allowed to prescribe his sugar pills nowadays.

The second problem is the fragmentary approach of conventional medicine. Fragmentation has been elevated to a positive religion in the NHS. You can’t experience the service without being handed to several different professionals of different shapes and sizes, each with their carefully rationalised boundaries. Each handoff creates risks, and stories of catastrophic breakdowns in hospital treatments abound – patients left for hours on trolleys, starving to death, or forced to drink water from plant pots – and even more cases where post hospital after care breaks down. One of the few common themes across complementary disciplines is that they are holistic. Indeed the very idea of holistic treatments (now very much part of modern management jargon) was originally derived from complementary medicine, or that is where I heard it first, anyway. You see a single therapist, who gathers as much information about you and your condition as she can, integrates it, and then moves on to treatment. The diagnosis is likely to be a large part of the cure in its own right. And yet scientific testing of complementary therapies is liable to start only after the diagnosis has ended. All this proves is that if you go out to a shop and buy homeopathic remedy, you are on to a hiding to nothing. That does not prove that the complete homeopathic therapeutic process is useless.

There is a third problem. Evidence has to be gathered by using large numbers of people. In this process there is very limited opportunity to distinguish between the different needs of individuals. As a result the evidence tends to show not that the therapy works for everybody, or even most people, but that on average it is better than the placebo. The result is that lots of people are prescribed treatments that are, for them as individuals, useless. How many people do you know who complain of medication that gives unpleasant side-effects but does not seem to be doing them any good? The scientific evidence says they could be right, but is rather helpless after that. Complementary therapies are much less likely to have side effects, though they don’t have the proven benefits either. I do wonder whether for some conditions the overall cost-benefit balance of complementary therapies against conventional ones is constructed fairly.

And finally we need to address the question that few advocates of scientific method will admit to. That scientific rigour has its costs. There are areas of potential knowledge into which it is incapable of reaching. The higher your standard of rigour, the less that is capable of being revealed. The method is too blunt an instrument to deal with many types of issue. It can’t handle too many variables at a time, especially if they are interdependent; and any ideas that mess with constancy of the laws of nature are ruled out a priori. It struggles to find ways of testing mind over matter propositions, which often play a part in complementary medicine’s thinking. How many people do you know who feel unwell, go to doctor, who commissions tests that just don’t find anything? You don’t have to take on mystical ideas to see that the bluntness of conventional diagnosis leaves huge areas of illness as a mystery. And when this happens conventional medicine is worse than useless. It creates stress and frustration, and doctors start to disbelieve the patient, making the problem worse, not better. Complementary techniques are much better at handling patients suffering from these sorts of problems.

So what are my conclusions? A little more humility on the part of the advocates of conventional medicine is warranted. They don’t know everything; they are not very good of handling conditions that are difficult to diagnose; they are too sanguine about the collateral damage arising from evidence based treatments on those they do not help; and they fail to see how the fragmentary way they handle problems is bad for patient health. With this humility they might understand that once they have eliminated the nice, well-defined illnesses in their comfort zone – cancer, heart disease, strokes, bacterial infections et al – being open to patients who want complementary treatments is often the best way forward. And I haven’t even mentioned the corrupting influence of big pharma.