Anyone who reads Science-Based Medicine on even a semi-regular basis will know our collective opinion of homeopathy. Basically, at its core, homeopathy is pure quackery.
I don’t care if it’s repetitive to say this yet again because it can’t be emphasized enough times that homeopathy is The One Quackery To Rule Them All. OK, there are others that compete for that title, such as reiki and other magical “energy therapies” like therapeutic touch, both of which, unfortunately, can be found in many academic medical centers where the faculty really should know better. Any “medicine” whose very precepts break multiple laws of physics and chemistry, laws that would have to be proven not just wrong but spectacularly wrong for homeopathy to work, deserves only ridicule.
The “laws” of homeopathy
Think of it this way. There are two “laws” of homeopathy, neither of which has any basis in reality. First, there is the law that states “like cures like” and asserts that, to relieve a symptom, you need to use a substance that causes that same symptom in healthy adults. There is, of course, no evidence that this is a general principle of medicine. For instance, we don’t generally treat fever by administering something that causes fever or treat vomiting with something that causes vomiting. The second law, however, is the one that’s completely ridiculous. Basically, it’s the law of infinitesimals. This law states that a homeopathic remedy is made stronger with dilution, specifically serial dilutions with vigorous shaking between each dilution step to “potentize” the remedy. That’s ridiculous enough, but homeopaths, never satisfied with the merely ridiculous have to turn the ridiculous up to 11 and beyond by using this principle to assert that dilutions far beyond the point where there is likely even to be a single molecule of the original remedy left are effective and become more so with more dilution. For instance, a 30C dilution is 30 one hundred-fold dilutions (C=100, get it?), or a 1060 dilution. Avogadro’s number is only on the order of 6 x 1023, or more than 1036-fold less than the dilution. The simple mathematics of homeopathy just doesn’t work, although this doesn’t stop homeopaths from coming up with some truly spectacular flights of pseudoscience (like the “memory of water”) to try to “explain” how it can work.
The persistence of homeopathy
Even though homeopathy was “discovered” over 200 years ago by Samuel Hahnemann, back in a time before Avogadro’s number had been determined, for some reason it has managed to live on into the 21st century. It was, in a way, understandable that homeopathy might persist throughout the 19th century. After all, homeopathy does nothing other than placebo. If, as was the case for all too many then “conventional” treatments 200 years ago, a treatment is worse than the disease, then of course homeopathy would produce better outcomes because doing nothing is better than, for example, bloodletting, purging using toxic heavy metals such as mercury and cadmium, and all the other things which were “standard of care” for various conditions at the dawn of the 19th century. It wasn’t quite as bad as Theodoric of York, but it was pretty bad. Remember, ether anesthesia wasn’t even discovered until roughly 50 years after Hahnemann first “discovered” homeopathy, and full acceptance of the germ theory of infectious disease was 70 years after Hahnemann’s discovery. Even so, as early as the 1840s, Oliver Wendell Holmes knew homeopathy was quackery, as his famous broadside against it demonstrated so well. Still, as useless and ridiculous as homeopathy has always been, it wasn’t until medicine started to become much more science-based and therefore effective that outcomes could clearly be shown to be better with modern scientific treatment.
The riddle of homeopathy
So why do we keep coming back to the topic of homeopathy again and again? If homeopathy is, as I like to refer to it, nothing more than the ancient concepts of sympathetic magic tarted up for a 19th century audience and then updated by generations of homeopaths to invoke pseudoscience such as the “memory of water” to “explain it,” why do we keep hearing about it? After all, homeopathy is so scientifically discredited that the National Center for Complementary and Integrative Health (NCCIH, formerly known as the National Center for Complementary and Alternative Medicine, or NCCAM) hasn’t funded a grant to study it since 2008. Why is it that Prince Charles is such an advocate of homeopathy? Why is it that academic medical centers are embracing naturopathy, which, as I’ve described before, includes homeopathy as one of its core medical practices?
These were the questions in my mind as I came across two articles. The first published in a prestigious medical journal, the BMJ, in a “point-counterpoint” format asking the question, “Should doctors recommend homeopathy?” Steve Novella already covered this when it came out last week, but I want to look at it as well, particularly since fellow SBM blogger Mark Crislip made me aware of similar article in the journal Managed Care arguing that “Homeopathic Medicine Should Have a Role in Managed Care.” Yes, despite being no more than magic, homeopathy manages to attract educated people who actually think it should be included in the armamentarium of science-based medicine and even that it’s appropriate to include it in managed care.
Let’s look at the BMJ first.
False balance over homeopathy in the BMJ
There is no good reason for a reputable scientific journal to publish research about homeopathy, and certainly there is no reason to publish a “debate” about homeopathy, any more than there is a reason to publish a debate over whether creationism (intelligent design or young earth) has validity compared to evolution. Unfortunately, that’s exactly what a prestigious medical journal, BMJ, did last week, asking “Should doctors recommend homeopathy?” On the “yes” side there was Peter Fisher, director of research, Royal London Hospital for Integrated Medicine. Note that “integrated medicine” seems to be a British variant of “integrative medicine,” the oft-criticized (on this blog at least) practice of integrating quackery with real medicine. Note also that the Royal London Hospital for Integrated Medicine used to be the Royal London Homeopathic Hospital before being rebranded as a more inclusive quack hospital. Indeed, the last time I was in London (alas, eight years ago!), I made it a point to have my picture taken in front of its sign. In any case, Fisher is a homeopath, and a rather famous one at that.
On the “no” side, there was Edzard Ernst. I have no idea why Ernst agreed to this and wish he hadn’t. Notably, Ernst now expresses some regret over having chosen to participate but justifies his decision by noting that if he had refused another would have been chosen and “sure as hell, that person would subsequently gotten attacked for not ever having researched and/or practiced homeopathy”. (Ernst used to practice homeopathy himself before he realized it was quackery.) In any case, Ernst’s debating a homeopath was not unlike an evolutionary biologist debating a young earth creationist. There was no point, and all it did was to elevate the stature of the crank by association. In fact, it was even more like a creationist debate than you might think in that Fisher proved himself adept at doing the old Gish Gallop.
Hilariously, this is how Fisher chose to begin:
Of all the major forms of complementary medicine, homeopathy is the most misunderstood. Based on the concept of “treating like with like,” homeopathy originated with the German physician Samuel Hahnemann (1755-1843). But similar ideas are found in the Hippocratic Corpus, in the work of Paracelsus, and in the medical traditions of several Asian countries.
Homeopathy is part of a family of toxicological and pharmacological phenomena that are attracting growing interest, characterised by secondary, reverse, or paradoxical reactions to drugs or toxins as a function of dose or time or both. These include hormesis (the paradoxical, stimulatory, or beneficial effect of low doses of toxins), paradoxical pharmacology, and rebound effects.
The controversial element of homeopathy is that some medicines are highly dilute, including “ultra-molecular” dilutions, in which it is highly unlikely that any of the original material is present. This is a major scientific concern and the source of the view that homeopathy “doesn’t work because it can’t work.”
Of course, the problem with homeopathy is not that it is misunderstood. The problem with homeopathy, for homeopaths at least, is that it is understood all too well by scientists who have looked into it and become its critics, and that understanding is that it is quackery. The real problem with homeopathy being misunderstood is that most of the lay public and even most doctors don’t know its true principles and view it as nothing more than another form of herbal medicine.
Even though Fisher correctly pointed out the central problem with homeopathy, notice how he rebranded it in terms favored by homeopaths. Whenever you see “ultra-molecular dilutions” used as a term, it’s an almost certain bet that you are dealing with a homeopath. The term sounds all science-y and important, but it is utterly meaningless. Notice how he also attacks a straw man. Yes, we skeptics do say that homeopathy can’t work, because for homeopathy to work, our understanding of some long-established bedrock principles of chemistry and physics would have to be not just wrong but spectacularly wrong. But that’s not the only reason why we say homeopathy doesn’t work. We also look at the clinical evidence, which, when aggregated, is most consistent with the effects of homeopathy being nothing more than placebo effects. That’s not surprising, given that homeopathy can’t work, but in this case the science and the clinical observations we have both agree: Homeopathy doesn’t work.
The usual Gish Gallop, just not for creationism
Fisher also trotted out a veritable Gish gallop’s worth of homeopathy tropes, many of which I’ve written about here before, as well as on my not-so-secret other blog. Similar ideas are found in Hippocratic writings? So what? Hippocrates’s followers also believed that illness was caused by imbalances in the four humors. Yes, Hippocrates and those who followed made some significant contributions to medicine, not the least of which was the idea that diseases were natural and not caused by gods and evil spirits, but what they taught was based on prescientific beliefs about biology and physiology. Paracelsus, too, made great contributions to medicine, basically inventing the field of toxicology, but he was also an alchemist, astrologer, and occultist. In fact, it is true that the ideas of homeopathy do resemble those of various ancients. Unfortunately for homeopaths the ancient ideas that homeopathy most resembles come from sympathetic magic, namely Frazer’s Law of Similarity (“like cures like”) and the Law of Contagion or “contagious magic” (the memory of water).
Fisher also invoked the usual nonsense about hormesis and paradoxical drug effects. Repeat after me: Hormesis does not justify homeopathy. It’s an analogy that homeopaths love because it’s a hypothesis that states that some substances that are toxic at high doses might be benign or even beneficial at lower doses. That hormesis has anything to do with homeopathy is, of course, wishful thinking on the part of homeopaths, representing extreme over-extrapolation. Hormesis might apply to low doses, but much of homeopathy involves no dose; i.e., dilution far, far beyond the point where it is highly unlikely that even a single molecule of the original remedy remains. Not that this stopped Fisher:
However, recent in vitro research shows repeatable effects (for instance, inhibition of basophil degranulation by highly dilute histamine1) while basic physical research shows that the homeopathic manufacturing process changes the structure of the diluent, including the formation of nanoparticles of silica and gas.2 The physical research is of little clinical relevance but provides a possible mechanism of action for the controversial high dilutions.
He was referring to Jacques Benveniste’s study, which he claimed to have found evidence for the “memory of water.” Basically, Benveniste diluted allergens down to homeopathic dilutions and showed that they could trigger basophils to activate. The then editor of Nature, Sir John Maddox, agreed to publish Benveniste’s paper—but only on one condition. Benveniste was required to open his laboratory to a team of independent referees, who would observe and evaluate his techniques. Among that team was James Randi. Indeed, the Benveniste affair was, from my perspective, one of Randi’s greatest achievements in skepticism. Basically, Randi and the team of referees asked Benveniste to repeat the experiment, but went to extraordinary lengths to make sure that the people carrying out the experiments didn’t know what groups were the control groups and which groups were the ultradilute samples. Under these conditions, Benveniste’s results were not replicable. Basically, Randi showed how critical proper blinding was to experiments involving homeopathy. Indeed, this is a lesson that anyone doing lab work could take to heart, because blinding is actually uncommon in basic lab research for most experiments.
As for the bit on “nanoparticles,” that’s just the latest pseudoscientific “explanation” for homeopathy. It’s one particularly favored by a rather vocal proponent of homeopathy whom we’ve met many times before before, Dana Ullman. It’s nonsense, of course, just like every “explanation” of homeopathy other than that it “works” solely through placebo effects.
It also turns out that Fisher expressed—surprise, surprise!—great unhappiness with some systemic reviews and meta-analyses of homeopathy that show it to have no specific effects above and beyond placebo effects, as one would expect given what homeopathy is. As is usual for homeopaths, he attacks the 2005 Lancet meta-analysis by Shang et al, but worse, he misrepresents its findings. Contrary to Fisher’s characterization of the meta-analysis, Shang et al did not find that there was “weak evidence for a specific effect of homeopathic remedies.” That’s a cherry-picked quote. Actually, Shang et al concluded quite the opposite:
We acknowledge that to prove a negative is impossible, but we have shown that the effects seen in placebo controlled trials of homoeopathy are compatible with the placebo hypothesis. By contrast, with identical methods, we found that the benefits of conventional medicine are unlikely to be explained by unspecific effects.
Then, as homeopaths are wont to do, Fisher picks crappy or old meta-analyses. Incredibly, this leads to a discussion of comparative effectiveness research involving homeopathy! Here’s a hint: Doing comparative effectiveness research is only appropriate to compare the effectiveness of treatments already shown in clinical trials to be efficacious. Such is not the case for homeopathy. One study he cites is an old study looking at comparing homeopathy to conventional therapy for a self-limited condition. It’s not randomized (of course), and the two groups (conventional treatment and homeopathy) are ridiculously poorly matched in terms of age and location. Sure, they had, as an aggregate, well-matched health scores, but demographically the groups are so different as to be uncomparable, making the study basically uninterpretable. Other studies referenced are all basically unrandomized and relied heavily on interviews, with the possibility of recall bias. Indeed, what the two studies suggest is not so much that homeopathy works rather than that general practitioners tend to overprescribe antibiotics for upper respiratory infections and nonsteroidal anti-inflammatory drugs for musculoskeletal pain.
All of this leads Fisher to conclude:
Doctors should put aside bias based on the alleged implausibility of homeopathy. When integrated with standard care homeopathy is safe, popular with patients, improves clinical outcomes without increasing costs, and reduces the use of potentially hazardous drugs, including antimicrobials.
Finally, contrary to Fisher’s plea to ignore the inconvenient science that shows how ridiculously implausible homeopathy is, doctors should most definitely not put aside “bias” regarding its implausibility because homeopathy has plausibility that is as close to zero as it is possible to get. In other words, Fisher doesn’t think that “plausibility bias“—or, as Mark Crislip and I like to call it sometimes, “reality bias“—is a good thing. Indeed, the only reason I don’t give homeopathy zero plausibility is more philosophical than anything else. I always leave open the possibility, however small, that maybe several laws of physics are not just wrong, but spectacularly wrong. Whether that is being too “open minded” or not, I leave to the reader. In practice, the difference is negligible, undetectable even. Using Bayesian methods, which take into account the plausibility (or lack thereof) of the remedy being tested, equivocal tiny “results” plus extreme implausibility of the method equal negative results. Basically, in clinical trials of homeopathy what is being observed is statistical noise and publication bias.
I don’t feel a need to go over Edzard Ernst’s response. It’s just Edzard Ernst doing what Edzard Ernst does best and, of course, mentioning some of the dangerous things homeopaths recommend, such as homeopathy for Ebola. I encourage you to read it. What I do feel obligated to do is to ask once again what the hell the editors of BMJ were thinking when they decided to publish this “point-counterpoint” in their journal, which is nothing but false balance?
Homeopathy and managed care
The second article I became aware of was actually published late last year, but it is worth noting because it features a faculty from a school of pharmacy (!) arguing for the inclusion of homeopathic remedies in the formularies of managed care plans. Of course, part of the problem here is that one author, Albert I. Wertheimer, is more of an business expert and economist, a professor of pharmacoeconomics. In other words, he is clearly not a scientist. Neither is his co-author, Frances A. Brentson, who lists herself on LinkedIn as a “talented and disciplined senior-level medical communications professional with over 17 years’ experience delivering high-quality medical writing and project management.” This lack of rigorous science really shows in Wertheimer and Brentson’s arguments.
A lot of what they wrote overlaps with Fisher’s defense of homeopathy, so I’ll emphasize what Fisher didn’t already cover. In their introduction, they lamented that the “formularies of nearly all managed care organizations (MCOs) and pharmacy benefit managers (PBMs) share the near-total absence of homeopathic drugs,” to which I reply: You say that as though it were a bad thing! MCOs and PBMs should stick with medicine that has strong scientific evidence backing its safety and efficacy, not magic, after all.
What most struck me about Wertheimer and Bentson’s arguments is that they get a lot about the history of homeopathy and the evidence (or rather lack of evidence) for its efficacy right but nonetheless come to exactly the wrong conclusion about it. For instance, they point out the origin of homeopathy in the late 18th century, its two main laws, how Hahnemann and his assistants recorded and compiled their homeopathic “provings” (although they don’t use the word) in the Materia Medica. They correctly note that in the US, homeopathic remedies are regulated by the FDA under the Homeopathic Pharmacopeia of the United States (HPUS), but “robust clinical testing is not a requirement for marketing approval.” (That’s an understatement!) Of course, they neglect to note how the HPUS was inserted into the 1938 Food, Drugs and Cosmetics Act by Senator Royal Copeland, a physician who practiced homeopathy, for unclear reasons. In any case, it’s correct that, if it’s in the HPUS, it can be sold in the US. Unfortunately, the process for deciding what is in the HPUS is controlled by the Homeopathic Pharmacopoeia Convention of the United States (HPCUS). It is a process that is—shall we say?—less than transparent. Fortunately, recently the FDA has held hearings on whether it should change how it regulates homeopathic remedies. In fairness, the FDA hearing took place months after this paper was published, but I can’t help but note that the representatives of the homeopathy industry made a poor showing.
Part of the problem is that this entire article keeps tending to conflate homeopathy with “complementary and alternative medicine” (CAM). Of course, the authors’ use of the term “CAM” instead of the more recent (and preferred among advocates of quackademic medicine) term “integrative medicine” makes me think that they aren’t too hip to the lingo, if you know what I mean, which makes me wonder how well they understand the whole issue. Be that as it may, their whole argument consists of three parts. The first part is an appeal to popularity. This is where they stumble into conflating all of CAM with the most pseudoscientific type of CAM, homeopathy. Starting with just homeopathy, they note:
Homeopathic preparations represent a growing market in the United States. From 1990 to 2000, the sale of homeopathic preparations rose 1,000% (Sayner-Flusche 2000), with that trend continuing to present. In 1994, 69% of all chain drugstores and more than 3,000 independent pharmacy retailers reported stocking homeopathic preparations (McDermott 1995). Furthermore, a 2000 study estimated CAM sales to be more than $34 billion in the United States (MacLennan 2002), up from $21 billion in 1998 (Eisenberg 1998).
And, conflating homeopathy with all of CAM:
CAM appears to be solidly entrenched in American society, enjoying support from politicians and health care professionals as well as the general public. Political support for CAM became manifest in 1992 when a controversial bill passed both houses of Congress to create the Office of Alternative Medicine within the National Institutes of Health. Dismayed by the office’s meager resources, in 1995 Congress transformed it into the National Center for Complementary and Alternative Medicine (NCCAM) and increased its budget to $50 million in 1999 (Jonas 2013). According to the NCCAM’s third strategic plan, which extends through 2015, 1 of its 5 strategic objectives is to advance research on CAM natural products, a category that includes homeopathic products, with a focus on mechanistic research that provides a scientifically sound hypothesis for these products (NCCAM 2011).
Of course, I’ve discussed NCCAM (now NCCIH’s) objectives before, and in reality, to its credit, it doesn’t really support research into homeopathy. Indeed, when we met with the director of then-NCCAM, Dr. Josephine Briggs, in 2010, while she would “never say never” about whether NCCAM would fund any more trials of homeopathy, she was very unenthusiastic about it. Also, the authors fail to note the influence of a single senator, Senator Tom Harkin, who created OAM and shepherded it past all obstacles.
Appeal to popularity
The authors then cite a bunch of surveys about how CAM is so popular and how even physicians recommend it. Of course, nowhere to be found is an explanation of how the popularity of CAM use is inflated by “rebranding” science-based modalities, such as nutrition/diet and exercise, and personal beliefs, such as religion and spirituality, as somehow being CAM. Let’s also not forget what I like to refer to as the “medicalization” of modalities that formerly were used just to help patients feel better and pass the time when in the hospital, such as massage, music, and pets as medical “therapies.” As Steve Novella has reminded us, when you strip away all of that, use of the “hard core” CAM therapies (like homeopathy) is in the single digits, percent-wise, and hasn’t changed much in years. Indeed, in the 2007 National Health Interview Survey (NHIS) administered by the NIH, only 3.65% of adults reported ever having used homeopathy. Unfortunately, that might be changing, given how, more and more, homeopathic remedies are finding themselves on pharmacy shelves alongside real medicine. Indeed, big chain drug stores like CVS now have now placed their brand on homeopathic remedies, leading to fiascos such as this response to a typical campaign to demonstrate the quackery that is homeopathy by taking “overdoses” of homeopathic remedies. In this case, it was the homeopathic sleep aid Hyland’s Calms Forte. This is how CVS responded:
In response, DeAngeli told PRWeek it is important to note that d’Entremont did not ingest a CVS brand product in the video.
“It appears to be a national brand product available at many pharmacy retailers,” he said. “She does indicate on the video that homeopathic products are available at CVS/pharmacy and other national pharmacy chains.”
The disingenuousness, it burns.
Money, money, money
The second argument, not surprisingly given that the authors come from a pharmacoeconomics background, is economic. True, this argument is intertwined with the appeal to popularity. After all, the reason why stocking homeopathic remedies could be profitable is because they are popular. However, darn it if that nasty federal government makes it hard for MCOs to cover CAM:
Despite the paucity of data on the use of homeopathy, specifically in a managed care environment, homeopathy represents a growing market in the United States. Historically, there has been an absence of coverage for homeopathic remedies by insurers in the United States. Over the last 2 decades, there has been some interest by insurers in favor of paying for these naturopathic remedies (Montoya 1998). With the popularity of CAM on the rise among subscribers in the United States, some insurers are taking a closer look at alternative treatments as a means to boost their enrollment numbers in a now marketplace that is now extremely competitive because of the advent of the Affordable Care Act. Some insurers, however, are still reluctant to pay for homeopathy because of the lack of standardization of care by clinicians and conflicting outcomes in programs designed to provide evidence-based medicine. CAM is not approved by the FDA, and thus the treatments offered are not eligible for payment under federal drug benefit programs (Medicare, Medicaid, etc.). Since CAM is not covered under this umbrella, managed care plans have no means by which to recapture costs and thus have been historically reluctant to offer benefits for any type of CAM
But, they argue:
An increase in public and private sector funding for research may lead to increased interest in establishing the safety and effectiveness of homeopathic preparations. This may help drive the number of MCOs that are paying for homeopathic treatments (Ullman 1999).
Take a look at that citation. Yes, that is Dana Ullman, who has been featured here many times. He is perhaps the most amusingly clueless yet vocal advocate of homeopathy currently alive and active, and Wertheimer cited an article by him published in the quackademic journal, the “Journal of Alternative and Complementary Medicine.” It’s half tempting to stop right here and conclude that Wertheimer is beyond ignorant of the issues involved, but that isn’t my way; instead I will note that there’s a reason Kimball Atwood once referred to Ullman as Dull-Man and postulated what he called the “Dull-Man” law: “In any discussion involving science or medicine, being Dana Ullman loses you the argument immediately…and gets you laughed out of the room.” I would broaden the law to “In any discussion involving science or medicine, invoking Dana Ullman to support your argument loses you the argument immediately…and gets you laughed out of the room.”
A return to medical paternalism
Finally, Wertheimer invokes—of course!—placebo effects. After all, since homeopathic remedies are no more than placebo, any time someone defends using homeopathic remedies, the topic will come up. And so it did in this article. Wertheimer first correctly describes why homeopathic remedies have been characterized as placebos, based on how most homeopathic remedies are diluted far beyond the likelihood that even a single molecule of active ingredient remains. He then tries to have it both ways, citing outlier randomized clinical trials that report benefits from homeopathy, such as one for fibromyalgia, which did not appear to assess adequacy of blinding, was more of a pilot study, and demonstrated at best modest results, and one for allergic rhinitis, which was not quite double-blinded (the investigators were not blinded to allergen testing). Basically, they’re cherry-picked studies. Then Wertheimer, seemingly admitting that homeopathy is placebo, asserts:
Thus, the use of homeopathy and the potential for the placebo effect may play an important role in the management of difficult-to-treat patients who present with symptoms of unknown etiology. For example, a patient may present with a generalized sense of anxiety but not be a candidate for treatment with a traditional pharmacologic agent because of 1 or more mitigating factors. Such a patient could be prescribed a homeopathic treatment for anxiety. In such a situation, the patient may feel satisfied with the holistic treatment approach and also may experience the placebo effect manifesting as a reduction in anxiety.
We posit that when no organic source of some symptoms can be determined, the use of some nonspecific homeopathic agent might be considered when the patient clearly expects a medication prescription. Perhaps, some brave P&T committees might monitor outcomes from homeopathic drug studies and, at least, report their experience in the literature.
So basically, Wertheimer is arguing that MCOs go back to supporting what physicians used to do decades ago, explicitly prescribing placebos (one was even called Obecalp). There are two big problems here. First, when you stock a homeopathic remedy, you aren’t saying that it’s a placebo, even though it is. You’re claiming that it works for something, that it is safe and effective for treating something. That leads to the second problem, and that stocking placebos inherently means either lying to the patient (contrary to what is sometimes claimed, there is no placebo effect without deception) or lying to doctors to convince them that the placebo is an active treatment. Let’s face it. There are enough doctors who do not know what homeopathy is and assume that it’s just herbal remedies. Some of them could be persuaded to believe that homeopathy works for some conditions, or at least that it might work.
Should doctors and MCOs recommend homeopathy? Wrong question!
Examining these two articles, one can see common themes from supporters of the sympathetic magic that is homeopathy. First is popularity; i.e., that we should study and offer it because it is popular, in essence ignoring its scientific impossibility and the lack of anything resembling good clinical evidence for it. The second is a false claim that homeopathy actually works, based on cherry-picked studies and fallacious attacks on meta-analyses that fail to find evidence of efficacy and the basic science that shows convincingly why homeopathy cannot work. Indeed, in the accompanying interview in the BMJ within which Fisher and Ernst butt heads, Fisher tries very hard to argue that homeopathy works and dismisses systematic reviews and studies that fail to find evidence that it does.
Finally, if all else fails, learn to stop worrying and love placebo effects, treating homeopathy as the placebo it is and using it for the “worried well” or for patients for whom an organic cause for their symptoms can’t be identified. That’s the argument that Wertheimer makes. Never mind that such an approach is now considered unethical and paternalistic. Of course, homeopaths don’t like that particular justification for using homeopathy, but in reality it’s the only one there is, because homeopathy is a placebo. All you have to do to accept it is to believe that it’s acceptable to lie to patients. Indeed, one can argue, as Ian Dunt does, that belief in homeopathy is a test of morality, although in Wertheimer’s case I’ll give him credit for being honest about advocating lying to patients and coming right out and saying that we should offer our patients placebos. Compare this to Fisher, who truly believes homeopathy works.