Alternative therapies could save the NHS money, says report commissioned by Prince Charles
BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7520.795-a (Published 06 October 2005) Cite this as: BMJ 2005;331:795All rapid responses
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Sadly, this is one of the subjects that the rational world must now
retreat from. The faithful will never be convinced, because they have a
completely different world view.
The only option now is for real medicine to move on and leave the
homeopaths to their metaphysical musings. You'll never convince them.
Competing interests:
None declared
Competing interests: No competing interests
Peter Morell's approach seems
to be to accuse those of us who prefer evidence and reason of being
zealous adherents of a dogmatic belief system, and emotionally addicted to
denouncing any contradiction to these beliefs - as nice an example of the
pot calling the chromium teapot black as one could possibly wish for.
However, this time he seems to have found a new bogey-man with which to
beat the emotional and ignorant EBM supporters. Gosh, we mustn't bad-
mouth homoeopathy because - wait for it - this will seriously harm our
chances of getting a gong from HRH!!
News flash, Mr. Morrell. Some of us are not in the slightest bit
interested in gongs and baubles, which in any case are no yardstick of
credibility. Perhaps we are more interested in objective truth.
As regards the objective truth of homoeopathy, it seems to me that
there are two aspects, indeed two quite separate questions. First, we may
ask whether the entire homoeopathic "experience" is beneficial to
patients. The case-taking, the sympathy, the ego-massage and all the
trimmings. It may well be the case that (in human medicine) this is so.
Dr. Kathy Ryan in a previous thread of a similar nature referred to the
concept of the "therapeutic consultation", and the potential of this
experience to yield psychological benefits should not be ignored.
However, the second question is the more rigorous one. Do
homoeopathic remedies have any therapeutic or even physiological effect in
themselves? This is the sticking point of the sceptics, and rightly so.
For all the protestations of Mr. Ambrosi regarding the Rey study and
related publications, it remains the case that there is no way whatsoever
to distinguish a potentised homoeopathic remedy from the stock solvent or
carrier material, either in vivo or in vitro. At the risk or re-opening
old wounds, I remind Mr. Ambrosi that the JREF million dollar prize,
available these twenty years to anyone who can demonstrate this feat
repeatedly and reliably, still remains unclaimed. The fact is that there
is nothing in these remedies - no structured water, no thermoluminescent
emissions, no quantum energies, nothing to distinguish them from plain old
water/alcohol and sugar pills.
The number of ways contrived by homoeopathy proponents to take
evidence of the benefits of the therapeutic consultation and twist this
into alleged evidence for a physiological effect of the magic sugar pills
never ceases to amaze me. However, one would hope that medical
publications and government reports would be more honest. If indeed the
case-taking ritual provided by homoeopaths offers cost-effective benefits,
then we should strive to ascertain how best these might be delivered.
However, what about the related matter of lying to the patients about the
medical benefits of the sugar pills? Is this a necessary component of the
process? And if it is, does the psychological benefit of the therapeutic
consultation justify lying to one's patient?
This is the real crux of the matter, and ought to be tackled head-on,
not concealed behind mealy-mouthed platitudes about patient satisfaction
and "credible ways forward". Given that there is no credible evidence
whatsoever that the homoeopathic ritual has any effect other than a
psychological one, is it possible to achieve this effect without the
incorporation of placebo? Or does the medical profession wish to endorse
the dispensing of placebos, with fraudulent claims of efficacy, and if so
how may this approach be most effectively delivered?
As a veterinary surgeon, I wish most fervently that the medical
Powers the Be would come clean on this one, and cease this charade of
supporting homoeopathy and other irrational methods as if there was indeed
some physiological efficacy present. Why? Because no matter how much
psychological support the homoeopathic ritual may provide to a pet owner,
this does precisely nothing for the unfortunate animal concerned.
Persuading a human patient that he feels better "in himself" arguably does
help, even if it's "only in the mind". However, applying rose-coloured
glasses to an animal owner is simply an affront to animal welfare. The
spectacle of the veterinary homoeopath assuring his client that the animal
is improving, when objectively this is simply not the case, or even
hailing a deterioration as "good news" because this "aggravation" shows
that the remedy is working, is simply sickening. The fact that the owners
of the animals concerned are so ready to fall for this claptrap should be
an object lesson for us all.
Sadly, attempts to combat the animal abuse that is veterinary
homoeopathy are all too easily countered by reference to the apparently
"respectable" position of homoeopathy within human medicine, and the
apparent endorsement by the medical establishment. Perhaps even worse,
adherents of "organic" farming are able to promote homoeopathy as an
alternative to proven safe and effective veterinary medicines in organic
herds and flocks, thus depriving animals of effective healthcare in the
name of dogma and so-called "nature".
If the medical profession wishes to indulge itself in the provision
of psychological support by placebo administration, then let it do so -
but let it do so openly, without hiding behind hints of scientifically
impossible (indeed magical) effects. Only then will innocent animal
patients be safe from the consequences of an approach which addresses only
the owner's ego, and not the patient's suffering.
Competing interests:
Veterinary surgeon who is sickened by the treatment of animals with content-free sugar pills
Competing interests: No competing interests
Simon J Baker seems to believe that most allopathic “cures” conform
to known chemical mechanisms [1].
One of the easiest way to try and make Simon J Baker reflect a little
bit more on his belief, could perhaps consist of reminding him that almost
all currently used drugs can have side-effects of unknown (or not
completely known) mechanisms.
[1] http://bmj.bmjjournals.com/cgi/eletters/331/7520/795-a#119537
Competing interests:
None declared
Competing interests: No competing interests
Dr. Foley made an error in referring to
the treatment of a patient dying from bronchospasm.
Perhaps he could explain this drastic mis-reading of my comment as
well as picture himself or me administering coffee in such a situation.
A Google search will bring to light sufficiently disturbing
information on my assertion as to what is the number one cause of death.
Assuming that we see and are told about the majority of untoward
events resulting from medical intervention the facts are still there, for
all to see. I think you would agree that we don't.
One reference to look at is a recent paper as follows:
Shocking statistical evidence is cited by Gary Null PhD, Caroly Dean
MD ND, Martin Feldman MD, Debora Rasio MD and Dorothy Smith PhD in their
recent paper Death by Medicine - October 2003, released by the Nutrition
Institute of America."
"A definitive review and close reading of medical peer-review
journals, and government health statistics shows that American medicine
frequently causes more harm than good. The number of people having in-hospital, adverse drug reactions (ADR) to prescribed medicine is 2.2
million. Dr. Richard Besser, of the CDC, in 1995, said the number of
unnecessary antibiotics prescribed annually for viral infections was 20
million. Dr. Besser, in 2003, now refers to tens of millions of
unnecessary antibiotics. The number of unnecessary medical and surgical
procedures performed annually is 7.5 million. The number of people exposed
to unnecessary hospitalization annually is 8.9 million. The total number
of iatrogenic deaths shown in the following table is 783,936. It is
evident that the American medical system is the leading cause of death and
injury in the United States. The 2001 heart disease annual death rate is
699,697; the annual cancer death rate, 553,251. (1)
According to one source, drug use alone is the 4th to 6th cause of
death (2)
Another quote from the prairies of Canada:
"As I said, it does not matter if 'modern medicine' is cause 1 or 6 of
deaths, and 1 dead per 5 minutes in U.S. hospitals by drugs is too many."
(3)
'nuff said.
P.S.: Yes, Dr. O'Donnell is correct and I do appreciate his sense
of humour.
References:
1 The Nutrition Institute of America. Deadly Medical Mistakes Exposed. October 28, 2003
2
http://www.ncbi.nml.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&...
3
Eddie Vos, Heart Health, personal communication
Competing interests:
None declared
Competing interests: No competing interests
" Therefore, its vociferous detractors ought to reflect a little
more
carefully on the very slender likelihood that its therapeutic successes
and its burgeoning public popularity--what Horton dismisses as
"credulous public," [1]--are grounded solely in misplaced faith, belief,
irrationality, 'placebo effect' or even what Horton curiously calls
"wayward meanderings into the recesses of medievalism." [1]
Uncomfortably for Horton's case, many cherished heroes and pioneers
of modern science: Galileo, Newton, Sydenham, Harvey, Boyle, Bacon,
etc, lived in "the recesses of medievalism," [1] breathed its very air
and
subscribed to its Christian doctrines."
The only problem for Mr Morrell is that when "misplaced faith,
belief,
irrationality, 'placebo effect'" are excluded there is nothing left.
It is indeed the case that the authorities he cites "lived in "the
recesses
of medievalism"", which is why their views on medicine ahould not be
taken at face value. The ability to accurately discern causal relations in
medical therapies was to wait for a later century.
"Critics of homeopathy like Horton have rarely ever studied it or
used its
remedies for themselves."
"Try it for yourself" is often the cry of the homeopath in these
debates.
One wonders why they can't see this to be logically invalid. Nonetheless
a number of us have tried their remedies and found nothing remarkable
in the experience. The small number of properly controlled "provings"
where volunteers report effects after taking a remedy also tend to find
nothing remarkable. Remarkable things are certainly reported in
traditional homeopathic provings but the participants are aware of what
they are taking and why.
Unfortunately in my career I have come across a number of instances
where nothing remarkable also happened to the disease being suffered
by animals under the supposed care of a homeopath. In several
instances, sadly the homepath was simultaneously claiming a great
success for homeopathy. So, Mr Morrel will have to excuse me if I
choose to pay little heed to their stories of clinical success.
"They...are usually innately opposed to it in principle because of
their
emotional commitment to scientific materialism, a zealous belief system
which demands its vigorous condemnation even if it works"
For myself, I would have no problem with homeopathy if it did indeed
work. Science and medicine would simply enlarge to absorb that datum.
What receives my vigorous condemnation is inefficacy paraded as
success, wilful disregard of contrary evidence and a pathological
reluctance to reconsider basic assumptions. An honest approach would
include a willingness to address the various fatal errors and internal
inconsistencies from which homeopathy suffers. That honesty would
then perforce extend to reconsidering their belief. Sadly I am yet to find
a homeopath in debate who will face up to these problems.
"How many allopathic 'cures' conform to known chemical mechanisms?"
Um, let's think about this one. How about, most of them?
"There is much in medicine that simply works, the mechanism
eventually being worked out much later."
That is a fair point. Homeopathy does not work, so we need not worry
about its mechanisms.
"exaggerating any epistemological disparities between these therapies
and scientific medicine."
The epistemological disparity is between medicine that knows how to
determine whether it works and medicine that cannot see beyond first-
person anecdotal account.
Many of homeopathy's proponents seem unable to see the truth about
homeopathy because homeopathy is a philosophy that has been finely
tuned over 200 years to render its adherents incapable of discerning the
truth for themselves. This problem is built into the structure of the
homeopathic process. Literally any outcome for the patient is used as
confirmation of homeopathy's truth. Recovery obviously means the
remedy worked. A lack of response merely dictates more prolonged
treatment or a change of remedy. More bizarrely, a deterioration is
called an "aggravation" and is specifically regarded as a sure sign the
remedy is having the desired effect. Homeopathy is not a system of
medicine, but a set of excuses. It does not provide successful treatment
but a set of narrative tools to accompany the natural history of the
disease.
Most of a homeopath's practice can be found among patients with self-
limiting trivial problems or chronically relapsing conditions both of
which are well-suited to an approach that permits the therapist to stand
by and take the credit for any recovery or even a temporary
amelioration. In addition, when homeopathy is used to "complement"
conventional medicine I have seen a depressingly frequent tendency to
ascribe any improvements to homeopathy.
It is a shame is that homeopathy's vociferous champions cannot see
that
these arguments are self-evident.
Competing interests:
None declared
Competing interests: No competing interests
It is an ancient British custom for some who have given public
service to receive honours. Examples in the medical
field include Sir William Arbuthnot Lane, Sir Liam Donaldson and Lord
Winston. One therefore imagines that
the hapless Richard Horton [1] has not enhanced his own chances of getting
a knighthood by launching such an
intemperate assault upon the future King and life-long homeopathy
supporter, the Prince of Wales, or to give him
his full title: Charles Philip Arthur George Mountbatten-Windsor, Duke of
Cornwall, Duke of Rothesay, Earl of
Carrick, Lord of Renfrew, Lord of the Isles, Prince and Great Steward of
Scotland and Earl of Chester [2].
And it is especially ironic for Horton when one compares his now dire
fortunes with those of the homeopathic
Physician Royal, Dr Peter Fisher, the Queen's private physician and head
of the Royal London Homeopathic
Hospital, whose prospects seem correspondingly much rosier when it comes
to the question of receiving public
honours. Several of his illustrious predecessors did indeed receive
knighthoods, such as Sir John Weir (1879-1971), once the Queen's
physician, who "was reputedly Physician Royal to six monarchs: George V
(1865-1936), Edward VIII (1894-1972), George VI (1895-1952), Elizabeth II,
King Gustav V of Sweden (1858-1950) and King Haakon VII of Norway (1872-
1957). The latter's wife, Princess Maud [1869-1938), was the youngest
daughter of King Edward
VII." [3]
Not only have the British royals been ardent supporters of homeopathy
for five generations, but homeopathy has
traditionally enjoyed very widespread support in all Europe's royal houses
and with aristocrats of all types over the same period. Therefore, its
vociferous detractors ought to reflect a little more carefully on the very
slender likelihood that its therapeutic successes and its burgeoning
public popularity--what Horton dismisses as "credulous public," [1]--are
grounded solely in misplaced faith, belief, irrationality, 'placebo
effect' or even what Horton curiously calls "wayward meanderings into the
recesses of medievalism." [1] Uncomfortably for Horton's case, many
cherished heroes and pioneers of modern science: Galileo, Newton,
Sydenham, Harvey, Boyle, Bacon, etc, lived in "the recesses of
medievalism," [1] breathed its very air and subscribed to its Christian
doctrines.
Critics of homeopathy like Horton have rarely ever studied it or used
its remedies for themselves. They tend to
speak solely from the 'authority' of an armchair theoretical position and
are usually innately opposed to it in principle because of their emotional
commitment to scientific materialism, a zealous belief system which
demands its vigorous condemnation even if it works; regardless of its
success, they feel compelled to condemn it at every opportunity because it
seems to contradict their precious and entrenched belief of how they think
the world is. All talk of mechanisms is an inconsequential side-issue only
of interest to these armchair detractors.
Regardless of whether or how the action of homeopathic drugs might be
explained by the so-called "laws of
physics and chemistry," [1] it is periodically worth reminding ourselves
that such 'laws of nature' are not cast in stone, but are revisable human
interpretations of events observed in the world. If homeopathy works, then
it is these 'laws' that humbly need some adjustment, to bring them closer
into line with the way the world is, and not
by arrogantly trying to bring the world into line with the cherished
theories of science zealots who peddle a
worrying breed of dogmatic absolutism for such 'laws of nature.' How many
allopathic 'cures' conform to known
chemical mechanisms? There is much in medicine that simply works, the
mechanism eventually being worked out
much later.
The main thrust of the report, that CAM could effectively make people
healthier and reduce NHS costs, is correct and
should carry far more weight with the medical profession than exaggerating
any epistemological disparities
between these therapies and scientific medicine.
We know that certain royals have acquired a reputation for doing and
saying silly, rude or inept things in public.
Examples include Prince Harry wearing a Nazi uniform to a party close to
the 60th anniversary of the liberation
of Auschwitz, [4] and Prince Philip's numerous, well-documented gaffes
about Chinese, Indians, sports weapons,
Hungarians, the Scottish love of drink, the Lockerbie aircrash, Canadians,
the cooking skills of British women, his scepticism of the benefits of
stress counselling, the singing abilities of Tom Jones and Adam Faith, [5]
and even the art of playing bowls. [6] So, while it is very heartening to
see that it is not only royals who publicly shoot themselves in the foot
occasionally, but also some prominent doctors, play-acting as scientists,
but it is probably true that royals can escape the professional
consequences of making these gaffes more easily than doctors.
Sources
[1] Richard Horton, Pandering to the Prince, BMJ e-letter, 7 October
2005
http://bmj.bmjjournals.com/cgi/eletters/331/7520/795-a#118608
[2] Profile of Prince Charles:
http://www.eonline.com/On/Royalty/Profiles/charles.html
[3] P Morrell, A History of Homeopathy in Britain, 2001
http://www.homeopathyhome.com/reference/articles/ukhomhistory.shtml
[4] Charles To Harry: Visit Auschwitz, LONDON, Jan. 14, 2005
http://www.cbsnews.com/stories/2005/01/12/earlyshow/main666570.shtml
[5] Prince Philip's gaffes
http://news.bbc.co.uk/1/hi/uk/416992.stm
[6] Nick Webster, Philip in bowls blunder, Manchester News, Saturday,
27th July 2002
http://www.manchesteronline.co.uk/news/s/14/14545_philip_in_bowls_blunde...
Competing interests:
None declared
Competing interests: No competing interests
" These studies suggest that extremely diluted solutions are not
simply
distilled water: they have different physical properties[4]."
They might. The studies await independent replication especially to
rule
out the possibility that contaminants influenced the results of what are
quite temperamental assay methods.
However, given that many remedies are given as sugar tablets after
the
magically enhanced water has been evaporated off them;
and given that homeopaths believe in "grafting", the ability of one
tablet
to magically empower a bottle full of plain tablets or, indeed, tablets in
an adjacent bottle;
and given that there is no way for the methods of homeopathic
pharmacy to instruct a remedy tablet which of the myriad chemicals
dissolved in water or present in reagent sugar stocks is the one that
matters to the patient;
these phsyicochemical studies have very little bearing on the
validity of
homeopathy itself.
An interesting sidenote is the funding of such studies by homeopathic
pharmacies. If reported results are positive then they are available to be
trumpeted as a "proof" of homeopathy, but they also contain the
element of plausible deniability, so that negative findings can be
dismissed as not really bearing on the heart of the matter
"I hope the debate on "homeopathic water is not simple water" will
soon be shifted to higher levels: "homeopathic water is not simple
water. Is it effective in medicine?" "
What you may hope for and what is appropriate are rather different
things. Homeopathy fails to beat placebo when proper controls are
applied. So the question of mechanism does not apply.
Some homeopaths complain about the methods of controlled trials and
try to excuse their field from such scrutiny. This is nonsense, but it is
nonetheless convenient in confronting this obtuseness to have available
a different line of argument and to remember that homeopathy is
riddled with so many internal inconsistencies that even in its own terms
the claims of homempaths cannot be taken at face value. For, example
you will find homeopaths who claim that airport X-ray scanners
completely inactivate remedies or coffee or alcohol will prevent the
remedies working while others say there is no problem. In each case,
both groups continue to claim success with their remedies, but at least
one must be wrong. This serves to highlight the point that it is
irrational
to reference themselves against daily clinical practice as if it gives
them
access to a truth that is inaccessible to scientific study.
Competing interests:
None declared
Competing interests: No competing interests
"Has Dr Horton ever tried to measure love? "
Oh, yes. Argument by false analogy. A favourite ploy of the advocates
of
homeopathy.
Let us suppose that homeopathic remedies "loved" the patients better
and the tablets were just jam-packed full of that "love". Dr. Donegan is
right that science might have a tough time quantifying that.
What it does not have a tough time doing is measuring the effects of
these potentially loved-up tablets on patients.
Homeopathy consistently fails to perform better than placebo in
properly-controlled trials, so we have no real need to speculate on any
bizarre properties that the tablets might have.
Competing interests:
None declared
Competing interests: No competing interests
for his statement that 'modern medicine' would be the number one cause
of death in the world today. It is really academic if such is number
1 or 3, one can argue either point, as JAMA,
here, suggests that drug deaths in U.S. hospitals alone are mortality
cause number 4, 5 or 6 (1).
Based on this analysis: Is
U.S. health really the best in the world?, one would argue that
in the U.S. it is the number 3 cause and this regarding basically hospital
care alone:
* 12,000 deaths/year from unnecessary surgery
* 7000 deaths/year from medication errors in hospitals
* 20,000 deaths/year from other errors in hospitals
* 80,000 deaths/year from nosocomial infections in hospitals
* 106,000 deaths/year from nonerror, adverse effects of medications
and:
"These total to 225,000 deaths per year from iatrogenic causes." (2).
That would be the third leading cause of deaths after cancer and cardiovascular
diseases. Not easily quantifiable is the role of 'modern medicine' in not
preventing deaths from preventable nutritional and infectious diseases
world wide, and in non-hospital related settings.
While I hope to have an anaesthetist like Dr. Foley over my bedside
if ever I need a hip joint replacement, I'd much prefer a 'complementary
medicine man' who would have helped me prevent needing one in the first
place through the use of antiinflammatory C20:3n3 containing fish oil and by the judicious use of bone and cartilage building nutrients and vitamin D.
I'd guess Dr. Foley would agree that more patients' last face they ever see belongs to an anaesthetist rather than of a physician practicing complementary and preventive medicine (CAPM) and thus maybe Prince Charles and Dr. Nehrlich
have an important message after all.
1. Lazarou J, Pomeranz BH, Corey PN. Incidence
of adverse drug reactions in hospitalized patients: a meta-analysis of
prospective studies. JAMA. 1998 Apr 15;279(15):1200-5.
2. Starfield B. Is
US health really the best in the world? JAMA. 2000;284:483-485.
Competing interests:
None declared
Competing interests: No competing interests
Re: Re: Re: Pandering to science
I'm sorry to say, M. Watine, that your point eludes me. Drugs are
chemicals and work chemically and you'll have a tough time finding a
drug with no side effects. It seems you are arguing against a straw man.
But quite what you are trying to prove by saying "almost all currently
used drugs can have side-effects of unknown...mechanisms." I have no
idea.
If you are wishing to say that every mechanism of all drug side
effects
have not been completely elucidated then I would agree, but regard the
point as irrelevant.
If you are wishing to imply a contrasting claim that homeopathic
remedies have no side effects then I would agree because they have no
main effect either. But I am not a homeopath.
However, if homeopathy were true then so would "aggravations". One of
homeopathy's open secrets is the claim that when things get worse, i.e.
the patient's sufferings increase, it is because the remedy is working.
On a connected subject, the leading UK homeopathic "prover" Jeremy
Sherr says;
"However it is true that a small number of provers do not emerge
unscathed. Usually these sufferings do not last long, but on rare
occasions I have known problems to last for months or even years"
From "The Dynamics and Methodology of Homoeopathic Provings"
Fortunately there is no evidence to support his assertion, but
homeopaths believe it. When one thinks of the shock-horror expressed
by the alt. med. community at the mere thought that real medicines are
not 100% safe the blithe disregard with which healthy people can
apparently be caused long term damage in the interests of
"proving" a homeopathic remedy is wonder to behold.
Perhaps M. Watine will wish to make his point clearer, but if he does
he
might also wish to consider the harm that homeopaths claim their own
remedies can do.
Competing interests:
None declared
Competing interests: No competing interests