Homeopathy is form of alternative medicine which was first developed in the late 18th Century and has been hovering on the fringes of medicine ever since. Homeopathic remedies are prepared by a process of extreme dilution of a harmful substance and it is claimed by homeopaths that a substance taken in very small amounts will actually cure the symptoms it tends to cause when taken in larger amounts. This is the homeopathic principle that ‘like causes like’. Some homeopathic remedies are diluted to such a degree that it is hard to see how they could possibly cause anything, even if the principle of ‘like causes like’ was accepted as a principle of conventional science. The Society of Homeopaths concedes that this is mysterious and gestures at quantum physics as a possible means of integrating homeopathy with mainstream science: http://www.homeopathy-soh.org/about-homeopathy/what-is-homeopathy/./. The author Jeanette Winterson, who is an advocate of homeopathy, gestures to nanoparticles to integrate homeopathy with mainstream science: http://www.guardian.co.uk/lifeandstyle/2007/nov/13/healthandwellbeing.health.
As well as being based on a mysterious principle homeopathy faces the problem that we lack evidence that any homeopathic remedies actually work. Some clinical trials show positive results, others negative results and others show that there is no effect of homeopathic remedies beyond the placebo effect. This is a well known problem for homeopathy and has been confirmed by as recent report by the Commons science and technology committee, which recommends that the NHS ceases funding homeopathic medicine and bans false statements of medical efficacy on homeopathic products: http://www.parliament.uk/parliamentary_committees/science_technology/s_t_homeopathy_inquiry.cfm. Defenders of homeopathy have disputed the lack of evidence of its efficacy, typically focussing on the fact that some trials have shown a positive effect, and taking this information out of the context of the overall evidence regarding the efficacy of homeopathic remedies. Such defenders of homeopathy include the Conservative MP David Tredinnick, who is a critic of the committee’s report: http://edmi.parliament.uk/EDMi/EDMDetails.aspx?EDMID=4051
The Commons science and technology committee infers that because there is no evidence that homeopathy works the NHS should not spend taxpayers money on it. I am inclined to think that this inference is too quick. I agree that if people suffer from serious illnesses then they certainly should be discouraged from seeking homeopathic cures, on the grounds that they are liable to rely on these rather than seek medical treatments that are actually effective. In the article linked above, Jeanette Winterson points to the case of a homeopath who claimed to be able to cure HIV. This is a very dangerous claim to make because it may encourage people not to take anti-retroviral drugs. However, most homeopaths steer clear of such extravagant claims and only claim to offer cures for aches and pains, stress, migraines, anxiety and so on. While I agree that homeopaths should not be allowed to make false claims about the efficacy of their treatments in these cases either, I am not convinced that the NHS should not spend money on homeopathic remedies.
Homeopathic remedies are relatively cheap to produce. It doesn’t cost much to dilute something (almost) endlessly. In many cases homeopathic treatments will be much cheaper than conventional medical alternatives. In such cases the alternative to the NHS spending taxpayers money on homeopathic remedies will be the NHS spending more even taxpayers money on conventional medicine. Now while I object to homeopaths misleading people about the efficacy of homeopathic treatments, I have no objection to people who are not misled choosing homeopathic remedies and saving the taxpayer money in the process. If people freely choose to ignore the relevant scientific and save the taxpayer money in the process, then this should be encouraged. The downside is that their aches and pains are not actually cured, but if as a consequence of the placebo effect, they believe that they are actually being cured and this belief makes them feel better, then there may not be much downside at all.
I am confused as to your definition of ‘someone who is not mislead’. Who do you mean? Your ‘non-misled’ person seems to be required simultaneously to know that homeopathy was never shown to be effective, to nevertheless choose to use it, and to believe in it sufficiently to benefit from the placebo effect…my imagination may be limited but here it fails me.
Also, you seem to assume that people who use homeopathy will use it instead of traditional medicine. This is a fast assumption. It seems most users of alternative medicine use both it and traditional medicine. Hence, the cost-savings you point to are likely to be wishful thinking…
This is an interesting argument and one which I have some sympathy with. However, I do have some concerns about it, particularly with regard to the efficacy of the placebo effect.
Firstly, in your last sentence, you suggest that a placebo will not actually *cure* aches and pains, but may make the patient *think* they are cured. Since ‘aches’ and ‘pains’ are entirely experiential complaints (not physically observable ones), I would contend that if the patient stops experiencing these unpleasant sensations following a placebo course, then they really *have* been cured. It is also my understanding (or perhaps just my assumption, correctly or incorrectly) that the placebo effect can induce physiological changes through a ‘psycho-somatic’ effect. So, I certainly believe that the ‘placebo effect’ is effective (hence the name!).
However, it is an important property of the placebo effect that it is much more effective if the patient believes that the placebo is a genuine treatment. If they know that it is a placebo and not scientifically validated, then the placebo effect does not work. So, although it is nice to think that we could explain to people that homeopathic medicine is just a placebo, and then let them continue taking it, it seems that this would defeat the object of the exercise!
This could raise another potentially challenging ethical issue. Would it be right to defend homeopathy, even if one believed it to be completely untrue, in order to preserve the placebo effect it creates and which many people benefit from?
Are homoeopathic remedies cheaper than conventional ones? Looking at the prices in stores seems to suggest they are comparable to other over-the-counter drugs that presumably do have an evidence base and non-trivial contents: the mark-up is likely enormous. If taxpayer money were to be spent on homoeopathy it would seem reasonable to use generic homoeopathic drugs rather than these: they would be even more cost-effective in producing the placebo and patient satisfaction.
In practice there is a balancing effect in that expensive placebos with nice framing tend to work better. But it is unlikely that the current situation corresponds to the most placebo per pound.
Medicine includes religious-like politics. What is there to allow an administrative decision against any particular idea about cure? Does the NHS exclude chiropractic? On what basis should it exclude any wild attempt to theorize about human disease? Private insurance can do that. But a government can’t.
Thank you for all the comments and I’m sorry not to have responded earlier, however I have been completely overloaded with work commitments. Anyway here are some brief responses to all of the above comments.
Re Samia’s comments: What I had in mind by someone who is not misled is someone who has the relevant scientific information available to inform their choice and who has not been given any false information. People draw inferences in all sorts of weird and wonderful ways and it is quite possible that someone will choose to ignore the lack of evidence of the efficacy of homeopathy, or think that there is a conspiracy going on to suppress relevant information, or think that mainstream scientists do not weigh evidence properly. Any or all of these lines of reasoning might lead someone to prefer homeopathy to mainstream medicine.
On the subject of cost savings, I suspect that an accurate account would be hard to make here as people often take multiple forms of medication. The general principle that I would like to see applied is that if (and only if) overall people are less of a financial burden on the state when taking homeopathic medicine than they would otherwise be, then the NHS should be willing to cover the costs of their use of homeopathic remedies.
Re David Jay’s comments: I’m not convinced that ‘aches and pains’ are entirely experiential complaints, as you put it. I imagine that in most cases a particular pain involves an experiential component and a physical component. You raise some good points about the placebo effect, but I think the claim that if people know that the placebo effect is not scientifically validated it will not work goes too far. You are right that belief is crucial to the efficacy of the placebo effect, but one can believe in the efficacy of a treatment without believing that that treatment is scientifically validated.
Re Ander’s comments: I did do a quick scout around on the web to see how expensive homeopathic remedies are and they seemed cheaper than conventional medicine, but I may be wrong about this, at least in some cases. If more than one homeopathic remedy is available for a particular medical problem then, given that all homeopathic remedies are, as far as we know, equally effective, the NHS should fund the cheapest one only.
Re Dennis’ comments: I agree that the politics of medicine is very tricky. However the NHS have a responsibility to provide medical care in a cost effective manner, so they ought not to fund expensive attempts to cure disease that lack a suitable evidential basis. The NHS does not appear to fund chiropractic treatment although the wording they use on their website suggests that they might be willing to do so under some circumstances. See: http://www.nhs.uk/chq/pages/1098.aspx?categoryid=68&subcategoryid=154
Homeopathy is where the harm is:
http://jme.bmj.com/content/36/3/130.full
I think the better title for this blog you be: “Should the NHS pay for water sold as medicine?”
The very blunt reason that disputes any public funding of a scam like homeopathy is that there is simply no biochemical plausibility to it. Zero. For the simple reason that the only condition that water cures is dehydration. In virtually all homeopathic remedies there is likely not a single molecule of the original substance. And any appeal to quantum physics is not only laughable but detestable! There is not a single self-respecting physicist who would corroborate this preposterous defense.
And I would strongly challenge the assumption there could ever be a reasonable person who, presented with the scientific facts about real medicine and homeopathy would prefer the later. If you were informed and competent you would have to admit to yourself that you are paying for water sold as medicine.
The public moneys should not be spent on indulging the (culpably or innocently) ignorant in their preferences. People are free to waste their money on mystical nonsense if they so please, but it is not the duty of the prudent taxpayer to foot the bill.
Dmitri, how exactly are you defining a “reasonable person” here? In my experience a typical user of homeopathic medicine is vaguely aware of what you describe as “the scientific facts” but has decided to trust their own experience instead, and because of luck, the placebo effect and various well-known psychological biases their experience tells them that it works. Does that make them unreasonable? Compared to whom? The “prudent” taxpayer perhaps, but certainly not the average one.
Well, lets put it this way. People who are aware of the scientific facts, and thus aware of the evidence indicating the impotence of homeopathic solutions as proper medicines, but who still take homeopathic solutions only two possibilities are available:
(1) They do not consider homeopathy as effective medicine but nevertheless take it in response to their illness and symptoms. This is not reasonable behavior. Medicating oneself is not a mere preference, it is goal oriented: you take medicine to make you better. As such taking a “medicine” that is not in service of that goal is unreasonable. So unless this kind of person responds with: I just take homeopathy because I like it, or some such thing, their actions are unreasonable.
(2) They believe homeopathy to be an effective medicine. But this is not a reasonable belief as there is no evidence of its efficacy. Indeed, there is both evidence of it not working and there is no biochemical plausibility for it to work in the first place. This kind of a belief unfounded on evidence and is simply faith, which is defacto unreasonable. It is beyond and immune to reason.
I should also mention that one should not put to much stock into the placebo effect. For one thing, a quick search on PubMed will show that controlling for placebo, homeopathy is still lacks any efficacy. Secondly, I would not put too much stock into subjective improvements that so often the basis of anecdotes with homeopathy. If a something is subjectively better (ie, they feel better) but are objectively the same or worse (the disease is still present and active) I would not consider the patient to have improved in their health. I’m sorry, but at the end of the day feelings count for precious little in health.
Finally, if all that homeopathy is good for is the placebo effect then why dilute anything in anything to begin with? And why pay exuberant prices for something that relies for its effect on not working? The same results would be achieved with a drop of tap water. Hence, the better title for this blog entry.
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