Bad Science

Colorfulpills01

This doctor can write. I look forward to his book, Bad Science. In this piece he takes apart homeopathy as what historian Robert Horton would have called a ‘closed belief system’ (albeit one that is more miltiant and litigous).

"When you [do all the meta-analysis]…and you exclude the unfair tests, and you account for publication bias, you find, in all homeopathy trials overall, that homeopathy does no better than placebos.

…Now, here is the meat. Should we even care, I asked, if homeopathy is no better than placebo? Because the strange answer is, maybe not.

Let me tell you about a genuine medical conspiracy to suppress alternative therapies. During the 19th-century cholera epidemic, death rates at the London Homeopathic Hospital were three times lower than at the Middlesex Hospital. Homeopathic sugar pills won’t do anything against cholera, of course, but the reason for homeopathy’s success in this epidemic is even more interesting than the placebo effect: at the time, nobody could treat cholera. So, while hideous medical treatments such as blood-letting were actively harmful, the homeopaths’ treatments at least did nothing either way.

Today, similarly, there are often situations where people want treatment, but where medicine has little to offer – lots of back pain, stress at work, medically unexplained fatigue, and most common colds, to give just a few examples. Going through a theatre of medical treatment, and trying every medication in the book, will give you only side-effects. A sugar pill in these circumstances seems a very sensible option.

But just as homeopathy has unexpected benefits, so it can have unexpected side-effects. Prescribing a pill carries its own risks: it medicalises problems, it can reinforce destructive beliefs about illness, and it can promote the idea that a pill is an appropriate response to a social problem, or a modest viral illness.

He goes on to describe the ethical issues surrounding homeopathy:

When a healthcare practitioner of any description prescribes a pill that they know full well is no more effective than a placebo – without disclosing that fact to their patient – then they trample all over some very important modern ideas, such as getting informed consent from your patient, and respecting their autonomy.

… If, on the other hand, you prescribe homeopathy pills, but you don’t know that they perform any better than placebo in trials, then you are not familiar with the trial literature, and you are therefore incompetent to prescribe them.